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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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Evidence Action — which runs the Deworm the World Initiative, one of GiveWell’s top charities — announced today that Alix Zwane will be stepping down as Executive Director on August 3. She is leaving to join the Global Innovation Fund as CEO. Laliteswar Kumar, currently Director, Africa Region, will serve as Interim Executive Director. Dr. Zwane expects to remain involved in the organization until August. Evidence Action aims to identify a new Executive Director within a few months.

Dr. Zwane’s departure does not change our recommendation of the Deworm the World Initiative and we would guess that it will not be a significant factor in our view of the Deworm the World Initiative in the future. Our recommendation is largely based on the strength of evidence and cost-effectiveness of its program and its track record of carrying out that program.

If this change has more of an effect on our funding recommendations than we expect, this will likely be due to one or more of the following factors:

• We have limited experience with changes in senior leadership at our top charities. All of our other current top charities are led by the organizations’ founders. It is possible that the new Executive Director will have a different vision for the organization or may be unable to generate similar results.
• Strong communication with each of our top charities is a key part of our research process. We have found Dr. Zwane particularly easy to communicate with. Although we have had substantial communication with other staff, much of our communication with the Deworm the World Initiative, particularly around issues related to room for more funding, has been with her. It is possible that communicating with other staff will not be as smooth and could lead to lower confidence in the Deworm the World Initiative’s work.
• Evidence Action’s new Executive Director may have a different approach to transparency. Evidence Action has been highly transparent to date, a quality which we have found to be relatively rare among charities. Dr. Zwane told us that she does not expect Evidence Action’s approach to transparency to change.
• We would not be surprised if Evidence Action fails to identify a new Executive Director within a few months. This search, particularly if it takes a while, could distract from oversight of current programs and planning for the future.

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 addition to recommending the Deworm the World Initiative, we have also recommended that Good Ventures provide funding for Evidence Action Beta, with the goal of supporting the development of new top charities (e.g., a planning grant and a grant for a seasonal income support project).

Dr. Zwane’s departure may have more of an effect on our work with Evidence Action Beta, where all of our communication to date has been with her, where the track record is more limited, and where our positive view of Dr. Zwane’s leadership plays a larger role in our confidence in the program.

Finally, the Global Innovation Fund is an organization that aims to “invest in social innovations that aim to improve the lives and opportunities of millions of people in the developing world” and has significant resources (at least $200 million over the next five years) at its disposal. We are excited about its future under Dr. Zwane’s leadership.

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In December, we published targets for how much money we hoped to move to each of our top four charities, with the expectation of revisiting these targets mid-year:

In past years, we’ve worked on an annual cycle, refreshing our recommendations each December. This year, because we anticipate closing (or nearly closing) the funding gaps of some of our top charities during giving season and moving a significant amount of money (~$5 million) after giving season before our next scheduled refresh, we plan to update our recommendations based solely on room for more funding in the middle of next year. We’re tentatively planning to do this on April 1st, the earliest we will realistically be able to post an update on charities’ ongoing funding needs that accounts for the funds they will receive over the next few months.

These targets were based on a guess that GiveWell-influenced donors would give $7.5 million to our top four charities in December 2014 to March 2015 (excluding Good Ventures and a $1 million gift to SCI from an individual that we knew about prior to setting the targets). Our actual money moved for this period was about $8.7 million to the top four charities, plus $0.4 million that we can allocate at our discretion and have not yet allocated.

Over the past couple of months, we have spoken with each of our top charities to get updates on how much funding they have received from GiveWell-influenced and other donors and their current room for more funding. In sum, the amounts that our top charities raised as a result of our recommendations were broadly consistent with what we expected and there have not been any significant updates to the charities’ room for more funding. Therefore, we are not revising our recommended allocation (for every $7.5 given, $5 to AMF, $1 to GiveDirectly, $1 to SCI, and $0.5 to Deworm the World) at this time.

Summary for December 2014 to March 2015 (all figures in USD millions):

Charity Target from individuals (Dec 2014) Max from individuals (Dec 2014) Actual from individuals Summary Against Malaria Foundation 5 5 4.5 Close to target Schistosomiasis Control Initiative 1 1 1.1 On target Deworm the World Initiative 0.5 1 0.7 Reached target but did not exceed max GiveDirectly 1 25 2.4 Reached target but did not exceed max

 

Against Malaria Foundation (AMF)

Donations to AMF from GiveWell-influenced donors were short of our target by about $0.5 million. AMF is currently in discussions about funding several large-scale bednet distributions. It is our understanding that the amount of funding AMF has available is a limiting factor on both how many nets it can provide to each distribution it is considering and on how many discussions it can pursue at one time.

We have written before about AMF’s lack of track record at signing agreements for and successfully completing large-scale distributions with partners other than Concern Universal in Malawi. In 2014, AMF signed its first agreement to fund a large-scale distribution with another partner in a different country: IMA World Health in the province of Kasaï Occidental in the Democratic Republic of the Congo (more). The Kasaï Occidental distribution was scheduled to be completed in late 2014. We have not yet seen results from this distribution, and AMF’s track record of completing and reporting on successful large-scale distributions remains limited. AMF expects to be able to share information from this distribution in the next few weeks.

We plan to continue recommending funds to AMF for now and to reassess AMF’s progress later in the year.

GiveDirectly

In December, we noted that GiveDirectly could likely absorb up to $25 million in funding from GiveWell-influenced individuals. We tracked $2.4 million to GiveDirectly from these individuals and it is possible that GiveWell influenced several million dollars more – between February 2014 and January 2015, GiveDirectly received several million dollars from individuals who did not provide information on how they learned about the organization. We continue to believe that GiveDirectly has substantial room for more funding.

Schistosomiasis Control Initiative (SCI)

In December we set a target of SCI receiving $1 million from GiveWell-influenced individual donors and set the max we aimed for SCI to receive from this group at the same amount. We estimate that SCI received about $1.1 million based on GiveWell’s recommendation.

We have fairly limited information on SCI’s room for more funding because (a) SCI recently began working with a new financial director and is in the process of reorganizing its financial system, and so has not yet been able to provide us with a comprehensive financial update; and (b) SCI held a meeting on March 24 to allocate unrestricted funds and sent us a report from that meeting recently, which we have not yet had time to review. We will be following up with SCI to learn more about its plans and funding needs.

We plan to continue recommending funds to SCI because (a) our room for more funding estimates for SCI are rough and we believe there is a reasonable chance that SCI has room for more funding; (b) we expect to learn more about SCI’s room for more funding in the next few months; and (c) we do not expect SCI to receive a large amount of funding due to our recommendation over the next few months (since most donors give in December).

Deworm the World Initiative, which is led by Evidence Action

In December we set a target of $0.5 million from GiveWell-influenced individual donors to Deworm the World and set the max we aimed for Deworm the World to receive from this group at $1 million. We estimate that Deworm the World received about $0.66 million based on GiveWell’s recommendation.

It’s our understanding that Deworm the World may have opportunities over the next few years to support up to three deworming programs which could each cost several million dollars. We are in the process of following up with Deworm the World to learn more about how likely these programs are to require unrestricted funding from Deworm the World and when funding might become a bottleneck to moving forward with these programs.

We plan to continue recommending funds to Deworm the World.

The post Top charities’ room for more funding appeared first on The GiveWell Blog.

In December, we published targets for how much money we hoped to move to each of our top four charities, with the expectation of revisiting these targets mid-year:

In past years, we’ve worked on an annual cycle, refreshing our recommendations each December. This year, because we anticipate closing (or nearly closing) the funding gaps of some of our top charities during giving season and moving a significant amount of money (~$5 million) after giving season before our next scheduled refresh, we plan to update our recommendations based solely on room for more funding in the middle of next year. We’re tentatively planning to do this on April 1st, the earliest we will realistically be able to post an update on charities’ ongoing funding needs that accounts for the funds they will receive over the next few months.

These targets were based on a guess that GiveWell-influenced donors would give $7.5 million to our top four charities in December 2014 to March 2015 (excluding Good Ventures and a $1 million gift to SCI from an individual that we knew about prior to setting the targets). Our actual money moved for this period was about $8.7 million to the top four charities, plus $0.4 million that we can allocate at our discretion and have not yet allocated.

Over the past couple of months, we have spoken with each of our top charities to get updates on how much funding they have received from GiveWell-influenced and other donors and their current room for more funding. In sum, the amounts that our top charities raised as a result of our recommendations were broadly consistent with what we expected and there have not been any significant updates to the charities’ room for more funding. Therefore, we are not revising our recommended allocation (for every $7.5 given, $5 to AMF, $1 to GiveDirectly, $1 to SCI, and $0.5 to Deworm the World) at this time.

Summary for December 2014 to March 2015 (all figures in USD millions):

Charity Target from individuals (Dec 2014) Max from individuals (Dec 2014) Actual from individuals Summary Against Malaria Foundation 5 5 4.5 Close to target Schistosomiasis Control Initiative 1 1 1.1 On target Deworm the World Initiative 0.5 1 0.7 Reached target but did not exceed max GiveDirectly 1 25 2.4 Reached target but did not exceed max

 

Against Malaria Foundation (AMF)

Donations to AMF from GiveWell-influenced donors were short of our target by about $0.5 million. AMF is currently in discussions about funding several large-scale bednet distributions. It is our understanding that the amount of funding AMF has available is a limiting factor on both how many nets it can provide to each distribution it is considering and on how many discussions it can pursue at one time.

We have written before about AMF’s lack of track record at signing agreements for and successfully completing large-scale distributions with partners other than Concern Universal in Malawi. In 2014, AMF signed its first agreement to fund a large-scale distribution with another partner in a different country: IMA World Health in the province of Kasaï Occidental in the Democratic Republic of the Congo (more). The Kasaï Occidental distribution was scheduled to be completed in late 2014. We have not yet seen results from this distribution, and AMF’s track record of completing and reporting on successful large-scale distributions remains limited. AMF expects to be able to share information from this distribution in the next few weeks.

We plan to continue recommending funds to AMF for now and to reassess AMF’s progress later in the year.

GiveDirectly

In December, we noted that GiveDirectly could likely absorb up to $25 million in funding from GiveWell-influenced individuals. We tracked $2.4 million to GiveDirectly from these individuals and it is possible that GiveWell influenced several million dollars more – between February 2014 and January 2015, GiveDirectly received several million dollars from individuals who did not provide information on how they learned about the organization. We continue to believe that GiveDirectly has substantial room for more funding.

Schistosomiasis Control Initiative (SCI)

In December we set a target of SCI receiving $1 million from GiveWell-influenced individual donors and set the max we aimed for SCI to receive from this group at the same amount. We estimate that SCI received about $1.1 million based on GiveWell’s recommendation.

We have fairly limited information on SCI’s room for more funding because (a) SCI recently began working with a new financial director and is in the process of reorganizing its financial system, and so has not yet been able to provide us with a comprehensive financial update; and (b) SCI held a meeting on March 24 to allocate unrestricted funds and sent us a report from that meeting recently, which we have not yet had time to review. We will be following up with SCI to learn more about its plans and funding needs.

We plan to continue recommending funds to SCI because (a) our room for more funding estimates for SCI are rough and we believe there is a reasonable chance that SCI has room for more funding; (b) we expect to learn more about SCI’s room for more funding in the next few months; and (c) we do not expect SCI to receive a large amount of funding due to our recommendation over the next few months (since most donors give in December).

Deworm the World Initiative, which is led by Evidence Action

In December we set a target of $0.5 million from GiveWell-influenced individual donors to Deworm the World and set the max we aimed for Deworm the World to receive from this group at $1 million. We estimate that Deworm the World received about $0.66 million based on GiveWell’s recommendation.

It’s our understanding that Deworm the World may have opportunities over the next few years to support up to three deworming programs which could each cost several million dollars. We are in the process of following up with Deworm the World to learn more about how likely these programs are to require unrestricted funding from Deworm the World and when funding might become a bottleneck to moving forward with these programs.

We plan to continue recommending funds to Deworm the World.

The post Top charities’ room for more funding appeared first on The GiveWell Blog.

Our top charities are (in alphabetical order):

• Against Malaria Foundation (AMF)
• Deworm the World Initiative (DtWI), led by Evidence Action
• GiveDirectly
• Schistosomiasis Control Initiative (SCI)

We have recommended all four of these charities in the past.

We have also included four additional organizations on our top charities page as standout charities. They are (in alphabetical order):

• Development Media International (DMI)
• The Global Alliance for Improved Nutrition’s Universal Salt Iodization program (GAIN – USI)
• International Council for the Control of Iodine Deficiency Disorders Global Network (ICCIDD)
• Living Goods

In the case of ICCIDD, GAIN-USI, and DMI, we expect to learn substantially more in the coming years (both through further investigation and through further progress by the organizations); we see a strong possibility that these will become top-tier recommended charities in the future, and we can see reasons that impact-minded donors could choose to support them today.

Ranking our top charities against each other is difficult and laden with judgment calls, particularly since:

• Our cost-effectiveness analyses are non-robust, and reasonable people could reach a very wide variety of conclusions regarding which charity accomplishes the most good per dollar.
• The charity we estimate as having the weakest cost-effectiveness (GiveDirectly) is also the one that we feel has the strongest organizational performance and the most direct, robust connection between donations and impact.
• We do not currently feel highly confident in our cost-effectiveness estimates. We changed a number of inputs to our estimates recently. We did not have time to fully consider and vet them, and we plan to put more work into these estimates over the next few months. We do not expect our estimates to change significantly but given the fact that we have been updating them very recently, we would not be surprised if they do. We plan to publish a post soon detailing the major changes and most debatable assumptions in our current estimates. We consider the lateness of major revisions to this year’s estimates a shortcoming (and will be adding it to our mistakes page when we do our annual review).
• This year we expect to influence a significant amount of donations. In some past years, we’ve been able to assume that each dollar of donations to an organization is about equally effective. This year, we could easily see one or more of our top charities reach the point of diminishing returns to additional donations and/or close its funding gap entirely.
• We’ve been trying to predict and coordinate donations from Good Ventures, from individual donors, and from major donors who have given us private information about their plans. In so doing, we’ve run into game-theoretic challenges. If two donors are interested in funding the same organization, each has an incentive to downplay his/her interest in the hopes that the other will provide more of the funding. We’ve been trying to avoid reinforcing such incentives. We discuss how these considerations affected our targets below, and we plan to elaborate on this issue in a future post.
• In past years, we’ve worked on an annual cycle, refreshing our recommendations each December. This year, because we anticipate closing (or nearly closing) the funding gaps of some of our top charities during giving season and moving a significant amount of money (~$5 million) after giving season before our next scheduled refresh, we plan to update our recommendations based solely on room for more funding in the middle of next year. We’re tentatively planning to do this on April 1st, the earliest we will realistically be able to post an update on charities’ ongoing funding needs that accounts for the funds they will receive over the next few months. This plan also raises questions about donor agency and coordination; we plan to discuss this in a future post.

