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### Allocation of discretionary funds and new recommendation for donors

Mon, 04/03/2017 - 20:07

Since we released our 2016 recommendations in November, we have received about $4.9 million in funding for making grants at our discretion. We noted at the time that we would use these funds to fill the next highest priority funding gaps among our top charities. We have now reassessed the funding gaps for our top charities and plan to allocate$4.4 million to the Against Malaria Foundation (AMF) and $0.5 million of the funding we received for granting to the Deworm the World Initiative. Our updated recommendation for donors We continue to recommend all seven of our current recommended charities as top charities and think all offer outstanding opportunities for donors to accomplish significant good with their donations. We have updated our bottom line recommendation for donors seeking to follow our recommended allocation. We now recommend that donors give 100% of their donation to AMF, which will continue to have a pressing need for funding after the grant from GiveWell’s discretionary funds and after accounting for expected fundraising. This is an update on the recommendation we made in November 2016 of giving 75% to AMF and 25% to the Schistosomiasis Control Initiative (SCI). We will update this recommendation again in November, and may do so sooner if we have new information that affects where we think additional donations would have the greatest impact. We have not completed any updates on our standout charities, and that list remains the same. Room for more funding reassessment For this analysis, we asked each of our top charities how much they raised in total through December 31 (because we were asking in early February, this is the most up-to-date information we expected to be available) and compared this information, along with how much funding we have received that was donated to GiveWell specifically for each charity (rather than for granting at our discretion), to our previous expectations. We did not ask each organization for the full details of how they would use additional funding, given that only a few months have elapsed since we last requested this information, but we did have conversations with AMF, Deworm the World, and SCI about how they would use additional funding. (For additional explanation of what we mean by execution level gaps below, see this post. In short, an execution level 1 gap as the amount at which we believe the charity has a 50% chance of being bottlenecked by funding and level 2 is 80%.) In short: • Deworm the World raised$0.53 million less than expected and has an execution level 2 gap.
• AMF raised slightly more than expected, but continues to have a large execution level 1 gap.
• SCI received $4.6 million less than the total we projected, which reflects both that we expected to allocate a portion of the discretionary funds we received to SCI and that other sources of revenue came in under our projections. • GiveDirectly raised slightly more than projected, but continues to be constrained by funding (it has a large execution level 1 gap) and told us that it has laid off some field staff as a result. GiveDirectly is also still in the process of raising funding for its basic income guarantee study, which begins this summer; it had projected raising the full amount by the end of February 2017. • We had less information with which to project revenues for the END Fund and Sightsavers’ deworming programs and Malaria Consortium’s seasonal malaria chemoprevention (SMC) program last year. We estimate that Malaria Consortium and the END Fund continue to have execution level 1 gaps and that Sightsavers does not have an execution level 1 or 2 gap for these programs. More detail in this spreadsheet. Why we selected this allocation The decision to fill the remainder of Deworm the World’s execution level 2 gap was an easy one. This was a fairly high-priority gap for us in November and Deworm the World continues to be the strongest opportunity we’ve found, when weighing all factors other than room for more funding. It is the strongest on cost-effectiveness among our top charities and it is strong on monitoring and communication. Execution level 2 means that marginal funds are fairly unlikely (~20-30% chance) to be used or make a difference for planning this year, but we believe it is worthwhile to further decrease the chances that Deworm the World is bottlenecked by funding. If the funds aren’t instrumental this year, they will be used in future years. AMF has a large remaining execution level 1 gap. From conversations with AMF early this year, our understanding is that AMF continues to have high-value opportunities that exceed its available funding. Below, we detail why we prefer further funding to AMF over further funding to other top charities. Other possibilities that we decided against SCI SCI raised less funding than we projected in November and recently told us that$2.4 million in additional funding could be used to provide deworming treatments to more children in its next budget year (April 2017 to March 2018).

At the same time, SCI already expects to grow rapidly this year. SCI is allocating a higher portion of funding on hand to its next budget year (as opposed to holding more for future years) than we projected in November. Merck KGaA has recently increased the amount of praziquantel (the drug used to treat schistosomiasis) it donates annually, and SCI has decided to do all it can to deliver treatments in the next year, in order to demonstrate to Merck that deworming programs are capable of reaching the treatment targets.

Out of about $16 million it has received since late last year, both due to GiveWell and from other sources,$1.6 million is unallocated; our understanding is that SCI expects to use the remainder in the following year. We had projected, based on conversations with SCI, that it would spend about 60% of the funds it received from a GiveWell recommendation in the next budget year and hold the remainder to ensure that programs could be sustained in the following year. In other words, our expectation for $16 million in funding directed to SCI was that$9.6 million would be used in the next budget year, rather than the $14.4 SCI has allocated. As a result, SCI’s budget for direct implementation (excluding central costs) is expected to double in the coming year. We believe that if we gave SCI additional funding now, it would allocate the additional funding to expanding its budget further this year and we are concerned that with such rapid growth, program quality may suffer. We are not opposed to taking risky bets when (a) the expected value is high; and (b) we expect to learn, after the fact, whether the results were in line with expectations. In SCI’s case, the expected value of additional funding, according to our cost-effectiveness analysis, is ~2x that of donations to AMF. Given the lack of precision in our model, ~2x is only a modest difference. And we believe that we are less likely to learn about significant problems in SCI programs than we are for AMF, Deworm the World, or GiveDirectly programs. This is because SCI has not conducted coverage surveys—the main tool it uses to monitor the quality of its programs—in a representative portion of the distributions it has funded, nor do we expect it to in the future. We worry that results may be systematically missing from the lowest quality programs: i.e., programs that struggle to implement distributions may also struggle to implement surveys. There are also methodological limitations to these surveys, particularly that they rely on children’s recall of the distribution several (~3) months after it has occurred. The END Fund The key differences in our assessments of the END Fund and SCI are that (1) we have seen monitoring results from SCI but not from the END Fund; (2) we do not yet have an estimate of the END Fund’s cost per deworming treatment, and therefore have not modeled its cost-effectiveness; and (3) the END Fund’s budget is set to increase more slowly in the coming year than SCI’s. On (1), as discussed above, we don’t find SCI’s monitoring results to be a major point in its favor. The main reason we decided against additional funding to the END Fund in this round is (2). There are reasons to expect that the END Fund’s cost per deworming treatment may be higher than SCI’s, such as donations being partially fungible with other neglected tropical disease programs being implemented by the END Fund—unlike SCI, which is focused exclusively on deworming—and the END Fund being a grantmaker itself to SCI and Deworm the World, which may increase the END Fund’s cost per treatment relative to SCI, since it is also following the work of the charities it supports—which may require additional funding. This may lead us to conclude that its cost-effectiveness is roughly on par with AMF, and worse than the other deworming organizations we recommend. We regret not recognizing earlier that the cost per treatment analysis could affect this allocation decision; it’s possible that we and the END Fund would have decided to accelerate the process of creating this analysis. GiveDirectly GiveDirectly is an outstanding organization and is currently very constrained by funding. We think GiveDirectly’s monitoring is stronger than AMF’s and that GiveDirectly would deploy funding more quickly, but we prefer to allocate the available funding to AMF because we believe that AMF’s work is significantly more cost-effective than GiveDirectly’s. Malaria Consortium We estimate that AMF and Malaria Consortium’s SMC programs are similarly cost-effective. We currently know considerably more about AMF’s track record and plans than we do about Malaria Consortium’s—we have followed AMF for about 8 years and Malaria Consortium for less than a year. We expect to learn significantly more about Malaria Consortium this year. Sightsavers Earlier this year, Good Ventures made a grant to Sightsavers to fully fill its execution level 1 gap on GiveWell’s recommendation. We now believe that Sightsavers has limited room for more funding for its deworming program. We had previously estimated a small execution level 2 gap, but no longer believe it has an execution level 2 gap. (The execution level 2 funding was for committing to three rather than two years of work in one country, however the work in that country is going forward with two years of funding on hand, so we believe it is of limited value to provide a third year of funding currently.) We have not funded execution level 3 for any deworming groups, preferring to fund AMF at that margin. The post Allocation of discretionary funds and new recommendation for donors appeared first on The GiveWell Blog. ### GiveWell as an organization: progress in 2016 and plans for 2017 Thu, 03/30/2017 - 12:38 This is the third of four posts that form our annual review and plan for the following year. This post reviews and evaluates GiveWell’s progress last year as an organization and sketches out some high level goals for the current year. The first two posts covered GiveWell’s progress and plans on research. The last post in the series will look at metrics on our influence on donations in 2016. First, a point of clarification. GiveWell as a legal entity currently employs both (a) staff whose work is described on givewell.org (finding outstanding evidence-backed, cost-effective programs) and (b) staff who work on the Open Philanthropy Project. We expect Open Philanthropy to become a separate organization this year (more below), pending board approval. The scope of this post is limited to (a) – the parts of the organization that will not become part of Open Philanthropy. Open Philanthropy has written about its progress and plans in this post. Below, we first note three high-level points about where GiveWell is as an organization today. We then reflect on four questions that are important for thinking about our performance as an organization: • Do we have sufficient staff capacity? • Does our impact justify our operating expenses? • Does GiveWell have a positive and accurate public image? • Are we in a stable financial position? Major organizational developments Separation of the Open Philanthropy Project We had aimed to complete the transition of Open Philanthropy staff to a new entity by the end of 2016 and did not accomplish this goal, though we are now effectively operating as two separate teams. We now expect, pending board approval, to complete the legal split by mid-2017. After the split, there will continue to be some shared staff between the organizations (GiveWell staff will track the time they spend on work for Open Philanthropy and GiveWell will bill Open Philanthropy for the time). We will continue to share office space. GiveWell as an entity currently employs 35 staff members. After the split, we anticipate that GiveWell will continue to employ 15-20 of the current employees and that Elie Hassenfeld will remain as Executive Director of GiveWell. Holden Karnofsky, Co-Founder of GiveWell, currently spends very little time on GiveWell and will work full time for Open Philanthropy. Outreach is now more of a limiting factor than research We’ve gone from feeling that we had more funding available than we had good giving opportunities to a situation where we believe that strong giving opportunities have surpassed available funding. We estimate that we left over$100 million worth of very strong opportunities (top charity execution level 1 or 2 gaps, excluding GiveDirectly) unfilled last year.

This is due to increased research output (we added three new top charities and two new standouts) in 2016, an expectation of increased research output in the future (from our standard process and Incubation Grants), and decreased expectations of funding from Good Ventures. In a change from the previous year, Open Philanthropy’s tentative guess is currently that the “last dollar” it will give (from the pool of currently available capital) has higher expected value than gifts to GiveWell’s top charities today, leading it to recommend that Good Ventures cap its giving to GiveWell’s top charities at $50 million in 2016. We expect to put more emphasis on expanding our outreach to potential donors interested in following our recommendations in 2017 than we have in past years. We are at early stages of thinking through what that might involve. Organizational maturity GiveWell will be 10 years old this year and we feel that we’ve reached a relatively stable place in our development. We are now making a major effort to strengthen our organizational infrastructure through filling specialized roles, particularly in operations (finance, donations management, technology, etc.); formalizing policies and procedures; and creating contingency plans for replacing senior staff. Four key questions Below we pose and respond to four questions about how we are doing as an organization. Do we have sufficient staff capacity? Operations: To date we have not had sufficient capacity for operations and have been slower to make improvements to our systems than we would have liked. In the last year, we have begun to make major changes to GiveWell’s operations team to try to correct for this. Sarah Ward was named Director of Operations, a new role, and we are pursuing a strategy of (a) hiring specialized firms to handle more of the HR and IT work that generalist staff have done in the past; (b) replacing our external accountants and auditors with firms that specialize in non-profits; and (c) moving current staff into and hiring for specialized roles, such as a donations manager, donor relations assistant, controller, and office manager. Our number of generalist operations staff has decreased; we expect to continue to have a need for a small number of generalist staff to manage relationships with external firms and fill gaps between specialist domains. Our current operations team includes a Director of Operations, two operations generalists (who work on the website, accounting, recruiting, personnel management, donation processing, and IT), an Office Manager, an Administrative Assistant, a Donations Manager, a Donations Assistant, and a Donor Relations Assistant. We are hiring for an Operations and Legal Program Manager and expect to hire for additional roles in the coming months. After the expected spinoff of Open Philanthropy into a separate organization, the office manager, administrative assistant and one of the operations generalists will divide their time between the two organizations and Sarah will manage operations for both organizations temporarily; Open Philanthropy will begin building a separate operations team this year. Research: Seven staff work on GiveWell’s research full time or close to full time. Elie Hassenfeld, GiveWell’s Executive Director, spends about half his time on GiveWell research. Elie spends the other half of his time on a combination of the Open Philanthropy project (about 20% of his time currently) and overseeing outreach, recruiting, and operations for GiveWell. Josh Rosenberg and I have taken over much of the research work that Elie and Holden, co-founders of GiveWell, used to do, including all updates on current top charities, reviewing top charity contenders, managing research staff, and some intervention assessments. Holden now spends almost no time on GiveWell research. We feel that we have sufficient capacity to follow up with our current top charities, consider promising contenders for top charity recommendations, and make decisions about Incubation Grants. We do not yet have sufficient capacity for reviewing the evidence for and modeling cost-effectiveness of interventions. We aim to make at least one hire for this work in the next few months. More on this in our post about our research plans for the year. Outreach: As noted above, we feel we’ve reached the point where we are identifying outstanding giving opportunities more quickly than we can expand our reach to donors to fill the opportunities. Throughout most of our history, we felt that the opposite was true, that the amount of funding we could influence surpassed the opportunities we had identified, so this represents a significant shift for us. We don’t yet have concrete plans for future outreach work, but expect to give outreach significantly more attention than we have in the past. We currently have one staff member, Catherine Hollander, who works on outreach full-time. Our outreach priorities in 2016 were to speak or meet with all major donors who were interested in talking to us, take any opportunities that came up to discuss our work with the media, and continue posting regularly to our blog. We feel that we accomplished our goals for connecting with major donors and keeping up with media requests, and fell short on blogging. Catherine is leading the search for a Research Analyst, Outreach Focus to do more of the types of outreach we’ve focused on in the past, namely connecting with more media and major donors, and increasing the frequency of blog posts. Does our impact justify our operating expenses? GiveWell’s impact on donations (or “money moved”) to our recommended charities likely decreased somewhat in 2016. We are in the process of gathering and analyzing data on our influence on donations, but expect it to be in the range of$80-90 million to recommended charities and $9.2 million for Incubation Grants. Money moved to top charities in 2015 was$110 million.

Good Ventures’ giving to top charities fell from about $70 million to$50 million, due to changes in the way it is allocating funding across priorities and to a large one-off grant to GiveDirectly in 2015. Based on GiveWell’s recommendations, Good Ventures also funded $9.2 million in Incubation Grants, up from about$400,000 to $500,000 in each of 2014 and 2015. Over the same period, we spent approximately$2 million on our operations. In total, GiveWell as an entity spent about $5.5 on operational expenses, of which$3.5 million was spent on the Open Philanthropy Project.

We previously wrote that we believe that expenses that are 15% of money moved are well within the range of normal, so we feel comfortable with the relative size of our operating expenses at this point.

Does GiveWell have a positive and accurate public image?

We believe that GiveWell’s public image is largely positive and reasonably accurate. This is true for all or nearly all of the major media coverage we have received. See, for example, coverage on NPR and in The Atlantic, Esquire and Vox.

There are two aspects of our public image that we would like to change. First, media has sometimes portrayed our top charities as having guaranteed impact and as being the “best” charities—for example, a 2015 article in The Atlantic said, “If what you want is to save lives with certainty, several people said, you have to go to GiveWell.” We believe that our top charities offer the highest expected value among evidence-backed opportunities that we have found to date, but are not risk-free and may not be the best giving opportunities for donors with different values or unique expertise, connections, or resources. Second, charities may have an inaccurate view of the costs and benefits of engaging with us—more in this post.

Our biggest public image project in the last year was launching a redesigned website. This project took much longer than expected. The original launch date was April 2015, but due to unexpected problems and lack of staff capacity, it didn’t go live until September 2016. Our previous website had an outdated look and confusing architecture. We think the new one is a large improvement, though we aim to make some further improvements in the future.

Are we in a stable financial position?

