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Fred Hollows Foundation
About this pageGiveWell aims to find the best giving opportunities we can and recommend them to donors. We tend to put a lot of investigation into the organizations we find most promising, and de-prioritize others based on limited information. When we decide not to prioritize an organization, we try to create a brief writeup of our thoughts on that charity because we want to be as transparent as possible about our reasoning. The following write-up should be viewed in this context: it explains why we determined that we wouldn't be prioritizing the organization in question as a potential top charity. This write-up should not be taken as a "negative rating" of the charity. Rather, it is our attempt to be as clear as possible about the process by which we came to our top recommendations.
A note on this page's publication dateThe last time we examined the Fred Hollows Foundation was in 2010. In our latest open-ended review of charities, we determined that it was unlikely to meet our criteria based on our past examination of it, so we did not revisit it. We invite all charities that feel they meet our criteria to apply for consideration. The content we created in 2010 appears below. This content is likely to be no longer fully accurate, both with respect to what it says about the Fred Hollows Foundation and with respect to what it implies about our own views and positions. With that said, we do feel that the takeaways from this examination are sufficient not to prioritize re-opening our investigation of this organization at this time.
What do they do?The Fred Hollows Foundation is a large, Australia-based charity aiming to improve vision in the developing world. They primarily focus on cataracts, which cause a significant amount of preventable vision loss in the developing world. The Fred Hollows Foundation funds a wide variety of eye care activities in Asia, Africa, and Australia.1 As members of the Vision 2020 initiative to end avoidable blindness by the year 2020, they seek to "strengthen national eye health systems."2 Toward this goal, funds they grant are intended to train surgeons, support staff, and community health workers in clinical eye care skills, upgrade and build facilities, provide equipment, and subsidize screenings and procedures, including cataract surgeries.3 The Fred Hollows Foundation also funds research and advocacy.4
ReviewWe conducted an extensive review of the Fred Hollows Foundation. We have reviewed the Fred Hollow Foundation's website and have spoken to Brain Doolan, CEO of Fred Hollows Foundation, Virginia Sarah, Manager of Information, Knowledge and Education, and Joe Boughton-Dent, Communications Manager on the phone.5 We reviewed numerous documents, including documents created by Fred Hollows Foundation CEO Brian Doolan. Our assessment has focused on the question of Fred Hollows Foundation's impact: has it changed lives, and if so, at what cost? Fred Hollows Foundation submitted documents that estimate the number of cataract and other sight saving or improving interventions that have resulted from its work.6 Since the Fred Hollows Foundation is involved in a wide variety of activities, we sought to understand how this number is calculated. The Fred Hollows Foundation provided one example for one location of how 'cases of blindness averted' was calculated.7 Given the wide variety of activities the Fred Hollows Foundation is involved in, we were not confident that the cited example was representative. The Fred Hollows Foundation's stated guidelines assert that its figures capture only "impact" (i.e., changes that occurred due to the Fred Hollows Foundation's funding, not simply operations in which its funding played some role), but we believe that gauging impact is very difficult and cannot be confident that these guidelines are being followed without having seen a clear and comprehensive (or at least clearly representative) explanation of how the cited numbers have been arrived at. Based on our review, we cannot confidently recommend that donors support the Fred Hollows Foundation.
- Boughton-Dent, Joe. Fred Hollows Foundation Communications & Community Education Manager. Email to GiveWell, September 9, 2009.
- Boughton-Dent, Joe. Fred Hollows Foundation Communications & Community Education Manager. Email to GiveWell, October 12, 2009.
- Chibuga, E., et al. 2008. Acceptance of cataract surgery in a cohort of Tanzanians with operable cataract. Eye 22: 830–833. Abstract available at http://www.nature.com/eye/journal/v22/n6/abs/6702736a.html (accessed July 11, 2010). Archived by WebCite® at http://www.webcitation.org/5r9ds8yDo.
- Cook, Colin. 2008. The economic burden of blindness, the cost of Vision 2020, and the cost benefit of Vision 2020 in Southern Africa. East African Journal of Ophthalmology.
- Doolan, Brian. Fred Hollows Foundation CEO. Email to Peter Singer, June 12, 2009.
