The END Fund - May 2016 Version | GiveWell

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The END Fund - May 2016 Version

We have published a more recent review of this organization. See our most recent report on END Fund.


The END Fund is applying to be a top-rated charity. Here we discuss what we have learned so far and our major outstanding questions.

More information: What is our evaluation process?

Published: May 2016

Summary

What do they do? The END Fund (end.org) manages grants and raises funding for controlling and eliminating neglected tropical diseases (NTDs). We focus our review on its support for programs that treat schistosomiasis and soil-transmitted helminthiasis (STH) ("deworming"). (More)

Does it work? We believe that there is relatively strong evidence for the positive impact of deworming. Based on the information we have seen to date, which focuses on the END Fund's work in Angola, we are uncertain about whether END Fund–supported deworming programs reduce worm infection rates or reach a substantial proportion of targeted populations. (More)

What do you get for your dollar? Deworming is generally very cost-effective. We have not performed an in-depth cost-effectiveness analysis of the END Fund's deworming programs. (More)

Is there room for more funds? The END Fund told us that it could support significantly more NTD programs with additional funding. We have not investigated the END Fund's room for more funding in depth. (More)

What are GiveWell's next steps? The END Fund has successfully completed the first phase of our investigation process. We now plan to (a) make a $100,000 grant to the END Fund (as part of our "top charity participation grants," funded by Good Ventures) and (b) continue our review process of the END Fund to try to answer our remaining questions. We may also expand the scope of our investigation to include the END Fund's other NTD programs.

Our process

As we stated in our 2015 plans, we are interested in finding additional top charities that work on deworming. The END Fund applied to be a GiveWell top charity in 2015. To date, our investigation has consisted of:

What do they do?

The END Fund manages grants and raises funding for programs to control and eliminate neglected tropical diseases (NTDs), with a focus on soil-transmitted helminthiasis (STH), schistosomiasis, lymphatic filariasis, trachoma, and onchocerciasis.1 We focus this review on the END Fund's support for deworming (mass drug administration targeting schistosomiasis and soil-transmitted helminthiasis), which we have identified as a priority program.2

The END Fund began supporting NTD programs in 2012.3 As of August 2014, it had disbursed $8.8 million to NTD programs in 14 countries with 12 implementing partners, including SCI and Deworm the World.4 We do not know how much of this funding was used for deworming programs.

The END Fund's role in deworming and other NTD programs

  • Surveying the global NTD landscape and choosing locations for programs: The END Fund told us that it conducts research on the global NTD landscape, including compiling information on where NTD treatment is needed, what work is being carried out by governments, NGOs, and other funders, and what capacity potential implementing partners have. It uses this information to decide where to fund programs.5
  • Making grants to create, scale up, or fill funding gaps for NTD programs: The END Fund told us that it makes grants to support several different types of programs, including new NTD programs in countries neglected by other donors, programs to scale up treatment coverage in countries with high NTD burdens, and established programs with small funding gaps.6 The END Fund's grantees include organizations with experience supporting NTD programs (including SCI and Deworm the World), organizations without experience implementing NTD programs that operate in areas in need of NTD treatments, and government agencies.7
  • Monitoring grantees' program operations: The END Fund asks grantees to provide program budgets, work plans, and target treatment schedules, and requires that grantees submit periodic progress reports during the implementation of the program.8 The extent of the END Fund's involvement in programs implemented by its grantees varies, and may include technical assistance from the END Fund.9
  • Raising funding for NTD programs: The END Fund told us that it actively engages with donors and philanthropic foundations (including those without previous involvement with NTDs) to raise funding for NTD programs.10

Overview of spending

As of August 2014, the END Fund had disbursed a total of $8.8 million to NTD programs and had commitments to disburse an additional $9.7 million.11 Note that our information is not up to date because we requested this information from END Fund in early 2015.

Total commitments and disbursements to NTD programs (in millions USD), as of August 2014

Country Total commitment (including funds already disbursed as of August 2014) % of total commitment Total disbursement (as of August 2014) % of total funds disbursed
Angola 7.3 39% 2.0 23%
Ethiopia 3.0 16% 1.2 14%
Mali 2.1 11% 1.9 22%
Namibia 1.3 7% 0.5 6%
Rwanda 1.3 7% 0.8 9%
Kenya 1.1 6% 0.6 7%
Nigeria 0.5 3% 0.5 6%
Yemen 0.4 2% 0.3 3%
Liberia 0.4 2% 0.1 1%
DRC 0.4 2% 0.4 4%
Burundi 0.3 2% 0.1 1%
India 0.2 1% 0.2 2%
Zimbabwe 0.2 1% 0.2 2%
Niger 0.1 0% 0.1 1%
Total 18.5 100% 8.8 100%

We do not know how much funding has been committed or disbursed for deworming programs specifically. With the exception of the grant to the program in Angola (details below), we have not seen breakdowns of in-country spending.

The END Fund's organizational expenses (management, fundraising, and other general expenses) do not seem to be included in these grant disbursement figures,12 but generally appear to account for around 15% of its total spending.13

Angola program spending breakdown

The END Fund chose to provide us with detailed documentation on its grant to support an NTD program in Angola (its largest grant commitment) as an example of its work; we have not yet seen similar documentation for the END Fund's other grants.14

The END Fund's five-year grant to the MENTOR Initiative was intended to support NTD-prevalence mapping (soil-transmitted helminthiasis, schistosomiasis, and lymphatic filariasis) in three provinces in Angola, school and community-based mass drug administration, and a school-based handwashing education program. (Lymphatic filariasis mapping was not completed).15

We have seen a breakdown of the MENTOR Initiative's spending by activity and by expenditure category for the first two years of the program (April 2013 – March 2015):16

The MENTOR Initiative, spending breakdown by activity, April 2013 - March 2015

Program activity Spending % of total spending
Program Management and Administration $873,000 43%
NTD Mapping $291,000 15%
Training and Workshops $248,000 12%
Supervision $215,000 11%
Mass Drug Administration $196,000 10%
NTD Capacity Building $99,000 5%
IEC/ACSM17 $33,000 2%
WASH $32,000 2%
Assessments and Surveys $20,000 1%
Support to Health Facilities $275 0%
Total $2,007,000 100%

The MENTOR Initiative, spending breakdown by expenditure category, April 2013 - March 2015

Expenditure category Spending % of total spending
Human Resources $643,000 32%
Infrastructure and Other Equipment $358,000 18%
Planning and Administration $285,000 14%
Training $235,000 12%
Overheads $171,000 9%
Technical Assistance $103,000 5%
Health Products and Health Equipment $70,000 3%
Procurement and Supply Management Costs $67,000 3%
Monitoring and Evaluation $54,000 3%
Communications Materials $23,000 1%
Living or Other Support to Beneficiary Population(s) $46 0%
Total $2,007,000 100%

The END Fund also provided more detail on the expenditures included in the above categories.18

Our understanding is that the mass drug administration in the MENTOR Initiative's spending breakdowns refers to two rounds of school-based MDA: one round of albendazole in October and November 2013 for the treatment of STH and one round of praziquantel in November 2014 for the treatment of schistosomiasis (albendazole was unavailable during the November 2014 distribution).19

Does it work?

END Fund-supported mass deworming programs are focused on delivering treatments that have been independently studied in rigorous trials and found to be effective.

