(900,000 - 1,000,000) + (600,000 - 700,000 pending appropriations outcome)
What if it is possible to save a life for $20? For the price of a meal? This is the value proposition RESULTS presents. In 2009 RESULTS targeted tuberculosis, a usually fatal disease that can be treated for $240. This treatement effectively saves on average 67% of a life. The cost to save a life by targeting TB is thus $240 / 67% or $360. RESULTS is tiny, but they go about attacking TB the smart way, by magnifying the effect of the dollars they receive. For each dollar RESULTS received they spent it on lobbying the US Congress to appropriate money for global TB treatment and other humanitarian aid priorities. TB was one of RESULTS successes in 2009, and each dollar spent on lobbying saw $25 being appropriated for global TB. RESULTS is the driving force behind lobbying for global TB, but it isn't the only force, so to account for this we conservatively estimate that each dollar RESULTS received in 2009 resulted in $18 dollars appropriated for global TB. The result, $20 dollars donated to RESULTS in 2009 resulted in $360 for global TB, enough to save a life. From year to year the issues targeted by RESULTS vary, but RESULTS has a solid track record of effectively saving a life for every $2-50 it receives.
There are a number of charities working as lobbyist for the poor. Poverty is so much more prevalent, and each dollar spent overseas goes so much further than a dollar spent domestically, so our focus is on evaluating overseas focussed organizations: RESULTS, Jubilee, ONE, and Bread for the World. Without their constant pressure the US humanitarian aid budget would be gutted.
Each dollar that goes to one of these organizations corresponds to about $1,000 of humanitarian spending by USAID. And so these organizations can have a real magnifying effect by bringing such expenditures to focus on areas with a high Leverage Factor, such as healthcare.
RESULTS is a grassroots lobbying organization that works to create the political will to end hunger and poverty. In the US it operates in synergy with RESULTS Educational Fund, a 501c3 non-profit. It is the combination of the two we evaluate in assessing performance. RESULTS operates in a number of countries, but we focus on RESULTS in the US.
RESULTS produces detailed performance assessments. Much of their performance comes from their work on TB, which RESULTS has been the standard bearer for, and it is this which we have given the greatest scrutiny.
The estimates of RESULTS Role (ie. the extent to which RESULTS did the advocacy that made things happen) given here have been made in conjunction with RESULTS. For the most part representatives don't take action unless prompted, and the various foreign aid lobbying organizations work independently on their own issues. As a result RESULTS is able to take a large part of the credit for the successful issues it worked on.
For funds to be provided there must be authorization legislation and appropriations legislation. The appropriations process is initiated by the president's budget request. RESULTS suggests a breakdown of effort as 40% authorization legislation and 60% appropriations legislation. It thus seems reasonable to allocate credit as 20% President's budget, 30% authorization, 50% appropriations. This may need to be modified on a case by case basis. For something to count as a win for RESULTS we require funds to be appropriated, this means it may be several years before we can evaluate the outcome of some multi-year authorization actions.
Does RESULTS have the capacity to absorb more funding? RESULTS would like more funding to expand their grass root network of lobbyist from 35 to 50 states, and from 1/2 to 2/3 of congressional districts. They would also like to increase their online presence, expand internationally, and perform more oversight research on the World Bank and USAID. This they believe would lead to more champions on both sides of the aisle, bolder legislative requests, and more legislative requests, which ultimately would lead to congress providing more and better targetted resources to address global poverty. RESULTS intends to continue to focus on high impact interventions. Today we are only detecting 60% of TB cases, so more capacity for TB is warranted, but beyond TB RESULTS has embraced vaccine advocacy, and in the planning stages are micronutrients, and community management of childhood and maternal illnesses.
Aren't budgets fixed, and all RESULTS does is move money from one pot to another, one year to the next? RESULTS responds that all pots are not created equal, some initiatives have a much higher impact than others. RESULTS also says budgets are not fixed, and if enough excitement can be generated around an issue there can be bipartisan support for increasing the budget, as was seen with HIV.
In a down year things might get cut, but RESULTS might succeed in making the cuts less than what they would have been. Ideally RESULTS would be compared to its counterfactual, but this is very hard to do.