In 2016, we raised about $3 million in revenue available for funding our operations that was not specifically for funding Open Philanthropy Project expenses (Open Philanthropy has, recently, been fully funded by Good Ventures). We have roughly projected GiveWell’s expenses (excluding pre-split Open Philanthropy expenses) at$2.7 million in 2017 and $3.2 million in 2018. Given our money moved to top charities and our experiences with fundraising in the past, it seems reasonable to expect that we will be able to raise this funding, though we expect to do a more detailed analysis of our financial situation once the details of the split with Open Philanthropy have been fully worked out. We do not expect revenue available for operations to decrease as a result of splitting with Open Philanthropy because most major donors have told us that they support GiveWell due to our work identifying top charities. We think it is likely that Good Ventures will continue to support 20% of GiveWell’s operational budget, as it has for the last several years. The post GiveWell as an organization: progress in 2016 and plans for 2017 appeared first on The GiveWell Blog. ### GiveWell’s research plans for 2017 Wed, 03/29/2017 - 12:10 This is the second of four posts that form our annual review and plan for the following year. The first post reviewed our progress in 2016. The following two posts will cover GiveWell’s progress and plans as an organization and metrics on our influence on donations in 2016. Our primary research goals for 2017 are to: • Speed up our output of new intervention assessments, by hiring a Senior Fellow and by improving our process for reviewing interventions at a shallow level. • Increase the number of promising charities that apply for our recommendation. Alternatively, we may learn why we have relatively few strong applicants and decide whether to change our process as a result. Research Analyst Chelsea Tabart will spend most of her time on this project. • Through GiveWell Incubation Grants, fund projects that may lead to more top charity contenders in the future and consider grantees No Lean Season and Zusha! as potential 2017 top charities. • Further improve the robustness and usability of our cost-effectiveness model. • Improve our process for following the progress of current top charities to reduce staff time, while maintaining quality. We also have some specific goals (discussed below) with respect to answering open questions about current top charities. We discuss each of these goals in more depth below. Intervention assessments Intervention assessments are key to our research process. We generally only consider recommending funding for programs that are implementing one of our priority programs (an exception is if an organization has done rigorous evaluation of its own program, though in practice we have found this to be very rare). In recent years, we have completed few intervention reports, which has limited our ability to consider new potential top charities. We plan to increase the rate at which we form views on interventions this year by: • Hiring a Senior Fellow (or possibly more than one). We expect a Senior Fellow to have a Ph.D. in economics, public health, or statistics or equivalent experience and to focus on in-depth evidence reviews and cost-effectiveness assessments of interventions that appear promising after a shallower investigation. In addition, Open Philanthropy Project Senior Advisor David Roodman may spend some more time on intervention related work. • Doing low-intensity research on a large number of promising interventions. We generally start with a two to four hour “quick intervention assessment,” and then prioritize interventions for a 20-30 hour “interim intervention report” (example). We don’t yet have a good sense of how many of these of these we will complete this year, because we’re unsure both about how much capacity we will have for this work and about how many promising interventions there will be at each step in the process. • Continuing to improve our systems for ensuring that we become aware of promising interventions and new relevant research as it becomes available. We expect to learn about additional interventions by tracking new research, particularly randomized controlled trials, in global health and development and by talking to select organizations about programs they run that they think we should look into. Charity applications In the past few years, we have been surprised by how little interest there has been from charities in applying for a GiveWell recommendation. Our impression is that for global health and development charities there are relatively few funders of our size: in 2015, we tracked$110 million given due to our research; we are in the process of compiling the data for 2016, but expect it to be in the range of $80-90 million to recommended charities. We would like to better understand whether we have failed to get the word out about the potential value we offer or communicate well about our process and charities’ likelihood of success, or, alternatively, whether charities are making well-informed decisions about their fit with our criteria. (More on why we think more charities should consider applying for a GiveWell recommendation in this post.) This year, we have designated GiveWell Research Analyst Chelsea Tabart as charity liaison. Her role is to increase and improve our pipeline of top charity contenders by answering charities’ questions about our process and which program(s) they should apply with, encouraging promising organizations to apply, and, through these conversations, understanding what the barriers are to more charities applying. We aim by the end of the year to have a stronger pipeline of charities applying, have confidence that we are not missing strong contenders, or understand how we should adjust our process in the future. Incubation Grants We made significant progress on Incubation Grants in 2016 and plan in 2017 to largely continue with ongoing engagements, while being open to new grantmaking opportunities that are brought to our attention. Among early-to-mid stage grants, we plan to spend the most time on working with IDinsight and New Incentives (where our feedback is needed to move the projects forward), and a smaller amount of time on Results for Development and Charity Science: Health (where we are only following along with ongoing projects). Another major priority will be following up on two later-stage grantees, No Lean Season and Zusha!, groups that are contenders for a top charity recommendation in 2017. For No Lean Season, a program run by Evidence Action, our main outstanding questions are whether the program will have room for more funding in 2018 and whether monitoring will be high quality as the program scales. We have similar questions about Zusha! and in addition are awaiting randomized controlled trial results that are expected later this year. Cost-effectiveness model We plan to continue making improvements to our cost-effectiveness model and the data it draws on (separate from adding new interventions to the model, which is part of the intervention report work discussed above). Projects we are currently prioritizing include: • Making it more straightforward to see how personal values are incorporated into the model and what the implications of those values are. • Revisiting the prevalence and intensity adjustment that we use to compare the average per-person impact of deworming in places that our top charities work to the locations where the studies that found long-term impact of deworming were conducted. More in this post. • Improving the insecticide-treated nets model by revisiting how it incorporates effects on adult mortality and adjustments for regions with different malaria burdens and changes in malaria burden over time. Current top charities Our goal this year is to maintain the quality of top charity updates while decreasing the amount of staff time we spend and we ask top charities to spend on this work. Below, we detail our plans for following up with each charity. Deworm the World Initiative, GiveDirectly, and Schistosomiasis Control Initiative (SCI) We have now followed these groups for several years and do not have major outstanding questions about them. We plan to ask for updates on financial information, monitoring results, and room for more funding and have regular phone calls with them to learn about operational changes that might lead us to ask additional questions. Against Malaria Foundation (AMF) We have two major outstanding questions about AMF that we hope to make progress on this year: 1. Will AMF’s monitoring processes be high quality? We wrote about our concerns about AMF’s past monitoring last year and expect new information to be available this year. 2. Going forward, AMF aims to fund larger distributions and commit funding further ahead of when a distribution is scheduled to occur than it has, for the most part, done in the past. Will this increase the extent to which AMF funds displace funds from other sources, or will there continue to be evidence that AMF’s funds are largely adding to the total number of nets distributed? More on this question in our review of AMF. To help us make progress on these questions, we and AMF have agreed to have monthly calls to discuss questions we have about the monitoring AMF is producing and what AMF is learning about distributions it is considering funding. We will likely also seek out calls with AMF’s partner organizations to discuss these questions. In order to estimate AMF’s room for more funding, we will seek out information on the location and size of funding gaps for mass net distribution campaigns from AMF, the African Leaders Malaria Alliance, and possibly other funders of nets. As we have in the past, we will use this information in conjunction with conversations with AMF about non-funding bottlenecks to its ability to fill various gaps. The END Fund – deworming program Compared with the charities we have recommended for several years, we have more open questions about the END Fund. The main questions we plan to seek more information on this year are: 1. We have not yet seen monitoring on par with that from our other top charities from the END Fund. We expect results from coverage surveys from END Fund programs this year. Will these surveys be high quality and demonstrate that the END Fund is funding successful programs? 2. We have not yet tried to compare the cost-effectiveness of the END Fund to our other top charities in our cost-effectiveness model. We will be seeking additional information from the END Fund to about cost per treatment and baseline infection rates. 3. Questions around room for more funding: the extent to which funding due to GiveWell’s recommendation increases the amount that the END Fund spends on deworming versus other programs, actual and projected revenue from other sources, and what deworming grantmaking opportunities the END Fund expects to have. We visited the END Fund’s programs in Rwanda and Idjwi island, DRC in January 2017 and will publish notes and photos from our visit shortly. Malaria Consortium – seasonal malaria chemoprevention program As with the END Fund, we have more open questions about Malaria Consortium than we do for the charities we have recommended for several years. Our main priorities are: 1. Further research on the evidence of effectiveness, cost-effectiveness, and potential downsides of seasonal malaria chemoprevention (SMC) (due to time constraints we have not yet completed a full intervention report, though we felt sufficiently confident in the intervention to recommend Malaria Consortium). 2. Getting a better understanding of the methodology Malaria Consortium uses for estimating coverage rates. 3. Completing a more in-depth room for more funding analysis for the program for 2018 than we did for 2017. Malaria Consortium expects to have several new studies of its SMC programs to share in April 2017 (details). We may visit a Malaria Consortium seasonal malaria chemoprevention program in summer 2017. As with the END Fund and Malaria Consortium, we have more open questions about Sightsavers than we do for the charities we have recommended for several years. We expect to make limited progress this year because the first deworming mass drug administration funded with GiveWell-influenced funds is not expected to take place until September at the earliest and monitoring results aren’t expected until early 2018. Because Sightsavers has done fairly little deworming in the past year, we don’t expect to be able to learn much from its ongoing programs. Our main priorities for the year are: 1. Getting more information from Sightsavers about baseline prevalence and intensity of worm infections in the areas it is working, to inform our cost-effectiveness analysis. 2. Using Sightsavers’ budget for the projects and planned treatment numbers to improve our estimate of the cost per treatment – another input into our cost-effectiveness analysis. Our current cost per treatment estimate is very rough. 3. Completing a room for more funding analysis for 2018. Standout charities Standout charities are groups that we have a large amount of information about and that meet some but not all of our criteria. Because we have not followed them closely over time, it is possible that they may now be a stronger fit (or that they no longer focus on the program we reviewed). We plan to have at least one phone call with each of these groups to discuss whether anything has changed that might lead us to reopen consideration of the organization as a potential top charity. Due to our focus on organizations that are most likely to become top charities, we don’t expect to make this work a priority beyond that. The post GiveWell’s research plans for 2017 appeared first on The GiveWell Blog. ### GiveWell’s progress on research in 2016 Mon, 03/27/2017 - 10:49 This is the first of four posts that form our annual review and plan for the following year. This post reviews and evaluates last year’s progress on our work of finding and recommending evidence-based, thoroughly vetted charities that serve the global poor. The following three posts will cover our plans for GiveWell’s research in 2017, GiveWell’s progress and plans as an organization and metrics on our influence on donations in 2016. Summary We feel that 2016 was a highly successful year for GiveWell’s research. We accomplished or made significant progress on all of our top priorities and accomplished some of the goals we didn’t know if we would have time for. Our research output was greater than in any past year. We added three new top charities and two new standout charities. We made important progress on building the pipeline of future GiveWell top charities through our work on GiveWell Incubation Grants. The research team’s staff capacity has continued increase and we expect output to continue to grow. More subjectively, we feel that the quality of our research has continued to improve. Of particular note are our improved understanding of room for more funding for insecticide-treated nets and of the evidence for deworming. We compare our annual output for 2012-2016 in this spreadsheet. Our progress in 2016 relative to our plans In early 2016, we laid out our goals for research in 2016. Below we discuss each goal in two of the categories we set out last year, “top priorities” and “other research we will undertake if we have the time to do so,” and what progress we made on each. “Top priorities” Supporting the development of potential future GiveWell top charities: making grants to organizations that could become top charity contenders in the future or supporting research that could lead to more organizations that are a strong fit with our criteria. […] We investigated and recommended that Good Ventures make grants to five early stage projects: No Lean Season (migration assistance), New Incentives (conditional cash transfers), Zusha! (road safety), Charity Science: Health (immunizations), and Results for Development (childhood pneumonia treatment). We have published grant descriptions for most of these grants; three are forthcoming. We have also begun working closely with IDinsight to partner with charities that work on priority programs to strengthen their monitoring and evaluation to increase the chances that the charities meet our criteria in the future. Considering additional funding for insecticide-treated nets [beyond the Against Malaria Foundation] […] We spent relatively little time on this priority because (a) the Against Malaria Foundation (AMF) succeeded in signing agreements for several major distributions early in the year, increasing our estimate of its ability to absorb additional funds; and (b) our initial conversations with large funders of nets seemed unlikely to result in a top charity recommendation. At the end of the year, we found that the Against Malaria Foundation was able to absorb considerably more funding than we directed to it. This was in part due to Good Ventures’s shift away from continued growth in funding for GiveWell top charities. Separately, we also gained a stronger understanding of the size and nature of funding gaps for nets globally through country case studies and conversations to understand the global funding landscape. Intervention prioritization: quick investigations on a large number of interventions with the goal of finding more priority programs. […] This was a major priority for us and we made some progress, but not as much as we wanted to. The main things we did were (a) quick reviews (3-10 hours spent reviewing the evidence base) for ~30 programs, which ultimately led us to prioritize seasonal malaria chemoprevention (SMC) and recommend Malaria Consortium’s work on SMC; (b) publishing three “interim intervention reports” (on SMC, integrated community case management, and severe acute malnutrition) which have provided a template for mid-level assessments and enabled more staff to produce such reports in 2017 (one of which, on Sayana Press, has been published); and (c) writing a full intervention assessment of voluntary male medical circumcision, which is now one of our priority programs. Current top charities: continuing to follow our current top charities and trying to answer our highest priority unanswered questions about these groups. […] We answered our most important questions about the top charities we recommended in 2015. In particular, we had stronger answers at the end of the year on AMF’s progress at signing agreements, the quality of AMF’s monitoring, Schistosomiasis Control Initiative’s past spending and financial position, and had an overall much stronger understanding of Deworm the World Initiative, particularly its work in Kenya. However, we feel that we spent too much time on this work in 2016. Three staff spent the majority of their time on top charity updates and, while following the progress and plans of our top charities is a crucial piece of GiveWell’s work, the value we got from this work felt out of proportion with the time spent. In 2017, we plan to have a single staff member do most of this work and expect it to take a half to two-thirds of a full-time job. Three other staff will spend a small portion of their time, totaling approximately the equivalent of one full-time job, on this work. New evidence on deworming and bednets. The next round of follow up on a key deworming study is expected to be available later this year and could make a big difference to our view of deworming. We’re also looking more into the degree to which insecticide resistance may be reducing the impact of bednets. […] We completed an evidence review on the impact of insecticide resistance on malaria control. David Roodman, Senior Advisor at the Open Philanthropy Project spent several months revisiting the evidence for deworming and summarizing his findings in two blog posts. We wrote last year that we expected to see a new round of follow-up data on a key deworming study that could significantly affect our view of deworming. We have seen preliminary results and hope to get more complete results later this year and write about them at that time. We also decided to recommend a ~$1 million grant to support a more intensive 20-year follow-up to the Worms at Work study (writeup forthcoming).

“Other research we will undertake if we have the time to do so”

Micronutrient fortification charities. […]

We completed interim reviews of Food Fortification Initiative and Project Healthy Children and added them to our list of standout charities.

Neglected tropical disease (NTD) charities [and…] other organizations – if organizations apply for a recommendation and seem sufficiently promising, we will aim to review them.

Perhaps the most important development in 2016 came out of two secondary goals for 2016: continuing investigations of deworming programs (which led to recommending Sightsavers and the END Fund for their work on deworming) and continuing to be open to applications from charities (which led to recommending Malaria Consortium for its work on seasonal malaria chemoprevention).

At the same time, in the past few years, we have been surprised by how little interest there has been from charities in applying for a GiveWell recommendation. We have come to believe that charities may have misconceptions about our process or lack the information about whether they would be a fit for our criteria, and that this could be improved by us reaching out to more promising organizations and taking the time to understand the reasons why they have not applied in the past. We discuss what we are doing this year on charity outreach in the next post in this series.

Surgery charities. We have had several conversations with organizations that work on cataract surgery and we may reach out to organizations that work on obstetric fistula surgery. […]

In addition to the conversations with organizations that work on on cataract, we also spoke to several groups that work on obstetric fistula. We have not identified a group we would like to invite to apply. This work is now moving ahead primarily through our engagement with IDinsight to work with charities to strengthen their monitoring and evaluation.

Publishing research we largely completed in 2015: updates on standout charities (GAIN, IGN, and Living Goods), interim reviews of charities we began investigating in 2015 (Sightsavers, END Fund, and Project Healthy Children), and intervention reports (folic acid fortification, surgery for cataracts, trachoma and fistula, measles immunization campaigns, mass drug administration for lymphatic filariasis, and “Targeting the Ultra Poor”).

We made some progress on this goal. We published updates on standout charities (GAIN, Iodine Global Network, and Living Goods), reviews of charities we began investigating in 2015 (Sightsavers, the END Fund, and Project Healthy Children), and one of the intervention reports we hoped to publish in 2016 (cataract surgery). We did not publish the other intervention reports we hoped to (folic acid fortification, surgery for trachoma and fistula, measles immunization campaigns, mass drug administration for lymphatic filariasis, and “Targeting the Ultra Poor”).

Other work

Compared to previous years, we made a lot of progress on improving the usability of and getting staff engagement with our cost-effectiveness model. We designated a staff member, currently Chris Smith, to work on this close to full-time. Chris re-formatted the file to make it easier for staff and others to input uncertain and subjective values, integrated the seasonal malaria chemoprevention analysis into the model, and restructured the bed nets model to take into account country-level variation in malaria rates.

The post GiveWell’s progress on research in 2016 appeared first on The GiveWell Blog.

Tue, 03/21/2017 - 13:36

Our goal with hosting quarterly open threads is to give blog readers an opportunity to publicly raise comments or questions about GiveWell or related topics (in the comments section below). As always, you’re also welcome to email us at info@givewell.org or to request a call with GiveWell staff if you have feedback or questions you’d prefer to discuss privately. We’ll try to respond promptly to questions or comments.

If you have questions related to the Open Philanthropy Project, you can post those in the Open Philanthropy Project’s most recent open thread.

You can view our December 2016 open thread here.

The post March 2017 open thread appeared first on The GiveWell Blog.

### Why we’re considering Zusha! as a potential 2017 top charity

Tue, 02/28/2017 - 12:33

This post will discuss Zusha!, a 2017 GiveWell top charity contender and GiveWell Incubation Grant recipient. We previously highlighted No Lean Season as a potential 2017 top charity originating from our Incubation Grants work.

GiveWell first learned about Zusha! in 2013 following our publication of a shallow investigation into road safety. This month, Good Ventures made a GiveWell Incubation Grant of $900,000 to support the Georgetown University Initiative on Innovation, Development and Evaluation (gui2de) for work on Zusha!. Also this month, two GiveWell staff members visited Zusha! in Nairobi to learn more about its work. We plan to share additional details from their site visit in the future; this post is meant to provide a higher-level overview of Zusha! as a potential GiveWell recommendation. Road safety campaign Car accidents are a major cause of preventable death and disability around the globe, killing approximately 1.25 million people each year and injuring an additional 20 to 50 million. On the current trajectory, the World Health Organization (WHO) projects that road traffic crashes will be the 7th leading cause of death globally in 2030. The problem is particularly pronounced in low- and middle-income countries, which account for 90% of all traffic deaths, despite having ~50% of the world’s vehicles, according to the WHO. Zusha! is a road safety campaign that targets unsafe drivers of public service vehicles. The campaign distributes stickers for buses with messages encouraging passengers to speak up and urge drivers to drive more safely—”Zusha” means “protest” in Swahili. Drivers are incentivized to keep the stickers in their vehicles via enrollment in a weekly lottery with cash prizes. The goal is to reduce traffic deaths and injuries. gui2de has primarily worked in Kenya. Zusha! is part of gui2de. Professors James Habyarimana and William Jack have conducted two randomized controlled trials (RCTs) of the program in Kenya: first, a small pilot study of ~2,400 vehicles followed by a larger study of ~12,500 vehicles. The researchers found large, statistically significant effects of the program in reducing the number of accidents for vehicles in the treatment group.[1] With support from a Development Innovation Ventures (DIV) grant from USAID, Zusha! scaled up in Kenya following the second RCT. As of March 2016, Professors Habyarimana and Jack estimated that the campaign was reaching 25,000 minibuses and larger buses, out of roughly 40,000 in the country. gui2de is running three additional RCTs on this program in Rwanda, Tanzania, and Uganda. A note on terminology in this blog post In this blog post, we generally refer to the program we’re interested in as Zusha! to distinguish it from gui2de‘s other programs (not related to road safety). However, Zusha! is only the name of the road safety campaign in Kenya; the road safety campaigns in Rwanda, Tanzania, and Uganda have other names. Although the Kenya campaign is the one we’re most knowledgeable about, it’s possible that a GiveWell top charity recommendation would include gui2de‘s road safety work in other countries. We’ve used the term Zusha! in this post for simplicity. Potential future top charity We’re interested in Zusha! as a potential future top charity due to the potential strength of the evidence base and cost-effectiveness. We believe the evidence for Zusha! is compelling. The pilot study finds that driving accidents decreased by a half to two-thirds and the larger Kenya RCT finds that driving accidents decreased by between one-quarter and one-third. These effects seem surprisingly large to us, and we are interested to see whether the intervention will find similar effects in future RCTs. In our most up-to-date cost-effectiveness calculation, we estimate a cost of ~$13,000 per road accident death averted (including injuries and incorporating discounts to account for whether the studies would be likely to replicate and questions around external validity).

GiveWell’s current estimate is that the cost-effectiveness of Zusha! is comparable to the Against Malaria Foundation, one of our top charities, and about 3-4x as cost-effective as direct cash transfers, a baseline we use for comparing interventions, although this may change as we incorporate additional inputs. We incorporated age weights into this estimate that reflect the older average age of passengers on vehicles, relative to average age of people whose deaths are averted by AMF-distributed nets, and approximate GiveWell median staff values for averting an adult death.

GiveWell Incubation Grant

Good Ventures’ recent grant to gui2de is intended to:

• Allow gui2de to continue operating at scale in Kenya and collect higher-quality monitoring data of that work. Strong monitoring data, such as information to demonstrate the stickers are being distributed to the intended vehicles or that the stickers remain in use over time, is a necessary component for a top charity recommendation and is one of our biggest open questions about Zusha!.
• Increase the sample size of the RCT in Uganda by ~50%, improving the study’s power and making it more likely the results will inform our views.
• Potentially improve the quality of data collection for the RCT in Tanzania.
• Provide funding to enable gui2de to continue its ongoing work through the end of 2017, when GiveWell might potentially name Zusha! a top charity, in which case we would expect to direct it substantial funding. Enabling gui2de to continue operating in Rwanda, Tanzania, and Uganda for six additional months would also allow faster scale-up if the RCT results are positive.

A write-up on the February 2017 grant is forthcoming. It will be published here.

Our open questions

We have several open questions about Zusha!‘s work that will be key in helping us decide whether to recommend Zusha! as a top charity:

• We expect that results from the three pending RCTs in Rwanda, Tanzania, and Uganda will substantially affect our view of the likely impact of the program, although we don’t expect to have full results from all three RCTs by the end of 2017.
• Zusha! researchers found a nearly statistically significant impact for the placebo intervention (stickers that had messages like “Travel well”) in the second Kenya study. This finding casts uncertainty on the mechanism by which the intervention works and whether the intervention is having an impact. Additional RCTs may help fill out our understanding.
• Our cost-effectiveness analysis suggests that Zusha! is competitive with—but not far better than—our current top charities, at ~3-4x as cost-effective as cash transfers. GiveWell’s cost-effectiveness analyses tend to become worse (less cost-effective) as we add new inputs and adjustments. Our estimate of Zusha!‘s cost-effectiveness already became significantly worse when a GiveWell Research Analyst, Leon Zhang, identified a mathematical error in one of the studies published on Zusha!‘s program. It’s possible we will conclude that Zusha! is not as cost-effective as our other top charities after spending additional time on this.
• Provision of high-quality monitoring information to demonstrate that the stickers are being used in buses over time. We understand from our recent site visit that Zusha! tentatively plans to do three types of monitoring in Kenya going forward: At National Transport and Safety Authority (NTSA) inspection centers, bus parks where passengers are picked up, and via the lottery. We have questions about the implementation of these processes, but our impression is that Zusha! is working to significantly improve its monitoring, and we expect to have more information by the end of the year.
• Zusha! is a behavioral intervention. Over time, people may get used to seeing the stickers, causing the effect to diminish. We currently have limited information on the extent to which this has occurred or may occur in the future. We hope additional information about long-term impacts of the program will enable us to assess this question over time.

Path to GiveWell top charity

We publish our updated top charities list in November. By then, we expect to have new monitoring information from Kenya as well as preliminary RCT results from Tanzania. We also expect to have partial results from the Uganda RCT. (We do not expect to have results from the Rwanda RCT.) We guess that the information we will have by late 2017 should be sufficient to assess Zusha! for a potential GiveWell recommendation.

Notes
• Results from the pilot study (published 2010): “Our results indicate that insurance claims fell by a half to two-thirds, from an annual rate of about 10 percent without the intervention, and that claims involving injury or death fell by 60%.” Habyarimana and Jack 2010, p. 1
• Results from the larger study (published 2015): “Overall, the stickers reduce insurance claims of matatus assigned to treatment groups by between one-quarter and one-third on an intent-to-treat (ITT) basis. Among the roughly 8,000 vehicles in the treatment groups, the reduction was 25%, and we estimate that about 140 accidents were avoided per year, and about 55 lives were saved annually.” Habyarimana and Jack 2015, p. 1

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### What does it mean when a charity declines to participate in GiveWell’s review process?

Tue, 02/21/2017 - 12:37

We noted in a recent blog post that 10 out of 23 organizations that we invited to apply for a recommendation were named top charities or standout charities, and that nine of the remaining charities declined to participate in our process. What does it mean when a charity declines to participate?

Charities can withdraw from GiveWell’s review process at any time and for any reason. Typically, when a charity withdraws from our process, we publish documents that we have permission to publish, such as notes from previous conversations. We also publish a page indicating that the charity declined to fully participate in our application process and run this page by the charity before publishing it. Some past ‘decline’ pages appear here, under “Organizations that declined to fully participate in our process.”

A charity may decline to participate at any stage of the GiveWell review. All of the following could lead to GiveWell publishing a page indicating that a charity declined to participate:

• A charity doesn’t respond to our invitation to apply.
• A charity has one call with GiveWell research staff and decides not to participate.
• GiveWell writes up an interim review (example of a published interim review, from a charity that did not decline to participate), the charity reviews it, and then declines to participate. The review is not published in this case.