We focus this section on the deworming component of an END Fund-supported program in Angola. When asked for an example of detailed program documentation, the END Fund chose to send documents on its grant to a program in Angola; we are uncertain whether this example is broadly representative of the END Fund's other programs, and do not have enough information on other programs to make comparisons.20 We have seen documents on the program describing the implementation of two rounds of deworming targeting school-aged children and plans for deworming activities for the remaining three years of the program.

We are uncertain overall about the program's impact on worm infection rates and about the proportion of targeted children reached through the program. We have not seen the types of monitoring from the Angola program that have increased our confidence in similar programs conducted by Deworm the World and SCI.

It seems plausible to us that the END Fund has an impact by causing deworming programs to start. The END Fund may also have a positive impact on deworming programs by providing non-monetary assistance to its grantees, but we have not investigated this question in depth.

Details follow.

Independent evidence of program effectiveness

The END Fund supports mass deworming programs, which we discuss extensively on another page. There is a very strong case that mass deworming is effective in reducing infections. The evidence on the connection to later positive quality-of-life impacts for children who are dewormed is less clear, but there is a fairly strong possibility that deworming is highly beneficial.

How is deworming conducted in programs the END Fund supports?

The documents we have seen on the END Fund-supported program in Angola refer to implementing two rounds of school-based mass drug administration targeting school-aged children. In the future, the program may support community-based deworming targeting pre-school-aged children or adults as well.21

We have seen a report describing some details of how the program was carried out in the second year of the Angola program, including teacher training, drug transportation to municipalities, and administration of praziquantel to school-aged children (details in footnote).22

Have infection rates decreased in targeted populations?

We are currently uncertain about the impact of the END Fund-supported deworming program in Angola on worm infection rates.

The program conducted mapping surveys (to measure the baseline prevalence of soil-transmitted helminthiasis and schistosomiasis) and mass drug administration in three target provinces in the first two years of the program.23 We have not seen exact timelines of the mapping surveys, but it is our understanding that they occurred before mass drug administration.24

Follow-up prevalence surveys, either re-mapping studies or studies tracking changes in worm prevalence rates at the same schools ("sentinel sites") over time, have increased our confidence in the impact of other deworming programs.25 We have not seen evidence that the END Fund-supported deworming program in Angola has implemented any follow-up re-mapping or sentinel site surveys that would be useful for evaluating the program's impact on worm infection rates to date, and there do not appear to be plans to do so in the future.26 The MENTOR Initiative plans to collect data from health facilities on the number of people seeking deworming treatments; we have not seen this data, but would guess that we would not find this type of data compelling.27

Are targeted children being reached?

We have limited information on the proportion of targeted children reached by the END Fund-supported deworming program in Angola.

MENTOR appears to measure the total number of targeted children reached by its deworming program in each province by aggregating data on the number of distributed treatments reported by each school.28 MENTOR then uses school enrollment data received from the schools or the Ministry of Education as the denominator to calculate the proportion of targeted children reached.29 For the first round of MDA in October and November 2013, MENTOR reported that the proportion of enrolled school-aged children treated for soil-transmitted helminthiasis ranged from 48% to 68% in the three targeted provinces.30 For the second round of MDA in November 2014, the MENTOR Initiative–reported coverage rates of enrolled school-aged children (with total numbers of enrolled children provided by schools) for the treatment of schistosomiasis ranged from 73% to 87% in the three provinces (or from 60% to 87% when calculated using total numbers of enrolled school children provided by Angola's Ministry of Education).31

Data on reported numbers of treatments delivered does not, on its own, give us much confidence that a significant proportion of targeted children are reached by the program. We believe that this type of data may generally be prone to errors,32 and that some of data we have seen from the END Fund-supported program in Angola appears imprecise or implausible.33 Coverage validation surveys (similar to those implemented by SCI) or monitors' direct observation of deworming activities and interviews with principals, teachers, with students (similar to the monitoring process of Deworm the World), or other additional monitoring to supplement reported treatment numbers could increase our confidence that a substantial proportion of targeted children are being reached in the END Fund-supported deworming program in Angola; we have not seen evidence that these types of program monitoring have been implemented to date, and there do not appear to be any plans to do so in the future.34

Does the END Fund cause deworming programs to start or scale up?

It is plausible to us that the deworming program in three provinces in Angola would not have occurred in the absence of the END Fund.

The END Fund noted that its early activities in Angola included approaching the government of Angola about a MDA program, raising funding from Dubai Cares and the Helmsley Trust to support the program, and approaching and partnering with MENTOR to implement the program (which had no previous involvement with deworming programs).35 The END Fund also told us that it believes that the Angola program would not have occurred without its involvement.36

We have not yet vetted this claim in depth or considered other cases where the END Fund may have caused a deworming program to start up or scale up significantly.

Does the END Fund improve the quality of deworming programs?

The END Fund's grant management process (including requiring periodic progress reports from implementing organizations and providing technical guidance on implementation issues) may improve the quality of deworming programs, but we have not investigated this question in depth.37

Possible negative or offsetting impacts

We have not looked closely into negative or offsetting impacts of programs the END Fund supports. We discuss possible negative or offsetting impacts of other deworming programs in our intervention report on deworming, and in previous reviews of deworming charities here and here. From the information we have reviewed, we have not seen any significant concerns unique to the END Fund.

What do you get for your dollar?

Deworming is potentially very cost-effective.

We have not evaluated the cost-effectiveness of the END Fund's support for deworming programs at a level of detail that is comparable to our top charities. In this section, we consider the cost per deworming treatment and the prevalence and intensity of schistosomiasis and soil-transmitted helminthiasis in areas where the END Fund supports deworming programs. We primarily focus on the END Fund-supported program in Angola, the program for which we have seen detailed documentation.

What is the cost per deworming treatment?

For the first two rounds of MDA of the END Fund-supported program in Angola (October-November 2013 and November 2014), we estimate that the cost per deworming treatment was $1.55.38 A few notes on this estimate:

  • We have not examined the inputs into this estimate as closely as we have for our top charities.
  • The estimate excludes the Angolan government's costs and the value of donated drugs and teachers' time administering the drugs. We have included these costs in our cost per treatment estimates for SCI and Deworm the World.
  • It is our understanding that the costs include program start up costs, so it is possible that cost per treatment will fall in the future.
  • We are unsure if the past cost per treatment of the deworming program in Angola is representative of END Fund's other work. The END Fund shared data on costs and treatment numbers in other programs, but we were not able to use this information to calculate meaningful cost per treatment estimates.39

What is the prevalence and intensity of schistosomiasis and STH where the END Fund supports deworming?

