Bill Gates
We can learn a lot about improving the 21st-century world
from an icon of the industrial era: the steam engine.
Harnessing steam power required many innovations, as William
Rosen chronicles in the book “The Most Powerful Idea in the World.”
Among the most important were a new way to measure the energy output of engines
and a micrometer dubbed the “Lord Chancellor” that could gauge tiny
Such measuring tools, Mr. Rosen writes, allowed inventors to
see if their incremental design changes led to the improvements—such as higher
power and less coal consumption—needed to build better engines. There’s a
larger lesson here: Without feedback from precise measurement, Mr. Rosen
writes, invention is “doomed to be rare and erratic.” With it,
invention becomes “commonplace.”

In the past year, I have been struck by how important
measurement is to improving the human condition. You can achieve incredible
progress if you set a clear goal and find a measure that will drive progress
toward that goal—in a feedback loop similar to the one Mr. Rosen describes.
This may seem basic, but it is amazing how often it is not
done and how hard it is to get right. Historically, foreign aid has been
measured in terms of the total amount of money invested—and during the Cold
War, by whether a country stayed on our side—but not by how well it performed
in actually helping people. Closer to home, despite innovation in measuring
teacher performance world-wide, more than 90% of educators in the U.S. still
get zero feedback on how to improve.
An innovation—whether it’s a new vaccine or an improved
seed—can’t have an impact unless it reaches the people who will benefit from
it. We need innovations in measurement to find new, effective ways to deliver
those tools and services to the clinics, family farms and classrooms that need
I’ve found many examples of how measurement is making a
difference over the past year—from a school in Colorado to a health post in
rural Ethiopia. Our foundation is supporting these efforts. But we and others
need to do more. As budgets tighten for governments and foundations world-wide,
we all need to take the lesson of the steam engine to heart and adapt it to
solving the world’s biggest problems.
One of the greatest successes in terms of using measurement
to drive global change has been an agreement signed in 2000 by the United
Nations. The Millennium Development Goals, supported by 189 nations, set 2015
as a deadline for making specific percentage improvements across a set of
crucial areas—such as health, education and basic income. Many people assumed
the pact would be filed away and forgotten like so many U.N. and government
pronouncements. The decades before had brought many well-meaning declarations
to combat problems from nutrition to human rights, but most lacked a road map
for measuring progress. However, the Millennium goals were backed by a broad
consensus, were clear and concrete, and brought focus to the highest
When Ethiopia signed on to the Millennium goals in 2000, the
country put hard numbers to its ambition to bring primary health care to all of
its citizens. The concrete goal of reducing child mortality by two-thirds
created a clear target by which to measure success or failure. Ethiopia’s
commitment attracted a surge of donor money toward improving the country’s
primary health-care services.
With help from the Indian state of Kerala, which had built a
successful network of community health-care posts, Ethiopia launched its own
program in 2004 and today has more than 15,000 health posts staffed by 34,000
workers. (This is one of the greatest benefits of measurement—the ability it
gives government leaders to make comparisons across countries and then learn
from the best.)
Last March, I visited the Germana Gale Health Post in the Dalocha
region of Ethiopia, where I saw charts of immunizations, malaria cases and
other data plastered to its walls. This information goes into a system—part
paper-based and part computerized—that helps government officials see where
things are working and to take action in places where they aren’t. In recent
years, data from the field have helped the government respond more quickly to
outbreaks of malaria and measles. Perhaps even more important, the government
previously didn’t have any official record of a child’s birth or death in rural
Ethiopia. It now tracks those metrics closely.
The health workers provide most services at the posts,
though they also visit the homes of pregnant women and sick people. They ensure
that each home has access to a bed net to protect the family from malaria, a
pit toilet, first-aid training and other basic health and safety practices. All
these interventions are quite simple, yet they’ve dramatically improved the
lives of people in this country.
Consider the story of one young
mother in Dalocha. Sebsebila Nassir was born in 1990, when about 20% of all
children in Ethiopia did not survive to see their fifth birthdays. Two of
Sebsebila’s six siblings died as infants. But when a health post opened its
doors in Dalocha, life started to change. Last year when Sebsebila became
pregnant, she received regular checkups. On Nov. 28, Sebsebila traveled to a
health center where a midwife was at her bedside during her seven-hour labor.
Shortly after her daughter was born, a health worker gave the baby vaccines
against polio and tuberculosis.
According to Ethiopian custom, parents wait to name a baby
because children often die in the first weeks of life. When Sebsebila’s first
daughter was born three years ago, she followed tradition and waited a month to
bestow a name. This time, with more confidence in her new baby’s chances of
survival, Sebsebila put “Amira”—”princess” in Arabic—in the
blank at the top of her daughter’s immunization card on the day she was born.
Sebsebila isn’t alone: Many parents in Ethiopia now have the confidence to do
the same.
