Madeleine Ballard
Bio
Participation1
i've spent my career on one problem: why good ideas don't move, and how to fix it. Not by being more persuasive. Not by working harder. By making it easy for the right people, at the right moment, to say yes.
I'm the CEO of Community Health Impact Coalition (CHIC). For the past decade I've worked to align 100+ organizations across wildly conflicting priorities to win global health policy. CHIC is a global movement to make professional community health workers the norm by changing guidelines, funding, and policy. CHWs are one of the most cost-effective platforms for delivering primary care in low- and middle-income countries, but most of the world's CHWs are still unpaid, unsupervised, and under-supplied. We're changing that: 55 countries now nave national policies to salary, skill, supervise, and supply this workforce to provide excellent care.
How others can help me
Are you heading to EA Global in London in May '26?
Would love to meet! Happy to talk about: cost-effectiveness of CHW platforms (and why platform economics is the next EA frontier), what's actually happening in global health financing post-USAID, how to move policy without authority, and what EA funders should be asking about systems-level health work.
Posts 1
Comments3
Thanks so much, Nick! We published a massive multi-paper cost-effective review only weeks after you shared your original post! You can dig into all the papers/numbers/methodology here: https://joinchic.org/resources/cost-effectiveness/
TL;DR: The numbers are medians across 380 scenarios in 130 studies. As I said in the footnote, data is heterogeneous (mostly due to platform design differences, including salaries). Ranges are big and depend on context, but would say a) your $0.95 BOTE is a fair floor for a professional program at modest catchment, but b) that your earlier take (CHWs are "often not cost-effective," they treat "few patients per month," they can only treat "a handful of conditions in young children") is not reflected in these data.
Re: DALYs: you'll see in the papers that vertical evidence is already in EA terms (e.g. there are DALY numbers for iCCM) but none of the 42 horizontal integrated scenarios in the BMJ GH piece report cost per DALY. The research I'd most want EA to fund is a prospective platform-economics evaluation: does bundling 6–8 service lines on one salaried CHW compound DALYs and lower cost-per-DALY the way fixed-cost-sharing predicts? (or to your point, maybe not?)
My bigger point though is that maybe this is already a good enough bet based on the vertical DALY evidence we both already accept (i.e. why not apply hits-based giving on the handover: catalytic financing to professionalize a salaried, skilled, supervised, supplied workforce via national, government). Esp, as this has what a hit almost never has, which is a decade of cost-effectiveness evidence already behind it. If the handover lands, the donor pays once and the government runs the whole portfolio forever (and the vertical $/DALY figures are the floor)
Appreciate it, Albert! The point your making about health being political and not just technical is well taken