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Rob Wiblin

, a project of the World Health Organization to encourage cost-effectiveness via both research and communication with policy-makers. Rob Wiblin and I sat down to interview Jeremy and learn about WHO-CHOICE. Jeremy's main points were:

WHO-CHOICE is about giving countries the tools needed to establish priorities in the health sector and make good, high-impact-for-money policy.

The landscape of global public health is starting to shift to a time where, more and more, "best buys" and "magic-bullet solutions" such as vaccines are fully funded. This is exciting because it means people are getting important treatments, but it is also daunting because the next generation of interventions will involve more complex technical work and clearer communication with the public.

If you have a strong economics background, are quantitatively minded, and also have interests in epidemiology, biostatistics, or computer programming, a career at WHO-CHOICE or a similar organization could be rewarding and impactful.

WHO-CHOICE is a program in the World Health Organization that helps countries decide priorities and figure out what they should be doing based on considerations of impact and cost-effectiveness. While other tools might be available to them to tell them how to do things, WHO-CHOICE is unique in this focus on establishing priorities.

RW and PH: What's your methodology for determining cost-effectiveness?

JL: Well, first I'd like to clarify that we don't look just at interventions that are considered cost-effective, but we try to include any activities that may be considered policy-relevant: either because they're highly cost-effective or the opposite. What we do is we get a list of things we'd like to look at that include best practices developed by WHO programmes and then add to it a list of things we feel we'd like to analyze - usually things that have tremendous upside if they turn out right, for example vaccines. We then begin to solicit the opinions of experts.

This kind of analysis usually involves epidemiological and clinical evidence of impact, oriented by clinical trials. We want to know what the impact on the population of interest is when you give a certain population a certain technology. What is the impact on a disease parameter that is of interest to us? Does it reduce fatality rates/disease rates/ remission rates? This gives our estimate of effectiveness. For cost, we add the costs of administration, training, and programme elements to the cost of operations as determined from best practice guidelines.

Right now it's exciting because WHO-CHOICE is working with a number of world-class disease modellers that are perhaps the best in the world. It could be a real coup to bring all this expertise together and demonstrate with the best available scientific evidence that there's a couple of interventions that are the best buys in the health sector.

What has been your most interesting or significant results so far?

It's hard to cherry-pick outstanding results. WHO-CHOICE isn't trying to astound people, but provide basic information about bread-and-butter interventions and orient people toward more effective interventions. However, there are a number of cases from my personal work that do stand out to me. First, we found that comprehensive cancer care that involves a full spectrum of prevention, detection, and treatment actually can be cost-effective. In fact, packaging these interventions together in one programme is as nearly cost-effective as just the most cost-effective part of the group. This is valuable information for considering programmes because ethical, medical, and social considerations often prevent splitting up the spectrum of care, so its good to have an economic argument that confirms this practice.

Another example is that in 2005, we published an analysis that implicitly determined the price at which an HPV vaccine could be sold and compete with current screening and prevention programmes in terms of cost effectiveness. It subsequently turned out that the price negotiated by the procurement agencies with the vaccine manufacturers for the HPV vaccine - a much lower price than the prevailing market price - was surprisingly close to the one suggested by WHO-led research. This leads me to suspect that we had an impact on these discussions, though it's difficult to know for sure and many other factors could equally have pointed in the same direction.

What have you found that has changed over the past ten years?

Lots has changed with technological and operational progress. For example, HIV treatment has changed a lot - it previously was all about school-based education, condom distribution, and reaching out to high-risk groups. But now we have cheap and affordable treatment programmes, and this is one example where treatment becomes prevention because if you get the viral load of HIV-positive people down low enough, through effective treatment, they cease to be as infective.

Malaria is another place where the game has changed a lot. We've seen a massive increase in the use of bed nets with both high coverage (the number of households with bednets) and high usage (the number of people actually sleeping under bednets). Ten years ago, this coverage was basically zero in most areas. Furthermore, there's a malaria vaccine coming out that's currently in phase three clinical trials.

However, we're shifting away from an era of "magic bullets", i.e. the model of disease elimination by single-dose vaccines conferring lifelong immunity. The HPV vaccine and the malaria vaccine won't provide lifelong immunity. Much of the 'low-hanging fruit' and quick fixes are gone, so the easy victories in global public health might be over. We seem to be heading now to the next frontier of progress, one that involves more complex methods and doesn't have any magic bullets. But the huge progress that is possible to make at this next stage, in cancers and cardiovascular disease and a whole host of non-communicable diseases, not to mention the unfinished battle against HIV/AIDS, TB and Malaria, this still could be an exciting message if it were conveyed effectively.

