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The Disease Control Priorities (DCP3) collection overviews the DALY cost-effectiveness of global health interventions in the following areas: 1) Essential Surgery; 2) Reproductive, Maternal, Newborn, and Child Health; 3) Cancer; 4) Mental, Neurological, and Substance Use Disorders; 5) Cardiovascular, Respiratory, and Related Disorders; 6) Major Infectious Diseases; 7) Injury Prevention and Environmental Health; and 8) Child and Adolescent Health and Development. 

Top causes in these areas can be covered by one highly cost-effective and three profitable projects: 1) Sliding-scheme health facility consultancy, 2) Complex family issues shows, 3) Health product advertisements on social media, and 4) Government policy consultancy. Relatively cost-ineffective interventions currently funded by Open Philanthropy include bednet distribution and preventive deworming. The first section of this post overviews these investment and divestment opportunities. The second part notes cost-effective interventions in individual areas.

This essay is for the Cause Exploration Prizes contest. I would most appreciate if you let me know about organizations that are already running programs similar to the four that I mention or those that provide any of the outcomes under $20/DALY that are not popular in EA.


Four projects that collectively cover cost-effective global health interventions

These projects are based on (Black et al., 2016; Bundy et al., 2017; Debas et al., 2015; Gelband et al., 2015; Holmes et al., 2017; Jamison et al., 2017; Mock et al., 2017; Patel et al., 2016; Prabhakaran et al., 2017). See volume and page references further below and in Appendix 1: DCP3 volumes notes.

1) Sliding-scheme health facility consultancy (profitable, high impact)

Medical consultancy details

DCP3 identifies the below listed interventions and practices as cost-saving to highly cost-effective (<$20/DALY). A consultancy could address all improvement opportunities in a global health facility, taking the advantage of low marginal cost of any individual advice. 

  • Prioritization
    • Drugs provision: hepatitis B, tetanus toxoid, pneumococcus, and rotavirus vs. less cost-effective human papillomavirus (HPV) vaccines; aspirin and beta-blockers for acute management of ischemic heart disease; misoprostol distribution through community health workers (CHWs), distributing NTD chemotherapy (onchocerciasis, lymphatic filariasis, visceral leishmaniasis, trypanosomiasis, etc vs. slightly less cost-effective schistosomiasis), treating smear positive tuberculosis with first-line drugs, blood pressure management in upper middle-income countries (UMICs), polypill for high absolute risk of cardiovascular disease in UMICs, angiotensin-converting enzyme (ACE) inhibitor for heart failure
    • Screening: hypertension and cholesterol screening in areas where treatment is affordable; adding syphilis to HIV screen (with syphilis treatment); mother to child transmission of syphilis screen and treatment with penicillin; mental health diagnostics and referrals to self-care and informal community care resources
    • Updating practices: new drugs and diagnostics equipment for tuberculosis, artesunate rather than quinine for severe malaria, zinc addition to oral rehydration solutions (ORS), task-sharing for surgeries (appendicitis; hernia repair; first-level and obstetric surgeries in settings with little specialized care, such as post-conflict; cleft lip and palate repair), case management decisionmaking diagrams for CHWs, clinical standards compliance
  • Preventive healthcare information
    • Detailed information: early childhood development practices; healthy diet; aflatoxin exposure mitigation; hazardous substances education
    • Concise information and reminders: handwashing, family planning, physical activity, voluntary male circumcision, stoves that decrease indoor air pollution, kerosene alternatives, female genital mutilation (FGM) prevention
    • Prevention and cessation programs: tobacco, alcohol, and areca nut use; violence

Partnerships consultancy

Facilities should develop partnerships to finance some of their services. Local institutions and businesses could invest in cost-saving opportunities, academic institutions benefit from research partnerships, and pharmaceutical companies gain affordable manufacturing and R&D capacity. Consultants should advise on the strategy of approaching these stakeholders in order to maximize impact, while finding mutually beneficial solutions.


The scheme could be profitable in industrialized economies where healthcare costs are high, since a relatively small percentage improvement could significantly reduce total costs. The cost of training could be reduced by higher purchasing power in developing countries.

2) Complex family issues shows (profitable, high impact)

Shows details

Radio and TV shows should engage wide audiences in gossiping about health-related practices recommended by DCP3. These channels should complement or emphasize information shared by healthcare providers and emphasize key messages. Covered topics can include:

  • All ages: abuse, neglect, returns to education, nutrition, mental health and support, helminthiases, safe driving, indoor air pollution and solutions, gender norms, physical activity, hazardous task training and OSH, sugar-sweetened beverages risks
  • Early childhood: various play activities and materials
  • Ages 5–9: WASH practices, FGM prevention
  • Ages 10–14: self-regulation; tobacco, alcohol, areca nut, and drugs use prevention
  • Ages 15–19: social skills development, family planning, sexually transmitted infection (STI) prevention, value of innovative problem solving
  • Parents: breastfeeding, ORS with zinc, postnatal hygiene, child stool disposal, maternal nutrition, child underweight and overweight, reducing aflatoxin exposure, vaccinations, hazardous substances child poisoning prevention


  • The shows can be sold to larger radio and TV stations, while provided for free to smaller and remote outlets

3) Health product advertisements on social media (profitable, high impact)

Targeted health product advertisements should be displayed to various audiences. The products include:

  • Soap; ORS sachets with zinc; condoms; voluntary male circumcision centers, healthy drinks and snacks (unsweetened; no trans fat; low sodium; low bad cholesterol content); insecticide-treated nets (ITNs); pellet stoves; swim lessons; kerosene alternatives (such as solar lamps); education loans; micronutrient powder; alcohol, tobacco, and areca nut cessation therapies and no-risk substitutes


Advertising profit can be gained by social media platforms.