In general, mass deworming programs treat everyone in a targeted demographic, regardless of whether each individual is infected (more), so the benefits (and therefore the cost-effectiveness) of a program are highly dependent on the baseline prevalence of worm infections. The END Fund told us that it only supports programs where the disease prevalence requires treatment according to WHO standards (which we have summarized in the table below).40

Summary: WHO recommended deworming treatment for school-aged children41

Category Prevalence Recommendation
STH High-risk Over 50% Twice a year treatment
STH Low-risk 20-50% Annual treatment
Schistosomiasis High-risk Over 50% Annual treatment
Schistosomiasis Moderate-risk 10-50% Treatment once every two years
Schistosomiasis Low-risk Under 10% Treatment twice during primary school

In Angola, mapping conducted in 2013-2014 assessed the prevalence of schistosomiasis and STH in three provinces (Huambo, Uíge, and Zaire). The table below summarizes these results (in all three provinces, results note that "[schistosomiasis] distribution [was] moderate and focalized.") 42

Angola: Prevalence of schistosomiasis and STH in 3 provinces (2013-2014)43

Huambo Uíge Zaire
Schistosomiasis 23.4% 14.1% 17.6%
STH (Hookworm) 0.1% 16.8% 4.8%
STH (Ascaris) 11.5% 49.2% 17.6%
STH (Trichuriasis) 1.0% 7.9% 3.3%

The MENTOR Initiative described using these mapping results and WHO's guidelines to create an MDA treatment strategy for the third year of the Angola program.44

These baseline prevalence figures are roughly similar to the figures for some of SCI's and Deworm the World's programs, but lower than the prevalence from studies providing the best evidence for the benefits of deworming (SCI discussed here and Deworm the World discussed here).45 We have not closely vetted the methodology used for the mapping studies and note that in some cases mapping studies are not directly comparable to baseline prevalence surveys.

The mapping studies in Angola do not appear to have measured worm intensity.46

Is there room for more funding?

The END Fund told us that it could use significantly more funding for NTD programs.

In February 2015, the END Fund told us that if it raised twice the funding it was targeting for the year (i.e. an additional $20 million), it could begin allocating the additional funding to programs in three months.47 The END Fund also told us that it maintains a "wish list" of grant opportunities, which included 58 countries where it has considered providing funding or done significant research (as of February 2015).48

We have not investigated whether funding provided to the END Fund for deworming treatments would be fungible with support for the END Fund's other NTD programs.

Major unresolved questions

We have spent significantly less time investigating the END Fund and have substantially less insight into The END Fund's activities and track record than we do for our current top charities. As such, we have a number of outstanding, high-level questions about its work supporting deworming.

  • Has the END Fund used coverage validation surveys, direct monitoring of deworming activities, follow-up prevalence surveys (re-mapping surveys or sentinel site surveys), or other types of monitoring to supplement aggregated administrative data in the deworming programs it supports?
  • How have programs been carried out in END Fund-supported programs other than the Angola program? How have funds been spent in these programs? We are particularly interested in learning more about programs that have received large grants from the END Fund.
  • Is there evidence that the END Fund adds value beyond providing funding (including through research on where programs are needed, providing advice and technical assistance to programs, and attracting new funders to NTD work)?
  • What are the total costs of END Fund deworming and/or NTD programs, including costs covered by other funders? How many treatments has the END Fund funded?
  • What is the average worm prevalence in areas where END Fund supports or plans to support deworming, and how reliable is this data?
  • What programs would the END Fund support if it had additional funding and how much would they cost?
  • How does the END Fund allocate unrestricted funding? Is funding provided to the END Fund for deworming treatments fungible with support for the END Fund's other NTD programs?