Ethiopia has lowered child
mortality more than 60% since 1990, putting the country on track to achieve the
Millennium goal of lowering child mortality two-thirds by 2015, compared with
1990. Though the world won’t quite meet the goal, we’ve still made great
progress: The number of children under 5 years old who die world-wide fell to
6.9 million in 2011, down from 12 million in 1990 (despite a growing global
Another story of success driven by better measurement is
polio. Starting in 1988, global health organizations (along with many
countries) established a goal of eradicating polio, which focused political
will and opened purse strings to pay for large-scale immunization campaigns. By
2000, the virus had nearly been wiped out; there are now fewer than 1,000 cases
But getting rid of the very last
cases is the hardest part. In order to stop the spread of infections, health
workers have to vaccinate nearly all children under the age of 5 multiple times
a year in polio-affected countries. There are now just three countries that
have not eliminated polio: Nigeria, Pakistan and Afghanistan. I visited
northern Nigeria four years ago to try to understand why eradication is so
difficult there. I saw that routine public health services were failing: Fewer
than half the kids were getting vaccines regularly. One huge problem was that
many small settlements in the region were missing from vaccinators’ hand-drawn
maps and lists documenting the locations of villages and numbers of children.
To fix this, the polio workers walked through all high-risk
areas in the northern part of the country, which enabled them to add 3,000
previously overlooked communities to the immunization campaigns. The program is
also using high-resolution satellite images to create even more detailed maps.
As a result, managers can now allocate vaccinators efficiently.
What’s more, the program is piloting the use of phones
equipped with a GPS application for the vaccinators. Tracks are downloaded from
the phone at the end of the day so managers can see the route the vaccinators
followed and compare it to the route they were assigned. This helps ensure that
areas that were missed can be revisited.
I believe these kinds of measurement systems will help us to
finish the job of polio eradication within the next six years. And those
systems can be used to help expand routine vaccination and other health
activities, which means the legacy of polio eradication will live beyond the
disease itself.
Another place where measurement is starting to lead to vast
improvements is in education.
In October, Melinda and I sat among two dozen 12th-graders
at Eagle Valley High School near Vail, Colo. Mary Ann Stavney, a language-arts
teacher, was leading a lesson on how to write narrative nonfiction pieces. She
engaged her students, walking among them and eliciting great participation. We
could see why Mary Ann is a master teacher, a distinction given to the school’s
best teachers and an important component of a teacher-evaluation system in
Eagle County.
Ms. Stavney’s work as a master teacher is informed by a
three-year project our foundation funded to better understand how to build an
evaluation and feedback system for educators. Drawing input from 3,000
classroom teachers, the project highlighted several measures that schools
should use to assess teacher performance, including test data, student surveys
and assessments by trained evaluators. Over the course of a school year, each
of Eagle County’s 470 teachers is evaluated three times and is observed in
class at least nine times by master teachers, their principal and peers called
mentor teachers.
The Eagle County evaluations are used to give a teacher not
only a score but also specific feedback on areas to improve and ways to build
on their strengths. In addition to one-on-one coaching, mentors and masters
lead weekly group meetings in which teachers collaborate to spread their
skills. Teachers are eligible for annual salary increases and bonuses based on
the classroom observations and student achievement.
The program faces challenges from
tightening budgets, but Eagle County so far has been able to keep its
evaluation and support system intact—likely one reason why student test scores
have improved in Eagle County over the past five years.
I think the most critical change we can make in U.S. K–12
education, with America lagging countries in Asia and Northern Europe when it
comes to turning out top students, is to create teacher-feedback systems that
are properly funded, high quality and trusted by teachers.
And there are plenty of other areas where our ability to
measure can improve people’s lives in powerful ways—areas where we are falling
short, unnecessarily.
In poor countries, we still need
better ways to measure the effectiveness of the many government workers
providing health services. They are the crucial link bringing tools such as
vaccines and education to the people who need them most. How well trained are
they? Are they showing up to work? How can measurement enable them to perform
their jobs better?
In the U.S., we should be measuring
the value being added by colleges. Currently, college rankings are focused on
inputs—the scores and quality of students entering college—and on judgments and
prejudices about a school’s “reputation.” Students would be better
served by measures of which colleges were best preparing their graduates for
the job market. They then could know where they would get the most for their
tuition money.
In agriculture, creating a
global productivity target would help countries focus on a key but neglected
area: the efficiency and output of hundreds of millions of small farmers who
live in poverty. It would go a long way toward reducing poverty if we had
public scorecards showing how developing-country governments, donors and others
are helping those farmers.
And if I could wave a wand, I’d
love to have a way to measure how exposure to risks like disease, infection,
malnutrition and problem pregnancies impact children’s potential—their ability
to learn and contribute to society. Measuring that could help us quantify the
broader impact of those risks and help us tackle them.
The lives of the poorest have
improved more rapidly in the past 15 years than ever before. And I am
optimistic that we will do even better in the next 15 years. The process I have
described—setting clear goals, choosing an approach, measuring results, and
then using those measurements to continually refine our approach—helps us to
deliver tools and services to everybody who will benefit, be they students in
the U.S. or mothers in Africa. Following the path of the steam engine long ago,
thanks to measurement, progress isn’t “doomed to be rare and
erratic.” We can, in fact, make it commonplace.
Source: The Wall Street Journal


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