4) Government policy consultancy (low-cost, very high impact)

Consultancy details

Policies recommended by DCP3 not implemented by nations should be suggested to the relevant actors. The positive impact maximization objective shared by this consultancy could indirectly benefit the government. The policy recommendations can include:

  • Taxation: tobacco, areca nut, sugar-sweetened beverages, alcohol
  • Bans: trans fat, kerosene, corporal punishment, asbestos, mercury, trash burning
  • Regulation: salt content in food; arsenic in water; (EU) fuel standards; street dust cleaning; OSH; industrial air pollution (including SO2, NO2, and dust); unhealthy drug, food, and beverage product marketing scientific-basis regulation and labeling; surrogate alcohol
  • School programs: swimming basics, social skills, gender norms, self-regulation, WASH practices, stress management, optimal nutrition, value of performing an impactful task, FGM, alcohol use prevention, self- and community-based mental health, family planning
  • Procurement-related: speed bumps at high-risk intersections, coal and diesel alternatives investment
  • Information: OSH practices, hazardous site locations
  • Training: teachers to pass tests and continuously upskill, cost-effectiveness-based prioritization and bottleneck-resource prevention for health centers, high ROI health products and practices knowledge of CHWs


The cost of advising policy drafts should be relatively low, since information is already available and similar policies enacted elsewhere. The policies should have a very high impact due to large scale. The institutionalization of impact cost-effectiveness consideration can provide additional long-term benefits for a high number of individuals at any time. Thus, cost-effectiveness of this program should be very high.

Divestment recommendations

DCP3 finds more cost-effective programs (from cost-saving and $1/DALY) than the following ones that Open Philanthropy funds or has previously invested in. Divestment from these programs should finance more cost-effective projects, unless these are fully financed.

  1. Insecticide treated bednet programs ($20–150/DALY) (Black et al., 2016, p. 277) or ($90–100/DALY) (Holmes et al., 2017, p. 21)
  2. South Asian Air Quality if DALY unit pollution decrease by clean stoves is more cost-effective (Gelband et al., 2015, p. 38)
  3. Campaigns (Patel et al., 2016, p. 112) of Development Media International that would normalize alcohol use (p. 110), for example (Angelin in the Doghouse, n.d.)
  4. Preventive deworming drugs for schistosomiasis and soil-transmitted helminthiases ($70–105/DALY) (Holmes et al., 2017, p. 21)
  5. Treatment of severe malaria ($5–$220/DALY) (Mock et al., 2017, p. 14) at the upper end of the range

Further, these relatively cost-ineffective programs should be avoided:

More cost-effective interventions in similar areas include:

1. and 5. Treatment of severe malaria with artesunate where that is cost-effective ($6–8/DALY) (Black et al., 2016, pp. 322–323; Holmes et al., 2017, p. 21)

2. Loans for pellet stoves (providing free clean fuel for poor households in India costs $25/DALY (Mock et al., 2017, pp. 14, 136); loans for cleaner-burning stoves can have greater DALY cost-effectiveness)

4. Chemoprevention of other neglected tropical diseases (NTDs), such as onchocerciasis ($3–15/DALY) but not lymphatic filariasis ($4–30/DALY) which is funded by GlaxoSmithKline (GSK) (GSK Announces £1 Billion, 2022), unless the distribution of lymphatic filariasis drugs is bottlenecking the effectiveness of the GSK's drugs provision commitment

Individual volumes notes

1: Essential Surgery


  • Task-sharing consultancy for appendicitis, obstetrics, and hernia repair (~$202–402/death averted) (pp. 343–345)
    • Neighboring country skills sharing seems possible due to large mortality rate differences. Local consultancy capacity was not specified
    • Other operations, including hydrocelectomy (p. 164), hydrocephalus (p. 140), obstetric fistula (p. 101), and cleft lip and palate repair (p. 324) could be task-shared if the marginal per DALY cost of consulting these units is comparable to the total per DALY cost of the initial consultancies
  • First-level hospitals ($11–223/DALY) (p. 222) and emergency obstetrics ($9.2–15/DALY) (pp. 84, 322)
    • Including in conflict and post-conflict settings where other care is limited and prices low
  • Cesarean delivery repayment schemes in Oman (profitable) (p. 374)
    • Benefit-cost ratio was 75.7, so customers could be able to repay. Profits could finance other programs
  • Operation Smile partnership (surgery: $9–108/DALY) (p. 324)
    • Inclusion of an OPP link on this widely advertised charity materials can grow the longtermism community

2: Reproductive, Maternal, Newborn, and Child Health


  • Pneumococcus ($1–20/death averted) and rotavirus ($20–40/death averted) vaccines (pp. 15, 323)
    • In especially neglected settings (such as conflict zones) since elsewhere could be covered, or increased uptake (such as community leaders endorsement)
  • Treatment of severe malaria with artesunate ($90–200/death averted or $8/DALY) (pp. 15, 323)
    • Including rather than quinine; where not yet covered
  • FGM prevention programs in countries with >80% rates (p. 42)
    • FGM can cause obstetric conditions including fistulas and can reflect and reinforce decreased subjective wellbeing of females and males
  • Integrated community case management algorithm sheets to community health workers (p. 152)
    • Facilitates task-sharing in all areas of healthcare and thus increases the resource-effectiveness of the healthcare system
  • Prophylactic zinc addition to ORS ($10–50/DALY) (pp. 177, 324)
    • Existing ORS programs that distribute packets should add zinc
  • Info on locally-available play materials and activities variety (p. 243)
    • Most effective in early childhood development, which significantly influences the child’s developmental potential
  • Continue vitamin A supplementation ($4–9/DALY) (p. 277)
    • Unless other actors can cover the need
  • Community-based distribution of misoprostol where cost-effective ($9–200/DALY) (p. 277)
    • Where postpartum hemorrhage risk is high and prices can be low and other care limited, such as conflict-affected areas of Somalia
  • Improved compliance with clinical standards (return–$0.5/DALY) (p. 294)
    • Use existing government and healthcare network connections to distribute useful material
  • Info on handwashing with soap, ORS, breastfeeding, clean postnatal practices, and hygienic child stool disposal (total of 529,000 deaths averted per year) (p. 10)
    • Cost-effective well-received info sharing, such as share-with-5 WhatsApp messages or community leaders on radio (especially if airtime is provided for free)


