Aggregator

This post provides an update on what we’ve learned about our top charities in the first half of 2016.

We continue to recommend all four of our top charities. Our recommendation for donors seeking to directly follow our advice remains the same: we recommend they give to the Against Malaria Foundation (AMF), which we believe has the most valuable current funding gap.

Below, we provide:

• Updates on our view about AMF, which we consider the most important information we’ve learned in the last half-year (More)
• Updates on other top charities (More)
• A discussion of the reasoning behind our current recommendation to donors (More)

Updates on AMF

 

Background

AMF (www.againstmalaria.com) provides funding for long-lasting insecticide-treated net distributions (for protection against malaria) in developing countries. There is strong evidence that distributing nets reduces child mortality and malaria cases. AMF has relatively strong reporting requirements for its distribution partners and provides a level of public disclosure and tracking of distributions that we have not seen from any other net distribution charity. Overall, AMF is the best giving opportunity we are currently aware of. That said, we have concerns about AMF’s recent monitoring and transparency that we plan to focus on in the second half of the year.

Updates from the last six months

We are more confident than we were before in AMF’s ability to successfully complete deals with most countries it engages with. Over the past few years, our key concern about AMF has been whether it would be able to effectively absorb additional funding and sign distribution agreements with governments and other partners. At the end of 2013, we stopped recommending AMF because we felt it did not require additional funding, and our end-of-year analyses in 2014 and 2015 discussed this issue in depth. In early 2016, AMF signed agreements to fund two large distributions (totaling $37 million) of insecticide-treated nets in countries it has not previously worked in. We now believe that AMF has effectively addressed this concern.

AMF is in discussions for several additional large distributions. AMF currently holds approximately $23.3 million, and we believe that it is very likely to have to slow its work if it receives less than an additional $11 million very quickly. It is possible that it could also use up to an additional (approximately) $18 million more during this calendar year.

It may be more valuable to give to AMF now than it will be later this year or next year. AMF’s funding gap may be time-sensitive because:

1. AMF is in several discussions about distributions that would take place in 2017. It has told us that it needs to make decisions within a month or two about which discussions to pursue. We don’t have a clear sense for how long before a distribution AMF needs to be able to commit funding, and note that, for example, AMF committed in February 2016 to a distribution in Ghana taking place in June to August 2016. That said, it seems quite plausible that AMF needs to commit soon to distributions taking place in 2017.
2. We don’t know whether there will be large funding gaps for nets in 2018 and beyond. The price of nets has been decreasing and the size of grants from the two largest funders of nets, the Global Fund to fight AIDS, TB, and Malaria and the President’s Malaria Initiative, is not yet known. (The Global Fund is holding its replenishment conference in September, in which donor governments are asked to make three-year pledges, so we may know more before the end of the year.) It’s possible that these funders will fund all or nearly all of the net needs in countries other than those that are particularly hard to work in for 2018. If that happens, gifts to AMF in late 2016 could be less valuable than gifts in the next couple of months. (This could also mean that, if AMF fills gaps in 2017 that would have been filled by other funders in 2018, gifts now are less valuable than they have been in the past. We have added an adjustment for this to our cost-effectiveness analysis, but given the high degree of uncertainty, this could be a more important factor than we are currently adjusting for.)

Notwithstanding the above, we have important questions about AMF that we plan to continue to investigate. None of these developments caused us to change our recommendation about giving to AMF, but they are important considerations for donors:

1. Monitoring data: We have new concerns about AMF’s monitoring of its distributions, particularly its post-distribution check-up (PDCU) surveys. These surveys are a key part of our confidence in the quality of AMF’s distributions. For Malawi, where most of the PDCUs completed to date have been done, our key concern is that villages that surveyors visit are not selected randomly, but are instead selected by hand by staff of the organization that both implements and monitors the distributions, which seems fairly likely to lead to bias in the results. We have also seen results from the first two PDCUs from DRC. We have not yet looked at the DRC results in-depth or discussed them with AMF, but there appear to be major problems in how the surveys were carried out (particularly a high percentage of internally inconsistent data – around 40%-50%) and, if we believe the remaining data, fairly high rates of missing or unhung nets (~20% at 6-months) and nets that deteriorated quickly (65% were in ‘very good’ or ‘good’ condition at 6-months).
2. Transparency: Recently, AMF has been slower to share documentation from some distributions. AMF has told us that it has this documentation and we are concerned that AMF is not being as transparent as it could be. We believe this documentation is important for monitoring the quality of AMF’s distributions; it includes PDCUs, results from re-surveying 5% of households in during pre-distribution registrations (AMF has told us that this is a standard part of its process, but we have not seen results from any distributions), and malaria case rate data from Malawi that AMF has told us it has on hand. AMF attributes the delays to lack of staff capacity. We plan to write more about monitoring and transparency in a future post.
3. Insecticide resistance: Insecticide resistance (defined broadly as “any ways in which populations of mosquitoes adapt to the presence of insecticide-treated nets (ITNs) in order to make them less effective”) is a major threat to the effectiveness of ITNs. Insecticide resistance seems to be fairly common across sub-Saharan Africa, and it seems that resistance is increasing. It remains difficult to quantify the impact of resistance, but our very rough best guess (methodology described in more detail below) is that ITNs are roughly one-third less effective in the areas where AMF is working than they would be in the absence of insecticide resistance. We continue to believe, despite resistance, ITNs remain a highly cost-effective intervention. See our full report for more detail.

Other updates on AMF

• To better understand whether AMF is providing nets that would not otherwise have been funded, we considered five cases where AMF considered funding a distribution and did not ultimately provide funding. We then looked at whether other funders stepped in and how long of a delay resulted from having to wait for other funders. We published the details here. In short, most distributions took place later than they would have if AMF had funded them (on average over a year), which probably means that the people were not protected with nets during that time. We feel that these case studies provide some evidence that nets that AMF buys do not simply displace nets from other funding sources.
• We’ve noted in the past that the delays in AMF signing agreements for distributions may have been due to AMF’s hesitation about paying for the costs of a distribution other than the purchase price of nets. For the distributions that AMF has signed this year, AMF has agreed to pay for some non-net costs, particularly the costs of PDCUs. The Global Fund to fight AIDS, TB, and Malaria is paying for the other non-net costs of the distribution. AMF’s willingness to fund some of the non-net costs may have made it easier for it to sign distribution agreements and put funds to use more quickly.

Updates on our other top charities

 

Schistosomiasis Control Initiative (full report)

Background

SCI (www3.imperial.ac.uk/schisto) works with governments in sub-Saharan Africa to create or scale up deworming programs (treating children for schistosomiasis and other intestinal parasites). SCI’s role has primarily been to identify recipient countries, provide funding to governments for government-implemented programs, provide advisory support, and conduct research on the process and outcomes of the programs.

In past years, we’ve written that we had significant concerns about SCI’s financial reporting and financial management that meant we lacked high-quality, basic information about how SCI was spending funding and how much funding it had available to allocate to programs. We decided to focus our work in the first half of 2016 on this issue. We felt that seeing significant improvements in the quality of SCI’s finances was necessary for us to continue recommending SCI.

We believe that deworming is a program backed by relatively strong evidence. We have reservations about the evidence, but we think the potential benefits are great enough, and costs low enough, to outweigh these reservations. SCI has conducted studies in about half of the countries it works in (including the countries with the largest programs) to determine whether its programs have reached a large proportion of children targeted. These studies have generally found moderately positive results, but have major methodological limitations. We have not asked SCI for monitoring results since last year.

Updates from the last six months

We published a separate blog post on our work on SCI so far this year. Our main takeaways:

• SCI has begun producing higher-quality financial documents that allow us to learn some basic financial information about SCI.
• We learned of two substantial errors in SCI’s financial management and reporting. 1) a July 2015 grant from GiveWell for about $333,000 was misallocated within Imperial College, which houses SCI, until we noticed it was missing from SCI’s revenue in March 2016; and (2) in 2015, SCI underreported how much funding it would have from other sources in 2016, leading us to overestimate its room for more funding by $1.5 million.
• The clarity of our communication with SCI about its finances has improved, but there is still substantial room for further improvement.

We feel that SCI has improved, but we would still rank our other top charities ahead of it in terms of our ability to communicate and understand their work. Given this situation, we continue to recommend SCI now and think that SCI is reasonably likely to retain its top charity status at the end of 2016. We plan, in the second half of 2016, to expand the scope of our research on SCI.

We have not asked SCI for an update on its room for more funding (due to our focus on financial documents in the first half of the year). It’s our understanding that funds that SCI receives in the next six months will be allocated to work in 2017 and beyond. Because of this, we don’t believe that SCI has a pressing need for additional funds, though our guess is that it will have room for more funding when we next update our recommendations in November and that funds given before then will help fund gaps for the next budget year.

GiveDirectly (full report)

Background

GiveDirectly (www.givedirectly.org) transfers cash to households in developing countries via mobile phone-linked payment services. It targets extremely low-income households. The proportion of total expenses that GiveDirectly has delivered directly to recipients is approximately 83% overall. We believe that this approach faces an unusually low burden of proof, and that the available evidence supports the idea that unconditional cash transfers significantly help people.

We believe GiveDirectly to be an exceptionally strong and effective organization, even more so than our other top charities. It has invested heavily in self-evaluation from the start, scaled up quickly, and communicated with us clearly. It appears that GiveDirectly has been effective at delivering cash to low-income households. GiveDirectly has one major randomized controlled trial (RCT) of its impact and took the unusual step of making the details of this study public before data was collected (more). It continues to experiment heavily.

Updates from the last six months

• GiveDirectly announced an initiative to test a “basic income guarantee” to provide long-term, ongoing cash transfers sufficient for basic needs. The cost-effectiveness of providing this form of cash transfers may be different from the one-time transfers GiveDirectly has made in the past.
• GiveDirectly continues to have more room for more funding than we expect GiveWell-influenced donors to fill in the next six months. Its top priority is funding the basic income guarantee project.
• In late 2015 and early 2016, when GiveDirectly began enrolling participants in Homa Bay county, Kenya, it experienced a high rate of people refusing to be enrolled in the program. The reason for this is not fully clear, though GiveDirectly believes in some cases local leaders advised people to not trust the program. While GiveDirectly has temporarily dealt with this setback by moving its operations to a different location in Homa Bay county, it is possible that similar future challenges could reduce GiveDirectly’s ability to commit as much as it currently projects.
• GiveDirectly has reached an agreement with a major funder which provides a mechanism through which multiple benchmarking projects (projects comparing cash transfers to other types of aid programs) can be launched. The major funder may fund up to $15 million for four different benchmarking projects with GiveDirectly. GiveDirectly plans to make available up to $15 million of the grant it received from Good Ventures in 2015 to match funds committed by the major funder. GiveDirectly and its partner have not yet determined which aid programs will be evaluated or how the evaluations will be carried out.
• We are reasonably confident that GiveDirectly could effectively use significantly more funding than we expect it to receive, including an additional $30 million for additional cash transfers in 2016, though scaling up to this size would require a major acceleration in the second half of the year. We have not asked GiveDirectly how funding above this amount would affect its activities and plans (because we think it is very unlikely that GiveDirectly will receive more than $30 million from GiveWell-influenced supporters before our next update in November).

Deworm the World (full report)

Background

Deworm the World (www.evidenceaction.org/deworming), led by Evidence Action, advocates for, supports, and evaluates government-run school-based deworming programs (treating children for intestinal parasites).

We believe that deworming is a program backed by relatively strong evidence. We have reservations about the evidence, but we think the potential benefits are great enough, and costs low enough, to outweigh these reservations. Deworm the World retains monitors whose reports indicate that the deworming programs it supports successfully deworm children.

Updates from the last six months

• We asked Deworm the World whether additional funding in the next six months would change its activities or plans. It told us that it does not expect funding to be the bottleneck to any work in that time. We’d guess that there is a very small chance that it will encounter an unexpected opportunity and be bottlenecked by funding before our next update in November.
• Deworm the World appears to be making progress expanding to new countries. It has made a multi-year commitment to provide technical assistance and resources to Cross River state, Nigeria for its school-based deworming program (the first deworming is scheduled for the end of this month), and are undertaking a nationwide prevalence survey in Pakistan.
• In the past, we have focused our review of Deworm the World on its work in India. We are in the process of learning more about its work in other locations, particularly Kenya. The monitoring we have seen from Kenya appears to be high quality.

Summary of key considerations for top charities

 

The table below summarizes the key considerations for our four top charities. With the exception of modest changes to room for more funding, our high-level view of our top charities, as summarized in the table below, is the same as at our last update in November 2015.

Consideration AMF Deworm the World GiveDirectly SCI Program estimated cost-effectiveness (relative to cash transfers) ~10x ~10x Baseline ~5x Directness and robustness of the case for impact Strong Moderate Strongest Moderate Transparency and communication Strong Strong Strongest Weakest Ongoing monitoring and likelihood of detecting future problems Strong Strong Strongest Weakest Organizational track record of rolling out program Moderate Moderate Strong Strong Room for more funding High Limited High Likely moderate (not investigated)

 

Reasoning behind our current recommendation to donors

 

Our recommendation for donors seeking to directly follow our advice is to give to AMF, which we believe has the most valuable current funding gap. We believe AMF will likely have opportunities to fund distributions this year which it will not be able to fund without additional funding. Due to the excellent cost-effectiveness of AMF’s work, we consider this a highly valuable funding gap to fill. Our current estimate is that on average AMF saves a life for about every $3,500 that it spends; this is an increase from our November 2015 estimate and reflects changes to our cost-effectiveness model as well as some of our inputs into bed nets’ cost-effectiveness. As always, we advise against taking cost-effectiveness estimates literally and view them as highly uncertain.

The below table lays out our ranking of funding gaps for June to November 2016. The first million dollars to a charity can have a very different impact from, e.g., the 20th million dollars. Accordingly, our ranking of individual funding gaps accounts for both (a) the quality of the charity and the good accomplished by its program, per dollar, and (b) whether a given level of funding is highly or only marginally likely to be needed in the next six months.
We consider funding that allows a charity to implement more of its core program (without substantial benefits beyond the direct good accomplished by this program) to be “execution funding.” We’ve separated this funding into three levels:

• Level 1: the amount we expect a charity to need in the coming year. If a charity has less funding than this level, we think it is more likely than not that it will be bottlenecked (or unable to carry out its core program to the fullest extent) by funding in the coming year. For this mid-year update, we have focused on funds that are needed before our next update in November, with the exception of SCI where we believe funds will not affect its work until next year.
• Level 2: if a charity has this amount, we think there is an ~80% chance that it will not be bottlenecked by funding.
• Level 3: if a charity has this amount, we think there is a ~95% chance that it will not be bottlenecked by funding.

(Our rankings can also take into account whether a gap is “capacity-relevant” or providing an incentive to engage in our process. We do not currently believe that our top charities have capacity-relevant gaps and are not planning to make mid-year incentive grants, so we haven’t gone into detail on that here. More details on how we think about capacity-relevant and execution gaps in this post.)

Priority Charity Amount (millions) Type Description Comment 1 AMF $11.3 Execution level 1 Fund distributions in two countries that AMF is in discussions with but does not have sufficient funding for AMF is strongest overall 2 AMF $7.3 Execution level 2 Fund the next largest gap on the list of remaining 2016-17 gaps in African countries – 3 SCI $10.1 Execution level 1 Very rough because we haven’t discussed this with SCI; further gaps not estimated Not as strong as AMF in isolation, so ranked below for same type of gap 4 AMF $10.5 Execution level 3 Fund the final two AMF-relevant gaps on the list of remaining 2016-17 gaps in African countries – 5 GiveDirectly $22.2 Execution level 1 Basic income guarantee program and additional standard transfers Not as cost-effective as bednets or deworming, so lower priority 6 Deworm the World $6.0 Execution level 3 A rough guess at the funding needed to cover a 3-year deworming program in a new country Strong cost-effectiveness, but unlikely to need funds in the short-term 6 GiveDirectly $7.8 Execution level 2 Funding for additional structured projects; further gaps not estimated –

 

We are not recommending that Good Ventures make grants to our top charities for this mid-year refresh. In November 2015, we recommended that Good Ventures fund 50% of our top charities’ highest-value funding gaps for the year and Good Ventures gave $44.4 million to our top four charities. We felt this approach resulted in Good Ventures funding its “fair share” while avoiding creating incentives for other donors to avoid the causes we’re interested in, which could lead to less overall funding for these causes in the long run. (More on this reasoning available here.)

The post Mid-year update to top charity recommendations appeared first on The GiveWell Blog.

In past years, we’ve written that we had significant concerns about the financial reporting and financial management of the Schistosomiasis Control Initiative (SCI), one of our top charities since 2011. Our concerns have included:

• We had not been able to learn important and basic financial information about SCI. Despite substantial effort, before 2016 we were not able to determine the total amount of funding that SCI held at any one time. We also had very little information on what SCI’s funds were spent on within country programs.
• We found that SCI’s financial reports were prone to containing errors.

Due to these concerns, we decided to focus our research on SCI in preparation for our June 2016 top charities update only on the quality of its financial reporting and financial management. We felt that seeing significant improvements in the quality of SCI’s finances was necessary for us to continue recommending SCI.

Our main takeaways from our research on SCI so far in 2016:

• SCI has begun producing higher-quality financial documents that allow us to learn some basic financial information about SCI, including the total amount of funding it holds, how much funding has been allocated to its upcoming budget year, and how it spent restricted and unrestricted funds by country in the previous budget year. We have also been able to learn somewhat more about how its funds are spent within national deworming programs.
• We learned of two substantial errors in SCI’s financial management and reporting. 1) a July 2015 grant from GiveWell for about $333,000 was misallocated within Imperial College, which houses SCI, until we noticed it was missing from SCI’s revenue in March 2016; and (2) in 2015, SCI provided inaccurate information about how much funding it would have from other sources in 2016, leading us to overestimate its room for more funding by $1.5 million.
• The clarity of our communication with SCI about these financial errors and its plans for the upcoming year has improved in comparison with previous years.

Details follow.

SCI’s financial documents in 2016

As of the beginning of April 2016, SCI had $15.8 million ($8.6 million in restricted funding and $7.2 million in unrestricted funding) available to allocate to its April 2016 to March 2017 budget year, according to its recent financial documents. Despite our discovery of additional financial errors this year (discussed below), we feel fairly confident that this information is accurate. We’ve seen transaction-level detail for each of SCI’s accounts, asked SCI’s new Finance and Operations Manager questions about the data, and largely received clear and reasonable answers.

SCI also sent us detailed breakdowns of in-country spending in its 2015-16 budget year for six of its country programs. Although this spending data gives us some information about what SCI’s funds were spent on within country programs last year, we note that we have not seen spending breakdowns for the eleven other deworming programs supported by SCI in 2015-16 (additional concerns about this spending data are discussed in our full review of SCI.)

Despite the improvements in SCI’s financial reporting that have allowed us to learn some basic financial information, we remain concerned about SCI’s use of Imperial College’s accounting system, which seems ill-suited to SCI’s needs. SCI has told us that it began using new accounting software in April 2016; we’re uncertain about the degree to which this will alleviate our concerns.

Financial errors we learned about in 2016

We’ve learned about two financial errors this year:

• Not realizing that it had not received a transfer of funds from GiveWell: In July 2015, we granted $333,414 to SCI, which included all donations we received designated for supporting SCI between February and May 2015. After reviewing SCI’s financial documents in March 2016, we informed SCI that the July 2015 funding did not appear to be accounted for. After investigating the issue, SCI found that the funds had been misallocated by Imperial College to a different part of the college. SCI did not receive the funds until April 2016. SCI has asked Imperial College why the error occurred, but has not yet received a substantive response.
• Underreporting available funding from DFID: In October 2015, SCI sent us its target treatment numbers for each national deworming program it supports, amounts of funding available from DFID and other large donors, and the amounts of additional funding required to deliver the targeted number of treatments and cover central expenditures for its April 2016 to March 2017 budget year. In March 2016, SCI sent GiveWell documents that indicated that around $1.5 million more funding was available from DFID to allocate to SCI’s 2016-2017 budget year than indicated in the October 2015 document. SCI told us that the October 2015 document included funding that was available from DFID to allocate to national deworming programs, but omitted $1.5 million in funding available from DFID to allocate to SCI’s central expenditures.

We consider both of these errors to be substantial. We are uncertain whether SCI would have ever received the funding from donations we collected on SCI’s behalf between February and May 2015 if we had not brought the issue to SCI’s attention. Our room for more funding analysis is a major factor in determining our funding recommendations to donors and to Good Ventures; an overestimation of SCI’s room for more funding by $1.5 million could have caused us to recommend donations to SCI that would have been better allocated to filling other funding gaps.

Our communication with SCI

Although we think that the financial errors we learned about in 2016 were substantial, we believe that it is a good sign that we were able to learn of these errors by communicating with SCI. In the past, we’ve noted that we’ve struggled to communicate effectively with SCI’s representatives, which sometimes meant that we were unable to clear up our confusion about inconsistencies we found in SCI’s documents.

We also feel that we’ve communicated clearly with SCI about its plans for the upcoming year and gained a better understanding of the factors that limit the delivery of additional deworming treatments in different contexts.

Bottom line

Given the improvements, we continue to recommend SCI now and think that SCI is a contender for a top charity recommendation at the end of 2016. We plan, in the second half of 2016, to expand the scope of our research on SCI to include looking at recent monitoring and evaluation, cost per treatment, and room for more funding in 2017 and beyond. We continue to have some concerns about SCI’s financial reporting and management (most notably, the errors noted above) and will be following up with SCI about our outstanding questions.

The post What we’ve learned about SCI this year appeared first on The GiveWell Blog.

GiveWell is dedicated to finding outstanding giving opportunities and publishing the full details of our analysis. In addition to evaluations of other charities, GiveWell publishes substantial evaluation of our own work. This post lays out highlights from our 2015 metrics report, which reviews what we know about how our research impacted donors. Please note:

• We report on “metrics years” that run from February through January; for example, our 2015 data cover February 1, 2015 through January 31, 2016.
• We differentiate between our traditional charity recommendations, our work on the Open Philanthropy Project, and other charitable giving.
• More context on the relationship between Good Ventures and GiveWell can be found here.

Summary of influence: In 2015, GiveWell influenced charitable giving in several ways. The following table summarizes our understanding of this influence.

Total money moved: In 2015, GiveWell tracked $110.1 million in money moved to our recommended charities. Our money moved only includes donations that we are confident were influenced by our recommendations.

Open Philanthropy Project: As part of our work on the Open Philanthropy Project, we advised Good Ventures to make grants totaling $6.4 million. This was in addition to Good Ventures’ support for our recommended charities.

Money moved by charity: Our four top charities received the majority of our money moved. Our four standout charities received a total of $2.2 million.

Money moved by size of donor: In 2015, the number of donors and amount donated increased across each donor size category. In 2015, 95% of our money moved (excluding Good Ventures) came from about 15% of our donors, each of whom gave $1,000 or more.

Donor retention: The total number of donors who gave to our recommended charities or to GiveWell unrestricted increased about 60% year-over-year to 15,274 in 2015. This included 10,669 donors who gave to our recommended charities for the first time. Among all donors who gave in the previous year, about 40% gave again in 2015, up from about 33% who gave again in 2014.

Our retention was stronger among donors who gave larger amounts or who first gave to our recommendations prior to 2013. Of larger donors (those who gave $10,000 or more in either of the last two years), about 80% who gave in 2014 gave again in 2015.

GiveWell’s expenses: GiveWell’s total operating expenses in 2015 were $3.4 million. Our expenses increased from about $1.8 million in 2014 as the size of our staff grew, largely to support the Open Philanthropy Project. We estimate that about one-third of our total expenses ($1.1 million) supported our traditional top charity work and about two-thirds supported the Open Philanthropy Project. In 2014, we estimated that expenses for our traditional charity work were about $900,000.

Donations supporting GiveWell’s operations: Prior to 2013, GiveWell relied on a small number of donors to provide unrestricted support for our operations. Since 2013, we have asked more donors to support our operational costs and asked donors to support us at a higher level than we had in previous years. In 2015, we raised $4.9 million, up from $3.0 million in 2014. Several institutions and the six largest individual donors contributed about two-thirds of GiveWell’s funding in 2015.

Donor demographics: We continued to collect information on our donors. We found the picture of our 2015 donors to be broadly consistent with previous information. Based on reports from donors who gave $2,000 or more, we found:

• The most common ways that donors found us were via Peter Singer and personal referrals.
• About 70% of our donors are under 40, and about 60% work in technology or finance.

Web traffic: Unique visitors to our website increased by 12% in 2015 compared to 2014 (when excluding visitors driven by AdWords, Google’s online advertising product).

For more detail, see our full metrics report (PDF).

The post GiveWell’s money moved and web traffic in 2015 appeared first on The GiveWell Blog.

Over the past couple of years, we’ve put a lot of effort into hiring and training staff and we now have significantly more capacity to do research than we have in past years. Some of our increased capacity will support the Open Philanthropy Project, which we hope will be a separate organization by the end of 2016; its plans for the year will be discussed on the new Open Philanthropy Project blog. We also expect to have more capacity for GiveWell’s work of finding outstanding evidence-based charities.

At the same time, we have come to believe that the kind of work we’ve recently been doing to find top charities – deeply investigating the most promising-seeming charities we know of, based largely on which interventions they carry out – has limited promise. In past years – and at the beginning of this year – we hoped that these investigations would lead relatively quickly to new top charities. Now, we believe that we’ve already (previously) identified most of the strongest charities by our criteria, and there aren’t many strong candidates left (though there are a few that we continue to investigate, and we remain willing and eager to investigate further promising groups if we come across them). With that in mind, we have begun seeing more potential in other research priorities, such as supporting the development of new organizations and new evidence bases.

A future post will elaborate on why we’ve formed this view. This post focuses on laying out our plans for GiveWell’s research work in 2016, taking this view into account.

In brief, in 2016:

• We plan to focus much of our capacity on a small number of initiatives that are unlikely to result in new top charities in 2016, but which we hope will lead to new top charities that are competitive with our current top charities in 2017 or 2018.
• We plan to intensify our work following our current top charities and are tentatively planning to make site visits to distributions funded by the Against Malaria Foundation and work supported by Evidence Action’s Deworm the World Initiative.
• We are also planning a substantial project focused on the question of whether or not we should recommend that Good Ventures give significantly more than it has in the past to support insecticide-treated nets, arguably the most promising area we know of for substantial additional funding.
• We also hope to take on additional work (described in detail below) but plan to prioritize this work below the items listed above.
• We plan to put more staff time into donor outreach than we have in the past and discuss our priorities for that work below.

This plan represents a significant shift from previous years, when our primary goal was improving the list of top charities we published at the end of each year. We plan to write more about the reasoning behind this shift in a future post.

What we’ve done so far this year

In January and February 2016 we:

• Put significantly more effort into getting input on our plans from non-senior staff than we have in past years. To start, we asked staff and a small number of GiveWell followers to make probabilistic predictions about which charities would become top charities if we investigated them this year. The results of this exercise led to this initial list of possible priorities (listed in no particular order). This list represents the organizations that we would guess are most likely to become top charities at the end of 2016. When we later revised our plan, we held a series of staff meetings to discuss details of the plan and what the new plan might be missing.
• Had exploratory conversations with several charities on that list and others in the field of global health and development. The goal of conversations with charities was to explain our application process and ask them basic questions about their programs, monitoring and evaluation, and need for additional funding. The goal of conversations with others working in global health and development was to generate a list of additional organizations to contact.

Ultimately, this work made us more pessimistic that prioritizing work on all the organizations listed above would lead to new top charities by the end of 2016, as discussed in the introduction of this post, and we refined our plans for the year as a result. A future post will elaborate on this development.

Top priorities for research

Our top priorities are:

• Supporting the development of potential future GiveWell top charities: making grants to organizations that could become top charity contenders in the future or supporting research that could lead to more organizations that are a strong fit with our criteria. This work is unlikely to result in new top charities in 2016, but we hope it will lead to new top charities that are competitive with our current top charities in 2017 or 2018. This work might include:
  • Providing early stage funding to organizations that aim to scale up programs with strong evidence of effectiveness and cost-effectiveness. (For example, New Incentives or Evidence Action’s No Lean Season program.)
  • Funding research on programs that are candidates to become priority programs. (For example, this grant to support research on an incentives for immunization program.)
  • Funding organizations that run priority programs to increase or improve their monitoring, or funding a third party to do this monitoring.
• Considering additional funding for insecticide-treated nets: A significant funding gap exists for insecticide-treated nets, and this gap appears to be as cost-effective an opportunity as any other we have found. This project involves determining whether there are high quality opportunities to provide significantly more funding for insecticide-treated nets than we have in the past. It will involve conversations with the major bednet funders (e.g., Global Fund to fight AIDS, Tuberculosis, and Malaria and the President’s Malaria Initiative) and others familiar with how to identify funding gaps for bednets and what the options are for monitoring distributions. We have also been discussing with the Against Malaria Foundation (AMF) what it would take to quickly scale up AMF’s work. The goal of this work is to identify additional funding opportunities for funding insecticide-treated nets in 2016.
• Intervention prioritization: quick investigations on a large number of interventions with the goal of finding more priority programs. We have looked at many interventions historically, but regularly learn of programs that we do not know very much about.
• Current top charities: continuing to follow our current top charities and trying to answer our highest priority unanswered questions about these groups. More on this below.
• New evidence on deworming and bednets. The next round of follow up on a key deworming study is expected to be available later this year and could make a big difference to our view of deworming. We’re also looking more into the degree to which insecticide resistance may be reducing the impact of bednets.

Other research we will undertake if we have the time to do so

• Micronutrient fortification charities. Last year, we tried but were unable to find compelling evidence that the Iodine Global Network (IGN) or the Global Alliance for Improved Nutrition (GAIN) had successfully contributed to the impact of salt iodization programs (write-ups forthcoming). We also began investigating Project Healthy Children. We may continue some of these investigations this year and have also reached out to the Micronutrient Initiative and the Food Fortification Initiative.
• Neglected tropical disease (NTD) charities. We began investigating Sightsavers and END Fund’s work on deworming last year and may continue with those organizations this year and expand the investigations to cover multiple NTDs. We have reached out to the Carter Center and Helen Keller International (HKI) about their NTD programs. HKI declined to participate at this time.
• Surgery charities. We have had several conversations with organizations that work on cataract surgery and we may reach out to organizations that work on obstetric fistula surgery. Our initial impression from these conversations is that it will be very challenging to understand the impact that these charities’ programs have. We may also consider other surgical interventions (such as trachoma).
• Other organizations. If organizations apply for a recommendation and seem sufficiently promising, we will aim to review them.
• Publishing research we largely completed in 2015: updates on standout charities (GAIN, IGN, and Living Goods), interim reviews of charities we began investigating in 2015 (Sightsavers, END Fund, and Project Healthy Children), and intervention reports (folic acid fortification, surgery for cataracts, trachoma and fistula, measles immunization campaigns, mass drug administration for lymphatic filariasis, and “Targeting the Ultra Poor”).

Research we considered but do not expect to undertake

The following investigations are ones that we considered doing this year but don’t currently expect to get to. This could change if some of the higher priority work turns out to be less promising than expected.

• Mega-charities. We could try to work with one or more large organizations with very diverse programs to figure out how to scale-up work on one of our priority programs.
• Charities that work on programs that are probably more cost-effective than cash transfers but not by a large enough margin that it seems worth highly prioritizing work on them.
  • Voluntary medical male circumcision. We are interested in talking to PSI, the only major organization we know of working on this program, but do not plan to prioritize this program beyond that.
  • “Targeting the ultra poor” or “graduation” programs.
  • Lymphatic filariasis.
  • Incentives for immunization. We previously funded research on this program and have been working with IDinsight on a cost-effectiveness analysis.
• Immunization programs. We have put in a fair amount of work into looking for room for more funding for scaling up immunization programs and have largely failed to find opportunities (2012 write-up; recent example).

More detail on potential further research on current recommended charities

One of our top priorities for 2016 is continuing to follow our current top charities and trying to answer our highest priority unanswered questions about these groups. We moved over $100 million to these groups in 2015 and whether we recommend a similar (or greater) level of support in 2016, and how we recommend allocating funds among them, depends on answering: (1) what is our best estimate of the organization’s impact and cost-effectiveness? and (2) how much room for more funding do they have?

Top charities

In past years, we’ve updated our top charity reviews once a year, in November. This year, we plan to refresh these reviews twice, in June and November. As we have at the end of the year, we expect to reconsider what recommendation we make to donors about how to allocate donations amongst our top charities in June.

Summary of our research plans for each of our top charities (note that the strategy documents were written in February):

• Against Malaria Foundation (AMF). We plan to follow AMF’s progress closely in 2016. Key questions include (a) how quickly is AMF committing funding to new distributions, and (b) can we get a more detailed understanding of how data is collected in pre- and post-distribution surveys. More details here.
• Schistosomiasis Control Initiative (SCI). The amount of time we spend on SCI this year depends on whether we see a significant improvement in the quality of SCI’s financial information (how it has spent funds, how much funding it holds, and projected expenses). If it does not improve, we will likely deprioritize much additional work on SCI. If it does, we would be interested in exploring the research questions detailed here.
• Deworm the World Initiative. Of our top charities, we feel that there is the largest gap between what we could know and what we do know for Deworm the World. In particular, we’ve focused on Deworm the World’s work in India, because in the past most unrestricted funds were used in India. Going forward, unrestricted funds will largely be used in new programs. We aim to follow Deworm the World’s progress in new countries closely and to better understand its past work by learning more about its program in Kenya. Details here.
• GiveDirectly. Our main goals from following GiveDirectly are to see if the quality of monitoring remains high, it is able to enroll new recipients quickly, and we can learn more about the impact of its work with partners to make cash a baseline against which other development programs are judged. Details here.

Standout charities

• Development Media International. We’re not planning to consider DMI as a possible top charity in 2016. The results from a randomized controlled trial (RCT) of its program that DMI shared last year were not in line with what we would have wanted to see for DMI to become a top charity. More recently, DMI shared some additional results from the RCT (which are not yet public). We believe that taken together these results provide conflicting evidence for DMI’s impact. DMI stands out for its commitment to transparency and rigorous evaluation and we will consider working with DMI to continue to build the evidence base around behavior change through mass media. We see this as a long-term project that is unlikely to result in DMI’s being a top charity in 2016.
• Iodine Global Network. We are planning to follow up with IGN about a few case studies that IGN thought might provide additional evidence of its impact.
• The Global Alliance for Improved Nutrition (GAIN) – Universal Salt Iodization (USI) program. We’re not planning to consider GAIN’s USI program as a possible top charity in 2016. We have not been able to establish clear evidence of GAIN successfully contributing to the impact of iodization programs, and think it is unlikely that more work on this will be useful.
• Living Goods. It’s fairly unlikely that we will consider Living Goods as a possible top charity in 2016. We would revisit this if we were to see significant improvements in the rigor of Living Goods’ monitoring or if we significantly changed our cost-effectiveness estimate for its work.

Plans for donor outreach

We have not historically prioritized outreach at GiveWell, instead choosing to devote staff capacity primarily to our research work. Now, with the addition of new research staff as well as the continued growth of GiveWell’s donor base, we feel it is appropriate to dedicate more capacity to outreach for GiveWell in service of our mission to make our research available to help individuals decide where to give.

In 2016, we plan to have 1.5 staff members devoted to outreach related to GiveWell and the Open Philanthropy Project. Due to this being early on in our outreach work, we’re tentatively planning to reassess our priorities every month for the first half of the year, and then every quarter. As of the publication of this blog post, we expect the following to be top priorities for GiveWell outreach in 2016:

• Donor calls and meetings. We expect that connecting with individuals who have donated to GiveWell will be an important part of our outreach going forward, although as we’re relatively new to prioritizing this, we plan to survey donors about whether this is something that they find useful. We’re hoping to learn more about the donors who use our work and any questions or feedback they have, as well as to offer an opportunity for donors to stay up to date on GiveWell’s work. More here.
• Launching a redesigned website. The redesign will largely improve the look and feel of the site with some minor improvements in navigation and content organization.
• Improving GiveWell’s written communications. This includes:
  • Revisiting and refreshing content on our website (e.g., a recent update to our criteria page) to ensure it’s up-to-date and clearly presented, particularly for individuals who aren’t familiar with our research.
  • Publishing content to our blog, in the hopes of highlighting research and providing additional insight into our values, process, and findings. We will need to put more effort into writing blog posts in order to maintain our previous pace of about one blog post per week, since many types of blog posts that previously appeared here will now be appearing on the Open Philanthropy Blog.

The post GiveWell research plans for 2016 appeared first on The GiveWell Blog.

This post reviews and evaluates last year’s progress on our traditional work of finding and recommending evidence-based, thoroughly vetted charities that serve the global poor. It has two parts. First, we look back at the plans we laid out in early 2015 and compare our progress against them, providing details on some of the most significant accomplishments and shortcomings of the year. Then, we reflect on the overall impact of our traditional work and critically evaluate some of our major strategic decisions. In our next post, we will cover our plans for GiveWell’s work in 2016.

SummaryIn brief, when evaluating ourselves against the goals we laid out in early 2015, we feel that we broadly achieved our primary goals for the year while we generally fell short on several of our secondary goals.

The overall impact of GiveWell’s recommendations continued to increase substantially in 2015, as we tracked more than $100 million that was donated to our recommended charities as a direct result of our research.

This self-evaluation post focuses primarily on how we have grown as an organization and the recent strategic decisions we have made since these are most relevant to thinking about the impact of recent GiveWell-focused work.

Our progress in 2015 relative to our plansIn our “2015 plan” blog post, we wrote:

This year, our primary goals are to:

• Build management and research capacity for GiveWell’s traditional work while further reducing senior staff time (note 1) spent on this work, primarily by reallocating Elie Hassenfeld’s management responsibilities related to GiveWell’s traditional work.
• Maintain our core research product by completing updates on all eight 2014 recommended charities and determining which of them should be recommended as top charities for the 2015 giving season.

Our secondary goals for 2015 are to:

• Continue to seek outstanding giving opportunities by reviewing 2-4 new charities and publishing 2-4 new intervention reports.
• Improve the cost-effectiveness analyses and room for more funding analyses in charity reviews.
• Finish and launch a redesigned GiveWell website.
• Make further progress on experimental work to “seed” potential recommended charities.We expect our total output on “top charities” work to be roughly comparable to last year’s, despite a growing staff, because (a) a major focus of the coming year is training, and we expect to trade some short-term efficiency for long-run output; (b) we may be reallocating some capacity from our “top charities” work to the Open Philanthropy Project this year.

We feel that we broadly achieved our primary goals for the year, while we fell short on several of our secondary goals.

Goals that we feel we accomplished include:

• Building management and research capacity for GiveWell’s traditional work while further reducing the time that Elie spent on this work. Specifically:
  • All GiveWell staff track how they spend time at work. In 2014, Elie spent 36% of his time on GiveWell’s traditional work, and in 2015, Elie spent 26% of his time on this work.
  • In 2014, Elie was primarily responsible for managing all research staff. In 2015, Natalie Crispin and Josh Rosenberg took on research management responsibilities, and at the end of the year, managed 10 research staff between them. Timothy Telleen-Lawton and Eliza Scheffler also took on management responsibilities, primarily for operations-focused staff.
  • Most of the other staff working on GiveWell’s traditional work in 2015 were relatively new. Because they were new, most of the time they spent was focused on training. We discuss staff time allocations in greater detail below.
• Maintaining our core research product. We completed and published updates on all four top charities from 2014. We also conducted deeper investigations of 3 out of 4 of our standout charities (Global Alliance for Improved Nutrition (GAIN), Iodine Global Network (IGN), and Development Media International (DMI)), as planned, in an effort to determine whether they should be recommended as top charities for the 2015 giving season. We ultimately did not recommend any of these charities as top charities. We did not publish our updates on GAIN and IGN, and those are still forthcoming.
• Improving our room for more funding analyses in charity reviews, which we wrote about extensively in our November 2015 blog post announcing our updated recommendations.
• Continuing to make limited but steady progress on experimental work to “seed” potential recommended charities via grants to Evidence Action’s No Lean Season Program, New Incentives, and two randomized controlled trials focused on incentives for immunization.

Areas in which we fell short include:

• We did not publish updates (or even reach tentative conclusions internally) about any new potential recommended charities, and we published only 2 new intervention reports. We engaged with Project Healthy Children, UNICEF, The END Fund, Episcopal Relief & Development’s NetsforLife® Program, and Sightsavers. (We published a page on Children Without Worms, but it was extremely short.) We published 2 new intervention reports — on vitamin A supplementation and tetanus immunization campaigns — but both of these largely relied on work we had completed in 2014.
• As discussed in our November 2015 blog post announcing our updated recommendations, we felt more confident in our cost-effectiveness analyses (CEAs) at the end of 2015 than we had in previous years, and we made some of the improvements we planned. Nevertheless, we don’t believe that we made as much progress as we had hoped for when we set the goal to improve our CEAs in early 2015. In particular, key inputs and judgment calls in our CEA were decided on by different staff members at different points in time, which made it more difficult than ideal for individual staff members to understand all details of the CEA. We hope to resolve this issue by making at least one staff member responsible for fully understanding and explaining all aspects of our core CEAs in the future.
• We did not finish and launch a redesigned GiveWell website. The GiveWell website is large and it took longer than the firm we worked with expected to complete a version that was working properly. The firm we contracted with also built the Open Philanthropy Project website, and in September 2015, we explicitly prioritized completing the Open Philanthropy Project (“Open Phil”) site before the GiveWell site.

Overall, we succeeded in passing significant responsibilities from Elie to others, but we saw somewhat less overall research output than we had hoped for. Part of this was because, in the process of transferring responsibilities, we made some mistaken decisions – i.e., in some cases staff put substantial work into assignments that we ultimately determined were not a fit for them.

Other self-evaluation questionsWhat was GiveWell’s overall impact in 2015?

The overall impact of GiveWell’s recommendations continued to increase substantially in 2015. We tracked more than $100 million that was donated to our recommended charities as a direct result of our research. Excluding Good Ventures’ giving, we moved more than $30 million to our recommended charities. (More details on our 2015 money moved will be in our forthcoming 2015 metrics blog post.) This was a major increase relative to 2014, when we tracked about $27.8 million in money moved to our recommended charities, with about $13 million coming from non-Good Ventures donors.

Does our impact justify our staff size, in absolute terms?

As mentioned above, in 2015 we moved more than $100 million to our recommended charities. Over the same period, we spent approximately $3.8 million on our operations, of which $1.3 million was spent on GiveWell’s traditional work and $2.5 million on the Open Philanthropy Project.

We previously wrote that we believe that expenses that are 15% of money moved are well within the range of normal, so we feel comfortable with the relative size of our operating expenses at this point.

Is recent growth in staff justified? Has growth in output matched growth in staff?

Staff size has grown significantly over the past few years: from 11 people at the end of 2013 to 32 at the end of 2015. We think it is reasonable to question whether this growth has been justified and productive, in light of the fact that:

• We haven’t significantly increased the number of new major reports (charities or interventions reviewed in depth). We estimate that we published 4 major new reports in 2013, 5 in 2014, and 6 in 2015 (details on our rough estimate in this Google sheet including year-to-date information for 2016).
• Most of our 2015 impact (in terms of money moved) likely could have been achieved with reduced research work in 2015. For example, if we had only stayed up-to-date on our past top charities, we would have been in a position to have the same top charities list as what we ultimately published at the end of 2015. The bulk of additional research work that we did in 2015 did not seem to have significant direct impact, largely because the new giving opportunities that we investigated did not lead to new top charities, though it would have been difficult to confidently predict that this would happen in advance (we reflect on whether we chose the best research priorities in 2015 below).

On the other hand:

• Since 2013, we have greatly expanded the Open Philanthropy Project, which is currently formally housed at GiveWell though we hope to separate the organizations in 2016. Much of our increase in staff size has been for the Open Philanthropy Project.
• Many of our most senior staff have switched over to working primarily on the Open Philanthropy Project, and senior staff are particularly challenging to replace. We don’t think we could have maintained the same output if we had simply hired one new person for each senior staff member who switched over.
• Capacity building – hiring, training and evaluating new staff – is itself a time-consuming and long-term project. In addition, increased staff size creates the need for more work in and of itself. For example: (1) in 2015, we outgrew our office and had to find new office space. Finding new office space was only necessary because of our staff size. (2) Because our staff is larger and we have a larger office, we now need an office manager. (Early in our history, we didn’t have an office, or we worked in a shared workspace where someone else played this role.)
• As our money moved grows, it becomes more worthwhile to be more thorough (as we believe we have been), and it becomes more worthwhile to try to find new top charities even if doing so is a long-term and uncertain proposition. While the work we did in 2015 did not lead to any immediate new top charities, we believe that some of it may have significant returns in the future (e.g., the “GiveWell experimental” work discussed above and the preliminary work that we did on new charities and interventions that we have not finished evaluating).

We previously discussed our reasoning about why we believe it is worthwhile to continue to expand GiveWell’s research capacity despite limited recent returns in last year’s self-evaluation post. This year, we decided to take a more in-depth look at specifically where our increased capacity has gone, while adjusting for staff seniority. Specifically, we roughly estimated the number of full-time, co-founder-equivalent people working on each area in each year. (Co-founder time was given a score of 1 but time spent by newer staff was scaled down significantly; for example, we multiplied time spent by entry-level staff in their first year at GiveWell by 0.1. These figures are far from precise, and are intended only to give a rough guess at our changes in total capacity over time.)

We’ve divided our work into several categories:

• GiveWell’s traditional research: time spent on evaluating new charities or interventions and updating our work on existing top charities or interventions.
• Open Phil: time spent on work related to the Open Philanthropy Project.
• Other output: work that directly furthers GiveWell’s and the Open Philanthropy Project’s missions but isn’t research related. Among other things, this includes work related to donation processing (e.g., opening the mail, entering donations into our database, sending thank you receipts), donor communication (answering donor questions, staying in touch with larger donors), and general outreach (giving talks, speaking to the media, and improving our web content). All of these categories of work have increased significantly as our public profile has grown.
• Overhead: work necessary due to the increased size of our staff, such as changing offices and having an office manager (as mentioned above).
• Capacity building: time spent by relatively senior staff to increase our future capacity. This includes time spent (a) recruiting (e.g., reviewing resumes, interviewing and evaluating candidates) and (b) training and evaluating new staff with the goal of increasing future capacity, not generating additional short-term research output. For example, in 2015, Elie estimates that he spent approximately 60% of his time building capacity.
• Training: time spent by newer staff being trained. These staff members are primarily working on projects where the goal is training and evaluation, not short-term research output.

The table shows that our overall capacity has increased significantly since 2012 (from approximately 3 co-founder equivalents then to 9 today). Most of that increase has gone to Open Phil (3.4 co-founder equivalents), capacity building (.8), and overhead (.9). The number of co-founder equivalents focused on GiveWell’s traditional work has stayed low (and relatively constant) since 2012.