GiveWell generally doesn’t publish the reason a charity decided not to participate in order to preserve this option for charities who are concerned that engaging with GiveWell could potentially harm them if GiveWell publishes a negative review. We discuss this in greater detail here:

While we want to be open, we don’t want to create a dynamic in which working with us creates significant risks for grantees. (This could lead good organizations to avoid working with us.) So we’ve had to find ways of balancing the goal of openness with the goal of making it “safe” for an organization to work with us.

For this reason, a typical ‘decline’ page reads: “Organization X declined to participate in our process,” with no further context, so that organizations can engage with GiveWell without worrying that we’ll publish a harmful review of their work. (This post discusses some of the pros and cons of this approach for donors who rely on our research and charities we review.)

We hope to minimize GiveWell staff time spent with groups that ultimately decline to participate so that we can focus our capacity on organizations that could become top charities. We also hope to minimize the number of groups that decline to participate due to misunderstanding GiveWell’s process, expectations around transparency and review publishing, or the value-add of a GiveWell recommendation. We now have a staff member, Chelsea Tabart, that works closely with charities we might review so they know what to expect.

We hope that concerns about a negative review will not be a barrier to organizations working with us, and recently published a blog post on why more charities should consider applying for a GiveWell recommendation.

The post What does it mean when a charity declines to participate in GiveWell’s review process? appeared first on The GiveWell Blog.

### Why more charities should consider applying for a GiveWell recommendation

Tue, 02/14/2017 - 12:00

This post will highlight major changes to GiveWell and our charity review process over the past few years, with hopes of encouraging certain organizations working in global health and development to apply for a top charity recommendation.

We believe that GiveWell may now be a better fit for a number of organizations than we had been in the past. However, we still do not expect to fund the vast majority of organizations. GiveWell remains focused on international aid, and our criteria will likely rule out many organizations.

In brief,

• GiveWell’s top charities receive a substantial amount of funding (millions of dollars each).
• Charities quickly learn whether we think they might be a potential top charity, before putting in lots of time. Charities we don’t recommend may receive a $100,000 participation grant. • We’re open to funding large, multi-program organizations as well as small, single-program organizations. Why charities should consider applying • Our recommended charities receive a lot of funding. In 2015, GiveWell’s recommendation resulted in charities receiving an estimated$110 million; the majority of this funding was divided between our four top charities. That’s money we directly track from individual donors who attribute their gifts to our recommended charities. The total has grown significantly in recent years. We have not yet completed our metrics report for 2016; we expect money moved last year to be similar or slightly lower than money moved in 2015.

Our top charities and standout charities have received annual “incentive” funding for earning these designations in recent years, with the aim of encouraging other organizations to seek to meet our criteria. These grants have been made by Good Ventures, with GiveWell’s recommendation. In 2016, we increased the annual incentive amount that each of our top charities receives from $1 million to$2.5 million.

Last year, we recommended that Good Ventures make $250,000 grants to each standout, and Good Ventures followed our recommendation. We’re not sure what we’ll recommend in the future, but we’re tentatively planning to recommend$100,000 grants for standout charities.

• We provide early-stage support to promising organizations and programs through our Incubation Grant program, and recommended more than $10 million in Incubation Grants in 2016. The goal of GiveWell Incubation Grants is to support the development of future top charities by providing funding to charities or programs that don’t yet meet GiveWell’s criteria but may develop into future top charities or priority programs with additional funding. • We’ve streamlined our charity review process so that we ask for relatively little time, compared to our understanding of a typical grant application, from an applicant before we tell them whether they are a promising candidate. Generally, the first phase of our application involves one or two 1-2 hour phone calls between GiveWell and program staff, after which we ask the staff to provide feedback on notes from that conversation for us to publish on our website. We also ask for internal documents to demonstrate how the organization uses funds and tracks impact. If a charity doesn’t seem likely to become a top charity after this initial review, we do not ask for more of its staff’s time. After GiveWell completes the first phase of our review, we ask charities to sign off on GiveWell publishing an interim review of that organization. GiveWell will then make a$100,000 participation grant to the group, regardless of whether it is ultimately named one of GiveWell’s recommended charities.

• Odds are good of being named a top charity for organizations we explicitly invite to continue in the application process after our initial review. Since 2013, 10 out of 23 organizations that we invited to apply have been named a top charity or standout; nine of the remaining organizations declined to participate, three are still being considered, and we decided not to recommend one.

• We’re open to assessing large, multi-program organizations as well as small, single-program groups. In 2016, we recommended restricted donations to individual programs run by large, multi-program organizations: in particular, Sightsavers’ deworming program and Malaria Consortium’s seasonal malaria chemoprevention (SMC) program. We previously almost exclusively recommended unrestricted donations to smaller organizations (for reasons discussed in this blog post).

• We have a staff member, Chelsea Tabart, dedicated to helping charities understand us, our process, and the types of funding GiveWell offers. We created this position in response to our impression that not all charities working on programs we are interested in are aware of our interest in funding their work, what is involved in our review process, or how much funding we’re directing to recommended charities . We hope that having a staff member serve as a charity liaison will make it more likely that charities who might be a good fit for GiveWell funding apply.

The above list highlights changes to GiveWell’s process that have occurred over time and may make GiveWell a better fit for some organizations than it was previously. Other core elements of our review process and criteria have not changed. We remain interested in international health and development, for example, and committed to supporting interventions for which a strong evidence base exists or may be developed with additional funding. In addition:

• We prefer to provide unrestricted funding. Within program areas, or when recommending funding to organizations that only run one program, we offer unrestricted funding and have no formal reporting requirements. Instead, we require check-in conversations approximately every quarter as well as ongoing budgets, monitoring and evaluation results, or similar materials to keep us up to date.
• We prefer to publish as much information as we can, although we keep all non-public information confidential until we have explicit permission to publish it. Conversations with GiveWell are ‘off the record’ until we have approval to share non-public information.
What makes a top charity?

GiveWell recommends charities that are evidence-backed, cost-effective, and underfunded. We’re looking for charities that are implementing a program with a strong independent evidence base, such as multiple randomized controlled trials (we list programs that meet this criteria—our “priority programs”—here). We’re looking for charities whose work is in the same range of cost-effectiveness as our current top charities, and with a significant need for additional funding. Our top charities are transparent about their work, and can share detailed monitoring and evaluation information, financials, and future plans, and are comfortable with GiveWell discussing their work publicly and in detail.

Applying for a GiveWell recommendation

We hope the above will encourage additional charities to consider applying for a GiveWell recommendation or reach out with questions about our process. If you work at or know of an organization that might be a good fit based on the above information, please contact us. You can email us for more details about our application process at applications@givewell.org.

The post Why more charities should consider applying for a GiveWell recommendation appeared first on The GiveWell Blog.

### Open Philanthropy Project post on giving suggestions pertaining to recent executive actions

Thu, 02/09/2017 - 14:12

GiveWell has recently received a number of questions about where to donate in response to recent executive actions in the United States. The Open Philanthropy Project published a blog post today with its suggestions. Read it here.

### Why we’re considering No Lean Season as a potential 2017 top charity

Fri, 02/03/2017 - 14:17

In recent years, we’ve added a new source for potential GiveWell top charity recommendations: GiveWell Incubation Grants. This post will highlight a GiveWell Incubation Grant recipient, No Lean Season, that we see as a top charity contender for 2017.

GiveWell has traditionally identified our top charities through our standard process, during which we examine a charity’s track record and funding needs. Our goal with GiveWell Incubation Grants, outlined in an earlier blog post, is to grow the pipeline of potential future top charities, in part by supporting organizations at an earlier stage than we would traditionally consider them for a top charity recommendation. We generally expect there to be a lag of a few years between receiving an Incubation Grant and being considered for a top charity recommendation.

Good Ventures, a large foundation with which we work closely, funds GiveWell Incubation Grants. Good Ventures made its first Incubation Grant to No Lean Season in 2014 and we now believe it is a top charity contender when we update our recommendations at the end of 2017. We’re planning to highlight another 2017 contender, Zusha!, in a future post.

Seasonal income support program

No Lean Season offers subsidies to low-income agricultural workers in Bangladesh to incentivize them to temporarily migrate from rural areas to urban areas, where they may earn higher wages seasonally. These subsidies (which may be made as grants or loans) are around $8-19 USD and cover travel costs and a couple days of food. Follow-up studies found that individuals who once received an incentive to migrate chose to do so again—without a subsidy—at a higher rate than would otherwise be expected, suggesting they found migrating to be useful. The below infographic from No Lean Season shows a high-level overview of the intervention (click for detail): Evidence Action, the parent organization of GiveWell top charity Deworm the World Initiative, started No Lean Season as part of Evidence Action Beta, its program to test interventions that could be significantly scaled up. How we decided to support No Lean Season We approached Evidence Action in late 2013 to express our interest in supporting the creation of new GiveWell top charities. In March 2014, Good Ventures made a$250,000 grant to Evidence Action to support the investigation and scale-up of promising programs. Since then, Good Ventures has made three additional grants totaling approximately $2.7 million to support the program’s scale-up; the write-up for the most recent grant, made in December 2016, is forthcoming. No Lean Season as a GiveWell top charity contender We assess potential GiveWell top charities along four criteria: evidence of effectiveness, cost-effectiveness, transparency, and room for more funding. No Lean Season appears as a plausible contender when reviewed along these dimensions. We plan to spend significantly more time reviewing No Lean Season this year as we move forward in our top charity review process and update our views on its work. Evidence of effectiveness. A number of randomized controlled trials (RCTs) have studied the effects of seasonal income support in northern Bangladesh, where Evidence Action is scaling up the program. Trials conducted in 2008 and 2014 found significant effects on household expenditures and income, respectively, during the relevant season. In addition, later follow-ups of households that were incentivized to migrate found that they did so again at higher rates, even in the absence of a continued incentive; Mushfiq Mobarak, a Yale economics professor and a lead researcher on No Lean Season, estimates that the effects persist for three additional years. However, the 2008 and 2014 studies did not measure directly comparable or combinable outcomes, so we can’t compare them or combine the results. We take these RCTs as strong evidence that No Lean Season’s seasonal migration subsidies lead to improved economic outcomes in northern Bangladesh. Analysis is not yet complete for a separate RCT, conducted in 2013, a year when labor unrest was unusually high (see Figure 1). Given the possibility of mitigating circumstances, we’re unsure how informative the 2013 RCT results will be to predicting future success of the program. Potential risks of the program could include negative impacts at the destination labor market (e.g. on job availability or food prices) or vulnerability of migrants or family members left at home after migration. As of January 2016, our impression was that Evidence Action planned to monitor possible negative effects on the destination labor market; Evidence Acton said it had not found indication in surveys that migrants or their families were less secure (see p. 4). Evidence Action is planning to run an RCT at scale during the 2017 lean season. Due to our current best estimate of the program’s cost-effectiveness and expectation that No Lean Season will collect and share high-quality monitoring data from its 2016 work (discussed below), we think the evidence base may be sufficient for the organization to qualify as a top charity at the end of 2017, before results from this RCT are available. Cost-effectiveness. We currently estimate that No Lean Season is between 5-14 times as cost-effective as direct cash transfers, a baseline we use for comparison among global health and development interventions. At scale, we estimate that individuals will experience a consumption benefit of$15 for every $3 No Lean Season spends. These benefits and costs are averages over the population that is eligible for and offered the program; we believe that the benefits are actually larger for households that send a migrant and smaller for households that don’t. We’re very uncertain about the baseline per capita lean season consumption in this population, but for comparison purposes, we estimate it at roughly$116 for the entire 5-month lean season. We also expect, based on previous studies, remigration without further incentive for about two future years, as well as at least one additional migration during the lesser lean season.

Our estimate of No Lean Season’s cost-effectiveness is in the range of our current top charities. We believe that the four deworming charities we recommend are ~4-10x as cost-effective as cash transfers, and the two charities we recommend for their work to prevent malaria, the Against Malaria Foundation and Malaria Consortium, are ~4x as cost-effective as cash transfers. However, our cost-effectiveness estimates typically become worse—the cost-effectiveness decreases—as we spend more time on our analysis and incorporate additional inputs and discounts. We expect this is likely to occur with our current estimate of No Lean Season’s cost-effectiveness, as well.

Monitoring. We have not yet reviewed No Lean Season’s monitoring. However, we are quite familiar with its parent organization, Evidence Action, as a result of our recommendation of the Deworm the World Initiative as a top charity since 2013, and our previous reviews of its work, and feel confident Evidence Action will share its monitoring of No Lean Season based on its track record. We expect this monitoring to be of a high quality.

Organizational strength and transparency. We have a positive view of Evidence Action as an organization, based on our significant experience communicating with its staff. Our impression is that Karen Levy, Evidence Action’s Director of Global Innovation and Beta, played a key role in scaling the Deworm the World Initiative, suggesting the organizational capacity exists to similarly scale a program like No Lean Season. We also believe that Evidence Action, based on its track record and our experience, will operate No Lean Season transparently.

Room for more funding. Evidence Action currently estimates that No Lean Season could productively use approximately $16 million over five years in Bangladesh and Indonesia, and additional funding to expand to India and Ghana; this estimate may be adjusted in the future. We remain unsure whether this program will be successful in locations beyond Bangladesh. If it isn’t a good fit in other locations, No Lean Season’s overall room for more funding could be quite limited. Progress to date and future plans As of early 2016, Evidence Action planned to scale up its program in Bangladesh to offer a total of 16,000 subsidies and reach 9,000 households with its implementing partner, RDRS Bangladesh, in 2016, the first of a four-year scale-up. By 2019, No Lean Season provisionally plans to offer ~295,000 subsidies and reach ~165,000 households in Bangladesh (see p. 5 here; No Lean Season staff plan to update these figures going forward). Evidence Action is also exploring the possibility of working in locations beyond Bangladesh. It visited Zambia and Malawi in 2014 to assess whether the program might help alleviate seasonal hunger in those locations. Our understanding is that Evidence Action is not planning to expand in Malawi based on its findings. We believe Evidence Action is also not planning to scale up in Zambia. Mobarak, the No Lean Season researcher, has conducted two research studies in Indonesia, which he says suggest the country may have similar underlying conditions to Bangladesh. As of August 2016, Evidence Action was also considering expanding into India, particularly states close to Bangladesh, although it had not yet done any research there. Evidence Action also considered Ghana as a potential future location, although we are not aware of concrete plans to begin implementation there.[1] Path to GiveWell top charity By November 2017, we expect to see results from No Lean Season’s first year of a four-year scaling effort (the September-December 2016 seasonal effort to reach 9,000 households described above). This, combined with the fact that there are multiple rounds of randomized controlled trials in the past and a large forthcoming RCT at scale, maybe sufficient for No Lean Season to qualify as a 2017 top charity. Notes [1] “Indonesia Mushfiq Mubarak has completed two research studies related to No Lean Season in Indonesia: 1. An exploratory study, similar to those done in Zambia and Malawi. 2. A small-scale pilot in West Timor conducted by the Southeast Asian office of the Abdul Latif Jameel Poverty Action Lab (J-PAL). This study was similar to a previous trial in Bangladesh, but was not a randomized evaluation. The studies’ initial results are promising. Indonesia appears to have similar underlying conditions to Bangladesh, including: lean season migration; availability of jobs in urban areas; and migration from rural to urban areas and between islands. India No Lean Season is also considering expanding into India but has not yet conducted research there. Its first activity in India would likely be a small-scale project, such as a pilot in one village. The underlying conditions in Indian states bordering the Rangpur region of Bangladesh are similar to those that exist in Rangpur. Ghana No Lean Season is considering expanding into Ghana but does not yet have concrete plans to initiate a project there. In general, it does not intend to expand into new countries until it has sufficient capacity to do so.” The post Why we’re considering No Lean Season as a potential 2017 top charity appeared first on The GiveWell Blog. ### GiveWell Incubation Grants Thu, 01/19/2017 - 13:32 GiveWell Incubation Grants have become an increasingly substantial part of our work, and our impression is that not everyone who follows GiveWell is familiar with this program. This blog post is intended to (a) briefly explain and outline our main goals and expectations for this work, and (b) share some updates on promising organizations that have been supported by Incubation Grants. The goal of GiveWell Incubation Grants (previously known as GiveWell’s experimental work) is to support the development of future top charities and improve our understanding of our current top charities. We plan to do this in a few ways (not an exclusive list): 1. Increasing the body of evidence around potential top charities and priority programs; 2. Providing early-stage support for new organizations; 3. Supporting improved monitoring and evaluation for potential or current top charities. Good Ventures, a foundation with which we work closely, has funded the grants made as part of this work, which are listed here. Promising investigations Due to the nature of this support—early-stage funding, intended to allow an organization to develop a stronger track record or to collect more evidence on a promising program—we don’t expect Incubation Grants to produce new top charities over very short time horizons. We expect there will be, in many cases, a period of multiple years between a grant and an organization or intervention being considered a potential top charity or priority program. This post highlights grants that we don’t expect to lead to top charities before 2018. It should provide a reasonable overview of the type of grants we’re excited to recommend as part of this work. Future posts will highlight the organizations we’re closely tracking as potential 2017 top charities (No Lean Season and Zusha!).[1] This post will discuss Incubation Grants to: IDinsight IDinsight supports and conducts rigorous evaluations of development interventions with an explicit focus on providing useful data to inform funders and policymakers. Good Ventures made a$1.985 million grant to IDinsight for general support in June 2016 as part of GiveWell Incubation Grants.

In conversations with our network, we’ve often heard that IDinsight fills a unique gap in the development sector. There are other organizations that conduct research and advocate for evidence-based decision-making, but our impression is that IDinsight is currently the one most focused on research whose primary goal is to help decision-makers with specific decisions (in contrast to e.g. academic merit). We have seen some indications of other organizations moving in a similar direction, however. We hope that this grant allows IDinsight to grow its staff and take on more projects. IDinsight’s work has the potential to inform GiveWell’s list of top charities by increasing the body of evidence around potential priority programs and improving available monitoring and evaluation information around specific organizations.

Recently, Good Ventures made an additional grant to IDinsight to support an “embedded IDinsight team” for GiveWell top charities, i.e., a small group of IDinsight staff explicitly focused on supporting the creation of high-quality monitoring and evidence for current and future GiveWell top charities. For example, IDinsight may work with New Incentives to run an impact study, and possibly a randomized controlled trial (RCT), on its pilot program to incentivize immunization. Another possible project for the embedded team is conducting monitoring and evaluation of cataract surgery programs, which could improve our understanding of the efficacy of the program and whether we should recommend charities that work on it. Additional possible projects for the IDinsight embedded team are discussed here.

We don’t expect a new GiveWell top charity to originate from this work in 2017, but hope that it will inform our future recommendations.

New Incentives
We made three Incubation Grants to New Incentives for its conditional cash transfer program aimed at preventing mother-to-child transmission (PMTCT) of HIV and encouraging pregnant women to deliver in health facilities (e.g., rather than at home). We decided not to recommend New Incentives’ PMTCT and facility delivery program as a 2016 top charity due to insufficient evidence supporting the program, although we were impressed by the organization’s staff. We wrote about this decision at length in this blog post.

With our encouragement, New Incentives shifted its focus to a new program, conditional cash transfers to incentivize immunizations in Nigeria. We’re planning to follow its work on this program as a potential future top charity, although we do not consider it likely to become a GiveWell-recommended charity in 2017.

Results for Development (R4D)
Pneumonia is one of the leading killers of children worldwide, and our impression is that there is no dedicated funding stream for its treatment (as there is for other major diseases like AIDS, tuberculosis, and malaria). R4D is implementing a program to increase use of amoxicillin, the World Health Organization-recommended first-line treatment, to treat childhood pneumonia in Tanzania. In May 2016, Good Ventures provided $6.4 million to support this program as part of GiveWell Incubation Grants. We have a positive view of R4D as an organization: its staff, evidence-driven approach, and transparency. We also believe that the use of amoxicillin to treat childhood pneumonia could be competitive with our current priority programs. Our key question around this program as a possible GiveWell top charity is monitoring and evaluation. We’re unsure whether R4D’s monitoring will lead us to feel confident that children sick with pneumonia actually receive treatment. This is due to the complex nature of the intervention, which may make it more challenging to collect high-quality monitoring data comparable with that of our current top charities. We currently expect that R4D will have the data available to potentially qualify as a top charity in 2018 or 2019 and we hope to evaluate it then. Charity Science: Health Charity Science: Health was founded by members of the effective altruism community with the explicit goal of creating a GiveWell top charity. Charity Science: Health plans to send SMS text reminders for vaccinations due to the strong evidence base they see for this program in increasing immunization rates. Good Ventures made a grant of$200,000 to support the first year of the organization’s work in India.

Because we have not yet vetted the relevant evidence closely, we remain unsure about whether we would recommend SMS reminders as a priority program. Charity Science: Health has been transparent and communicative with us, and we expect to learn from its work. Charity Science: Health is also a young organization with a very short track record, and we don’t anticipate evaluating it as a top charity until 2018 or 2019.