We’ve tried to balance these considerations against each other and come up with an “ideal allocation” of the ~$7.5 million in estimated “money moved” we expect to influence (not counting grants from Good Ventures) over the next 4 months. Details are below. Based on this allocation, for any donors looking to give as we would, we recommend an allocation of $5 to AMF (67%), $1 to SCI (13%), $1 to GiveDirectly (13%) and $.50 to DtWI (7%) for every $7.50 given.

Good Ventures is planning to make grants of $5 million to each of AMF and GiveDirectly, $3 million to SCI, and $250,000 to DtWI. Good Ventures also plans to make grants of $250,000 to each of the standout organizations. We advised on these grants a few weeks ago, and did so while weighing our funding targets for each charity and forecasts of what other donors are likely to do; parts of our picture have since changed, and these grants do not represent the allocation we would advise donors to use nor do they reflect our views about the relative ranking of these organizations. We made sure to settle on and announce these grants before giving season so that no donor would have to grapple with questions about Good Ventures’s likely actions (more in our upcoming post on donor coordination), and Good Ventures will not be making additional grants to these charities in the near to medium future (6-12 months) unless there are substantive updates on things like evidence bases and capacity for absorbing money (i.e. Good Ventures will not be giving further simply in response to new information about donor behavior over the next 4 months).

Below we provide:

• Additional detail on each of these eight organizations, including (for past recommendations) major changes over the past year, strengths and weaknesses for each, and our understanding of each organization’s room for more funding (which forms the basis for our funding targets and recommended allocation). More
• The thinking behind our funding targets and recommended allocation. More
• The process we followed that led to these top charities. More
• Brief notes on giving now vs. giving later and giving to GiveWell vs. our top charities. More

Conference call to discuss our recommendationsWe are planning to hold a conference call at 5:30pm EST on Wednesday, December 3rd 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.

Top charitiesWe present information on our top charities in alphabetical order.

Against Malaria Foundation (AMF)Our full review of AMF is here.

Important changes in the last 12 months

We named AMF our #1-ranked charity at the end of 2011. Over the next 2 years, AMF received more than $10 million on the basis of our recommendation but struggled to identify opportunities to use the funds it had received. At the end of 2013, we announced that we planned not to recommend additional donations to AMF until it committed the bulk of its current funds. This did not reflect a negative view of AMF; instead it reflected room for more funding related issues. More detail in this blog post.

In 2014, AMF finalized several distributions in Malawi and the Democratic Republic of the Congo (DRC) with three different implementing partners (two of which account for the bulk of the nets to be distributed). In 2014, it committed approximately $8.4 million to distributions which will take place before January 1, 2016 (some of which have already begun) and now has $6.8 million available for future distributions. $1.7 million of this is committed to a distribution scheduled for 2017 (and could potentially be allocated to distributions taking place sooner). Excluding the 2017 distribution, AMF has committed approximately $11.2 million to distributions in its history.

AMF continued to collect and share follow up information on its programs. We covered these reports in our August 2014 AMF update.

Funding gap

AMF requires access to funding in order to negotiate deals because it cannot initiate discussions with potential partners unless it is confident that it will have sufficient funding to support its future agreements. The funding it currently holds would enable it to fund approximately 3 distributions at a scale similar to what it has funded recently.

AMF has told us that it has a pipeline of possible future net distributions that add up to $36 million (details in our review).

We see some reason for caution in thinking about AMF’s room for more funding. It has made strong progress on being able to negotiate distributions and commit funds. However, as of today there have only been two large-scale distributions that have moved forward far enough for data to be available. Both of these are significantly smaller than distributions AMF has recently or will soon fund, and both are in the same area with the same partner as each other. Some of the recently negotiated distributions could prove more challenging (since they are in DRC).

If AMF received an additional $10 million in total over the next 4 months, it would have about twice as much funding available as the total it committed to large-scale distributions in 2014. (As stated above, it committed $8.4 million to distributions taking place before 2017 and has $6.8 million available for further commitments.) If it received $25 million, it would have about 4 times that total. 2-4 times past distributions seems like a range that would allow AMF to do significantly more than it has in the past, without going so far beyond its past capacity as to raise serious scaling concerns.

We believe that $10 million total (the low end of that range), which means $5 million after the Good Ventures grant, is an appropriate target after which further donations are likely better off going to other charities.

Key considerations:

• Program impact and cost-effectiveness. Our best guess is that distributing bednets is in the same cost-effectiveness range as deworming programs and more cost-effective than cash transfers by a factor of 5-10. Our estimates are subject to substantial uncertainty. (Note: all our cost-effectiveness analyses are available here. Our file for bednets is here (.xls), and the comparison to deworming, cash transfers and iodine is here (.xls).)
• 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 DtWI’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 SCI and worse than 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 followup).
• Risks:
  • Two of AMF’s recent distributions (and much of its future pipeline) will take place in the DRC. Our impression is that the DRC is a particularly difficult place to work, and it is possible that AMF’s distributions there will struggle or fail. We view this as a moderate risk.
  • 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.

A note on how quickly we expect AMF to spend the funds it receives. AMF works by sourcing, evaluating and negotiating deals for net distributions. This process takes time and requires AMF to have significant access to funding – it cannot approach a country to begin negotiations unless it is confident that it will have sufficient funding to pay for the nets it offers. We would not be surprised if AMF fails to reach additional deals in the next 12 months. We do expect it to commit the majority of its available funds (that it will have as of this coming January) within the next 24 months. If AMF does not make much progress in committing funds in the next 12 months, we will adjust our recommendation for 2015 accordingly, possibly recommending a lower target level of funds or suspending the recommendation entirely (depending on the specifics of the situation).

Our full review of AMF is here.

Deworm the World Initiative, (DtWI), led by Evidence ActionOur full review of DtWI is here.

Important changes in the last 12 months

Dr. Kevin Croke released a new study of a randomized controlled trial of a deworming program showing large, long-term impacts from deworming programs (for more, see this blog post). This study is a significant positive update on the impacts of deworming and increased our confidence that deworming programs have significant long-term impacts.

DtWI spent the funds it received due to GiveWell’s recommendation largely as we anticipated; it now has some (though limited) room for more funding.

In 2014, two events affected DtWI’s projection of the additional funding it would require to scale up in India:

• The Children’s Investment Fund Foundation (CIFF), a major foundation that had supported DtWI’s programs in Kenya, agreed to a 6-year, $17.7 million grant to support DtWI’s expansion to additional states in India and technical assistance to the Government of India for a national deworming program. With these funds, DtWI does not require significant additional funding to support its India expansion.
• The new Indian government expressed interest in conducting a single deworming day nationally with increased national attention and resources. Advocating for such a policy and assisting the national government in creating a plan became the major focus of DtWI’s India work in 2014, which both reduced the amount of time it was able to spend generating interest in heavy DtWI involvement in new states and also required little funding since there were few costs of that project aside from staff time. We see this as positive news regarding DtWI’s potential impact; it may simply reduce DtWI’s further need for funds from individual donors.

Together, these changes led DtWI to the conclusion that funding is no longer the bottleneck to reaching more people in India. (More detail in this blog post.)

Funding gap

DtWI told us that it seeks $1.3 million over the next two years. We expect it to allocate approximately 30% of the additional funds it receives for work related to expanding school-based, mass deworming programs (including related operating and impact evaluation expenses) and will allocate other funds to priorities that are less directly connected to expanding and evaluating deworming programs (investigating ways to combine other evidence-based programs with deworming rollouts, supplementing a project supported by another funder).

Good Ventures has announced a $250,000 grant to DtWI, leaving it with $1.05 million in remaining room for more funding over the next two years. We would ideally like DtWI to receive an additional $500,000 (for a total of $750,000) to provide it with more than half of its two-year gap.

Key considerations:

• Program impact and cost-effectiveness. Our current calculations indicate that DtWI-associated deworming, when accounting for DtWI’s potential “leverage” in influencing government funds, has extremely strong cost-effectiveness, better than bednets and 10-20 times better than cash transfers. Our estimates are subject to substantial uncertainty. (Note: all our cost-effectiveness analyses are available here. Our file for deworming, cash transfers and iodine is here (.xls).)
• Directness and robustness of the case for impact. DtWI 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. There are substantial potential advantages to supporting such an organization, as it may be able to have more impact per dollar by influencing government policy than by simply carrying out programs on its own, but this situation also complicates impact assessment. While we believe DtWI is impactful, our evidence is limited, and in addition, there is always a risk that future expansions will prove more difficult than past ones. In addition, DtWI is now largely raising funds to support research projects that are not directly connected to short-term implementation of deworming programs. We do not have a view about the value of these research projects.
• Transparency and communication. DtWI has been communicative and open with us. We have only recommended DtWI for one year and therefore have less history with it than AMF, GiveDirectly, or SCI, but we believe that were something to go wrong with DtWI’s work, we would be able to learn about it and report on it.
• Risks:
  • DtWI is part of a larger organization, Evidence Action, so changes that affect Evidence Action (and its other programs) could indirectly impact DtWI. 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 DtWI.
  • Most of DtWI’s funding is in the form of restricted funding from large, institutional funders. We are not sure how DtWI’s plans would change in response to a large funder offering it significant support to undertake a project not directly in line with its current plans.

Our full review of DtWI is here.

GiveDirectlyOur full review of GiveDirectly is here.

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 high quality.

In June, three of its board members launched Segovia, a for-profit company aimed at improving the efficiency of cash transfer distributions in the developing world (see our blog post on Segovia for more information).

GiveDirectly is working with other researchers to begin a very large study on cash transfers and the impact they have on broader economic factors such as inflation and job growth. This study will include a long-term follow up component as well. GiveDirectly told us that the ideal sample size for this study, which is randomized at the village level, would require $15 million for cash transfers. Baseline data collection for the study began in August 2014. GiveDirectly has preregistered its plans for measurement and analysis (more information in our review).

Funding gap

GiveDirectly has scaled up significantly over the past year, spending (or committing to spend by enrolling recipients) approximately $13.6 million of the $17.4 million it received last year. (It also allocated an additional $1.8 million to other organizational costs.) It now believes that it could spend up to $40 million in a year.

We believe this is a reasonable cap for GiveDirectly and would not hesitate to see it receive this amount. However, due to other charities’ significantly superior estimated cost-effectiveness, we are seeking larger total amounts for them. We hope that GiveDirectly will receive at least $1 million from individual donors (excluding Good Ventures) this giving season as a result of our recommendation.

Key considerations:

• Program impact and cost-effectiveness. Our best guess is that deworming or distributing bednets achieves 5-10 times more humanitarian benefit per dollar donated than cash transfers. Our estimates are subject to substantial uncertainty. (Note: all our cost-effectiveness analyses are available here. Our file for deworming, cash transfers and iodine is here (.xls).)
• 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.
• 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 we expect.

Our full review of GiveDirectly is here.

Schistosomiasis Control Initiative (SCI)Our full review of SCI is here.

Important changes in the last 12 months

As discussed above regarding DtWI, Dr. Kevin Croke released a new study of a randomized controlled trial of a deworming program showing large, long-term impacts from deworming programs (for more, see this blog post). This study is a significant positive update on the impacts of deworming and increased our confidence that deworming programs have significant long-term impacts.

We continued our work revisiting SCI’s case for impact (detailed here). There appear to have been major problems with some, though not all, of the studies we had relied on (pre-2013) to assess SCI’s impact. SCI shared some additional monitoring information with us which supported the conclusion that its programs have generally succeeded, though these reports have significant limitations.

We also reviewed the papers of several academics who had previously been critical of SCI’s activities. We found little in this literature to change our views on SCI’s programs.

We spent significantly more time with SCI in 2014 (including a 3-day visit to its headquarters in London) than we had in previous years, aiming to improve our understanding of its operations and spending. The picture that emerged was more detailed though largely consistent with what we believed before. Specifically:

• We are less confident in our understanding of how SCI has spent unrestricted funds. At the end of 2013, we believed we had a relatively strong understanding of SCI’s unrestricted spending, but after spending additional time reviewing reports and discussing with SCI staff, we have more questions today than we did a year ago.
• We have better information about how SCI plans to use additional funds it receives and the constraints, besides funding, that SCI faces in utilizing additional funding (more in our review).

Funding gap

SCI told us that it has approximately $3.8 million worth of opportunities that it would be highly likely to undertake if it had the funding available. (Some of this would be spent in 2015 and some held for the following year to ensure programs can continue once started). It believes it could possibly absorb an additional $4.5 million (up to $8.3 million total) for opportunities that are more speculative. Overall, our best guess is that SCI will use up to approximately $6.3 million and, beyond that, would build up reserves.

Partly for reasons of donor coordination, we have set its target at $6.8 million total (more below). We hope that SCI will receive $1 million from individual donors (excluding Good Ventures) this giving season as a result of our recommendation.

Key considerations:

• Program impact and cost-effectiveness. Our best guess is that deworming is roughly as cost-effective as distributing bednets and more cost-effective than cash transfers by a factor of 5-10. Our estimates are subject to substantial uncertainty. (Note: all our cost-effectiveness analyses are available here. Our file for deworming, cash transfers and iodine is here (.xls).)
• Directness and robustness of the case for impact. We have seen some evidence demonstrating that SCI successfully deworms 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 is successfully deworming people. We have had difficulties communicating with SCI (see below), which has reduced our ability to understand it; we have also spent significant time interviewing SCI staff and reviewing documents over the past 5 years and have found minor but not major concerns.
• Transparency and communication. We have had consistent difficulties communicating with SCI. 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 of 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 AMF and GiveDirectly, both of which we feel we have a strong ability to follow up.
• Risks: There are significantly more unknown risks with SCI than our other top charities due to our limited understanding of its activities. We hope for SCI to have $6.8 million available, which is significantly more unrestricted funding than it has had available in the past.

