Bottom line on SCI: We expect to fully refresh our rankings at the end of 2012. We have not yet determined SCI's precise ranking but expect it to remain among our top charities.
Published: November 2012
We have been following SCI’s progress since we recommended it in November 2011. We have at times struggled to communicate with SCI, and some of the material that we've received from SCI has been inconsistent (details in footnote).1
The report below presents the most accurate view we've been able to form about how SCI has spent and plans to spend unrestricted funding. Where spending figures conflicted, we have relied on an expenditure report SCI provided as we believe this to be more reliable than a program update that SCI compiled at our request.2
The table below provides a summary of the unrestricted funds that the Schistosomiasis Control Initiative (SCI) has received (or was already holding) since GiveWell recommended SCI in November 2011. In brief, SCI has had approximately $2.8 million of which it has spent approximately $640,000 and has allocated (but not yet spent) $1.37 million.3
| Total unrestricted funds held (as of Nov 2011) and received (Nov 2011 to Oct 2012) | $2,850,796 |
| Total spent (Nov 2011 to Oct 2012) | $637,003 |
| Total committed (as of Oct 2012) | $1,374,600 |
| Total committed + spent | $2,011,603 |
SCI told us that it has spent (and plans to spend) these funds in three main categories:5
The table below breaks down funds SCI has spent or committed to each category. Approximately 41% of the money SCI has spent has gone to category 1 (new countries), 32% to category 2 (DFID-funded countries), and 27% to category 3 (SCI's operations). All of SCI's committed funds are for category 1 countries.8
| Spending category | Spent | Committed | Total |
|---|---|---|---|
| Non-DFID-funded country | $260,817 | $1,374,600 | $1,635,417 |
| DFID-funded country | $201,450 | $0 | $201,450 |
| Operational | $174,735 | $0 | $174,735 |
| TOTAL | $637,003 | $1,374,600 | $2,011,603 |
Country-level details of how SCI has spent these funds are available in this footnote.9
Of the $1.374 million committed to non-DFID-funded countries (in the table above), SCI has told us that it intends to spend almost $1.2 million (almost 60% of all the unrestricted funds it has received since November 2011) supporting new programs (category 1) in Ethiopia and Zimbabwe. It intends to spend $158,000 on gathering baseline data and mapping (i.e., determining which areas have high levels of schistosomiasis and need to be treated) in Zimbabwe (update: these funds have been transferred to Zimbabwe10) and $316,000 on mapping and $711,000 on delivering treatments in Ethiopia.11 SCI notes that Ethiopia is likely to receive support for its program from other donors, including the Partnership for Child Development, Dubai Cares and possibly the Children's Investment Fund Foundation (CIFF), the UK government, and Save the Children. Local partners will include the Ethiopian Health and Nutrition Research Institute (EHNRI).12
The rest of the $1.374 million listed in the table above is accounted for by commitments to spend about $95,000 on each of (a) distributing a second round of donated drugs in Senegal, and (b) starting a national schistosomiasis control program in Mauritania.13 SCI is not yet able to say when these funds will be spent, due to the complexities of receiving approval for its plans at multiple levels of government,14 and we will be following up on this in future updates.
Above, we detail how SCI has spent and plans to spend additional unrestricted funds. Below, we discuss the information we have seen on progress on SCI's programs.
At this point, we do not have a concrete sense of the impact of the programs that SCI has funded with the unrestricted funds it has received since November 2011. Partly this is because the full process from committing funding to executing programs to collecting data on them can take years.
Ethiopia
This year, SCI has spent about $51,000 on its work to start a national deworming program in Ethiopia, including $13,000 to support a deworming conference in March that SCI saw as the first step towards building a program there and $25,000 on a stakeholders' meeting in July.15 SCI currently plans to significantly scale up spending there, implying to us that SCI (with other partners, including the World Health Organization16) has been successful in advocating for the creation of a larger scale deworming program in the country. (We will be following the progress of this program closely.)
SCI shared with us a non-public trip report from a staff member's visit to Ethiopia.17 The report provides insight into the interactions between SCI, government, and other actors, as well as some information on the progress of the program.
