Recommendation to Open Philanthropy for Grants in November 2020
Published: February 2021; Last Updated: October 2022
Please note that this page describes our understanding of our top charities' funding needs and plans as of November 2020, when we made our recommendation to Open Philanthropy.
Open Philanthropy, a philanthropic organization with which we work closely, is the largest single funder of our recommended charities. We make recommendations to Open Philanthropy each year for grants to make to our top and standout charities, subject to a budget set by Open Philanthropy. As this funding is significant, we think it is important to be transparent about the recommendations we make to Open Philanthropy, and so discuss them in depth on this page.1 This page explains what we decided to recommend to Open Philanthropy in November 2020 and why. If you’re interested in a recommendation for where to donate this year, please view this post with recommendations for non-Open Philanthropy donors.
Open Philanthropy plans to grant a total of $100 million to our recommended charities during the 2020 giving season. We are waiting to make recommendations about which organizations should receive $30 million of this funding until January 2021, when we expect to have more information about some promising funding opportunities.
- $27.0 million to Malaria Consortium's seasonal malaria chemoprevention (SMC) program.
- $16.8 million to New Incentives.
- $8.1 million to Helen Keller International's vitamin A supplementation (VAS) program.
- $6.7 million to the Against Malaria Foundation.
- $4.1 million to Evidence Action's Deworm the World Initiative.
- $3.1 million to the SCI Foundation's deworming program.
- $2.8 million to Sightsavers' deworming program.
- $500,000 to the END Fund's deworming program.
- $500,000 to GiveDirectly.
- $50,000 to each of our eight standout charities.
Table of Contents
- How did Open Philanthropy determine how much to give?
- How did we arrive at the allocation for the $70 million we recommended that Open Philanthropy grant in November?
Our recommended allocation to Open Philanthropy
- Malaria Consortium's seasonal malaria chemoprevention program
- New Incentives
- Helen Keller International's vitamin A supplementation program
- Against Malaria Foundation
- Evidence Action's Deworm the World Initiative
- SCI Foundation
- Sightsavers' deworming program
- END Fund's deworming program
- Standout charities
How did Open Philanthropy determine how much to give?
Open Philanthropy set its 2020 budget for our recommended charities with a goal of giving in a way that has the most impact over time. It based its estimate of how to have the most impact on (a) estimates of the cost-effectiveness of giving opportunities now and in the future, and (b) the projected growth of its invested assets over time. It also confirmed with GiveWell that (a) the budget level implied by these estimates did not exceed the total room for more funding GiveWell had identified for highly cost-effective programs, and (b) that it was enough to fill the time-sensitive funding gaps of these programs. Based on these factors, Open Philanthropy set a budget of $100 million for giving season 2020 to be granted based on our recommendations.
We recommended that Open Philanthropy grant $70 million to top and standout charities in November 2020. We recommended that it reserve the other $30 million to allocate by the end of January 2021, since we expect to learn more about a few potential giving opportunities over the next few months and want to account for that in our recommendations.2
How did we arrive at the allocation for the $70 million we recommended that Open Philanthropy grant in November?
Principles we followed
The principles we followed in arriving at this recommended allocation are the same as those we followed and described in detail last year:
- Principle 1: Put significant weight on our cost-effectiveness estimates.
- Principle 2: Consider additional information that we have not explicitly modeled about an organization.
- Principle 3: Consider additional information that we have not explicitly modeled about a funding gap.
- Principle 4: Assess charities’ funding gaps at the margin, i.e., how they would spend additional funding, where possible.
- Principle 5: Default to not imposing restrictions on charities' spending.
- Principle 6: Default to funding on a three-year horizon, modifying to preserve our options for the future where doing so is low-cost.
- Principle 7: Ensure charities are incentivized to engage with our process.
