Note: This page summarizes the rationale behind a GiveWell grant to Helen Keller Intl as of April 2025, when we made the grant. Helen Keller Intl staff reviewed this page prior to publication.
In a nutshell
In April 2025, GiveWell recommended a $389,997 grant to Helen Keller Intl to support vitamin A supplementation (VAS) campaigns in three regions across Mali and Guinea for June 2025. This grant expands Helen Keller's VAS program to two new regions (Mopti in Mali and Boké in Guinea) and continues operations in one existing region (Sikasso in Mali).
We are recommending this grant because:
- We estimate Helen Keller's VAS program is about 17 times as cost-effective as cash transfers in Mali and about 11 times as cost-effective as cash transfers in Guinea, well above our threshold for funding.
- There is a clear funding gap for VAS in these regions after UNICEF's withdrawal from supporting them, and we believe this gap is unlikely to be filled by other funders in time for the June 2025 campaigns.
- Based on our understanding of the support needed and Helen Keller Intl's expertise, Helen Keller is well-positioned to provide the support needed in these regions.
Our main reservations about this grant are:
- Significant uncertainty about key parameters in our cost-effectiveness model, including the effect of VAS on mortality, current vitamin A deficiency rates, the number of children who will be reached, and what would happen without our funding.
- Providing funding for regions where UNICEF has withdrawn may create a risk that other funders reduce their support for VAS in the future, expecting GiveWell to fill the gaps.
Published: October 2025
The organization
Helen Keller Intl (Helen Keller) is an international nonprofit organization that works to prevent blindness, reduce malnutrition, and control and eliminate neglected tropical diseases.1 It operates a variety of programs, including vitamin A supplementation (VAS) programs in Africa and Asia.2 GiveWell has directed funding to Helen Keller Intl for VAS programs since 2017.3 You can read more in our write-up on Helen Keller.
The intervention
Vitamin A deficiency (VAD) is a common condition in low and middle income countries that can lead to blindness, increased susceptibility to infection, and death.4
Vitamin A supplementation (VAS) involves getting 6-59 month old children to swallow a small amount of fluid containing vitamin A, which can be delivered via a single-use capsule.5 Helen Keller Intl provides funding and technical support to governments to deliver VAS via mass distribution campaigns.6 We think these campaigns increase the number of children who receive VAS and reduce child mortality.7 You can read more in our report on vitamin A supplementation.
The grant
This $389,997 grant will support Helen Keller Intl's VAS program in three regions across Mali and Guinea for the first of two VAS campaign rounds in 2025. Specifically, the grant will:
- Continue Helen Keller's support for VAS in Sikasso region (Mali), where Helen Keller stepped in to provide support in late 2024 after UNICEF withdrew funding.8
- Expand Helen Keller's VAS program to Mopti region (Mali) and Boké region (Guinea). These regions were previously covered by UNICEF.9
We are providing funding for one campaign round (June 2025) rather than multiple rounds because we think a longer timeline will increase the likelihood that we crowd out UNICEF in Mali and Guinea ("funging"). This is especially concerning in Mali, where UNICEF covers 8 of 11 regions. It is less concerning in Guinea, where UNICEF covers 2 of 9 regions.10
While it seems highly unlikely that UNICEF will cover VAS campaigns in these regions in the first round of 2025, they might be able to cover them in the second one.11 We expect to learn more in the next few months, prior to making a decision about further renewal of support in these regions.
Additionally, in the coming months, we expect to gain a better understanding in the coming months of how US government funding cuts might indirectly affect VAS programs in both countries.12
Grant activities
We expect Helen Keller to provide technical and financial assistance to the government in Mali and Guinea to distribute VAS via door-to-door campaigns in Sikasso, Mopti, and Boke. We expect this support to closely resemble the support Helen Keller typically provides, which is described in more detail in our vitamin A supplementation intervention report.
Budget for grant activities
| Country | Region | Target population | Budget (USD) 13 |
|---|---|---|---|
| Mali | Sikasso | 858,610 | $177,843 |
| Mali | Mopti | 661,297 | $148,531 |
| Guinea | Boké | 272,047 | $63,623 |
| Total | $389,997 | ||
Note: Helen Keller Intl also proposed supporting the capital regions of Bamako (Mali) and Conakry (Guinea) at an additional cost of $145,625 and $51,470, respectively. We decided not to fund these regions based on evidence suggesting lower cost-effectiveness in these urban areas. Details below.
