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Updated: 50 min 48 sec ago

Maximum Impact Fund update: We estimate GiveWell donors’ $15.3 million to the Against Malaria Foundation will save over 3,000 lives

Tue, 10/13/2020 - 13:07

Thanks to our donors, we have disbursed $23.3 million in flexible funding to our top charities this year. This generous, flexible support is worthy of celebration!

This post focuses on our decision to grant $15.3 million to the Against Malaria Foundation (AMF), which includes the $11.7 million that donors gave to “Grants to recommended charities at GiveWell’s discretion” in the first half of 2020.[1]

AMF supports the distribution of insecticide-treated nets in areas with high rates of malaria. The nets stop mosquitoes from biting and spreading the disease. We estimate our donors’ support for AMF will collectively save over 3,000 lives, mostly of young children in the Democratic Republic of the Congo (DRC) and Guinea.[2] Without this grant, we think net distributions in DRC and Guinea would have been delayed.

We believe that AMF was the highest-impact choice for this grant. We chose AMF after assessing the effect of the COVID-19 pandemic on our top charities, the urgency of our top charities’ funding needs, and our estimates of their impact per dollar. We’re grateful for GiveWell donors’ trust in providing flexible funding to fill this need.

Why we chose AMF

We typically allocate flexible donations to our top charities every quarter. However, we delayed allocating the donations we received to “Grants to recommended charities at GiveWell’s discretion” in the first quarter of 2020. We wanted to better understand the impact of the growing COVID-19 pandemic on charities’ budgets and plans before making a decision about where funding would have the greatest impact.

AMF was a top contender for receiving this grant because of its high estimated impact per dollar. It is continuing its work during the pandemic, with some delays and modifications.[3] However, we wanted to resolve a couple open questions about its work before making a grant.[4]

First, we wanted to make sure that AMF needed additional funding. At the end of 2019, it held around $70 million that was earmarked for specific distributions, but we were unsure how much of this funding would be formally committed.[5] As of June 2020, AMF had committed nearly all of this funding and held only around $4 million in uncommitted funds.[6] Distributions AMF hoped to carry out in DRC and Guinea in late 2021 to early 2022 would require significantly more than $4 million.[7] There is a strong case the distributions would be delayed without this grant, as funding needs to be secured well before nets are provided.[8]

Second, we wanted to confirm that AMF had solid processes for checking that nets reached their intended recipients and were in use and in good condition. We expect strong monitoring from all of our top charities. We investigated AMF’s current monitoring practices in detail this year and believe AMF meets our high standards.[9] We plan to share more about this work in the coming months.

Other options considered

We considered making grants to Malaria Consortium’s seasonal malaria chemoprevention (SMC) program and Helen Keller International (HKI)’s vitamin A supplementation program, as we estimated that they were similarly cost-effective to AMF when we began our decisionmaking process. However, our investigation into their current plans and budgets did not turn up urgent funding needs. We had directed an $8 million grant to Malaria Consortium’s SMC program in June because of its high estimated cost-effectiveness, and we did not believe that it had additional time-sensitive needs following receipt of those funds.[10] We decided to wait until the end of the year to revisit making grants to Malaria Consortium and HKI.[11]

AMF emerged as our clear choice with its time-sensitive need for funding that we estimated would save a lot of lives.

Our bottom line for donors giving today

Going forward, we recommend that donors give to the Maximum Impact Fund (formerly known as “Grants to recommended charities at GiveWell’s discretion”). We will direct these funds where we believe they can be used most effectively.

We expect the $15.3 million grant to cover most of AMF’s urgent needs. For donors who wish to support a specific charity today, we recommend Malaria Consortium’s SMC program. We now model donations there as having the highest impact among our top charities.

We expect donations to Malaria Consortium will support its work in 2022. Providing funding to enable work in the future can be a high-impact option for donors, and we believe that supporting Malaria Consortium today is a great choice for donors seeking to maximize the good they accomplish per dollar donated.

We’re so grateful to our community of donors for providing flexible funding that will support the distribution of nets in the Democratic Republic of the Congo and Guinea. Thank you!

References

Sources and footnotes for this post may be found here.

The post Maximum Impact Fund update: We estimate GiveWell donors’ $15.3 million to the Against Malaria Foundation will save over 3,000 lives appeared first on The GiveWell Blog.

September 2020 open thread

Fri, 09/11/2020 - 18:13

Our goal with hosting quarterly open threads is to give blog readers an opportunity to publicly raise comments or questions about GiveWell or related topics (in the comments section below). As always, you’re also welcome to email us at info@givewell.org or to request a call with GiveWell staff if you have feedback or questions you’d prefer to discuss privately. We’ll try to respond promptly to questions or comments.

You can view our June 2020 open thread here.

The post September 2020 open thread appeared first on The GiveWell Blog.

Why we’re excited to fund charities’ work a few years in the future

Tue, 08/25/2020 - 16:21

We recently spoke with someone who wanted to donate to a GiveWell top charity. They were interested in getting the funding “out the door” and to program participants as quickly as possible.

But our top choice for funding today is Malaria Consortium’s seasonal malaria chemoprevention program—for work it expects to complete in 2022.[1] The potential donor was puzzled. Shouldn’t we prioritize an organization that needs the money sooner?

We often recommend donations today that support programs a few years from now. This probably diverges from many people’s intuitions about getting funding out the door as soon as possible.

Three key reasons why funding today leads to more impact in the future

1. Upfront coordination and planning increases charities’ impact.

Highly effective charities tend to spend a lot of time preparing before they implement their programs.

The Against Malaria Foundation (AMF) is a GiveWell top charity that supports the distribution of insecticide-treated nets, primarily in sub-Saharan Africa. These nets are hung over sleeping spaces and prevent mosquitoes from biting and transmitting potentially deadly malaria. AMF says the ideal lead time for its work is 23 months.[2] During that time, it takes the following steps:

  • Choosing a location: AMF decides where it should direct funding to have the greatest impact. It considers malaria prevalence, the number of people in need of nets, and whether partner organizations can conduct distributions according to AMF requirements.[3]
  • Negotiating an agreement: AMF and the country’s national malaria program negotiate a net distribution agreement and seek government approval.[4]
  • Ordering nets: AMF negotiates with net manufacturers to place an order for nets suited to local needs, which may vary in size, color, and insecticide.[5]
  • Producing, shipping, and transporting nets: Nets are manufactured and shipped to regional warehouses.[6]
  • Visiting households: AMF’s partners visit households to determine how many nets are needed.[7]

Some of these steps are practical requirements for conducting a distribution, such as ordering and shipping nets to the relevant location. Other steps increase the impact of the distribution. Though 23 months may seem like a long lead time, it enables AMF to coordinate with in-country groups, identify the highest-need areas, order the quantities and types of nets that are most suitable for those areas, and select partners that can conduct high-quality distributions and monitoring. We believe that the overall impact of donations is much greater than they would be if they were allocated more quickly but less thoughtfully.

2. Charities with longer-term funding are more likely to hire and retain staff.

Charities have told us that it’s hard to retain and hire staff when they are uncertain about their long-term funding. Staff may leave if they don’t have confidence in an organization’s future funding. Their replacements must be recruited and trained, requiring significant time from existing staff.

A charity leader who is concerned their program might not be funded in the future may decide to limit investment in hiring. They may make quick hiring decisions that lead to poor fit and reduced program impact, or further staff turnover. Or, they may simply not hire at all. Instead, existing staff may be spread thin to cover the vacant roles.

A charity leader with long-term confidence in their organization’s funding may be willing to invest in hiring. We expect charities with steady, excellent staff to have more impact than those facing high turnover and suboptimal allocation of staff.

3. Two to three years from now, highly cost-effective charities will likely still have more impact than faster-spending but less cost-effective charities.

Charities’ impact per dollar donated drives our recommendations to donors. We expect differences in cost-effectiveness to overwhelm differences in charities’ spending speed over a few years.

We estimate that Malaria Consortium’s seasonal malaria chemoprevention (SMC) program is 16 times as cost-effective as GiveDirectly’s standard (non-COVID-19) cash transfer program.[8] Malaria Consortium distributes cheap medicine to prevent children under five from getting malaria. GiveDirectly provides cash transfers to very poor households. Both work in sub-Saharan Africa. GiveDirectly estimates that participants in its standard cash transfer program receive funds between three and six months after those funds are donated.[9] Donations to Malaria Consortium reach program participants in two to three years.

It’s likely that two to three years from now, the costs and benefits of Malaria Consortium’s SMC program and GiveDirectly’s cash transfer program will be about the same as they are today. In 2022, we expect that Malaria Consortium’s SMC program will be 16 times as cost-effective as GiveDirectly’s cash transfer program, as we do today. Even though donations reach Malaria Consortium’s program participants more slowly, they are likely to have more impact.

There is a way to change this calculus. If you believe that reaching program participants sooner is more valuable, you could apply a “discount rate” to the cost-effectiveness of SMC. Cost-effectiveness analyses often include discount rates to reduce the value of future costs and benefits because they occur in the future. We have used a discount rate of 4% for programs that lead to increases in future income for participants.[10]

In order for GiveDirectly to be more cost-effective than Malaria Consortium’s SMC program, you would need to apply a discount rate of more than 300% per year to Malaria Consortium.[11] We think that most donors would not apply such a steep discount. We believe they would choose to give to Malaria Consortium on the basis of cost-effectiveness, even if donations are deployed more slowly.

What we’re balancing

We balance the benefits of providing future funding with the potential downsides of doing so by limiting how many years in advance we fund charities’ work. This preserves our ability to donate funds to more effective opportunities that we may identify in the future. We direct funds to charities that will be spent in two to three years, rather than in ten years, for this reason.

We constantly update our charity recommendations with new information. We also look for charities with greater impact per dollar.[12] This work will likely change how we prioritize funding our existing top charities and may lead to new top charities. We don’t want to commit funding so far in advance that we would have preferred to give that funding to an organization we’ve recently concluded has greater impact per dollar.

Funding a few years out is a reasonable balance of the benefits and pitfalls of providing future funding. The optimal timeline for funding will vary depending on the program and implementation model.

Responding to urgent needs

While we generally direct funding to our top charities for future work, we retain a pool of funding that may be used for urgent needs: “Grants to recommended charities at GiveWell’s discretion.” We typically grant these funds quarterly to the charity or charities we believe can use them most effectively.

We might have the most impact by supporting a pressing need. Last year, we made a grant to AMF to support a time-sensitive need in the Democratic Republic of the Congo. We estimated that the cost per life saved by donating to AMF was the same as the cost per life saved by donating to the other charity we were considering funding, Malaria Consortium’s SMC program. However, by providing additional funding to AMF, we were directly increasing the number of nets it could distribute in the Democratic Republic of the Congo the following year. By contrast, our near-term funding decisions would not have impacted Malaria Consortium’s plans.[13]

We are open to granting or informing charities of our plans to grant discretionary funds sooner than quarterly, if that would make a difference for a charity’s ability to carry out high-impact work. But many times, we choose to grant discretionary funds to support charities’ work two or three years from now—because that is the most impactful option.

References

Sources and footnotes for this post may be found here.

The post Why we’re excited to fund charities’ work a few years in the future appeared first on The GiveWell Blog.

A brief look at how some groups we’ve supported are responding to COVID-19

Thu, 07/16/2020 - 14:45

Organizations supporting and delivering public health and poverty alleviation programs have been impacted by the COVID-19 pandemic in many ways. Here, we provide a brief look at how some of the groups we’ve supported are responding to the pandemic.

