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Population Services International (PSI)
2008-2009 update to 2007-2008 report on PSI
All of the content following this section comes from our 2007-2008 report on developing-world aid, which was published on 12/6/2007.
We intend to complete a full update on Population Services International as part of our 2008-2009 report. In the meantime, we have conducted a preliminary scan of its publicly available information. As of 3/2/2009, we still endorse Population Services International as one of the top international aid charities we have seen. We offer the following comments as updates on the 2007-2008 content.
Update on PSI's transparency: In 2007-2008, PSI stood out from other charities we examined partly because of its transparency: its willingness to publicly share information about its operations, expenses and estimated impact. Since then PSI has further improved its transparency, with a new Health Impact page that provides information on its sales, expenses, and estimated health impacts broken out by product and country. Much of the information we cited from the Unit Cost Analyses and Sales Reports (which we could publicly provide only excerpts from, although we had access to the full documents) is included in the documents on the Health Impact page, although past years (prior to 2006 for some information and 2007 for other information) are not available.
Update on PSI's activities: based on data from pages 2 and 7 of the 2006 Cost-effectiveness report, we believe that PSI's 2006 expenses were more concentrated than in previous years on (a) sub-Saharan Africa (up from 72% in 2005 to around 80% in 2006, with roughly even parts of this shift coming from other regions); (b) malaria products (up from 23% in 2005 to around 30% in 2006; HIV/AIDS and contraception products maintained roughly stable shares of expenses, with the balance coming from smaller programs). We feel that the activities we focus on in our review are still representative of PSI's activities as a whole (and if anything are more representative due to the higher share of malaria-related activities.)
Update on PSI's effectiveness and cost-effectiveness: PSI still does not appear to publish the full details of its cost-effectiveness calculations; it also does not track impact for all its programs (see its scorecard), though it does so more than the great majority of other charities.
We urge caution in interpreting our cost-effectiveness estimates, as they involve many assumptions and are based on the few regions for which we had relevant data available. However, we do not wish to revise these estimates numerically. Other cost-effectiveness estimates for insecticide-treated nets (detailed here) are consistent with our existing estimate for PSI's program.
Since last year, we have investigated some literature on the topic of selling vs. giving away insecticide-treated nets (details here), and now believe that the weight of available evidence is against PSI's stance that selling is superior.
Other notes: we have updated material on two topics discussed in this review:
- The Disability-adjusted life year (DALY) metric
- The issue of publication bias.
Review of PSI: Summary (from 2007-2008 report)
What they do: PSI sells and promotes products and services addressing major causes of death in the developing world: condoms to prevent HIV/AIDS, insecticide-treated bednets to prevent malaria, birth control to prevent unwanted pregnancies (which often lead to death in childbirth or death due to a botched abortion), etc. Close to 50% of PSI's budget goes to HIV prevention activities; roughly 20% goes to malaria treatment and prevention; roughly 10% goes to family planning. The rest is detailed below. PSI works mostly in sub-Saharan Africa (75%) and south-east Asia.
Does it work? Condoms and bednets (PSI's two biggest activities) are proven methods for preventing HIV/AIDS and malaria, but only when used properly and consistently. PSI only monitors use of its products and services in a small percentage of regions where it works, but the evaluations we went through left us relatively confident in PSI's impact, and thus relatively confident that it is saving lives.
What do you get for your dollar: We estimate that it costs PSI $650-$1000 to prevent a case of HIV/AIDS and
$500-$2500 to prevent a death from malaria; across the organization, we estimate that it costs PSI about $650-$1000 to save a life. These estimates do not include other benefits of PSI's activities, such as preventing unwanted pregnancies and reducing non-fatal malaria infections.
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