Author Archives: Jeremy Rehwaldt

What If We Have Extra?

What do you do if you’re in the very fortunate position of having more money than you need to meet your own immediate needs? You might find new things to buy. You might stockpile it for a rainy day. You might donate it to cost-effective global health programs. Or you might do some combination of the three.
GiveWell thinks about that same question.
First, a bit of context: All donations made to GiveWell’s Top Charities Fund, All Grants Fund, and specific Top Charities go to the programs we recommend. (We do not take a percentage of donations made to recommended organizations through GiveWell’s website, nor do we receive any fees from organizations for being featured on our site.)
Our own organizational needs are met by donors who choose to direct funding to GiveWell’s operations (by giving to our Unrestricted Fund). In other words, we are supported only by donors who explicitly choose to support GiveWell itself through unrestricted donations.
But what happens when we receive more unrestricted donations than we need? We could choose to spend the funds on something new for the organization. We could squirrel those funds away, building an endowment to cover future needs. Or, like you, we could donate to cost-effective global health programs.
When we have more than we need as an organization, we think carefully about how we can maximize the impact of those funds.
Our “excess assets” policy helps us do this. It balances our need to ensure organizational stability with our goal of maximizing global well-being. In simple terms, the excess assets policy guides us to hold enough unrestricted funding to ensure that, after conservatively accounting for additional expected revenue and projected expenses, GiveWell will be able to continue operating for two years into the future. The way we do this is by projecting expenses and revenue, then aiming to hold at least 12 months of reserves in each of the next 12 months (more detail here). Any remaining funds are then used to make grants to the same kinds of giving opportunities we recommend to donors.
We have another related policy, which we call the “single donor cap,” to ensure that we avoid relying too much on any single source of support. The single donor cap means that any person or entity may

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Four ‘T’s for Better Funding Relationships and Healthier Nonprofits

As the old saying goes “Victory has a thousand fathers.” And few victories come as close to that claim as the successes wrought by funders and their grantees.  It takes […]
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How Giving Circles Have Shaped the Latino Community Foundation’s Grantmaking — And What Comes Next

At the heart of the Latino Community Foundation’s (LCF) mission to unleash the civic and economic power of Latinos are our most passionate advocates: the members of our Latino Giving […]
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More than a Spoonful of Medicine

What does it take to prevent malaria? Some of the programs GiveWell recommends might sound straightforward—for example, seasonal malaria chemoprevention (SMC) programs provide antimalarial drugs to young children—but the process of accomplishing this is not simple at all.
Below, we offer a post from Malaria Consortium that describes the many complex steps required to carry out an SMC campaign. See our reports for more information about the evidence for SMC and about Malaria Consortium’s SMC program.
You can read the original post on Malaria Consortium’s website.
***
Distributing anti-malaria medicines to 25 million children: The supply chain step-by-step
Ashley Giles, Nkoli Nnamonu and Lawrence Ekeocha, August 16, 2023
Author’s note: This blog is an update from the original article published in 2019. Since then, Malaria Consortium’s SMC activities have grown from targeting six million children to 25 million children in 2023. This expansion has taken place as a result of geographic expansion to new areas of Nigeria, in addition to SMC implementation research in Mozambique, South Sudan and Uganda. The work continues to take place in close collaboration with national malaria programmes and generous support from philanthropists and institutional donors.
The moment a community distributor gives a spoonful of life-saving malaria medicine to each of 25 million children across sub-Saharan Africa this year, it marks the finish line of a long and winding road from manufacturer to community.
Since 2013, Malaria Consortium has supported the transportation and distribution of medicines for seasonal malaria chemoprevention (SMC), an intervention recommended by the World Health Organization (WHO), in areas where malaria transmission peaks during the rainy season. SMC involves the distribution of full courses of safe and effective antimalarial medication (a combination of two drugs, sulfadoxine-pyrimethamine (SP) and amodiaquine (AQ) in four monthly intervals, or five in some regions, during the rainy season to those most at risk: children under five. The aim is to maintain sufficient levels of antimalarial drugs in children’s bloodstreams throughout the period when malaria transmission is at its highest. SMC, which has been implemented in areas of West Africa since 2013, has now expanded to include communities in parts of East and southern Africa. In 2022, Malaria Consortium reached children in seven countries: Burkina Faso, Chad, Mozambique, Nigeria, South Sudan, Togo and Uganda.
Warehouse at health centre in Karamoja, Uganda
So how do the drugs reach

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Elections Are Coming, and the Time for Funders to Act Is Now

Summer is heating up and so, too, are efforts to register voters and get out the vote in advance of what is promising to be a tense election season. Not […]
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Making It Count: Expanding the Ford Foundation’s Diversity Data Collection Beyond the United States

As a global funder, we often hear from, and share with, our peers the challenges of collecting grantee demographic data internationally. This includes questions of how to navigate different legal […]
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Some Things We’re Reading

Today we’re sharing quotes with links to a few pieces we’ve come across recently in our work—claims have not been vetted, and (of course) interest is not endorsement.

