Note: This page summarizes the rationale behind a GiveWell grant to Notify Health. Notify Health staff reviewed this page prior to publication.
In a nutshell
In March 2025, GiveWell recommended a $160,000 bridge grant to an early-stage organization called Notify Health to support their program and operating costs between April and October 2025. Notify Health sends SMS and voice call reminders to caregivers in Nigeria when their children's vaccinations are due. Our grant will support them during a pivotal development phase as they:
- Pilot and refine their program design to improve cost-effectiveness
- Test complementary interventions
- Hire key Nigeria-based staff positions
- Continue to raise additional funds
The primary justifications for this grant include:
- Notify Health is unusually focused on cost-effectiveness, with founders demonstrating willingness to pivot their approach based on evidence
- The organization is at a critical juncture where targeted program refinements could significantly improve their cost-effectiveness
- Our best guess is that other potential funders are unlikely to make decisions before the end of Notify Health’s funding runway in April
Our main reservations include:
- Notify Health is still early in their organizational development, and we are highly uncertain whether they will find a program design that meets our cost-effectiveness bar (their current pilot does not, according to Notify Health’s estimates)
- Notify Health’s leadership has limited experience in the Nigerian context
- GiveWell is not particularly experienced in assessing and supporting early-stage organizations
Published: May 2025
1. Background
Notify Health is an early-stage organization founded in April 2024 through the Charity Entrepreneurship incubation program run by Ambitious Impact (AIM).1 They implement SMS and voice call reminders for childhood vaccinations2 in Nigeria, starting in Kogi state.3 Their program builds on the approach of Suvita, another GiveWell grantee that implements a similar intervention in India.
2. What we think this grant will do
This $160,000 grant will support most of Notify Health's programmatic and operating expenses for Q2 and Q3 of 2025, covering the period from April through September.
During this time, Notify Health plans to:4
- Refine their core reminder program by testing new enrollment methods5 and implementing cost-reduction measures.
- Test complementary interventions that could be layered with their core reminders-based program to improve cost-effectiveness, including ORS/Z distribution in partnership with Clear Solutions, an organization focused on reducing diarrhea mortality.
- Expand their Nigeria-based team by hiring a Program Manager, Monitoring & Evaluation Officer, and M&E Specialist to build local capacity and implementation expertise.
- Continue fundraising efforts.
Notify Health initially requested $85,000 intended for use only during Q2 (April-June 2025).6 We ended up recommending a larger amount7 and a longer funding runway for two main reasons:
- It seemed unlikely that Notify Health’s other potential funding sources would materialize quickly enough to prevent another funding gap.
- A longer runway will reduce short-term fundraising pressure, giving Notify Health’s leadership more time to dedicate to program refinement during a critical juncture in their organizational development.
When divided equally across the two quarters, this $160,000 grant will cover approximately 97% of Notify Health’s target budget for Q28 and 78% of their budget for Q3.9 The largest budget categories during this period will be co-founder salaries and travel (34%),10 followed by the programmatic costs (33%) included in implementing the project in Kogi state, piloting in a new state, and new needs assessments and pilots related to program refinement.11
Given the many uncertainties around Notify Health’s program, we don’t plan to consider another grant until they have a more established program model. We expect that this will take another 1-2 years.
2.1 Do phone-based reminders increase vaccination coverage rates?
GiveWell has reviewed the evidence for short message service (SMS) reminders for infant vaccination and concluded that this intervention has the potential to be highly cost-effective, given low costs12 and moderately strong13 evidence that SMS reminders can reduce the number of children who do not receive childhood vaccinations (we estimate by about 15%) in low- and middle-income countries.14 However, we think the impact of any given program is likely to vary based on factors such as the method and timing of enrollment; different frequency, timing, and content of the messages; and the ways in which caregivers can interact with the messaging service.15
We have not compared Notify Health’s program in-depth to others that we’ve reviewed evidence for, in part because the program model is still changing. For example, Notify Health’s program currently enrolls children using immunization registers at health facilities,16 so the caregivers reached through their program may be more likely than a general population to bring their children in for immunizations even absent the program (or on the flipside, the caregivers reached may respond more strongly to reminders messages than a general population). Notify Health is also exploring ways to broaden their enrollment.17 Given these differences, plus the multiple additional program adjustments that Notify Health is currently considering in their program refinement, we are currently highly uncertain how Notify Health’s impact will compare to the programs we’ve reviewed in the past and have not estimated the impact of their specific program.
3. The case for the grant
- Notify Health’s leadership is extremely focused on cost-effectiveness. They have developed their own cost-effectiveness analysis based on our model, which estimates that the program is on average 12 times as cost-effective as unconditional cash transfers ('x cash'), our grantmaking benchmark,18 across all Nigerian states.19 They also candidly shared their assessment that they are unsatisfied with the early cost-effectiveness results, but that they have numerous ideas they are considering piloting this year for reducing costs,20 increasing impact,21 and possibly exploring more promising geographies within Nigeria.
