“Multiplying Impact:

How to Change the Lives of Millions by Investing in Thousands”

Scott Rozelle

Stanford University (Professor/Senior Fellow) Director, Rural Education Action Project

(REAP) &

Colleagues in the Chinese Academy of Sciences, Northwest University, and Others

Hourly Wages in the 1990s

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China in late 1990s Park and Cai, 2008

Late 1990s to Today

The 1970s/Early 1980s

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Percent of Students Going to High School: South Korea in the 1970s/1980s

Kuan, 2011

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Mexico’s Story: Hourly Wages from 1975 to 1990

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Mexico in 1975

As would be expected, low-wage factories in Mexico shut down and

moved elsewhere in the world

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A Key to Development: Education

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Travel Warning U.S. DEPARTMENT OF STATE Bureau of Consular Affairs, Mexico

Mexico in Crisis

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Foreign Direct Investment

in Mexico

Cartels & gangs

Violence

Unemployment

Is it inevitable that Developing Countries that are growing fast and achieve Middle

Income status always will continue to grow and become rich, industrialized nations?

•  In fact, history is littered with a lot of wannabe OECD members: – Argentina … one of the four richest countries in

the world in the early 20th century … collapse and stagnation after WWII

– Uruguay / Iraq / Venezuela (in the 1960s & 70s) – MORE RECENTLY:

•  Or … as we are seeing before our eyes: Mexico

≈ $2.00 / hour in 2010

Park and Cai, 2008 ≈ 50 ¢ / hour in 1978

Annual Real Hourly Unskilled Wage in

China (1978 dollars)

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This is my auto mechanic … in Palo Alto …

Question: “Will these boys be able to do the jobs that need to be done in the future economy?”

None of these students have ever touched a computer or surfed the web

So: China’s real challenge is coming … and there are fundamental questions:

•  Can China transform itself like: Taiwan / South Korea / Ireland / New Zealand

•  Or è will China become a: Mexico / or / Argentina

China’s human capital problem is most severe in poor rural areas.

≈ 35% of school-aged children in poor rural areas

(> 50 million children in poor rural areas, ages 6 to 15)

cities

other rural

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The High School Education Gap China in 2005

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The High School Education Gap China in 2005 Mexico in the 1980s

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Is China planting the seeds for a Mexico-like crisis in the future?

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Why are there these gaps?

•  Why don’t rural students stay in school?

•  There are many reasons … but, perhaps one of the most fundamental is:

poor health poor nutrition

If children are sick or malnourished, how can they learn?

REAP study (Luo et al., 2010) of 4000 students in rural Shaanxi Province

Students with anemia (39%) Students

without anemia (61%)

Luo, et al., 2010

REAP study of 4000 students in rural Shaanxi Province

Report to Center for Disease Control:

“There are Still High Rates of Anemia” è

Response: “It must be those guys from Shaanxi … they

have never had good diets …”

We went on to test nearly 40,000 additional children across China….

National Institute of Health & Pfizer Corp.

In fact, anemia is all over China

Luo, R., X. Wang, C. Liu, et al. (2011) “Alarmingly High Anemia Prevalence in Western China.” Southeast Asian Journal of Tropical Medicine and Public Health Vol. 42 No. 5

Total

Total 33.7 Shaanxi—2008 (Dataset 1) 37.5 Shanxi—2009a (Dataset 2) 31.6 Gansu—2010 (Dataset 3) 31.2 Qinghai—2009 (Dataset 4) 51.1 Ningxia—2009 (Dataset 5) 25.4 Sichuan—2010 (Dataset 6) 24.8 Guizhou—2010 (Dataset 7) 33.1

Poor areas of China

Children with anemia (≈ 33%)

Children with out

≈ 20 million school aged children are estimated to have anemia …

Which of these kids are sick? With a disease like iron-deficiency anemia, it is impossible to tell … there are no outward symptoms … this in part makes it truly a neglected disease

But, these two students were anemic … we know (from later work) that their IQ had dropped by 10 to 20 points because of this illness … They attended school 10 less days per year

Testing >25,000 children in Gansu and Shaanxi Provinces

myopic

normal vision

3680 (≈15%) were myopic (or nearsighted).

What happens when students cannot see …

•  The chalk board? •  Teachers’ illustrations? •  The work of fellow students?

Testing > 25,000 children in Gansu and Shaanxi Provinces

myopic

normal vision

3680 (≈15%) were myopic (or nearsighted).

Only 142 had eyeglasses

Academic performance suffers

Chinese Math English Average Nearsighted students -0.174***

(0.055) -0.109* (0.056)

-0.179*** (0.061)

-0.182** (0.059)

Other covariates yes yes yes yes

Treatment Township (τ) -0.053

(0.069) -0.070 (0.071)

0.078

(0.077) -0.018

(0.075)

Poor Vision×Treatment Township (β)

0.024 (0.047)

-0.087

(0.067) -0.065 (0.046)

-0.050 (0.053)

As you can see, holding all things constant, children that can not see well, perform worse! They should be 80+, but, they are <75 points.

