A counterfactual QALY for USD 2.60–28.94?

by brb2434 min read6th Sep 20206 comments

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Armed ConflictWorkplace ActivismGet InvolvedCause PrioritizationGlobal Health and Development
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October 1 update:

The Mobile Clinics project gained USD 5,062, which enables it to run one clinic for additional 2 months. Conversations with WHO regarding 'phase 2' of the project are ongoing.

In addition, Reach Out is offering a remote community mobilizer internship. It should be a great opportunity for anyone to advance their skills in securing counterfactual funding, analyzing data, developing humanitarian projects, and institutionalizing the EA framework in aligned organizations.

Applicants should e-mail Marc marc@reachoutcameroon.org with a CV and a cover letter.


September 19 update:

The GlobalGiving 50% matching has ended. However, GlobalGiving still offers matching of up to 93% (100% net of the 7% platform fee) – of the first donation up to USD 200, if you set a monthly donation. Donations are tax-deductible in the US. More information follows in the Donation details section below.


September 9 update:

50% matching for donations up to $50 is available via GlobalGiving. GlobalGiving collects 7% total fee. Still, 43% will be matched. The campaign starts on Monday, September 14 at 9 am EDT and ends on Friday, September 18 at 11:59 pm EDT.


Summary

Reach Out Cameroon (REO) seeks up to USD 618,750 to continue its mobile clinics project in the conflict Northwest and Southwest (NWSW) regions of Cameroon for 6 months from October 1, 2020. The mobile clinics provide free primary preventive and curative healthcare in communities without other free primary care to persons of whom 95% are internally displaced and whose average daily expenses are below 1.25 USD (World Food Programme, October 2019). REO estimates that 74.7% of patients do not have other (paid) health facility in their community and 81% cannot pay for healthcare. We further estimate that during the past 5 months, the mobile clinics provided a counterfactual quality-adjusted life year (QALY) for USD 2.60–28.94. This makes them 1.72–19.15× more cost-effective than Against Malaria Foundation. The ongoing project has been financed from a WHO emergency grant that ends on September 30, 2020. If you consider this project competitive, please donate now, solicit donations, or work with us on grant writing. We will also appreciate any feedback.

Background

In September 2017, the Anglophone Crisis, an ongoing conflict between state military and non-state armed groups, began in the NWSW regions of Cameroon. Recurrent cycles of inhabitant displacement followed. In December 2019, 466,000 internally displaced persons resided in the region (Internal Displacement Monitoring Centre, 2019). The crisis also led to closures of health facilities. In 2019, 53% of persons within the Divisions where mobile clinics operate reported inability to access healthcare (International Organization for Migration, 2019).

Current project overview

Since March 2020, Reach Out has been operating 8 mobile clinics in 5 Divisions of the NWSW regions of Cameroon. Each mobile clinic is staffed by 1 doctor, 3 nurses, 1 driver, and 1 safety officer. The clinics provide free primary healthcare to all patients. This care includes prevention, diagnosis, and treatment.

Current project data

We scaled our past data from 154 clinic-weeks (8 clinics, ~5 months) to 208 clinic-weeks (8 clinics, 6 months). A workbook version can be accessed here.

35,533 total diagnoses


100% of patients have no other free health facility in their community

Mobile clinics operate only in communities without other free government or NGO primary healthcare facility.

81 % of patients are unable to pay for healthcare

The below % of patients unable to pay for healthcare are averages of estimates of the 8 mobile clinic doctors.


On average, patients are 31.7 years old


74.7% of patients have no other (paid) healthcare facility in their community

>100,000 Preventive care outputs

Past cost-effectiveness calculations (counterfactual QALY for USD 2.60–28.94)

Calculations can be reviewed in the data workbook.

Our calculations do not consider any health outcomes resulting from preventive care measures and may thus underestimate the project cost-effectiveness.


Comparison to Against Malaria Foundation (1.72–19.15× more cost-effective)


Cost-effectiveness updating

If we continue the project from October 1, 2020, we will collect baseline, midline, and endline health outputs/outcomes data in communities where mobile clinics begin to operate and in comparable non-intervention communities. Based on this data, we will update the project cost-effectiveness estimates.

Room for more funding (USD 618,750)

REO can utilize USD 618,750 to run 11 mobile clinics for additional 6 months from October 1, 2020, with the current counterfactual cost-effectiveness. The ongoing project has been financed by a WHO emergency grant that ends on September 30, 2020. So far, REO has secured USD 3,425 for this project (September 17, 2020). We will update this number when additional funding is secured. During the next 6 months, we will continue to seek further institutional funding.

Donation details (tax-deductible in USA and Germany)

We will appreciate any donations.

If you are interested in soliciting donations that would not have happened otherwise, e. g. in your company or at your school, please contact Bara, a trained economic diplomat. Also, please let us know if you can work with us on grant writing.

Please follow this link to donate via GlobalGiving from anywhere. Donations to GlobalGiving are tax-deductible in the US. The platform charges 7% fee but matches up to 100% (of the first donation up to USD 200, if you set a monthly donation). Donation options include Debit/Credit Card, PayPal, Gift Card, Check, Wire Transfer, Donor Advised Funds, Stock, and Charities Aid Foundation.

