We have published a more recent review of this organization. See our most recent report on Helen Keller International's (HKI) vitamin A supplementation (VAS) program.
In a nutshell
HKI is an aid organization focused on combating blindness and malnutrition; its approach is centered less on direct intervention than on research and technical support. We cannot confidently recommend HKI, since - as with many of our other applicants - we ultimately do not have either broad evidence of its effectiveness in changing lives, or a bird's-eye view of its organizational strategy and activities.
However, we wish to bring attention to one of its programs, which aims to systematically reduce Vitamin A deficiency across eight countries. Going off the conclusions of its research on Vitamin A would imply that this program is saving lives more reliably and cost-effectively than other programs we have looked at. We ultimately do not have enough confidence in this program or in HKI as a whole to recommend it to an individual donor, but find the program worth noting.
We first discuss the Vitamin A supplementation program, then briefly give our limited understanding of the rest of the organization.
Table of Contents
Vitamin A supplementation program
Attachment B-1 details a Vitamin A supplementation program that HKI carried out in seven countries, in conjunction with UNICEF. By adding Vitamin A supplementation to various existing health programs, this program appears to have resulted in extremely inexpensive coverage of life-saving Vitamin A supplements.
What do they do?
The program described is a joint venture of HKI and UNICEF, with funding from the Canadian International Development Agency, aiming to maximize coverage of Vitamin A in nine countries (these countries, along with estimates of how much of their population is deficient in Vitamin A, are found on Attachment B-1 Pg 3).
The exact nature of HKI's and UNICEF's activities seems to be supporting and providing technical assistance to governments, particularly by adding Vitamin A into existing public health campaigns (see Attachment B-1 Pg 4 for the details of these health campaigns). Attachment B-1 Pg 8-9 gives more detail on HKI's value-added in particular, which seems to generally take the form of developing and distributing plans of action; in a some cases, they have also helped with local publicity (making people aware of public health campaigns) and/or with training local community health workers.
Does it work?
Vitamin A supplementation is generally administered directly (Attachment B-18), giving us reason to believe that the data on Attachment B-1 Pg 4 is reliable (although we wonder what a "coverage" of over 100%, which appears in several cells, refers to). This data indicates that many children were given Vitamin A supplements, relatively cheaply (see immediately below). Together with our understanding (also from HKI) about the impact of Vitamin A, this implies that the program saved lives.
What do you get for your dollar?
If we assume that a child given two Vitamin A supplements per year has a 20% reduction in annual chances of mortality (see our brief overview of research on Vitamin A supplementation), and use the child mortality rates on file with the WHO Statistical Information System database - coming out to about 20 annual deaths per thousand children for the countries covered - this implies that administering Vitamin A prevents about one death for every 250 children, per year. As we state in our brief overview of research on Vitamin A supplementation, this estimate is based on research that may give an exaggerated picture of Vitamin A's impact.
We do not have information on the total cost of this project, only on the expenses incurred by the funder (i.e., HKI's and UNICEF's expenses in providing technical support to local governments). As the table at the top of Attachment B-1 Pg 7 shows, these expenses come out to only about 20 cents per dose administered, and at two doses per child per year (as the table indicates), that's 40 cents per child per year. Putting this together with the above logic, that's about $100 per life saved, a far lower number than we find in our other applicants' programs. However, this comparison fails to put HKI and our other applicants on the same terms, as our other applicants pay all or nearly all of their programs' costs, while the budget we analyzed is for HKI's and UNICEF's technical support only.
Still, it intuitively seems to us that a program along these lines should be an extremely cost-effective way to save lives. To the extent that there are existing health campaigns, well-positioned to provide Vitamin A, that are not doing so, adding Vitamin A into the programs offers significant potential benefits to children's health, at relatively low costs. We don't know the extent to which there are more opportunities like this one, in which life-saving nutrients and other materials can be added on to existing programs in particularly inexpensive and straightforward ways - but we would hope any good aid organization would seek, and prioritize, all such opportunities before more expensive and comprehensive interventions.
HKI as a whole
Unlike our other applicants, HKI is focused on providing technical assistance and research rather than carrying out projects directly. We believe this may be an extremely valuable service, and worth supporting with individual donations; however, doing so requires clarity on the nature of HKI's expenses and value-added, and at this point we do not have that clarity.
Even for the project described above - the one we have the most information for, by far - we have no information on the aggregate expenses of Vitamin A coverage (important in assessing whether governments' resources and attention were well prioritized), and we have no information on how much of the budget was attributable to HKI as opposed to the partner, UNICEF. We know from HKI's Form 990 (available on GuideStar) that that its most recent operating expenses were $30 million, so this project (with expenses of $4.7 million in 2006 - see Attachment B-1 Pg 7) - was at most around 15% of its 2006 budget.
Our understanding of HKI's other programs is far weaker:
|New York City
|Increase access to and use of eye health services by underprivileged pre-school age children in New York City.
|Attachments B-5 & B-6
|Vitamin A supplementation (detailed above)
|Cameroon, Nigera, and Cote D'Ivoire
|Fighting trachoma by performing surgeries, training surgeons, providing medicine, building latrines, and training teachers (to promote sanitation).
|Jan 2006 - June 2006
|Support Ivemectin distribution (for fighting onchocerciasis)
|Cameroon, Nigera, and Cote D'Ivoire
|Vitamin A supplementation
|Promote the cultivation and consumption of orange-fleshed sweetpotatoes to improve food security and to combat Vitamin A deficiency
|Improving Vitamin A intakes of women and children through production and consumption of orange-fleshed sweet potatoes
Ultimately, we cannot confidently recommend HKI because we have too little information about the organization as a whole. We have neither comprehensive evidence on outcomes nor an overall view of the organization's strategy; this means that while there are some programs we are confident in and others we are less confident in, we have no sense of what to expect from this organization if and when it brings in more donations.
That said, we find the Vitamin A supplementation program described above to be an extremely promising approach to saving lives: focusing on technical assistance to add more life-saving nutrients and materials to existing distribution campaigns, rather than implementing a new program from the ground up. We are hopeful that we will gain more information on HKI's overall activities in the future.
A. Application and response
B. Program related attachments
- Attachment B-1:VAS HKI Annual Progress Report, 2006
- Attachment B-2: Beaton GH, Martorell R, Aronson KJ, Edmonston B, McCabe G, Ross AC, Harvey B. Effectiveness of Vitamin A supplementation in the control of young child morbidity and mortality in developing countries. ACC/SCN State-of-the-Art Series: Nutrition Policy Discussion Paper No. 13. Geneva: Administrative Committee on Coordination – Sub-Committee on Nutrition (ACC/SCN). 1993.
- Attachment B-3: Glasziou PP, Mackerras DEM. Vitamin A supplementation and infectious diseases: a meta-analysis. BMJ 1993;306:366–70. (Available through Pubmed).
- Attachment B-4: WHO Statistical Information System database
- Attachment B-5: ChildSight 2006 report
- Attachment B-6: ChildSight
- Attachment B-7: Overview of HKI's VAS work
- Attachment B-8: List of Round 2 Attachments
- Attachment B-9: Trachoma report 1H 2006
- Attachment B-10: VAD in sub-Saharan Africa
- Attachment B-11: VAS and Ivermectin 2007
- Attachment B-12: VAS in Niger
- Attachment B-13: VAS in Sierra Leone
- Attachment B-14: Vit A foods ad
- Attachment B-15: Vitamin A and Ivermectin
- Attachment B-16: Vitamin A food training
- Attachment B-17: Workshop on Vitamin A foods
- Attachment B-18: Email exchange with HKI