Cost-effectiveness analysis of Lafiya Nigeria intervention
This article was first published on the Rethink Priorities website by Greer Gosnell, Jamie Elsey, Tom Hird & John Firth
Summary and key takeaways
We model the near-term cost-effectiveness (2025-2026) of Lafiya Nigeria’s intervention, in which they upskill trained female health workers to provide family planning counseling and distribute injectable contraceptives (Sayana Press, or DMPA-SC) to women in remote parts of rural northern Nigeria. This update supersedes earlier work modeling the intervention’s cost-effectiveness over 2024-2025.
We estimate that the cost-effectiveness of the intervention is $23 per unintended pregnancy averted at the beginning of 2025, falling to $12 per unintended pregnancy by the end of 2026 when approximately calibrating the model to the current and planned rate of intervention scaling.
We provide additional cost-effectiveness estimates, including cost per DALY averted (maternal, child, total), death averted (maternal, child, total), couple-year protection, additional contraceptive user, unsafe abortion averted, and $1 increase in women’s income, which can be found here.
We also provide a rough estimate of income effects: increasing the income of women serviced by Lafiya Nigeria by $1 cost $0.42 at the beginning of 2025, declining to $0.35 by the end of 2026. Reproducing GiveWell’s approach to understanding these benefits in terms of multiples of cash transfers, we find that the intervention’s impact on income increases from approximately 35x cash transfers at the beginning of 2025 to 42x cash transfers by the end of 2026.
The most substantive update to the model aims to account for the rise in self-injection among Lafiya Nigeria’s client base in 2025, and the resulting distribution of an increased number of doses for self-injection at home. We have additionally refined some of our maternal health outcome estimates to improve accuracy following conversations with practitioners in the field, and have adjusted parameter inputs based on changes to Lafiya Nigeria’s operations and costs (most notably the cost per dose, which increased from $0.27 to $0.85), and to better reflect their updated M&E data.
We conduct uncertainty analysis using a Monte Carlo simulation to gain insight into the effect of uncertainties from 16 inputs/factors on our cost-effectiveness estimates (Figure 1).
Looking at the effect of uncertainty on cost per unintended pregnancy averted, in Q1 2025 the 90% highest density interval (HDI) spans from $21-$25 per unintended pregnancy averted (mean cost-effectiveness is ~$23). This uncertainty narrows over time, with a 90% HDI spanning $11-$13 in Q4 2026 (mean cost-effectiveness is ~$12).
Uncertainties affect our cost-effectiveness estimation for other modeled outcomes similarly, except for the intervention’s impacts on income in multiples of cash transfers: increasing cost-effectiveness over time causes the absolute magnitude of this outcome to increase over time (from ~33x in Q1 2025 to 39x in Q4 2026) and the uncertainty bounds widen slightly over time (14x-53x to 18x-67x). The 90% HDIs exceed a 10x multiplier for cash transfers in all quarters we assessed.
Overall, our uncertainty analysis maintains the impression of cost-effectiveness from the spreadsheet version of the model, and indicates continuing increases in cost-effectiveness over time.