- Doolan, Brian, Virginia Sarah, and Joe Boughton-Dent. Fred Hollows Foundation staff. Phone conversation with GiveWell, September 10, 2009.
- Fred Hollows Foundation. Fred Hollows Foundation has asked us not to publish the following documents.
- Abbreviated financial statement.
- Cambodia: Ophthalmology residency training project.
- Eritrea budget (2007).
- Country program output summary.
- Country program output summary (breakdown of 'other' interventions).
- International programs budget strategy (2007).
- Response regarding Fred Hollows Foundation impact for GiveWell.
- Fred Hollows Foundation. Our programs. http://www.hollows.org/au/home/ (accessed July 11, 2010). Archived by WebCite® at http://www.webcitation.org/5r9eEbq43.
- Gilbert, Clare E., et al. 2008. Poverty and blindness in Pakistan: Results from the Pakistan national blindness and visual impairment survey (PDF). BMJ 336: 29-32.
- Gogate, Parikshit M. 2009. Small incision cataract surgery: Complications and mini-review. Indian Journal of Ophthalmolology 57:45-49.
- Gooding, Kate. 2006. Poverty and blindness: A survey of the literature. West Sussex: SightSavers International.
- Guan, Chunhong and Andreas Mueller. Forthcoming. Cataract surgical outcomes during micro surgical training in China. Unpublished paper.
- IAPB, Vision 2020, and the World Health Organization. 2007. Global Initiative for the Elimination of Avoidable Blindness: action plan (2006-2011) (PDF).
- Kuper, Hannah, et al. 2008. A case-control study to assess the relationship between poverty and visual impairment from cataract in Kenya, the Philippines, and Bangladesh (PDF). PLoS Medicine 5: 1716-1728.
- Venkatesh, R., et al. 2005. Outcomes of high volume cataract surgeries in a developing country (PDF). British Journal of Ophthalmology 89: 1079–1083.
- 1. Fred Hollows Foundation, "Our Programs."
- 2. Brain Doolan, Virginia Sarah, and Joe Boughton-Dent, conversation with GiveWell, September 10, 2009.
- 3. Fred Hollows Foundation, “Country Program Output Summary.”
- 4. Brain Doolan, Virginia Sarah, and Joe Boughton-Dent. Phone conversation with GiveWell, September 10, 2009.
- 5. Brian Doolan, Virginia Sarah, and Joe Boughton-Dent. Phone conversation with GiveWell, September 10, 2009.
- 6. Fred Hollows Foundation, "Country Program Output Summary" and Fred Hollows Foundation, "Country Program Output Summary (Breakdown of 'Other' Interventions)."
- 7. Fred Hollows Foundation, "Response Regarding Fred Hollows Foundation Impact for GiveWell."
Response to GiveWell's report from Fred Hollows Foundation:
Thank you for your continued interest in our work which has been recognised as best practice in numerous independent external evaluations, including in formal evaluations and accreditation processes carried out by independent assessors on behalf of the Australian Government international aid and development agency AusAID, and by the Givewell organisation here in Australia. The Foundation's work in Cambodia was recently recognised with an award from the King and in Vietnam with an award from the Government of the Socialist Republic of Vietnam.
We are disappointed that your final focus seems to have been only on the number of eye operations and interventions reported as performed and that you are “not confident that the cited example was representative”, and that you feel you “cannot be confident” that our guidelines for recording eye surgeries and other interventions are being followed.
Our examples, guidelines and figures illustrating activities are subjected to the greatest scrutiny and, by limiting the inclusion of figures to being directly linked to activities undertaken only in the previous two years, intentionally undercount the much higher activity levels being achieved and the more substantial impact of The Foundation's longer term work.
As one example, The Fred Hollows Foundation established intraocular lens factories in Eritrea and Nepal in 1994 and these factories have now produced over four million low cost international standard quality lenses. This achievement alone has helped restore the sight of millions of people worldwide. These figures are not included in the tables to which you have referred.
We appreciate that your conclusion is a result of the limited desk research you are able to carry out from within the United States. We are also aware of your lack of familiarity with eye health and the social and economic impacts of restoring sight.
Thank you again for your interest and we wish you well.
Communications and Community Education Manager