We share an example of a charity that continues to implement its health program, with modifications for social distancing and safety; charities that have paused their programs, but continue supporting their staff; and a charity that is allocating funding to pandemic-response efforts.

This is neither a comprehensive update nor a static one. The situation is evolving rapidly. We will share a more complete update on what the pandemic means for our top charities and their funding needs closer to the end of the year. We continue to recommend that donors give to “Grants to recommended charities at GiveWell’s discretion,” which we allocate among our recommended charities where we see the greatest need.

What follows is a snapshot of what’s happening now.

Examples of how charities are responding

A charity that is continuing its program, but with modifications: Malaria Consortium’s seasonal malaria chemoprevention program

Seasonal malaria chemoprevention (SMC) is the delivery of anti-malarial medication to children under age five during the time of year when malaria transmission is highest.[1] The World Health Organization (WHO) recommends that programs to prevent malaria, including SMC, continue during the pandemic.[2]

Malaria Consortium is a GiveWell top charity that supports SMC campaigns (primarily door-to-door) in the Sahel region of Africa.[3] We expect Malaria Consortium’s next SMC distributions to take place during the upcoming July-to-October rainy season.[4]

GiveWell-directed funding to Malaria Consortium’s SMC program is flexible. We don’t restrict its use to specific activities. That means Malaria Consortium can use GiveWell-directed funds to quickly adapt its distribution model to prevent the spread of COVID-19.

Malaria Consortium will aim to provide personal protective equipment, including masks and gloves, to its community SMC distributors. It also plans to provide alcohol-based hand sanitizers, disinfecting wipes, soap, bio-waste bags, and additional T-shirts and hijabs.[5] Malaria Consortium has instructed community distributors to maintain two meters of distance in their interactions and to share information on how to prevent COVID-19 while visiting each household.[6]

Image from Malaria Consortium’s visual aid for community distributors. SPAQ (sulfadoxine-pyrimethamine and amodiaquine) is medication to prevent malaria.

Overall, Malaria Consortium expects slightly higher costs for its campaigns as a result of these changes.[7] We expect these additional costs to amount to a modest increase in the cost per child treated. In our projections of Malaria Consortium’s 2020 spending, we use an assumption of 20% higher costs due to program modifications.[8] This reduces our estimate of the cost-effectiveness of past donations to Malaria Consortium that are now being used for the 2020 SMC campaigns. Even with that adjustment, we still consider these past donations to be highly cost-effective, given our assessment of Malaria Consortium’s cost-effectiveness overall.

We expect that donations made to Malaria Consortium today will support its SMC campaigns in 2022, at which point we hope that these additional measures are no longer necessary. Our estimate of the cost-effectiveness of donations made to Malaria Consortium today thus remains high at $2,000 to $3,000 per death averted.[9]

Charities that are pausing programs and retaining staff: organizations that treat parasitic worm infections (deworming)

Our top charities list includes four organizations that support deworming programs: Evidence Action’s Deworm the World Initiative, SCI Foundation, Sightsavers, and the END Fund. The WHO has recommended pausing deworming programs to mitigate the spread of COVID-19.[10] Our top charities are not distributing deworming treatments at this time.

As with Malaria Consortium, the donations we’ve directed to the deworming organizations we recommend have been allocated flexibly, so they may support operations as well as delivery of deworming treatments. We understand that our top charities plan to retain most staff using this and other funding. Maintaining stability in uncertain times benefits staff. It will also enable a quick and smooth transition back to providing deworming treatments once campaigns restart, as hiring and training new staff can be difficult and time-consuming.

We’re unclear how long the pause will last and thus how disruptive it will be. The hope is that it will be short-lived.

Deworming is done on an annual basis in many locations, or at most twice per year.[11] Many rounds of deworming are scheduled for later in the year and so have not yet been missed. It’s possible that in many of these cases, deworming will take place as scheduled.[12]

If the pause persists beyond the end of the year, it will impact our estimated cost-effectiveness of deworming. We estimate that the maintenance of staff costs in the absence of program implementation during a 12-month interruption of deworming would lead to a roughly 10-25% decrease in the cost-effectiveness for our deworming top charities over three years (our typical deworming funding period).[13] This estimate relies upon a number of simplifying assumptions and judgment calls; more information is in the following footnote.[14] We believe that deworming would remain a cost-effective intervention overall.

A charity that is allocating funds to respond to COVID-19: Abdul Latif Jameel Poverty Action Lab’s Innovation in Government Initiative

In December 2018, we recommended a grant of $1 million to the Innovation in Government Initiative (IGI), a grantmaking entity within the Abdul Latif Jameel Poverty Action Lab (J-PAL) focused on scaling evidence-based policies in collaboration with low- and middle-income country governments.[15] This grant was part of a new area of our work to explore approaches to improve government policies.[16] Our grant supported IGI’s general operations and two requests for proposals (RFPs). The RFPs sought proposals primarily for technical assistance to governments to scale up evidence-based policies.[17]

In March 2020, IGI reached out to us about allocating approximately $150,000 of the remaining funding from the GiveWell-directed grant to COVID-19 response. Specifically, IGI was interested in funding off-cycle, rapid-response grants to mitigate the impact of COVID-19 in low- and middle-income countries by supporting technical assistance and analysis for governments to inform COVID-19 policy responses in areas like health and social protection.[18] This goal is in line with the original grant purpose, and we approved. A list of COVID-19 projects IGI has funded so far can be found here.

A broader list

This update highlights the importance of allocating funding flexibly so that grantees can respond to unforeseen events. But it doesn’t address all of the work our top charities and other groups we support are doing in response to the pandemic. GiveWell standout charity Development Media International is supporting public health broadcasts to promote behaviors to mitigate the spread of the pandemic. We’ve provided grant funding to expand this work. GiveDirectly has launched COVID-19 cash transfer programs in the United States, Kenya, and Uganda, and it plans to expand its COVID-19 response into five more countries.[19]

Other charities we support have adjusted their operations in large and small ways. We plan to share a more detailed look at the pandemic’s impact on charities we support later in the year.

References

Sources and footnotes for this post may be found here.

The post A brief look at how some groups we’ve supported are responding to COVID-19 appeared first on The GiveWell Blog.

Why you’ll see more matching campaigns at GiveWell

Thu, 06/25/2020 - 11:52

Lots of charities run matching campaigns with claims like “Give today and double your impact!” We’re generally skeptical of these claims, which are true only if the matching donor would not have otherwise given to the charity.

We guess that many donors who are motivated to make a large gift to charity (as donors who put up funding for matches typically are) would do so whether or not their support is matched by others. What may often be happening with matching campaigns, then, is that a matching donor would have given to the charity anyway but has agreed to structure their donation as a “match” for marketing purposes. We’ve written about these concerns in the past.

But we don’t think matches are inherently problematic. In fact, if executed such that the matching donor would not have given otherwise, we believe they can be highly motivating for donors.

We’re aiming to increase the amount of funding we direct each year, and we’re planning to start regularly running matching campaigns in 2020 ourselves, in the hopes of reaching new donors and learning which channels are the most successful for marketing. We plan to take extra steps to structure our matching campaigns to offer a “true” match to the extent possible.

How we’ll structure matching campaigns

In order to make a more truthful claim about matching, we plan to verify that the donors who provide matching funds for GiveWell campaigns would not have otherwise donated. We are taking the following steps to do so:

  • Approaching donors who have shown interest in increasing GiveWell’s reach.
  • Asking if they would be interested in making an additional gift this year to underwrite our matching campaigns.
  • Assessing their giving history and our expectation of their likely giving in 2020 so that we can see if matching funds appear additive.
  • Confirming with potential matching donors that we are only interested in donations they would not have otherwise made.
  • Communicating to potential matching donors that we will only accept their gift in the amount we are able to match from other supporters. This might mean asking the donor to wait to give until the matching campaign is complete so that we only receive the correct amount, or returning unused funds to the matching donor.

It will be impossible to say with certainty that a matching donor would not have given but for the opportunity to provide matching funds, but we believe we can make a credible case following the above steps. We expect this to become more difficult over time (see footnote for details).1As we offer opportunities to fund donation matching campaigns more consistently over time, we think it’s possible that some donors may hold back their gifts to wait for a matching opportunity, and that it will be more challenging for us to tell if they are making a counterfactual gift. jQuery("#footnote_plugin_tooltip_1").tooltip({ tip: "#footnote_plugin_tooltip_text_1", tipClass: "footnote_tooltip", effect: "fade", fadeOutSpeed: 100, predelay: 400, position: "top right", relative: true, offset: [10, 10] });

Why we’re excited to run matching campaigns

We believe matching campaigns are an effective way to bring in new donors. Matching also helps improve our ability to track the performance of specific ads.

Our matching campaigns this year will build on the successful matching campaign we ran in late 2019 for podcast ads. Four donors put up a total of $250,000 in matching funds for that campaign, all of which was matched by 740 new donors.2This information comes from our internal records, which we do not plan to publish to maintain donor confidentiality. jQuery("#footnote_plugin_tooltip_2").tooltip({ tip: "#footnote_plugin_tooltip_text_2", tipClass: "footnote_tooltip", effect: "fade", fadeOutSpeed: 100, predelay: 400, position: "top right", relative: true, offset: [10, 10] });

In addition to bringing in new supporters, the 2019 campaign helped us track which podcast ads were most successful. The campaigns asked donors to visit custom landing pages where they could make use of the matching funds. This enabled us to see which ads were driving donations.

What we’ll test in 2020 matching campaigns

A key takeaway from the 2019 campaign was that podcast ads were successful in driving new donations. This year, we’re planning to scale what worked by running additional matching campaigns via podcast ads.

We also plan to offer donation-matching for new donors on our website and in paid marketing to see if it increases the number of new donors, the size of their donations, or the frequency with which they give.

We’re excited to try new things to increase our impact. We think matches may be a great way to do this.

Notes   [ + ]

1. ↑ As we offer opportunities to fund donation matching campaigns more consistently over time, we think it’s possible that some donors may hold back their gifts to wait for a matching opportunity, and that it will be more challenging for us to tell if they are making a counterfactual gift. 2. ↑ This information comes from our internal records, which we do not plan to publish to maintain donor confidentiality. function footnote_expand_reference_container() { jQuery("#footnote_references_container").show(); jQuery("#footnote_reference_container_collapse_button").text("-"); } function footnote_collapse_reference_container() { jQuery("#footnote_references_container").hide(); jQuery("#footnote_reference_container_collapse_button").text("+"); } function footnote_expand_collapse_reference_container() { if (jQuery("#footnote_references_container").is(":hidden")) { footnote_expand_reference_container(); } else { footnote_collapse_reference_container(); } } function footnote_moveToAnchor(p_str_TargetID) { footnote_expand_reference_container(); var l_obj_Target = jQuery("#" + p_str_TargetID); if(l_obj_Target.length) { jQuery('html, body').animate({ scrollTop: l_obj_Target.offset().top - window.innerHeight/2 }, 1000); } }

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June 2020 open thread

Wed, 06/10/2020 - 14:22

Our goal with hosting quarterly open threads is to give blog readers an opportunity to publicly raise comments or questions about GiveWell or related topics (in the comments section below). As always, you’re also welcome to email us at info@givewell.org or to request a call with GiveWell staff if you have feedback or questions you’d prefer to discuss privately. We’ll try to respond promptly to questions or comments.

You can view our March 2020 open thread here.

The post June 2020 open thread appeared first on The GiveWell Blog.

