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Charlie Satow

A bed net is distributed in the forest and no one is there to track its delivery and use. Does it contribute to reducing the incidence of malaria?

This question gets to the heart of a key issue in development policy and one that is extremely important to Giving What We Can: data. And with the much-heralded ‘data revolution’ demanded by the UN High-Level Panel on the post-2015 development agenda, it seems to be rising up the list of priorities for governments and multilateral institutions. In this post I want to take a look at this ‘data revolution’ and why data are important for tackling global poverty.

But first, the ‘so what?’ question. Why is data important? The first reason comes from an efficiency argument central to Giving What We Can’s mission: you need to gather data 

to judge whether an intervention is having the effects it was supposed to have

, and thus whether it is a success. What we really mean when we talk of investing in data collection is investing in effective school systems, in well-run hospitals or in successful nutrition programmes. That much is familiar. But this can also 

contribute to the democratic political process

, by equipping people with the information they require to hold their leaders accountable.

Claire Melamed, of the Overseas Development Institute, makes a further, ‘equity’ argument for gathering data[1]: 

we tend to have least information about the people who are most marginalised

 (e.g. slum dwellers[2], women, the disabled), which leads them to receive less attention in terms of policy responses**.If we had more information about these groups we would provide better services for them**. These are three compelling reasons for caring about data or evidence.

What are the current problems associated with data collection in developing countries?

The problem is that the current state of data collection in many developing countries is extremely poor - so much so that Morten Jerven has written an 

 about the poverty of GDP statistics in Africa. And here we are not talking about minor mistakes: for example, when Nigeria’s GDP was re-based, the new estimate showed a 90% increase[3]. And to give another example, the High-Level Panel’s briefing document on the data revolution states that every year around 50 million births go unregistered.[4]

Given this situation, some sort of ‘revolution’ seems appropriate. But the term ‘data revolution,’ officially comprising ‘two main objectives’ and ‘four components’[4], is a slippery one. As Claire Melamed discusses on a 

 on the subject, it holds different meanings for different people.

bringing ‘big data’ into the mainstream of measurement and policy

. This could mean using mobile phone data to track refugee movements [5], or satellite imagery of trees to measure rates of deforestation [6].

strengthening capacity in traditional government statistics agencies

: training more statisticians, getting computer systems to work, etc. Perhaps, then, the ‘data revolution’ is simply an aspirational term, 

pushing policymakers to prioritise “more data, better data, disaggregated data, frequent data,”

 as Amanda Glassman of the Center for Global Development expresses it in the same podcast. It has certainly succeeded in drawing political attention.

For Glassman, one of the key issues is addressing the fundamental problem of incentives underlying the poor data. Administrative, government-collected data remain low-quality in many countries partly because of donor actions: they have demanded accurate household surveys to be able to evaluate their programmes, and to track indicators of their interest (e.g. the Millennium Development Goals). This has produced a system of little coherence and with certain types of information prioritised over others, for example at the national level at the expense of more data disaggregated into population groups.

Faced with this situation, one concrete proposal for 

donors is to engage in funding compacts with recipient-country governments to achieve certain standards on data

, following the payment by results strategy discussed in an 

, and with civil society oversight [7]. This could perhaps be nested within what the High-Level Panel calls a 

‘Global Partnership for Development Data’

, which would also help set common global standards for data reporting, reducing fragmentation and double-collecting.

Visible, user-friendly and practical data

What else can be done here and now to improve the data we collect? Melamed identifies some such steps, for example 

, particularly by publicly-funded bodies such as the UN, and also 

 to create a baseline for 2015 by which we can judge progress on the Sustainable Development Goals, the successor to the Millennium Development Goals. These are both linked to the further point that the final packaging of data must be 

 i.e. visible, user-friendly and practical [8]. The UK Department for International Development leads the way on this matter with its 

Whichever particular proposal you favour - making better use of ‘big data’ for development, forming ‘data compacts’ to improve statistics agencies in developing countries, standardising the way data are reported, or any other initiative - the key point is to take advantage of the current political moment to create a list of specific actions which can be taken forward even after attention has moved on from the data revolution (which it will), balancing the need to strengthen existing systems with the potential advantage to be gained from tapping into new and exciting data projects.

Giving What We Can puts gathering good data on an intervention at the heart of its philosophy. The ‘data revolution,’ if successfully translated into a series of concrete measures and integrated into the post-2015 development settlement, can reap the benefits of this approach on a global scale.