Year GiveWell trad-itional research Other output Capacity building Train-ing Open Phil Over-head Total co-founder equiv. Total staff at year-end 2012 0.9 0.4 0.7 0 0.7 0.2 2.9 5.5 2013 0.8 0.6 0.5 0.3 1.4 0.3 3.9 11 2014 0.9 0.4 0.8 0.6 2.6 0.4 5.7 18 2015 0.9 0.7 1.5 1.1 4.1 1.1 9 32

Overall, we find this picture reasonable. While our work on GiveWell’s traditional research has stayed relatively constant in the short term, we think of it as a major benefit of increased staff that we’ve been able to do this while building the Open Philanthropy Project. And we also believe we’ve been laying the groundwork for future capacity increases, since much of our increased staff time has gone into capacity building itself.

Over time, as new staff train and are able to produce more, we hope that this picture begins to shift and that we can devote more capacity to GiveWell’s traditional research, other output, and Open Phil. Our guess is that we will start to see some of this shift in 2016.

Did we make mistakes in allocating staff capacity in 2015?

We see mistakes in our allocation of staff capacity in 2015. Specifically, we didn’t move as quickly as we should have to move staff from one type of work to another. We had several cases where we continued to try to train staff to work on research projects even though we should have already recognized that they were unlikely to be a good long-term fit for thIs type of research, and would be a better fit for another role. It is generally difficult to predict fit, so we classify this as a relatively easy-to-make mistake, though a costly one, since capacity building is a large time investment for relatively senior staff.

Did we make the right choices about how to spend the time that we had for research (i.e., did we choose the best research priorities)?

In addition to staying up to date on our top charities, we prioritized researching the below opportunities with the goal of maximizing our chances of identifying new top charities.

• Deworming organizations. At the end of 2014, we felt that deworming was one of the most promising interventions we were aware of, but the giving opportunities we had found to scale up deworming had limited room for more funding. In 2015, we prioritized finding new deworming organizations and began evaluations of the END Fund, Sightsavers, and Children Without Worms.
• Development Media International (DMI). At the end of 2014, we believed there was a significant probability that we would name DMI a top charity at the end of 2015. We prioritized work on DMI with this in mind, but the results from DMI’s randomized controlled trial were not in line with what they would have needed to be in order for DMI to become a top charity.
• Micronutrient fortification organizations. We prioritized this area because micronutrient fortification programs reach many people at relatively low cost and they are often backed by strong evidence of effectiveness. We prioritized evaluating salt iodization programs run by IGN and GAIN. We also began an evaluation of Project Healthy Children’s programs and invited the Micronutrient Initiative (MI) to apply for a recommendation. MI declined to participate.
• Bednet organizations. We invited Nothing but Nets to apply for a recommendation (it declined) and we began an evaluation of Episcopal Relief & Development’s NetsforLife® Program.

We believe these priorities were reasonable, given the amount of time we had available and the information we had at the time. However, as these investigations – and further investigations in 2016 – have had fairly disappointing results (in terms of not resulting in new top charities), we are rethinking our approach significantly going forward. More on this in a future post.

Have we failed to publish materials that we should?

We have struggled to publish information about many research projects that we have essentially completed. For example, we have formed views on several interventions for which we have not yet published intervention reports. One major reason for this is that we often try to resolve almost all of our major questions about an intervention before publishing a report on that intervention. A possible solution would be to publish more materials that explicitly note that we are sharing preliminary views that could be substantially affected by additional research. We plan to experiment with publishing more research about preliminary views we’ve reached in the future.

However, a continuing challenge in publishing our research work is that we have limited management capacity to review and sign off on public write-ups. We hope that building management and research capacity will steadily reduce this bottleneck over time.

The post GiveWell’s progress in 2015 appeared first on The GiveWell Blog.

In addition to evaluations of other charities, GiveWell publishes substantial evaluation of itself, from the quality of its research to its impact on donations. We publish quarterly updates regarding two key metrics: (a) donations to recommended charities and (b) web traffic. This post is being published late due to staff focusing on updating GiveWell’s charity recommendations in the fourth quarter; it also includes a preliminary view of our money moved since the end of our third quarter.

Preliminary estimate of 2015 money moved (since February 1, 2015)

As of early January 2016, we have tracked about $98 million in money moved to our recommended charities. Excluding Good Ventures, we have tracked about $28 million (of which, roughly half has come from donors giving $1 million or more).

These data are preliminary. We expect that in some cases we are currently overstating our impact (e.g. due to double counting or incorrect attribution of our influence) and in other cases we are understating our impact (since there are several weeks left in our metrics year and there are delays entering data); overall, we would guess that we are currently underestimating our annual money moved. We plan to publish our annual metrics (covering February 1, 2015 – January 31, 2016) in March, at which point we will have more confidence in our data and be able to share more details.

GiveWell’s web traffic / money moved through Q3 2015

The tables and chart below present basic information about our growth in money moved and web traffic in the first three quarters of 2015 compared to the previous two years (note 1).

Money moved and donors: first three quarters

Money moved by donors who have never given more than $5,000 in a year increased about 80% to $2.44 million. The total number of donors in the first three quarters increased about 80% to about 8,300 (note 2). These growth rates are reasonably consistent with the growth we previously reported in our first and second quarter metrics.

Web traffic through October 2015

Growth in web traffic excluding Google AdWords increased about 25% in the first three quarters. Last year, we saw a drop in total web traffic because we removed ads on searches that we determined were not driving high quality traffic to our site (i.e. searches with very high bounce rates and very low pages per visit).

GiveWell’s website receives elevated web traffic during “giving season” around December of each year. To adjust for this and emphasize the trend, the chart below shows the rolling sum of unique visitors over the previous twelve months, starting in December 2009 (the first period for which we have 12 months of reliable data due to an issue tracking visits in 2008).

We use web analytics data from two sources: Clicky and Google Analytics (except for those months for which we only have reliable data from one source). The raw data we used to generate the chart and table above (as well as notes on the issues we’ve had and adjustments we’ve made) is in this spreadsheet (note 3, on how we count unique visitors).

Note 1: Since our 2012 annual metrics report we have shifted to a reporting year that starts on February 1, rather than January 1, in order to better capture year-on-year growth in the peak giving months of December and January. Therefore, metrics for the “first three quarters” reported here are for February through October.

Note 2: Our measure of the total number of donors may overestimate the true number. We identify individual donors based on the reported name and email. Donors may not share all of this information or may update it (for example, using a different email), in which case, we may mistakenly treat a donation as if it was made by a new donor. We plan to investigate how large of an overstatement there may be and possibly adjust the total for our next annual metrics report.

Note 3: We count unique visitors over a period as the sum of monthly unique visitors. In other words, if the same person visits the site multiple times in a calendar month, they are counted once. If they visit in multiple months, they are counted once per month.

The post Update on GiveWell’s web traffic / money moved appeared first on The GiveWell Blog.

People often ask us how they can help spread the word about effective charities. One way is to ask friends and family members to donate to effective charities in lieu of giving presents during the holiday season.

If you’re interested in asking friends and family to donate to effective charities rather than buy you presents for the holidays, our top-ranked charity — the Against Malaria Foundation — allows you to create a fundraising page.

Giving to the Against Malaria Foundation (AMF) is our number-one recommendation for donors interested in maximizing their impact in 2015. AMF distributes insecticide-treated bed nets to prevent malaria, a leading cause of child deaths in Africa. Filling AMF’s remaining ~$27.5 million funding gap is our #1 ranked giving opportunity for donors because we feel its funding need is the most pressing of our top-rated organizations and that additional donations to AMF will enable the organization to continue distributing bed nets without being bottlenecked due to lack of funding. (More on what this means and our process for making this recommendation here.)

Charity Science, a foundation which aims to educate the public about the “science of doing good” (and which recommends giving to GiveWell’s top charities), brought this to our attention as a way of spreading the word about the organizations we recommend, and has written about the benefits of this approach on its website.

If you’re interested in encouraging your friends and family to give to AMF this holiday season, you can set up a fundraising page directly through AMF’s website: https://www.againstmalaria.com/Register.aspx. If you’d like to see a finished page, AMF lists their fundraisers here. And if you’d like tips for running a fundraising campaign, Charity Science has you covered.

The post Encouraging friends and family to give to AMF for the holidays appeared first on The GiveWell Blog.

People often ask us how they can help spread the word about effective charities. One way is to ask friends and family members to donate to effective charities in lieu of giving presents during the holiday season.

If you’re interested in asking friends and family to donate to effective charities rather than buy you presents for the holidays, our top-ranked charity — the Against Malaria Foundation — allows you to create a fundraising page.

Giving to the Against Malaria Foundation (AMF) is our number-one recommendation for donors interested in maximizing their impact in 2015. AMF distributes insecticide-treated bed nets to prevent malaria, a leading cause of child deaths in Africa. Filling AMF’s remaining ~$27.5 million funding gap is our #1 ranked giving opportunity for donors because we feel its funding need is the most pressing of our top-rated organizations and that additional donations to AMF will enable the organization to continue distributing bed nets without being bottlenecked due to lack of funding. (More on what this means and our process for making this recommendation here.)

Charity Science, a foundation which aims to educate the public about the “science of doing good” (and which recommends giving to GiveWell’s top charities), brought this to our attention as a way of spreading the word about the organizations we recommend, and has written about the benefits of this approach on its website.

If you’re interested in encouraging your friends and family to give to AMF this holiday season, you can set up a fundraising page directly through AMF’s website: https://www.againstmalaria.com/Register.aspx. If you’d like to see a finished page, AMF lists their fundraisers here. And if you’d like tips for running a fundraising campaign, Charity Science has you covered.

The post Encouraging friends and family to give to AMF for the holidays appeared first on The GiveWell Blog.

We have refreshed our top charity rankings and recommendations. Our set of top charities and standouts is the same as last year’s, but we have introduced rankings and changed our recommended funding allocation, due to a variety of updates – particularly to our top charities’ room for more funding. In particular, we are recommending that Good Ventures, a foundation with which we work closely, support our top charities at a higher level than in previous years. This post includes our recommendations to Good Ventures, and gives our recommendations to individual donors after accounting for these grants.

Overall, we think the case for our top charities is stronger than in previous years, and room for more funding is greater.

Our top charities and recommendations for donors, in brief

 

Top charities

1. Against Malaria Foundation (AMF)
2. Schistosomiasis Control Initiative (SCI)
3. Deworm the World Initiative, led by Evidence Action
4. GiveDirectly

This year, we are ranking our top charities based on what we see as the value of filling their remaining funding gaps. Unlike in previous years, we do not feel a particular need for individuals to divide their allocation between the charities, since we are recommending that Good Ventures provide significant support to each. For those seeking our recommended allocation, we simply recommend giving to the top-ranked charity on the list, which is AMF.

Our recommendation takes the grants we are recommending to Good Ventures into account, as well as accounting for charities’ existing cash on hand and expected non-GiveWell-related fundraising, and recommends charities according to how much good additional donations (beyond these sources of funds) can do. (Otherwise, as explained below, Deworm the World would be ranked higher.) Thus, AMF’s #1 ranking is not based on its overall value as an organization, but based on the value of its remaining funding gap.

Standout charities

As with last year, we also provide a list of charities that we believe are strong standouts, though not at the same level (in terms of likely good accomplished per dollar) as our top charities. They are not ranked, and are listed in alphabetical order.

• Development Media International (DMI)
• The Global Alliance for Improved Nutrition’s Universal Salt Iodization program (GAIN – USI)
• Iodine Global Network (IGN), formerly known as ICCIDD
• Living Goods

Below, we provide:

• An explanation of major changes in the past year that are not specific to any one charity. More
• A summary of our top charities’ relative strengths and weaknesses, and how we would rank them if room for more funding were not an issue. More
• A discussion of our refined approach to room for more funding. More
• The recommendations we are making to Good Ventures, and how we rank our top charities after taking these grants (and their impact on room for more funding) into account. More
• Detail on each of our top charities, including major changes over the past year, strengths and weaknesses for each, and our understanding of each organization’s room for more funding. More
• The process we followed that led to these recommendations. More
• A brief update on giving to support GiveWell’s operations vs. giving to our top charities. More

Conference call to discuss recommendations

We are planning to hold a conference call at 5:30pm ET/2:30pm PT on Tuesday, December 1st to discuss our recommendations and answer questions.

If you’d like to join the call, please register using this online form. If you can’t make this date but would be interested in joining another call at a later date, please indicate this on the registration form.

Major changes in the last 12 months

 

Below, we summarize the major causes of changes to our recommendations (since last year).

Overall, the case for our top charities is stronger than it was in past years. The Deworm the World Initiative shared new monitoring and evaluation materials with us, so we are more confident than we were a year ago that it is a strong organization implementing high-quality programs. In addition, the extra year of work we have seen from AMF and GiveDirectly bolsters our view that they will be able to utilize additional funding effectively.

Our top charities have increased room for more funding. Last year, we expected donors following our recommendations to fully fill the most critical funding gaps of our top charities (excluding GiveDirectly) because they had limited room for more funding: GiveDirectly had a total funding gap of ~$40 million and our other three top charities had a total gap of ~$18 million. This year, all of our top charities have more room for more funding. We believe that GiveDirectly could absorb more than $80 million and other top charities together could collectively utilize more than $100 million. We do not expect donors following our recommendations to fully fill these gaps.

We are recommending that Good Ventures make larger grants to top charities. For reasons we will be detailing in a future post, we are recommending that Good Ventures make substantial grants to our top charities this year, though not enough to close their funding gaps.

Continued refinement of the concept of “room for more funding.” We’ve tried to create a much more systematic and detailed room for more funding analysis, because the stakes of this analysis have become higher due to (a) increased room for more funding across the board and (b) increased interest from Good Ventures in providing major support.

In past years, we’ve discussed charities’ room for more funding as a single figure without distinguishing between (a) the amount the charity would spend in the next 12 months, (b) the amount the charity needs to prevent it from slowing its work due to lack of funds, and (c) funding that would be especially important to the organization’s development and success (a dual benefit) in addition to expanding implementation of its program. This year, we’ve made three changes to our room for more funding analysis:

• We’ve made (a) an assessment of whether additional funds merely allow a charity to implement its program (“execution”) or (b) whether additional funds would be especially important to the charity’s development and success as an organization (“capacity-relevant”). We also explicitly note the role of incentives for meeting GiveWell’s top-charity criteria in our recommendations (we seek to ensure that each top charity receives at least $1 million, to encourage other organizations to seek to meet these criteria).
• We are explicitly assessing “execution”-related room for more funding based on our estimate of the probability that lack of funding will lead to a charity slowing its progress. We distinguish between Level 1, Level 2, and Level 3 “execution” funding gaps; a higher number means the money is less likely to be needed.
• We are now ranking “funding gaps,” not just ranking charities, because the first million dollars to a charity can have a very different impact from, e.g., the 20th million dollars. For example, if Charity A accomplishes more good per dollar with its programs than Charity B, we would rank Charity A above Charity B for a given type of gap (we would rank Charity A’s “Execution Level 1” gap above Charity B’s), but we might rank Charity B’s “Execution Level 1” gap (the amount of funding it will likely need) above Charity A’s “Execution Level 3” gap (the amount of funding gap it might, but probably will not, need to carry out more of its programs in the coming year).

We discuss these ideas in greater depth below.

Summary of key considerations for top charities

 

The table below summarizes the key considerations for our four top charities. More detail is provided below as well as in the charity reviews.

Consideration AMF Deworm the World GiveDirectly SCI Program estimated cost-effectiveness (relative to cash transfers) ~10x ~10x Baseline ~5x Directness and robustness of the case for impact Strong Moderate Strongest Moderate Transparency and communication Strong Strong Strongest Weakest Ongoing monitoring and likelihood of detecting future problems Strong Strong Strongest Weakest Organizational track record of rolling out program Moderate Moderate Strong Strong Room for more funding, after accounting for grants we are recommending to Good Ventures (more below) Very high Limited Very high High

 

Overall, our ranking of the charities with room for more funding issues set aside (just considering a hypothetical dollar spent by the charity on its programs, without the “capacity-relevant funding” and “incentives” issues discussed below) would be:

1. AMF and Deworm the World
3. SCI
4. GiveDirectly

However, when we factor in room for more funding (including the impact of the grants we’re recommending to Good Ventures), the picture changes. More on this below.

Room for more funding analysis

 

Capacity-relevant funding and incentives

 

Capacity-relevant funding: additional funding can sometimes be crucial for a charity’s development and success as an organization. For example, it can contribute to a charity’s ability to experiment, expand, and ultimately have greater room for more funding over the long run. It can also be important for a charity’s ability to raise funds from non-GiveWell donors, which can be an important source of long-term leverage and can put the organization in a stronger overall position.

We think of this sort of funding gap as particularly important to fill, because it can make a big difference over the long run; in particular, it may substantially affect the long-term quality of our giving recommendations.

“Capacity-relevant” funds can include (a) funds that are explicitly targeted at growth (e.g., funds to hire fundraising staff); (b) funds that enable a charity to expand into areas it hasn’t worked in before, which can lead to important learning about whether and how the charity can operate in the new location(s); and (c) funds that would be needed in order to avoid challenging contractions in a charity’s activities which could jeopardize the charity’s long-term growth and funding prospects.

Some specific examples:

• The grant that Good Ventures made to GiveDirectly earlier this year is capacity-relevant because it will be used for: (a) building a fundraising team that will aim to raise substantial donations from non-GiveWell donors, and (b) developing partnerships with bilateral donors and local governments to deliver cash transfers or to run experiments comparing standard aid programs to cash transfers.
• Early funding that GiveDirectly received was capacity-relevant because it enabled GiveDirectly to rapidly grow from a small organization moving a few hundred thousand dollars per year to a much larger organization moving more than $10 million per year. If this funding hadn’t been forthcoming, GiveDirectly might be much smaller today and have much less room for more funding.
• We now think that some additional funding to AMF and Deworm the World will be capacity-relevant because each organization has only operated in a very small number of countries and new funding will enable each to enter new countries. This will allow them to learn how to operate there, and demonstrate that they can do so, increasing our willingness (and likely that of other donors) to recommend more to these organizations in the future.

It’s hard to draw sharp lines around capacity-relevant funding, and all funding likely has some effect on an organization’s development, but we have tried to identify and prioritize the funding gaps that seem especially relevant.

Execution funding allows charities to implement more of their core program but doesn’t appear to have substantial benefits beyond the direct good accomplished by this program. We’ve separated this funding into three levels:

• Level 1: the amount we expect a charity to need in the coming year. If a charity has less funding than this level, we think it is more likely than not that it will be bottlenecked (or unable to carry out its core program to the fullest extent) by funding in the coming year.
• Level 2: if a charity has this amount, we think there is an ~80% chance that it will not be bottlenecked by funding.
• Level 3: if a charity has this amount, we think there is a ~95% chance that it will not be bottlenecked by funding.

Incentives: we think it is important that charities we recommend get a substantial amount of funding due to being a GiveWell top charity, because this ensures that incentives are in place for charities (and potential charity founders) to seek to meet our criteria for top charities and thus increase the number of charities we recommend and the total room for more funding available, even when they don’t end up being ranked #1. We seek to ensure that each top charity gets at least $1 million as a result of our recommendation, and we consider this to be a high-priority goal of our recommendations.

The charity-specific sections of this post discuss the reasoning behind the figures we’ve assigned to “capacity-relevant” and “Execution Level 1” gaps, but they do not provide the full details of how we arrived at these figures (and do not explicitly address the “Execution Level 2” and “Execution Level 3” gaps). We expect to add this analysis to our charity reviews in the coming weeks.

Funding gaps

 

The total (i.e., Capacity-relevant, Execution Levels 1, 2, and 3, and Incentive) funding gaps (in millions of dollars, rounded to one decimal place) for each of our top charities are:

• AMF: $98.2
• Deworm the World: $19.0
• GiveDirectly: $84.0
• SCI: $26.3

However, for reasons described above, the first million dollars to a charity can have a very different impact from, e.g., the 20th million dollars. Accordingly, we have created a ranking of individual funding gaps that accounts for both (a) the quality of the charity and the good accomplished by its program, per dollar (as laid out above), and (b) whether a given level of funding is capacity-relevant and whether it is highly or only marginally likely to be needed in the coming year.

The below table lays out our ranking of funding gaps. When gaps have the same “Priority,” this indicates that they are tied.

The table below includes the amount we are recommending to Good Ventures. For reasons we will lay out in another post, we are recommending to Good Ventures a total of ~$44.4 million in grants to top charities. Having set that total, we are recommending that Good Ventures start with funding the highest-rated gaps and work its way down, in order to accomplish as much good as possible.

When gaps are tied, we recommend filling them by giving each equal dollar amounts until one is filled, and then following the same procedure with the remaining tied gaps. See footnote for more.*

Priority Charity Amount Type Recommendation to Good Ventures Comments 1 DtWI $7.6 Capacity-relevant $7.6 DtWI and AMF are strongest overall 1 AMF $6.5 Capacity-relevant $6.5 See above 1 GD $1.0 Incentive $1.0 Ensuring each top charity receives at least $1 million 1 SCI $1.0 Incentive $1.0 Ensuring each top charity receives at least $1 million 2 GD $8.8 Capacity-relevant $8.8 Not as cost-effective as bednets or deworming, so lower priority, but above non-capacity-relevant gaps 2 DtWI $3.2 Execution Level 2 / possibly capacity-relevant $3.2 Level 1 gap already filled via “capacity-relevant” gap. See footnote for more** 2 AMF $43.8 Execution Level 1 $16.3 Exhausts remaining recommendations to Good Ventures 3 SCI $4.9 Execution Level 1 0 Not as strong as DtWI and AMF in isolation, so ranked below them for same type of gap 3 AMF $24.0 Execution Level 2 0 – 4 DtWI $8.2 Execution Level 3 0 – 4 AMF $24.0 Execution Level 3 0 – 4 SCI $11.6 Execution Level 2 0 – 5 GD $24.8 Execution Level 1 0 – 5 SCI $8.8 Execution Level 3 0 – 6 GD $20.9 Execution Level 2 0 – 7 GD $28.6 Execution Level 3 0 –

Our recommendations to Good Ventures and others

 

Summing the figures from the above table, we are recommending that Good Ventures make the following grants (in millions of dollars, rounded to one decimal place):

• AMF: $22.8
• Deworm the World: $10.8
• GiveDirectly: $9.8
• SCI: $1

We also recommend that Good Ventures give $250,000 to each of our standout charities. These grants go to the outstanding organizations and create additional incentives for groups to try to obtain a GiveWell recommendation.

After these grants, AMF will require an additional ~$27.5 million to close its Execution Level 1 gap (i.e., to make it more likely than not that it is able to proceed without being bottlenecked due to lack of funding). We rank this gap higher than any of the other remaining funding gaps for our top charities, as laid out in the table above.

We estimate that non-Good Ventures donors will give approximately $15 million between now and January 31, 2016. Because we do not expect AMF’s remaining ~$27.5 million Execution Level 1 funding gap to be fully filled, we rank it #1 and recommend that donors give to AMF. We rank the remaining charities for donors who are interested in having the greatest impact per dollar based on how highly their highest-rated remaining gap ranks in the table above. That results in the following rankings for individual donors:

1. AMF
2. SCI
3. Deworm the World Initiative
4. GiveDirectly

Details on top charities

 

We present information on our top charities in alphabetical order.

Against Malaria Foundation (AMF)

 

Our full review of AMF is here.

Background

AMF (www.againstmalaria.com) provides funding for long-lasting insecticide-treated net distributions (for protection against malaria) in developing countries. There is strong evidence that distributing nets reduces child mortality and malaria cases. AMF has relatively strong reporting requirements for its distribution partners and provides a level of public disclosure and tracking of distributions that we have not seen from any other net distribution charity.

In 2011, AMF received a large amount of funding relative to what it had received historically, so it began to focus primarily on reaching agreements for large-scale net distributions (i.e., distributions on the order of hundreds of thousands of nets rather than tens of thousands of nets). In its early efforts to scale up, AMF struggled to finalize large-scale net distribution agreements. At the end of 2013, we announced that we planned not to recommend additional donations to AMF due to room for more funding-related issues (more detail in this blog post).

In 2014, AMF committed most of its funds to several new distributions — some in Malawi, some in the Democratic Republic of the Congo (DRC) — and we recommended it as a top charity again.

Important changes in the last 12 months

In 2015, AMF carried out and/or monitored many of the distributions that it committed to in 2014.

Previously, our confidence in AMF’s ability to scale had been limited by the fact that it had only completed large-scale distributions with one partner (Concern Universal) in one country (Malawi). However, AMF carried out its largest distribution to date (~620,000 nets) with a new partner in the DRC in late 2014. We have not yet seen some key documentation from the large DRC distribution, but early indications suggest that the distribution generally went as planned, despite our concern that the DRC may have been an especially challenging place to work (more details here). We see this as a positive update that AMF will be able to carry out high-quality large-scale distributions in a variety of locations in the future.

AMF has continued to collect and share follow-up information on its past large-scale distributions, and this information seems to support the notion that these distributions are high-quality (i.e., that nets are reaching the target population and are being used). We provide a summary of these reports in our review.

Funding gap

AMF currently holds $18.5 million, and we estimate it will receive an additional $1.6 million before January 31, 2016 (excluding donations influenced by GiveWell) that it could use for future distributions. AMF has told us that it has a pipeline of possible future net distributions that add up to roughly $100 million beyond what it currently holds (details in our review).

We believe that AMF’s progress would be slowed due to lack of funding were it to receive less than $50.3 million in additional funding (this is its total capacity-relevant and “Execution Level 1” gap as presented earlier in the post). In particular, we view the first additional $6.5 million that AMF would receive as capacity-relevant (and thus particularly valuable) because it would enable AMF to fund a distribution in a 5th country with a 5th partner, generating additional information about its ability to expand beyond the contexts in which it has worked to date. (Note that AMF already has funds on hand to enter its 3rd and 4th countries.)

We arrived at the capacity-relevant and Execution Level 1 figure by noting that AMF has $70.4 million worth of deals it is actively negotiating (5 deals in 4 countries) that it can only continue with if it holds the funds to do so. Subtracting the $20.1 million we expect to be available (the $18.5 million it currently holds plus the $1.6 million we expect it to receive in the coming months) leaves a $50.3 million funding gap.

AMF failed to reach new distribution agreements in 2015; there is still significant uncertainty regarding AMF’s ability to finalize agreements with new partners and countries. Nevertheless, we see providing a large amount of additional funds to AMF as a reasonable bet, and see AMF as a very strong giving opportunity.

We think it is possible that in November 2016 (when we next expect to complete a full refresh of our recommendations), we will recommend significantly less funding to AMF. We consider the funding we’re recommending to AMF now to be a good bet, but a risky one, because AMF currently has a relatively limited track record: it has worked with only two partners in two countries. Because of the lag between the time we provide funding and the time net distributions take place (often 2 years) and the additional lag caused by the time it takes to monitor distributions, we may not have additional information about whether or not AMF’s additional distributions were successful for 2-3 years. Next year, it is possible that we will choose to recommend significantly less funding to AMF while we wait for additional data to become available.

There still appears to be a large global funding gap for bednets; a global bednet coordination group estimated that about 245 million additional nets would be needed in 2015-2017 (details in our review).

Key considerations:

• Program impact and cost-effectiveness. We estimate that bednets are ~10x as cost-effective as cash transfers. Our estimates are subject to substantial uncertainty. All of our cost-effectiveness analyses are available here. Our 2015 cost-effectiveness file is available here (.xlsx).
• Directness and robustness of the case for impact. We believe that the connection between AMF receiving funds and those funds helping very poor individuals is less direct than GiveDirectly’s and more direct than SCI’s or Deworm the World’s. The uncertainty of our estimates is driven by a combination of AMF’s challenges historically disbursing the funds it receives and a general recognition that aid programs, even those as straightforward as bednets, carry significant risks of failure via ineffective use of nets, insecticide resistance, or other risks we don’t yet recognize relative to GiveDirectly’s program. AMF conducts extensive monitoring of its program; these results have generally indicated that people use the nets they receive.
• Transparency and communication. AMF has been extremely communicative and open with us. We feel we have a better understanding of AMF than of SCI, and a similar level of knowledge about AMF as we have for Deworm the World, though our understanding is not as strong as our understanding of GiveDirectly. In particular, were something to go wrong in one of AMF’s distributions, we believe we would eventually find out (something we are not sure of in the case of SCI), but we believe our understanding would be less quick and complete than it would be for problems associated with GiveDirectly’s program (which has more of a track record of consistent intensive follow-up).
• Risks:
  • We are not highly confident that AMF will be able to finalize additional distributions and do so quickly. AMF could struggle again to agree to distribution deals, leading to long delays before it spends funds. We view this as a relatively minor risk because the likely worst-case scenario is that AMF spends the funds slowly (or returns funds to donors).
  • We remain concerned about the possibility of resistance to the insecticides used in bednets. There don’t appear to be major updates on this front since our 2012 investigation into the matter; we take the lack of major news as a minor positive update.

Our full review of AMF is here.

Deworm the World Initiative, led by Evidence Action

 

Our full review of Deworm the World is here.

Background

Deworm the World (www.evidenceaction.org/deworming), led by Evidence Action, advocates for, supports, and evaluates government-run school-based deworming programs (treating children for intestinal parasites).

We believe that deworming is a program backed by relatively strong evidence. We have reservations about the evidence, but we think the potential benefits are great enough, and costs low enough, to outweigh these reservations. Deworm the World retains monitors whose reports indicate that the deworming programs it supports successfully deworm children.

Important changes in the last 12 months

In 2015, Deworm the World continued to support the scale-up and monitoring of deworming programs in India and Kenya. One of its notable activities this year was providing technical assistance to the Indian national government in support of India’s first national deworming day: a program in which the government provided assistance to Indian states to implement school-based deworming on a single day to encourage more states to implement the program. The first national deworming day took place in February 2015, and 12 states participated in the program (more details here).

The quality of the monitoring that we saw from Deworm the World improved in 2015. Deworm the World continued to hire and train third-party monitors to directly observe deworming activities, and it slightly improved its estimates of how many children were treated. This information strongly suggests that the programs are generally operating as intended. More details in our review.

Last year, Deworm the World stated to us that it could not use significant additional funding to scale up deworming programs. Deworm the World now believes that it has identified countries where it could use additional funds to support the scale-up of deworming programs, beginning with a potential program in Punjab province, Pakistan (more). (Deworm the World also plans to use funds it already holds or expects to receive to expand into Ethiopia and Nigeria.)

Future donations to Deworm the World will likely be used outside of India, and in those cases governments may have less funding to support deworming. This may cause Deworm the World to pay a higher fraction of the overall cost of the program, making the potential for leverage of future donations more limited. Overall program costs may also be higher outside of India. More details in our review.

A significant organizational update is that Alix Zwane stepped down as Executive Director of Evidence Action in August; she left to join the Global Innovation Fund as CEO. Evidence Action has since hired Jeff Brown (formerly Interim CEO of the Global Innovation Fund) as Executive Director. Grace Hollister remains Director of the Deworm the World Initiative. Overall, our impression is that Dr. Zwane has been a highly effective leader of Evidence Action and her departure risks disruptions that could lead to us changing our view of the organization, though we would guess that this will not be the case.

In July, researchers published two new analyses of a key study regarding deworming (the most important piece of evidence we rely on), and the Cochrane Collaboration published an updated review of the evidence for mass deworming programs. The new papers did not change our overall assessment of the evidence on deworming. More in our blog post.

Funding gap

We believe that Deworm the World has significant opportunities to use additional funding to expand its program. We believe it may have opportunities to enter at least two more countries (in addition to Nigeria and Ethiopia, which it will be able to enter with funds it already has or expects to receive). We estimate its funding need using the two countries it is most likely to enter — Pakistan and Nepal — though note that in both cases, we see these as representative of the types of opportunities it may have, rather than the specific opportunities we expect it to take. Altogether, Deworm the World estimates that it would need $11.25 million to commit to fully funding three years of deworming programs in both countries. Because it holds (or expects to receive shortly) funding that will total $3.6 million, we estimate its funding gap for this work at $7.6 million.

Funding this gap is capacity-relevant, and is therefore a high priority, because we would like to see Deworm the World try to work in additional countries beyond India and Kenya, where it has worked historically. Next year, Deworm the World will also enter Nigeria and Ethiopia (with funding already available), so it will likely end the year having had some experience in five or more countries. This could substantially increase Deworm the World’s long-term room for more funding.

A complicating factor in thinking about Deworm the World’s funding gap is that Deworm the World is part of a larger organization, Evidence Action. Funding for Deworm the World may be fungible with funding for Evidence Action’s other activities, such as its Dispensers for Safe Water initiative (which we believe to be substantially less cost-effective than deworming). Because of this, it is difficult to determine Deworm the World’s true funding gap, and it is possible that some additional funds given to support Deworm the World could effectively lead to additional funds for a non-Deworm the World project. We understand that Evidence Action has received approximately $2.4 million in unrestricted funding over the past year. Fully funding Deworm the World could potentially cause Evidence Action to redirect some or all of these funds to its other programs.

More details on all of the above are in our review.

Key considerations:

• Program impact and cost-effectiveness. We estimate that Deworm the World-associated deworming programs are ~10x as cost-effective as cash transfers. Our estimates are subject to substantial uncertainty. It’s important to note that we view deworming as high expected value, but this is due to a relatively low probability of very high impact. Most GiveWell staff members would agree that deworming programs are more likely than not to have very little or no impact, but there is some possibility that they have a very large impact. (Our cost-effectiveness model implies that most staff members believe there is at most a 1-2% chance that deworming programs conducted today have similar impacts to those directly implied by the randomized controlled trials on which we rely most heavily, which differed from modern-day deworming programs in a number of important ways.) Our 2015 cost-effectiveness file is available here (.xlsx).
• Directness and robustness of the case for impact. Deworm the World doesn’t carry out deworming programs itself; it advocates for and provides technical assistance to governments implementing deworming programs, making direct assessments of its impact challenging. We have seen evidence that strongly suggests that Deworm the World-supported programs successfully deworm children. While we believe Deworm the World is impactful, our evidence is limited, and in addition, there is always a risk that future expansions will prove more difficult than past ones.
• Transparency and communication. Deworm the World has been communicative and open with us. We believe that were something major to go wrong with Deworm the World’s work, we would be able to learn about it and report on it.
• Risks:
  • Deworm the World is part of a larger organization, Evidence Action. It is possible that some additional funds given to support Deworm the World could effectively lead to additional funds for a non-Deworm the World project due to fungibility. Also, changes that affect Evidence Action (and its other programs) could indirectly impact Deworm the World. For example, if a major event occurs (either positive or negative) for Evidence Action, it is likely that it would reduce the time some staff could devote to Deworm the World.
  • Deworm the World is now largely raising funds to support programs that will be carried out under a different model in new countries, which makes it harder for us to predict future success based on historical results and may make it harder to understand and quantify Deworm the World’s impact even after the program is completed.

Our full review of Deworm the World is here.

GiveDirectly

 

Our full review of GiveDirectly is here.

Background

GiveDirectly (www.givedirectly.org) transfers cash to households in developing countries via mobile phone-linked payment services. It targets extremely low-income households. The proportion of total expenses that GiveDirectly has delivered directly to recipients is approximately 85% overall. We believe that this approach faces an unusually low burden of proof, and that the available evidence supports the idea that unconditional cash transfers significantly help people.

We believe GiveDirectly to be an exceptionally strong and effective organization, even more so than our other top charities. It has invested heavily in self-evaluation from the start, scaled up quickly, and communicated with us clearly. It appears that GiveDirectly has been effective at delivering cash to low-income households. GiveDirectly has one major randomized controlled trial (RCT) of its impact and took the unusual step of making the details of this study public before data was collected (more). It continues to experiment heavily, to the point where every recipient is enrolled in a study or a campaign variation.

Important changes in the last 12 months

GiveDirectly continued to scale up significantly, utilizing most of the funding it received at the end of last year. It continued to share informative and detailed monitoring information with us. Overall, it grew its operations while maintaining the high quality of its program.

In August, Good Ventures granted $25 million to GiveDirectly to support potentially high-upside opportunities, such as (a) building a fundraising team that will aim to raise substantial donations from non-GiveWell donors, and (b) developing partnerships with bilateral donors and local governments to deliver cash transfers or to run experiments comparing standard aid programs to cash transfers.

GiveDirectly’s increased efforts to network with potential government and donor partners have led to some results in 2015. For example, GiveDirectly will be implementing cash transfers in a randomized controlled trial in Rwanda that will be funded by a bilateral aid donor and Google. The study will test cash transfers against another still-to-be-chosen aid program. GiveDirectly is currently in several preliminary conversations with partners for similarly large projects in the future.

Funding gap

GiveDirectly believes it could move a total of ~$94 million to poor households in the year following March 1, 2016, for which it expects to have ~$12.6 million available by March 1. We have classified ~$34.5 million of this as the total “Execution Level 1,” capacity-relevant, and incentive funding gap (more on what this means above). We arrived at this figure by assuming that GiveDirectly could double its operations in Kenya (from ~$16.5 million/year to ~$33 million/year) and scale up to ~$12.1 million/year in Uganda. This would cost a total of ~$45.1 million, of which GiveDirectly already has ~$10.6 million on hand (ignoring $2 million that we exclude due to donor coordination issues), which results in a ~$34.5 million gap.

We’ve classified some of this as a “capacity-relevant” funding gap for our purposes (making it higher priority). First, we view the ~$12.1 million it would hope to spend in Uganda as capacity-relevant, in the sense that providing it could make a major difference to GiveDirectly’s long-term development. GiveDirectly told us that operating in Uganda is more challenging than in Kenya and that it expects to learn a significant amount as it grows. It is therefore planning to grow more slowly in Uganda than it did in Kenya. GiveDirectly made two arguments for Uganda being important for its long-term trajectory:

1. If GiveDirectly lost the ability to operate in Kenya, this would significantly diminish its ability to move funds out the door. Operating in Uganda is an important hedge against this risk.
2. Kenya is a particularly easy environment in which to operate because of the existence of M-PESA, a powerful and ubiquitous provider that enables GiveDirectly to transfer funds to recipients via mobile phones. The mobile payments network is significantly less developed outside of Kenya. As such, Uganda offers an important test case for operating in a more standard environment, which could be particularly valuable to GiveDirectly as it encourages aid agencies and country governments to expand direct cash assistance.

It’s harder to estimate how much of the Kenya funding needs are properly classified as “capacity-relevant” (an important distinction for our purposes, as discussed above). We guess that were GiveDirectly to be operating at a level 50% its current size (such that it only spent ~$8.25 million/year in Kenya), it would be able to build capacity from that level to its current level (and beyond) as quickly as it did in its recent past. We therefore classify ~$8.25 million of the ~$16.5 million it hopes to spend in Kenya as “capacity-relevant” and ~$8.25 million as “execution.” We note that we are highly uncertain about these estimates and that were GiveDirectly to receive no additional funding, this would cause it to contract in Kenya and lay off some of its middle management, an action that would cause it to incur reasonably high costs; we think much more contraction than that would be significantly more challenging for GiveDirectly as an organization.

Based on the above, and based on GiveDirectly’s existing available funds (with some adjustments for coordination issues, along the lines of this discussion from last year) we estimate that GiveDirectly has ~$9.8 million worth of unfunded opportunities that we ought to classify as capacity-relevant or incentive funding. (We arrive at this estimate based on: ~$20.35 million (total amount we classify as capacity-relevant from Kenya and Uganda) – ~$10.6 million (funds on hand, excluding donations we ignore due to coordination issues) = ~$9.75 million.)

Longer-term, we expect to continue to view funding ~$8.25 million in Kenya as capacity-relevant support and would expect to consider future expansion in Uganda (up to the current level of Kenya, i.e., ~$16.5 million/year) capacity-relevant, as well. Once GiveDirectly reaches ~$16.5 million in Uganda and proves that it can operate at that level, we only expect to view ~$8.25 million as capacity-relevant and hope that it can raise funds from other sources to support its work.

More details in our review.

Key considerations:

• Program impact and cost-effectiveness. Our best guess is that deworming or distributing bednets achieves ~10x times more humanitarian benefit per dollar donated than cash transfers. Our estimates are subject to substantial uncertainty. All of our cost-effectiveness analyses are available here. Our 2015 cost-effectiveness file is available here (.xlsx).
• Directness and robustness of the case for impact. GiveDirectly collects and shares a significant amount of relevant information about its activities. The data it collects show that it successfully directs cash to very poor people, that recipients generally spend funds productively (sometimes on food, clothing, or school fees, other times on investments in a business or home infrastructure), and that it leads to very low levels of interpersonal conflict and tension. We are more confident in the impact of GiveDirectly’s work than in that of any of the other charities discussed in this post; we believe that cash transfers face a lower burden of proof than other interventions.
• Transparency and communication. GiveDirectly has always communicated clearly and openly with us. It has tended to raise problems to us before we ask about them, and we generally believe that we have a very clear view of its operations. We feel more confident about our ability to keep track of future challenges than with any of the other charities discussed in this post.
• Risks:
  • GiveDirectly has scaled (and hopes to continue to scale) quickly. Thus far, it has significantly increased the amount of money it can move with limited issues as a result. The case of staff fraud that GiveDirectly detected is one example of an issue possibly caused by its pace of scaling, but its response demonstrated the transparency and rigor we expect.

Our full review of GiveDirectly is here.

Schistosomiasis Control Initiative (SCI)

 

Our full review of SCI is here.

Background

SCI (www3.imperial.ac.uk/schisto) works with governments in sub-Saharan Africa to create or scale up deworming programs (treating children for schistosomiasis and other intestinal parasites). SCI’s role has primarily been to identify recipient countries, provide funding to governments for government-implemented programs, provide advisory support, and conduct research on the process and outcomes of the programs. Despite SCI sharing a number of spending reports with us, we do not feel we have a detailed and fully accurate picture of how SCI and the governments it supports have spent funds in the past. We don’t feel that SCI has ever purposefully been indirect with us, but we have often struggled to communicate effectively with SCI representatives. We still lack important and in some cases basic information about SCI’s finances, and we find this problematic.

We believe that deworming is a program backed by relatively strong evidence. We have reservations about the evidence, but we think the potential benefits are great enough, and costs low enough, to outweigh these reservations. SCI has conducted studies in about half of the countries it works in (including the countries with the largest programs) to determine whether its programs have reached a large proportion of children targeted. These studies have generally found moderately positive results, but have some methodological limitations.

Important changes in the last 12 months

SCI reports that it has continued to scale up its deworming programs and that it has supported some programs in new countries, though we have limited monitoring information from these programs (e.g., we have not seen monitoring from its programs in Ethiopia, Sudan, Madagascar, and the DRC).

This year, SCI has shared a few more coverage surveys that found reasonably high coverage of its programs.

We have continued to have communication challenges with SCI. In particular:

• We have a limited understanding of SCI’s work because we still lack important and basic information about how SCI spends money. SCI recognizes that its financial management system is disorganized, and some spending reports that SCI has sent us have contained errors.
• We have struggled to gain a confident understanding of how SCI will use additional funds, and we cannot check how its funds were used after the fact because we lack information about its spending. In some cases, SCI has not spent additional funds as expected and it is unclear what caused the shift (more detail on one example in our August 2015 update).

In July, researchers published two new analyses of a key study regarding deworming (the most important piece of evidence we rely on), and the Cochrane Collaboration published an updated review of the evidence for mass deworming programs. The new papers did not change our overall assessment of the evidence on deworming. More in our blog post.

Funding gap

SCI estimates that it would use the following amounts of unrestricted funding in each of the next three years (in millions of US dollars):

• April 2016 – March 2017: $9.5
• April 2017 – March 2018: $13.6
• April 2018 – March 2019: $13.3

Our impression is that GiveWell-influenced donors contribute most of SCI’s unrestricted funds.

Our best guess is that, excluding the funds SCI may receive due to GiveWell’s recommendation, SCI will hold approximately $1.5 million in April 2016 that it could allocate to the above gaps. Also, after SCI set its fundraising targets, a funder committed $6 million over the next three years ($2 million per year) to deworming programs in Ethiopia, with which SCI is involved. Our best guess is that this funding reduces SCI’s “Execution Level 1” and incentive funding gap for the coming year from $9.5 million to $5.9 million. (We arrive at this estimate by subtracting ~$1.5 million and another $2 million from the total Level 1/incentive gap for the coming year).

We do not classify any of this as “capacity-relevant” because we have little understanding of how it will be spent, and we do not expect to be able to understand how it was spent after the fact, either.

More details on SCI’s funding gap are in our review.

Key considerations:

• Program impact and cost-effectiveness. Our best guess is that deworming programs implemented by SCI are ~5x as cost-effective as cash transfers. Our estimates are subject to substantial uncertainty. It’s important to note that we view deworming as high expected value, but this is due to a relatively low probability of very high impact. Most GiveWell staff members would agree that deworming programs are more likely than not to have very little or no impact, but there is some possibility that they have a very large impact. (Our cost-effectiveness model implies that most staff members believe there is at most a 1-2% chance that deworming programs conducted today have similar impacts to those directly implied by the randomized controlled trials on which we rely most heavily, which differed from modern-day deworming programs in a number of important ways.) Our 2015 cost-effectiveness file is available here (.xlsx).
• Directness and robustness of the case for impact. SCI doesn’t carry out deworming programs itself; it advocates for and provides technical assistance to governments implementing deworming programs, making direct assessments of its impact challenging. We have seen some evidence demonstrating that SCI-supported programs successfully deworm children, though this evidence is relatively thin. Nevertheless, deworming is a relatively straightforward program, and we think it is likely (though far from certain) that SCI-supported deworming programs successfully deworm people. We have had difficulties communicating with SCI, which has reduced our ability to understand it. We have also spent significant time interviewing SCI staff and reviewing documents over the past 6 years and have found minor but not major concerns.
• Transparency and communication. We don’t feel that SCI has ever purposefully been indirect with us, but we have often struggled to communicate effectively with SCI representatives. Specifically, (a) we had a major miscommunication with SCI about the meaning of its self-evaluations (more) and (b) although we have spent significant time with SCI, we remain unsure how SCI has spent funds and how much funding it has available (and we believe SCI itself does not have a clear understanding of this). Importantly, if there is a future unanticipated problem with SCI’s programs, we don’t feel confident that we will become aware of it. This contrasts with our other top charities, which we feel we have a strong ability to follow up on.
• Risks: There are significantly more unknown risks with SCI than our other top charities due to our limited understanding of its activities.

Our full review of SCI is here.

Standouts

As we did last year, we recommend four organizations as “standouts.” These charities score well on some of our criteria, but we are not confident enough in them to name them top charities. This year, we retain the same four standout organizations: Development Media International (DMI), the Global Alliance for Improved Nutrition’s Universal Salt Iodization program (GAIN-USI), the Iodine Global Network (IGN), and Living Goods.