GiveWell’s plans for 2020

Thu, 05/28/2020 - 07:10

Each spring, we share our plans for the year. Here, we highlight the work we plan to do in 2020 that is most likely to help us realize our mission of identifying and directing funding to highly cost-effective giving opportunities.1This post does not include a complete accounting of everything we plan to do in 2020. In particular, it does not include work aimed at primarily internal-facing results, such as improvements to internal staff communications. jQuery("#footnote_plugin_tooltip_1").tooltip({ tip: "#footnote_plugin_tooltip_text_1", tipClass: "footnote_tooltip", effect: "fade", fadeOutSpeed: 100, predelay: 400, position: "top right", relative: true, offset: [10, 10] }); We focus on three projects:

  1. Expanding into new areas of research.
  2. Searching for new, cost-effective funding opportunities in our traditional research areas.
  3. Building our donor community.

Sharing our annual plans and publicly reflecting back on them a year later is our typical practice. This year, of course, is atypical. The plans we laid out internally at the beginning of the year have been disrupted by the COVID-19 pandemic. The plans we share in this post take the pandemic into account, but we are more uncertain than usual about what will happen in 2020. We expect that much of our work will go forward as anticipated, but we will be flexible if there are unforeseen disruptions or changes to our research agenda that result from the pandemic.

Expanding into new areas of research

Grants in response to the pandemic

We have already expanded into a new area of work in 2020: grantmaking in response to the COVID-19 pandemic. We don’t typically focus on high-uncertainty, short-timeline reviews of funding opportunities. However, we think that we should be open to making grants in a lower-information environment due to the potentially severe consequences of the pandemic in low- and middle-income countries, where we focus our work, and that acting sooner may be more impactful in preventing the spread of the disease. As of the publication of this post, we’ve made three grants for COVID-19 mitigation.

We plan to consider whether there are additional grants we should make in response to the pandemic. We will make these grants if we believe they are more cost-effective than the opportunities to which we would otherwise direct funds.

Prioritizing within public health regulation

We began this year with the goal of clarifying which areas were most promising within public health regulation, a relatively new-to-GiveWell domain that we see as potentially highly cost-effective but that we made limited progress in assessing last year.

We made a lot of headway on this work in the early months of 2020. We conducted research that led us to prioritize alcohol policy and pesticide suicide prevention and to deprioritize additional work on other areas such as air pollution, tobacco, and road safety. Shortly before the pandemic intensified, we also began an investigation into a potential alcohol policy grant we might make. We were delayed in completing our investigation of the alcohol grant because the potential grantee shifted its focus to COVID-19 response.

We have paused work on public health regulation for now, outside of an investigation into a potential grant renewal for the 2017 GiveWell Incubation Grant recipient Centre for Pesticide Suicide Prevention. We plan to do more work on public health regulation in the coming months or after 2020, depending on our capacity for work outside of assessing opportunities in response to COVID-19. When we return to public health regulation, we plan to complete our investigation into the alcohol policy grant mentioned above. At that point, we plan to reflect on what we’ve learned to date about public health regulation before deciding whether to do additional work in this area.

Searching for new, cost-effective funding opportunities in our traditional research areas

We continue to assess evidence-backed global health and poverty alleviation programs that may meet our traditional criteria. We significantly expanded our research team in 2019 and expect to make great progress in vetting new evidence and moving programs through our review process in 2020.

Our research process operates as a funnel: we start by conducting shallow reviews of a large number of programs, followed by in-depth reviews of the most promising. This year, we’re planning to assess a large number of programs at various stages of the funnel. Here, we highlight a few that we’re particularly excited about:

  • New Incentives. We recently received preliminary results from a randomized controlled trial (RCT) of New Incentives‘ work. New Incentives provides cash incentives for caregivers in North West Nigeria who take their babies to a health clinic to receive routine immunizations. New Incentives is a GiveWell Incubation Grant recipient and the study of its work, which was funded by another GiveWell Incubation Grant, is the first RCT into which GiveWell has had significant input. This year, we expect to complete our review of the RCT results and to make a decision about whether to direct additional funding to support New Incentives’ work.
  • Evidence Action programs. We plan to complete additional research on two programs run by Evidence Action: GiveWell standout charity Dispensers for Safe Water and a maternal syphilis screening and treatment program.

We hope to conduct in-depth reviews of one to two other charities (most likely Precision Agriculture for Development and/or Sanku, though possibly others) as well, but may have limited capacity to do so due to COVID-19-responsive work.

Building the GiveWell donor community

We aim to grow the GiveWell donor community in 2020.

Our marketing team plans to reach new donors through advertising campaigns, including additional advertising on podcasts. The marketing team also plans to conduct and support research to inform updates to our website that may improve how we present information. For example, the team is examining how users engage with our website and where they may become confused or misinterpret our work, so that we can make improvements to those areas.

We’re hiring!

We have ambitious plans this year and are looking to hire staff to help us achieve our goals. If you think the plans above sound exciting, we encourage you to consider whether working at GiveWell would be a good fit for you. Many of our successful hires in the past have come through the community of people who engage with our work. You can read about the roles we’re hiring for here. Staff may work remotely and we accommodate flexible work schedules, including flexible hours. Additional details are in each job description.

We hope you’ll consider joining the team and sharing this with others who might like to. Thank you!

Notes   [ + ]

1. ↑ This post does not include a complete accounting of everything we plan to do in 2020. In particular, it does not include work aimed at primarily internal-facing results, such as improvements to internal staff communications. function footnote_expand_reference_container() { jQuery("#footnote_references_container").show(); jQuery("#footnote_reference_container_collapse_button").text("-"); } function footnote_collapse_reference_container() { jQuery("#footnote_references_container").hide(); jQuery("#footnote_reference_container_collapse_button").text("+"); } function footnote_expand_collapse_reference_container() { if (jQuery("#footnote_references_container").is(":hidden")) { footnote_expand_reference_container(); } else { footnote_collapse_reference_container(); } } function footnote_moveToAnchor(p_str_TargetID) { footnote_expand_reference_container(); var l_obj_Target = jQuery("#" + p_str_TargetID); if(l_obj_Target.length) { jQuery('html, body').animate({ scrollTop: l_obj_Target.offset().top - window.innerHeight/2 }, 1000); } }

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Reflecting on our progress in 2019

Wed, 05/20/2020 - 12:54

GiveWell grew significantly in 2019. We hired 13 full-time staff members, bringing our total size to 37, and expanded our ability to take on new projects across domains. We feel positioned to do more and better work going forward as a result.

We see a strong indication that the amount of funding we directed to our recommended charities increased last year, too. While we haven’t reconciled all giving from 2019, the value of donations we processed increased by about 30% in 2019.

We’re proud of what we accomplished in 2019. We also fell short of some goals last year. Most notably, we failed to make as much progress as we planned in researching new areas of global health and poverty alleviation.

This blog post provides a brief look at our key successes and failures last year. A more detailed accounting of how our progress in 2019 compared to the goals we set is available on this page.

Successes

Hiring new staff

Years of planning for our needs and recruiting efforts culminated in hiring 13 new staff to join our small team in 2019. GiveWell ended last year over 50% bigger than it was at the end of 2018.

We hired across the domains of our work: seven joined the research team, two joined the outreach team, three joined the operations team, and one will serve as Managing Director. We expect each staff member will enable us to accomplish more and achieve better outcomes across these key areas of our work. Below, we highlight a few senior hires whom we expect to help steer the direction of our work.

  • Managing Director. We hired Neil Buddy Shah as our first Managing Director in late 2019. Buddy will work closely with GiveWell’s CEO Elie Hassenfeld to set GiveWell’s high-level strategy. He will also engage with the international development community to learn from and contribute to discussions of how to do as much good as possible and to identify promising funding opportunities. We expect Buddy to start at GiveWell this summer.
  • Research. We’ve been looking to hire senior researchers to expand our ability to assess new types of evidence since 2016. We described in early 2019 how our research is evolving and how we hoped to hire additional experienced researchers to enable us to do this work. We hired Alex Cohen and Teryn Mattox as Senior Fellows in 2019.
  • Outreach. We’ve gradually been expanding our outreach work since 2017. In 2019, Steph Stojanovic and Jim Bobowski joined GiveWell as a Major Gifts Officer and VP of Marketing, respectively, and will lead our future work on donor retention and acquisition.
  • Operations. Our Director of Operations, Whitney Shinkle, who joined GiveWell in 2018, built out her team by bringing on three new staff members in 2019.

GiveWell’s expansion enables us to improve in each area of our work. For example, we hope to make progress this year on evaluating new research areas as well as looking for new, cost-effective room for more funding in the areas in which we’ve traditionally worked. We also expect to increase the amount of money we direct to our recommended charities with our expanded outreach team.

Increasing the amount of funding we direct to recommended charities

We see an early indication that we directed more money to our recommended charities in 2019 than we did the previous year: the value of donations we processed in 2019 grew by around 30%.

Directing funding to our recommended charities is one of the main metrics to which we hold ourselves accountable. We aim to grow the amount of money we move to our top charities each year.

The “donations we processed” figure doesn’t account for the donations that were made through our partner organizations and directly to our recommended charities, but we think it’s a good sign of our continued influence last year. We’ll share the final figure later this year, once we have more information.

Shortcomings

Making progress in understanding new areas of research

In May 2019, we wrote that we planned to make progress on exploring new areas of research in 2019. In particular, we planned to focus on public health regulation and ways to support government aid agencies.1“We plan to look into several new areas in 2019, including public health regulation and possible paths to support government aid agencies…. We also plan to continue our investigation into possible paths to support government aid agencies; in particular, we plan to complete an investigation into an opportunity to do so in the area of results-based financing.” GiveWell blog, GiveWell’s plans for 2019, May 16, 2019 jQuery("#footnote_plugin_tooltip_1").tooltip({ tip: "#footnote_plugin_tooltip_text_1", tipClass: "footnote_tooltip", effect: "fade", fadeOutSpeed: 100, predelay: 400, position: "top right", relative: true, offset: [10, 10] }); Due to shifting responsibilities among the research team, we did not make progress in this area last year.

We had planned for a single staff member to focus on this work. As this person’s responsibilities evolved throughout the year, they were unable to dedicate significant time to this project. This led us to deprioritize making progress in this area.

Conclusion

The above highlights don’t tell the full story of what we achieved—we had a busy year! Listing everything we worked on in 2019 would lead to a very long post. But, to briefly share a few other interesting projects (this list is non-exhaustive):

  • We published research on moral weights. This was the culmination of over two years of research and will inform and improve our ability to make difficult tradeoffs in our funding decisions going forward.
  • We recommended a $1 million Incubation Grant to support the work of Fortify Health on whole wheat flour iron fortification in India. We believe Fortify Health, a young organization, may one day become a GiveWell top charity.
  • Four staff members visited Malaria Consortium, our current top recommendation for donors, to deepen our understanding of its seasonal malaria chemoprevention work in Burkina Faso.

We’re proud of what we accomplished last year and look forward to sharing our plans for 2020 in a forthcoming post. Additional details on our 2019 goals and progress are available here.

