New Incentives — Extension of Support in Northern Nigeria (March 2025)

Note: This page summarizes the rationale behind a GiveWell grant to New Incentives. New Incentives staff reviewed this page prior to publication.

Published: June 2025

The organization

New Incentives’ conditional cash transfers (CCTs) for childhood vaccination program is one of GiveWell’s Top Charities. New Incentives was founded in 2011 and has been implementing its CCT program since 2016.1 Following promising results from a GiveWell-funded randomized controlled trial (RCT) of the CCT program, conducted by IDinsight, New Incentives began scaling up its program in December 2020.2

GiveWell has been supporting New Incentives since 2014, when we made an incubation grant to its program,3 and has since directed over $130 million to New Incentives.4 The organization currently operates in 11 states in northern Nigeria,5 where we expect child mortality from vaccine-preventable diseases to be high.6

For more on New Incentives, see our review of the organization.

The intervention

New Incentives' program aims to increase uptake of routine childhood vaccinations by providing small cash incentives to caregivers to help cover the transportation and opportunity costs of attending vaccination sessions.7 New Incentives also works to address other barriers to vaccination, such as lack of awareness about vaccines, misconceptions about vaccination safety,8 and bottlenecks in the vaccine supply chain.9
Caregivers receive 1,000 naira (~$0.6210 ) when their infant receives each dose of the following vaccines: BCG (for tuberculosis), PENTA (for diphtheria, tetanus, pertussis, hepatitis B, and HIB), PCV (for pneumococcal diseases; with doses delivered at the same visits as the PENTA vaccine doses), and MCV (for measles), for a total of 6,000 naira across the 6 vaccination visits where these vaccines are provided.11 Caregivers also receive a 5,000 naira (~$3.20) completion incentive when their infant completes the full immunization schedule.12

For more details on our assessment of New Incentives' program, see our intervention report.

The grant

This $19,127,586 grant will ensure New Incentives has funding to continue operations across nine states in northern Nigeria from January 2027 to March 2028.13 Our best guess is that this grant will lead to over 170,000 more children being vaccinated than would have been otherwise.14

With this funding, New Incentives will continue employing field officers to verify infant vaccinations and provide caregiver incentives, conducting regular coverage surveys to measure vaccination coverage in areas where New Incentives operates, supporting community outreach efforts to raise awareness about the program and the importance of vaccinations, and identifying and addressing vaccine supply issues.15

Budget for grant activities

The grant amount was determined after accounting for projected surplus funds from 2024-2026, estimated additional funds from outside sources, and surplus from our Niger and Yobe expansion grant. The budget breakdown by category for 2025 (which we expect to be roughly consistent for 2027) is as follows16 :

• Conditional cash transfers: ~37%
• Field activities, transportation, field supplies, and stakeholder relations: ~23%
• Staff compensation: ~32%
• Office expenses, including accounting and legal: ~3%
• Communications and technology: ~6%

The funding breakdown by state is:17

• Bauchi: $2,823,596
• Gombe: $1,392,280
• Jigawa: $2,563,357
• Kaduna: $1,066,981
• Kano: $5,373,941
• Katsina: $3,057,811
• Kebbi: $1,314,208
• Sokoto: $832,766
• Zamfara: $702,646

Niger and Yobe states, which are also part of New Incentives' program, are not included in this grant as they are already funded for this period through our October 2024 expansion grant.

New Incentives' budget is based on a cost per infant estimate of $16.25 at a foreign exchange rate of 1,625 naira to USD,18 and an infant enrollment target of 1,915,704 for 2027 (including enrollments in Niger and Yobe, which are funded separately)19 .

