Thursday, February 7, 2013

The Art and Science of Finding and Helping the 'Poor': Tzu Chi's Charity Mission

A core tenet of Tzu Chi Foundation is to "help the poor and educate the rich" (濟貧教富). It sounds so simple, right -- to "help the poor"?

"Poverty" as a topic studied by economists
Before one can help the poor, one must first define "who is poor?" I'm no social worker, but I have studied the field of "development" along with health economics since college. And there's one thing that I know: measuring poverty ain't a piece of cake, at least from an economist's view of the world. There are reams and reams of academic literature on how to best measure poverty. If you search Google Scholar for "measurement poverty", there are at least 1.17 million papers that come up, with Amartya Sen's classic paper "Poverty: an ordinal approach to measurement" at the top of the list with 2,124 citations.

Today there are basically two standard ways to measure poverty in the economic literature. The first involves counting how much you spend on every possible commodity and service out there (consumption expenditure) as a proxy for 'income', doing so for everyone else in your neighborhood (or state or country), and then drawing a line ('the poverty line'), and counting all those below that line as 'poor'. Some make that line universal ($1 or $2 a day), while some would make that line specific to a nation, to urban or rural areas, or other specific locale. It also means, in crude terms, that the less you spend, the poorer you are.

The second involves counting all the things or "assets" you have in your house, and then comparing that to everyone else in the neighborhood (or state or country). You assign weights to those assets (e.g. weigh all assets equally or weigh each asset differently, by obtaining the weights through various methods, such as principal components analysis). Then you assign each household an index based on their assets and the weights to each asset, and then you can rank households on that index. Then you can take the bottom 20% (bottom quintile) or whatever "bottom" you prefer. This definition also implies crudely that the less you have, the poorer you are.

These two economic methods are seen as complementary and not without flaws. For example, the former consumption expenditure method often is subject to under-reporting of spending and hence there are often mismatches when aggregating to the national level when comparing to other sources of data to estimate national spending. The former requires trying to recall how much you spent in the last month or year. The latter involves self-reports on what you own (if not obvious from visual inspection by an interviewer). Both can be quite time intensive, because it involves a lot of questions from a survey, and asking a large number of people through a population representative household survey or census.

But, a new study has found -- in spite of a few decades of economic research and lots of thinking and lots of PhD these on this topic -- ironically, there is a much simpler way to find out whether someone is poor, without having to determine the poverty of every single household in the neighborhood (or state or nation) through such a detailed, extensive survey. It turns out, you can just have them tell you if they are poor or not. Surprise, surprise! Common sense beats research: Common sense, 1. Research, 0.

How Tzu Chi finds the poor
It also turns out that Tzu Chi has been doing this since its inception. If a person requests help, Tzu Chi volunteers will reach out and assess whether in fact that person needs help, and then help them as needed. Assessment involves home visits and inquiries and verification of the household's livelihood and lifestyle. It's Social Work 101, folks (I'm addressing the economists reading this blog). So, how does Tzu Chi find and find and help the poor, exactly?

Well, Tzu Chi has a large force of social workers, professional ones as well as supporting volunteers. Social workers have a method for assessing the household's economic situation, livelihood, and various needs. The social worker may observe that a person has fallen ill, lost her job, and has lost her income for the month. The person may be just above some government cut-off for welfare, but nevertheless still require help. Or the case may deemed needy for a multitude of other reasons, even if the person is already receiving some form of government assistance.

I note that there is one other and newer strand of research on poverty measurement, which attempts to reflect the multidimensionality of poverty, not limited merely to how much one spends or how much one spends, for example, to account for education levels and health status of household members, etc. Tzu Chi's approach to assessing potential social work and charity cases, I imagine, probably reflects aspects of all these different approaches to measuring poverty -- how much a household spends, how much the household has, and other factors in the household. (Master's or bachelor's thesis topic, anyone?)

How Tzu Chi helps the poor
So far I've made the argument that Tzu Chi's approach to measuring and identifying the poor is both practical and "cutting edge". But Tzu Chi's approach to helping the poor has also been equally pragmatic as well.

Tzu Chi has long provided "cash transfers" and "cash assistance" to its social work cases since its inception. Tzu Chi will step up to offer cash assistance as needed until the person no longer needs it, with regular case visits and support and accompaniment (陪伴), a term that I have pulled from Paul Farmer's work in Haiti, but is also a term that has been long used within Tzu Chi. The act of accompanying others cannot be underestimated, and Tzu Chi has done this from the beginning of its work. It means that the mere presence of another person to co-suffer with the person undergoing suffering is effective at alleviating suffering. While some economists or even medical researchers might view this as a "placebo effect" ("you're not giving them any 'treatment' per se"), in fact the "treatment" is be there with someone. And we know from neuroscience and psychology that simply "being there" matters. (More on this as a separate post!)

