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In the past two decades, the world has spent more than $196 billion trying to save people from death and disease in poor countries.

But just what the world’s gotten for its money isn’t clear, according to two studies published today in the medical journal Lancet.

Millions of people are now protected against diseases such as yellow fever, sleeping under anti-malaria bed nets and taking AIDS drugs. Much beyond that, it’s tough to gauge the effectiveness of pricey programs led by the United Nations and its partners, and in some cases, big spending may even be counterproductive, the studies say.

Trying to show health campaigns actually saved lives is “a very difficult scientific dilemma,” said Tim Evans of the World Health Organization.

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