The Guardian: The Data Revolution is Coming

Post2015: We need a 'data revolution' for the global poor

Reuters: Nigeria surpasses South Africa as continent's biggest economy

CGDev: Delivering on the Data Revolution on Sub-Saharan Africa

SciDev: How to Engineer a Data-for-Development Revolution

The data revolution: what's behind the barricades?

Sebastian Roing

The outbreak of Ebola in West Africa is the only outbreak of Ebola to this day that has taken place in a densely populated, urban environment. There is no vaccine against the horrible virus and tragically few medical options for those infected. The most effective interventions at the time of writing seem to be information campaigns and isolated treatment centres. It remains impossible to say whether these interventions are as effective as other 

charities recommended by Giving What We Can

. Ebola may also be difficult to compare with certain other issues due to its acute and plague-like characteristics.

Ebola is a virus which is transmitted to humans from wild animals and spreads human-to-human. Monkeys, fruit bats and consumption of raw meat are a few documented sources of transmission to humans. Human-to-human transmission occurs through bodily fluids. Contact between broken skin or mucous membranes (e.g. in the nose and mouth) with an infected fluid allows the virus to enter the body and be transmitted. The 

 and has varied from 25% to 90% in past outbreaks.

Past outbreaks have been limited to rural settings, but the most recent outbreak in West Africa (of a virus subtype called Zaire[1]) has affected both urban and rural areas. Since the disease can spread rapidly and has a high fatality rate, it puts a huge strain on the healthcare systems of affected countries.

The West African outbreak started in March 2014. 86 cases were reported by the Ministry of Health of Guinea on the 24th of March in the south-eastern part of the country. Efforts were quickly taken in cooperation with Médecins Sans Frontières (MSF) to establish a treatment centre and to investigate reported cases in the neighbouring countries of Sierra Leone and Liberia.

6 cases were identified in Liberia and the Ministry of Health together with the International Red Cross (IRC) began running information campaigns. It was not until 26th May that one case of Ebola was laboratory-confirmed in Sierra Leone. The disease later spread to Nigeria at the end of July. Mali and Senegal have also reported singular cases of Ebola, but both countries succeeded in containing the disease.[2] There is currently a separate outbreak of Ebola in the Democratic Republic of Congo (DRC), but with no cases reported since early October, the 60 MSF staff working in the local treatment centre are preparing to exit.[3]

The outbreak of Ebola in Nigeria was successfully contained even though the disease caused 8 deaths and 20 reported cases. Ebola was brought into the country by a man who travelled from Liberia by plane. This set off a chain reaction in which 19 people were infected. There was an immediate response from the Nigerian government, together with the WHO and MSF, to identify people who had been in close contact with the man, who died 5 days later in hospital.[4] The WHO declared 20 October as the end of the epidemic after 42 days without any new cases. “Strong public awareness campaigns, teamed with early engagement of traditional, religious and community leaders, also played a key role in successful containment of this outbreak.”

The table below lists the number of identified cases and fatalities per country in the West African outbreak.

| Countries | Cases | Deaths | | Guinea | 1,760 | 1,054 | | Liberia | 6,619 | 2,766 | | Nigeria | 20 | 8 | | Sierra Leone | 4,862 | 1,130 | | Senegal | 1 | 0 | | Mali | 1 | 1 | | **Total** | **13,263** | **4,959** |

Table 1 (WHO statistics as of 7 November 2014)[5]

The response to the West African outbreak of Ebola has largely been focused on 

setting up of treatment centres where infected people are effectively isolated

. Alternative treatments such as antivirals and monoclonal antibodies are currently undergoing clinical trials in MSF treatment centres.[6]

The 2 most promising vaccines are also undergoing 

, although not currently in MSF treatment centres as these trials require healthy volunteers outside treatment facilities. One volunteer in the UK has been injected with the vaccine and clinical trials are also being conducted in Mali. One of the vaccines has been developed by the Public Health Agency of Canada in Winnipeg, with the licence of commercialisation held by the American company NewLink Genetics. The other vaccine has been developed by the British company GlaxoSmithKlein (GSK) in collaboration with the UN National Institute of Allergy and Infectious Diseases.[7]

As noted by the medical director of MSF, Dr Bertrand Draguez, the two vaccines could theoretically be distributed as soon as efficacy and safety are determined. However, in practice, if mass production starts only after results from clinical trials have come out, “we could be waiting months for that product to be available in sufficiently large quantities”.[8] MSF therefore advocates the mass production of vaccines before the results of the clinical trials are known, and that a solution must be found where someone (an institution or company) accepts the risk of having to scrap the vaccine produced.

