2023 in Review
Published on: February 12, 2024

Introduction from LEEP’s Co-Executive Directors


2023 has been a year of progress, learning, and growth, all towards our founding goal of improving the health, wellbeing, and potential of children around the world. As we’ve expanded our paint programs, which aim to end the availability of lead paint, and begun investigating and addressing other sources of lead poisoning, our commitment to impact, evidence, and collaboration has remained central to our work.

Important steps forward are being made in each of our programs. Perhaps the most concrete result of the year was our follow-up study in Malawi, which demonstrated a significant reduction in the availability of lead paint, in line with the projections of our initial cost-effectiveness analysis. Most importantly, this represents real health and wellbeing improvements for children in Malawi. It also provides evidence that our programs are having the impact that they were designed to achieve. We have been similarly encouraged by early results in Pakistan, Zimbabwe, and Ghana, where manufacturers representing over half of the lead paint market share have started switching to lead-free. 

It’s been a pleasure working with a growing team of exceptional colleagues, who have made these results and much more possible. In particular, their hard work and creativity has shown us how we can engage manufacturers more effectively to bring about earlier moves to lead-free, and their experience has shown us how we can be more supportive to our government partners so they can bring about progress faster.

Looking beyond our programs, it’s been an exciting time to be working towards an end to childhood lead poisoning. Momentum is growing towards this goal: USAID made a global call to action to eliminate lead from consumer goods, G7 Environment Ministers reiterated their commitment to reduce lead pollution and exposure, and Open Philanthropy launched a global public health policy program with lead as a focus area. We look forward to continuing to be a part of this community, and witnessing this momentum build into impact at scale.

With scale in mind, our plans for 2024 are ambitious. We plan to: make a significant step towards eliminating the availability of lead paint across countries representing 45% of births in low- and middle-income countries; identify impactful interventions addressing other sources of lead exposure; and continue contributing our learnings to international agenda-setting. We believe our progress so far demonstrates that ambitious goals are achievable, and that progress towards a world where children are not limited by lead poisoning is possible.

Thank you to all of our partners, advisors and supporters. We are particularly grateful to Founders Pledge, Schmidt Futures, Open Philanthropy, Greenbridge Family Foundation, and the individuals who generously donated to enable this work.

Lucia and Clare

Our work in 2023


Initiated paint programs

As laid out in the theory of change below, our paint programs aim to reduce the use of lead paint, thereby reducing lead exposure, and improving children’s health and wellbeing.

  • In 2023 we started paint programs in eight new countries: Rwanda, Côte d’Ivoire, Senegal, Burundi, Benin, Uganda, Uzbekistan, and Nigeria. These countries were at various stages of the regulation process when we began our programs in each of them. Some had, to our knowledge, no current activity towards regulation, while others had begun the process but encountered barriers that we could assist with. LEEP has now established collaborative government relationships in 18 countries.


Figure 1: Theory of change for our paint programs.

Completed paint studies

Generating data on the lead content of paint in a country is a key step in many of our paint programs. The data motivates and informs the development and enforcement of regulation. Support in conducting paint studies is often a main request from our government partners. Paint studies also allow us to prioritise countries with the highest levels of lead paint, identify which manufacturers might benefit from technical reformulation support, and evaluate the progress towards a market free of lead paint through follow-up studies. 

  • In collaboration with government, academic or NGO partners, we completed seven new paint studies and shared the results with key stakeholders, on our website, or in an academic publication. 
  • As shown in the summary of results below, high levels of lead in oil-based paints are still common in most countries. 

Figure 2: Paint study data.

Supported governments in implementing lead paint regulations

We collaborate closely with our government partners so that we can provide technical and financial assistance throughout the process of implementing lead paint regulation. In addition to paint studies, other support has included:

  • Providing funding for government meetings and multi-stakeholder workshops.
  • Sharing educational and technical resources related to lead paint regulation, such as testing guidance, examples of lead paint laws, and existing research.
  • Providing technical feedback on draft standards and decrees.
  • Funding a consultant to be embedded in government, to work on a draft decree and increase compliance with regulation through industry engagement.
  • Providing guidance on effective enforcement approaches.
  • Funding external lab testing of paint samples so governments can enforce based on the results, and validate their internal testing.

