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Vitamin A supplementation (VAS) - Helen Keller InternationalBurkina FasoCameroonCôte d'IvoireDRCGuineaKenyaMadagascarMaliNigerAdamawaAkwa IbomBenueEkitiNasarawaTarabaAnambraDeltaEbonyiEdoImoKogiOgunOsunRivers
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Funding allocation
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Percentage of total program costs covered by Helen Keller International43%64%47%47%55%47%60%43%36%47%47%47%47%47%47%47%47%47%47%47%47%47%47%47%
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Percentage of total costs covered by Nutrition International (vitamin A capsule procurement)6%6%7%7%5%7%7%8%8%7%7%7%7%7%7%7%7%7%7%7%7%7%7%7%
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Percentage of total program costs covered by other philanthropic actors6%0%13%13%10%13%0%18%26%13%13%13%13%13%13%13%13%13%13%13%13%13%13%13%
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Government financial costs as a percentage of total costs15%0%3%3%0%3%3%0%0%3%3%3%3%3%3%3%3%3%3%3%3%3%3%3%
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In-kind government costs as a percentage of total costs30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%30%
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Number of children covered with VAS with a hypothetical donation
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Donation to Helen Keller International (arbitrary size)$100,000$100,000$100,000$100,000$100,000$100,000$100,000$100,000$100,000$100,000$100,000$100,000$100,000$100,000$100,000$100,000$100,000$100,000$100,000$100,000$100,000$100,000$100,000$100,000
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Total amount spent on hypothetical program by all contributors$231,984$156,167$214,597$214,597$180,908$214,597$167,137$231,232$276,482$214,597$214,597$214,597$214,597$214,597$214,597$214,597$214,597$214,597$214,597$214,597$214,597$214,597$214,597$214,597
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Cost per child covered per supplementation round$1.06$1.14$1.02$1.02$1.39$1.02$1.02$0.80$0.86$1.02$1.02$1.02$1.02$1.02$1.02$1.02$1.02$1.02$1.02$1.02$1.02$1.02$1.02$1.02
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Supplementation rounds per year222222222222222222222222
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Cost per child covered per year$2.11$2.27$2.03$2.03$2.79$2.03$2.03$1.60$1.72$2.03$2.03$2.03$2.03$2.03$2.03$2.03$2.03$2.03$2.03$2.03$2.03$2.03$2.03$2.03
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Total number of children covered in one year109,83968,700105,472105,47264,914105,47282,146144,217160,815105,472105,472105,472105,472105,472105,472105,472105,472105,472105,472105,472105,472105,472105,472105,472
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Meta-analysis finding on relative rate of mortality reduction
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Relative risk of all-cause mortality for children aged 6- to 59-months participating in VAS programs
0.760.760.760.760.760.760.760.760.760.760.760.760.760.760.760.760.760.760.760.760.760.760.760.76
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Corresponding reduction in all-cause mortality rates24%24%24%24%24%24%24%24%24%24%24%24%24%24%24%24%24%24%24%24%24%24%24%24%
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Estimated coverage in RCTs included in meta-analysis87%87%87%87%87%87%87%87%87%87%87%87%87%87%87%87%87%87%87%87%87%87%87%87%
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Reduction in all-cause mortality rates for all children treated27%27%27%27%27%27%27%27%27%27%27%27%27%27%27%27%27%27%27%27%27%27%27%27%
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Mortality reduction with hypothetical donation
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Baseline deaths per 1,000 child-years for children aged 6- to 59-months17.88.58.97.414.74.06.717.919.416.26.610.27.710.217.64.78.710.66.64.65.66.84.29.0
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Expected number of deaths in hypothetical cohort of children over one year in absence of VAS program
1,9555849427779524235522,5863,1211,7106921,0818111,0761,8584959141,116697484591718444947
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Expected deaths averted in cohort due to program (before internal and external validity adjustments)
537161259214262116152711858470190297223296511136251307192133163197122260
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Internal validity adjustment — VAS74%74%74%74%74%74%74%74%74%74%74%74%74%74%74%74%74%74%74%74%74%74%74%74%
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External validity adjustment — VAS31%53%26%48%29%51%59%36%57%30%16%22%18%27%37%13%14%29%14%17%18%17%14%20%
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Additional adjustment for baseline mortality rate and VAD prevalence estimates in Kenya0%0%0%0%0%41%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%
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External validity adjustment (after additional adjustment)31%53%26%48%29%30%59%36%57%30%16%22%18%27%37%13%14%29%14%17%18%17%14%20%
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Expected deaths averted in cohort due to program (after internal and external validity adjustments)
123.262.749.675.856.225.665.8186.9364.1103.222.847.329.858.7138.212.626.665.919.916.821.624.912.738.5
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Value assigned to averting the death of a 6- to 59-month-old child (VAS)119119119119119119119119119119119119119119119119119119119119119119119119
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Total units of value from mortality reduction14,6337,4495,8889,0036,6783,0457,81022,19643,23212,2582,7055,6163,5426,97416,4131,5013,1567,8272,3641,9922,5642,9551,5104,567
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Development benefits
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Units of value from development effects per treatment-year of VAS, compared to SMC (before internal and external adjustments)
47%47%47%47%47%47%47%47%47%47%47%47%47%47%47%47%47%47%47%47%47%47%47%47%
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Units of value from development effects per treatment-year of SMC, average across contexts
0.090.090.090.090.090.090.090.090.090.090.090.090.090.090.090.090.090.090.090.090.090.090.090.09
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Units of value from development effects per treatment-year of VAS (before internal and external validity adjustments)
0.040.040.040.040.040.040.040.040.040.040.040.040.040.040.040.040.040.040.040.040.040.040.040.04