Mindset engagement for cash transfers
GiveDirectly, one of GiveWell’s top charities, provides unconditional cash transfers to very poor individuals in East Africa. In May 2016, Good Ventures made a $350,000 grant to Innovations for Poverty Action to support an RCT—in collaboration with GiveDirectly—testing whether “mindset engagement” approaches to cash transfers, such as watching an inspirational film or meeting with a counselor, affects the outcomes for cash transfer recipients by changing the framing of the transfer and thus how it is spent. The approaches are aimed at encouraging recipients to use the transfers to pursue their goals by increasing their sense of self-efficacy and understanding of their opportunities, which—according to the researchers’ theory—may have been adversely impacted by time spent in poverty. This study could influence the work of one of our current top charities (GiveDirectly) or our understanding of cash transfers as a priority program. Incentives for immunization studies In 2015, Good Ventures made two$100,000 grants to support further study of whether providing incentives for immunization could increase vaccination rates. These grants were made as part of our work to grow the body of evidence around promising programs that could become potential GiveWell priority programs.

The Incubation Grants were made to the Abdul Latif Jameel Poverty Action Lab (J-PAL) at the Massachusetts Institute of Technology and Interactive Research and Development (IRD) to support high-quality replications of a promising study on the impact of providing non-cash incentives, such as grocery vouchers, for parents to vaccinate their children. The replication studies are being conducted in India and Pakistan.

We are unsure when the results of these studies will be available.

Other work to support potential future top charities

Evidence Action, the parent organization of GiveWell top charity Deworm the World Initiative as well as No Lean Season, a GiveWell Incubation Grant recipient, recently announced a call for results of RCTs and other rigorous empirical studies that demonstrated a positive impact of an intervention benefiting poor households, and is planning to fund 3-6 of these proposals for further research. We’re excited to see this announcement and expect the results may further our understanding of potential GiveWell priority programs.

Full list of GiveWell Incubation Grants

A full list of grants we’ve recommended is available at www.givewell.org/research/incubation-grants.

If you know of a strong proposal for a potential GiveWell Incubation Grant, please email applications@givewell.org. We’d be particularly interested in new groups that work on promising programs for which we have not found charity implementers.

