The Sustainable Development Goals (SDGs) are ambitious but in deep trouble. Benefit–cost analysis can help. This Special Issue highlights 12 of the most efficient interventions to speed up progress on the SDGs with Benefit–Cost Ratios (BCRs) above 15. The approaches cover tuberculosis, education, maternal and newborn health, agricultural R&D, malaria, e-procurement, nutrition, land tenure security, chronic diseases, trade, child immunization, and skilled migration. Spanning 2023–2030, these policy approaches are estimated to cost an annual average of $41 billion (of which $6 billion is non-financial). They will realistically deliver $2.1 trillion in annual benefits, consisting of $1.1 trillion in economic benefits and 4.2 million lives saved. The pooled benefit–cost ratio of all 12 investments is 52. By prioritizing these high-impact “best buy” interventions, decision-makers can enhance resource allocation and contribute most efficiently to the SDGs.

This article examines a policy of scaling up LLINs by 10 percentage points from 2020 levels with a 90% cap in the 29 highest-burden countries in Africa along with social and behavioral change (SBC) and information education and communication (IEC) campaigns to increase the use and effectiveness of LLINs. The incremental cost of this scenario compared to a baseline of maintaining malaria interventions at 2020 levels has a present-day (2023) value of 5.7 billion US$ 2021 discounted at 8% over the period 2023–2030 (undiscounted starting at US$ 416 million in 2023 increasing to US$ 1.4 billion in 2030). This investment will prevent 1.07 billion clinical cases and save 1,337,069 lives. With standardized Copenhagen Consensus Center assumptions, the mortality benefit translates to a present value of US$ 225.9 billion. The direct economic gain is also substantial: the incremental scenarios lead to US$ 7.7 billion in reduced health system expenditure from the reduced treatment of cases, a reduction in the cost of delivering malaria control activities, and reduced household out-of-pocket expenses for malaria treatment. The productivity gains from averted employee and caretaker absenteeism and presenteeism add benefits with a present value of US$ 41.7 billion. Each dollar spent on the incremental scenario delivers US$ 48 in social and economic benefits.

The current challenge of education systems is learning. Across low-income countries (LICs) and lower-middle-income countries (LMCs), 62 % of 10-year-olds could not read at a minimally sufficient level in 2015. This study provides an overview of recent spending on education and its correlation with learning outcomes. We show that the relationship between education spending and learning is historically weak. From 2000 to 2015, LICs and LMCs increased spending on education in primary schools by ~$137 per student, an 80 % inflation-adjusted increase, with no corresponding change on the average learning outcomes. We then conduct a benefit-cost analysis of candidate interventions that could increase learning at low cost. Two interventions – structured pedagogy and, teaching at the right level, with and without a technology component generate large benefit-cost ratios. If deployed uniformly to reach 90 % of the 467 million students in LICs and LMCs, these interventions would cost on average $18 per student per year or $7.6 billion annually, generating $65 in benefits for every $1 spent. The economic logic behind this finding is that the hard and costly work of getting children into primary schools has mostly been accomplished, leaving open the possibility of learning interventions that improve the efficiency of the existing education system at low cost. Our results show that increasing education expenditure by just 6 % could increase learning by 120 % if directed toward these highly cost-effective interventions.

In almost every country, government is the largest buyer of works, goods, and services from the private sector. Through the laws and practice of public procurement, governments create competition among firms, thus optimizing public expenditure. However, public procurement is often associated with inefficient allocation of resources and corruption. One method to reduce inefficiencies and abuse in public procurement is the use of e-government procurement (e-GP) platforms. Yet nearly 40% of countries—mostly low- and lower-middle income countries—do not have functioning e-GP platforms. Cost–benefit analysis is used to make the investment case for the development and integration of e-procurement systems in low- and lower middle-income countries. The costs of setting up an e- GP system include an initial investment of $9.03 million, on average, for the planning, design, and build phases spread over a 5-year period. Annual operating and maintenance expenses during pilot and deployment phases are estimated at $1.1 million annually. In total, it is estimated that the net present value of costs to design, build, test, deploy, and operate a robust e-GP system is $16.7 million for a typical low- and middle-income country (at an 8% discount rate). While there are many tangible benefits of e-GP, the benefit assessed here is the reduction in the prices of goods, works, and services paid by government buyers. Using the average percentage reduction in procurement prices of 6.75%, the savings from an e-procurement system are valued at $637.9 million and $5.2 billion for low- and lower middle-income countries, respectively. The benefit–cost ratio of implementing an e-GP system in the average low-income country ranges from 8 to 58 and is 142 to 473 for a lower middle-income country. The size of the procurement market, the reduction in procurement prices, the duration of the implementation process, and the penetration rate of e-GP throughout government are principal determinants in the return on investment.