  • Divest from insecticide treated bednet programs ($20–150/DALY) (p. 277) unless all more cost-effective programs are fully funded
    • For example, if pneumococcus and rotavirus vaccine and artesunate for severe malaria at the above cost-effectiveness are not fully funded
  • Avoid maternal and child health programs in India if these are funded by development banks (p. 310)
    • Social return on investment in India is 15–53 so these programs could be funded by development banks
    • Possibly, increasing the demand for these programs could be complementary to the banks’ programs, if these are focused on infrastructure development but not demand

3: Cancer


  • School programs that build habits that reduce cancer risk (p. 9)
  • Education on tobacco hazards (p. 9)
  • Healthy diets promotion in the Arab Peninsula and former Soviet republics (pp. 30, 37)
  • Reduced alcohol consumption in South Asia (pp. 30, 37)
  • Persistent infections in sub-Saharan Africa and China programs (p. 36)
  • Hepatitis, tobacco, and alcohol prevention awareness in West Africa and Mongolia (p. 30)
  • Smokeless tobacco and harmful and safe alternatives awareness in India and safe alternatives producer support (p. 89)
    • “More than 50 percent of oral cancers in India … are attributable to smokeless tobacco … [harmful betel quid substitutes] often claiming to be safer products, have become … increasingly used by young people, particularly in India”
  • Reducing aflatoxin exposure (pp. 153–157)
    • Improved storage, maize liming, risk information, HBV patients and high aflatoxin risk areas targeting, fungus-resistant strains and fungicide marketing
  • Raw fish consumption risks education in high prevalence areas (p. 157)
  • Hepatitis B virus (HBV) vaccination, priority in endemic countries (≥$13.22/QALY) (pp. 158, 30)
    • Hepatitis B prevalence and liver cancer caused by longer-term infections is the highest in West Africa and Mongolia
  • Tobacco taxation in LMICs (income gain–$195/DALY averted) (p. 187)
    • Especially in countries with rising middle class, such as BRICS nations
  • Tobacco advertisement (p. 185) critique with healthier alternatives introduction
    • $9 billion is spent on advertisement and promotion in the US annually – shifting this to healthier products can have high impact
  • Non-harmful cigarette and e-cigarette (p. 186) alternatives for teenagers with marketing that makes tobacco products uncool
    • Such as sugar-free herbal skill bubble gum
  • Shifting global cancer funding from relatively cost-ineffective to 1,000× more cost-effective programs, including prevention


  • Divest from South Asian Air Quality if (DALY) unit pollution decrease by clean stoves is more cost-effective (p. 38)
    • “[H]ousehold air pollution may account for about 2.4 percent [in LMICs] …  3.6 percent of cancer deaths in LMICs are attributed to ambient air pollution”

4: Mental, Neurological, and Substance Use Disorders


  • Mental disorders and substance use prevention programs and skills and psychosocial interventions for primary school children (pp. 31, 115)
  • Limiting surrogate alcohol (p. 127) use
    • Surrogate alcohol is “nonbeverage alcohol not officially intended for human consumption”
    • Its use may be limited most cost-effectively by mandating very bad taste flavors
  • Improve parental care, reduce exposure to trauma, improve group social skills, and decrease early or unwanted pregnancy rates (pp. 148, 156)
    • These comprise risk factors for mental and developmental disorders
  • Provide existing mental health and social skills resources to educators and mandate universal coverage (pp. 149–150, 190)
    • “Manuals … enabled non-mental health professionals in areas with limited resources to deliver the [mental health] interventions … ‘The Incredible Years’ (The Incredible Years, n.d.) … children’s mental health program led to significant reductions in conduct problems … and increased friendship skills,” both with relatively large effect sizes
    • “[social and emotional learning] interventions are considered as best-practice interventions for LMICs”
  • Voluntary sector child mental health services program evaluation research support in high marginality countries (p. 150)
    • “In some countries, the voluntary sector provides the bulk of child mental health services. However, the evidence base for such interventions is poor, largely because of the absence of research support for program evaluation”
    • Local volunteer work could be highly cost-effective due to low cost and context-relevant emotional skills or cost-ineffective if volunteers make little or negative difference
    • Most impactful volunteers could be offered a stipend to reduce their alternative work commitments
  • Scale up no-cost population-based alcohol control measures (p. 229)


  • Divestment from campaigns (p. 112) of Development Media International that would normalize (p. 110) alcohol use (example: (Angelin in the Doghouse, n.d.))
    • Illicit drug dependence risk factors include “social norms that are tolerant of alcohol and other drug use”
    • “Mass media campaigns [can have] negative and others positive impacts on drug attitudes and use”


  • Tobacco taxation, labeling and advertisement regulation, cessation therapy, and mass media programs (p. 5)
  • Optimal nutrition education (pp. 104, 111, 119–120, 130)
    • “Suboptimal diet is the single-largest risk factor for poor health globally”
    • “The prevalence of obesity correlates positively with the initial stages of economic growth and development, as populations of rapidly developing LMICs undergo nutritional and lifestyle transitions while having little access to health services and education”
    • “Some demographics consider being underweight to be the epitome of beauty”
    • Fiscal measures to prevent obesity are cost-saving in all listed countries (p. 130)
  • Unhealthy food marketing regulation and its analysis and nutritionally adequate meals with explanations in schools [type of a school feeding program] (p. 125)
  • Physical activity promotion (p. 93)
    • “[B]etween 3 percent and 6 percent of national health care costs are attributable to physical inactivity.” Thus, government promotion of healthy exercise can be cost-saving.
  • Salt content regulation ($2.60–3.74/DALY) (pp. 5, 110)
  • Trans fatty acid bans and sugar-sweetened beverages taxation (p. 5)
  • Aspirin and beta-blockers for acute management of ischemic heart disease ($11–22/DALY averted) (p. 12, 141)
  • Prevent fetal undernutrition and overnutrition (p. 39)
    • Including by nutrition supplementation for undernourished pregnant women (especially in South Asia where average child birth weight is low) or risk awareness programs
  • Child obesity prevention programs for ages 6–12 (pp. 44–45)
    • In LMICs, where costs should be lower and about ¾ of overweight under age five children are: “[I]n India and many LMICs, there is a general misconception that an obese child is a healthy child
  • Stress reduction in rapidly urbanizing LMICs (p. 120)
    • Such as occupational demands management training and social support promotion
  • Screening for hypertension and cholesterol in areas where treatment is affordable ($4/QALY) (p. 397)