We followed all four of these charities in 2015, but have only published an updated review for DMI. We expect to publish updated reviews for GAIN-USI, IGN, and Living Goods in the near future.

We provide brief updates on these charities below:

• DMI. DMI produces radio and television programming in developing countries that encourages people to adopt improved health practices. It is a standout because of its commitment to monitoring and the possibility that it is implementing a highly cost-effective program. DMI has recently completed a randomized controlled trial of its program. Last year, we had midline results from this trial, which generally looked promising.In November 2015, DMI privately shared preliminary endline results from the RCT. These results did not find any effect of DMI’s program on child mortality, and found substantially less effect on behavior change than was found in the midline results. We (understandably) cannot publicly discuss the details of the endline results we have seen, because they are not yet finalized and because the finalized results will be embargoed prior to publication. DMI believes that there were serious problems with endline data collection (note that we have not yet tried to independently assess this claim). With the support of the trial’s Independent Scientific Advisory Committee, DMI is planning to conduct another endline survey in late 2016, with results available in 2017.We are impressed by DMI’s openness with us about its results (and its willingness for us to share the high-level summary), and we hope to have discussions with DMI about how it might be able to work toward becoming a top charity in the future. Our full review of DMI is here.
• GAIN-USI. GAIN’s Universal Salt Iodization (USI) program supports national salt iodization programs. There is strong evidence that salt iodization programs have a significant, positive effect on children’s cognitive development. GAIN-USI does not work directly to iodize salt; rather, it supports governments and private companies to do so, which could lead to leveraged impact of donations or to low impact, depending on its effectiveness. Last year, we wrote, “We tried but were unable to document a demonstrable track record of impact; we believe it may have had significant impacts, but we are unable to be confident in this with what we know now. More investigation next year could change this picture.” In 2015, we continued our assessment of GAIN, focusing on its work in India and Ethiopia, including a site visit to Ethiopia in July.Overall, we tried but were unable to establish clear evidence of GAIN successfully contributing to the impact of iodization programs. This is primarily due to (a) the difficulty in attributing impact to specific activities that GAIN carried out and (b) challenges we have had communicating with GAIN about its work. We have not yet completed our final report on GAIN but hope to publish it in the near future. We have published notes from some of the conversations that were part of this research and they are available here. Our 2014 review of GAIN is here.
• IGN. Like GAIN-USI, IGN supports (via advocacy and technical assistance rather than implementation) salt iodization, and as with GAIN-USI, we tried but were unable to establish clear evidence of IGN successfully contributing to the impact of iodization programs. Unlike GAIN-USI, IGN is small, operating on a budget of approximately $0.5-$1 million per year, and relies heavily on volunteer time. We are planning to post an updated review in the near future. Our 2014 review of IGN is here.
• Living Goods recruits, trains, and manages a network of community health promoters who sell health and household goods door-to-door in Uganda and Kenya and provide basic health counseling. They sell products such as treatments for malaria and diarrhea, fortified foods, water filters, bednets, clean cookstoves, and solar lights. Living Goods completed a randomized controlled trial of its program and measured a 27% reduction in child mortality. We estimate that Living Goods saves a life for roughly each $10,000 it spends, approximately 3 times as much as our estimate for the cost per life saved of AMF’s program. We spoke with Living Goods and reviewed documents about their progress in 2015. We do not have major updates to report but are planning to post an updated review in the near future. Our 2014 review of Living Goods is here.

Our research process in 2015

 

This section describes the new work we did in 2015 to supplement our previous work on defining and identifying top charities. See the process page on our website for our overall process.

This year, we did not put a substantial amount of senior staff time into new top charities research work because (a) we were largely focused on building capacity, and (b) we reallocated a significant amount of capacity to the Open Philanthropy Project (see our post on our plans for 2015 for more details).

We focused the bulk of our research capacity for top charities work on staying up-to-date on our recommended charities. We also did an intensive evaluation of GAIN-USI, including a site visit (more details forthcoming).

We completed investigations of vitamin A supplementation and maternal and neonatal tetanus immunization campaigns. Both programs seem potentially competitive with our other priority programs, but we were not able to identify charities that worked on these programs that were willing to apply for a recommendation. We also made substantial progress on investigating several other programs, such as measles immunization, meningitis A vaccination, folic acid fortification, voluntary medical male circumcision for the prevention of HIV, and “Targeting the Ultra-Poor” (or “Ultra-Poor Graduation”) programs.

We stayed up to date on the research for bednets, cash transfers, and deworming.

We did not conduct an extensive search for new charities this year. We feel that we have a relatively good understanding of the existing charities that could potentially meet our criteria, based on past searches (see the process page on our website for more information). Instead, we solicited applications from organizations that we viewed as contenders for recommendations. A March post laid out which organizations we were hoping to investigate and why.

We did some initial research on several charities that we had not investigated before, but we did not complete the reviews in time for our 2015 recommendations. The organizations that we began investigating were:

• END Fund
• Episcopal Relief & Development’s NetsforLife® Program
• Project Healthy Children
• Sightsavers.

We plan to complete these reviews in 2016.

Giving to GiveWell vs. top charities

 

We have grown significantly over the past few years and continue to raise funds to support our operations. This includes work on GiveWell’s top charities and the Open Philanthropy Project.

We plan to post an update on our funding situation before the end of the year.

The most up-to-date information available on this topic is linked from our June 2015 board meeting. The short story is that we are still seeking additional donations and encourage donors who feel they are sufficiently confident in our impact to give to us.

Footnotes:

* For example, if $30 million were available to fund gaps of $10 million, $5 million, and $100 million, we would recommend allocating the funds so that the $10 million and $5 million gaps were fully filled and the $100 million gap received $15 million.

This rule is material to the three gaps tied at priority level 2. It causes us to recommend that Good Ventures’ last $28.3 million to recommended charities is used to fully fill GiveDirectly’s $8.8 million capacity-relevant gap and Deworm the World’s $3.2 million Execution Level 2 (possible capacity-relevant) gap, but only fill $16.3 million of AMF’s Execution Level 1 gap.

** This gap can’t be cleanly classified because we think the funding is relatively unlikely to be needed, but if it is needed, it is likely to have capacity-relevant effects. Thus, it is technically classified as Execution Level 2, but we think it has similar value to Execution Level 1.

The post Our updated top charities for giving season 2015 appeared first on The GiveWell Blog.

We have refreshed our top charity rankings and recommendations. Our set of top charities and standouts is the same as last year’s, but we have introduced rankings and changed our recommended funding allocation, due to a variety of updates – particularly to our top charities’ room for more funding. In particular, we are recommending that Good Ventures, a foundation with which we work closely, support our top charities at a higher level than in previous years. This post includes our recommendations to Good Ventures, and gives our recommendations to individual donors after accounting for these grants.

Overall, we think the case for our top charities is stronger than in previous years, and room for more funding is greater.

Our top charities and recommendations for donors, in brief

 

Top charities

1. Against Malaria Foundation (AMF)
2. Schistosomiasis Control Initiative (SCI)
3. Deworm the World Initiative, led by Evidence Action
4. GiveDirectly

This year, we are ranking our top charities based on what we see as the value of filling their remaining funding gaps. Unlike in previous years, we do not feel a particular need for individuals to divide their allocation between the charities, since we are recommending that Good Ventures provide significant support to each. For those seeking our recommended allocation, we simply recommend giving to the top-ranked charity on the list, which is AMF.

Our recommendation takes the grants we are recommending to Good Ventures into account, as well as accounting for charities’ existing cash on hand and expected non-GiveWell-related fundraising, and recommends charities according to how much good additional donations (beyond these sources of funds) can do. (Otherwise, as explained below, Deworm the World would be ranked higher.) Thus, AMF’s #1 ranking is not based on its overall value as an organization, but based on the value of its remaining funding gap.

Standout charities

As with last year, we also provide a list of charities that we believe are strong standouts, though not at the same level (in terms of likely good accomplished per dollar) as our top charities. They are not ranked, and are listed in alphabetical order.

• Development Media International (DMI)
• The Global Alliance for Improved Nutrition’s Universal Salt Iodization program (GAIN – USI)
• Iodine Global Network (IGN), formerly known as ICCIDD
• Living Goods

Below, we provide:

• An explanation of major changes in the past year that are not specific to any one charity. More
• A summary of our top charities’ relative strengths and weaknesses, and how we would rank them if room for more funding were not an issue. More
• A discussion of our refined approach to room for more funding. More
• The recommendations we are making to Good Ventures, and how we rank our top charities after taking these grants (and their impact on room for more funding) into account. More
• Detail on each of our top charities, including major changes over the past year, strengths and weaknesses for each, and our understanding of each organization’s room for more funding. More
• The process we followed that led to these recommendations. More
• A brief update on giving to support GiveWell’s operations vs. giving to our top charities. More

Conference call to discuss recommendations

We are planning to hold a conference call at 5:30pm ET/2:30pm PT on Tuesday, December 1st to discuss our recommendations and answer questions.

If you’d like to join the call, please register using this online form. If you can’t make this date but would be interested in joining another call at a later date, please indicate this on the registration form.

Major changes in the last 12 months

 

Below, we summarize the major causes of changes to our recommendations (since last year).

Overall, the case for our top charities is stronger than it was in past years. The Deworm the World Initiative shared new monitoring and evaluation materials with us, so we are more confident than we were a year ago that it is a strong organization implementing high-quality programs. In addition, the extra year of work we have seen from AMF and GiveDirectly bolsters our view that they will be able to utilize additional funding effectively.

Our top charities have increased room for more funding. Last year, we expected donors following our recommendations to fully fill the most critical funding gaps of our top charities (excluding GiveDirectly) because they had limited room for more funding: GiveDirectly had a total funding gap of ~$40 million and our other three top charities had a total gap of ~$18 million. This year, all of our top charities have more room for more funding. We believe that GiveDirectly could absorb more than $80 million and other top charities together could collectively utilize more than $100 million. We do not expect donors following our recommendations to fully fill these gaps.

We are recommending that Good Ventures make larger grants to top charities. For reasons we will be detailing in a future post, we are recommending that Good Ventures make substantial grants to our top charities this year, though not enough to close their funding gaps.

Continued refinement of the concept of “room for more funding.” We’ve tried to create a much more systematic and detailed room for more funding analysis, because the stakes of this analysis have become higher due to (a) increased room for more funding across the board and (b) increased interest from Good Ventures in providing major support.

In past years, we’ve discussed charities’ room for more funding as a single figure without distinguishing between (a) the amount the charity would spend in the next 12 months, (b) the amount the charity needs to prevent it from slowing its work due to lack of funds, and (c) funding that would be especially important to the organization’s development and success (a dual benefit) in addition to expanding implementation of its program. This year, we’ve made three changes to our room for more funding analysis:

• We’ve made (a) an assessment of whether additional funds merely allow a charity to implement its program (“execution”) or (b) whether additional funds would be especially important to the charity’s development and success as an organization (“capacity-relevant”). We also explicitly note the role of incentives for meeting GiveWell’s top-charity criteria in our recommendations (we seek to ensure that each top charity receives at least $1 million, to encourage other organizations to seek to meet these criteria).
• We are explicitly assessing “execution”-related room for more funding based on our estimate of the probability that lack of funding will lead to a charity slowing its progress. We distinguish between Level 1, Level 2, and Level 3 “execution” funding gaps; a higher number means the money is less likely to be needed.
• We are now ranking “funding gaps,” not just ranking charities, because the first million dollars to a charity can have a very different impact from, e.g., the 20th million dollars. For example, if Charity A accomplishes more good per dollar with its programs than Charity B, we would rank Charity A above Charity B for a given type of gap (we would rank Charity A’s “Execution Level 1” gap above Charity B’s), but we might rank Charity B’s “Execution Level 1” gap (the amount of funding it will likely need) above Charity A’s “Execution Level 3” gap (the amount of funding gap it might, but probably will not, need to carry out more of its programs in the coming year).

We discuss these ideas in greater depth below.

Summary of key considerations for top charities

 

The table below summarizes the key considerations for our four top charities. More detail is provided below as well as in the charity reviews.

Consideration AMF Deworm the World GiveDirectly SCI Program estimated cost-effectiveness (relative to cash transfers) ~10x ~10x Baseline ~5x Directness and robustness of the case for impact Strong Moderate Strongest Moderate Transparency and communication Strong Strong Strongest Weakest Ongoing monitoring and likelihood of detecting future problems Strong Strong Strongest Weakest Organizational track record of rolling out program Moderate Moderate Strong Strong Room for more funding, after accounting for grants we are recommending to Good Ventures (more below) Very high Limited Very high High

 

Overall, our ranking of the charities with room for more funding issues set aside (just considering a hypothetical dollar spent by the charity on its programs, without the “capacity-relevant funding” and “incentives” issues discussed below) would be:

1. AMF and Deworm the World
3. SCI
4. GiveDirectly

However, when we factor in room for more funding (including the impact of the grants we’re recommending to Good Ventures), the picture changes. More on this below.

Room for more funding analysis

 

Capacity-relevant funding and incentives

 

Capacity-relevant funding: additional funding can sometimes be crucial for a charity’s development and success as an organization. For example, it can contribute to a charity’s ability to experiment, expand, and ultimately have greater room for more funding over the long run. It can also be important for a charity’s ability to raise funds from non-GiveWell donors, which can be an important source of long-term leverage and can put the organization in a stronger overall position.

We think of this sort of funding gap as particularly important to fill, because it can make a big difference over the long run; in particular, it may substantially affect the long-term quality of our giving recommendations.

“Capacity-relevant” funds can include (a) funds that are explicitly targeted at growth (e.g., funds to hire fundraising staff); (b) funds that enable a charity to expand into areas it hasn’t worked in before, which can lead to important learning about whether and how the charity can operate in the new location(s); and (c) funds that would be needed in order to avoid challenging contractions in a charity’s activities which could jeopardize the charity’s long-term growth and funding prospects.

Some specific examples:

• The grant that Good Ventures made to GiveDirectly earlier this year is capacity-relevant because it will be used for: (a) building a fundraising team that will aim to raise substantial donations from non-GiveWell donors, and (b) developing partnerships with bilateral donors and local governments to deliver cash transfers or to run experiments comparing standard aid programs to cash transfers.
• Early funding that GiveDirectly received was capacity-relevant because it enabled GiveDirectly to rapidly grow from a small organization moving a few hundred thousand dollars per year to a much larger organization moving more than $10 million per year. If this funding hadn’t been forthcoming, GiveDirectly might be much smaller today and have much less room for more funding.
• We now think that some additional funding to AMF and Deworm the World will be capacity-relevant because each organization has only operated in a very small number of countries and new funding will enable each to enter new countries. This will allow them to learn how to operate there, and demonstrate that they can do so, increasing our willingness (and likely that of other donors) to recommend more to these organizations in the future.

It’s hard to draw sharp lines around capacity-relevant funding, and all funding likely has some effect on an organization’s development, but we have tried to identify and prioritize the funding gaps that seem especially relevant.

Execution funding allows charities to implement more of their core program but doesn’t appear to have substantial benefits beyond the direct good accomplished by this program. We’ve separated this funding into three levels:

• Level 1: the amount we expect a charity to need in the coming year. If a charity has less funding than this level, we think it is more likely than not that it will be bottlenecked (or unable to carry out its core program to the fullest extent) by funding in the coming year.
• Level 2: if a charity has this amount, we think there is an ~80% chance that it will not be bottlenecked by funding.
• Level 3: if a charity has this amount, we think there is a ~95% chance that it will not be bottlenecked by funding.

Incentives: we think it is important that charities we recommend get a substantial amount of funding due to being a GiveWell top charity, because this ensures that incentives are in place for charities (and potential charity founders) to seek to meet our criteria for top charities and thus increase the number of charities we recommend and the total room for more funding available, even when they don’t end up being ranked #1. We seek to ensure that each top charity gets at least $1 million as a result of our recommendation, and we consider this to be a high-priority goal of our recommendations.

The charity-specific sections of this post discuss the reasoning behind the figures we’ve assigned to “capacity-relevant” and “Execution Level 1” gaps, but they do not provide the full details of how we arrived at these figures (and do not explicitly address the “Execution Level 2” and “Execution Level 3” gaps). We expect to add this analysis to our charity reviews in the coming weeks.

Funding gaps

 

The total (i.e., Capacity-relevant, Execution Levels 1, 2, and 3, and Incentive) funding gaps (in millions of dollars, rounded to one decimal place) for each of our top charities are:

• AMF: $98.2
• Deworm the World: $19.0
• GiveDirectly: $84.0
• SCI: $26.3

However, for reasons described above, the first million dollars to a charity can have a very different impact from, e.g., the 20th million dollars. Accordingly, we have created a ranking of individual funding gaps that accounts for both (a) the quality of the charity and the good accomplished by its program, per dollar (as laid out above), and (b) whether a given level of funding is capacity-relevant and whether it is highly or only marginally likely to be needed in the coming year.

The below table lays out our ranking of funding gaps. When gaps have the same “Priority,” this indicates that they are tied.

The table below includes the amount we are recommending to Good Ventures. For reasons we will lay out in another post, we are recommending to Good Ventures a total of ~$44.4 million in grants to top charities. Having set that total, we are recommending that Good Ventures start with funding the highest-rated gaps and work its way down, in order to accomplish as much good as possible.

When gaps are tied, we recommend filling them by giving each equal dollar amounts until one is filled, and then following the same procedure with the remaining tied gaps. See footnote for more.*

Priority Charity Amount Type Recommendation to Good Ventures Comments 1 DtWI $7.6 Capacity-relevant $7.6 DtWI and AMF are strongest overall 1 AMF $6.5 Capacity-relevant $6.5 See above 1 GD $1.0 Incentive $1.0 Ensuring each top charity receives at least $1 million 1 SCI $1.0 Incentive $1.0 Ensuring each top charity receives at least $1 million 2 GD $8.8 Capacity-relevant $8.8 Not as cost-effective as bednets or deworming, so lower priority, but above non-capacity-relevant gaps 2 DtWI $3.2 Execution Level 2 / possibly capacity-relevant $3.2 Level 1 gap already filled via “capacity-relevant” gap. See footnote for more** 2 AMF $43.8 Execution Level 1 $16.3 Exhausts remaining recommendations to Good Ventures 3 SCI $4.9 Execution Level 1 0 Not as strong as DtWI and AMF in isolation, so ranked below them for same type of gap 3 AMF $24.0 Execution Level 2 0 – 4 DtWI $8.2 Execution Level 3 0 – 4 AMF $24.0 Execution Level 3 0 – 4 SCI $11.6 Execution Level 2 0 – 5 GD $24.8 Execution Level 1 0 – 5 SCI $8.8 Execution Level 3 0 – 6 GD $20.9 Execution Level 2 0 – 7 GD $28.6 Execution Level 3 0 –

Our recommendations to Good Ventures and others

 

Summing the figures from the above table, we are recommending that Good Ventures make the following grants (in millions of dollars, rounded to one decimal place):

• AMF: $22.8
• Deworm the World: $10.8
• GiveDirectly: $9.8
• SCI: $1

We also recommend that Good Ventures give $250,000 to each of our standout charities. These grants go to the outstanding organizations and create additional incentives for groups to try to obtain a GiveWell recommendation.

After these grants, AMF will require an additional ~$27.5 million to close its Execution Level 1 gap (i.e., to make it more likely than not that it is able to proceed without being bottlenecked due to lack of funding). We rank this gap higher than any of the other remaining funding gaps for our top charities, as laid out in the table above.

We estimate that non-Good Ventures donors will give approximately $15 million between now and January 31, 2016. Because we do not expect AMF’s remaining ~$27.5 million Execution Level 1 funding gap to be fully filled, we rank it #1 and recommend that donors give to AMF. We rank the remaining charities for donors who are interested in having the greatest impact per dollar based on how highly their highest-rated remaining gap ranks in the table above. That results in the following rankings for individual donors:

1. AMF
2. SCI
3. Deworm the World Initiative
4. GiveDirectly

Details on top charities

 

We present information on our top charities in alphabetical order.

Against Malaria Foundation (AMF)

 

Our full review of AMF is here.

Background

AMF (www.againstmalaria.com) provides funding for long-lasting insecticide-treated net distributions (for protection against malaria) in developing countries. There is strong evidence that distributing nets reduces child mortality and malaria cases. AMF has relatively strong reporting requirements for its distribution partners and provides a level of public disclosure and tracking of distributions that we have not seen from any other net distribution charity.

In 2011, AMF received a large amount of funding relative to what it had received historically, so it began to focus primarily on reaching agreements for large-scale net distributions (i.e., distributions on the order of hundreds of thousands of nets rather than tens of thousands of nets). In its early efforts to scale up, AMF struggled to finalize large-scale net distribution agreements. At the end of 2013, we announced that we planned not to recommend additional donations to AMF due to room for more funding-related issues (more detail in this blog post).

In 2014, AMF committed most of its funds to several new distributions — some in Malawi, some in the Democratic Republic of the Congo (DRC) — and we recommended it as a top charity again.

Important changes in the last 12 months

In 2015, AMF carried out and/or monitored many of the distributions that it committed to in 2014.

Previously, our confidence in AMF’s ability to scale had been limited by the fact that it had only completed large-scale distributions with one partner (Concern Universal) in one country (Malawi). However, AMF carried out its largest distribution to date (~620,000 nets) with a new partner in the DRC in late 2014. We have not yet seen some key documentation from the large DRC distribution, but early indications suggest that the distribution generally went as planned, despite our concern that the DRC may have been an especially challenging place to work (more details here). We see this as a positive update that AMF will be able to carry out high-quality large-scale distributions in a variety of locations in the future.

AMF has continued to collect and share follow-up information on its past large-scale distributions, and this information seems to support the notion that these distributions are high-quality (i.e., that nets are reaching the target population and are being used). We provide a summary of these reports in our review.

Funding gap

AMF currently holds $18.5 million, and we estimate it will receive an additional $1.6 million before January 31, 2016 (excluding donations influenced by GiveWell) that it could use for future distributions. AMF has told us that it has a pipeline of possible future net distributions that add up to roughly $100 million beyond what it currently holds (details in our review).

We believe that AMF’s progress would be slowed due to lack of funding were it to receive less than $50.3 million in additional funding (this is its total capacity-relevant and “Execution Level 1” gap as presented earlier in the post). In particular, we view the first additional $6.5 million that AMF would receive as capacity-relevant (and thus particularly valuable) because it would enable AMF to fund a distribution in a 5th country with a 5th partner, generating additional information about its ability to expand beyond the contexts in which it has worked to date. (Note that AMF already has funds on hand to enter its 3rd and 4th countries.)

We arrived at the capacity-relevant and Execution Level 1 figure by noting that AMF has $70.4 million worth of deals it is actively negotiating (5 deals in 4 countries) that it can only continue with if it holds the funds to do so. Subtracting the $20.1 million we expect to be available (the $18.5 million it currently holds plus the $1.6 million we expect it to receive in the coming months) leaves a $50.3 million funding gap.

AMF failed to reach new distribution agreements in 2015; there is still significant uncertainty regarding AMF’s ability to finalize agreements with new partners and countries. Nevertheless, we see providing a large amount of additional funds to AMF as a reasonable bet, and see AMF as a very strong giving opportunity.

We think it is possible that in November 2016 (when we next expect to complete a full refresh of our recommendations), we will recommend significantly less funding to AMF. We consider the funding we’re recommending to AMF now to be a good bet, but a risky one, because AMF currently has a relatively limited track record: it has worked with only two partners in two countries. Because of the lag between the time we provide funding and the time net distributions take place (often 2 years) and the additional lag caused by the time it takes to monitor distributions, we may not have additional information about whether or not AMF’s additional distributions were successful for 2-3 years. Next year, it is possible that we will choose to recommend significantly less funding to AMF while we wait for additional data to become available.

There still appears to be a large global funding gap for bednets; a global bednet coordination group estimated that about 245 million additional nets would be needed in 2015-2017 (details in our review).

Key considerations:

• Program impact and cost-effectiveness. We estimate that bednets are ~10x as cost-effective as cash transfers. Our estimates are subject to substantial uncertainty. All of our cost-effectiveness analyses are available here. Our 2015 cost-effectiveness file is available here (.xlsx).
• Directness and robustness of the case for impact. We believe that the connection between AMF receiving funds and those funds helping very poor individuals is less direct than GiveDirectly’s and more direct than SCI’s or Deworm the World’s. The uncertainty of our estimates is driven by a combination of AMF’s challenges historically disbursing the funds it receives and a general recognition that aid programs, even those as straightforward as bednets, carry significant risks of failure via ineffective use of nets, insecticide resistance, or other risks we don’t yet recognize relative to GiveDirectly’s program. AMF conducts extensive monitoring of its program; these results have generally indicated that people use the nets they receive.
• Transparency and communication. AMF has been extremely communicative and open with us. We feel we have a better understanding of AMF than of SCI, and a similar level of knowledge about AMF as we have for Deworm the World, though our understanding is not as strong as our understanding of GiveDirectly. In particular, were something to go wrong in one of AMF’s distributions, we believe we would eventually find out (something we are not sure of in the case of SCI), but we believe our understanding would be less quick and complete than it would be for problems associated with GiveDirectly’s program (which has more of a track record of consistent intensive follow-up).
• Risks:
  • We are not highly confident that AMF will be able to finalize additional distributions and do so quickly. AMF could struggle again to agree to distribution deals, leading to long delays before it spends funds. We view this as a relatively minor risk because the likely worst-case scenario is that AMF spends the funds slowly (or returns funds to donors).
  • We remain concerned about the possibility of resistance to the insecticides used in bednets. There don’t appear to be major updates on this front since our 2012 investigation into the matter; we take the lack of major news as a minor positive update.

Our full review of AMF is here.

Deworm the World Initiative, led by Evidence Action

 

Our full review of Deworm the World is here.

Background

Deworm the World (www.evidenceaction.org/deworming), led by Evidence Action, advocates for, supports, and evaluates government-run school-based deworming programs (treating children for intestinal parasites).

We believe that deworming is a program backed by relatively strong evidence. We have reservations about the evidence, but we think the potential benefits are great enough, and costs low enough, to outweigh these reservations. Deworm the World retains monitors whose reports indicate that the deworming programs it supports successfully deworm children.

Important changes in the last 12 months

In 2015, Deworm the World continued to support the scale-up and monitoring of deworming programs in India and Kenya. One of its notable activities this year was providing technical assistance to the Indian national government in support of India’s first national deworming day: a program in which the government provided assistance to Indian states to implement school-based deworming on a single day to encourage more states to implement the program. The first national deworming day took place in February 2015, and 12 states participated in the program (more details here).

The quality of the monitoring that we saw from Deworm the World improved in 2015. Deworm the World continued to hire and train third-party monitors to directly observe deworming activities, and it slightly improved its estimates of how many children were treated. This information strongly suggests that the programs are generally operating as intended. More details in our review.

Last year, Deworm the World stated to us that it could not use significant additional funding to scale up deworming programs. Deworm the World now believes that it has identified countries where it could use additional funds to support the scale-up of deworming programs, beginning with a potential program in Punjab province, Pakistan (more). (Deworm the World also plans to use funds it already holds or expects to receive to expand into Ethiopia and Nigeria.)

Future donations to Deworm the World will likely be used outside of India, and in those cases governments may have less funding to support deworming. This may cause Deworm the World to pay a higher fraction of the overall cost of the program, making the potential for leverage of future donations more limited. Overall program costs may also be higher outside of India. More details in our review.

A significant organizational update is that Alix Zwane stepped down as Executive Director of Evidence Action in August; she left to join the Global Innovation Fund as CEO. Evidence Action has since hired Jeff Brown (formerly Interim CEO of the Global Innovation Fund) as Executive Director. Grace Hollister remains Director of the Deworm the World Initiative. Overall, our impression is that Dr. Zwane has been a highly effective leader of Evidence Action and her departure risks disruptions that could lead to us changing our view of the organization, though we would guess that this will not be the case.

In July, researchers published two new analyses of a key study regarding deworming (the most important piece of evidence we rely on), and the Cochrane Collaboration published an updated review of the evidence for mass deworming programs. The new papers did not change our overall assessment of the evidence on deworming. More in our blog post.

Funding gap

We believe that Deworm the World has significant opportunities to use additional funding to expand its program. We believe it may have opportunities to enter at least two more countries (in addition to Nigeria and Ethiopia, which it will be able to enter with funds it already has or expects to receive). We estimate its funding need using the two countries it is most likely to enter — Pakistan and Nepal — though note that in both cases, we see these as representative of the types of opportunities it may have, rather than the specific opportunities we expect it to take. Altogether, Deworm the World estimates that it would need $11.25 million to commit to fully funding three years of deworming programs in both countries. Because it holds (or expects to receive shortly) funding that will total $3.6 million, we estimate its funding gap for this work at $7.6 million.

Funding this gap is capacity-relevant, and is therefore a high priority, because we would like to see Deworm the World try to work in additional countries beyond India and Kenya, where it has worked historically. Next year, Deworm the World will also enter Nigeria and Ethiopia (with funding already available), so it will likely end the year having had some experience in five or more countries. This could substantially increase Deworm the World’s long-term room for more funding.

A complicating factor in thinking about Deworm the World’s funding gap is that Deworm the World is part of a larger organization, Evidence Action. Funding for Deworm the World may be fungible with funding for Evidence Action’s other activities, such as its Dispensers for Safe Water initiative (which we believe to be substantially less cost-effective than deworming). Because of this, it is difficult to determine Deworm the World’s true funding gap, and it is possible that some additional funds given to support Deworm the World could effectively lead to additional funds for a non-Deworm the World project. We understand that Evidence Action has received approximately $2.4 million in unrestricted funding over the past year. Fully funding Deworm the World could potentially cause Evidence Action to redirect some or all of these funds to its other programs.

More details on all of the above are in our review.

Key considerations:

• Program impact and cost-effectiveness. We estimate that Deworm the World-associated deworming programs are ~10x as cost-effective as cash transfers. Our estimates are subject to substantial uncertainty. It’s important to note that we view deworming as high expected value, but this is due to a relatively low probability of very high impact. Most GiveWell staff members would agree that deworming programs are more likely than not to have very little or no impact, but there is some possibility that they have a very large impact. (Our cost-effectiveness model implies that most staff members believe there is at most a 1-2% chance that deworming programs conducted today have similar impacts to those directly implied by the randomized controlled trials on which we rely most heavily, which differed from modern-day deworming programs in a number of important ways.) Our 2015 cost-effectiveness file is available here (.xlsx).
• Directness and robustness of the case for impact. Deworm the World doesn’t carry out deworming programs itself; it advocates for and provides technical assistance to governments implementing deworming programs, making direct assessments of its impact challenging. We have seen evidence that strongly suggests that Deworm the World-supported programs successfully deworm children. While we believe Deworm the World is impactful, our evidence is limited, and in addition, there is always a risk that future expansions will prove more difficult than past ones.
• Transparency and communication. Deworm the World has been communicative and open with us. We believe that were something major to go wrong with Deworm the World’s work, we would be able to learn about it and report on it.
• Risks:
  • Deworm the World is part of a larger organization, Evidence Action. It is possible that some additional funds given to support Deworm the World could effectively lead to additional funds for a non-Deworm the World project due to fungibility. Also, changes that affect Evidence Action (and its other programs) could indirectly impact Deworm the World. For example, if a major event occurs (either positive or negative) for Evidence Action, it is likely that it would reduce the time some staff could devote to Deworm the World.
  • Deworm the World is now largely raising funds to support programs that will be carried out under a different model in new countries, which makes it harder for us to predict future success based on historical results and may make it harder to understand and quantify Deworm the World’s impact even after the program is completed.

Our full review of Deworm the World is here.

GiveDirectly

 

Our full review of GiveDirectly is here.

Background

GiveDirectly (www.givedirectly.org) transfers cash to households in developing countries via mobile phone-linked payment services. It targets extremely low-income households. The proportion of total expenses that GiveDirectly has delivered directly to recipients is approximately 85% overall. We believe that this approach faces an unusually low burden of proof, and that the available evidence supports the idea that unconditional cash transfers significantly help people.

We believe GiveDirectly to be an exceptionally strong and effective organization, even more so than our other top charities. It has invested heavily in self-evaluation from the start, scaled up quickly, and communicated with us clearly. It appears that GiveDirectly has been effective at delivering cash to low-income households. GiveDirectly has one major randomized controlled trial (RCT) of its impact and took the unusual step of making the details of this study public before data was collected (more). It continues to experiment heavily, to the point where every recipient is enrolled in a study or a campaign variation.

Important changes in the last 12 months

GiveDirectly continued to scale up significantly, utilizing most of the funding it received at the end of last year. It continued to share informative and detailed monitoring information with us. Overall, it grew its operations while maintaining the high quality of its program.

In August, Good Ventures granted $25 million to GiveDirectly to support potentially high-upside opportunities, such as (a) building a fundraising team that will aim to raise substantial donations from non-GiveWell donors, and (b) developing partnerships with bilateral donors and local governments to deliver cash transfers or to run experiments comparing standard aid programs to cash transfers.

GiveDirectly’s increased efforts to network with potential government and donor partners have led to some results in 2015. For example, GiveDirectly will be implementing cash transfers in a randomized controlled trial in Rwanda that will be funded by a bilateral aid donor and Google. The study will test cash transfers against another still-to-be-chosen aid program. GiveDirectly is currently in several preliminary conversations with partners for similarly large projects in the future.

Funding gap

GiveDirectly believes it could move a total of ~$94 million to poor households in the year following March 1, 2016, for which it expects to have ~$12.6 million available by March 1. We have classified ~$34.5 million of this as the total “Execution Level 1,” capacity-relevant, and incentive funding gap (more on what this means above). We arrived at this figure by assuming that GiveDirectly could double its operations in Kenya (from ~$16.5 million/year to ~$33 million/year) and scale up to ~$12.1 million/year in Uganda. This would cost a total of ~$45.1 million, of which GiveDirectly already has ~$10.6 million on hand (ignoring $2 million that we exclude due to donor coordination issues), which results in a ~$34.5 million gap.

We’ve classified some of this as a “capacity-relevant” funding gap for our purposes (making it higher priority). First, we view the ~$12.1 million it would hope to spend in Uganda as capacity-relevant, in the sense that providing it could make a major difference to GiveDirectly’s long-term development. GiveDirectly told us that operating in Uganda is more challenging than in Kenya and that it expects to learn a significant amount as it grows. It is therefore planning to grow more slowly in Uganda than it did in Kenya. GiveDirectly made two arguments for Uganda being important for its long-term trajectory:

1. If GiveDirectly lost the ability to operate in Kenya, this would significantly diminish its ability to move funds out the door. Operating in Uganda is an important hedge against this risk.
2. Kenya is a particularly easy environment in which to operate because of the existence of M-PESA, a powerful and ubiquitous provider that enables GiveDirectly to transfer funds to recipients via mobile phones. The mobile payments network is significantly less developed outside of Kenya. As such, Uganda offers an important test case for operating in a more standard environment, which could be particularly valuable to GiveDirectly as it encourages aid agencies and country governments to expand direct cash assistance.

It’s harder to estimate how much of the Kenya funding needs are properly classified as “capacity-relevant” (an important distinction for our purposes, as discussed above). We guess that were GiveDirectly to be operating at a level 50% its current size (such that it only spent ~$8.25 million/year in Kenya), it would be able to build capacity from that level to its current level (and beyond) as quickly as it did in its recent past. We therefore classify ~$8.25 million of the ~$16.5 million it hopes to spend in Kenya as “capacity-relevant” and ~$8.25 million as “execution.” We note that we are highly uncertain about these estimates and that were GiveDirectly to receive no additional funding, this would cause it to contract in Kenya and lay off some of its middle management, an action that would cause it to incur reasonably high costs; we think much more contraction than that would be significantly more challenging for GiveDirectly as an organization.

Based on the above, and based on GiveDirectly’s existing available funds (with some adjustments for coordination issues, along the lines of this discussion from last year) we estimate that GiveDirectly has ~$9.8 million worth of unfunded opportunities that we ought to classify as capacity-relevant or incentive funding. (We arrive at this estimate based on: ~$20.35 million (total amount we classify as capacity-relevant from Kenya and Uganda) – ~$10.6 million (funds on hand, excluding donations we ignore due to coordination issues) = ~$9.75 million.)

Longer-term, we expect to continue to view funding ~$8.25 million in Kenya as capacity-relevant support and would expect to consider future expansion in Uganda (up to the current level of Kenya, i.e., ~$16.5 million/year) capacity-relevant, as well. Once GiveDirectly reaches ~$16.5 million in Uganda and proves that it can operate at that level, we only expect to view ~$8.25 million as capacity-relevant and hope that it can raise funds from other sources to support its work.

More details in our review.

Key considerations:

• Program impact and cost-effectiveness. Our best guess is that deworming or distributing bednets achieves ~10x times more humanitarian benefit per dollar donated than cash transfers. Our estimates are subject to substantial uncertainty. All of our cost-effectiveness analyses are available here. Our 2015 cost-effectiveness file is available here (.xlsx).
• Directness and robustness of the case for impact. GiveDirectly collects and shares a significant amount of relevant information about its activities. The data it collects show that it successfully directs cash to very poor people, that recipients generally spend funds productively (sometimes on food, clothing, or school fees, other times on investments in a business or home infrastructure), and that it leads to very low levels of interpersonal conflict and tension. We are more confident in the impact of GiveDirectly’s work than in that of any of the other charities discussed in this post; we believe that cash transfers face a lower burden of proof than other interventions.
• Transparency and communication. GiveDirectly has always communicated clearly and openly with us. It has tended to raise problems to us before we ask about them, and we generally believe that we have a very clear view of its operations. We feel more confident about our ability to keep track of future challenges than with any of the other charities discussed in this post.
• Risks:
  • GiveDirectly has scaled (and hopes to continue to scale) quickly. Thus far, it has significantly increased the amount of money it can move with limited issues as a result. The case of staff fraud that GiveDirectly detected is one example of an issue possibly caused by its pace of scaling, but its response demonstrated the transparency and rigor we expect.

Our full review of GiveDirectly is here.

Schistosomiasis Control Initiative (SCI)

 

Our full review of SCI is here.

Background

SCI (www3.imperial.ac.uk/schisto) works with governments in sub-Saharan Africa to create or scale up deworming programs (treating children for schistosomiasis and other intestinal parasites). SCI’s role has primarily been to identify recipient countries, provide funding to governments for government-implemented programs, provide advisory support, and conduct research on the process and outcomes of the programs. Despite SCI sharing a number of spending reports with us, we do not feel we have a detailed and fully accurate picture of how SCI and the governments it supports have spent funds in the past. We don’t feel that SCI has ever purposefully been indirect with us, but we have often struggled to communicate effectively with SCI representatives. We still lack important and in some cases basic information about SCI’s finances, and we find this problematic.

We believe that deworming is a program backed by relatively strong evidence. We have reservations about the evidence, but we think the potential benefits are great enough, and costs low enough, to outweigh these reservations. SCI has conducted studies in about half of the countries it works in (including the countries with the largest programs) to determine whether its programs have reached a large proportion of children targeted. These studies have generally found moderately positive results, but have some methodological limitations.

Important changes in the last 12 months

SCI reports that it has continued to scale up its deworming programs and that it has supported some programs in new countries, though we have limited monitoring information from these programs (e.g., we have not seen monitoring from its programs in Ethiopia, Sudan, Madagascar, and the DRC).

This year, SCI has shared a few more coverage surveys that found reasonably high coverage of its programs.

We have continued to have communication challenges with SCI. In particular:

• We have a limited understanding of SCI’s work because we still lack important and basic information about how SCI spends money. SCI recognizes that its financial management system is disorganized, and some spending reports that SCI has sent us have contained errors.
• We have struggled to gain a confident understanding of how SCI will use additional funds, and we cannot check how its funds were used after the fact because we lack information about its spending. In some cases, SCI has not spent additional funds as expected and it is unclear what caused the shift (more detail on one example in our August 2015 update).

In July, researchers published two new analyses of a key study regarding deworming (the most important piece of evidence we rely on), and the Cochrane Collaboration published an updated review of the evidence for mass deworming programs. The new papers did not change our overall assessment of the evidence on deworming. More in our blog post.

Funding gap

SCI estimates that it would use the following amounts of unrestricted funding in each of the next three years (in millions of US dollars):

• April 2016 – March 2017: $9.5
• April 2017 – March 2018: $13.6
• April 2018 – March 2019: $13.3

Our impression is that GiveWell-influenced donors contribute most of SCI’s unrestricted funds.

Our best guess is that, excluding the funds SCI may receive due to GiveWell’s recommendation, SCI will hold approximately $1.5 million in April 2016 that it could allocate to the above gaps. Also, after SCI set its fundraising targets, a funder committed $6 million over the next three years ($2 million per year) to deworming programs in Ethiopia, with which SCI is involved. Our best guess is that this funding reduces SCI’s “Execution Level 1” and incentive funding gap for the coming year from $9.5 million to $5.9 million. (We arrive at this estimate by subtracting ~$1.5 million and another $2 million from the total Level 1/incentive gap for the coming year).

We do not classify any of this as “capacity-relevant” because we have little understanding of how it will be spent, and we do not expect to be able to understand how it was spent after the fact, either.

More details on SCI’s funding gap are in our review.

Key considerations:

• Program impact and cost-effectiveness. Our best guess is that deworming programs implemented by SCI are ~5x as cost-effective as cash transfers. Our estimates are subject to substantial uncertainty. It’s important to note that we view deworming as high expected value, but this is due to a relatively low probability of very high impact. Most GiveWell staff members would agree that deworming programs are more likely than not to have very little or no impact, but there is some possibility that they have a very large impact. (Our cost-effectiveness model implies that most staff members believe there is at most a 1-2% chance that deworming programs conducted today have similar impacts to those directly implied by the randomized controlled trials on which we rely most heavily, which differed from modern-day deworming programs in a number of important ways.) Our 2015 cost-effectiveness file is available here (.xlsx).
• Directness and robustness of the case for impact. SCI doesn’t carry out deworming programs itself; it advocates for and provides technical assistance to governments implementing deworming programs, making direct assessments of its impact challenging. We have seen some evidence demonstrating that SCI-supported programs successfully deworm children, though this evidence is relatively thin. Nevertheless, deworming is a relatively straightforward program, and we think it is likely (though far from certain) that SCI-supported deworming programs successfully deworm people. We have had difficulties communicating with SCI, which has reduced our ability to understand it. We have also spent significant time interviewing SCI staff and reviewing documents over the past 6 years and have found minor but not major concerns.
• Transparency and communication. We don’t feel that SCI has ever purposefully been indirect with us, but we have often struggled to communicate effectively with SCI representatives. Specifically, (a) we had a major miscommunication with SCI about the meaning of its self-evaluations (more) and (b) although we have spent significant time with SCI, we remain unsure how SCI has spent funds and how much funding it has available (and we believe SCI itself does not have a clear understanding of this). Importantly, if there is a future unanticipated problem with SCI’s programs, we don’t feel confident that we will become aware of it. This contrasts with our other top charities, which we feel we have a strong ability to follow up on.
• Risks: There are significantly more unknown risks with SCI than our other top charities due to our limited understanding of its activities.

Our full review of SCI is here.

Standouts

As we did last year, we recommend four organizations as “standouts.” These charities score well on some of our criteria, but we are not confident enough in them to name them top charities. This year, we retain the same four standout organizations: Development Media International (DMI), the Global Alliance for Improved Nutrition’s Universal Salt Iodization program (GAIN-USI), the Iodine Global Network (IGN), and Living Goods.

We followed all four of these charities in 2015, but have only published an updated review for DMI. We expect to publish updated reviews for GAIN-USI, IGN, and Living Goods in the near future.

We provide brief updates on these charities below:

• DMI. DMI produces radio and television programming in developing countries that encourages people to adopt improved health practices. It is a standout because of its commitment to monitoring and the possibility that it is implementing a highly cost-effective program. DMI has recently completed a randomized controlled trial of its program. Last year, we had midline results from this trial, which generally looked promising.In November 2015, DMI privately shared preliminary endline results from the RCT. These results did not find any effect of DMI’s program on child mortality, and found substantially less effect on behavior change than was found in the midline results. We (understandably) cannot publicly discuss the details of the endline results we have seen, because they are not yet finalized and because the finalized results will be embargoed prior to publication. DMI believes that there were serious problems with endline data collection (note that we have not yet tried to independently assess this claim). With the support of the trial’s Independent Scientific Advisory Committee, DMI is planning to conduct another endline survey in late 2016, with results available in 2017.We are impressed by DMI’s openness with us about its results (and its willingness for us to share the high-level summary), and we hope to have discussions with DMI about how it might be able to work toward becoming a top charity in the future. Our full review of DMI is here.
• GAIN-USI. GAIN’s Universal Salt Iodization (USI) program supports national salt iodization programs. There is strong evidence that salt iodization programs have a significant, positive effect on children’s cognitive development. GAIN-USI does not work directly to iodize salt; rather, it supports governments and private companies to do so, which could lead to leveraged impact of donations or to low impact, depending on its effectiveness. Last year, we wrote, “We tried but were unable to document a demonstrable track record of impact; we believe it may have had significant impacts, but we are unable to be confident in this with what we know now. More investigation next year could change this picture.” In 2015, we continued our assessment of GAIN, focusing on its work in India and Ethiopia, including a site visit to Ethiopia in July.Overall, we tried but were unable to establish clear evidence of GAIN successfully contributing to the impact of iodization programs. This is primarily due to (a) the difficulty in attributing impact to specific activities that GAIN carried out and (b) challenges we have had communicating with GAIN about its work. We have not yet completed our final report on GAIN but hope to publish it in the near future. We have published notes from some of the conversations that were part of this research and they are available here. Our 2014 review of GAIN is here.
• IGN. Like GAIN-USI, IGN supports (via advocacy and technical assistance rather than implementation) salt iodization, and as with GAIN-USI, we tried but were unable to establish clear evidence of IGN successfully contributing to the impact of iodization programs. Unlike GAIN-USI, IGN is small, operating on a budget of approximately $0.5-$1 million per year, and relies heavily on volunteer time. We are planning to post an updated review in the near future. Our 2014 review of IGN is here.
• Living Goods recruits, trains, and manages a network of community health promoters who sell health and household goods door-to-door in Uganda and Kenya and provide basic health counseling. They sell products such as treatments for malaria and diarrhea, fortified foods, water filters, bednets, clean cookstoves, and solar lights. Living Goods completed a randomized controlled trial of its program and measured a 27% reduction in child mortality. We estimate that Living Goods saves a life for roughly each $10,000 it spends, approximately 3 times as much as our estimate for the cost per life saved of AMF’s program. We spoke with Living Goods and reviewed documents about their progress in 2015. We do not have major updates to report but are planning to post an updated review in the near future. Our 2014 review of Living Goods is here.