The case for the grant
We decided to recommend this grant because:
The program is likely to be highly cost-effective
We estimate that Helen Keller's VAS program is about 17 times as cost-effective as cash transfers14
in Mali ("17x") and about 11 times as cost-effective as cash transfers in Guinea ("11x"), well above our 8x funding threshold for grants to our Top Charities.15
While we did not develop region-specific cost-effectiveness estimates for this grant decision due to the relatively small size of the grant and the expected noisiness of subnational data, we have several reasons to believe the non-capital regions we're supporting will have cost-effectiveness comparable to our national estimates:
- Demographic and Health Survey (DHS) data from 2018 indicates that under-5 mortality rates in these regions are comparable to national averages, suggesting that a key driver of cost-effectiveness is similar across regions.16
- Helen Keller Intl expects under-5 mortality in these regions to be similar to or higher than national rates.17
- A rough analysis suggests the cost per child reached in these regions will be comparable to or lower than in regions where Helen Keller already operates.18
There is a clear funding gap unlikely to be filled by other funders
Evidence from stakeholders in both countries indicates that without our grant, VAS campaigns in these regions would likely not occur in June 2025.
In Guinea:
- UNICEF confirmed they no longer have sufficient funds to support Boké region for VAS in 2025.19
- Global Affairs Canada indicated they do not plan to renew their support for UNICEF in time for the June 2025 campaign.20
In Mali:
- We see evidence in favor of funding gaps, but we're more uncertain about UNICEF's funding status.
- Evidence in favor of funding gaps:
- Government officials specifically requested Helen Keller's support for these regions due to funding shortfalls.21
- A government official confirmed that UNICEF's financial support for these regions ended in mid-2024.22
- Helen Keller told us that Mopti region missed the VAS campaign in late 2024 due to lack of funding, while Sikasso was only covered because Helen Keller stepped in with GiveWell funds.23
- Uncertainty about UNICEF's funding status:
- We lack clarity on UNICEF's funding status in Mali as we were unable to speak directly with their representatives by the deadline by which Helen Keller required a decision for this campaign round.
Helen Keller is well-positioned to implement the program effectively
Based on our understanding of the support needed and Helen Keller's expertise, we think Helen Keller is well-positioned to implement the program effectively.
- Helen Keller has demonstrated success implementing VAS programs in other regions of Mali and Guinea,24 giving us confidence in their ability to support these additional regions.
- In Guinea, the support UNICEF previously provided in Boké was very similar to the type of support Helen Keller typically provides, suggesting Helen Keller can successfully fill this role.25
- In Mali, a government official told us that he expected Helen Keller to be able to meet the technical and financial needs of these regions, based on their track record elsewhere in the country.26
Why we didn't recommend funding the capital regions
We decided not to fund VAS campaigns in the capital regions of Bamako (Mali) and Conakry (Guinea), despite Helen Keller's request to include them, because our analysis suggested these regions would be significantly less cost-effective than our other supported regions and may fall below our 8x funding bar for top charities, without a sufficiently strong qualitative case in favor of support.
Evidence for lower cost-effectiveness in capital regions
Several indicators point to lower cost-effectiveness of VAS in capital regions:
- Under-5 mortality rates are approximately half the national average in capital regions. According to DHS data from 2018, under-5 mortality in Bamako and Conakry is roughly 50% of the national rate in each country.27 Since under-5 mortality is a key driver in our cost-effectiveness model, this would significantly reduce the expected impact of the program.
- Lower prevalence of diarrhea and higher measles vaccination coverage. Data shared by Helen Keller, which we did not independently vet, shows capital regions have lower diarrhea prevalence and higher measles vaccination coverage compared to other regions.28 Helen Keller attributes this to "better access to safe water, hygiene infrastructures, and routine vaccination" in urban areas.29 These factors reduce the potential impact of VAS in these settings, as we model VAS as reducing mortality via VAS-susceptible causes of death including diarrhea and measles.30
- Higher baseline VAS coverage through existing health services. Helen Keller indicated that children in capital regions are more likely to receive vitamin A supplements through routine health services and vaccination outreach, resulting in higher baseline coverage compared to rural areas,31 though this was not fully supported by the DHIS2 data Helen Keller shared for the five regions under consideration for this grant.32 This means our funding would make less of a difference in the proportion of children receiving VAS.