Size of incentive grants
Each year since 2016, we have recommended that Open Philanthropy make a minimum grant to each of our top and standout charities. These "incentive grants" are designed to compensate charities for the time they spend engaging with our process and for the risk they take by allowing us to write publicly about their strengths and weaknesses.
Since 2016, the size of the incentive grants has been $2.5 million for top charities and $100,000 for standout charities. In early 2020, we revisited our goals for these grants and whether the sizes of the grants were appropriate. We considered the cases where an organization is on our top charity list, but due to relatively lower cost-effectiveness, we are not prioritizing its funding needs most highly—i.e. we don't expect to grant donations from the Top Charities Fund to it or recommend that Open Philanthropy make a grant to it beyond the incentive grant. In those cases, we felt that the amount of time we asked from the organization's staff to engage with us was not commensurate with the $2.5 million grants we had been making. We considered other grants we've made and our perception of norms in international development and decided to change the standard amount of these grants to $500,000 for top charities.
We also reduced our incentive grant recommendations for standout charities to $50,000. Once a standout charity has been added to our list, we ask it to have one conversation with us each year and to review the notes we write to summarize what we learned from that conversation. We believe a smaller grant of $50,000 is appropriate for the time commitment this requires from standout charities.
We notified all of our top and standout charities about our plans to change the size of these grants in early 2020, before they had invested much time in responding to our questions and requests for the year. All decided to continue participating in our process.
A note on how we discuss cost-effectiveness on this page
We often use GiveDirectly's unconditional cash transfers as a benchmark for comparing the cost-effectiveness of different programs. When discussing cost-effectiveness, we generally refer to the cost-effectiveness of a program in multiples of "cash." Thus, if a program is estimated to be "10x cash," this means it is estimated to be ten times as cost-effective as unconditional cash transfers.
Our recommended allocation to Open Philanthropy
We've allocated the $70 million that we are recommending that Open Philanthropy grant to our top and standout charities in five categories:
- Incentive grants: $1.4 million total in incentive grants to GiveDirectly ($500,000), the END Fund's deworming program ($500,000), and our standout charities ($50,000 for each of eight charities).
- Scoping grants: $300,000 to Evidence Action's Deworm the World Initiative for identifying new opportunities in two countries.
- Limited support to programs that we have funded in the past that are less cost-effective than the needs we're prioritizing: $6.8 million to fund a few programs that are less cost-effective than the top charity needs we're prioritizing, but that we want to preserve the option of funding in the future (rather than risking them shutting down due to lack of funding).
We've recommended funding to support the following programs in the past and now recommend funding them through 2022:
- Malaria Consortium's SMC program in Chad,
- SCI Foundation's deworming program, and
- Sightsavers' deworming programs in the Democratic Republic of the Congo (DRC) and parts of Nigeria and Cameroon.
Many of these programs are only slightly less cost-effective than the programs we recommend on the margin (the programs that we model as more than 10x cash, listed in the next bullet). We may want to fund these programs in the future if available funding for our top charities outpaces new giving opportunities or if new information increases our estimate of their cost-effectiveness. We also think this funding could be justified on the basis of being responsible funders—i.e., not making large changes in our funding each year, which may help charities in their ability to plan.
Charity Amount (millions) Cost-effectiveness (x cash) SCI Foundation $3.1 10 Malaria Consortium $2.9 7 Sightsavers $0.7 2-9
- All fully-vetted opportunities for 2021-2022 that are more than 10x cash: $52.3 million for opportunities in 2021 and 2022 with modeled cost-effectiveness of more than 10x cash, as well as funding in 2023 for programs that will begin in 2021 and 2022. Our impression is that new programs benefit from longer funding runways than existing programs. This impression is based on what we've consistently heard from charities.
Charity Amount (millions) Cost-effectiveness (x cash) Malaria Consortium $24.1 14 New Incentives $16.8 11 Against Malaria Foundation $6.7 14 Helen Keller International $2.6 15-50+ Sightsavers $2.1 11-50+
- The most cost-effective opportunities we know of for 2023: The remaining $9.2 million for the best opportunities we know of in 2023.