Other new programs
Yemen: We reported in our last update on SCI that SCI has made a grant of $100,000 to Yemen. SCI told us that in Yemen, funding was expected to be available from the World Bank for 2010-2011, but because of instability in the country, funding was delayed and SCI funded the first round of treatment with unrestricted funds.18 Yemen plans to conduct a study of schistosomiasis prevalence "using cluster sampling," and SCI plans to conduct a survey of "knowledge, attitudes, and practices" and a study comparing the "effectiveness of mobile and school-based interventions" in the country.19 SCI's future work in Yemen will be as a technical partner and its research work will be funded by the World Bank.20
Senegal: We reported in our last update on SCI that SCI had made a grant of $80,000 to Senegal. SCI provided a non-public report on a staff member's visit to Senegal to observe the April 2012 mass drug distribution. The staff member visited distribution sites and reported on problems observed.21 SCI also shared a government report on the distribution, which provides treatment coverage data for part of the area that received SCI-funded treatments and notes that not all data is available because some has been withheld by health workers who are involved in a labor dispute.22
Tanzania: In March 2012, SCI told us that it planned to grant $25,000 from unrestricted funds to Tanzania to treat 153,000 students.23 SCI told us that this transfer occurred and that the treatments were completed.24 The grant does not appear on SCI's list of expenditures in January to October 2012.25
Additional monitoring and evaluation: Trip reports
SCI has provided trip reports from SCI staff visits to Burundi (funded by a private donor), Senegal, Ethiopia, Cote d'Ivoire, and Malawi.26 The reports provide insight into the interactions between SCI, governments, and other actors, as well as some information on the progress of the programs. The Burundi and Senegal reports provide some evidence that SCI is informally auditing its programs for problems27 (note that we have these two examples of such "informal audits," which may not be representative of SCI's visits to other countries or to these countries on other occasions). SCI has told us that it will continue to send trip reports to us as it completes them.
Plans for future monitoring and evaluation
DFID-funded countries. SCI shared a draft report it is preparing for DFID detailing progress in each of the eight countries in which DFID is funding schistosomiasis control.28 SCI plans to collect the following data in each country:
SCI has collected or is in the process of collecting baseline data for the prevalence and morbidity studies in Cote d'Ivoire, Liberia, Malawi, and Mozambique, and is planning baseline data collection in Zambia.32 It does not plan to collect baseline data in Tanzania (SCI states that good historical baseline data is already available)33 or in Niger or Uganda (where treatment programs have been ongoing).34 We have not yet seen the baseline data that SCI has collected.
Other countries. Monitoring plans for other countries include:35
SCI has not yet developed plans for monitoring and evaluating programs in Ethiopia, DRC and Zimbabwe. In Ethiopia, a government agency will be responsible for monitoring and evaluation.37 We have not seen monitoring plans for Rwanda (SCI is waiting for the government to sign a memorandum of understanding before moving forward38) or Kenya.
This information is from SCI’s program update39 and from our conversation with SCI in August.40 We note that SCI's plans have been somewhat fluid to date. We do not consider this a bad thing and have encouraged unrestricted funding to allow SCI flexibility.
Examples include:
Expenditure report: GiveWell, "SCI Financial Details and Summary (November 2011-October 2012)," Sheet Email from SCI Nov 6.
Program update: Schistosomiasis Control Initiative, "Program Update (September 2012)."
GiveWell, "SCI Financial Details and Summary (November 2011-October 2012)," Sheet Summary.
For details, see GiveWell, "SCI Financial Details and Summary (November 2011-October 2012)."
Spending allocation in GiveWell, "SCI Financial Details and Summary (November 2011-October 2012)," Sheet Summary. List of expenditures by broad category in same source, Sheet Totals. More detail on each program in Schistosomiasis Control Initiative, "Program Update (September 2012)." Details from Alan Fenwick, phone conversation with GiveWell, August 13, 2012.
Alan Fenwick, phone conversation with GiveWell, August 13, 2012.
See our April 2012 update on SCI.
GiveWell, "SCI Financial Details and Summary (November 2011-October 2012)," Sheet Summary.
Data from:
Expenditures:
Alan Fenwick, email to GiveWell, October 15, 2012.
GiveWell, "SCI Financial Details and Summary (November 2011-October 2012)," Sheet Email from SCI Nov 6. Converted to USD in Sheet Summary.
Alan Fenwick, email to GiveWell, November 8, 2012.
"Mauritania: SCI has committed $64,000 for mass drug administration (MDA) in areas where prevalence is 30% and above. This will include training of health workers, mobilisation and sensitisation of the population, monitoring & evaluation.
Senegal: Following on from the successful delivery of 400,000 treatments in April 2012 of donated drugs that were about to expire, SCI has committed $60,000 over the next 6 months to support the development of a national programme." Schistosomiasis Control Initiative, "Newsletter (November 2012)," Pg 4.
Updated commitment amounts from Alan Fenwick, email to GiveWell, November 7, 2012.
Alan Fenwick, email to GiveWell, October 15, 2012.
Schistosomiasis Control Initiative, "Program Update (September 2012)."
Alan Fenwick, email to GiveWell, November 8, 2012.
Schistosomiasis Control Initiative, "Field Trip Report: Ethiopia (June 2012)."
