Selectivity

ONE OF THE GREATEST challenges facing Russian President Vladimir Putin in 2001 was the problem of “selectivity” in serving the poor. In speaking to a conference of social workers, he noted, “it is necessary to answer the question of how and whom to support. To do so, one must have precise information on incomes.” This was at a time in Russian history when an overwhelming majority of the population was in distress and needed social services and government protections.

Not everyone suffering from the ravages of poverty could be served because government resources were limited. So, rather than choose who would be assisted on the basis of political connections, or past service to the nation, or ease in delivery, the principle of selectivity was invoked—to determine who needed help the most.

In emergency medicine, the principle of selectivity is demonstrated in triage, a system first developed by French surgeon Dominique Jean Larrey during the Napoleonic wars. He devised a method to quickly evaluate and categorize the wounded in battle, then evacuate those requiring the most urgent medical attention – with no regard to rank. Three levels were assigned to the wounded: 1) the “walking wounded” whose treatment could wait; 2) the severely injured for whom emergency care was less urgent because they were unlikely to survive; and 3) those with life-threatening wounds, but who could recover if they received immediate emergency care. Likewise in social work, choosing who will receive services is not done lightly.

Selectivity is also demonstrated in the World Bank's efforts to improve its effectiveness in serving countries with high levels of poverty. “The principle of selectivity (deploying resources where they can have the greatest positive impact) is clear but its practical application is challenging,” noted an internal study that reviewed how “selectivity is exercised at three levels: across countries, within countries, and in the context of global programs and partnerships.” The study also noted “the importance of selectivity across countries—with regard to need as measured by relative poverty or income per capita.” In evaluating who should receive assistance, the memo noted, “a country must be pursuing sound policies to promote growth and reduce poverty.”

The selectivity principle also directs U.S. assistance organizations when they are investing scarce aid resources on a limited budget. Often the determination is made on three criteria: humanitarian need, the foreign policy interests of the United States, and the commitment of a country and its leadership to reform.

In Afghanistan the restored Kabul-to-Kandahar highway illustrates the selectivity principle. More than 35 percent of the country's population live within 50 kilometers of this highway; however, 20 years of war and government neglect had devastated the road. Restoration of the highway was a high priority for President Hamid Karzai.

The U.S. Agency for International Development (USAID) was asked to assist and approved the project on the following principles: that the highway was crucial to extending the influence of the new government, the road would lead to increased rates of economic development, it would foster the growth of civil society, and it would help ensure unity and long-term security in the country. Additionally, it was determined that the road circulated through a significant number of Taliban strongholds. Thus, upgrading the road diminished the Taliban's ability to exert influence in that portion of the country.

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