Sources

Document Source
END Fund 2012 Financial Summary Source (archive)
END Fund 2013 Financial Summary Source (archive)
END Fund 2014 Financial Summary Source (archive)
END Fund Aggregate Portfolio Figures 6 May 2014 Source
END Fund Aggregate Portfolio Figures 9 Sept 2014 Source
END Fund Aid Memoire notes from Mentor Angola meeting Redacted 2 July 2015 Source
END Fund Angola MENTOR Annex 1 - Organizational chart 2015 Source
END Fund Angola MENTOR Annex 2 - List of Partners 2015 Source
END Fund Angola MENTOR Annex 3 - Huambo Mapping Report 9 October 2014 Source
END Fund Angola MENTOR Annex 3 - Uíge Mapping Repor 20 October 2014 Source
END Fund Angola MENTOR Annex 3 - Zaire Mapping Report 16 April 2014 Source
END Fund Angola MENTOR Annex 5 - Huambo Workplan September 2014 Source
END Fund Angola MENTOR Annex 5 - Mentor Angola P6 Periodic Reporting and Cash Request, 31 Oct 2014 Source
END Fund Angola MENTOR Annex 5 - MENTOR Workplan Yr2-S2 With targets 2015 Source
END Fund Angola MENTOR Annex 6 - Justification - bna regime 2015 Source
END Fund Angola MENTOR Annex 6 - Justification - Fuel taxes 1 Oct 2014 Source
END Fund Angola MENTOR Annex 8 - Human Interest Story Interview-Zaire July 2014 Source
END Fund Angola MENTOR Annex 8 - Human Interest Story Uíge March 2014 Source
END Fund Angola MENTOR Annex 9 - Training photo 2015 Source
END Fund Angola MENTOR Cost Share 2014-2015 Source
END Fund Angola MENTOR Cronograma Oct 2014 Source
END Fund Angola MENTOR Initiative USAID audit report 2009 Source
END Fund Angola MENTOR Initiative USAID audit report 2010 Source
END Fund Angola MENTOR Initiative USAID audit report 2011 Source
END Fund Angola MENTOR M173 Abbreviated Accounts 2011 Source
END Fund Angola MENTOR M173 Accounts 2009 Source
END Fund Angola MENTOR M173 Accounts 2010 Source
END Fund Angola MENTOR MDA Training of Area Coordinators, Uíge Roleplaying 2, 21 Oct 2014 Source
END Fund Angola MENTOR MDA Training of Area Coordinators, Uíge Roleplaying, 21 Oct 2014 Source
END Fund Angola MENTOR MDA Training of Area Coordinators, Uíge Sample for Distribution 22 Oct 2015 Source
END Fund Angola MENTOR MDA Training of Trainer, Uíge 22 Oct 2014 Source
END Fund Angola MENTOR MDA Training of Trainer, Uíge Microplaning 22 Oct 2014 Source
END Fund Angola MENTOR MDA Training of Trainer, Uíge Rulers in the making 2, 22 Oct 2014 Source
END Fund Angola MENTOR MDA Training of Trainer, Uíge Rulers in the making 3, 22 Oct 2014 Source
END Fund Angola MENTOR MDA, Uíge October November 2014 12, 28 Oct 2014 Source
END Fund Angola MENTOR MDA, Uíge October November 2014 13, 29 Oct 2014 Source
END Fund Angola MENTOR MDA, Uíge October November 2014 14, 31 Oct 2014 Source
END Fund Angola MENTOR MDA, Uíge October November 2014 3, 06 Nov 2014 Source
END Fund Angola MENTOR MDA, Uíge Praziquantel Arriving, Inside the Truck, 22 Oct 2014 Source
END Fund Angola MENTOR P6 Periodic Reporting and Cash Request Template 31 Oct 2014 Source
END Fund Angola MENTOR P7 150126 MDA report November 2014 Source
END Fund Angola MENTOR P7 Annex 1 - NTD treatment strategies Y3 updated, 2015 Source
END Fund Angola MENTOR P7 Annex 10 - Human Interest Story Huambo November 2014 Source
END Fund Angola MENTOR P7 Annex 2 - Bios new personnel, 2014 Source
END Fund Angola MENTOR P7 Annex 3 - Mentor AO organogram International staff- Jan 2015 Source
END Fund Angola MENTOR P7 Annex 4 - Mentor AO Organogram NTD provincial - Jan 2015 Source
END Fund Angola MENTOR P7 Annex 5 - MENTOR Workplan Yr2-P8, 2015 Source
END Fund Angola MENTOR P7 Annex 6 - Report Narrative Jan 2015 Source
END Fund Angola MENTOR P7 Annex 7 - List of Partners, 2015 Source
END Fund Angola MENTOR P7 Annex 8 - Human Interest Story MDA PZQ Zaire 4 November 2014 Source
END Fund Angola MENTOR P7 Annex 9 - Human Interest Story Uíge October 2014 Source
END Fund Angola MENTOR P7 Budget Summary 02 April 2014 Source
END Fund Angola MENTOR P7 Periodic Reporting and Cash Request 31 Dec 2014 Source
END Fund Angola MENTOR P7 Periodic Reporting and Cash Request 31 Dec 2014 - 24 Feb 2015 Source
END Fund Angola MENTOR P7 Periodic Reporting and Cash Request-signed, 31 Dec 2014 Source
END Fund Angola MENTOR P7 Tecnicos aumentam conhecimentos 28 Oct 2014 Source
END Fund Angola MENTOR Planificacao DMM 2015 Source
END Fund Angola MENTOR Proposal, Budget Draft Year 3, V10, 25 March 2015 Source
END Fund Angola MENTOR Proposal, Budget Draft Year 4, V4, 25 March 2015 Source
END Fund Angola MENTOR Proposal, Budget narrative with comments, Year 3, Redacted 2015 Source
END Fund Angola MENTOR Proposal, Budget Simulation Years 2-5, 25 March 2015 Source
END Fund Angola MENTOR Proposal, HR Analysis 2015 Source
END Fund Angola MENTOR Proposal, Performance Assessment Framework Year 3, 24 March 2015 Source
END Fund Angola MENTOR Proposal, proposal strategy with comments Years 3-5, Redacted 27 March 2015 Source
END Fund Angola MENTOR Proposal, Workplan Year 3, 24 March 2015 Source
END Fund Angola MENTOR Representation Letter, 21 Sept 2012 Source
END Fund Angola MENTOR Revised Plan, Budget draft Year 3, V16, 21 April 2015 Source
END Fund Angola MENTOR Revised Plan, Budget narrative, Year 3, V8, Redacted 2015 Source
END Fund Angola MENTOR Revised Plan, Budget Summary Years 3-4, 22 April 2015 Source
END Fund Angola MENTOR Revised Plan, Performance Assessment Framework Year 3, 23 April 2015 Source
END Fund Angola MENTOR Revised Plan, Proposal, 22 April 2015 Source
END Fund Angola MENTOR Revised Plan, Workplan Year 3, 3 April 2015 Source
END Fund Angola MENTOR, cover letter for level 3 projects, 21 Sept 2012 Source
END Fund Angola Program Log 2015 Source
END Fund Angola Program Partnership Agreement signed 17 April 2014 Source
END Fund Angola Trip Report Final Redacted October 2014 Source
END Fund Angola trip report Redacted June 2014 Source
END Fund Annex A Standard Terms and Conditions v3 2014 Source
END Fund Annex B Angola Program Assessment Framework 2015 Source
END Fund Annex B Program Assessment 2 Years Template 2015 Source
END Fund Annex C Angola Budget Summary 2015 Source
END Fund Annex C Budget Summary Template 2015 Source
END Fund Annex D Communications and Branding Guidelines 2015 Source
END Fund Close Out Letter Example from India 2014 Source
END Fund document flow chart through process of granting 2015 Source
END Fund Due Diligence Program Analysis Scoresheet 2015 Source
END Fund Due Diligence Program Analysis Tool 2007 Source
END Fund Grant Tracking 2015 Source
END Fund MENTOR Program Assessment Tool Worksheet Redacted 2015 Source
END Fund MENTOR Scoresheet 2015 Source
END Fund MENTOR, NTD Budget 14 Oct 2012 Source
END Fund MENTOR, NTD Budget Narrative 14 Oct 2012 Source
END Fund MENTOR, NTD Proposal 14 Oct 2012 Source
END Fund Narrative Periodic Reporting Template 2015 Source
END Fund Periodic Reporting and Cash Request Worksheets 2015 Source
END Fund Program Close Out Check List 2015 Source
END Fund Program Partnership Agreement version 3 2014 Source
END Fund Program Process Overview 2015 Source
END Fund Proposal Application Template 2015 Source
END Fund Visit Plan Options 2015 Source
END Fund website, Intestinal worms Source (archive)
END Fund website, Our strategy Source (archive)
END Fund website, River blindness Source (archive)
END Fund website, What we do Source (archive)
GiveWell's analysis of END Fund Aggregate Portfolio Figures 9 Sept 2014 Source
GiveWell's analysis of END Fund Angola MENTOR Revised Plan Budget Summary Years 3-4 22 April 2015 Source
GiveWell's analysis of END Fund Angola MENTOR Revised Plan, Budget draft Year 3, V16, 21 April 2015 Source
GiveWell's non-verbatim summary of a conversation with Ellen Agler and Sarah Marchal Murray, July 30, 2015 Source
GiveWell's non-verbatim summary of a conversation with END Fund staff, February 25, 2015 Source
Sarah Marchal Murray, END Fund Chief Operating Officer, email to GiveWell, May 1, 2015 Unpublished
World Health Organization. Preventive chemotherapy in human helminthiasis Source (archive)
  • 1.
    • "The END Fund works to control and eliminate neglected tropical diseases (NTDs). This work includes, but is not limited to, deworming initiatives. The END Fund is aligned with the London Declaration on Neglected Tropical Diseases, which was launched in January 2012 and aims to eliminate or control 10 neglected diseases by 2020. The END Fund’s portfolio currently covers the five most common NTDs that, together, cause up to 90% of the NTD burden in sub-Saharan Africa." GiveWell's non-verbatim summary of a conversation with END Fund staff, February 25, 2015
    • "The END Fund focuses on tackling the five most prevalent NTDs: intestinal worms, schistosomiasis, lymphatic filariasis, trachoma, and river blindness - all of which can be treated by medicines generously donated by pharmaceutical companies for national mass drug administration programs." END Fund website, What we do
      • "Intestinal worms, or soil-transmitted helminths (STH), are the most common NTDs worldwide. STHs are caused by a group of parasitic worms, most commonly hookworm, roundworm (ascariasis) and whipworm (trichuriasis) that are either transmitted through contaminated soil or by ingesting parasite eggs." END Fund website, Intestinal worms
      • "Onchocerciasis (also known as river blindness) is an eye and skin infection that is caused by a parasitic worm (onchocerca volvulus), transmitted by the bite of a black fly that lives and breeds on the banks of fast-flowing rivers and streams." END Fund website, River blindness
    • "The END Fund, in collaboration with government partners and non-governmental organizations on the ground, treats NTDs by following a proven implementation model that is tailored to meet the needs of individual countries. Successful implementation involves understanding the scale of the problem and designing a robust MDA campaign targeted to reach and treat the right people. It is a process that catalyzes resources, builds capacity among health professionals, and mobilizes communities to distribute medicines for maximum impact at minimal cost." END Fund website, Our strategy
    • GiveWell's non-verbatim summary of a conversation with END Fund staff, February 25, 2015:
      • "The END Fund also aims to increase capacity of existing non-governmental organizations (NGOs) working on NTDs and expanding the field of organizations working on NTDs by giving direct grants and working with ministries of health and local and international NGOs. When the END Fund re-grants to another program, it is often involved in programming design."
      • "The END Fund aims to increase the number of philanthropies that work on NTDs. It often starts conversations with people and organizations that aren’t currently engaged in the field."
      • "The END Fund is always looking to find donors who might be interested in the NTD opportunities that it has identified."
  • 2.

