Sometimes, skepticism about philanthropy in developing countries is in order. Here's an interesting comment (via Chris Blattman) from Friends of Ethiopia, where Todd Johnson asked his friend Sammy (an Ethiopian entrepreneur) about the effect of NGOs:
"Africans don't see a reward system in place for being entrepreneurial. In fact, they view it as a matter of survival, not an opportunity to lift themselves out of poverty. Rather, what they learn at a very early age, is that in order to make good money, they should learn to speak English incredibly well and then maybe, just maybe, they can get a job driving for an NGO. In a few years, if they play their cards right, they might be able to land an NGO job as a project manager and even advance further."
Sammy's point was simply this. As a struggling businessman creating new start-ups, he could not compete with what NGO's were paying for some of the best and brightest. And even worse, he said, "by the time the NGO's are done with them, there isn't an ounce of entrepreneur left."
This makes it all the more important that we understand which forms of philanthropy are most efficient, with the greatest impact on welfare for the least expense and interference with the local economy. And I don't think that there is any better candidate than basic public health campaigns, particularly measles vaccination.
Relative to its impact, mass vaccination is perhaps the least economically invasive intervention imaginable. It costs very, very little for each vaccinated child (generally less than $1), and it's spread evenly throughout the population.
Meanwhile, the successes have been overwhelming. From 2000 to 2008, the Measles Initiative reduced mortality by 78 percent worldwide and 92 percent in Africa, with an estimated total impact of 4.3 million lives saved. Given that the initiative has invested $670 million in vaccinations to date, the cost per life saved has been roughly $150. (How's that for cost-effectiveness?) Even this, however, is an overestimate of the lifetime cost of the program, since the costs of vaccination are incurred upfront while the benefits dribble out over time.
You can see the decline in measles deaths in this chart from the World Health Organization's annual report on vaccine-preventable diseases: