GiveWell and IDinsight: Fistula Surgery Project

Published: May 2017

As part of our Incubation Grants program, GiveWell is partnering with IDinsight ( to support the identification or development of a GiveWell top charity focused on fistula surgery.


We have completed an internal draft of an intervention report on surgery for obstetric fistula. We have not yet classified fistula surgery as a "priority program" for GiveWell primarily because we remain highly uncertain about the full cost per successful surgery, and therefore whether the program is cost-effective compared with the other programs we recommend.

In addition, we have spoken with several organizations that support fistula surgeries to consider whether they might be a good fit for a GiveWell top-charity recommendation. Based on those conversations, we believe that these organizations would be more likely to qualify for a GiveWell top charity recommendation if they had support for monitoring and evaluation.

GiveWell is partnering with IDinsight, an international NGO which helps generate and use rigorous evidence to improve social impact, to first analyze cost data from one organization to determine whether fistula surgery in general is likely to be cost-effective, and, if so, to then identify a fistula surgery organization to work with. The aim of partnering with a fistula surgery organization will be to improve the monitoring and evaluation data the surgery organization can share so that it could potentially qualify as a GiveWell top charity.

More on GiveWell and IDinsight's work together here.


We expect this work to proceed in the stages described below.

  • Costing work: IDinsight will request data from the Fistula Foundation for one of its programs to estimate the full cost per surgery completed. The Fistula Foundation has agreed to assist with this stage of work because it expects to use the costing estimate to aid its scale-up planning. Update: This work was completed and published here.
  • Stage 1: scoping calls with each organization: We and IDinsight plan to contact the organizations listed below to ask for a phone conversation to answer basic questions about each organization's work. We plan to ask them:
    • What specific intervention(s) do you implement (e.g. training surgeons, funding hospitals, mobile surgery units, demand generation) to increase the volume of fistula surgeries?
    • What monitoring and evaluation information do you have available?
    • What work do you support other than fistula surgery? How do you make decisions about how to allocate funding across programs?
    • How do your programs differ across locations where you work?
    • Approximately how much additional funding could you absorb in the next three years?

      This stage may include limited requests for documents (i.e. requests for a small number of documents that organizations already have available).

  • Stage 2: deeper investigation of 1-3 organizations: Our impression, based on initial conversations with some organizations, is that many largely operate as funders of a diverse set of local organizations (e.g. hospitals, community-based organizations, other health facilities), so Stage 2 may require asking questions similar to those in Stage 1, but to specific parts of single organizations (e.g. country offices). This stage may include site visits by IDinsight staff and will likely include more substantial requests for documents, including information to help us estimate a full cost per surgery.
  • Stage 3: implement with one organization: In this stage, IDinsight would work closely with an organization to develop a monitoring and evaluation system and/or conduct an impact evaluation aimed at potentially qualifying the organization for a GiveWell recommendation.


Number of organizations we expect to work with at each stage

If we decide to go ahead with the project after completing the costing work, we believe we are likely to identify 1-3 organizations with which to proceed to Stage 2 above. We are uncertain whether we will choose to proceed to Stage 3 with any organization. Even if we proceed to Stage 3 with an organization, there remains a significant possibility that this work will not result in a new GiveWell top-recommended charity.

Funding for the project

GiveWell expects to recommend grants to Good Ventures that will fully fund IDinsight's work on this project. To enable participation, we will need to ask for organizations to allocate some staff time to the project. GiveWell welcomes conversations about how to minimize the burden placed on participating organizations.


Consistent with our general approach to transparency, we plan to write publicly about this project. As we normally do, we will keep all non-public documents that organizations share with us confidential until we have explicit approval to publish them.

Organizations we plan to contact

Note that in some cases, we have already completed an initial conversation.

  • AMREF Health Africa
  • Direct Relief
  • EngenderHealth
  • Fistula Foundation
  • Freedom from Fistula
  • Hamlin Fistula
  • IntraHealth International
  • One by One
  • Operation Fistula
  • Pathfinder
  • UNFPA (Campaign to End Fistula)
  • Worldwide Fistula Fund