    We have not completed up-to-date intervention reports for the other NTD programs the END Fund supports; our published intervention report on lymphatic filariasis is outdated (as of March 2016).

  • 3.

    Beneficiaries of programs reported beginning in 2012 in END Fund Aggregate Portfolio Figures 9 Sept 2014, "Beneficiaries" sheet.

  • 4.

    GiveWell's analysis of END Fund Aggregate Portfolio Figures 9 Sept 2014:

    • "This information is as of 30 August 2014," "Beneficiaries" sheet.
    • "GW calculations" sheet, cell B33
    • Funding listed under "Volume dispersed to date" (column F) for programs in Angola, Burundi, DRC, Ethiopia, India, Kenya, Liberia, Mali, Namibia, Niger, Nigeria, Rwanda, Yemen, and Zimbabwe, "Program Financing" sheet.
    • Current implementing partners listed as SCI, CBM, The MENTOR Initiative, Deworm the World/Evidence Action, HKI, CNTD, GGI/EF, Ethiopia FMoH, APOC, Synergos, Zimbabwe Family Health MoH Dept. Sightsavers listed as a past implementing partner. "Number of GsPsIPs" sheet.
  • 5.

    GiveWell's non-verbatim summary of a conversation with END Fund staff, February 25, 2015:

    • "The END Fund works to identify the highest need NTD areas globally and then attempts to address the gaps where there is high burden and little available treatment."
    • "Ms. Agler and Mr. Lancaster spend a lot of their time surveying the evolving landscape of NTD prevalence and related philanthropic, governmental, and NGO activity. "
    • "END Fund staff members are constantly researching opportunities where additional philanthropic dollars would make a difference and where the END Fund could ensure additive coverage. The END Fund asks:
      • Is there a need?
      • Is the need sufficient to justify treatment?
      • Does the implementing partner have the capacity to meet results (i.e., reducing prevalence and intensity of infection) within the timeline?"
  • 6.

    GiveWell's non-verbatim summary of a conversation with END Fund staff, February 25, 2015:

    • "The END Fund is interested in the following kinds of opportunities:
      1. Ensuring additive coverage in high burden countries – E.g., Nigeria, Ethiopia, and the Democratic Republic of the Congo (DRC). There are opportunities to scale up coverage in these countries because many people aren’t getting treated and there are possible implementing partners already on the ground. The END Fund spends a lot of time looking into these opportunities.
      2. Providing coverage in “orphan countries” with few donors and local partners – E.g., Angola, the Central African Republic, and South Sudan.
      3. Investing in specific projects that have a potential high return on investment:
        1. For example, the END Fund has been working with the Zimbabwean government on a school-based deworming campaign because it may be especially cost-effective. Three million children were treated last year. The END Fund is hoping another two million children will be treated this year. With additional funding, the END Fund would help the Zimbabwean government scale up the program to treat 4.7 million children in 2016.
        2. There may be an especially high return on investment in South Sudan as well. Due to the recent conflict, there is no NTD program there and few implementing agencies. There has been no mapping to identify NTD prevalence. If an organization made a substantial grant by the end of 2015, the END Fund would be in position to use that money in South Sudan. There is also a need for funding in (northern) Sudan, where 4.3 million children need treatment for NTDs.
        3. The END Fund is looking at partnering with the Ethiopian Federal Ministry of Health on a national deworming campaign to treat intestinal worms and schistosomiasis for over 20 million children, which will require increased investment and donor coordination."
    • "The END Fund identified a large gap in Angola: there was high NTD burden, little treatment provided by the government, and none of the traditional aid donors were involved. Since the end of the civil war there has been little bilateral funding and institutional aid. Angola is now a middle-income country, but there is incredible health inequality. Before The Helmsley Trust was involved, the END Fund had some funding for the area through Dubai Cares, but there was the potential to do a bigger project.
      […]
      "The END Fund also identified a local partner, the MENTOR Initiative. The MENTOR Initiative had not worked broadly in the NTD space, but it was a grantee of the President’s Malaria Initiative and had successfully reduced malaria burden in Angola.
      […]
      "The END Fund wants to aid in the building of a large and scalable national deworming program, in line with the control and elimination agenda. It worked closely with the MENTOR Initiative to ensure this program would be a 3-year collaboration."
    • "India – A few years ago a Deworm the World project to reach 17 million children in Bihar had a gap in funding. The END Fund provided a small grant that allowed the program to continue. Now, Evidence Action in partnership with the Children’s Investment Fund Foundation and the Indian government have funded the program, so the END Fund was able to cover a 'gap' year of funding to ensure continuity of the program."
  • 7.
    • GiveWell's non-verbatim summary of a conversation with END Fund staff, February 25, 2015:
      • "The END Fund also aims to increase capacity of existing non-governmental organizations (NGOs) working on NTDs and expanding the field of organizations working on NTDs by giving direct grants and working with ministries of health and local and international NGOs. When the END Fund re-grants to another program, it is often involved in programming design. Ideally, the END Fund works with governmental and local NGO implementing partners. This approach usually works best. However, in some cases, the END Fund will directly fund and work with the government. It is currently funding government projects in Zimbabwe and Ethiopia; the government has executed programs successfully."
      • "The END Fund also identified a local partner, the MENTOR Initiative. The MENTOR Initiative had not worked broadly in the NTD space, but it was a grantee of the President’s Malaria Initiative and had successfully reduced malaria burden in Angola."
    • SCI and Deworm the World (which have experience supporting NTD programs) and the MENTOR Initiative (which did not have prior experience with NTD programs) listed as implementing partners in END Fund Aggregate Portfolio Figures 9 Sept 2014, "Number of GsPsIPs" sheet.
  • 8.
  • 9.

    END Fund Program Process Overview 2015:

    • "The primary function of the END Fund programs team is to manage grants in a professional manner that meets the standard expectations for good practice in the NTD sector. In doing so, the team must ensure that all aspects of a program are consistent with WHO guidelines for delivery of NTD interventions and treatment. Team members monitor programs and provide technical assistance to partners when necessary to ensure minimal risk to funds provided by the END Fund and our donors. With the overall objective to deliver high performing projects, the team works collegially at different levels of involvement with our various partners. Depending on their existing capacity and the complexity of the program, the team takes an approach of light touch, moderate engagement, or substantial involvement to also ensure that donors and the END Fund receive a maximum return on their investment." Pg 1.
    • "Substantive Involvement - PD to be in regular communication with IPs to discuss implementation issues and assist in any necessary decision making or technical guidance; communicate any material program variances to Senior Management Team so donor communications and financial impact can be assessed" Pg 4.
    • "Program Visit - Schedule and complete in-country monitoring site visits; minimum one per program year, record findings in TOR and trip report template" Pg 4.
  • 10.