Drawing upon recent studies that empirically estimate both the benefits and costs of trade, this paper addresses a simple and important question: By how much do the benefits of increased global trade outweigh the costs? To the best of our knowledge, this is the first attempt to answer this question at global and World Bank income-grouping levels using empirically estimated relationships from the trade cost literature. Using a structural gravity model, we simulate changes in three primary trade constraints: a 10% reduction in tariff levels, a 10% reduction in effective distance, and a 10% increase in free trade agreement depth. The projection leads to a roughly 5% increase in global trade by value. Our model suggests that increased trade has an incredibly high benefit–cost ratio (BCR) for the developing world with an order-of-magnitude estimate for low- and lower–middle-income countries of 100 and for upper–middle-income countries of 50. However, the BCR for high-income countries is substantially lower, with a value closer to 5. Overall, the results suggest that free trade leads to substantial net benefits globally, generating US$ 700 billion in benefits (0.83% of global GDP) and US$ 100 billion in costs (0.12% of global GDP) in the first year, a differential that grows over time. Sensitivity analyses suggest that our BCRs are on the lower end of a plausible range. The results point to the incredible value of free trade, particularly for developing countries, and reiterate the importance of considering distributional impacts when implementing trade reforms.

In 2023, the world will be at “halftime” with respect to the sustainable development goals (SDGs). This midline acts as an important milestone to review the progress of the SDGs and develop policies based on the most effective interventions. To estimate the remaining resources needed to achieve SDG targets for vaccines from 2023 to 2030 as well the resulting economic benefits, in this analysis, the incremental economic benefit-cost ratio (BCR) for immunization programs in 80 low- and middle-income countries targeted by the Global Vaccine Action Plan from 2023 to 2030 is calculated. Of these 80 countries, 27 are classified as low-income countries and 53 are classified as lower-middle-income countries (LMICs). The economic evaluation covers 9 vaccines employed against 10 antigens and delivered through both routine immunization programs and supplemental immunization activities. The vaccines covered in the analysis include pentavalent vaccine, human papillomavirus vaccine, Japanese encephalitis vaccine, measles vaccine, measles-rubella vaccine, meningococcal conjugate A vaccine, pneumococcal conjugate vaccine, rotavirus vaccine, and yellow fever vaccine, and correspond to the vaccines covered in the return-on-investment estimates presented in Sim et al., which covered 94 LMICs from 2011 to 2030. For these countries, we estimate program costs from the health system perspective, including vaccine costs such as costs to procure vaccines, which incorporate injection supplies and freight; and immunization delivery costs, which include nonvaccine commodity costs to deliver immunizations to target populations and incorporate labor, cold chain and storage, transportation, facilities, training, surveillance, and wastage. Economic benefits are calculated using a value of statistical life year (VSLY) approach applied to modeled cases, and deaths averted are converted into averted years of life lost using life expectancy data. BCRs are presented as the final output that compares incremental costs and benefits from the baseline of 2022 levels, assuming diminishing returns to scale. Overall, for this period, we estimate total costs of US$ 7,581,837,329.08 with VSLY benefits of US$ 762,172,371,553.54, resulting in a BCR of 100.53.

This paper conducts a benefit–cost analysis of expanding agricultural research and development (R&D) in the Global South. We extend a recent modeling exercise that used IFPRI’s IMPACT model to estimate the investments required to reduce the global prevalence of hunger below 5%. After 35 years, the increased funding is estimated to increase agricultural output by 10%, reduce the prevalence of hunger by 35%, reduce food prices by 16%, and increase per capita incomes by 4% relative to a counterfactual where funding continues to rise on historical trends. Using an 8% discount rate, the net present value of the costs of agricultural R&D are estimated at $61 billion for the next 35 years, while the net present benefits in terms of net economic surplus (the sum of consumer and producer surplus) are estimated at $2.1 trillion. The central estimate of the benefit–cost ratio (BCR) is 33, consistent with previous research documenting high average returns to agricultural research and development. The central BCR reported in this study places the intervention at the 91st percentile of all previous Copenhagen Consensus BCRs in agriculture, and 87th percentile for all BCRs regardless of sector. Agricultural R&D is likely one of the best uses of resources for the remainder of the Sustainable Development Goals and decades beyond.

