Note: This page summarizes the rationale behind a GiveWell grant recommendation to Jhpiego. Jhpiego staff reviewed this page prior to publication.
Addendum to this grant page
In May 2025, GiveWell recommended a contingent, month-by-month bridge grant to keep Seasonal Malaria Chemoprevention (SMC) campaigns in Cameroon on track during a temporary gap in U.S. government funding. In August 2025, the U.S. government resumed funding for the campaigns. At that time, we had already distributed $1.8 million for these campaigns.
This grant page represents our thinking at the time that the grant was made, in May 2025, when the length and amount of the funding gap was uncertain. In it, we consider the cost-effectiveness of the whole campaign, the full budget for which was $3.2 million.
In a nutshell
In May 2025, GiveWell recommended contingent, month-by-month bridge funding to support Seasonal Malaria Chemoprevention (SMC) campaigns in Cameroon. This grant follows our previous support for pre-campaign activities in multiple countries, which was necessary due to a U.S. government foreign aid funding freeze beginning in January 2025. The funds will be directed to Jhpiego to support the implementation of the 2025 SMC campaigns in Cameroon’s North and Far North regions.
We recommended this grant primarily because:
- The SMC campaign appears highly cost-effective. We estimate that the campaign is approximately 25x as cost-effective as cash transfers. (More)
- Without our support, at least the first cycle of this campaign likely wouldn't happen. While we think it’s possible that the U.S. government will resume funding this campaign at some point, we don’t expect that funding to come in time for the start of the campaign in June.
- Our grant structure creates conditions that will let the U.S. government resume responsibility for funding this campaign, which we view as the best long-term outcome. (More)
Our main reservations about this grant are:
- Our support could crowd out other funding. By filling this gap, we may reduce the likelihood that the government of Cameroon or U.S. foreign aid prioritizes SMC campaign funding. (More)
- We’ve had limited time to assess Jhpiego’s track record. We have less experience with Jhpiego than with Malaria Consortium, one of our Top Charities that typically implements SMC programs we fund. We are unsure how they perform in terms of campaign implementation quality and alignment with GiveWell on the importance of maximizing cost-effectiveness and performing high-quality monitoring. (More)
We previously recommended temporary support to SMC campaigns in Guinea, Mali, Cameroon, Côte d'Ivoire, Togo, and Benin due to the uncertainty around U.S. government funding. We do not believe that there are persisting funding gaps for SMC campaign implementation in any of the other five countries where we previously supported pre-campaign activities (Guinea, Mali, Côte d'Ivoire, Togo, and Benin).
These grants are part of GiveWell’s efforts to respond to the U.S. government funding cuts. You can hear more in our public podcast on addressing urgent needs in seasonal malaria chemoprevention.
Published: November 2025
1. The organizations
This grant provides temporary support to Jhpiego, who was previously implementing SMC campaigns in Cameroon with USAID funding. Jhpiego has been implementing SMC campaigns in Cameroon since 2018, previously operating in the North Region under USAID's SEMBE I project. Following the USAID funding freeze and termination of SEMBE I and II projects, we are funding Jhpiego to support SMC in Cameroon’s North and Far North regions for the 2025 campaign until they are able to access U.S. government funding.1
While Jhpiego has experience delivering SMC campaigns, our assessment of their implementation quality is much shallower than our assessment of Malaria Consortium, whose SMC program is one of our Top Charities.
2. The intervention
Seasonal Malaria Chemoprevention (SMC) involves giving children monthly courses of antimalarial medicines during the high malaria transmission season. SMC is typically delivered to children aged 3-59 months through door-to-door campaigns,2 with community health workers administering the first dose of the drug combination sulfadoxine-pyrimethamine and amodiaquine (SPAQ) and caregivers giving the remaining amodiaquine doses on the following two days.3
SMC campaigns typically run for 3-5 consecutive months during the rainy season when malaria transmission is highest. In Cameroon, these campaigns will target approximately 2.2 million children in total with 4-5 rounds of monthly preventative treatment.4
We estimate that receiving SMC reduces malaria mortality by approximately 79% during the period when it is delivered. This estimate is based on multiple randomized controlled trials from the Sahel region showing substantial reductions in malaria cases. We also estimate that about 70% of annual malaria mortality in these regions occurs during the months when SMC is delivered, making the seasonal approach particularly effective.
