Successes of international aid and effective development charities: global health

Does aid work? Some authors argue yes, and we should give more. Others argue that it has been ineffective, or even hindered development of poor countries. It’s clear that some charities are much more effective than others, and certain forms of government-financed aid can sometimes exacerbate corruption within a country. But there are also examples where aid seems to have been rather effective, particularly in the area of health. Here are some of its successes, along with some recommended charities to donate to if you want to contribute to ongoing achievements.

1. The Marshall Plan. 

No, this wasn’t a health-based aid project, and in terms of effectiveness this is probably the least empirically justified out of the whole list.  I provide it first because many opponents of aid in the UK seem to have forgotten how the UK and Europe as a whole were recipients of large amounts of aid not too long ago. After World War II, European countries benefitted from a substantial financial gift from the United States in order to rebuild their devastated infrastructure.

In today’s currency, a Marshall Plan would be worth more than $740bn.

2. Eradication of small pox.

Small pox used to kill millions of people every year. In the 1960s a plan was announced to provide sufficient vaccinations to completely eliminate the virus within a decade. It was successful; the last case of smallpox was in 1977. About a third of the funding was provided by ‘international assistance’.

3. Near-eradication of polio. 

Infection by poliovirus lead to the paralysis of tens of thousands of people each year in the early-mid 20th century.  In 1988 the World Health Organisation (WHO) resolved to eradicate polio worldwide. That year, there were an estimated 350,000 cases globally. By 2012 this had fallen to just a few hundred cases. The WHO is funded by governments of the United Nations. Members of the organisation Rotary International have also raised and donated huge sums (over $1bn) to help fund provision of the polio vaccine.

4. Near-eradication of Guinea-Worm disease.

Guinea-worm disease is caused by a parasitic worm caught by drinking contaminated water. Symptoms include “intense pain…fever, nausea, and vomiting. 

Unlike polio and smallpox, there is no vaccine. But the Carter Center, an NGO established by former US President Jimmy Carter, has helped almost completely eradicate it, working alongside the WHO, UNICEF and other groups to prevent contamination and infection:

“In 1986, the disease afflicted an estimated 3.5 million people a year in 21 countries in Africa and Asia. Today, thanks to the work of The Carter Center and its partners — including the countries themselves — the incidence of Guinea worm has been reduced by more than 99 percent….In 2012, there were 542 cases reported in South Sudan, Mali, Ethiopia, and Chad.”

5. Big decline in deaths and suffering from malaria.

Malaria causes illness in hundreds of millions of people each year, and kills thousands (mostly children) every day. But since 2000, these numbers have fallen by 25% globally, and 33% in Sub-Saharan Africa. Much of this is because of the mass-distribution and use of insecticide-treated bednets, which charity-evaluator GiveWell describe as ‘among the most cost-effective ways to save lives‘. These bednets have primarily been funded by the governments of wealthy nations via The Global Fund. The UK’s Department for International Development, for example, has funded tens of millions of nets.

The Against Malaria Foundation. Private donations have also helped buy bednets. Bill Gates is a notable contributor to the Global Fund. For those of us who aren’t billionaires, the Against Malaria Foundation is a highly recommended charity that spends all of its donations on bednets. So far, over 475,000 people have donated more than $18m to buy more than 5 million nets, showing that everyone can make an important contribution. The Life You Can Save, GiveWell and Giving What We Can currently rate the AMF as the top charity to support for private donors; this means their work has demonstrated very high cost-effectiveness and high transparency/accountability. You can donate to them here.

6. Near-eradication of River Blindness (onchocerciasis) in West Africa. 

The OCP, a 30-year program lead by WHO and United Nations Development Program, ended in 2002 “after virtually stopping the transmission of the disease in the 11 West African countries covered by the program. This “reopened to farming 60 million acres of land once abandoned to the disease, and protected the sight of an estimated 30 million people at risk for blindness”.

A new program, the APOC, is now seeking to control and then eliminate it from the remaining endemic Africa countries over the next 2 decades. It is funded by a number of countries, including the UK and USA.