Qualitative factors unlikely to outweigh low expected cost-effectiveness
While Helen Keller noted there might be some learning opportunities from operating in urban settings and potentially lower per-child costs due to population density,33 these factors were not compelling enough to outweigh the expected lower cost-effectiveness.
Risks and reservations
Our main reservations about this grant include:
Uncertainty about key cost-effectiveness parameters
Our VAS cost-effectiveness estimates involve significant uncertainty about several key parameters:
- The effect of VAS on mortality: We are more uncertain about the effect of VAS on mortality than we are about GiveWell’s other top recommended programs. We discuss this in detail in our VAS intervention report.34
- Current vitamin A deficiency (VAD) rates: The VAD survey data we rely on in our model is quite old (Mali) or non-existent (Guinea).35 While we make adjustments based on proxies to extrapolate to our best guess of present-day VAD levels, we remain very uncertain about the current levels of VAD in the locations we're funding. We are considering funding VAD surveys to address this information gap going forward.
- The number of children reached: We make a -10% adjustment to Helen Keller's reported target populations in all locations, based on high-level concerns raised in a report shared by IDinsight and rough, internal analysis comparing different population sources.36 However, we're very uncertain about the size of this adjustment and how it should vary by location.
- Counterfactual coverage: It's difficult to predict exactly how many children would receive VAS without our funding, through either routine health services or potential alternative funders.
Potential for increasing long-term funging risk
While we think there is minimal risk in the short term that other funders would support these regions for the June 2025 campaign, there is a longer-term concern: by stepping in to fill gaps left by UNICEF's withdrawal, we may signal to other funders that GiveWell will cover VAS funding shortfalls. This could potentially influence their future funding decisions, leading them to direct their resources elsewhere. We currently lack sufficient information about Global Affairs Canada's and UNICEF's priorities to confidently assess this dynamic.
Plans for follow up
We plan to follow up on this grant as we typically do with Helen Keller Intl funding, which includes regular check-ins and annual reporting on:
- Coverage achieved by Helen Keller
- Target populations in areas served by Helen Keller
- Spending by Helen Keller
- Spending by other actors
- Funding gaps
Since we are only providing one semester of support, we expect to make a decision about potential renewal for these regions in approximately September 2025, in time for the second round of campaigns in late 2025. We expect to be able to run a short investigation by:
- Making progress on understanding the likelihood that other funders would support these regions, by talking with representatives of UNICEF in Mali and Guinea about funding availability and their priorities, and by talking again with government officials to discuss funding availability.
- Forming a qualitative impression of how the campaigns have gone, by talking to government officials and Helen Keller.
- Reviewing coverage data from June 2025 campaigns, if available.
Internal forecasts
For this grant, we are recording the following forecasts:
Confidence Prediction By time Resolution 55% We will renew funding in all three regions supported by this grant for at least one additional semester. October 15, 2025 65% We will renew funding in some, but not all, regions supported by this grant for at least one additional semester. October 15, 2025 Our process
Our investigation for this grant included:
- Conversations with Helen Keller Intl, UNICEF in Guinea, and Global Affairs Canada.
- Exchange of messages with a government official in Mali to confirm the funding gap and assess Helen Keller's suitability to fill it.
- Review of heuristics related to cost-effectiveness.
Sources
- 1
See "Our priorities," Helen Keller Intl. Work on neglected tropical diseases is described at the link from "Eliminating diseases of poverty": "Neglected tropical diseases, some of which have been around since ancient times, affect more than a billion people around the world…While there are many diseases considered neglected, Helen Keller focuses on five. These diseases — including trachoma, lymphatic filariasis, schistosomiasis, river blindness, and intestinal worms — are a group of mainly parasitic and bacterial diseases that can cause a host of disabling conditions, such as blindness, painful physical deformities, and worsened undernutrition."
- 2
"Partnering with governments across Africa and Asia, we provide millions of children every year with lifesaving vitamin A and other nutrients." Helen Keller Intl, Combatting Vitamin A Deficiencies
- 3
GiveWell, Helen Keller International's Vitamin A Supplementation Program
- 4
- "Vitamin A deficiency results from a dietary intake of vitamin A that is inadequate to satisfy physiological needs…It is common in developing countries, but rarely seen in developed countries."
