Dan Frost

Where should we donate to do the most good? - Essay Competition Runner up

The question of where charitable funds should be directed is not a simple one.

The Global Fund to Fight AIDS, Tuberculosis and Malaria

 (The Global Fund or TGF, henceforth). This cause was selected because it is scalable. The organisation was chosen based on evidence of their past work, potential cost-effectiveness of additional funds and the capacity they have for added funds.

This framework for selection is valuable and the recommendations of this paper are solely based on this criteria. However, this does not account for a donor’s unique passion for a particular cause, which is undoubtedly important when making a donation. Nonetheless, the framework does allow for an impact-based conclusion and a recommendation for those who want to see the best value for their donation.

Preventing and curing AIDS, tuberculosis and malaria are certainly scalable interventions, due to the high burden of disease. Combined, they account for 8.61% of the global disability-adjusted life years (DALYs) (Murry et al., 2012), which measures the number of years of life lost due to ill-health, disability or early death. The three diseases combined account for 5 million deaths each year (Vitoria et al., 2009), and in low income countries they constitute 3 of the 5 infectious diseases that caused the most deaths each year (WHO, 2008). These statistics show that the problem is sizeable and unresolved.

The means for education, prevention and treatment of these diseases are available. Standard antiretroviral therapy (ARV) is a course of drugs used for treating HIV. Within 4 years of the drugs becoming available, death rates caused by AIDs related illnesses fell by 84% (Porter, 2003). The main instrument in the prevention of malaria is distribution of insecticide-treated nets, which halves the cases of malaria among children (The Global Fund, 2015). Tuberculosis is treated with short-course chemotherapy, which delivers an approximate success rate of 83% (Espinal et al., 2000). These interventions are clearly scalable and have great potential for impact.

The Global Fund is a financial organisation that provides funding primarily to governments of developing countries to allow them to enact the necessary measures to tackle the problems of HIV/AIDS, malaria or tuberculosis. Grants are applied for and then reviewed by the Global Fund’s Technical Review Panel. If granted funding, the project is required to have set targets that are overseen by Local Fund Agents. These are independent bodies that monitor the progress of grantees.

The Global Fund is responsible for a lot of the progress against these diseases so far. As of 2015 the Global Fund provided financing for 12.3 million cases of tuberculosis detection and treatment, 450 million insecticide-treated nets and 7.3 million people receiving ARV. It also provided approximately 20% of global funding for HIV/AIDs and 66% of funding for tuberculosis and malaria projects in 2005 (Schoken, 2005).

The large scale of the Global Fund inevitably raises questions of whether it still has the capacity for additional funds, or whether the marginal returns to these funds will have been diminished due to the size of the organisation. However, from 2013 to 2014 donor pledges fell by 32% (TGF Annual Report, 2014), likely due to weakened economic positions of donor governments, who are by far their largest donors. This reduction in pledges led to a reduction in grants by 21.7%.

Therefore, despite its size, The Global Fund still has capacity for added funding. It undoubtedly would have provided more grants were it not for the fall in pledges. Hence, the organisation is not at full funding capacity, due to the dramatic fall in donations in recent years.

The Global Fund would use additional funds in a way that is cost-effective. Firstly, the projects that it funds use proven, cost-effective methods. Tuberculosis treatment, for example, is estimated to be ‘among the most cost-effective of all interventions available’ (Chapter 2, Laxminarayan et al., 2006) in improving health in developing countries. HIV/AIDS treatment and prevention are generally estimated to be cost-effective. One example where it is very cost-effective is in the prevention of mother to child transmission, which can cost as little as $6 per DALY averted (Laxminarayan et al., 2006), while conventional ARV drugs therapy ranges from $13,000 to $23,000 per quality-adjusted year of life gained (Freedberg et al, 2001). Malaria prevention through distributing long-lasting insecticide-treated nets is also very effective: it is estimated to save one life per $3,300 spent (givewell.org, 2013).

Not only are available methods for the causes cost-effective, but The Global Fund is also a strong organisation for carrying out these interventions, due to the structure of its grant distribution. After a grant is awarded, ‘continued funding is dependent upon demonstration of proven results’ (pg. 7, TGF Annual Report, 2014). And this principle is enacted, with the least effective grants losing their funding if they do not meet targets. For example, in 2005 The Global Fund removed funding from Myanmar due to suspicions that their grants were not being used for their intended purposes (Parry, 2005). This process ensures that the areas where funds are not used effectively are avoided over time, so that only the cost-effective projects remain funded.

The Global Fund’s current financial status and cause selection make it an excellent charity to donate to. It makes effective projects possible through provision of funding, and offers excellent value per unit of donation.

Chow J., Laxminarayan R., and Shahid-Salles S. A., (2006). Disease Control Priorities in Developing Countries. 2nd edition. [online]. Available at: [

http://www.ncbi.nlm.nih.gov/books/NBK11784/

Espinal, M., Kim, S., Suarez, P., Kam, K., Khomenko, A., Migliori, G., Baéz, J., Kochi, A., Dye, C. and Raviglione, M. (2000). Standard Short-Course Chemotherapy for Drug-Resistant Tuberculosis. JAMA, 283(19), p.2537.

Freedberg, K., Losina, E., Weinstein, M., Paltiel, A., Cohen, C., Seage, G., Craven, D., Zhang, H., Kimmel, A. and Goldie, S. (2001). The Cost Effectiveness of Combination Antiretroviral Therapy for HIV Disease. New England Journal of Medicine, 344(11), pp.824-831.

GiveWell, (2013). Mass distribution of long-lasting insecticide-treated nets (LLINs) | GiveWell. [online] Available at: [

http://www.givewell.org/international/technical/programs/insecticide-treated-nets#HowcosteffectiveisLLINdistribution

Murray, C., et al. (2012). Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. The Lancet, 380(9859), pp.2197-2223.

Parry, J. (2015). WHO | Global Fund withdraws grants to Myanmar. [online] Who.int. Available at: 

http://www.who.int/bulletin/volumes/83/10/news11005/en/

Porter, K., (2003). Determinants of survival following HIV-1 seroconversion after the introduction of HAART. The Lancet, 362(9392), pp.1267-1274.Vitoria, M., Granich, R., Gilks, C., Gunneberg, C., Hosseini, M., Were, W., Raviglione, M. and De Cock, K. (2009). The Global Fight Against HIV/AIDS, Tuberculosis, and Malaria: Current Status and Future Perspectives. American Journal of Clinical Pathology, 131(6), pp.844-848.

Schocken, C., (2005). Overview of the Global Fund to Fight AIDS, Tuberculosis and Malaria. Center for Global Development [online]. Available at: 

http://www.cgdev.org/page/overview-global-fund-fight-aids-tuberculosis-and-malaria

The Global Fund (2014), The Global Fund 2014 Annual Financial Report. [online] Available at: 

http://www.theglobalfund.org/en/publications/annualreports/

The Global Fund to fight AIDS, Tuberculosis and Malaria, (2015). Fighting AIDS, Tuberculosis and Malaria - The Global Fund to Fight AIDS, Tuberculosis and Malaria. [online] Available at: 

http://www.theglobalfund.org/en/about/diseases/

Vitoria, M., Granich, R., Gilks, C., Gunneberg, C., Hosseini, M., Were, W., Raviglione, M. and De Cock, K. (2009). The Global Fight Against HIV/AIDS, Tuberculosis, and Malaria: Current Status and Future Perspectives. American Journal of Clinical Pathology, 131(6), pp.844-848.

Dan Frost

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Where should we donate to do the most good? - Essay Competition Runner up