Following our paint studies and other support, we were delighted that the relevant government agencies or ministries in Ghana, Senegal, Angola, Nigeria, Rwanda, and Côte d’Ivoire shared with us their intentions to introduce lead paint regulation, and that drafting has begun in Bolivia and Angola.  Furthermore, new regulation will soon be submitted to parliament in Sierra Leone, and the decree in Madagascar is close to being finalised. We also made critical progress in supporting the governments of Malawi and Pakistan in enforcing lead paint regulation and increasing manufacturer compliance. 

At a regional level, we attended and presented at the African Ministerial Conference on the Environment, and a meeting of the East African Standards Committee on Paints. 


Provided technical assistance to help paint manufacturers reformulate, and received reports of their switching to lead-free paint

By supporting paint manufacturers in switching to lead-free raw materials, we aim to increase industry’s support for new regulation and to improve compliance, particularly in areas where enforcement capacity is limited. Our technical assistance has included: 

  • Providing information on the harms of lead and how to switch to lead-free raw materials
  • Providing free consultations with our Paint Technologist, Philip Green
  • Identifying low-cost lead-free pigments
  • Determining the supply chain structure in order to get these pigments to manufacturers
  • Providing manufacturers with free samples
  • Providing instructions on how to effectively use the lead-free pigments 
  • Offering free testing of reformulated paint samples

This year we have received positive indications of the impact of our assistance: manufacturers representing >50% of lead paint market share in three additional focus countries (Pakistan, Zimbabwe, and Ghana) have reported switching to lead-free following LEEP’s engagement and support. We have also received reports of manufacturers beginning or intending to reformulate in Uganda, Madagascar, Angola, and the UAE following our engagement. 


Conducted our first follow-up study, which confirmed progress towards a lead-free paint market

LEEP and the Malawi Bureau of Standards conducted a new study to assess recent changes in lead paint levels in Malawi, following our ongoing joint work over the previous two years. Taking into account estimated market share data, the results suggest that the market share of brands selling lead paint for home use has reduced from approximately 67% in 2021 to 24% in 2023.

The main driver of this reduction was that the study did not detect lead in the samples from Malawi’s most popular paint brand, which previously had high levels of lead. This brand is estimated to have approximately 45% of market share, and the study results suggest that it has switched to lead-free following LEEP’s engagement. Of the five smaller brands still found to be using lead, one has told LEEP that it has stopped using lead since the study, and three others, including one that was found to have replaced some of its lead ingredients, have publicly committed to moving to lead-free by mid 2024.


Upstream projects and other sources of lead exposure

Paint programs are our focus, but we have always had our eyes on the ultimate objective: a world without lead poisoning. There are several additional, potentially cost-effective avenues to this goal, including eliminating lead from non-paint sources, and effecting change on a more macro level. This year, we pursued several projects toward these ends: 

  • We conducted a preliminary study of the lead content of spices in Turkey and a more comprehensive study into the lead content of spices in Ethiopia. (Full results will be shared soon, but we did not identify evidence of lead adulteration in either study.)
  • We engaged the Pakistan Standards and Quality Control Authority on lead in kajal and surma (cosmetics), which resulted in the Director General agreeing to work with LEEP to introduce a mandatory standard.   
  • We contributed to the Centre for Global Development (CGD)’s Final Statement, which is a call to action to end childhood lead poisoning globally. We presented at a CGD working group meeting in Washington DC and participated in a number of global agenda-setting discussions.
  • LEEP has been collaborating with Dr Jenna Forsyth and Dr Alandra Lopez at Stanford with the aim of validating cheaper and easier lead detection technology that could improve LMIC governments’ capacity to monitor and enforce lead regulation.
  • We have conducted further prioritisation research on other solutions and approaches for lead elimination. 