Charity Amount (millions) Cost-effectiveness (x cash) Helen Keller International $5.4 15-50+ Deworm the World $3.8 13-30+
We aren't filling every funding need that top charities have told us about—the total exceeds $70 million. For a full list of charities' stated funding needs, see this spreadsheet.
Below, we provide a closer look at the recommendations we're making for each individual organization. We discuss what the funding we recommend that Open Philanthropy provide will enable each charity to do if it spends funds as we currently expect. The charity will retain the option to allocate the funds flexibly, as long as the funding goes to the program for which we recommend the charity, where applicable (e.g., funding we direct to Malaria Consortium is restricted to use for SMC but can be used in any country).
Malaria Consortium's seasonal malaria chemoprevention program
We are recommending a grant of $27.0 million to Malaria Consortium's SMC program, to which we will add an estimated $3.8 million from GiveWell's Top Charities Fund for Q3 2020. This is the amount that will allow Malaria Consortium to:
- Extend its funding runway for its current programs in Burkina Faso, Chad, Nigeria, and Togo through 2022 ($20.8 million) at the scale Malaria Consortium expects to achieve in 2021. We estimate the cost-effectiveness of Malaria Consortium's overall SMC portfolio to be 14x cash.
- This funding includes $2.9 million to continue its program in Chad at its 2021 scale through 2022 but excludes funding to expand that program further in 2022. We estimate that the cost-effectiveness of SMC in Chad is only 7x cash, and we have greater confidence in that figure this year after having implemented a country-specific funging adjustment, which takes into account whether other funders would be likely to fill funding gaps in each country in the absence of GiveWell-directed donations.3 We are recommending that Open Philanthropy fund this program, because (a) we don't want to restrict how Malaria Consortium uses funding within SMC (see principle 5 above) but want to fund opportunities that we expect Malaria Consortium would prioritize below maintaining its program in Chad in 2022, and not funding Chad would require us to forego those opportunities; (b) funding Chad at a lower level of support in the future may mean the program is more cost-effective (because of more targeting of the program to highly cost-effective areas or less crowding out of other funders), or, alternatively, 7x cash may be a level of cost-effectiveness we will want to fund in the future—in both cases, we're interested in keeping this program as an option; and (c) planning for 2022 is set to begin at the end of 2020, and we prefer not to reduce funding with such little warning. We plan to discuss further with Malaria Consortium possibilities for responsibly reducing its involvement in Chad, likely without fully withdrawing support.
- Expand to newly-eligible states or local government areas (LGAs) in Nigeria in 2022 and maintain work in those new areas in 2023 ($7.8 million). We estimate that the cost-effectiveness of SMC in Nigeria is 14x cash. Not all of this funding may be needed if more funding than expected becomes available from the Global Fund to Fight AIDS, Tuberculosis and Malaria and/or the President's Malaria Initiative (PMI) to support these new areas. If less funding than expected is needed, we expect the excess funding will likely be used to extend Malaria Consortium's funding runway in the areas it currently works in.
- Put $2.2 million toward continuing its work in 2023. This is the amount of remaining funding after allocating the rest of the $70 million that we agreed to recommend to Open Philanthropy in November 2020. We think funding SMC in 2023 (14x cash) is the best current option among the unfunded gaps we know about.4
Funding gaps that Malaria Consortium told us about that we are not recommending filling at this time:
- $36.3 million for maintaining its programs in Nigeria (14x cash), Burkina Faso (21x cash), and Togo (12x cash) in 2023. We could have recommended that Open Philanthropy grant more of its total budget in this round and use the funding to fill more of Malaria Consortium's funding gap, but we prefer to wait until January 2021 to recommend the allocation of the remaining $30 million. We may prefer to recommend that the remaining funding go to Helen Keller International or the Against Malaria Foundation, given that they have funding opportunities that are or soon will be time-sensitive.