Our full review of SCI is here.

SummaryThe table below summarizes the key considerations for our four top charities.

Consideration AMF DtWI GiveDirectly SCI Program estimated cost-effectiveness (relative to cash transfers) 5-10x 10-20x 1x 5-10x (and possibly more) Directness and robustness of the case for impact Strong Weakest 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 (more below) High Limited Very high Limited when accounting for all donors

 

Note the absence of two criteria we have put weight on in years past:

• Program evidence of effectiveness. With the new evidence about deworming, we think differences on this front are much reduced, though we still think net distribution and cash transfers have more robust cases than deworming.
• Potential for innovation/upside. All of these organizations are fairly mature at this point, and we expect each to get significant revenue this giving season.

Standouts

Much of the work we did this year went into investigating potential new additions to our top charities list. The strongest contenders we found are discussed below.

Ultimately, none of these made it into our top tier of recommendations, but that could easily change in the future. We believe that more investigative effort could result in a much better understanding of GAIN-USI (discussed below) and potentially a top-tier recommendation. Meanwhile, ICCIDD and DMI (also discussed below) do not have the track record we’d want to see for our top tier of recommendations, but in both cases we expect major developments in the next year. Specifically, ICCIDD will have a substantially larger working budget (due to GiveWell money moved), and DMI may have new data from its randomized controlled trial that could cause a significant upgrade in its status.

These are all strong giving opportunities, and we’ve vetted them all relatively thoroughly. Two work on a program (universal salt iodization) that we believe has excellent cost-effectiveness and a strong evidence base, and the other two have recently released data from randomized evaluations of their own programs (something that is very rare among charities). We have thoroughly vetted each of these organizations, including site visits. And we can see arguments for supporting these organizations in lieu of our top charities this year, though we ultimately recommend our top charities above them.

Below are some brief comments on each standout organization. Donors interested in learning more should read our full reviews of each organization.

Development Media International (DMI) produces radio and television broadcasts in developing countries that encourage people to adopt improved health practices, such as exclusive breastfeeding of infants and seeking treatment for symptoms associated with fatal diseases. Its programs reach many people for relatively little money, so if its program successfully changes listeners’ behavior, it may be extremely cost-effective. It is in the midst of running a randomized controlled trial of its program; the midline results were released earlier this year, at which point we blogged about them.

At midline, the study found moderate increases (relative to the control group) in self-reported health behaviors. Our attempt to estimate the likely mortality impact of these behaviors – when accounting for other concerns about the generalizability of the study – implied cost-effectiveness worse than AMF’s. This isn’t sufficient for a recommendation this year, as DMI has much less of a track record than our top charities. However, if endline results hit DMI’s targeted mortality impact, we would expect to adjust our estimate significantly, and DMI could become a top charity.

DMI’s current budget is approximately $2.5 million; it has told us it expects to receive approximately $2.5-$4 million from existing funders in the next year and could absorb an additional $6-$7.5 million, which it would either use to supplement a program already broadcasting in a country or move into a new country, depending on how much it received.

Our cost-effectiveness analysis for DMI is here (.xls).

Our full review of DMI is here.

GAIN-USI. GAIN’s Universal Salt Iodization (USI) program supports salt iodization programs. There is strong evidence that salt iodization programs have a significant, positive effect on children’s cognitive development, and we consider the program to accomplish (very roughly speaking) comparable good per dollar to bednets and deworming (see our intervention report).

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 diminished impact depending on its effectiveness. 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.

GAIN’s USI program was one of the recipients of a large, multi-year grant from the Bill and Melinda Gates Foundation. The grant ends in 2015 and has yet to be renewed; we are unsure of whether it will be.

Donors whose primary interest is supporting a strong intervention, and who are comfortable supporting a large and reputable organization whose role is to promote and support the intervention (but whose track record we cannot assess at this time), should strongly consider supporting GAIN’s USI program.

GAIN is a large organization running many programs, so donors should consider the possibility that funds restricted to GAIN’s USI program might effectively support its other efforts (more on this general concern here). GAIN told us that it has very little unrestricted funding, so it is unlikely to be able to reallocate funds from other programs to continue to support USI work. It is possible that resources that are shared across programs (such as some staff) could be shifted toward other programs if resources for USI increased, but we would guess that this effect would be small.

Our cost-effectiveness analysis for deworming, cash transfers and iodine is here (.xls).

Our full review of GAIN is here.

International Council for the Control of Iodine Deficiency Disorders Global Network (ICCIDD). Like GAIN-USI, ICCIDD supports (via advocacy and technical assistance rather than implementation) salt iodization, and as with GAIN-USI, we tried but were unable to establish a track record of successfully contributing to iodization programs. Unlike GAIN-USI, ICCIDD is small, operating on a budget of approximately half a million dollars per year, and relies heavily on volunteer time. We believe that additional funding in the range of a few hundred thousand dollars could have a significant positive impact on its operations.

Good Ventures has granted a total of $350,000 to ICCIDD this year ($100,000 as a participation grant and $250,000 with the grants announced today), and we would be happy to see ICCIDD receive a few hundred thousand dollars more, after which point we would be more hesitant as it would be more than doubling its budget. We hope that ICCIDD will use the additional funding to improve its capacity and potentially become a top charity in the future.

Our cost-effectiveness analysis for deworming, cash transfers and iodine is here (.xls).

Our full review of ICCIDD 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, bed nets, clean cook stoves and solar lights.

It 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. Living Goods has been operating on a budget of $3 million per year and aims to scale up to operate on a budget of $10 million per year, of which it expects to receive approximately two-thirds from existing funders.

Our cost-effectiveness analysis for Living Goods is here (.xls).

Our full review of Living Goods is here.

Funding targets by charityIn order to give guidance to donors seeking to give as we would, we’ve come up with funding targets for each charity. These targets are based on “dividing up” $7.5 million in money moved, which is our best guess for how much individual donors will give based on our recommendations over the next 4 months.

We are using the following principles in setting targets:

• We’d like each top charity to receive a substantial amount of funding. When a charity receives substantial funding at our recommendation, it (a) gives that charity good reason to continue working with us, reporting to us, and helping us learn further about its activities; (b) gives that charity the opportunity to continue building its track record and demonstrating its capabilities, information we will use in future years; and (c) continues to reinforce the idea that GiveWell-recommended charities receive substantial funding – the main incentive charities have to participate in our process.
• All else equal, we’d like stronger overall charities – defined as those that accomplish more good per dollar, taking all considerations into account – to receive more funding.
• Each charity has a conceptual “maximum” past which we think donations would hit strongly diminishing returns. We aren’t allocating any “money moved” to a charity in excess of the max; beyond that point, we think the money is better spent supporting other top charities.

We are also taking the announced Good Ventures grants into account. These grants were recommended using similar considerations, though some of our information has changed.

Our targets are as follows. Note the distinction between “total max” (the most we’d be comfortable seeing a charity take in, at which point we would make an announcement), “total target” (the total amount we would like to see this charity take in, including Good Ventures grants and other donations), “target from individuals” (the amount we are seeking specifically from GiveWell-influenced individual over the next four months), and “max from individuals” (the most we’d be comfortable seeing a charity take in, taking into account what we know about other donors’ plans).

• Against Malaria Foundation: $5 million target from individuals, $5 million max from individuals. As discussed in the section on AMF, our ideal amount for AMF to take in would be $10 million this giving season, and Good Ventures has already committed $5 million. We therefore target $5 million for AMF.
• Deworm the World Initiative: $0.5 million target from individuals, $1 million max from individuals. We think Deworm the World Initiative is an outstanding giving opportunity with limited room for more funding, as discussed above.
• Schistosomiasis Control Initiative: $1 million target from individuals, $1 million max from individuals. We believe SCI will end the giving season with $3 million from Good Ventures, $1 million from a major donor who discussed his plans with us, $1 million in donations that we expect to come from non-GiveWell-related sources (based on projections from past years rather than on knowledge of specific donors). We also believe it has $1 million in cash available for the $6.3-$8.3 million in opportunities we describe above. In total, then, SCI already can expect to have $6 million available, which would be around the maximum we’d recommend in isolation. However, our discussion with the possible $1 million donor has led us to set a higher overall “total target” than we would have otherwise, settling on a total target of $6.8 million. (We plan to elaborate on our thoughts about donor coordination and donor agency in a future post.) Since we are hoping for SCI to have a total of $6.8 million available for its activities, we are recommending $1 million in donations from GiveWell-influenced individuals this giving season. (We are rounding $0.8 million in estimated remaining gap to $1 million in recommended giving since these figures are not precise, and we see value in round numbers for our targets.)
• GiveDirectly: $1 million target from individuals, $25 million max from individuals. We believe GiveDirectly could absorb up to $40 million total ($5 million from the Good Ventures grant, $10 million we expect it to receive from non-GiveWell-related sources already, and $25 million on top of that). However, our revised cost-effectiveness estimates (which we will discuss more in a future post) now classify cash transfers as significantly less cost-effective than bednet distribution and deworming, by a factor of around 5-10. In addition, the $5 million grant from Good Ventures and the funds we expect it to receive from elsewhere means that GiveDirectly will raise nearly as much in its next fiscal year as it did last year. Given that we anticipate moving roughly $7.5 million from individual donors in the next four months, we’d like to direct roughly $1 million of those donations to GiveDirectly. Note that GiveDirectly is, by a substantial amount, the organization we feel has performed best and most consistently in carrying out its intervention and providing quality data on the results, and people who are particularly skeptical of cost-effectiveness estimates are likely to find it the most appealing. We also are very excited about the future of GiveDirectly, in terms of its continuing ability to produce useful information via studies and its potential to grow and raise more from sources unconnected to GiveWell, though at this point we feel GiveDirectly is mature enough that further donations are not crucial in helping it toward this goal.

Summary table (all figures in USD millions):

Charity Total max (including all donations) Total target (including all donations) Donations committed or expected from Good Ventures and non-GiveWell sources Target from individuals Max from individuals Against Malaria Foundation 10 10 5 5 5 Schistosomiasis Control Initiative 6.8 6.8 6 1 1 Deworm the World Initiative 1.3 0.75 0.25 0.5 1 GiveDirectly 40 16 15 1 25

For donations beyond the ~$7.5 million total we’re projecting over the next four months, we think the decision of which charity to support would be particularly difficult. Of our top charities, only GiveDirectly would have clear room for more funding after receiving an amount in line with the above, but the others – and to a lesser extent, some of our standout charities – have significantly superior estimated cost-effectiveness according to our latest analyses. We will be continuing to stress-test and reflect on these analyses as we reflect on the question of how to modify our recommendations once the above targets are hit.

Our research process in 2014This section describes the new work we did in 2014 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 completed an investigation of one new intervention (salt iodization). We made substantial progress on several others (maternal and neonatal tetanus immunization campaigns, mass drug administration for lymphatic filariasis, and vitamin A supplementation) but did not complete them.

We also stayed up to date on the research for bednets, cash transfers and deworming and made a substantial update to our view on deworming, based on a new study by Kevin Croke.

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. (Living Goods is an exception; it contacted us with the results from its randomized controlled trial.)

A February post laid out which organizations we were hoping to investigate and why.

In addition to the 4 standout charities, we also considered Nothing but Nets (a bednets organization that declined to participate in our process), Evidence Action’s Dispensers for Safe Water program (which is forthcoming), the Center for Neglected Tropical Disease and UNICEF’s maternal and neonatal tetanus program. In the case of the latter two, we ran out of time to complete the relevant intervention reports this year (due to prioritizing other work, which seemed more likely to lead to new recommendations) and plan to complete them in 2015.

Brief notes on giving now vs. later and supporting GiveWell vs. top charitiesGiving now vs. giving later

Last year, some staff members chose to save some of their charitable giving budget for future giving opportunities, and we discussed the considerations about giving now vs. later in this post.

This year, we think the situation is a bit different, as AMF has returned to our top charities list, the case for both SCI and GiveDirectly has improved (due to new evidence on deworming and GiveDirectly’s strong performance in disbursing cash transfers), and we have extensively investigated possible other options. With these changes, we feel that (unlike last year) this year is an excellent year to give a substantial amount if you are interested primarily on our top charities work. We think our top charity recommendations are unlikely to improve a great deal (i.e. they’re unlikely to improve enough to make saving worthwhile) in the coming years. A couple considerations that might be relevant in weighing the decision to give now versus later:

• Will the giving opportunities available in the future be better than the ones we have identified now? There are competing factors. On one hand, our research capacity has expanded significantly over the past 2 years, and this has given us the ability to research more opportunities both in our traditional, top charities work and the Open Philanthropy Project. On the other, the world is getting better and some of the best opportunities available today (e.g., deworming, bednets, salt iodization) may no longer be available 10 years from now. We now feel that we’ve investigated a large proportion of realistic short-to-medium-term contenders for top charity recommendations. If money moved ends up exceeding the ~$7.5 million we’re projecting over the next four months, a stronger case for waiting may emerge, as many of the strongest charities will be near what we think they can productively absorb in the short term (and our standout charities may become recommended next year, as discussed in the section on standouts).
• How much funding will be available in the future to the opportunities we identify? Our impression is that funding available for the opportunities we identify has and will continue to grow significantly. Good Ventures is a part of this, but we hope that other future, major philanthropists will consider supporting our recommendations as Good Ventures has.

Donors interested in supporting opportunities that come from the Open Philanthropy Project have a stronger case for saving to give later. Note that it could be several years before the Open Philanthropy Project has recommendations suitable for individual donors, and these recommendations will likely reflect a very different process, very different criteria, and a much higher tolerance for high-risk opportunities that are difficult to fully explain and defend in writing (though we will work hard to lay out the basic case).

Giving to GiveWell vs. our top charities

We have grown significantly over the past 2 years and continue to raise funds to support our operations. The funds we have received have enabled us to expand our staff. Without this increased capacity, we would not have been able to consider as many organizations as we did this year.

We plan to post an update soon about our budget situation. The most up to date information available is linked from our August board meeting. The short story is that we are still seeking additional donations. For the first time this year, our checkout form will ask donors to consider allocating 10% of their donation to our operating expenses. This option is not yet live on our website; we hope to implement this change in the next few weeks.

