About this page
GiveWell aims to find the best giving opportunities we can and recommend them to donors (why we recommend so few charities). We tend to put a lot of investigation into the organizations we find most promising, and de-prioritize others based on limited information. When we decide not to prioritize an organization, we try to create a brief writeup of our thoughts on that charity because we want to be as transparent as possible about our reasoning.
The following write-up should be viewed in this context: it explains why we determined that (for the time being), we won't be prioritizing the organization in question as a potential top charity. This write-up should not be taken as a "negative rating" of the charity. Rather, it is our attempt to be as clear as possible about the process by which we came to our top recommendations.
Published: October 2012
Doctors Without Borders (Médecins Sans Frontières, MSF) is a large, international medical humanitarian organization, focused on providing care “to people whose survival is threatened by violence, neglect, or catastrophe.”
We have a positive view of MSF and have recommended them for disaster-relief donations in the past. We considered evaluating MSF more thoroughly for a potential “top charity” recommendation, because we perceive them to be unusually transparent. However, we currently have decided to not prioritize additional analysis of MSF because:
- Although MSF is unusually transparent, it is not one of the most transparent organizations we have encountered.
- We believe that the overall cost-effectiveness of MSF's activities are unlikely to compare well with those of our top charities.
In short, while we continue to hold a positive view of MSF, and expect to recommend them in future disaster-relief situations, we believe that our top charities are likely to be a better giving opportunity for donors who are not committed to the cause of disaster relief.
For the previous version of this page, see our 2009 review of MSF.
Why we decided to consider MSF
We considered MSF for an in-depth evaluation for several reasons:
- In the aftermath of the 2011 Japan Earthquake/Tsunami, we recommended MSF to donors interested in supporting disaster relief based on its transparency about (a) its activities and spending in past disasters (see our report on the Haiti earthquake) and (b) need for funding.
- MSF allows meaningful and sometimes critical information about its activities to be public, something that we believe to be rare (and needed) in the nonprofit sector. For example:
- A report from its tuberculosis program in China which contained frank and negative conclusions on the program. In our experience, charities rarely publish evaluations that directly conclude a program has failed.
- In late 2011, a GiveWell staff member attended a public event at which MSF representatives frankly discussed weaknesses in a program they had recently run. Multiple GiveWell supporters have also told us that they have attended events MSF has convened where programs are critically evaluated.
- MSF provides additional information about its activities on a site called “MSF Crash.” We have scanned, though not closely analyzed this site.
Why we decided not to go further with our research
Nevertheless, we have currently decided to not prioritize additional analysis of MSF for two reasons.
Types of activities implemented
We believe that there is a set of global health and nutrition interventions that provide particularly promising opportunities for donors because these interventions are relatively proven, cost-effective, and scalable. (We provide a more complete articulation of this view this blog post.) MSF’s activities include highly cost-effective interventions (such as providing basic vaccinations and distributing bednets), but also include activities with lower or poorly understood cost effectiveness (such as HIV treatment, outpatient health care and mental health care). We therefore would guess that our top charities -- which focus solely on programs that meet these criteria -- offer donors more impact for their donation than supporting MSF's activities as a whole.
Possibility of restricting funding to specific activities
One way to lessen the uncertainty around cost-effectiveness might be to restrict funding to specific activities known to be especially cost effective. MSF's answer to our question regarding the effects of restricting a donation is among the clearest and most informative we have seen. We asked MSF, "If we direct funding to MSF and request that the funding be used for vaccination, how will MSF's programs change (if at all)?" MSF replied:
MSF creates its operational budgets based on operational needs and priorities. The operations/finance team then checks with the fundraising departments internationally that funding can be raised to meet the goals outlined. So far the goals have been achievable. 90% of the funds raised are unrestricted, so what that means is that funds are directed to priority medical projects first and foremost, not to specific project envelopes (such as vaccinations)…
We can and will accept restricted funds for vaccinations, but a restricted gift for this project may not mean that we do 'more.' Our vaccination budget is huge, tens of millions of dollars every year. So, unless we were awarded an extraordinarily large grant (we are talking something like $50 million+ here) for a specific purpose like vaccines, we would not necessarily do 'more.' Even then we would have to determine if we have the human resources or medical tools available to do more than we already are doing.
We appreciate the frankness of this reply, and take it as a positive sign about MSF's commitment to transparency.
While MSF is more transparent than the vast majority of charities we have considered, it is not as transparent as the most transparent charities we have found. In particular, MSF has shared only limited examples of its monitoring and evaluation reports:
- MSF told us that it regularly conducts evaluations of its programs. We have only found a small number of publicly available evaluations of a limited set of MSF’s programs, which did not allow us to get a representative picture of the quality of MSF’s work. We do not know how these evaluations were selected for publication.
- MSF told us that program leaders in the field provide monthly progress updates to staff in operational centers in Europe. MSF shared one example report from 2004 and a report template with us.
MSF has stated that sharing more program reports would take excessive time and resources. The fact that we have not seen more program reports does not necessarily make MSF a less effective organization, but it makes evaluation of it more difficult (from our perspective) than evaluation of charities that are a completely "open book" from our perspective.
- Doctors Without Borders. Activity report (2011) (PDF).
- Doctors Without Borders. China tuberculosis assistance project: End of evaluation report (2002) (PDF).
- Doctors Without Borders. History and principles. http://www.doctorswithoutborders.org/aboutus/ (accessed September 7, 2012). Archived by WebCite® at http://www.webcitation.org/6AVgvGNe8.
- Doctors Without Borders. How we work. http://www.doctorswithoutborders.org/aboutus/activities.cfm (accessed September 13, 2012). Archived by WebCite® at http://www.webcitation.org/6AeCkvWJm.
- Doctors Without Borders. OCG response to cholera in Haiti (October 2010–March 2011) (PDF).
- MSF CRASH. Homepage. http://www.msf-crash.org/en (accessed September 10, 2012). Archived by WebCite® at http://www.webcitation.org/6AZqznP21.
- Oosterloo, Jan, and Jean Claude B. Djoumessi. 2010. Knowledge, attitude and practice in the use of insecticide-treated mosquito nets distributed through antenatal and vaccination consultations in the “Cercle de Kangaba” region of Koulikoro, Mali (PDF). Brussels: MSF.
- Urrego, Zulma, et al. 2009. Evaluation of results from a single-session psychotherapeutic intervention in population affected by the Colombian internal armed conflict (PDF). MSF.
- van den Boogaard, Wilma, et al. 2011. Reducing malaria in Mail: Effective diagnostics and treatment are not enough (PDF). Brussels: MSF.