Alan Fenwick, phone conversation with GiveWell, August 13, 2012.
"Proposal in Schisto prevalence in Yemen using cluster sampling: NSCP.
Design KAP study and budget: SCI.
A study on the comparison of effectiveness of the mobile and school based interventions: SCI."
Yemen National Schistosomiasis Control Program, "Joint NSCP/WHO/WB/SCI EMTR Meeting - Actions (September 28, 2012)," Pgs 3 and 6.
Alan Fenwick, email to GiveWell, November 8, 2012.
Schistosomiasis Control Initiative, "Field Trip Report: Senegal (April 2012)."
"Withholding of the data by the health unionists since 2010. Negotiation was started during the meetings and the great importance of the MDA had was also highlighted as well as the negative consequences the MoH might have to face regarding the future of partnership, in case of not being able to get data and reports. " (pg 10) "Due to health information withholding, it was impossible to collect all data." Government of Senegal, "Report on MDA (2012)," Pg 12.
Alan Fenwick, email to GiveWell, March 29, 2012.
Alan Fenwick, phone conversation with GiveWell, August 13, 2012.
GiveWell, "SCI Financial Details and Summary (November 2011-October 2012)," Sheet Email from SCI Nov 6.
Schistosomiasis Control Initiative, "Field Trip Report: Burundi (June 2012)."
Schistosomiasis Control Initiative, "Field Trip Report: Senegal (April 2012)."
Schistosomiasis Control Initiative, "Field Trip Report: Ethiopia (June 2012)."
Schistosomiasis Control Initiative, "Field Trip Report: Cote d'Ivoire (October 2012)."
Schistosomiasis Control Initiative, "Field Trip Report: Malawi (October 2012)."
Examples of problems and potential problems identified in the Burundi report:
Schistosomiasis Control Initiative, "Field Trip Report: Burundi (June 2012)."
Examples of problems and potential problems identified in the Senegal report:
Schistosomiasis Control Initiative, "Field Trip Report: Senegal (April 2012)."
Schistosomiasis Control Initiative, "Integrated Control of Schistosomiasis and Intestinal Helminths in sub‐Saharan Africa (ICOSA): 2nd Annual Report (October 2012 Draft)."
"Coverage validation surveys are essential to validate the routine reporting of treatment numbers from the MDA and provide a true estimate of the proportion of individuals reached at national level. ICOSA has developed a coverage validation survey protocol and questionnaire which will:
Schistosomiasis Control Initiative, "Integrated Control of Schistosomiasis and Intestinal Helminths in sub‐Saharan Africa (ICOSA): 2nd Annual Report (October 2012 Draft)," Pg 25.
Schistosomiasis Control Initiative, "Integrated Control of Schistosomiasis and Intestinal Helminths in sub‐Saharan Africa (ICOSA): 2nd Annual Report (October 2012 Draft)," Pg 27-28.
Study design described in previous footnote.
"Morbidity indicators:
When measuring these indicators, they will inevitably be confounded by a number of other interventions. A variety of different diseases will all impact on height, weight and anaemia. However reduction of prevalence and intensity of SCH can be solely attributed to MDA."
Schistosomiasis Control Initiative, "Integrated Control of Schistosomiasis and Intestinal Helminths in sub‐Saharan Africa (ICOSA): 2nd Annual Report (October 2012 Draft)," Pg 28.
"Group 1:
Group 2:
Schistosomiasis Control Initiative, "Integrated Control of Schistosomiasis and Intestinal Helminths in sub‐Saharan Africa (ICOSA): 2nd Annual Report (October 2012 Draft)," Pg 28.
Schistosomiasis Control Initiative, "Integrated Control of Schistosomiasis and Intestinal Helminths in sub‐Saharan Africa (ICOSA): 2nd Annual Report (October 2012 Draft)," Pg 28.
"For Group 3 countries (Niger and Uganda), M and E activities that were started 6 years ago have already shown the impact of long term control." Schistosomiasis Control Initiative, "Integrated Control of Schistosomiasis and Intestinal Helminths in sub‐Saharan Africa (ICOSA): 2nd Annual Report (October 2012 Draft)," Pg 29.
Schistosomiasis Control Initiative, "Program Update (September 2012)."
Yemen National Schistosomiasis Control Program, "Joint NSCP/WHO/WB/SCI EMTR Meeting - Actions (September 28, 2012)."
Schistosomiasis Control Initiative, "Program Update (September 2012)."
Alan Fenwick, email to GiveWell, October 15, 2012.
Schistosomiasis Control Initiative, "Program Update (September 2012)," Sheet By Country Plans.
Alan Fenwick, phone conversation with GiveWell, August 13, 2012.