7.  Measles vaccination success

In 2011 around 158 000 people, many children, died of measles. But the World Health Organisation reports that, because of vaccination, there has been a 71% global decline of measles since 2000. This vaccination campaign has been supported by the WHO, UNICEF, the American Red Cross, and the United States Centers for Disease Control and Prevention.

Other vaccination campaigns include:

8. Hepatitis B

In China, hundreds of thousands of people die each year from the consequences of hepatitis B infection, in the form of liver cancer and cirrhosis. But the GAVI Alliance has worked alongside the Chinese government and co-funded over 25 million vaccines to newborns, signficantly reducing Hep B infection. Given the huge population of China, deaths from Hep B are still widespread, but the Chinese government is now working on expanding the program across the whole country.

9. Pneumonia

Pneumonia is a leading cause of childhood mortality, killing 18% of the 6.9 million under-5s that died in 2011. The type-b strain of the Haemophilus influenzae bacteria (Hib) is one the main causes of such pneumonia, along with Streptococcus pneumoniae, which it interacts with.

In the 1990s, only one low-income country offered the vaccine to Hib. GAVI, a partnership that promotes vaccinations, then campaigned and presented strong evidence as to the benefits of the vaccine. Governments responded: “By 2011, nearly all GAVI-eligible countries had introduced Hib vaccines with GAVI support, immunising a cumulative 124 million children and preventing an estimated 697,000 future deaths.”

10. pertussis (whooping cough), 11. pneumococcal disease/pneumonia, 12. rotavirus diarrhoea, 13. yellow fever

Vaccines/treatment of these have all been significantly funded by the GAVI Alliance, which is supported by government aid (including the UK) and private philanthropists. It raises funds by selling long-term bonds backed by donor governments, meaning money is immediately provided by investors in those bonds.

14. Reduction in burden of Schistosomiasis (and other parasitic worms)

Schistosomiasis is a parasitic worm estimated to kill up to 280,000 people due to organ damage, though it probably kills closer to 40,000. It also contributes to malnutrition and causes pain, fever and anaemia. Schistosomiasis is still widespread, infecting several hundred million people globally. But there is a cheap and effective treatment, and given the success of reducing the burden of other parasites such as guinea-worm disease (see above), it is plausible that the coming decades will see a large decline and perhaps eradication of schistomiasis and other tropical parasitic worms.

Deworming drugs cost around half a dollar (~£0.30) per person treated, according to GiveWell. Studies in Burkina Faso, Niger, Uganda, and Burundi by the Schistosomiasis Control Initiative (SCI) report significant declines in parasite prevalence and intensity after treatment with these drugs. There is also evidence from Kenya that deworming is by far the most cost-effective way to increase primary school attendance. In Rwanda, recent reports state that the prevalance of schistosomiasis infection has fallen by over 80%.

-The Schistomiasis Control Initiative, run from Imperial College London, has received significant funds from the Gates Foundation, as well as the US and UK governments. But private donations have also made important contributions. And for good reason; the SCI is another highly-recommended charity according to GiveWell and Giving What We Can, demonstrating its cost-effectiveness, commitment to transparency, and ability to properly use any additional funds it receives. You can donate to the SCI here.

But what about overpopulation?

A very common concern is that by reducing mortality, these efforts are simply contributing to overpopulation. There are two key points in response to this:

Firstly, as this World Bank article highlights, probably the biggest influence on fertility rates (how many children a woman has) is childhood mortality. If you reduce child mortality, adults have fewer children (see box 2 on page 11 of the article for a summary). And the wonderfully enthusiastic Hans Rosling presents this 3-minute video showing how fertility rates and childhood mortality rates have changed since the 1960s.

There are of course other important influences on fertility rates, including education and access to family planning/contraception, but childhood mortality appears to be more influential than each of these. But the second point is that these diseases don’t just kill: they often also cause serious physical weakness, mental exhaustion and disability. This makes it much harder for children to receive good education in the first place; children can’t access school or are unable to properly concentrate once there, or the teachers themselves have the same problem.

Continuing to reduce the burden of disease should therefore speed up a ‘demographic transition’ whereby fewer children are born in the first place.

Furthermore, these diseases impact the economy both in the short-term (seriously reducing the amount and quality of work that can be done) and in the long-term (i.e reducing quality of education and hence ability to grow businesses successfully when the children grow up).