Our assessment of BasicNeeds leads us to tentatively conclude that the narrow impact of their intervention is cost-effective but an order of magnitude less cost-effective than our top charities. On the other hand, BasicNeeds is conducting pioneering advocacy work which is difficult to measure, but equally difficult to ignore.
What is the problem? Mental, neurological and substance use disorders account for an estimated 10% of the global disease burden. Mental health is severely underfunded, particularly in the developing world. One third of LMICs have no designated budget for mental health and among those that do, average expenditure is 0.5% of total budgets.
How does this charity address it? BasicNeeds partners with local organisations, working with patients, healthcare professionals, and family members to improve access to mental healthcare (both through prescription medication and self-help groups), build capacity (through training), and advocate for increased mental health budgets in Africa and Asia. They treat patients with epilepsy (35% of affected persons reached), serious mental disorders like schizophrenia (21%) and more common disorders like depression (12%).
As BasicNeeds conducts its activities in countries with less developed health systems, there is a strong opportunity to provide basic levels of mental health services (such as access to psychotropic medicine) which have already been covered in countries with more robust health systems. Moreover, BasicNeeds uses a task-shifting model meaning that treatment and coordination is usually undertaken by laymen. We are therefore reasonably confident that it does not divert the limited number of mental health professionals from other patients and so results in an increase in the number of people treated.
An important benefit of BasicNeeds work is in raising awareness for mental disorders in developing countries and in advocating for changes in local and national mental health policy. In 2014, BasicNeeds trained 1,893 health personnel, partner staff and community based workers. There has been significant reform of mental health policy in five countries in which BasicNeeds operate, although we are not confident that this reform would not have happened anyway, or that it does not divert health system resources from other effective interventions.
The interventions prioritised by BasicNeeds, such as community based treatment of schizophrenia and depression, tend to fall in the higher (less favorable) range of the interventions considered in Disease Control Priorities 3 (DCP3). Moreover, DCP3 reports that “hardly any published evidence exists on the cost-effectiveness of population-based or community-level strategies in or for low-income and middle-income settings.”
BasicNeeds conduct routine evaluations of their programmes. One study reported that the cost-effectiveness of BasicNeeds interventions in Kenya was $727 per DALY averted. However, we do not put a great deal of weight on this study as it was implemented by BasicNeeds employees, had no control group, and we have not been able to see the calculations behind the DALY estimate. There is stronger evidence of a significant impact on economic empowerment and psychological wellbeing than there is for clinical outcomes.
We were not able to do a full-cost accounting analysis, because BasicNeeds were unable to provide us with details of their partners’ costs, making it difficult to assess the cost-effectiveness of the programmes as a whole.
We believe that BasicNeeds are a high quality and reasonably transparent organisation. We have interviewed their Executive Director, Jess Mcquail, who has been quick to share available information with us. BasicNeeds is highly recommended by Professor Vikram Patel, a respected expert in international mental health, has received a grant from the Skoll foundation, and were recognised as the top organisation working in mental health by the World Innovation Summit for Health (WISH).
We are confident that BasicNeeds can absorb additional funds of up to $120,000 in 2016 and $250,000 in 2017. Additional funds will be used to maintain operational capacity in the UK and fund additional partners to expand the programme to new locations. These locations have not yet been identified.
"Missed Opportunities in Global Health: Identifying New …" 2015. 8 Jan. 2016 <http://www.cgdev.org/publication/missed-opportunities-global-health-identifying-new-strategies-improve-mental-health> ↩︎
"BasicNeeds Annual Impact Report 2014 1.0 DIGITAL (low …" 2015. 15 Jan. 2016 <http://www.basicneeds.org/wp-content/uploads/2015/02/BasicNeeds-Annual-Impact-Report-2014-1.0-DIGITAL-low-res.pdf > ↩︎
Patel, Vikram et al. "Addressing the burden of mental, neurological, and substance use disorders: key messages from Disease Control Priorities." The Lancet (2015). ↩︎
de Menil, Victoria et al. "Cost-effectiveness of the Mental Health and Development model for schizophrenia-spectrum and bipolar disorders in rural Kenya." Psychological medicine (2015): 1-10. ↩︎
"A conversation with Vikram Patel on December … - GiveWell." 14 Jan. 2016 <http://files.givewell.org/files/conversations/Patel%2012-12-13%20(public).pdf > ↩︎
"transforming lives, enhancing communities - WISH - World …" 2013. 14 Jan. 2016 <https://www.nejm.org/doi/full/10.1056/NEJMp1315214> ↩︎