Note: This page summarizes the rationale behind a GiveWell grant to Evidence Action. Evidence Action staff reviewed this page prior to publication.
In a nutshell
In February 2025, GiveWell recommended a $144,250 grant to fund IDinsight to conduct an independent analysis of baseline iron and folic acid (IFA) coverage survey data in Uttar Pradesh and Bihar, India. The data had been collected by Evidence Action. We recommended this grant because it will help us decide whether to make a larger grant to fund Evidence Action to provide technical assistance (TA) to increase IFA coverage in these two states.
We're recommending this grant because:
- The analysis will inform a large (up to $7.9 million) grant decision to expand Evidence Action’s TA program in Uttar Pradesh and Bihar. Our current estimate suggests that expanding technical assistance in these states could be approximately 17 times as cost-effective as direct cash transfers.
- Using IDinsight to analyse the data ensures consistency with coverage analyses already conducted in Rajasthan, Madhya Pradesh, Jharkhand, Haryana, and Uttarakhand, where Evidence Action is already implementing a TA program. The consistency makes it easier to compare baseline coverage across different states and will help us refine our estimates of Evidence Action's impact on IFA coverage.
- IDinsight's technical expertise allows for potential process evaluation in the future, even though we opted not to include this component for now.
The key uncertainties we have for this grant are:
- Our current 17x cost-effectiveness estimate for IFA expansion in Uttar Pradesh and Bihar is highly uncertain, with several major questions that could potentially push our estimate below our 10x cost-effectiveness bar.
- We have not explored alternative, less expensive options. We would guess IDinsight is likely the safer choice to ensure quality and comparability with previous analyses, but have not investigated alternatives in detail.
Published: August 2025
The intervention
IFA supplementation is done by providing oral supplements, in either syrup or tablet form.1 Evidence Action supports IFA supplementation programs that aim to reach school going children ages 5-19 years weekly and children ages 6-59 months twice per week.2
We expect most of the benefits of this intervention to come from iron, rather than folic acid, supplementation.3 We think there is strong evidence that iron supplementation reduces cases of anemia and that there is weak to moderate quality evidence that iron supplementation, with or without folic acid, increases cognitive ability. We discuss the evidence for IFA supplementation in greater detail in our intervention report on iron supplementation.
We have several uncertainties about the evidence for iron fortification/supplementation programs, which we are currently working on addressing.4
The organizations
Evidence Action provides technical assistance to the government to implement IFA programs. Since March 2018, we've directed approximately $13.7 million to support Evidence Action's technical assistance program for IFA supplementation in five Indian states: Haryana, Jharkhand, Madhya Pradesh, Rajasthan, and Uttarakhand.5
IDinsight is an international NGO that partners with clients to generate and apply rigorous evidence to maximize social impact. Depending on client needs, IDinsight helps diagnose social sector challenges, design and test potential solutions, and operationalize those solutions found to be most impactful.6 GiveWell partners with IDinsight to provide monitoring and evaluation support to grantees.
The grant
In August 2024, we made a ~$200,000 grant to support baseline coverage surveys in Uttar Pradesh and Bihar. It collected this data from December 2024–January 2025, and this data is now ready to be analyzed. This $144,250 grant will fund IDinsight to analyze this data and produce a report on current IFA coverage rates across different population groups in these states.7
As part of its analysis, IDinsight will measure how much of the target population currently receives and consumes IFA. In brief, we think this analysis will:
- Inform our decision to expand support for Evidence Action’s IFA program in Uttar Pradesh and Bihar, if IFA coverage is currently low enough.
- Serve as a benchmark for comparison against potential endline coverage data should we decide to fund expansion in these states.
Budget for grant activities
The grant budget is for five months:8
| IDinsight staff costs | $96,941 |
| Evidence Action fee and Shared Direct Costs | $23,266 |
| Evidence Action Indirect Costs | $24,042 |
| Total | $144,250 |
We expect that IDinsight’s preliminary analysis will be completed May 31st, 2025, and a final analysis completed by July 31st, 2025.
