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From Garth Luke on Does $2,000 save a life? Conditionally, yes
Thanks Robin and Joel for this discussion.
The message World Vision was trying to convey was that "$4.5 bn could save at least 450,000 lives based on Global Fund and other health program experience". Unfortunately in the rush of media interviews the original wording sometimes gets blurred a bit.
In order to be extra conservative we assumed that only 20% of the ODA would be used to "save lives" and therefore made our calculations based on $10,000 of aid expenditure per life saved. However we were not trying to claim that the planned Australian aid program would save an additional 450,000 lives if it had not been cut by $4.5 bn - just that there are available practical opportunities for governments to save at least this number of lives with $4.5 bn.
We decided to talk about lives lost, and give an actual number that we thought was conservative and justifiable, because we are concerned that these sort of budget decisions are not just about numbers in a balance sheet. They are literally life and death decisions for the people who cannot afford the simple and cost effective health interventions that have been proven to work across the world.
While millions of people continue to die from unsupported childbirth and untreated diarrhoea, pneumonia, AIDS, TB and malaria the opportunity to save hundreds of thousands or millions of lives, at very low cost, will be available to aid ministers.
In addition, in the interests of maximising the effectiveness of Australia's aid, we believe that it is important to talk more specifically about the cost effectiveness and proven impact of the different types of aid (eg health, economic development, governance etc), different delivery mechanisms (eg multilateral, bilateral, NGO) and comparative need and capacity in each country. It seems to us at World Vision that the current balance is not maximising impact and that a starting point for improvement would be to increase the share of funding going to well proven health programs.
While we can't be precise about the number of lives health aid can save, we believe that there is sufficient evidence that $4.5 bn in aid can save at least 450,000 lives by supporting and expanding existing effective programs.
From Jo Spratt on Child mortality declining, but much more work to do
I thought the same when I looked at the graph but want to extend Joel's suggested approach to preventing neonatal deaths. As well as focusing action at the potential time of death, reducing neonatal death extends backwards from birth and the first month of life (or even the first week, when 3/4 of neonatal deaths occur). Prevention is also about providing contraceptive services to women who do not want to get pregnant, or who will experience high health risks if she does get pregnant: a pregnant woman's health has an impact on the health of her foetus and newborn. Antenatal care is vital, for the same reasons. Finally, quality of care is important - some studies show high neonatal deaths in hospital settings so being in a health care facility is not enough: the care needs to be of an acceptable quality to prevent deaths. Definitely challenging but definitely possible.
From Jonathan Pryke on The other scale-up: Australian public donations for development over the last decade
Hi Joanna,
We have every intention of releasing the data. We are currently in the process of putting all of the sources together into one sheet and cleaning it up to make it presentable. We will release it either as a comment on this blog post or in a subsequent blog post in the coming weeks.
Regards,
Jonathan
From Patrick Kilby on The other scale-up: Australian public donations for development over the last decade
There are a few in the National Library as well (early 2000s). If you want older ones pre-2000 then there are ACFOA Archives (MSN 9347) in the National Library as well.
From Joel Negin on Child mortality declining, but much more work to do
Hi Ashlee,
As you state, we are making good progress in reducing overall child mortality. But what is really important about these trends is how little progress we are making in reducing neonatal mortality (first 28 days of life). The lines for child (under 5) and infant (under 1) are relatively steep compared to neonatal. Not surprisingly, neonatal care is really challenging as you have to get to the child and the mother (often in the home) right after birth (most neonatal death is in first week of life). So this is about outreach work, community health workers and also getting women to give birth in health facilities. Neonatal health is the opposite of low-hanging fruit. It's the fruit at the very top of the tree that is hardest to get to. But we need to get some taller ladders (not to take the metaphor too far...).
Joel
From Nik Soni on The AusAID-Carnival agreement: a backward step
I have seen the documentary and it is a little bit confused. The problem on Wala is that the cruise ships did a deal with a landowner - but not the ones complaining in the documentary. Secondly, the Government does not get anything from this - contrary to the assertions from the documentary makers. The Government makes some money from fees at Port Vila Port and other charges but it does not amount to very much. In the old days (before the current management of SSS) they also almost never paid - however - that was not the fault of Carnival but their intermediary in Vanuatu. Since SSS got new owners things improved markedly.
So the documentary could have done with a proper fact check and historical timeline.
The challenges of this industry today are more to do with the externalities presented by Joseph's team and ironically this is something that AusAID could help with and there was progress when the new wharfs were built under the ECF.
