In more than a decade of fieldwork in rural India, Manoj Mohanan has seen many hopeful efforts to improve the health of the country’s most vulnerable populations. But he also has learned that human behavior often defies the best of intentions.
In the Indian state of Bihar, for example, rates of preventable or treatable diseases such as childhood diarrhea and tuberculosis have remained among the worst in the world despite years of government intervention. “For six or seven decades, the government has tried to send in doctors and nurses,” says Mohanan, an assistant professor at the Sanford School of Public Policy and a researcher for the Duke Global Health Institute. “It has not worked.”
Mohanan is using the tools of social science to learn why those interventions haven’t been more successful. In other parts of India, he has surveyed pregnant women to understand why many pay informally trained midwives rather than receive free obstet ric care at a hospital. His data have helped reshape policies and approaches to rural health care in the country. Recently, he helped design and implement a new health-insurance program for the state of Karnataka.
In Bihar, one of India’s poorest regions, Mohanan is working with the Bill and Melinda Gates Foundation to evaluate the effectiveness of telemedicine, which aims to use communication technology to improve health care in rural areas. The foundation has set up kiosks throughout Bihar and other regions where local health-care providers can transmit test results and consult with doctors in urban hospitals. The technology, though promising, remains untested, says Mohanan.
“We’re trying to look at it empirically,” he says. “Whether it works or not, let the data tell.”