EA - Remote Health Centers In Uganda - a cost effective intervention? by NickLaing

Link to original articleWelcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: Remote Health Centers In Uganda - a cost effective intervention?, published by NickLaing on February 27, 2023 on The Effective Altruism Forum.TLDR: Operating basic health centers in remote rural Ugandan communities looks more cost-effective than top GiveWell interventions on early stage analysis - with huge uncertainty.I’m Nick, a medical doctor who is co-founder and director of OneDay Health (ODH). We operate 38 nurse-led health centers in healthcare “black holes,” remote rural areas more than 5 km from government health facilities. About 5 million Ugandans live in these healthcare black holes and only have bad options when they get sick. ODH health centers provide high-quality primary healthcare to these communities at the lowest possible cost. We train our talented nurses to use protocol based guidelines and equip them with over 50 medications to diagnose and treat 30 common medical conditions. In our 5 years of operation, we have so far treated over 150,000 patients – including over 70,000 for malaria.Since we started up 5 years ago, we’ve raised about $290,000 of which we’ve spent around $220,000 to date. This year we hope to launch another 10-15 OneDay Health centers in Uganda and we're looking to expand to other countries which is super exciting!If you’re interested in how we select health center sites or more details about our general ops, check our website or send me a message I’d love to share more!Challenges in Assessing Cost-Effectiveness of OneDay HealthUnfortunately, obtaining high-quality effectiveness data requires data from an RCT or a cohort study that would cost 5-10 times our current annual budget. So we've estimated our impact by estimating the DALYs our health centers avert through treating four common diseases and providing family planning. I originally evaluated this as part of my masters dissertation in 2019 and have updated it to more recent numbers. As we’re assessing our own organisation, the chance of bias here is high.Summary of Cost-Effectiveness ModelTo estimate the impact of our health centers, we estimated the DALYs averted through treating individual patients for 4 conditions: malaria, pneumonia, diarrhoea, and STIs. We started with Ugandan specific data on DALYs lost to each condition. We then adjusted that data to account for the risk of false diagnosis and treatment failure (in which case the treatment would have no effect). We then added impact from family planning. Estimating impact per patient isn’t a new approach. PSI used a similar method to evaluate their impact (with an awesome online calculator), but has now moved to other methods. Inputs for our approachHeadline findingsFor each condition, we multiplied the DALYs averted per treatment by the average number of patients treated with that condition in one health center in one month. When we added this together that each ODH health center averted 13.70 DALYs per month, predominantly through treatment of malaria in all ages, and pneumonia in children under 5.ODH health centers are inexpensive to open and operate. Each health center currently needs only $137.50 per month in donor subsidies to operate. The remaining $262.50 in expenses are covered by small payments from patients. Many of these patients would have counterfactually received treatment, but would have incurred significantly greater expense to do so (mainly for travel). In addition, about 40% of patient expenses were for treating conditions not included in the cost-effectiveness analysis.We estimate that In one month, each health center averts 13.70 DALYs and costs $137.50 in donor subsidies. This is roughly equivalent to saving a life for $850, or more conservatively for $1766 including patient expenses. However, there is huge uncertainty in our analysis.The AnalysisMeasuring Impact by Estimating DALYs...