Our research process in 2015

 

This section describes the new work we did in 2015 to supplement our previous work on defining and identifying top charities. See the process page on our website for our overall process.

This year, we did not put a substantial amount of senior staff time into new top charities research work because (a) we were largely focused on building capacity, and (b) we reallocated a significant amount of capacity to the Open Philanthropy Project (see our post on our plans for 2015 for more details).

We focused the bulk of our research capacity for top charities work on staying up-to-date on our recommended charities. We also did an intensive evaluation of GAIN-USI, including a site visit (more details forthcoming).

We completed investigations of vitamin A supplementation and maternal and neonatal tetanus immunization campaigns. Both programs seem potentially competitive with our other priority programs, but we were not able to identify charities that worked on these programs that were willing to apply for a recommendation. We also made substantial progress on investigating several other programs, such as measles immunization, meningitis A vaccination, folic acid fortification, voluntary medical male circumcision for the prevention of HIV, and “Targeting the Ultra-Poor” (or “Ultra-Poor Graduation”) programs.

We stayed up to date on the research for bednets, cash transfers, and deworming.

We did not conduct an extensive search for new charities this year. We feel that we have a relatively good understanding of the existing charities that could potentially meet our criteria, based on past searches (see the process page on our website for more information). Instead, we solicited applications from organizations that we viewed as contenders for recommendations. A March post laid out which organizations we were hoping to investigate and why.

We did some initial research on several charities that we had not investigated before, but we did not complete the reviews in time for our 2015 recommendations. The organizations that we began investigating were:

• END Fund
• Episcopal Relief & Development’s NetsforLife® Program
• Project Healthy Children
• Sightsavers.

We plan to complete these reviews in 2016.

Giving to GiveWell vs. top charities

 

We have grown significantly over the past few years and continue to raise funds to support our operations. This includes work on GiveWell’s top charities and the Open Philanthropy Project.

We plan to post an update on our funding situation before the end of the year.

The most up-to-date information available on this topic is linked from our June 2015 board meeting. The short story is that we are still seeking additional donations and encourage donors who feel they are sufficiently confident in our impact to give to us.

Footnotes:

* For example, if $30 million were available to fund gaps of $10 million, $5 million, and $100 million, we would recommend allocating the funds so that the $10 million and $5 million gaps were fully filled and the $100 million gap received $15 million.

This rule is material to the three gaps tied at priority level 2. It causes us to recommend that Good Ventures’ last $28.3 million to recommended charities is used to fully fill GiveDirectly’s $8.8 million capacity-relevant gap and Deworm the World’s $3.2 million Execution Level 2 (possible capacity-relevant) gap, but only fill $16.3 million of AMF’s Execution Level 1 gap.

** This gap can’t be cleanly classified because we think the funding is relatively unlikely to be needed, but if it is needed, it is likely to have capacity-relevant effects. Thus, it is technically classified as Execution Level 2, but we think it has similar value to Execution Level 1.

The post Our updated top charities for giving season 2015 appeared first on The GiveWell Blog.

We have refreshed our top charity rankings and recommendations. Our set of top charities and standouts is the same as last year’s, but we have introduced rankings and changed our recommended funding allocation, due to a variety of updates – particularly to our top charities’ room for more funding. In particular, we are recommending that Good Ventures, a foundation with which we work closely, support our top charities at a higher level than in previous years. This post includes our recommendations to Good Ventures, and gives our recommendations to individual donors after accounting for these grants.

Overall, we think the case for our top charities is stronger than in previous years, and room for more funding is greater.

Our top charities and recommendations for donors, in brief

 

Top charities

1. Against Malaria Foundation (AMF)
2. Schistosomiasis Control Initiative (SCI)
3. Deworm the World Initiative, led by Evidence Action
4. GiveDirectly

This year, we are ranking our top charities based on what we see as the value of filling their remaining funding gaps. Unlike in previous years, we do not feel a particular need for individuals to divide their allocation between the charities, since we are recommending that Good Ventures provide significant support to each. For those seeking our recommended allocation, we simply recommend giving to the top-ranked charity on the list, which is AMF.

Our recommendation takes the grants we are recommending to Good Ventures into account, as well as accounting for charities’ existing cash on hand and expected non-GiveWell-related fundraising, and recommends charities according to how much good additional donations (beyond these sources of funds) can do. (Otherwise, as explained below, Deworm the World would be ranked higher.) Thus, AMF’s #1 ranking is not based on its overall value as an organization, but based on the value of its remaining funding gap.

Standout charities

As with last year, we also provide a list of charities that we believe are strong standouts, though not at the same level (in terms of likely good accomplished per dollar) as our top charities. They are not ranked, and are listed in alphabetical order.

• Development Media International (DMI)
• The Global Alliance for Improved Nutrition’s Universal Salt Iodization program (GAIN – USI)
• Iodine Global Network (IGN), formerly known as ICCIDD
• Living Goods

Below, we provide:

• An explanation of major changes in the past year that are not specific to any one charity. More
• A summary of our top charities’ relative strengths and weaknesses, and how we would rank them if room for more funding were not an issue. More
• A discussion of our refined approach to room for more funding. More
• The recommendations we are making to Good Ventures, and how we rank our top charities after taking these grants (and their impact on room for more funding) into account. More
• Detail on each of our top charities, including major changes over the past year, strengths and weaknesses for each, and our understanding of each organization’s room for more funding. More
• The process we followed that led to these recommendations. More
• A brief update on giving to support GiveWell’s operations vs. giving to our top charities. More

Conference call to discuss recommendations

We are planning to hold a conference call at 5:30pm ET/2:30pm PT on Tuesday, December 1st to discuss our recommendations and answer questions.

If you’d like to join the call, please register using this online form. If you can’t make this date but would be interested in joining another call at a later date, please indicate this on the registration form.

Major changes in the last 12 months

 

Below, we summarize the major causes of changes to our recommendations (since last year).

Overall, the case for our top charities is stronger than it was in past years. The Deworm the World Initiative shared new monitoring and evaluation materials with us, so we are more confident than we were a year ago that it is a strong organization implementing high-quality programs. In addition, the extra year of work we have seen from AMF and GiveDirectly bolsters our view that they will be able to utilize additional funding effectively.

Our top charities have increased room for more funding. Last year, we expected donors following our recommendations to fully fill the most critical funding gaps of our top charities (excluding GiveDirectly) because they had limited room for more funding: GiveDirectly had a total funding gap of ~$40 million and our other three top charities had a total gap of ~$18 million. This year, all of our top charities have more room for more funding. We believe that GiveDirectly could absorb more than $80 million and other top charities together could collectively utilize more than $100 million. We do not expect donors following our recommendations to fully fill these gaps.

We are recommending that Good Ventures make larger grants to top charities. For reasons we will be detailing in a future post, we are recommending that Good Ventures make substantial grants to our top charities this year, though not enough to close their funding gaps.

Continued refinement of the concept of “room for more funding.” We’ve tried to create a much more systematic and detailed room for more funding analysis, because the stakes of this analysis have become higher due to (a) increased room for more funding across the board and (b) increased interest from Good Ventures in providing major support.

In past years, we’ve discussed charities’ room for more funding as a single figure without distinguishing between (a) the amount the charity would spend in the next 12 months, (b) the amount the charity needs to prevent it from slowing its work due to lack of funds, and (c) funding that would be especially important to the organization’s development and success (a dual benefit) in addition to expanding implementation of its program. This year, we’ve made three changes to our room for more funding analysis:

• We’ve made (a) an assessment of whether additional funds merely allow a charity to implement its program (“execution”) or (b) whether additional funds would be especially important to the charity’s development and success as an organization (“capacity-relevant”). We also explicitly note the role of incentives for meeting GiveWell’s top-charity criteria in our recommendations (we seek to ensure that each top charity receives at least $1 million, to encourage other organizations to seek to meet these criteria).
• We are explicitly assessing “execution”-related room for more funding based on our estimate of the probability that lack of funding will lead to a charity slowing its progress. We distinguish between Level 1, Level 2, and Level 3 “execution” funding gaps; a higher number means the money is less likely to be needed.
• We are now ranking “funding gaps,” not just ranking charities, because the first million dollars to a charity can have a very different impact from, e.g., the 20th million dollars. For example, if Charity A accomplishes more good per dollar with its programs than Charity B, we would rank Charity A above Charity B for a given type of gap (we would rank Charity A’s “Execution Level 1” gap above Charity B’s), but we might rank Charity B’s “Execution Level 1” gap (the amount of funding it will likely need) above Charity A’s “Execution Level 3” gap (the amount of funding gap it might, but probably will not, need to carry out more of its programs in the coming year).

We discuss these ideas in greater depth below.

Summary of key considerations for top charities

 

The table below summarizes the key considerations for our four top charities. More detail is provided below as well as in the charity reviews.

Consideration AMF Deworm the World GiveDirectly SCI Program estimated cost-effectiveness (relative to cash transfers) ~10x ~10x Baseline ~5x Directness and robustness of the case for impact Strong Moderate Strongest Moderate Transparency and communication Strong Strong Strongest Weakest Ongoing monitoring and likelihood of detecting future problems Strong Strong Strongest Weakest Organizational track record of rolling out program Moderate Moderate Strong Strong Room for more funding, after accounting for grants we are recommending to Good Ventures (more below) Very high Limited Very high High

 

Overall, our ranking of the charities with room for more funding issues set aside (just considering a hypothetical dollar spent by the charity on its programs, without the “capacity-relevant funding” and “incentives” issues discussed below) would be:

1. AMF and Deworm the World
3. SCI
4. GiveDirectly

However, when we factor in room for more funding (including the impact of the grants we’re recommending to Good Ventures), the picture changes. More on this below.

Room for more funding analysis

 

Capacity-relevant funding and incentives

 

Capacity-relevant funding: additional funding can sometimes be crucial for a charity’s development and success as an organization. For example, it can contribute to a charity’s ability to experiment, expand, and ultimately have greater room for more funding over the long run. It can also be important for a charity’s ability to raise funds from non-GiveWell donors, which can be an important source of long-term leverage and can put the organization in a stronger overall position.

We think of this sort of funding gap as particularly important to fill, because it can make a big difference over the long run; in particular, it may substantially affect the long-term quality of our giving recommendations.

“Capacity-relevant” funds can include (a) funds that are explicitly targeted at growth (e.g., funds to hire fundraising staff); (b) funds that enable a charity to expand into areas it hasn’t worked in before, which can lead to important learning about whether and how the charity can operate in the new location(s); and (c) funds that would be needed in order to avoid challenging contractions in a charity’s activities which could jeopardize the charity’s long-term growth and funding prospects.

Some specific examples:

• The grant that Good Ventures made to GiveDirectly earlier this year is capacity-relevant because it will be used for: (a) building a fundraising team that will aim to raise substantial donations from non-GiveWell donors, and (b) developing partnerships with bilateral donors and local governments to deliver cash transfers or to run experiments comparing standard aid programs to cash transfers.
• Early funding that GiveDirectly received was capacity-relevant because it enabled GiveDirectly to rapidly grow from a small organization moving a few hundred thousand dollars per year to a much larger organization moving more than $10 million per year. If this funding hadn’t been forthcoming, GiveDirectly might be much smaller today and have much less room for more funding.
• We now think that some additional funding to AMF and Deworm the World will be capacity-relevant because each organization has only operated in a very small number of countries and new funding will enable each to enter new countries. This will allow them to learn how to operate there, and demonstrate that they can do so, increasing our willingness (and likely that of other donors) to recommend more to these organizations in the future.

It’s hard to draw sharp lines around capacity-relevant funding, and all funding likely has some effect on an organization’s development, but we have tried to identify and prioritize the funding gaps that seem especially relevant.

Execution funding allows charities to implement more of their core program but doesn’t appear to have substantial benefits beyond the direct good accomplished by this program. We’ve separated this funding into three levels:

• Level 1: the amount we expect a charity to need in the coming year. If a charity has less funding than this level, we think it is more likely than not that it will be bottlenecked (or unable to carry out its core program to the fullest extent) by funding in the coming year.
• Level 2: if a charity has this amount, we think there is an ~80% chance that it will not be bottlenecked by funding.
• Level 3: if a charity has this amount, we think there is a ~95% chance that it will not be bottlenecked by funding.

Incentives: we think it is important that charities we recommend get a substantial amount of funding due to being a GiveWell top charity, because this ensures that incentives are in place for charities (and potential charity founders) to seek to meet our criteria for top charities and thus increase the number of charities we recommend and the total room for more funding available, even when they don’t end up being ranked #1. We seek to ensure that each top charity gets at least $1 million as a result of our recommendation, and we consider this to be a high-priority goal of our recommendations.

The charity-specific sections of this post discuss the reasoning behind the figures we’ve assigned to “capacity-relevant” and “Execution Level 1” gaps, but they do not provide the full details of how we arrived at these figures (and do not explicitly address the “Execution Level 2” and “Execution Level 3” gaps). We expect to add this analysis to our charity reviews in the coming weeks.

Funding gaps

 

The total (i.e., Capacity-relevant, Execution Levels 1, 2, and 3, and Incentive) funding gaps (in millions of dollars, rounded to one decimal place) for each of our top charities are:

• AMF: $98.2
• Deworm the World: $19.0
• GiveDirectly: $84.0
• SCI: $26.3

However, for reasons described above, the first million dollars to a charity can have a very different impact from, e.g., the 20th million dollars. Accordingly, we have created a ranking of individual funding gaps that accounts for both (a) the quality of the charity and the good accomplished by its program, per dollar (as laid out above), and (b) whether a given level of funding is capacity-relevant and whether it is highly or only marginally likely to be needed in the coming year.

The below table lays out our ranking of funding gaps. When gaps have the same “Priority,” this indicates that they are tied.

The table below includes the amount we are recommending to Good Ventures. For reasons we will lay out in another post, we are recommending to Good Ventures a total of ~$44.4 million in grants to top charities. Having set that total, we are recommending that Good Ventures start with funding the highest-rated gaps and work its way down, in order to accomplish as much good as possible.

When gaps are tied, we recommend filling them by giving each equal dollar amounts until one is filled, and then following the same procedure with the remaining tied gaps. See footnote for more.*

Priority Charity Amount Type Recommendation to Good Ventures Comments 1 DtWI $7.6 Capacity-relevant $7.6 DtWI and AMF are strongest overall 1 AMF $6.5 Capacity-relevant $6.5 See above 1 GD $1.0 Incentive $1.0 Ensuring each top charity receives at least $1 million 1 SCI $1.0 Incentive $1.0 Ensuring each top charity receives at least $1 million 2 GD $8.8 Capacity-relevant $8.8 Not as cost-effective as bednets or deworming, so lower priority, but above non-capacity-relevant gaps 2 DtWI $3.2 Execution Level 2 / possibly capacity-relevant $3.2 Level 1 gap already filled via “capacity-relevant” gap. See footnote for more** 2 AMF $43.8 Execution Level 1 $16.3 Exhausts remaining recommendations to Good Ventures 3 SCI $4.9 Execution Level 1 0 Not as strong as DtWI and AMF in isolation, so ranked below them for same type of gap 3 AMF $24.0 Execution Level 2 0 – 4 DtWI $8.2 Execution Level 3 0 – 4 AMF $24.0 Execution Level 3 0 – 4 SCI $11.6 Execution Level 2 0 – 5 GD $24.8 Execution Level 1 0 – 5 SCI $8.8 Execution Level 3 0 – 6 GD $20.9 Execution Level 2 0 – 7 GD $28.6 Execution Level 3 0 –

Our recommendations to Good Ventures and others

 

Summing the figures from the above table, we are recommending that Good Ventures make the following grants (in millions of dollars, rounded to one decimal place):

• AMF: $22.8
• Deworm the World: $10.8
• GiveDirectly: $9.8
• SCI: $1

We also recommend that Good Ventures give $250,000 to each of our standout charities. These grants go to the outstanding organizations and create additional incentives for groups to try to obtain a GiveWell recommendation.

After these grants, AMF will require an additional ~$27.5 million to close its Execution Level 1 gap (i.e., to make it more likely than not that it is able to proceed without being bottlenecked due to lack of funding). We rank this gap higher than any of the other remaining funding gaps for our top charities, as laid out in the table above.

We estimate that non-Good Ventures donors will give approximately $15 million between now and January 31, 2016. Because we do not expect AMF’s remaining ~$27.5 million Execution Level 1 funding gap to be fully filled, we rank it #1 and recommend that donors give to AMF. We rank the remaining charities for donors who are interested in having the greatest impact per dollar based on how highly their highest-rated remaining gap ranks in the table above. That results in the following rankings for individual donors:

1. AMF
2. SCI
3. Deworm the World Initiative
4. GiveDirectly

Details on top charities

 

We present information on our top charities in alphabetical order.

Against Malaria Foundation (AMF)

 

Our full review of AMF is here.

Background

AMF (www.againstmalaria.com) provides funding for long-lasting insecticide-treated net distributions (for protection against malaria) in developing countries. There is strong evidence that distributing nets reduces child mortality and malaria cases. AMF has relatively strong reporting requirements for its distribution partners and provides a level of public disclosure and tracking of distributions that we have not seen from any other net distribution charity.

In 2011, AMF received a large amount of funding relative to what it had received historically, so it began to focus primarily on reaching agreements for large-scale net distributions (i.e., distributions on the order of hundreds of thousands of nets rather than tens of thousands of nets). In its early efforts to scale up, AMF struggled to finalize large-scale net distribution agreements. At the end of 2013, we announced that we planned not to recommend additional donations to AMF due to room for more funding-related issues (more detail in this blog post).

In 2014, AMF committed most of its funds to several new distributions — some in Malawi, some in the Democratic Republic of the Congo (DRC) — and we recommended it as a top charity again.

Important changes in the last 12 months

In 2015, AMF carried out and/or monitored many of the distributions that it committed to in 2014.

Previously, our confidence in AMF’s ability to scale had been limited by the fact that it had only completed large-scale distributions with one partner (Concern Universal) in one country (Malawi). However, AMF carried out its largest distribution to date (~620,000 nets) with a new partner in the DRC in late 2014. We have not yet seen some key documentation from the large DRC distribution, but early indications suggest that the distribution generally went as planned, despite our concern that the DRC may have been an especially challenging place to work (more details here). We see this as a positive update that AMF will be able to carry out high-quality large-scale distributions in a variety of locations in the future.

AMF has continued to collect and share follow-up information on its past large-scale distributions, and this information seems to support the notion that these distributions are high-quality (i.e., that nets are reaching the target population and are being used). We provide a summary of these reports in our review.

Funding gap

AMF currently holds $18.5 million, and we estimate it will receive an additional $1.6 million before January 31, 2016 (excluding donations influenced by GiveWell) that it could use for future distributions. AMF has told us that it has a pipeline of possible future net distributions that add up to roughly $100 million beyond what it currently holds (details in our review).

We believe that AMF’s progress would be slowed due to lack of funding were it to receive less than $50.3 million in additional funding (this is its total capacity-relevant and “Execution Level 1” gap as presented earlier in the post). In particular, we view the first additional $6.5 million that AMF would receive as capacity-relevant (and thus particularly valuable) because it would enable AMF to fund a distribution in a 5th country with a 5th partner, generating additional information about its ability to expand beyond the contexts in which it has worked to date. (Note that AMF already has funds on hand to enter its 3rd and 4th countries.)

We arrived at the capacity-relevant and Execution Level 1 figure by noting that AMF has $70.4 million worth of deals it is actively negotiating (5 deals in 4 countries) that it can only continue with if it holds the funds to do so. Subtracting the $20.1 million we expect to be available (the $18.5 million it currently holds plus the $1.6 million we expect it to receive in the coming months) leaves a $50.3 million funding gap.

AMF failed to reach new distribution agreements in 2015; there is still significant uncertainty regarding AMF’s ability to finalize agreements with new partners and countries. Nevertheless, we see providing a large amount of additional funds to AMF as a reasonable bet, and see AMF as a very strong giving opportunity.

We think it is possible that in November 2016 (when we next expect to complete a full refresh of our recommendations), we will recommend significantly less funding to AMF. We consider the funding we’re recommending to AMF now to be a good bet, but a risky one, because AMF currently has a relatively limited track record: it has worked with only two partners in two countries. Because of the lag between the time we provide funding and the time net distributions take place (often 2 years) and the additional lag caused by the time it takes to monitor distributions, we may not have additional information about whether or not AMF’s additional distributions were successful for 2-3 years. Next year, it is possible that we will choose to recommend significantly less funding to AMF while we wait for additional data to become available.

There still appears to be a large global funding gap for bednets; a global bednet coordination group estimated that about 245 million additional nets would be needed in 2015-2017 (details in our review).

Key considerations:

• Program impact and cost-effectiveness. We estimate that bednets are ~10x as cost-effective as cash transfers. Our estimates are subject to substantial uncertainty. All of our cost-effectiveness analyses are available here. Our 2015 cost-effectiveness file is available here (.xlsx).
• Directness and robustness of the case for impact. We believe that the connection between AMF receiving funds and those funds helping very poor individuals is less direct than GiveDirectly’s and more direct than SCI’s or Deworm the World’s. The uncertainty of our estimates is driven by a combination of AMF’s challenges historically disbursing the funds it receives and a general recognition that aid programs, even those as straightforward as bednets, carry significant risks of failure via ineffective use of nets, insecticide resistance, or other risks we don’t yet recognize relative to GiveDirectly’s program. AMF conducts extensive monitoring of its program; these results have generally indicated that people use the nets they receive.
• Transparency and communication. AMF has been extremely communicative and open with us. We feel we have a better understanding of AMF than of SCI, and a similar level of knowledge about AMF as we have for Deworm the World, though our understanding is not as strong as our understanding of GiveDirectly. In particular, were something to go wrong in one of AMF’s distributions, we believe we would eventually find out (something we are not sure of in the case of SCI), but we believe our understanding would be less quick and complete than it would be for problems associated with GiveDirectly’s program (which has more of a track record of consistent intensive follow-up).
• Risks:
  • We are not highly confident that AMF will be able to finalize additional distributions and do so quickly. AMF could struggle again to agree to distribution deals, leading to long delays before it spends funds. We view this as a relatively minor risk because the likely worst-case scenario is that AMF spends the funds slowly (or returns funds to donors).
  • We remain concerned about the possibility of resistance to the insecticides used in bednets. There don’t appear to be major updates on this front since our 2012 investigation into the matter; we take the lack of major news as a minor positive update.

Our full review of AMF is here.

Deworm the World Initiative, led by Evidence Action

 

Our full review of Deworm the World is here.

Background

Deworm the World (www.evidenceaction.org/deworming), led by Evidence Action, advocates for, supports, and evaluates government-run school-based deworming programs (treating children for intestinal parasites).

We believe that deworming is a program backed by relatively strong evidence. We have reservations about the evidence, but we think the potential benefits are great enough, and costs low enough, to outweigh these reservations. Deworm the World retains monitors whose reports indicate that the deworming programs it supports successfully deworm children.

Important changes in the last 12 months

In 2015, Deworm the World continued to support the scale-up and monitoring of deworming programs in India and Kenya. One of its notable activities this year was providing technical assistance to the Indian national government in support of India’s first national deworming day: a program in which the government provided assistance to Indian states to implement school-based deworming on a single day to encourage more states to implement the program. The first national deworming day took place in February 2015, and 12 states participated in the program (more details here).

The quality of the monitoring that we saw from Deworm the World improved in 2015. Deworm the World continued to hire and train third-party monitors to directly observe deworming activities, and it slightly improved its estimates of how many children were treated. This information strongly suggests that the programs are generally operating as intended. More details in our review.

Last year, Deworm the World stated to us that it could not use significant additional funding to scale up deworming programs. Deworm the World now believes that it has identified countries where it could use additional funds to support the scale-up of deworming programs, beginning with a potential program in Punjab province, Pakistan (more). (Deworm the World also plans to use funds it already holds or expects to receive to expand into Ethiopia and Nigeria.)

Future donations to Deworm the World will likely be used outside of India, and in those cases governments may have less funding to support deworming. This may cause Deworm the World to pay a higher fraction of the overall cost of the program, making the potential for leverage of future donations more limited. Overall program costs may also be higher outside of India. More details in our review.

A significant organizational update is that Alix Zwane stepped down as Executive Director of Evidence Action in August; she left to join the Global Innovation Fund as CEO. Evidence Action has since hired Jeff Brown (formerly Interim CEO of the Global Innovation Fund) as Executive Director. Grace Hollister remains Director of the Deworm the World Initiative. Overall, our impression is that Dr. Zwane has been a highly effective leader of Evidence Action and her departure risks disruptions that could lead to us changing our view of the organization, though we would guess that this will not be the case.

In July, researchers published two new analyses of a key study regarding deworming (the most important piece of evidence we rely on), and the Cochrane Collaboration published an updated review of the evidence for mass deworming programs. The new papers did not change our overall assessment of the evidence on deworming. More in our blog post.

Funding gap

We believe that Deworm the World has significant opportunities to use additional funding to expand its program. We believe it may have opportunities to enter at least two more countries (in addition to Nigeria and Ethiopia, which it will be able to enter with funds it already has or expects to receive). We estimate its funding need using the two countries it is most likely to enter — Pakistan and Nepal — though note that in both cases, we see these as representative of the types of opportunities it may have, rather than the specific opportunities we expect it to take. Altogether, Deworm the World estimates that it would need $11.25 million to commit to fully funding three years of deworming programs in both countries. Because it holds (or expects to receive shortly) funding that will total $3.6 million, we estimate its funding gap for this work at $7.6 million.

Funding this gap is capacity-relevant, and is therefore a high priority, because we would like to see Deworm the World try to work in additional countries beyond India and Kenya, where it has worked historically. Next year, Deworm the World will also enter Nigeria and Ethiopia (with funding already available), so it will likely end the year having had some experience in five or more countries. This could substantially increase Deworm the World’s long-term room for more funding.

A complicating factor in thinking about Deworm the World’s funding gap is that Deworm the World is part of a larger organization, Evidence Action. Funding for Deworm the World may be fungible with funding for Evidence Action’s other activities, such as its Dispensers for Safe Water initiative (which we believe to be substantially less cost-effective than deworming). Because of this, it is difficult to determine Deworm the World’s true funding gap, and it is possible that some additional funds given to support Deworm the World could effectively lead to additional funds for a non-Deworm the World project. We understand that Evidence Action has received approximately $2.4 million in unrestricted funding over the past year. Fully funding Deworm the World could potentially cause Evidence Action to redirect some or all of these funds to its other programs.

More details on all of the above are in our review.

Key considerations:

• Program impact and cost-effectiveness. We estimate that Deworm the World-associated deworming programs are ~10x as cost-effective as cash transfers. Our estimates are subject to substantial uncertainty. It’s important to note that we view deworming as high expected value, but this is due to a relatively low probability of very high impact. Most GiveWell staff members would agree that deworming programs are more likely than not to have very little or no impact, but there is some possibility that they have a very large impact. (Our cost-effectiveness model implies that most staff members believe there is at most a 1-2% chance that deworming programs conducted today have similar impacts to those directly implied by the randomized controlled trials on which we rely most heavily, which differed from modern-day deworming programs in a number of important ways.) Our 2015 cost-effectiveness file is available here (.xlsx).
• Directness and robustness of the case for impact. Deworm the World doesn’t carry out deworming programs itself; it advocates for and provides technical assistance to governments implementing deworming programs, making direct assessments of its impact challenging. We have seen evidence that strongly suggests that Deworm the World-supported programs successfully deworm children. While we believe Deworm the World is impactful, our evidence is limited, and in addition, there is always a risk that future expansions will prove more difficult than past ones.
• Transparency and communication. Deworm the World has been communicative and open with us. We believe that were something major to go wrong with Deworm the World’s work, we would be able to learn about it and report on it.
• Risks:
  • Deworm the World is part of a larger organization, Evidence Action. It is possible that some additional funds given to support Deworm the World could effectively lead to additional funds for a non-Deworm the World project due to fungibility. Also, changes that affect Evidence Action (and its other programs) could indirectly impact Deworm the World. For example, if a major event occurs (either positive or negative) for Evidence Action, it is likely that it would reduce the time some staff could devote to Deworm the World.
  • Deworm the World is now largely raising funds to support programs that will be carried out under a different model in new countries, which makes it harder for us to predict future success based on historical results and may make it harder to understand and quantify Deworm the World’s impact even after the program is completed.

Our full review of Deworm the World is here.

GiveDirectly

 

Our full review of GiveDirectly is here.

Background

GiveDirectly (www.givedirectly.org) transfers cash to households in developing countries via mobile phone-linked payment services. It targets extremely low-income households. The proportion of total expenses that GiveDirectly has delivered directly to recipients is approximately 85% overall. We believe that this approach faces an unusually low burden of proof, and that the available evidence supports the idea that unconditional cash transfers significantly help people.

We believe GiveDirectly to be an exceptionally strong and effective organization, even more so than our other top charities. It has invested heavily in self-evaluation from the start, scaled up quickly, and communicated with us clearly. It appears that GiveDirectly has been effective at delivering cash to low-income households. GiveDirectly has one major randomized controlled trial (RCT) of its impact and took the unusual step of making the details of this study public before data was collected (more). It continues to experiment heavily, to the point where every recipient is enrolled in a study or a campaign variation.

Important changes in the last 12 months

GiveDirectly continued to scale up significantly, utilizing most of the funding it received at the end of last year. It continued to share informative and detailed monitoring information with us. Overall, it grew its operations while maintaining the high quality of its program.

In August, Good Ventures granted $25 million to GiveDirectly to support potentially high-upside opportunities, such as (a) building a fundraising team that will aim to raise substantial donations from non-GiveWell donors, and (b) developing partnerships with bilateral donors and local governments to deliver cash transfers or to run experiments comparing standard aid programs to cash transfers.

GiveDirectly’s increased efforts to network with potential government and donor partners have led to some results in 2015. For example, GiveDirectly will be implementing cash transfers in a randomized controlled trial in Rwanda that will be funded by a bilateral aid donor and Google. The study will test cash transfers against another still-to-be-chosen aid program. GiveDirectly is currently in several preliminary conversations with partners for similarly large projects in the future.

Funding gap

GiveDirectly believes it could move a total of ~$94 million to poor households in the year following March 1, 2016, for which it expects to have ~$12.6 million available by March 1. We have classified ~$34.5 million of this as the total “Execution Level 1,” capacity-relevant, and incentive funding gap (more on what this means above). We arrived at this figure by assuming that GiveDirectly could double its operations in Kenya (from ~$16.5 million/year to ~$33 million/year) and scale up to ~$12.1 million/year in Uganda. This would cost a total of ~$45.1 million, of which GiveDirectly already has ~$10.6 million on hand (ignoring $2 million that we exclude due to donor coordination issues), which results in a ~$34.5 million gap.

We’ve classified some of this as a “capacity-relevant” funding gap for our purposes (making it higher priority). First, we view the ~$12.1 million it would hope to spend in Uganda as capacity-relevant, in the sense that providing it could make a major difference to GiveDirectly’s long-term development. GiveDirectly told us that operating in Uganda is more challenging than in Kenya and that it expects to learn a significant amount as it grows. It is therefore planning to grow more slowly in Uganda than it did in Kenya. GiveDirectly made two arguments for Uganda being important for its long-term trajectory:

1. If GiveDirectly lost the ability to operate in Kenya, this would significantly diminish its ability to move funds out the door. Operating in Uganda is an important hedge against this risk.
2. Kenya is a particularly easy environment in which to operate because of the existence of M-PESA, a powerful and ubiquitous provider that enables GiveDirectly to transfer funds to recipients via mobile phones. The mobile payments network is significantly less developed outside of Kenya. As such, Uganda offers an important test case for operating in a more standard environment, which could be particularly valuable to GiveDirectly as it encourages aid agencies and country governments to expand direct cash assistance.

It’s harder to estimate how much of the Kenya funding needs are properly classified as “capacity-relevant” (an important distinction for our purposes, as discussed above). We guess that were GiveDirectly to be operating at a level 50% its current size (such that it only spent ~$8.25 million/year in Kenya), it would be able to build capacity from that level to its current level (and beyond) as quickly as it did in its recent past. We therefore classify ~$8.25 million of the ~$16.5 million it hopes to spend in Kenya as “capacity-relevant” and ~$8.25 million as “execution.” We note that we are highly uncertain about these estimates and that were GiveDirectly to receive no additional funding, this would cause it to contract in Kenya and lay off some of its middle management, an action that would cause it to incur reasonably high costs; we think much more contraction than that would be significantly more challenging for GiveDirectly as an organization.

Based on the above, and based on GiveDirectly’s existing available funds (with some adjustments for coordination issues, along the lines of this discussion from last year) we estimate that GiveDirectly has ~$9.8 million worth of unfunded opportunities that we ought to classify as capacity-relevant or incentive funding. (We arrive at this estimate based on: ~$20.35 million (total amount we classify as capacity-relevant from Kenya and Uganda) – ~$10.6 million (funds on hand, excluding donations we ignore due to coordination issues) = ~$9.75 million.)

Longer-term, we expect to continue to view funding ~$8.25 million in Kenya as capacity-relevant support and would expect to consider future expansion in Uganda (up to the current level of Kenya, i.e., ~$16.5 million/year) capacity-relevant, as well. Once GiveDirectly reaches ~$16.5 million in Uganda and proves that it can operate at that level, we only expect to view ~$8.25 million as capacity-relevant and hope that it can raise funds from other sources to support its work.

More details in our review.

Key considerations:

• Program impact and cost-effectiveness. Our best guess is that deworming or distributing bednets achieves ~10x times more humanitarian benefit per dollar donated than cash transfers. Our estimates are subject to substantial uncertainty. All of our cost-effectiveness analyses are available here. Our 2015 cost-effectiveness file is available here (.xlsx).
• Directness and robustness of the case for impact. GiveDirectly collects and shares a significant amount of relevant information about its activities. The data it collects show that it successfully directs cash to very poor people, that recipients generally spend funds productively (sometimes on food, clothing, or school fees, other times on investments in a business or home infrastructure), and that it leads to very low levels of interpersonal conflict and tension. We are more confident in the impact of GiveDirectly’s work than in that of any of the other charities discussed in this post; we believe that cash transfers face a lower burden of proof than other interventions.
• Transparency and communication. GiveDirectly has always communicated clearly and openly with us. It has tended to raise problems to us before we ask about them, and we generally believe that we have a very clear view of its operations. We feel more confident about our ability to keep track of future challenges than with any of the other charities discussed in this post.
• Risks:
  • GiveDirectly has scaled (and hopes to continue to scale) quickly. Thus far, it has significantly increased the amount of money it can move with limited issues as a result. The case of staff fraud that GiveDirectly detected is one example of an issue possibly caused by its pace of scaling, but its response demonstrated the transparency and rigor we expect.

Our full review of GiveDirectly is here.

Schistosomiasis Control Initiative (SCI)

 

Our full review of SCI is here.

Background

SCI (www3.imperial.ac.uk/schisto) works with governments in sub-Saharan Africa to create or scale up deworming programs (treating children for schistosomiasis and other intestinal parasites). SCI’s role has primarily been to identify recipient countries, provide funding to governments for government-implemented programs, provide advisory support, and conduct research on the process and outcomes of the programs. Despite SCI sharing a number of spending reports with us, we do not feel we have a detailed and fully accurate picture of how SCI and the governments it supports have spent funds in the past. We don’t feel that SCI has ever purposefully been indirect with us, but we have often struggled to communicate effectively with SCI representatives. We still lack important and in some cases basic information about SCI’s finances, and we find this problematic.

We believe that deworming is a program backed by relatively strong evidence. We have reservations about the evidence, but we think the potential benefits are great enough, and costs low enough, to outweigh these reservations. SCI has conducted studies in about half of the countries it works in (including the countries with the largest programs) to determine whether its programs have reached a large proportion of children targeted. These studies have generally found moderately positive results, but have some methodological limitations.

Important changes in the last 12 months

SCI reports that it has continued to scale up its deworming programs and that it has supported some programs in new countries, though we have limited monitoring information from these programs (e.g., we have not seen monitoring from its programs in Ethiopia, Sudan, Madagascar, and the DRC).

This year, SCI has shared a few more coverage surveys that found reasonably high coverage of its programs.

We have continued to have communication challenges with SCI. In particular:

• We have a limited understanding of SCI’s work because we still lack important and basic information about how SCI spends money. SCI recognizes that its financial management system is disorganized, and some spending reports that SCI has sent us have contained errors.
• We have struggled to gain a confident understanding of how SCI will use additional funds, and we cannot check how its funds were used after the fact because we lack information about its spending. In some cases, SCI has not spent additional funds as expected and it is unclear what caused the shift (more detail on one example in our August 2015 update).

In July, researchers published two new analyses of a key study regarding deworming (the most important piece of evidence we rely on), and the Cochrane Collaboration published an updated review of the evidence for mass deworming programs. The new papers did not change our overall assessment of the evidence on deworming. More in our blog post.

Funding gap

SCI estimates that it would use the following amounts of unrestricted funding in each of the next three years (in millions of US dollars):

• April 2016 – March 2017: $9.5
• April 2017 – March 2018: $13.6
• April 2018 – March 2019: $13.3

Our impression is that GiveWell-influenced donors contribute most of SCI’s unrestricted funds.

Our best guess is that, excluding the funds SCI may receive due to GiveWell’s recommendation, SCI will hold approximately $1.5 million in April 2016 that it could allocate to the above gaps. Also, after SCI set its fundraising targets, a funder committed $6 million over the next three years ($2 million per year) to deworming programs in Ethiopia, with which SCI is involved. Our best guess is that this funding reduces SCI’s “Execution Level 1” and incentive funding gap for the coming year from $9.5 million to $5.9 million. (We arrive at this estimate by subtracting ~$1.5 million and another $2 million from the total Level 1/incentive gap for the coming year).

We do not classify any of this as “capacity-relevant” because we have little understanding of how it will be spent, and we do not expect to be able to understand how it was spent after the fact, either.

More details on SCI’s funding gap are in our review.

Key considerations:

• Program impact and cost-effectiveness. Our best guess is that deworming programs implemented by SCI are ~5x as cost-effective as cash transfers. Our estimates are subject to substantial uncertainty. It’s important to note that we view deworming as high expected value, but this is due to a relatively low probability of very high impact. Most GiveWell staff members would agree that deworming programs are more likely than not to have very little or no impact, but there is some possibility that they have a very large impact. (Our cost-effectiveness model implies that most staff members believe there is at most a 1-2% chance that deworming programs conducted today have similar impacts to those directly implied by the randomized controlled trials on which we rely most heavily, which differed from modern-day deworming programs in a number of important ways.) Our 2015 cost-effectiveness file is available here (.xlsx).
• Directness and robustness of the case for impact. SCI doesn’t carry out deworming programs itself; it advocates for and provides technical assistance to governments implementing deworming programs, making direct assessments of its impact challenging. We have seen some evidence demonstrating that SCI-supported programs successfully deworm children, though this evidence is relatively thin. Nevertheless, deworming is a relatively straightforward program, and we think it is likely (though far from certain) that SCI-supported deworming programs successfully deworm people. We have had difficulties communicating with SCI, which has reduced our ability to understand it. We have also spent significant time interviewing SCI staff and reviewing documents over the past 6 years and have found minor but not major concerns.
• Transparency and communication. We don’t feel that SCI has ever purposefully been indirect with us, but we have often struggled to communicate effectively with SCI representatives. Specifically, (a) we had a major miscommunication with SCI about the meaning of its self-evaluations (more) and (b) although we have spent significant time with SCI, we remain unsure how SCI has spent funds and how much funding it has available (and we believe SCI itself does not have a clear understanding of this). Importantly, if there is a future unanticipated problem with SCI’s programs, we don’t feel confident that we will become aware of it. This contrasts with our other top charities, which we feel we have a strong ability to follow up on.
• Risks: There are significantly more unknown risks with SCI than our other top charities due to our limited understanding of its activities.

Our full review of SCI is here.

Standouts

As we did last year, we recommend four organizations as “standouts.” These charities score well on some of our criteria, but we are not confident enough in them to name them top charities. This year, we retain the same four standout organizations: Development Media International (DMI), the Global Alliance for Improved Nutrition’s Universal Salt Iodization program (GAIN-USI), the Iodine Global Network (IGN), and Living Goods.

We followed all four of these charities in 2015, but have only published an updated review for DMI. We expect to publish updated reviews for GAIN-USI, IGN, and Living Goods in the near future.

We provide brief updates on these charities below:

• DMI. DMI produces radio and television programming in developing countries that encourages people to adopt improved health practices. It is a standout because of its commitment to monitoring and the possibility that it is implementing a highly cost-effective program. DMI has recently completed a randomized controlled trial of its program. Last year, we had midline results from this trial, which generally looked promising.In November 2015, DMI privately shared preliminary endline results from the RCT. These results did not find any effect of DMI’s program on child mortality, and found substantially less effect on behavior change than was found in the midline results. We (understandably) cannot publicly discuss the details of the endline results we have seen, because they are not yet finalized and because the finalized results will be embargoed prior to publication. DMI believes that there were serious problems with endline data collection (note that we have not yet tried to independently assess this claim). With the support of the trial’s Independent Scientific Advisory Committee, DMI is planning to conduct another endline survey in late 2016, with results available in 2017.We are impressed by DMI’s openness with us about its results (and its willingness for us to share the high-level summary), and we hope to have discussions with DMI about how it might be able to work toward becoming a top charity in the future. Our full review of DMI is here.
• GAIN-USI. GAIN’s Universal Salt Iodization (USI) program supports national salt iodization programs. There is strong evidence that salt iodization programs have a significant, positive effect on children’s cognitive development. GAIN-USI does not work directly to iodize salt; rather, it supports governments and private companies to do so, which could lead to leveraged impact of donations or to low impact, depending on its effectiveness. Last year, we wrote, “We tried but were unable to document a demonstrable track record of impact; we believe it may have had significant impacts, but we are unable to be confident in this with what we know now. More investigation next year could change this picture.” In 2015, we continued our assessment of GAIN, focusing on its work in India and Ethiopia, including a site visit to Ethiopia in July.Overall, we tried but were unable to establish clear evidence of GAIN successfully contributing to the impact of iodization programs. This is primarily due to (a) the difficulty in attributing impact to specific activities that GAIN carried out and (b) challenges we have had communicating with GAIN about its work. We have not yet completed our final report on GAIN but hope to publish it in the near future. We have published notes from some of the conversations that were part of this research and they are available here. Our 2014 review of GAIN is here.
• IGN. Like GAIN-USI, IGN supports (via advocacy and technical assistance rather than implementation) salt iodization, and as with GAIN-USI, we tried but were unable to establish clear evidence of IGN successfully contributing to the impact of iodization programs. Unlike GAIN-USI, IGN is small, operating on a budget of approximately $0.5-$1 million per year, and relies heavily on volunteer time. We are planning to post an updated review in the near future. Our 2014 review of IGN is here.
• Living Goods recruits, trains, and manages a network of community health promoters who sell health and household goods door-to-door in Uganda and Kenya and provide basic health counseling. They sell products such as treatments for malaria and diarrhea, fortified foods, water filters, bednets, clean cookstoves, and solar lights. Living Goods completed a randomized controlled trial of its program and measured a 27% reduction in child mortality. We estimate that Living Goods saves a life for roughly each $10,000 it spends, approximately 3 times as much as our estimate for the cost per life saved of AMF’s program. We spoke with Living Goods and reviewed documents about their progress in 2015. We do not have major updates to report but are planning to post an updated review in the near future. Our 2014 review of Living Goods is here.

Our research process in 2015

 

This section describes the new work we did in 2015 to supplement our previous work on defining and identifying top charities. See the process page on our website for our overall process.

This year, we did not put a substantial amount of senior staff time into new top charities research work because (a) we were largely focused on building capacity, and (b) we reallocated a significant amount of capacity to the Open Philanthropy Project (see our post on our plans for 2015 for more details).

We focused the bulk of our research capacity for top charities work on staying up-to-date on our recommended charities. We also did an intensive evaluation of GAIN-USI, including a site visit (more details forthcoming).

We completed investigations of vitamin A supplementation and maternal and neonatal tetanus immunization campaigns. Both programs seem potentially competitive with our other priority programs, but we were not able to identify charities that worked on these programs that were willing to apply for a recommendation. We also made substantial progress on investigating several other programs, such as measles immunization, meningitis A vaccination, folic acid fortification, voluntary medical male circumcision for the prevention of HIV, and “Targeting the Ultra-Poor” (or “Ultra-Poor Graduation”) programs.

We stayed up to date on the research for bednets, cash transfers, and deworming.

We did not conduct an extensive search for new charities this year. We feel that we have a relatively good understanding of the existing charities that could potentially meet our criteria, based on past searches (see the process page on our website for more information). Instead, we solicited applications from organizations that we viewed as contenders for recommendations. A March post laid out which organizations we were hoping to investigate and why.

We did some initial research on several charities that we had not investigated before, but we did not complete the reviews in time for our 2015 recommendations. The organizations that we began investigating were:

• END Fund
• Episcopal Relief & Development’s NetsforLife® Program
• Project Healthy Children
• Sightsavers.

We plan to complete these reviews in 2016.

Giving to GiveWell vs. top charities

 

We have grown significantly over the past few years and continue to raise funds to support our operations. This includes work on GiveWell’s top charities and the Open Philanthropy Project.

We plan to post an update on our funding situation before the end of the year.

The most up-to-date information available on this topic is linked from our June 2015 board meeting. The short story is that we are still seeking additional donations and encourage donors who feel they are sufficiently confident in our impact to give to us.

Footnotes:

* For example, if $30 million were available to fund gaps of $10 million, $5 million, and $100 million, we would recommend allocating the funds so that the $10 million and $5 million gaps were fully filled and the $100 million gap received $15 million.

This rule is material to the three gaps tied at priority level 2. It causes us to recommend that Good Ventures’ last $28.3 million to recommended charities is used to fully fill GiveDirectly’s $8.8 million capacity-relevant gap and Deworm the World’s $3.2 million Execution Level 2 (possible capacity-relevant) gap, but only fill $16.3 million of AMF’s Execution Level 1 gap.

** This gap can’t be cleanly classified because we think the funding is relatively unlikely to be needed, but if it is needed, it is likely to have capacity-relevant effects. Thus, it is technically classified as Execution Level 2, but we think it has similar value to Execution Level 1.

The post Our updated top charities for giving season 2015 appeared first on The GiveWell Blog.

We have refreshed our top charity rankings and recommendations. Our set of top charities and standouts is the same as last year’s, but we have introduced rankings and changed our recommended funding allocation, due to a variety of updates – particularly to our top charities’ room for more funding. In particular, we are recommending that Good Ventures, a foundation with which we work closely, support our top charities at a higher level than in previous years. This post includes our recommendations to Good Ventures, and gives our recommendations to individual donors after accounting for these grants.