Each year, 295,000 women die during and just after pregnancy, and 2.4 million babies die in the first month of their lives. In 2019, 2,160,000 neonatal deaths and 275,000 maternal deaths occurred in low-income and lower-middle-income countries alone, translating to a welfare loss equivalent to $426 billion and $36 billion for neonatal and maternal deaths, respectively. The total loss was $462 billion or almost 6 % of these countries’ combined GDP. In the sustainable development goals pledge, the world promised to reduce maternal deaths to 0.07 % and neonatal mortality to below 1.2 %, saving about 200,000 women and 1.2 million children from dying annually. However, on the current trajectory, maternal mortality is expected to decline to only 0.16 % and neonatal deaths to only 1.5 % by 2030. This article analyses the most cost-effective way to reduce maternal and neonatal deaths – Increase coverage of basic emergency obstetric and newborn care from 68 to 90 % combined with increased family planning services in 55 low-income and lower-middle-income countries which account for around 90 % of the burden of maternal and neonatal mortality globally. The proposed package will require $3.2 billion per year more investment and will deliver benefits worth $278 billion per year in avoided deaths and higher economic growth. It will also yield a demographic dividend benefit equivalent to $25 billion annually. For every $1 invested, the social and economic benefits are estimated to be $87. The benefit-cost ratio is 87.

Undernutrition and micronutrient deficiencies are key drivers of infant and child mortality and are causes of impaired human potential for hundreds of millions of children every year. Investing in nutrition in the first 1,000 days from conception not only supports individual lifetime health, education, and productivity, but is also key to breaking the intergenerational cycle of malnutrition and enhance equitable development pathways for low- and middle-income countries. This paper provides a cost–benefit analysis of three nutrition interventions: 1) provision of preventive small-quantity lipid-based nutrient supplements (SQ-LNS) to children 6−23 months of age; 2) Complementary Feeding Promotion (CFP) for children 6−23 months of age; 3) provision of multiple micronutrient (MMN) and calcium (Ca) supplements to pregnant women. The benefit–cost ratios (BCRs) for MMN supplementation for pregnant women replacing iron and folic acid (37.5), as well as MMN and Ca combined (19-24), are the highest. The BCRs for CFP for children in the two highest socio-economic status (SES) quintiles and SQ-LNS for children in the three lowest SES quintiles are fairly similar at 16 and 14, respectively. The lowest BCR is for CFP for children in the three lowest SES quintiles due to the high cost of accomplishing behavioral change for improved complementary feeding in resource-poor households.

The world remains off-track for the sustainable development goal (SDG) target 3.4, which calls for a one-third reduction in noncommunicable diseases (NCDs) mortality by 2030. This paper presents benefit–cost analyses of various NCD interventions in low-income (LICs) and lower–middle-income (LMCs) countries. We looked at 30 interventions recommended by the Disease Control Priorities Project, including six intersectoral policies (e.g., taxes) and 24 clinical services. We used a previously published model to estimate intervention costs and benefits through 2030, discounted at 8%. We focused on interventions with benefit–cost ratios (BCRs) > 15 and their contribution toward achieving the SDG target. We found that intersectoral policies often provided great value for money, with BCRs ranging from 40 (trans-fat bans) to 100 (tobacco excise taxes). However, seven clinical interventions (e.g., basic treatment of cardiovascular disease or breast cancer) also had BCRs > 15. The overall population impact of clinical interventions over the 2023–2030 period would be much higher than that of the intersectoral policies, which can take many years to reach their peak effects. Fully implementing the best-investment interventions would accelerate progress toward SDG 3.4 everywhere, but only one in 10 countries would achieve the target. This strategy would require an additional US$ 2.4 billion annually across all LICs and LMCs. We conclude that there are several cost-beneficial opportunities to tackle NCDs in LICs and LMCs. In countries with very limited resources, the best-investment interventions could begin to address the major NCD risk factors and build greater health system capacity, with benefits continuing to accrue beyond 2030.