Notes   [ + ]

1. ↑ “We plan to look into several new areas in 2019, including public health regulation and possible paths to support government aid agencies…. We also plan to continue our investigation into possible paths to support government aid agencies; in particular, we plan to complete an investigation into an opportunity to do so in the area of results-based financing.” GiveWell blog, GiveWell’s plans for 2019, May 16, 2019 function footnote_expand_reference_container() { jQuery("#footnote_references_container").show(); jQuery("#footnote_reference_container_collapse_button").text("-"); } function footnote_collapse_reference_container() { jQuery("#footnote_references_container").hide(); jQuery("#footnote_reference_container_collapse_button").text("+"); } function footnote_expand_collapse_reference_container() { if (jQuery("#footnote_references_container").is(":hidden")) { footnote_expand_reference_container(); } else { footnote_collapse_reference_container(); } } function footnote_moveToAnchor(p_str_TargetID) { footnote_expand_reference_container(); var l_obj_Target = jQuery("#" + p_str_TargetID); if(l_obj_Target.length) { jQuery('html, body').animate({ scrollTop: l_obj_Target.offset().top - window.innerHeight/2 }, 1000); } }

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Why ongoing assessment of top charities leads to more impact: HKI’s vitamin A supplementation program

Wed, 04/29/2020 - 08:01

Charities must meet rigorous requirements to make our list of top charities. However, a common misconception about our work is that our assessment process ends with the naming of a top charity. Not so! We continually examine our top charities—in fact, four staff members are devoted to ongoing assessment of our top charities. We collect information to update our assessment of our top charities’ track records and to evaluate the effectiveness of their spending plans.

Continuous assessment is critical because we direct donations to our top charities on an ongoing basis. Donors can make a gift anytime throughout the year, and we want to ensure their support is directed to the charity or charities that will best use it. We formally assess where funds can be best used each quarter when we allocate “Grants to recommended charities at GiveWell’s discretion” (discretionary funds).

We allocate discretionary funds based on our understanding of charities’ spending plans and their estimated cost-effectiveness. This is heavily informed by our understanding of the cost-effectiveness of the charities’ past work and track record to date. Although our understanding of charities’ spending plans is a key part of our allocation decision, we don’t restrict discretionary funds to a particular purpose within the program we recommend. Organizations may reallocate GiveWell-directed funding as new information becomes available.

This post will highlight how this combination of continual assessment and flexible funding leads to positive outcomes by sharing the recent example of our work with Helen Keller International (HKI)’s vitamin A supplementation (VAS) program, one of GiveWell’s top charities.

HKI’s vitamin A supplementation program

In late 2019, we allocated discretionary funding from GiveWell donors to HKI to support VAS campaigns in Bauchi State, Nigeria, from 2020 to 2022. VAS campaigns target preschool-aged children and are most impactful in areas with high rates of vitamin A deficiency. The World Health Organization recommends that children in these areas receive vitamin A supplements two to three times per year.[1] We recommend HKI’s VAS program because we believe that VAS reduces children’s mortality from infectious disease.[2]

HKI told us in July 2019 that VAS campaigns were ongoing in Bauchi State but that a 2018 government survey found very low coverage rates there. At the time of the survey, only 30% of individuals targeted for VAS in Bauchi State received it. HKI proposed to help government-run VAS campaigns in Bauchi State achieve higher coverage rates.[3]

HKI had a strong track record of impact and we estimated that its work in Bauchi State would be highly cost-effective. We decided to grant discretionary funds to HKI’s VAS program. Although we expected $2.4 million of GiveWell-directed funding to be used in Bauchi State, we did not formally restrict HKI to spending it there.[4]

Before it began GiveWell-supported work in Bauchi State, we asked HKI to conduct a baseline survey to measure coverage achieved by a November VAS campaign.[5] Our goal was to have a benchmark against which to assess the difference in VAS coverage due to HKI’s assistance in 2020 to 2022. This would help us assess HKI’s track record in the future.

HKI conducted the survey in December and found a surprisingly high coverage rate of 86 percent. It learned that another organization, Catholic Relief Services (CRS), had supported the November campaign in Bauchi State. We don’t know for sure, but CRS’ support may have led to the much higher coverage rate. HKI was not aware of CRS’ support prior to the survey.[6]

Whether due to CRS or not, if the same conditions that led Bauchi State to have high coverage in December continue going forward, the value of HKI assisting VAS campaigns there is much lower than HKI and we originally estimated.[7]

HKI proposed to redirect the funding that it would have otherwise spent in Bauchi State to another state in Nigeria, Nasarawa State, believed to have low VAS coverage—and to conduct a survey before working there, as well.[8]

Conclusion

Without the Bauchi State coverage survey leading to a change in course, GiveWell donors’ support may have had little impact. It seems plausible that Bauchi State may not have needed more funding, as it already had a high VAS coverage rate.

This experience illustrates how we assess whether our top charities are using additional funds well and how we support them in doing so. Our request for a baseline survey in Bauchi State to inform our assessment of HKI’s track record showed us and HKI that the funds would not be spent as effectively as expected and enabled HKI to redirect those funds to have more impact. We make similar requests of all eight of our top charities.

The post Why ongoing assessment of top charities leads to more impact: HKI’s vitamin A supplementation program appeared first on The GiveWell Blog.

GiveWell donors supported more than direct delivery: AMF and new net research

Thu, 04/23/2020 - 08:02

Supporters of the Against Malaria Foundation in recent years may have had even more impact than they expected.

The Against Malaria Foundation (AMF) is a GiveWell top charity because we believe its program to distribute insecticide-treated nets prevents people from dying of malaria. AMF-supported net distributions are incredibly cost-effective; we estimate that a $2,000-3,000 donation averts one death.[1] AMF’s work is important in and of itself to fund.

Not all AMF donations, however, just support typical net distributions. In recent years, AMF supported research on a new type of insecticide-treated net, the piperonyl butoxide (PBO) net. This research itself (i.e., researcher time, equipment, and administrative costs) was funded by a small number of AMF donors who explicitly agreed to support it. The research was conducted on nets that were contributed by a broad group of AMF donors.

Preliminary data suggest that PBO nets are more effective at preventing malaria than standard insecticide-treated nets in areas where mosquitoes have developed insecticide resistance. We think it is likely that AMF sped up the completion of a large-scale, high-quality study of these new nets.

We’re thrilled to recommend charities that contribute research in the fields in which they operate. AMF doesn’t just prevent deaths from malaria by distributing nets—it has improved our and others’ understanding of which nets can work best in the future. This post is to share this story with our donors, whose contributions make this work possible.

Summary

In this post, we’ll discuss:

  • Insecticide resistance and the potential of PBO nets. (More)
  • AMF’s role in PBO net research. (More)

What is insecticide resistance? How could PBO nets help?

AMF distributes insecticide-treated nets to prevent malaria. These nets, which are typically hung over sleeping spaces, block mosquitoes from biting. They’re also treated with insecticide to repel and kill mosquitoes.[2] There is strong evidence that insecticide-treated nets prevent malaria.

Mosquitoes’ resistance to standard insecticide seems to be rising.[3] We estimate (very roughly) that insecticide-treated nets are one-third less effective in the places where AMF works than they would be in the absence of resistance. (Even with this adjustment, we continue to estimate that AMF’s work is highly cost-effective.)[4] It has been challenging to estimate the precise degree to which insecticide resistance is reducing nets’ effectiveness due to a lack of high-quality evidence.[5]

A new type of net offers a promising countermeasure as well as some insight into the level of resistance. Piperonyl butoxide (PBO) nets contain the standard insecticide as well as PBO, which inhibits the enzymes in mosquitoes that enable insecticide resistance.[6] The World Health Organization (WHO) approved a small rollout of PBO nets in 2015. However, at the time, limited information was available on their performance relative to standard nets and the WHO did not recommend them universally over standard nets.[7]

The first randomized controlled trial (RCT) of PBO nets was conducted in Tanzania from 2014 to 2016 (Protopopoff et al. 2018).[8] The WHO conditionally recommended PBO nets in 2017 based on the Protopopoff findings. It said it needed to see results from another study before recommending that PBO nets be used in additional contexts.[9]

AMF’s role in PBO net research

AMF enabled another RCT of PBO nets by seeking research collaborators, serving as the primary funder of the research, and funding the nets in the study.

Although it is difficult to prove, it appears that AMF contributed to a second PBO RCT occurring earlier than it otherwise would have and at a larger scale.[10] If PBO nets are more effective than standard nets, rolling them out sooner and more broadly could avert many more deaths from malaria.

AMF told us that it was interested in funding research on PBO nets in 2015.[11] After supporting a small-scale initial study of PBO nets in the Democratic Republic of the Congo in 2016, AMF made a more significant investment as the primary funder of a large-scale RCT in conjunction with a planned 2017-18 national net distribution campaign in Uganda.[12]

In addition to supporting the study financially, AMF identified researchers to lead the study and managed procurement of the four different types of nets that were compared (two PBO nets and two standard nets). The national campaign by the Uganda Ministry of Health included millions of nets funded by AMF.[13] AMF also supported the first two follow-ups to the study, assessing the impact on malaria six and twelve months following the campaign.[14]

AMF’s participation seems to have sped up the pace of research on these nets. We think most researchers in this space would agree the Uganda study is the second major PBO RCT.[15] We are not aware of another RCT being conducted on PBO nets, nor have we heard of other actors offering to do this research. It is difficult to know by how much AMF may have sped up PBO research, but it seems likely that it did.

Our impression is that the number of people participating in AMF’s study is unusually large relative to typical RCTs of global health interventions. The Uganda RCT involved 10.2 million nets.[16] By contrast, the earlier Protopopoff study in Tanzania involved 90,000 nets.[17]

Finally, based on the study design, the Uganda RCT appears to be high quality.

The large scale and quality design suggest the results of this study will significantly update the field on the effectiveness of PBO nets and the degree to which insecticide resistance is reducing the effectiveness of standard nets. Other funders seem to agree on its promise. The U.K. Department for International Development and Gates Foundation each funded additional follow-ups to the study, tracking the impact of the PBO nets at 18- and 24-months post-distribution.[18]

The Uganda RCT could influence a large amount of government and philanthropic funding for malaria programs. We estimate that $2.1 billion was committed to nets globally between 2018 and 2020.[19] If PBO nets turn out to be more effective than standard nets and AMF contributed to speeding up this high-quality study, it could improve the effectiveness of a large amount of malaria prevention funding.

Conclusion

AMF shared preliminary findings from the Uganda study in November.[20] They’re promising. AMF reported that PBO nets were more effective at reducing malaria cases than standard nets six months after distribution (26% more), 12 months after distribution (27% more), and 18 months after distribution (16% more).[21] There will be one more measurement completed as part of this study.[22]

The full results from the Uganda RCT have not been published. We will review them closely and share our conclusions once they are available.

Our current best guess is that in many of the locations where AMF works, PBO nets are more cost-effective than standard nets. We estimate that in areas with sufficiently high insecticide resistance, the benefits of PBO nets outweigh the higher cost of these nets. We expect to revise our estimate of the cost-effectiveness of PBO nets once we have fully reviewed the results from the Uganda RCT. We look forward to seeing how the research community interprets these results and whether they conclude that PBO nets are a worthwhile investment. A possible sign of increased demand for PBO nets is that one manufacturer of PBO nets increased its production by a large amount in 2020, according to AMF.[23]

AMF’s work on PBO nets is one example of how our top charities can have more impact than expected. We’re thrilled to recommend our top charities based on the great work they do: not only on direct delivery of cost-effective programs, but also on new research to shape their fields of work.

The post GiveWell donors supported more than direct delivery: AMF and new net research appeared first on The GiveWell Blog.

Three grants in response to the COVID-19 pandemic

Tue, 04/21/2020 - 07:23

We began exploring opportunities to mitigate the effects of the COVID-19 (coronavirus) pandemic in March. We are excited to announce that we granted a total of $450,000 to support coronavirus-response projects run by Development Media International (DMI), IDinsight, and Yale professor Mushfiq Mobarak, respectively.

With our grant funding, we expect DMI to run or support mass media campaigns to promote essential health messages. We expect IDinsight and Professor Mobarak to support policymakers responding to the pandemic in low- and middle-income countries through data collection and analysis and by making recommendations.