Our full analysis of SMC is available in our intervention report.
3. The grant
This grant addresses a funding gap that resulted from the U.S. government foreign aid funding freeze that began in January 2025.5 The freeze affected ongoing projects supporting SMC campaigns in multiple countries, including Cameroon. In March and April 2025, we provided initial grants totaling $3.2 million (including $1,275,000 to Cameroon) to support pre-campaign activities such as microplanning, tool revision, training, and procurement of non-SPAQ commodities.6
This follow-on grant will support campaign implementation activities in Cameroon’s North and Far North regions, including:
- SMC distribution - Paying for per-diems and transportation for community distributors who go door-to-door to administer SPAQ to eligible children and record administrative data.
- Supervision - Supporting supervisors at national, regional, district, and field levels to oversee the campaign and address implementation challenges.
- Training - Providing refresher trainings for community distributors and supervisors.
- Community engagement - Supporting town criers and radio messaging to spread awareness about the campaign.
- Monitoring and evaluation - Funding post-cycle review meetings and external monitors to conduct coverage surveys.
The grant will be structured as a "recoverable grant" with monthly disbursements. Before each monthly payment, Jhpiego will confirm that funding is not available from other sources to support the campaign. If U.S. government funding becomes available during implementation, our remaining grant funds will not be disbursed and may be returned.
4. The case for the grant
4.1 Cost-effectiveness
We estimate that this grant is approximately 25x as cost-effective as our benchmark,7 which is above our funding bar of 10x.8 The main reasons we expect this program to be cost-effective are:
- Moderate malaria burden - We estimate annual under-5 malaria mortality rates of 0.36% in Cameroon, which is close to or higher than in many areas where we support Malaria Consortium's SMC programs. These estimates combine data from multiple sources and account for subnational variation in malaria burden.9 We also believe it’s possible that malaria mortality may rise this year due to broader health system disruptions resulting from the U.S. government foreign aid funding freeze, though we have not accounted for this in our model.
- Low cost per child reached - We estimate a total cost per child treated with all cycles of SMC of $5.68, which is comparable with costs in Malaria Consortium's programs. These estimates take the full campaign budgets and target populations shared by implementing partners, assume that 80% of the target population will be covered, and include our rough best guess of SPAQ procurement costs that have already been borne by other funders. 80% may also be a conservative estimate, since it is significantly lower than the coverage rates achieved by most of Malaria Consortium's SMC programs, and it's possible Jhpiego will be similarly successful in achieving high coverage.
- High proportion of malaria mortality avertable by SMC - Cameroon’s North and Far North regions are in the Sahel region of West and Central Africa, where we do not have significant concerns about lower SMC effectiveness due to SP drug resistance and where malaria incidence is typically highly seasonal.
- Low risk of crowding out other funding (“funging”) - We have assumed a 0% risk of funging because our expectation is that if other funding does become available, any unused funding from GiveWell would be returned. We do think there is some risk that GiveWell support crowds out other funding, particularly in the medium term. However, we think any underestimation of funging risk in our model is outweighed by underestimating the potential leverage benefits of enabling the U.S. government to resume funding under our recoverable grant structure.