Overall, we think the case for our top charities is stronger than in previous years, and room for more funding is greater.

Our top charities and recommendations for donors, in brief

 

Top charities

1. Against Malaria Foundation (AMF)
2. Schistosomiasis Control Initiative (SCI)
3. Deworm the World Initiative, led by Evidence Action
4. GiveDirectly

This year, we are ranking our top charities based on what we see as the value of filling their remaining funding gaps. Unlike in previous years, we do not feel a particular need for individuals to divide their allocation between the charities, since we are recommending that Good Ventures provide significant support to each. For those seeking our recommended allocation, we simply recommend giving to the top-ranked charity on the list, which is AMF.

Our recommendation takes the grants we are recommending to Good Ventures into account, as well as accounting for charities’ existing cash on hand and expected non-GiveWell-related fundraising, and recommends charities according to how much good additional donations (beyond these sources of funds) can do. (Otherwise, as explained below, Deworm the World would be ranked higher.) Thus, AMF’s #1 ranking is not based on its overall value as an organization, but based on the value of its remaining funding gap.

Standout charities

As with last year, we also provide a list of charities that we believe are strong standouts, though not at the same level (in terms of likely good accomplished per dollar) as our top charities. They are not ranked, and are listed in alphabetical order.

• Development Media International (DMI)
• The Global Alliance for Improved Nutrition’s Universal Salt Iodization program (GAIN – USI)
• Iodine Global Network (IGN), formerly known as ICCIDD
• Living Goods

Below, we provide:

• An explanation of major changes in the past year that are not specific to any one charity. More
• A summary of our top charities’ relative strengths and weaknesses, and how we would rank them if room for more funding were not an issue. More
• A discussion of our refined approach to room for more funding. More
• The recommendations we are making to Good Ventures, and how we rank our top charities after taking these grants (and their impact on room for more funding) into account. More
• Detail on each of our top charities, including major changes over the past year, strengths and weaknesses for each, and our understanding of each organization’s room for more funding. More
• The process we followed that led to these recommendations. More
• A brief update on giving to support GiveWell’s operations vs. giving to our top charities. More

Conference call to discuss recommendations

We are planning to hold a conference call at 5:30pm ET/2:30pm PT on Tuesday, December 1st to discuss our recommendations and answer questions.

If you’d like to join the call, please register using this online form. If you can’t make this date but would be interested in joining another call at a later date, please indicate this on the registration form.

Major changes in the last 12 months

 

Below, we summarize the major causes of changes to our recommendations (since last year).

Overall, the case for our top charities is stronger than it was in past years. The Deworm the World Initiative shared new monitoring and evaluation materials with us, so we are more confident than we were a year ago that it is a strong organization implementing high-quality programs. In addition, the extra year of work we have seen from AMF and GiveDirectly bolsters our view that they will be able to utilize additional funding effectively.

Our top charities have increased room for more funding. Last year, we expected donors following our recommendations to fully fill the most critical funding gaps of our top charities (excluding GiveDirectly) because they had limited room for more funding: GiveDirectly had a total funding gap of ~$40 million and our other three top charities had a total gap of ~$18 million. This year, all of our top charities have more room for more funding. We believe that GiveDirectly could absorb more than $80 million and other top charities together could collectively utilize more than $100 million. We do not expect donors following our recommendations to fully fill these gaps.

We are recommending that Good Ventures make larger grants to top charities. For reasons we will be detailing in a future post, we are recommending that Good Ventures make substantial grants to our top charities this year, though not enough to close their funding gaps.

Continued refinement of the concept of “room for more funding.” We’ve tried to create a much more systematic and detailed room for more funding analysis, because the stakes of this analysis have become higher due to (a) increased room for more funding across the board and (b) increased interest from Good Ventures in providing major support.

In past years, we’ve discussed charities’ room for more funding as a single figure without distinguishing between (a) the amount the charity would spend in the next 12 months, (b) the amount the charity needs to prevent it from slowing its work due to lack of funds, and (c) funding that would be especially important to the organization’s development and success (a dual benefit) in addition to expanding implementation of its program. This year, we’ve made three changes to our room for more funding analysis:

• We’ve made (a) an assessment of whether additional funds merely allow a charity to implement its program (“execution”) or (b) whether additional funds would be especially important to the charity’s development and success as an organization (“capacity-relevant”). We also explicitly note the role of incentives for meeting GiveWell’s top-charity criteria in our recommendations (we seek to ensure that each top charity receives at least $1 million, to encourage other organizations to seek to meet these criteria).
• We are explicitly assessing “execution”-related room for more funding based on our estimate of the probability that lack of funding will lead to a charity slowing its progress. We distinguish between Level 1, Level 2, and Level 3 “execution” funding gaps; a higher number means the money is less likely to be needed.
• We are now ranking “funding gaps,” not just ranking charities, because the first million dollars to a charity can have a very different impact from, e.g., the 20th million dollars. For example, if Charity A accomplishes more good per dollar with its programs than Charity B, we would rank Charity A above Charity B for a given type of gap (we would rank Charity A’s “Execution Level 1” gap above Charity B’s), but we might rank Charity B’s “Execution Level 1” gap (the amount of funding it will likely need) above Charity A’s “Execution Level 3” gap (the amount of funding gap it might, but probably will not, need to carry out more of its programs in the coming year).

We discuss these ideas in greater depth below.

Summary of key considerations for top charities

 

The table below summarizes the key considerations for our four top charities. More detail is provided below as well as in the charity reviews.

Consideration AMF Deworm the World GiveDirectly SCI Program estimated cost-effectiveness (relative to cash transfers) ~10x ~10x Baseline ~5x Directness and robustness of the case for impact Strong Moderate Strongest Moderate Transparency and communication Strong Strong Strongest Weakest Ongoing monitoring and likelihood of detecting future problems Strong Strong Strongest Weakest Organizational track record of rolling out program Moderate Moderate Strong Strong Room for more funding, after accounting for grants we are recommending to Good Ventures (more below) Very high Limited Very high High

 

Overall, our ranking of the charities with room for more funding issues set aside (just considering a hypothetical dollar spent by the charity on its programs, without the “capacity-relevant funding” and “incentives” issues discussed below) would be:

1. AMF and Deworm the World
3. SCI
4. GiveDirectly

However, when we factor in room for more funding (including the impact of the grants we’re recommending to Good Ventures), the picture changes. More on this below.

Room for more funding analysis

 

Capacity-relevant funding and incentives

 

Capacity-relevant funding: additional funding can sometimes be crucial for a charity’s development and success as an organization. For example, it can contribute to a charity’s ability to experiment, expand, and ultimately have greater room for more funding over the long run. It can also be important for a charity’s ability to raise funds from non-GiveWell donors, which can be an important source of long-term leverage and can put the organization in a stronger overall position.

We think of this sort of funding gap as particularly important to fill, because it can make a big difference over the long run; in particular, it may substantially affect the long-term quality of our giving recommendations.

“Capacity-relevant” funds can include (a) funds that are explicitly targeted at growth (e.g., funds to hire fundraising staff); (b) funds that enable a charity to expand into areas it hasn’t worked in before, which can lead to important learning about whether and how the charity can operate in the new location(s); and (c) funds that would be needed in order to avoid challenging contractions in a charity’s activities which could jeopardize the charity’s long-term growth and funding prospects.

Some specific examples:

• The grant that Good Ventures made to GiveDirectly earlier this year is capacity-relevant because it will be used for: (a) building a fundraising team that will aim to raise substantial donations from non-GiveWell donors, and (b) developing partnerships with bilateral donors and local governments to deliver cash transfers or to run experiments comparing standard aid programs to cash transfers.
• Early funding that GiveDirectly received was capacity-relevant because it enabled GiveDirectly to rapidly grow from a small organization moving a few hundred thousand dollars per year to a much larger organization moving more than $10 million per year. If this funding hadn’t been forthcoming, GiveDirectly might be much smaller today and have much less room for more funding.
• We now think that some additional funding to AMF and Deworm the World will be capacity-relevant because each organization has only operated in a very small number of countries and new funding will enable each to enter new countries. This will allow them to learn how to operate there, and demonstrate that they can do so, increasing our willingness (and likely that of other donors) to recommend more to these organizations in the future.

It’s hard to draw sharp lines around capacity-relevant funding, and all funding likely has some effect on an organization’s development, but we have tried to identify and prioritize the funding gaps that seem especially relevant.

Execution funding allows charities to implement more of their core program but doesn’t appear to have substantial benefits beyond the direct good accomplished by this program. We’ve separated this funding into three levels:

• Level 1: the amount we expect a charity to need in the coming year. If a charity has less funding than this level, we think it is more likely than not that it will be bottlenecked (or unable to carry out its core program to the fullest extent) by funding in the coming year.
• Level 2: if a charity has this amount, we think there is an ~80% chance that it will not be bottlenecked by funding.
• Level 3: if a charity has this amount, we think there is a ~95% chance that it will not be bottlenecked by funding.

Incentives: we think it is important that charities we recommend get a substantial amount of funding due to being a GiveWell top charity, because this ensures that incentives are in place for charities (and potential charity founders) to seek to meet our criteria for top charities and thus increase the number of charities we recommend and the total room for more funding available, even when they don’t end up being ranked #1. We seek to ensure that each top charity gets at least $1 million as a result of our recommendation, and we consider this to be a high-priority goal of our recommendations.

The charity-specific sections of this post discuss the reasoning behind the figures we’ve assigned to “capacity-relevant” and “Execution Level 1” gaps, but they do not provide the full details of how we arrived at these figures (and do not explicitly address the “Execution Level 2” and “Execution Level 3” gaps). We expect to add this analysis to our charity reviews in the coming weeks.

Funding gaps

 

The total (i.e., Capacity-relevant, Execution Levels 1, 2, and 3, and Incentive) funding gaps (in millions of dollars, rounded to one decimal place) for each of our top charities are:

• AMF: $98.2
• Deworm the World: $19.0
• GiveDirectly: $84.0
• SCI: $26.3

However, for reasons described above, the first million dollars to a charity can have a very different impact from, e.g., the 20th million dollars. Accordingly, we have created a ranking of individual funding gaps that accounts for both (a) the quality of the charity and the good accomplished by its program, per dollar (as laid out above), and (b) whether a given level of funding is capacity-relevant and whether it is highly or only marginally likely to be needed in the coming year.

The below table lays out our ranking of funding gaps. When gaps have the same “Priority,” this indicates that they are tied.

The table below includes the amount we are recommending to Good Ventures. For reasons we will lay out in another post, we are recommending to Good Ventures a total of ~$44.4 million in grants to top charities. Having set that total, we are recommending that Good Ventures start with funding the highest-rated gaps and work its way down, in order to accomplish as much good as possible.

When gaps are tied, we recommend filling them by giving each equal dollar amounts until one is filled, and then following the same procedure with the remaining tied gaps. See footnote for more.*

Priority Charity Amount Type Recommendation to Good Ventures Comments 1 DtWI $7.6 Capacity-relevant $7.6 DtWI and AMF are strongest overall 1 AMF $6.5 Capacity-relevant $6.5 See above 1 GD $1.0 Incentive $1.0 Ensuring each top charity receives at least $1 million 1 SCI $1.0 Incentive $1.0 Ensuring each top charity receives at least $1 million 2 GD $8.8 Capacity-relevant $8.8 Not as cost-effective as bednets or deworming, so lower priority, but above non-capacity-relevant gaps 2 DtWI $3.2 Execution Level 2 / possibly capacity-relevant $3.2 Level 1 gap already filled via “capacity-relevant” gap. See footnote for more** 2 AMF $43.8 Execution Level 1 $16.3 Exhausts remaining recommendations to Good Ventures 3 SCI $4.9 Execution Level 1 0 Not as strong as DtWI and AMF in isolation, so ranked below them for same type of gap 3 AMF $24.0 Execution Level 2 0 – 4 DtWI $8.2 Execution Level 3 0 – 4 AMF $24.0 Execution Level 3 0 – 4 SCI $11.6 Execution Level 2 0 – 5 GD $24.8 Execution Level 1 0 – 5 SCI $8.8 Execution Level 3 0 – 6 GD $20.9 Execution Level 2 0 – 7 GD $28.6 Execution Level 3 0 –

Our recommendations to Good Ventures and others

 

Summing the figures from the above table, we are recommending that Good Ventures make the following grants (in millions of dollars, rounded to one decimal place):

• AMF: $22.8
• Deworm the World: $10.8
• GiveDirectly: $9.8
• SCI: $1

We also recommend that Good Ventures give $250,000 to each of our standout charities. These grants go to the outstanding organizations and create additional incentives for groups to try to obtain a GiveWell recommendation.

After these grants, AMF will require an additional ~$27.5 million to close its Execution Level 1 gap (i.e., to make it more likely than not that it is able to proceed without being bottlenecked due to lack of funding). We rank this gap higher than any of the other remaining funding gaps for our top charities, as laid out in the table above.

We estimate that non-Good Ventures donors will give approximately $15 million between now and January 31, 2016. Because we do not expect AMF’s remaining ~$27.5 million Execution Level 1 funding gap to be fully filled, we rank it #1 and recommend that donors give to AMF. We rank the remaining charities for donors who are interested in having the greatest impact per dollar based on how highly their highest-rated remaining gap ranks in the table above. That results in the following rankings for individual donors:

1. AMF
2. SCI
3. Deworm the World Initiative
4. GiveDirectly

Details on top charities

 

We present information on our top charities in alphabetical order.

Against Malaria Foundation (AMF)

 

Our full review of AMF is here.

Background

AMF (www.againstmalaria.com) provides funding for long-lasting insecticide-treated net distributions (for protection against malaria) in developing countries. There is strong evidence that distributing nets reduces child mortality and malaria cases. AMF has relatively strong reporting requirements for its distribution partners and provides a level of public disclosure and tracking of distributions that we have not seen from any other net distribution charity.

In 2011, AMF received a large amount of funding relative to what it had received historically, so it began to focus primarily on reaching agreements for large-scale net distributions (i.e., distributions on the order of hundreds of thousands of nets rather than tens of thousands of nets). In its early efforts to scale up, AMF struggled to finalize large-scale net distribution agreements. At the end of 2013, we announced that we planned not to recommend additional donations to AMF due to room for more funding-related issues (more detail in this blog post).

In 2014, AMF committed most of its funds to several new distributions — some in Malawi, some in the Democratic Republic of the Congo (DRC) — and we recommended it as a top charity again.

Important changes in the last 12 months

In 2015, AMF carried out and/or monitored many of the distributions that it committed to in 2014.

Previously, our confidence in AMF’s ability to scale had been limited by the fact that it had only completed large-scale distributions with one partner (Concern Universal) in one country (Malawi). However, AMF carried out its largest distribution to date (~620,000 nets) with a new partner in the DRC in late 2014. We have not yet seen some key documentation from the large DRC distribution, but early indications suggest that the distribution generally went as planned, despite our concern that the DRC may have been an especially challenging place to work (more details here). We see this as a positive update that AMF will be able to carry out high-quality large-scale distributions in a variety of locations in the future.

AMF has continued to collect and share follow-up information on its past large-scale distributions, and this information seems to support the notion that these distributions are high-quality (i.e., that nets are reaching the target population and are being used). We provide a summary of these reports in our review.

Funding gap

AMF currently holds $18.5 million, and we estimate it will receive an additional $1.6 million before January 31, 2016 (excluding donations influenced by GiveWell) that it could use for future distributions. AMF has told us that it has a pipeline of possible future net distributions that add up to roughly $100 million beyond what it currently holds (details in our review).

We believe that AMF’s progress would be slowed due to lack of funding were it to receive less than $50.3 million in additional funding (this is its total capacity-relevant and “Execution Level 1” gap as presented earlier in the post). In particular, we view the first additional $6.5 million that AMF would receive as capacity-relevant (and thus particularly valuable) because it would enable AMF to fund a distribution in a 5th country with a 5th partner, generating additional information about its ability to expand beyond the contexts in which it has worked to date. (Note that AMF already has funds on hand to enter its 3rd and 4th countries.)

We arrived at the capacity-relevant and Execution Level 1 figure by noting that AMF has $70.4 million worth of deals it is actively negotiating (5 deals in 4 countries) that it can only continue with if it holds the funds to do so. Subtracting the $20.1 million we expect to be available (the $18.5 million it currently holds plus the $1.6 million we expect it to receive in the coming months) leaves a $50.3 million funding gap.

AMF failed to reach new distribution agreements in 2015; there is still significant uncertainty regarding AMF’s ability to finalize agreements with new partners and countries. Nevertheless, we see providing a large amount of additional funds to AMF as a reasonable bet, and see AMF as a very strong giving opportunity.

We think it is possible that in November 2016 (when we next expect to complete a full refresh of our recommendations), we will recommend significantly less funding to AMF. We consider the funding we’re recommending to AMF now to be a good bet, but a risky one, because AMF currently has a relatively limited track record: it has worked with only two partners in two countries. Because of the lag between the time we provide funding and the time net distributions take place (often 2 years) and the additional lag caused by the time it takes to monitor distributions, we may not have additional information about whether or not AMF’s additional distributions were successful for 2-3 years. Next year, it is possible that we will choose to recommend significantly less funding to AMF while we wait for additional data to become available.

There still appears to be a large global funding gap for bednets; a global bednet coordination group estimated that about 245 million additional nets would be needed in 2015-2017 (details in our review).

Key considerations:

• Program impact and cost-effectiveness. We estimate that bednets are ~10x as cost-effective as cash transfers. Our estimates are subject to substantial uncertainty. All of our cost-effectiveness analyses are available here. Our 2015 cost-effectiveness file is available here (.xlsx).
• Directness and robustness of the case for impact. We believe that the connection between AMF receiving funds and those funds helping very poor individuals is less direct than GiveDirectly’s and more direct than SCI’s or Deworm the World’s. The uncertainty of our estimates is driven by a combination of AMF’s challenges historically disbursing the funds it receives and a general recognition that aid programs, even those as straightforward as bednets, carry significant risks of failure via ineffective use of nets, insecticide resistance, or other risks we don’t yet recognize relative to GiveDirectly’s program. AMF conducts extensive monitoring of its program; these results have generally indicated that people use the nets they receive.
• Transparency and communication. AMF has been extremely communicative and open with us. We feel we have a better understanding of AMF than of SCI, and a similar level of knowledge about AMF as we have for Deworm the World, though our understanding is not as strong as our understanding of GiveDirectly. In particular, were something to go wrong in one of AMF’s distributions, we believe we would eventually find out (something we are not sure of in the case of SCI), but we believe our understanding would be less quick and complete than it would be for problems associated with GiveDirectly’s program (which has more of a track record of consistent intensive follow-up).
• Risks:
  • We are not highly confident that AMF will be able to finalize additional distributions and do so quickly. AMF could struggle again to agree to distribution deals, leading to long delays before it spends funds. We view this as a relatively minor risk because the likely worst-case scenario is that AMF spends the funds slowly (or returns funds to donors).
  • We remain concerned about the possibility of resistance to the insecticides used in bednets. There don’t appear to be major updates on this front since our 2012 investigation into the matter; we take the lack of major news as a minor positive update.

Our full review of AMF is here.

Deworm the World Initiative, led by Evidence Action

 

Our full review of Deworm the World is here.

Background

Deworm the World (www.evidenceaction.org/deworming), led by Evidence Action, advocates for, supports, and evaluates government-run school-based deworming programs (treating children for intestinal parasites).

We believe that deworming is a program backed by relatively strong evidence. We have reservations about the evidence, but we think the potential benefits are great enough, and costs low enough, to outweigh these reservations. Deworm the World retains monitors whose reports indicate that the deworming programs it supports successfully deworm children.

Important changes in the last 12 months

In 2015, Deworm the World continued to support the scale-up and monitoring of deworming programs in India and Kenya. One of its notable activities this year was providing technical assistance to the Indian national government in support of India’s first national deworming day: a program in which the government provided assistance to Indian states to implement school-based deworming on a single day to encourage more states to implement the program. The first national deworming day took place in February 2015, and 12 states participated in the program (more details here).

The quality of the monitoring that we saw from Deworm the World improved in 2015. Deworm the World continued to hire and train third-party monitors to directly observe deworming activities, and it slightly improved its estimates of how many children were treated. This information strongly suggests that the programs are generally operating as intended. More details in our review.

Last year, Deworm the World stated to us that it could not use significant additional funding to scale up deworming programs. Deworm the World now believes that it has identified countries where it could use additional funds to support the scale-up of deworming programs, beginning with a potential program in Punjab province, Pakistan (more). (Deworm the World also plans to use funds it already holds or expects to receive to expand into Ethiopia and Nigeria.)

Future donations to Deworm the World will likely be used outside of India, and in those cases governments may have less funding to support deworming. This may cause Deworm the World to pay a higher fraction of the overall cost of the program, making the potential for leverage of future donations more limited. Overall program costs may also be higher outside of India. More details in our review.

A significant organizational update is that Alix Zwane stepped down as Executive Director of Evidence Action in August; she left to join the Global Innovation Fund as CEO. Evidence Action has since hired Jeff Brown (formerly Interim CEO of the Global Innovation Fund) as Executive Director. Grace Hollister remains Director of the Deworm the World Initiative. Overall, our impression is that Dr. Zwane has been a highly effective leader of Evidence Action and her departure risks disruptions that could lead to us changing our view of the organization, though we would guess that this will not be the case.

In July, researchers published two new analyses of a key study regarding deworming (the most important piece of evidence we rely on), and the Cochrane Collaboration published an updated review of the evidence for mass deworming programs. The new papers did not change our overall assessment of the evidence on deworming. More in our blog post.

Funding gap

We believe that Deworm the World has significant opportunities to use additional funding to expand its program. We believe it may have opportunities to enter at least two more countries (in addition to Nigeria and Ethiopia, which it will be able to enter with funds it already has or expects to receive). We estimate its funding need using the two countries it is most likely to enter — Pakistan and Nepal — though note that in both cases, we see these as representative of the types of opportunities it may have, rather than the specific opportunities we expect it to take. Altogether, Deworm the World estimates that it would need $11.25 million to commit to fully funding three years of deworming programs in both countries. Because it holds (or expects to receive shortly) funding that will total $3.6 million, we estimate its funding gap for this work at $7.6 million.

Funding this gap is capacity-relevant, and is therefore a high priority, because we would like to see Deworm the World try to work in additional countries beyond India and Kenya, where it has worked historically. Next year, Deworm the World will also enter Nigeria and Ethiopia (with funding already available), so it will likely end the year having had some experience in five or more countries. This could substantially increase Deworm the World’s long-term room for more funding.

A complicating factor in thinking about Deworm the World’s funding gap is that Deworm the World is part of a larger organization, Evidence Action. Funding for Deworm the World may be fungible with funding for Evidence Action’s other activities, such as its Dispensers for Safe Water initiative (which we believe to be substantially less cost-effective than deworming). Because of this, it is difficult to determine Deworm the World’s true funding gap, and it is possible that some additional funds given to support Deworm the World could effectively lead to additional funds for a non-Deworm the World project. We understand that Evidence Action has received approximately $2.4 million in unrestricted funding over the past year. Fully funding Deworm the World could potentially cause Evidence Action to redirect some or all of these funds to its other programs.

More details on all of the above are in our review.

Key considerations:

• Program impact and cost-effectiveness. We estimate that Deworm the World-associated deworming programs are ~10x as cost-effective as cash transfers. Our estimates are subject to substantial uncertainty. It’s important to note that we view deworming as high expected value, but this is due to a relatively low probability of very high impact. Most GiveWell staff members would agree that deworming programs are more likely than not to have very little or no impact, but there is some possibility that they have a very large impact. (Our cost-effectiveness model implies that most staff members believe there is at most a 1-2% chance that deworming programs conducted today have similar impacts to those directly implied by the randomized controlled trials on which we rely most heavily, which differed from modern-day deworming programs in a number of important ways.) Our 2015 cost-effectiveness file is available here (.xlsx).
• Directness and robustness of the case for impact. Deworm the World doesn’t carry out deworming programs itself; it advocates for and provides technical assistance to governments implementing deworming programs, making direct assessments of its impact challenging. We have seen evidence that strongly suggests that Deworm the World-supported programs successfully deworm children. While we believe Deworm the World is impactful, our evidence is limited, and in addition, there is always a risk that future expansions will prove more difficult than past ones.
• Transparency and communication. Deworm the World has been communicative and open with us. We believe that were something major to go wrong with Deworm the World’s work, we would be able to learn about it and report on it.
• Risks:
  • Deworm the World is part of a larger organization, Evidence Action. It is possible that some additional funds given to support Deworm the World could effectively lead to additional funds for a non-Deworm the World project due to fungibility. Also, changes that affect Evidence Action (and its other programs) could indirectly impact Deworm the World. For example, if a major event occurs (either positive or negative) for Evidence Action, it is likely that it would reduce the time some staff could devote to Deworm the World.
  • Deworm the World is now largely raising funds to support programs that will be carried out under a different model in new countries, which makes it harder for us to predict future success based on historical results and may make it harder to understand and quantify Deworm the World’s impact even after the program is completed.

Our full review of Deworm the World is here.

GiveDirectly

 

Our full review of GiveDirectly is here.

Background

GiveDirectly (www.givedirectly.org) transfers cash to households in developing countries via mobile phone-linked payment services. It targets extremely low-income households. The proportion of total expenses that GiveDirectly has delivered directly to recipients is approximately 85% overall. We believe that this approach faces an unusually low burden of proof, and that the available evidence supports the idea that unconditional cash transfers significantly help people.

We believe GiveDirectly to be an exceptionally strong and effective organization, even more so than our other top charities. It has invested heavily in self-evaluation from the start, scaled up quickly, and communicated with us clearly. It appears that GiveDirectly has been effective at delivering cash to low-income households. GiveDirectly has one major randomized controlled trial (RCT) of its impact and took the unusual step of making the details of this study public before data was collected (more). It continues to experiment heavily, to the point where every recipient is enrolled in a study or a campaign variation.

Important changes in the last 12 months

GiveDirectly continued to scale up significantly, utilizing most of the funding it received at the end of last year. It continued to share informative and detailed monitoring information with us. Overall, it grew its operations while maintaining the high quality of its program.

In August, Good Ventures granted $25 million to GiveDirectly to support potentially high-upside opportunities, such as (a) building a fundraising team that will aim to raise substantial donations from non-GiveWell donors, and (b) developing partnerships with bilateral donors and local governments to deliver cash transfers or to run experiments comparing standard aid programs to cash transfers.

GiveDirectly’s increased efforts to network with potential government and donor partners have led to some results in 2015. For example, GiveDirectly will be implementing cash transfers in a randomized controlled trial in Rwanda that will be funded by a bilateral aid donor and Google. The study will test cash transfers against another still-to-be-chosen aid program. GiveDirectly is currently in several preliminary conversations with partners for similarly large projects in the future.

Funding gap

GiveDirectly believes it could move a total of ~$94 million to poor households in the year following March 1, 2016, for which it expects to have ~$12.6 million available by March 1. We have classified ~$34.5 million of this as the total “Execution Level 1,” capacity-relevant, and incentive funding gap (more on what this means above). We arrived at this figure by assuming that GiveDirectly could double its operations in Kenya (from ~$16.5 million/year to ~$33 million/year) and scale up to ~$12.1 million/year in Uganda. This would cost a total of ~$45.1 million, of which GiveDirectly already has ~$10.6 million on hand (ignoring $2 million that we exclude due to donor coordination issues), which results in a ~$34.5 million gap.

We’ve classified some of this as a “capacity-relevant” funding gap for our purposes (making it higher priority). First, we view the ~$12.1 million it would hope to spend in Uganda as capacity-relevant, in the sense that providing it could make a major difference to GiveDirectly’s long-term development. GiveDirectly told us that operating in Uganda is more challenging than in Kenya and that it expects to learn a significant amount as it grows. It is therefore planning to grow more slowly in Uganda than it did in Kenya. GiveDirectly made two arguments for Uganda being important for its long-term trajectory:

1. If GiveDirectly lost the ability to operate in Kenya, this would significantly diminish its ability to move funds out the door. Operating in Uganda is an important hedge against this risk.
2. Kenya is a particularly easy environment in which to operate because of the existence of M-PESA, a powerful and ubiquitous provider that enables GiveDirectly to transfer funds to recipients via mobile phones. The mobile payments network is significantly less developed outside of Kenya. As such, Uganda offers an important test case for operating in a more standard environment, which could be particularly valuable to GiveDirectly as it encourages aid agencies and country governments to expand direct cash assistance.

It’s harder to estimate how much of the Kenya funding needs are properly classified as “capacity-relevant” (an important distinction for our purposes, as discussed above). We guess that were GiveDirectly to be operating at a level 50% its current size (such that it only spent ~$8.25 million/year in Kenya), it would be able to build capacity from that level to its current level (and beyond) as quickly as it did in its recent past. We therefore classify ~$8.25 million of the ~$16.5 million it hopes to spend in Kenya as “capacity-relevant” and ~$8.25 million as “execution.” We note that we are highly uncertain about these estimates and that were GiveDirectly to receive no additional funding, this would cause it to contract in Kenya and lay off some of its middle management, an action that would cause it to incur reasonably high costs; we think much more contraction than that would be significantly more challenging for GiveDirectly as an organization.

Based on the above, and based on GiveDirectly’s existing available funds (with some adjustments for coordination issues, along the lines of this discussion from last year) we estimate that GiveDirectly has ~$9.8 million worth of unfunded opportunities that we ought to classify as capacity-relevant or incentive funding. (We arrive at this estimate based on: ~$20.35 million (total amount we classify as capacity-relevant from Kenya and Uganda) – ~$10.6 million (funds on hand, excluding donations we ignore due to coordination issues) = ~$9.75 million.)

Longer-term, we expect to continue to view funding ~$8.25 million in Kenya as capacity-relevant support and would expect to consider future expansion in Uganda (up to the current level of Kenya, i.e., ~$16.5 million/year) capacity-relevant, as well. Once GiveDirectly reaches ~$16.5 million in Uganda and proves that it can operate at that level, we only expect to view ~$8.25 million as capacity-relevant and hope that it can raise funds from other sources to support its work.

More details in our review.

Key considerations:

• Program impact and cost-effectiveness. Our best guess is that deworming or distributing bednets achieves ~10x times more humanitarian benefit per dollar donated than cash transfers. Our estimates are subject to substantial uncertainty. All of our cost-effectiveness analyses are available here. Our 2015 cost-effectiveness file is available here (.xlsx).
• Directness and robustness of the case for impact. GiveDirectly collects and shares a significant amount of relevant information about its activities. The data it collects show that it successfully directs cash to very poor people, that recipients generally spend funds productively (sometimes on food, clothing, or school fees, other times on investments in a business or home infrastructure), and that it leads to very low levels of interpersonal conflict and tension. We are more confident in the impact of GiveDirectly’s work than in that of any of the other charities discussed in this post; we believe that cash transfers face a lower burden of proof than other interventions.
• Transparency and communication. GiveDirectly has always communicated clearly and openly with us. It has tended to raise problems to us before we ask about them, and we generally believe that we have a very clear view of its operations. We feel more confident about our ability to keep track of future challenges than with any of the other charities discussed in this post.
• Risks:
  • GiveDirectly has scaled (and hopes to continue to scale) quickly. Thus far, it has significantly increased the amount of money it can move with limited issues as a result. The case of staff fraud that GiveDirectly detected is one example of an issue possibly caused by its pace of scaling, but its response demonstrated the transparency and rigor we expect.

Our full review of GiveDirectly is here.

Schistosomiasis Control Initiative (SCI)

 

Our full review of SCI is here.

Background

SCI (www3.imperial.ac.uk/schisto) works with governments in sub-Saharan Africa to create or scale up deworming programs (treating children for schistosomiasis and other intestinal parasites). SCI’s role has primarily been to identify recipient countries, provide funding to governments for government-implemented programs, provide advisory support, and conduct research on the process and outcomes of the programs. Despite SCI sharing a number of spending reports with us, we do not feel we have a detailed and fully accurate picture of how SCI and the governments it supports have spent funds in the past. We don’t feel that SCI has ever purposefully been indirect with us, but we have often struggled to communicate effectively with SCI representatives. We still lack important and in some cases basic information about SCI’s finances, and we find this problematic.

We believe that deworming is a program backed by relatively strong evidence. We have reservations about the evidence, but we think the potential benefits are great enough, and costs low enough, to outweigh these reservations. SCI has conducted studies in about half of the countries it works in (including the countries with the largest programs) to determine whether its programs have reached a large proportion of children targeted. These studies have generally found moderately positive results, but have some methodological limitations.

Important changes in the last 12 months

SCI reports that it has continued to scale up its deworming programs and that it has supported some programs in new countries, though we have limited monitoring information from these programs (e.g., we have not seen monitoring from its programs in Ethiopia, Sudan, Madagascar, and the DRC).

This year, SCI has shared a few more coverage surveys that found reasonably high coverage of its programs.

We have continued to have communication challenges with SCI. In particular:

• We have a limited understanding of SCI’s work because we still lack important and basic information about how SCI spends money. SCI recognizes that its financial management system is disorganized, and some spending reports that SCI has sent us have contained errors.
• We have struggled to gain a confident understanding of how SCI will use additional funds, and we cannot check how its funds were used after the fact because we lack information about its spending. In some cases, SCI has not spent additional funds as expected and it is unclear what caused the shift (more detail on one example in our August 2015 update).

In July, researchers published two new analyses of a key study regarding deworming (the most important piece of evidence we rely on), and the Cochrane Collaboration published an updated review of the evidence for mass deworming programs. The new papers did not change our overall assessment of the evidence on deworming. More in our blog post.

Funding gap

SCI estimates that it would use the following amounts of unrestricted funding in each of the next three years (in millions of US dollars):

• April 2016 – March 2017: $9.5
• April 2017 – March 2018: $13.6
• April 2018 – March 2019: $13.3

Our impression is that GiveWell-influenced donors contribute most of SCI’s unrestricted funds.

Our best guess is that, excluding the funds SCI may receive due to GiveWell’s recommendation, SCI will hold approximately $1.5 million in April 2016 that it could allocate to the above gaps. Also, after SCI set its fundraising targets, a funder committed $6 million over the next three years ($2 million per year) to deworming programs in Ethiopia, with which SCI is involved. Our best guess is that this funding reduces SCI’s “Execution Level 1” and incentive funding gap for the coming year from $9.5 million to $5.9 million. (We arrive at this estimate by subtracting ~$1.5 million and another $2 million from the total Level 1/incentive gap for the coming year).

We do not classify any of this as “capacity-relevant” because we have little understanding of how it will be spent, and we do not expect to be able to understand how it was spent after the fact, either.

More details on SCI’s funding gap are in our review.

Key considerations:

• Program impact and cost-effectiveness. Our best guess is that deworming programs implemented by SCI are ~5x as cost-effective as cash transfers. Our estimates are subject to substantial uncertainty. It’s important to note that we view deworming as high expected value, but this is due to a relatively low probability of very high impact. Most GiveWell staff members would agree that deworming programs are more likely than not to have very little or no impact, but there is some possibility that they have a very large impact. (Our cost-effectiveness model implies that most staff members believe there is at most a 1-2% chance that deworming programs conducted today have similar impacts to those directly implied by the randomized controlled trials on which we rely most heavily, which differed from modern-day deworming programs in a number of important ways.) Our 2015 cost-effectiveness file is available here (.xlsx).
• Directness and robustness of the case for impact. SCI doesn’t carry out deworming programs itself; it advocates for and provides technical assistance to governments implementing deworming programs, making direct assessments of its impact challenging. We have seen some evidence demonstrating that SCI-supported programs successfully deworm children, though this evidence is relatively thin. Nevertheless, deworming is a relatively straightforward program, and we think it is likely (though far from certain) that SCI-supported deworming programs successfully deworm people. We have had difficulties communicating with SCI, which has reduced our ability to understand it. We have also spent significant time interviewing SCI staff and reviewing documents over the past 6 years and have found minor but not major concerns.
• Transparency and communication. We don’t feel that SCI has ever purposefully been indirect with us, but we have often struggled to communicate effectively with SCI representatives. Specifically, (a) we had a major miscommunication with SCI about the meaning of its self-evaluations (more) and (b) although we have spent significant time with SCI, we remain unsure how SCI has spent funds and how much funding it has available (and we believe SCI itself does not have a clear understanding of this). Importantly, if there is a future unanticipated problem with SCI’s programs, we don’t feel confident that we will become aware of it. This contrasts with our other top charities, which we feel we have a strong ability to follow up on.
• Risks: There are significantly more unknown risks with SCI than our other top charities due to our limited understanding of its activities.

Our full review of SCI is here.

Standouts

As we did last year, we recommend four organizations as “standouts.” These charities score well on some of our criteria, but we are not confident enough in them to name them top charities. This year, we retain the same four standout organizations: Development Media International (DMI), the Global Alliance for Improved Nutrition’s Universal Salt Iodization program (GAIN-USI), the Iodine Global Network (IGN), and Living Goods.

We followed all four of these charities in 2015, but have only published an updated review for DMI. We expect to publish updated reviews for GAIN-USI, IGN, and Living Goods in the near future.

We provide brief updates on these charities below:

• DMI. DMI produces radio and television programming in developing countries that encourages people to adopt improved health practices. It is a standout because of its commitment to monitoring and the possibility that it is implementing a highly cost-effective program. DMI has recently completed a randomized controlled trial of its program. Last year, we had midline results from this trial, which generally looked promising.In November 2015, DMI privately shared preliminary endline results from the RCT. These results did not find any effect of DMI’s program on child mortality, and found substantially less effect on behavior change than was found in the midline results. We (understandably) cannot publicly discuss the details of the endline results we have seen, because they are not yet finalized and because the finalized results will be embargoed prior to publication. DMI believes that there were serious problems with endline data collection (note that we have not yet tried to independently assess this claim). With the support of the trial’s Independent Scientific Advisory Committee, DMI is planning to conduct another endline survey in late 2016, with results available in 2017.We are impressed by DMI’s openness with us about its results (and its willingness for us to share the high-level summary), and we hope to have discussions with DMI about how it might be able to work toward becoming a top charity in the future. Our full review of DMI is here.
• GAIN-USI. GAIN’s Universal Salt Iodization (USI) program supports national salt iodization programs. There is strong evidence that salt iodization programs have a significant, positive effect on children’s cognitive development. GAIN-USI does not work directly to iodize salt; rather, it supports governments and private companies to do so, which could lead to leveraged impact of donations or to low impact, depending on its effectiveness. Last year, we wrote, “We tried but were unable to document a demonstrable track record of impact; we believe it may have had significant impacts, but we are unable to be confident in this with what we know now. More investigation next year could change this picture.” In 2015, we continued our assessment of GAIN, focusing on its work in India and Ethiopia, including a site visit to Ethiopia in July.Overall, we tried but were unable to establish clear evidence of GAIN successfully contributing to the impact of iodization programs. This is primarily due to (a) the difficulty in attributing impact to specific activities that GAIN carried out and (b) challenges we have had communicating with GAIN about its work. We have not yet completed our final report on GAIN but hope to publish it in the near future. We have published notes from some of the conversations that were part of this research and they are available here. Our 2014 review of GAIN is here.
• IGN. Like GAIN-USI, IGN supports (via advocacy and technical assistance rather than implementation) salt iodization, and as with GAIN-USI, we tried but were unable to establish clear evidence of IGN successfully contributing to the impact of iodization programs. Unlike GAIN-USI, IGN is small, operating on a budget of approximately $0.5-$1 million per year, and relies heavily on volunteer time. We are planning to post an updated review in the near future. Our 2014 review of IGN is here.
• Living Goods recruits, trains, and manages a network of community health promoters who sell health and household goods door-to-door in Uganda and Kenya and provide basic health counseling. They sell products such as treatments for malaria and diarrhea, fortified foods, water filters, bednets, clean cookstoves, and solar lights. Living Goods completed a randomized controlled trial of its program and measured a 27% reduction in child mortality. We estimate that Living Goods saves a life for roughly each $10,000 it spends, approximately 3 times as much as our estimate for the cost per life saved of AMF’s program. We spoke with Living Goods and reviewed documents about their progress in 2015. We do not have major updates to report but are planning to post an updated review in the near future. Our 2014 review of Living Goods is here.

Our research process in 2015

 

This section describes the new work we did in 2015 to supplement our previous work on defining and identifying top charities. See the process page on our website for our overall process.

This year, we did not put a substantial amount of senior staff time into new top charities research work because (a) we were largely focused on building capacity, and (b) we reallocated a significant amount of capacity to the Open Philanthropy Project (see our post on our plans for 2015 for more details).

We focused the bulk of our research capacity for top charities work on staying up-to-date on our recommended charities. We also did an intensive evaluation of GAIN-USI, including a site visit (more details forthcoming).

We completed investigations of vitamin A supplementation and maternal and neonatal tetanus immunization campaigns. Both programs seem potentially competitive with our other priority programs, but we were not able to identify charities that worked on these programs that were willing to apply for a recommendation. We also made substantial progress on investigating several other programs, such as measles immunization, meningitis A vaccination, folic acid fortification, voluntary medical male circumcision for the prevention of HIV, and “Targeting the Ultra-Poor” (or “Ultra-Poor Graduation”) programs.

We stayed up to date on the research for bednets, cash transfers, and deworming.

We did not conduct an extensive search for new charities this year. We feel that we have a relatively good understanding of the existing charities that could potentially meet our criteria, based on past searches (see the process page on our website for more information). Instead, we solicited applications from organizations that we viewed as contenders for recommendations. A March post laid out which organizations we were hoping to investigate and why.

We did some initial research on several charities that we had not investigated before, but we did not complete the reviews in time for our 2015 recommendations. The organizations that we began investigating were:

• END Fund
• Episcopal Relief & Development’s NetsforLife® Program
• Project Healthy Children
• Sightsavers.

We plan to complete these reviews in 2016.

Giving to GiveWell vs. top charities

 

We have grown significantly over the past few years and continue to raise funds to support our operations. This includes work on GiveWell’s top charities and the Open Philanthropy Project.

We plan to post an update on our funding situation before the end of the year.

The most up-to-date information available on this topic is linked from our June 2015 board meeting. The short story is that we are still seeking additional donations and encourage donors who feel they are sufficiently confident in our impact to give to us.

Footnotes:

* For example, if $30 million were available to fund gaps of $10 million, $5 million, and $100 million, we would recommend allocating the funds so that the $10 million and $5 million gaps were fully filled and the $100 million gap received $15 million.

This rule is material to the three gaps tied at priority level 2. It causes us to recommend that Good Ventures’ last $28.3 million to recommended charities is used to fully fill GiveDirectly’s $8.8 million capacity-relevant gap and Deworm the World’s $3.2 million Execution Level 2 (possible capacity-relevant) gap, but only fill $16.3 million of AMF’s Execution Level 1 gap.

** This gap can’t be cleanly classified because we think the funding is relatively unlikely to be needed, but if it is needed, it is likely to have capacity-relevant effects. Thus, it is technically classified as Execution Level 2, but we think it has similar value to Execution Level 1.

The post Our updated top charities for giving season 2015 appeared first on The GiveWell Blog.

We have refreshed our top charity rankings and recommendations. Our set of top charities and standouts is the same as last year’s, but we have introduced rankings and changed our recommended funding allocation, due to a variety of updates – particularly to our top charities’ room for more funding. In particular, we are recommending that Good Ventures, a foundation with which we work closely, support our top charities at a higher level than in previous years. This post includes our recommendations to Good Ventures, and gives our recommendations to individual donors after accounting for these grants.

Overall, we think the case for our top charities is stronger than in previous years, and room for more funding is greater.

Our top charities and recommendations for donors, in brief

 

Top charities

1. Against Malaria Foundation (AMF)
2. Schistosomiasis Control Initiative (SCI)
3. Deworm the World Initiative, led by Evidence Action
4. GiveDirectly

This year, we are ranking our top charities based on what we see as the value of filling their remaining funding gaps. Unlike in previous years, we do not feel a particular need for individuals to divide their allocation between the charities, since we are recommending that Good Ventures provide significant support to each. For those seeking our recommended allocation, we simply recommend giving to the top-ranked charity on the list, which is AMF.

Our recommendation takes the grants we are recommending to Good Ventures into account, as well as accounting for charities’ existing cash on hand and expected non-GiveWell-related fundraising, and recommends charities according to how much good additional donations (beyond these sources of funds) can do. (Otherwise, as explained below, Deworm the World would be ranked higher.) Thus, AMF’s #1 ranking is not based on its overall value as an organization, but based on the value of its remaining funding gap.

Standout charities

As with last year, we also provide a list of charities that we believe are strong standouts, though not at the same level (in terms of likely good accomplished per dollar) as our top charities. They are not ranked, and are listed in alphabetical order.

• Development Media International (DMI)
• The Global Alliance for Improved Nutrition’s Universal Salt Iodization program (GAIN – USI)
• Iodine Global Network (IGN), formerly known as ICCIDD
• Living Goods

Below, we provide:

• An explanation of major changes in the past year that are not specific to any one charity. More
• A summary of our top charities’ relative strengths and weaknesses, and how we would rank them if room for more funding were not an issue. More
• A discussion of our refined approach to room for more funding. More
• The recommendations we are making to Good Ventures, and how we rank our top charities after taking these grants (and their impact on room for more funding) into account. More
• Detail on each of our top charities, including major changes over the past year, strengths and weaknesses for each, and our understanding of each organization’s room for more funding. More
• The process we followed that led to these recommendations. More
• A brief update on giving to support GiveWell’s operations vs. giving to our top charities. More

Conference call to discuss recommendations

We are planning to hold a conference call at 5:30pm ET/2:30pm PT on Tuesday, December 1st to discuss our recommendations and answer questions.

If you’d like to join the call, please register using this online form. If you can’t make this date but would be interested in joining another call at a later date, please indicate this on the registration form.

Major changes in the last 12 months

 

Below, we summarize the major causes of changes to our recommendations (since last year).

Overall, the case for our top charities is stronger than it was in past years. The Deworm the World Initiative shared new monitoring and evaluation materials with us, so we are more confident than we were a year ago that it is a strong organization implementing high-quality programs. In addition, the extra year of work we have seen from AMF and GiveDirectly bolsters our view that they will be able to utilize additional funding effectively.

Our top charities have increased room for more funding. Last year, we expected donors following our recommendations to fully fill the most critical funding gaps of our top charities (excluding GiveDirectly) because they had limited room for more funding: GiveDirectly had a total funding gap of ~$40 million and our other three top charities had a total gap of ~$18 million. This year, all of our top charities have more room for more funding. We believe that GiveDirectly could absorb more than $80 million and other top charities together could collectively utilize more than $100 million. We do not expect donors following our recommendations to fully fill these gaps.

We are recommending that Good Ventures make larger grants to top charities. For reasons we will be detailing in a future post, we are recommending that Good Ventures make substantial grants to our top charities this year, though not enough to close their funding gaps.