Sometimes the needs of the poor are cannot be solved by cash alone. If the social worker identifies that because of her falling ill, she hasn't been able to take care of herself, take showers, cook, or clean her house, and she needs some assistance in kind, Tzu Chi volunteers will step in to help. Not only do the volunteers do a professional job (in their blue-and-white uniforms), the volunteers also cheer people up, too, and offer their accompaniment. Hassle-free help.

Basically, any and all needs that Tzu Chi can provide, be it financial or in kind, they will do it if help is requested and needed. As Brother Zach Tse (謝景貴) once told me, "If you told a 85-year-old Tzu Chi granny volunteer that someone in the neighboring town is poor and needs help, that old lady would stand up right away and say, 'Where is she? Let's go!'" That epitomizes the go-getter attitude of Tzu Chi volunteers. Where there is a call for help, there they wish to be. It's no small wish to be like Avalokiteśvara, a being or a person who has vowed to respond to all calls for help, with a thousand eyes and a thousand arms. It also explains why, in Taiwan's devastating earthquake in 1999 (called the 921 Earthquake for occurring on September 21), Tzu Chi volunteers were documented across Taiwan to arrive first at the site of each disaster scene in uniform, even before any government or military emergency officers arrived.

I've described briefly Tzu Chi's practical if not novel approach to helping -- but what I find somewhat funny is that today one of the most fashionable topic in development economics is "cash transfers", and whether it is "unconditional" or "conditional". But if only the development economists spoke to the social workers, then, it would not seem so "new" or "fashionable". At times, I feel the different disciplines don't talk to each other enough, in this case, social work and economics -- especially when talking about poverty, cash transfers, etc. Social workers have been at it way longer than economists, and doing a great job in our own country: Common Sense, 1. Research, 0. (It might also be that economists, particular conservative ones, being generally against forms of social welfare, probably don't like talking to social workers.)

Do social work and economics converge on the use of research and evidence?
Although social work and economics at times are fields that do not seem to be communicating with each other (as suggested by the fashionability of "cash transfers" within economics), there is one thing where social work and economics converge, and that is on the use of scientific evidence. Both social work and economics rely heavily on determining what kinds of interventions work at a population level. Rigorous evaluation studies, not unlike an experimental or quasi-experimental study at the community level, are designed, conducted, and published.

Here is where Tzu Chi, unfortunately, needs to get better. For all its "doing", it has much less "talking" outside of Tzu Chi. Granted, within Tzu Chi there is a lot of both doing and talking -- talking from an individual, colloquial perspective to share and learn from personal experiences, not unlike what I wrote a few days ago on my winter relief experiences. But there is much less talking from a rigorous or research perspective, talking that helps with communicating what they do and with public relations.

As a consequence, that lack of talking, especially in English, has become a missed opportunity for sharing its experiences to different policy audiences and institutions engaged in similar activities. An obvious example of a missed opportunity for Tzu Chi to embark on research: the lack of "rigorous" evidence of Tzu Chi's social work programs, for example. It turns out that Tzu Chi's work will, by onlooking Westerners, seem somewhat "not based on evidence", where "evidence" means "research". From a communications standpoint, it simply means talking in the same language as the audience. If the audience is policymakers, and if Tzu Chi wants to reach out to that audience, then it needs to use some of the language that the policymakers are used to.

And, in order for it to talk to these audiences, Tzu Chi first needs to be open to thinking and talking in similar languages as them. So, for starters, can we set out to evaluate the effectiveness of Tzu Chi's charity and social work programs on poverty in Taiwan, Indonesia, Malaysia, the Philippines, the US, China, or other countries where Tzu Chi has a large or growing presence?

Moreover, there are other forms of data and information on poverty and deprivation -- such as from the data collected through household surveys or censuses described above -- that any agency or organization can use, not necessarily to identify individual poor people per se, but to help them target their efforts and programs in specific regions or locales. How does Tzu Chi prioritize its efforts, and how does it use data in that endeavor of setting program priorities?

I hope more people interested in economics and social work will take interest in Tzu Chi and wish to evaluate its programs, and thereby learn from what Tzu Chi has to offer. And I hope Tzu Chi, as much as I love this organization, will be open to that critical inquiry. I also hope that Tzu Chi will learn from those scholars on how evidence and data can be used to make better decisions. After all, with mutual learning, everybody, regardless of whether they are Tzu Chi volunteers or donors, will benefit. 

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