6: Major Infectious Diseases


  • Voluntary male circumcision ($1–10/DALY) (p. 21)
  • Treating severe malaria with artesunate ($6/DALY) (p. 21)
    • This was identified by volume 2 at $8/DALY (p. 323)
  • Preventive chemotherapy for onchocerciasis ($3–15/DALY) (p. 21)
  • Adding syphilis screen to HIV screen and syphilis treatment ($9–10/DALY) (p. 21)
  • Preventive chemotherapy for lymphatic filariasis ($4–30/DALY) (p. 21)
  • Treating smear positive tuberculosis with first-line drugs ($8–40/DALY) (p. 21)
  • Detecting and treating visceral leishmaniasis ($15–20/DALY) (p. 21)
  • RPR prevention of mother to child transmission of syphilis screen and treatment with penicillin in high-prevalence areas (cost-saving) and switching ICS screen where that is more cost-effective than RPR (p. 128)
  • Relatively new tuberculosis drugs (can be cost-saving) (p. 286)
  • Investigate the cost-effectiveness of malaria elimination by eliminating mosquitoes (p. 332) considering impact on human and mosquito generations
    • “Costs for [malaria-carrying mosquitoes] elimination have varied but have generally been low” (332)
    • Include insect welfare metrics and r-selected species’ experiences
  • Voluntary counseling and testing for HIV ($2.75–1,900/DALY) (pp. 71–74) in low-cost areas


7: Injury Prevention and Environmental Health


  • Speed bumps at high-risk junctions ($12/DALY) (p. 11)
  • Swimming lessons for children ($27/DALY) (pp. 11, 65, 201)
  • Clean fuel for poor households in India (public-private subsidy) ($825/death averted ($25/DALY) impact for up to 44,000 individuals) (pp. 14, 136)
    • Such as three-stone stove replacement with a pellet stove: “Pellet stove has the lowest particulate matter with an aerodynamic diameter of less than 2.5 micrometers (about 0.1), while three-stone stove the highest (3.25–7.5)”
  • Parental education on hazardous substances to prevent poisoning (p. 16)
  • High-risk families parental support to prevent violence (p. 16)
  • School-based social skills and gender norms programs (p. 16)
  • Corporal punishment bans (p. 16)
    • Enforced/reportable in schools and with a fine range from zero to a relatively large proportion of a parent’s (or household’s, if parent has no income) income where any reporting is not fined but used as a learning opportunity for the entire community while alternatives are offered (e. g. via a WhatsApp video)
  • Mitigating drinkers’ abuse and harmful alcohol use programs (p. 16)
    • Such as low-disturbance and low-violence fair drinking games with the norm of showcasing good time with friends
  • Engineering controls to decrease release of silica and other toxins (p. 16)
  • Safe injection devices, such as blunt-tip suture needle (p. 16), acquisition where marginal cost is minimal
  • Informal sector OSH (p. 16) regulation, especially dusting payments (p. 17)
  • Formal sector OSH, emissions regulation, asbestos and mercury bans (p. 17)
    • Such as dust and SO2 and NO2 emissions control
    • Asbestos and mercury bans with offering alternatives and an achievable phase-out timeline
  • Trash burning and new kerosene devices bans (p. 17)
    • With fines relatively low as a proportion of one’s income but enforceable anytime someone reports trash burning
  • Community street dust cleaning (p. 17) schedule
    • With a possibility to pay a professional cleaner
  • Senior skilled staff training for hazardous tasks and effective use of available personal protective equipment (p. 16)
    • For example, encouragement by an entertaining radio/TV show
  • Marketing-competitive less-alcoholic but tastier and cheaper liquor plastic (p. 16) sachets
    • That is marketed for aggressive people as showcasing ‘being smart and drinking big’ with friends where any fighting is a safety-first imitation that engages one in navigating dynamics among close ones
  • Coal and diesel alternatives investment (p. 17)
    • To make subsidies to these sectors more long-term profitable than coal subsidies
    • Possibly, interpreting international law that prohibits subsidies as having a health (I. (b)) (Article XX General Exceptions, 1994) exception for clean technologies
  • Monitoring and reducing arsenic in water (p. 17)
  • Developing and sharing a public resource on hazardous sites locations (p. 17)
  • EU fuel standards (p. 17)
  • Occupational health training (p. 29) videos database
    • “[Occupational health in LMICs] knowledge is limited; regulations are either nonexistent or unenforceable because of lack of trained personnel; and the research community has focused on more salient health issues, such as infectious diseases”
  • Abuse and neglect prevention parental care programs (p. 74)
    • “[W]orldwide, 11 percent to 22 percent of girls and 4 percent to 19 percent of boys have experienced child sexual abuse, 14 percent to 55 percent have experienced child physical abuse, 12 percent to 22 percent have experienced physical neglect, and 13 percent to 25 percent have experienced emotional neglect”
  • Violence reduction programs can be sold to governments with large proportions of violence-related GDP spending (pp. 78–80)
    • In El Salvador, violence-associated costs are 24.9% of GDP, in Colombia 24.7%, and in Morocco 22.0%