Team growth

To enable the continued expansion of our work, LEEP’s team grew:

  • Nafisatou Cissé joined as Program Manager and Team Leader, Nasser Hassane became a Program Manager, and Tomos Davies joined as Chief Operating Officer.



LEEP’s work was publicly highlighted for its expected impact and cost effectiveness:


Did we meet our goals? Overall, we made good progress towards the goals we set for 2023. A summary can be found here

Key metrics and impact

The table below summarises the status of our paint programs. Each column is an indicator of progress towards the outcome of reduced lead paint available on the market, and links to our theory of change (see graphic in ‘2024 goals’ section). 

Figure 3: Summary of paint program statuses, with blue check marks indicating that the status was reached in 2023.

*We are currently unable to share identifying information on the fifth country for this category.

**The paint study we conducted in Botswana in 2021 found that levels of lead were less than 100 ppm in all samples. We deprioritised work in Botswana as a result of these findings.  

Cost-effectiveness and total impact 

The results of the follow-up study conducted in Malawi in 2023 are in line with the increase in manufacturer compliance projected in our January 2022 estimate of the cost-effectiveness of the program. The model projected a 53% reduction in non-compliance by market share in 2023 and the recent results suggest an approximately 64% reduction in non-compliance. This suggests that the program is on track to prevent lead poisoning in 215,000 children, averting ~43,000 DALY-equivalents.

In 2023 we updated our cost-effectiveness model to include all of LEEP’s focus countries and to improve the transparency and clarity of the model. We aim to finish the accompanying documentation, have the model reviewed, and then share it publicly in early 2024.  So far, overall cost-effectiveness is similar to the estimate in our previous model of our Malawi program ($14 per DALY-equivalent averted). 

Last year, Founders Pledge conducted their own cost-effectiveness analysis of our work. In 2023, they updated this analysis: “We estimate that it costs $1.66 to prevent one child’s lead exposure (in expectation). As of August 2023, that makes LEEP one of our most cost-effective charities.”


2024 goals


Paint programs

Our overall goal for our 2024 paint programs is to make a significant step to eliminate new lead paint across countries representing 45% of births in low- and middle-income countries (LMICs). We define a significant step as having met an additional key goal, as laid out below. 

For each program, our goals are summarised in the following diagram. The top half of the diagram shows our overall theory of change; the bottom half shows our key goals for the coming year. In 2024, we’re aiming to conduct 11 more paint studies, see regulation being drafted in 8 more countries, agree with our government partners on enforcement projects in 11 more countries, and receive reports from manufacturers representing over half of the lead paint market share that they’re taking active steps towards reformulating in 11 more countries, among other goals.  

(Click to enlarge) Figure 4: Goals for our paint programs in 2024, and how they correspond to our theory of change.    

As we work towards these milestones, we also plan to continue to explore and strengthen our paint programs. We will further codify our processes, particularly around stakeholder engagement, paint studies, support for introducing regulation, and manufacturer assistance. 

Further, we’ll continue to test out different program elements and address areas of relative uncertainty in our programs. For example, we think it will likely be effective to work more proactively with our government partners on enforcement, such as by co-creating enforcement plans and providing training, and we plan to develop our support on this over the year.  

In many countries, the informal paint manufacturing sector represents a small but significant proportion of the total market share. For example, micro-enterprises might represent 20% of the market share in Nigeria. We want to continue exploring how best to influence this part of the sector. Relatedly, we want to get a better sense of the level of compliance that we, and our government partners, should be aiming for. Complete elimination of lead paint from the market is the ideal, but we think it remains to be seen whether this is a practical goal in some contexts, and we intend to develop clearer guidance on this. 

Finally, we’re aiming to start programs in some very large countries in 2024, such as India and Indonesia. Given the difference in scale in these large countries compared to most of our current focus countries (in terms of population size, geography, and number of manufacturers), we recognise that our programs may look quite different there, and we will investigate how to have a cost-effective and persistent impact.


Other sources and upstream projects

We plan to continue to spend a small proportion of our resources exploring working on sources of exposure other than paint. We’re most excited about potential cost-effective interventions that are synergistic with our paint programs; addressing spices and cosmetics (e.g., kajal and surma) currently look most promising on this basis, but we will consider other options. 