- "In its more severe forms, vitamin A deficiency contributes to blindness by making the cornea very dry, thus damaging the retina and cornea…It also diminishes the ability to fight infections. Even mild, subclinical deficiency can be a problem, because it may increase children's risk for respiratory and diarrhoeal infections, decrease growth rates, slow bone development and decrease the likelihood of survival from serious illness."
- 5
"High-dose vitamin A supplementation is recommended in infants and children 6–59 months of age in settings where vitamin A deficiency is a public health problem…An oil-based vitamin A solution can be delivered using soft gelatin capsules, as a single-dose dispenser or a graduated spoon." WHO, Guideline: vitamin A supplementation in infants and children 6-59 months of age, 2011.
- 6
See our review of Helen Keller Intl's vitamin A supplementation program here.
- 7
- 8
"In Mali, UNICEF was already unable to support the three regions (Bamako, Sikasso, and Mopti) in the second round of 2024 because the funding that enabled them to do so had expired. That's why the Sikasso region sent in its request last December, and why we were able to support it. The other two regions, Bamako and Mopti, did not participate in the second round. UNICEF said it had funding for the northern regions for the time being." Email from David Doledec, Helen Keller Intl, to GiveWell, March 26, 2025 (unpublished)
- 9
- Conversation with Dr Theophile Bansimba, UNICEF Guinea, April 9, 2025 (unpublished)
- "For Mali, we got confirmation from UNICEF that they do not have funds anymore to support 3 of the regions they previously supported." Email from David Doledec, Helen Keller Intl, to GiveWell, March 25, 2025 (unpublished)
- 10
David Doledec, Helen Keller Intl, response to GiveWell questions on November 18, 2024 (unpublished)
- 11
- Guinea
- UNICEF's VAS program in Guinea is funded by a Global Affairs Canada (GAC) grant that ends in December 2025. Global Affairs Canada, Project profile — Vitamin A Supplementation in a New Age (VINA)
- GAC is uncertain of the timeline on which they will renew this grant. It's possible their support will be renewed by the end of the year, though it is very unlikely their support will be renewed by June 2025. Conversation with Christine Roy, Global Affairs Canada, April 22, 2025 (unpublished)
- Mali
- We have not spoken to a UNICEF representative in Mali and do not have a clear picture of how their VAS program is funded. We expect to be able to do so prior to making a decision about renewing support for these regions in Mali later this year.
- Guinea
- 12
Our understanding is that VAS programs are largely funded by Global Affairs Canada and GiveWell, so they aren't expected to face direct cuts as a result of U.S. government funding reductions for foreign aid. However, significant indirect effects may arise, such as through changes to shared delivery platforms or health infrastructure. We anticipate having greater visibility into these effects later this year.
- 13Email from David Doledec, Helen Keller Intl, to GiveWell, March 25, 2025 (unpublished)
- 14
This estimate of the value per dollar donated to cash transfer programs is out of date as of 2024. We are continuing to use this outdated estimate for now to preserve our ability to compare across programs, while we reevaluate the benchmark we want to use to measure and communicate cost-effectiveness.
- 15
For our full cost-effectiveness analysis of vitamin A supplementation, see here.
Note that a) our cost-effectiveness analyses are simplified models that are highly uncertain, and b) our cost-effectiveness threshold for directing funding to particular programs changes periodically. See GiveWell’s Cost-Effectiveness Analyses webpage for more information about how we use cost-effectiveness estimates in our grantmaking.
- 16
See our analysis here.
- 17
Email from David Doledec, Helen Keller Intl, April 12, 2025 (unpublished)
- 18
See analysis here. The new regions are $0.22 on average. Existing regions are $0.62 in Guinea on average and $0.40 in Mali on average. This is a very rough analysis that does not account for factors such as administrative costs being incorporated into the cost per supplement for existing regions but not the new regions, for example, but we think it is directionally useful.