  • Treatment of severe malaria ($5–$220/DALY) (p. 14) at the upper end of the range

8: Child and Adolescent Health and Development


  • Condom use promotion in Madagascar, DRC, and India (p. 64)
    • Condom use rates are in Madagascar (below 10%), DRC (10–20%), and India (20–30%)
    • Such as by profitable marketing
  • No-cost contraception methods information in the Sahel region and sub-Saharan Africa (p. 64)
    • Such as traditional and fertility sign methods (vol. 1, p. 117)
    • The highest percentage of married females ages 15–24 with unmet contraception need is in the Sahel Region and sub-Saharan Africa (about 25%) (p. 64)
  • Teen family planning option awareness in West and Central Africa (p. 64)
    • 30% of West African and 20% of Central African females gave birth by 18
    • Option rather than expectation; can be joined with parental responsibility program (if a teenage female or male wants to have children and these would be well taken care of, that is great)
  • Smoking prevention programs for pre-teens in high prevalence and increase countries (pp. 65–66)
    • Smoking prevalence for ages 10–24 is highest in the former Soviet republics and Papua New Guinea (more than 20%) and increasing the most (more than 2% per year) in Egypt, Saudi Arabia, and Mongolia (p. 65–66)
  • Binge drinking prevention for 14-year-olds in highest increase countries (p. 67)
    • The highest increase in binge drinking for ages 15–24 is in Egypt, Mauritania, Nigeria, Angola, Botswana, Cambodia, and Vietnam
  • Show peer adolescent groups the value of performing a task (p. 110)
  • Engage adolescents in impactful and innovative problem solving (pp. 110–111)
    • “[A]dolescents [can] respond in novel and adaptive ways. Thus, specific learning or training experiences during adolescence may guide the final connectivity patterns in some of these long-range cognitive control networks”
  • Attachment bond brain and behavior development information for primary caregivers (p. 125)
    • “[If the] attachment bond between children and significant others— mothers, fathers, or primary caregivers—is disrupted [that is] extremely detrimental for brain and behavior development” (p. 125)
  • Self-regulation course scale-up in LMICs (pp. 127–128)
  • Health-related social media ads for adolescents targeted to their interests (p. 300)
    • “Media and social marketing have the potential to target the health-related attitudes and values of adolescents as well as those of their families and the broader community. … Social media and marketing have greater capacity than traditional media to target actions according to adolescents’ interests.”
  • Tetanus toxoid vaccine ($3.61/DALY) (p. 358)
  • Sliding scheme for HPV vaccination to save funding for other vaccines, such as tetanus toxoid (pp. 358, 205)
  • Education loans promotion (p. 424)
    • Due to returns on education
  • Encouraging divestment from relative cost-ineffective interventions on pp. 150–151 instead of the cost-effective ones on p. 149, until these are fully funded


  • Avoid non-specialized school feeding programs ($52–84/child/year) instead of micronutrient powder provision ($2.92/child/year) that has comparable outcomes (pp. 156–158)
    • Micronutrient powder can have comparable outcomes on height, weight, and micronutrient status as in-school meals
  • Avoid GAVI’s HPV vaccination programs ($4,500–8,890/DALY) (p. 358)

9: Improving Health and Reducing Poverty


  • Cost-effective components of health packages otherwise covered by the Gates Foundation (p. 13)
  • Cost-saving regulations that address intersectoral priorities: WASH, tobacco, drugs, air pollution, OSH, physical activity, and diet (pp. 26–29)
  • Target $1/DALY interventions, if these are still available: blood pressure management (UMICs), polypill for high absolute risk CVD (UMICs), female condoms to sex workers in South Africa, and angiotensin converting enzyme (ACE) inhibitor for heart failure (p. 149)
  • Detecting and treating human African trypanosomiasis ($20/DALY) (p. 149)
  • Sugar-sweetened beverages taxation in India (tax income and $27.3 million annual health expenditure decrease) (p. 366)
  • More accurate competitively-priced tuberculosis diagnostics in India (5.4 million years of life gained and $105 million private health expenditure saved per one million sputum smear tests replaced annually) (p. 367)


  • Infectious diseases if these are or would be fully covered by the Gates Foundation and other funders (p. x)


A variety of cost-effective global health and development opportunities is available. Open Philanthropy should consider funding a few organizations that cover the majority of the easiest-achievable health outcomes at low marginal cost. The DALY cost-effectiveness of global health grants can be estimated with the DCP3 collection.


Appendix 1: DCP3 volumes notes

My notes include the collection quotes which I noticed and some of my reactions. Thus, these notes can show my biases.


2019 Nobel laureate Michael Kremer emphasizes WASH and deworming benefits. (2021, October 6). https://www.who.int/news/item/06-10-2021-2019-nobel-laureate-michael-kremer-emphasizes-wash-and-deworming-benefits

Alexander. (2012, December 5). Revisiting the case for developmental effects of deworming. The GiveWell Blog. https://blog.givewell.org/2012/12/05/revisiting-the-case-for-developmental-effects-of-deworming/

Article XX General Exceptions. (1994). World Trade Organization. https://www.wto.org/english/res_e/booksp_e/gatt_ai_e/art20_e.pdf

Black, R., Laxminarayan, R., Temmerman, M., & Walker, N. (2016). Disease Control Priorities, Third Edition: Volume 2. Reproductive, Maternal, Newborn, and Child Health. World Bank. https://doi.org/10.1596/978-1-4648-0348-2

Bundy, D. A. P., de Silva, N., Horton, S., Jamison, D. T., & Patton, G. C. (2017). Disease Control Priorities, Third Edition: Volume 8. Child and Adolescent Health and Development. World Bank. https://doi.org/10.1596/978-1-4648-0423-6

