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Response by New Incentives to GiveWell May 2015 Update

New Incentives is grateful for GiveWell’s continued support beginning in 2014, which was granted because New Incentives “runs a priority program, is committed to transparency, and is at an early stage of development.” New Incentives is pleased to note that in 2014, according to GiveWell, it “made substantial progress towards possibly becoming a GiveWell top charity in the future.”

We agree with the assessment that the organization is still at a very early stage and faces several challenges, including retention.

The current GiveWell page on New Incentives relies on data from the initial program phase, which ran from June through November 2014. From December 2014 to May 2015, we have taken various steps to address the key challenges encountered during the initial program phase.

At the heart of our program lies the challenge of incentivizing HIV-positive pregnant women to consistently utilize medical treatment throughout pregnancy and after their child’s birth, thus ensuring the health of the newborn. Without intervention, approximately one in three HIV-positive women in the Southern Nigerian state of Akwa Ibom give birth at a clinic, the most important step in reducing transmission of HIV (as the drug Nevirapine, which is given immediately after birth, is only available and applied in proper medical facilities). Low usage rates of clinics, the norm without incentive, are the result of high transport and clinic costs, traditional beliefs, lack of information and/or misinformation, and various other reasons.

Our approach is to overcome some of the biggest hurdles by offering these disadvantaged HIV-positive women substantial cash transfers to help them complete life-saving treatment and reduce their family’s poverty.

Retention in medical treatment is the key goal the program aims to achieve. Following the earliest program phase from June to November 2014, we have taken the following strategic measures to improve the rate of women adhering to treatment:

  • Hired local employees that enroll beneficiaries and manage follow-up calls in the local language.
  • Introduced an additional cash transfer to reduce the gap between the first cash transfer at enrollment and the subsequent transfer after delivery. This improves on our initial program phase wherein beneficiaries would wait up to seven months for a cash transfer.
  • Implemented a system of automated text messages and robotic calls that keep beneficiaries informed and engaged throughout the program.
  • Introduced an additional small cash incentive handed out at enrollment to increase a new beneficiary’s trust in New Incentives. This has helped increase the rate of women who go on to collect their first cash transfer.

These measures are supported by several additional changes that have been made per the initial findings and suggestions of the UCSF research team carrying out the randomized control trial of New Incentives’ program.

Given the length of a pregnancy, the impact of the program changes will only be accurately measurable by the end of 2015. Independent confirmation of program success will be available by fall 2016 when the results of our randomized controlled trial will be published.

New Incentives will continue to closely measure program retention and looks forward to sharing information about the challenges and successes of scaling the program from 500 HIV-positive pregnant women to over 1,000 women in the coming months.

New Incentives, May 2015