at Scale: The Green Revolution and Treatment of HIV/AIDS

BOX 4.1 Timeline from Scientific Discoveries to Adoption of Technologies at Scale: The Green Revolution and Treatment of HIV/AIDS

Developing and using technologies to achieve development outcomes face common challenges, including identifying and scaling workable solutions, often through global, national, and subnational exchanges of political, knowledge, and financial resources and through building conducive capacities at multiple levels of societies. It has taken decades for technologies to show impact on social indicators. Figure 4.2 traces the stages of technological adoption for two of the most significant global efforts since the 1950s. The Green Revolution is credited with saving millions of lives from famines in India and elsewhere (figure 4.2, panel a). It dates back to the early 1960s, when American agronomist Norman Borlaug visited India, bringing with him 100 kilograms of wheat seeds he had crossbred in Mexico. Until then, Mahatma Gandhi’s vision of “Village Republics” had guided the Indian government’s policy. Its agricultural community development program had reached 16,300 villages by the late 1950s. Starting from about the mid-1960s, however, diffusion of the technologies characterizing the Green Revolution became the policy priority, specifically the adoption of high-yielding varieties and modern agricultural techniques such as irrigation, tractors, and fertilizers, in specific regions of the country, supported by agricultural extension and a network of agricultural colleges. By 1970, wheat yields had begun to rise. Nevertheless, the impact on rural poverty was negligible. By the 1980s, policy makers with a renewed focus on the multidimensionality of poverty had launched the Integrated Rural Development Program. Over time, environmental problems associated with the Green Revolution technologies (such as overuse of fertilizers and pesticides and depletion of groundwater)—problems not originally understood or addressed—began to offset the gains of the Green Revolution through negative impacts on health and sustainability. HIV/AIDS is another case in point (figure 4.2, panel b). In the late 1970s, doctors in Africa observed opportunistic infections. The first HIV clinical case was identified in the United States in 1981. Antiretroviral therapy was shown to be effective in 1996, 15 years after the epidemic started. However, communities and national authorities in developing countries continued to be in denial, faced with the stigma attached to the disease. The creation of the Joint United Nations Programme on HIV/AIDS (UNAIDS) to promote international dialogue, resource mobilization, and publication and dissemination of research findings was a critical turning point in the fight against HIV/AIDS. As the Global Fund to Fight AIDS, Tuberculosis and Malaria and bilateral aid began to fill financing gaps, multilateral agencies shifted focus to strengthening capacities across relevant ministries to plan and implement national programs. It was only in 2005—10 years after the discovery of an effective treatment—that the rising trajectory of HIV-related deaths was finally reversed. Several lessons can be drawn from these examples. The adoption of technologies occurs within a sociotechnical system, both within nations and globally. The pace of scientific discoveries, technology diffusion, and application at scale depends on sequencing and coordination of efforts to achieve political alignment and on the relevant capacities at the subnational, national, and international levels. How many lives could have been saved if these efforts had been accelerated and programs had been able to reach the poor a decade or more earlier?

Source: World Bank study team based on Global Fund–World Bank HIV/AIDS Programs (2006); India, Government of, Ministry of Statistics and Program Implementation (2015); Immerwahr (2015); Liu, Kanehira, and Alcorta (2015); Mansuri and Rao (2013); UNAIDS (2010).