Malaria is of particular interest to Giving What We Can because we promote the Against Malaria Foundation so highly. But why does malaria treatment need to be promoted so heavily? Is there a funding gap?

With the global financial crisis, there has been more competition for resources and international donor funds for malaria have stabilized and slightly tailed off. Furthermore, trends and fashions in global health have moved on, and malaria is seen as maybe having had its day in the sun so it needs to move over and make room for other challenges.

Billionaires and sometimes also donor agencies like funding magic bullets because they are game changers - it's a nice thing to say you've done. But we need to change the paradigm from this kind of thinking to a more science-based, rationality-based, understandable, effectively communicated paradigm. We, as researchers, need to get our heads out of our books and tools and communicate these messages more effectively to decision-makers. A disease shouldn't need a compelling spokesperson, but rather be defended by scientific rationale with strong evidentiary consensus.

How did you end up working at WHO-CHOICE?

I actually landed at WHO-CHOICE by chance. I initially was studying for a masters in pure economics, but I didn't feel at home in the economics field. I was interested in working somewhere where I could apply my skills and was in the DC area with lots of medical groups, so I found it natural to apply my quantitative interests and skills as a technical writer in medicine, writing up case histories as research articles. I then came to work at WHO as an editor in the office of publications. This was in 1995 when WHO had a large Office of Publications with 5 technical editors, and they were with one exception all trained as scientists.

Over time though, WHO switched from a doctor-focused organization dominated by a medicalized paradigm of thinking to a more broadly policy-focused group, looking more critically and analytically at economics, epidemiology and statistics. I was interested in the idea that the social sciences and related fields have a key role, so made a transfer to work in that area. I was then immediately placed with other economists, doing what I'm doing now. I then did a PhD at a leading Dutch university and major WHO collaborator. In the Netherlands, a doctorate is a pure research degree, so I could do it essentially on the basis of publications, mostly just by writing up my WHO work.

What advice would you offer other people who want to work in this area?

If someone were to plan for a career at WHO-CHOICE, they should have an economics background and be quantitatively minded. It also would be good if they could demonstrate interest in the public health sphere, epidemiology, biostatistics, or maybe computer programming. It's good to have a PhD, but you also need real world experience. Typically people are public health specialists, but not necessarily someone with a medical degree as first degree.

If a person has all these things, it is easy to make a case for hiring them. Having said that, WHO is currently hiring externally only on a limited basis because of funding shortfalls and internal reorganization.

What are the benefits to working at WHO-CHOICE?

It's very motivating to be doing something you consider important. I just think I couldn't be as happy in the private sector, especially not after having tasted the excitement and value of the WHO. However you may criticise it as a 'bureaucracy', the WHO has great people doing great work, some of the best I've seen, and for the right kind of person that combination allows you to benefit personally from the exposure.

Interview with the World Health Organisation

Carolina Flores

Progress in education has been rated as satisfactory. The main focus has been funding to the Global Partnership for Education (GPE), which provides funding and technical support to help low income countries implement sound education plans. In 2011 and 2012, G8 members provided 49% of the contributions to this partnership. There has been some progress. GPE support has helped:

enrol nearly 23 million more children into school,

However, the report acknowledges that large funding gaps remain. As at least 250 million children cannot read or count, it is clear that the G8 has not been doing enough for education. According to the Overseas Development Office, the target the G8 sets for education is very unambitious: it represents only 2% of the education for all funding gap, while the G8 accounts for 70% of all aid.

G8: KEEPING PROMISES?-Education

The report also considers that progress in food security was good. This is based mainly on the L'Aquila Food Security Initiative (AFSI), and on the New Alliance for Food Security and Nutrition. AFSI is aimed at supporting agriculture and food security initiatives on a large scale, and includes commitments to country ownership, global coordination, transparency and accountability. Taking into account the dimension of the problem of hunger - 870 million people are unable to get enough food to meet daily energy needs, and around 1 billion people suffer from micronutrient deficiency - $22.2 billion was pledged for the period between 2009 and 2012. But, though the entire amount has been committed, only $16.4 billion was disbursed by April 2013.