Notes

[1] In December, we recommended a grant of $900,000 to Zusha! to scale up its road-safety programs. This grant write-up is not yet public, but notes from our initial conversations with Zusha! are available here and here. The post GiveWell Incubation Grants appeared first on The GiveWell Blog. ### How thin the reed? Generalizing from “Worms at Work” Wed, 01/04/2017 - 14:37 Hookworm (AJC1/flickr) My last post explains why I largely trust the most famous school-based deworming experiment, the report in Worms at Work about its long-term benefits. That post also gives background on the deworming debate, so please read it first. In this post, I’ll talk about the problem of generalization. If deworming in southern Busia County, Kenya, in the late 1990s permanently improved the lives of some children, what does that tell us about the impact of deworming programs today, from sub-Saharan Africa to South Asia? How safely can we generalize from this study? I’ll take up three specific challenges to its generalizability: • That a larger evidence base appears to show little short-term benefit from mass deworming—and if it doesn’t help much in the short run, how can it make a big difference in the long run? • That where mass deworming is done today, typically fewer children need treatment than in the Busia experiment. • That impact heterogeneity within the Busia sample—the same treatment bringing different results for different children—might undercut expectations of benefits beyond. For example, if examination of the Busia data revealed long-term gains only among children with schistosomiasis, that would devalue treatment for the other three parasites tracked. In my view, none of the specific challenges I’ll consider knocks Worms at Work off its GiveWell-constructed pedestal. GiveWell’s approach to evaluating mass deworming charities starts with the long-term earnings impacts estimated in Worms at Work. Then it discounts by roughly a factor of ten for lower worm burdens in other places, and by another factor of ten out of more subjective conservatism. As in the previous post, I conclude that the GiveWell approach is reasonable. But if I parry specific criticisms, I don’t dispel a more general one. Ideally, we wouldn’t be relying on just one study to judge a cause, no matter how compelling the study or how conservative our extrapolation therefrom. Nonprofits and governments are spending tens of millions per year on mass deworming. More research on whether and where the intervention is especially beneficial would cost only a small fraction of all those deworming campaigns, yet potentially multiply their value. Unfortunately, the benefits that dominate our cost-effectiveness calculations manifest over the long run, as treated children grow up. And long-term research tends to take a long time. So I close by suggesting two strategies that might improve our knowledge more quickly. Here are Stata files for the uantitative assertions and graphs presented below. Evidence suggests short-term benefits are modest Researchers have performed several systematic reviews of the evidence on the impacts of deworming treatment. In my research, I focused on three of those reviews. Two come from institutions dedicated to producing such surveys, and find that mass deworming brings little benefit, most emphatically in the short run. But the third comes to a more optimistic answer. The three are: • The Cochrane review of 2015, which covers 45 trials of the drug albendazole for soil-transmitted worms (geohelminths). It concludes: “Treating children known to have worm infection may have some nutritional benefits for the individual. However, in mass treatment of all children in endemic areas, there is now substantial evidence that this does not improve average nutritional status, haemoglobin, cognition, school performance, or survival.” • The Campbell review of 2016, which extends to 56 randomized short-term studies, in part by adding trials of praziquantel for water-transmitted schistosomiasis. “Mass deworming for soil-transmitted helminths …had little effect. For schistosomiasis, mass deworming might be effective for weight but is probably ineffective for height, cognition, and attendance.” • The working paper by Kevin Croke, Eric Hsu, and authors of Worms at Work. The paper looks at impacts only on weight, as an indicator of recent nutrition. (Weight responds more quickly to nutrition than height.) While the paper lacks the elaborate, formal protocols of the Cochrane and Campbell reviews, it adds value in extracting more information from available studies in order to sharpen the impact estimates. It finds: “The average effect on child weight is 0.134 kg.” Before confronting the contradiction between the first two reviews and the third, I will show you a style of reasoning in all of them. The figure below constitutes part of the Campbell review’s analysis of the impact of mass administration of albendazole (for soil-transmitted worms) on children’s weight (adapted from Figure 6 in the initial version): Each row distills results from one experiment; the “Total” row at the bottom draws the results together. The first row, for instance, is read as follows. During a randomized trial in Uganda run by Harold Alderman and coauthors, the 14,940 children in the treatment group gained an average 2.413 kilograms while the 13,055 control kids gained 2.259 kg, for a difference in favor of the treatment group of 0.154 kg. For comparability with other studies, which report progress on weight in other ways, the difference is then re-expressed as 0.02 standard deviations, where a standard deviation is computed as a sort of average of the 7.42 and 8.01 kg figures shown for the treatment and control groups. The 95% confidence range surrounding the estimate of 0.02 is written as [–0.00, 0.04] and is in principle graphed as a horizontal black line to the right, but is too short to show up. Because of its large sample, the Alderman study receives more weight (in the statistical sense) than any other in the figure, at 21.6% of the overall number. The relatively large green square in the upper right signifies this influence. In the lower-right of the figure, the bolded numbers and the black diamond present the meta-analytical bottom line: across these 13 trials, mass deworming increased weight by an average 0.05 standard deviations. The aggregate 95% confidence interval stretches from –0.02 to 0.11, just bracketing zero. The final version of the Campbell report expresses the result in physical units: an average gain of 0.09 kg, with a 95% confidence interval stretching from –0.09 kg to +0.28 kg. And so it concludes: “Mass deworming for soil-transmitted helminths with albendazole twice per year compared with controls probably leads to little to no improvement in weight over a period of about 12 months.” Applying similar methods to a similar pool of studies, the Cochrane review (Analysis 4.1) produces similar numbers: an average weight gain of 0.08 kg, with a 95% confidence interval of –0.11 to 0.27. This it expresses as “For weight, overall there was no evidence of an effect.” But Croke et al. incorporate more studies, as well as more data from the available studies, and obtain an average weight gain of 0.134 kg (95% confidence interval: 0.03 to 0.24), which they take as evidence of impact. How do we reconcile the contradiction between Croke et al. and the other two? We don’t. For no reconciliation is needed, as is made obvious by this depiction of the three estimates of the impact of mass treatment for soil-transmitted worms on children’s weight: Each band depicts one of the confidence intervals I just cited. The varied shading reminds us that within each band, confidence is highest near the center. The bands greatly overlap, meaning that the three reviews hardly disagree. Switching from graphs to numerical calculations, I find that the Cochrane results reject the central Croke et al. estimate of 0.134 kg at p = 0.58 (two-tailed Z-test), which is to say, they do not reject with any strength. For Croke et al. vs. Campbell, p = 0.64. So the Croke et al. estimate does not contradict the others; it is merely more precise. The three reviews are best seen as converging to a central impact estimate of about 0.1 kg of weight gain. Certainly 0.1 kg fits the evidence better than 0.0 kg. If wide confidence intervals in the Cochrane and Campbell reviews are obscuring real impact on weight, perhaps the same happening with other outcomes, including height, hemoglobin, cognition, and mortality. Discouragingly, when I scan the Cochrane review’s “Summary of findings for the main comparison” and Campbell’s corresponding tables, confidence intervals for outcomes other than weight look more firmly centered on zero. That in turn raises the worry that by looking only at weight, Croke et al. make a selective case on behalf of deworming.[1] On the other hand, when we shift our attention from trials of mass deworming to trials restricted to children known to be infected—which have more power to detect impacts—it becomes clear that the boost to weight is not a one-off. The Cochrane review estimates that targeting treatment at kids with soil-transmitted worms increased weight by 0.75 kilograms, height by 0.25 centimeters, mid-upper arm circumference by 0.49 centimeters, and triceps skin fold thickness by 1.34 millimeters, all significant at p = 0.05. Treatment did not, however, increase hemoglobin (Cochrane review, “Data and Analyses,” Comparison 1). In this light, the simplest theory that is compatible with the evidence arrayed so far is that deworming does improve nutrition in infected children while leaving uninfected children unchanged; and that available studies of mass deworming tend to lack the statistical power to detect the diluted benefits of mass deworming, even when combined in a (random effects) meta-analysis. The compatibility of that theory with the evidence, by the way, exposes a logical fallacy in the Cochrane authors’ conclusion that “there is now substantial evidence” that mass treatment has zero effect on the outcomes of interest. Lack of compelling evidence is not compelling evidence of lack. Yet the Cochrane authors might be right in spirit. If the benefit of mass deworming is almost too small to detect, it might be almost too small to matter. Return to the case of weight: is ~0.1 kg a lot? Croke et al. contend that it is. They point out that “only between 2 and 16 percent of the population experience moderate to severe intensity infections in the studies in our sample that report this information,” so their central estimate of 0.134 could indicate, say, a tenth of children gaining 1.34 kg (3 pounds). This would cohere with Cochrane’s finding of an average 0.75 kilogram gain in trials that targeted infected children. In a separate line of argument, Croke et al. calculate that even at 0.134, deworming more cost-effectively raises children’s weight than school feeding programs do. But neither defense gets at what matters most for GiveWell, which is whether small short-term benefits make big long-term earnings gains implausible. Is 0.134 kg in weight gain compatible with 15% income gain 10 years later reported in Worms at Work? More so than it may at first appear, once we take account of two discrepancies embedded in that comparison. First, more kids had worms in Busia. I calculate that 27% of children in the Worms sample had moderate or serious infections, going by World Health Organization (WHO) guidelines, which can be viewed conservatively as double the 2–16% Croke et al. cite as average for the kids behind that 0.134 kg number.[2] So in a Worms-like setting, we should expect twice as many children to have benefited, doubling the average weight gain from 0.134 to 0.268 kg. Second, at 13.25 years, the Worms children were far older than most of the children in the studies surveyed by Croke et al. Subjects averaged 9 months of age in the Awasthi 2001 study, 12–18 months in Joseph 2015, 24 months in Ndibazza 201236 months in Willett 1979, and 2–5 years in Sur 2005. 0.268 kg means more for such small people. As Croke et al. point out, an additional 0.268 kg nearly suffices to lift a toddler from the 25th to the 50th percentile for weight gain between months 18 and 24 of life (girls, boys). In sum, the statistical consensus on short-term impacts on nutritional status does not render implausible the long-term benefits reported out of Busia. The verdict of Garner, Taylor-Robinson, and Sachdev—“no effect for the main biomedical outcomes…, making the broader societal benefits on economic development barely credible”—overreaches. In many places, fewer kids have worms than in Busia in 1998–99 If we accept the long-term impact estimates from Worms at Work, we can still question whether those results carry over to other settings. This is precisely why GiveWell deflates the earnings impact by two orders of magnitude in estimating the cost-effectiveness of deworming charities. One of those orders of magnitude arises from the fact that school-age children in Busia carried especially heavy parasite loads. Where loads are lighter, mass deworming will probably do less good. (The other order of magnitude reflects a more subjective worry that if Worms at Work were replicated in other places with similar parasite loads, it would fail to show any benefits there, a theme to which I will return at the end.) GiveWell’s cost-effectiveness spreadsheet does adjust for difference in worm loads between Worms and places where recommended charities support mass deworming today. So I spent some time scrutinizing this discount—more precisely, the discounts of individual GiveWell staffers. I worried in particular that the ways we measure worm loads could lead my colleagues to overestimate the need for and benefit from mass deworming. As a starting point, I selected a few data points from one of the metrics GiveWell has gathered, the fraction of kids who test positive for worms. This table shows the prevalence of worm infection, by type, in Busia, 1998–99, before treatment, and in program areas of two GiveWell-recommended charities: The first row, computed from the public Worms data set, reports that before receiving any treatment from the experiment, 81% of tested children in Busia were positive for hookworm, 51% for roundworm, 62% for whipworm, and 36% for schistosomiasis. 94% tested positive for at least one of those parasites. On average, each child carried 2.3 distinct types of worm. Then, from the GiveWell cost-effectiveness spreadsheet, come corresponding numbers for areas served by programs linked to the Schistosomiasis Control Initiative (SCI) and Deworm the World. Though approximate, the numbers suffice to demonstrate that far fewer children served by these charities have worms than in the Worms experiment. For example, the hookworm rate for Deworm the World is estimated at 24%, which is 30% of the rate of Busia in 1998–99. Facing less need, we should expect these charities’ activities to do less good than is found in Worms at Work. But that comparison would misrepresent the value of deworming today if the proportion of serious infections is even lower today relative to Busia. To get at the possibility, I made a second table for the other indicator available to GiveWell, which is the intensity of infection, measured in eggs per gram of stool: Indeed, this comparison widens the apparent gap between Busia of 1998–99 and charities of today. For example, hookworm prevalence in Deworm the World service areas was 30% of the Busia rate (24 vs. 81 out of every 100 of kids), while intensity was only 20% (115 vs. 568 eggs/gram). After viewing these sorts of numbers, the median GiveWell staffer multiplies the Worms at Work impact estimate by 14%—that is, divides it by seven. In aggregate, I think my coworkers blend the discounts implied by the prevalence and intensity perspectives.[3] To determine the best discount, we’d need to know precisely what characterized the children within the Worms experiment who most benefited over the long term—perhaps lower weight, or greater infection with a particular parasite species. As I will discuss below, such insight is easier imagined than attained. Then, if we had it, we would need to know the number of children in today’s deworming program areas with similar profiles. Obtaining that data could be a tall order in itself. To think more systematically about how to discount for differences in worm loads, within the limits of the evidence, I looked to some recent research that models how deworming affects parasite populations. Nathan Lo and Jason Andrews led the work (2015, 2016). With Lo’s help, I copied their approach in order to estimate how the prevalence of serious infection varies with the two indicators at GiveWell’s fingertips.[4] For my purposes, the approach introduces two key ideas. First, data gathered from many locales shows how, for each worm type, the average intensity of infection tends to rise as prevalence increases. Not surprisingly, where worm infection is more common, average severity tends to be higher too—and Lo and colleagues estimate how much so. Second is the use a particular mathematical family of curves to represent the distribution of children by intensity levels—how many have no infection, how many have 1-100 eggs/gram, how many are above 100 eggs/gram, etc. (The family, the negative binomial, is an accepted model for the prevalence of infectious diseases.) If we know two things about the pattern of infection, such as the fraction of kids who have it and their average intensity, we can mathematically identify a unique member of the family. And once a member is chosen, we can estimate the share of children with, for example, hookworm infections exceeding 2,000 eggs/gram, which is the WHO’s suggested minimum for moderate or heavy infection. The next two graphs examine how, under these modeling assumptions, the fraction of children with moderate/heavy infections varies in tandem with the two indicators at GiveWell’s disposal, which are prevalence of infection and average infection intensity: The important thing to notice is that the curves are much curvier in the first graph. There, for example, as the orange hookworm curve descends, it converges to the left edge just below 40%. This suggests that if a community has half as many kids with hookworm as in Busia—40% instead of about 80%—then it could have far less than half as many kids with serious infections—indeed, almost none. But the straighter lines in the second graph mean that a 50% drop in intensity (eggs/gram) corresponds to a 50% drop in the number of children with serious disease. While we don’t know exactly what defines a serious infection, in the sense of offering hope that treatment could permanently lift children’s trajectories, these simulations imply that it is reasonable for GiveWell to extrapolate from Worms at Work on the basis of intensity (eggs/gram). Returning to the intensity table above, I find that the Deworm the World egg counts, by worm type, average 16% of those in Busia. For the Schistosomiasis Control Initiative, the average ratio is 7% (and is 6% just for SCI’s namesake disease). These numbers say—as far as this sort of analysis can take us—that GiveWell’s 14% discounts are about right for Deworm the World, and perhaps ought to be halved for SCI. Halving is not as big a big change as it may seem; GiveWell has no illusions about the precision of its estimates, and performs them only to sense the order of magnitude of expected impact. Impact heterogeneity in the Worms experiment Having confronted two challenges to the generalizability of Worms at Work—that short-term non-impacts make long-term impacts implausible, and that worm loads are lower in most places today than they were in Busia in 1998–99—I turned to one more. Might there be patterns within the Worms at Works data that would douse hopes for impact beyond? For example, if only children with schistosomiasis experienced those big benefits, that would call into question the value of treating geohelminths (hookworm, roundworm, whipworm). Returning to the Worms at Work data, I searched for—and perhaps found—signs of heterogeneity in impact. I gained two insights thereby. The first, as it happens, is more evidence that is easier-explained if we assume that the Worms experiment largely worked, the theme of the last post. The second is a keener sense that there is no such thing as the “the” impact of an intervention, since it varies by person, time, and place. That heightened my nervousness about extrapolating from a single study. Beyond that general concern, I did not find specific evidence that would explicitly cast grave doubt on whole deworming campaigns. My hunt for heterogeneity went through two phases. In the first, motivated by a particular theory, I brought a narrow set of hypotheses to the data. In the second, I threw about 20 hypotheses at the data and watched what stuck: Did impact vary by sex or age? By proximity to Lake Victoria, where live the snails that carry Schistosoma mansoni? As statisticians put it, I mined the data. The problem with that is that since I tested about 20 hypotheses, I should expect about one to manifest as statistically significant just by chance (at p = 0.05). So the pattern I unearthed in the second phase should perhaps not be viewed as proof of anything, but as the basis for a hypothesis that, for a proper test, requires fresh data from another setting. Introducing elevation My search began this way. In my previous post, I entertained an alternative theory for Owen Ozier‘s finding that deworming indirectly benefited babies born right around the time of the original Worms experiment. Maybe, I thought, the 1997–98 El Nino, which brought heavy flooding to Kenya, exacerbated the conditions for the spread of worms, especially at low elevations. And perhaps by chance the treatment schools were situated disproportionately at high elevations, so their kids fared better. This could explain all the results in Worms and its follow-ups, including Ozier’s paper. But the second link in that theory proved weak, especially when defining the treatment group as groups 1 and 2 together, as done in Worms at Work. (Group 1 received treatment starting in 1998, group 2 in 1999, and group 3 in 2001, after the experiment ended.) Average elevation was essentially indistinguishable between the Worms at Work treatment and control groups. Nevertheless, my investigation of the first link in the theory led me to some interesting discoveries. To start, I directly tested the hypothesis that elevation mattered for impact by “interacting” elevation with the treatment indicator in a key Worms at Work regression. In the original regression, deworming is found to increase the logarithm of wage earnings by 0.269, meaning that deworming increased wage earnings by 30.8%. In the modified regression, the impact could vary with elevation in a straight-line way, as shown in this graph of the impact of deworming in childhood on log wage earnings in early adulthood as a function of school elevation: The grey bands around the central line show confidence intervals rather as in the earlier graph on weight gains. The black dots along the bottom show the distribution of schools by elevation. I was struck to find the impact confined to low schools. Yet it could be explained. Low schools are closer to Lake Victoria and the rivers that feed it; and their children therefore were more afflicted by schistosomiasis. In addition, geohelminths (soil-transmitted worms) might have spread more easily in the low, flat lands, especially after El Nino–driven floods. So lower schools may have had higher worm loads.[5] To fit the data more flexibly, I estimated the relationship semi-parametrically, with locally weighted regressions[6]. This involved analyzing whether among schools around 1140 meters, deworming raised wages; then the same around 1150 meters, and so on. That produced this Lowess-smoothed graph of the impact of deworming on log wage earnings: This version suggests that the big earnings impact occurred in schools below about 1180 meters, and possibly among schools at around 1250. (For legibility, I truncated the fit at 1270 meters; beyond which the confidence intervals explode for lack of much data.) Motivated by the theory that elevation mattered for impact because of differences in pre-experiment infection rates, I then graphed how those infections varied with elevation, among the subset of schools with the needed data.[7] Miguel and Kremer measure worm burdens in three ways: prevalence of any infection, prevalence of moderate or heavy infection, and intensity (eggs/gram). So I did as well. First, this graph shows infection prevalence versus school elevation, again in a locally smoothed way: Like the first table in this post, this graph shows that hookworms lived in nearly all the children, while roundworm and whipworm were each in about half. Not evident before is that schistosomiasis was common at low elevations, but faded higher up. Roundworm and whipworm also appear to fall as one scans from left to right, but then rebound around 1260 meters. The next graph is the same except that it only counts infections that are moderate or heavy according to WHO definitions[8]: Interestingly, restricting to serious cases enhances the similarity between the infection curves, just above, and the earlier semi-parametric graph of earnings impact versus elevation. The “Total” curve starts high, declines until 1200 meters or so, then peaks again around 1260. Last, I graphed Miguel and Kremer’s third measure of worm burden, intensity, against elevation. Those images resemble the graph above, and I relegate them to a footnote for concision.[9] These elevation-stratified plots teach three lessons. First, the similarity between the prevalence contours and the earnings impact contour shown earlier—high at the low elevations and then again around 1260 meters—constitutes circumstantial evidence for a sensible theory: children with the greatest worm burdens benefited most from treatment. Second, that measuring worm load to reflect intensity—moving to the graph just above from the one before—strengthens this resemblance and reinforces the notion of extrapolating from Worms at Work on the basis of intensity (average eggs/gram, not how many kids have any infection). Finally, these patterns buttress the conclusion of my last post, that the Worms experiment mostly worked. If we grant that deworming probably boosted long-term earnings of children in Busia, then it becomes unsurprising that it did so more where children had more worms. But if we doubt the Worms experiments, then these results become more coincidental. For example, if we hypothesize that flawed randomization put schools whose children were destined to earn more in adulthood disproportionately in the treatment group, then we need another story to explain why this asymmetry only occurred among the schools with the heaviest worm loads. And all else equal, per Occam’s razor, more-complicated theories are less credible. As I say, the evidence is circumstantial: two quantities of primary interest—initial worm burden and subsequent impact—relate to elevation in about the same way. Unfortunately, it is almost impossible to directly assess the relationship between those two quantities, to ask whether impact covaried with need. The Worms team did not test kids until their schools were about to receive deworming treatment “since it was not considered ethical to collect detailed health information from pupils who were not scheduled to receive medical treatment in that year.” My infection graphs are based on data collected at treatment-group schools only, just before they began receiving deworming in 1998 or 1999. Absent test results for control-group kids, I can’t run the needed comparison. Contemplating the exploration to this point, I was struck to appreciate that while elevation might not directly matter for the impacts of deworming, like a saw through a log, introducing it exposed the grain of the data. It gave me insight into a relationship that I could not access directly, between initial worm load and subsequent benefit. Mining in space After I confronted the impossibility of directly testing whether initial worm burden influenced impact, I thought of one more angle from which to attack the question, if obliquely. This led me, unplanned, to explore the data spatially. As we saw, nearly all children had geohelminths. So all schools were put on albendazole, whether during the experiment (for treatment groups) or after (control group). In addition, the pervasiveness of schistosomiasis in some areas called for a second drug, praziquantel. I sought to check whether the experiment raised earnings more for children in those areas. Such a finding could be read to say that schistosomiasis is an especially damaging parasite, making treatment for it especially valuable. Or, since the low-elevation schistosomiasis schools tended to have the highest overall worm burdens, it could be taken as a sign that higher parasite loads in general lead to higher benefit from deworming. Performing the check first required some educated guess work. The Worms data set documents which of the 50 schools in the treatment groups needed and received praziquantel, but not which of the 25 control group schools would have needed it in 1998–99. To fill in these blanks, I mapped the schools by treatment group and praziquantel status. Group 1 schools, treated starting in 1998, are green. Group 2 schools, treated starting in 1999, are yellow. And group 3 (schools not treated till 2001) are red. The white 0’s and 1’s next to the group 1 and 2 markers show which were deemed to need praziquantel, with 1 indicating need: Most of the 1’s appear in the southern delta and along the shore of Lake Victoria. By eyeballing the map, I could largely determine which group 3 schools also needed praziquantel. For example, those in the delta to the extreme southwest probably needed it since all their neighbors did. I was least certain about the pair to the southeast, which lived in a mixed neighborhood, as it were; I arbitrarily marked one for praziquantel and one not.[10] Returning to the Worms at Work wage earnings regression and interacting treatment with this new dummy for praziquantel need revealed no difference in impact between schools where only albendazole was deemed needed and given, and schools where both drugs were needed and given: Evidently, treatment for geohelminths and schistosomiasis, where both were needed, did not help future earnings much more or less than treatment for geohelminths, where only that was warranted. So the comparison generates no strong distinction between the worm types. After I mapped the schools, it hit me: I could make two-dimensional versions of my earlier graphs, slicing the data not by elevation, but by longitude and latitude. To start, I fed the elevations of the 75 schools, marked below with white dots, into my statistics software, Stata, and had it estimate the topography that best fit. This produced a depiction of the contours of the land in southern Busia County, with the brightest reds indicating the highest areas: (Click image for a larger version.) I next graphed the impact of deworming on log wage earnings. Where before I ran the Worms at Work wage earnings regression centering on 1140 meters, then 1150, etc., now I ran the regression repeatedly across a grid, each time giving the most weight to the nearest schools [11]: Two valleys of low impact dimly emerge, one toward the Lake in the south, one in the north where schools are higher up. Possibly these two troughs are linked to the undulations in my earlier, elevation-stratified graphs. Next, I made graphs like these for all 21 baseline variables that Worms checks for balance—such as fraction of students who are girls and average age. All the graphs are here. Now I wonder if this was a mistake. None of the graphs fit the one above like a key in lock, so I found myself staring at blobs and wondering which vaguely resembled the pattern I sought. I had no formal, pre-specified measure of fit, which increased uncertainty and discretion. Perhaps it was just a self-administered Rorschach test. Yet the data mining had the power to dilute any p values from subsequent formal tests. In the end, one variable caught my eye when mapped, and then appeared to be an important mediator of impact when entered into the wage earnings regression. It is: a child’s initial weight-for-age Z-score (WAZ), which measures a child’s weight relative to his or her age peers.[12] Here is the WAZ spatial plot side by side with the impact plot I just showed you. To my eye, where WAZ was high, subsequent impact was generally lower: (Since most children in this sample fell below the reference median, their weight-to-age Z-scores were negative, so in here average WAZ ranges between –1.3 and about –1.5.) Going back to two dimensions, this graph more directly checks the relationship I glimpsed above, by showing how the impact of deworming on wage earnings varied with children’s pre-treatment weight-to-age Z-score: It appears that only children below –2, which is the standard definition of “underweight,” benefited enough from deworming treatment that it permanently lifted their developmental trajectories. If the pattern is real, two dynamics could explain it. Children who were light for their age may have been so precisely because they carried more parasites, and were in deep need of treatment. Or perhaps other health problems made them small, which also rendered them less resilient to infection, and again more needful of treatment. The lack of baseline infection data for the control group prevents me from distinguishing between these theories. Struck by this suggestion that low initial weight predicted impact, and mindful of the meta-analytic consensus that deworming affects weight, I doubled back to the original Worms study to ask a final question. Were any short-term weight gains in Busia concentrated among kids who started out the most underweight? This could link short-term impacts on weight with long-term impacts on earnings, making both more credible. I made this graph of the one-year impact of deworming treatment on weight-for-age Z-score versus weight-for-age Z-score before treatment (1998)[13]: The graph seems to support my hypothesis. Severely underweight children (at or below –3) improve by about 0.2 points in Z-score. Underweight children (at or below –2) gain perhaps 0.1 on average. But there is a puzzling twist. While treatment raised weight among the most severely underweight children, it apparently reduced the weight of the heaviest children. (Bear in mind that in registering just above 0, the highest-WAZ children in Busia were merely surpassing 50th percentile in the global reference population.) Conceivably, certain worm infections cause weight gain, which is reversed by treatment; but here I am speculating. Statisticians might wonder if this graph reveals regression toward the mean. Just as the temperature must rise after the coldest day of the year and fall after the hottest, we could expect that the children who started the experiment the most underweight would become less so, and vice versa. But since the graph compares treatment and control schools, regression toward the mean only works as a theory if it occurred more in the treatment group. That would require a failure of randomization. The previous post argued that the imperfections in the Worms randomization were probably not driving the main results; but possibly they are playing a larger role in these second-order findings about heterogeneity of impact. Because of these doubts, and because I checked many hypotheses before gravitating to weight-for-age as a mediator of impact, I am not confident that physical health was a good predictor of the long-run impact of deworming on earnings. I view the implications of the last two graphs—that deworming increased weight in the short run and earnings in the long run only among the worst-off children—merely as intriguing. As an indicator of heavy worm burden or poor general health, low weight may have predicted impact. That hypotheses ought to probed afresh in other data, this time with pre-registered transparency. The results from such replication could then sharpen our understanding of how to generalize from Worms at Work. But I emphasize that my earlier findings revolving around elevation are more confident, because they came out of a small and theoretically motivated set of hypotheses. At elevations where worms were more prevalent, deworming did more long-term good. Conclusions I glean these facts: • Treatment of children known to carry worms improves their nutritional status, as measured by weight and height. • Typically, a minority of children in today’s deworming settings are infected, so impacts from mass deworming are smaller and harder to detect. • In meta-analyses, 95% confidence intervals for the impacts of mass deworming tend to contain zero. • In the case of weight—which is among the best-studied outcomes and more likely to respond to treatment in the short run—Croke et al. improve the precision of meta-analysis. Their results are compatible with others’ estimates, yet make it appear unlikely that average short-term impact of mass deworming is zero or negative. • Though the consensus estimate of about 0.1 kg for weight gain looks small, once one accounts for the youth and low infection rates of the children behind the number, it does not sit implausibly with the big long-term earnings benefit found in Worms at Work. • Extrapolating the Worms at Work results to other settings in proportion to infection intensity (eggs/gram) looks reasonable. This will adjust for the likelihood that as prevalence of infection falls, prevalence of serious infection falls faster. Extrapolating this way might leave GiveWell’s cost-effectiveness rating for the Deworm the World unchanged while halving that for the Schistosomiasis Control Initiative (which is not a lot in calculations that already contain large margins of error). • Within Busia, 1998–99, evidence suggests that the benefits of deworming were confined to children who were the worst off, e.g., who were more numerous at elevations with the most worm infections. • To speak to the theme of the previous post, this hint of heterogeneity is harder to explain if we believe randomization failure caused the Worms at Work results. • I did not find heterogeneity that could radically alter our appraisal of charities, such as signs that only treatment of schistosomiasis had long-term benefits. This recitation of facts makes GiveWell’s estimate of the expected value of deworming charities look reasonable. Yet, it is also unsatisfying. It is entirely possible that today’s deworming programs do much less, or much more, good than implied by the most thoughtful extrapolation from Worms at Work. Worms, humans, institutions, and settings are diverse, so impacts probably are too. And given the stakes in wealth and health, we ideally would not be in the position of relying so much on one study, which could be flawed or unrepresentative, my defenses notwithstanding. Only more research can make us more sure. If donors and governments are willing to spend nine-figure sums on deworming, they ought to devote a small percentage of that flow to research that could inform how best to spend that money. Unfortunately, research on long-term impacts can take a long time. In the hope of bringing relevant knowledge to light faster, here are two suggestions. All reasonable effort should be made to: • Gather and revisit underlying data (“microdata”) from existing high-quality trials, so that certain potential mediators of impact, such as initial worm load and weight, can be studied. This information could influence how we extrapolate from the studies we have to the contexts where mass deworming may be undertaken today. As a general matter, it cannot be optimal that only the original authors can test hypotheses against their data, as is so often the case. In practice, different authors test different outcomes measured different ways, reducing comparability across studies and eroding the statistical power of meta-analysis. Opportunities for learning left unexploited are a waste potentially measured in the health of children. • Turn past short-term studies into long-term ones by tracking down the subjects and resurvey them.[14] This is easier said than done, but that does not mean a priori that it would be a waste to push harder against this margin. Then, long-term research might not take quite so long. Notes [1] Croke et al. do motivate their focus on weight in a footnote. Only three outcomes are covered by more than three studies in the Cochrane review’s meta-analyses: weight, height, and hemoglobin. Height responds less to recent health changes than weight, so analysis of impacts on height should have lower power. Hemoglobin destruction occurs most with hookworm, yet only one of the hemoglobin studies in the Cochrane review took place in a setting with significant hookworm prevalence. [2] I thank Kevin Croke for pointing out the need for this adjustment. [3] Columns S–W of the Parameters tab suggest several choices based on prevalence, intensity, or a mix. Columns Y–AC provide explanations. GiveWell staff may then pick from suggested values or introduce their own. [4] Lo et al. 2016 fit quadratic curves for the relationship between average infection intensity among the infected (in eggs/gram) and prevalence of any infection. The coefficients are in Table A2. If we then assume that the distribution of infection intensity is in the (two-parameter) negative binomial family, fixing two statistics—prevalence and average intensity as implied by its quadratic relationship with prevalence—suffices to determine the distribution. We can then compute the number of people whose infection intensity exceeds a given standard. In the usual conceptual framework of the negative binomial distribution, each egg per gram is considered a “success.” A fact about the negative binomial distribution that helps us determine the parameters is P = 1–(1 + M/r)^(–r), where M is average eggs/gram for the entire population, including the uninfected; r is the dispersion parameter, i.e., the number of failures before the trials stop; and P is prevalence of any infection, i.e., the probability of at least one success before the requisite number of failures. One conceptual problem in this approach is that intensity in eggs/gram is not a natural count variable despite being modeled as such. Changing the unit of mass in denominator, such as to 100 mg, will somewhat change the simulation results. In the graphs presented here, I work with 1000/24 = 41.67 grams as the denominator since that is a typical mass on the slide of a Kato-Katz test and 24 is thus a standard multiplier when performing the test. [5] I also experimented with higher-order polynomials in elevation. This hardly changed the results. [6] I rerun the Worms at Work regression repeatedly while introducing weights centered around elevations 1140, 1150, …, etc. meters. Following the default in Stata’s lowess command, the kernel is Cleveland’s bicube. The bandwidth is 50% of the sample elevation span. [7] The Worms research team tested random subsets of children at treatment schools just before they were treated, meaning that pre-treatment infection data are available for a third of schools (group 1) for early 1998 and another third (group 2) for early 1999. To maximize statistical power, I merge these pre-treatment samples. Ecological conditions changed between those two collection times, as the El Nino passed, which may well have affected worm loads. But pooling them should not cause bias if schools are reasonably well mixed in elevation, as they appear to be. Averages adjust for the stratification in the sampling of students for testing: 15 students were chosen for each school and grade. [8] Miguel and Kremer modify the World Health Organization’s suggested standards for moderate infection, stated with reference to eggs per gram of stool. To minimize my discretion, I follow the WHO standards exactly. [9] There are separate graphs for hookworm, roundworm, whipworm, and schistosomiasis. Here, the shades of grey do not signify levels of confidence about the true average value. Rather, they indicate the 10th, 20th, …, 90th percentiles in eggs per gram, while the black lines show medians (50th percentiles). [10] Among the group 3 schools, I marked those which school identifiers 108, 218, 205, 202, 189, 167, 212, 211 as warranting praziquantel. [11] The spatially smoothed impact regressions, and the spatially smoothed averages of baseline variables graphed next, are plotted using the same bandwidth and kernel as before, except that now distance is measured in degrees, in two dimensions. Since Busia is very close to the equator, latitude and longitude degrees correspond to the same distances. Locally weighted averages are computed at a 21×21 grid of points within the latitude and longitude spans of the schools. Points more than .05 degrees from all schools are excluded. Stata’s thin-plate-spline interpolation then fills in the contours. [12] Weight-for-age z scores are expressed relative to the median of a reference distribution, which I believe comes from samples of American children from about 50 years ago. The WHO and CDC provide reference tables. [13] The regressions behind the following two graphs incorporate all controls from the Baird et al. low wage earnings regression that are meaningful in this shorter-term context: all interactions of sex and standard (grade) dummies, zone dummies, and initial pupil population. [14] This idea is inspired by a paper by Kevin Croke, although that paper links a short-term deworming study to long-term outcomes at the parish level, not the individual level. The post How thin the reed? Generalizing from “Worms at Work” appeared first on The GiveWell Blog. ### Just a few days left in 2016… Wed, 12/28/2016 - 07:38 There are only a few days left to give to charity this calendar year. The majority of donors who support GiveWell’s recommendations choose to make their gifts in December, for tax reasons or due to the holiday season. This blog post contains quick tips and information about donating to GiveWell’s recommended charities. But first, to everyone who supported our charities or followed our work in 2016: Thank you! Will my donation be tax-deductible? Donors in many countries can make tax-deductible donations to GiveWell’s recommended charities. • Click here to view this information by country; scroll down to see this information listed by charity. What’s the best way for me to donate? We discuss tips for giving efficiently (including tax considerations) on our website. More information about methods of donating is available here. Please don’t hesitate to reach out to donations@givewell.org if you have any questions about donation logistics. We’re happy to talk with you about questions about our research or recommendations, too. Thank you! The post Just a few days left in 2016… appeared first on The GiveWell Blog. ### Front-loading my personal giving this year Thu, 12/22/2016 - 17:12 I’ve decided to give a little more than double what I normally give to charity this year, and skip giving next year. I see many reasons to give a larger-than-normal gift this year, and no countervailing reasons. If it weren’t for some idiosyncratic factors in my situation, I would roll my next three years of giving into this year’s gift. I decided to write up my reasoning in the hopes of prompting others to consider whether they should be doing similarly. That said, everyone’s financial situation is different, and it may be a good idea to consult with a tax lawyer for personalized advice. Tax policy The issue that originally prompted me to consider a larger-than-usual gift was the prospect of changing tax policy due to the new administration, which could result in lower tax benefits for charitable giving in 2017 vs. 2016. A quick summary of my thinking follows; this should not be taken as tax advice, merely as my own personal guesswork and reasoning behind my own giving. President-elect Trump’s public tax plan has three important features that could affect tax benefits for charitable giving: • Reducing tax rates “across-the-board.”* The proposal looks similar in this respect to the 2016 House Republican Tax Reform Plan. Depending on one’s tax bracket, this could mean that the benefit for charitable giving falls by a few percentage points, so giving this year could save more money on taxes than giving next year. • Raising the standard deduction significantly (more than doubling it). The proposal looks similar in this respect to the 2016 House Republican Tax Reform Plan. Charitable deductions are only beneficial insofar as total itemized deductions exceed the standard deduction; depending on how else treatment of itemized deductions changes, and on a taxpayer’s specific situation, this could reduce the amount of charitable giving that is effectively deductible by several thousand dollars per year, or not at all. It could also strengthen the case for giving less frequently than once per year. • Capping total itemized deductions at$100k for singles/200k for couples. If this happened as stated, it could effectively eliminate the tax benefit of charitable giving for many people (most of them earning very high amounts, giving very high amounts, or both). The 2016 House Republican Tax Reform Plan does not have a similar provision, and I consider this change less likely than the above two. Giving opportunities GiveWell’s top charities look strong this year and have very large amounts of room for more funding. It’s reasonably likely that this will be true again in the next few years, but I don’t know that it will be, and it’s hard to imagine the giving opportunities on this front getting much better in the near term. I also see a fair amount of appeal in the option I mentioned in the staff personal giving post: I thought about reallocating my giving to another individual, someone who is quite value-aligned with me and quite knowledgeable, and thinks differently enough that they might see opportunities I don’t. Right now, I can think of more than one individual in this category, and some of the giving opportunities they’re interested in are not a fit for Good Ventures. In future years, I hope that the Open Philanthropy Project makes connections with more donors and effective philanthropy rises generally, and this could mean that more money flows to opportunities in this category (opportunities that I don’t see and/or that aren’t a good fit for Good Ventures). This is another case where it seems like giving opportunities may get weaker, but are unlikely to get stronger. What I’m doing I’m planning to give an amount equivalent to my next two years’ worth of charitable giving, taking the likely trajectory of my salary into account. If not for some idiosyncratic aspects of my situation, I would have gone with three years. I don’t want to plan beyond three years because I think there are a lot of difficult-to-anticipate changes that could take place in that time. Note that there are limits on the total proportion of income that can be deducted in a year, and one should check these before deciding to make a multi-year gift this year. * Though as written, the tax plan would appear to constitute a major tax increase for many single filers, based on this statement: “Brackets for single filers are ½ of these amounts.” I’ve chosen not to focus on this issue, partly because there is no similar change in the 2016 House Republican Tax Reform Plan. The post Front-loading my personal giving this year appeared first on The GiveWell Blog. ### GiveWell’s operations team is hiring! Wed, 12/21/2016 - 15:40 I’m the Director of Operations at GiveWell, and I’m spreading the word about two openings on my team for experienced professionals. We’re hiring a Donations Manager to lead the team that processes donations to GiveWell for the support of our recommended charities and our operating support. We’re also hiring an Operations and Legal Program Manager to lead complex, multi-disciplinary projects and assist with compliance and legal matters. If you’re interested in applying, we’d love to hear from you! Links to the application forms are included in the job descriptions linked above. The post GiveWell’s operations team is hiring! appeared first on The GiveWell Blog. ### We’d be glad to chat with you! Tue, 12/20/2016 - 12:02 If you’re currently trying to figure out where you’ll give this year and think it might be helpful to talk to us about your decision, please feel free to contact us at info@givewell.org or via this form. We’d be happy to set up a phone call or answer questions over email. We’ve spoken with many individuals who use our research over the past year. Our impression is that these conversations can be useful for donors and potential donors because (1) we publish a lot of information on our website, and it can be challenging for a time-constrained individual to find, read, and analyze all of it; and (2) different donors have different values and intuitions, and we believe it can be helpful to talk through the strengths and weaknesses of, and other considerations related to, the organizations we recommend. Conversations like these also help us understand how people use our research and what questions they have. Due to limited staff capacity, it’s possible we won’t be able to speak with everyone who requests a call, although based on past experience we hope to be able to connect with anyone who gets in touch. We look forward to hearing from you! The post We’d be glad to chat with you! appeared first on The GiveWell Blog. ### Discretionary grant making and implications for donor agency Mon, 12/19/2016 - 10:37 A few weeks ago, we wrote: […] we are recommending that donors split their gift, with 75% going to [the Against Malaria Foundation (AMF)] and 25% going to [the Schistosomiasis Control Initiative (SCI)], or give to GiveWell for making grants at our discretion and we will use the funds to fill in the next highest priority gaps. We’ve gotten some questions about what the difference is between giving according to our recommended allocation (75% to AMF and 25% to SCI) and giving to GiveWell for making grants at our discretion. This post explains the difference. How we will use discretionary grant funds In the past, we allocated grants to top charities either in line with our most recent recommendation to individual donors or, if we had tracked enough funding to hit the targeted amounts recommended to individual donors, we would allocate grants to top charities where we judged them to be most needed. (See this post for a more in-depth description of this process.) For the next set of grants we will make with discretionary funds, in February or March 2017, we plan to: • Ask top charities for an update on their total revenues from all sources; and • Use this information to update our views on which remaining funding gaps are most valuable to fill, and grant the funds to that gap. AMF currently has our highest-ranked funding gap for individuals, followed by SCI. (We are recommending that individuals give 75% of their donation to AMF and 25% to SCI, instead of 100% to AMF, because we expect donors following our recommendation to give more than it would take to fill AMF’s highest priority gap and it would be difficult for us to coordinate a quick change in our recommended allocation as soon as AMF’s highest-ranked funding gap was filled.) Note that, using the plan described above, we would likely not allocate exactly 75% of our grant to AMF and 25% to SCI. If the AMF funding gap we are prioritizing is still sufficiently large in February or March when taking all of AMF’s revenues from all sources into account, it’s likely that we would allocate 100% of the grant to AMF. If AMF’s gap were already filled (or could be filled with only part of the grant), we may allocate the funds to SCI or another top charity that we judge to have the most valuable funding gap. We are uncertain whether we will continue to use this full process for other grants we make in the future. If we decide to not reassess charities’ funding gaps before making a grant, we will plan to allocate the grant according to our last public recommendation to individual donors. What implications does our approach have for donor agency It is almost always the case in charitable giving that donors that give after you will be affected, in expectation, by your gift and may reduce their gift to the organization of your choice as a result. There are some specific ways in which that dynamic plays out as a result of the allocation decisions we have made: • For donors who give to our top charities, but not the one(s) that we recommend on the margin, those gifts will affect how much funding we expect those organizations to get next year. The funds may also affect how quickly the organization is able to scale in the next year, which could increase how much we think they can use productively in the following year. Both these factors (working in opposite directions) could affect how much funding we recommend donors give to them next year. (See our review of Deworm the World for an example of how we calculate room for more funding based on past revenue.) • For donors who give to the charities we recommend on the margin (AMF and SCI currently), their gifts increase the chance that the funding gaps we have prioritized are filled and that we reallocate funds to other charities. The reallocation could happen as soon as February/March, when we plan to make our next round of grants. We would guess that many of our donors would be happy to learn that these decisions allow us to play a “coordinating” role, in which we direct some additional funding to where we believe it’s needed most. However, donors who disagree with us to some degree may decide to give to top charities we haven’t prioritized on the margin. For example, donors who feel strongly about giving to deworming over malaria prevention (because, say, they disagree with how steeply we’ve discounted the evidence for deworming or because they value lives improved over deaths averted more than we do), may choose to give to the END Fund, whose funding gap is GiveWell’s highest priority deworming gap that is unlikely to be filled, rather than SCI. Donors who feel strongly about supporting malaria prevention over deworming, they may decide to give to Malaria Consortium over AMF, for the same reason. For a full list of the funding gaps we seek to fill and in what order, see this spreadsheet. The post Discretionary grant making and implications for donor agency appeared first on The GiveWell Blog. ### December 2016 open thread Wed, 12/14/2016 - 16:19 Our goal with hosting quarterly open threads is to give blog readers an opportunity to publicly raise comments or questions about GiveWell or related topics (in the comments section below). As always, you’re also welcome to email us at info@givewell.org or to request a call with GiveWell staff if you have feedback or questions you’d prefer to discuss privately. We’ll try to respond promptly to questions or comments. If you have questions related to the Open Philanthropy Project, you can post those in the Open Philanthropy Project’s most recent open thread. You can view our September 2016 open thread here. The post December 2016 open thread appeared first on The GiveWell Blog. ### AMF and Population Ethics Mon, 12/12/2016 - 19:38 One important input we consider in our top charity recommendations is our quantitative cost-effectiveness estimate of each charity: an estimate of how much good the charity accomplishes per dollar. We have written before about the many challenges of constructing and interpreting such cost-effectiveness estimates. One such challenge is the problem of how to assign a numerical “score” to various good outcomes such as averted deaths or increased incomes, so that they can all be compared on the same scale. This involves answering questions such as: • What would I do if I had a choice between doubling the income of three individuals in extreme poverty for a year and averting the death of a child under the age of 5? • How many deaths of children under the age of 5 would I need to avert to accomplish as much good as averting the death of one adult? GiveWell staff members enter their estimates for such values-based comparisons in our cost-effectiveness analysis (CEA). Along with empirical estimates of program costs and outcomes, this forms the basis for the numerical comparisons we make between our top charities. Recently, a post on the Effective Altruism Forum raised concerns about our recommendation of AMF specifically. It argues that the value of averting deaths for children under five depends on one’s view of population ethics – a branch of philosophy that asks questions like “Is it good to avert a death if it has no long-run impact on the total population?” – and that some approaches to population ethics would imply a substantial discount to our cost-effectiveness estimates. We’ve chosen to respond to this argument at length because we think it is interesting, serves as a good example of the thorny issues we grapple with in estimating cost-effectiveness, and gives the opportunity to explain some aspects of our 2016 cost-effectiveness model that are not widely understood. In this post, I will • Explain basic concepts in population ethics and how they inform the way people think about the value of averting death • Summarize arguments from the post mentioned above, which argues that people with certain views on population ethics should substantially discount our cost-effectiveness estimate of the Against Malaria Foundation (AMF) to better reflect their values • Walk through the reasoning behind our current estimate of AMF’s cost-effectiveness and explain why I believe it’s compatible with most plausible accounts of population ethics, so discounts as aggressive as those suggested in the linked post are likely inappropriate. Population ethics and the value of averting death Population ethics is a branch of philosophy which outlines some major considerations that influence how people value averting deaths. It is defined in the link as “the theory of when one state of affairs is better than another, where the states of affairs may differ over the number of people who ever live.” Population ethics deals with questions such as: • Can it be morally good or bad to create new people who would not have otherwise lived, or is creating people always morally neutral (assuming they do not affect people who are already living)? • Is the badness of death lessened if someone else will be born to “replace” the person who died? • What makes (premature) death bad? Is it because the individual misses out on the years of happy life they would have otherwise lived? Is it because they had a strong preference to live that was violated? Is it because surviving loved ones will grieve? Is it some combination of these? • Is death worse at some ages than at others? A population ethics stance is a set of beliefs that inform how to compare different states of the world by answering these and similar questions. Staff members’ implicit or explicit stance on population ethics guides the way they quantify the value of averting death in the CEA. This in turn can greatly affect how the cost-effectiveness of life-saving charities such as the Against Malaria Foundation (AMF) and Malaria Consortium’s seasonal malaria chemoprevention program compares to the cost-effectiveness of life-improving charities such as GiveDirectly and charities implementing mass deworming programs. In a recent post on the Effective Altruism Forum, Michael Plant argues that AMF is unlikely to be highly cost-effective under four plausible population ethics stances: • Total hedonic utilitarianism: The stance that the best state of the world is the one with the most total happiness or fulfillment. Under total hedonic utilitarianism, averting someone’s death is only good to the extent that it results in more overall happiness experienced in the world (regardless of who experiences it). Thus, if a child dies, and as a result the family has another child they would not otherwise have had, the badness of the child’s death comes only from the gap between their death and the new child’s birth and the grief and other negative effects experienced by family members. (This is assuming the child who died and the new child who is born as a result would live similarly happy lives.) This counterintuitive result is referred to as “the replacement problem” in this post. Michael argues that a total utilitarian should substantially discount GiveWell’s cost-effectiveness estimate for AMF to account for the replacement problem. • The deprivation stance: According to the deprivation stance, the badness of death is equal to the number of years of life that the individual who died misses out on as a result of their death: in other words, their life expectancy at the time of death. Unlike in total hedonic utilitarianism, this badness is not lessened even if someone else is immediately born as a direct result of the death. Michael argues that this is the point of view which is most favorable to AMF, but those who hold this view should still be more interested in other interventions, such as life extension. • The time-relative interest stance: Quoting from Michael’s original post, [The time-relative interest account] holds the badness of death depends, roughly, on the extent to which it frustrates the person’s interests in continuing to live. This captures the [intuition] many people have that it’s much more important to save a 20-year old than a 1-minute old foetus because, in essence, that 1-minute old foetus hasn’t developed enough to miss out on life. Note: the time-relative interest stance, unlike the previous two stances on population ethics, doesn’t suggest a simple formula that would capture most of the “badness” of death if all the empirical facts were known. Michael argues that those who subscribe to the time-relative interest stance should “reduce [GiveWell’s] estimate of AMF’s effectiveness by however much [they] discount child deaths compared to adult ones.” • Epicureanism: This stance holds that death in itself cannot be bad for the individual who died, because as soon as they die, they cease to have morally relevant interests. Thus, a given death is only bad due to suffering in the process of death, and the grief and other negative effects it has on survivors. Epicureanism also does not immediately suggest a simple formula that would estimate the badness of death given all the empirical facts. I believe Michael suggests discounts on our cost-effectiveness estimate of AMF that would be too aggressive for most people’s value systems. I explain this further in the rest of the post, but I want to first make a general point: if you are concerned your stance on population ethics does not align with the GiveWell median, I believe it would be better to download an editable copy of GiveWell’s CEA and input your own values for rows 7, 53, 63, and 64 on the “Parameters” sheet than to attempt to multiply GiveWell’s bottom-line cost-effectiveness estimate by some factor to account for expected differences in population ethics. This is because the cost-effectiveness model is complex and in parts unintuitive, and I don’t believe it will be straightforward to guess how your stance on population ethics differs from the implicit stance of the median GiveWell staff member. Summary of considerations against discounting our cost-effectiveness estimate Here are the key reasons why I believe most people should likely not reduce GiveWell’s stated cost-effectiveness estimate of AMF as much as Michael suggests: • GiveWell’s 2016 cost-effectiveness model suggests that the median GiveWell staff member believes that averting the death of a young child averts ~8 disability-adjusted life-years, or DALYs (“Parameters”, C14), whereas last year the GiveWell median opinion was ~35 DALYs averted, as Michael states in the post. While GiveWell does not take an official stance on population ethics as an organization, I believe this change is a result of some staff members leaning away from an explicit “discounted age-weighted expected years of life lost” model of value to a more complex and less precise model of value that does not map intuitively to the concept of DALYs as used in health economics. (More.) • GiveWell’s current cost-effectiveness estimate does not predict that a3500 donation to AMF will, on expectation, prevent the death of one young child. It predicts that a $3500 donation to AMF will on expectation cause a combination of outcomes that are equivalent in value to saving the life of one young child, according to the median staff member. (More.) According to staff median estimates, the benefits of AMF are driven • ~27% by preventing deaths of children under the age of 5 • ~36% by preventing deaths of people age 5 and over • ~37% by providing future financial benefits due to improved young-childhood development, similar to deworming charities. • It is not clear that the “replacement problem” described in the original post fully applies to AMF, and if it does, it’s not clear that conservative staff estimates of value (see A) don’t already account for it in the 2016 model. (More). Because of this, a total utilitarian may end up concluding that AMF is more cost-effective than we suggest. (More.) • I don’t believe it’s obvious than even an Epicurean would consider AMF to be dramatically less cost-effective than the GiveWell CEA suggests — although it is likely that they would discount our cost-effectiveness estimate somewhat. (More.) I provide more detail on these four points in the rest of the post. I’m going to reference specific cell numbers and sheets in our November 2016 CEA throughout. DALYs are a flexible, non-literal measure in our CEA From Michael’s original post: [GiveWell claims that saving a child’s life is worth] 35 ‘QALYs’ (Quality-Adjusted Life Years), which is [a] more technical way of saying it creates 35 years of healthy life for the beneficiary. As mentioned above, the new median value is 8 DALYs per under-5 life saved. (See the “YLL per Death” sheet in our CEA for examples of calculations that take a more explicit deprivation or time-relative interest stance, which were more common in the past.) More generally, in the context of our CEA, I don’t think it makes sense to treat “DALYs” as straightforwardly denoting “years of life lost by the person with the disease + years lived with disability due to the disease.” Particularly in 2016, staff members interpreted the “DALYs averted per death of an under-5 averted—AMF” parameter (“Parameters”, B63) as an opportunity to quantify how holistically “bad” the death of a young child is. This interpretation can take into account broader considerations such as: • For total utilitarians, concerns of replacement • Harm caused by parental grief • Potential economic harm caused by sickness and death • Time-relative interest considerations which weigh young children less highly than older people • Considerations around the loss of the child’s individual identity and the child’s desire for life Note: I’m not sure what considerations different staff members actually did take into account; I’m just observing that our interpretation of the DALY unit is broad enough to allow for a range of such considerations. Because DALYs have been somewhat divorced from their rigid, concrete meaning, I think comparing how a given staff member filled in row 7, row 53, row 63, and row 64 in the “Parameters” sheet (all of which are value inputs) is more informative for understanding their values than looking at any one of those inputs in isolation. For example, staff member Sophie included comments on her inputs in O7, O63, and O64. Also because of this ambiguity, if you want to make adjustments for your beliefs on population ethics, I believe it would be better to download an editable copy of GiveWell’s CEA and input your own values for rows 7, 53, 63, and 64 in the “Parameters” sheet than to attempt to discount GiveWell’s bottom-line cost-effectiveness estimate by some factor to account for expected differences in population ethics. In particular, I think that with certain reasonable assumptions about replacement rate (calculated here), a total utilitarian or someone with a time-relative interest account of value may end up concluding that AMF is more cost-effective than our estimates suggest (see below). Over 65% of AMF’s expected benefits are not driven by saving young children From Michael’s original post: GiveWell estimate[s], although this is not to be taken too seriously, [that]$3,500 to AMF saves a child’s life.