Choosing and implementing control measures for silica dust. (n.d.). Safe Work Australia. Retrieved July 10, 2022, from https://www.safeworkaustralia.gov.au/safety-topic/hazards/crystalline-silica-and-silicosis/choosing-and-implementing-control-measures-silica-dust

Debas, H. T., Donkor, P., Gawande, A., Jamison, D. T., Kruk, M. E., & Mock, C. N. (2015). Disease Control Priorities, Third Edition: Volume 1. Essential Surgery. World Bank. https://doi.org/10.1596/978-1-4648-0346-8

DMI: ’Angelin in the doghouse’—Early childhood development, Cote d’Ivoire. (n.d.). YouTube. Retrieved July 9, 2022, from https://www.youtube.com/watch?v=JtUHSokj8TE

Fiennes, C. (2015, July 24). Deworming: Problems under re-analysis. Giving Evidence. https://giving-evidence.com/2015/07/24/deworming/

Gelband, H., Jha, P., Sankaranarayanan, R., & Horton, S. (2015). Disease Control Priorities, Third Edition: Volume 3. Cancer. World Bank. https://doi.org/10.1596/978-1-4648-0349-9

GSK announces £1 billion R&D investment over ten years to get ahead of infectious diseases in lower-income countries. (2022, July 23). GSK. https://www.gsk.com/en-gb/media/press-releases/gsk-announces-1-billion-rd-investment-over-ten-years-to-get-ahead-of-infectious-diseases-in-lower-income-countries/

Holmes, K. K., Bertozzi, S., Bloom, B. R., & Jha, P. (2017). Disease Control Priorities, Third Edition: Volume 6. Major Infectious Diseases. World Bank. https://doi.org/10.1596/978-1-4648-0524-0

Jamison, D. T., Gelband, H., Horton, S., Jha, P., Laxminarayan, R., Mock, C. N., & Nugent, R. (2017). Disease Control Priorities, Third Edition: Volume 9. Improving Health and Reducing Poverty. World Bank. https://doi.org/10.1596/978-1-4648-0527-1

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Mock, C. N., Nugent, R., Kobusingye, O., & Smith, K. R. (2017). Disease Control Priorities, Third Edition: Volume 7. Injury Prevention and Environmental Health. World Bank. https://doi.org/10.1596/978-1-4648-0522-6

Patel, V., Chisholm, D., Dua, T., Laxminarayan, R., & Medina-Mora, M. E. (2016). Disease Control Priorities, Third Edition: Volume 4. Mental, Neurological, and Substance Use Disorders. World Bank. https://doi.org/10.1596/978-1-4648-0426-7

Prabhakaran, D., Anand, S., Gaziano, T. A., Mbanya, J.-C., Wu, Y., & Nugent, R. (2017). Disease Control Priorities, Third Edition: Volume 5. Cardiovascular, Respiratory, and Related Disorders. World Bank. https://doi.org/10.1596/978-1-4648-0518-9

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The Incredible Years. (n.d.). Incredible Years. Retrieved July 9, 2022, from https://incredibleyears.com/





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This is a really comprehensive effort, and I strongly support EAs getting more in the weeds with expert reports like the DCP. However, I downvoted this post because I worry it goes about this effort in the wrong way. This is a truly dizzying number of proposed interventions, and the extent of argumentation for them seems to be citing a $/DALY number from DCP3. I think it would be a lot more transparent if you elaborated more on what exactly DCP3 was evaluating, where that evidence is from, and how credible the evidence base is (one study? ten?) Here's what could go wrong without any of these:

  • If OpenPhil were to begin funding one of these interventions but in a different form than DCP3 evaluated, that could end up being much less cost effective. For example, a proposal like "smoking prevention programs" is not a helpful level of specificity, since there can obviously be more effective and less effective smoking prevention programs.
  • Without knowing where the evidence is from, OpenPhil could end up recommending it in places where the contextual factors that made the intervention work are not present. That would make the intervention much less cost effective than advertised.
  • Making massive funding allocations based off a single study, or worse a single small scale study, is obviously not a good idea. The intervention might not scale appropriately - e.g. it worked in a lab study or with a small set of highly trained doctors, but not when you roll it out to thousands of hospitals with less well trained doctors. We aren't always able to have gold standard evidence, but we should at least know what we are working with so we can decide how much to revise down our credences.

Providing the necessary context for these $/DALY numbers is the heart of cost-effectiveness analysis, in my opinion. $/DALY numbers aren't handed down to us from heaven, and we need to know a lot more about interventions than a single number in order to evaluate whether we should fund them.

That said, these interventions do look really promising and I'm sure the numbers have some basis. If you elaborated in detail on a few of them I think this could be a really excellent contribution to our understanding of what interventions to prioritize.

Thank you for your suggestions.

what exactly DCP3 was evaluating, where that evidence is from, and how credible the evidence base is (one study? ten?)

DCP3 was evaluating the DALY cost-effectiveness of interventions. You may be familiar but just to restate, DALY is the sum of years of life lost and equivalent of years of life lost due to living with disability (Vos et al., 2020, p. 1431). The Institute of Health Metrics and Evaluation took the first term of the sum from national vital registration records and disability weights from surveys that focused on one's ability to perform tasks similar to those that others do (p. 473). A limited sample of people was asked and the weights assume death as the worst state. So, DALY can be understood as a weighted sum of medical conditions where survival and ability to perform tasks are the objectives.

The evidence for various recommendation varies, some are based on a single study and some on meta-analyses and multiple studies. When a $/DALY range is specified, then it seems to me that a meta-analysis or several high-quality studies were used. For point estimates, such as  $12.88/DALY for hernia repair with a bednet (vol. 1, 161), only one study can be cited. I assume that not only RCTs are considered but are strongly preferred, for example vol. 8, p. 156 shows a table with evidence for outcomes from 1, 2, or 3 RCTs.

funding one of these interventions but in a different form than DCP3 evaluated, that could end up being much less cost effective ... not a helpful level of specificity

I agree. For example, info on returns to education can provide 43 additional years of schooling for $100 spent (p. 33) or 0.23. Where the relationship between outputs and DALYs averted is understood, depending on several factors, then top cost-effective programs can be found by the cost and the factors. Programs where the output-DALY relationship is not known, such as the target health product ads, would need to be evaluated on a small scale before larger investment is made.

