This paper examines an influential randomised control trial (RCT) that aimed to identify how to recruit the best community health workers (CHWs) in Zambia. The economists who designed the RCT found that when they used job advertisement posters that emphasised future career prospects, they attracted applicants who were more “effective” health workers (according to various quantitative measures). The Zambian government accepted this policy advice and recruited thousands of new CHWs using posters that highlighted the career path available. However, since rolling out the programme nationally, the Zambian government has not built a career ladder into this position and the recruitment process has offered false hope to those who were selected. While acknowledging the responsibility of the Zambian government, this paper analyses the role of the RCT in this outcome. Drawing on ethnographic research and interviews conducted between 2019 and 2020, the paper shows how the RCT was flawed. The economists who designed the RCT framed it as a study of “bureaucrats” and “civil servants” and therefore overlooked crucial academic and policy debates about the distinctive role of CHWs – including the well-documented reluctance of governments to offer them careers. By failing to consider the political context of the CHW programme, the economists who designed the RCT provided policy advice that “worked” for the Zambian government in the short-term but which has ultimately been harmful to CHWs. Drawing on this case study, the paper contributes to the growing critical scholarship on RCTs and raises questions about whether these studies objectively improve policymaking, as many of their proponents claim.

本文研究了一项有影响力的随机对照试验 (RCT)，该试验旨在确定如何在赞比亚招募最优秀的社区卫生工作者 (CHW)。设计 RCT 的经济学家发现，当他们使用强调未来职业前景的招聘广告海报时，他们会吸引那些更“有效”的卫生工作者（根据各种量化指标）。赞比亚政府接受了这一政策建议，并使用强调可用职业道路的海报招募了数千名新的 CHW。然而，自从在全国范围内推出该计划以来，赞比亚政府并没有为这个职位建立职业阶梯，招聘过程给被选中的人带来了虚假的希望。在承认赞比亚政府的责任的同时，本文分析了随机对照试验在这一结果中的作用。该论文利用 2019 年至 2020 年间进行的人种学研究和访谈，展示了 RCT 是如何存在缺陷的。设计 RCT 的经济学家将其定义为对“官僚”和“公务员”的研究，因此忽略了关于 CHW 独特作用的重要学术和政策辩论——包括有据可查的政府不愿为他们提供职业的事实。由于没有考虑 CHW 计划的政治背景，设计 RCT 的经济学家提供了短期内对赞比亚政府“有效”但最终对 CHW 有害的政策建议。借鉴这个案例研究，该论文有助于对 RCT 越来越重要的学术研究，并提出了这些研究是否客观地改善了政策制定的问题，