$97 Per Year of Healthy Life: Why Digital Mental Health Is One of the Most Cost-Effective Causes You’ve Never Heard Of

In global health philanthropy, cost-effectiveness is the currency of serious decision-making. The question isn’t just “does this work?” — it’s “how much good does each dollar buy, and how does that compare to the alternatives?”

By that standard, digital mental health programs for depression in low- and middle-income countries represent one of the most compelling funding opportunities in global health today. And yet they remain dramatically underfunded relative to their potential impact.

This post makes the case for why donors and funders — whether individuals, foundations, or institutional investors in global health — should be paying serious attention to this space, and to one organization in particular.

The Headline Number

Let’s start with the figure that anchors this analysis: $97 per DALY averted.

A DALY — disability-adjusted life year — is the standard unit of measurement in global health burden analysis. One DALY represents one year of healthy life lost, either through death or through living with a disability or illness. Averting a DALY means preventing that loss — giving someone a year of healthy life they wouldn’t otherwise have had.

The $97 figure comes from the cost-effectiveness analysis of WHO Step-by-Step as scaled by Kaya Guides, the nonprofit organization incubated by Ambitious Impact (Charity Entrepreneurship) specifically to deliver this program at scale. It accounts for the full cost of the intervention: counselor time, technology, training, supervision, overhead, and program administration.

To understand what $97/DALY means in context: the global health community generally uses a threshold of 1-3x the GDP per capita of the recipient country as a benchmark for “highly cost-effective.” In Pakistan, that threshold is roughly $400-1,200. In Nigeria, $350-1,050. In Bangladesh, $270-800. At $97, Step-by-Step clears these bars with substantial margin.

For comparison: malaria prevention through insecticide-treated bed nets — often cited as one of the most cost-effective health interventions in existence — costs in the range of $50-100 per DALY averted in high-transmission areas. Step-by-Step is in the same range. For a mental health intervention, that is extraordinary.

Why Mental Health Has Been Underfunded

The case for mental health funding in LMICs isn’t new. Researchers and advocates have been making it for years. So why has funding remained so low?

Several factors have contributed. Mental health conditions are less visible than infectious diseases — depression doesn’t spread from person to person, doesn’t cause the dramatic visible symptoms of malaria or cholera, and doesn’t generate the same kind of humanitarian urgency. Mental health interventions have also historically been harder to measure and evaluate than, say, vaccine distribution or bed net coverage. And there has been a persistent — and now thoroughly rebutted — assumption that mental health treatment is an unaffordable luxury for low-income countries.

The data tell a different story. Depression is a leading cause of disability worldwide, contributing more to the global burden of disease than most of the conditions that dominate global health funding. In 2019, less than 2 percent of official development assistance for health went to mental health, despite mental disorders accounting for roughly 13 percent of the global disease burden.

That misalignment between funding and burden has persisted in part because good evidence on cost-effective interventions was lacking. That’s no longer true. The evidence base for guided digital self-help programs now includes five randomized controlled trials with consistent, compelling results. The measurement infrastructure exists. The cost models have been developed. The gap between evidence and funding is now a choice, not a knowledge gap.

An Alternative Metric: WELLBYs

DALYs are the dominant metric in global health, but they have limitations — particularly for mental health, which affects wellbeing in ways that aren’t fully captured by disability weights and mortality statistics. A complementary approach uses WELLBYs: wellbeing-adjusted life years, a measure of subjective wellbeing improvement equivalent to one person living one year at the highest level of life satisfaction.

The WELLBY framework, developed by researchers including those at the London School of Economics, tries to measure the actual experience of health improvement rather than just the absence of disease or disability. Using this framework, the cost-effectiveness of Step-by-Step is approximately $25 per WELLBY.

This figure is particularly striking when benchmarked against programs in other domains. Economic development interventions, education programs, and health campaigns have been evaluated using the WELLBY framework, and most fall well above $100/WELLBY. At $25/WELLBY, Step-by-Step is among the most cost-effective wellbeing interventions ever evaluated.

Both metrics — $97/DALY and $25/WELLBY — point to the same conclusion: this is an exceptionally cost-effective use of philanthropic resources.

The Evidence Base

Cost-effectiveness numbers are only as good as the underlying evidence. How strong is the evidence for Step-by-Step?

Strong. Five randomized controlled trials have evaluated the program in five different countries: Lebanon (with Syrian refugees), China, Pakistan, Egypt, and South Africa. Total sample size across the trials: approximately 2,210 participants. The trials used standardized depression outcome measures, adequate randomization, and appropriate controls.

The pooled effect size across these trials is 0.78, placing Step-by-Step in the medium-to-large range. For comparison, the effect size for face-to-face cognitive behavioral therapy is approximately 0.99. The difference between guided digital self-help and in-person therapy is not statistically significant.