This issue has still not been resolved and is frequently debated in different forums. GSK has committed to producing 10,000 doses of the vaccine before results of trials come out. If the results are positive, the vaccine could be administered to frontline health care workers in early December. However, writing for Science magazine, Jon Cohen notes that “hundreds of thousands of doses would be needed to put a dent in the outbreak”.[9] According to Ripley Ballou, head of the Ebola vaccine program at GSK, a hundred thousand doses would take one and a half years to produce if the rate of production isn’t increased.

The only available treatment of Ebola at this stage is rehydration.

treating them in isolated treatment centres

 for the deceased (the disease is at its most infectious stage after victims have died).

Public awareness campaigns have also been crucial to limit the spread of the epidemic. There are challenges to such awareness campaigns particularly in areas where there is widespread mistrust of western healthcare workers.

Below is a list of organisations that are currently accepting private donations in the fight against Ebola. 

MSF stands out as the most transparent and potentially most effective

 organisation among those listed. They have been at the forefront of information about Ebola since March 2014 and we have previously written about emergency-aid and MSF 

MSF currently runs 6 treatment centres in Liberia, Sierra Leone and Guinea

They are also active with community engagement, public awareness campaigns and provide coordination and guidance to the national health authorities in the affected countries

They have a website which is specific to their Ebola appeal where they illustrate what a donation can be used for.[10]

In previous emergency-aid appeals such as the 2004 Indian Ocean tsunami, MSF have been known to close their appeal when the maximum amount needed has been reached. This prevents a waste of resources as appeals tend to overflow when western media focuses solely on one emergency or issue.

Another reason to support MSF is their presence – MSF warned the international community about Ebola already in March, but it has been incredibly and unforgivably slow to react. MSF has a much better capacity to intervene in acute situations than other organisations, because of their presence, access to information and medical expertise. The trade-off between responsiveness and documented statistical effectiveness is debated further on Giving What We Can’s emergency-aid page.

Giving What We Can has previously compared the Red Cross and Red Crescent movement with MSF in its charity evaluations and 

 MSF should be preferred when it comes to large disasters, such as Ebola. The response of the Red Cross and Red Crescent seem particularly slow in countries where they have less well-established national societies.

The Red Cross is currently running 1 treatment centre in Sierra Leone and have 5000 volunteers working locally. Their volunteers are mainly working with public awareness, and according to their website the Red Cross can reach some areas other organisations cannot.

The Red Cross have previously published comprehensive reviews of their interventions which contribute to transparency.

Save the Children’s efforts have been very similar to those of the Red Cross. They have trained 3000 volunteers who are now running public awareness campaigns, and they are running one treatment centre in Sierra Leone.

Giving What We Can has not conducted a specific charity evaluation of Save the children. Intuitively, their work in response to the West African Ebola outbreak could be deemed as similar to that of the Red Cross. However, they do not have the same structure of reviews for different interventions.

Notably, this organisation is listed on Facebook’s 

 page, together with Save the Children and the Red Cross. A look at their website suggests that the organisation is similar to MSF, but less transparent and therefore less reliable.

They also have a smaller presence than MSF in the region, suggesting that there might be some positive scale effects of choosing MSF over the International Medical Corps.

Political advocacy for mass-production of vaccines

This is another area in which intervention could be very effective, whilst more uncertain. Organisations working for advocacy of patent reform and cheaper access to medicines include MSF, which launched their Access Campaign shortly after receiving the Nobel Peace Prize in 1999.

MSF seems to be the best organisation fighting the spread of Ebola, and they are currently running interventions that seem cost-effective. With their longstanding commitment in the region and medical expertise it seems like that they are also the best organisation to lead efforts in the future.

Updates in the fight against Ebola will have to run continuously, particularly when the results from medical trials of the vaccines become available.

There really is an interesting methodological issue with the effective altruist movement when it comes to emergency-aid. At least with current methods we don’t seem to be able to evaluate whether emergencies such as Ebola are the most effective causes to give to. In scale, Ebola is much smaller than, for example, Malaria. But that doesn’t necessarily mean that the marginal effect of a donation to the fight against Ebola is lower.

Another problem I would like to highlight concerns the DALY (Disability-Adjusted Life Year) measurement. If we want to compare interventions targeting different issues, then we need a measurement such as the DALY to compare the impact across causes. But it will inevitably be debatable if it is morally defensible to apply a linear weighting to diseases such as trachoma (blindness) relative to Ebola, since Ebola destroys whole communities. While this discussion is outside the scope of this blog post, it would be very interesting to see more on the topic in the future.

Centers for Disease Control and Prevention: Previous Ebola Outbreaks

WHO declares end of ebola outbreak in Nigeria

A Brief Update on Ebola - Are There Any Effective Interventions in Sight?

