Targeting UCTs to women in the third trimester of pregnancy under these assumptions would cost about USD PPP 92,000 (or $39,000 in nominal dollars) per child death averted. We can benchmark these calculations to 37 WHO-recommended maternal and child health interventions in East Africa as estimated by Stenberg et al. (2021). Across interventions and scenarios, the cost per death averted ranges from USD PPP 27 to USD PPP 222,952.[1] Hence, even without taking into account any of the other documented benefits of UCTs (such as gains in consumption), the transfers are squarely in the range of cost per death averted among these WHO-recommended interventions.
Article at p. 34 (footnote # is 36).
Stenberg et al. is here. Eastern sub-Saharan Africa is table 3. I’m not sure how to convert HLYs into deaths averted, but of the 37 interventions, #36 (ACER [2]of 1156.2) and #37 (ACER of 1310.6) are significantly less cost-effective than even #35 (ACER of 355.9). Based on the range in the article, it sounds like UCT-for-pregnant-women might rank somewhere between #35 and #36 here?
That doesn’t sound like a particularly strong showing. The 27th out of 37 interventions has an ACER of 94.9. Some interventions I’ve seen discussed in EA circles are rated by Stenberg et. al much lower than even that: Vitamin A supplementation (0-4 years), 7.1; Kangaroo mother care, 20.1; Syphilis detection and treatment in pregnancy, 24.8.
Stenberg et al. (2021) evaluates cost-effectiveness using three coverage level scenarios: 50%, 80%, and 95%, and report health impacts in terms of healthy life years (HLY) saved. We converted HLYs to deaths averted using WHO data on total and healthy life expectancy in Kenya (World Health Organization, 2025).
I imagine that’s the purpose of the trial—to optimise the programme for lifesaving and get that cost-per-life down.
They’ve already got data that villages nearer a physician show stronger benefit, timing on month of birth shows stronger benefit. I wouldn’t be surprised to find other things (e.g. maternal age, child number, season in year, country, harvest quality) contributing and therefore optimisable, as well as the benefit/$ rising if the $ amount drops.
Also the 77% drop from a one-time intervention is already a huge whole-issue tackle that’s going to have massive donor appeal (e.g. give $1000 to safeguard one child—this child). We had a Forum post some time back from someone expressing strong preference for knowing exactly where their money went. It’s a very common donor preference.
Adding this quote for context:
Targeting UCTs to women in the third trimester of pregnancy under these assumptions
would cost about USD PPP 92,000 (or $39,000 in nominal dollars) per child death averted.
We can benchmark these calculations to 37 WHO-recommended maternal and child health
interventions in East Africa as estimated by Stenberg et al. (2021). Across interventions
and scenarios, the cost per death averted ranges from USD PPP 27 to USD PPP 222,952.[1]
Hence, even without taking into account any of the other documented benefits of UCTs (such
as gains in consumption), the transfers are squarely in the range of cost per death averted
among these WHO-recommended interventions.
Article at p. 34 (footnote # is 36).
Stenberg et al. is here. Eastern sub-Saharan Africa is table 3. I’m not sure how to convert HLYs into deaths averted, but of the 37 interventions, #36 (ACER [2]of 1156.2) and #37 (ACER of 1310.6) are significantly less cost-effective than even #35 (ACER of 355.9). Based on the range in the article, it sounds like UCT-for-pregnant-women might rank somewhere between #35 and #36 here?
That doesn’t sound like a particularly strong showing. The 27th out of 37 interventions has an ACER of 94.9. Some interventions I’ve seen discussed in EA circles are rated by Stenberg et. al much lower than even that: Vitamin A supplementation (0-4 years), 7.1; Kangaroo mother care, 20.1; Syphilis detection and treatment in pregnancy, 24.8.
Stenberg et al. (2021) evaluates cost-effectiveness using three coverage level scenarios: 50%, 80%, and 95%, and report health impacts in terms of healthy life years (HLY) saved. We converted HLYs to deaths averted using WHO data on total and healthy life expectancy in Kenya (World Health Organization, 2025).
“The average cost-effectiveness ratios (ACERs) were calculated by dividing the total cost for scale-up by the total health gain.”
I imagine that’s the purpose of the trial—to optimise the programme for lifesaving and get that cost-per-life down.
They’ve already got data that villages nearer a physician show stronger benefit, timing on month of birth shows stronger benefit. I wouldn’t be surprised to find other things (e.g. maternal age, child number, season in year, country, harvest quality) contributing and therefore optimisable, as well as the benefit/$ rising if the $ amount drops.
Also the 77% drop from a one-time intervention is already a huge whole-issue tackle that’s going to have massive donor appeal (e.g. give $1000 to safeguard one child—this child). We had a Forum post some time back from someone expressing strong preference for knowing exactly where their money went. It’s a very common donor preference.
Well done GiveDirectly!