I could broadly say that experts who studied the output-DALY values should estimate the cost-effectiveness of the former program types and experts on geography, method, and covered health topics should estimate the cost-effectiveness of the latter type.

If you elaborated in detail on a few of them I think this could be a really excellent contribution to our understanding of what interventions to prioritize.

That makes sense. Also, especially for the programs that OPP is considering. If the GAVI program that is used as an example is considered, then going through the references to estimate the cost-effectiveness of individual vaccines in different settings, and trying to understand the likely development of pharmaceutical company drug provision commitments, also depending on philanthropic funding of distribution, research, and manufacturing, can be valuable. I further assume that several OPP employees read the collection and use the cited studies for grant evaluation in funded cause areas (such as alcohol taxation). However, I do not believe that the volumes have been read in a way to come up with innovative solutions that cover multiple interventions, such as the four which I am suggesting (that includes, for example surrogate alcohol regulation in addition to taxation of recorded alcohol), which have not been extensively evaluated. So, I think that my greatest marginal contribution can be to suggest these programs.

Very impressive work. I haven't heard of DCP3 before and if I had I wouldn't have read 4000 pages of it. Thank you for making this summary.

I'm skeptical of these impact estimates ($1-20 per life saved with pneumococcal vaccines!!) but I hope they're right

Yeah, it's misleading.  

For a bit of context, the cost of the pneumococcus vaccine is $2-$3.50 per dose. It can only be that cheap because the AMC (Advance Market Commitment) agreed to pay top-up prices for the first 200 million doses (to incentivise development). Least-developed, GAVI-eligible countries can effectively get them for free. I'm still sceptical about the low estimates, as there are surely many other costs to getting them into arms, especially in neglected areas/ conflict zones, and I'd assume that all the 'low-hanging fruit' (very poor, very easy-to-access) kids are already being vaccinated. 

I couldn't find the study supporting this, but I'd assume that the low-end estimates were simply talking about how many lives could be saved by adding free (to the recipient country) pneumococcus vaccines to an existing vaccine schedule. 

As for the actual pneumococcus vaccine cost-effectiveness estimates, according to Kremer: "At initial program prices, the pneumococcal vaccine rollout avoided the loss of a disability adjusted life year (DALY) at cost of only $83."

Thank you for pointing this out! It also seemed a bit low to me .. but I assumed that subsidies are never taken into account , although can be discussed as an opportunity (for example, for HPV "Gavi-subsidized [HPV] vaccine costs only US$0.20 to US$0.40 per dose, while program costs range between US$4 and US$13 per fully immunized girl (Denny and others 2015; Gavi 2013)" (vol. 3, p. 10). 

But you are right - for pneumococcus GAVI seems to be using something like a sliding price scheme: "Rotavirus and pneumococcus vaccine costs to LICs are a fraction (for example, 5 percent) of the price paid by Gavi, the Vaccine Alliance to procure the vaccines; Gavi, in turn, receives prices that are more favorable than what upper-middle-income countries pay as a result of volume discounts and other factors" vol. 2, p. 15).

The cost in conflict zones or post-conflict areas does not need to be so high - for example, a high pay for a primary healthcare NGO employee in communities in Ambazonia controlled by armed groups can be $450/month. Another example is paying local community members in this region below the minimum wage ($0.25/hour) to share healthcare messages on COVID prevention (trekking to communities). Considering that vaccination requires little specialized training then the distribution cost could be low. Also, according to the primary healthcare NGO, the government clinics are closed due to the conflict, so after the organization stopped operating the mobile clinics, there was no primary healthcare for the communities. So, I hypothesize that some not easy, but cost-effective to reach patients are uncovered due to neglectedness. The majority of the internally displaced persons that the NGO served were extremely poor.

According to this study, a dose averts 0.059-0.067 DALYs (p. 12). So, for the cost to be $1/DALY, the provision of 1,000 vaccines would have to cost $59-$67, which requires low or no cost of the vaccine.

The argument for considering the subsidized price rather than the production cost is that philanthropes use marginal cost to others' donations (that is done for deworming for which drugs are 100% donated). If the donation recommendation is for drug donors, such as pharmaceutical companies, then production cost (alongside with distribution and other expenses) should be taken into account to maximize cost-effectiveness.

In especially neglected settings (such as conflict zones) since elsewhere could be covered, or increased uptake (such as community leaders endorsement)

It's not clear to me if the cost-effectiveness assessment is just for the vaccine itself or for a program implementing its provision. I assume distributing vaccines in conflict zones is hard work (meaning costs more), and same for increasing uptake in other areas. I'm not sure about the scalability of either.

Thank you. See my response to Jack_S on the hypothesized cost-effectiveness in conflict settings. Based on the scale and neglectedness of this particular conflict in Ambazonia - according to the Norwegian Refugee Council "4.4 million people [are] in need of humanitarian support" and 1.9 million have been reached. Thus, there seem to be, broadly, coverage opportunities. Pneumococcus vaccination rates are not specified.

This reasoning is based on these anecdotes so can be biased by overestimating the neglectedness of conflict areas and underestimating the coverage in non-conflict settings.

The community leaders endorsement is another hypothesis, based on the relative cost and effectiveness of incentives and community leaders endorsement: vaccine incentive can be of the cost of a bag of lentils while a radio show recorded with community leaders can be much lower per person and could change behavior comparably. For the COVID example in Ambazonia, maybe >10% of people knew about COVID before the program, so informing extremely poor people could be cost-effective, if that is the bottleneck.

Thanks for posting, I found this interesting.  