The case for the grant

We are recommending this grant because of:

• High estimated cost-effectiveness: We estimate New Incentives' program is highly cost-effective, ranging from 11-44x20 as cost-effective as direct cash transfers21 across the states covered by this grant, with a population-weighted average cost-effectiveness of 22x. This is well above our funding bar of 8x for top charities. More on the cost-effectiveness of the grant below.
• Strong qualitative impression: New Incentives continues to stand out for several qualities we look for in grantees: focus on maximizing cost-effectiveness, attitude towards self-improvement, extensive information sharing, and openness to providing us feedback. See more about our assessment of New Incentives in our review here.
  
• Sustainable funding runway: This grant ensures New Incentives maintains a minimum of 24 months of funding runway between our funding decisions. Our goal in providing a funding runway is to commit enough money upfront that if GiveWell were to stop renewing funding for New Incentives for any reason, it can continue the program while it either plans for phaseout or fundraises from other sources. We believe this length of runway is necessary given the length of the vaccination schedule, the geographic footprint of the program, the program's integration with the health system, and concerns about potential distortions to behavior when the program ends. We plan to continue exploring with New Incentives and other stakeholders how to best structure our longer-term commitments to the program.
  
• Increased confidence in our model: We've made significant improvements to our cost-effectiveness model for New Incentives over the past year, including updates to our estimates of disease burden, the program's effect on vaccination uptake, counterfactual vaccination coverage, and program costs. More below.

Cost-effectiveness

The cost-effectiveness of this program is driven by several key factors:

• High burden of vaccine-preventable diseases in northern Nigeria. We estimate that unvaccinated children in the states covered by this grant have a 4-8% chance of dying from vaccine-preventable diseases before the age of five.
• New Incentives' program increases vaccination rates. Based on results from a GiveWell-funded randomized controlled trial (RCT) of the program, conducted by IDInsight, and ongoing coverage surveys, we estimate that New Incentives' program leads to an 11-19 percentage point increase in mortality-weighted vaccination coverage across the states where it operates.
• Vaccination is effective at preventing disease and death. We estimate that receiving the full set of vaccines that we model reduces the risk of dying from vaccine-preventable diseases by 51-55% in children under age five.
• The benefits per child are high. While the per-child cost of this program is high relative to many other programs we fund, we estimate that the benefits per child enrolled are also very high: at a cost of $19.08 per unique child reached, but $1,400-$5,100 per life saved.

Below is a simple cost-effectiveness analysis for Bauchi state, where we estimate New Incentives' program has a cost-effectiveness of 22x cash transfers, roughly equal to the weighted average across all states covered by this grant.

Our cost-effectiveness estimates vary significantly across states due to differences in baseline vaccination rates and disease burden. Of the states covered under this grant, Kebbi has the highest estimated cost-effectiveness at 44x cash transfers, while Kaduna has the lowest at 11x.

Cost-effectiveness model updates

Alongside this grant renewal, we re-evaluated the evidence for New Incentives’ impact at scale and are relatively confident that the program is having large effects on vaccination uptake. We expect to publish more information on the updates we've made to our model in our New Incentives intervention report. We’ve also made a number of other changes to our cost-effectiveness model to improve our estimates for other key parameters, including disease burden, counterfactual vaccination coverage, program costs, and herd effects from vaccines. These key parameters were previously scrutinized by our cross-cutting team during its red-teaming project, which examined our top charity cost-effectiveness models with a critical eye in order to identify mistakes or gaps in our research. Overall, we are now more confident in our model of New Incentives' impact as a result of these efforts.

Even with conservative assumptions, our estimates of the impact of this program generally remain above our funding bar; see our cost-effectiveness estimates across our 25th - 75th percentile confidence interval for key parameters here.22

Risks and reservations

Our main reservations about this grant are:

• Potential distortionary effects on the health system. In addition to the incentives provided to caregivers for receipt of routine childhood vaccinations, New Incentives also provides 1,000 naira stipends for vaccinators when conducting outreaches that require transportation, as well as 1,000 naira weekly stipends for community members and town criers for supportive activities to further increase vaccination uptake.23 Some stakeholders have expressed concerns that this support could create dependency and make these activities, such as vaccination outreach sessions, less likely to occur without external funding.24 We have limited evidence on how significant these effects might be, and we are pursuing opportunities to learn more. However, New Incentives has not yet withdrawn this type of support in any locations (and has no current plans to do so), so it's not possible to directly observe how behaviors change as a result. We aim to continue deepening our relationships with other stakeholders in Nigeria so we can better understand how New Incentives' program interacts with the broader vaccination landscape.
• Potential negative effects when incentives end. A common concern we have heard about incentive programs is that they could have negative effects on behavior when incentives are eventually discontinued. While we include an adjustment in our cost-effectiveness model for this risk when considering expansion to new areas, we have limited evidence to date to help us estimate the size and direction of potential post-program effects.25 We are actively pursuing opportunities to study the post-program effects of other incentives for immunization programs. We will also continue discussing phaseout plans with New Incentives, and brainstorming strategies to try to mitigate negative effects upon the withdrawal of incentives.
• Opposition from some stakeholders. Some stakeholders in Nigeria have expressed reservations about the program, particularly regarding its sustainability and how the program is implemented through its own staff members instead of through clinic staff.26 While we believe New Incentives formulated its strategy for stakeholder engagement after careful consideration, its approach might limit opportunities to impact the broader health and development space through collaboration and/or increased buy-in for the program at the national level and among global health actors. This approach could also make the program more vulnerable to disruptions from opposition by other partners or the federal government. We have not seen any major disruptions to date. We plan to continue monitoring program challenges via New Incentives' monitoring data and our monthly check-ins.
• Possible excess incentive costs. New Incentives increased the size of incentives in 2024 by introducing a new 5,000 naira incentive for completing the immunization schedule,27 but did not see an increase in program enrollments after this change took effect.28 We originally approved this new incentive because we worried that the prior incentive structure was not maintaining its value relative to the RCT due to high inflation in Nigeria,29 and were concerned that a lower value incentive may not encourage vaccinations to the same extent as during the RCT. We would have expected a large, sudden change in the incentive to result in more children enrolling, if caregivers are sensitive to the size of the incentive. It's possible that it's taking time for information to spread about the higher incentive and the effects will be gradual over time. However, if caregivers are not in fact very sensitive to the size of the incentive, then this additional payment may be unnecessary to achieve roughly the same effect on vaccination uptake. We plan to revisit the incentive structure with New Incentives in the future to explore whether a different structure might be more cost-effective.

Plans for follow up

We will continue to assess New Incentives' program through the following activities:

• Monthly check-ins with New Incentives to discuss program operations, challenges, and achievements
• Annual review of program metrics, including enrollment numbers, costs, retention rates, and stockout rates, among other data
• Continued updates to our cost-effectiveness model, based on new information from New Incentives, data or research from outside sources, conversations with outside experts, and other methods of interrogating our model
• Exploration of a project with an external partner to better understand New Incentives' coverage survey data and monitoring processes
• A potential site visit (pending security conditions)
• Continued engagement with other stakeholders in Nigeria
• Exploring opportunities to study post-program effects of other incentives for immunization programs

Our 2025 follow up plans for New Incentives' program are recorded here.

Internal forecasts

For this grant, we are recording the following forecasts:

Our process

Our investigation for this grant included:

• Reviewing New Incentives' 2024 program data, expenses, and coverage survey results
• Analyzing New Incentives' budget and cost per child
• Updating our cost-effectiveness analysis for New Incentives' program, including incorporating new evidence on treatment effects, burden estimates, and counterfactual coverage trends, among other updates.
• Speaking with other stakeholders in Nigeria, including representatives from Gavi, the Gates Foundation, and state health officials in Kaduna and Sokoto, among others
• Reviewing New Incentives' progress against our follow-up plans from previous grants
• Discussions with New Incentives' leadership about program operations, phaseout plans, and engagement with external stakeholders, among other topics

Sources

• 1

  “2011: Inspired by evidence on the effectiveness of conditional cash transfers while doing research with the Center for Effective Global Action, Svetha Janumpalli raises seed funding from Unorthodox Philanthropy to create New Incentives…
  2016…By the end of the year, New Incentives reassesses the evidence and the program’s theory of change for reducing neonatal mortality. The organization decides to pivot based on the evidence and starts collecting data from health clinics about childhood vaccination rates and challenges.” New Incentives, “History” page.

• 2

  We recommended a grant of $16.8 million in 2020 to support this scaling up.

• 3

  See GiveWell, New Incentives — General Support (2014).

• 4

  For a full list of the grants that GiveWell has recommended to New Incentives, see this table.

• 5

  "Where We Work: We closely collaborate with the state governments of Bauchi, Gombe, Jigawa, Kaduna, Kano, Katsina, Kebbi, Niger, Sokoto, Yobe and Zamfara in northern Nigeria." New Incentives, "Our Work".

• 6

  See this row of our New Incentives cost-effectiveness analysis for our estimate of the probability that a person will die of a vaccine-preventable cause before reaching age 5 in these states.

• 7

  "The total amount of 6,000 Naira (approximately US$8) helps caregivers cover transportation costs and lost income." New Incentives, Our Work

  Note that caregivers can receive 1,000 naira at each of 6 vaccination visits, plus an additional incentive of 5,000 naira at the 15 month visit (the last visit in the routine immunization schedule) if their child completed the full schedule.

• 8

  "The goal of the meetings is to make communities aware of the life-saving benefits of vaccinations and the incentives—if they aren’t aware, they can’t take advantage of them. The sessions are also designed to address misconceptions around the safety of vaccines and address any other questions that participants might have." New Incentives, How We Are Building Demand for Our Program—and Vaccinations—with Thousands of Awareness Sessions

• 9

  See more about New Incentives' support of the vaccine supply chain here.

• 10

  This is based on the assumption of an exchange rate of 1,625 naira per USD. 1,000 naira / 1,625 naira per USD = ~0.62USD.

• 11
  • See the “Vaccine Timeline” section of this page on New Incentives’ work. Note that other indirectly incentivized vaccines are provided at these visits as well.
  • From New Incentives, "How We Encourage All Routine Childhood Vaccines": "The directly incentivized vaccines were selected because they provide the largest health benefits and reduction in mortality per dollar spent. They are:
  • BCG (tuberculosis)
  • Penta (diphtheria, pertussis, tetanus, hepatitis B, and HIB)
  • PCV (pneumococcal)
  • MCV (measles)."

• 12

  "In July, we changed the incentive structure of our program, adding a bonus of ₦5,000 that is given to caregivers after their child completes their childhood immunizations." New Incentives, "What’s on the Horizon at New Incentives: Malnutrition Monitoring, a Vaccination Completion Incentive, and More", October 2024.

• 13

  Note that the full program budget for these 9 states from January 2027 - March 2028 is ~$35 million. Our ~$19 million grant will cover the funding gap left over after accounting for surplus from prior GiveWell grants and funding from other sources. GiveWell, Budget for New Incentives Renewal

• 14

  Note that we do not count additional children vaccinated in Niger or Yobe towards this total since those states are funded through 2027 by a different GiveWell grant.

