Busara — Qualitative Research on Helen Keller International's Vitamin A Supplementation Program in Nigeria (February 2025)

Note: This page summarizes the rationale behind GiveWell’s decision to offer a service contract to Busara. Busara staff reviewed this page prior to publication.

Published: May 2025

1. The project

1.1 Background

Vitamin A deficiency is a major public health issue for young children in low- and middle-income countries that can lead to visual impairment and increased risk of illness and mortality from common childhood infections.1 Helen Keller Intl (Helen Keller), one of GiveWell’s Top Charities, supports government-run vitamin A supplementation (VAS) distribution in multiple countries, including Nigeria.2 We are particularly interested in exploring Nigeria with this project as we’ve directed significant funding to support VAS in Nigeria in recent years3 and we believe there is substantial potential for VAS expansion in the country.4

We have a number of key uncertainties about how Helen Keller’s support influences VAS campaigns in Nigeria (more below). These uncertainties have been difficult to resolve due to limited staff time and potential social desirability bias in responses to our questions.5

This type of issue is not restricted to Helen Keller’s VAS campaigns in Nigeria. Across GiveWell’s program areas, we often have uncertainties about on-the-ground realities that are difficult to resolve due to limited staff time or limitations in our ability to elicit useful information through desk research or discussions with other actors. We think collaborating with qualitative researchers could be a useful tool in resolving these uncertainties.

1.2 Project activities

This $168,509 service contract will fund a qualitative research project to be conducted by Busara from March to September 2025.6 The timeline is designed to coincide with the May 2025 vitamin A supplementation campaign so that the preparations and campaign will be fresh in respondents' minds.

Research activities will include discussions with national-level stakeholders in VAS, stakeholders in a Helen Keller-supported state, and stakeholders in a state without VAS campaign support. The timeline we have agreed upon with Busara is as follows:7

• April–May 2025: Project planning
  • Developing strategies for accessing and sampling respondents
  • Submitting the project to a local Institutional Review Board (IRB)
• May–June 2025: 20–25 key informant interviews with government officials and other funders/implementers
• June–July 2025: 35-40 in-depth interviews with local healthcare staff, community leaders, and caregivers
• August–September 2025: 6-8 focus group discussions, primarily with caregivers of VAS recipients
• September–October 2025: Data analysis and preparation of a final report

2. The case for the spending

2.1 Improving our understanding of Helen Keller's work in Nigeria

We think this research will improve our understanding of one of our Top Charities in a key geography. The research will allow us, via Busara, to interview stakeholders involved in all aspects of program delivery whom we wouldn't otherwise be able to reach due to limited connections and time constraints. We think that the information gathered will be informative because it incorporates more perspectives on the program (e.g. healthcare workers, caregivers, and local government officials whom GiveWell would not be easily able to interview) and because professional qualitative interviewers should be able to get less biased answers than GiveWell would directly.

This research could significantly impact our assessment of Helen Keller in Nigeria. The spectrum of results could be anywhere between:

• Helen Keller is having a greater impact than we thought and we should consider funding expansion to other states in Nigeria.
• Things are generally as we’ve assumed they are, so we should stick to our current grantmaking plans.
• There are red flags indicating Helen Keller might not be having the impact we expected, so we should investigate deeper and potentially discuss program changes with Helen Keller.

• In the absence of Helen Keller support, what proportion of children would receive VAS? Why?
• In the absence of Helen Keller support, what VAS campaign activities would not be funded or would receive less funding? Why?
• In the absence of Helen Keller support, what coordination and planning activities would not occur or would be completed less efficiently or effectively? Why?
• In the absence of Helen Keller support, what supervision activities would not occur or would be completed less efficiently or effectively? Why?
• With Helen Keller support, are communities more likely to receive the correct amount of VAS capsules/less likely to experience stockouts? Why or why not?
• With Helen Keller support, are healthcare workers more likely to distribute VAS effectively and efficiently? Why or why not?
• Do Helen Keller activities influence caregivers' desire for their children to receive VAS? Why or why not?
• What other NGOs play a role in VAS campaigns in Nigeria?
• How will the USAID funding cuts affect the efficacy of VAS campaigns in Nigeria?

2.2 Understanding the value of qualitative research

GiveWell has not previously funded much qualitative research on the interventions we are interested in. We believe this spending will help us assess the value of commissioning qualitative research, as well as where, when and how to use qualitative research in our work in the future, potentially unlocking future grant opportunities. We believe qualitative research could be valuable for quickly learning about uncertainties that cannot be resolved through desk research alone (e.g., why households don't use a health product that evidence suggests is useful).

If this project goes well, we could regularly use Busara for similar projects, expediting the process over time. If it goes poorly, we might need to reconsider our approach, possibly using different partners or alignment methods, or focusing more on our own field visits to gather qualitative insights. We plan to conduct multiple qualitative research projects over the next few years. These projects (including this one) will help us learn about the research partners and practices that maximize the learning value of qualitative research for GiveWell.

2.3 Incorporating program participant perspectives

This project aligns with our long-term goal of incorporating more program participant feedback into our research.8 Program participants may identify important issues we might otherwise miss, or provide valuable insights on implementation quality. If successful, we could adapt this approach to eliciting program participant feedback to other intervention areas.

3. Risks and reservations

3.1 Alignment with Busara

Our main concern is that Busara might focus on making general recommendations to improve VAS campaigns rather than addressing our specific learning goals. Busara’s initial proposal included some methods and learning goals we didn't request, suggesting a potential misalignment. Promisingly, several rounds of feedback have brought Busara’s proposal into greater alignment with our goals.
To address the potential risk of misalignment, we will:

• Share a refined version of our team’s learning agenda with Busara
• Review IRB materials, interview guidelines, and outputs early on to ensure alignment

3.2 Staff time requirements

While this is a relatively small amount of spending for us, this type of research project involves many details that could require substantial GiveWell staff time to oversee. To mitigate this issue, we've developed a plan to limit total staff time spent on this project by time-boxing various teams’ involvement in the project.

4. Plans for follow up

We have developed a learning agenda for this project centered on four areas:

1. Learning about the qualitative research process: What time investments are required for qualitative research, which questions is this approach well-suited to answer, and how can we streamline our qualitative research processes?
2. Learning about Busara's qualitative research: Should we make more qualitative research grants to Busara?
3. VAS-specific learning: Can we improve our understanding of Helen Keller's theory of change in Nigeria?
4. Learning about beneficiary feedback: What areas do program participants demonstrate knowledge about in surveys, interviews and focus groups, and how might their perspectives enhance GiveWell's research and decision-making?

We aim to track progress through regular check-ins with Busara, including the three debrief sessions suggested by their proposal (see timeline above). Busara will prepare several debrief reports throughout the project as well as a comprehensive final report.

5. Internal forecasts

For this project, we are recording the following forecasts:

Confidence	Prediction	By time	Resolution
50%	Busara’s first draft of in-depth interview protocols will be sufficiently aligned with our learning goals that we will not need to suggest significant changes (i.e., more than line edits or clarification questions).	June 1st, 2025	-
90%	We will receive a draft of a comprehensive report from Busara.	December 1st, 2025	-
85%	Busara’s final report will align with our original research questions.	February 1st, 2026	-
40%	The project will lead to a change to our VAS cost-effectiveness analysis that pushes at least one VAS location above or below our cost-effectiveness bar	September 1st, 2026	-
60%	We will recommend another grant to Busara for qualitative research	September 1st, 2026	-

6. Our process

We decided to pursue this service contract after identifying uncertainties about Helen Keller's theory of change in Nigeria which we believe could be addressed through qualitative research. We conducted a relatively light-touch, qualitative investigation to be able to move forward with this time-sensitive but relatively small project,9 including:

• Reviewing Busara's past projects in Nigeria and consulting with researchers who had previously worked with them to determine that they were well-suited to undertaking this work
• Going through multiple rounds of proposal review with Busara to ensure alignment with our learning goals and to refine the budget and scope
• Communicating with Helen Keller about the purpose and scope of the project to ensure their support and cooperation (which we secured)

Sources

Document	Source
Busara, GiveWell Qualitative Research Nigeria Proposal 2025.01.13 [Staff names redacted]	Source
Busara, Homepage	Source (archive)
GiveWell, Busara center updated proposal budget [Staff names redacted]	Source
GiveWell, CEA of vitamin A supplementation, 2024 v1 (public)	Source
GiveWell, Helen Keller International — Vitamin A Supplementation (August & September 2024)	Source
GiveWell, Helen Keller Intl — Vitamin A Supplementation (January 2022)	Source
GiveWell, Helen Keller Intl — Vitamin A Supplementation (January 2023)	Source
GiveWell, Helen Keller Intl’s Vitamin A Supplementation Program	Source
GiveWell, IDinsight — Beneficiary Preferences Survey (2019)	Source
GiveWell, IDinsight — Updated Beneficiary Preference Research and Pilots (2025)	Source
GiveWell, Internal forecasts	Source
GiveWell, Moral Weights	Source
GiveWell, Our Top Charities	Source
GiveWell, Room for More Funding	Source
GiveWell, Vitamin A Supplementation	Source
Helen Keller Intl, Homepage	Source (archive)
World Health Organization, Vitamin A deficiency	Source (archive)

• 1

  From the World Health Organization’s page on vitamin A deficiency, “Vitamin A deficiency is a public health problem in more than half of all countries, especially those in Africa and South-East Asia. The most severe effects of this deficiency are seen in young children and pregnant women in low-income countries.” … “Night blindness is one of the first signs of vitamin A deficiency. In its more severe forms, vitamin A deficiency contributes to blindness by making the cornea very dry, thus damaging the retina and cornea. An estimated 250 000–500 000 children who are vitamin A-deficient become blind every year, and half of them die within 12 months of losing their sight. Deficiency of vitamin A is associated with significant morbidity and mortality from common childhood infections, and is the world’s leading preventable cause of childhood blindness. Vitamin A deficiency also contributes to maternal mortality and other poor outcomes of pregnancy and lactation. 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.”

• 2

  For more on our general assessment of Helen Keller as an organization and VAS as an intervention, see this report.

• 3

  See here three (1, 2, 3) recent grant pages on grants made to support VAS in Nigeria.

• 4

  This is based on unpublished conversations with Helen Keller Intl and Nutrition International, as well as GiveWell's internal analysis.

• 5

  For example, grantee and government staff may over-emphasize the positive aspects of a program because they want GiveWell to keep funding the program or think this is what we want to hear.

• 6

  Busara shared an itemized budget in their research proposal. GiveWell’s summary of this budget is here.

• 7

  The months in brackets in this overview are based on our predictions for when Busara will be able to complete this work. See the Gantt chart in Busara’s proposal for more details on the project timeline.

• 8

  GiveWell’s first major step towards incorporating program participant preferences into our research was our 2019 beneficiary preferences survey conducted by IDinsight, which influenced our moral weights. More recently, we funded IDinsight to perform desk research and piloting to determine whether we should fund another beneficiary preferences survey.

• 9

  Busara’s proposed research is designed to coincide with the May 2025 VAS campaign to limit recall bias (i.e., participants not recalling past events accurately or completely). We offered the contract to Busara in February so they can draft and submit IRB materials in April, receive approval (typically 6-8 weeks) by June, and begin fieldwork shortly after approval. Even if this timeline isn't met, the project would still be valuable, as interviews after the campaign would still provide useful information. Alternatively, Busara could wait for the next campaign later in 2025.