Continued refinement of the concept of “room for more funding.” We’ve tried to create a much more systematic and detailed room for more funding analysis, because the stakes of this analysis have become higher due to (a) increased room for more funding across the board and (b) increased interest from Good Ventures in providing major support.

In past years, we’ve discussed charities’ room for more funding as a single figure without distinguishing between (a) the amount the charity would spend in the next 12 months, (b) the amount the charity needs to prevent it from slowing its work due to lack of funds, and (c) funding that would be especially important to the organization’s development and success (a dual benefit) in addition to expanding implementation of its program. This year, we’ve made three changes to our room for more funding analysis:

• We’ve made (a) an assessment of whether additional funds merely allow a charity to implement its program (“execution”) or (b) whether additional funds would be especially important to the charity’s development and success as an organization (“capacity-relevant”). We also explicitly note the role of incentives for meeting GiveWell’s top-charity criteria in our recommendations (we seek to ensure that each top charity receives at least $1 million, to encourage other organizations to seek to meet these criteria).
• We are explicitly assessing “execution”-related room for more funding based on our estimate of the probability that lack of funding will lead to a charity slowing its progress. We distinguish between Level 1, Level 2, and Level 3 “execution” funding gaps; a higher number means the money is less likely to be needed.
• We are now ranking “funding gaps,” not just ranking charities, because the first million dollars to a charity can have a very different impact from, e.g., the 20th million dollars. For example, if Charity A accomplishes more good per dollar with its programs than Charity B, we would rank Charity A above Charity B for a given type of gap (we would rank Charity A’s “Execution Level 1” gap above Charity B’s), but we might rank Charity B’s “Execution Level 1” gap (the amount of funding it will likely need) above Charity A’s “Execution Level 3” gap (the amount of funding gap it might, but probably will not, need to carry out more of its programs in the coming year).

We discuss these ideas in greater depth below.

Summary of key considerations for top charities

 

The table below summarizes the key considerations for our four top charities. More detail is provided below as well as in the charity reviews.

Consideration AMF Deworm the World GiveDirectly SCI Program estimated cost-effectiveness (relative to cash transfers) ~10x ~10x Baseline ~5x Directness and robustness of the case for impact Strong Moderate Strongest Moderate Transparency and communication Strong Strong Strongest Weakest Ongoing monitoring and likelihood of detecting future problems Strong Strong Strongest Weakest Organizational track record of rolling out program Moderate Moderate Strong Strong Room for more funding, after accounting for grants we are recommending to Good Ventures (more below) Very high Limited Very high High

 

Overall, our ranking of the charities with room for more funding issues set aside (just considering a hypothetical dollar spent by the charity on its programs, without the “capacity-relevant funding” and “incentives” issues discussed below) would be:

1. AMF and Deworm the World
3. SCI
4. GiveDirectly

However, when we factor in room for more funding (including the impact of the grants we’re recommending to Good Ventures), the picture changes. More on this below.

Room for more funding analysis

 

Capacity-relevant funding and incentives

 

Capacity-relevant funding: additional funding can sometimes be crucial for a charity’s development and success as an organization. For example, it can contribute to a charity’s ability to experiment, expand, and ultimately have greater room for more funding over the long run. It can also be important for a charity’s ability to raise funds from non-GiveWell donors, which can be an important source of long-term leverage and can put the organization in a stronger overall position.

We think of this sort of funding gap as particularly important to fill, because it can make a big difference over the long run; in particular, it may substantially affect the long-term quality of our giving recommendations.

“Capacity-relevant” funds can include (a) funds that are explicitly targeted at growth (e.g., funds to hire fundraising staff); (b) funds that enable a charity to expand into areas it hasn’t worked in before, which can lead to important learning about whether and how the charity can operate in the new location(s); and (c) funds that would be needed in order to avoid challenging contractions in a charity’s activities which could jeopardize the charity’s long-term growth and funding prospects.

Some specific examples:

• The grant that Good Ventures made to GiveDirectly earlier this year is capacity-relevant because it will be used for: (a) building a fundraising team that will aim to raise substantial donations from non-GiveWell donors, and (b) developing partnerships with bilateral donors and local governments to deliver cash transfers or to run experiments comparing standard aid programs to cash transfers.
• Early funding that GiveDirectly received was capacity-relevant because it enabled GiveDirectly to rapidly grow from a small organization moving a few hundred thousand dollars per year to a much larger organization moving more than $10 million per year. If this funding hadn’t been forthcoming, GiveDirectly might be much smaller today and have much less room for more funding.
• We now think that some additional funding to AMF and Deworm the World will be capacity-relevant because each organization has only operated in a very small number of countries and new funding will enable each to enter new countries. This will allow them to learn how to operate there, and demonstrate that they can do so, increasing our willingness (and likely that of other donors) to recommend more to these organizations in the future.

It’s hard to draw sharp lines around capacity-relevant funding, and all funding likely has some effect on an organization’s development, but we have tried to identify and prioritize the funding gaps that seem especially relevant.

Execution funding allows charities to implement more of their core program but doesn’t appear to have substantial benefits beyond the direct good accomplished by this program. We’ve separated this funding into three levels:

• Level 1: the amount we expect a charity to need in the coming year. If a charity has less funding than this level, we think it is more likely than not that it will be bottlenecked (or unable to carry out its core program to the fullest extent) by funding in the coming year.
• Level 2: if a charity has this amount, we think there is an ~80% chance that it will not be bottlenecked by funding.
• Level 3: if a charity has this amount, we think there is a ~95% chance that it will not be bottlenecked by funding.

Incentives: we think it is important that charities we recommend get a substantial amount of funding due to being a GiveWell top charity, because this ensures that incentives are in place for charities (and potential charity founders) to seek to meet our criteria for top charities and thus increase the number of charities we recommend and the total room for more funding available, even when they don’t end up being ranked #1. We seek to ensure that each top charity gets at least $1 million as a result of our recommendation, and we consider this to be a high-priority goal of our recommendations.

The charity-specific sections of this post discuss the reasoning behind the figures we’ve assigned to “capacity-relevant” and “Execution Level 1” gaps, but they do not provide the full details of how we arrived at these figures (and do not explicitly address the “Execution Level 2” and “Execution Level 3” gaps). We expect to add this analysis to our charity reviews in the coming weeks.

Funding gaps

 

The total (i.e., Capacity-relevant, Execution Levels 1, 2, and 3, and Incentive) funding gaps (in millions of dollars, rounded to one decimal place) for each of our top charities are:

• AMF: $98.2
• Deworm the World: $19.0
• GiveDirectly: $84.0
• SCI: $26.3

However, for reasons described above, the first million dollars to a charity can have a very different impact from, e.g., the 20th million dollars. Accordingly, we have created a ranking of individual funding gaps that accounts for both (a) the quality of the charity and the good accomplished by its program, per dollar (as laid out above), and (b) whether a given level of funding is capacity-relevant and whether it is highly or only marginally likely to be needed in the coming year.

The below table lays out our ranking of funding gaps. When gaps have the same “Priority,” this indicates that they are tied.

The table below includes the amount we are recommending to Good Ventures. For reasons we will lay out in another post, we are recommending to Good Ventures a total of ~$44.4 million in grants to top charities. Having set that total, we are recommending that Good Ventures start with funding the highest-rated gaps and work its way down, in order to accomplish as much good as possible.

When gaps are tied, we recommend filling them by giving each equal dollar amounts until one is filled, and then following the same procedure with the remaining tied gaps. See footnote for more.*

Priority Charity Amount Type Recommendation to Good Ventures Comments 1 DtWI $7.6 Capacity-relevant $7.6 DtWI and AMF are strongest overall 1 AMF $6.5 Capacity-relevant $6.5 See above 1 GD $1.0 Incentive $1.0 Ensuring each top charity receives at least $1 million 1 SCI $1.0 Incentive $1.0 Ensuring each top charity receives at least $1 million 2 GD $8.8 Capacity-relevant $8.8 Not as cost-effective as bednets or deworming, so lower priority, but above non-capacity-relevant gaps 2 DtWI $3.2 Execution Level 2 / possibly capacity-relevant $3.2 Level 1 gap already filled via “capacity-relevant” gap. See footnote for more** 2 AMF $43.8 Execution Level 1 $16.3 Exhausts remaining recommendations to Good Ventures 3 SCI $4.9 Execution Level 1 0 Not as strong as DtWI and AMF in isolation, so ranked below them for same type of gap 3 AMF $24.0 Execution Level 2 0 – 4 DtWI $8.2 Execution Level 3 0 – 4 AMF $24.0 Execution Level 3 0 – 4 SCI $11.6 Execution Level 2 0 – 5 GD $24.8 Execution Level 1 0 – 5 SCI $8.8 Execution Level 3 0 – 6 GD $20.9 Execution Level 2 0 – 7 GD $28.6 Execution Level 3 0 –

Our recommendations to Good Ventures and others

 

Summing the figures from the above table, we are recommending that Good Ventures make the following grants (in millions of dollars, rounded to one decimal place):

• AMF: $22.8
• Deworm the World: $10.8
• GiveDirectly: $9.8
• SCI: $1

We also recommend that Good Ventures give $250,000 to each of our standout charities. These grants go to the outstanding organizations and create additional incentives for groups to try to obtain a GiveWell recommendation.

After these grants, AMF will require an additional ~$27.5 million to close its Execution Level 1 gap (i.e., to make it more likely than not that it is able to proceed without being bottlenecked due to lack of funding). We rank this gap higher than any of the other remaining funding gaps for our top charities, as laid out in the table above.

We estimate that non-Good Ventures donors will give approximately $15 million between now and January 31, 2016. Because we do not expect AMF’s remaining ~$27.5 million Execution Level 1 funding gap to be fully filled, we rank it #1 and recommend that donors give to AMF. We rank the remaining charities for donors who are interested in having the greatest impact per dollar based on how highly their highest-rated remaining gap ranks in the table above. That results in the following rankings for individual donors:

1. AMF
2. SCI
3. Deworm the World Initiative
4. GiveDirectly

Details on top charities

 

We present information on our top charities in alphabetical order.

Against Malaria Foundation (AMF)

 

Our full review of AMF is here.

Background

AMF (www.againstmalaria.com) provides funding for long-lasting insecticide-treated net distributions (for protection against malaria) in developing countries. There is strong evidence that distributing nets reduces child mortality and malaria cases. AMF has relatively strong reporting requirements for its distribution partners and provides a level of public disclosure and tracking of distributions that we have not seen from any other net distribution charity.

In 2011, AMF received a large amount of funding relative to what it had received historically, so it began to focus primarily on reaching agreements for large-scale net distributions (i.e., distributions on the order of hundreds of thousands of nets rather than tens of thousands of nets). In its early efforts to scale up, AMF struggled to finalize large-scale net distribution agreements. At the end of 2013, we announced that we planned not to recommend additional donations to AMF due to room for more funding-related issues (more detail in this blog post).

In 2014, AMF committed most of its funds to several new distributions — some in Malawi, some in the Democratic Republic of the Congo (DRC) — and we recommended it as a top charity again.

Important changes in the last 12 months

In 2015, AMF carried out and/or monitored many of the distributions that it committed to in 2014.

Previously, our confidence in AMF’s ability to scale had been limited by the fact that it had only completed large-scale distributions with one partner (Concern Universal) in one country (Malawi). However, AMF carried out its largest distribution to date (~620,000 nets) with a new partner in the DRC in late 2014. We have not yet seen some key documentation from the large DRC distribution, but early indications suggest that the distribution generally went as planned, despite our concern that the DRC may have been an especially challenging place to work (more details here). We see this as a positive update that AMF will be able to carry out high-quality large-scale distributions in a variety of locations in the future.

AMF has continued to collect and share follow-up information on its past large-scale distributions, and this information seems to support the notion that these distributions are high-quality (i.e., that nets are reaching the target population and are being used). We provide a summary of these reports in our review.

Funding gap

AMF currently holds $18.5 million, and we estimate it will receive an additional $1.6 million before January 31, 2016 (excluding donations influenced by GiveWell) that it could use for future distributions. AMF has told us that it has a pipeline of possible future net distributions that add up to roughly $100 million beyond what it currently holds (details in our review).

We believe that AMF’s progress would be slowed due to lack of funding were it to receive less than $50.3 million in additional funding (this is its total capacity-relevant and “Execution Level 1” gap as presented earlier in the post). In particular, we view the first additional $6.5 million that AMF would receive as capacity-relevant (and thus particularly valuable) because it would enable AMF to fund a distribution in a 5th country with a 5th partner, generating additional information about its ability to expand beyond the contexts in which it has worked to date. (Note that AMF already has funds on hand to enter its 3rd and 4th countries.)

We arrived at the capacity-relevant and Execution Level 1 figure by noting that AMF has $70.4 million worth of deals it is actively negotiating (5 deals in 4 countries) that it can only continue with if it holds the funds to do so. Subtracting the $20.1 million we expect to be available (the $18.5 million it currently holds plus the $1.6 million we expect it to receive in the coming months) leaves a $50.3 million funding gap.

AMF failed to reach new distribution agreements in 2015; there is still significant uncertainty regarding AMF’s ability to finalize agreements with new partners and countries. Nevertheless, we see providing a large amount of additional funds to AMF as a reasonable bet, and see AMF as a very strong giving opportunity.

We think it is possible that in November 2016 (when we next expect to complete a full refresh of our recommendations), we will recommend significantly less funding to AMF. We consider the funding we’re recommending to AMF now to be a good bet, but a risky one, because AMF currently has a relatively limited track record: it has worked with only two partners in two countries. Because of the lag between the time we provide funding and the time net distributions take place (often 2 years) and the additional lag caused by the time it takes to monitor distributions, we may not have additional information about whether or not AMF’s additional distributions were successful for 2-3 years. Next year, it is possible that we will choose to recommend significantly less funding to AMF while we wait for additional data to become available.

There still appears to be a large global funding gap for bednets; a global bednet coordination group estimated that about 245 million additional nets would be needed in 2015-2017 (details in our review).

Key considerations:

• Program impact and cost-effectiveness. We estimate that bednets are ~10x as cost-effective as cash transfers. Our estimates are subject to substantial uncertainty. All of our cost-effectiveness analyses are available here. Our 2015 cost-effectiveness file is available here (.xlsx).
• Directness and robustness of the case for impact. We believe that the connection between AMF receiving funds and those funds helping very poor individuals is less direct than GiveDirectly’s and more direct than SCI’s or Deworm the World’s. The uncertainty of our estimates is driven by a combination of AMF’s challenges historically disbursing the funds it receives and a general recognition that aid programs, even those as straightforward as bednets, carry significant risks of failure via ineffective use of nets, insecticide resistance, or other risks we don’t yet recognize relative to GiveDirectly’s program. AMF conducts extensive monitoring of its program; these results have generally indicated that people use the nets they receive.
• Transparency and communication. AMF has been extremely communicative and open with us. We feel we have a better understanding of AMF than of SCI, and a similar level of knowledge about AMF as we have for Deworm the World, though our understanding is not as strong as our understanding of GiveDirectly. In particular, were something to go wrong in one of AMF’s distributions, we believe we would eventually find out (something we are not sure of in the case of SCI), but we believe our understanding would be less quick and complete than it would be for problems associated with GiveDirectly’s program (which has more of a track record of consistent intensive follow-up).
• Risks:
  • We are not highly confident that AMF will be able to finalize additional distributions and do so quickly. AMF could struggle again to agree to distribution deals, leading to long delays before it spends funds. We view this as a relatively minor risk because the likely worst-case scenario is that AMF spends the funds slowly (or returns funds to donors).
  • We remain concerned about the possibility of resistance to the insecticides used in bednets. There don’t appear to be major updates on this front since our 2012 investigation into the matter; we take the lack of major news as a minor positive update.

Our full review of AMF is here.

Deworm the World Initiative, led by Evidence Action

 

Our full review of Deworm the World is here.

Background

Deworm the World (www.evidenceaction.org/deworming), led by Evidence Action, advocates for, supports, and evaluates government-run school-based deworming programs (treating children for intestinal parasites).

We believe that deworming is a program backed by relatively strong evidence. We have reservations about the evidence, but we think the potential benefits are great enough, and costs low enough, to outweigh these reservations. Deworm the World retains monitors whose reports indicate that the deworming programs it supports successfully deworm children.

Important changes in the last 12 months

In 2015, Deworm the World continued to support the scale-up and monitoring of deworming programs in India and Kenya. One of its notable activities this year was providing technical assistance to the Indian national government in support of India’s first national deworming day: a program in which the government provided assistance to Indian states to implement school-based deworming on a single day to encourage more states to implement the program. The first national deworming day took place in February 2015, and 12 states participated in the program (more details here).

The quality of the monitoring that we saw from Deworm the World improved in 2015. Deworm the World continued to hire and train third-party monitors to directly observe deworming activities, and it slightly improved its estimates of how many children were treated. This information strongly suggests that the programs are generally operating as intended. More details in our review.

Last year, Deworm the World stated to us that it could not use significant additional funding to scale up deworming programs. Deworm the World now believes that it has identified countries where it could use additional funds to support the scale-up of deworming programs, beginning with a potential program in Punjab province, Pakistan (more). (Deworm the World also plans to use funds it already holds or expects to receive to expand into Ethiopia and Nigeria.)

Future donations to Deworm the World will likely be used outside of India, and in those cases governments may have less funding to support deworming. This may cause Deworm the World to pay a higher fraction of the overall cost of the program, making the potential for leverage of future donations more limited. Overall program costs may also be higher outside of India. More details in our review.

A significant organizational update is that Alix Zwane stepped down as Executive Director of Evidence Action in August; she left to join the Global Innovation Fund as CEO. Evidence Action has since hired Jeff Brown (formerly Interim CEO of the Global Innovation Fund) as Executive Director. Grace Hollister remains Director of the Deworm the World Initiative. Overall, our impression is that Dr. Zwane has been a highly effective leader of Evidence Action and her departure risks disruptions that could lead to us changing our view of the organization, though we would guess that this will not be the case.

In July, researchers published two new analyses of a key study regarding deworming (the most important piece of evidence we rely on), and the Cochrane Collaboration published an updated review of the evidence for mass deworming programs. The new papers did not change our overall assessment of the evidence on deworming. More in our blog post.

Funding gap

We believe that Deworm the World has significant opportunities to use additional funding to expand its program. We believe it may have opportunities to enter at least two more countries (in addition to Nigeria and Ethiopia, which it will be able to enter with funds it already has or expects to receive). We estimate its funding need using the two countries it is most likely to enter — Pakistan and Nepal — though note that in both cases, we see these as representative of the types of opportunities it may have, rather than the specific opportunities we expect it to take. Altogether, Deworm the World estimates that it would need $11.25 million to commit to fully funding three years of deworming programs in both countries. Because it holds (or expects to receive shortly) funding that will total $3.6 million, we estimate its funding gap for this work at $7.6 million.

Funding this gap is capacity-relevant, and is therefore a high priority, because we would like to see Deworm the World try to work in additional countries beyond India and Kenya, where it has worked historically. Next year, Deworm the World will also enter Nigeria and Ethiopia (with funding already available), so it will likely end the year having had some experience in five or more countries. This could substantially increase Deworm the World’s long-term room for more funding.

A complicating factor in thinking about Deworm the World’s funding gap is that Deworm the World is part of a larger organization, Evidence Action. Funding for Deworm the World may be fungible with funding for Evidence Action’s other activities, such as its Dispensers for Safe Water initiative (which we believe to be substantially less cost-effective than deworming). Because of this, it is difficult to determine Deworm the World’s true funding gap, and it is possible that some additional funds given to support Deworm the World could effectively lead to additional funds for a non-Deworm the World project. We understand that Evidence Action has received approximately $2.4 million in unrestricted funding over the past year. Fully funding Deworm the World could potentially cause Evidence Action to redirect some or all of these funds to its other programs.

More details on all of the above are in our review.

Key considerations:

• Program impact and cost-effectiveness. We estimate that Deworm the World-associated deworming programs are ~10x as cost-effective as cash transfers. Our estimates are subject to substantial uncertainty. It’s important to note that we view deworming as high expected value, but this is due to a relatively low probability of very high impact. Most GiveWell staff members would agree that deworming programs are more likely than not to have very little or no impact, but there is some possibility that they have a very large impact. (Our cost-effectiveness model implies that most staff members believe there is at most a 1-2% chance that deworming programs conducted today have similar impacts to those directly implied by the randomized controlled trials on which we rely most heavily, which differed from modern-day deworming programs in a number of important ways.) Our 2015 cost-effectiveness file is available here (.xlsx).
• Directness and robustness of the case for impact. Deworm the World doesn’t carry out deworming programs itself; it advocates for and provides technical assistance to governments implementing deworming programs, making direct assessments of its impact challenging. We have seen evidence that strongly suggests that Deworm the World-supported programs successfully deworm children. While we believe Deworm the World is impactful, our evidence is limited, and in addition, there is always a risk that future expansions will prove more difficult than past ones.
• Transparency and communication. Deworm the World has been communicative and open with us. We believe that were something major to go wrong with Deworm the World’s work, we would be able to learn about it and report on it.
• Risks:
  • Deworm the World is part of a larger organization, Evidence Action. It is possible that some additional funds given to support Deworm the World could effectively lead to additional funds for a non-Deworm the World project due to fungibility. Also, changes that affect Evidence Action (and its other programs) could indirectly impact Deworm the World. For example, if a major event occurs (either positive or negative) for Evidence Action, it is likely that it would reduce the time some staff could devote to Deworm the World.
  • Deworm the World is now largely raising funds to support programs that will be carried out under a different model in new countries, which makes it harder for us to predict future success based on historical results and may make it harder to understand and quantify Deworm the World’s impact even after the program is completed.

Our full review of Deworm the World is here.

GiveDirectly

 

Our full review of GiveDirectly is here.

Background

GiveDirectly (www.givedirectly.org) transfers cash to households in developing countries via mobile phone-linked payment services. It targets extremely low-income households. The proportion of total expenses that GiveDirectly has delivered directly to recipients is approximately 85% overall. We believe that this approach faces an unusually low burden of proof, and that the available evidence supports the idea that unconditional cash transfers significantly help people.

We believe GiveDirectly to be an exceptionally strong and effective organization, even more so than our other top charities. It has invested heavily in self-evaluation from the start, scaled up quickly, and communicated with us clearly. It appears that GiveDirectly has been effective at delivering cash to low-income households. GiveDirectly has one major randomized controlled trial (RCT) of its impact and took the unusual step of making the details of this study public before data was collected (more). It continues to experiment heavily, to the point where every recipient is enrolled in a study or a campaign variation.

Important changes in the last 12 months

GiveDirectly continued to scale up significantly, utilizing most of the funding it received at the end of last year. It continued to share informative and detailed monitoring information with us. Overall, it grew its operations while maintaining the high quality of its program.

In August, Good Ventures granted $25 million to GiveDirectly to support potentially high-upside opportunities, such as (a) building a fundraising team that will aim to raise substantial donations from non-GiveWell donors, and (b) developing partnerships with bilateral donors and local governments to deliver cash transfers or to run experiments comparing standard aid programs to cash transfers.

GiveDirectly’s increased efforts to network with potential government and donor partners have led to some results in 2015. For example, GiveDirectly will be implementing cash transfers in a randomized controlled trial in Rwanda that will be funded by a bilateral aid donor and Google. The study will test cash transfers against another still-to-be-chosen aid program. GiveDirectly is currently in several preliminary conversations with partners for similarly large projects in the future.

Funding gap

GiveDirectly believes it could move a total of ~$94 million to poor households in the year following March 1, 2016, for which it expects to have ~$12.6 million available by March 1. We have classified ~$34.5 million of this as the total “Execution Level 1,” capacity-relevant, and incentive funding gap (more on what this means above). We arrived at this figure by assuming that GiveDirectly could double its operations in Kenya (from ~$16.5 million/year to ~$33 million/year) and scale up to ~$12.1 million/year in Uganda. This would cost a total of ~$45.1 million, of which GiveDirectly already has ~$10.6 million on hand (ignoring $2 million that we exclude due to donor coordination issues), which results in a ~$34.5 million gap.

We’ve classified some of this as a “capacity-relevant” funding gap for our purposes (making it higher priority). First, we view the ~$12.1 million it would hope to spend in Uganda as capacity-relevant, in the sense that providing it could make a major difference to GiveDirectly’s long-term development. GiveDirectly told us that operating in Uganda is more challenging than in Kenya and that it expects to learn a significant amount as it grows. It is therefore planning to grow more slowly in Uganda than it did in Kenya. GiveDirectly made two arguments for Uganda being important for its long-term trajectory:

1. If GiveDirectly lost the ability to operate in Kenya, this would significantly diminish its ability to move funds out the door. Operating in Uganda is an important hedge against this risk.
2. Kenya is a particularly easy environment in which to operate because of the existence of M-PESA, a powerful and ubiquitous provider that enables GiveDirectly to transfer funds to recipients via mobile phones. The mobile payments network is significantly less developed outside of Kenya. As such, Uganda offers an important test case for operating in a more standard environment, which could be particularly valuable to GiveDirectly as it encourages aid agencies and country governments to expand direct cash assistance.

It’s harder to estimate how much of the Kenya funding needs are properly classified as “capacity-relevant” (an important distinction for our purposes, as discussed above). We guess that were GiveDirectly to be operating at a level 50% its current size (such that it only spent ~$8.25 million/year in Kenya), it would be able to build capacity from that level to its current level (and beyond) as quickly as it did in its recent past. We therefore classify ~$8.25 million of the ~$16.5 million it hopes to spend in Kenya as “capacity-relevant” and ~$8.25 million as “execution.” We note that we are highly uncertain about these estimates and that were GiveDirectly to receive no additional funding, this would cause it to contract in Kenya and lay off some of its middle management, an action that would cause it to incur reasonably high costs; we think much more contraction than that would be significantly more challenging for GiveDirectly as an organization.

Based on the above, and based on GiveDirectly’s existing available funds (with some adjustments for coordination issues, along the lines of this discussion from last year) we estimate that GiveDirectly has ~$9.8 million worth of unfunded opportunities that we ought to classify as capacity-relevant or incentive funding. (We arrive at this estimate based on: ~$20.35 million (total amount we classify as capacity-relevant from Kenya and Uganda) – ~$10.6 million (funds on hand, excluding donations we ignore due to coordination issues) = ~$9.75 million.)

Longer-term, we expect to continue to view funding ~$8.25 million in Kenya as capacity-relevant support and would expect to consider future expansion in Uganda (up to the current level of Kenya, i.e., ~$16.5 million/year) capacity-relevant, as well. Once GiveDirectly reaches ~$16.5 million in Uganda and proves that it can operate at that level, we only expect to view ~$8.25 million as capacity-relevant and hope that it can raise funds from other sources to support its work.

More details in our review.

Key considerations:

• Program impact and cost-effectiveness. Our best guess is that deworming or distributing bednets achieves ~10x times more humanitarian benefit per dollar donated than cash transfers. Our estimates are subject to substantial uncertainty. All of our cost-effectiveness analyses are available here. Our 2015 cost-effectiveness file is available here (.xlsx).
• Directness and robustness of the case for impact. GiveDirectly collects and shares a significant amount of relevant information about its activities. The data it collects show that it successfully directs cash to very poor people, that recipients generally spend funds productively (sometimes on food, clothing, or school fees, other times on investments in a business or home infrastructure), and that it leads to very low levels of interpersonal conflict and tension. We are more confident in the impact of GiveDirectly’s work than in that of any of the other charities discussed in this post; we believe that cash transfers face a lower burden of proof than other interventions.
• Transparency and communication. GiveDirectly has always communicated clearly and openly with us. It has tended to raise problems to us before we ask about them, and we generally believe that we have a very clear view of its operations. We feel more confident about our ability to keep track of future challenges than with any of the other charities discussed in this post.
• Risks:
  • GiveDirectly has scaled (and hopes to continue to scale) quickly. Thus far, it has significantly increased the amount of money it can move with limited issues as a result. The case of staff fraud that GiveDirectly detected is one example of an issue possibly caused by its pace of scaling, but its response demonstrated the transparency and rigor we expect.

Our full review of GiveDirectly is here.

Schistosomiasis Control Initiative (SCI)

 

Our full review of SCI is here.

Background

SCI (www3.imperial.ac.uk/schisto) works with governments in sub-Saharan Africa to create or scale up deworming programs (treating children for schistosomiasis and other intestinal parasites). SCI’s role has primarily been to identify recipient countries, provide funding to governments for government-implemented programs, provide advisory support, and conduct research on the process and outcomes of the programs. Despite SCI sharing a number of spending reports with us, we do not feel we have a detailed and fully accurate picture of how SCI and the governments it supports have spent funds in the past. We don’t feel that SCI has ever purposefully been indirect with us, but we have often struggled to communicate effectively with SCI representatives. We still lack important and in some cases basic information about SCI’s finances, and we find this problematic.

We believe that deworming is a program backed by relatively strong evidence. We have reservations about the evidence, but we think the potential benefits are great enough, and costs low enough, to outweigh these reservations. SCI has conducted studies in about half of the countries it works in (including the countries with the largest programs) to determine whether its programs have reached a large proportion of children targeted. These studies have generally found moderately positive results, but have some methodological limitations.

Important changes in the last 12 months

SCI reports that it has continued to scale up its deworming programs and that it has supported some programs in new countries, though we have limited monitoring information from these programs (e.g., we have not seen monitoring from its programs in Ethiopia, Sudan, Madagascar, and the DRC).

This year, SCI has shared a few more coverage surveys that found reasonably high coverage of its programs.

We have continued to have communication challenges with SCI. In particular:

• We have a limited understanding of SCI’s work because we still lack important and basic information about how SCI spends money. SCI recognizes that its financial management system is disorganized, and some spending reports that SCI has sent us have contained errors.
• We have struggled to gain a confident understanding of how SCI will use additional funds, and we cannot check how its funds were used after the fact because we lack information about its spending. In some cases, SCI has not spent additional funds as expected and it is unclear what caused the shift (more detail on one example in our August 2015 update).

In July, researchers published two new analyses of a key study regarding deworming (the most important piece of evidence we rely on), and the Cochrane Collaboration published an updated review of the evidence for mass deworming programs. The new papers did not change our overall assessment of the evidence on deworming. More in our blog post.

Funding gap

SCI estimates that it would use the following amounts of unrestricted funding in each of the next three years (in millions of US dollars):

• April 2016 – March 2017: $9.5
• April 2017 – March 2018: $13.6
• April 2018 – March 2019: $13.3

Our impression is that GiveWell-influenced donors contribute most of SCI’s unrestricted funds.

Our best guess is that, excluding the funds SCI may receive due to GiveWell’s recommendation, SCI will hold approximately $1.5 million in April 2016 that it could allocate to the above gaps. Also, after SCI set its fundraising targets, a funder committed $6 million over the next three years ($2 million per year) to deworming programs in Ethiopia, with which SCI is involved. Our best guess is that this funding reduces SCI’s “Execution Level 1” and incentive funding gap for the coming year from $9.5 million to $5.9 million. (We arrive at this estimate by subtracting ~$1.5 million and another $2 million from the total Level 1/incentive gap for the coming year).

We do not classify any of this as “capacity-relevant” because we have little understanding of how it will be spent, and we do not expect to be able to understand how it was spent after the fact, either.

More details on SCI’s funding gap are in our review.

Key considerations:

• Program impact and cost-effectiveness. Our best guess is that deworming programs implemented by SCI are ~5x as cost-effective as cash transfers. Our estimates are subject to substantial uncertainty. It’s important to note that we view deworming as high expected value, but this is due to a relatively low probability of very high impact. Most GiveWell staff members would agree that deworming programs are more likely than not to have very little or no impact, but there is some possibility that they have a very large impact. (Our cost-effectiveness model implies that most staff members believe there is at most a 1-2% chance that deworming programs conducted today have similar impacts to those directly implied by the randomized controlled trials on which we rely most heavily, which differed from modern-day deworming programs in a number of important ways.) Our 2015 cost-effectiveness file is available here (.xlsx).
• Directness and robustness of the case for impact. SCI doesn’t carry out deworming programs itself; it advocates for and provides technical assistance to governments implementing deworming programs, making direct assessments of its impact challenging. We have seen some evidence demonstrating that SCI-supported programs successfully deworm children, though this evidence is relatively thin. Nevertheless, deworming is a relatively straightforward program, and we think it is likely (though far from certain) that SCI-supported deworming programs successfully deworm people. We have had difficulties communicating with SCI, which has reduced our ability to understand it. We have also spent significant time interviewing SCI staff and reviewing documents over the past 6 years and have found minor but not major concerns.
• Transparency and communication. We don’t feel that SCI has ever purposefully been indirect with us, but we have often struggled to communicate effectively with SCI representatives. Specifically, (a) we had a major miscommunication with SCI about the meaning of its self-evaluations (more) and (b) although we have spent significant time with SCI, we remain unsure how SCI has spent funds and how much funding it has available (and we believe SCI itself does not have a clear understanding of this). Importantly, if there is a future unanticipated problem with SCI’s programs, we don’t feel confident that we will become aware of it. This contrasts with our other top charities, which we feel we have a strong ability to follow up on.
• Risks: There are significantly more unknown risks with SCI than our other top charities due to our limited understanding of its activities.

Our full review of SCI is here.

Standouts

As we did last year, we recommend four organizations as “standouts.” These charities score well on some of our criteria, but we are not confident enough in them to name them top charities. This year, we retain the same four standout organizations: Development Media International (DMI), the Global Alliance for Improved Nutrition’s Universal Salt Iodization program (GAIN-USI), the Iodine Global Network (IGN), and Living Goods.

We followed all four of these charities in 2015, but have only published an updated review for DMI. We expect to publish updated reviews for GAIN-USI, IGN, and Living Goods in the near future.

We provide brief updates on these charities below:

• DMI. DMI produces radio and television programming in developing countries that encourages people to adopt improved health practices. It is a standout because of its commitment to monitoring and the possibility that it is implementing a highly cost-effective program. DMI has recently completed a randomized controlled trial of its program. Last year, we had midline results from this trial, which generally looked promising.In November 2015, DMI privately shared preliminary endline results from the RCT. These results did not find any effect of DMI’s program on child mortality, and found substantially less effect on behavior change than was found in the midline results. We (understandably) cannot publicly discuss the details of the endline results we have seen, because they are not yet finalized and because the finalized results will be embargoed prior to publication. DMI believes that there were serious problems with endline data collection (note that we have not yet tried to independently assess this claim). With the support of the trial’s Independent Scientific Advisory Committee, DMI is planning to conduct another endline survey in late 2016, with results available in 2017.We are impressed by DMI’s openness with us about its results (and its willingness for us to share the high-level summary), and we hope to have discussions with DMI about how it might be able to work toward becoming a top charity in the future. Our full review of DMI is here.
• GAIN-USI. GAIN’s Universal Salt Iodization (USI) program supports national salt iodization programs. There is strong evidence that salt iodization programs have a significant, positive effect on children’s cognitive development. GAIN-USI does not work directly to iodize salt; rather, it supports governments and private companies to do so, which could lead to leveraged impact of donations or to low impact, depending on its effectiveness. Last year, we wrote, “We tried but were unable to document a demonstrable track record of impact; we believe it may have had significant impacts, but we are unable to be confident in this with what we know now. More investigation next year could change this picture.” In 2015, we continued our assessment of GAIN, focusing on its work in India and Ethiopia, including a site visit to Ethiopia in July.Overall, we tried but were unable to establish clear evidence of GAIN successfully contributing to the impact of iodization programs. This is primarily due to (a) the difficulty in attributing impact to specific activities that GAIN carried out and (b) challenges we have had communicating with GAIN about its work. We have not yet completed our final report on GAIN but hope to publish it in the near future. We have published notes from some of the conversations that were part of this research and they are available here. Our 2014 review of GAIN is here.
• IGN. Like GAIN-USI, IGN supports (via advocacy and technical assistance rather than implementation) salt iodization, and as with GAIN-USI, we tried but were unable to establish clear evidence of IGN successfully contributing to the impact of iodization programs. Unlike GAIN-USI, IGN is small, operating on a budget of approximately $0.5-$1 million per year, and relies heavily on volunteer time. We are planning to post an updated review in the near future. Our 2014 review of IGN is here.
• Living Goods recruits, trains, and manages a network of community health promoters who sell health and household goods door-to-door in Uganda and Kenya and provide basic health counseling. They sell products such as treatments for malaria and diarrhea, fortified foods, water filters, bednets, clean cookstoves, and solar lights. Living Goods completed a randomized controlled trial of its program and measured a 27% reduction in child mortality. We estimate that Living Goods saves a life for roughly each $10,000 it spends, approximately 3 times as much as our estimate for the cost per life saved of AMF’s program. We spoke with Living Goods and reviewed documents about their progress in 2015. We do not have major updates to report but are planning to post an updated review in the near future. Our 2014 review of Living Goods is here.

Our research process in 2015

 

This section describes the new work we did in 2015 to supplement our previous work on defining and identifying top charities. See the process page on our website for our overall process.

This year, we did not put a substantial amount of senior staff time into new top charities research work because (a) we were largely focused on building capacity, and (b) we reallocated a significant amount of capacity to the Open Philanthropy Project (see our post on our plans for 2015 for more details).

We focused the bulk of our research capacity for top charities work on staying up-to-date on our recommended charities. We also did an intensive evaluation of GAIN-USI, including a site visit (more details forthcoming).

We completed investigations of vitamin A supplementation and maternal and neonatal tetanus immunization campaigns. Both programs seem potentially competitive with our other priority programs, but we were not able to identify charities that worked on these programs that were willing to apply for a recommendation. We also made substantial progress on investigating several other programs, such as measles immunization, meningitis A vaccination, folic acid fortification, voluntary medical male circumcision for the prevention of HIV, and “Targeting the Ultra-Poor” (or “Ultra-Poor Graduation”) programs.

We stayed up to date on the research for bednets, cash transfers, and deworming.

We did not conduct an extensive search for new charities this year. We feel that we have a relatively good understanding of the existing charities that could potentially meet our criteria, based on past searches (see the process page on our website for more information). Instead, we solicited applications from organizations that we viewed as contenders for recommendations. A March post laid out which organizations we were hoping to investigate and why.

We did some initial research on several charities that we had not investigated before, but we did not complete the reviews in time for our 2015 recommendations. The organizations that we began investigating were:

• END Fund
• Episcopal Relief & Development’s NetsforLife® Program
• Project Healthy Children
• Sightsavers.

We plan to complete these reviews in 2016.

Giving to GiveWell vs. top charities

 

We have grown significantly over the past few years and continue to raise funds to support our operations. This includes work on GiveWell’s top charities and the Open Philanthropy Project.

We plan to post an update on our funding situation before the end of the year.

The most up-to-date information available on this topic is linked from our June 2015 board meeting. The short story is that we are still seeking additional donations and encourage donors who feel they are sufficiently confident in our impact to give to us.

Footnotes:

* For example, if $30 million were available to fund gaps of $10 million, $5 million, and $100 million, we would recommend allocating the funds so that the $10 million and $5 million gaps were fully filled and the $100 million gap received $15 million.

This rule is material to the three gaps tied at priority level 2. It causes us to recommend that Good Ventures’ last $28.3 million to recommended charities is used to fully fill GiveDirectly’s $8.8 million capacity-relevant gap and Deworm the World’s $3.2 million Execution Level 2 (possible capacity-relevant) gap, but only fill $16.3 million of AMF’s Execution Level 1 gap.

** This gap can’t be cleanly classified because we think the funding is relatively unlikely to be needed, but if it is needed, it is likely to have capacity-relevant effects. Thus, it is technically classified as Execution Level 2, but we think it has similar value to Execution Level 1.

The post Our updated top charities for giving season 2015 appeared first on The GiveWell Blog.

We wish we had more top charities, and as we look to the future we expect (and hope) that there will need to be more recommended charities in order to productively use all the donations that GiveWell-influenced donors are making. One of our major activities is trying to expand our top charities list – both by investigating charities that already exist, and by supporting activities (from new nonprofits to studies) that could eventually result in a larger set of evidence-backed programs and a larger set of top charities.

This post discusses types of charities that we would be excited to learn more about if they existed. We would also consider providing support to individuals trying to create the types of organizations described below. In a similar spirit to a request for startups, we’re sharing this list in the hopes that it might help us find out about such charities – or might help us find and support people looking to create them.

In brief, we would be excited to see:

• Charities that implement GiveWell’s priority programs: vitamin A supplementation, immunizations, conditional cash transfers, micronutrient fortification, or even bednets and deworming (since our top charities that focus on the latter two have limited room for more funding). More
• Charities implementing potential priority programs that are particularly challenging, particularly those revolving around (a) treatment of treatable conditions in a hospital or clinic setting; (b) behavior change for improving health. We see several hurdles to successfully focusing on such programs, but would be excited to see charities that overcome such hurdles. More
• Charities that collect or generate information and data relevant to our recommendations. Currently, we recommend charities based partly on the data they themselves collect and share. But we could potentially recommend an organization that does not, itself, collect and share strong monitoring data, if we had independent data showing its activities’ effectiveness. More

Charities that implement GiveWell’s priority programsThe first step in our research process is considering the independent evidence of effectiveness and cost-effectiveness of a program to determine whether we should classify it as a priority program. The programs that our top charities implement — bednet distribution, cash transfers and mass deworming programs — are among our priority programs.

There are cases where we have classified a program as a priority, but have not found a promising charity that focuses on that program.

We would be excited to see new charities implementing our priority programs who plan to publicly share significant monitoring and evaluation data and generally expect to be extremely transparent about their work.

Some specific examples of organizations we would be interested in:

• Providing vitamin A supplements to areas with high rates of vitamin A deficiency and child mortality. One illustrative example: the Central African Republic has a high child mortality rate (139 deaths per 1,000 children under 5, data from Gapminder here) and low rates of vitamin A supplementation (40%, data from the World Bank here). More on vitamin A supplementation and the questions we would ask a charity to answer here.
• Providing immunizations in areas with low coverage rates. An illustrative example: the Central African Republic has low rates of measles (49%) and DTP (diphtheria, tetanus and pertussis) immunizations (47%). (Data from UNICEF here.) We have not recently completed an intervention report on routine immunization but our report on maternal and neonatal tetanus immunization campaigns lays out the questions we would use to evaluate charities.
• Providing conditional cash transfers to encourage school attendance, clinic visits, etc. while also transferring wealth to low-income people. (Note that we currently support a charity taking this approach, in the hopes that it may become a top charity in the future.)

There are also some cases where we have identified charities that run priority programs, but are not completely satisfied with the evidence we’ve seen for the charities’ track records, either because we don’t find the case for impact compelling or because the charities have been hesitant to share information to the degree necessary. In these cases, we would be excited about organizations that implemented these programs and shared a significant amount of information about their work.

Possibilities in this category include:

• Organizations working on micronutrient fortification, such as salt iodization or folic acid fortification.
• Organizations working on immunizations campaigns for tetanus or measles.
• Organizations working on mass drug administration for neglected tropical diseases other than deworming.

Note that in some of the above cases, we have not completed our intervention reports, so it’s possible that we might conclude that a program does not have sufficient evidence of effectiveness or is not cost-effective enough to be a priority program. In general, we allocate our time with the goal of finding the combination of a strong program and strong organization; there are promising programs we have not completed our investigations of because we have not found promising charities running them.

Finally, we would be excited about organizations working on priority programs where we currently have top charities that may have limited room for more funding. In particular, we would be excited to see a new charity focusing on bednet distribution or deworming programs, while having a high willingness to collect and share data.

Note that we have intentionally not included areas like surgery, education, and family planning in this post. We have not prioritized research in these areas recently, but we do hope to revisit them in the future. Because we have not recently looked into these areas, we want to put more time into determining whether existing organizations may be able to meet our criteria before calling for new ones.

Charities implementing potential priority programs that are particularly challengingTwo types of promising programs are those (a) that focus on treating specific diseases or (b) that aim to promote behavior change. We have not completed intervention reports for either because both seem particularly challenging for charities to implement successfully.

Treatment programs

Treatment programs would focus on treating individuals after they contract a disease (e.g., malaria, HIV/AIDS, pneumonia, diarrhea, and tuberculosis). Unlike the programs we currently recommend, which target all members of a population (e.g., all women of childbearing age, all children under age 5), treatment programs are significantly more complicated. To receive treatment, (a) an individual generally must go to a clinic when s/he requires treatment, (b) be accurately diagnosed as having the condition, and (c) the clinic must have the necessary drug in stock. In some cases (e.g., HIV/AIDS or tuberculosis), the individual would have to return to the clinic and replenish his/her supply of the medication and also adhere to a long (or perpetual, in the case of HIV/AIDS) treatment regimen.

Because of the costs associated with providing treatments (training skilled diagnosticians or keeping drugs in stock), it seems unlikely that a charity should focus on providing just one of the above treatments. Possible approaches a charity could take include:

• Setting up high-quality clinics that provide treatments and other medical care. We have previously reviewed and recommended two organizations that follow this model: Partners in Health and Possible. Our guess is that clinics are unlikely to be as cost-effective as our current top charities.
• Running a program that involves community health workers to provide a limited range of treatments. This is somewhat similar, though not identical, to Living Goods’ model. Our impression is that there is a relatively large literature related to programs implemented by community health workers and the quality of the services they provide vary widely. Were we evaluating a charity implementing this model, we would be particularly focused on its monitoring and evaluation data as well as its cost-effectiveness.
• Providing treatments or diagnostics to clinics that would otherwise not have them. Were we evaluating a charity implementing this model, we would seek compelling evidence that the charity is causing the clinics to have access to treatments it otherwise would not have had, that the treatments are ultimately provided to people who need them (i.e., are accurately diagnosed as needing them) and that the recipients follow the prescribed regimen. Note that that this model seems similar to the some of what the Global Fund does. We evaluated the Global Fund in 2009 and 2010 but were not able to obtain the data we needed to recommend it.

We have not completed intervention reports for treatment programs, but we would likely consider them priority programs were we to find a charity effectively implementing one of the models above.

Behavior change

We have also not completed intervention reports for behavior change programs. Our impression is that programs to promote handwashing, breastfeeding or other health behaviors could be highly cost-effective because they can reach many people at low cost. (Note that Development Media International, a standout charity of ours, implements a behavior change intervention using mass media.)

The key challenge facing behavior change charities is demonstrating that their intervention causes behavior change and that that behavior change improves health. DMI is running a randomized controlled trial of its program to address this question, but very few charities are in a position to run a study like this. In GiveWell’s early years, we recommended PSI, a behavior change organization, but we changed its recommendation status because we no longer felt the evidence for its effectiveness was sufficiently strong.

We would be excited to evaluate a behavior change organization that could make a compelling case for its impact and is ready to share significant information about its activities with us.

Charities that collect or generate information and data relevant to our recommendationsThe types of charities discussed above are ones that could meet our criteria and receive a recommendation. We would also be interested in supporting groups that generate information or data that could inform our recommendations.

