This page is in progress
We're sharing this page now to give up-to-date information about how GiveWell is responding to recent USAID funding cuts. We haven't yet had time to include all the supporting materials we typically provide with our research. We plan to add more information soon, including our cost-effectiveness analysis, materials from grant recipients, and details about possible future grants.
In a nutshell
In March 2025, GiveWell recommended approximately $3.2 million in recoverable grants and funding reallocations to six implementing partners to fund pre-campaign activities for seasonal malaria chemoprevention (SMC) campaigns in Guinea, Mali, Cameroon, Côte d'Ivoire, Togo, and Benin. These grants will support critical pre-campaign activities that were originally due to be funded by the U.S. President's Malaria Initiative (PMI) before a funding freeze disrupted these plans (more). These preparatory activities include planning, training, procurement of non-drug commodities, community engagement, and retention of key staff. We estimate the campaigns these grants support will reach approximately 4.5 million children. (more)
We recommended these grants primarily because:
- The full SMC campaigns that these pre-campaign activities support appear highly cost-effective (ranging from approximately 8x to 50x as cost-effective as cash transfers). (more)
- Without funding for pre-campaign activities, we think the 2025 SMC campaigns in these regions would likely be delayed, compromised in quality, or cancelled outright, putting millions of children at a higher risk of malaria. (more)
- Our grant structure creates conditions that will let the U.S. government resume responsibility for funding these campaigns, which we view as the best long-term outcome. (more)
Our main reservations about making these grants are:
- By filling gaps created by U.S. government funding cuts, we may inadvertently signal that philanthropy will fill larger gaps, potentially reducing incentives for restored government funding. (more)
- With the exception of PATH, Malaria Consortium, and the Clinton Health Access Initiative (CHAI), we have not previously made grants to these implementing partners and have not deeply investigated their alignment on data collection, cost-effectiveness optimization, or transparency. (more)
- We may be crowding out domestic government funding from filling these gaps. While our best guess is that governments will prioritize funding other gaps left by PMI funding cuts, such as treatment for malaria rather than prevention. We do not have a strong view in this case about which use is more cost-effective. (more)
These grants are part of GiveWell’s efforts to respond to the USAID funding cuts. You can hear more in our public podcast on addressing urgent needs in seasonal malaria chemoprevention. We plan to investigate additional grantmaking opportunities in SMC and may update this page if additional grants are made.
Published: May 2025
Background
Malaria is a major driver of under-5 mortality in the regions covered by these grants.1 Seasonal malaria chemoprevention (SMC) involves giving children monthly courses of antimalarial medicines during the high malaria transmission season,2 which coincides with the rainy season in the Sahel region of West Africa.3 SMC has strong evidence of effectiveness in preventing malaria cases and deaths and has been recommended for malaria prevention by the WHO since 2012.4
GiveWell has previously supported SMC programs primarily through our Top Charity Malaria Consortium.5 PMI has also historically been a major funder of SMC campaigns in several West African countries.6 In early 2025, PMI implementing partners for SMC in Guinea, Mali, Cameroon, Côte d'Ivoire, Togo, and Benin faced funding disruptions due to stop work orders and contract terminations.7 This created a risk that 2025 SMC campaigns would be delayed or might not occur without alternative funding sources.
What we think these grants will do
These grants will support pre-campaign activities for SMC campaigns targeting approximately 4.5 million children across Guinea, Mali, Cameroon, Côte d'Ivoire, Togo, and Benin. Pre-campaign activities are critical preparatory work that must be completed months before drug distribution begins. They include:
- Microplanning activities at the subnational level to determine quantities of medications and materials needed at the lowest levels (e.g. a health facility catchment area)
- Tool reproduction (printing and distribution of necessary forms and materials)
- Procurement and movement of non-SPAQ8 commodities (disposable materials, vehicle rentals, etc.)
- Training activities for community distributors, supervisors, and other campaign personnel
- Essential staff retention to maintain technical and operational expertise
- Community engagement to prepare communities for the campaign
We believe that without funding for these activities, campaigns are likely to experience delays and compromises in quality.