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Units of value from development benefits1,0581,1278491,5735869771,4971,5942,8689735317065938801,199412469952460558589558461655
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Initial results
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Initial cost per life saved estimate$1,882$2,489$4,328$2,830$3,216$8,367$2,541$1,237$759$2,079$9,420$4,537$7,194$3,653$1,552$16,975$8,073$3,255$10,777$12,793$9,937$8,623$16,877$5,579
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Total units of value generated 15,6928,5766,73710,5767,2644,0239,30723,79046,10013,2323,2366,3214,1357,85417,6131,9133,6258,7792,8252,5503,1533,5131,9715,222
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Units of value generated per dollar spent0.0680.0550.0310.0490.0400.0190.0560.1030.1670.0620.0150.0290.0190.0370.0820.0090.0170.0410.0130.0120.0150.0160.0090.024
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Initial cost-effectiveness estimate in multiples of cash transfers20.216.49.414.712.05.616.630.749.718.44.58.85.710.924.52.75.012.23.93.54.44.92.77.3
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Percent of total units of value generated from mortality reduction93%87%87%85%92%76%84%93%94%93%84%89%86%89%93%78%87%89%84%78%81%84%77%87%
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Percent of total units of value generated from development benefits7%13%13%15%8%24%16%7%6%7%16%11%14%11%7%22%13%11%16%22%19%16%23%13%
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Supplemental charity-level adjustments — Helen Keller International
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Risk of wastage
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Double treatment25%25%25%25%25%25%44%25%25%25%25%25%25%25%25%25%25%25%25%25%25%25%25%25%
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Ineffective goods0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%
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Goods purchased and left in storage until they expire / Cash doesn't reach recipients or is taken back from them inappropriately
0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%
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Total adjustment for risk of wastage25%25%25%25%25%25%44%25%25%25%25%25%25%25%25%25%25%25%25%25%25%25%25%25%
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Quality of monitoring and evaluation
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Misappropriation without monitoring results15%15%15%15%15%15%15%15%15%15%15%15%15%15%15%15%15%15%15%15%15%15%15%15%
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False monitoring results2%2%2%2%2%2%2%2%2%2%2%2%2%2%2%2%2%2%2%2%2%2%2%2%
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Total adjustment for quality of monitoring and evaluation17%17%17%17%17%17%17%17%17%17%17%17%17%17%17%17%17%17%17%17%17%17%17%17%
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Confidence in funds being used for intended purpose
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Change of priorities0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%
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Non-funding bottlenecks0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%0%
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Within-org fungibility5%5%5%5%5%5%5%5%5%5%5%5%5%5%5%5%5%5%5%5%5%5%5%5%
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Total adjustment for confidence in funds being used for intended purpose5%5%5%5%5%5%5%5%5%5%5%5%5%5%5%5%5%5%5%5%5%5%5%5%
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Total adjustment factor53%53%53%53%53%53%34%53%53%53%53%53%53%53%53%53%53%53%53%53%53%53%53%53%
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Results after supplemental charity-level adjustments
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Expected deaths averted in cohort due to program6533264030142299193551225163173714351191113720
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Cost per death averted, after supplemental charity-level adjustments$3,552$4,697$8,165$5,340$6,069$15,787$7,473$2,334$1,433$3,922$17,773$8,561$13,573$6,893$2,929$32,028$15,232$6,142$20,334$24,137$18,748$16,271$31,843$10,527
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Total units of value generated8,3174,5453,5715,6063,8502,1323,16412,60924,4337,0131,7153,3502,1924,1639,3351,0141,9214,6531,4971,3521,6711,8621,0452,768
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Units of value generated per dollar spent0.0360.0290.0170.0260.0210.0100.0190.0550.0880.0330.0080.0160.0100.0190.0430.0050.0090.0220.0070.0060.0080.0090.0050.013
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Cost-effectiveness in multiples of cash transfers, after supplemental charity-level adjustments
10.78.75.07.86.33.05.616.326.39.72.44.73.05.813.01.42.76.52.11.92.32.61.53.8
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Supplemental intervention-level adjustments — VAS
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Outcomes included in our core model (above)
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Mortality effects
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Development effects
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Supplemental intervention-level adjustments
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Short-term consequences of reduced infectious disease morbidity6%6%6%6%6%6%6%6%6%6%6%6%6%6%6%6%6%6%6%6%6%6%6%6%
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Short-term anemia effects9%9%9%9%9%9%9%9%9%9%9%9%9%9%9%9%9%9%9%9%9%9%9%9%
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Investment of income increases3%3%3%3%3%3%3%3%3%3%3%3%3%3%3%3%3%3%3%3%3%3%3%3%
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Vision benefits9%9%9%9%9%9%9%9%9%9%9%9%9%9%9%9%9%9%9%9%9%9%9%9%
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Benefits from other programs supported by our funding (e.g. deworming, immunizations)18%18%18%18%18%18%18%18%18%18%18%18%18%18%18%18%18%18%18%18%18%18%18%18%
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Interaction between VAS and vaccines2%2%2%2%2%2%2%2%2%2%2%2%2%2%2%2%2%2%2%2%2%2%2%2%
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Effect on fertilityNot specifiedNot specifiedNot specifiedNot specifiedNot specifiedNot specifiedNot specifiedNot specifiedNot specifiedNot specifiedNot specifiedNot specifiedNot specifiedNot specifiedNot specifiedNot specifiedNot specifiedNot specifiedNot specifiedNot specifiedNot specifiedNot specifiedNot specifiedNot specified