The case for the grant
We are recommending this grant because:
- The analysis will inform a large (up to $7.9 million) expansion grant decision with high potential cost-effectiveness. Our current estimate suggests that expanding technical assistance in Uttar Pradesh and Bihar could be approximately 17 times as cost-effective as direct cash transfers.9 As such, we're placing a lot of weight on having accurate and unbiased coverage data, which we feel confident IDinsight is well positioned to provide.
- Using IDinsight ensures consistency with analyses already conducted in Rajasthan, Madhya Pradesh, Jharkhand, Haryana, and Uttarakhand. IDinsight analyzed baseline and endline coverage data for our 2022 grant to Evidence Action for IFA programs in Rajasthan, Madhya Pradesh, Jharkhand, Haryana, and Uttarakhand. Having the same organization conduct the analysis for Uttar Pradesh and Bihar will ensure consistent methodology, making it easier to compare baseline coverage across different states. Comparing coverage in states with and without Evidence Action’s technical assistance could help us refine our estimates of Evidence Action's impact on IFA coverage, which is a key input in our cost-effectiveness model.10
- IDinsight's technical expertise allows for potential process evaluation. We opted not to include a process evaluation in this grant for the time being. However, working with IDinsight allows us to consider adding this component in the future.11
Risks and reservations
Our main reservations about this grant are:
- Uncertainty about our cost-effectiveness estimate for Evidence Action's IFA expansion in Uttar Pradesh and Bihar. Our current 17x cost-effectiveness estimate for expansion is highly uncertain. Our current model includes several major questions that we plan to make progress on over the coming months. In total, these have the potential of pushing our cost-effectiveness estimate below our 10x cost-effectiveness bar. Some of these uncertainties include:
- How much Evidence Action’s TA program increases IFA coverage annually.
- Whether we should be using a newer meta-analysis for iron supplementation, which estimates a smaller effect (39% reduction in anemia) than the meta-analysis we're currently using (50% reduction).
- Issues related to whether IFA supplements are taken on an empty stomach, and the extent to which iron absorption inhibitors in tea could impact iron absorption.
- We have not explored alternative, less expensive options.We considered contracting with an independent survey firm to conduct the analysis on a smaller budget. However, Evidence Action has not worked with alternative firms in this capacity before, so we think IDinsight is the safer bet to ensure quality and comparability with the five state analyses. We are still considering funding this independent firm to conduct the coverage analysis in parallel with the IDinsight analysis to test this hypothesis.
Plans for follow up
- We expect that IDinsight’s preliminary analysis will be completed May 31st, 2025, and a final analysis completed by July 31st, 2025.
- We will continue discussing the possibility of adding a process evaluation component with Evidence Action and IDinsight.
- We will continue discussing the possibility of conducting a secondary baseline analysis with another survey firm with Evidence Action.
- We plan to conduct a grant investigation on whether to support Evidence Action’s IFA expansion in Uttar Pradesh and Bihar after receiving the baseline results.
Internal forecasts
For this grant, we are recording the following forecasts:
| Confidence | Prediction | By time | Resolution |
|---|---|---|---|
| 50% chance | We make a grant >$3.5m to support IFA in either Bihar or Uttar Pradesh | Dec. 2025 | - |
Our process
- We had several written and verbal conversations with Evidence Action and IDinsight about different options for analyzing baseline data from Uttar Pradesh and Bihar
- We reviewed proposals and budgets for different analysis options from IDinsight
Sources
- 1
"Iron supplementation is the oral consumption of iron-containing compounds, typically in pill form." GiveWell, "Iron supplementation for school-age children"
"Based on the technical guidelines, children <5 are recommended to receive 2 doses of IFA syrup per week and children 5-19 years are recommended to receive one IFA tablet weekly." Evidence Action, IFA investigation plan, 2022 (unpublished) - 2
"With the IFA program, given it is a routine program that requires weekly/bi-weekly administration…" Evidence Action, IFA investigation plan, 2022 (unpublished)
- 3
In the last grant we recommended to Evidence Action, we wrote, "In this report, we primarily discuss the effects of iron rather than folic acid.