Below is a simplified version of our cost-effectiveness analysis:
| What are we estimating | Best guess (rounded) | Confidence intervals (25th - 75th percentile) | Implied cost-effectiveness |
|---|---|---|---|
| Grant size | $5,145,946 | ||
| Cost per person under age five reached | $5.01 | $2.51 - $7.52 | 38x - 13x |
| Number of people under age five reached | 1,026,113 | ||
| Proportion of reached children who would have received SMC in the absence of the program | 0% | ||
| Number of additional children receiving SMC as a result of the program | 1,026,113 | ||
| Malaria-attributable mortality rate among people under age five | 0.36% | 0.18% - 0.54% | 11x - 34x |
| Proportion of malaria mortality occurring during the SMC season | 70% | 63% - 77% | 20x - 25x |
| Effect of SMC on under-five deaths related to malaria | 79% | 71% - 87% | 21x - 25x |
| Initial cost-effectiveness estimate | |||
| Number of deaths averted among people under age five | 2,071 | ||
| Cost per under-five death averted (before adjustments) | $2,485 | ||
| Moral value of averting the death of a person under age five | $116 | ||
| Initial cost-effectiveness in terms of multiples of GiveDirectly's unconditional cash transfer program | 13.9 | ||
| Summary of primary benefits (% of modeled benefits) | |||
| Mortalities averted for people under age five | 66% | ||
| Mortalities averted for people over age five | 7% | ||
| Developmental benefits (long-term income increases) | 27% | ||
| Additional adjustments | |||
| Adjustment to account for mortalities averted among people age 5 and older | 11% | 4% - 17% | 21x - 24x |
| Adjustment to account for developmental benefits (long-term income increases) | 36% | 20% - 53% | 20x - 25x |
| Adjustment for additional program benefits and downsides | 18% | 12% - 24% | 21x - 25x |
| Adjustment for grantee-level factors | -8% | -15% – -1% | 21x - 24x |
| Adjustment for diverting other actors’ spending into SMC (“leverage”) | -1% | ||
| Adjustment for diverting other actors’ spending away from SMC (“funging”) | 0% | ||
| Final cost-effectiveness estimate | |||
| Final cost per life saved | $2,954 | ||
| Final cost-effectiveness estimate (multiples of cash transfers) | 22.6 | 13x - 40x |
4.2 Our grant structure preserves conditions that allow the U.S. government to resume funding
Our approach in structuring this grant is meant to ensure this cost-effective program continues while creating conditions for the U.S. government to resume funding when possible:
- In Cameroon’s North region, we’re funding the same implementing partner (Jhpiego) that previously received funding from USAID.10
- The grant is structured as a recoverable grant with monthly disbursements, meaning if U.S. government funding resumes, Jhpiego would return any unused funds to GiveWell.
Based on our conversations with stakeholders and Jhpiego, we estimate there's a moderate to low probability that U.S. government funding resumes during the course of the campaign.
5. Risks and reservations
5.1 Potential crowding out of other funding
By committing to fill this funding gap, we risk reducing pressure on the U.S. government to prioritize SMC campaign funding. This creates both short-term and medium-term risks:
Short-term risk: Our commitment could disincentivize the U.S. government from allocating funding to this campaign. However, based on our conversations with key stakeholders, we believe the U.S. government is making decisions primarily based on where its implementing partners are still operational and where their country teams are engaging, rather than where GiveWell has made commitments.
Medium-term risk: Our support could signal to the U.S. government that philanthropy will cover government funding cuts more broadly, potentially disincentivizing restoration of funding for SMC and other programs next year. However, given the small size of this gap relative to the U.S. government’s total foreign aid funding, we think this risk is worth taking to ensure this cost-effective campaign proceeds.
We've attempted to mitigate these risks through our recoverable grant structure (more) and clear communication with U.S. government officials and Jhpiego that our support is only intended as a backstop.
5.2 Risk of working with a new partner
We have not conducted as thorough an investigation of Jhpiego as we typically would for implementing partners, and we have less evidence about their effectiveness, alignment on data collection and optimization for cost-effectiveness, or transparency than we do for Malaria Consortium (our Top Charity for SMC).
However, we believe this risk is mitigated by the following factors:
- Jhpiego has multi-year experience implementing SMC in Cameroon.
- Communications from them have been clear and responsive.
- Early signals on campaign preparation indicate they are hitting key milestones.
- SMC is a relatively standardized intervention across contexts, so we don’t expect there to be huge differences in implementation quality across implementers.
- Our cost-effectiveness model assumes a conservative 80% coverage rate, which we think Jhpiego is likely to achieve.
6. Plans for follow up
Our follow-up plans include:
- Monthly check-ins with Jhpiego to monitor progress and adjust plans as needed.
- Monthly check-ins with other key stakeholders on campaign funding status.
