“Policy Influence: Lessons from the 3ie/GDN Project on WSS Impact on Child Health in Cameroon” Debazou Y. Yantio Evaluation & Development Policy Consultant

The Problem of Influence of Impact Evaluations “To improve lives, especially the lives of poor people, development research will almost always have to influence policy in order to influence development” (Maureen O’Neil in Carden, 2009) “Neglecting research findings was [is] a common recreation in arenas of action” (Carol Weiss, 2009) That hold true for “WSS impact analysis in Cameroon”, a research project carried out by 3ie/GDN consultants in selected developing countries? What when wrong with this study to fail policy influence in the case of Cameroon?

Outline Overview of the 3ie/GDN Research Project The conceptual framework of analysis The findings Implications for evaluators

The 3ie/GDN Research Project “Improved access to water supply and sanitation is argued to contribute towards many development goals, most notably better health in the form of reduced prevalence of diarrhoea” (UN, 2008) However, the evidence base, especially with respect to sanitation, is extremely weak (World Bank, 2008; Waddington et al., 2009) 3ie/GDN research project “Impact of Water Supply and Sanitation interventions on child health: a Multi-country Study” seeks to fill the evidence gap. Launched in 2009 in selected developing countries: Cameroon, Egypt, Philippines, Peru, Senegal, and Zambia It is a quasi-experimental study applying propensity score matching (PSM) to Demographic Health Survey (DHS) data to estimate the ATT of water and sanitation interventions on diarrhoea prevalence among children below the age of 5 Preliminary results were presented in Prague (January 2010), and New Delhi (October 2010)

The 3ie/GDN Research Project In Cameroon, it is found that in matched sample, access to improved drinking sources of water does have significant effect on diarrhoea prevalence, even when coupled with access to improved sanitation facilities On the contrary, access to improved sanitation facilities significantly decreases prevalence of diarrhoea by 3.6 % In unmatched sample (no control for confounding factors), all interventions were significant having effect on diarrhoea prevalence.

The Conceptual Framework On the occasion of diarrhoea disease outbreak in 2009, 2010 and beginning 2011, the government has responded by increasing investment to improve water supply to households across the country These investments include: Increase in water supply capacity of the water utility company Subsidizing the connection of households to the piped public water supply network, especially for urban population Officials in the Ministry of Health also broadcast through TV and radio, messages to promote the observance of hygiene However, this communication effort is limited in time and scope The response pattern of the Government of Cameroon to diarrhoeal disease is not consistent with 3ie/GDN WSS Impact Study

The Conceptual Framework Weyrauch & Diaz Langou (2010)

What When Wrong? At the supply side: The major stakeholders were not associated at conception of the research project Trial to establish communication with policy makers and local research organizations was weak At inception, awareness on the issue of diarrhoea (among children and adult population) was limited No policy influence objective was explicitly set

What When Wrong? At the demand side: There was no political pressure at that time; situation has changed with the incidence of cholera outbreak and the presidential election to occur this year Now there is a national outbreak that have attracted huge interest from the government and the media Governement seems ready to show willingness to act upon, especially in this « unsure » political time, coupled with the upcoming election – opportunities are now open Tradition of decision makers of using evidence from research to formulate policy is not established At the level of interplay between demand and supply The link between decision makers and governemental & non governmental research organizations is extremely weak Institutional spaces for dialogue are freezed and inoperational

Implications for Evaluators Know your audience and identify major policy stakeholders Get major stakeholders involved at the very beginning of the project (identification of the issue, framing question, etc.) Set explicit policy influence objectives, and plan accordingly Find the appropriate timing for the awareness raising communication.