The New Alliance - launched in 2012 - is a commitment to lift 50 million people in sub-Saharan Africa out of poverty in the next ten years through:

accelerating responsible investment in African agriculture,

Six African partner countries have joined. This initiative has a strong focus on private sector investment, with commitments from more than 80 companies having been received already. As remaining challenges, the report mentions integration of gender objectives and more measure of the impact of programmes on smallholder farmers. The report has come under strong criticism in this area. According to Oxfam, the non-delivery of a quarter of the funds pledged to the L'Aquila Food Security Initiative, and the lack of progress on public on public investment in agriculture show a lack of commitment to ending hunger. Furthermore, the New Alliance, which focuses solely on private investment, can hardly replace public funding, and its focus on corporate-led agriculture over publicly-funded small, farmer-led initiatives risks undermining poor people's land rights and access to natural resources.

G8: KEEPING PROMISES?-Food Security

Based on the progress on maintaining political momentum and increasing funding for this sector, the rating attributed to this area is good. In 2011, the G8 contributed $4.7 billion to water and sanitation programmes and increased the number of partnerships with developing countries. This represents a 16% increase in aid compared to 2010, and ¾ of the total OECD donations for this type on intervention.

But big problems remain to be solved, and much needs to be done for the 2.5 billion people-nearly half the population in developing regions, and over a third of the world's population - who do not have access to improved sanitation facilities, and in particular for the 1.1 billion (15% of the global population) who have no sanitation facilities at all.

The Overseas Development Institute claims that the poor progress towards the Millennium Development Goal shows that the G8 have paid little attention to this area. DevEx stresses that the majority of the money in this area seems to go into building large infrastructure, and not into basic systems; and on countries which are political allies and strategic partners of the G8, instead of on the countries in the most need.

G8: KEEPING PROMISES?-Water and Sanitation 

Stephanie Crampin

On Tuesday 22nd October 2012, Giving What We can researchers Rob Wiblin (CEO of the Centre for Effective Altruism) and Chloe Kane (Giving What We Can researcher) took part in a Skype conversation with Alix Zwane (Executive Director of Evidence Action: an organisation pioneering 

, as well as Deworm the World, another of our recommended charities), and Karen Levy (Evidence Action’s Regional Director). You can see the highlights of the conversation below.

Dispensers for Safe Water is a charity that Chloe and the research team investigated as part of a larger project, the report of which can be read 

. They found that the new programme looked very promising, and of a comparable level of effectiveness to Against Malaria Foundation, and our other top charities. We took part in this Skype call to find out more about what Dispensers for Safe Water do and to answer questions such as how much funding they need, what they measure and why when recording their success, and more general information about why the dispensers programme is favourable to other WASH-related interventions such as promoting handwashing.

We were impressed by what we heard, and learned a lot, including the following key facts: Dispensers for Safe Water has a goal of "reaching twenty five million people by the end of 2018. The intention of the programme is to become sustainable from carbon revenue by this time.” This is because they are "taking advantage of the increased cost-effectiveness that comes from operating at scale. So every additional resource has more and more leverage, towards that goal." They track that the dispensers working, and full of chlorine. While lacking specific “health evidence on dispensers, they have health evidence on chlorine, and are currently measuring adoption. The two of those things together give meaningful information” which is used to calculate the programme’s effectiveness, and which has so far provided very promising results.

Evidence Action is a new organisation, and expects to have an 

 and donations system by early November 2013. Giving What We Can will report further on their work, and expects GiveWell to do so as well, so look out for more details!

You can download a full transcript of the interview 

Video interview with Evidence-Action

Christopher Hogg

Giving What We Can’s mission statement, staring at me from the wall of our office as I write this, is to “move money to the world’s most effective charities”. Working out what these are though can be tricky, as us at the research team have found out over the past week in delving into the literature of schemes involving 

Handwashing promotion programs (teaching people the importance of using soap properly) compare very favourably to our recommended interventions (in terms of $/

There is not much data relating to the success of WASH schemes, and the methodology is weak, hence at present we will not recommend charities to the same extent as our 

, soap manufacturers are in a position, unique to this sector, to fund handwashing campaigns in a manner that benefits both themselves (in profits) and society (in increasing health).

Washing your hands can make you both happy and healthy.

In most instances diarrhoea is caused by consuming bacterial contaminants, often through fingers or food. Washing hands 

 at important periods of the day (such as after defecation and before eating) removes these contaminants from the surface of the skin, cutting the risk of diarrhoeal disease by 40-50% (Curtis and Cairncross, 2003).