However, the cost-effectiveness estimate for AMF produced by our staff median parameters (B74) is around $3400 per young life saved-equivalent, not$3400 per young life saved.

That is, our cost-effectiveness estimate does not predict that if you give $3400 to AMF you will, on expectation, prevent the death of one young child. It predicts that if you give$3400 to AMF, you will on expectation cause a combination of outcomes that, according to the values of the median GiveWell staff member, are morally equivalent to saving the life of one young child. Specifically, the expected benefits of AMF are split between:

• Preventing the deaths of children under 5
• Preventing the deaths of people 5 or older
• Improving the expected future income of young children, similar to deworming

Note that benefits in the 2015 model were also not exclusively driven by preventing deaths of children under the age of 5: cell M20 in the “GW medians” sheet of the 2015-2016 CEA implies that the median staff member believed that one year of bed net coverage was almost as effective as one year of deworming for improving expected future income of children. The primary new addition this year is accounting for the deaths of older people.

Example calculation

This section walks through the math of how we achieved our “cost per young life saved”-equivalent figure; please consider this section especially optional.

According to our median cost-effectiveness estimates (all cell numbers taken from the “Bed Nets” sheet of our CEA):

• For every ~$9,161 spent, on expectation one marginal death of a child under the age of 5 is averted (cell B55). Each under-5 death prevented gets a weight of one “young life equivalent” unit. According to the median GiveWell staff member, averting the death of a child under 5 averts about 8 DALYs (“Bed Nets”, B57). • For every ~$37,391 spent, on expectation one marginal death of a person age 5 or over is averted (multiply cells B61 and B63 to get the ratio of 5-or-over deaths averted / under-5 death averted, and then divide the cost per under-5 death above by this value). According to the median GiveWell staff member, each 5-or-over death prevented gets a weight of 4 “young life equivalent” units (“Bed Nets”, B62).
• For every ~$500 spent, on expectation you have produced financial utility equivalent to increasing an individual’s ln(consumption) by one unit for one year (“Bed Nets”, B69, multiplied by 500)—which means ~doubling their income for a year. According to the median GiveWell staff member, averting 1 DALY is equivalent to increasing ln(consumption) by one unit for three years (“Bed Nets”, B72). Combining that with the value of 8 DALYs per death of a young child above, this means that each unit increase of ln(income) gets a weight of 1 / 24 “young life equivalent” units. This means that a$37,391 donation to AMF would, in expectation:

• Prevent the deaths of ~4.08 children under the age of 5, i.e. ~4.08 young-life equivalent units
• Prevent the death of ~1 person over the age of 5, i.e. ~4 young-life equivalent units.
• Have a financial benefit equivalent to increasing the ln(income) of 37.391 * 2 = 74.782 people by one unit, i.e. 3.12 young-life equivalent units.

Putting that together we have $37,391 / (4.08 + 4 + 3.12) =$3338 per young life saved-equivalent. (Note: this is not exactly equivalent to the value in “Results”, R4, likely because of a combination of rounding and small adjustments that are not accounted for here.)

Do parents have additional children to replace those who die at a young age?

In 2014, GiveWell commissioned David Roodman to write a report on the possible causal link between mortality and fertility, which is linked in Michael’s post:

By GiveWell’s own estimates, the effect of AMF is that it leaves total population numbers largely unchanged. I call this the ‘replacement problem’ for total utilitarians because, in these replacement cases, they can’t say there’s much (or any) value in saving lives apart from the effects of bereavement on the parents.

However, I think the picture presented in David Roodman’s analysis is more nuanced than this. From the conclusion of that report:

As mentioned at the outset, we should expect that where fertility is most controlled, typically indicated by total fertility of about 2 births/woman or less, that the volitional replacement effect is large—that for every child’s life saved, parents avert one birth. That births/woman averaged 2.7 in developing countries as a whole in 2005–10, and that the number has probably fallen more since, suggest that most couples today are engaging in family planning. Meanwhile, where the fertility transition does not yet appear to have occurred the replacement effect is likely much smaller. The studies I find most informative tend to corroborate this theory, indicating near-full replacement among a group of relatively affluent countries; partial replacement in a context where fertility had begun to decline but still had far to go (Uttar Pradesh); and no replacement in an area of continuing high fertility (Northern Ghana).

I spent a little bit of time trying to come up with a reasonable range of estimates for the fertility replacement rate in the areas AMF operates in, primarily informed by whether it seems like those areas are converging to a fertility rate of 2 births per woman. This should definitely not be considered the final word on the complicated topic of replacement rates, nor should it be considered an official GiveWell estimate. However, I found it to be helpful as a personal exercise, and it may be valuable to some people to see my reasoning:

According to GiveWell’s latest update on top charities, marginal funds from GiveWell-influenced donors will go toward AMF’s Execution Level 1 gap. We believe at Execution Level 1, AMF will likely use marginal funds to do more work in the places it had worked previously: primarily Malawi, Ghana, and Uganda. According to this tool, estimates for fertility 2010-2015 for these countries were:

• ~5.25 lifetime births per woman in Malawi
• ~5.91 births per woman in Uganda
• ~4.25 births per woman in Ghana

(To get the above estimates, I chose the following options in the linked tool, in order: “Total fertility (children per woman)”, “Malawi, Ghana, Uganda”, “2010-2015”.)

I also calculated the average fertility rate across these three countries (weighted by population) to be approximately 5.2 in this spreadsheet (see sheet “AMF Countries”).

Furthermore, according to the United Nations’ probabilistic predictions as shown in this tool, it seems none of these three countries are likely to converge to two births per woman until past 2050. Based on David’s analysis, this would imply that family planning is not pervasive in the countries where AMF will likely operate over the next couple of years, and so the death of a child would lead to significantly less than one additional expected birth in the family. After a very quick scan of the table in the Conclusions section of the mortality-fertility report, one study struck out as potentially most informative for estimating replacement rates in such countries: Bhalotra and van Soest 2008.