    GiveWell's non-verbatim summary of a conversation with END Fund staff, February 25, 2015:

    • "The END Fund is always looking to find donors who might be interested in the NTD opportunities that it has identified."
    • "The END Fund aims to increase the number of philanthropies that work on NTDs. It often starts conversations with people and organizations that aren’t currently engaged in the field."
    • "The Helmsley Trust has a longstanding interest in education and children, but it had never funded a NTD related project and was just beginning to develop its Africa portfolio. The END Fund began speaking with The Helmsley Trust staff about the importance of deworming. The Helmsley Trust wanted to work in Sub-Saharan Africa because of the high NTD burden and asked the END Fund what areas current funders were neglecting. The END Fund directed them to the Angola deworming project. While this is a restricted donation, The Helmsley Trust tailored its donation to the END Fund’s assessment of current needs and the donor space."
    • "An anonymous donor had previously funded initiatives focused on child health and education in Africa, but it had never funded NTD interventions. As with the Helmsley Trust, the END Fund persuaded the anonymous donor of the importance of deworming. The donor and the END Fund discussed structuring its support as unrestricted funding."
  • 11.
  • 12.

    GiveWell's analysis of END Fund Aggregate Portfolio Figures 9 Sept 2014, "Program financing" sheet does not mention the END Fund's organizational expenses. Our interpretation is that reported figures only include the amount disbursed to implementing organizations.

  • 13.

    See this sheet for our calculations based on the END Fund's summary financial documents.

  • 14.
  • 15.

    "In 2012 The MENTOR Initiative, commenced a 5 year grant with END Fund to work with the Government of Angola to build the capacity and reach of their Neglected Tropical Diseases programme. Specifically the programme was to map three key NTDs in Uíge, Zaire and Huambo provinces and work to reduce disease burden through biannual mass drug administrations through school and community networks, whilst building capacity of health workers through training and supervisions, coupled with a school-based programme to encourage hand-washing in children.
    "Working through MENTOR’s existing structure and relationships at national level and in the 3 provinces the programme initiated mapping and an initial mass drug administration (MDA) of albendazole (ALB) to school aged children and subsequently a larger MDA with Praziquantel (PZQ) in year 2. The mapping had been planned to integrate soil transmitted helminths (STH), schistosomiaisis (SCH) and lymphatic filariasis (LF) in the 3 provinces in the centre and north of Angola, however, mapping of LF mapping was not possible and was ultimately dropped from the protocol." END Fund Angola MENTOR Revised Plan, Proposal, 22 April 2015, Pg 2.

  • 16.

    GiveWell's analysis of END Fund Angola MENTOR Revised Plan Budget Summary Years 3-4 22 April 2015, "GW calculations" sheet.

  • 17.
    • IEC stands for Information, Education, and Communication. We have not seen ACSM defined in the END Fund's documents.
    • "Information, Education and Communication (IEC) in order to educate children and communities on the ways of identifying and preventing NTDs, and on the places where they can find a treatment." END Fund Angola MENTOR Revised Plan, Proposal, 22 April 2015, Pg 14.
  • 18.

    GiveWell's analysis of END Fund Angola MENTOR Revised Plan Budget Summary Years 3-4 22 April 2015, "Definitions" sheet.

  • 19.
  • 20.

    Sarah Marchal Murray, END Fund Chief Operating Officer, email to GiveWell, May 1, 2015

  • 21.
    • END Fund Angola MENTOR Revised Plan, Proposal, 22 April 2015:
      • "Working through MENTOR’s existing structure and relationships at national level and in the 3 provinces the programme initiated mapping and an initial mass drug administration (MDA) of albendazole (ALB) to school aged children and subsequently a larger MDA with Praziquantel (PZQ) in year 2." Pg 2.
      • "In Year 3 support will focus the following interventions: 1. Reinforcement of the coordination of all NTD interventions in three provinces. 2. Expansion of MDA activities to a further three provinces 3. Mass-Drug Administration to school enrolled children in target provinces with ALB and PZQ 4. Mass Drug Administration to communities identified as at risk of LF and Oncho in Uíge and Kuando Kubango 5. MDA of ALB to pre-school aged children during community drug distribution in Uíge and Kuando Kubango 6. Training of teachers and health workers in WASHE and the requirement for hand washing in Uíge, Huambo and Zaire 7. Supply of WASHE hardware to schools in three provinces 8. Health facility support visits to reinforce capacity to diagnose, treat and accurately record all NTDs presenting at clinics (including anti natal clinic) in Uíge province. 9. Information, Education and Communication (IEC) in order to educate children and communities on the ways of identifying and preventing NTDs, and on the places where they can find a treatment." Pg 14.
    • "Two rounds of school based MDA have been completed in the first two years of the grant, one in October/November 2013 and another in November 2014 in Uíge, Zaire and Huambo provinces as well as comprehensive disease mapping of STH and SCH." END Fund Angola MENTOR Proposal, proposal strategy with comments Years 3-5, Redacted 27 March 2015, Pg 13.
    • "The first END Fund sponsored MDA of Praziquantel as curative and preventive treatment against schistosomiasis infections in Angola has taken place late October/early November in the three provinces where MENTOR supports the implementation of the NTD programme (Huambo, Uíge and Zaire). The campaign has been designed, planned and implemented by the partnership DPS, DPE and MENTOR Initiative and has targeted all school-age children (5-15 years)." END Fund Angola MENTOR P7 Annex 6 - Report Narrative Jan 2015, Pg 1.
    • "PZQ Drug donations are not currently available for us to deliver at community level, only for school level distributions. . However, if some hotspots are identified it may be possible to target some communes with remaining tablets (and possibly other donations) of School MDA (given that tablets will expire soon). Possibility of targeting adults is under discussion." END Fund Angola MENTOR P7 Periodic Reporting and Cash Request 31 Dec 2014 - 24 Feb 2015, Program Progress Outputs sheet, cell N33
  • 22.

    END Fund Angola MENTOR P7 150126 MDA report November 2014:

    • "Prior to the campaign, planning and coordination meetings have been held, attended by the delegations of the Provincial Health and Education Departments and The Mentor Initiative provincial team. The purpose of these meetings was to prepare the micro planning for two types of trainings at provincial and municipal level:
      • Training of the trainers: addressing training of two representatives from the municipal level (one from the health and one from the education department) and the areal coordinators of all the municipalities.
      • Training by the trained representatives of the directors and one teacher from each of the targeted schools for the MDA Praziquantel." Pg 4.
    • Data on number of trainees at provincial and municipal levels, Table 1 – Table 2.4, Pgs 4-7.
    • "The Praziquantel from the national central warehouse was delivered to the provincial stock at the end of October 2014. The transportation to the different municipalities this was done with the support of the respective municipal bodies and Mentor - Initiative. The drugs have been provided from the to the area coordinators during the trainings. The treatments have been done early November and were performed by the teachers and directors of all the target schools. (Table 3). Teachers administered the drug to the target group students according the corresponding dose. The supervision of the distribution was made daily by DPS teams, DPE and Mentor." Pg 8.
  • 23.

    END Fund Angola MENTOR Proposal, proposal strategy with comments Years 3-5, Redacted 27 March 2015:

    • "Two rounds of school based MDA have been completed in the first two years of the grant, one in October/ November 2013 and another in November 2014 in Uíge , Zaire and Huambo provinces as well as comprehensive disease mapping of STH and SCH." Pg 13.
    • "In years 1 and 2 of the END Fund grant, disease mapping for soil transmitted helminths (STH) and Schistosomiaisis was planned and conducted in Uíge, Zaire and Huambo provinces. The mapping was led by an external consultant, Dr. Jose Sousa-Figueiredo using and integrated schools based model." Pg 8.
  • 24.
  • 25.

    See our reviews of Deworm the World and SCI for examples.