However, rates of handwashing with soap (HWWS) are low. This is not caused by a lack of (clean) water, or indeed a lack of soap. Rather, the soap available is used to wash clothes and not hands (Aunger et al, 2010). Therefore what is required prevent the disease are education schemes that encourage behavioural and attitude changes towards soap.

Tip-toeing into the Pool of Private Public Partnerships...

Traditionally donor funded NGO programmes, such as Charity Water and Water Aid, provide these schemes, often in combination with infrastructural improvements. The (too) few studies that exist on standalone schemes have been shown in 

I wish to stress that private companies which have both a financial and PR incentive, can implement schemes which have the same, if not better results. Unilever is one of these companies, whose Lifebuoy soap brand has the potential to be well publicised and used across the world.

It worked in the past. Could similar adverts eradicate diarrhea in the developing world?

The Lifebuoy soap brand began in Victorian England and is known in North America for its adverts which 

. Its focus is now on the developing world where it is one of Unilever’s top selling products, bought from markets in Ghana to 

, the brand states its main aim: “to change the hygiene behaviour of one billion consumers across Asia, Africa and Latin America, by promoting the benefits of handwashing with soap at key occasions”. At present, no NGO lists this as a single aim. Though we are cautious, given that too often big businesses say one thing, but do another (for example 

Coca Cola’ climate change campaign in contradiction to its relation

), there are two reasons to be optimistic about their strategies in relation to the wider WASH sector.

First, their focus on cost-effectiveness. Giving What We Can’s take on the charity sector is to treat donations in a similar way to business investment, a 

 but which we wholeheartedly defend. Just like its advertising campaigns, the promotion schemes are designed to get the largest impact for the money the company invests in. It makes sense in a competitive market. When Unilever saw that by working with governments, local NGOs and schools to “train the trainers”, it saved the company funds but delivered equal results in Indonesia, it sought to extend the scheme to other countries.

Second, Lifebuoy appears to collect good evidence on the impact of its schemes. This kind of self evaluation is what we want to see 

. The Lifebuoy brand has conducted its own Randomised Control Trial in Mumbai, keeps sales data on its soaps through consumer surveys, and are even developing three dimensional sensors in some of their soaps to monitor their use, a method which, due to its unobtrusive nature, is perhaps more accurate than the current norm of participant observation (Vindigni et al, 2011).

It will be good to see more transparency in Unilever’s data. Their website does not show, or may not have, these evidence reports mentioned above. If Giving What We Can are going to support schemes such as this, being able to see the data and analysing it for ourselves is crucial. Perhaps this is where the private sector collides with the public sector, as companies are notoriously secretive about releasing knowledge which may provide a competitor a route into the market.

We would also like to see the company investing more money on these schemes. Unilever funds are diverted away from the Lifebuoy schemes to other brands, which add less health benefits to the world. There is a growing market for soap in Africa and Asia, and potential for lots of money to be made, although the risks at present seem to be too great for the soap companies to invest.

Money for (new) soap? Large companies must be persuaded that there is large enough demand for soap in developing countries such as India to make investment worthwhile.

An advocacy organisation could therefore be needed who can show and persuade private companies to divert funds to the developing world. Currently I do not know of any group which does this, but please 

 or add a comment below. There is an urgent need for more hygiene promotion schemes, and with the funds, knowledge and incentive of private companies, these can be successfully run without donations. Hopefully I have shown you that this change can be realistically achieved surprisingly soon. Part of the solution of moving money to the world’s most effective charities may well be putting more power to the world’s most effective companies.

Aunger et al, 2010: “Three kinds of psychological determinants for hand-washing behaviour in Kenya” Social Science & Medicine 70 (pp 383-391).

Curtis and Cairncross, 2003: Effect of washing hands with soap on diarrhea risk in the community: a systematic review. Lancet Infect Dis 3(5): 275–81.

DCP2 Report. Cairncross, Valdmanis (2006) “Water supply, sanitation, and hygiene promotion” In: Disease Control Priorities in Developing Countries (2nd Edition). New York: Oxford University Press. 771-792

DfID, 2013: “Water, Sanitation and Hygiene Evidence paper” Department for International Development May 2013.