The grant recipients and approximate amounts are:
| Partner | Country (Area) | Grant Amount | Target Population |
|---|---|---|---|
| RTI International | Guinea (Labé and Boké regions) | $560,000 | ~360,000 |
| Jhpiego | Cameroon (North & Far North regions) | $1,275,000 | ~2.2 million |
| PATH | Mali (Sikasso, Kayes and Koulikoro regions) | $690,000 | ~1.4 million |
| Population Services International (PSI) | Côte d'Ivoire (Dikoudougou, Dabakala, and Niakaramandougou districts) | $230,000 | ~100,000 |
| Malaria Consortium | Togo (Plateaux region) | $150,000 | ~130,000 |
| CHAI | Benin (Atakora and Donga departments) | $260,622 | ~300,000 |
| Total | $3,165,622 | ~4.5 million |
With the exception of Jhpiego in Cameroon’s Far North region, Malaria Consortium in Togo’s Plateaux region, and CHAI in Benin, these were the organizations that PMI funded to implement the previous year’s SMC campaigns in these locations. In general, we have attempted to keep these partners in place based on our belief that it makes it simpler and more likely for the U.S. government to resume funding these campaigns and their expertise implementing SMC campaigns in these areas. (more)
We haven't previously worked with these organizations, apart from PATH9
, Malaria Consortium10
, and CHAI.11
After speaking with representatives from each organization and countries’ National Malaria Control Programs (NMCPs), we don't have significant reservations about their ability to implement SMC pre-campaign activities. However, we do discuss our reservations about working with new partners on short notice below.
Why we made these grants
The primary reasons we made these grants are:
These programs appear highly cost-effective
We estimate that the full SMC campaigns that these pre-campaign activities support are 8-51 times as cost-effective as cash transfers.12 Our full cost-effectiveness analysis is not yet public, but we plan to include it in this page when it is complete. This high cost-effectiveness is driven by:
- Moderate to high malaria burden in target regions: We estimate annual under-5 malaria mortality rates of 0.25% (Cameroon), 0.36% (Guinea), 0.4% (Mali), 0.24% (Côte d'Ivoire), 0.19% (Togo), and 0.49% (Benin).
- Reasonable cost per child reached: We estimate a cost per child treated with all cycles of SMC of $4.52 (Cameroon), $10.08 (Guinea), $6.10 (Mali), $8.04 (Togo), $5.17 (Benin) and $17.15 (Côte d'Ivoire), which is comparable to other SMC programs we've supported (with the exception of Côte d'Ivoire, which has higher costs per child due to its smaller target population13 ).
- Strong evidence of effectiveness: SMC has been shown to reduce malaria morbidity and mortality by approximately 79% during the intervention period, and we estimate that about 70% of annual malaria deaths occur during the SMC season in the Sahel region.
Our cost-effectiveness estimates for these SMC campaigns contain significant uncertainty, but we believe they more likely underestimate than overestimate cost-effectiveness. Considerations supporting this view include:
- The majority of SPAQ drugs required for these campaigns have already been procured by other funders and are either in-country or en route, representing a leveraging of existing resources.
- Our pre-campaign grants may enable PMI funding to resume for campaign implementation.
- While we’ve already worked with these partners on reducing pre-campaign budgets, there may be further reductions if we fund the whole campaign.
- Given widespread disruptions on malaria treatment and prevention efforts in these countries due to the USAID funding cuts, we think that malaria mortality in these countries may rise, making SMC campaigns more urgent.
However, we've also identified several factors that could lead us to overestimate the cost-effectiveness of these campaigns:
- Our model currently assumes that these campaigns would not happen without our funding. As discussed in our reservations section, we believe it is possible that we are displacing both U.S. government and domestic government funds by funding these campaigns ourselves. However, we discuss below why we do not see these as significant concerns. We also think it is possible that another actor would have funded this work, which would lower the cost-effectiveness of our grants if the result is that we've crowded out that funding into something less cost-effective.
- As mentioned above, we currently estimate that 70% of malaria transmission occurs during the SMC campaign period for Sahelian countries.14 We believe that this may overestimate the proportion of malaria occurring in non-Sahelian countries, such as Togo, Benin, and Côte d'Ivoire, meaning SMC campaigns in these locations would prevent a smaller share of annual malaria deaths.15
- We may be overestimating the coverage that these campaigns will achieve. We assume that 80% of children targeted by these campaigns will actually receive SMC. This figure is based on coverage achieved by Malaria Consortium in SMC campaigns that we’ve previously funded and a light review of coverage reports from these implementing partners, adjusted downwards to remain conservative. We have not deeply investigated the methods of these partners’ coverage reports and it’s possible that delays that have already occurred in these campaigns may result in reduced coverage.
Despite these reasons for potential overestimates in our analysis, we believe the factors suggesting underestimation, particularly the leverage of past and future funding from other actors, likely outweigh these concerns.
Time-sensitivity
We believe that these grants are extremely time-sensitive for several reasons:
- Implementing partners have told us that without immediate funding, they will not be able to retain key staff members, making it harder to get information about the programs and potentially fund the full SMC campaigns later.