- Consideration of funding for end-of-round representative coverage surveys. We will likely decide on this by mid-June, contingent on funding status.11
7. Our process
We have been investigating SMC campaigns affected by the U.S. government foreign aid funding freeze since February 2025. Our process included:
- Connecting with implementing partners and other stakeholders
- Meeting with National Malaria Control Programs during the SMC Alliance meeting in Lomé, Togo in February 2025
- Reviewing detailed information from each implementing partner about their annual work plans, budgets, timelines, and campaign activities
- Having check-in calls with implementing partners and other stakeholders to understand the evolving situation
- Analyzing budgets and developing budget ceilings for campaign activities
8. GiveWell context
This grant is part of our strategy to find and fill gaps that resulted from early 2025 disruptions to U.S. government foreign aid funding in interventions we understand well, of which SMC is one. At this time, our bar is 10x for grants to non-Top Charities.
9. Relationship disclosures
None.
Sources
- 1
As we stated in our previous grant page, we made the decision to fund Jhpiego in Cameroon’s Far North region despite not being the previous PMI implementing partner due to our determination that they were better positioned to implement the campaign on schedule.
- 2
From our intervention report on SMC, “Seasonal malaria chemoprevention (SMC) involves giving children monthly courses of antimalarial medicines in locations where malaria is highly seasonal (i.e., a high proportion of cases occur during a relatively short period each year). SMC is delivered to all children in a given location (exceptions in footnote). The antimalarial medicines used are sulfadoxine–pyrimethamine (SP) and amodiaquine (AQ). SMC has scaled up rapidly in recent years. An estimated 2.6 million children were reached with SMC in 2014, rising to approximately 49 million in 2022.”
Note: since the our intervention report was published, the 2024 World Malaria Report was published by WHO, which states that, “The average number of children receiving at least one dose of SMC continues to increase, with 53 million children treated in 2023 compared with 49 million in 2022.” WHO, World Malaria Report 2024 p xviii - 3
From our intervention report on SMC, “The antimalarial medicines are administered over three days. The community distributor administers the first day’s doses of SMC (one tablet of SP and one tablet of AQ) and gives the remaining doses (two tablets of AQ) to caregivers to administer over the next two days.”
- 4
In Cameroon, approximately half of the districts perform 4 monthly distributions with the other half performing 5.
- 5
The timeline of events regarding the U.S. foreign aid freeze is detailed on the Kaiser Family Foundation website by Kates, Rouw, and Oum. They state that on January 20, 2025, an executive order was issued that, “called for a pause on funding on new obligations and disbursements and a 90-day review of all U.S. foreign assistance to assess alignment with American values.”
- 6
See this section of our previous grant page for more on what we expected these grants to do.
- 7
- To date, GiveWell has used GiveDirectly's unconditional cash transfers as a benchmark for comparing the cost-effectiveness of different funding opportunities, which we describe in multiples of "cash” (more). In 2024, we re-evaluated the cost-effectiveness of direct cash transfers as implemented by GiveDirectly and we now estimate that their cash program is 3 to 4 times more cost-effective than we’d previously estimated. (more)
- For the time being, we continue to use our estimate of the cost-effectiveness of unconditional cash transfers prior to the update to preserve our ability to compare across programs, while we reevaluate the benchmark we want to use to measure and communicate cost-effectiveness.
- 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.
- 8
For more on why we compare programs to unconditional cash transfers and our funding bar, see this page on how we use cost-effectiveness estimates in our grantmaking.
- 9
To improve our estimates of malaria mortality in these locations, we included disease burden data from the:
- UN Inter-agency Group for Child Mortality Estimation (UN IGME)
- Institute for Health Metrics and Evaluation (IHME) Global Burden of Disease (GBD)
- Demographic and Health Surveys (DHS) Program
- Malaria Atlas Project
- UNICEF Multiple Indicator Cluster Surveys (MICS)
- IHME Local Burden of Disease (LBD) survey
- 10
In the Far North region we’ve also decided to fund Jhpeigo to support implementation despite not being the previous USAID implementing partner in the region. This is due to our assessment that Jhpiego was the best-placed organization to implement the campaign as scheduled in the region, with the understanding that the arrangement may complicate the resumption of U.S. government assistance.
- 11
Note: we did not ultimately fund coverage surveys, as we came to understand that USG funding was likely to resume and the learning value of these surveys became less clear.