At the heart of this project on tuberculosis treatment in India is the simple and practical question of whether community volunteers can be used instead of professional monitors to ensure drug-therapy compliance; but the investigators use this idea in order to explore broader social science questions, including the extent to which caste membership creates effective generalized (as opposed to specific) reciprocity among its members. The unsatisfactory performance of public health systems, particularly in poor rural areas, has lead to calls for decentralization and greater community participation throughout the developing world. This project rigorously investigates where and why community health volunteers will be motivated to effectively carry out their assigned tasks. The project focuses on tuberculosis, a leading contributor to the global burden of disease, and will use community volunteers as Directly Observed Treatment (DOT) providers to ensure that TB patients adhere to their extended treatment regimen. Social solidarity—the selfless willingness to help another without receiving direct benefits in return—is seen as the primary motivation for community volunteers when strict confidentiality must be maintained, as with TB case management. Their new theory of solidarity formation indicates that spatially dispersed communities with less dense social networks will compensate for their limited ability to enforce cooperation among their members by investing in solidarity. The theory predicts that these communities should therefore produce more effective DOT providers and this hypothesis will be tested in rural south India with a population of 1.2 million, covering 420 villages (neighborhoods) and including 50 kin-groups (sub-castes). Based on the theory, patients assigned to TB volunteers from their own kin-group are expected to enjoy relatively high levels of treatment success and solidarity is expected to be greater within kin-groups than within villages. Given current efforts to decentralize the health system in India and other countries, research aiming to systematically evaluate successful community participation and understand its underlying preconditions comes at a particularly opportune time.
Director: Kaivan Munshi
Collaborator: Nancy Luke
Research Theme: Development, Institutions and Demographic Change
Location: Republic of India