This could include groups that:

• Collect data that directly informs our views on current and potential top charities or the programs they implement. For example, Good Ventures provided funding (based on our recommendation) to IDinsight to conduct additional monitoring on the Schisotosomias Control Initiative’s programs. We could also imagine IDinsight, or a group like them, collecting and sharing better data that would inform our view of large-scale bednet distrubtions implemented by groups other than the Against Malaria foundation, salt iodization programs, or tetanus immunization campaigns. In all of these cases, we could recommend an organization that does not, itself, collect and share strong monitoring data, if we had independent data showing its activities’ effectiveness.
• Run randomized controlled trials (or replications of RCTs) of interventions that could be at least as cost-effective as our current priority programs. We’d be particularly excited about interventions that could plausibly be significantly more cost-effective than our current top charities.
• Qualitative research or journalism that informs our views of top charities or the programs they implement. This could include (a) articles about current top charities or the programs they implement (e.g., these pieces by Jacob Kushner that we commissioned in 2014 and 2015), (b) surveys of people served by the programs we recommend or the aid community in general, (c) research that directly addresses unanswered questions in our research (e.g., to what extent do individuals served by Development Media International’s program have access to clinics that can diagnose their conditions and provide them with medicine?), and/or (d) provides additional context on the lives of people living in extreme poverty, among others.
• GiveDirectly has suggested the idea of creating a facility for funding and implementing cash transfers as a control group for randomized controlled trials of development interventions. GiveDirectly has told us that this is something it doesn’t plan to currently prioritize and that it would be excited to see another organization undertake this. (It has expanded on this idea, suggesting a broader mandate for supporting cash transfer work, in this recent article.)

The post Charities we’d like to see appeared first on The GiveWell Blog.

Last year, Jacob Kushner, a journalist living in Kenya, reported on his observations from villages in which GiveDirectly had distributed some of its earliest cash transfers. This year, we funded him to report on the National School-Based Deworming Programme in Kenya, a program supported by Deworm the World.

Mr. Kushner’s article follows. His colleague, Anthony Langat, observed the program and interviewed some stakeholders; his interview notes are posted here.

In addition to Mr. Kushner’s article:

• We summarize our takeaways here.
• Evidence Action, which runs Deworm the World, responds to the article here.

School-based deworming: A parent’s perspective

In Kenya, some parents fear potential, minor side effects of deworming, and a few may even oppose it for religious reasons. Others say they just want to be better informed.

By Jacob Kushner and Anthony Langat

Since 2009, Evidence Action’s Deworm the World Initiative has provided technical assistance to the highly praised government-run National School-Based Deworming Programme, in Kenya. Last year the program de-wormed 6.4 million students in 16,000 schools. The Deworm the World Initiative encourages a multi-faceted strategy toward informing parents about the program, using radio announcements, community meetings, and by training teachers to encourage students to let their parents know about the program in advance of each ‘deworming day.’

But to ensure that each and every parent is made aware of it beforehand is impossible. Many families in rural Kenya lack radios, and communication between schools and certain families can be limited. And it’s safe to assume that children don’t always dutifully relay to parents each and every announcement they hear in class.

In March, Anthony Langat traveled to Kenya’s western Siaya county to observe deworming day at several schools. In Siaya county, over 312,000 students were targeted for deworming on that day. Over the course of a week he interviewed 13 parents, four teachers and one government official as well as three of Evidence Action’s staff members. He was surprised to find that many of these 13 parents said they were poorly informed or entirely uninformed about the March deworming before it occurred and that some were upset about that fact.

Parents want more information

Julius, a 65-year-old farmer and father of six, said he was disappointed that he wasn’t informed as to what, precisely, the deworming treatment consisted of, nor of its possible side effects.

Julius said that he eventually came to learn more about the drug’s purpose, and that in the future he’d encourage his children to participate. “I will accept when they come next time. But I need a written form stating what they are going to give my child. Just a form that has information regarding the drug so that we know and stay informed,” he said.

Evidence Action staff said the deworming program is part of Kenya’s overall government school health program for children, which does not require parental permission for its individual school based treatments. Even so, Evidence Action supports training of local government agents such as Community Health Extension Workers (part of Kenya’s Health Department) to reach out to parents and communities to inform them about the deworming. The program’s community sensitization efforts include meetings with regional stakeholders, public county-level launch events, displaying posters, and public service announcements via radio. (Originally, staff tried paying a vehicle to drive around with someone announcing the program over loudspeakers, but that seemed to have less reach than radio. Some parents who were interviewed acknowledged how difficult it would have been to inform them in advance, noting that they themselves did not have working radios).

“It’s important for everybody in the community to have an awareness of what’s going on so that people feel comfortable sending their children to school to receive deworming medication and to increase the awareness of why deworming is a positive thing for communities,” said Grace Hollister, Director of the Deworm the World Initiative.

One of the most effective ways to inform parents seems to be through teacher training.

“You will find that a teacher is very well trusted in the society. Whatever the teacher says or tells the children, it is usually taken as a gospel truth. So when they tell people that their children will be dewormed, they (parents) are very sure of what the teacher has told them,” said Charles Ang’iela, District Education Officer for the sub-county of Rarieda in Western Kenya. “The teachers are playing a very crucial role.”

One parent, a 57-year old mother, seemed to echo that sentiment, suggesting teachers invite parents to discuss the program in advance. “If parents could have been called to a meeting in school and told of the deworming rather than sending the children, the information could have been received better by parents,” she said.

Children, parents, fear sickness brought on by pill

Beyond the concern over lack of prior information about the process, a few parents said their children had become sick from taking the de-worming pills, and teachers shared some anecdotes of students vomiting or becoming dizzy after taking the pill.

Julius, the father who expressed concern at his lack of information about the treatment, said the reason he was hesitant this time is that his daughter became sick from a previous deworming. “We thought it was malaria and we took her to the hospital,” where he was informed that her stomach had likely simply reacted poorly to the de-worming pills, he said. Julius said that this time around, his daughter didn’t attend school the day of the deworming. His 11-year-old son did, and Julius said he too experienced side effects of the pill.

“After he was given the pills at school, I was called (and told) that the boy had fallen sick on the way (home) and could not walk,” Julius said. “When I found him he was dizzy, and looked tired and unable to walk. I took him on my bicycle and brought him home. Upon arriving he started vomiting.”

Julius said that “When I was called that he had fallen sick because he had taken the drugs I was angry.” (The boy’s teacher, who escorted reporter Anthony Langat to the boy’s home later in the day, confirmed that on the day of the deworming the boy was sick to the point that he was unable to walk home by himself).

Jael, a 29-year-old mother of four who owns a few acres of land where she grazes cattle and raises chickens, said two of her children have also become sick from the deworming treatment. This deworming day, one of her sons refused to take the deworming pills at school. The boy’s teacher said he told her that his parents told him not to participate.

“I didn’t tell them not to take the pills. My son just feared the drug,” said Jael. “The other time my daughter felt dizzy and vomited so she feared and even the other siblings feared.”

A teacher at Ramba Primary school said that when he informed his students the day before that the deworming program was to take place, some of them reacted negatively due the side effects they’d experienced during previous dewormings. “‘What, PZQ?’” he recalled some of them saying. (PZQ refers to drug praziquantel which is administered in some parts of Kenya to treat schistosomiasis, a disease caused by a waterborne parasite. Albendazole treats the soilborne parasite helminths, which is more common in Kenya and therefore albendazole is administered to a larger target population than PZQ. Both drugs are approved by the World Health Organization.) “‘Over my dead body, I will not take that drug again. The way it reacted with me? No, no, no, I will not take it.’” A teacher at Gagra Primary School recalled a 2013 deworming in which about six of his students fainted, having taken PZQ.

Hollister said “there is the potential that there could be some side effects because of the medication, which can happen especially to children with very large worm loads, for example stomach pains.”

Kenya’s government recommends a detailed protocol for mitigating and responding to side effects brought on by the pill. Teachers undergo a half day of training during which they’re instructed to keep students in class for two hours after a de-worming so as to observe whether any suffer side effects. They’re given phone numbers for doctors who are on-call nearby and they’re advised to locate and find contact information for the closest hospitals in advance of a deworming.

A small minority of parents may fear deworming for religious reasons

Teachers and Evidence Action staff said on rare occasions some parents may quietly but intentionally not send their children to school on de-worming days because they object to it for religious reasons. No parents interviewed for this article expressed this sentiment, but staff presumed that those parents who do withhold their children from deworming for religious reasons may mistakenly associate the pill with infertility, contraceptives or abortion.

The head teacher at Ramba Primary school said about 10 of the school’s 900 or so students refused to take the pill. “Some were because of the parents and the denomination factor—some kind of cult within their church could not allow them to take the drug,” he said, referring to one local church called Roho Israel. “Some parents also tried to demonize praziquantel (PZQ) unfairly just because of the dizziness and all that. So there is that kind of fear and fright that some people would say that you may collapse and fall down.”

A teacher at Gagra Primary School said five of his female students were afraid that the drug could cause infertility. “I do not know how the parents were connecting it to that,” he said. (A teacher at another local primary school, Lwak, said he hadn’t heard of any cases of parents refusing to let their children participate for religious reasons.)

“You know, this school is sponsored by (the) Catholic Church, and the population around here is mostly Catholic,” said Dickson Akawo, another teacher at Gagra Primary school. He said that for some parents, “what is in their mind is that even this (drug) has some sort of sterilizing effect on them. So the parents can deter a child from coming during the deworming day.”

“What they do not know is that we can become so clever,” said Akawo, describing how he and other teachers stock extra pills on deworming day in order to deworm students on subsequent days because “we know the repercussions of somebody not being dewormed.”

Kenya director for Evidence Action’s Deworm the World Initiative Thomas Kisimbi said that while the program does allow for extra drugs to be administered to students who may have missed it, he said the program doesn’t sanction teachers’ administering the pill to children who they believe missed it the first time due to objections by them or their parents.

Kisimbi estimated that only a few hundred children out of the more than 6 million who are dewormed through the program refuse to take the pills for religious or cultural reasons. (Hollister suggested that even those few may be geographically confined to just certain sub-counties). Toward convincing such parents to agree to the deworming, Kisimbi said “The best we can do is provide information and for them to make an informed decision around that.” Beyond that, Kisimbi said some of those parents are bound to eventually notice that other children undergo health improvements as a result of the program and therefore come around.

Parent’s priorities

Many parents interviewed said that they were far more concerned with malaria than they were with parasites. Kisimbi said this is likely due to the fact that Malaria has the potential to kill, whereas worms only sicken their children. Some parents cited other health concerns such as lack of clean water, and one father said that while schools implement the deworming program, they often fail to address other, important health issues. “I even urge teachers in school to ensure that children wash their hands before they eat,” the parent said.

Ang’iela, the government official, agreed that parasites are one of many health issues that plague children here, but cautioned that parents aren’t always aware of how seriously parasites do affect their children.

“You know, the traditional approach to life here is still strong whereby some people think that water is water so long as it is lake water, fruit is a fruit so long as it is a fruit that nobody has touched,” Ang’iela said. “They only see that their hands are dirty when they see charcoal on it and even that charcoal they will just rub it off and continue eating. So there is a lot of work which still needs to be done from this traditional approach, but that in my opinion has continued exposing them to things like worms.”

For his part, Kisimbi said the most urgent challenge for Kenya’s deworming program isn’t addressing fear of side effects or parent’s concerns about the drug. Rather, it’s how to get students who are not enrolled in school—or whose schools are not legally registered with the government—in for treatment. And in the long run, for the program to continue, Kenya’s government will have to buy in further.

“We want this program to go on 10 years, 20 years beyond the [involvement] of Evidence Action and we want the government to be able to take greater responsibility over the program,” he said.

In most respects, the National School-Based Deworming Program seems to be working quite smoothly. There were no indications that children who attended school on the March deworming day were being missed, that pills were not arriving at the correct locations, or that teachers were insufficiently trained in administering them. For their part, teachers unanimously noted significant improvements in class attendance, presumably a result of the reduction in parasites affecting their students. And nearly all the parents interviewed—even those who wished they had been better informed about the program—said they viewed the program favorably and were glad their children were being dewormed in school. Many parents said their children were sick less often and missed fewer school days as a result of an improvement in their children’s health they attributed to the dewormings.

This reporting offers merely an anecdotal look into the question of whether parents are sufficiently informed about the program. Elsewhere, Evidence Action is already working to determine the extent of parent satisfaction and knowledge and how to improve both. In India they are conducting a human centered design process, interviewing parents, teachers and other actors in the deworming process to determine what precisely each want to know about the process and how to best deliver that information in a cost effective way. Similarly, in Uganda Evidence Action was working with a human-centered design firm to understand consumer behavior toward using chlorine in drinking water so as to better inform families with small children.

Jacob Kushner is an investigative journalist currently based in East/Central Africa and the Caribbean. He reports on development economics and inequality, foreign aid and investment, governance and innovation in developing nations. Anthony Langat is a Kenyan journalist living in Nairobi.

GiveWell’s response

We are excited that we were able to commission Mr. Kushner and Mr. Langat to visit the Deworm the World Initiative on the ground in Kenya. (We previously commissioned Mr. Kushner to report on GiveDirectly’s operations in Kenya.)

To date, the information we have on the Deworm the World Initiative has come from (a) Deworm the World Initiative staff, (b) monitoring and evaluation information provided to us by the Deworm the World Initiative, and (c) our own site visit to the Deworm the World Initiative in India. Mr. Kushner and Mr. Langat’s visit represents a different perspective on this program, and a chance to identify issues we couldn’t have otherwise.

The intensity of our research process gives us confidence that we’ve likely identified and considered key issues relevant to our top charities, but we’re also aware that we may have missed some. Our goal in asking Mr. Kushner and Mr. Langat to visit top charities in the field is to reduce the likelihood that we have missed any major problems. Mr. Kushner and Mr. Langat did not encounter any problems of this sort. Overall, their report is consistent with our expectations, and it bolsters our confidence in the Deworm the World Initiative.

Based on information from randomized controlled trials, we know that the pills used in combination deworming programs can sometimes cause relatively benign side effects (more in our intervention report). We are also not surprised that some parents say that they are less informed than they would like to be about the program.

We believe these issues are worth addressing, but we don’t think these costs come close to outweighing the benefits that the program provides.

Finally, we would not expect it to be hard to find similar examples were someone to interview recipients of other aid programs. It is worth keeping in mind that very few aid agencies have allowed themselves to be subject to this type of analysis, so we are grateful to support an organization like Evidence Action (which runs the Deworm the World Initiative) that is ready to open itself up to outside criticism.

Evidence Action’s response

To GiveWell and Jacob Kushner:

We appreciate the time that Jacob Kushner and Anthony Langat spent with Kenya’s National School-Based Deworming Programme, and with Evidence Action’s Deworm the World Initiative. Evidence Action provides technical assistance to this evidence-based program of the Kenyan government.

The writers’ time is paid for by GiveWell which we hope is clearly disclosed. Anthony Langat, one of the writers, visited Siaya county during the most recent school-based deworming day (Jacob Kushner did not visit the communities). During that day, 312,226 children were targeted for deworming in their schools; more recently, in early June 2015, more than 2 million children received treatment for parasitic worms in counties across Kenya. In the last school year (2013/14), 6.4 million children were dewormed as part of Kenya’s national program, and this year the program is on track to deworm a similar number of children.

We appreciate that the journalists are trying to find out what parents understand about the National School-Based Deworming Programme. We are naturally keenly interested in this aspect of the program as well, as teachers and parents are very important in making school-based deworming a success.

However, there are a few important points to remember:

1. Kenya’s National School-Based Deworming Programme is a government program, jointly implemented by the Ministry of Health and the Ministry of Education, Science, and Technology. The Kenyan government administers a variety of public health interventions through its public schools and has the full and final say on all such programs and how they are run. Such school health programs are promulgated by the government to ensure children have equitable access to quality health services; the National School-Based Deworming Programme is one such program. We provide technical support to the government on implementation of a cost-effective, high coverage program; assist in developing procedures and protocols; and serve as the coordinating body for the program.
2. We do not think that this article evaluates parental knowledge and involvement in a rigorous or scientific manner. Anthony Langat chatted with 13 parents – a highly anecdotal and non-representative sample. A few parents that he spoke to expressed confusion about the reason for why children received deworming treatment. We very much regret that these parents had a less than desirable experience. Incidentally, the side effects of receiving treatment for parasitic worms that one parent noted — nausea and vomiting — are actually associated with very high worm loads in children, making the child’s parasitic worm treatment all the more important.
   
   In a representative survey of parents that we conducted at the beginning of the 2014/15 school year to assess parental awareness about deworming, we found that 21% of parents were informed about Deworming Day by their child’s teacher and 50% of parents by their child. Poster, radio, and community health extension workers (“CHEW” bar in the figure below) were other significant sources of information about Deworming Day (n=308 parents in 53 schools, Q3 2014, multiple answers were possible so total is >100%).

   We continuously evaluate the quality of the outreach of the program with representative surveys (rather than anecdotal stories) and suggest to the ministries ways to improve community awareness.

   As the authors noted, we are also engaged in a detailed qualitative study in India to better understand how to improve the government’s training cascade that conveys information about deworming all the way to every teacher, classroom, and families. We are nearing the end of this assessment that will yield important lessons for deworming programs in other countries as well.

3. Most importantly, we want to emphasize this point that got lost in the piece by Kushner and Langat: All who are involved in the National School-Based Deworming Programme are keenly concerned about the health and safety of children. The children and their well-being are all of our utmost priority. That is why we engage in school-based deworming in the first place. As a result, children’s safety always comes first.
   
   There are two points to be made on this matter: First, the drug given for the majority of deworming treatment in Kenya, albendazole, has a remarkable safety record. Hundreds of millions of patients have taken the drug all over the world over the last 20 years. There is extensive data on the minimal adverse experiences. Side effects reported in the published literature are extremely low. Gastrointestinal side effects, the main side effect, occur with an overall frequency of less than 1%. A second drug, praziquantel, is administered in communities endemic for schistosomiasis – this is a subset of the overall communities treated by the program. It is recommended that children are provided with food prior to the administration of praziquantel, to minimize nausea and other minor side effects of the medication. Like albendazole, this drug is considered very safe for treating school-age children.

   Second, the Kenyan government, with our assistance, has implemented a strict and rigorous ‘adverse event’ protocol. This is standard procedure for all national deworming programs and every last person involved in deworming is extensively trained on procedures. The protocol is here.

   The Adverse Event Protocol contains these elements:

   • Prescribes the protocol for preventing adverse events such as emphasizing the importance of not deworming sick children;
   • Emphasizes importance of relevant training messages (i.e., making sure drinking water is available, that children chew albendazole tablets, and if treating for schistosomiasis, that children eat beforehand);
   • Clarifies the difference between mild adverse events and serious adverse events and gives examples of each;
   • Prescribes the actions to be taken for managing adverse events on and after deworming day;
   • Explains the need to ensure children have eaten prior to praziquantel administration – the program also provides funds for school feeding on treatment days to schools in high-need areas;
   • Establishes an emergency response team and phone trees to ensure school personnel connect with appropriate health providers and the affected child’s parents;
   • Lists contact information for local medical officers and emergency response team;
   • Includes reporting forms and protocol for mild and serious events.

   Kids’ safety and health will always come first and that is why the government of Kenya has implemented this national program.

4. The detrimental health effects of parasitic worms are profound. 6.4 million kids have better lives because of being dewormed once a year. Now entering Kenya’s fourth year of the national program, the government of Kenya is closing in to eliminate parasitic worms in Kenya as a public health threat. Worm prevalence rates in Kenya rapidly dropped by more than 20% in the last two years to the point where the country is nearing just a few percentage points prevalence in several counties. The government of Kenya is very forward looking with this health policy and at the vanguard of protecting the lives of its children. Similarly to how the U.S. American South eliminated worms as a public health threat at the turn of the century, Kenya, as a fast-developing country, is protecting its children from the devastating health effects of parasitic worms. We applaud the government of Kenya in implementing what is a best buy in development and good public health policy.

We would urge GiveWell and the journalists to continue to be rigorous in evaluating the programs it recommends.

As more governments in countries with high worm burdens roll out national school-based deworming programs, we are ever so much closer to eliminating the public health threat of parasitic worms in children worldwide. Significant progress is being made — and hundreds of millions of children have a brighter future as a result.

The post Journalists report on deworming program supported by Deworm the World Initiative in Kenya appeared first on The GiveWell Blog.

For many years we’ve received emails from donors asking whether donations to any of our top charities were tax-deductible in Australia and we’ve had to tell them that we did not have a tax-deductible option to offer them. So, we’re happy to share the news that the Against Malaria Foundation (AMF) has just received Deductible Gift Recipient status in Australia, which means that donations to AMF (Australia) are now tax-deductible. You can read AMF’s announcement here.

AMF has been seeking this status since 2009 and we are glad that its efforts have paid off. Of GiveWell’s top charities, AMF is the only one to have tax-deductible status in Australia at this point in time. More information on the tax-deductibility of donations to our top charities in various countries is available here.

AMF has told us it is happy to share information about its experience with the application process with other organizations that are considering applying for Deductible Gift Recipient status in Australia. It has posted information about the process, including some of its application materials, here.

The post A tax-deductible top charity for Australians appeared first on The GiveWell Blog.

Good Ventures has granted $25 million to GiveDirectly for the support of GiveDirectly’s general operations. While the grant is unrestricted, we expect that GiveDirectly will most likely use this grant as follows:

• ~$6-9 million: to hire a marketing team to raise significantly more funding than GiveDirectly has raised in the past.
• ~$16-19 million: to provide cash transfers to extremely low-income households, either using its standard operating model or as part of collaborations with large aid institutions or governments. These collaborations are intended to address questions that institutional funders have about cash transfers and could include running experiments comparing other aid programs against cash transfers.

We see this grant as an outstanding giving opportunity because:

• We believe that GiveDirectly is an exceptionally strong organization, and we see supporting its growth as an excellent opportunity.
• Providing funds to help GiveDirectly build its marketing team and arrange partnerships with large institutions could lead to future funding for cash transfers that dwarfs this initial investment.
• Funding GiveDirectly’s current model is one of the best giving opportunities we know of. A significant portion of this grant will directly fund GiveDirectly’s core model.

However, we see GiveDirectly’s plans as ambitious, so we would not be surprised if GiveDirectly fails to meet the full scope of its goals. More details on what we see as some of the risks to the success of this grant are below.

GiveDirectly continues to have significant room for more funding, so this grant is unlikely to have a direct impact on our end-of-year recommendations to donors.

Below, we go into more detail on:

• The process that led to making this grant.
• How we expect the grant funds to be used.
• The timeframe within which we expect to see results.
• Our case for the grant, as well as the risks of making it.
• How the grant affects GiveDirectly’s room for more funding.
• Our reflections on the benefits of sometimes being an ”active” funder.
• Good Ventures’ future giving plans and the possibility of large grants to other GiveWell top charities.

For more background on GiveDirectly and its core operations, see our GiveDirectly review.

Process
In late 2014, Good Ventures expressed an interest in contributing significantly more to our top charities than it had in the past. It also asked whether additional grants could accelerate the growth of our top charities as organizations. We considered grants for all four of our top charities and ultimately prioritized discussions with GiveDirectly (more about our other top charities below).

Over the course of three months, we had four conversations with GiveDirectly about how it would use a large grant from Good Ventures. GiveDirectly put together a proposal that explained how it would use grants ranging in size from $23.5 million to $89 million. GiveWell and Good Ventures representatives discussed this proposal. GiveWell recommended that Good Ventures grant $25 million to GiveDirectly to support its general operations, and Good Ventures agreed.
What will the grant be used for?

The $25 million grant will primarily be used to support two activities:

• Fundraising: ~$6-9 million
• Cash transfers (including partnerships and research): ~$16-19 million

More details on these activities are below.

Fundraising

GiveDirectly plans to spend $6-9 million of this grant over the next 3-4 years (spending ~$3.5 million over the next two years with the budget growing in later years) to hire a marketing team that will substantially increase GiveDirectly’s fundraising efforts. GiveDirectly expects these funds to cover a) hiring a marketing team that will develop a new fundraising strategy, and b) implementing the team’s strategy over the next 3-4 years. GiveDirectly’s long-term goal for its marketing team is to help GiveDirectly become an organization that raises and spends over $100 million per year with a reasonable fundraising cost-to-revenue ratio (more below).

GiveDirectly’s first step under this grant will be to hire a new marketing director who will build and lead the new marketing team (including hiring 3-5 other staff members for the marketing team). GiveDirectly believes that it will be able to attract a top-talent marketing director because a) based on its research, the size of its marketing budget is competitive with other companies or non-profits where a top marketing director might be able to work, and b) it believes that having already secured the next 3-4 years of its marketing budget will make it easier to attract promising candidates.

GiveDirectly intends for the marketing team to develop a fundraising strategy that will significantly expand GiveDirectly’s donor base. In particular, GiveDirectly aims to fundraise from donors who would not otherwise have given to GiveWell’s recommended charities.

Tentatively, GiveDirectly believes the new fundraising strategy will focus on developing an improved web and mobile experience for donors. For example, the new web and mobile experience may enable donors to track and learn about the specific recipient to whom their donations were routed.

Cash transfers (including partnerships and research)

Approximately $16-19 million of Good Ventures’ grant will be used for cash transfers, either using GiveDirectly’s standard model or through partnerships with other institutional funders. In either case, GiveDirectly expects the delivery of the transfers to be accompanied by additional research. GiveDirectly told us that all of its standard transfers are now part of experimental evaluations that test the impact and design of its cash transfer programs. In collaborations with large aid institutions or governments, transfers could be used to a) run experiments with partners that compare the effectiveness of standard aid programs against cash transfers or b) help partners to experiment with delivering cash transfers.

In the past, GiveDirectly has found that it can more successfully arrange collaborative projects if it can co-fund the cash transfers in the project, so it requested funds from Good Ventures that could be used for this purpose.

Long-term, GiveDirectly hopes that such collaborative projects will encourage aid agencies and governments to deliver more cash transfers with their own funds. It also hopes that such projects may help to establish cash transfers as a standard “benchmark” program against which other global aid programs should be compared.

GiveDirectly plans to discuss partnerships with the following types of institutions:

• Donor aid agencies.
• Developing country governments (national and local). (For example, several governors in Kenya have already approached GiveDirectly about running cash transfer programs in their counties.)

How quickly will the funds be spent and when do we expect to see results?

In brief, we expect to be able to make a preliminary assessment of the success of this grant after the 2016 giving season (December 2016 – January 2017), at which point GiveDirectly expects that its fundraising strategy will be operational, that the cash transfers funded by this grant will be disbursed, and that it will have made some progress on arranging partnerships.

More details are below. We plan to follow up on each of the below expectations according to our standard timeline for charity updates.

Fundraising

As mentioned above, GiveDirectly expects the marketing team to spend its $6-9 million budget over the next 3-4 years.

GiveDirectly has already begun to interview candidates to lead its marketing activities and expects to hire someone for the position by the end of 2015. It expects the rest of the marketing team (3-5 people) to be hired soon after the lead is on board.

Many retail donors give significantly more during December, the time of year we refer to as “giving season.” We believe that giving season is the right period during which to assess GiveDirectly’s marketing team’s results. GiveDirectly expects its new marketing strategy to be fully operational by the 2016 giving season. After that giving season ends, GiveDirectly expects to have at least broken even on its fundraising expenses; i.e., it expects that the funds that it will have raised due to its new strategy will at least equal the money that it has spent on the strategy up to that point, and it hopes to do significantly better.

Eventually, GiveDirectly hopes to be spending roughly $0.05 on fundraising for every $1 raised, which it believes would be a greater level of efficiency than the industry average. GiveDirectly expects that during the first several years of implementing its new fundraising strategy, it will spend closer to $0.10 – $0.20 per $1 raised.

We do not have a strong sense of what we should expect from a fundraising operation like GiveDirectly’s planned operation, but our rough expectation about its likely near-term efficiency is less optimistic than GiveDirectly’s. We would not be surprised if GiveDirectly managed only to cover its fundraising costs in these early years.

Cash transfers (and research)

GiveDirectly believes it will transfer most of the money allocated for standard cash transfers within the next year and a half (2015-2016). This seems like a reasonable expectation from our perspective. GiveDirectly has scaled up rapidly and has a track record of moving donations to recipients in a timely manner.

Partnerships

Of the three areas to which GiveDirectly is planning to allocate Good Ventures’ grant funds, this is the one for which we have the least well-defined expectations. GiveDirectly’s work on partnership projects has been preliminary, and we are uncertain how these projects will progress.

GiveDirectly has told us that it has promising prospects for partnerships, but we would not be surprised if it does not ultimately develop major partnerships with large institutions. However, if GiveDirectly is able to establish at least one major partnership, we would likely consider its partnerships work to be a success.

The large institutions that GiveDirectly would like to partner with tend to move relatively slowly, so we would not be surprised if these funds took a number of years to be disbursed. If GiveDirectly fails to find a partnership arrangement within a reasonable amount of time, we would expect it to allocate the funds earmarked for partnerships to other near-term uses.
What is the case for making the grant?

Our primary reasons for recommending this grant are:

• We believe that GiveDirectly is an exceptionally strong organization, and we see supporting its growth as an excellent giving opportunity. We felt comfortable recommending a grant of this size to GiveDirectly partly because we trust its staff’s views about the best use of additional funds and we expect that it will be able to competently execute on its plans. Some of the reasons that we have a positive view of GiveDirectly include:
  • It has an impressive track record of scaling up as an organization: in its 2012 fiscal year, GiveDirectly transferred less than $0.5 million. In its 2014 fiscal year, it transferred $5 million, and incurred liabilities (future transfers for currently enrolled recipients) totaling $8.6 million (more in our full review of GiveDirectly and its financials).
  • It has always communicated clearly with us and has transparently discussed its mistakes (see a recent example here). We are confident that we will be able to follow up on and learn from the results of this grant, whether they are positive or negative.
• We believe that the activities that this grant is funding have the potential to make a large, positive impact by increasing individual and institutional donors’ support for cash transfers. In particular, if GiveDirectly’s new fundraising strategy is successful, it could greatly improve the impact of a huge amount of donations. GiveDirectly may also be in a position to persuade institutional donors to fund cash transfers instead of less cost-effective activities.
• GiveDirectly’s core model is one of the best opportunities we know of to use money to accomplish a great deal of good. It has significant room for more funding, and we believe that the money it transfers to very poor people and the research it conducts will have substantial impact.

How did we settle on this grant size?

GiveDirectly sent us a high-level summary of how it could use grants ranging in size from $23.5 million to $89 million. We decided to recommend a grant of $25 million primarily because a grant of this size would enable GiveDirectly to fully pursue what we saw as its two highest-leverage opportunities – implementing a new fundraising strategy and seeking partnerships with large aid institutions – while also providing GiveDirectly a large amount of funding to carry out its core activities of delivering cash transfers and running experiments on those transfers. GiveDirectly told us that it would plan to distribute any additional money it received beyond $23.5 million in roughly a proportion of 3:1:1 for cash:fundraising:partnerships, so most additional money would go to cash transfers.

Also, we told GiveDirectly that Good Ventures would consider a grant in the range of approximately $20 million, and that initial figure likely played some role in anchoring GiveDirectly’s proposals.
What are the risks to the success of this grant?

The major risks to the success of this grant that we are aware of include:

• Possibility of fundraising failure: We do not have a strong sense of how likely GiveDirectly’s fundraising campaign is to succeed, but we would not be surprised if it failed to attract new donors at a desirable rate of efficiency. We see supporting GiveDirectly’s fundraising plans as a risky bet.
• Diversion of funds from other top charities: It is possible that GiveDirectly’s new fundraising campaigns could end up attracting donors who would have given to GiveWell’s other top charities if not for GiveDirectly’s campaigns. This may have the effect of diverting donors away from potentially more cost-effective giving opportunities. However, we see this as a relatively minor risk because GiveDirectly explicitly plans to target donors who would not otherwise become part of GiveWell’s audience.
• Possible slow disbursement of partnership funds: We think that the main risk associated with GiveDirectly’s partnerships plan is simply that the funds for partnership projects may not be used for a long period of time. In this situation, it may be that the funds would have been better spent on near-term opportunities to do good. However, this risk seems limited because we believe that GiveDirectly shares our desire for funds to be used in a timely fashion and will work to move these partnerships forward quickly.
• Too much focus on marketing: A small risk of the fundraising campaign is that GiveDirectly could eventually become too focused on marketing, at the cost of transparency and the quality of its operations. Based on our impression of the GiveDirectly team, we see this as relatively unlikely.

How does this grant affect GiveDirectly’s room for more funding?

We believe that GiveDirectly still has substantial room for more funding, and we continue to recommend donations to GiveDirectly.

Including this grant, GiveDirectly currently holds approximately $40 million that it plans to allocate to its core model. GiveDirectly believes that it has the capacity to transfer about $75 million over the next two years (2015 and 2016). If it received significantly more funding than $75 million, GiveDirectly believes it could hire an additional Field Director and move substantially more money.

We view GiveDirectly’s estimates of its room for more funding as reliable due to its demonstrated ability to scale, and this estimate is consistent with our December 2014 analysis of GiveDirectly’s room for more funding.

We plan to provide more details on our view of GiveDirectly’s room for more funding in our year-end refresh of our GiveDirectly review.
Reflections on the potential benefits of sometimes being an “active” funder
Previously, we’ve written about the distinction between passive and active funding and the strengths and weaknesses of each approach.

Our experiences with GiveDirectly over the last few months demonstrate some potential benefits of sometimes being an active funder. In this case, it was only after Good Ventures encouraged us to ask our top charities about how they could use additional large amounts of funding that we had extensive discussions with GiveDirectly about possible growth plans. Our impression is that GiveDirectly’s vision for how it could use additional funds to grow as an organization sharpened over the course of these discussions as it became clear that Good Ventures was interested in making a substantial grant.

Ultimately, these discussions revealed potentially high-impact giving opportunities that we would not have been aware of if we had not pursued the question of how GiveDirectly could use additional funding to accelerate its growth relatively actively. We had previous discussions with GiveDirectly’s leadership where we explicitly asked them a) whether there was anything else we could do to support their growth and b) whether it would potentially be valuable to provide additional funding for their fundraising team. In both cases, GiveDirectly answered that it did not see promising opportunities for additional funding. Our impression is that our persistent encouragement to think more deeply about how it would use significantly more funding, coupled with a strong interest from Good Ventures in providing such funding, motivated GiveDirectly to reflect on its needs and make the funding request detailed in this post. (Likewise, we would not have pursued these conversations with GiveDirectly as actively in the absence of Good Ventures’ persistent encouragement to do so.)
What are Good Ventures’ future giving plans, and does this affect the expected room for more funding of GiveWell’s top charities?

Below is our summary of Good Ventures’s stance, which Good Ventures has reviewed:

Good Ventures is open to making other large grants (i.e., grants on a similar scale to this grant to GiveDirectly) to GiveWell’s top charities in the future, though it does not have any firm plans to do so at this time. We have explained to GiveDirectly that it should consider this to be a one-time grant and that it should not necessarily expect another large grant in the future. As discussed below, we plan to be continually thinking through the question of whether our other top charities might present comparably good cases for large grants.

Good Ventures has no current plans to change its approach to making end-of-the-year grants to GiveWell’s top charities.

Some of our followers may be wondering whether this grant implies that Good Ventures could fill all of our top charities’ funding gaps at some point soon. Good Ventures does not expect to close the funding gaps of GiveWell’s top charities in the foreseeable future. Good Ventures is still early in its exploration of higher-risk, potentially higher-expected value giving opportunities as part of the Open Philanthropy Project, and there are many possibilities for where its giving might eventually go. Good Ventures is interested in making large enough grants to top charities to take advantage of particularly exciting opportunities (such as those described in this post) and send a significant signal about the benefits to being a top charity, but fully closing each top charity’s funding gap would mean spending significantly more without significantly increasing these benefits. In addition, Good Ventures (as we do) sees it as a good thing for top charities to attract a large number of donations (and not just a large number of dollars); we believe this dynamic is better in terms of the signals it sends about the benefits of being a top charity, and in terms of the robustness of top charities’ financial situations.

If Good Ventures were considering providing enough funding to fill our top charities’ funding gaps, it would let us know of its plans well in advance so that we would have time to alert our donors. If our top charities’ funding gaps were filled, we would find the next-highest priority funding gaps to recommend.

Does Good Ventures plan to make large grants to GiveWell’s other top charities?
When Good Ventures asked us about high-impact giving opportunities related to growing our top charities as organizations, we considered asking each of the top charities how they would use significantly more funding. We ultimately chose not to recommend large grants to other top charities for the time being. We explain the reasoning behind our decision for each of our other top charities below:

• The Against Malaria Foundation (AMF) – At the same time that we first spoke with GiveDirectly about this grant, we also began discussions with AMF about a possible large grant. AMF believes that it has a large amount of room for more funding (roughly $50 million or more), but as we noted in our May 2015 update, we are hesitant to recommend that it receive a large amount of additional funding (i.e., on the order of tens of millions of dollars) until we can evaluate results from Kasaï Occidental, its first large-scale distribution outside of Malawi. It has recently posted reports from the Kasaï Occidental distribution (see “Distribution” section on this page), and we are currently reviewing them.
• Deworm the World Initiative, led by Evidence Action – We decided not to have a conversation with the Deworm the World Initiative about how it could grow with substantially more funding because, based on our recent analyses, we believed that the organization had limited room for more funding.
• Schistosomiasis Control Initiative (SCI) – We decided not to have a conversation with SCI about how it might be able to use a large grant because a) we felt that we would need to be able to have a better understanding of SCI’s past spending and monitoring before considering recommending a large grant, and b) we have often struggled to communicate effectively with SCI representatives in the past.

The post Good Ventures’ $25 million grant to GiveDirectly appeared first on The GiveWell Blog.

Good Ventures has granted $25 million to GiveDirectly for the support of GiveDirectly’s general operations. While the grant is unrestricted, we expect that GiveDirectly will most likely use this grant as follows:

• ~$6-9 million: to hire a marketing team to raise significantly more funding than GiveDirectly has raised in the past.
• ~$16-19 million: to provide cash transfers to extremely low-income households, either using its standard operating model or as part of collaborations with large aid institutions or governments. These collaborations are intended to address questions that institutional funders have about cash transfers and could include running experiments comparing other aid programs against cash transfers.

We see this grant as an outstanding giving opportunity because:

• We believe that GiveDirectly is an exceptionally strong organization, and we see supporting its growth as an excellent opportunity.
• Providing funds to help GiveDirectly build its marketing team and arrange partnerships with large institutions could lead to future funding for cash transfers that dwarfs this initial investment.
• Funding GiveDirectly’s current model is one of the best giving opportunities we know of. A significant portion of this grant will directly fund GiveDirectly’s core model.

However, we see GiveDirectly’s plans as ambitious, so we would not be surprised if GiveDirectly fails to meet the full scope of its goals. More details on what we see as some of the risks to the success of this grant are below.

GiveDirectly continues to have significant room for more funding, so this grant is unlikely to have a direct impact on our end-of-year recommendations to donors.

Below, we go into more detail on:

• The process that led to making this grant.
• How we expect the grant funds to be used.
• The timeframe within which we expect to see results.
• Our case for the grant, as well as the risks of making it.
• How the grant affects GiveDirectly’s room for more funding.
• Our reflections on the benefits of sometimes being an ”active” funder.
• Good Ventures’ future giving plans and the possibility of large grants to other GiveWell top charities.

For more background on GiveDirectly and its core operations, see our GiveDirectly review.

Process
In late 2014, Good Ventures expressed an interest in contributing significantly more to our top charities than it had in the past. It also asked whether additional grants could accelerate the growth of our top charities as organizations. We considered grants for all four of our top charities and ultimately prioritized discussions with GiveDirectly (more about our other top charities below).

Over the course of three months, we had four conversations with GiveDirectly about how it would use a large grant from Good Ventures. GiveDirectly put together a proposal that explained how it would use grants ranging in size from $23.5 million to $89 million. GiveWell and Good Ventures representatives discussed this proposal. GiveWell recommended that Good Ventures grant $25 million to GiveDirectly to support its general operations, and Good Ventures agreed.
What will the grant be used for?

The $25 million grant will primarily be used to support two activities:

• Fundraising: ~$6-9 million
• Cash transfers (including partnerships and research): ~$16-19 million

More details on these activities are below.

Fundraising

GiveDirectly plans to spend $6-9 million of this grant over the next 3-4 years (spending ~$3.5 million over the next two years with the budget growing in later years) to hire a marketing team that will substantially increase GiveDirectly’s fundraising efforts. GiveDirectly expects these funds to cover a) hiring a marketing team that will develop a new fundraising strategy, and b) implementing the team’s strategy over the next 3-4 years. GiveDirectly’s long-term goal for its marketing team is to help GiveDirectly become an organization that raises and spends over $100 million per year with a reasonable fundraising cost-to-revenue ratio (more below).

GiveDirectly’s first step under this grant will be to hire a new marketing director who will build and lead the new marketing team (including hiring 3-5 other staff members for the marketing team). GiveDirectly believes that it will be able to attract a top-talent marketing director because a) based on its research, the size of its marketing budget is competitive with other companies or non-profits where a top marketing director might be able to work, and b) it believes that having already secured the next 3-4 years of its marketing budget will make it easier to attract promising candidates.

GiveDirectly intends for the marketing team to develop a fundraising strategy that will significantly expand GiveDirectly’s donor base. In particular, GiveDirectly aims to fundraise from donors who would not otherwise have given to GiveWell’s recommended charities.

Tentatively, GiveDirectly believes the new fundraising strategy will focus on developing an improved web and mobile experience for donors. For example, the new web and mobile experience may enable donors to track and learn about the specific recipient to whom their donations were routed.

Cash transfers (including partnerships and research)

Approximately $16-19 million of Good Ventures’ grant will be used for cash transfers, either using GiveDirectly’s standard model or through partnerships with other institutional funders. In either case, GiveDirectly expects the delivery of the transfers to be accompanied by additional research. GiveDirectly told us that all of its standard transfers are now part of experimental evaluations that test the impact and design of its cash transfer programs. In collaborations with large aid institutions or governments, transfers could be used to a) run experiments with partners that compare the effectiveness of standard aid programs against cash transfers or b) help partners to experiment with delivering cash transfers.

In the past, GiveDirectly has found that it can more successfully arrange collaborative projects if it can co-fund the cash transfers in the project, so it requested funds from Good Ventures that could be used for this purpose.

Long-term, GiveDirectly hopes that such collaborative projects will encourage aid agencies and governments to deliver more cash transfers with their own funds. It also hopes that such projects may help to establish cash transfers as a standard “benchmark” program against which other global aid programs should be compared.

GiveDirectly plans to discuss partnerships with the following types of institutions:

• Donor aid agencies.
• Developing country governments (national and local). (For example, several governors in Kenya have already approached GiveDirectly about running cash transfer programs in their counties.)

How quickly will the funds be spent and when do we expect to see results?

In brief, we expect to be able to make a preliminary assessment of the success of this grant after the 2016 giving season (December 2016 – January 2017), at which point GiveDirectly expects that its fundraising strategy will be operational, that the cash transfers funded by this grant will be disbursed, and that it will have made some progress on arranging partnerships.

More details are below. We plan to follow up on each of the below expectations according to our standard timeline for charity updates.

Fundraising

As mentioned above, GiveDirectly expects the marketing team to spend its $6-9 million budget over the next 3-4 years.

GiveDirectly has already begun to interview candidates to lead its marketing activities and expects to hire someone for the position by the end of 2015. It expects the rest of the marketing team (3-5 people) to be hired soon after the lead is on board.

Many retail donors give significantly more during December, the time of year we refer to as “giving season.” We believe that giving season is the right period during which to assess GiveDirectly’s marketing team’s results. GiveDirectly expects its new marketing strategy to be fully operational by the 2016 giving season. After that giving season ends, GiveDirectly expects to have at least broken even on its fundraising expenses; i.e., it expects that the funds that it will have raised due to its new strategy will at least equal the money that it has spent on the strategy up to that point, and it hopes to do significantly better.

Eventually, GiveDirectly hopes to be spending roughly $0.05 on fundraising for every $1 raised, which it believes would be a greater level of efficiency than the industry average. GiveDirectly expects that during the first several years of implementing its new fundraising strategy, it will spend closer to $0.10 – $0.20 per $1 raised.

We do not have a strong sense of what we should expect from a fundraising operation like GiveDirectly’s planned operation, but our rough expectation about its likely near-term efficiency is less optimistic than GiveDirectly’s. We would not be surprised if GiveDirectly managed only to cover its fundraising costs in these early years.

Cash transfers (and research)

GiveDirectly believes it will transfer most of the money allocated for standard cash transfers within the next year and a half (2015-2016). This seems like a reasonable expectation from our perspective. GiveDirectly has scaled up rapidly and has a track record of moving donations to recipients in a timely manner.

Partnerships

Of the three areas to which GiveDirectly is planning to allocate Good Ventures’ grant funds, this is the one for which we have the least well-defined expectations. GiveDirectly’s work on partnership projects has been preliminary, and we are uncertain how these projects will progress.

GiveDirectly has told us that it has promising prospects for partnerships, but we would not be surprised if it does not ultimately develop major partnerships with large institutions. However, if GiveDirectly is able to establish at least one major partnership, we would likely consider its partnerships work to be a success.

The large institutions that GiveDirectly would like to partner with tend to move relatively slowly, so we would not be surprised if these funds took a number of years to be disbursed. If GiveDirectly fails to find a partnership arrangement within a reasonable amount of time, we would expect it to allocate the funds earmarked for partnerships to other near-term uses.
What is the case for making the grant?

Our primary reasons for recommending this grant are:

• We believe that GiveDirectly is an exceptionally strong organization, and we see supporting its growth as an excellent giving opportunity. We felt comfortable recommending a grant of this size to GiveDirectly partly because we trust its staff’s views about the best use of additional funds and we expect that it will be able to competently execute on its plans. Some of the reasons that we have a positive view of GiveDirectly include:
  • It has an impressive track record of scaling up as an organization: in its 2012 fiscal year, GiveDirectly transferred less than $0.5 million. In its 2014 fiscal year, it transferred $5 million, and incurred liabilities (future transfers for currently enrolled recipients) totaling $8.6 million (more in our full review of GiveDirectly and its financials).
  • It has always communicated clearly with us and has transparently discussed its mistakes (see a recent example here). We are confident that we will be able to follow up on and learn from the results of this grant, whether they are positive or negative.
• We believe that the activities that this grant is funding have the potential to make a large, positive impact by increasing individual and institutional donors’ support for cash transfers. In particular, if GiveDirectly’s new fundraising strategy is successful, it could greatly improve the impact of a huge amount of donations. GiveDirectly may also be in a position to persuade institutional donors to fund cash transfers instead of less cost-effective activities.
• GiveDirectly’s core model is one of the best opportunities we know of to use money to accomplish a great deal of good. It has significant room for more funding, and we believe that the money it transfers to very poor people and the research it conducts will have substantial impact.