Our first goal is to conduct at least two more studies investigating sources of lead exposure other than lead paint. If we detect high levels of lead, we will likely pilot an intervention to address them.

We’re also working to support the introduction of regulation on kajal/surma in Pakistan with our government partners who we’ve been working with on paint. These products are widely used in Pakistan, including by children, and our testing has found that the market-leading brand of surma contains approximately 75% lead. 

In addition to testing these different aspects of new interventions, more broadly, we plan to identify if there are promising regulatory interventions for sources of lead exposure, other than paint, that we can cost-effectively support government partners with.

Finally, our goal is to meet regularly with key actors in the international lead community to stay updated, collaborate, share our data and learnings, and contribute to impact-orientated and evidence-based international agenda setting. We believe we are well placed to guide new and increased efforts in the field, such as those following USAID Administrator Samantha Power’s call for a global effort to eliminate toxic lead from consumer goods. 

These 2024 goals are summarised here.

Looking to 2025 and 2026

As mentioned above, by the end of 2024, we aim to be making significant progress to eliminate new lead paint across countries representing 45% of births in LMICs. By the end of 2026, we would like to reach approximately 75% of births in LMICs. We believe we can achieve this by expanding our programs to roughly ten new countries each year from 2024 to 2026. As always, we prioritise countries based on: the estimated burden of lead exposure from paint; whether there’s a gap where LEEP can support; and whether there’s local interest in a lead paint project.




In 2023, we spent a total of $830,735. 

A comparison of our 2023 budget to our actual spending from that same period can be seen here. While we had budgeted $1.26 million for this period, we ultimately spent $830,735. This is partly due to having budgeted conservatively in most categories, and because we did not spend any allocated ‘contingency’. It is also partly accounted for by the decision to not hire as many ‘in-country partnership officers and consultants’; however, we did test out working with NGOs and local consultants in several countries, and may scale this up in 2024. We also didn’t hire a full-time researcher in 2023, but may well prioritise this more in 2024.

Our estimated budget for 2024 can be seen here: it totals $2.58 million, reflecting our plans to scale our paint programs to approximately 29 countries, grow our team, and explore more work focused on other sources of lead exposure.

*LEEP will be undergoing an audit during the first half of 2024. Some of these numbers may not be exact and may be subject to change after the audit has been completed.


In 2023, rather than fundraising only for the following year, we began to fundraise for three years of each existing and new program. This allows us to make longer-term plans and longer-term commitments of support to our government partners. This will make it easier for our partners to commit to working towards well enforced regulation, and we expect that it will improve the efficiency of our programs. We were grateful to be able to fill this gap completely, covering all current programs and enabling us to scale up to approximately 11 more in 2024.

Learnings and reflection

In this section, we briefly describe some lessons learned over the period of this review and explain how our thinking is developing on some strategic considerations for LEEP. 


We can help manufacturers switch to lead-free more quickly than we thought

By trying out new approaches, we’ve learnt that when we engage with lead paint manufacturers either earlier or more persistently, some will start switching to lead-free very quickly. For example, in Zimbabwe, nine manufacturers, estimated to represent over 90% of the market share, reported having started to switch to lead-free raw materials in June 2023. This followed an initial awareness-raising workshop, jointly organised with our government partners, and one-on-one meetings, but was before lead paint regulation was imminent.


Figuring out local supply of lead-free raw materials is one of the most useful things we can do for manufacturers

We know that lead-free raw materials are available and often cost-comparable, but we’ve learnt that we can be much more helpful than simply telling lead paint manufacturers this and leaving the sourcing to them. This year we’ve been identifying products, testing them to make sure they have the right properties, figuring out supply chains, connecting distributors to local suppliers, and introducing paint manufacturers to local suppliers. We’ve seen that this can remove an important barrier that paint manufacturers face, and that doing so is sometimes sufficient in spurring a manufacturer to switch. We’re still on the lookout for more low-cost lead-free pigment options – let us know if you have any tips! 


