Thank you for raising this issue, Jack, I share the concern regarding governance and the right accountability mechanisms, particularly as our community is expected to have a lot more money at its disposal. I liked how you not only diagnosed the problem but also shared your own actionable mitigation mechanisms. I have two questions on them and one suggestion:
There are many different interpretations of what a non-profit board should do, but at its very core it has the power to change the CEO. Given how founder-driven philanthropic advisories tend to be, do you think that Ultra’s board would realistically have that power of you? If not, what other mechanisms would it have to push back, especially when you disagree?
I like the concept of personal advisors and I’m curious how you expect it to work in practice:
How will they gather information about your decisions and actions? Is it self-reported, or is there a structure or cadence for proactively getting external feedback
Beyond your personal respect for the advisors, what mechanisms will they have to influence your actions if you disagree? Also, if you have more than one advisor and they disagree with each other, how is that resolved?
Suggestion: EA, as any group, is likely to have shared biases and blind spots. To reduce this risk, I’d suggest including non-EA people both on your board and among your ethics advisors.
I recognise these are ‘what-ifs’ and you might be still figuring out the answers yourself. I’m interested in the operational details because I would love to see similar steps taken across our community so that we can learn together how to bring more accountability to the community. Really glad to see you bringing this discussion forward!
Thank you for your hard work on this report, Rethink Priorities team! I would be happy to be a point of contact if anyone has any questions regarding Lafiya's model or internal inputs used for the analysis.
Thank for writing this and explaining your model to the wider EA community, as well as taking your time to explain the limitations of your calculations, that’s very thoughtful and can inspire an interesting discussion in a global health community here or elsewhere.
And I am happy to hear that Lafiya Nigeria’s analysis has been helpful!
I wish you best of luck with this project and I would be keen to work closer to assess the family planning benefits of your organisation, I know that Lafiya Nigeria can learn a lot from your vast experience and we can address some of the impact assessment limitations together.
Hi Joshua, great question! I've been waiting to finish this phase of the training to have a better estimate of the future $/DALY. Once I'm back to the UK, I'll spend some time to prepare a forecast for the upcoming cost-effectiveness and share a speculative number then! I'm personally quite conservative with future numbers and will make sure to conduct an in-depth analysis before sharing it on the Forum. I'll remember to reply to this comment once it's ready :)
Thank you for your patience with my reply. I'm currently in Nigeria and organising two trainings for 40+ health workers so it's really busy now.
Of course, feel free to use our calculations, I am happy that it can be useful for your organisation. Also, I'd love to see your own cost-effectiveness analysis for OneDay Health, I'll be waiting for your post soon. I'll also post soon forecasted calculations for this year.Â
My strong belief is you do not need a lot to make a lot of positive impact and it is better to do things on a shoestring budget to avoid unnecessary spending. It is yet another exercise in responsibility for the founder - not only for the effects but also for inputs. One thing we are conscious about are the scaling up costs. The costs may increase temporarily but ultimately we are scaling up our health worker network 3.5 times this month and initial calculations look quite promising! Thank you for your kind words - it is important to remember that some of the new costs are investments for future impact.
It is so interesting to hear about your connection with MSI and RHI -I'd love to hear more about it and just dropped you a message on LinkedIn, let's chat soon!
At Lafiya Nigeria, we would be very supportive of this! We understand that GiveWell in particular is very keen to evaluate impact of Sayana Press in community distributed models. Our pilot data clearly shows that family-planning interventions can be highly cost-effective.
Thank you so much for your kind words! It truly is - family planning is a very important area within global health but sadly still not receiving as much attention or donor funding as other causes. I'd love to hear more about your work at OneDay Health, I'm sure there are many lessons learned to be shared.
1. Of course, here is our DALY calculation - we based some of key health assumptions on the model provided by  Marie Stopes International and their methodology. This is the first iteration of our model so I'd be keen to see how this model's assumption compare to others in the field - let's talk more!
2. Yes, as you'll be able to see in the model, out total cost of the pilot was $6256.8 USD to deliver the first 2400 doses. We are currently scaling up our program so hoping to bring this number even lower. The key point here is that both Jefferson and myself have been working on it without compensation. I decided to go full time in October after seeing the results of the pilot and we also just employed our Program Officer, so we will be adding those costs as we incur them.
3. Family planning is still a difficult issue to discuss - both with end users and state officials. Jigawa started work on family planning only in 2002 and for the first 15 years, it was more of an afterthought it seems. Then the Federal Ministry of Health prioritised family planning and released national guidelines to increase the use of modern contraception. So, the states are now building the groundwork for advocacy and distribution, struggling with budgeting for such high needs.Â
On the user side, the fertility rate is 8 children per family in Jigawa state, which means that this a fast-growing problem. Few people use any contraception in the state but many health facilities receive no contraceptives products at all. Our pilot number of contraception delivered may seem small but FP state coordinator told us that last year they received only 1400 doses of any injectables across 400 health facilities in the state.
This is definitely a fascinating question. It seems like there are numerous push and pull factors for both state provision and user demand for family planning. Many of our users report fear of side effects, fear of infertility, and lack of any education of family planning as the reasons of their previous lack of FP usage. Our model addresses both demand generation as well as providing the products to meet this demand in an accessible and affordable way.
