SCI & Deworm the World

We are reasonably confident that charities that focus on deworming are among the most cost-effective in the world. We want to emphasise that the decision to fund a charity that does this intervention is far more important than the decision about which deworming charity to fund.

In this category, there are two charities that we recommend: Schistosomiasis Control Initiative (SCI) and Deworm the World. Both are outstanding charities, implementing a 'best buy for education and health'.1 Because we have found no general and decisive reason for recommending one rather than the other, we simply provide information on both2 and leave it up to the donor to decide between the two.

Introductions

SCI was founded in 2002 and originally focused on the control of schistosomiasis. Since then it has expanded its program in order to treat the seven most prevalent neglected tropical diseases (NTDs). These are a collection of serious diseases that are cheap to treat or prevent, but have not attracted the attention of donors and are thus chronically underfunded. Six of the seven diseases are caused by parasitic worms that live inside the body and cause symptoms ranging from general malaise through to kidney damage, intestinal damage, disfiguration of the limbs, blindness, and death. SCI focuses on the treatment of NTDs through the use of rapid impact packages: a combination package of four or five drugs. Generally, this involves supplying schools with the drugs, and training teachers in how to administer them. SCI currently works in Burkina Faso, Burundi, Mali, Niger, Rwanda, Tanzania and Uganda. With additional funding, they aim to expand coverage to other areas in Africa and to Yemen.

Deworm the World was founded as an initiative of the Young Global Leaders at the 2007 World Economic Forum, after an influential study by Michael Kremer and Edward Miguel demonstrated the remarkable educational benefits of deworming.3 They focus on four neglected tropical diseases: schistosomiasis and the three soil-transmitted helminths (STHs). Deworm the World’s primary activity is to provide substantial technical assistance to help Kenya and India’s governments implement deworming programs. They also encourage governments in South America, Asia and Africa to adopt deworming programs and facilitate the provision of donated medications and technical assistance. They work in over 26 countries across the world.

Both SCI and Deworm the World treat STHs and schistosomiasis in some of the poorest countries in the world. They are the only two donor-fundable organisations that focus on these diseases. Both are motivated by considerations of cost-effectiveness, and are careful to make impact-assessment of the work that they do. Both work closely with the governments of the country: the aim is to help the government set up deworming programs in the country so that they can be sustainably managed by the government.

Differences and Evaluation

At the risk of oversimplifying, the central difference between the two is that SCI sees deworming as a health intervention with educational benefits, whereas Deworm the World sees deworming as an educational intervention with health benefits. SCI works primarily through the Ministry of Health in each country, whereas Deworm the World works primarily through the Ministry of Education.

Tax

One potentially important consideration for donors is whether they can reclaim the tax on their donation (in the UK, this is through Gift Aid). Tax can usually only be reclaimed if the donation goes to a charity based in the donor’s own country. Deworm the World is based in the US and SCI is based in the UK, so citizens of these countries may be able to make their donations go 20% further or more by donating to the organisation in their own country.

Cost per Treatment

SCI claims that the cost per child treated in their programs that focus on schistosomiasis and STHs is $0.32/treatment in Burkina Faso and $0.39/treatment in Uganda. Their programs that treat all seven NTDs in Nigeria, Uganda and Burkina Faso cost less than $0.40/treatment.4

Deworm the World claims that the cost per treatment is around $0.30 in Kenya, where they treat both STHs and schistosomiasis, and $0.12 in India, where they treat only STHs (because there is little schistosomiasis prevalence).5 The principal reason why treatment in India is considerably cheaper is that the Education for All initiative makes it easier to train teachers how to administer deworming drugs.

School versus Community-based treatment

Deworm the World’s programs are almost entirely school-based: trained teachers administer deworming drugs to schoolchildren. SCI also runs community-based treatment to other groups with high rates of infection, such as children not enrolled in school and fishermen. It’s unclear which is more cost-effective in the long run. Though school-based deworming reduces costs by using schools as a distribution network (which partly explains Deworm the World's lower cost-per-treatment figures), often the most sick children are those not attending school, and it's possible that retransmission rates are higher when only school-based treatment is implemented.

Focusing on STHs and Schistosomiasis versus the Rapid Impact Package

Deworm the World treats STHs and Schistosomiasis only. SCI also treats Lymphatic Filariasis (LF), Onchocerciasis and Trachoma.

Given that the drug-based treatment for Onchocerciasis and Trachoma is considerably less cost-effective than drug-based treatment for STHs and Schistosomiasis, one might think that SCI are therefore likely to be less cost-effective.6 However, these figures are based on treating each disease in isolation. The rapid impact package can treat all of these diseases at once, and since the cost of the drugs themselves is very small, it may well be very cost-effective to treat these other diseases at the same time. Moreover, given that LF, Onchocerciasis and Trachoma are going to be treated anyway, it might be that treating them all using the same delivery mechanism saves money in the long run.

Global versus Africa-focused

SCI works only in countries in sub-Saharan Africa (with the exception of Yemen). Deworm the World advocates and facilitates programs in countries in Africa, Asia and South America. However, primarily they work in Kenya and India (these programs receive 75% of their income).

One might think that this would make SCI more cost-effective, since interventions are likely to be both more important and cheaper to implement in poorer countries. However, operational costs (such as costs of teacher training) may be lower in countries such as India, so, once again, this does not provide a decisive reason for preferring one charity to the other.

In conclusion, we strongly recommend both SCI and Deworm the World.