How did we settle on this grant size?

GiveDirectly sent us a high-level summary of how it could use grants ranging in size from $23.5 million to $89 million. We decided to recommend a grant of $25 million primarily because a grant of this size would enable GiveDirectly to fully pursue what we saw as its two highest-leverage opportunities – implementing a new fundraising strategy and seeking partnerships with large aid institutions – while also providing GiveDirectly a large amount of funding to carry out its core activities of delivering cash transfers and running experiments on those transfers. GiveDirectly told us that it would plan to distribute any additional money it received beyond $23.5 million in roughly a proportion of 3:1:1 for cash:fundraising:partnerships, so most additional money would go to cash transfers.

Also, we told GiveDirectly that Good Ventures would consider a grant in the range of approximately $20 million, and that initial figure likely played some role in anchoring GiveDirectly’s proposals.
What are the risks to the success of this grant?

The major risks to the success of this grant that we are aware of include:

• Possibility of fundraising failure: We do not have a strong sense of how likely GiveDirectly’s fundraising campaign is to succeed, but we would not be surprised if it failed to attract new donors at a desirable rate of efficiency. We see supporting GiveDirectly’s fundraising plans as a risky bet.
• Diversion of funds from other top charities: It is possible that GiveDirectly’s new fundraising campaigns could end up attracting donors who would have given to GiveWell’s other top charities if not for GiveDirectly’s campaigns. This may have the effect of diverting donors away from potentially more cost-effective giving opportunities. However, we see this as a relatively minor risk because GiveDirectly explicitly plans to target donors who would not otherwise become part of GiveWell’s audience.
• Possible slow disbursement of partnership funds: We think that the main risk associated with GiveDirectly’s partnerships plan is simply that the funds for partnership projects may not be used for a long period of time. In this situation, it may be that the funds would have been better spent on near-term opportunities to do good. However, this risk seems limited because we believe that GiveDirectly shares our desire for funds to be used in a timely fashion and will work to move these partnerships forward quickly.
• Too much focus on marketing: A small risk of the fundraising campaign is that GiveDirectly could eventually become too focused on marketing, at the cost of transparency and the quality of its operations. Based on our impression of the GiveDirectly team, we see this as relatively unlikely.

How does this grant affect GiveDirectly’s room for more funding?

We believe that GiveDirectly still has substantial room for more funding, and we continue to recommend donations to GiveDirectly.

Including this grant, GiveDirectly currently holds approximately $40 million that it plans to allocate to its core model. GiveDirectly believes that it has the capacity to transfer about $75 million over the next two years (2015 and 2016). If it received significantly more funding than $75 million, GiveDirectly believes it could hire an additional Field Director and move substantially more money.

We view GiveDirectly’s estimates of its room for more funding as reliable due to its demonstrated ability to scale, and this estimate is consistent with our December 2014 analysis of GiveDirectly’s room for more funding.

We plan to provide more details on our view of GiveDirectly’s room for more funding in our year-end refresh of our GiveDirectly review.
Reflections on the potential benefits of sometimes being an “active” funder
Previously, we’ve written about the distinction between passive and active funding and the strengths and weaknesses of each approach.

Our experiences with GiveDirectly over the last few months demonstrate some potential benefits of sometimes being an active funder. In this case, it was only after Good Ventures encouraged us to ask our top charities about how they could use additional large amounts of funding that we had extensive discussions with GiveDirectly about possible growth plans. Our impression is that GiveDirectly’s vision for how it could use additional funds to grow as an organization sharpened over the course of these discussions as it became clear that Good Ventures was interested in making a substantial grant.

Ultimately, these discussions revealed potentially high-impact giving opportunities that we would not have been aware of if we had not pursued the question of how GiveDirectly could use additional funding to accelerate its growth relatively actively. We had previous discussions with GiveDirectly’s leadership where we explicitly asked them a) whether there was anything else we could do to support their growth and b) whether it would potentially be valuable to provide additional funding for their fundraising team. In both cases, GiveDirectly answered that it did not see promising opportunities for additional funding. Our impression is that our persistent encouragement to think more deeply about how it would use significantly more funding, coupled with a strong interest from Good Ventures in providing such funding, motivated GiveDirectly to reflect on its needs and make the funding request detailed in this post. (Likewise, we would not have pursued these conversations with GiveDirectly as actively in the absence of Good Ventures’ persistent encouragement to do so.)
What are Good Ventures’ future giving plans, and does this affect the expected room for more funding of GiveWell’s top charities?

Below is our summary of Good Ventures’s stance, which Good Ventures has reviewed:

Good Ventures is open to making other large grants (i.e., grants on a similar scale to this grant to GiveDirectly) to GiveWell’s top charities in the future, though it does not have any firm plans to do so at this time. We have explained to GiveDirectly that it should consider this to be a one-time grant and that it should not necessarily expect another large grant in the future. As discussed below, we plan to be continually thinking through the question of whether our other top charities might present comparably good cases for large grants.

Good Ventures has no current plans to change its approach to making end-of-the-year grants to GiveWell’s top charities.

Some of our followers may be wondering whether this grant implies that Good Ventures could fill all of our top charities’ funding gaps at some point soon. Good Ventures does not expect to close the funding gaps of GiveWell’s top charities in the foreseeable future. Good Ventures is still early in its exploration of higher-risk, potentially higher-expected value giving opportunities as part of the Open Philanthropy Project, and there are many possibilities for where its giving might eventually go. Good Ventures is interested in making large enough grants to top charities to take advantage of particularly exciting opportunities (such as those described in this post) and send a significant signal about the benefits to being a top charity, but fully closing each top charity’s funding gap would mean spending significantly more without significantly increasing these benefits. In addition, Good Ventures (as we do) sees it as a good thing for top charities to attract a large number of donations (and not just a large number of dollars); we believe this dynamic is better in terms of the signals it sends about the benefits of being a top charity, and in terms of the robustness of top charities’ financial situations.

If Good Ventures were considering providing enough funding to fill our top charities’ funding gaps, it would let us know of its plans well in advance so that we would have time to alert our donors. If our top charities’ funding gaps were filled, we would find the next-highest priority funding gaps to recommend.

Does Good Ventures plan to make large grants to GiveWell’s other top charities?
When Good Ventures asked us about high-impact giving opportunities related to growing our top charities as organizations, we considered asking each of the top charities how they would use significantly more funding. We ultimately chose not to recommend large grants to other top charities for the time being. We explain the reasoning behind our decision for each of our other top charities below:

• The Against Malaria Foundation (AMF) – At the same time that we first spoke with GiveDirectly about this grant, we also began discussions with AMF about a possible large grant. AMF believes that it has a large amount of room for more funding (roughly $50 million or more), but as we noted in our May 2015 update, we are hesitant to recommend that it receive a large amount of additional funding (i.e., on the order of tens of millions of dollars) until we can evaluate results from Kasaï Occidental, its first large-scale distribution outside of Malawi. It has recently posted reports from the Kasaï Occidental distribution (see “Distribution” section on this page), and we are currently reviewing them.
• Deworm the World Initiative, led by Evidence Action – We decided not to have a conversation with the Deworm the World Initiative about how it could grow with substantially more funding because, based on our recent analyses, we believed that the organization had limited room for more funding.
• Schistosomiasis Control Initiative (SCI) – We decided not to have a conversation with SCI about how it might be able to use a large grant because a) we felt that we would need to be able to have a better understanding of SCI’s past spending and monitoring before considering recommending a large grant, and b) we have often struggled to communicate effectively with SCI representatives in the past.

The post Good Ventures’ $25 million grant to GiveDirectly appeared first on The GiveWell Blog.

On Wednesday, the International Journal of Epidemiology published two new reanalyses of Miguel and Kremer 2004, the most well-known randomized trial of deworming. Deworming is an intervention conducted by two of our top charities, so we’ve read the reanalyses and the simultaneously updated Cochrane review closely and are responding publicly. We still have a few remaining questions about the reanalyses, and have not had a chance to update much of the content on the rest of our website regarding these issues, but our current view is that these new papers do not change our overall assessment of the evidence on deworming, and we continue to recommend the Schistosomiasis Control Initiative and the Deworm the World Initiative.

Key points:

• We’re very much in support of replicating and stress-testing important studies like this one. We did our own reanalysis of the study in question in 2012, and the replication released recently is more thorough and identifies errors that we did not.
• We don’t think the two replications bear on the most important parts of the case we see for deworming. Both focus on Miguel and Kremer 2004, which examines impacts of deworming on school attendance; in our view, the more important case for deworming comes from a later study that found impacts on earnings many years later. The school attendance finding provides a possible mechanism through which deworming might have improved later-in-life earnings; this is important, because (as stated below) the mechanism is a serious question.
• However, the replications do not directly challenge the existence of an attendance effect either. One primarily challenges the finding of externalities (effects of treatment on untreated students, possibly via reducing e.g. contaminated soil and water) at a particular distance. The other challenges both the statistical significance and the size of the main effect for attendance but we believe is best read as finding significant evidence for a smaller attendance effect. Regardless, the results we see as most important, particularly on income later in life, are not affected.
• The updated Cochrane review seems broadly consistent with the earlier version, which we wrote about in 2012. We agree with its finding that there is little sign of short-term impacts of deworming on health indicators (e.g., weight and anemia) or test scores, and, as we have previously noted, we believe that this does undermine – but does not eliminate – the plausibility of the effect on earnings.
• In our view, the best reasons to be skeptical about the evidence for deworming pertain to external validity, particularly related to the occurrence of El Nino during the period of study, which we have written about elsewhere. These issues are not addressed in the recent releases.
• At the same time, because mass deworming is so cheap, there is a good case for donating to support deworming even when in substantial doubt about the evidence. This has consistently been our position since we first recommend the Schistosomiasis Control Initiative in 2011. Our current cost-effectiveness model (which balances the doubts we have about the evidence with the cost of implementing the program) is here.
• While we think that replicating and challenging studies is a good thing, it looks in this case like there was an aggressive media push – publication of two papers at once coinciding with an update of the Cochrane review and a Buzzfeed piece, all on the same day – that we think has contributed to people exaggerating the significance of the findings.

Details follow. We also recommend the comments on this issue by Chris Blattman (whose post has an interesting comment thread) and Berk Ozler.

The reanalyses of Miguel and Kremer 2004Aiken et al. 2015 and Davey et al. 2015 participated in a replication program hosted by the International Initiative for Impact Evaluation (3ie), in which Miguel and Kremer shared the data from their trials and Aiken, Davey and colleagues reanalysed them. Working paper versions of these reanalyses were published on the 3ie website dated October 2014, and Joan Hamory Hicks, Miguel and Kremer responded to both of them there. The World Bank’s Berk Ozler wrote a blog post in January reviewing the reanalyses and Hicks, Miguel, and Kremer’s replies.

Aiken et al. 2015 straightforwardly attempts to replicate Miguel and Kremer 2004’s results from data and code shared by the authors. They do a much more thorough job than when we attempted something similar in 2012, and find a number of errors.

Amongst a number of smaller issues, Aiken et al. find a coding error in Miguel and Kremer’s estimate of the externality impacts of deworming on students in nearby schools, in which Miguel and Kremer only counted the population of the nearest 12 schools. That coding error substantially changes estimates of the impact of deworming on both the prevalence of worm infections in nearby schools and the attendance of students in nearby schools, particularly estimates of the impact of further out schools, between 3 and 6 km away.

Aiken et al. state: “Having corrected these errors, re-analysis found no statistically significant indirect-between-school effect on the worm infection out- come, according to the analysis methods originally used. However, among variables used to construct this effect, a parameter describing the effect of Group 1 living within 0–3 km did remain significant, albeit at a slightly smaller size (original -0.26, SE 0.09, significant at 95% confidence level; updated -0.21, SE 0.10, significant at 95% confidence). The corresponding parameter for the 3–6- km distances became much smaller and statistically insignificant (original -0.14, SE 0.06, significant at 90% confidence; updated -0.05, SE 0.08, not statistically significant).” Aiken et al.’s supplementary material and Hicks, Miguel, and Kremer’s response to the 3ie replication working paper clarifies this explanation. In short, fixing the coding error does not much affect estimates of the externality within 3 km of treatment schools, but does significantly change estimated externalities between 3 and 6 km out, and following the original Miguel and Kremer 2004 process for synthesizing those estimates into an overall estimate of the cross-school externality on worm prevalence, the resulting figure is not statistically significant. However, if you simply drop the 3-6 km externality estimate, which is now negative and no longer statistically significant, then you continue to see a statistically significant cross-school externality (see the second to last row of Table 1).

The same coding error also affects estimates of the externality effect on school attendance, in a broadly similar way. Aiken et al. write: “Correction of all coding errors in Table IX thus led to the major discrepancies shown in Table 3. The indirect-between-school effect [on attendance] was substantially reduced (from +2.0% to -1.7%) with an increased standard error (from 1.3% to 3.0%) making the result non-significant. The total effect on school attendance was also substantially reduced (from 7.5% to 3.9% absolute improvement), making it only slightly more than one standard error interval away [from] zero, hence also non-significant.” The correction to the coding error significantly increases the standard error of the 3-6km externality estimate, which then increases the standard error of the overall estimate significantly. The increased uncertainty, rather than the change in the point estimate of the externality, is what drives the conclusion that the total effect on school attendance is no longer statistically significant. As in the prevalence externality case, dropping the 3-6km estimate altogether preserves a statistically significant cross-school externality (and total effect).

We are uncertain about what to believe about the externality terms at this point. It seems fairly clear that had Miguel and Kremer caught the coding error prior to publication, their paper would have ignored potential externalities beyond 3km, and the replication done today would have found that the analysis up to 3km was broadly right. The replication penalizes the paper for having initially (incorrectly) found externalities further out. While we continue to be worried about the possibility of specification searching in the externality terms, and we see a case for treating the initial paper as a form of preregistration, we don’t see it as at all obvious that we should penalize the Miguel and Kremer results in the way that Aiken et al. suggest.

The Aiken et al. replication, like the original paper, finds no evidence of an impact on test scores.

Davey et al. 2015 is a more interpretive reanalysis, in which the authors use a more “epidemiological” analytical approach to reanalyze the data. The abstract states:

Results: Quasi-randomization resulted in three similar groups of 25 schools. There was a substantial amount of missing data. In year-stratified cluster-summary analysis, there was no clear evidence for improvement in either school attendance or examination performance. In year-stratified regression models, there was some evidence of improvement in school attendance [adjusted odds ratios (aOR): year 1: 1.48, 95% confidence interval (CI) 0.88–2.52, P = 0.150; year 2: 1.23, 95% CI 1.01–1.51, P = 0.044], but not examination performance (adjusted differences: year 1: −0.135, 95% CI −0.323–0.054, P = 0.161; year 2: −0.017, 95% CI −0.201–0.166, P = 0.854). When both years were combined, there was strong evidence of an effect on attendance (aOR 1.82, 95% CI 1.74–1.91, P < 0.001), but not examination performance (adjusted difference −0.121, 95% CI −0.293–0.052, P = 0.169).
Conclusions: The evidence supporting an improvement in school attendance differed by analysis method. This, and various other important limitations of the data, caution against over-interpretation of the results. We find that the study provides some evidence, but with high risk of bias, that a school-based drug-treatment and health-education intervention improved school attendance and no evidence of effect on examination performance.

Reviewing the key conclusions in order:

• “In year-stratified cluster-summary analysis, there was no clear evidence for improvement in either school attendance or examination performance.” The results of the year-stratified cluster-summary analysis are substantively the same as the results of the year-stratified regression models that Davey et al. use (next bullet), with wider confidence intervals resulting from the reduction in sample size of caused by using unweighted school-level data (N=75). Table 2 reports a 5.5 percentage point impact on attendance in 1998 (corresponding to an odds ratio of 1.78) and a 2.2 percentage point impact for 1999 (corresponding to an odds ratio of 1.21). Davey et al.’s regressions find an odds ratio for 1998 of 1.77 (unadjusted, p=0.097) or 1.48 (adjusted, p=0.150) and for 1999 of 1.23 (unadjusted, p=0.047, or adjusted, p=0.044), i.e. the same point estimates with tighter confidence intervals. We don’t see it as surprising or problematic that collapsing a large cluster-randomized trials’ data to the cluster level results in a loss of statistical significance.
• “In year-stratified regression models, there was some evidence of improvement in school attendance [adjusted odds ratios (aOR): year 1: 1.48, 95% confidence interval (CI) 0.88–2.52, P = 0.150; year 2: 1.23, 95% CI 1.01–1.51, P = 0.044], but not examination performance (adjusted differences: year 1: −0.135, 95% CI −0.323–0.054, P = 0.161; year 2: −0.017, 95% CI −0.201–0.166, P = 0.854).” The lack of a result on exam performance echoes Miguel and Kremer 2004’s results. The “some evidence of improvement” result for school attendance is more striking, since the year 2 results are positive and statistically significant while the year 1 results are more positive but not statistically significant (due to a wider confidence interval). We read this as the test in year 1 being underpowered; treating years 1 and 2 as two independent randomized control trials, a fixed-effects meta-analysis would find a statistically significant overall effect.
• “When both years were combined, there was strong evidence of an effect on attendance (aOR 1.82, 95% CI 1.74–1.91, P < 0.001), but not examination performance (adjusted difference −0.121, 95% CI −0.293–0.052, P = 0.169).” These results accord with the Miguel and Kremer 2004 results.
• “We find that the study provides some evidence, but with high risk of bias, that a school-based drug-treatment and health-education intervention improved school attendance and no evidence of effect on examination performance.” The authors make two main arguments for the high risk of bias. First, they note (in Figure 3) that the correlation across schools between attendance rates and the number of attendance observations appears to differ across the treatment and control groups, with a broad tendency towards positive correlation between observations and attendance rates in the intervention group and a negative correlation in the control group, which would lead to estimates weighted by the number of observations to overestimate the true impact. However, we see three reasons not to regard this evidence as particularly problematic:
  • Hicks, Miguel, and Kremer report conducting a test for the claimed change in the correlation and finding a non-statistically significant result (page 9). As far as we know, Davey et al. have not responded to this point, though we think it is possible that Hicks, Miguel, and Kremer’s test is underpowered.
  • As noted above, the unweighted (year-stratified cluster-summary) estimates are not lower than the year-stratified regression models (which Davey et al. report do weight by observation–“we used random-effects regression on school attendance observations, an approach which gives greater weight to clusters with higher numbers of observations”), they just have wider confidence intervals. In order for the observed correlation to be biasing the weighted results, the weighted estimates would need to be meaningfully different from the unweighted ones, which is not the case here. Accordingly, we see little reason even in Davey et al.’s framework for preferring the less precise year-stratified cluster-summary results to the year-stratified regressions, which use significantly more information to reach virtually the same point estimates.
  • Hicks, Miguel, and Kremer report results weighted by pupil instead of observation (Table 3), and find results strongly consistent with their attendance-weighted results, without the risk of being biased by attendance observations. However, their results imply treatment effects that are larger than the odds ratios reported in Davey et al.’s year-stratified regression models, which Davey et al. report do weight by observation. We’re not sure what to make of this discrepancy, and we haven’t see Davey et al. respond on this point.

  Second, and relatedly, Davey et al. note that the estimated attendance effect in the combined years analysis is larger than in either of the underlying years, and they suggest that the change is due to the inclusion of a before-after comparison for Group 2 (which switched from control in year one to treatment in year two) in the purportedly experimental analysis. We see this concern as more plausible, and don’t have a conclusive view on it at this point, but we think it would affect the magnitude of the observed effect rather than its existence (since we read the year-stratified regressions, which are not subject to this potential bias, as supporting an impact on attendance).

To summarize, we see no reason even based on Davey et al.’s own choices to prefer the year-stratified cluster-summary, which discards a significant amount of information, to the year-stratified regression models, which together point to a statistically significant impact on attendance. Hicks, Miguel, and Kremer make a variety of other arguments against decisions made by Davey et al., and they, along with Blattman and Ozler, argue that many of the changes are jointly necessary to yield non-significant results. We haven’t considered this claim fully because we see the Davey et al. results as supporting a statistically significant attendance impact, but if we turn out to be wrong about that, it would be important to more fully weigh the other deviations they make from Miguel and Kremer’s approach in reaching a conclusion.

School attendance data has never played a major role in our view about deworming (more on our views below), but we see little reason based on these re-analyses to doubt the Miguel and Kremer 2004 result that deworming significantly improved attendance in their experiment. We see much more reason to be worried about external validity, particularly related to the occurrence of El Nino during the period of study, which we have written about elsewhere.

The new Cochrane ReviewThe new Cochrane review on deworming reaches largely the same conclusions as the 2012 update, which we have discussed previously.

The new review incorporates the Aiken et al. and Davey et al. replications of Miguel and Kremer 2004 and the results of the large DEVTA trial, but continues to exclude Baird et al. 2011, Croke 2014, and Ozier 2011.

We agree with the general bottom line that there is little evidence for any biological mechanism linking deworming to longer term outcomes, and that that should significantly reduce one’s confidence in any claimed long-term effects of deworming. However, the Cochrane authors make some editorial judgments we don’t agree with.

They state:

• “The replication highlights important coding errors and this resulted in a number of changes to the results: the previously reported effect on anaemia disappeared; the effect on school attendance was similar to the original analysis, although the effect was seen in both children that received the drug and those that did not; and the indirect effects (externalities) of the intervention on adjacent schools disappeared (Aiken 2015).” As described above, in summarizing the results of Aiken et al. 2015, we would have noted that estimated cross-school externalities remain statistically significant in the 0-3km range.
• “The statistical replication suggested some impact of the complex intervention (deworming and health promotion) on school attendance, but this varied depending on the analysis strategy, and there was a high risk of bias. The replication showed no effect on exam performance (Davey 2015).” We think it is misleading to summarize the results as “[impact on school attendance] varied depending on the analysis strategy, and there was a high risk of bias.” Our read is that Davey et al. reported some analyses in which they discarded a significant amount of information and accordingly lost statistical significance, but found attendance impacts that were consistently positive and of the same magnitude (and statistically significant in analyses that preserved information).
• “There have been some recent trials on long-term follow-up, none of which met the quality criteria needed in order to be included in this review (Baird 2011; Croke 2014; Ozier 2011; described in Characteristics of excluded studies). Baird 2011 and Ozier 2011 are follow-up trials of the Miguel 2004 (Cluster) trial. Ozier 2011 studied children in the vicinity of the Miguel 2004 (Cluster) to assess long-term impacts of the externalities (impacts on untreated children). However, in the replication trials (Aiken 2014; Aiken 2015; Davey 2015), these spill-over effects were no longer present, raising questions about the validity of a long-term follow-up.” This last sentence seems problematic from multiple perspectives:
  • Davey et al. 2015 does not mention or look for externalities or spill-over effects.
  • Aiken et al. 2015 replicates Miguel and Kremer 2004’s finding of a statistically significant externality within 0-3 km, so summarizing it as “these spill-over effects were no longer present” seems to be an over-simplification.
  • The lack of geographic externality is a particularly unpersuasive explanation for excluding Ozier 2011, which focuses on spill-over effects to younger siblings of children who were assigned to deworming, especially given that Aiken et al. confirm Miguel and Kremer’s finding of within-school externalities (which seems more similar to the siblings case). More generally, the fact that one study failed to find a result seems like a bad reason to exclude a follow-up study to it that did.

More generally, we agree with many of the conclusions of the Cochrane review, but excluding some of the most important studies on a topic because they eventually treated the control group seems misguided. Doing so structurally excludes virtually all long-term follow-ups, since they are often ethically required to eventually treat their control groups.

Our case for dewormingAs we wrote in 2012, the last time the Cochrane review on deworming was updated, our review of deworming focuses on three kinds of benefits:

• General health impacts, especially on haemoglobin. We currently conclude, partly based on the last edition of the Cochrane review: “Evidence for the impact of deworming on short-term general health is thin, especially for soil-transmitted helminth (STH)-only deworming. Most of the potential effects are relatively small, the evidence is mixed, and different approaches have varied effects. We would guess that deworming populations with schistosomiasis and STH (combination deworming) does have some small impacts on general health, but do not believe it has a large impact on health in most cases. We are uncertain that STH-only deworming affects general health.” This last claim continues to be in line with Cochrane’s updated finding of no impact of STH-only deworming on haemoglobin and most other short-term outcomes.
• Prevention of potentially severe effects, such as intestinal obstruction. These effects are rare and play a relatively small role in our position on deworming.
• Developmental impacts, particularly on income later in life. The new Cochrane review continues to exclude the studies we see as key to this question. Bleakley 2004 is outside of the scope of the Cochrane review because it is not an experimental analysis, and Baird et al. 2011 is excluded because its control group eventually received treatment. However, as before, the Cochrane review does discuss Miguel and Kremer 2004, which underlies the Baird et al. 2011 follow-up; in their assessment of the risk of bias in included studies, Miguel and Kremer 2004 continues to be the worst-graded of the included trials. We also do not think that the Aiken et al. or Davey et al. papers should substantially affect our assessment of the Baird et al. 2011 results. Aiken et al.’s main finding is about the coding error affecting the 3-6km externality terms. I’m not clear on whether the coding error in the construction of the externality variable extends to Baird et al. 2011, but, regardless, the results we see as most important, particularly on income, do not rely on the externality term. Davey et al.’s key argument is against the combined analysis in which Group 2 is considered control in year one and treatment in year two. I remain uncertain about whether this worry is fundamentally correct, but Baird et al. is not subject to it because their estimates treat Group 2 as consistently part of the treatment group.

  Nonetheless, we continue to have serious reservations about these studies and would counsel against taking them at face value.

We think it’s a particular mistake to analyze the evidence in this case without respect to the cost of the intervention. Table 4 of Baird et al. 2012 estimates that, not counting externalities, their results imply that deworming generates a net present value of $55.26, against an average cost of $1.07, i.e. that deworming is ~50 times more effective than cash transfers. We do not think it is appropriate to take estimates like these at face value or to expect them to generalize without adjustment, but the strong results leave significant room for cost-effectiveness to regress to the mean and still beat cash. In our cost-effectiveness model, we apply a number of ad-hoc adjustments to penalize for external validity and replicability concerns, and most of us continue to guess that deworming is more cost-effective than cash transfers, though of course these are judgment calls and we could easily be wrong.

The lack of a clear causal mechanism to connect deworming to longer term developmental outcomes is a significant and legitimate source of uncertainty as to whether deworming truly has any effect, and we do not think it would be inappropriate for more risk-averse donors to prefer to support other interventions instead, but we don’t agree with the Cochrane review’s conclusion that it’s the long-term evidence that is obviously mistaken in this case. (We have noted elsewhere that most claims for long-term impact seem to be subject to broadly similar problems.)

The importance of data sharing and replicationWe continue to believe that it is extremely valuable and important for authors to share their data and code, and we appreciate that Miguel and Kremer did so in this case. We’re also glad to see the record corrected regarding the 3-6km externality terms in Miguel and Kremer 2004. But our overall impression is that this is a case in which the replication process has brought more heat than light. We hope that the research community can develop stronger norms supporting data sharing and replication in the future.

The post New deworming reanalyses and Cochrane review appeared first on The GiveWell Blog.

On Wednesday, the International Journal of Epidemiology published two new reanalyses of Miguel and Kremer 2004, the most well-known randomized trial of deworming. Deworming is an intervention conducted by two of our top charities, so we’ve read the reanalyses and the simultaneously updated Cochrane review closely and are responding publicly. We still have a few remaining questions about the reanalyses, and have not had a chance to update much of the content on the rest of our website regarding these issues, but our current view is that these new papers do not change our overall assessment of the evidence on deworming, and we continue to recommend the Schistosomiasis Control Initiative and the Deworm the World Initiative.

Key points:

• We’re very much in support of replicating and stress-testing important studies like this one. We did our own reanalysis of the study in question in 2012, and the replication released recently is more thorough and identifies errors that we did not.
• We don’t think the two replications bear on the most important parts of the case we see for deworming. Both focus on Miguel and Kremer 2004, which examines impacts of deworming on school attendance; in our view, the more important case for deworming comes from a later study that found impacts on earnings many years later. The school attendance finding provides a possible mechanism through which deworming might have improved later-in-life earnings; this is important, because (as stated below) the mechanism is a serious question.
• However, the replications do not directly challenge the existence of an attendance effect either. One primarily challenges the finding of externalities (effects of treatment on untreated students, possibly via reducing e.g. contaminated soil and water) at a particular distance. The other challenges both the statistical significance and the size of the main effect for attendance but we believe is best read as finding significant evidence for a smaller attendance effect. Regardless, the results we see as most important, particularly on income later in life, are not affected.
• The updated Cochrane review seems broadly consistent with the earlier version, which we wrote about in 2012. We agree with its finding that there is little sign of short-term impacts of deworming on health indicators (e.g., weight and anemia) or test scores, and, as we have previously noted, we believe that this does undermine – but does not eliminate – the plausibility of the effect on earnings.
• In our view, the best reasons to be skeptical about the evidence for deworming pertain to external validity, particularly related to the occurrence of El Nino during the period of study, which we have written about elsewhere. These issues are not addressed in the recent releases.
• At the same time, because mass deworming is so cheap, there is a good case for donating to support deworming even when in substantial doubt about the evidence. This has consistently been our position since we first recommend the Schistosomiasis Control Initiative in 2011. Our current cost-effectiveness model (which balances the doubts we have about the evidence with the cost of implementing the program) is here.
• While we think that replicating and challenging studies is a good thing, it looks in this case like there was an aggressive media push – publication of two papers at once coinciding with an update of the Cochrane review and a Buzzfeed piece, all on the same day – that we think has contributed to people exaggerating the significance of the findings.

Details follow. We also recommend the comments on this issue by Chris Blattman (whose post has an interesting comment thread) and Berk Ozler.

The reanalyses of Miguel and Kremer 2004Aiken et al. 2015 and Davey et al. 2015 participated in a replication program hosted by the International Initiative for Impact Evaluation (3ie), in which Miguel and Kremer shared the data from their trials and Aiken, Davey and colleagues reanalysed them. Working paper versions of these reanalyses were published on the 3ie website dated October 2014, and Joan Hamory Hicks, Miguel and Kremer responded to both of them there. The World Bank’s Berk Ozler wrote a blog post in January reviewing the reanalyses and Hicks, Miguel, and Kremer’s replies.

Aiken et al. 2015 straightforwardly attempts to replicate Miguel and Kremer 2004’s results from data and code shared by the authors. They do a much more thorough job than when we attempted something similar in 2012, and find a number of errors.

Amongst a number of smaller issues, Aiken et al. find a coding error in Miguel and Kremer’s estimate of the externality impacts of deworming on students in nearby schools, in which Miguel and Kremer only counted the population of the nearest 12 schools. That coding error substantially changes estimates of the impact of deworming on both the prevalence of worm infections in nearby schools and the attendance of students in nearby schools, particularly estimates of the impact of further out schools, between 3 and 6 km away.

Aiken et al. state: “Having corrected these errors, re-analysis found no statistically significant indirect-between-school effect on the worm infection out- come, according to the analysis methods originally used. However, among variables used to construct this effect, a parameter describing the effect of Group 1 living within 0–3 km did remain significant, albeit at a slightly smaller size (original -0.26, SE 0.09, significant at 95% confidence level; updated -0.21, SE 0.10, significant at 95% confidence). The corresponding parameter for the 3–6- km distances became much smaller and statistically insignificant (original -0.14, SE 0.06, significant at 90% confidence; updated -0.05, SE 0.08, not statistically significant).” Aiken et al.’s supplementary material and Hicks, Miguel, and Kremer’s response to the 3ie replication working paper clarifies this explanation. In short, fixing the coding error does not much affect estimates of the externality within 3 km of treatment schools, but does significantly change estimated externalities between 3 and 6 km out, and following the original Miguel and Kremer 2004 process for synthesizing those estimates into an overall estimate of the cross-school externality on worm prevalence, the resulting figure is not statistically significant. However, if you simply drop the 3-6 km externality estimate, which is now negative and no longer statistically significant, then you continue to see a statistically significant cross-school externality (see the second to last row of Table 1).

The same coding error also affects estimates of the externality effect on school attendance, in a broadly similar way. Aiken et al. write: “Correction of all coding errors in Table IX thus led to the major discrepancies shown in Table 3. The indirect-between-school effect [on attendance] was substantially reduced (from +2.0% to -1.7%) with an increased standard error (from 1.3% to 3.0%) making the result non-significant. The total effect on school attendance was also substantially reduced (from 7.5% to 3.9% absolute improvement), making it only slightly more than one standard error interval away [from] zero, hence also non-significant.” The correction to the coding error significantly increases the standard error of the 3-6km externality estimate, which then increases the standard error of the overall estimate significantly. The increased uncertainty, rather than the change in the point estimate of the externality, is what drives the conclusion that the total effect on school attendance is no longer statistically significant. As in the prevalence externality case, dropping the 3-6km estimate altogether preserves a statistically significant cross-school externality (and total effect).

We are uncertain about what to believe about the externality terms at this point. It seems fairly clear that had Miguel and Kremer caught the coding error prior to publication, their paper would have ignored potential externalities beyond 3km, and the replication done today would have found that the analysis up to 3km was broadly right. The replication penalizes the paper for having initially (incorrectly) found externalities further out. While we continue to be worried about the possibility of specification searching in the externality terms, and we see a case for treating the initial paper as a form of preregistration, we don’t see it as at all obvious that we should penalize the Miguel and Kremer results in the way that Aiken et al. suggest.

The Aiken et al. replication, like the original paper, finds no evidence of an impact on test scores.

Davey et al. 2015 is a more interpretive reanalysis, in which the authors use a more “epidemiological” analytical approach to reanalyze the data. The abstract states:

Results: Quasi-randomization resulted in three similar groups of 25 schools. There was a substantial amount of missing data. In year-stratified cluster-summary analysis, there was no clear evidence for improvement in either school attendance or examination performance. In year-stratified regression models, there was some evidence of improvement in school attendance [adjusted odds ratios (aOR): year 1: 1.48, 95% confidence interval (CI) 0.88–2.52, P = 0.150; year 2: 1.23, 95% CI 1.01–1.51, P = 0.044], but not examination performance (adjusted differences: year 1: −0.135, 95% CI −0.323–0.054, P = 0.161; year 2: −0.017, 95% CI −0.201–0.166, P = 0.854). When both years were combined, there was strong evidence of an effect on attendance (aOR 1.82, 95% CI 1.74–1.91, P < 0.001), but not examination performance (adjusted difference −0.121, 95% CI −0.293–0.052, P = 0.169).
Conclusions: The evidence supporting an improvement in school attendance differed by analysis method. This, and various other important limitations of the data, caution against over-interpretation of the results. We find that the study provides some evidence, but with high risk of bias, that a school-based drug-treatment and health-education intervention improved school attendance and no evidence of effect on examination performance.

Reviewing the key conclusions in order:

• “In year-stratified cluster-summary analysis, there was no clear evidence for improvement in either school attendance or examination performance.” The results of the year-stratified cluster-summary analysis are substantively the same as the results of the year-stratified regression models that Davey et al. use (next bullet), with wider confidence intervals resulting from the reduction in sample size of caused by using unweighted school-level data (N=75). Table 2 reports a 5.5 percentage point impact on attendance in 1998 (corresponding to an odds ratio of 1.78) and a 2.2 percentage point impact for 1999 (corresponding to an odds ratio of 1.21). Davey et al.’s regressions find an odds ratio for 1998 of 1.77 (unadjusted, p=0.097) or 1.48 (adjusted, p=0.150) and for 1999 of 1.23 (unadjusted, p=0.047, or adjusted, p=0.044), i.e. the same point estimates with tighter confidence intervals. We don’t see it as surprising or problematic that collapsing a large cluster-randomized trials’ data to the cluster level results in a loss of statistical significance.
• “In year-stratified regression models, there was some evidence of improvement in school attendance [adjusted odds ratios (aOR): year 1: 1.48, 95% confidence interval (CI) 0.88–2.52, P = 0.150; year 2: 1.23, 95% CI 1.01–1.51, P = 0.044], but not examination performance (adjusted differences: year 1: −0.135, 95% CI −0.323–0.054, P = 0.161; year 2: −0.017, 95% CI −0.201–0.166, P = 0.854).” The lack of a result on exam performance echoes Miguel and Kremer 2004’s results. The “some evidence of improvement” result for school attendance is more striking, since the year 2 results are positive and statistically significant while the year 1 results are more positive but not statistically significant (due to a wider confidence interval). We read this as the test in year 1 being underpowered; treating years 1 and 2 as two independent randomized control trials, a fixed-effects meta-analysis would find a statistically significant overall effect.
• “When both years were combined, there was strong evidence of an effect on attendance (aOR 1.82, 95% CI 1.74–1.91, P < 0.001), but not examination performance (adjusted difference −0.121, 95% CI −0.293–0.052, P = 0.169).” These results accord with the Miguel and Kremer 2004 results.
• “We find that the study provides some evidence, but with high risk of bias, that a school-based drug-treatment and health-education intervention improved school attendance and no evidence of effect on examination performance.” The authors make two main arguments for the high risk of bias. First, they note (in Figure 3) that the correlation across schools between attendance rates and the number of attendance observations appears to differ across the treatment and control groups, with a broad tendency towards positive correlation between observations and attendance rates in the intervention group and a negative correlation in the control group, which would lead to estimates weighted by the number of observations to overestimate the true impact. However, we see three reasons not to regard this evidence as particularly problematic:
  • Hicks, Miguel, and Kremer report conducting a test for the claimed change in the correlation and finding a non-statistically significant result (page 9). As far as we know, Davey et al. have not responded to this point, though we think it is possible that Hicks, Miguel, and Kremer’s test is underpowered.
  • As noted above, the unweighted (year-stratified cluster-summary) estimates are not lower than the year-stratified regression models (which Davey et al. report do weight by observation–“we used random-effects regression on school attendance observations, an approach which gives greater weight to clusters with higher numbers of observations”), they just have wider confidence intervals. In order for the observed correlation to be biasing the weighted results, the weighted estimates would need to be meaningfully different from the unweighted ones, which is not the case here. Accordingly, we see little reason even in Davey et al.’s framework for preferring the less precise year-stratified cluster-summary results to the year-stratified regressions, which use significantly more information to reach virtually the same point estimates.
  • Hicks, Miguel, and Kremer report results weighted by pupil instead of observation (Table 3), and find results strongly consistent with their attendance-weighted results, without the risk of being biased by attendance observations. However, their results imply treatment effects that are larger than the odds ratios reported in Davey et al.’s year-stratified regression models, which Davey et al. report do weight by observation. We’re not sure what to make of this discrepancy, and we haven’t see Davey et al. respond on this point.

  Second, and relatedly, Davey et al. note that the estimated attendance effect in the combined years analysis is larger than in either of the underlying years, and they suggest that the change is due to the inclusion of a before-after comparison for Group 2 (which switched from control in year one to treatment in year two) in the purportedly experimental analysis. We see this concern as more plausible, and don’t have a conclusive view on it at this point, but we think it would affect the magnitude of the observed effect rather than its existence (since we read the year-stratified regressions, which are not subject to this potential bias, as supporting an impact on attendance).

To summarize, we see no reason even based on Davey et al.’s own choices to prefer the year-stratified cluster-summary, which discards a significant amount of information, to the year-stratified regression models, which together point to a statistically significant impact on attendance. Hicks, Miguel, and Kremer make a variety of other arguments against decisions made by Davey et al., and they, along with Blattman and Ozler, argue that many of the changes are jointly necessary to yield non-significant results. We haven’t considered this claim fully because we see the Davey et al. results as supporting a statistically significant attendance impact, but if we turn out to be wrong about that, it would be important to more fully weigh the other deviations they make from Miguel and Kremer’s approach in reaching a conclusion.

School attendance data has never played a major role in our view about deworming (more on our views below), but we see little reason based on these re-analyses to doubt the Miguel and Kremer 2004 result that deworming significantly improved attendance in their experiment. We see much more reason to be worried about external validity, particularly related to the occurrence of El Nino during the period of study, which we have written about elsewhere.

The new Cochrane ReviewThe new Cochrane review on deworming reaches largely the same conclusions as the 2012 update, which we have discussed previously.

The new review incorporates the Aiken et al. and Davey et al. replications of Miguel and Kremer 2004 and the results of the large DEVTA trial, but continues to exclude Baird et al. 2011, Croke 2014, and Ozier 2011.

We agree with the general bottom line that there is little evidence for any biological mechanism linking deworming to longer term outcomes, and that that should significantly reduce one’s confidence in any claimed long-term effects of deworming. However, the Cochrane authors make some editorial judgments we don’t agree with.

They state:

• “The replication highlights important coding errors and this resulted in a number of changes to the results: the previously reported effect on anaemia disappeared; the effect on school attendance was similar to the original analysis, although the effect was seen in both children that received the drug and those that did not; and the indirect effects (externalities) of the intervention on adjacent schools disappeared (Aiken 2015).” As described above, in summarizing the results of Aiken et al. 2015, we would have noted that estimated cross-school externalities remain statistically significant in the 0-3km range.
• “The statistical replication suggested some impact of the complex intervention (deworming and health promotion) on school attendance, but this varied depending on the analysis strategy, and there was a high risk of bias. The replication showed no effect on exam performance (Davey 2015).” We think it is misleading to summarize the results as “[impact on school attendance] varied depending on the analysis strategy, and there was a high risk of bias.” Our read is that Davey et al. reported some analyses in which they discarded a significant amount of information and accordingly lost statistical significance, but found attendance impacts that were consistently positive and of the same magnitude (and statistically significant in analyses that preserved information).
• “There have been some recent trials on long-term follow-up, none of which met the quality criteria needed in order to be included in this review (Baird 2011; Croke 2014; Ozier 2011; described in Characteristics of excluded studies). Baird 2011 and Ozier 2011 are follow-up trials of the Miguel 2004 (Cluster) trial. Ozier 2011 studied children in the vicinity of the Miguel 2004 (Cluster) to assess long-term impacts of the externalities (impacts on untreated children). However, in the replication trials (Aiken 2014; Aiken 2015; Davey 2015), these spill-over effects were no longer present, raising questions about the validity of a long-term follow-up.” This last sentence seems problematic from multiple perspectives:
  • Davey et al. 2015 does not mention or look for externalities or spill-over effects.
  • Aiken et al. 2015 replicates Miguel and Kremer 2004’s finding of a statistically significant externality within 0-3 km, so summarizing it as “these spill-over effects were no longer present” seems to be an over-simplification.
  • The lack of geographic externality is a particularly unpersuasive explanation for excluding Ozier 2011, which focuses on spill-over effects to younger siblings of children who were assigned to deworming, especially given that Aiken et al. confirm Miguel and Kremer’s finding of within-school externalities (which seems more similar to the siblings case). More generally, the fact that one study failed to find a result seems like a bad reason to exclude a follow-up study to it that did.

More generally, we agree with many of the conclusions of the Cochrane review, but excluding some of the most important studies on a topic because they eventually treated the control group seems misguided. Doing so structurally excludes virtually all long-term follow-ups, since they are often ethically required to eventually treat their control groups.

Our case for dewormingAs we wrote in 2012, the last time the Cochrane review on deworming was updated, our review of deworming focuses on three kinds of benefits:

• General health impacts, especially on haemoglobin. We currently conclude, partly based on the last edition of the Cochrane review: “Evidence for the impact of deworming on short-term general health is thin, especially for soil-transmitted helminth (STH)-only deworming. Most of the potential effects are relatively small, the evidence is mixed, and different approaches have varied effects. We would guess that deworming populations with schistosomiasis and STH (combination deworming) does have some small impacts on general health, but do not believe it has a large impact on health in most cases. We are uncertain that STH-only deworming affects general health.” This last claim continues to be in line with Cochrane’s updated finding of no impact of STH-only deworming on haemoglobin and most other short-term outcomes.
• Prevention of potentially severe effects, such as intestinal obstruction. These effects are rare and play a relatively small role in our position on deworming.
• Developmental impacts, particularly on income later in life. The new Cochrane review continues to exclude the studies we see as key to this question. Bleakley 2004 is outside of the scope of the Cochrane review because it is not an experimental analysis, and Baird et al. 2011 is excluded because its control group eventually received treatment. However, as before, the Cochrane review does discuss Miguel and Kremer 2004, which underlies the Baird et al. 2011 follow-up; in their assessment of the risk of bias in included studies, Miguel and Kremer 2004 continues to be the worst-graded of the included trials. We also do not think that the Aiken et al. or Davey et al. papers should substantially affect our assessment of the Baird et al. 2011 results. Aiken et al.’s main finding is about the coding error affecting the 3-6km externality terms. I’m not clear on whether the coding error in the construction of the externality variable extends to Baird et al. 2011, but, regardless, the results we see as most important, particularly on income, do not rely on the externality term. Davey et al.’s key argument is against the combined analysis in which Group 2 is considered control in year one and treatment in year two. I remain uncertain about whether this worry is fundamentally correct, but Baird et al. is not subject to it because their estimates treat Group 2 as consistently part of the treatment group.

  Nonetheless, we continue to have serious reservations about these studies and would counsel against taking them at face value.

We think it’s a particular mistake to analyze the evidence in this case without respect to the cost of the intervention. Table 4 of Baird et al. 2012 estimates that, not counting externalities, their results imply that deworming generates a net present value of $55.26, against an average cost of $1.07, i.e. that deworming is ~50 times more effective than cash transfers. We do not think it is appropriate to take estimates like these at face value or to expect them to generalize without adjustment, but the strong results leave significant room for cost-effectiveness to regress to the mean and still beat cash. In our cost-effectiveness model, we apply a number of ad-hoc adjustments to penalize for external validity and replicability concerns, and most of us continue to guess that deworming is more cost-effective than cash transfers, though of course these are judgment calls and we could easily be wrong.

The lack of a clear causal mechanism to connect deworming to longer term developmental outcomes is a significant and legitimate source of uncertainty as to whether deworming truly has any effect, and we do not think it would be inappropriate for more risk-averse donors to prefer to support other interventions instead, but we don’t agree with the Cochrane review’s conclusion that it’s the long-term evidence that is obviously mistaken in this case. (We have noted elsewhere that most claims for long-term impact seem to be subject to broadly similar problems.)

The importance of data sharing and replicationWe continue to believe that it is extremely valuable and important for authors to share their data and code, and we appreciate that Miguel and Kremer did so in this case. We’re also glad to see the record corrected regarding the 3-6km externality terms in Miguel and Kremer 2004. But our overall impression is that this is a case in which the replication process has brought more heat than light. We hope that the research community can develop stronger norms supporting data sharing and replication in the future.

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