  • 26.
    • There is no mention of implementing a follow-up prevalence survey in the report narrative for the second year of the project. END Fund Angola MENTOR P7 Annex 6 - Report Narrative Jan 2015
    • The plan for years three to five of the project does not mention follow-up prevalence surveys. END Fund Angola MENTOR Proposal, proposal strategy with comments Years 3-5, Redacted 27 March 2015
    • One of the MENTOR Initiative's documents mentions a planned mapping survey for 2015. Our interpretation is that the mapping survey could not be used for evaluating the impact of the 2013 and 2014 rounds of deworming MDA in Huambo, Uíge and Zaire since it will cover "the remaining 15 provinces" (not Huambo, Uíge and Zaire).
      • "At the time of writing (20th March 2015) WHO-AFRO is supporting Government of Angola to complete country-wide coordinated NTD mapping (SCH/STH/LF) using the Coordinated Mapping Protocol. The mapping surveys will provide accurate and updated information of the NTD disease burden. The mapping is planned to cover the remaining 15 provinces commencing in June 2015, all mapping activities must be complete by the end of 2015. MENTOR is in discussions with the National NTD programme to understand if additional support for LF mapping in Uíge, Zaire and Huambo is required to ensure that all provinces and all diseases can be mapped in the country." END Fund Angola MENTOR Revised Plan, Proposal, 22 April 2015, Pg 9.
    • The END Fund told us that it uses sentinel site surveys. However we have not seen evidence that it required the MENTOR Initiative to implement a sentinel site survey to measure the impact of the Angola program.
  • 27.
    • "Unfortunately existing data on NTDs is weak and unreliable. In addition to a large-scale randomized community level mapping surveillance exercise, MENTOR intends to roll out a passive surveillance program using data collected at health facility level. In particular, MENTOR staff and MoH officers, when conducting field level supervisions to health facilities, will collect data from register books and drug supplies to calculate any changes in NTDs in the area. It is hoped that with the roll out of the preventive therapy program in the school system that there will be a noticeable decrease in patients presenting at the health facility." END Fund Angola MENTOR Revised Plan, Proposal, 22 April 2015, Pg 22.
    • The number of patients recorded at health facilities seems to us like a poor proxy for overall infection rates. We would guess that only a small proportion of people with STH or schistosomiasis seek treatment in health facilities.
  • 28.

    "3- Treatment data collection and management
    "The distribution data were recorded, counted and compiled by teachers, directors and area coordinators on three levels, class, school and province respectively. Subsequently, these data were collected and compiled by the provincial partnership DPS / DPE / Mentor. A recount of the data was carried out in the provincial offices of the Mentor - Initiative to ensure its accuracy.
    "4- Results
    "The tables below are showing the general data of the deworming campaign. In total, 659,145 school children in schools of the provinces of Huambo (356 765), Uíge (214,529) and Zaire (87,851) were dewormed with Praziquantel." END Fund Angola MENTOR P7 150126 MDA report November 2014, Pg 10.

  • 29.
    • END Fund Angola MENTOR P7 150126 MDA report November 2014 reports the proportion of enrolled school-aged children treated by the program using both the Ministry of Education's total numbers of enrolled students and data provided by schools on the total number of enrolled students:
      • "Huambo
        "Therapeutic coverage
        "Considering the number of schools that participated in the campaign and the enrolled children, the treatment coverage is 75%. This percentage is also including 10.790 non-enrolled children that came to the distribution points and received treatment.
        "The number of enrolled children provided by the provincial Ministry of Education department (DPS) is different from the number of enrolled children provided by the schools. Taking the data from the DPS in account, the therapeutic coverage is 60% (also taking in account the nonenrolled dewormed children)." END Fund Angola MENTOR P7 150126 MDA report November 2014, Pg 10.
  • 30.
  • 31.
    • END Fund Angola MENTOR P7 150126 MDA report November 2014:
      • "The tables below are showing the general data of the deworming campaign. In total, 659,145 school children in schools of the provinces of Huambo (356 765), Uíge (214,529) and Zaire (87,851) were dewormed with Praziquantel." Pg 10.
      • "Huambo
        "Therapeutic coverage
        "Considering the number of schools that participated in the campaign and the enrolled children, the treatment coverage is 75%. This percentage is also including 10.790 non-enrolled children that came to the distribution points and received treatment.
        "The number of enrolled children provided by the provincial Ministry of Education department (DPS) is different from the number of enrolled children provided by the schools. Taking the data from the DPS in account, the therapeutic coverage is 60% (also taking in account the nonenrolled dewormed children)." Pg 10.
      • "Uíge
        "Therapeutic coverage
        "Considering the number of schools that participated in the campaign and the enrolled children, the treatment coverage is 73%. This percentage is also including 3.288 non-enrolled children that came to the distribution points and received treatment.
        "The number of enrolled children provided by the provincial Ministry of Education department (DPS) is different from the number of enrolled children provided by the schools. Taking the data from the DPS in account, the therapeutic coverage is 64% (also taking in account the nonenrolled dewormed children)." Pg 13.
      • "Zaire
        "Based on the numbers of schools that participated in the distribution campaign and the enrolled children, 87 % of the children have been dewormed. As the school reported numbers are corresponding with the data provided by the DPE, this high percentage of 87 % coverage applies equally to the DPE figure." Pg 17.
    • We note that non-enrolled school-aged children who received treatments are included in the numerator in these proportions, but the denominator appears to be only enrolled school-aged children.
  • 32.

    See our review of Deworm the World, "Estimates of total coverage" section.

  • 33.
    • END Fund Angola MENTOR P7 150126 MDA report November 2014 reports the proportion of enrolled school-aged children treated by the program using both the Ministry of Education's total numbers of enrolled students and data provided by schools on the total number of enrolled students:
      • "Huambo
        "Therapeutic coverage
        "Considering the number of schools that participated in the campaign and the enrolled children, the treatment coverage is 75%. This percentage is also including 10.790 non-enrolled children that came to the distribution points and received treatment.
        "The number of enrolled children provided by the provincial Ministry of Education department (DPS) is different from the number of enrolled children provided by the schools. Taking the data from the DPS in account, the therapeutic coverage is 60% (also taking in account the nonenrolled dewormed children)." END Fund Angola MENTOR P7 150126 MDA report November 2014, Pg 10.
    • There appears be a relatively large amount of variance in estimates of the proportion of children reached at the municipality level using the two data sources for total numbers of children enrolled. END Fund Angola MENTOR P7 150126 MDA report November 2014:
      • For example, using total enrollment data provided by schools, 98% of children were reported to have received treatment in Caala. Using data provided by the Ministry of Education on total enrollment numbers, 59% were reported to have received treatment. Pg 11, Table 4.
      • In Damba, 75% of children were reported to have been treated using total enrollment data from schools, and 116% were reported to have been treated using data provided by the Ministry of Education. Pg 14.
      • See tables 4-6 on Pgs 11, 14, and 17 for all municipal-level results.
    • We do not know which source of data for total school enrollment is likely to be more accurate.
  • 34.
  • 35.
    • END Fund Angola Program Log 2015:
      • "October-December 2011: Decision to focus on Angola
      • "Proposal submitted to DC: Start date project for April 2012
      • "Official request made to Govt of Angola for engagement 15 March
      • "Mentor Initiative able to work with smaller amounts in two to three northern provinces
      • "22-May-13: HT Concept Note finalised
      • "20-Feb-14: Notice of HT Board approval passed along"
    • "The END Fund also identified a local partner, the MENTOR Initiative. The MENTOR Initiative had not worked broadly in the NTD space, but it was a grantee of the President’s Malaria Initiative and had successfully reduced malaria burden in Angola." GiveWell's non-verbatim summary of a conversation with END Fund staff, February 25, 2015
  • 36.