Our goal at GiveWell is always to direct funding to maximize impact. This typically leads us to conduct thorough, monthslong investigations into potential grantees. However, in response to the coronavirus pandemic, we believe we can have more impact by acting quickly to prevent the spread of the disease—even if it means completing only relatively shallow grant investigations.

These three grants may save or improve lives as well as or better than our current top charities. Nevertheless, we are more uncertain about their potential impact, given our brief review. The $450,000 in grants is the full amount we’re comfortable directing to these opportunities at this time; we do not suggest additional donations beyond this amount today.

We remain very worried about the effects of the pandemic on non-coronavirus health programs as the global funding landscape shifts in response to coronavirus. The need for the programs operated by our top charities is already large and we are unsure if our top charities will receive less funding than usual in the coming year. We expect that our top charities will require significant additional resources to continue to carry out their programs.

Our recommendation to individual donors is thus unchanged: our top recommendation is to give to “Grants to recommended charities at GiveWell’s discretion,” which we will allocate quarterly among our recommended charities where we believe it will do the most good. For donors who prefer to give directly to a GiveWell top charity, we recommend Malaria Consortium’s seasonal malaria chemoprevention program. We do not expect to make coronavirus-specific recommendations for individual donors.

Why we made these three grants

Our process for identifying and assessing grant recipients

We focused our investigation on projects operating in low- and middle-income countries. After initial conversations, we believed the pandemic’s impacts would be more severe in these contexts than in high-income countries due to their already-overburdened health systems. Funding opportunities in low- and middle-income countries also seemed more likely to be equally or more cost-effective than our top charities, which work in the same contexts. This is an important point of comparison, as we expect that the coronavirus grant funding would have otherwise been given to our top charities.

We started with a broad look at potential opportunities to fund. GiveWell researchers spoke to around 30 people from our networks, such as staff at the Center for Global Development and the Abdul Latif Jameel Poverty Action Lab. We reached out to groups we had previously funded that we thought may be well positioned to contribute to coronavirus mitigation efforts we could support and asked about their plans and funding needs. We also received a number of inbound requests for funding.

We narrowed the list of potential grants based on the following:

  • We ruled out opportunities that we did not believe we had the expertise to assess well and quickly.
    • We deprioritized programs that looked significantly different from the types we’ve historically investigated, such as scientific research and development. We didn’t think we could make good, quick decisions about where to give in a space that was very new to us. Investigating new types of programs may require developing novel analytical frameworks in which we wouldn’t expect to feel confident in a short timeframe.
    • We deprioritized organizations we didn’t know well. We believe that thoroughly assessing an organization’s strength requires a significant time investment. We didn’t think we could become sufficiently knowledgeable about the coronavirus pandemic and all potential projects to be in a position to evaluate organizations we knew very little about.
  • Since thoroughly assessing a new organization was not compatible with our brief timeline for these grants, we prioritized organizations that we knew well and thought highly of.
  • We considered the likelihood the grant would be very cost-effective, based on our experience assessing similar interventions. For example, we believe programs to assist government policymakers may offer strong returns on investment, based on our initial investigations into policy organizations.
  • We considered whether the grant had a plausible theory of change. In other words, we considered whether we understood the case for how the grant would have an impact and if that case seemed reasonable.
  • We considered the likelihood the grant work would be funded without our support.

This led us to DMI, IDinsight, and Professor Mobarak. We feel these represent excellent opportunities to support coronavirus efforts. We decided to make relatively small grants to fill particularly urgent funding gaps in each case because (a) we know less about these grants than we would following a typical GiveWell investigation and (b) we have some reservations about the possibility that these grants are displacing funding from other donors. In each case, we may decide to make larger grants at a later date.

How the grants will be used

Development Media International: $200,000 grant

Our grant will support DMI’s work to run or support mass media campaigns, mostly over the radio, to promote handwashing, social distancing, and cough etiquette (also called “respiratory hygiene”) in nine African countries. There’s a common-sense argument that in countries where extreme social distancing is difficult, low-cost interventions like cough etiquette are particularly important. In addition, DMI has been a GiveWell standout charity since 2014.

We are excited to support DMI because it is an organization we know well and think highly of, there’s a common-sense case for this work, and our very rough cost-effectiveness analysis of this work looks promising.

IDinsight: $150,000 grant

Our grant will enable IDinsight, a development consulting group we partner closely with, to provide additional assistance to governments with their coronavirus response and to increase the amount of data IDinsight can collect to inform that response. Working with governments to improve responses to the pandemic may be highly cost-effective and a plausible way to have a lot of impact. Please note the relationship disclosure in the footnote.1We hired Dr. Neil Buddy Shah, IDinsight’s Founding Partner and CEO, as GiveWell’s managing director. We expect him to start at GiveWell this summer. Buddy is currently employed at IDinsight and provided information about and input on this grant. jQuery("#footnote_plugin_tooltip_1").tooltip({ tip: "#footnote_plugin_tooltip_text_1", tipClass: "footnote_tooltip", effect: "fade", fadeOutSpeed: 100, predelay: 400, position: "top right", relative: true, offset: [10, 10] });

Professor Mushfiq Mobarak: $100,000 grant

Mushfiq Mobarak is an economics professor at Yale who we worked closely with in our assessment of former top charity Evidence Action’s No Lean Season. Our grant to Professor Mobarak will enable him to either (a) hire a new analyst to help respond to coronavirus-related policy requests from the Bangladesh government or (b) collect additional data to inform the Bangladesh government’s response to coronavirus. As with IDinsight, we think that assisting governments may be a particularly effective and cost-effective way to have impact. We have a very positive opinion of Professor Mobarak from our previous engagement with No Lean Season.

What’s next?

Our focus is finding the most cost-effective ways to help people. We may make additional grants to these organizations or others in response to the pandemic. We also plan to continue our work to understand the effects of the pandemic on our current top charities.

Notes   [ + ]

1. ↑ We hired Dr. Neil Buddy Shah, IDinsight’s Founding Partner and CEO, as GiveWell’s managing director. We expect him to start at GiveWell this summer. Buddy is currently employed at IDinsight and provided information about and input on this grant. function footnote_expand_reference_container() { jQuery("#footnote_references_container").show(); jQuery("#footnote_reference_container_collapse_button").text("-"); } function footnote_collapse_reference_container() { jQuery("#footnote_references_container").hide(); jQuery("#footnote_reference_container_collapse_button").text("+"); } function footnote_expand_collapse_reference_container() { if (jQuery("#footnote_references_container").is(":hidden")) { footnote_expand_reference_container(); } else { footnote_collapse_reference_container(); } } function footnote_moveToAnchor(p_str_TargetID) { footnote_expand_reference_container(); var l_obj_Target = jQuery("#" + p_str_TargetID); if(l_obj_Target.length) { jQuery('html, body').animate({ scrollTop: l_obj_Target.offset().top - window.innerHeight/2 }, 1000); } }

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The impact of COVID-19 on GiveWell’s plans

Thu, 03/26/2020 - 10:08

We hope everyone is staying well during these difficult times. We are publishing this blog post to provide a brief update on how the COVID-19 (coronavirus) pandemic impacts our plans.

We are looking into the impact of the pandemic on the organizations we support as well as opportunities to mitigate its effects. We are in the early stages of this work and will update you as we reach conclusions.

We don’t have a new recommendation for donors: our bottom line continues to be to donate to “Grants to recommended charities at GiveWell’s discretion,” which we allocate quarterly to the highest priority need we see.

Monitoring the organizations we support

We are monitoring how the coronavirus pandemic is impacting the organizations we support. We’re in the early stages of seeing the myriad ways in which the pandemic is expected to impact their programs in 2020, such as:

  • Restrictions (mandated by government or self-imposed) on reaching program participants in their homes.
  • School closures that affect school-based deworming programs.
  • Reduced availability of government resources for organizations that typically rely on health ministries or government-run networks of health workers.
  • Additional costs for protective equipment for staff.
  • Challenges obtaining commodities for distribution.

The organizations we support are updating their program implementation plans in response to the coronavirus. One of our top charities, the Against Malaria Foundation, suspended the monitoring it typically conducts after distributing malaria nets for at least one month in Ghana, though it says its overall operations have been minimally impacted so far. Another top charity, GiveDirectly, paused door-to-door operations for its cash transfer program and has begun exploring a contactless operational model to prevent the spread of the virus.

We are working to get a complete picture of the effects of the coronavirus on the organizations we support so that we can update our assessment of their funding needs and expected impact. Overall, we expect low- and middle-income countries, in which our charities operate, to have greater funding needs for healthcare in 2020 due to the coronavirus.

Exploring opportunities to mitigate the effects

We are also exploring opportunities to mitigate the effects of the coronavirus pandemic. Consistent with our usual practice for assessing giving opportunities, we are prepared to make new grants or to work with partners to reallocate our funding if there appear to be more cost-effective uses than the program to which we’d otherwise direct funds. These opportunities could explicitly target the coronavirus and its broader health and economic effects or could respond to its impact on the funding landscape for global health and poverty alleviation.

We are unsure if we will find new cost-effective giving opportunities that haven’t received government or philanthropic funding. If we do, we will report on any grants or funding decisions we recommend as a result of our investigation.

We are open to the landscape of opportunities in 2020 looking different than we expected before the pandemic. That said, we expect a continued need for funding for the programs implemented by the organizations we support.

Continuing our work

Thanks to our donors’ generous support of GiveWell’s own operations—enabling us to pay our staff to conduct research, process donations, and keep the lights on—we remain in a solid financial position. We expect to fundraise to ensure we can continue our work over the long term, but we don’t expect the pandemic to have a direct effect on our ability to do our work. We remain dedicated to our mission of finding and recommending highly cost-effective giving opportunities, and we’ll keep you posted, as we always do, on our findings. In the meantime, please stay safe and be well.

The post The impact of COVID-19 on GiveWell’s plans appeared first on The GiveWell Blog.

Allocation of discretionary funds from Q4 2019

Tue, 03/17/2020 - 07:53

We recently allocated donations made from October through December 2019 to “Grants to recommended charities at GiveWell’s discretion.” We granted $11.9 million to Malaria Consortium’s seasonal malaria chemoprevention program and $1.5 million to Helen Keller International’s vitamin A supplementation program.

We allocate donations to “Grants to recommended charities at GiveWell’s discretion” (discretionary funds) quarterly, according to where we see the highest-priority funding needs. Malaria Consortium’s seasonal malaria chemoprevention (SMC) program and Helen Keller International (HKI)’s vitamin A supplementation (VAS) program had the top-priority needs among our top charities at the time we made this decision.

Malaria Consortium provides preventive anti-malarial medication to young children during the time of year when malaria transmission is highest. HKI supports provision of vitamin A supplements to young children, which reduces their risk of dying of infectious disease.[1] We estimate that the combined discretionary grants to these organizations will save 5,600 lives.[2]

In this post, we discuss:

  • Our process for deciding where to allocate discretionary funds. (More)
    • We share updates on:
      • HKI’s VAS program. (More)
      • Malaria Consortium’s SMC program. (More)
      • SCI Foundation. (More)
    • We also discuss uncertainties in our decision. (More)
  • Our bottom line for donors giving today. (More)
Our process for deciding where to allocate discretionary funds

GiveWell donors gave $13.4 million in discretionary funds in the fourth quarter of 2019. We decide how to allocate discretionary funds by reviewing which of our top charities’ unmet funding needs, or “funding gaps,” are the most cost-effective and time-sensitive.