The post Our updated top charities appeared first on The GiveWell Blog.

Our top charities are (in alphabetical order):

• Against Malaria Foundation (AMF)
• Deworm the World Initiative (DtWI), led by Evidence Action
• GiveDirectly
• Schistosomiasis Control Initiative (SCI)

We have recommended all four of these charities in the past.

We have also included four additional organizations on our top charities page as standout charities. They are (in alphabetical order):

• Development Media International (DMI)
• The Global Alliance for Improved Nutrition’s Universal Salt Iodization program (GAIN – USI)
• International Council for the Control of Iodine Deficiency Disorders Global Network (ICCIDD)
• Living Goods

In the case of ICCIDD, GAIN-USI, and DMI, we expect to learn substantially more in the coming years (both through further investigation and through further progress by the organizations); we see a strong possibility that these will become top-tier recommended charities in the future, and we can see reasons that impact-minded donors could choose to support them today.

Ranking our top charities against each other is difficult and laden with judgment calls, particularly since:

• Our cost-effectiveness analyses are non-robust, and reasonable people could reach a very wide variety of conclusions regarding which charity accomplishes the most good per dollar.
• The charity we estimate as having the weakest cost-effectiveness (GiveDirectly) is also the one that we feel has the strongest organizational performance and the most direct, robust connection between donations and impact.
• We do not currently feel highly confident in our cost-effectiveness estimates. We changed a number of inputs to our estimates recently. We did not have time to fully consider and vet them, and we plan to put more work into these estimates over the next few months. We do not expect our estimates to change significantly but given the fact that we have been updating them very recently, we would not be surprised if they do. We plan to publish a post soon detailing the major changes and most debatable assumptions in our current estimates. We consider the lateness of major revisions to this year’s estimates a shortcoming (and will be adding it to our mistakes page when we do our annual review).
• This year we expect to influence a significant amount of donations. In some past years, we’ve been able to assume that each dollar of donations to an organization is about equally effective. This year, we could easily see one or more of our top charities reach the point of diminishing returns to additional donations and/or close its funding gap entirely.
• We’ve been trying to predict and coordinate donations from Good Ventures, from individual donors, and from major donors who have given us private information about their plans. In so doing, we’ve run into game-theoretic challenges. If two donors are interested in funding the same organization, each has an incentive to downplay his/her interest in the hopes that the other will provide more of the funding. We’ve been trying to avoid reinforcing such incentives. We discuss how these considerations affected our targets below, and we plan to elaborate on this issue in a future post.
• In past years, we’ve worked on an annual cycle, refreshing our recommendations each December. This year, because we anticipate closing (or nearly closing) the funding gaps of some of our top charities during giving season and moving a significant amount of money (~$5 million) after giving season before our next scheduled refresh, we plan to update our recommendations based solely on room for more funding in the middle of next year. We’re tentatively planning to do this on April 1st, the earliest we will realistically be able to post an update on charities’ ongoing funding needs that accounts for the funds they will receive over the next few months. This plan also raises questions about donor agency and coordination; we plan to discuss this in a future post.

We’ve tried to balance these considerations against each other and come up with an “ideal allocation” of the ~$7.5 million in estimated “money moved” we expect to influence (not counting grants from Good Ventures) over the next 4 months. Details are below. Based on this allocation, for any donors looking to give as we would, we recommend an allocation of $5 to AMF (67%), $1 to SCI (13%), $1 to GiveDirectly (13%) and $.50 to DtWI (7%) for every $7.50 given.

Good Ventures is planning to make grants of $5 million to each of AMF and GiveDirectly, $3 million to SCI, and $250,000 to DtWI. Good Ventures also plans to make grants of $250,000 to each of the standout organizations. We advised on these grants a few weeks ago, and did so while weighing our funding targets for each charity and forecasts of what other donors are likely to do; parts of our picture have since changed, and these grants do not represent the allocation we would advise donors to use nor do they reflect our views about the relative ranking of these organizations. We made sure to settle on and announce these grants before giving season so that no donor would have to grapple with questions about Good Ventures’s likely actions (more in our upcoming post on donor coordination), and Good Ventures will not be making additional grants to these charities in the near to medium future (6-12 months) unless there are substantive updates on things like evidence bases and capacity for absorbing money (i.e. Good Ventures will not be giving further simply in response to new information about donor behavior over the next 4 months).

Below we provide:

• Additional detail on each of these eight organizations, including (for past recommendations) major changes over the past year, strengths and weaknesses for each, and our understanding of each organization’s room for more funding (which forms the basis for our funding targets and recommended allocation). More
• The thinking behind our funding targets and recommended allocation. More
• The process we followed that led to these top charities. More
• Brief notes on giving now vs. giving later and giving to GiveWell vs. our top charities. More

Conference call to discuss our recommendationsWe are planning to hold a conference call at 5:30pm EST on Wednesday, December 3rd 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.

Top charitiesWe present information on our top charities in alphabetical order.

Against Malaria Foundation (AMF)Our full review of AMF is here.

Important changes in the last 12 months

We named AMF our #1-ranked charity at the end of 2011. Over the next 2 years, AMF received more than $10 million on the basis of our recommendation but struggled to identify opportunities to use the funds it had received. At the end of 2013, we announced that we planned not to recommend additional donations to AMF until it committed the bulk of its current funds. This did not reflect a negative view of AMF; instead it reflected room for more funding related issues. More detail in this blog post.

In 2014, AMF finalized several distributions in Malawi and the Democratic Republic of the Congo (DRC) with three different implementing partners (two of which account for the bulk of the nets to be distributed). In 2014, it committed approximately $8.4 million to distributions which will take place before January 1, 2016 (some of which have already begun) and now has $6.8 million available for future distributions. $1.7 million of this is committed to a distribution scheduled for 2017 (and could potentially be allocated to distributions taking place sooner). Excluding the 2017 distribution, AMF has committed approximately $11.2 million to distributions in its history.

AMF continued to collect and share follow up information on its programs. We covered these reports in our August 2014 AMF update.

Funding gap

AMF requires access to funding in order to negotiate deals because it cannot initiate discussions with potential partners unless it is confident that it will have sufficient funding to support its future agreements. The funding it currently holds would enable it to fund approximately 3 distributions at a scale similar to what it has funded recently.

AMF has told us that it has a pipeline of possible future net distributions that add up to $36 million (details in our review).

We see some reason for caution in thinking about AMF’s room for more funding. It has made strong progress on being able to negotiate distributions and commit funds. However, as of today there have only been two large-scale distributions that have moved forward far enough for data to be available. Both of these are significantly smaller than distributions AMF has recently or will soon fund, and both are in the same area with the same partner as each other. Some of the recently negotiated distributions could prove more challenging (since they are in DRC).

If AMF received an additional $10 million in total over the next 4 months, it would have about twice as much funding available as the total it committed to large-scale distributions in 2014. (As stated above, it committed $8.4 million to distributions taking place before 2017 and has $6.8 million available for further commitments.) If it received $25 million, it would have about 4 times that total. 2-4 times past distributions seems like a range that would allow AMF to do significantly more than it has in the past, without going so far beyond its past capacity as to raise serious scaling concerns.

We believe that $10 million total (the low end of that range), which means $5 million after the Good Ventures grant, is an appropriate target after which further donations are likely better off going to other charities.

Key considerations:

• Program impact and cost-effectiveness. Our best guess is that distributing bednets is in the same cost-effectiveness range as deworming programs and more cost-effective than cash transfers by a factor of 5-10. Our estimates are subject to substantial uncertainty. (Note: all our cost-effectiveness analyses are available here. Our file for bednets is here (.xls), and the comparison to deworming, cash transfers and iodine is here (.xls).)
• 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 DtWI’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 SCI and worse than 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 followup).
• Risks:
  • Two of AMF’s recent distributions (and much of its future pipeline) will take place in the DRC. Our impression is that the DRC is a particularly difficult place to work, and it is possible that AMF’s distributions there will struggle or fail. We view this as a moderate risk.
  • 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.

A note on how quickly we expect AMF to spend the funds it receives. AMF works by sourcing, evaluating and negotiating deals for net distributions. This process takes time and requires AMF to have significant access to funding – it cannot approach a country to begin negotiations unless it is confident that it will have sufficient funding to pay for the nets it offers. We would not be surprised if AMF fails to reach additional deals in the next 12 months. We do expect it to commit the majority of its available funds (that it will have as of this coming January) within the next 24 months. If AMF does not make much progress in committing funds in the next 12 months, we will adjust our recommendation for 2015 accordingly, possibly recommending a lower target level of funds or suspending the recommendation entirely (depending on the specifics of the situation).

Our full review of AMF is here.

Deworm the World Initiative, (DtWI), led by Evidence ActionOur full review of DtWI is here.

Important changes in the last 12 months

Dr. Kevin Croke released a new study of a randomized controlled trial of a deworming program showing large, long-term impacts from deworming programs (for more, see this blog post). This study is a significant positive update on the impacts of deworming and increased our confidence that deworming programs have significant long-term impacts.

DtWI spent the funds it received due to GiveWell’s recommendation largely as we anticipated; it now has some (though limited) room for more funding.

In 2014, two events affected DtWI’s projection of the additional funding it would require to scale up in India:

• The Children’s Investment Fund Foundation (CIFF), a major foundation that had supported DtWI’s programs in Kenya, agreed to a 6-year, $17.7 million grant to support DtWI’s expansion to additional states in India and technical assistance to the Government of India for a national deworming program. With these funds, DtWI does not require significant additional funding to support its India expansion.
• The new Indian government expressed interest in conducting a single deworming day nationally with increased national attention and resources. Advocating for such a policy and assisting the national government in creating a plan became the major focus of DtWI’s India work in 2014, which both reduced the amount of time it was able to spend generating interest in heavy DtWI involvement in new states and also required little funding since there were few costs of that project aside from staff time. We see this as positive news regarding DtWI’s potential impact; it may simply reduce DtWI’s further need for funds from individual donors.

Together, these changes led DtWI to the conclusion that funding is no longer the bottleneck to reaching more people in India. (More detail in this blog post.)

Funding gap

DtWI told us that it seeks $1.3 million over the next two years. We expect it to allocate approximately 30% of the additional funds it receives for work related to expanding school-based, mass deworming programs (including related operating and impact evaluation expenses) and will allocate other funds to priorities that are less directly connected to expanding and evaluating deworming programs (investigating ways to combine other evidence-based programs with deworming rollouts, supplementing a project supported by another funder).

Good Ventures has announced a $250,000 grant to DtWI, leaving it with $1.05 million in remaining room for more funding over the next two years. We would ideally like DtWI to receive an additional $500,000 (for a total of $750,000) to provide it with more than half of its two-year gap.

Key considerations:

• Program impact and cost-effectiveness. Our current calculations indicate that DtWI-associated deworming, when accounting for DtWI’s potential “leverage” in influencing government funds, has extremely strong cost-effectiveness, better than bednets and 10-20 times better than cash transfers. Our estimates are subject to substantial uncertainty. (Note: all our cost-effectiveness analyses are available here. Our file for deworming, cash transfers and iodine is here (.xls).)
• Directness and robustness of the case for impact. DtWI 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. There are substantial potential advantages to supporting such an organization, as it may be able to have more impact per dollar by influencing government policy than by simply carrying out programs on its own, but this situation also complicates impact assessment. While we believe DtWI is impactful, our evidence is limited, and in addition, there is always a risk that future expansions will prove more difficult than past ones. In addition, DtWI is now largely raising funds to support research projects that are not directly connected to short-term implementation of deworming programs. We do not have a view about the value of these research projects.
• Transparency and communication. DtWI has been communicative and open with us. We have only recommended DtWI for one year and therefore have less history with it than AMF, GiveDirectly, or SCI, but we believe that were something to go wrong with DtWI’s work, we would be able to learn about it and report on it.
• Risks:
  • DtWI is part of a larger organization, Evidence Action, so changes that affect Evidence Action (and its other programs) could indirectly impact DtWI. 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 DtWI.
  • Most of DtWI’s funding is in the form of restricted funding from large, institutional funders. We are not sure how DtWI’s plans would change in response to a large funder offering it significant support to undertake a project not directly in line with its current plans.

Our full review of DtWI is here.

GiveDirectlyOur full review of GiveDirectly is here.

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 high quality.

In June, three of its board members launched Segovia, a for-profit company aimed at improving the efficiency of cash transfer distributions in the developing world (see our blog post on Segovia for more information).

GiveDirectly is working with other researchers to begin a very large study on cash transfers and the impact they have on broader economic factors such as inflation and job growth. This study will include a long-term follow up component as well. GiveDirectly told us that the ideal sample size for this study, which is randomized at the village level, would require $15 million for cash transfers. Baseline data collection for the study began in August 2014. GiveDirectly has preregistered its plans for measurement and analysis (more information in our review).

Funding gap

GiveDirectly has scaled up significantly over the past year, spending (or committing to spend by enrolling recipients) approximately $13.6 million of the $17.4 million it received last year. (It also allocated an additional $1.8 million to other organizational costs.) It now believes that it could spend up to $40 million in a year.

We believe this is a reasonable cap for GiveDirectly and would not hesitate to see it receive this amount. However, due to other charities’ significantly superior estimated cost-effectiveness, we are seeking larger total amounts for them. We hope that GiveDirectly will receive at least $1 million from individual donors (excluding Good Ventures) this giving season as a result of our recommendation.

Key considerations:

• Program impact and cost-effectiveness. Our best guess is that deworming or distributing bednets achieves 5-10 times more humanitarian benefit per dollar donated than cash transfers. Our estimates are subject to substantial uncertainty. (Note: all our cost-effectiveness analyses are available here. Our file for deworming, cash transfers and iodine is here (.xls).)
• 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.
• 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 we expect.

Our full review of GiveDirectly is here.

Schistosomiasis Control Initiative (SCI)Our full review of SCI is here.

Important changes in the last 12 months

As discussed above regarding DtWI, Dr. Kevin Croke released a new study of a randomized controlled trial of a deworming program showing large, long-term impacts from deworming programs (for more, see this blog post). This study is a significant positive update on the impacts of deworming and increased our confidence that deworming programs have significant long-term impacts.

We continued our work revisiting SCI’s case for impact (detailed here). There appear to have been major problems with some, though not all, of the studies we had relied on (pre-2013) to assess SCI’s impact. SCI shared some additional monitoring information with us which supported the conclusion that its programs have generally succeeded, though these reports have significant limitations.