Thank you for raising this issue, Jack, I share the concern regarding governance and the right accountability mechanisms, particularly as our community is expected to have a lot more money at its disposal. I liked how you not only diagnosed the problem but also shared your own actionable mitigation mechanisms. I have two questions on them and one suggestion:
Suggestion: EA, as any group, is likely to have shared biases and blind spots. To reduce this risk, I’d suggest including non-EA people both on your board and among your ethics advisors.
I recognise these are ‘what-ifs’ and you might be still figuring out the answers yourself. I’m interested in the operational details because I would love to see similar steps taken across our community so that we can learn together how to bring more accountability to the community. Really glad to see you bringing this discussion forward!
Congratulations to EA Nigeria for facilitating such an inspiring event and thank you for inviting Lafiya Nigeria to share our program experience!
Thank you for your hard work on this report, Rethink Priorities team! I would be happy to be a point of contact if anyone has any questions regarding Lafiya's model or internal inputs used for the analysis.
Thank for writing this and explaining your model to the wider EA community, as well as taking your time to explain the limitations of your calculations, that’s very thoughtful and can inspire an interesting discussion in a global health community here or elsewhere.
And I am happy to hear that Lafiya Nigeria’s analysis has been helpful!
I wish you best of luck with this project and I would be keen to work closer to assess the family planning benefits of your organisation, I know that Lafiya Nigeria can learn a lot from your vast experience and we can address some of the impact assessment limitations together.
Hi Joshua, great question! I've been waiting to finish this phase of the training to have a better estimate of the future $/DALY. Once I'm back to the UK, I'll spend some time to prepare a forecast for the upcoming cost-effectiveness and share a speculative number then! I'm personally quite conservative with future numbers and will make sure to conduct an in-depth analysis before sharing it on the Forum. I'll remember to reply to this comment once it's ready :)
Hi Nick,
Thank you for your patience with my reply. I'm currently in Nigeria and organising two trainings for 40+ health workers so it's really busy now.
Of course, feel free to use our calculations, I am happy that it can be useful for your organisation. Also, I'd love to see your own cost-effectiveness analysis for OneDay Health, I'll be waiting for your post soon. I'll also post soon forecasted calculations for this year.Â
My strong belief is you do not need a lot to make a lot of positive impact and it is better to do things on a shoestring budget to avoid unnecessary spending. It is yet another exercise in responsibility for the founder - not only for the effects but also for inputs. One thing we are conscious about are the scaling up costs. The costs may increase temporarily but ultimately we are scaling up our health worker network 3.5 times this month and initial calculations look quite promising! Thank you for your kind words - it is important to remember that some of the new costs are investments for future impact.
It is so interesting to hear about your connection with MSI and RHI -I'd love to hear more about it and just dropped you a message on LinkedIn, let's chat soon!
Sending lots of love still from Nigeria,
Klau
At Lafiya Nigeria, we would be very supportive of this! We understand that GiveWell in particular is very keen to evaluate impact of Sayana Press in community distributed models. Our pilot data clearly shows that family-planning interventions can be highly cost-effective.
Thank you so much, Grace!Â
Hi Nick,
Thank you so much for your kind words! It truly is - family planning is a very important area within global health but sadly still not receiving as much attention or donor funding as other causes. I'd love to hear more about your work at OneDay Health, I'm sure there are many lessons learned to be shared.
1. Of course, here is our DALY calculation - we based some of key health assumptions on the model provided by  Marie Stopes International and their methodology. This is the first iteration of our model so I'd be keen to see how this model's assumption compare to others in the field - let's talk more!
2. Yes, as you'll be able to see in the model, out total cost of the pilot was $6256.8 USD to deliver the first 2400 doses. We are currently scaling up our program so hoping to bring this number even lower. The key point here is that both Jefferson and myself have been working on it without compensation. I decided to go full time in October after seeing the results of the pilot and we also just employed our Program Officer, so we will be adding those costs as we incur them.
3. Family planning is still a difficult issue to discuss - both with end users and state officials. Jigawa started work on family planning only in 2002 and for the first 15 years, it was more of an afterthought it seems. Then the Federal Ministry of Health prioritised family planning and released national guidelines to increase the use of modern contraception. So, the states are now building the groundwork for advocacy and distribution, struggling with budgeting for such high needs.Â
On the user side, the fertility rate is 8 children per family in Jigawa state, which means that this a fast-growing problem. Few people use any contraception in the state but many health facilities receive no contraceptives products at all. Our pilot number of contraception delivered may seem small but FP state coordinator told us that last year they received only 1400 doses of any injectables across 400 health facilities in the state.
This is definitely a fascinating question. It seems like there are numerous push and pull factors for both state provision and user demand for family planning. Many of our users report fear of side effects, fear of infertility, and lack of any education of family planning as the reasons of their previous lack of FP usage. Our model addresses both demand generation as well as providing the products to meet this demand in an accessible and affordable way.
Lots of love from Nigeria,
Klau
Thank you so much!