About this page
GiveWell 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.
We investigated the Worldwide Fistula Fund because it works to increase access to surgery for obstetric fistula, an approach we find promising. (For more, see our overview of obstetric fistula.)
A note on this page's publication date
The last time we examined Worldwide Fistula Fund was in 2009. 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 2009 appears below. This content is likely to be no longer fully accurate, both with respect to what it says about Worldwide Fistula Fund 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 they do
We reviewed Worldwide Fistula Fund's website1 and spoke to Dr. Lewis Wall, founder and president of Worldwide Fistula Fund, on the phone. Dr. Wall told us that his organization is currently involved in building model fistula facilities in Africa to demonstrate the superiority of specialized centers for dealing with this devastating problem.2 We believe this is a new initiative for Worldwide Fistula Fund, which in the past has primarily granted funds to other organizations working on fistula and engaged in research and advocacy efforts.3
In general, we require charities working on developing-world surgeries to provide compelling answers to the following questions before we can feel confident recommending that donors support such a charity (more at our overview of developing-world surgery):
- Is the charity increasing the number of surgeries performed by addressing the bottleneck to more surgeries?
- How is quality assured?
- Is one surgery enough?
To address these questions in the case of the Worldwide Fistula Fund, we asked the specific questions below. We do not believe that the materials Worldwide Fistula Fund provided answer these questions. We therefore cannot confidently recommend that donors support the Worldwide Fistula Fund.
Questions we asked Worldwide Fistula Fund
- Do you have evidence that there are qualified surgeons who are ready to work on fistula if the facilities are provided?
- Do you have evidence that women receive higher quality care at dedicated facilities than at general hospitals?
- Would it be possible to get a copy of the Worldwide Fistula Fund's budget, broken down by program activity?
- What are the professions of those you train before your training?
- Do you have any empirical evidence that compares quality of care at general hospitals to that of specialist fistula centers?
- Wall, Lewis. Worldwide Fistula Fund President. Email correspondence with GiveWell, August 13 to October 11, 2009.
- Wall, Lewis. Worldwide Fistula Fund President. Phone conversation with GiveWell, August 11, 2009.
- Worldwide Fistula Fund. Homepage. http://worldwidefistulafund.org (accessed November 28, 2010). Archived by WebCite® at http://www.webcitation.org/5uaUu060o.
- Worldwide Fistula Fund. IRS form 990:
Additionally, Dr. Wall sent us the following articles:
- Wall, Lewis, et al. 2004. The obstetric vesicovaginal fistula: Characteristics of 899 patients from Jos, Nigeria. American Journal of Obstetrics and Gynecology 190(4):1011-9. Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15118632 (accessed October 1, 2009). Archived by WebCite® at http://www.webcitation.org/5uagc2ilE.
- Wall, Lewis. 2006. Obstetric vesicovaginal fistula as an international public-health problem. Lancet 368(9542): 1201-1209. Available at http://www.lancet.com/journals/lancet/article/PIIS0140-6736%2806%296947… (free registration required; accessed October 1, 2009). Archived by WebCite® at http://www.webcitation.org/5uahHsAhK.
- Wall, Lewis, et al. 2006. Humanitarian ventures or ”˜fistula tourism?': The ethical perils of pelvic surgery in the developing world. International Urogynecology Journal and Pelvic Floor Dysfunction 17(6): 559–62. Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16391881 (accessed October 1, 2009). Archived by WebCite® at http://www.webcitation.org/5uahLHePg.
- Wall, Lewis. 2007. Where should obstetric vesico-vaginal fistulas be repaired: At the district general hospital or a specialized fistula center? International Journal of Gynecology and Obstetrics 99: S28–S31. Abstract available at http://www.ijgo.org/article/S0020-7292%2807%2900367-0/abstract (accessed October 1, 2009). Archived by WebCite® at http://www.webcitation.org/5uahckSU2.
- Wall, Lewis, et al. 2008. A code of ethics for the fistula surgeon (PDF). International Journal of Gynecology and Obstetrics 101:84–87.