We also reviewed the papers of several academics who had previously been critical of SCI’s activities. We found little in this literature to change our views on SCI’s programs.

We spent significantly more time with SCI in 2014 (including a 3-day visit to its headquarters in London) than we had in previous years, aiming to improve our understanding of its operations and spending. The picture that emerged was more detailed though largely consistent with what we believed before. Specifically:

• We are less confident in our understanding of how SCI has spent unrestricted funds. At the end of 2013, we believed we had a relatively strong understanding of SCI’s unrestricted spending, but after spending additional time reviewing reports and discussing with SCI staff, we have more questions today than we did a year ago.
• We have better information about how SCI plans to use additional funds it receives and the constraints, besides funding, that SCI faces in utilizing additional funding (more in our review).

Funding gap

SCI told us that it has approximately $3.8 million worth of opportunities that it would be highly likely to undertake if it had the funding available. (Some of this would be spent in 2015 and some held for the following year to ensure programs can continue once started). It believes it could possibly absorb an additional $4.5 million (up to $8.3 million total) for opportunities that are more speculative. Overall, our best guess is that SCI will use up to approximately $6.3 million and, beyond that, would build up reserves.

Partly for reasons of donor coordination, we have set its target at $6.8 million total (more below). We hope that SCI will receive $1 million from individual donors (excluding Good Ventures) this giving season as a result of our recommendation.

Key considerations:

• Program impact and cost-effectiveness. Our best guess is that deworming is roughly as cost-effective as distributing bednets and more cost-effective than cash transfers by a factor of 5-10. Our estimates are subject to substantial uncertainty. (Note: all our cost-effectiveness analyses are available here. Our file for deworming, cash transfers and iodine is here (.xls).)
• Directness and robustness of the case for impact. We have seen some evidence demonstrating that SCI successfully deworms 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 is successfully deworming people. We have had difficulties communicating with SCI (see below), which has reduced our ability to understand it; we have also spent significant time interviewing SCI staff and reviewing documents over the past 5 years and have found minor but not major concerns.
• Transparency and communication. We have had consistent difficulties communicating with SCI. 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 of 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 AMF and GiveDirectly, both of which we feel we have a strong ability to follow up.
• Risks: There are significantly more unknown risks with SCI than our other top charities due to our limited understanding of its activities. We hope for SCI to have $6.8 million available, which is significantly more unrestricted funding than it has had available in the past.

Our full review of SCI is here.

SummaryThe table below summarizes the key considerations for our four top charities.

Consideration AMF DtWI GiveDirectly SCI Program estimated cost-effectiveness (relative to cash transfers) 5-10x 10-20x 1x 5-10x (and possibly more) Directness and robustness of the case for impact Strong Weakest 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 (more below) High Limited Very high Limited when accounting for all donors

 

Note the absence of two criteria we have put weight on in years past:

• Program evidence of effectiveness. With the new evidence about deworming, we think differences on this front are much reduced, though we still think net distribution and cash transfers have more robust cases than deworming.
• Potential for innovation/upside. All of these organizations are fairly mature at this point, and we expect each to get significant revenue this giving season.

Standouts

Much of the work we did this year went into investigating potential new additions to our top charities list. The strongest contenders we found are discussed below.

Ultimately, none of these made it into our top tier of recommendations, but that could easily change in the future. We believe that more investigative effort could result in a much better understanding of GAIN-USI (discussed below) and potentially a top-tier recommendation. Meanwhile, ICCIDD and DMI (also discussed below) do not have the track record we’d want to see for our top tier of recommendations, but in both cases we expect major developments in the next year. Specifically, ICCIDD will have a substantially larger working budget (due to GiveWell money moved), and DMI may have new data from its randomized controlled trial that could cause a significant upgrade in its status.

These are all strong giving opportunities, and we’ve vetted them all relatively thoroughly. Two work on a program (universal salt iodization) that we believe has excellent cost-effectiveness and a strong evidence base, and the other two have recently released data from randomized evaluations of their own programs (something that is very rare among charities). We have thoroughly vetted each of these organizations, including site visits. And we can see arguments for supporting these organizations in lieu of our top charities this year, though we ultimately recommend our top charities above them.

Below are some brief comments on each standout organization. Donors interested in learning more should read our full reviews of each organization.

Development Media International (DMI) produces radio and television broadcasts in developing countries that encourage people to adopt improved health practices, such as exclusive breastfeeding of infants and seeking treatment for symptoms associated with fatal diseases. Its programs reach many people for relatively little money, so if its program successfully changes listeners’ behavior, it may be extremely cost-effective. It is in the midst of running a randomized controlled trial of its program; the midline results were released earlier this year, at which point we blogged about them.

At midline, the study found moderate increases (relative to the control group) in self-reported health behaviors. Our attempt to estimate the likely mortality impact of these behaviors – when accounting for other concerns about the generalizability of the study – implied cost-effectiveness worse than AMF’s. This isn’t sufficient for a recommendation this year, as DMI has much less of a track record than our top charities. However, if endline results hit DMI’s targeted mortality impact, we would expect to adjust our estimate significantly, and DMI could become a top charity.

DMI’s current budget is approximately $2.5 million; it has told us it expects to receive approximately $2.5-$4 million from existing funders in the next year and could absorb an additional $6-$7.5 million, which it would either use to supplement a program already broadcasting in a country or move into a new country, depending on how much it received.

Our cost-effectiveness analysis for DMI is here (.xls).

Our full review of DMI is here.

GAIN-USI. GAIN’s Universal Salt Iodization (USI) program supports salt iodization programs. There is strong evidence that salt iodization programs have a significant, positive effect on children’s cognitive development, and we consider the program to accomplish (very roughly speaking) comparable good per dollar to bednets and deworming (see our intervention report).

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 diminished impact depending on its effectiveness. 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.

GAIN’s USI program was one of the recipients of a large, multi-year grant from the Bill and Melinda Gates Foundation. The grant ends in 2015 and has yet to be renewed; we are unsure of whether it will be.

Donors whose primary interest is supporting a strong intervention, and who are comfortable supporting a large and reputable organization whose role is to promote and support the intervention (but whose track record we cannot assess at this time), should strongly consider supporting GAIN’s USI program.

GAIN is a large organization running many programs, so donors should consider the possibility that funds restricted to GAIN’s USI program might effectively support its other efforts (more on this general concern here). GAIN told us that it has very little unrestricted funding, so it is unlikely to be able to reallocate funds from other programs to continue to support USI work. It is possible that resources that are shared across programs (such as some staff) could be shifted toward other programs if resources for USI increased, but we would guess that this effect would be small.

Our cost-effectiveness analysis for deworming, cash transfers and iodine is here (.xls).

Our full review of GAIN is here.

International Council for the Control of Iodine Deficiency Disorders Global Network (ICCIDD). Like GAIN-USI, ICCIDD supports (via advocacy and technical assistance rather than implementation) salt iodization, and as with GAIN-USI, we tried but were unable to establish a track record of successfully contributing to iodization programs. Unlike GAIN-USI, ICCIDD is small, operating on a budget of approximately half a million dollars per year, and relies heavily on volunteer time. We believe that additional funding in the range of a few hundred thousand dollars could have a significant positive impact on its operations.

Good Ventures has granted a total of $350,000 to ICCIDD this year ($100,000 as a participation grant and $250,000 with the grants announced today), and we would be happy to see ICCIDD receive a few hundred thousand dollars more, after which point we would be more hesitant as it would be more than doubling its budget. We hope that ICCIDD will use the additional funding to improve its capacity and potentially become a top charity in the future.

Our cost-effectiveness analysis for deworming, cash transfers and iodine is here (.xls).

Our full review of ICCIDD 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, bed nets, clean cook stoves and solar lights.

It 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. Living Goods has been operating on a budget of $3 million per year and aims to scale up to operate on a budget of $10 million per year, of which it expects to receive approximately two-thirds from existing funders.

Our cost-effectiveness analysis for Living Goods is here (.xls).

Our full review of Living Goods is here.

Funding targets by charityIn order to give guidance to donors seeking to give as we would, we’ve come up with funding targets for each charity. These targets are based on “dividing up” $7.5 million in money moved, which is our best guess for how much individual donors will give based on our recommendations over the next 4 months.

We are using the following principles in setting targets:

• We’d like each top charity to receive a substantial amount of funding. When a charity receives substantial funding at our recommendation, it (a) gives that charity good reason to continue working with us, reporting to us, and helping us learn further about its activities; (b) gives that charity the opportunity to continue building its track record and demonstrating its capabilities, information we will use in future years; and (c) continues to reinforce the idea that GiveWell-recommended charities receive substantial funding – the main incentive charities have to participate in our process.
• All else equal, we’d like stronger overall charities – defined as those that accomplish more good per dollar, taking all considerations into account – to receive more funding.
• Each charity has a conceptual “maximum” past which we think donations would hit strongly diminishing returns. We aren’t allocating any “money moved” to a charity in excess of the max; beyond that point, we think the money is better spent supporting other top charities.

We are also taking the announced Good Ventures grants into account. These grants were recommended using similar considerations, though some of our information has changed.

Our targets are as follows. Note the distinction between “total max” (the most we’d be comfortable seeing a charity take in, at which point we would make an announcement), “total target” (the total amount we would like to see this charity take in, including Good Ventures grants and other donations), “target from individuals” (the amount we are seeking specifically from GiveWell-influenced individual over the next four months), and “max from individuals” (the most we’d be comfortable seeing a charity take in, taking into account what we know about other donors’ plans).

• Against Malaria Foundation: $5 million target from individuals, $5 million max from individuals. As discussed in the section on AMF, our ideal amount for AMF to take in would be $10 million this giving season, and Good Ventures has already committed $5 million. We therefore target $5 million for AMF.
• Deworm the World Initiative: $0.5 million target from individuals, $1 million max from individuals. We think Deworm the World Initiative is an outstanding giving opportunity with limited room for more funding, as discussed above.
• Schistosomiasis Control Initiative: $1 million target from individuals, $1 million max from individuals. We believe SCI will end the giving season with $3 million from Good Ventures, $1 million from a major donor who discussed his plans with us, $1 million in donations that we expect to come from non-GiveWell-related sources (based on projections from past years rather than on knowledge of specific donors). We also believe it has $1 million in cash available for the $6.3-$8.3 million in opportunities we describe above. In total, then, SCI already can expect to have $6 million available, which would be around the maximum we’d recommend in isolation. However, our discussion with the possible $1 million donor has led us to set a higher overall “total target” than we would have otherwise, settling on a total target of $6.8 million. (We plan to elaborate on our thoughts about donor coordination and donor agency in a future post.) Since we are hoping for SCI to have a total of $6.8 million available for its activities, we are recommending $1 million in donations from GiveWell-influenced individuals this giving season. (We are rounding $0.8 million in estimated remaining gap to $1 million in recommended giving since these figures are not precise, and we see value in round numbers for our targets.)
• GiveDirectly: $1 million target from individuals, $25 million max from individuals. We believe GiveDirectly could absorb up to $40 million total ($5 million from the Good Ventures grant, $10 million we expect it to receive from non-GiveWell-related sources already, and $25 million on top of that). However, our revised cost-effectiveness estimates (which we will discuss more in a future post) now classify cash transfers as significantly less cost-effective than bednet distribution and deworming, by a factor of around 5-10. In addition, the $5 million grant from Good Ventures and the funds we expect it to receive from elsewhere means that GiveDirectly will raise nearly as much in its next fiscal year as it did last year. Given that we anticipate moving roughly $7.5 million from individual donors in the next four months, we’d like to direct roughly $1 million of those donations to GiveDirectly. Note that GiveDirectly is, by a substantial amount, the organization we feel has performed best and most consistently in carrying out its intervention and providing quality data on the results, and people who are particularly skeptical of cost-effectiveness estimates are likely to find it the most appealing. We also are very excited about the future of GiveDirectly, in terms of its continuing ability to produce useful information via studies and its potential to grow and raise more from sources unconnected to GiveWell, though at this point we feel GiveDirectly is mature enough that further donations are not crucial in helping it toward this goal.

Summary table (all figures in USD millions):

Charity Total max (including all donations) Total target (including all donations) Donations committed or expected from Good Ventures and non-GiveWell sources Target from individuals Max from individuals Against Malaria Foundation 10 10 5 5 5 Schistosomiasis Control Initiative 6.8 6.8 6 1 1 Deworm the World Initiative 1.3 0.75 0.25 0.5 1 GiveDirectly 40 16 15 1 25

For donations beyond the ~$7.5 million total we’re projecting over the next four months, we think the decision of which charity to support would be particularly difficult. Of our top charities, only GiveDirectly would have clear room for more funding after receiving an amount in line with the above, but the others – and to a lesser extent, some of our standout charities – have significantly superior estimated cost-effectiveness according to our latest analyses. We will be continuing to stress-test and reflect on these analyses as we reflect on the question of how to modify our recommendations once the above targets are hit.

Our research process in 2014This section describes the new work we did in 2014 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 completed an investigation of one new intervention (salt iodization). We made substantial progress on several others (maternal and neonatal tetanus immunization campaigns, mass drug administration for lymphatic filariasis, and vitamin A supplementation) but did not complete them.

We also stayed up to date on the research for bednets, cash transfers and deworming and made a substantial update to our view on deworming, based on a new study by Kevin Croke.

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. (Living Goods is an exception; it contacted us with the results from its randomized controlled trial.)

A February post laid out which organizations we were hoping to investigate and why.

In addition to the 4 standout charities, we also considered Nothing but Nets (a bednets organization that declined to participate in our process), Evidence Action’s Dispensers for Safe Water program (which is forthcoming), the Center for Neglected Tropical Disease and UNICEF’s maternal and neonatal tetanus program. In the case of the latter two, we ran out of time to complete the relevant intervention reports this year (due to prioritizing other work, which seemed more likely to lead to new recommendations) and plan to complete them in 2015.

Brief notes on giving now vs. later and supporting GiveWell vs. top charitiesGiving now vs. giving later

Last year, some staff members chose to save some of their charitable giving budget for future giving opportunities, and we discussed the considerations about giving now vs. later in this post.