If we look at the tourism industry in (say) Asia and see how it currently works in terms of operators working in a more cooperative fashion with locals only Carnival comes close. The rest of the industry pretty much works against any sort of local development and this is what worries me about this documentary and also Stephens blog. It is not to say there is nothing wrong but in my opinion - by far the bigger problem - is the way the non cruise industry works in Vanuatu.
This reminds me of working in Finance - by taking on challenges and admitting things are wrong and trying to fix them you become the target. External observers then end up creating a perverse environment for policy makers because you end up overly criticising the very people that are willing to change things.
From Joanna Williams on The other scale-up: Australian public donations for development over the last decade
Thanks Patrick for the heads up. I emailed ACFID earlier this morning to request access to their annual reports prior to the 2009-2010 FY (given that subsequent ones are accessible on their website).
From Patrick Kilby on The other scale-up: Australian public donations for development over the last decade
Joanna the figures are available each year in ACFID's Annual Reports
From Jonathan Pryke on Australian aid stakeholder survey now closed with 358 responses
Hi Rick,
We have every intention of releasing the raw data, though parts of section 1 ("about the respondent") may not be shared to remove any chance of participants being identified.
Regards,
Jonathan
From Satish Chand on From expansion to crisis in Australian aid: reflections on the Coalition’s aid cuts
Cutting the ODA budget has not lost votes for the coalition and it may have actually gained them a few. Taking to folks in one cafe that I frequent reveals to me that many think Australia gives tons of aid and that most of it is wasted.
On the first, the fact is that we give 36 cents in every $100 that we earn. The response I get from most Aussies to the above is: Are you sure? Yes, I am! Most of us spend many multiples of the above on chocolates and the like.
On whether most aid is wasted, I would like to believe that this is not the case. But we need good data and thorough analysis to get the skeptics onboard.
And unless and until lucky Australians are told of how little we give away to those less fortunate and shown that what we give delivers much needed support, there is little chance that we will ever reach the 0.5 percent target.
From Joel Negin on Does $2,000 save a life? Conditionally, yes
Hi Robin,
Fundamentally, I think that fact-checking regarding the 450,000 kind of misses the point: the aid cuts will have a big impact on what AusAID is able to deliver and that includes life-saving or life-prolonging interventions, education that expands opportunity, agricultural interventions that fill hungry bellies. Whether the figure is 450,000 or 300,000 or something else, is not - to me at least - the crux of the matter. So we shouldn't spend too much time analysing the figure.
That being said - I am going to do just that! As you note, the $2000 figure is an extrapolation of Global Fund spending by Global Fund analysis of lives saved. So the $2000 figure represents an extrapolation on analysis based on some GF assumptions – and then assuming that the AusAID cuts will be applied at a consistent percentage to the health sector – and within the health sector to interventions that are equally cost-effective. That represents multiple assumptions. In the absence of specific data from the Coalition on the nature of the cuts, assumptions do have to be made but the 450,000 is hard to validate at this time.
There are however a number of health interventions that can save lives for around $2000 (or much less) so that figure itself is not inaccurate. For example:
• “Expanded vaccine coverage is among the most cost-effective programs we've considered. In Sub-Saharan Africa, <a href="http://www.givewell.org/international/technical/programs/immunization" rel="nofollow">available estimates</a> claim that it costs approximately $14 to fully vaccinate a child and $200 to save a life with this program.”
• Bednets "cost under $10 each to purchase and distribute (including all costs), and this intervention is <a href="http://www.givewell.org/international/technical/programs/insecticide-treated-nets " rel="nofollow">generally considered</a> to be among the most cost-effective ways to save lives. We estimate one life saved for just under $2,300 (this does not include other benefits of ITNs).”
• The World Health Organization has <a href="http://www.who.int/choice/results/mnh_afroe/en/index.html. But it confirms that lives can be prolonged/saved for very little money" rel="nofollow">cost effectiveness tables</a> but they are not organised by “life saved” but rather by “disability-adjusted life year saved”.
If the AusAID cuts are to programs that deliver immunisation coverage (which a good chunk of AusAID health spending does), then the World Vision figure does have some merit.
I personally wouldn't use the 450,000 figure as it implies specificity where we have little. But we can all agree that the aid cuts will have an impact on lives saved and hunger and development.
Joel
From Nash G. Sorariba on Rebuilding the University of Papua New Guinea