"Priority" Programs for International Aid: Proven Health Interventions - 2012 Version

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Published: December 2010; Updated: 2012

We've identified multiple programs within the area of global health and nutrition that we consider highly promising because

• They appear to be well-supported by strong evidence.
• The evidence for their effectiveness appears to have relatively high external validity and thus generalizability: it is relatively clear which components of the program are important for effectiveness, and thus we expect a higher-than-usual chance of being able to meaningfully assess a charity's impact when it focuses on these programs.
• They appear to be potentially highly cost-effective.

Below we list the programs we have considered as potential priority programs. For each, we provide summary columns on the strength of evidence, conditions under which the program is effective, and cost-effectiveness.

Note that

• All of the programs we have identified as priority programs are in the area of global health and nutrition. For more information on the evidence for other types of programs, see our overviews of developing-world education and economic empowerment.
• We previously listed cost-effectiveness figures drawn from the Disease Control Priorities in Developing Countries report, but we have become less confident in these figures after finding major errors that raised general concerns. In the table below, "Potentially strong" cost-effectiveness means that this report gives a favorable estimate but that we have not constructed our own estimate. We have removed cost-effectiveness estimates from the summary table in order to de-emphasize the exact figures.

For more details, use the links provided to our writeups. For information on how we created this list of potential priority programs, see below.

For an older version of this page, see 2009 report version.

Programs we consider highly promising

Disease	Program	Writeup	Conditions under which program is effective	Evidence of effectiveness	Cost-effectiveness
Vaccine-preventable diseases	Expanding immunization coverage	Click here	Functional vaccines administered to at-risk populations	Extremely strong	Potentially strong
Malaria	Distribution of insecticide-treated nets (ITNs)1	Click here	ITNs consistently used by at-risk people (infants and pregnant women)	Very strong	Strong
Malaria	Drug treatment including artemisinin combination therapy (ACT)	Click here	Appropriate drug regimen adhered to by patients	Very strong	Potentially strong
Tuberculosis	Tuberculosis case finding and treatment	Click here	Appropriate drug regimen adhered to by patients	Very strong	Potentially strong
Lymphatic filariasis	Mass drug administration to control lymphatic filariasis	Click here	Appropriate drugs administered to at-risk populations	Strong	Potentially strong
River blindness (onchocerciasis)	Mass drug administraiton to control river blindness	Click here	Appropriate drugs administered to at-risk populations	Strong	Potentially strong
Schistosomiasis and soil-transmitted helminths	Combination deworming program (mass drug administration)	Click here	Appropriate drugs administered to at-risk populations	Strong	Strong, though probably less so than ITN distribution
Surgery-correctable conditions	Surgeries (missions and support of local surgeons)	Click here	Surgeries appropriately executed	Strong	$35-$1400 per surgery performed; impact of surgeries varies widely
HIV/AIDS	Prevention of mother-to-child transmission (PMTCT)	Click here	Appropriate drugs administered to at-risk populations	Very strong	Potentially cost-effective
Diarrhea	Therapeutic zinc supplementation	Click here	Supplementation in young children with diarrhrea	Moderate	Potentially strong
Malnutrition	Vitamin supplementation/ fortification2	Writeups forthcoming	Forthcoming	Forthcoming	Forthcoming

Other programs we've investigated

Disease	Program	Writeup	Conditions under which program is effective	Evidence of effectiveness	Cost-effectiveness
Diarrheal disease	Water infrastructure and water quality interventions	Click here and here	Unclear	Limited	Unclear
Diarrheal disease and pneumonia	Non-therapeutic zinc supplementation	Click here	Supplements are consistently delivered and taken	Strong	Likely not as strong as deworming
HIV/AIDS	Antiretroviral therapy	Click here	Appropriate drug regimen adhered to by patients	Strong	Being revisited3
HIV/AIDS	Condom promotion and distribution	Click here	Condoms used consistently by at-risk individuals	Strong	Potentially strong
Maternal mortality	A variety of interventions	Click here	Varies by specific intervention	Limited	Unclear
Trachoma	SAFE Strategy to control trachoma	Click here	Surgeries appropriately executed; appropriate antibiotics administered to population	Strong	Some components of strategy appear potentially cost-effective; others appear quite costly
Polio / guinea worm	Disease eradication programs	Click here	Vary by disease	Interventions are effective but eradication is difficult: there is only one case to date of eradicating a human disease	Depends heavily on whether eradication achieved
Unwanted pregnancies	Family planning services4	Writeups forthcoming	Forthcoming	Forthcoming	Forthcoming

How we identified programs for investigation

We first started working on identifying promising programs for investigation in 2009. At that time, we focused on reviewing two sources:

• The Copenhagen Consensus, the only case we have seen of an independent panel of experts attempting to identify the most promising philanthropic investments (discussed more here)
• Millions Saved, the best collection we have found of large-scale, well-documented past successes in international aid (discussed more here)

If a program was both featured in one of these two publications and similar to a program focused on by one or more of the charities we reviewed, we generally conducted further investigation into the program. Details on which programs are featured in these two publications, which similar programs are focused on by the charities we've reviewed, and which programs we investigated are available here (XLS).

Over time, we have added programs to this list; we have added any program that seems to potentially fit the criteria laid out at the top of the page. We place more emphasis than we previously did on external validity, and less on estimated cost-effectiveness, for reasons laid out in a 2012 blog post.

• 1The track record of ITN distribution programs leaves some room for interpretation regarding the importance of ensuring use of the ITNs, vs. simply distributing them to at-risk populations. The track record of ITN distribution programs appears quite strong. We feel that evidence of use is necessary for full confidence (as the table above states), but we also believe that simply demonstrating delivery is enough to instill some confidence in impact. We have thus marked ITN distribution as a priority program.
• 2Micronutrient supplementation/
  fortification appears to be a promising program type, but we have found very few charities focusing on it. We've found that these charities don't currently provide the information we would need to have confidence in them, regardless of how promising micronutrient supplementation/fortification is in general. This is why we have not yet created writeups on these interventions despite their meeting our basic criteria for writeups.
• 3

  We previously concluded that antiretroviral therapy compares negatively to other interventions on this list in terms of cost-effectiveness. We are now rethinking this conclusion in light of issues with the cost-effectiveness figures we previously used, as well as the possibility that we have underestimated the effectiveness of antiretroviral therapy in slowing the spread of disease. We plan to revisit this program.

• 4

  Based on preliminary investigation, family planning services appear to clearly require behavior change in order to be effective, and thus do not meet our revised criteria despite meeting our initial criteria. We still plan to investigate this program area (and associated charities) further, as a low priority.