In January 2020, we asked HKI, Malaria Consortium, and SCI Foundation (SCI) for updates on their funding needs. We asked HKI and Malaria Consortium because we estimated that their unfunded work was highly cost-effective relative to that of our other top charities.[3] We asked SCI for information because we had pledged to revisit its funding needs in early 2020 (details below). We did not request updated funding information from our other five top charities. We discuss below what we have learned this year about the funding gaps at HKI, Malaria Consortium, and SCI.

In addition to our proactive requests for more information, we have asked our top charities to inform us when they have new funding opportunities we should consider. We were not informed of any opportunities this quarter outside of the information we received from HKI, Malaria Consortium, and SCI.

HKI’s VAS program

In 2019, HKI told us that it did not expect Global Affairs Canada (GAC) to renew its support for VAS programs in Côte d’Ivoire and Kenya from 2020 onward. HKI confirmed in January 2020 that GAC had not renewed its funding.[4]

We consider HKI’s VAS program in Côte d’Ivoire to be highly cost-effective.[5] Our top priority for fourth-quarter discretionary funds is filling the $1.5 million funding gap left by GAC in Côte d’Ivoire from 2020 to 2022.[6]

Malaria Consortium’s SMC program

We incorporated the following information into our estimate of Malaria Consortium’s funding needs in January 2020: a $33.9 million grant we recommended in November 2019; the revenue Malaria Consortium raised through the end of 2019; and Malaria Consortium’s updated budgets for 2020 to 2022.

We estimate that Malaria Consortium can now effectively absorb approximately $36 million for SMC programs in 2022 in Burkina Faso, Chad, Nigeria, and Togo.[7] This $36 million funding gap has the highest estimated cost-effectiveness among our top charities’ funding gaps after HKI’s work in Côte d’Ivoire.[8] We allocated the remaining $11.9 million in fourth-quarter discretionary funds to Malaria Consortium’s SMC program as our second priority.

SCI Foundation

We wrote in November 2019 that SCI had not, at that time, identified opportunities to effectively absorb additional funding. We moved it to a new, separate category off of our top charities list: “Top Charities without capacity to use new donations effectively at this time.”

We also decided to wait until 2020 to consider whether to make an “incentive grant” to support SCI’s work.[9] Subject to charities’ ability to use additional funding, we recommend annual “incentive grants” to each of our top charities to reward them for engaging in our intensive review process.[10] We were not confident in late 2019 that SCI could use additional funding.

SCI recently shared new information about funding gaps in the countries where it works. We now believe SCI can likely absorb additional funding (though we are uncertain about its total funding needs) and plan to recommend that it receive a standard $2.5 million incentive grant. We also moved SCI from the “Top Charities without capacity to use new donations effectively at this time” category to the regular top charities list.

We decided not to make SCI’s incentive grant out of our fourth-quarter discretionary funding. We recently received an $8 million donation that is partially restricted to GiveWell’s “top life improving nonprofit/s,” of which SCI is one. We estimate that our top charities that focus on programs to reduce mortality, such as HKI’s VAS program and Malaria Consortium’s SMC program, have more cost-effective funding gaps at this time, and we prefer to save our non-restricted discretionary funding for them.

Uncertainties in our decision

HKI’s VAS program

We don’t know whether, in the absence of a GiveWell grant to HKI, VAS campaigns in the districts formerly funded by GAC would be skipped or if HKI would reallocate other available funding to support these campaigns. Reallocation of HKI’s available funding would make its funding gap in Côte d’Ivoire less time-sensitive but would leave funding gaps for other work in a year or two. These new gaps would be our top priority to fill due to their high cost-effectiveness.

We haven’t resolved this question because we believe our discretionary grant to HKI will support the most cost-effective unfunded work we are aware of, regardless of time-sensitivity.

Malaria Consortium’s SMC program

We believe that our estimate of Malaria Consortium’s funding gap represents the maximum amount it can absorb effectively for its SMC program ($36 million). GiveWell donors’ $11.9 million discretionary grant will close some of this gap.

It is possible that other funders will also step in to fill some of this gap. In particular, we believe that one funder that supported SMC coverage in part of Burkina Faso in 2020 may choose to extend its support through 2022; this would decrease Malaria Consortium’s room for more funding by around $8 million. Even if this occurs, Malaria Consortium would still have a significant unfilled gap ($16.1 million) for its work in 2022.[11]

We thus expect that donations to Malaria Consortium today will support its work in 2022, which we generally expect to be highly cost-effective.

Our bottom line for donors giving today

We continue to recommend that donors give to “Grants to recommended charities at GiveWell’s discretion.” We direct these funds where we believe they can be used most effectively.

For donors who wish to give to a specific charity, we recommend Malaria Consortium’s SMC program, as we believe it continues to have a highly cost-effective and large unfilled funding gap after receiving GiveWell discretionary funding.

Footnotes

Footnotes for this post may be found here.

The post Allocation of discretionary funds from Q4 2019 appeared first on The GiveWell Blog.

March 2020 open thread

Tue, 03/10/2020 - 12:34

Our goal with hosting quarterly open threads is to give blog readers an opportunity to publicly raise comments or questions about GiveWell or related topics (in the comments section below). As always, you’re also welcome to email us at info@givewell.org or to request a call with GiveWell staff if you have feedback or questions you’d prefer to discuss privately. We’ll try to respond promptly to questions or comments.

You can view our December 2019 open thread here.

The post March 2020 open thread appeared first on The GiveWell Blog.

How did we do in 2019? A preliminary look at our growth.

Thu, 02/20/2020 - 12:04

We see an early indication that GiveWell continued its trajectory of robust donor growth last year. The total value of donations processed by GiveWell increased 30% in 2019.[1]

We’re sharing this data now because we believe it is an informative early update about our growth last year. However, GiveWell-processed donations don’t tell the full story of our impact. Many donors who rely on our research give via our partner organizations or directly to our top charities. Their gifts account for the majority of donations due to our work and are not processed by GiveWell. Information about these gifts is time-consuming to gather and has usually led us to release our metrics data many months after the end of the year. We plan to release a complete 2019 metrics report and assessment of our impact, including donations not processed by GiveWell, later this year.

Here’s what we know so far, based on the nearly complete information we have about donations we processed:

  • We processed $54.1 million in donations in 2019. Sixty-five percent of this amount was restricted to our recommended charities and 35% was unrestricted, which we may use to support GiveWell’s operations.
  • Support from donors giving $10,000 to $100,000 comprised the largest proportion of our growth (35%).[2]
  • Returning donors who gave more than last year made up 75% of our growth in funds donated (excluding anonymous donations).[3]
  • We believe that the majority of our growth was organic and would have occurred without any outreach and marketing efforts from GiveWell, although we can attribute some to specific outreach and marketing initiatives.[4]

We’re encouraged by this growth and excited to write about it. We also discuss below some ways that GiveWell-processed donations could be a misleading indicator of our overall impact.

Summary

This post covers the following topics:

  • About GiveWell-processed donations (More)
  • Donations we processed in 2019
    • Restricted donations by donor size (More)
    • Unrestricted donations by donor size (More)
    • New donors and returning donors (More)
  • Ways in which these data are incomplete (More)
  • Additional information: Where did donors give? (More)
About GiveWell-processed donations

This is our first time releasing information on GiveWell-processed donations as a standalone post.

It is very time-consuming to gather and analyze information from the many disparate sources through which GiveWell donors can support GiveWell and our recommended charities.[5] We have generally shared reports on donations due to our work quite late in the year as a result.[6]

We do have nearly complete information at this point of the year on GiveWell-processed donations in 2019. We’re experimenting with sharing this information as an early look at our impact.

What is included in GiveWell-processed donations?

The $54.1 million only includes donations that we processed ourselves, such as gifts that were made by credit card on our website, bank transfers to GiveWell’s account, checks made out to GiveWell, and other options listed here.[7] It includes both restricted and unrestricted donations:

  • Restricted: A donor tells us to use the gift for one or more of our top charities or for “Grants to recommended charities at GiveWell’s discretion,” which we allocate quarterly to the recommended charity or charities with the most pressing needs.
  • Unrestricted: A donor does not place any restrictions on the donation. We may use the donation for GiveWell’s operations or grant it to charities.

The $54.1 million does not include gifts that were made directly to our recommended charities or via our partner organizations.[8] Additional ways in which GiveWell-processed donations may not tell the full story of our impact are discussed below.

Our impact: donations we processed

Restricted donations: by donor size

We saw strong growth in 2019 in restricted donations across donor size categories under $1 million.[9] Most donors making restricted donations of $1 million or more give directly to our top charities and not through GiveWell; we discuss this in greater detail below.

Note: Anonymous donations are only tracked in the penultimate row and are not reflected in the other size category totals.[10]

Note: This table excludes all anonymous donors.

Unrestricted donations: by donor size

The largest absolute growth (just over $1 million) and relative growth (69%) in unrestricted donations was from donors giving between $100,000 and $1 million. We explain the slight decline in unrestricted donations from donors giving more than $1 million in the following footnote.[11]

Note: Anonymous donations are only tracked in the penultimate row and are not reflected in the other size category totals.

The total number of non-anonymous donors providing unrestricted gifts increased by 22%, with the strongest relative growth (34%) in the number of donors giving between $1,000 and $10,000.

Note: This table excludes all anonymous donors.

New donors and returning donors

Returning donors increasing their donations drove approximately 75% of our growth in funds donated, excluding anonymous donations. Funds from new donors increased more than 40% over the previous year and accounted for approximately 25% of our total growth in non-anonymous funds donated.

Note: This chart shows total donations by new and returning donors, as well as from anonymous donors who cannot be included in either category, as a percentage of all donations (restricted and unrestricted).

How GiveWell-processed donations don’t tell the full story

While we see GiveWell-processed donations as an early indicator of strong growth, we have significant uncertainty about the final picture of our influence in 2019.

Donors giving over $1 million have tended to donate directly to our recommended charities rather than through GiveWell, and so are not well-represented in GiveWell-processed donations.[12] They have also accounted for a large proportion of our impact each year as major contributors to our recommended charities. This group made up roughly one-third of our money moved to recommended charities in 2018, excluding donations from Open Philanthropy.[13] Our best guess is that growth among donors giving under $1 million is related to growth among donors giving over $1 million—if more donors are giving to GiveWell in general, we think it’s likely that additional larger donors will find our work. However, we’re unsure of the extent to which 2019 donors who gave under $1 million are predictive of the 2019 donors who gave over $1 million directly to our recommended charities.

Another way in which GiveWell-processed donations could fail to predict our overall growth is if donors shifted how they gave in 2019. If a greater proportion of donors chose to give through GiveWell in 2019, extrapolating from the proportion of GiveWell-processed donations in previous years to our total impact in 2019 would be overly optimistic. Although we don’t expect this to be the case, we won’t know for sure until we see the complete data from 2019.

Additional information: Where did donors give in 2019?

Restricted gifts accounted for $35 million of the $54.1 million we processed last year. Donors allocated 64% of restricted dollars in 2019 to “Grants to recommended charities at GiveWell’s discretion,” which was (and is) our top recommendation for GiveWell donors.

The remainder of the $54.1 million ($19.1 million) was unrestricted. We typically use unrestricted funding for our operations, though some of these funds will likely be granted to charities.[14]

Footnotes

Footnotes for this post may be found here.


Devin Jacob co-authored this post.

The post How did we do in 2019? A preliminary look at our growth. appeared first on The GiveWell Blog.

Introducing our new Managing Director: Dr. Neil Buddy Shah

Thu, 02/06/2020 - 08:05

I’m very excited to announce that Dr. Neil Buddy Shah is joining GiveWell as Managing Director starting this summer.