We have not carefully considered the potential benefits of folic acid as distinct from iron. Our understanding is that in some of the iron supplementation studies we rely on, folic acid is also part of the treatment. However, our rough impression from reviewing the folic acid literature is that most of the potentially important public health impacts of folic acid come from providing supplements to pregnant women to reduce birth defects, and we expect that pregnant women would be a small portion of beneficiaries targeted by this program.
To simplify our analysis, we have focused on the effects of iron. However, our analysis would be conservative if the public health effects of folic acid in this population are larger than we currently expect." GiveWell, "Evidence Action Beta — iron and folic acid supplementation ('Phase 2')"
We are not aware of any further work on folic acid that has been conducted since. - 4
See this section of our previous grant page for more on the evidence behind IFA.
- 5
- In March 2018, we recommended funding ($320,000) to the Evidence Action Accelerator to scope a technical assistance (TA) program for IFA supplementation in India.
- Based on the results of this scoping work, we recommended a grant (approximately $3.4 million) in December 2018 to Evidence Action to scale a pilot of the IFA TA program and a grant in March 2019 ($800,000) to evaluate the program.
- In August 2022, we recommended funding (approximately $9.2 million) to support the IFA TA program across five states in India (Haryana, Jharkhand, Madhya Pradesh, Rajasthan, and Uttarakhand).
- $320,000 + ~$3,400,000 + $800,000 + ~$9,200,000 = ~$13,720,000.
- 6
“IDinsight is a mission-driven global advisory, data analytics, and research organization that helps global development leaders maximize their social impact. We tailor a wide range of data and evidence tools, including randomized evaluations and machine learning, to help decision-makers design effective programs and rigorously test what works to support communities. We work with governments, multilateral agencies, foundations, and innovative non-profit organizations in Asia and Africa.” IDinsight, “About us.”
“IDinsight is on-site with our clients to translate data into actionable insights. We provide rigorous evidence to improve social sector programs and help clients understand how to use data to inform decisions large and small, within time, budget, operational, and political constraints.Our teams begin with a careful diagnosis of a client’s most pressing questions and challenges.” IDinsight, “Services.” - 7
"IDinsight aims to analyze data from Evidence Action’s IFA Coverage Evaluation Surveys in Uttar Pradesh and Bihar. These surveys are to be conducted across December 2024 and January 2025 and aim to measure the proportion of children in the target age groups for IFA supplementation that receive and consume IFA Tablets/syrup across these two states…The final deliverable for this work will be a comprehensive report that details this analysis and helps better understand current IFA coverage rate." IDinsight, UP-Bihar Coverage Analysis for Evidence Action, 2024 (unpublished)
- 8
IDinsight, UP-Bihar Coverage Analysis for Evidence Action, 2024 (unpublished)
- 9
Note that this estimate of the value per dollar of direct cash transfers is out of date as of 2024. We are continuing to use this outdated estimate for now to preserve our ability to compare across programs, while we reevaluate the benchmark we want to use to measure and communicate cost-effectiveness.
- 10
We think baseline coverage data in Uttar Pradesh and Bihar will give us an indication of what the counterfactual coverage in the existing five states would be without Evidence Action support. Consistent analysis methodology should ensure that any differences in baseline coverage between states reflect real coverage variations rather than differences in how data is analyzed. Our impression is that:
- If Uttar Pradesh and Bihar baseline data suggests low existing coverage, it will strengthen the case that TA has been impactful and justifies continued funding in the five states.
- If Uttar Pradesh and Bihar baseline data suggests higher-than-expected coverage without TA, it could reduce our estimate of Evidence Action’s impact.
- 11
A process evaluation provides a qualitative analysis on how well a program is being implemented by examining factors such as supply chain functionality, training effectiveness, and adherence to program protocols. Working with IDinsight allows for the option of including a process evaluation at a future date. Evidence Action has told us that other independent survey firms likely won’t have the technical capacity to conduct a similar analysis. We think that the process evaluation information could be useful for evaluating the qualitative case for the impact of Evidence Action's TA, as it might serve as a cross-check for the quantitative coverage estimates.