Thanks for these thoughtful questions, and you’re right that scaling hasn’t been straightforward.
The favorable exchange rate has significantly improved our dollar-denominated cost per infant. The Naira has depreciated by roughly 4x relative to the dollar since 2020, which is the dominant driver of that reduction. At the same time, we’ve increased our total cash transfer from N4,000 to N11,000 to keep the incentive meaningful for caregivers in light of inflation. We also track budget-versus-actuals in detail and review operational trends weekly. That visibility has helped us adapt to many of the realities of operating in remote and insecure areas while also identifying cost efficiencies. Managing costs at scale requires continuously responding to changing conditions such as inflation, fuel prices, security dynamics, and transportation constraints.
Expansion to other geographies is an open question. We’ve reviewed different countries, weighing factors like security, existing health infrastructure, disease burden, vaccination coverage, and population density (some top countries include Niger, DRC, Chad, and Cameroon). We may extend our coverage surveys to Niger as a near-term step because we think there may be some important similarities to northern Nigeria and potential gaps in existing vaccination data that could help answer key questions related to estimated cost-effectiveness. We’re also exploring a lower-cost delivery model (see below) that could make expansion more viable in contexts where our current model would not be cost-effective to operate.
We think the most promising path to improving cost-effectiveness is through alternative incentive modalities. We’re actively exploring how to deliver cash incentives through clinic staff or community mobilizers. If we can develop a lower-overhead transfer method that reaches caregivers directly at the point of immunization with appropriate verifications, it could unlock geographies where our current delivery model is not cost-effective enough to operate. We’re interested in understanding what becomes possible when delivery costs fall substantially by challenging assumptions and adapting the model to different operational contexts.
Thanks for these thoughtful questions, and you’re right that scaling hasn’t been straightforward.
The favorable exchange rate has significantly improved our dollar-denominated cost per infant. The Naira has depreciated by roughly 4x relative to the dollar since 2020, which is the dominant driver of that reduction. At the same time, we’ve increased our total cash transfer from N4,000 to N11,000 to keep the incentive meaningful for caregivers in light of inflation. We also track budget-versus-actuals in detail and review operational trends weekly. That visibility has helped us adapt to many of the realities of operating in remote and insecure areas while also identifying cost efficiencies. Managing costs at scale requires continuously responding to changing conditions such as inflation, fuel prices, security dynamics, and transportation constraints.
Expansion to other geographies is an open question. We’ve reviewed different countries, weighing factors like security, existing health infrastructure, disease burden, vaccination coverage, and population density (some top countries include Niger, DRC, Chad, and Cameroon). We may extend our coverage surveys to Niger as a near-term step because we think there may be some important similarities to northern Nigeria and potential gaps in existing vaccination data that could help answer key questions related to estimated cost-effectiveness. We’re also exploring a lower-cost delivery model (see below) that could make expansion more viable in contexts where our current model would not be cost-effective to operate.
We think the most promising path to improving cost-effectiveness is through alternative incentive modalities. We’re actively exploring how to deliver cash incentives through clinic staff or community mobilizers. If we can develop a lower-overhead transfer method that reaches caregivers directly at the point of immunization with appropriate verifications, it could unlock geographies where our current delivery model is not cost-effective enough to operate. We’re interested in understanding what becomes possible when delivery costs fall substantially by challenging assumptions and adapting the model to different operational contexts.