    "Ms. Agler thinks that the Angola project would definitely have not happened without the END Fund's involvement." GiveWell's non-verbatim summary of a conversation with END Fund staff, February 25, 2015

  • 37.
    • Steps in the End Fund's grant management process from END Fund Program Process Overview 2015:
      • "Periodic Reports - Review periodic reports and cash requests as necessary to ensure IP is fulfilling conditions of PA, use Project Cycle Management approach and provide systematic feedback to IPs on performance; standard practice is for the END Fund to receive quarterly program updates from grantees" Pg 4.
      • "Substantive Involvement - PD to be in regular communication with IPs to discuss implementation issues and assist in any necessary decision making or technical guidance; communicate any material program variances to Senior Management Team so donor communications and financial impact can be assessed" Pg 4.
  • 38.
    • For the first two rounds of MDA of the program (October-November 2013 and November 2014), our calculated cost per deworming treatment was $1.55:
      • Total spending Year 1 (1 Apr 2013 – 31 Mar 2014) and P5-P7 of Year 2 (1 Apr 2014 – 31 Dec 2014): $1,674,244. END Fund Angola MENTOR Revised Plan, Budget Summary Years 3-4, 22 April 2015, "Budget Summary" sheet, sum of cells I29, K29, M29, and O29.
      • We are including all program spending from 1 Apr 2013 to 31 Dec 2014 to estimate the MENTOR Initiative's total costs to implement two rounds of MDA (in October-November 2013 and November 2014).
      • The END Fund's organizational expenses (management, fundraising, and other general expenses) account for around 15% of its total spending. See this sheet for details.
      • Total cost estimate for delivering two rounds of MDA (including the MENTOR Initiative's spending and an allocation of the END Fund's organizational costs: $1,674,244 *1.15 = $1,925,381
      • Reported treatments: total of 1,244,114 (sum of 570,891 STH treatments in October-November 2013 and 673,223 schistosomiasis treatments in November 2014). END Fund Angola MENTOR P7 Periodic Reporting and Cash Request 31 Dec 2014 - 24 Feb 2015, "Program Progress Outputs" sheet, indicators 3.1.3, 3.2.1 and 3.2.2, cells L25, L31 and L32
      • Average cost per treatment is $1.55 ($1,925,381 / 1,244,114)
  • 39.

    In 2013 across all of the programs it supports, the END Fund reports that it disbursed $3.6 million and supported a total of 40 million NTD treatments (we are uncertain how many included deworming), implying that END Fund's cost per treatment supported was $0.09 in 2013. END Fund Aggregate Portfolio Figures 9 Sept 2014

    • Disbursement: $3,591,806 from "Program Financing" sheet, cell D39
    • Reported treatments: 39,631,627 from "Beneficiaries" sheet, cell C44

    Additional details:

    • We are uncertain whether the END Fund's disbursements occurred in the same year that the treatments they supported occurred.
    • We are uncertain what proportion of each program's total costs were covered by the disbursement from the END Fund.
    • Data from 2012 and 2014 suggest similar estimates of END Fund's cost per treatment.
      • 2012: $1,550,789 disbursed in support of 12,178,988 reported treatments implies $0.13 per treatment. (See “Program Financing” sheet, cell C39, and “Beneficiaries” sheet, cell C23, from END Fund Aggregate Portfolio Figures 9 Sept 2014.)
      • 2014: $6,243,441 total projected disbursement in support of 47,701,163 projected treatments implies $0.13 per treatment. (See “Program Financing” sheet, cell H39, and “Beneficiaries” sheet, cell B23, from END Fund Aggregate Portfolio Figures 9 Sept 2014.)
    • The 2013 estimate is heavily influenced by a few programs that accounted for almost 90% of the treatments but less than 50% of the funding.
      • $910,000 supported 12.1 million treatments in Mali
      • $500,000 supported 12.8 million treatments in Nigeria
      • $140,000 funded 9.6 million treatments in Yemen.

    All data from END Fund Aggregate Portfolio Figures 9 Sept 2014

  • 40.

    "The END Fund also uses World Health Organization (WHO) guidelines to determine when intervention is necessary, though it will adapt these to local conditions. Mr. Lancaster shared that the END Fund only works in countries that have a level of disease prevalence that would require treatment according to WHO guidelines." GiveWell's non-verbatim summary of a conversation with END Fund staff, February 25, 2015

  • 41. World Health Organization. Preventive chemotherapy in human helminthiasis, Pg 41
  • 42.
    • END Fund Angola MENTOR Revised Plan, Proposal, 22 April 2015, Table 2, Pg 8
    • Data from mapping conducted in 2005 generally showed higher prevalence (included in same table). In 2005, schistosomiasis prevalence was >30% in all three provinces; STH prevalence was 20%-50% in Huambo, >50% in Uíge, and <50% in Zaire.
    • Further information on focalized infections: ”even though overall and municipality levels are moderate to low (<50%), we were able to identify higher foci of infection such as School no. 115 in Mbanza Congo (63% prevalence of S. haematobium) and School no. 253 in Mbanza Congo (70% of S. mansoni). See Appendix 6 for details on school-level prevalence.” END Fund Angola MENTOR Annex 3 - Zaire Mapping Report 16 April 2014 Pg 13
  • 43. END Fund Angola MENTOR Revised Plan, Proposal, 22 April 2015, Table 2, Pg 8.
  • 44.

    "The 2014 mapping results show a lower disease burden than expected, compared to the mapping results from 2005. The lower endemnicity means that Zaire and some municipalities of Huambo and Uíge fall below the threshold of two MDA rounds per year according to WHO recommendations. Being the most up to date mapping, we have used our 2014 results to inform the MDA strategy for this document. MDA plan for 2015: ALB one round in Zaire and 2 municipalities of Huambo, 2 rounds in Uíge, PZQ : 1 round in 1 municipality of Uíge (see submit treatment MDA treatment schedule ALB and PZQ till 2017)." END Fund Angola MENTOR P7 Annex 1 - NTD treatment strategies Y3 updated, 2015, Pg 2

  • 45.
    • See this sheet, "Prevalence" tab, to see prevalence rates of STH and schistosomiasis in studies providing the best evidence for the benefits of deworming and in countries where SCI operates programs.
    • We have seen reports from each of the three provinces. So far, we have only reviewed the report from Zaire since the other two are in Portuguese. Further information from the Zaire report follows:
  • 46.

    Worm intensity is usually measured by number of eggs per 10 mL of urine. See here, footnote 144, for an example.

  • 47.

    "If the END Fund received an additional $20 million dollars tomorrow (doubling its annual operating goals for 2015), it could complete the necessary research and due diligence and begin allocating the funds in three months." GiveWell's non-verbatim summary of a conversation with END Fund staff, February 25, 2015, Pg 8

  • 48.

    "The END Fund maintains an ongoing wish list of opportunities it would like to invest in if it finds further funding. As the landscape changes, the wish list evolves. There are 58 countries where the END Fund doesn’t currently have active grants, but where it has considered projects or has done significant research on the NTD landscape." GiveWell's non-verbatim summary of a conversation with END Fund staff, February 25, 2015