We’re beyond thrilled that Buddy, a leader in the global health and development space, has chosen to be part of our team at this exciting time. We have significantly expanded our research focus over the past few years to identify high-impact giving opportunities beyond our current top charities list. In addition to working with me to set our strategy generally, a core component of Buddy’s work will be pushing our research and funding expansion forward by leading GiveWell’s efforts to learn from and contribute to the broader international development community.

He is exceptionally qualified to do so. Buddy has spent the last eight years as Founding Partner and CEO of IDinsight, a group GiveWell has worked closely with and supported through our Incubation Grants program. We’re confident that IDinsight will continue to do great work over the coming years.

Buddy is now heading the leadership transition process at IDinsight. He expects to join GiveWell around July. Welcome to the team!

About Buddy

Buddy’s impressive biography speaks to his commitment to and accomplishments in the global development sector. In addition to co-founding and leading IDinsight, a nearly 200-person organization dedicated to using data to improve international development programs and funding, he helped conceptualize and launch many of IDinsight’s contributions to the sector, including “decision-focused evaluations,” “embedded learning partnerships,” machine learning applications, and IDinsight’s large-scale, tech-enabled rural data collection infrastructure, “Data on Demand.”

Buddy has designed and co-led IDinsight engagements across Asia and Africa, working as a trusted advisor to senior leaders within national government ministries, multilaterals, foundations, and NGOs. He split his time between Cambodia, India, and Uganda while launching IDinsight’s first projects.

Before co-founding IDinsight, Buddy worked in the World Bank’s Governance and Public Sector Reform Unit and at MIT’s Abdul Latif Jameel Poverty Action Lab (J-PAL). He holds an AB in economics from Harvard, an MD from Albert Einstein College of Medicine, and an MPA in International Development from Harvard Kennedy School. Buddy is a term member of the Council on Foreign Relations and serves as visiting faculty in Harvard Kennedy School’s Executive Education program.

Buddy’s role

Buddy will work closely with me to set GiveWell’s high-level strategy: our goals and plans for achieving them. I expect that his success in founding, growing, and running a large non-profit will make him an excellent partner in this work. I have no plans to fundamentally change my role at GiveWell; Buddy will provide additional capacity and insights.

Another significant part of Buddy’s role will be engaging with the international development community. Although we have engaged regularly with the community over the past 12+ years, we haven’t made it a strategic priority to learn from and contribute to the community’s conversation about doing as much good as possible and to fund opportunities in support of that goal—until now.

Buddy plans to meet with leaders at development institutions, write op-eds and articles to raise our profile and share our findings, speak at key conferences, and identify opportunities to co-fund grants with others in this space. We believe this engagement will increase the impact of our work in a number of ways, including by:

  • Learning from the community. How can we improve our methodology? Which programs, charities, and grants should we evaluate?
  • Increasing the reach of our findings and methodology by proactively sharing with a community of people dedicated to poverty alleviation and global health.
  • Uncovering promising funding opportunities in global health and development and leading GiveWell’s grantmaking process to support them.
  • Raising our profile so that we can connect with great job candidates who will increase our impact.

We’re excited about all we expect Buddy to accomplish at GiveWell and look forward to having him on the team.

The post Introducing our new Managing Director: Dr. Neil Buddy Shah appeared first on The GiveWell Blog.

Why it’s important to think through all of the factors that influence a charity’s impact

Mon, 01/13/2020 - 08:51

Charity evaluation is rarely straightforward. Many factors, within a charity’s control or outside of it, can influence the impact a charity has.

This blog post will highlight a case that illustrates how thinking through these factors can lead to surprising information that changes our understanding of a charity’s impact.

Summary

GiveWell recommended a grant to Results for Development (R4D) in May 2016 for its recently-launched program to increase access to pneumonia treatments for children in Tanzania. We thought this program was promising enough to potentially join our short list of GiveWell top charities once we had more information on its impact.

Expanded access to treatments is a factor in reducing child mortality from pneumonia, but not the only factor. We ultimately want to know not just whether more pneumonia treatments are available in Tanzania, but whether fewer children die of pneumonia as a result of R4D’s work. We expect the program to best achieve this impact if pneumonia patients visit health clinics with treatments in stock and are diagnosed and treated correctly.

We learned as we followed R4D’s work that there was limited information available on the accuracy of clinicians’ pneumonia diagnoses. We initially guessed that clinicians were diagnosing pneumonia accurately around 80 percent of the time. R4D collected data on diagnostic accuracy and we learned that the rate of accurate pneumonia diagnosis was actually 18 percent. This caused our estimate of the program’s impact to fall, though it remains in the range that we look for in potential top charities.

This finding highlights why it’s important to think through all of the factors along the path from a charity’s activities to its ultimate impact; if we had just considered whether more treatments were available, we would have missed this part of the story. We’re excited to continue following R4D’s work because of the role it has played in collecting this information to date and our expectation that it will continue collecting information that allows us to estimate its impact on the availability of pneumonia treatments across Tanzania. We expect to consider R4D as a potential future top charity.

In this post, we discuss:

  • The background for GiveWell’s grant to R4D (More)
  • Our plans for assessing the impact of R4D’s program (More)
  • Approaches to measuring R4D’s impact (More)
  • Lessons from this work (More)
Grant background

Pneumonia is a leading cause of children’s death worldwide.[1] R4D approached us in 2015 and told us that Tanzania did not have sufficient funding to maintain an adequate supply of pneumonia treatments in the country’s public sector health system.[2] R4D was interested in providing market-shaping technical assistance and catalytic, time-limited funding for pneumonia drug supplies, with the goal of improving the availability of drugs in order to avert more deaths.[3]

We recommended a GiveWell Incubation Grant in May 2016 of $6.4 million to support the first phase of R4D’s scale-up of pneumonia treatments in Tanzania. We thought R4D might meet our top charity criteria once we had more information with which to assess its impact.[4]

How will we know if R4D is reducing deaths from pneumonia?

Funding the purchase of additional pneumonia treatments would seem a simple solution to the inadequate supply of the drugs. But to truly assess the impact of the program on reducing child mortality from pneumonia, we wanted to understand:[5]

  1. Would R4D increase the availability of pneumonia treatments?
  2. Would clinicians diagnose pneumonia accurately? (We initially estimated 80 percent accuracy in diagnoses in the public and private sectors.[6])
  3. Would clinicians prescribe pneumonia treatments to people who needed them?

The second and third questions relate to factors outside of the scope of R4D’s program, which aimed to increase the availability of treatments. However, they play an important role in R4D’s success in reducing deaths from pneumonia.

We were surprised by how difficult it was to answer the second and third questions. There did not appear to be existing data from Tanzania on pneumonia diagnosis and treatment and it was challenging to design effective ways to measure them.

Gathering information

A common story we hear is that many charities do not conduct surveys to verify whether they’re reaching program participants and having the hoped-for impact because:

  • donors don’t want to pay for monitoring; or
  • charities don’t want to implement monitoring: it’s time-consuming, expensive, and not clearly in demand from donors.

Neither was true in this case. We were interested in funding measurement of the rates of accurate diagnosis and treatment. R4D was interested not only in implementing the measurement, but in taking the lead on developing creative ways to tackle questions about the program’s impact. The latter is rare in our experience. When we have asked charities how they monitor their work, we have often been told that the charity simply knows its program works.

Initial plans

R4D initially planned to use health clinic records to see whether pneumonia treatments were increasing due to its program and whether those treatments were correctly prescribed.[7] However, R4D found in an initial investigation that these records were incomplete and thus did not indicate whether the intended impact was occurring.[8]

R4D considered and decided against a number of other means of assessing whether children who had pneumonia received treatment, such as video-recording clinicians (which was rejected due to anticipated challenges in obtaining consent for patients), surveying patients outside of health clinics (which was rejected due to its cost and anticipated challenges with patient recall), and conducting a high-quality study focused on child mortality (which was rejected due to the high cost of running a sufficiently large study).[9]

Eventual solution

R4D next partnered with IDinsight, another GiveWell Incubation Grant recipient, to develop a new approach to gathering this information.[10] Working with IDinsight, the government of Tanzania, and the Tanzanian national medical school, R4D used lung ultrasounds, which directly tested whether patients with respiratory symptoms had pneumonia, to measure the accuracy rate for clinicians’ pneumonia diagnoses—a neat solution.[11]

The lung ultrasound information yielded surprising results. The rates of accurate pneumonia diagnosis were quite low. Only 18 percent of children with pneumonia confirmed by lung ultrasound were correctly diagnosed.[12]

Getting the full picture

Even that, however, didn’t tell the full story. If we had just looked at diagnostic rates and assumed that incorrect diagnosis leads to incorrect prescription of treatment, then we would have missed another important element of the story: many children who were not diagnosed with pneumonia were still prescribed the right drug to treat pneumonia. When they had the pneumonia treatment in stock, clinicians prescribed it in 46 percent of cases in which they had incorrectly diagnosed a child as having something other than pneumonia. We are unsure why.[13]

Our estimate of the cost-effectiveness of R4D’s pneumonia program fell by 27 percent when we updated it to reflect this new information.[14]

A broader question

The importance of looking for factors that influence impact across a charity’s causal chain, whether under the charity’s control or not, is not unique to pneumonia, nor Tanzania, nor R4D. For example, when we try to understand whether GiveWell top charity Against Malaria Foundation‘s work to prevent malaria by supplying insecticide-treated nets results in fewer people dying of malaria, we think through all the parts of the process that could fail. We aim to do this for our other top charities, as well.

Our estimate of R4D’s pneumonia program’s cost-effectiveness remains in the range that we look for in potential top charities and we’re excited to continue following its work.[15] But without the new information on diagnostic accuracy, we, R4D, and the government of Tanzania might have gotten an incorrect picture of its impact.

We made another grant to R4D in January 2019 to support the second phase of the pneumonia treatment program. We forecast a 40 percent chance that R4D (as a whole) or one of its specific programs (like pneumonia treatment) is a top charity by December 2023.[16] As we move forward, we plan to continue to ask ourselves all of the ways this grant might have more or less impact, as we did before, and as we do in all cases.

Sources

Sources for this post may be found here.

The post Why it’s important to think through all of the factors that influence a charity’s impact appeared first on The GiveWell Blog.

Update on our work on Fistula Foundation

Thu, 01/02/2020 - 10:06

Although our list of top charities is short (just eight excellent organizations), we’re always on the lookout for other groups to add. Fistula Foundation is one of the charities we’re planning to prioritize highly for further evaluation. Donating to Fistula Foundation is not yet one of our recommendations—as it’s still under active investigation—but we’re excited to share an update on our work so far and next steps.

Living with fistula

An obstetric fistula is an abnormal opening between the vagina and the bladder or rectum, which causes leakage of urine and/or feces through the vagina.[1] This type of fistula[2] is typically caused by a prolonged obstructed labor in which the fetus presses on the mother’s pubic bone and cuts off blood flow to the tissue nearby.[3]

Living with fistula may cause harm in many ways: physically, through skin conditions and constipation; economically, as it may be hard to get or keep a job, due to odor; and socially, as fistula is associated with divorce and isolation, also due to the odor.[4] Describing a fistula patient’s experience in 2016, New York Times columnist Nicholas Kristof referred to people with fistulas as “modern-day lepers.”[5]

Surgery may be used to repair fistulas in many cases.[6] Fistula Foundation supports fistula repair surgeries and a variety of activities to increase the number of fistula patients who receive treatment.[7]

GiveWell and Fistula Foundation

We first reviewed Fistula Foundation as a potential top charity in 2011, two years after it expanded its mission to treat fistula globally.[8] We decided that it did not then meet our strict top charity requirements due to our uncertainty about the success of surgeries and our lack of confidence in the degree to which Fistula Foundation’s support caused surgeries to take place that otherwise would not have.[9]

Our charity review process evolved over the years that followed. We began placing more emphasis on completing independent evidence reviews for promising programs as a first step in our research process, before looking at individual charities implementing the most promising programs that we identify: our “priority programs.”