THE SCOURGE WITHIN:INTESTINAL WORMS IN RURAL CHINA

Chinese Academy of Sciences

Center for Disease Control, Shanghai

Stanford University (with support of Asia Health Care Initiative funding) + Rural Education Action Program’s Advisory Board

SURVEY SITES

Total 1701 children •  8 students/village (8-10 years old/grades 3-4) •  8 children/village (3-5 years old, pre-school)

Incidence of Intestinal Worms, Guizhou Province, 2010

3 to 5 year olds 8 to 10 year olds

34% with worms

40% with worms

Without Without

Zhang et al., 2011

… millions of children are infested with these …

Response by Ministries

•  Mostly: silence •  Why?

– MOE: “What does health and nutrition have to do with education?”

– MOH: “We know this / tell us what to do about it …”

Response by the NGO community

•  Lots of: Action

Building Schools … Giving scholarships … Migrant community centers … Teacher training … Improved cook stoves … Giving out Embrace sleeping bags … Empowering women … Raising awareness of minorities … and more …

But no matter how many: •  Dell’s … providing 100s of computers …

•  Starbuck’s … training 1,000s of teachers …

•  CDYF’s … building 10,000s of schools …

•  Zigen’s … teaching 100,000s of migrant children …

•  Ford Foundation’s … giving 1,000,000s in scholarships …

•  Give2Asia’s … organize / facilitate >$10,000,000 in grants and program aid!

There are still: •  50,000,000 children more without computers …

•  5,000,000 migrant children in inferior schools without health care …

•  500,000 teachers that lack training …

•  50,000 schools with no libraries or IT programs or livable dorms

•  UNCOUNTABLE NEEDS … for all of the donors in one Give2Asia or 100 Give2Asias

There are still: •  50,000,000 children more without computers …

•  5,000,000 migrant children in inferior schools without health care …

•  500,000 teachers that lack training …

•  50,000 schools with no libraries or IT programs or livable dorms

•  UNCOUNTABLE NEEDS … for all of the donors in one Give2Asia or 100 Give2Asias

The basic truth (we believe) is:

•  The ultimate goal of philanthropy in China today … “should be” to show something works on 1000 kids … show how to do it more effectively … get the government to buy into the program … and let them upscale … and have an impact on 1,000,000 kids … or more!

Despite what you hear about corruption today, the basic fact is true:

The government has fiscal resources … The government is looking for good projects that will further China’s development … Government officials benefit personally from being identified with SUCCESS …

The need for “Action Research” or Social Experimentation with

Chinese Characteristics! •  Seeing is believing …

•  Show the effect of treatment on China …

•  Experiment with different ways of treating … compare efficacy / cost …

è To gain policy traction …

The Rural Education Action Project is a Research Organization/NGO/Government

Organization/Policy Action partnership Collaborators in China At Stanford University

We are committed to finding solutions to the help bridge the

gap … cost effective … scalable … efficient solutions

Our Vision

Help brian

To understand the barriers keeping the rural poor from closing the gap and learn what can be done

REAP works in two ways

1. REAP designs and implements new program interventions and conducts the evaluations

2. REAP partners with NGOs and government agencies who are trying to implement projects –  REAP advises –  They carry out –  REAP evaluates

We call this “action research”

REAP partners

REAP partners

Academic organizations

Corporations (CSR groups)

Foundations

Individuals

Competitive Grant-making Agencies

US and other foreign companies

[Some] Chinese companies

REAP partners

One of our KEY partners

REAP partners

REAP Experiments (Projects) in China’s Poor Rural Areas (and

Migrant Communities)

REAP’s Three “Action Platforms”

Keeping Kids in School Technology and Human Capital

Health, Nutrition and Education

So what is the key to “action research”?

Two things:

1. The rigorous / but simple way that we demonstrate IMPACT …

2. Our commitment to scaling up … through engagement in policy …

These are also the two sources of engagement with our other set of partners … the government!!

An illustration:

How “action research” works!

The FIRST anti-anemia intervention: October, 2008 – June, 2009

The NGO wanted to work in schools in Shaanxi … REAP “figured out” they needed to “work” in 30 schools (to be able to be certain that their program could show an effect) … So we pick 60 schools of the type they wanted …

*

The NGO wanted to work in schools in Shaanxi … REAP “figured out” they needed to “work” in 30 schools (to be able to be certain that their program could show an effect) … So we pick 60 schools of the type they wanted …

Before the project was launched by the NGO …

REAP went to 60 schools …

And collected baseline information

(again: BEFORE the NGO ever visited the schools)

Using Hemocue 201+ technology gives Hb levels in 45 seconds (Oct. 2008)

Baseline TIMMS test (October 2008)

All fourth grade students

Randomly Choose the Treatment Schools and Control Schools

But, do it over and over until:

Pre-balanced at the baseline between 30 Treatment (T) Schools &

30 Control (C) Schools

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Hb levels AnemiaRates

TestScores

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122.1 122.3 39.8 38.7 72.3 73.1

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Locations of sample schools in Shaanxi Province