Vindigni et al, 2011: “Systematic review: handwashing behaviour in low- to middle-income countries: outcome measures and behaviour maintenance” Tropical Medicine and International Health 16(4) pp 466-477

Is private soap squeaky clean? A look at the potential effectiveness of corporate handwashing promotion

Michelle Hutchinson

Giving What We Can aims to review its progress and plans every six months, and to publish the conclusions on the blog. In addition to the usual review of the previous 6 months of and plan for the following 6 months, in this case one of the trustees of the Centre for Effective Altruism (Nick Beckstead) produced a review of Giving What We Can as a project. This blog post and the following one contain the headline conclusions of these and links to them.

The first six months of the year have been an important period of learning for Giving What We Can, and have indicated that we should shift our focus more towards individual discussions of charity effectiveness and donation, away from mass methods of communication. GWWC has continued to grow steadily, and expected money moved to effective charities seems to be well worth the money invested.

Giving What We Can’s mission is moving money to the world’s most effective charities. Each of our members commits to donating at least 10% of their income to the most effective poverty relief charities. Therefore, the key metric we use to measure our progress is the number of members we have. In the first half of this year we gained slightly fewer new members than we did in the preceding 6 months, but about the same number as we had in the 6 months before that; this may indicate that the December giving season has a noticeable effect on our membership numbers. This was steady growth for the period, but meant that we ended it on 329 members, which was slightly below our goal.

We set an ambitious target for this period because it included the second half of a press push we had organised in December, which we were hoping would increase member growth. Having updated the website with an improved look and a blog with meant readers could be kept up to date with new research developments, our aim was to publicise the organisation and website as widely as possible to get members. The media campaign was a big success in terms of coverage, with articles on Giving What We Can in the Sunday Times and the New Statesman and on Sky, BBC Breakfast and NPR, among others. This coverage did not lead to as many new members as we had hoped.

Our best guess for why membership growth following the media push wasn’t higher is that taking a pledge to donate 10% of your income is a big step for someone to take simply from reading a media article. This would indicate that we ought to take a more personal approach, and that it would be good to have a more gradual way for people to get involved. The most important lesson we drew from this was that we needed to learn more about the process which leads to people joining Giving What We Can.

In order to learn more about that process we interviewed members, and did a survey with interview follow-up of people who weren’t previously involved with Giving What We Can. Two findings were particularly interesting. One was that people who heard about Giving What We Can through the media had typically not needed much persuading to join, indicating that media pieces (at least of the fairly brief form we got) didn’t tend to have much persuasive force. The other was that people who weren’t interested in joining Giving What We Can became so after having an in-depth conversation about it. These indicate that in order to make more impact on people’s behaviour, we should focus more on having in-depth and ongoing conversations with people. For more details, our full six month review is 

Over this period, we worked both on first order research into finding effective charities, and on more methodological questions, such as what the best ways are to find great giving opportunities, whether it’s better for people to donate now or invest to give later and what the appropriate age-weighting for DALYs is.

With regard to methodological questions, we produced research papers on the topics we set out to, but they generated less interest than we had expected. Investigating individual charities was reasonably successful. Our individual charity research resulted in finding a charity which we consider to be an opportunity for very high leverage, Project Healthy Children. We also wrote reports on a few other charities which seemed promising, though we did not end up recommending them. However, this research required a large time input, and in order to find a charity which is in expectation more effective than AMF (for example) and for which our estimate is equally reliable and exact would take far more resources, since charities in areas which are effective and have low uncertainty are more likely already to have been found. Overall, we think that at the moment it would be more effective for Giving What We Can to focus on driving donations to charities we know to be cost-effective than on trying to find better charities. Therefore, over the next six months we will be concentrating on outreach. In order to achieve that, we will produce blog content which aims to interest people in the idea of cost-effective giving and to drive traffic to the website.

performance review of Giving What We Can for 2011 and 2012

 estimated the return from gaining one member as being $17,000 to the most effective charities, counter-factually adjusted and time discounted. There was a very large range on this figure. Over 2012, the year in which Giving What We Can took on staff, the cost per member was calculated to be $260. The review contains the conclusions from the 2011 giving survey (the results from the 2012 survey weren’t all in at the time the review was written). Of the over 60% of members who had filled in the survey, 90% had kept their pledge. Approximately 70% of members donated to recommended charities. One question we were particularly interested in was whether members who had joined as students continued to give when they entered employment, since many of our original members were students who now have jobs. Of people in that category, just over 70% responded to the survey, and of those nearly all had kept their pledge. This is a very good sign. Although this obviously does not mean they will definitely continue giving for their whole career, it seems less likely that a person will cease giving once they have begun than that they would fail to start.