- Expansion in Chad in 2022 ($600,000) and maintenance of work in Chad in 2023 ($7.8 million). See note above about the lower cost-effectiveness of SMC in Chad.
- Expansion to three new countries. Malaria Consortium is currently conducting a pilot project in Mozambique and plans to conduct a pilot in Uganda in 2021. It has already set aside funding for those pilot projects. Malaria Consortium told us that scaling up in these two countries in 2021-2023 and adding another country in 2023, when it next expects to have capacity for such an expansion, would cost an estimated $30 million. We are not recommending funding this expansion, because funding is not the bottleneck to this expansion at this time.
We are recommending a grant of $16.8 million to New Incentives. This is the amount that will allow New Incentives to:
- Scale as fast as it believes it can in 2021 ($5.6 million needed in total; New Incentives has $1.2 million remaining from previous grants that it can use).5
- Maintain the scale it projects it will achieve at the end of 2021 in 2022 and 2023 ($12.4 million).6
We estimate the cost-effectiveness of this work as 11x cash.7
Before the end of 2021, we expect to decide whether to recommend additional funding that would enable New Incentives to scale up to new clinics in 2022. We decided to wait until 2021 to make this decision so that we could observe how its initial scale-up proceeds.
Helen Keller International's vitamin A supplementation program
We are recommending a grant of $8.1 million to Helen Keller International for its vitamin A supplementation (VAS) program. This is the amount that will allow Helen Keller International to:
- Extend its funding runway for its current programs through 2023 ($5.4 million). We estimate that the cost-effectiveness of these programs is 15-50x cash.
- Expand to Benue State, Nigeria ($2.6 million for 2021-2023). We estimate that the cost-effectiveness of VAS in Nigeria is 25x cash. There are VAS campaigns ongoing in Benue (implemented by the government without external assistance), and Helen Keller International believes these campaigns are achieving low coverage. To test this assumption, we have asked Helen Keller International to do a coverage survey of an October 2020 VAS campaign in Benue that it did not support. It is possible that Helen Keller International will conclude from the coverage survey that its support is not needed in Benue, in which case it will look for other states where its support would have more impact. We believe it is very likely that if Helen Keller International decided not to support the VAS campaign in Benue, it would be able to use this funding on another highly cost-effective opportunity.
Funding gaps that Helen Keller International told us about that we are not recommending filling at this time:
- Expansion in Cameroon ($3.8 million for 2021-2023). We estimate that the cost-effectiveness of VAS in Cameroon is 15x cash. This program is currently funded by the government of Canada, and the grant runs out at the end of the year. We think there is a 40% chance that we'll know by January whether this funding is going to continue, so we're recommending waiting to decide whether to fill this funding gap.
- Expansion in Kenya ($3.5 million for 2021-2023). We estimate that the cost-effectiveness of this program is 10x cash, which is on the lower end of the range of cost-effectiveness of programs we are recommending funding. We have outstanding questions about the likelihood that another funder would fill some or all of this funding gap if we do not and about the level of vitamin A deficiency in Kenya. We plan to continue looking into these questions and may recommend funding for this program in the future.
- Helen Keller International expects that it will have capacity to expand to one Nigerian state in 2021 (see Benue above), two in 2022 and two in 2023. We are not currently recommending funding the 2022 and 2023 expansions, despite high cost-effectiveness (23x cash), because we expect Helen Keller International's capacity, rather than funding, to be the bottleneck to expansion in the next year, and we expect to learn more (particularly through the Benue coverage survey) about the cost-effectiveness of these programs in the future. For these reasons, we recommend waiting to decide whether to fund further expansion in Nigeria. Because we estimate these programs to be highly cost-effective and because it is possible that funding them sooner rather than later will allow expansions to take place more quickly, we plan to consider making a recommendation for the 2022 expansion ($3.6 million) in early 2021, when we expect to get the Benue coverage results, rather than waiting until the end of 2021.