- While phone-based reminders are not our highest priority intervention within vaccination, Notify Health’s program design is still in flux and they are willing to pivot. They are exploring options to layer this intervention with others that we are more excited about, such as data-driven outreach and targeted mobile money cash transfers.22 According to AIM leadership, Notify Health’s founders have also expressed a particularly high willingness to adjust or pivot their approach based on evidence of effectiveness.23
- Based on our investigation, it doesn’t seem very likely that other funding will come through in the short term from any of their other planned sources, meaning that our risk of crowding out other funders is low and GiveWell’s support provides a clear value-add.
- Notify Health is working in Nigeria, a country with substantial room for potential impact. Nigeria at the national level has relatively high rates of vaccine-preventable disease (4% probability that an unvaccinated person will die of a vaccine-preventable cause before reaching age 5) and relatively low coverage rates (73%, averaged across vaccines).24
- Our vaccines grantmaking strategy includes a lower-priority goal to continue to explore support for early-stage effective altruism (EA)-aligned organizations (such as AIM incubatees) working in vaccination because of our positive impression of their transparency and focus on cost-effectiveness and measuring their impact.
4. Risks and reservations
- Uncertain path to meeting our bar for cost-effectiveness: While Notify Health’s founders are committed to finding a cost-effective approach, it's unclear if their planned refinements will be enough to reach GiveWell’s bar of 10x cash. Their current pilot achieves only 5x cash in Kogi state (according to Notify Health's estimate),25 although could prove more cost-effective in other states with lower baseline vaccination coverage and higher burden of vaccine-preventable diseases. Furthermore, many of their ideas for program design adjustments are still untested. Based on the available evidence, we think that SMS reminders typically generate more modest improvements in vaccination coverage compared to other interventions we fund, like demand-side incentives.26
- Limited contextual expertise: The founders are based in Europe with relatively limited experience in Nigeria or other low-income country contexts prior to starting Notify Health.27 They also rely heavily on a local implementing partner (Renaissance Care and Empowerment Foundation) that we don't have experience with. The founders do plan to spend about 35% of their time in Nigeria this year and intend to hire Nigeria-based staff during the grant period.28
- GiveWell is not particularly experienced in assessing and supporting early stage organizations. We tend to have a more hands-off style of grant follow-up than some other funders of comparably new organizations, and Notify Health might benefit from more intensive support than we have the capacity to provide in the short term.
5. Plans for follow up
- Quarterly update calls and written progress reports
- Information sharing with other GiveWell staff who manage early-stage organization grants to build our institutional knowledge
6. Internal forecasts
For this grant, we are recording the following forecasts:
| Confidence | Prediction | By time | Resolution |
|---|---|---|---|
| 90% | [Conditional on recommending a grant] Givewell is able to successfully transfer funds to Notify Health prior to the end of their stated funding runway | April 2025 | Yes |
| 65% | Notify Health completes one full round of piloting and program refinement during the grant period | June 2025 | - |
| 43% | Contingent on GW assessing this, Notify Health’s program exceeds the 10x bar by June 2026 | June 2026 | - |
| 55% | GiveWell will make more than one grant to Notify Health in the next three years | January 2028 | - |
| 35% | Contingent on still operating in Nigeria at the time, Notify Health decides to remove the SMS reminders component of their intervention in Nigeria | December 2027 | - |
| 55% | Notify shifts operations from Kogi to states with lower coverage rates and higher rates of vaccine-preventable disease. | March 2026 | - |
| 20% | Notify Health stops operations in Nigeria and starts operations in another African country | December 2026 | - |
7. Our process
- GiveWell had a couple of conversations and several email exchanges with Notify Health, beginning in October 2024
- Notify Health shared a proposal in January 2025
- GiveWell had external discussions with AIM, the Mulago Foundation, and Founders Pledge
- GiveWell had internal conversations with a staff member who led an AIM-incubated organization and between multiple staff working on simultaneous investigations of early-stage organizations incubated by AIM
8. Relationship disclosures
Sarah Eustis-Guthrie, a Senior Program Associate at GiveWell, completed a peer review of the investigation plan for this grant, as she has personal experience completing the AIM incubation program and launching an AIM charity. Sarah has a personal connection with Samuel Harvey, one of Notify Health’s co-founders. She managed him as a volunteer for several months and they’ve met periodically since he launched Notify Health. Sarah was not a decision-maker for this grant.
Sources
- 1
"We are excited to unveil the 2024 Spring Cohort:...Notify Health Improves life-saving vaccine coverage for children through effective and scalable vaccination reminders." Ambitious Impact, Presenting nine new charities - a record for the AIM (CE) Incubation Program, May 2024
- 2
"We are a non-profit supporting healthcare systems to implement automated message and voice-based vaccination reminders for parents of newborn children. Our reminders notify parents based on the local routine vaccination schedule." Notify Health, homepage.
- 3
"Over the last few months, we’ve taken significant steps forward, including conducting two needs assessments in the Nigerian states of Kogi and Ogun."
- "While the results from Ogun were equally promising in terms of the potential impact of our program, we chose Kogi to launch this year…We remain excited about the opportunity for impact in Ogun and hope to launch a pilot there early next year if our program pilot in Kogi is successful."
Notify Health, From Insight to Action: How Our Pilot Plans to Strengthen Routine Immunization in Kogi State, Nigeria, October 2024.
- 4
See Notify Health, GiveWell $85k 2025 Bridge Grant Short Proposal (redacted), "Plans for 2025" section.
- 5
Notify Health’s current approach of enrolling children using health facility immunization registers limits their program reach to children who have already received at least one vaccine. During the grant period, they plan to test alternatives that would broaden their target population such working with traditional birth attendants or using birth records to reach more vulnerable populations before they receive their first vaccines.
- 6
"We suggest a $85,000 bridge/seed-extension grant before the April 2025 end of our runway. This grant would cover 27% of our yearly budget, funding our Q2 with one core program refinement cycle to test the most promising new enrolment method and significant cost-reduction levers, as well as a program extension e.g. of Ambassadors or other viable interventions." Notify Health, GiveWell $85k 2025 Bridge Grant Short Proposal (redacted), p. 3
- 7
We decided on $160,000 based on an analysis of Notify Health’s expenses over the past year as well as their projected expenses for 2025. We estimate that Notify Health’s spending in Q1 of 2025 will be around $40,000. Notify Health, Budget 2025 (unpublished).
Based on advice from AIM leadership, we decided that we would be comfortable supporting Notify Health’s expenses up to 2x their previous quarterly spending, amounting to about $80,000 per quarter. - 8
Notify Health's target budget for Q2 is $82,568.63. $80,000/$82,568.63 = 0.97. Notify Health, Budget 2025 (unpublished).
- 9
Notify Health's target budget for Q3 is $102,563.04. $80,000/$102,563.04 = 0.78. Notify Health, Budget 2025 (unpublished).
- 10
Notify Health, Budget 2025 (unpublished).
- 11
Notify Health, Budget 2025 (unpublished).
- 12
We estimate $0.01 per SMS message (more here).
- 13
We estimate the effect of an SMS reminders program on immunization uptake using a meta-analysis of 16 randomized controlled trials (RCTs) in low- and middle-income countries, which were of moderate quality overall. We have not investigated the individual studies in detail. See more here.
- 14
We conducted a meta-analysis of 16 RCTs in low- and middle-income countries and estimated that SMS reminders programs increase vaccination rates by 19% (more here). To estimate the impact of a reminders program at different levels of baseline coverage, we calculate that this corresponds to a 34% decrease in the unvaccinated population (more here). We adjust for internal as well as external validity concerns to arrive at our best guess for a 15% reduction in non-vaccination rates.
- 15
For more, see our intervention report on SMS reminders.
- 16
"Second, we sign up caregivers with newborn children by digitising standardised health facility paper records (“Immunization registers”)." Notify Health, GiveWell $85k 2025 Bridge Grant Short Proposal (redacted), p. 1
- 17
"Finding the right enrolment methods….We plan to test other methods like ANC/birth records, traditional birth attendants, digital databases or NGO partnerships to find methods that are scalable and reach the right caregivers cost-effectively." Notify Health, GiveWell $85k 2025 Bridge Grant Short Proposal (redacted), p. 2
- 18
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. As of early 2025, our bar for directing funding is about 10 times as cost-effective as unconditional cash transfers. See GiveWell’s Cost-Effectiveness Analyses webpage for more information about how we use cost-effectiveness estimates in our grantmaking.
- 19
- 20
"Ideas include using only paper record pictures provided by health workers instead of own staff, focusing on high-density urban areas, digital birth registr, using optical character recognition, and early government co-financing." Notify Health, CEA Results Discussion Executive Summary, p. 2
- 21
- "Ideas include ANC or birth paper records, central (digital) birth registries, Traditional Birth Attendants or partnerships with other non-profits that recruit the general population at scale incl. With door-to-door methods."
- "Layer on high(er) impact interventions…Preliminary ideas include reminders for other high-value health behaviours, data services to improve outreach/supply, targeted incentives/travel support, or Ambassadors."
Notify Health, CEA Results Discussion Executive Summary, p. 1-2
- 22
"Reminders might remain a scalable core with other interventions like outreach/supply data services, targeted mobile money incentives or vaccination ambassadors added." Notify Health, GiveWell $85k 2025 Bridge Grant Short Proposal (redacted), p. 2
- 23
AIM, conversation with GiveWell, February 25 2025 (unpublished).
- 24
Based on our Global Vaccines cost-effectiveness analysis (unpublished). Note that the vaccines pod is doing some ongoing work in early 2025 to sense-check these numbers.
- 25
- 26
"We think SMS reminders are much less impactful at increasing vaccination uptake. We estimate that SMS reminders can decrease the number of unvaccinated children by roughly 15%, compared to roughly 29% for CCTs provided by New Incentives." GiveWell, Short Message Service (SMS) Reminders to Increase Infant Vaccination
- 27
See the Notify Health team here.
- 28
See "Implementing team & capacity" table, Notify Health, GiveWell $85k 2025 Bridge Grant Short Proposal (redacted), p. 3