Innovations for Poverty Action — Scale-Up of Face Masks in South Asia

Note: This page summarizes the rationale behind a GiveWell-recommended grant to Innovations for Poverty Action (IPA). IPA staff reviewed this page prior to publication.

Published: July 2021

Context

A randomized controlled trial previously funded by GiveWell tested an intervention to promote mask use to reduce the transmission of SARS-CoV-2, the virus that causes COVID-19. You can read more about our rationale for funding that trial here.

The headline results of the study suggested that observed mask use in the treatment group increased by approximately 29 percentage points relative to the control group.1

We place weight on this study due to its narrow confidence intervals, cluster-randomized design, and because mask-wearing was directly observed rather than self-reported.2

The results for the effect of the intervention on prevalence of infection with SARS-CoV-2 are not yet available.

The grant

The grantees are working with governments and NGOs to scale an adapted version of the intervention tested in the trial in various locations in South Asia and requested additional funding to assist with scale-up.3 We expect the funding will be used on some combination of:4

• Purchasing some number of masks (with distribution and promotion costs being covered by implementers).
• Conducting monitoring on the scale-up.
• Providing technical support to implementers, such as adapted protocols for implementing the intervention.

Our process

We made this grant based on limited investigation because we had already been having regular conversations with the grantees, understood that there was interest from governments and NGOs in scaling the intervention due to the high number of COVID-19 cases in South Asia, and believed that IPA could productively use additional funding to cover time-sensitive funding needs.5

This grant was recommended through a process that gives Program Officers discretion to recommend grants up to $250,000 each year with a limited review process.

​​Sources

Document	Source
Abaluck et al. 2021 (working paper)	Source (archive)
IPA, "NORMalize Mask-Wearing Scale-Up"	Source (archive)

• 1

  "Mask-wearing in intervention villages increased by 29.0 percentage points. If we omit all covariates (except the fixed effects necessary due to our stratification procedure), our point-estimate is identical. These estimates are quite precise, with standard errors of about 1 percentage point." Abaluck et al. 2021 (working paper), Pg. 16.

• 2

  Abaluck et al. 2021 (working paper)

  • See the confidence intervals listed next to the study's headline results: "Adding periodic monitoring by mask promoters to remind people in streets and public places to put on the masks we provided increased proper mask-wearing by 29.0 percentage points (95% CI: 26.7% - 31.3%). This tripling of mask usage was sustained over all 10 weeks of surveillance, which includes a period after intervention activities ended. Physical distancing, measured as the fraction of individuals at least one arm’s length apart, also increased by 5.2 percentage points (95% CI: 4.2%-6.3%)." Pg. 2.
  • "Entire villages were selected to receive that intervention package or serve as controls. The clustered village-level randomization was important for two reasons. First, unlike technologies with primarily private benefits, mask adoption is likely to yield especially large benefits at the community-level. Second, mask adoption by some may influence mask adoption by others because mask-wearing is immediately visible to other members of the community [23]." Pg. 6.
  • "Mask-wearing was assessed through direct observation in public locations including mosques, markets, the main entrance roads to villages, and tea-stalls." Pg. 6.

• 3

  "The COVID-19 pandemic has taken the lives of more than 3.5 million people globally.1 South Asia has become the epicenter of the pandemic. While face masks can slow the spread of the disease and save lives, getting people to consistently and properly wear masks has been a major public health challenge. However, a new model shown to normalize mask-wearing points to a scalable solution. IPA and a large coalition of partners have quickly mobilized to support government and non-government organizations in scaling the model [...] Our large collaborative team has been building other interested coalitions in Bangladesh, India, Pakistan, and now Latin America to scale the model." IPA, "NORMalize Mask-Wearing Scale-Up" [at the time we recommended this grant, we understood that the work would likely focus on South Asia (rather than including Latin America)]

• 4

  "Emerging scale-up coalitions are underway to reach millions more people in in [sic] South Asia, and now also Latin America, with potential to save many thousands of lives. However, funding and technical gaps exist, and further support is needed to make these scale-ups a reality. High leverage opportunities to fill gaps in coalitions include the following:

  • Procuring high-quality masks: some coalitions already have the staff needed to scale it up, but not enough masks. A small purchase of masks (which cost $0.05-$0.10 each) helps ensure the overall package is delivered.
  • Monitoring support: other coalitions have all the pieces for the program but lack a small team to do safe, public observation of mask-wearing to confirm the program is working. In the original program, we found that data to quickly course correct was a critical component in rollout.
  • Technical assistance for implementers: the teams at IPA, J-PAL, Yale, the Lahore University of Management Sciences (LUMS), and Stanford are all providing technical staff to support governments and organizations to deploy the model. These staff need to be complemented as we reach more coalitions.
  • Urban adaptation of the model: the original study was implemented in rural areas, and while we think the mechanisms are similar, the precise activities will necessarily be different. To ensure the model is successfully adapted to urban areas, data should be gathered as it is scaled to adjust if necessary." IPA, "NORMalize Mask-Wearing Scale-Up"

• 5

  Conversation with Heidi McAnnally-Linz and Professor Mushfiq Mobarak, May 3, 2021 (unpublished)