We often think of efficiency gains in terms of an increase of a few percent here or there. Finessing at the edges. That is not the topic of this book. Rather, it is about making phenomenal strides to make the world better. This book shows us where we can spend money to do the most good, whether we are looking at aid money, philanthropic donations, or funds from developing country budgets.

What this book reveals is that the best polices are hundreds of percent better than an average policy, and the difference between the best and the poorest is thousands of percent.

As will be shown in the Conclusion, it is possible for us to do four times more good with every dollar, euro, or peso spent on development. This is not just about abstract efficiency: it means we can save four people from dying instead of one. It means we can help four children out of poverty instead of one, clean the air for four families instead of one, or teach four girls instead of one.

Being efficient isn't just an arcane concept. It is the difference between leaving the world better and making it four times better.

The UN Global Goals

In 2015, the United Nations negotiated one of the world's most powerful policy documents. Over 15 years, it will influence more than $2.5 trillion of development aid along with trillions from national budgets. It is aimed at helping pull hundreds of millions of people out of poverty, reduce hunger and disease, improve the environment, target the causes of violence, and improve education. Much depends on this being done well.

Tremendous progress has already been made in the fight against humanity's biggest challenges. In 1820 – nearly 200 years ago – around 94 percent of the planet was impoverished. Even in 1990, poverty sat around 52 percent. Recently, the World Bank has found that for the first time ever, in 2015, less than 10 percent of the globe is living in absolute poverty.

Over the next 15 years the Global Goal targets examined in the research section of this book will help to direct somewhere in the region of $2.5 trillion to be spent on development assistance, as well as countless trillions in national budgets. As the members of the Eminent Panel that examined the research and made recommendations on the proposed targets, particularly in terms of value-for-money, we believe that it is important that those making funding decisions have access to information on costs and benefits.

A natural political inclination is to promise all good things to everyone. This, in no small part, is how the United Nations ended up with 169 targets. All are well-intentioned.

However, the analyses presented in this book demonstrate that some of the targets are less worthwhile, producing only a little more than $1 in social benefits per dollar spent, while others produce much higher social returns. After careful consideration and engagement with the research authors, we selected the 19 targets that we expect to produce the greatest benefits.

The analyses suggest that if the United Nations (UN) concentrates on these top 19 targets, it could achieve $20 to $40 in social benefits per dollar spent. In contrast, allocating it evenly across all 169 targets would reduce the figure to less than $10.

Targets that will help people directly through health benefits are worth championing. As we read about in Chapter 13, tuberculosis (TB) is a “hidden” disease. More than two billion people carry the bacterium that causes it. About 10 percent of those people will develop TB at some point, and about 1.5 million people each year die from TB. But treatment is inexpensive and, in most cases, highly effective. Spending a dollar on diagnosis and treatment is a low-cost way to give many more years of productive life to many people. Ebola and Zika may receive the headlines, but TB is a much bigger problem, and one that we recommend receives high priority.

Reducing childhood malnutrition, described in Chapter 20, is another excellent target. A good diet allows children's brains and muscles to develop better, producing lifelong benefits. Wellnourished children stay in school longer, learn more, and end up being much more productive members of society. The available evidence suggests that providing better nutrition for 68 million children each year would produce over $40 in long-term social benefits for every dollar spent.