This year, we think the situation is a bit different, as AMF has returned to our top charities list, the case for both SCI and GiveDirectly has improved (due to new evidence on deworming and GiveDirectly’s strong performance in disbursing cash transfers), and we have extensively investigated possible other options. With these changes, we feel that (unlike last year) this year is an excellent year to give a substantial amount if you are interested primarily on our top charities work. We think our top charity recommendations are unlikely to improve a great deal (i.e. they’re unlikely to improve enough to make saving worthwhile) in the coming years. A couple considerations that might be relevant in weighing the decision to give now versus later:

• Will the giving opportunities available in the future be better than the ones we have identified now? There are competing factors. On one hand, our research capacity has expanded significantly over the past 2 years, and this has given us the ability to research more opportunities both in our traditional, top charities work and the Open Philanthropy Project. On the other, the world is getting better and some of the best opportunities available today (e.g., deworming, bednets, salt iodization) may no longer be available 10 years from now. We now feel that we’ve investigated a large proportion of realistic short-to-medium-term contenders for top charity recommendations. If money moved ends up exceeding the ~$7.5 million we’re projecting over the next four months, a stronger case for waiting may emerge, as many of the strongest charities will be near what we think they can productively absorb in the short term (and our standout charities may become recommended next year, as discussed in the section on standouts).
• How much funding will be available in the future to the opportunities we identify? Our impression is that funding available for the opportunities we identify has and will continue to grow significantly. Good Ventures is a part of this, but we hope that other future, major philanthropists will consider supporting our recommendations as Good Ventures has.

Donors interested in supporting opportunities that come from the Open Philanthropy Project have a stronger case for saving to give later. Note that it could be several years before the Open Philanthropy Project has recommendations suitable for individual donors, and these recommendations will likely reflect a very different process, very different criteria, and a much higher tolerance for high-risk opportunities that are difficult to fully explain and defend in writing (though we will work hard to lay out the basic case).

Giving to GiveWell vs. our top charities

We have grown significantly over the past 2 years and continue to raise funds to support our operations. The funds we have received have enabled us to expand our staff. Without this increased capacity, we would not have been able to consider as many organizations as we did this year.

We plan to post an update soon about our budget situation. The most up to date information available is linked from our August board meeting. The short story is that we are still seeking additional donations. For the first time this year, our checkout form will ask donors to consider allocating 10% of their donation to our operating expenses. This option is not yet live on our website; we hope to implement this change in the next few weeks.

The post Our updated top charities appeared first on The GiveWell Blog.

Summary

The Deworm the World Initiative (DtWI), led by Evidence Action, received approximately $2.3 million as a result of GiveWell’s recommendation last year. While there were some deviations, it largely allocated these funds as we expected.

DtWI now has limited room for funding; it is currently seeking to raise an additional $1.3 million to support its activities in 2015 and 2016. We expect it to allocate approximately 30% of the additional funds it receives for work related to expanding school-based, mass deworming programs and funding related operating expenses (including impact evaluation related expenses), and will allocate other funds to priorities that are less directly connected to expanding and evaluating deworming programs (investigating ways to combine other evidence-based programs with deworming rollouts, supplementing a project supported by another funder).

We currently expect to release updated recommendations by December 1st. We think it is likely that the Deworm the World Initiative will remain on our top charities list.

How did DtWI spend the money it received due to GiveWell, and how does this compare to our expectations?

GiveWell directed approximately $2.3 million to the Deworm the World Initiative since we added it to our top charities list in December 2013.

At the time of our recommendation, we expected DtWI to spend additional funds in the following ways; we did not have precise estimates for how much it would spend in each category:

• Some portion to provide reserves for DtWI, both to make the organization more resilient and to allow it to respond to high impact opportunities
• Some portion to allow DtWI to offer a lower-intensity level of assistance to regions that didn’t require its standard level of assistance
• Some portion to support expansion to new states in India

It has allocated these funds as follows (years when we expect funds to be spent in parentheses; 2014 means funds have been spent):

• $881,000 – ongoing reserves. Our understanding is that DtWI does not have plans to spend these funds in the near future. Instead, these funds make DtWI more robust as an organization: for example, it is less likely to need to significantly shift priorities in order to fundraise and it is more likely to be able to respond quickly to high-impact opportunities it identifies.
• $509,000 – expansion into new countries (2015 and 2016). This includes preliminary work in Ethiopia, Indonesia, Philippines to support possible future work and $104,000 for prevalence surveys and technical assistance to the government and partner organization in Vietnam.
• $430,000 – ongoing work in India (2014 and early 2015). This will fund a follow-up prevalence survey in Bihar to assess the impact of three rounds of deworming on worm prevalence and intensity, and enable expansion to preschool children there, as well as contribute to the third round of the Rajasthan and Delhi programs.
• $207,000 – contribution to elimination research primarily funded by the Children’s Investment Fund Foundation (CIFF) and the Bill and Melinda Gates Foundation (BMGF) (2015-2017). CIFF and BMGF provided approximately $1.6 million in funding to the Deworm the World Initiative and the London School of Hygiene and Tropical Medicine to conduct research on the feasibility and cost effectiveness of breaking transmission of soil-transmitted helminths. Breaking transmission would potentially require a different approach (likely covering more than just school-aged children) than DtWI’s standard school-based deworming model.
• $151,000 – DtWI overhead (2014). These funds support DtWI as an organization but are not directly programmed (e.g., a portion of Alix Zwane’s, the Executive Director of Evidence Action salary, Evidence Action financial staff, etc.). Note that DtWI estimated $151,000 based on allocating 15% of programmed GiveWell-sourced funding to DtWI overhead. DtWI said it could more explicitly track these funds but would be time consuming to do so. We agreed that more detailed accounting was not necessary.
• $129,000 – additional staff (2014). In 2014, DtWI hired (a) a deputy director to support its programming worldwide and (b) someone to focus on its impact evaluation. The latter hire is likely to be doing work on the breaking transmission work discussed below. We allocate some of this line item to expansion and related operating expenses and some to research.

Overall, DtWI’s funding decisions seem reasonable to us and are broadly consistent with what we anticipated.

• 46% ($1,067,000) supported expanding deworming programs and funding related operating expenses (including impact evaluation related expenses). This includes the deputy director who supports the organization as a whole but is necessary to expanded work in India and other new countries and half of the salary for the impact-evaluation-focused new staffer since he works on programmatic and technical support across DtWI.
• 38% ($881,000) supported ongoing reserves.
• 10% ($241,000) supported research that we had not anticipated (including the other half of the new staffer since he is spending a significant part of his time on this research).
• 6% (151,000) supported DtWI as a whole.

How would DtWI spend additional funds?

The Deworm the World Initiative seeks an additional $1.3 million to support its activities in 2015 and 2016. DtWI expects to spend $377,000 of the $1.3 million (29%) it seeks on work related to expanding school-based mass deworming programs and funding related operating expenses (including impact evaluation related expenses). More specifically, these activities would be:

• $230,000: staff to support expansion in India, new countries, and related operating and evaluation expenses. This line item is the salary for the deputy director and part of the salary for the impact evaluation focused staff member described above.
• $144,000: DtWI overhead (described above).
• $500,000: evaluation of new evidence-based programs that leverage deworming. We have limited detail about what this would entail. One idea that DtWI has investigated is the possibility of distributing bednets along with deworming pills in schools as an alternative distribution mechanism to national net distributions. Another is including hand-washing educational programming alongside deworming days. This line item includes $50,000 to support DtWI’s evaluation of its hygiene and deworming program funded by Dubai Cares and $50,000 to enable DtWI to hire a senior epidemiologist.
• $230,000: staff to support evaluation of DtWI’s work in Kenya. This work is primarily funded by CIFF. DtWI believes that additional resources can improve significantly the quality of the analysis done regarding the cost effectiveness of breaking transmission. This line item includes $100,000 to support the impact evaluation focused staff member described above.
• $170,000: implementation support for the integrated deworming, sanitation and hygiene education program in Vietnam, in partnership with Thrive Networks.

Why is DtWI seeking additional funds primarily to support research and evaluation rather than scale up? What changed in the past year?

In 2014, two events affected DtWI’s projection of the additional funding it would require to scale up in India:

1. The Children’s Investment Fund Foundation (CIFF), a major foundation that had supported DtWI’s programs in Kenya, agreed to a 6-year, $17.7 million grant to support DtWI’s expansion to additional states in India and technical assistance to the Government of India for a national deworming program. At the end of 2013, DtWI believed it was reasonably likely that it would not receive this grant and had not anticipated how quickly it would come through. With these funds, DtWI does not require significant additional funding to support its India expansion.
2. The new Indian government expressed interest in conducting a single deworming day nationally with increased national attention and resources. Advocating for such a policy and assisting the national government in creating a plan became the major focus of DtWI’s India work in 2014, which both reduced the amount of time it was able to spend generating interest in heavy DtWI involvement in new states, and also required little funding since there were few costs of that project aside from staff time. DtWI believes that the first national deworming day will likely happen in February 2015.

Together, these changes led DtWI to the conclusion that funding is no longer the bottleneck to reaching more people in India.

More broadly, we believe that if donors close both the $1.3-million 2-year funding gap of DtWI and the ~5-$8-million funding gap of the Schistosomiasis Control Initiative (SCI), another deworming organization we recommend, funding will not be the primary bottleneck to deworming programs’ scaling in general. Overall, our impression is that there is currently more funding available for scaling up deworming programs than capacity at organizations to utilize funds for scaleup.

Dr. Zwane believes that DtWI’s research agenda is important for two reasons:

1. She believes it is possible that this research will demonstrate that other approaches to deworming are more cost-effective, such as eliminating worms from areas to avoid the need for mass treatments, or combining deworming with other interventions such as bednet distributions or hygiene education.
2. She would like DtWI to consistently provide useful information to funders and policymakers and undertaking this research will enable it to continue doing so.

Notes on other deworming implementers and funders

It is not unlikely that GiveWell-directed donors will close the funding gaps of both DtWI and Schistosomiasis Control Initiative in the coming few months. Because of this, we also asked Alix Zwane (Executive Director of Evidence Action) about other implementers and funders working on deworming.

Implementers

Dr. Zwane told us DtWI and SCI are the two primary organizations that focus primarily on expanding countrywide deworming programs. Other organizations work on deworming but are not as directly focused on scaleup with government partners to her knowledge. There are other NGOs that work on other neglected tropical diseases (e.g., SightSavers) and school health (e.g., Partnership for Child Development), but Dr. Zwane is less familiar with the reach and scope of the service delivery they support.

Organizations that do a smaller amount of deworming implementation include UNICEF, Micronutrient Initiative and Vitamin Angels, which have begun adding deworming pills to their vitamin A supplementation programs, and WaterAid, which adds deworming to some of its water and sanitation programs.

IMA World Health, Helen Keller International, Sight Savers International, The MENTOR Initiative, and possibly others implement deworming programs supported by the funders discussed below. We have yet to speak with these organizations and have little information about their deworming programs or funding needs.

According to Dr. Zwane, the Global Network for Neglected Tropical Diseases works primarily on advocacy and does not focus on deworming, specifically, while Children without Worms coordinates partners globally and does not work on providing technical assistance for program delivery directly currently to her knowledge.

Funders

Major funders of deworming service delivery include the following: Dubai Cares, The END Fund, CIFF, the UK government’s Department for International Development (DFID), Michael and Susan Dell Foundation, and the US government’s USAID.

According to Dr. Zwane, these funders are interested in supporting scale-up, and she believes that DtWI will be in a strong position to raise funds for scale up from them if and when funding becomes a bottleneck. These funders are less likely to fund the types of activities to which DtWI has allocated GiveWell-directed funding.

A longer list of organizations working on deworming is available in this document, from a recent meeting of groups that are part of the STH Coalition.

The post Deworm the World Initiative (led by Evidence Action) update appeared first on The GiveWell Blog.

Note: GAIN has reviewed a draft of this post and added responses below.

The Global Alliance for Improved Nutrition (GAIN) focuses on reducing malnutrition by fortifying foods and condiments with essential nutrients and through other interventions. We have been considering GAIN for a 2014 recommendation for its work on Universal Salt Iodization (USI) because of our impression that iodization has strong evidence of effectiveness, cost-effectiveness, and room for more funding (our take on salt iodization is in our post on ICCIDD), and our understanding that GAIN is one of only a few organizations working on salt iodization on a large scale in many different countries. We decided to prioritize GAIN after speaking with Greg S. Garrett from GAIN as part of our investigation of ICCIDD.

We’ve now spent a considerable amount of time talking to GAIN and analyzing documents GAIN shared with us. This post shares what we’ve learned so far and what questions we’re planning to focus on throughout the rest of our investigation. (For more detail, see our detailed interim review.)

Broadly, GAIN’s USI work includes advocacy, technical assistance, supplying equipment and building supply systems for potassium iodate and iodized salt, training government officials and salt producers, and monitoring coverage and impact, among other activities.

GAIN has completed the first phase of our investigation process and we view it as a contender for a future recommendation. We now plan to make a $100,000 grant to GAIN (as part of our “top charity participation grants,” funded by Good Ventures). However, we are planning to prioritize work on other organizations first because we think that will yield a higher return on our time. GAIN is a challenging organization for us to evaluate, because its work (e.g., training/monitoring) is often several steps removed from increases in the impact we hope to see (e.g., improvements in iodization rates); we have evaluated and recommended organizations like this before, but with the information we currently have from GAIN, we feel we are still far from a full understanding of GAIN’s work and impact.

Questions we hope to answer in our ongoing analysis

We feel that we are still at a relatively early stage of our investigation of GAIN and have many important, open questions.

What’s GAIN’s track record at improving USI programs?

There are two components of this question, and we have only limited information on both: (1) in the countries that GAIN has worked, is a higher percentage of salt being iodized at the correct concentration than it was previously, and/or have measures of iodine levels in the population improved? and (2) what evidence is there that GAIN caused any improvements that are observed?

On (1), the trend seems quite mixed: in a set of nine countries, use of adequately iodized salt decreased in three countries, increased by a small amount in four countries, and increased substantially in two countries. Were we to rely on this data, we would need more information on the data sources. The data is not necessarily comparable within or across countries due to different survey design and salt iodine assessment methodology.