( ) Treatment Schools

( ) Control Schools

Therefore, after the intervention, we can interpret any differences to the outcome variables (Hb levels, anemia, test scores) to be due to the intervention

Prebalancing ensures that schools in treatment groups and schools in control groups are statistically identical prior to

the intervention (like identical twins)

Treated schools

Control schools

School Type A (30 schools)

“Vitamin / Day”

Give students one over the counter multi-vitamin with iron per day (5 mg of iron) … from November 2008 to May 2009

(≈4 US cents/day)

The Intervention

30 control schools

Zero: no vitamins

Using Hemocue 201+ technology gives Hb levels in 45 seconds (Oct. 2008)

Baseline TIMMS test (October 2008)

All fourth grade students

Impact of vitamin on students: Hemoglobin Points Anemia Rates (%)

Math Test Scores (std. dev.)

Is one result enough?

•  It works in Shaanxi … … but does it work in Ningxia? •  It works in an NGO project …

… but can it work “inside the system?” •  What is the most effective way (time / cost)?

Other interventions

Intervention One: 1 egg/day + vitamin

Intervention Two

Vita Meal (vitamin-fortified porridge)

Supported by Nu-skin Cosmetic Company’s CSR group

Intervention Three

Chewable Vitamin per Day

Impact of vitamin supplementation on students

Hemoglobin Points Anemia Rates (%)

Math Test Scores (std. dev.) Win

Win

Win

Formal  no)fica)on  that  there  has  been  a  “policy  direc)ve”  direc)ng  MoEdu  and  MoHealth  to  move  our  informa)on  into  the  policy  discussion  

Official  policy  brief  (think  of  President  Obama’s  desk  and  the  desks  of  his  cabinet  members)  

And policy making circles …

Policy Action—Central Government In 2009 è direct MoE to begin a plan to put

nutrition into the school system …

Wen Jiabao: Premiere

Liu Yandong: Standing Committee member (education)

Li Keqiang: Vice Premiere

(for health)

“Necessary But Not Sufficient”

Challenges of Working with (Local/regional) Policy Makers for

Implementation

An Example: •  We say “give vitamins” / local policy

makers give eggs

This has happened twice:

Shaanxi in 2009-10

Ningxia in 2010-11

Do eggs have any impact?

Does one egg per day, improve test scores / attendance?

25 elementary schools in Gansu 25 elementary schools in Gansu

One Egg Per Day No intervention.

So what is the result?

Impact of Eggs on Hb Levels …

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Control One Egg/Day Chewable Vitamin

Standard deviations

No impact … as expected!

Impact of Eggs on Test Scores …

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Control One Egg/Day Chewable Vitamin

Standard deviations

No impact on test scores… either!

Conclusion for egg study:

•  NO: it is NOT that eggs are bad for you … –  In fact: kids liked it … teachers liked it … parents liked –  The “satisfaction” of stakeholders in “egg schools”

were higher than in “vitamin schools”

•  But, the problem is that eggs do not address one of

the fundamental problems of rural children in the poor areas of Northwest China: iron-deficiency anemia

While we are discovering what works and what does not work …

The State Council moves …

Oct. 30, 2011 China’s new nutrition program: -- 16 billion yuan [$US 2 billion dollars] to put nutrition into schools in rural China [or 20 billion US dollars over 10 years] [equals about 3 yuan / student / day …]

An Example:

Treating 40,000 students through philanthropy è

Turned into nutritious lunches for 20,000,000 million

[Many groups helped in the “action research” …. CDRF / CDC / and: REAP]

There are many low cost, effective solutions beyond reducing anemia

•  Vitamin / day è 0.2 yuan per day •  Deworming è 1-2 yuan per year •  Eyeglasses è 80 yuan per year

(< 0.10 yuan per day)

•  Early Childhood Education •  Computer room + Software + Teacher training

– One PC Tablet per Child •  Conditional cash transfers for junior high

students

What if China can not overcome the [BIG] human capital challenge?

•  If human capital does not rise, will China stop growing?

•  What happens if there are two distinct classes … haves and have nots … and China’s growth slows?

•  What happens if there are: 100 million unemployed? 70 million unmarried?

There will only be two choices for the unemployed in China (they will NOT be able to cross the border into a neighboring rich country) … they will either seek employment in the informal economy OR seek refuge in organized crime [this is

NOT new in Chinese history]

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Is China planting the seeds for a Mexico-like crisis in the future?

We believe that the optimistic path is still possible because:

“There is exactly enough time

starting now”

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One other keys the PEOPLE:

the Collaborations è Action Research …

–  NGOs –  Corporation CSR programs –  Individual donors + –  Action Research Organization/Partners

è Policy Collaboration … … with collaborations at all levels of government

Village doctors and school nurses

School principals

County officials

Provincial/ national leaders

Real objective è the kids!

•  Not to change policy … for policy sakes …

•  Not to run a good program … for the sake of running a good program …

•  But, to impact the lives of the students in China … and their families …

for them … for their children … for China

Thank You!

http://reap.stanford.edu 123