Against Malaria Foundation
We are recommending a grant of $6.7 million to the Against Malaria Foundation (AMF).
This is the amount that we estimate will allow AMF to fund all the campaigns it is considering implementing that require commitments before August 2021. It is possible that this is an underestimate, as we are assuming AMF will continue to receive a relatively high amount of revenue from individual donors, based on recent trends. This risk is mitigated by the fact that we will have the opportunity to check whether this assumption has held up when we revisit AMF's room for more funding in January 2021. We expect that AMF will use this funding for campaigns in DRC (15x cash) and/or Guinea (14x cash) in 2022.
Funding gaps that AMF told us about that we are not recommending filling at this time include those for distributions that will occur in 2023 (totaling $37.8 million). We are not recommending funding these gaps at this time because (a) we want to review recently-available monitoring results from AMF's recent distributions in DRC before committing additional funding to distributions there, and (b) these gaps are less time-sensitive (we expect that AMF will need to commit funding to these distributions in the latter half of 2021 to avoid delaying them). We expect to revisit AMF's room for more funding as part of our January 2021 recommendation to Open Philanthropy.
Evidence Action's Deworm the World Initiative
We are recommending a grant of $4.1 million to Evidence Action's Deworm the World Initiative. This is the amount that will allow Deworm the World to:
- Extend its funding runway for its programs in Kenya ($1.9 million, 32x cash) and in three states in Nigeria ($1.9 million, 13-16x cash) through 2023.
- Conduct scoping work in Ghana and Indonesia and do a prevalence survey in Ghana ($300,000). We don't have a cost-effectiveness estimate for this funding gap and are assessing it qualitatively. The case for the grant is that this modest amount of funding may open up room for more funding at high cost-effectiveness levels if either (a) worm prevalence is sufficiently high in Ghana or (b) there are highly-leveraged ways to improve the deworming program in Indonesia (and prevalence is sufficiently high there). Deworm the World seems to be following a thoughtful process for determining where the best opportunities are and to be planning next steps that will be informative.8
Funding gaps that Deworm the World told us about that we are not recommending filling at this time:
- Extending its funding runway through 2023 for its programs in Pakistan and Lagos State, Nigeria. In the past, these programs were on the lower end of the cost-effectiveness levels that we directed funding to, and with the recent updates to our worm burden adjustments,9 we now estimate them to be 5x cash, which is currently well below our funding threshold. Without this funding, Deworm the World will have two years of funding runway for these programs left. We plan to discuss the future of these programs with Deworm the World, including getting further feedback on our worm burden update.
We are recommending a grant of $3.1 million to the SCI Foundation's deworming program.
We estimate that SCI's overall cost-effectiveness is 10x cash, which is right at our current funding threshold. We focus on SCI's overall cost-effectiveness because, based on our past experience with SCI and our understanding that SCI has access to a substantial amount of non-GiveWell-driven flexible funding, we don't currently believe that we can either predict or drive how SCI will use marginal funding.
SCI's overall cost-effectiveness is driven by a mix of country programs that we estimate are very highly cost-effective (20% of its portfolio, 3 countries, 25-30x cash) and others that are much less cost-effective (50%, 3+ countries, <5x cash). This means that our estimate of SCI's overall cost-effectiveness is quite sensitive to our estimates for its three most cost-effective country programs. We are wary of those top three estimates, because we have major open questions about two of them: (1) whether additional funding will be needed for Madagascar, which has been (and may continue to be) funded by a grant restricted to that country; and (2) whether we have made a mistake or used low-quality data for our worm burden adjustment for SCI's DRC program—our estimate of the program's cost-effectiveness in the province in DRC in which Sightsavers works is much lower than our estimate for the areas SCI funds in the country, and we have not yet identified what is driving the difference in the two estimates, leading us to wonder if the difference is real or not.