This evidence base is notably better than most of what exists in global health philanthropy. Many high-profile global health programs are funded on the basis of far fewer trials, smaller samples, or evidence from a single context. Step-by-Step has been tested across multiple countries, multiple cultural contexts, and multiple delivery modalities. The consistency of the results across these diverse settings provides strong grounds for confidence in its generalizability.

The Organization Doing the Work

Knowing that a program is cost-effective is only half the analysis. The other half is evaluating the organization delivering it. How capable is it? How does it deploy resources? Is it building toward scale?

Kaya Guides was incubated by Ambitious Impact (Charity Entrepreneurship), a charity incubator known for rigorous evidence review and careful selection of high-potential intervention areas. Ambitious Impact conducts detailed cost-effectiveness analysis before selecting focus areas, ensuring that the organizations it incubates are built around interventions with compelling evidence-to-impact ratios.

Since launching in India in August 2023, Kaya has served approximately 3,600 participants. The organization has built a counselor model in which a single trained lay counselor can support approximately 400 enrolled participants per year, maintaining the brief weekly contact that research shows is essential for program effectiveness.

The organization’s cost model projects total program costs at full scale of approximately $1.3 million per year. Current funding needs are substantially below that figure, meaning that early-stage donors are providing capital at the point where it has the highest marginal impact — funding growth and learning, not just steady-state operations.

The Household Spillover Multiplier

One factor that makes the case for mental health funding even stronger than headline DALYs suggest is the household spillover effect.

Depression affects families, not just individuals. When someone is depressed, their ability to parent, to maintain relationships, to contribute to household income, and to participate in community life is compromised. The people around them — particularly partners and children — experience measurable reductions in their own wellbeing.

Research on Step-by-Step found that household spillover effects account for approximately 16.24 percent of the program’s total impact. In other words, when you treat one person for depression, you generate benefits for the people who live with them. This effect is not captured in standard cost-effectiveness analyses, which focus on the individual participant. Accounting for household spillovers would further improve an already exceptional cost-effectiveness ratio.

For funders who think in terms of systems rather than individuals, this is significant. Mental health investment isn’t just a health intervention — it’s a family wellbeing intervention, a productivity intervention, and a children’s development intervention. The case for it looks even better when you count all the benefits.

Comparing to Alternatives

The strongest case for any funding opportunity is made not in isolation but in comparison to alternatives. How does digital mental health for depression in LMICs compare to other things a donor focused on global health and wellbeing could fund?

Consider some benchmarks:

Malaria prevention: ~$50-100/DALY (bed nets in high-transmission settings)
Tuberculosis treatment: ~$100-300/DALY
Vitamin A supplementation: ~$100-200/DALY
WHO Step-by-Step at scale: ~$97/DALY

Step-by-Step is competitive with some of the most celebrated cost-effective health interventions in global health. And it’s operating in a space — mental health — where the funding gap relative to burden is far greater than in infectious disease or nutrition.

There is also an argument for “portfolio diversification” in global health philanthropy. If you are already funding malaria or tuberculosis work, adding mental health funding to your portfolio increases your exposure to a large, neglected cause area without reducing the impact of your existing commitments. The covariance of mental health outcomes with infectious disease outcomes is low — the factors that affect one don’t much affect the other. A diversified global health portfolio including mental health is likely more robust than one concentrated in any single area.

The Right Moment to Give

Timing matters in philanthropy as in investing. Giving to an organization at the right stage of its development — when resources are most constrained relative to potential — can have dramatically higher impact than giving to the same organization when it has abundant funding and an established operational base.

Kaya Guides is at an early, high-leverage stage. The model has been validated by the RCT evidence and by its first year of operations. The team has been built. The systems are being developed. What constrains growth is funding, not evidence or organizational capability.

Early-stage support to Kaya directly enables expansion to new geographies, development of new counselor cohorts, and the organizational learning that will inform the program’s long-run design. The impact per dollar of funding at this stage is likely higher than it will be once the organization is fully scaled and has a broader donor base.

The Ask

Digital mental health is not a niche cause. It addresses one of the world’s most prevalent conditions, in the places where the gap between need and available care is largest, using an evidence base that is exceptional by the standards of global health philanthropy, at a cost per impact that is competitive with the most celebrated interventions in the field.

The opportunity isn’t theoretical. The organization doing the work exists. The evidence is in. The funding need is real.

At $97 per year of healthy life, there are few more compelling answers to the question: where can my money do the most good?

To learn more about funding opportunities with Kaya Guides and the work of scaling digital depression treatment, visit besidehealth.org.