Government is the custodian of the most critical (and limited) factor of production, namely, land. Assuring the security of tenure, arbitrating disputes, and facilitating the transfer or sales of titles renders the land market more efficient and less volatile, attracting investors and promoting sustainable urban development. Land tenure security is also a critical government service that has repercussions on agricultural productivity, housing development, business investment, and the development of urban areas. However, land administration is mired in corruptive practices, elite capture, and inefficient allocation. Globally, only 24% of rural areas are mapped (46 in urban areas), with approximately the same percentage registered, that is, 22%. In Africa, only about 14% of rural land is formally recorded in a public register. Land tenure security can take a variety of forms depending on national regulatory frameworks that allocate land and specify its use. Success stories include transferable user certificates in China and individual land titles in Rwanda. Systematic evaluation of the evidence on tenure programs demonstrates that improved tenure security increases agricultural output (40% on average), increases urban land values (25% on average), and increases household welfare (15% on average). Other observed country-specific benefits include additional years of schooling, better academic performance, access to credit, reforestation, and improved household nutrition. The costs of establishing tenure security in Sub-Saharan Africa include the separate costs of rural (US$ 3 billion) and urban (US$ 2.2 billion) land registration; the cost of digitizing land registries and information to improve efficiency and transparency (US$ 880 million), the cost of strengthening institutions and systems to resolve land disputes and manage expropriations (US$ 960 million) over a ten-year implementation period, and land administration operations and land records maintenance over 30 years (US$ 64 billion). The net present value (8%) of costs is US$ 21.7 billion for rural land tenure and US$ 5.3 billion for urban areas. The benefits of rural land registration were based on the observed 15% household wealth effect noted in the literature. The net present value (8%) of a 30-year benefits stream is US$ 396 billion. The benefit–cost ratio of completing and modernizing land registration and improving land administration coverage and effectiveness in rural Sub-Saharan Africa is 18. The benefits of urban land registration were based on the average 25% increase in property values observed in the literature. Using housing prices for the 20 largest, Sub-Saharan African countries, the net present value (8%) of the benefits over a 30-year period is US$ 237 billion, yielding a benefit–cost ratio of 45 when the average housing price is used. When the population-weighted housing price is used, benefits are valued at US$ 160 billion, yielding a benefit–cost ratio of 30.

Greater labor migration can establish more channels for information flows, directly contributing to faster economic growth and improved innovation and work. It can also expand international remittances, which can be invested by recipient households in home countries in education, entrepreneurship, and improved and sustainable agricultural technologies. At the same time, however, increased emigration of medical professionals and technical workers from poor countries can reduce quality of local services, innovation, health status, and productivity. This analysis attempts to quantify the economic benefits and costs of permitting an immediate 10% increase in the bilateral migration of skilled workers (physicians, engineers or science, engineering, technology, and mathematics workers, and other persons with advanced educations) among the nations of the African Continental Free Trade Area and, more broadly, among 25 global regions. Economic benefits include higher migrant incomes abroad, welfare gains in destination countries associated with higher economic efficiency, spillover productivity gains, and an improved ability of the younger and more skilled working force to support the needs of the wider population, resulting in higher national production. Benefits in source countries include productivity enhancements from two sources: (a) greater access to knowledge associated with more bilateral trade and investment and (b) the ability of local households to invest remittances in productivity-enhancing activities. Welfare losses in source nations include static efficiency reductions and a worsened demographic support capability. In Africa, the benefit-cost ratios range from 3.7 to 6.9; in the global analysis, 17 to 38.

This report presents a cost–benefit analysis of increased spending on tuberculosis (TB) using impacts and costs drawn from the Global Plan to End Tuberculosis, 2023–2030. The analysis indicates that the return on TB spending is substantial with a centrally estimated benefit–cost ratio (BCR) of 46, meaning every US$ 1 invested in TB yields US$ 46 in benefits. Alternative specifications using different baselines, interventions, cost profiles, and discount rates still yield robustly high BCRs, in the range of 28–84. This report also shows that TB investment would avert substantial mortality, estimated at 27.3 million averted deaths over the 28-year period between 2023 and 2050 inclusive: almost 1 million averted deaths per year on average. Accounting for all estimated direct and indirect costs, the cost per averted death is slightly over US$ 2000. Interventions to address TB represent exceptional value-for-money.