• 15

  Source: New Incentives, 2025 Budget Summary and Report (unpublished)

• 16

  Source: New Incentives, FY 2025 Financial Budget Summary

• 17

  GiveWell, Budget for New Incentives Renewal

• 18
  • "We've revised the FX Rate in our cost model to N1,625 (the middle-ground of our initial estimate and current trend), resulting in a $16.25 cost per infant without ORS/Zinc, which is similar to the per infant cost from the recently completed funding cycle. This adjustment is somewhat conservative, and we are incorporating it in order to provide some buffer in the case of unexpected cost increases; we are still aiming to hit a cost per infant of $15.07-$16.25 as we expect to realize efficiencies in some key areas this year" New Incentives, responses to GiveWell budget questions, February 2025 (unpublished)
  • Note that we use a different cost per child estimate in our cost-effectiveness model, $19.08, which is based on New Incentives' spending in 2024 and our estimate of the rate of repeat enrollments in the program.
  • "We're pretty confident that we won't need to further update the $19.1 million RFMF [room for more funding] even if the Naira stabilizes at N1,500 due to savings we'll realize from several areas we are streamlining today as well as small reductions in inflation and the cost of certain goods and services due to currency stabilization." New Incentives, responses to GiveWell budget questions, February 2025 (unpublished)

• 19

  See New Incentives' infant enrollment target for 2027 on New Incentives' Future Plans page.

• 20

  After making this grant decision, we discovered that we’d made an error when inputting the population of two cohorts in a spreadsheet supporting our cost-effectiveness analysis for this grant. We have left this error in the cost-effectiveness analysis to preserve this representation of our reasoning at the time that the grant was made. Correcting this error led to a less than .1 unit difference in cost-effectiveness, so correcting for this error would not have affected our decision.

• 21
  • 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 its 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. This estimate of the value of cash transfers 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.

• 22

  Even in Kaduna, where we estimate lower cost-effectiveness than other states covered by this grant, our confidence intervals for most of the program's parameters still imply cost-effectiveness above our funding bar.

  For example, our 25th/75th confidence interval for the cost per child reached of the program in Kaduna is $16.21 - $21.94, implying a cost-effectiveness range of 10x - 14x. The only parameter for which the lower end of our confidence interval dips significantly below our funding bar is the proportion of children reached who would be vaccinated in the absence of the program (25th/75th = 71% - 96%, implying cost-effectiveness of 3x - 20x).

• 23

  "Community Members Engagements Description: Small stipends are paid for activities including Defaulter Tracking, filtering out-of-catchment infants, identifying households and settlements with low uptake of immunizations, resolving identified uptake issues, attracting unimmunized infants, referrals, increasing program awareness, and maintaining community support." GiveWell, Questions for New Incentives on program activities, May 18, 2020, p. 3.

• 24

  We are not publishing the details of these conversations to preserve anonymity and continue encouraging candid feedback from other stakeholders.

• 25

  You can read more about how we assess the evidence on potential post-program effects in this section of our intervention report.

• 26

  You can read more about opposition from some members of the Nigerian federal government in this section of our review of New Incentives.

  We are not publishing the details of specific conversations to preserve anonymity and continue encouraging candid feedback from other stakeholders.

  Note that while we've heard concerns about New Incentives operating independently, New Incentives does contribute to the broader health system in many ways, such as by sharing data on vaccine stockouts and working with local and state government partners to address those stockouts.

• 27

  "Completion Incentive for Caregivers: In July, we changed the incentive structure of our program, adding a bonus of ₦5,000 that is given to caregivers after their child completes their childhood immunizations." New Incentives, "What’s on the Horizon at New Incentives: Malnutrition Monitoring, a Vaccination Completion Incentive, and More," October 2024.

• 28

  "In July of 2024, New Incentives launched its Livelihood Grant which provides caregivers with an additional ₦5,000 upon completing the routine immunization schedule…Comparing the 4 months before and after implementing the Livelihood Grant, there was a 2.04 percentage point decrease in uptake in the LGAs that were operational on or before November 2023.New Incentives, Impact of Livelihood Grant (Unpublished).

  At the same time as the Livelihood Grant, New Incentives rolled out updated program eligibility criteria to deter duplicate enrollment of the same caregiver and infant. It is also plausible that effects are delayed/will be observed as awareness of the Livelihood Grant increases since the increased incentive amount is given at the last visit.

• 29

  Read more about our concerns on the effect on inflation on New Incentives' program here.