However, I also found the way this was written to be somewhat  confusing.  Specifically, are the 4 main ideas your ideas, or are they laid out within the report?  And how do those ideas fit in with the other figures represented in 1-9?  

The first proposal listed is a consulting company that is going to generate profits at hospitals in developed countries and provide free services to hospitals in developing countries.  It's unclear to me that a new consultancy would be profitable.  Certainly, many such organizations already exist.  Why would the market not have already filled this need?  For developing countries, I believe that non-profits such as Red Cross already provide these services as well.  So it's also not clear to me that this is an unmet need.  Also, consulting across cultures is very, very tough.  All your projected gains can be eaten up by these cultural barriers.

The third proposal is advertising on social media for health products.  Could you explain why this would be profitable?

Throughout the post parts 1-9 you cite $ per DALY figures, but I'd be very curious to understand what the evidence base is for any of these.  I tried chasing one down just to get an idea for myself.  Under part 5: 

Screening for hypertension and cholesterol in areas where treatment is affordable ($4/QALY) (p. 397)

This appears to reference this study (or maybe this is a summary of the study?):


It states that in Mexico this screening costs $3.57 per QALY compared to the usual standard of care, so that is a match to the summary.  It actually says the cost is negative in South Africa.

I don't have a great deal of familiarity with these types of studies.  I'm curious if this is such a great opportunity why it hasn't already been acted upon, do you have thoughts on this?

A few thoughts I had that may or may not relate: Regarding the community health workers, maybe practices vary by country, but if they are employed by the government vs. an NGO that would make a difference to the type of intervention e.g. direct vs. advocacy.  There also may be challenges with scaling if community health workers only have a certain scope (e.g. they see people in urban settings but the need is in rural settings).  The very low cost is contingent on the treatment drug being very low cost, $9 per year, and when the drug costs $149 per year then $2000-5000  per QALY, which is obviously much less impressive.  It would be important to know how realistic that drug cost is for the relevant patients.  Finally, this is supposed to be an improvement to the current standard of care, it would be helpful to understand that standard of care, which I don't see laid out in the study.

Thanks! The four project ideas are mine but all the aspects that they cover are from the collection, reported as cost-saving or highly cost-effective. For example, clinic consultancy is not mentioned but hepatitis B (>$13.22/QALY, vol. 3, p. 158) or tetanus toxoid ($3.61/DALY, vol. 8., p. 424) vaccines are. These are examples of the figures from 1-9, which I am not citing for each aspect due to concision. I am hypothesizing that joining them can increase the cost-effectiveness by decreasing the marginal cost of each aspect.

If such consultancies exist in the developed and developing countries, then either they are profitable or useful. Joining and supporting them can be an opportunity and the organization does not need to be developed from scratch. Cultural accessibility could be something that can be either already present, e. g. at the Red Cross or called for in a grant application.

The social media health products would be profitable to social media platforms. Large proportion of Open Philanthropy recommendations are for Good Ventures, a philanthropic foundation of Dustin Moskovitz and Cari Tuna. Dustin Moskovitz owns a share in Facebook (responsible for much of the wealth in EA). Thus, advertisement on Facebook could be, in turn, profitable to this foundation.

I almost entirely deferred to experts on the DALY figures. This example suggests that in this case, the $/DALY was not an overestimate for a subset of countries and that cost-saving treatment is possible in specific contexts. I estimated that the benefit-cost ratio of over 70 is comparable to <$20/DALY. (A Brazilian vector control program for the Chagas disease “cost US$57 per DALY averted or saved US$25 for every dollar spent on prevention" (vol. 5, p. 204). 25/20*54=67.5). I believe that this is because the benefit accrues to the country as a whole, in healthcare savings, productivity, etc, while it is assumed to be paid by a sole donor. 

If loans are offered to the government (who would run efficient programs in cost-effectiveness priority settings), then  this seems like a great opportunity to the funders. From glancing at major development banks websites, targeting cost-effective healthcare opportunities is not emphasized in their agenda, while infrastructural and regulatory investment is. So, my thought is that finding a loan provider, suggesting cost-saving healthcare opportunities and assisting the government with effective spending of these loans can best address these opportunities, if they are yet uncovered.

Possibly, this has not yet been acted upon due to the overall reluctance of prevention, if this is relates to lifestyle. In this example, hypertension could relate to unhealthy diet and limited exercise. People may hesitate to be screened since that could suggest  a lifestyle change. Some decisionmakers may reflect the public attitudes, so changes are relatively slow. Lobbies can be another reason. For example, tobacco lobby spending can prevent taxation or regulation of tobacco products. Fear of deeper issue uncovering could be a third, more rare, cause. For example, paying vineyard workers in alcohol in South Africa has been banned but screening could suggest that this is being done, even if the hypertension cause is unrelated.

I think that CHW recommendations should be generally more direct - it can be assumed that government is interested in pro bono upskilling of the workers and does not need to be extensively lobbied to share a training resource (e. g. online), unless they would have to pay for the training. Practices that are locally useful should be suggested to both government and NGO employees. I think that the easiest would be to develop some online training courses that have some shared core and 'specializations' for different settings (rural, urban, by different community characteristic). Employees would not need to study for what they already know and would learn what they are missing.

There is the question whether to take into account the drug production cost or the price paid by the patient/healthcare provider, if that is subsidized or free. Then, the cost-effectiveness can easily vary by an order of 10 or more.

Unless otherwise specified (e. g. providing artesunate rather than quinine for severe malaria), the cost-effectiveness of is in comparison to non-intervention, which is assumed as the current practice (or was in some of the studies). The volumes have been written in 2015-2017, so an updated understanding on what has improved and is remaining can be valuable. My guess is that about 80% of the need is still unmet, except for infectious diseases, where maybe 40% can be already covered, due to pharmaceutical company commitments and large philanthropy, such as the Bill and Melinda Gates Foundation, funding. 

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