Bhalotra and van Soest 2008 was a study in Uttar Pradesh, India, which used data from 1963-1999 to estimate that the death of a child under one month old is followed by 0.37-0.52 extra births. In the “India” sheet of my spreadsheet, I calculate that average fertility over the period of 1960-2000 was approximately 4.78. Assuming fertility in Uttar Pradesh 1963-1999 was similar, it seems the average fertility today in Ghana, Malawi, and Uganda is slightly higher than in the population studied in Bhalotra and van Soest 2008 (5.2 vs 4.78). This implies the expected replacement rate should potentially be even lower than 0.37-0.52.

I want to emphasize that these calculations are extremely rough, but they support my general impression that it is not clear that replacement is close to 1 in countries where AMF is likely to use its marginal funds in 2016.

A total utilitarian may consider AMF more cost-effective than GiveWell does

From Michael’s original post:

I should note it’s not particularly important what the exact replacement ratio is. If it turns out AMF causes parents to have 0.5 fewer children for every 1 life it saves, the total utilitarian should still [halve] AMF’s effectiveness.

This doesn’t seem obvious to me; there are a couple of flavors of total utilitarian I could imagine, and in general they don’t seem to assign a substantially lower value of DALYs averted per death of a young child averted than the GiveWell median, even assuming a 75% replacement rate (which is significantly higher than my best guess). The values used below come from the results of modifying the following values on the “YLL per death” sheet of our CEA: “Discount rate” (C6), “Age-weight parameter beta” (C7), and life expectancy at age 5 (I8 and J8).

• You could count additional years of life created without discounting over time or weighting by age. After the deprivation stance, this is perhaps the view of population ethics that is most favorable to AMF. Assuming a life expectancy of ~65 years at age 5, preventing the death of a five-year-old in Malawi or Papua New Guinea would avert 65 * 0.25 = ~16 DALYs if there is a 75% replacement rate.
• You could discount by time and weight by age. This is the sub-type of the total utilitarian viewpoint that is least favorable to AMF. Suppose the “Discount rate” is set to 0.03 and the “Age-weight parameter beta” is set to 0.04 (giving the highest weight to a year of experience as a 25 year old and a lower weight to a year of experience as a young child). If life expectancy at age five is still 65, then causing an additional five-year-old to exist would produce the equivalent ~36 years of healthy life for a 25 year old. Adjusting for replacement, preventing the death of a five-year-old in Malawi or Papua New Guinea would avert 36 * 0.25 = 9 DALYs, similar to the GiveWell median of 8.
• You could have an in-between view (for example, weighting by age without discounting or vice versa), which would produce in-between estimates for DALYs per young death prevented.

It seems that because GiveWell staff members’ median estimates for the value of averting the death of a young child are already relatively conservative from a pure total utilitarian standpoint, it may be too aggressive for most total utilitarians to discount further due to the replacement problem, unless they believe replacement rates to be close to 1.

I believe broadly similar considerations would apply to certain kinds of time-relative interest viewpoints.

An Epicurean may still believe AMF produces substantial value per dollar

From Michael’s original post:

The fourth option is the Epicurean view, named after Greek philosopher Epicurus. It holds that there’s nothing good about creating someone and that death doesn’t harm anyone: once someone is dead, there is no them for anything to be bad. Obviously the process of dying can be painful. The point Epicureans make is that nothing is good or bad for you once you’re dead. On this account, the badness of death consists only in the suffering felt by the living.

For Epicureans, the value of their 3,500 donation to AMF is that it stops a family from having to grieve for a lost child. I think there are significant costs for survivors beyond the emotional cost of grief associated with the deaths prevented by AMF: • For the deaths of children under the age of 5: if parents “replace” their lost child by having another, we must include in the DALY burden estimate: • The monetary costs of having a new baby and raising that baby to the age the deceased child was at the time of death, which may significantly impact the consumption or savings of a poor family • The strain on the mother’s health and productivity associated with the course of a normal pregnancy • The expected harm due to the possibility of serious complications in pregnancy — if this results in the mother’s death, it could result in serious permanent harm to her surviving dependents (see the next bullet point) The above costs are higher the higher you believe the replacement rate is. • For the deaths of people over the age of 5, particularly if they are parents or heads of households, we must account for: • The loss of the productive income they provide to the family • Other harm caused to dependents due to the loss of their care and guidance — it’s plausible this is very long-lasting • For all malaria deaths, we must account for the costs of seeking medical care to attempt to prevent the death and the costs of funeral rites, both of which might be a large strain on a poor family’s income In the comments section of the original post, Michael also suggests that it’s implausible that grief alone could impose a significant welfare cost here: [Replacement] doesn’t say anything about the parents. Total utils should account for that too, but note how much of the value of the intervention replacement removes. You thought you were giving a child 35+ years of life and preventing parental suffering, but now you’re just (in effect) doing the [latter]. If parental suffering is equivalent to taking away 1 year of happy life away from each parent (IMO, v unlikely), then AMF is equivalent to 2 happy years rather than 37+. I run through some calculations here http://www.plantinghappiness.co.uk/the-questionable-importance-of-saving-lives/ It’s not clear to me that the non-tangible costs to the parents should be assigned a value of less than 1 DALY total, particularly under the broad and flexible conception of DALYs that is used in the GiveWell CEA. I think there are two plausible ways we could try to quantify this from the parents’ perspective: • Preference utilitarianism: How many years of their lives would parents trade away to prevent their young child from dying? • Hedonic utilitarianism: How long do parents grieve after the death of their young child, and how intensely on average do they experience this grief? If you have a preference utilitarian theory of value, then it seems plausible that averting the death of a child could be equivalent to averting multiple DALYs to a parent. One parent has replied to the linked comment saying they would likely trade multiple years of their life to prevent the death of their two-year-old child, and this doesn’t strike me as a very unusual sentiment. Parents have also been known to sacrifice their life or take large risks to save their child. However, Michael’s theory of value appears to be hedonic utilitarianism, as explained in this comment: I’m thinking hedonically and am leaning on the literature on hedonic adaptation….few [life] events have a long term impact on happiness, either positive or negative. I am not familiar enough with the literature on bereavement, subjective well-being and hedonic adaptation to have an informed view on how long parents typically grieve for the death of a young child, or a good sense of how intense the subjective experience of grief is. I find it plausible that the negative effects on parents’ subjective well-being could be relatively moderate and short-lived, and I also find it plausible that these effects could be extreme and long-lasting. My colleague Luke Muehlhauser studied the literature on subjective well-being several months ago, so I asked him for his impressions. He replied: It’s hard to say. First, the strongest designs used for studies of subjective well-being (SWB) and life events are panel studies (for a review see Luhmann et al. 2012), which makes causal inference quite tricky, even given recent econometric innovations. Second, the outcome measures typically used in SWB studies are not as well-validated as (e.g.) patient-reported outcomes used in health care (PROMIS) or the measures typically used in educational testing, especially for use across cultures and over long periods of time (as in studies of SWB and life events). That said, if we cross our fingers and hope that the available panel studies are very roughly capturing what’s going on, we can make some guesses. I haven’t seen panel studies on SWB and the loss of a child, but perhaps we should expect the SWB effects to be similar as with the loss of a spouse, or perhaps somewhat smaller than that, especially in areas with a high rate of under-5 mortality. The Luhmann et al. meta-analysis of prospective panel studies on SWB and the loss of a spouse says (p. 605), roughly, that loss of a spouse is indeed quite bad for SWB initially, that pre-event levels of “cognitive well-being” (cognitively-assessed life satisfaction) are typically achieved within a couple years, and that adaptation is surprisingly rapid for “affective well-being” (feelings of happiness/sadness), with pre-event levels achieved within a couple months. So loss of a spouse is bad, but (according to Luhmann et al.) less bad than (e.g.) unemployment. That said, I should add that I don’t personally trust these underlying studies, nor Luhmann et al.’s method of combining them. All told, I would guess an Epicurean would likely choose a lower value for “DALYs averted per death of an under-5 averted” than the GiveWell median of 8 (“Parameters”, C63), but I am unsure whether it would be a dramatic downward adjustment, particularly if the Epicurean places relatively more weight on parents’ stated or revealed preferences compared to their subjective experiences, or if they are relatively skeptical of academic research on subjective well-being. For example, my value of 4 DALYs per under-5 death averted (“Parameters”, E63) seems within the realm of plausibility for an Epicurean. This along with my other inputs suggests that I should believe AMF is approximately as cost-effective as GiveDirectly (“Results”, D12). Conclusion If you have strong beliefs about population ethics, and are interested in donating to organizations serving the global poor that meet our criteria, I think it would be valuable to download an editable copy of our CEA, override cells C7, C53, C63, and C64 in the “Parameters” sheet with your own values, and then view column R in the “Results” sheet to see what charity cost-effectiveness estimates and rankings that would imply. I’ve outlined some considerations that may apply to total utilitarians and Epicureans above. If you don’t have a strong stance on population ethics and are wondering what the original critique should imply about whether your giving decisions, two main things are worth keeping in mind: • According to the median GiveWell staff member, over half of the benefits of AMF are driven by saving the life of people aged 5 and older or by improving future incomes for young children, rather than saving the lives of children under 5 (“Bed Nets”, B78-80). If you otherwise agreed with the median staff member’s values but believed that averting a young child’s death averts ~0 DALYs, AMF’s cost-effectiveness would be reduced ~37%. If you believed that averting death in general has ~0 value but agreed with the median staff member’s empirical and moral beliefs about improving future incomes, AMF’s cost-effectiveness would be reduced ~73%. • The median staff member’s estimate of 8 DALYs averted per young death averted appears to be within the realm of plausibility for multiple stances on population ethics, including total utilitarianism (where it seems to be more on the low end) and Epicureanism (where it seems to be on the high end). I would guess that it is also within the range of many interpretations of the time-relative interest theory of value. The post AMF and Population Ethics appeared first on The GiveWell Blog. ### Staff members’ personal donations for giving season 2016 Fri, 12/09/2016 - 10:52 For this post, GiveWell staff members wrote up the thinking behind their personal donations for the year. We made similar posts in 2013, 2014, and 2015. After Elie and Holden, staff are listed in order of their start dates at GiveWell. Elie Hassenfeld For my year-end donation, I’m planning to give to GiveWell for regranting. I already gave a significant portion of this year’s donation to a political campaign, so I’m planning to give less at the end of this year than I have in previous years. I spend most of my time working on GiveWell’s research, so it’s likely not surprising that I plan to follow our recommendation. I think the quality of the research our team produced this year was higher than it has ever been. In particular: • We significantly increased our focus on organizations’ funding gaps and have a better picture of how GiveWell-directed funds could interact with other funders than we had in the past. • Our cost-effectiveness analysis was subject to significantly more staff debate than it was in the past, leading to several important changes that, I believe, improved the model. • David Roodman is in the midst of a deep investigation of the evidence for deworming. His analysis of that intervention has significantly improved our understanding of the strengths and weaknesses of this evidence. The option I considered most seriously instead of following GiveWell’s recommendation was supporting organizations I know about through the Open Philanthropy Project’s work on biosecurity and pandemic preparedness, which I’m very involved in. The two options I considered seriously are iGEM and the Center for Health Security. As far as I know, these are both extraordinary organizations that I would be excited to support in Open Philanthropy’s absence. Given Open Philanthropy’s work in this area, I’m uncertain about the impact of additional funds. I also considered saving to give later. My intuition is that there are few opportunities that I would personally decide I wanted to give to in the future that I would be unable to convince someone else to give to instead. That led me to decide to give now instead of later. Holden Karnofsky My personal giving is very small compared to the giving I advise on. I’ve chosen to focus my personal giving on: (a) things that larger donors I advise can’t or won’t do; (b) checking boxes I want to check for considering myself a personally moral/ethical person, which is related but not identical to trying for maximum expected positive impact on the world. Earlier this year, I gave to a political campaign that I considered important and high-impact per dollar. This falls under (a) because there are per-individual contribution limits. I expect that I will see future opportunities in category (a) as well, but I don’t see any at the moment that seem a good match for my level of giving, so I considered a few possibilities: • I thought about simply saving my money for future opportunities. • I thought about participating in the donor lottery mentioned by Tim, Ajeya and Helen—I think it’s a very interesting idea and I am on board with the arguments for how it can be beneficial. • I thought about reallocating my giving to another individual, someone who is quite value-aligned with me and quite knowledgeable, and thinks differently enough that they might see opportunities I don’t. As a general point, I think reallocating to others addresses a similar issue to the donor lottery—trying to consolidate donations so that a smaller number of people can put in a greater amount of effort – and it seems to me that it is a better way of doing so when one has a person in mind they’re comfortable reallocating to. (Of course, hybrid approaches are possible too —one could reallocate to a person who then plays the lottery, with the winner of the lottery considering reallocation as well.) I haven’t finalized my decision yet, but I am leaning toward the last option. The “EA Giving Group” DAF mentioned by Nick is one possibility, and there are others as well. Regarding (b): every year, I want to give a significant amount to “charity” as conventionally construed, straightforwardly helping the less fortunate. I generally believe in trying to be an ethical person by a wide variety of different ethical standards (not all of which are consequentialist). And I wouldn’t feel that I were meeting this standard if I were giving nothing (or a trivial amount) to known, outstanding opportunities to help the less fortunate, for purposes of saving as much money as possible for adversarial projects (such as political campaigns) and/or more speculative projects (such as work related to artificial intelligence). I think the best giving opportunities in this category are GiveWell’s top charities, so I will be giving a portion of this year’s donation there, following the recommended allocation. One more comment: this year I am considering donating an unusually large amount because I think tax rates are likely to fall soon. Natalie Crispin I continue to believe that GiveWell top charities are the best option for impact-focused giving for individuals and I plan to give most of my annual gift this year to GiveWell for regranting at its discretion to top charities. I am grateful for all the work, thoughtfulness, and hours of debate that my colleagues put into the recommendations, and I believe that the recommendations are as strong as they’ve ever been. I am excited to support the most effective charities I know of. At a smaller scale, I’m planning to make a number of “good citizenship” donations. I’m distressed by the growth of illiberalism and disregard for the truth in our society. I don’t expect to be able to make an impact against these threats with my dollars, but hope that setting aside a small portion of my charitable budget for this cause leads me to think seriously about the issues involved and have conversations with people who know more than I do about this. I feel that it’s an important time to be an engaged and alert citizen and it’s important to me to have some skin in the game. Alexander Berger I’m planning to give 80% of my charitable contributions this year according to the GiveWell recommended split. I think the main updates on our top charities since last year are positive, and I continue to be very excited about giving to them. Additionally, I wasn’t really involved in the GiveWell top charity selection process at all this year, and at this point I don’t see any grounds for differing with my colleagues on their recommended split. That said, I feel mildly less urgent about these opportunities than I did last year, because I think they may be available longer than I had suggested then and because I’ve become somewhat more optimistic about the possibility that the Open Philanthropy Project will find considerably more impactful opportunities in the future. (These considerations are mainly why I recommended that Good Ventures not significantly increase its contributions to top charities this year, but I’m not reducing my giving to save more for the future because I think it’s good for me to be in the habit of giving meaningfully each year.) With the other 20% of my giving: • As with last year, I’m planning to give 5% to GiveWell for operating expenses. At this point, I value the top charities research but am primarily a consumer rather than a producer of it, and I think it’s totally appropriate for me to contribute to pay for it. This decision probably doesn’t matter this year because I think GiveWell is likely to hit its excess assets policy in the coming year due to the separation of the Open Philanthropy Project, so the marginal contributions to GiveWell’s operating expenses will just be passed on to top charities. But I hope that I can save my colleagues some time on fundraising efforts and promote the idea that it’s a good choice for donors who use GiveWell’s research to direct some portion of their giving to it. • Also in line with last year, I’m giving 5% to GiveDirectly. As I said then, “I continue to feel that they are a uniquely outstanding organization and add a huge amount of value by serving as a benchmark against which other organizations and interventions can be compared… I don’t think that my contribution will add as much value with GiveDirectly as it would elsewhere, but if I didn’t give significantly to GiveDirectly this year, I’d want to again within the next few years to renew my claim to being a ‘supporter’ and because I find them a particularly valuable organization to be able to discuss when making the case for giving a lot.” • For the first time this year, I’m planning to give 10% of my giving to organizations focused on farm animals. I still don’t feel like I have any real grasp on how to weigh animal organizations against those focused on humans, but I believe that animal suffering is worthy of some moral concern, and having seen Lewis’ work up close, I no longer feel that 0% is the right portion of my portfolio to be allocating to these issues. That said, I’m not sure if this will prove a sustainable level for me: at this point the case for me here is almost entirely intellectual rather than emotional, and I’m hoping that starting to give in this area might help me begin to feel more emotionally motivated by the cause. As in past years, I considered and ultimately decided against devoting my annual giving to one of the organizations we’ve come across at Open Phil. I continue to spend the bulk of my working hours on Open Phil’s policy efforts, and see supporting other organizations with my charitable contributions as an attractive form of diversification (even though I don’t generally think it’s useful to diversify in charity). Timothy Telleen-Lawton Giving to GiveWell’s recommendation is not quite as attractive to me this year as it has been in past years because my expectation that my donations might reach better opportunities elsewhere has increased. Even if I am able to find opportunities that I am more excited about, I expect GiveWell’s recommendation to remain my primary suggestion for family, friends, and others who aren’t planning to spend a lot of their own time on the process. I expect that seriously considering non-GiveWell opportunities would take a substantial amount of time, so I have signed up for a donation lottery to save that time in expectation, and justify spending more time in the 5% chance that I win. Options that I already know I would want to investigate if I won the lottery: • Giving the money to people who I believe would make the decision at least as well as I would (as measured by my values) • Trying to influence very long-term outcomes • Improving animal welfare • Capitalizing on unique political opportunities • Speculating on small projects that I believe I have a comparative advantage in discovering or evaluating • Regranting to top charities by giving to GiveWell I would also like to think more about ideal donor behavior in a community of donors that want to cooperate and have overlapping but non-identical values and beliefs, and substantial uncertainty. For example, I would like to consider when and how the following are appropriate: • Spreading gifts among plausibly-ideal opportunities versus highest expected value only • ‘Coordinating’ with Open Phil as an individual donor in its priority cause areas • Giving to one’s employer • Aggregating donations, such as donation lotteries and passing donations to other donors • Saving for later giving I continue to make donations to some organizations that provide services I value, on the expectation that this is a good practice for people to follow generally in order to offset the cost of providing those services and signal its value. The vast majority of such donations this year went to CFAR; I particularly benefitted from attending a workshop in January. Josh Rosenberg I plan to give 65% of my charitable budget to GiveWell for regranting to top charities. I generally follow GiveWell’s recommended allocation for my global poverty-related giving unless I have very strong reason not to. This helps to ensure that I debate any of my personal disagreements with the recommended allocation with my coworkers, which could ultimately influence much more funding than my personal donation. And, if my arguments don’t succeed, it ensures that I factor in my coworkers’ knowledge and values to my giving decision. Ultimately, I feel confident in our recommended allocation this year and am excited to support it. That said, there were many difficult judgment calls that went into our final recommendation. The allocation decision we made that I was most unsure about was not prioritizing some further funding to Malaria Consortium’s seasonal malaria chemoprevention (SMC) work above part of the Against Malaria Foundation’s (AMF) and the Schistosomiasis Control Initiative’s (SCI) remaining gaps. I think there is a strong argument that Malaria Consortium is roughly as cost-effective as these other opportunities, and it seems unlikely that Malaria Consortium would hit diminishing returns at the level of funding it received (5 million). Also, I think that Malaria Consortium may be a stronger option than AMF for donors who put especially high weight on strength of evidence and cost-effectiveness. (This year, for most staff members, about 60%+ of the benefits of AMF in our cost-effectiveness analysis came from averting adult malaria mortality and improving childhood development, but the evidence base for both of these impacts is relatively limited.) However, I ultimately felt that it was reasonable to prioritize the next tier of AMF and SCI funding gaps above Malaria Consortium since those gaps had similar cost-effectiveness and have been more thoroughly vetted. (For full disclosure, I was the main researcher who worked on reviewing Malaria Consortium—it’s possible that those who interact directly with a charity are more often biased in favor of it.)

I already gave 30% of my charitable budget to a political campaign earlier this year because I believed that it was among the most cost-effective uses of my money.

With the final 5% of my charitable budget, I plan to give to charities that promote farm animal welfare. I have not yet fully worked out my view on the cost-effectiveness of these charities, but I’m convinced enough that they could be outstanding opportunities that I want to provide some funding to them.

Other options that I considered were organizations that work on reducing the likelihood of global catastrophic risks and organizations that work against authoritarianism. However, I wasn’t able to feel confident enough in any particular organization to be willing to donate to it. I hope to learn more about these types of organizations in the future and hope to see more public debate about the best groups to donate to in these causes.

Another factor in deciding against additional donations to relatively speculative giving opportunities (beyond my political donation) was that I have a strong desire to tangibly help people in the near term. Even if I give a larger portion of my donations to more speculative causes in the future, I always want to make sure that I’m doing my part to provide significant support to those who are worst off.

Rebecca Raible

I have not yet decided where I am going to give this year; this post only represents my preliminary thoughts. I do not plan to spend a large amount time thinking about my donation this year, given its relatively small size, so the conclusions I reach are probably close to those I will ultimately act upon.

I probably won’t give to a GiveWell top charity this year. But, if I were going to, I would likely give to SCI, based on my estimates of GiveWell’s top charities’ cost-effectiveness and room for more funding. This year, differences between staff members’ conclusions in GiveWell’s cost-effectiveness analysis (CEA) were largely driven by the inputs related to:

• Value judgments (e.g. how to weigh improving a life against preventing a death).