- 19
Conversation with Dr Theophile Bansimba, UNICEF Guinea, April 9, 2025 (unpublished)
- 20
Conversation with Christine Roy, Global Affairs Canada, April 22, 2025 (unpublished)
- 21
Letter from Dr. Kalifa Keita, Ministry of Health and Social Development, Mali, to Helen Keller Intl, February 7, 2025 (unpublished)
- 22
Message from Mahamadou N’Tji Samaké, Sub-Director Nutrition, Directorate General of Health and Public Hygiene, Mali, April 22, 2025 (unpublished)
- 23
"In Mali, UNICEF was already unable to support the three regions (Bamako, Sikasso, and Mopti) in the second round of 2024 because the funding that enabled them to do so had expired. That's why the Sikasso region sent in its request last December, and why we were able to support it. The other two regions, Bamako and Mopti, did not participate in the second round." Email from David Doledec, Helen Keller Intl, to GiveWell, March 26, 2025 (unpublished)
- 24
For example, Helen Keller's Post Event Coverage Surveys in 2024 indicated 85% VAS coverage in the regions it supported in Guinea and 82% in Mali.
- Guinea: "Vitamin A coverage during the June 2024 campaign was 84.6%." Helen Keller Intl, Post-campaign coverage survey of vitamin A administration, Guinea, October 2024, p. 13 [Note that this quote was translated from the original French]
- Mali: "Coverage during the campaign: Nearly 82.1% of children aged 6-59 months received vitamin A supplementation, but 95.7% of supplementation information was not verifiable by official document." Helen Keller Intl, Post-campaign coverage survey of vitamin A administration, Mali, October 2024, p. 14 [Note that this quote was translated from the original French]
- 25
Conversation with Dr Theophile Bansimba, UNICEF Guinea, April 9, 2025 (unpublished)
- 26
Email received from Dr Mahamadou N’Tji Samaké, Sub-Director Nutrition, Directorate General of Health and Public Hygiene, Mali on April 23, 2025 (unpublished)
- 27
See our analysis here.
- 28
Country Region Diarrhea Prevalence (DHS 2018) Measles Vaccination Coverage (MCV1) Mali Sikasso ~23% (U5 with diarrhea in last 2 weeks) ~72% Mopti ~25% ~70% Bamako ~12% >90% Guinea Boké ~21% ~73% Conakry ~10% >90% Email from David Doledec, Helen Keller Intl, April 12, 2025 (unpublished)
- 29
"Yes, data suggest that the situation in capital cities may be slightly better than in other regions. This is likely due to better access to safe water, hygiene infrastructures, and routine vaccination." Email from David Doledec, Helen Keller Intl, April 12, 2025 (unpublished)
- 30
See section on "Changes in the causes of child mortality" in our intervention report on vitamin A supplementation. As of April 2025, we are making revisions to this report, but our general approach to account for changes in the share of child deaths attributable to diarrhea, measles, and other infectious diseases is unchanged.
- 31Conversation with David Doledec, Helen Keller Intl, April 16, 2025 (unpublished)
- 32Routine VAS coverage in Mali's DHIS2:
Semester Region Percentage of children aged 6-59 months receiving vitamin A Semester 1 2024 Bamako 33.43 Mopti 55.06 Sikasso 20.83 Semester 2 2024 Bamako 57.04 Mopti 58.14 Sikasso 20.86 Email from David Doledec, Helen Keller Intl, April 12, 2025 (unpublished)
- 33
- Helen Keller told us that there would be some learning value to supporting VAS in capital regions, given that a unique approach is needed there, but they also expressed skepticism about having significant learnings without, for example, the ability to conduct a baseline survey on this timeframe. Call with David Doledec, Helen Keller Intl, April 16, 2025 (unpublished)
- Helen Keller told us that costs in capital regions may be comparable to or lower than other locations. However, it seems unlikely that costs are so much lower that they would counterbalance lower mortality, measles, or diarrhea rates. Call with David Doledec, Helen Keller Intl, April 16, 2025 (unpublished)
- 34
As of April 2025, we are in the process of updating our vitamin A supplementation intervention report to reflect an update to how we estimate the effect of VAS on mortality to address potential publication bias. However, our overall uncertainty about the effect size remains.
- 35
The most recent VAD survey data we have in Mali is from 1997, and for Guinea we have no VAD survey data.
- 36
"The critical finding here from these example datasets is that there is significant variation across countries, in terms of both the difference between submitted charity data and other estimates; and the difference between estimation platforms.There is also a suggestion that the data submitted by charities may not match the official administrative boundaries." IDinsight, Estimating Populations, 2023.
See IDinsight's comparison of Helen Keller Intl's population estimates against other population estimates in Guinea and Mali.
- Evidence in favor of funding gaps: