PATH Technical Support Unit (TSU) (April 2025)

Published: June 2025

The grant

GiveWell and Open Philanthropy recommended a grant of $1,529,231 to PATH to provide technical assistance to the Ministry of Health (MoH) in the Democratic Republic of Congo (DRC) as they execute a government-led reform agenda in response to the funding cuts from the US government (USG) and other entities. The grant supports PATH's technical support unit (TSU) in DRC for 18 months.1

This grant will fund a team of 3 in-country staff supported by a small global team of 3 staff.2 This team will provide technical assistance to help the MoH to: i) identify the impact of the cuts across programs and systems, ii) identify cost-efficiencies in programs to make remaining funds go further, iii) conduct cost-effectiveness analyses to reallocate funding to more cost-effective uses, and iv) try to crowd-in new funding for health programs either from external donors or through other parts of the domestic government budget.

PATH has proposed creating a broad taskforce in which its TSU will sit alongside government stakeholders. They are calling this taskforce the Financial Advisory Strategy Taskforce (FAST).3 The intention is to have a senior MoH official chair the taskforce and have direct participation from MoH and Ministry of Finance staff in order to facilitate alignment and collaboration between the TSU team and government stakeholders. PATH will adapt the exact structure to DRC's needs once it has spent more time consulting with the MoH at the start of this work.

PATH will customize their support based on the priorities of the MoH and the work the MoH has already done towards these objectives. Within the first month of the grant period, PATH will solicit a letter of support from the MoH to ensure the grant activities fully align with government priorities.4

GiveWell and Open Philanthropy co-investigated and co-funded this grant.

Budget for grant activities

PATH's $1,529,231 budget is for a TSU team of 2.8 full-time equivalent (FTE) in-country staff and a global team of 1.3 FTE, for 18 months.

Cost category	Year 1 (12 mo.)	Year 2 (6 mo.)	Total
Personnel	519,772	296,160	815,932
Travel	37,297	16,800	54,097
Workshops & Training	75,000	78,750	153,750
Other direct costs	158,550	92,030	250,580
Total direct	790,619	483,740	1,274,359
Indirect costs (20%)	158,124	96,748	254,872
Total	948,743	580,488	1,529,231

GiveWell is contributing $824,770, and Open Philanthropy is contributing $704,461 to the total grant amount.

What we think this grant will do

What will the TSU do?

PATH will provide technical assistance through a team of 3 staff in DRC (supported by a small global team of 3 staff) working with the MoH on its response to the USG funding cuts for 18 months.5

The TSU will support the MoH on four different workstreams:

1. The TSU will support information gathering to identify the impact of the USG funding cuts across programs and systems. Our understanding is that this will require meeting with staff from across government departments and implementing partners and aggregating existing information into one place (such as a dashboard and written reports) which can be more easily used by the MoH's relevant cross-sector planning department.6 We do not believe this will require new first-hand data collection. We understand that information gathering is the first exercise most MoHs started working on immediately after the funding freeze began, so a portion of this work may already be done. PATH plans to tailor their support based on what has already been completed.7
2. The TSU will work to identify cost-efficiencies in health programs and systems to enable remaining resources to go further. Our understanding is that this will involve meetings with government stakeholders and conducting analysis to identify ways to structure programs and health systems more efficiently, such as:
   • Transitioning activities from former USG contractors to government or local organizations. USG often hired international for-profit organizations to provide services at a high cost and paid these workers at a higher pay scale than the domestic government. PATH believes they can work with the MoH to find ways to deliver the same services at lower cost, for instance by hiring local organizations or otherwise paying for these services in line with the domestic government pay scale.8
   • Integrating shared services: PATH believes they can support improvements in the efficiency of health program delivery by integrating shared services—such as quantification and procurement, supply chains, and training—across programs which address different disease or cause areas.9
3. The TSU will conduct cost-effectiveness analyses and present them to the MoH to advise its prioritization decisions and in order to help allocate remaining resources to the most cost-effective uses. These analyses will be an input for the MoH as they conduct prioritization decisions across remaining funding sources, which may help them to identify improvements to the cost-effectiveness of health programs such as through changes in geographic or demographic targeting or choices of intervention. We expect that the MoH will consider these cost-effectiveness analyses as one factor among many other decision-making objectives and constraints, and PATH’s intention is to support the MoH to make evidence-based decisions within their existing priorities, not to try to introduce new priorities.10
4. The TSU will work to support the MoH to crowd in new funding for health programs either from external donors or through other parts of the domestic government budget. Through the work done in the workstreams outlined above, PATH will generate a list of funding opportunities and present them to external donors, including GiveWell.11 They will also work with the MoH to try to obtain additional funding for health from the domestic government budget, which might involve negotiating with the Ministry of Finance and making the case for the impact and cost-effectiveness of the additional health spending.12 PATH will also help the MoH use its full health budget by strengthening the flow of data and improving expenditure monitoring.

PATH aims to support across these four work streams while tailoring their support to the progress already made and the specific context of DRC after initial fact-finding. PATH has proposed their FAST taskforce structure for the TSU, but they may adjust the planned structure to align with government preferences.13 After the initial phase of the grant, PATH will share a work plan with GiveWell outlining in more detail the specific activities that PATH and the MoH agree on.

The case for the grant

The primary reasons we made this grant are as follows.

This grant will address a real, urgent need within a time-limited window

We think this TSU work will address a real and urgent need to help the government make difficult planning and prioritization decisions in DRC, following the reduction in available resources due to the USG funding cuts (and other reductions in foreign aid). DRC also has a high disease burden, which means there is significant potential impact from supporting efficient and effective health system restructuring.14 It is our understanding that DRC is in the midst of identifying the direct and indirect impact of the funding cuts and determining how to reallocate resources efficiently.

There is indication of strong government support for this work

We spoke with senior MoH officials about this grant given that coordinating DRC's response to USG funding cuts will be government led. The officials we met with spoke highly of PATH as a partner and were eager to have support across the activities proposed. They also emphasized the need to keep this work closely coordinated with existing efforts across the MoH, which is fully in line with GiveWell and PATH's vision for this work. In order to confirm complete alignment with the MoH, PATH will obtain an official letter of support from the MoH in the first month of the grant period.

This grant looks highly cost-effective

We are making this grant predominantly based on the qualitative case. We don't place much weight on the rough cost-effectiveness model we have created because the numbers are highly subjective. However, our model does increase our confidence that these grants could have cost-effective impact. We roughly modeled the cost-effectiveness of TSUs across a range of countries, which indicated that they could be around 13-28x as cost-effective as unconditional cash transfers.15 We think that this range is likely to be representative of the cost-effectiveness of a TSU program in the DRC. The model demonstrates that this grant looks highly cost-effective if it supports the MoH to make even a relatively small portion of its expenditure more cost-effective. For instance, we conducted a threshold analysis which suggests that a TSU that costs around $1 million would have to find 31% cost savings and a 20% improvement in cost-effectiveness through improved program allocation across $1 million of annual government expenditure and $8 million of crowded-in funds over 1.5 years in order to meet GiveWell's 10x bar.16

PATH has the relevant experience and government relationships to do this work well

PATH has demonstrated their experience and capacity to provide this technical support based on their track record and existing relationships with the DRC MoH.17 They are setting up a malaria TSU in DRC with Gates Foundation funding, which we believe will feed into this broader TSU work.

This grant may generate learning value

This grant provides several valuable learning opportunities for GiveWell. First, the TSU will identify potentially cost-effective funding gaps through its information-gathering activities, which GiveWell may investigate and support directly. Second, we'll learn about PATH's ability to provide high-level technical support to governments through process indicators and case studies they'll share at regular intervals. Third, we'll gain insights into how the DRC MoH makes prioritization decisions in practice, including what factors they consider beyond cost-effectiveness. PATH will report on instances where they find cost-effectiveness modelling is or isn't helpful for government decision-making and why, which could inform our broader approach to government engagement. Finally, the information gathered by the TSU could serve as a valuable public good if it can be shared more widely with other donors and implementers responding to the funding cuts, if—and only if—the government wants the information to be shared.

This grant could help attract additional funding for TSUs in additional countries and other cost-effective health programs

Our decision to fund this TSU could encourage additional philanthropic support for similar work in other countries. GiveWell and Open Philanthropy are aware of other funders and donors who are interested in supporting this type of work. Additionally, the TSU itself will work to identify high-priority funding opportunities and present them to external donors, potentially mobilizing significant additional resources for effective health programs.

Our main reservations

Our main reservations about this grant are as follows.

We are highly uncertain about the impact of TSU work

The work this TSU will undertake is more "upstream" than many of the programs that GiveWell typically funds. There are several ways the TSU might fail to achieve its intended impact, despite the interest expressed by government officials. First, the MoH may have already completed some of the proposed work, particularly the information-gathering activities to identify funding gaps, which could diminish the additive impact of the TSU compared to our expectations. Second, despite initial expressions of support, the MoH might not ultimately implement the TSU's recommendations due to political factors or competing priorities. Third, external constraints, such as World Bank loan conditionalities, might restrict the government's ability to reallocate resources as recommended. Additionally, the TSU might face challenges in crowding in additional funding or identifying the expected cost efficiencies. We've tried to mitigate these risks by speaking directly with senior officials and requesting letters of support to confirm government alignment on the TSU's work plans, but these uncertainties remain. The DRC is currently facing political instability and ongoing conflicts, which means PATH may be navigating complex political dynamics, infrastructure challenges, and security concerns that make the work more difficult.

It is possible our grant could replace, rather than add to, other funding sources for this work

There's a risk that our funding might replace rather than complement support from other donors, particularly given the overlapping donor interests in this area. We know that PATH is actively seeking funding from multiple sources for TSU work and that another funder has established a financing facility with similar objectives. However, we believe the risk is lower for this grant because DRC is not on this funder’s initial list of countries for TSU support.

The TSUs may not sustainably transfer long-term capacity within domestic government such that the MoH can continue this work beyond the end of the grant period

TSUs are intended to provide temporary analytical support to augment government capacity during a crisis period. In highly technical areas such as cost-effectiveness modeling the short-duration of the grant may not allow time to build capacity within existing long-term MoH staff to continue these complex analyses. PATH has committed to transferring activities to the MoH by the end of the grant, but we are uncertain what this handoff will look like, given limited time and resources.

However, PATH has proposed a task force structure which explicitly has a senior MoH chair in order to increase the chance that the work is sustained, and wants to include some basic training on cost-effectiveness in the program.18 Since PATH has partnered with the government in DRC in varying capacities for years,19 we think they will be able to coordinate a handoff that avoids any detrimental effects, leaving government capacity either at the same level or better than it was before the TSU work.

We did not extensively look into alternative implementers for this work

We're aware of multiple organizations that offer similar kinds of support to what PATH has proposed for this TSU. It is plausible that another of these organizations could be better positioned to offer this support in DRC. However, we've chosen not to investigate a wider range of organizations given the urgency of the need and the fact that the MoH officials we spoke to confirmed they were happy to partner with PATH.
GiveWell remains open to considering additional proposals from other implementers to support TSU work in additional locations.

Plans for follow up

Within the first month of the grant period, we will request brief work plans from PATH outlining the key activities agreed upon with the MoH, including eventual handoff activities.

Beyond that, GiveWell and Open Philanthropy will have regular check-ins throughout the grant period to track progress and learn about:

• Process indicators (staff hiring, government engagement, recommendations implemented);
• Case studies of how government prioritization decisions are made;
• Promising funding opportunities identified through the TSU work;
• Contexts where cost-effectiveness considerations are or aren't helpful for government decision-making.

Our process

We co-investigated this grant opportunity with Open Philanthropy. Our process included:

1. Reviewing PATH's proposal and budget;
2. Conducting multiple meetings with PATH's global team;
3. Meeting with PATH's DRC country team;
4. Consulting external stakeholders, including other funders and technical assistance providers;
5. Holding meetings with senior MoH officials from DRC to gauge government interest and buy-in.

We expedited this investigation given the urgent need for support.

Sources

Document	Source
GiveWell, "USAID Funding Cuts: Our Response and Ways to Help," April 25, 2025	Source
GiveWell, Simple CEA/BOTEC of CHAI TSUs, April 2025	Source
PATH, updated proposal, April 2025	Unpublished
PATH, proposal, March 2025	Unpublished

• 1

  We simultaneously investigated and recommended a grant to CHAI of $4,657,500 to fund TSUs to provide similar technical assistance to the MoHs across five countries: Nigeria (across 7 states: Bauchi, Federal Capital Territory, Ondo, Ogun, Gombe, Akwa Ibom, Enugu; and at the national level), Malawi, Uganda, Burkina Faso, and Zambia. You can read more about this grant here.

• 2
  • "The implementation of the FAST program as it is currently designed will require a budget of $1,529,231 USD over a period of 18 months. This will fund the staffing model described above, as well as associated travel, convenings, and operational costs of the FASTs. Indicative costs for staffing by country are as follows: DRC: 2.8 full-time equivalent staff (FTE) for 18 months. Global: 1.3 FTE for 18 months." PATH’s updated proposal, April 2025 (unpublished), p. 11.
  • PATH are calling this taskforce the Financial Advisory Strategy Taskforce, or FAST.
  • "The DRC country team will be backstopped by a small global team consisting of a part-time project director, a full-time analyst, and a part-time financial management specialist." PATH’s updated proposal, April 2025 (unpublished), p.9.

• 3

  We will refer to the FAST as “the TSU” whenever we are not quoting PATH in this grant page.

• 4

  “Though PATH will convene and support [the FAST], our vision is for these teams to be led and owned by the MOH from day one in order to ensure country buy-in for the process, relevance of recommendations, and sustainability of the effort after the period of performance should the MOH choose to continue.” PATH’s updated proposal, April 2025 (unpublished), p. 9.

• 5

  "The implementation of the FAST program as it is currently designed will require a budget of $1,529,231 USD over a period of 18 months. This will fund the staffing model described above, as well as associated travel, convenings, and operational costs of the FASTs. Indicative costs for staffing by country are as follows: DRC: 2.8 full-time equivalent staff (FTE) for 18 months. Global: 1.3 FTE for 18 months." PATH’s updated proposal, April 2025 (unpublished), p. 11.

• 6

  "PATH will leverage its strong country presence and partner relationships to augment public information and develop a high-level dashboard of impacted health delivery efforts … Collected information will be analyzed and packaged in up-to-date, easy-to-interpret briefing decks and shared back with MoH as well as GiveWell to highlight gaps and needs across health areas instead of siloed within specific programmatic areas, aiding in prioritization and trade-offs across the health system." PATH’s proposal, March 2025 (unpublished), pp. 3-4.

• 7

  “Under this program, PATH will work directly with senior MOH counterparts to convene and support a Financial Allocation Strategy Taskforce (FAST) to develop and implement recommendations to rapidly evolve health spending priorities in the wake of reductions in health funding – most acutely, but not exclusively USG project terminations. In countries where such a government-led effort has already begun, PATH will support MoH to formalize, strengthen with data-backed analysis, and execute this effort.” PATH’s updated proposal, April 2025 (unpublished), p. 2.

• 8

  "PATH and other IPs have often suggested that MoHs subcontract functions like supply chain / distribution of health commodities to improve cost efficiency, these recommendations have traditionally faced strong political headwinds. We expect that the USG funding cuts – and the systemic shock they have created – may reopen the door for further negotiation and consideration." PATH’s updated proposal, April 2024, p. 5.

• 9
  • "Integration across programs and shared services. MOHs – and most donors – think and fund vertically, leading to duplication and parallel programs in areas like sourcing and supply chain, training of providers, or social insurance." PATH’s updated proposal, April 2025 (unpublished), p. 5.
  • "Training budgets. Reducing the frequency and number of attendees at MoH trainings; identifying opportunities for more cost-efficient trainings e.g., by expanding existing e-learning platforms." PATH’s updated proposal, April 2025 (unpublished), p. 5.

• 10
  • "First and foremost, PATH's role will be supportive of existing government and partner stakeholders. The PATH team in each country will convene stakeholders, provide supporting information and analysis, and facilitate transparent and objective decision making. PATH will NOT attempt to impose a particular lens on key decisions." PATH’s proposal, March 2025 (unpublished), p. 4.
  • "Utilizing a cost-effectiveness lens that also takes into account political priorities and realities as stated by MoH, PATH will support the FAST Chair with intel gathering and analysis to identify gaps and potential cost-effective uses of remaining funding across and within the health areas most impacted by USG funding cuts." PATH’s proposal, March 2025 (unpublished), p. 4.

• 11

  "PATH will use the above methodology and recommendations to further develop investment cases for GiveWell and other donors to support gap-filling and transition funding in the wake of USG cuts. On a quarterly basis, PATH will present GiveWell with a prioritized list of recommendations for funding … based on CE, urgency of the need, and probability of success of the intervention." PATH’s proposal, March 2025 (unpublished), p. 5.

• 12

  “FAST task forces will also support the identification of other domestic resources that could be allocated towards cost-effective health priorities. Early ideas include … supporting MoH advocacy for increased total health spend through the use of investment cases for concrete, high-impact opportunities.” PATH’s updated proposal, April 2025 (unpublished), p. 6.

• 13

  “We will ensure that the FAST structure will be flexible and able to adapt to MoH priorities.” PATH’s updated proposal, April 2025 (unpublished), p. 3.

• 14

  We have not spent time trying to model the burden of preventable disease which could be influenced by this work, but this is our understanding, not least judging by where previous GiveWell programs have been targeted.

• 15

  Note: We put together BOTECs for four other countries we were investigating for TSU work (which we were considering with both CHAI and PATH). We used the BOTEC primarily to sanity check whether it seems likely that this type of program will be a cost-effective use of funds rather than generating a point estimate of cost-effectiveness that would represent our true best guess. Given the need to move quickly on this grant decision, we chose not to extend this BOTEC to additional countries, but we think that PATH’s work DRC will be similar to those countries modelled. As noted, we are making this grant primarily based on the qualitative case for its impact.

• 16
  • 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 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.

• 17

  For example, PATH included a case study of their Technical Working Group on Oxygen, which they set up in response to the COVID-19 pandemic, in their initial proposal.

• 18

  "The proposed … investment is designed as a short-term measure to assist MoHs in planning and reprioritizing in the face of USG health funding and program cuts. Though PATH will convene and support the individual FAST(s), our vision is for these teams to be led and owned by the MoH from day one in order to ensure country buy-in for the process, relevance of recommendations, and sustainability of the effort after the period of performance should the MoH choose to continue. To support this sustainability plan, PATH will identify champions for the process within the MoH and work with MoH to appoint a chair of the FAST to lead the taskforce, including making decisions on membership among other government and IP stakeholders. PATH will work closely with the MoH champion(s) to build CE and other data and analytical capabilities … so that MoH can be fully empowered to lead evidence-based decision making about health financing in a world of declining donor support. PATH will also provide context-specific training in how to update the analyses should they wish to continue tool use in the next budget cycle." PATH’s updated proposal, April 2025 (unpublished), pp. 9-10.

• 19

  See, for example, PATH’s recent work supporting the DRC responses to mpox and COVID-19.