• Our confidence in the evidence for the developmental effects from deworming and bed nets.

You can find my inputs and other staff members’ in the CEA linked above.

I think it makes sense to adjust my views towards the median staff views on parameters related to evidence. I’m not sure whether or not it makes sense to adjust my value judgments towards the staff medians, but right now I lean against doing so. If I change our CEA so that everyone shares my value judgments, then AMF and the Malaria Consortium appear to be as cost-effective as GiveDirectly. Sightsavers comes out as about 5x as cost-effective as GiveDirectly, SCI 8x, and Deworm the World 10x. Deworm the World is already fully funded through its “Execution Level 2” gap and I doubt that more funding next year would significantly affect its plans, given the slow rate at which it has used funding in the past. SCI, however, is only funded partially through its Execution Level 2 gap. So, SCI would be my first pick.

However, I suspect I won’t give to any of GiveWell’s top charities this year, because I think there are other giving opportunities that better match my values. For example, I value animal welfare, and, although I haven’t looked into the calculations closely, my understanding is that the number of animals you’d have to be willing to trade off against a human to make GiveWell’s recommended charities look better than farm animal welfare charities is high. (For an example of a rough estimate of the cost-effectiveness of corporate campaigns, see here. Although note that corporate campaigns may be significantly more cost-effective than other animal welfare interventions). Therefore, I may choose to give to Animal Charity Evaluators, one of their recommended charities, or organizations that Lewis recommends. I’m also pretty excited about reducing global catastrophic risks, but I have even less certainty about which organizations are doing great work in this space.

I have considered giving to the options Nick and Ajeya describe, but these choices are somewhat logistically challenging for me this year. It’s likely that I’ll give to opportunities like these in the future.

This year I am donating to the “EA Giving Group” DAF (donor-advised fund). Since 2012, one of my side projects has been working with a private individual (who has provided the vast majority of the funds and prefers to remain anonymous) to make donations to organizations working in the effective altruism space and organizations working on mitigating global catastrophic risks (especially potential risks from advanced AI). We meet every three weeks to discuss potential donation opportunities and make decisions, and we both keep up with activities in the space through relationships we’ve built up over time. The DAF is jointly controlled by me and this partner.

A list of donations we’ve made in the past (without dollar amounts) is available here (arranged by year and decreasing order of grant size). The organizations that received the most funding were the Centre for Effective Altruism (CEA), the Future of Life Institute, 80,000 Hours (part of CEA), and Founders Pledge. I think these grants have gone well overall, as has our support for Charity Entrepreneurship and the Cambridge Centre for the Study of Existential Risk. In most cases, we supported these organizations relatively early in their existence, and we’ve mainly supported them when they were new or relatively young.

Over the last year, Open Phil has also made grants in these areas based on my recommendations. I anticipate that there will be some cases where a grant would be a good fit for this DAF but not Open Phil. However, with Open Phil as a funder in this space it has been harder to find opportunities that are as promising and neglected as we were able to find previously.

I don’t yet know what this DAF will support in the coming year, but it will probably have a similar flavor to what was supported in the past.

I am making this donation instead of a donation to GiveWell’s top charities primarily because (i) I think this is more optimized for influencing long-term outcomes for the world (which is my primary altruistic objective—reasoning here) and secondarily because (ii) I think we have a good chance of getting a “multiplier effect” where support of the effective altruist community eventually results in more total donations to GiveWell’s top charities and other things I find comparably good.

If you want to make a contribution to this DAF, then fill out this form.

This might be a good fit for people who have some combination of the following properties: interest in effective altruism and/or global catastrophic risks, context needed to assess our (still early) track record, trust in my judgment and/or my partner’s judgment, limited time/context available to make donation decisions themselves. We update contributors on grants made a couple of times per year.

Helen Toner

This year, I am giving to the donor lottery set up by Carl Shulman and Paul Christiano. My reasons are largely similar to those described in the linked post and by Ajeya elsewhere in this post: creating a chance that my donation will be large enough to significantly affect the recipient organization, and reducing the time I spend thinking about where to donate unless my donation is that size. In keeping with the latter point, I haven’t thought hard about where I would give if I ended up winning the donor lottery. Some organizations and areas I would want to consider include the Machine Intelligence Research Institute, Animal Charity Evaluators, the International Refugee Assistance Project, and organizations working against populism/authoritarianism/nationalism.

Sophie Monahan

While I believe that all of GiveWell’s recommended charities are excellent giving opportunities, I plan to deviate from GiveWell’s recommendation and give 100% to GiveDirectly this year.

GiveWell’s recommendation is informed by our estimation of the comparative cost-effectiveness of donations to our top-recommended charities. This model is heavily influenced by a small number of inputs related to the trade-off between the value of consumption benefits and the value of preventing deaths, especially of very young children (see “Parameters” tab rows 7, 53, 63, and 64). Since last year, it has become increasingly clear to me that my values differ somewhat from GiveWell’s as a whole. I am uncertain about the stability of my own values, and very uncertain about the values of those I aim to benefit and whether these last are likely to be closer to my values or to GiveWell’s values.

My values differ from GiveWell’s in the following ways:

1. I value increasing household consumption comparatively more highly than averting deaths of very young children. For more, see the comments on rows 7, 53, and 63 of the “Parameters” tab of GiveWell’s cost-effectiveness model.
2. I am more skeptical that deworming has effects similar to those described in Baird et al. 2015 in the contexts where GiveWell-recommended charities work. I have not seen David Roodman’s forthcoming blog post on this topic, but he has written, “My confidence fell in the generalizability of that finding to other settings, as discussed in the next post.”

These values lead me to believe that GiveWell’s top-recommended charities are roughly similar in cost-effectiveness. (My results for charities range from 0.3x-2.2x as cost-effective as GiveDirectly, which is well within my margin of uncertainty for our model accuracy and for my value judgements.) However, based on our collective values, GiveWell has prioritized the top-tier funding gaps for every other top charity above the top-tier funding gap for GiveDirectly. Thus, we expect that GiveDirectly will be constrained by funding this year and will downsize somewhat. Because I believe that GiveDirectly’s cost-effectiveness is similar to that of other top charities, and that GiveDirectly is strong or strongest on other key considerations such as evidence of impact and transparency, yet GiveDirectly will be underfunded compared to other top charities, I believe that additional contributions are best given to GiveDirectly.

Laura Muñoz

Though I have not yet finalized my giving decisions for this year, they will likely be similar to last year’s, and for similar reasons. I will give a portion to GiveWell top charities for regranting, and a portion specifically to GiveDirectly. I will also give a portion to social justice, advocacy and human rights organizations. One of these organizations will be Northwest Health Law Advocates (NoHLA), an underfunded healthcare consumer advocacy organization whose work and impact I understand well due to a personal connection. I believe their work will be especially critical in fighting cutbacks to programs that provide access to healthcare. More research on charities in the abovementioned categories remains to be done before I make my final decisions.

I will also likely give to Strong Minds after doing a little more research, for reasons similar to Chelsea’s and Isabel’s.

Catherine Hollander

I plan to give the majority of my year-end donation to GiveWell’s recommended charities. Among GiveWell’s top charities, I plan to give 75% of my donation to the Against Malaria Foundation, in line with GiveWell’s recommended allocation. I spent a significant amount of time with the GiveWell research team this year and feel more confident in GiveWell’s year-end recommendations as a result; reading my colleagues’ contributions to this post is a reminder of why I value the recommendations put forward by this group.

I plan to deviate from GiveWell’s remaining recommended allocation (25% to the Schistosomiasis Control Initiative) and provide the remaining 25% of my donation to the Malaria Consortium for its work on seasonal malaria chemoprevention. I value improving health outcomes highly (and relative to income-improving interventions), although like Sophie I am uncertain about the stability of my values, as I remain relatively early in my charitable giving.

I am planning to make a smaller number of donations to charities working to support domestic causes and social justice, in addition to my gifts to GiveWell’s recommended charities, to fulfill what I see as my civic responsibility.

Andrew Martin

This year, I’m planning on following GiveWell’s recommended allocation of donations to top charities: 75% to the Against Malaria Foundation (AMF) and 25% to the Schistosomiasis Control Initiative (SCI). I agree with my colleagues that, taking grants GiveWell recommended to Good Ventures into account, an allocation of 75% to AMF and 25% to SCI is best for contributing towards filling the most valuable remaining funding gaps among our top charities.

Before deciding on donating according to GiveWell’s recommended allocation, I considered several other donation options:

• Giving part of my donation to covering GiveWell’s operational costs: As a GiveWell employee, I don’t think I’m in the best position the diversify the donor base for covering GiveWell’s operating expenses, though I think it’s valuable and reasonable for others who use GiveWell’s research to allocate some of their donation to do so.
• Giving part of my donation to GiveDirectly: Last year, I allocated 10% of my donation to GiveDirectly, mostly because the idea of allocating some of my donation to a “low-risk” opportunity (i.e., I was highly confident that it would do some significant good) appealed to me as a donor. After more intensive engagement with our cost-effectiveness analysis this year, I don’t find this consideration as salient as I did last year.
• Giving part of my donation to Malaria Consortium for its work on seasonal malaria chemoprevention: I have wavered between allocating 25% of my donation to Malaria Consortium or SCI. My best guess is that additional donations to Malaria Consortium would be highly valuable, since I think that seasonal malaria chemoprevention is roughly as cost-effective as bed nets, and since GiveWell capped its recommended grant from Good Ventures to Malaria Consortium at \$5 million, since we know significantly less about the organization and the intervention than we do for our other recommendations. Additionally, the amount of funding that GiveWell recommended Good Ventures grant to SCI would fill all of SCI’s execution level 1 funding gap and half of its execution level 2 funding gap, but it seems likely that Malaria Consortium still has a large unfilled execution level 1 funding gap (see this blog post for definitions for these terms). However, given our relatively limited knowledge of seasonal malaria chemoprevention and Malaria Consortium, and given my uncertainty about whether to interpret the differences between the cost-effectiveness of bed nets, seasonal malaria chemoprevention, and deworming given my values and inputs into our cost-effectiveness analysis as meaningful, I’ve decided to default to my colleagues’ wisdom and follow GiveWell’s recommended allocation.

Lewis Bollard

I will again give exclusively to farm animal welfare groups for similar reasons to last year:

• Farm animal welfare is important: Roughly six billion caged layer hens, 15 billion broiler chickens, and 80 billion fish are confined globally at any time, and many suffer from mutilations and inhumane slaughter.
• Farm animal welfare is still neglected, though less so than before: The Open Philanthropy Project and other new donors have brought much-needed funds to the field, but farm animal welfare philanthropy remains tiny compared to the problem’s scale.
• Farm animal welfare is more tractable than ever: The unexpectedly rapid success of corporate cage-free campaigns has created a window of opportunity to push for further reforms—especially global cage-free, broiler chicken, and farmed fish welfare policies.

I was torn this year on my recommendations. The Open Philanthropy Project’s farm animal welfare grants have significantly reduced the short-term need for more funding at the most effective groups, so my dollar might go further at groups we’re not funding. In particular, my dollar would probably go furthest at smaller groups that we’re unlikely to fund soon due to the time required to investigate them. But I also didn’t want to devote time to investigating these groups for my personal donations, or to donate blindly to groups I haven’t investigated yet. (After discussing a draft of this post with my coworkers, we’re now going to put more thought into whether there might be an efficient way to get some of these groups funded, such as by finding a re-grantor.) So I’ve decided to support the groups I’m already most excited about, most of which are grantees:

• I plan to support the five advocacy groups that I believe are primarily responsible for the major recent US and international corporate wins for layer hens and broiler chickens: The Humane Society of the US Farm Animal Protection Campaign, The Humane League, Mercy for Animals, Humane Society International, and Compassion in World Farming USA.
• I also plan to donate to Animal Charity Evaluators, which I’ve recently become more positive on and believe (like the groups above) would benefit from a broader donor support base even if we do fund it.
• I also plan to donate to the Good Food Institute, which I believe is the most effective non-profit working in the important space of promoting technological alternatives to animal products.
• I donated earlier this year to Citizens for Farm Animal Protection, the group that ran the successful Massachusetts farm animal welfare ballot measure, because I believe ballot measure campaigns are important and benefit from a broad base of support.

Chelsea Tabart

I plan to split my gift this year between Malaria Consortium’s seasonal malaria chemoprevention program and Strong Minds, a charity that treats women in Uganda with depression through talk therapy groups led by community workers. Strong Minds’ program has randomized evidence of effectiveness, is in my assessment potentially highly cost-effective, and is supported by monitoring published online.

I plan to allocate 50% of my giving to Malaria Consortium because on my values and assumptions (as entered in GiveWell’s publicly available 2016 cost-effectiveness analysis) seasonal malaria chemoprevention is the most cost-effective, evidence-backed giving opportunity I am aware of. My decision to differ from GiveWell’s recommended allocation for giving season 2016 relies on the difference between my personal values and those of the median GiveWell staffer. As some readers are aware, GiveWell’s assessment of the relative cost-effectiveness of its recommended organizations rests, among other things, on how the median GiveWell staffer makes two controversial philosophical tradeoffs. The first is how many years of roughly doubling a person’s income is as valuable an additional year of healthy life. The second is how many child lives are equal to the value of one adult life. Relative to the values underlying our recommendations, I value improving health more highly than increasing wealth, and I consider the value of saving the lives of young children to be much closer to the value of saving the lives of adults.

My decision to allocate 50% of my giving to Strong Minds is both more speculative and more personal. I have decided to give 50% to Strong Minds over GiveWell charities for three reasons. Firstly, I think mental health is one of the most neglected areas in global health funding and innovation, and I want to incentivise and celebrate early-stage, evidence-driven, transparent organizations like Strong Minds. Second, I believe that the suffering experienced by adults with moderate to severe mental illness and their dependants and loved ones is often underestimated. It is plausible to me that giving to Strong Minds may improve well-being as much as GiveWell’s most effective charities. Finally, mental health treatment has fundamentally changed my life and the lives of many of my loved ones. For that reason, I consider it a personal privilege to donate to an organization making effective health services available to women facing stigma and difficult circumstances without comparison in the developed world.

Sarah Ward

I gave most of my charitable giving budget for this year to GiveWell (for grants to recommended charities at its discretion, so to AMF) in January, shortly before I left my prior job. I timed my donation this way to take advantage of my former employer’s generous charitable donation matching program.

I haven’t settled on final proportions yet, but I will probably give about half of the remainder of my annual contributions to GiveDirectly and the other half to nonprofits working to preserve political freedom and the rule of law in democratic societies. I spent very little time engaging in our top charities selection process this year, and was torn between donating to SCI to align with our updated recommendations and donating to GiveDirectly. Like Alexander, I value GiveDirectly as a benchmark for other organizations and interventions. This, along with my lack of deep engagement in our charity evaluation process, skepticism about the cost-effectiveness of deworming (for reasons similar to Sophie’s), and desire to limit the amount of time I spend thinking about where to give, led me to settle on GiveDirectly.

Chris Somerville

My largest donations during the past ten years or more have been to several Universities where I was a student or a faculty member. They are all public Universities and are always starved for funding. In 2016 my largest gift by far was to UC Berkeley, which currently obtains only 12% of its financial support from the State of California and is running a large deficit. In contrast to the other Universities ranked in the top six in the world, all of which are private, UC Berkeley is public and about 40% of the Berkeley undergraduates are from low income families and are eligible for Pell grants from the federal government. Thus, Berkeley is a particularly powerful engine for upward social mobility. My family was poor but I was able to earn enough working nights and summers to pay my way through a public University. I am grateful to the excellent education I received and want to pass that opportunity along. (My second largest gifts have been to pay for the tuition and living expenses of several relatives).

Ajeya Cotra

This year, I gave approximately 55% of my donation budget to a political campaign in mid-October. I plan to give the remaining 45% to the donor lottery set up by Carl Shulman and Paul Christiano. This lottery allows me to contribute a certain amount of money to a common fund, in exchange for a probability of deciding the allocation of the whole fund that is proportional to the amount of money I put in. There are three main reasons I prefer giving to this lottery over donating to a charity directly:

• I can stop worrying about where to give unless I win. If I win, I will control several times as much money as I put in, so then I can justify spending much more time and energy optimizing this decision than I could if I were allocating my individual contribution.
• Even if I were fairly confident about what charity I would give to if I were to win the lottery, giving a large chunk of money at once would allow me to have influence and access to that charity which I wouldn’t have been able to achieve with a smaller donation: for example, my donation might enable the creation of an entirely new sub-program in that charity.
• I think the lottery is an interesting innovation in how people give, and I want to contribute to it having a healthy launch and signal my support for the idea of experimenting with giving in this way.

In the spirit of the lottery, I haven’t thought very much at all about where I would give if I won—but currently, I am weakly leaning toward Animal Charity Evaluators, based largely on a single conversation with Lewis.

Chris Smith

I plan to contribute 80% of my year-end giving to the END Fund. When my personal views are accounted for in our cost-effectiveness analysis, deworming charities have the highest expected value. I chose the END Fund over our other deworming charities based on its room for more funding.

Although I am giving to the END Fund, I would not be comfortable broadly recommending deworming organizations to all my friends and family members wondering where to give. It’s possible that our deworming charities accomplish very little, and not everyone shares the view that the best charities to give to are the ones where contributions have the highest expected value.

I intend to split the last 20% of my annual donations among GiveWell’s other top charities and a few organizations that don’t fit into GiveWell’s evaluation framework.

I won’t be contributing any portion of my donations to GiveWell’s operating costs. I would be uncomfortable donating to my employer, and I would prefer that donating to GiveWell does not become a norm among staff.

Isabel Arjmand

GiveWell’s recommendations represent the most convincing estimate I’ve seen of where to give money in order to do the most good per dollar, in terms of averting deaths and improving lives, and they are also reasonably well-aligned with my values. For that reason, I’ll be giving the bulk of my year-end donation (two-thirds) to GiveWell top charities according to our headline recommendation.

I find some of my coworkers’ arguments for deviating from our headline recommendation compelling. For example, I think it’s plausible that Malaria Consortium has an unfilled funding gap on par with AMF or SCI’s. However, I’ll be following the standard GiveWell recommendation, giving 75% of what I’ve allocated for top charities to AMF and the remaining 25% to SCI. At this point in time, I don’t believe I have any insights that would make me confident in deviating from the collective wisdom of the GiveWell research team. While I’m uncertain about the impact of deworming, my best-guess inputs to our cost-effectiveness analysis find it to be more cost-effective in estimation than most of my coworkers’ do, and so in the case of SCI, I’m comfortable giving to an opportunity that I view as risky but with a nontrivial chance of high impact per dollar.

The remaining one-third of my year-end giving will go to causes that are less evidence-backed in some cases but highly-aligned with my values, namely in terms of furthering social justice and my own civic engagement. Similarly to Holden, I believe in trying to be ethical according to a variety of ethical standards, including nonconsequentialist ones. I also view financial support as a means of engaging with causes I care about and signaling my support for organizations that do work I’d like to see more of. Prior to finalizing how I will allocate this portion of my giving, I hope to continue to discuss promising giving opportunities with coworkers and friends. As of now, I tentatively plan to support:

• Causa Justa :: Just Cause: As a resident of a predominantly Latinx, predominantly working-class neighborhood in Oakland, I see supporting Causa Justa :: Just Cause—a Bay Area-based grassroots organization supporting housing rights, immigrant rights, and racial justice—as a means of supporting the community in which I live.

• Planned Parenthood: I want to support an organization that provides and advocates for reproductive health services in the United States, and Planned Parenthood is one I am familiar with and trust. I haven’t yet decided whether I will give to Planned Parenthood or to the Planned Parenthood Action Fund.
• International Refugee Assistance Project (IRAP): Refugee resettlement is a cause I feel personally drawn to, and I admire IRAP’s focus on systemic advocacy.
• Strong Minds: Mental health is another cause I feel passionate about supporting. My colleague Chelsea brought this organization to my attention, and I’m excited about the opportunity to support a program that is providing much-needed mental health care to women in Uganda. In my opinion, mental health is severely underfunded worldwide, and I would like to see Strong Minds scale up and possibly inspire the creation of more evidence-based mental health programs around the world.
• GiveDirectly: This is a bit different from the other organizations in this list, in that it is one of GiveWell’s evidence-backed, underfunded top charities. While I believe GiveDirectly is most likely less cost-effective than AMF and SCI, I want to support its work as an organization that is empowering people living in extreme poverty, carrying out programs that allow for autonomy, and doing rigorous research on its programs. I’ve placed it in this category because I’m donating to it primarily because I see it as supporting a model of distributive justice that I would like to see further developed, rather than because I believe it is the most cost-effective giving opportunity available to me this year.

I considered supporting a variety of other causes with this portion of my giving, including environmental justice, animal welfare, criminal justice reform, preventing homelessness in the Bay Area, and justice for Native people in the U.S. In the end, I limited myself to the five causes above in order to keep each donation large enough to feel meaningful. I imagine I might make a significant contribution to political advocacy in the first half of 2017, but I’m currently uncertain what form that might take.

I briefly considered but decided against donating to GiveWell unrestricted to support our operating costs. I believe it makes sense for donors who value our research and recommendations to support GiveWell financially, but as an employee, I—like many of my colleagues—don’t believe I’m in a good position to diversify our donor base.

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