Skip to content


optimal guidelines: a pain in the gluteal region

Blog Post1 min read

Diane got bit by a dog a little the other day.  She's really quite fine, it was nothing.  There is every reason to believe this dog doesn't have rabies, but we decided to get Diane the post-exposure prophylaxis (she already had the pre shots, so she only needed the two follow-up shots).  Things have much progressed from the horrifying shots into the belly that I remember seeing pictures of in a library as a little boy: now it is just a shot in the arm.

Surprisinly often, people tell me that we shouldn't be complaining about the improbability of India's Swatch Bharat Mission eliminating open defecation in the next 4.5 years, because the government has formulated such perfect, optimal guidelines.  But I'm increasingly persuaded that writing optimal guidelines is a deeply suboptimal approach: instead, we should be attempting to design robust policies, doing our very best to admit challenges at the outset and design systems to fail well and to achieve something valuable in a wide range of realistic scenarios.

Anyway, apparently both nurses, at two separate facilities, very much wanted to give Diane her rabies shot in what the WHO guidelines delicately call the gluteal region.  It turns out, this is not what you are supposed to do; luckily, Diane was able to persuade both to go for her arm instead.

But there is a point to the story, which is that it turns out the Ministry of Healthy and Family Welfare of the Government of India has written optimal guidelines for rabies vaccine, and these guidelines are well aware of this rule (page 13).  Problem solved!  The rest is just implementation -- which I guess is someone else's problem.  How much more energy, time, attention, and other resources should the development business be pouring into fancy conferences and prestigious careers, spent supporting the government's recycling of optimal lists of rules?


r.i.c.e. is a non-profit research organization focused on health and well-being in India. Our core focus is on children in rural north India. Our research studies health care at the start of life, sanitation, air pollution, maternal health, social inequality, and other dimensions of population-level social wellbeing.

501(c)(3) Status

Privacy Policy

Research Themes

Content by Category

© 2024 r.i.c.e.