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Food for the Hungry International (FHI)

In a nutshell

Food for the Hungry implements a diverse set of programs aimed at improving health and reducing poverty across 20 countries in the developed and developing world. We named it a finalist on the strength of its Care Group model, a CSHGP-funded project that we believe demonstrates a logical and cost-effective approach to saving lives. However, in trying to examine the organization as a whole, we are unable to gain the same confidence in a large enough portion of its activities, and therefore cannot confidently recommend the organization.

The details

We first discuss the Care Group model - what it is, the evidence that it works, and our estimate of "lives saved per dollar" - and then discuss our relatively limited understanding of the rest of the organization.
Table of contents 

Care Group model

What do they do?

The Care Group model is a CSHGP-funded program that FHI has implemented in Mozambique and Bolivia, and like many such programs, it takes a broad approach to improving health and quality of life (rather than focusing narrowly on a particular problem); includes detailed monitoring that gives us confidence in its effectiveness; and appears to save lives cost-effectively. In these ways, it is a good match with our priorities for this cause. The model centers around the use of FHI-employed "Promoters," who train groups of 10-12 "Leader Mothers" (Attachment B-3 Pg 5) in basic health practices, including: These Leader Mothers are then expected to train 10-14 mothers each (Attachment B-3 Pg 5). In addition, FHI leverages Ministry of Health services to provide immunizations, deworming medication, and vitamin A supplementation to the children living in the region (Attachment B-6, slide 8).

Does it work?

FHI provided relatively strong evidence of effectiveness for its Care Group programs in Bolivia and Mozambique (particularly Mozambique):

What do you get for your dollar?

Attachment B-6 Pg 18 states that between 1999 and 2004, the under-5 mortality rate in Mozambique Care Group areas fell from 107 to 41 deaths per 1000 live births; converted into an annual mortality number, this implies that annual mortality among under-5 children (the main targets of the program, as the above description shows) fell from 2.1% to 0.8%. We do not have a good deal of confidence in this statement, as we explain below, but for the moment we take it at face value in order to estimate the total number of lives saved per year. We first estimate the total number of children reached by the program, based on the assumption that 1457 Leader Mothers were trained (as Attachment B-6 Pg 25 states), that each trained 10-14 more mothers (Attachment B-3 Pg 5), and that each of the mothers reached had 2-4 children in the household - implying that a total of around 30,000-80,000 children were reached. If the annual mortality rate among these children fell from 2.1% to 0.8%, that's 400-1000 lives saved per year, at a total cost of $500,000 per year (Attachment A-1 Pg 3) - implying $500 to $1,250 per life saved. However, we know very little about how FHI collected this data in general or how it assessed or estimated mortality rates in particular. The only information we have comes from Attachment B-6 Pg 10, which describes whom they surveyed and where. We aren't sure whether the decline in mortality is based on direct observation (i.e., counting the number of deaths reported), projections based on survey responses, or theoretical models of lives saved based on the survey data described above (i.e., how many lives would be theoretically saved if better nutritional practices were observed). Without information about this number, we have very low confidence in our estimate of cost-effectiveness, although it is in the ballpark of USAID's estimate for similar programs.

Other programs

In aggregate, we know relatively little about FHI's activities. The following table summarizes the projects that we do have documentation on:
LocationDescriptionDurationBudgetSource
BoliviaChild survival program (see above)2002-2006$23mAttachment B-2
MozambiqueChild survival program (see above)2006-2010$3.3mAttachment B-3
MozambiqueImproving farmers' incomes through training in better farming technologies and marketing their products; child survival program2005?Attachment B-7
SudanBuilding schools and promoting equality in education for girls??Attachment B-5
Ethopia, Mozambique, Haiti, NigeriaAbstinence promotion?$2.2mAttachment B-1
UgandaConstruction of latrines and water pumps; agricultural training?$559kAttachment B-16
SudanDistributing seeds and training farmers to increase food security?$937kAttachment B-9
BangladeshMicrofinance (savings and loans); literacy training2006?Attachment B-8
IndonesiaTsunami relief: shipping supplies, distributing bednets, etc.2005$973kAttachment B-13
Dominican RepublicLatrine construction-$6kAttachment B-4
RwandaProposal to improve farming practices through terracing-$874kAttachment A-3
The concerns we have are:

Conclusion

Ultimately, we cannot confidently recommend FHI because we have too little information about the organization as a whole. We have neither comprehensive evidence on outcomes, nor an overall view of the organization's strategy; while there are some programs we are confident in and others we are less confident in, we have no sense of what to expect from this organization if and when it brings in more donations.

Attachments

A. Application and response

B. Program related attachments

C. Organization related attachments

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Source URL (retrieved on 02/05/2012 - 08:06): http://givewell.org/international/charities/Food-for-the-Hungry/2007-Review