Annual budget: $2.1m (data supplied by RESULTS; excludes separately financed Microcredit Summit Campaign and Action projects)
| Project | Funding | Real world outcome | Outcome estimates | Economic value in Western terms | RESULTS role | RESULTS value add |
|---|---|---|---|---|---|---|
| Microcredit | $0 | Congressional Gold Medal for Muhammud Yunis | valuable from a PR perspective but difficult to quantify | $0 | 50-80%? | $0 |
| Education for All | +$750m World Bank interest free loans over 5 years | 2.3m children educated | EFA will cost $9.1b/year for 170m children (UNICEF estimate cited in Attaining Universal Primary Completion by 2015: How Much Will It Cost?) or $54/child/year; 6 years primary education; $750m / $54 / 6 = 2.3m children educated | $120b-1200b | 60% | $70b-700b |
| Global Fund for AIDS, TB and Malaria (HIV component) | +$1.1b over 3 years budget request (all diseases) | 200k DALYs saved | assume 20% effort is budget request; 55% funding goes to HIV (Global Fund through 2010 had disbursed $7.7b of $14.1b for HIV); $493/yr patient on ART (Towards an improved investment approach to an effective response to HIV/AIDS, The Lancet 2011, webappendix); reduce by 25% since administration may not survive 3 years; not all funds may go on ART, but assuming this is the least effective intervention, this provides a lower bound on effectiveness; $1.1b * 54% / $493 * 20% * 3/4 = 200k DALYs saved | $16b | 30% | $5b pending appropriations outcome |
| Global Fund for AIDS, TB and Malaria (Malaria component) | +$1.1b over 3 years budget request (all diseases) | 1.5m-9.6m DALYs saved | assume 20% of effort is budget request; 29% funding goes to TB (Global Fund through 2010 had disbursed $4.1b of $14.1b for Malaria); assume $5-31/DALY based on Nothing but Nets page; reduce by 25% since administration may not survive 3 years; $1.1b * 29% / $5-31 x 20% x 3/4 = 1.5m-9.6m DALYs saved | $140b-860b | 30% | $40b-260b pending appropriations outcome |
| Global Fund for AIDS, TB and Malaria (TB component) | +$1.1b over 3 years budget request (all diseases) | 74k lives saved | assume 20% of effort is budget request; 16% funding goes to TB (Global Fund through 2010 had disbursed $2.3b of $14.1b for TB); assume $240 to treat and 67% fatal based on tuberculosis treatment page; reduce by 25% since administration may not survive 3 years; $1.1b * 16% / $240 x 67% x 20% x 3/4 = 74k lives saved | $150b | 30% | $50b pending appropriations outcome |
Estimated aggregate impact: $70b-700b + $95b-$315b pending
Leverage factor: (30,000 - 300,000) + (50,000 - 150,000) pending
The bulk of the impact this year is through authorization legislation and World Bank actions, and we conservatively don't assume this will have a persistant effect for longer than it lasts. Hence we use the raw leverage factor.
(30,000 - 300,000) + (50,000 - 150,000) pending
Annual budget: $1.8m (data supplied by RESULTS; excludes separately financed Microcredit Summit Campaign and Action projects)
| Project | Authorization | Real world outcome | Outcome estimates | Economic value in Western terms | RESULTS role | RESULTS value add |
|---|---|---|---|---|---|---|
| Foreign Aid Reform | - | no concrete outcome to date | - | - | 10%? | - |
| Education for All | - | no concrete outcome to date | - | - | 20%? | - |
| Appropriations (TB) - already counted under 2008 | +$50m | 70k lives saved | assume 50% of effort is appropriation; assume $240 to treat and 67% fatal based on tuberculosis treatment page; $50m x 50% / $240 x 67% = 70k lives saved | $140b | 75-80% | $100-110b |
Estimated aggregate impact: $100-110b
Leverage factor: 60,000
This effectiveness estimate is probably an underestimate because budget increases tend to persist from one year to the next. This is very difficult to estimate, but accounting for this conservatively suggests applying a factor of 2 or 3 to the above leverage factor.
120,000 - 200,000 - not counted since counted under 2008
2008 is an excellent year for RESULTS, but this is in large part because we don't have a break out for the subsequent appropriations for the TB authorization bill, and so we count the appropriations all in 2008. If we assume an even split, each of the subsequent years would have their leverage factor increased by roughly 500,000, and 2008's leverage factor would drop by 1,500,000.