As part of our work to complete more evidence reviews, we looked into surgery to repair obstetric fistula in 2017. We estimated that fistula surgery was potentially in the range of cost-effectiveness of our priority programs, although we had major open questions about the cost of surgery and patients’ long-term outcomes.[10] Despite these questions, we felt that fistula surgery met our criteria to be named a priority program and we continued our work to better understand it.

We partnered with a group called IDinsight through GiveWell’s Incubation Grants program to improve our understanding of the cost of fistula surgery. This was particularly challenging for us to estimate due to our uncertainty over (a) the cost to reach potential patients, who may be in remote areas and socially disconnected, and (b) the costs and impact of training surgeons and providing equipment (typical activities conducted by fistula management charities) on the long-term success of the surgeries.[11] Though we were interested in fistula management charities broadly, IDinsight identified Fistula Foundation as a promising group and produced an estimate of Fistula Foundation’s cost per surgery in Kenya, including outreach and indirect costs such as training.[12]

Our evidence review and work with IDinsight led us to revisit Fistula Foundation as a potential top charity. We made a $100,000 participation grant to Fistula Foundation after publishing an interim review of its work.[13]

Top charity contender

We consider Fistula Foundation a top charity contender. Our next steps are to determine which evidence will help us understand the effect Fistula Foundation’s programs have had on the number of surgeries performed, which is a key input into our understanding of its cost-effectiveness, and to review recent studies on the impact of fistula surgery at one to two years post-surgery.

Our open questions and next steps

Open questions

We plan to prioritize several key questions as we continue our review of Fistula Foundation. We want to better understand:[14]

  • the role Fistula Foundation plays in supporting additional surgeries;
  • the long-term outcomes of surgeries supported by Fistula Foundation;
  • the counterfactual impact of Fistula Foundation (i.e. the degree to which it is increasing the number of fistula surgeries performed, relative to what would have occurred in its absence); and
  • the opportunity costs of fistula surgery (e.g. what the doctors who treat fistulas would have done in the absence of this program).

Next steps

We’re unsure when we will complete our review. The timing will depend on our overall research capacity as well as how we prioritize Fistula Foundation alongside review of other potential top charities. We very roughly estimate that there’s a 30% chance we will review Fistula Foundation in 2020.

We’re still in the process of vetting Fistula Foundation and have more confidence in our current list of top charities. We’re excited to continue learning about the work of this promising organization in the future.

Sources

Sources for this post may be found here.

The post Update on our work on Fistula Foundation appeared first on The GiveWell Blog.

Allocation of discretionary funds from Q3 2019

Thu, 12/19/2019 - 11:18

In the third quarter of 2019, donors gave a combined $2.6 million to GiveWell for granting to recommended charities at our discretion. We greatly appreciate this support, which enables us to direct funding where we believe it can be used most impactfully. We grant this funding to one or more of our top charities each quarter.

We decided to allocate all $2.6 million to Helen Keller International’s (HKI) vitamin A supplementation (VAS) program. HKI is a GiveWell top charity that supports provision of vitamin A supplements to young children, reducing their likelihood of dying from infectious disease. It does so by providing technical assistance, engaging in advocacy, and contributing funding to government-run VAS programs in sub-Saharan Africa. We based our decision on our estimate of the high cost-effectiveness of the work HKI expects to conduct with this funding.

We provide an updated recommendation for donors below.

Summary

In this post, we discuss:

  • what HKI will do with this funding. (More)
  • our process for deciding where to allocate funds. (More)
  • our bottom line for donors giving today. (More)

Unlike other quarters, we made our decision of where to allocate third-quarter (Q3) discretionary funding alongside annual updates to our list of top charity recommendations, which we published in November. As part of our annual update, we provided a recommendation to Open Philanthropy, a philanthropic organization that is a major supporter of our top charities, about how it should allocate funding to each of our top charities in 2019. We reference this recommendation below.

What will HKI do with this funding?

In addition to granting $2.6 million in Q3 discretionary funding, in November 2019, we recommended that Open Philanthropy grant $9.7 million to HKI’s VAS program, for a total of $12.3 million. This funding will enable HKI to spend:

  • $5.5 million to continue its work in five countries (Guinea, Mali, Burkina Faso, Côte d’Ivoire, and Niger), including supplementing its budgets in 2020 and 2021 and extending its funding runway to 2022.
  • $4.5 million to start a new program in the Democratic Republic of Congo, with funding to cover 2020-2022.
  • $2.4 million to expand its program to Bauchi State, Nigeria, with funding to cover 2020-2022.

We believe that Q3 discretionary funding will be pooled with the Open Philanthropy grant to enable the above; we don’t restrict discretionary funds to a particular piece of HKI’s VAS work, and see all of the above as valuable.

This work is highly cost-effective. We estimate that it is 28 times as cost-effective as cash transfers (“28x cash”)1We use the unconditional cash transfer program implemented by top charity GiveDirectly as a benchmark for comparing the cost-effectiveness of different programs. When discussing cost-effectiveness, we generally refer to the cost-effectiveness of a program in multiples of “cash.” jQuery("#footnote_plugin_tooltip_1").tooltip({ tip: "#footnote_plugin_tooltip_text_1", tipClass: "footnote_tooltip", effect: "fade", fadeOutSpeed: 100, predelay: 400, position: "top right", relative: true, offset: [10, 10] }); overall, and, by country, ranges from 19x cash to 38x cash.2Estimates of the cost-effectiveness of each funding gap can be found in this spreadsheet, sheet “List of funding gaps.” See column AB, rows 38-43 and 46 for our country-level estimates and cell T60 for our overall estimate. Throughout this page, we are using “adjusted” cost-effectiveness figures, i.e. cost-effectiveness estimates that adjust for certain factors, such as a charity’s quality of monitoring, that are not part of our main cost-effectiveness analysis. The adjusted estimates drive our allocation recommendations. jQuery("#footnote_plugin_tooltip_2").tooltip({ tip: "#footnote_plugin_tooltip_text_2", tipClass: "footnote_tooltip", effect: "fade", fadeOutSpeed: 100, predelay: 400, position: "top right", relative: true, offset: [10, 10] }); Additional details on HKI’s funding needs and spending plans are here.

Our process for deciding where to allocate funds

In late 2019, our top charities shared information about how they would use additional funding. Each charity has different opportunities to spend funding that can vary in cost-effectiveness: for example, extension of a charity’s program in one country or expansion of its program to a new country. In some cases, we don’t believe that a charity will be able to support those opportunities with its existing budget and projected donations. In those cases, we refer to the charity’s “funding gaps.”

In general, we follow the seven principles described in this page when deciding which funding gaps to fill. The first of these principles is to put significant weight on our cost-effectiveness estimates, which aim to capture total improvement in well-being per dollar spent. These estimates suggested that HKI’s VAS program had a very high priority funding gap (28x cash overall in the seven countries listed above).

Other possibilities we considered

Sightsavers’ deworming program. We estimated that allocating $2.6 million to GiveWell top charity Sightsavers for its deworming program would be similar in cost-effectiveness to HKI’s VAS program.3See this spreadsheet, sheet “List of funding gaps,” cell T58. jQuery("#footnote_plugin_tooltip_3").tooltip({ tip: "#footnote_plugin_tooltip_text_3", tipClass: "footnote_tooltip", effect: "fade", fadeOutSpeed: 100, predelay: 400, position: "top right", relative: true, offset: [10, 10] });

We decided to allocate the $2.6 million to HKI’s VAS program because at the time we made the decision (in October), we were considering changes to our deworming cost-effectiveness model and were uncertain whether we would estimate Sightsavers’ cost-effectiveness as higher or lower than HKI’s.

Other top charities (Against Malaria Foundation, Malaria Consortium’s seasonal malaria chemoprevention program, END Fund’s deworming program, and GiveDirectly). At the time of our decision, we estimated that supporting HKI’s VAS program or Sightsavers’ deworming program would be significantly more cost-effective than supporting other top charities, and thus decided to focus our decision on comparing HKI’s VAS program and Sightsavers’ deworming program.

We did not compare HKI’s VAS program to our top charities SCI Foundation or Evidence Action’s Deworm the World, which we do not believe have near-term funding needs.

Our bottom line for donors giving today

We continue to recommend that donors giving to GiveWell choose the option on our donation form for “grants to recommended charities at GiveWell’s discretion” so that we can direct the funding to the top charity or charities with the most pressing funding needs.

As part of our annual update, we recommended that Open Philanthropy make several grants to our top charities. Taking Open Philanthropy’s support into account, we note that if we had additional funds to allocate at this time, we would likely allocate them to Malaria Consortium’s seasonal malaria chemoprevention (SMC) program. We believe that Malaria Consortium’s program has the highest impact per additional dollar donated today. After the Open Philanthropy grant and the Q3 discretionary funding, additional donations to HKI’s VAS program would support funding gaps that we model as less cost-effective than the funding gaps on Malaria Consortium’s current margin.

Notes   [ + ]

1. ↑ We use the unconditional cash transfer program implemented by top charity GiveDirectly as a benchmark for comparing the cost-effectiveness of different programs. When discussing cost-effectiveness, we generally refer to the cost-effectiveness of a program in multiples of “cash.” 2. ↑ Estimates of the cost-effectiveness of each funding gap can be found in this spreadsheet, sheet “List of funding gaps.” See column AB, rows 38-43 and 46 for our country-level estimates and cell T60 for our overall estimate. Throughout this page, we are using “adjusted” cost-effectiveness figures, i.e. cost-effectiveness estimates that adjust for certain factors, such as a charity’s quality of monitoring, that are not part of our main cost-effectiveness analysis. The adjusted estimates drive our allocation recommendations. 3. ↑ See this spreadsheet, sheet “List of funding gaps,” cell T58. function footnote_expand_reference_container() { jQuery("#footnote_references_container").show(); jQuery("#footnote_reference_container_collapse_button").text("-"); } function footnote_collapse_reference_container() { jQuery("#footnote_references_container").hide(); jQuery("#footnote_reference_container_collapse_button").text("+"); } function footnote_expand_collapse_reference_container() { if (jQuery("#footnote_references_container").is(":hidden")) { footnote_expand_reference_container(); } else { footnote_collapse_reference_container(); } } function footnote_moveToAnchor(p_str_TargetID) { footnote_expand_reference_container(); var l_obj_Target = jQuery("#" + p_str_TargetID); if(l_obj_Target.length) { jQuery('html, body').animate({ scrollTop: l_obj_Target.offset().top - window.innerHeight/2 }, 1000); } }

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We’re glad to answer your questions

Tue, 12/17/2019 - 07:45

We know that many individuals make their charitable donations at this time of year. We’re here to help!

If you would like to discuss your 2019 giving decision with a GiveWell staff member, please email us at info@givewell.org or schedule a call here.

For example, we’re glad to:

  • Provide a brief overview of our 2019 top charity recommendations.
  • Assist with the logistics of making a donation and discuss options for donating, such as appreciated securities, checks, and wire transfers.
  • Answer any questions about our research or recommendations.

We look forward to hearing from you!

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