GAIN’s response: We have advocated globally and ensured that within our target countries a sub-sample of salt will be tested for iodine using a recognized quantitative method in any assessment taking place. This is reflected in the fact that eight of the nine update assessments measured salt iodine quantitatively, and all forthcoming (2015) end of project assessments will include quantitative analysis for the entire salt sample.

In the interim, the data we have access to (from surveys and other reliable sources of information since project start) for nine of our target countries show that baseline coverage of adequately iodized salt was 72.6%. This coverage has increased to 80.3% in these nine countries over the project period to date, representing an increase in the reach of adequately iodized salt to approximately 195 million people, mostly in China, Ethiopia, India and Pakistan.

We’ve looked more closely at iodization trends in four countries that GAIN highlighted to us in case studies of its work. In Bangladesh and India, rates of adequately iodized salt increased by a small amount (4 to 7 percentage points). In Ethiopia, GAIN reports that iodization rates have roughly doubled (from 20 to 40%) over a period that included GAIN’s involvement in the country (but follow up data is incomplete). In the fourth country, the Philippines, GAIN has only provided data for a group of salt producers it worked with, and found that samples meeting iodization standards increased from less than a third to over 80%.

We put limited weight on these claims – particularly in the last two examples – because we have not seen details of how the data was collected.

GAIN’s response: In India, which is self-sufficient in salt supply, the most recent data are based on supply QC reports from the national salt management information system, the development of which was a major achievement of GAIN support to the Salt Dept. This system has greatly facilitated obtaining timely and higher quality data, comparable over time, on iodized salt supply and quality. The system and rapid review time also increases accountability of salt producers as well as regulatory monitoring staff. How the supply QC data relate to household access to iodized salt will be determined after the national survey which will be conducted before the end of 2014.

2013 data for Ethiopia were presented at the Micronutrient Forum by the Ethiopian Public Health Institute. These salt iodine data are from a sample of over 5,000 households, selected from 354 enumeration areas to provide regionally and nationally representative data. The full national micronutrient survey, conducted by the end of 2014, will repeat the collection of salt samples and also include assessment of iodine status. It is expected that this will have improved considerably, in line with increased access to iodized salt, since the very low baseline. GAIN has been a key player working with the salt producers in challenging conditions to establish a sustainable KIO3 supply, develop iodization technology and is currently working on these as well as on improving quality control and regulatory monitoring of the salt supply with FMHACA.

For (2), linking GAIN to improvements in specific countries will be difficult because its activities (such as technical assistance, monitoring, training, etc.) tend to be a few steps removed from the outcomes of improved salt iodization and iodine consumption rates. Furthermore, GAIN generally works in collaboration with other groups (more below), making attribution to one party difficult or impossible. For more details on GAIN’s activities and reported accomplishments in these countries, see our interim review.

GAIN’s response: GAIN focuses its work primarily on proven drivers of supply which are mapped against the 2011 WHO/CDC logic model for micronutrient interventions in public health.  GAIN works closely with partners (government, private sector and other agencies in particular UNICEF) and therefore attributing progress to one agency alone and set of activities can be challenging. 

Do we have a comprehensive understanding of GAIN’s USI activities?

We have found it challenging to understand what, specifically, GAIN’s work on USI involves. This is because GAIN’s activities on USI vary considerably across countries and it works in 16 countries, and GAIN works closely with UNICEF, ICCIDD, and governments on this work, making it difficult to understand GAIN’s role. To date we have focused on understanding GAIN’s work in 4 countries because (a) GAIN has shared the most information for these countries, and (b) together they account for roughly 50% of its primary grant for USI.

Details in our interim review of GAIN.

GAIN’s response: As explained above, GAIN focuses its work primarily on proven drivers of supply which are mapped against the 2011 WHO/CDC logic model for micronutrient interventions in public health.  GAIN works closely with partners (government, private sector and other agencies in particular UNICEF) and therefore attributing progress to one agency alone and set of activities can be challenging.

Specifically, in addition to ongoing policy and advocacy and monitoring of national programs (e.g. designing and delivering coverage surveys) GAIN’s work can be summarized by the following four proven supply drivers: 1) improving quality assurance quality control/regulatory monitoring/improving testing capability; 2) integrating the use of adequately iodized salt in the food industry; 3) designing models for sustained KIO3 procurement; and 4) delivering innovations along the supply chain which apply positive pressure on iodized salt supply.

Room for more funding

GAIN’s USI work is mostly supported by a large, multi-year grant from the Gates Foundation that is ending in 2015. It is not yet clear if the Gates Foundation will renew this support. It seems likely that if it does not, GAIN will have a funding gap for its USI work. We have not yet discussed with GAIN how it would prioritize USI work at different levels of funding.

GAIN’s response: GAIN is concerned by the apparent lack of continued funding for iodine nutrition across the sector. GAIN is not alone in the sector and others are also struggling to fund what we believe to be critical activities towards improving global iodine intakes. This includes technical assistance, monitoring and evaluation and policy and advocacy towards continued improvement of national iodization programs and other proven iodine interventions. Global progress towards the virtual elimination of iodine deficiency disorders has been enormous to date but there is much work to be done. GAIN hopes to see commitments made by funders for this important work to ensure sustainability and to complete these efforts.

The post Our ongoing review of GAIN appeared first on The GiveWell Blog.

Three members of GiveDirectly‘s board of directors (Paul Niehaus, Michael Faye, and Chris Hughes) are planning to start a for-profit technology company, Segovia, aimed at improving the efficiency of cash transfer distributions in the developing world. Segovia plans to sell software to developing-country governments for use in implementing their cash transfer programs.

This development was announced today (though we have been aware of and discussing it with GiveDirectly for some time). Some discussion is available at today’s post on the Development Channel blog.

GiveDirectly and Segovia will work out of the same office space in New York City.

Dr. Niehaus, who has been our primary contact at GiveDirectly and has unofficially played the role of GiveDirectly’s full-time Executive Director, will continue to devote significant time to GiveDirectly and serve as its President with primary responsibility for GiveDirectly. He will be co-employed by Segovia and has told us that he may spend up to 20% of his time on Segovia. Dr. Faye will become Segovia’s president. (Previously, both Dr. Niehaus and Dr. Faye have had full-time jobs outside of GiveDirectly, though they have had substantial responsibilities at GiveDirectly.)

We think this development is simultaneously a potentially very positive one broadly – bringing the possibility of greatly leveraged positive impact on the world – and one that raises new issues and risks for GiveDirectly and its donors.

We think these issues and risks (discussed further below) are noteworthy but ultimately similar in magnitude to, or smaller than, similar risks that exist for our other present and past recommended charities. We plan to continue recommending GiveDirectly as a top charity and continue to see it as an outstanding giving opportunity.

Note that we have discussed all of these issues with Dr. Niehaus and Dr. Faye – they have reviewed a draft of this post – and we believe they are aware of all of the issues we discuss below.

This post focuses on the following:

• What costs and benefits does this decision pose for GiveDirectly right now?
• What additional issues could arise in the future, particularly potential conflicts of interest between Segovia and GiveDirectly?
• Why have Dr. Niehaus, Dr. Faye, and Mr. Hughes decided to serve developing country governments and why are they using a for-profit-company structure?
• What effect will this have on our recommendation of GiveDirectly?

We have not tried to formulate a view on Segovia’s possible impact because this does not seem directly relevant to GiveWell or our donors. Based on what Dr. Niehaus and Dr. Faye have told us, we believe it’s plausible that given (a) the amount of money governments transfer to recipients and (b) the amount of money that may be lost by those programs due to negligence and/or corruption, Segovia could be very impactful and may represent some of the “upside” we hoped to see from GiveDirectly.

What costs and benefits does this decision pose for GiveDirectly right now?

We discuss several potential negative impacts Segovia could have on GiveDirectly; we also discuss potential positive impacts.

1. What impact will Segovia have on key staff’s time allocation to GiveDirectly?
2. Will Segovia’s existence affect the intensity with which GiveDirectly leadership work to maximize GiveDirectly’s impact?
3. Will Segovia directly affect GiveDirectly’s ability to absorb and distribute funds to recipients?
4. Will the general public react negatively to this announcement in a way that affects GiveDirectly’s ability to raise funds or otherwise distracts it from its core work?
5. What benefits might Segovia have for GiveDirectly?

What impact will Segovia have on key staff’s time allocation to GiveDirectly?

Dr. Niehaus and Dr. Faye told us that they expect the following changes to staff time allocations due to Segovia:

• Paul Niehaus, GiveDirectly’s President, had previously been splitting his time between GiveDirectly and his academic position at University of California at San Diego. Pending the university’s approval, he hopes to take a one-year leave of absence from his academic position to enable co-employment at GiveDirectly and Segovia. During this one-year leave of absence, he expects that the total amount of time he devotes to GiveDirectly will increase slightly and that he will spend a maximum of 20% of his time on Segovia.
• Michael Faye, Segovia’s president and a member of GiveDirectly’s Board of Directors, had previously worked at a management consulting firm but spent significant time on GiveDirectly. He has now taken a leave of absence from his job and intends to spend the vast majority of his time on Segovia while still offering time to GiveDirectly. He expects the time he spends on GiveDirectly to increase. More on this below.
• Melissa Harpool, Outreach Coordinator, will split her time between GiveDirectly and Segovia. Her current primary role is managing schedules, and the people whose schedules she manages will now be splitting time between Segovia and GiveDirectly. She had previously been full-time at GiveDirectly.

Dr. Niehaus and Dr. Faye told us that relevant staff track their time allocation to projects and will be able to share whether or not they have hit the targets described above.

Will Segovia affect the intensity with which GiveDirectly leadership work to maximize GiveDirectly’s impact?

Dr. Niehaus told us that he retains his ambitions for and commitment to GiveDirectly’s long term impact, but splitting attention between two organizations is difficult, especially when both are growing rapidly and likely to face significant obstacles.

It is plausible that given GiveDirectly’s and Segovia’s overlapping leadership, staff and office space, those involved with both might see Segovia as the more exciting opportunity. We believe that this could lead to reduced ambition or it could reduce the quality of the mental effort GiveDirectly’s leadership dedicates to maximizing GiveDirectly’s impact.

Will Segovia directly affect GiveDirectly’s ability to absorb and distribute funds to recipients?

Assuming that GiveDirectly staff meets the time targets described above, we don’t think Segovia will have a direct impact on GiveDirectly’s ability to absorb and distribute funds to recipients.

Will GiveDirectly receive a negative response from the general public that affects its ability to raise funds or otherwise distracts it from its core work?

We continue to see GiveDirectly as an outstanding giving opportunity and plan to continue recommending it to donors. That said, we are not confident about how others will react and remain concerned about the impact that the general public’s reaction might have on GiveDirectly’s future fundraising prospects.

Dr. Niehaus and Dr. Faye told us that they have attempted to reduce the likelihood that the response is negative by speaking at length with media in advance of the announcement so that stories written about their decision present a reasonable perspective on this new development. They have also communicated with their major donors and report that they have not encountered negative reactions.

What benefits will Segovia provide for GiveDirectly?

Potential benefits include:

• GiveDirectly will receive an equity stake in Segovia, which could result in GiveDirectly’s receiving additional funding in the future. The size of the stake is not yet determined. Dr. Niehaus, Dr. Faye, and Mr. Hughes are currently discussing the size of this stake with potential investors.
• The technology Segovia is planning to develop would likely be helpful to GiveDirectly. Segovia would give this technology to GiveDirectly without charge.
• As discussed above, Paul Niehaus has been based in San Diego and the rest of GiveDirectly staff is in New York. Dr. Faye has been employed full-time at a management consulting firm. Dr. Niehaus will be spending half his time in New York and hopes to take leave from his academic position, and Dr. Faye will now be working full-time out of the same office. Dr. Niehaus’s co-location with the rest of GiveDirectly staff will likely improve his ability to manage other staff. Dr. Faye’s co-location with Dr. Niehaus and other GiveDirectly staff may also increase his contribution to GiveDirectly. (Dr. Faye has told us that the time he has spent on GiveDirectly has increased since he took leave of absence from his job.)
• Mr. Hughes intends to significantly increase his work on advocating for cash transfers. This should benefit both Segovia and GiveDirectly.

What additional issues could arise in the future, particularly potential conflicts of interests between Segovia and GiveDirectly?

There may be cases where GiveDirectly has to consider actions that would maximize its impact but might harm Segovia’s interests. GiveDirectly board members (Paul Niehaus, Michael Faye, and Chris Hughes) will hold equity stakes in Segovia, so their financial interests could come into conflict with their roles as Directors of GiveDirectly. We see the following possible conflicts of interest:

• GiveDirectly’s board members’ financial interest in Segovia could lead them to use GiveDirectly as a means to promote Segovia. This could be via using Segovia’s software even if it’s not well suited to GiveDirecty’s needs, or otherwise using contacts/meetings that might take place due to GiveDirectly (e.g., government, academic or media contacts) to promote Segovia’s offering.
• Segovia will also have (a) investors and (b) staff who hold significant financial stakes in Segovia, which could lead to conflicts between maximizing profit and maximizing impact.
• If Segovia were bidding on a contract with a particular government, would GiveDirectly avoid offering its service in the same area/to the same government so that Segovia would have an easier path to a sale?

We have spent significant time with Paul Niehaus and some time with Michael Faye and Chris Hughes over the past few years, and we believe they have good intentions.

In addition, Dr. Niehaus, Dr. Faye, and Mr. Hughes hope to identify investors whose primary motivation is social impact, and believe that choosing investors wisely is a priority. They have also told us that they plan to expand GiveDirectly’s board to 6-7 directors, 3-4 of whom have no overlap with Segovia. Dr. Niehaus told us that overlapping directors would recuse themselves from votes that involve conflicts.

Why have Dr. Niehaus, Dr. Faye, and Mr. Hughes decided to serve developing country governments and why are they using a for-profit-company structure?

Dr. Niehaus and Dr. Faye believe that Segovia’s product is one that governments will want to purchase, and the product will have significant social impact. They have had a long-standing interest in working directly with governments.

Dr. Niehaus and Dr. Faye told us of their hope that GiveDirectly would work with government-run cash transfer programs in November 2013. We discuss this possibility in our review of GiveDirectly, relying on a summary of a conversation we had with them at the time.

