2019 Nobel Prize Economics Science recipient Esther Duflo had visited Kerala in 2017 to aid the state government in policy making and left with a decision not to attend any such meetings in future, a paper written by the French economist in 2017 reveals.
“We tried, and failed, to engage them (Kerala officials) on the details of policy. Not only did they have no understanding of plumbing issues, there was not even a realization that plumbing was an issue at all,” Duflo states in the paper titled The Economist As Plumber in which she argues that economists should seriously engage with plumbing, in the interest of both society and our discipline.
Duflo was accompanied by Abhijeet Banerjee, the 2019 Nobel Economics Science Prize recipient and her husband, and Geetha Gopinath, the then Kerala economy advisor who is currently IMF (International Monetary Fund) chief economist.
While detailing her experience in meeting with Kerala health department officials, Duflo writes that it was striking for her to learn that not only did they (Kerala officials) not have any answer to questions, but they showed no real interest in even entertaining them.
Duflo and others were invited on the backdrop of Kerala’s plan to try out a new organisation of the health care sector where nurses, volunteers from the local governments, and doctors would work seamlessly in a health team that would be in charge of keeping the population healthy, with a heavy focus on encouraging lifestyle changes and preventive activities.
“Though the Additional Chief Secretary of Kerala in charge of health had invited us to the meeting, he was called away to deal with a doctors’ strike around the time the conversation turned to the specifics of the reform,” Duflo writes adding that he handed them over to a retired professor and a retired doctor, who had been charged with designing the specifics of the policy.
According to Duflo, that itself was suggestive that top policy makers usually have absolutely no time for figuring out the details of a policy plan, and delegate it to “experts.”
Duflo and her team asked the Kerala officials why patients would pay attention to a nurse, given that until now they have only taken doctors seriously.
Were they really sure that if the nurse started to take blood pressure and fill prescriptions, this would give her the authority she would need to dispense advice or that doctors would be willing and able to signal that nurses were to be respected, in a system that has always been heavily hierarchical?
And for that matter, did the planners really think it was going to be possible for healthcare professionals to spend a lot more time on public health and prevention when there were only two doctors for every 30,000 people?
According to Duflo, the Kerala officials did not have any answers to these questions.
She adds that whenever she and her team asked Kerala officials to spell out what they thought their policy lever was (as opposed to their aspiration), the stock answer was that they did not really have one, that the local governments and medical officers could not be forced to do anything.
Duflo adds that the Kerala officials were much more interested in organising yoga classes in the schools.
“They displayed a power point with each of the new UN Sustainable Development Goals, and a list of proposals to achieve them in Kerala. These amounted to a long, meritorious, and likely totally vacuous, wish list (30 minutes of exercise per day mandatory in all schools, awareness of obesity to be built in communities, etc.),” Duflo writes.
Duflo adds that interestingly enough, yoga classes had nothing to do with the healthcare reform that they had discussed that morning.
Concluding the paragraph in her essay, Duflo writes that she has since learned to avoid such meetings in general, but the encounter with Kerala officials reminded her of her early days as a plumber.
“It turns out that most policy makers, and most bureaucrats, are not very good plumbers,” she adds.
According to Duflo, as economists increasingly help governments design new policies and regulations, they take on an added responsibility to engage with the details of policy making and, in doing so, need to adopt the mindset of a plumber.
“Plumbers try to predict as well as possible what may work in the real world, mindful that tinkering and adjusting will be necessary since our models gives us very little theoretical guidance on what (and how) details will matter,” she adds.