Media had a positive impact on our Pakistan and Malawi programs

Before our Malawi follow-up study, and in the interests of being communicative and collaborative, we let manufacturers know that the results would be released to the media. Once this was communicated, we saw a noticeable increase in their engagement with reformulation support. In other countries where we plan to release follow-up study data to the media, it will likely be most effective to inform manufacturers of a specific date as early as possible to make the most of this motivating pressure. In Pakistan, we also shared the study results with the media, resulting in extensive coverage. Soon after, five of the six most popular lead paint brands that we identified reported to be switching to lead-free, and we expect the media coverage and their motivation to uphold brand reputation were influential.


Multi-stakeholder workshops are an effective tool to accelerate progress

As part of our paint programs, we have increasingly organised and supported one- or two-day workshops with stakeholders from across government, industry, and civil society. The benefits of these workshops are numerous: they allow stakeholders the time and attention to more deeply engage with the issue; they facilitate cross-government coordination on regulation; they demonstrate to attendees the importance of the issue on the international stage; and they underscore how seriously the attendees and the organisations they represent are taking the issue.


We’re still working to understand how best to support testing capacity

The capacity to test for lead in paint is something that our government partners often ask about, and we’re continuing to sharpen our understanding of how we can best support its development. In 2023, we’ve offered various types of support, depending on the specific needs in a given country, and in all of our programs, we’ve offered three years of free testing at an accredited lab. The ideal would be for testing to not rely, as it currently does, on expensive, complex, and time-consuming machines and consumables. We’re therefore collaborating on a project, with academics at Stanford and Mercer universities, to develop and validate a new method for testing the lead content of new paint samples, which uses a more robust, simpler, faster and lower-cost technology (pXRF). We hope this could be a longer-term solution for in-country testing capacity.  


Our paint programs can open up potentially highly impactful opportunities to prevent lead exposure from other sources

Our collaboration with the Pakistan Standards and Quality Control Authority to improve compliance with lead paint regulation fostered discussion about the problem of high levels of lead in the widely used cosmetics surma and kajal, which led to the Director General agreeing to work with LEEP to introduce a mandatory standard for these products. We’ve seen similar enthusiasm from other partners to consider ‘what’s next?’, and in 2024 we plan to identify if there are other LEEP programs where we can cost effectively and synergistically work to eliminate other sources of lead exposure. 


Widespread adulteration of spices with lead may be less prevalent than we believed at the beginning of the year

The discovery of widespread lead adulteration of spices in Georgia and Bangladesh over the last few years, combined with a lack of data from most countries, opened up the question of how prevalent the practice might be. With local partners, we conducted a preliminary study into the lead content of spices in Turkey, with a focus on the region bordering Georgia, and a more comprehensive study into the lead content of spices in Ethiopia (a major producer and consumer of brightly coloured spices). We did not find raised levels of lead consistent with adulteration in either study. Our impression, partly informed by the results of Pure Earth’s rapid market surveys, is that there may be five to ten countries where the practice is occurring and it’s unlikely that any country has as widespread lead adulteration as was found in Bangladesh. However, due to the importance of the problem where it does occur, we believe it is valuable to gather more data to identify where interventions are needed, and we plan to conduct further spice sampling in 2024.


LEEP’s first team retreat was really worthwhile

LEEP is a “remote-first” organisation whose staff are spread across the globe (four continents, to be exact!). In September, almost the entire team came together for a week-long retreat. The aim of the retreat was to cement a shared understanding of our goals and values, increase connection among the team, facilitate sharing of knowledge and experiences, and generate ideas for program improvements. All of these aims were met and we came away with a strong list of prioritised next steps for program improvements, which we then translated into OKRs for the final quarter of the year. We also came away more grateful than ever for our brilliant and dedicated colleagues!



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Sylvia Yomisi, Environmental Laboratory Manager at the Environmental Management Agency of Zimbabwe and Dr Clare Donaldson signing a Memorandum of Understanding





Thank you to everyone who has supported LEEP this year.