Annual budget: $2.2m (data supplied by RESULTS; excludes separately financed Microcredit Summit Campaign and Action projects)
| Project | Authorization | Real world outcome | Outcome estimates | Economic value in Western terms | RESULTS role | RESULTS value add |
|---|---|---|---|---|---|---|
| Global Leadership Against HIV/AIDS, Tuberculosis and Malaria Reauthorization Act (non-TB component) | +$29b (prior act $15b; both over 5 years) | 18m DALYs saved | assume 30% of effort is authorization; most funding goes to HIV; $493/yr patient on ART (Towards an improved investment approach to an effective response to HIV/AIDS, The Lancet 2011, webappendix); not all funds may go on ART, but assuming this is the least effective intervention, this provides a lower bound on effectiveness; $29b x 30% / $493 = 18m life years saved | $1.6t | 20% | $320b pending appropriations outcome |
| Global Leadership Against HIV/AIDS, Tuberculosis and Malaria Reauthorization Act (TB component) | +$4b | 3.4m lives saved | assume 30% of effort is authorization; assume $240 to treat and 67% fatal based on tuberculosis treatment page; $4b x 30% / $240 * 67% = 3.4m lives saved | $6.7t | 75% (we have talked with RESULTS to verify this figure since it creates a huge win for RESULTS and if anything this is a conservative estimate) | $2.9t + $1.1t pending appropriations outcome (split based on $2.3b of $4b appropriated to date) |
| Global Leadership Against HIV/AIDS, Tuberculosis and Malaria Reauthorization Act (TB component; subsequent appropriations); data supplied b RESULTS indicates $2.3b has been appropriated under this act during 2008-2011; we would like to book these successes in the appropriate years but lack a year by year breakout to do so, so we book them all here | +$2.3b | 3.4m lives saved | assume 50% of effort is appropriation; assume $240 to treat and 67% fatal based on tuberculosis treatment page; $2.3b x 50% / $240 * 67% = 3.2m lives saved | $6.4t | 75% | $4.8t in subsequent years |
Estimated aggregate impact: $2.9t + $4.8t in subsequent years + $1.1t pending appropriations
The bulk of the impact this year is through authorization legislation, and we conservatively don't assume this will have a persistant effect for longer than it lasts. Hence we use the raw leverage factor.
1,300,000 + 2,000,000 subsequent + 500,000 pending appropriations
Annual budget: $2.1m (data supplied by RESULTS; excludes separately financed Microcredit Summit Campaign and Action projects)
| Project | FY08 appropriations | Real world outcome | Outcome estimates | Economic value in Western terms | RESULTS role | RESULTS value add | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Global Fund to Fight AIDS, TB, and Malaria | +$120m | 120,000 DALYs saved | assume 50% of effort is appropriations; assume most funding goes to HIV; $493/yr patient on ART (Towards an improved investment approach to an effective response to HIV/AIDS, The Lancet 2011, webappendix); not all funds may go on ART, but assuming this is the least effective intervention, this provides a lower bound on effectiveness | $11b | 1/3 | $3.7b | ||||||||||||||
| Bilateral TB and Global TB Drug Facility | +$70m | 100k lives saved | assume 50% of effort is appropriations; assume $240 to treat and 67% fatal based on tuberculosis treatment page | $200b | 75% | $150b | ||||||||||||||
| Child Survival and Maternal Health | +$90m | 9k-45k lives saved | assume 50% of effort is appropriations; very rough guess $1-5k/life saved | $18b-90b | 40% | $7b-36b | Microfinance | +$40m | 70k individuals lifted out of poverty | assume 50% of effort is appropriations; $200/loan; 50% loans target very poor; 2.4% leave poverty/year (Grameen data); 3 individuals/family; amortize over 20 years | $28b | 50% | $14b | Basic Education and Abolition of School Fees | +$200m | 310k individuals receive primary education | assume 50% of effort is appropriations; EFA will cost $9.1b/year for 170m children (UNICEF estimate cited in Attaining Universal Primary Completion by 2015: How Much Will It Cost?) or $54/child/year; 6 years primary education | $15b-150b | 50%+ (50% on basic ed. and 100% on abolition of school fees) | $8b-80b |
Estimated aggregate impact: $183b-284b
Leverage factor: 90,000 - 140,000
This effectiveness estimate is probably an underestimate because budget increases tend to persist from one year to the next. This is very difficult to estimate, but accounting for this conservatively suggests applying a factor of 2 or 3 to the above leverage factor.
200,000 - 400,000