The review contained various useful lessons. One was the importance of increased data centralisation – of having one system which captures all our relevant data. We are putting this into practice by making increased use of our CRM. With the arrival of a full-time Director of Community, Ben Clifford, we are able to have one person collecting and analysing all our member data. Another recommendation made by the review was to have a real-time donation mechanism, rather than an annual survey. This would make it easier for people to let us know about their donations, and thus for us to track our impact. We aim to do this in our next iteration of the website, in which we plan to introduce ‘personal dashboards’, which will allow people to keep a record of their giving, and tell them how much they have achieved with that giving.

The first 6 months of 2013 were an important learning time for Giving What We Can. The most important lesson was that we should try out a way of encouraging people to gradually increase their level of giving, and provide as much support and personal discussion as possible – it is not enough to simply present the information to as many people as possible. The next blog post will describe how we plan to put it into practice. The conclusion of the performance review was that the expected amount raised for extremely cost-effective charities by Giving What We Can appears to be well worth the resources invested in it.

Six Month Retrospective Progress Review

Health has been the focus of a large number of G8 commitments, and the achievement is rated as good. In fact, there has been a lot of progress over the past decades. From 1990 to 2011, there have been:

a 30% fall in malaria deaths, with 1.1 million deaths averted,

24% fewer people became infected with HIV/AIDS in 2011 than in 2001. In low and middle income countries, the figure is as high as 50%,

since 1988 the number of cases of polio has decreased by over 99%, and polio-endemic countries have declined from 125 to 3,

between 2000 and 2011, the percentage of households in sub-Saharan Africa owning at least one bednet rose from 3 to 53%,

in the same period, global coverage in measles vaccination rose from 72% to 84% and estimated measles deaths decreased by 71%.

How do these advances connect to G8 intervention?

The G8 supports health system strengthening through a variety of programmes. The biggest commitment - to provide 60 billion in funding to fight infectious diseases and improve health systems between 2008 and 2012 - was 80% delivered by 2011, so it is on track to be fulfilled. In 2005, the G8 pledged to mobilise support for the 

Global Fund to fight AIDS, Tuberculosis, and Malaria

. So far, these countries have provided almost ¾ of its funding - $13.5 billion. The Fund has provided:

anti-Tuberculosis treatment for 9.7 million people,

G8 countries have also provided support for:

Global Alliance for Vaccines and Immunisation

 (GAVI), with a pledge of $4.3 billion. Since 2000, GAVI has helped 72 low-income countries immunise 370 million children and avert more than 5.5 million deaths,

. In April 2013, $4 billion was pledged to the Polio Eradication and Endgame Strategic Plan 2013-2014.

the development of new vaccines, microbicides and drugs for AIDS, malaria, tuberculosis and virus research. G8 funding has increased by 22% since 2005, support for Product Development Partnerships has grown 77%.

maternal and child health, with $5 billion additional funding pledged in 2010 and support for initiatives such as the 

the development of treatment for neglected tropical diseases, with an increase in funding of 44% between 2007 and 2011, and a commitment to the control and elimination of ten priority neglected tropical diseases was also made last year.

But many important challenges remain. The central problem seems to be the lack of a qualified health workforce in developing countries. The improvement in this area has been negligible. Of the 57 countries below the World Health Organisation threshold of 2.3 health workers per 1000 people, 19 countries have seen an improvement, and 18 countries have had a decrease in density of health workers (there isn't data from the remaining 20). This is a critical situation: without health workers in place, new vaccines or treatments cannot reach many of the people who need them.

Also, we must not forget that AIDS and tuberculosis continue to be big problems. 7 million people in need of anti-retrovirals still lack access to these; and there were still 8.7 million cases of tuberculosis in 2011, with 1.4 million deaths. With the latter disease, there is the added risk of multi-drug-resistance TB.

For these reasons, Oxfam considers the report to be overly generous in this area.

G8: KEEPING PROMISES? Health

The G8 rate their work in economic development as good, claiming that there has been positive progress in supporting trade and development, including infrastructure and the investment climate, particularly in Africa. Most of the support has been in the form of:

facilitating dialogue with regional economic communities and governments.

As a highlight, over $20 billion have been donated to 