Dr. Niehaus and Dr. Faye told us recently that they had initially hoped governments would transfer funds directly to/through GiveDirectly. The developing-country governments that GiveDirectly spoke with preferred technology to fully outsourcing implementation, saying that they already had a significant number of individuals employed to implement their cash transfer programs. Instead, governments asked for software that could improve their operations, which Segovia now aims to provide.

GiveDirectly still believes it will have opportunities to implement government programs, but Dr. Niehaus and Dr. Faye have come to the conclusion that there will be many more cases where governments want technology alone.

Dr. Niehaus and Dr. Faye pointed us to a World Economic Forum report estimating that developing-country governments distribute $400 billion in transfers each year. Dr. Niehaus and Dr. Faye have also told us that data showing rates of leakage of 50% or more are not uncommon in large public-sector transfer programs (i.e., the amount that never reaches the intended recipients). (More information about these sources in this footnote.) They believe that governments will see that purchasing Segovia’s product will save them money by allowing them to transfer more money to recipients at lower overall cost.

We find the above explanation of Segovia’s potential impact plausible but have not tried to vet it as we don’t think our take on it has direct relevance to GiveDirectly or the donors who use our research.

We have the impression that the belief that Segovia could have great social impact is the primary driver of Dr. Niehaus’s, Dr. Faye’s, and Mr. Hughes’ desire to start Segovia.

Why has GiveDirectly settled on this corporate structure as opposed to another structure?

Dr. Niehaus, Dr. Faye, and Mr. Hughes had initially expected to undertake this project as part of GiveDirectly’s existing non-profit structure but told us that they decided on the structure of a for-profit, independent company for three reasons:

1. Recruiting. We spoke with the recruiting firm that GiveDirectly retained for this search, and the person who led the search told us that recruiting top technology talent was slow. In some cases, the engineers GiveDirectly contacted were not interested in working for a non-profit. Even when GiveDirectly offered compensation packages competitive with for-profit companies, some engineers balked when they saw the negative attention that the media and donors give to high salaries in the non-profit sector. Dr. Niehaus, Dr. Faye, and Mr. Hughes place high priority on recruiting the very best possible talent, so while they feel they could have reasonable success recruiting as a non-profit, they see the improved recruiting prospects associated with a for-profit to be a major consideration.
2. Investment. GiveDirectly told us that there are investors who would support Segovia as a for-profit entity but would not be interested in supporting GiveDirectly, the non-profit.
3. Legal advice. GiveDirectly received legal advice that an independent for-profit company is the most straightforward way to avoid jeopardizing GiveDirectly’s tax exempt status.

What effect will this have on our recommendation of GiveDirectly?

We do not expect the existence of Segovia to change our recommendation of GiveDirectly. We expect GiveDirectly to continue to successfully distribute cash to very poor individuals in the developing world, and believe that the issues and risks described above are smaller than, or at worst similar in importance to, those that exist with all of our other recommended charities.

We will continue to follow GiveDirectly closely and report on its progress.

We have written previously about the “upside” we saw in GiveDirectly. We think that Segovia may be one example of that “upside” — Dr. Niehaus and Dr. Faye, partly through their work on GiveDirectly, saw an opportunity for significant social impact and are now pursuing it. However, we think the attention they will now pay to Segovia likely diminishes the upside of future donations to GiveDirectly.

Footnote: On the World Economic Forum report described above, Dr. Niehaus wrote, “I have some questions about the methodology but believe the basic message that it is big and has problems.” On the leakage rates, he wrote, “India’s two largest social programs are the employment scheme (NREGS) and ration scheme (TPDS). For NREGS, the best nationally representative leakage estimate is by Imbert and Papp (published in R. Khera, editor, The battle for employment guarantee. Oxford University Press, 2011) who estimate that between 44% and 58% of participation reported in official figures is fictitious. This likely understates leakage in dollar figures since people who do work are often underpaid, but nationally representative data on earnings are not to the best of my knowledge available. For TPDS, the most recent nationally representative figures I know of are from the 2004-2005 NSS and are discussed in work by Svedberg in EPW who reports a national average estimate of 54% leakage of grains intended for the poor.”

The post Update on GiveDirectly appeared first on The GiveWell Blog.

In February, Jacob Kushner, a journalist living in Kenya, contacted us. We have long been interested in seeing more substantive coverage of philanthropy, so we were excited to talk to him.

As a pilot project, Mr. Kushner decided to visit villages in which GiveDirectly had distributed some of its earliest cash transfers. We spoke with Mr. Kushner several times to offer thoughts and feedback, but we encouraged him to write about whatever he found (positive or negative about GiveDirectly). We also put him in touch with GiveDirectly to confirm that staff there were amenable to this project.

Mr. Kushner completed his trip in April, and his full article follows. He also shared his full interview notes with us which we’ve posted here.

We’ve summarized what we took away from his article here. Carolina Toth, Manager, People and Partnerships at GiveDirectly responds here.

When giving out cash to the poor, what happens when some are left behind?
A closer look at whether GiveDirectly’s cash transfers stoke community tension in Western Kenya

By Jacob Kushner

For several years now, the charity GiveDirectly has experimented with different ways of deciding who among Western Kenya’s rural poor should receive cash transfers. It’s an important consideration, because $1,000 means a lot to the families that receive it—and it can mean a lot of disappointment to the families that don’t. Last month I traveled to Western Kenya to speak with both lots, and I found that the discrepancy did not go unnoticed in their communities.

To date, GiveDirectly has undergone five different transfer programs in Siaya over the past three years, with different metrics for selecting recipients. I interviewed recipients from three of those cohorts:

• The Google Cohort (approximately 850 ‘thatch-roof only’ recipients whose transfers were completed in October 2013)
• The 200k Cohort (approximately 200 ‘thatch-roof only’ recipients whose transfers were completed in January 2013)
• The 2M cohort (approximately 2,000 recipients divided into ‘thatch-roof only’ villages and ‘saturation’ villages (in which nearly everyone is eligible) who have received one major transfer and will receive the second and final one in July 2014).

In a follow-up to a randomized controlled trial, GiveDirectly asked residents if they’d heard any complaints about GiveDirectly in their community. Sixty-four percent of respondents in Siaya County answered “yes,” as did 48 percent of those in the “Google” cohort (in Rareida it was 28 percent).

Fewer than 6 percent of respondents in all four groups said shouting or angry arguments had ensued because of the transfers, and fewer than 4 percent said they’d experienced crime, theft or violence or felt threatened as a result. Virtually no one said they’d argued with family members over how to spend the money, and no more than 7 percent in any group said their village elder had approached them asking for money.

Carolina Toth, Kenya Field Director for GiveDirectly, explained the results of a series of informal community group meetings in which GiveDirectly led residents in a discussion of who should be eligible for transfers.

Sixty-two percent of respondents in thatch-only villages said they’d heard complaints relating to ineligible households, compared with 46 percent in saturation villages. Thirty percent of those in thatch-only villages said they’d heard complaints about different criteria being used across different villages, compared with only 4 percent in saturation villages.

GiveDirectly concluded that the strongest takeaway from the discussions is that poorer ‘thatched’ households are more deserving but also that certain households that have mabati or permanent houses are deserving of the transfers as well. When asked about their own villages, residents preferred the saturation method. When asked about other villages, they preferred thatch-only. No one thought it would be “bad” if cash were given to some wealthier households.

Because recipients in saturation villages have yet to receive their second transfer (due in July), it’s too early to draw definite conclusions. But this and other previous reports leave several question unanswered:

To the extent that community tension may result in the wake of cash disbursements, how does that tension actually unfold? Who are the parties and what are some examples? Most importantly, what do non-recipients in those communities think about the fairness of the selection process? Do they feel stigmatized for not having received the money, and how does their perception of whether animosity resulted from the cash transfers compare with those of the recipients’ themselves?

In April I made a reporting trip to Siaya County to interview recipient and non-recipients in the communities where GiveDirectly has made those disbursements. Over three days I interviewed 15 people, asking whether they were happy with GiveDirectly’s selection process and whether any tension arose in their communities as a result of it.

I interviewed some recipients from each of the three cohorts and also interviewed recipients and in both the ‘saturation’ and ‘thatch’ divisions of the 2M cohort. I interviewed four non-recipients, at least one in each of the three cohorts.

My interviews seemed to reflect many of the conclusions of the RCT and subsequent follow up interviews and meetings. No one reported intra-family arguments about how to spend the money or being coerced by a spouse or family member to spend it in a particular way. Only one recipient said he’d originally disagreed with his spouse but that they eventually came to a mutual agreement. No one reported theft or that their own money had gone to waste in any way.

But 12 of the 15 respondents did indicate that some amount of tension had fostered in their community as a factor of some people having received money while others did not. By far the most tangible conflict mentioned to me occurred in the 200k cohort in the village of Koga.

There, the village elder did not receive a cash transfer. He was, however, consulted by GiveDirectly staff to assist in a tour of the boundaries of the village so GiveDirectly could identify eligible households, for which he was given a small token payment as compensation for his time. But in the words of one recipient there, “there was a scandal.” The elder “had conspired (to enlist) some households that were outside the area and had better houses, with the understanding that they would give him some money.”

GiveDirectly staff say the elder seems to have directed residents who lived in tin-roof houses to “squat” in vacant thatch roofed houses in order to receive the money. Subsequently, the assistant chief, with the support of the other village council members, dismissed the elder from his position.

When I spoke with the elder, he confirmed that he had misrepresented certain households in the village so they would be enrolled in the program. He justified that decision saying, “I was the village elder and I was working for the (entire) community.”

He said tension resulted when the initial disbursements were made and some families, including his own, were left out.

“I felt degraded by my community members. They were laughing at me that I didn’t receive any help even though I was the leader of the community. I was so humiliated.” He said the incident led him to ‘resign’ after more than 35 years of serving as an elder in Koga (he is 62 years old).

The second most tangible takeaway was the resentment and frustration expressed by the four non-recipients I interviewed. One woman in a “saturation” village was visibly angry as she described how she was not selected because the living room in her tin roof house is cemented, even though her other rooms are not. Another Koga man said he was cheated out of a transfer:

“The time the GiveDirectly team was working in the village, they came to my home but at that time I was grazing cattle outside the compound and I saw them in my sister-in-law’s house. I was curious. But due to how relations within households go sour, my sister told the GiveDirectly team that I had left and was never around.”

Despite an appeal he said he made to GiveDirectly field staff, this man did not receive a transfer. He says his economic situation is similar to that of the other recipients:

“I live in a house like this—(a) grass thatch house. I have children in school and I struggle to pay their fees. Some of my children for lack of funds have to be supported by my relatives in other areas, in Nairobi. I have only two cattle.”

GiveDirectly staff pointed out that “targeting” is a universal problem in development aid. Other methods used to select recipients—such as letting communities vote on who should receive, or requiring people to go to some lengths to prove they are indeed quite economically poor-off—have major drawbacks: Cronyism, and excessive bureaucracy and burdens, respectively. As an alternative, GiveDirectly employs another common method that uses easy-to-observe characteristics such as roof style to judge how wealthy or poor a household is. According to GiveDirectly’s own research, less than 5 percent of people in the 2M cohort villages complained, legitimately or otherwise, of being unfairly excluded. (In comparison, a recent study of the Kenya Hunger Safety Net Program found an exclusion error rate of 46 percent).

The man in Koga who says he was unfairly excluded also expressed sympathy for the Koga village elder. “I would not be happy with what has happened to him, because the feeling he has now at losing his job is the same feeling I have at not getting the money. I feel bad for him because I am also going through some pain.”

The man also aired some critiques as to how some people in the community spent their money.

“I saw some beneficiaries, the way they misbehaved when they got the money, and that made me feel it is important that recipients receive training on how to spend it. For example there are people who wasted it on drinking sprees, and others bought items that they didn’t understand how they would maintain. For example, one bought a motorbike and used it for a few months, but now it is unused and has not really helped him.”

Indeed, several interviewees mentioned the need for training to accompany the transfer process. GiveDirectly currently does not provide training or advise recipients as to how they should spend their money. GiveDirectly does, however, provide a brochure that lists different possible categories of expenditure such as home construction, business, and farming. GiveDirectly is considering experiments in which brochures also list the average returns that previous beneficiaries earned on each category of investment.

After completing the interviews, I asked Carolina Toth, the GiveDirectly field director, what she made of it all. I asked Toth what she thought about the village elder scandal in Koga—that a man who had served as elder for 35 years lost that position not because he violated a community custom, but simply a rule imposed by GiveDirectly.

“The village elder more often than not is one of the richer members of the community,” Toth said. As to his “previous feelings of entitlement to benefit from whatever is happening … I don’t think that’s an expectation we want to uphold.”

Toth and I also discussed the consequences for individuals who are excluded in a community where most residents receive the cash.

“It’s definitely a psychological event in their live,” Toth said. “But we know from the (randomized controlled trial) that there are huge spillover effects to the people who didn’t receive.”

When I asked Toth about the man who says he missed out on the transfer because his sister-in-law misinformed the GiveDirectly staff that he was not living in the village, Toth said it’s certainly true that some people get left out by mistake. But she said such cases are rare. As to the woman with the cemented living room who didn’t receive cash even though the rest of her home is not yet cemented, Toth said the GiveDirectly field staff can only make decisions based upon what they see—and that the distinction between a cemented house and a non-cemented house is not always entirely clear under such circumstances.

The vast majority of people who aren’t selected, said Toth, are skipped because they come from a marginally higher socioeconomic standing to whom the money would be less useful.

“What is the value of $250 given to a family that’s richer? Wouldn’t that be more valuable in the hands of people who are really poor?” Toth asked. “We have a mission of giving to the extreme poor, so by excluding some people who are not in the extreme poor, you are able to reach more extreme poor.”

Ultimately, the question any cash transfer implementer must decide is, “Is the possibility that community tension may result from a non-universal disbursement so great or concerning that transfers should be made to all residents in a village despite the opportunity cost that fewer, even poorer people in other villages will not receive any cash?”

Thus far GiveDirectly has answered that question in the negative. With certain exceptions (such as allowing communities to nominate a pre-determined number of otherwise unqualified people for the disbursements) and with increased nuance (by considering more advanced criteria than simply thatch versus tin roofs and indoor plastering), GiveDirectly intends to continue excluding those residents who do not qualify as the poorest of the poor.

Jacob Kushner is a journalist based in Nairobi. He reports on foreign aid and investment in Africa, human rights and the extractives sector.

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