Joseph O'Neill

 of this series, we looked at the problem of violence in its different guises, and at how much damage different forms of violence cause. In this, we will start from the knowledge of the ways in which violence causes the most damage to consider what we can do to help.

In the “Conflict and Violence Assessment Paper” recently released by the Copenhagen Consensus Centre, researchers estimate that sexual and physical violence against women and children costs society at least 5 times more than the cost of homicides, wars, and terrorism put together. Given the large cost of violence worldwide, it is important to prioritise the most effective responses aimed at solving the problem.

To this end, authors evaluate the literature and estimate Benefit-to-Cost Ratios (BCRs) for promising relevant interventions. The paucity of good data in this field makes it difficult to arrive at accurate numbers. The authors themselves admit their BCR estimates are “extremely conjectural”.[1]

, the report finds no evidence that aid prevents civil war onset, with the one proven post-conflict intervention (UN peace-keeping operations) only being applicable in limited circumstances.

 seem more promising. For example, a program enforcing reduction of alcohol consumption in the UK reported quite a high BCR ($17 for each $1 spent) and programs to improve policing in general are also expected to have large BCRs, as they cost little to implement. Unfortunately though, the authors note that current aid programs pay little attention to rates of violent crime, focussing instead on preventing and dealing with the consequences of civil war.

(female genital mutilation, harsh physical discipline, domestic violence), the report notes that merely changing the law to make such practices illegal is unlikely to be effective. The top interventions for these issues were instead those focussed on improving education around specific issues and improving the overall quality of social services. Programs improving parenting skills in the US (BCR = 8), or increasing early response of social workers in child abuse cases in the US (BCR = 13-14), both look promising for preventing violence against children. A program to help social workers identify women at high-risk for domestic violence in the UK also looks promising due to its low rollout costs.

The authors propose the following 5 targets based on their findings:

Although these figures seem promising, we have some reservations about how well the BCRs reported for these programs (which have mostly occurred in rich countries) will translate to the developing world. Reviewers were also less optimistic about the BCRs given by Fearon and Hoeffler, with one concluding that most of the policies considered “are most likely to have modest impact with little evidence that these policies [would be] implemented in a manner that would be exceptional [in the developing world].”[13] This reviewer goes on to provide their own BCR estimates for the report’s top interventions, which range from 0 - 8 as opposed to the original 5 – 17.

BCRs for mitigating violence are in general lower and involve more uncertainty than those for interventions in other areas.

 Compare these values with those for highly effective interventions: micronutrient fortification (BCR estimates often over 20, sometimes over 200)[14], deworming (BCR = 24.7 to 41.6)[15], and subsidising malaria medication (BCR = 35)[16].

Giving opportunities for individual donors

The large total cost of violence suggests that 

violence prevention may be an area in need of funding

. However, the recommendations listed in this study are mostly aimed at policy makers rather than individual donors, and at the current time we do not know of any charities working in this area that present better opportunities than our current top charities.[6] This also applies to donating to the Copenhagen Consensus Centre itself - while we are supportive of Centre’s approach and research, we have some doubts about the centre’s research priorities, and are uncertain about the centre’s ability to significantly influence global aid policy through their research. See our full report on the CCC 

Even with doubts about the accuracy of the estimates made by Fearson and Hoeffler, the work in this paper serves to 

illuminate important areas for future research

in our efforts to help those in the developing world we need to think about unseen problems as well as very public ones

Giving What We Can Summary of Micronutrient Interventions

Worms at Work: Long-run Impacts of Child Health Gains

Copenhagen Consensus 2012 Challenge Paper on Infectious Disease

The Cost of Violence II: What can we do?

Owain Johnstone

Every time you choose to donate to a particular charity you're choosing a particular problem which you want to address. But the menu of problems that you choose from isn't fixed. What gets onto that menu and, to stretch the analogy, how each item is described, can change over time. In other words, you can change what we define as problems and how we define them. In this post I explore that idea and why it's so important.

Blog

The data revolution: what's behind the barricades?

A Brief Update on Ebola - Are There Any Effective Interventions in Sight?

The Cost of Violence II: What can we do?

Problems are in the eye of the beholder

The Cost of Violence I: What should our priorities be?

The Centre for Effective Altruism is seeking a Chief Operating Officer

Maternal Nutrition - Who Pulls the Strings of Maternal Mortality

Giving What We Can is seeking a Director of Communications

The Promise of the Safe Childbirth Checklist

Giving What We Can is seeking a Director of Research