But it's also true that, over the last two decades, the same issues have gained increasingly more traction within the so-called Randomistas and the recent studies have put a lot more emphasis on the generalizability of results compared to their predecessors. The questions Ricardo poses re the ‘external validity’ of RCTs are valid ones, one must admit. The objective of the project was defined by the method rather than the other way around. It was considered a success not because of its outcomes on health but the study team was able to do an RCT. In spite of the fact that this study had little relevance to the Tibetan Health Bureau, the research project was deemed a success. At the last minute, their funders told them that their methodology was not rigorous enough-it was “not scientific.” Adams explains that, “Despite the fact that more women died in childbirth in rural Tibet than in just about any other country, and despite the fact that training would be conducted in a large rural prefecture and was endorsed by the Health Bureau, we were told that in their catchment area ‘not enough women die to get a robust power calculation.’” As a result of this perverse logic-and to maintain their funding-, the project team changed course and ran an RCT in the capital, Lhasa, to compare traditional Tibetan medicine with a Western drug that prevents hemorrhage in delivering women. In 2005, a project team set out to train health workers in techniques of safe motherhood in rural Tibet. Here's one from The anthropologist Vincanne Adams provides a sad example of what is all too common in the sector. I think we need a website to crowdsource the stories in which this "auditor-becomes-the-R&D-department" happens. Our approach considers capacity at multiple levels: civil servants' individual capacity to find, evaluate and communicate quality evidence to decision makers, organisational processes for determining and responding to evidence needs, and a wider enabling environment of media and civil society including networks between researchers and policymakers. gained through stakeholder consultations), research evidence, and practice informed evidence (eg. Read more here: We look at four types of evidence which are needed for policy: administrative data/statistics, citizen knowledge (eg. Across these countries we are working with 3 ministries/depts, 3 Parliaments and 1 civil service training college as well as local research and civil society organisations. Our Consortium, called the VakaYiko Consortium, consists of 5 organisations working in 4 core countries (Uganda, Zimbabwe, South Africa and Ghana) to build civil servants' capacity for using evidence. At INASP we are leading one of 5 DfID-funded consortia working around around the world on evidence informed policymaking. But not all implementing agencies take the approach described. I agree with the issues pointed out about the danger of RCTs as a 'gold standard'.
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