SCI's current and expected funding, along with this grant of $3.1 million, will allow SCI to maintain its current work through 2022. Since this spending will be driven by available funding much more than ongoing revenue, SCI will be facing a large budget shortfall in 2023. We plan to decide in the next year whether we believe that SCI's use of additional funding in 2022 and 2023 is competitive with other opportunities to which we could direct funding. We plan to do further work on our worm burden assessment and have further conversations with SCI about how its choices of which countries to work with affect our estimate of its cost-effectiveness.
Sightsavers' deworming program
We are recommending a grant of $2.8 million to continue, through 2022, Sightsavers' deworming programs that have previously been funded by GiveWell-directed funding. This includes deworming programs in several states in Nigeria ($1.5 million, 30x cash), Cameroon ($1.2 million, 15x cash), and DRC ($200,000, 2x cash10 ).
Funding gaps that Sightsavers told us about that we are not recommending filling at this time:
- $5.4 million to start a deworming program in Chad and fund it for three years. Based on the data we have on the prevalence and intensity of intestinal worms in Chad, we estimate that the cost-effectiveness of this program would be 14x cash. Because this is a new program and, in particular, some of the areas to be covered have not recently received deworming, we see this as an opportunity to collect higher quality data than is currently available to inform our worm burden adjustment, which we apply to our cost-effectiveness estimates for deworming programs to account for the prevalence and intensity of intestinal worms in each country. We will lose this opportunity if Sightsavers funds deworming before that data is collected, so instead of recommending funding for this deworming program immediately, we have started a conversation with Sightsavers about conducting a new prevalence/intensity survey prior to implementing the program. We may later recommend that Open Philanthropy make a grant to Sightsavers to fund such a survey.
- $1.3 million to start a deworming program in Senegal and fund it for three years. We estimate that the cost-effectiveness of this program would be 4x cash, using Sightsavers' data on projected spending and children reached. These figures imply an average cost per child that is more than twice as expensive as Sightsavers' average. We plan to discuss these estimates further with Sightsavers to check whether we've correctly understood its plans.
- $900,000 to fund impact assessment surveys in Nigeria. We are skeptical that this would meet our cost-effectiveness bar, though we have not attempted to estimate its cost-effectiveness.11
END Fund's deworming program
We are recommending an incentive grant of $500,000 to the END Fund.
We completed a project in October that changed the worm burden adjustment in our cost-effectiveness analysis and increased our estimate of the END Fund's cost-effectiveness from 5x cash to 11x cash. We have lower confidence in this estimate than we do for our other deworming top charities. Based on past experience with cost-effectiveness estimates that we have low confidence in, we expect this estimate to go down as we continue to work on it. We had previously deprioritized work on improving this estimate, due to both the low cost-effectiveness of the program and challenges in understanding what the END Fund was funding with marginal GiveWell-directed dollars. Given the recent increase in our estimate of the END Fund's cost-effectiveness, we plan to consider whether to increase our time investment in understanding the END Fund's cost-effectiveness.
We are recommending an incentive grant to GiveDirectly of $500,000. GiveDirectly is significantly less cost-effective (1x cash) than the other funding gaps recommended here.
We have eight standout charities and are recommending $50,000 grants to each, for a total of $400,000:
- Development Media International
- Evidence Action's Dispensers for Safe Water
- Food Fortification Initiative
- Global Alliance for Improved Nutrition (GAIN)'s universal salt iodization (USI) program
- Iodine Global Network
- Living Goods
- Project Healthy Children
- Zusha! Road Safety Campaign
More about our relationship with Open Philanthropy here.
We typically recommend Open Philanthropy's full allocation early in "giving season" (the November-December period in which most individual donors make their gifts).
