I'm new to this forum but work in Global Health and evidence-informed prioritisation.
I recently wrote a paper which argues that global health donors should not target the most cost-effective interventions. Instead they should do more to recognise the primary role of national institutions in countries receiving aid and focus on financing services at the margin.
I would say our proposed approach is still aligned with the philosophy of Effective Altruism (i.e. doing the most good that you can), but perhaps disagrees with the focus on giving to the most cost-effective causes, at least for the financing of health services in low-income countries.
You can find summary blog and link to the full paper here: https://www.cgdev.org/blog/putting-aid-its-place-new-compact-financing-health-services
And for those of you who like to think about things such as cost-effectiveness thresholds, see this too: https://f1000research.com/articles/12-214
Interested to hear your thoughts.
EDIT: As requested I'm including the abstracts for each of the papers I mention below.
Reimagining Global Health Financing
Health aid has helped domestic financing achieve historic gains in global health but there is much still to be done. Six major issues currently prevent aid from being more effective, fit for the future, and aligned with country priorities, namely: funding volatility, aid fragmentation, the displacement of domestic finance, ineffective prioritization, the lack of transition planning, and the lack of country ownership.
We propose a new model that aims to address these challenges: that domestic finances should support essential health services and health aid should primarily be used to expand the package of affordable services at the margin. Instead of targeting the most cost-effective interventions, donors should support countries to have strong and effective prioritisation processes and direct any additional financial support for health services to those that would otherwise not be covered by domestic funds. A marginal aid approach would address issues of volatility, fragmentation, and fungibility, and encourage better planning and prioritisation by countries and donors, leading to more overall health for the money. As countries’ health financing improves, health aid focused at the margin is naturally crowded out, offering a seamless aid exit strategy for thriving countries and ensuring the sustainability of financing for countries that continue to need support. Perhaps most fundamentally, a marginal aid approach empowers national decision makers and national policy processes.
Why cost-effectiveness thresholds for global health donors differ from thresholds for Ministries of Health (and why it matters)
Healthcare cost-effectiveness analysis is increasingly used to inform priority-setting in low- and middle-income countries and by global health donors. As part of such analyses, cost-effectiveness thresholds are commonly used to determine what is, or is not, cost-effective. Recent years have seen a shift in best practice from a rule-of-thumb 1x or 3x per capita GDP threshold towards using thresholds that, in theory, reflect the opportunity cost of new investments within a given country. In this paper, we observe that international donors face both different resource constraints and opportunity costs compared to national decision makers. Hence, their perspective on cost-effectiveness thresholds must be different. We discuss the potential implications of distinguishing between national and donor thresholds and outline broad options for how to approach setting a donor-perspective threshold. Further work is needed to clarify healthcare cost-effectiveness threshold theory in the context of international aid and to develop practical policy frameworks for implementation.