- Without funding, pre-campaign activities scheduled for April-May will likely be delayed, potentially jeopardizing the timely start of campaigns that typically begin in June-July.
- Implementers whose contracts have been terminated have told us that they need to submit asset disposition plans to the U.S. government, and having grant agreements in place would allow them to transfer assets to these projects rather than transferring them to other entities.
Our grant structure preserves conditions that allow the U.S. government to resume funding
Our approach is designed to ensure these cost-effective programs continue while creating conditions for U.S. government to resume funding when possible:
- In most cases we're funding the same implementing partners that PMI has previously funded to maintain continuity and make it easier for the U.S. government to resume funding. However, in Togo and Cameroon’s Far North region we determined that other organizations were better positioned to implement these pre-campaign activities.16 In Benin, we recommended a different grant recipient, as the previous recipient was the government of Benin who were supported by a USAID government-to-government grant.17
- We're making a short term funding commitment, covering only the pre-campaign period.
- The grants are structured as recoverable grants, meaning if the U.S. government funding resumes during the pre-campaign period, implementing partners would return any unused funds to GiveWell.
Our main reservations
Our main reservations about these grants are:
Concerns about gap filling for the U.S. government
Funding these gaps creates a risk of signaling that philanthropic funding will fill additional gaps, potentially disincentivizing the restoration of USAID funding. However, we’ve attempted to mitigate this concern through our grant structure (more) and we believe that the immediate health needs of the children at risk in these areas outweighs any concerns about potential signals to the U.S. government.
Risks of working with new partners
With the exception of PATH, Malaria Consortium, and CHAI, we have not made grants to these organizations before, and we have not yet deeply investigated their alignment on data collection, optimizing for cost-effectiveness, or transparency. Also, several of these organizations relied heavily on USAID funding, and they may be undermined by layoffs and financial strain given recent disruptions.
We believe these risks are worth taking (versus moving these activities to another organization) because:
- It makes it more likely that the U.S. government, rather than GiveWell, ultimately pays for most SMC costs in these locations, both in 2025 and future years (more)
- We don't expect there would be large differences in SMC coverage among different implementers, given that the program is fairly standardized and has been implemented in each country for a number of years
- We will mitigate risks by making monthly disbursements rather than providing all funding upfront
Crowding out government funding for SMC
Given the recent disruptions to the funding landscape, this may be an opportune time to work with national governments and encourage them to cover the costs of SMC campaigns. By supporting SMC, we may be encouraging governments to use their resources elsewhere.
However, we think it's relatively unlikely that we're directly displacing government funds for SMC, because our best guess is that governments will prioritize treatment over prevention and routine health systems over campaigns. We also think that government resources are unlikely to cover all high priority health interventions.
Plans for follow up
Our planned follow up will consist of monthly check-ins with implementing partners to monitor progress.
Our process
We have been investigating PMI-funded SMC campaigns affected by the USAID stop work order since February 2025. We connected with implementing partners and other stakeholders in recent weeks and through the SMC Alliance meeting in Lomé, Togo in February 2025. We met with several National Malaria Control Programs during the SMC Alliance meeting in Lomé to understand their perspectives on the funding gaps.
We received detailed information from each implementing partner about their annual work plans, budgets, timelines, and pre-campaign activities. We reviewed budgets and drafted budget ceilings for pre-campaign activities, which implementers used to craft revised budgets.
These grants are part of our strategy to find and fill gaps that resulted from early 2025 disruptions to U.S. government funding in interventions we understand well, of which SMC is one.
Sources
- 1
We estimate that the total malaria-attributable mortality rates in these countries range from 0.29% - 0.73%.
The World Health Organization country disease outlooks for all six of these countries cite malaria as a significant public health concern. - 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
With the exceptions of Côte d'Ivoire, Togo, and Benin, these countries are part of Africa’s Sahel region, defined by the WHO as “10 countries comprising Burkina Faso, Cameroon, Chad, The Gambia, Guinea, Mali, Mauritania, Niger, Nigeria, and Senegal”. The Sahel is an area “where the majority of childhood malarial disease and deaths occur during and immediately after the short rainy season, WHO recommends the intermittent administration of seasonal malaria chemoprevention (SMC) with sulfadoxine–pyrimethamine plus amodiaquine to prevent Plasmodium falciparum malaria among children aged 3–59 months.” Gilmartin et al., 2021
In 2022, the WHO updated their original recommendation, which recommended SMC only in the Sahel, to remove geographic restriction and recommend SMC for other countries where malaria transmission is seasonal. Our understanding is that malaria transmission in Côte d'Ivoire, Togo, and Benin follows a similar, but possibly less pronounced, seasonal pattern to the Sahelian countries.
We plan to continue researching the seasonality of malaria transmission in areas outside of the Sahel and may update our model in the future.
- 4
- SMC, and the evidence for its effectiveness, is described in further detail in our intervention report.
- The WHO initially recommended SMC campaigns in Africa’s Sahel region in 2012. They’ve since updated their recommendation to extend to other areas in Africa where malaria is common and seasonal.
- 5
All of the content that we’ve published on Malaria Consortium’s SMC program, including prior funding recommendations, can be seen here.
- 6
For example, PMI previously supported the Impact Malaria project, which provided support for SMC campaigns. This Impact Malaria post describes campaigns that they supported in Cameroon, Mali, and Niger in 2023.
- 7
- “The chaos began with a stop-work order for employees and contractors of the United States Agency for International Development and a freezing of all funds, including reimbursements for hundreds of millions of dollars already spent. That was followed by a process allowing organizations that provided lifesaving medical treatment and food aid to seek a waiver allowing them to continue their work.Then came terminations, last Wednesday, of more than 5,000 projects and programs. Since then, some projects have been told they were fully restored, and others that they are restored only to the terms of their original waiver, which runs out next month. Almost none have seen any of the funds they are owed unfrozen.” Nolen 2025
- For a timeline (up to March 2, 2025) of cuts and legal orders related to the United States Agency for International Development (USAID), the primary US government agency responsible for providing foreign assistance, including global health programs, see Schoenfeld Walker and Lai, March 5, 2025
- 8
Sulfadoxine-pyrimethamine and amodiaquine (SPAQ), the antimalarial drugs used in SMC campaigns. (more)
- 9
GiveWell has made multiple grants to PATH in the past, primarily related to technical assistance for malaria vaccine rollouts. See the grant pages here:
- PATH — Technical Assistance to Support Malaria Vaccines Rollout (March 2024)
- PATH — Study of Perennial Malaria Chemoprevention/RTS,S Malaria Vaccine (February 2023)
- PATH — Perennial Malaria Chemoprevention Pilot in the Democratic Republic of the Congo (November 2022)
- PATH — RTS,S Malaria Vaccines in Pilot Comparison Areas (January 2022)
- 10
Malaria Consortium’s SMC program is a GiveWell Top Charity, meaning that we believe the program is highly cost-effective and we’ve recommended a significant amount of funding to it. All of the content that we’ve published on Malaria Consortium’s SMC program, including prior funding recommendations, can be seen here.
- 11
GiveWell has made multiple grants to CHAI that can be seen on this dashboard, including one in February 2025, “to quickly plug very time-sensitive and high impact malaria funding gaps emerging from the USAID stop work order.” (more)
- 12
- 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.
- 13
While the Plateaux region of Togo in the table above has a similarly small target population, Malaria Consortium's existing presence in Togo allows for comparatively lower costs.
- 14
For more on how we arrive at this estimate, see this section of our intervention report on SMC.
- 15
In the paper that we rely on to arrive at our estimate of the proportion of malaria transmission occurring during SMC campaigns, Cairns et al., 2012, the authors discuss the fact that campaigns are likely to be less effective in areas where a smaller proportion of annual rainfall occurs during the campaign period. See Figure 2c and 2d for a geographical representation of areas where campaigns are most likely to be effective.
- 16
- In Togo, we made the decision to fund Malaria Consortium in Togo’s Plateaux region rather than the previous PMI implementing partner due to the limited scope of this campaign (target population of ~130,000 children under 5 compared to an average of ~1.6 million in Mali and ~2.2 million in Cameroon (more)) which resulted in a significantly higher cost per child reached according to the previous implementing partner compared to Malaria Consortium, which already has a significant presence in Togo given their support of SMC campaigns in other parts of the country.
- In Cameroon’s Far North region, we made the decision to fund Jhpiego, who was previously the implementing partner in Cameroon’s North region, due to our concern that the previous implementing partner in the Far North was not in a position to support these activities in the necessary timeline. We came to this decision after meetings with multiple stakeholders in the country.
- 17
In Benin, we made the decision to fund CHAI rather than the Beninois government as GiveWell does not have experience or systems set up to grant directly to governments. CHAI has a strong track record working with the Beninois government across multiple projects and had already engaged with the Beninois government as part of our previous grant to them to plug short-term malaria funding gaps.