German bank account

Donations are tax-deductible in Germany and subject to national tax deduction laws in other European countries.

Currency: EUR

IBAN: DE43 5206 0410 0008 0074 54

Payee’s name: "Freundeskreis Reach Out Cameroon e.V."

Payee’s address: "Gleina 48, 07586 Bad Köstritz"

Bank name: "Evangelische Bank"

Bank address: "Kohlenstrasse 132, 34121 Kassel"

Bank BIC: GENODEF1EK1

United States donation information

Donations to Friends of Reach Out International 501(c)(3) (EIN of 83-2978981) are tax-deductible in the US. The US bank account is currently dormant. We will update with account information. You can send the free Zelle US transfer to my US bank account (Wells Fargo, USD), using brb243{at}atlas[dot]cz as the recipient unique identifier. I am not formally associated with the Foundation.

Cameroonian bank account

Currency: Any major currency (will be automatically converted to XAF)

Recipient name: REACH OUT CAMEROON

Recipient Address: P O BOX 88, BUEA, CAMEROON

IBAN: CM2110001068423082594200417

Bank name: BANQUE INTERNATIONALE DU CAMEROUN POUR L'EPARGNE ET LE CREDIT

Bank address: AVENUE DU GENERAL DE GAULLE, BP 1925, DOUALA, CAMEROON

SWIFT/BIC: ICLRCMCXXXX

Bank code: 10001

Agency code: 06842

Account number: 30825942004

RIB key: 17

Feedback and questions

Please comment below with any feedback or questions.

Contact details

For other general questions, please contact Marc (marc@reachoutcameroon.org, WhatsApp: +237 650 32 34 92), the Humanitarian Coordinator of REO. For technical inquiries, contact Dr. Jarman (eljarman89@gmail.com), the mobile clinics project coordinator.

References

GBD 2016 Diarrhoeal Disease Collaborators. (2018). Estimates of the global, regional, and national morbidity, mortality, and aetiologies of diarrhoea in 195 countries: a systematic analysis for the Global Burden of Disease Study 2016. Lancet of Infectious Diseases, 18, 1211-28. Retrieved from https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(18)30362-1/fulltext

Health Cluster. (2020). Immunisation 2019 in South West region, Cameroon. Health Cluster meeting. Buea: Health Cluster, Southwest.

Human Rights Watch. (2020a). Cameroon Events on 2019. Retrieved July 9, 2020, from https://www.hrw.org/world-report/2020/country-chapters/cameroon

IDMC. (2019). Global Report of Internal Displacement 2019. Geneva: Internal Displacement Monitoring Centre. Retrieved from https://www.internal-displacement.org/global-report/grid2019/

IDMC. (2020). IDMC Cameroon. Retrieved June 17, 2020, from https://www.internal-displacement.org/countries/cameroon

Internal Displacement Monitoring Centre. (2019). Global Internal Displacement Database. Retrieved February 10, 2020, from https://www.internal-displacement.org/database/displacement-data

International Organization for Migration. (2019). Multi-Sector Needs Assessment. Geneva: OCHA.

MINSANTE. (2019). Northwest Regional delegation of Public Health / Southwest Regional Delegation of Public Health. Buea / Bamenda: MINSANTE.

Norweigan Refugee Council. (2020, August 20). Africa is home to nine of ten of the world’s most neglected crises . Retrieved from Norweigan Refugee Council: https://www.nrc.no/news/2020/june/africa-is-home-to-nine-of-ten-of-the-most-neglected-crises/#:~:text=Cameroon%2C%20DR%20Congo%20and%20Burkina,and%20deprioritized%20in%20the%20world.

OCHA. (2020e). CAMEROON North-West and South-West regions - Operational Presence. Geneva: OCHA. Retrieved from https://reliefweb.int/map/cameroon/cameroon-north-west-and-south-west-regions-operational-presence-march-2020

Organisation for the Coordination of Humanitarian Affaris. (2020). Geneva: OCHA.

Regional Delegation of Public Health Southwest. (2020). Cholera Outbreak Situation Report No 28. Buea: MINSANTE.

Schwinger, C., Golden, M., Grellety, E., Roberfroid, D., & Guesdon, B. (2019). Severe acute malnutrition and mortality in children in the community: Comparison of indicators in a multi-country pooled analysis. PLOS ONE, https://doi.org/10.1371/journal.pone.0219745.

Tekelab, T., Chojenta, C., Smith, R., & Loxton , D. (2019). The impact of antenatal care on neonatal mortality in sub-Saharan Africa: A systematic review and meta-analysis. Europe PMC, 10.1371/journal.pone.0222566 .

UNICEF. (2019). MATERNAL AND NEWBORN HEALTH DISPARITIES. Geneva: UNICEF. Retrieved from https://data.unicef.org/wp-content/uploads/country_profiles/Cameroon/Maternal%20and%20newborn%20health%20country%20profiles/country%20profile_CMR.pdf

World Data Atlas. (2020, 18 August). Cameroon - Neonatal mortality rate. Retrieved from World Data Atlas: https://knoema.com/atlas/Cameroon/Neonatal-mortality-rate#:~:text=In%202018%2C%20neonatal%20mortality%20rate,1%2C000%20live%20births%20in%202018.

World Food Programme. (October 2019). Emergency Food Security Assessment.

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