This year, we preferred to wait until January to allocate part of Open Philanthropy's support. This leads to an increase in the "fungibility" of donations within our top charities. For example, if a donor gives $100 to Charity A, they likely expect Charity A to have $100 more to spend. But if Open Philanthropy makes its giving decision after this donor, and GiveWell sees that $100 has already been donated to Charity A, and recommends that Open Philanthropy give Charity A $100 less as a result (recommending another $100 to the next highest-priority opportunity we recommend instead), then the impact of the donor's $100 wasn't actually to expand Charity A's budget—though it did increase the total budget of all GiveWell-recommended charities by $100. We refer to this phenomenon as donation "funging," from the term "fungibility."
In the past, we believed it was possible, based on what Malaria Consortium had told us, that our cost-effectiveness estimate was not capturing the fact that Chad is relatively more neglected by malaria funders than the other countries Malaria Consortium works in. This year, we have incorporated this consideration into our model by using country-specific funging adjustments.
For more detail on how we think about fungibility of donations to our top and standout charities, see this blog post.
The next best options are to fund AMF's programs in 2023 (14x cash) or to fund Helen Keller International's VAS program in Cameroon from 2021-2023 (15x cash). However, we would prefer to wait to decide whether to fund these gaps until we have more information, as we have not yet reviewed AMF's new monitoring data in DRC, and we may find out that the government of Canada has decided to renew its funding for HKI's program in Cameroon in the next couple of months.
GiveWell: New Incentives budget, "Source: NI budget with scale up assumptions" tab, cell E38.
GiveWell: New Incentives budget, "Grant size" tab, cell B5.
GiveWell: New Incentives budget, "Source: NI budget with scale up assumptions" tab, cells F38 and G38.
GiveWell: New Incentives CEA for evidence and cost-effectiveness writeup, "CEA summary" tab, cell B16.
Deworm the World generated a list of 13 countries to consider expanding to based on World Health Organization (WHO) reports of deworming coverage. Largely through conversation with USAID-funded neglected tropical disease groups, it narrowed down the list to two countries: Ghana and Indonesia. The case for Ghana rests largely on reductions in USAID funding for lymphatic filariasis programs (which also deliver the drug used for soil-transmitted helminthiasis [STH] deworming). The case for Indonesia largely rests on it being a very large country, where, if there is room for improvement in its existing program, Deworm the World may be able to provide technical assistance that would lead to higher coverage rates, while spending relatively little. Deworm the World writes, "We are seeking funds to continue scoping work and to conduct due diligence work in selected geographies...We are seeking $118k to conduct a STH prevalence survey in Ghana in 2021." See GiveWell's room for more funding analysis for Deworm the World.
See this document for more information.
We are recommending funding for the DRC program, despite its low cost-effectiveness, due to the small amount of funding required and the time-sensitivity of the funding. We recently revised our worm burden adjustments, which caused the estimated cost-effectiveness of this program to drop from 19x cash to 2x cash. We may do some more work to interrogate that data, collect more data, or talk to Sightsavers about ceasing funding for its work in DRC, but we haven't done so yet due to the timing of our update and the small amount of funding requested.
It could be argued that impact surveys should be built into the cost of deworming programs, given that WHO recommends them as a standard component of deworming. However, we aren't convinced of their value, they are fairly expensive, and we believe that Sightsavers and its government partners are willing to continue deworming programs without them. The idea behind the surveys is to (a) make deworming programs more cost-effective through better targeting of the areas where worm burden remains high, and (b) get more buy-in for the program through demonstrating to governments and donors that the program has reduced worm burden and, where applicable, that there continues to be a need for treatment. On (a), our weakly-held impression is that governments have been reluctant to stop or reduce the frequency of deworming in places where worm burden used to be higher. On (b), speaking as donors, the impact assessments we've seen to date haven't been particularly helpful to our understanding of deworming programs' impact, and we haven't encountered cases where government buy-in for externally-funded deworming programs was a bottleneck. We plan to continue discussing the value of impact assessment surveys with Sightsavers and our other top charities that work on deworming and may consider funding these surveys in the future.