“The story of Ethiopian manufacturing—its rise, its faltering, and its potential for renewal—is an example, I believe, of where a little more empathy can lead to better economics.” (Oliver Kim, Global Developments)
“Every year, tuberculosis kills over a million people. Can a new vaccine turn the tide? For the last 100 years, we’ve only had one TB vaccine—and it leaves a lot to be desired.” (Jess Craig, Future Perfect)
“[O]ur study identified pneumonia as a major cause of mortality in low-income and middle-income countries with high under-5 mortality rates…. These findings underscore the importance of enhancing pneumonia prevention efforts.” (Sana Mahtab et al., The Lancet Child & Adolescent Health)
“When the ‘diff in diff credibility revolution’ started to grow, and we had a half dozen or more different methods for estimating the same parameter … I remember reading online people hoping for a checklist.” (Scott Cunningham, Scott’s Substack).
“The southern coastal zone of Western Africa … experienced abnormal early season heat in February 2024 [with] average Heat Index values of about 50°C [122°F]…. Locally, values even entered the level of ‘extreme danger’ that is associated with high risk of heat stroke [up to 60°C / 140°F]” (World Weather Attribution)
“Advance market commitments … are promises to buy or subsidize something in the future, if someone can invent and produce it. Their purpose is to guarantee enough future demand … to encourage suppliers … to try to build something that should exist, but doesn’t.” (Nan Ransohoff, Works in Progress)
“Most health care providers in India know that oral rehydration salts (ORS) are an inexpensive, lifesaving treatment for child diarrhea, yet they are widely underused…. [Trials showed] the dominant barrier was assuming that patients were uninterested.” (Zachary Wagner et al., Science)

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Reimagining the Philanthropic Resource Chain: Lessons from Fiscal Sponsorship and Intermediary Funds

In the philanthropic sector, intermediaries and fiscal sponsors play a vital role. They are the critical links that connect resources from donors to historically overlooked causes and marginalized communities. Pooling […]
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100 miles of monitoring

We’re crossposting a blog post by New Incentives, one of our grantee organizations and Top Charities. New Incentives promotes vaccination in Northern Nigeria by providing cash incentives to parents and caregivers. Recently, one of New Incentives’ field officers wrote about his experience collecting program data.
GiveWell asks all of our Top Charities to share detailed monitoring information, which we review to assess the quality of program implementation and the number of children reached. We also use this data as part of our cost-effectiveness analyses, which are the basis of our funding decisions.
We’re sharing this post to provide a firsthand account of how that monitoring data is collected. We recognize that individual stories about a program can be misleading, as they can often highlight the best examples rather than typical cases. Still, we hope Sanusi’s experience opens one small window into the efforts our Top Charities take to ensure high-quality implementation; for more rigorous information about the extent of New Incentives’ monitoring and evaluation efforts, see this section of our review of the program.
You can read the original post on New Incentives’ website, and sign up for New Incentives’ email newsletter here.
***
Boats, Motorbikes, and Vaccines: My Travels to Hard-to-Reach Areas of Nigeria to Collect High-Quality Data
Sanusi Bala Sanusi, January 25, 2024
As a field officer conducting rapid assessments, my job involves traveling to remote, hard-to-reach communities to interview caregivers and collect data on immunization coverage in their community. Along with either a community leader or someone they assign to help, I work to obtain reliable, evidenced-based, and actionable data from the caregivers for proper planning and interventions by New Incentives in northern Nigeria.


Rapid assessments are coverage monitoring surveys that typically take place every six months to measure the proportion of vaccinated children in a given geographic area, along with other related indicators, giving the organization an estimate of its ongoing impact on vaccination coverage. (Learn more about this data.)
Before starting an initial screening, I get verbal and written consent to proceed with the survey. I explain to caregivers that our discussions are strictly confidential and solely for use by New Incentives – All Babies Are Equal (NI-ABAE—this is how the organization is referred to in Nigeria) for internal decision-making processes and future interventions, also noting that overall results will be shared

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A Pride Month Call to Action: Highlighting the Less Positive Experiences of LGBTQ+ Grantees

Part protest, part commemoration, and part celebration, Pride Month joyfully invites us all to see the rich and diverse lives of queer folks — and to recognize that as far […]
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Research strategy: Water

Written by Erin Crossett and Keir Bradwell
Water is a relatively new area of grantmaking for GiveWell, but we’re excited about its potential. Two billion people around the world lack access to clean drinking water, and unclean water is a major cause of illness and death, primarily through waterborne diseases such as diarrhea and cholera.
Within the water portfolio, we think about which specific programs in which specific places are likely to address these health burdens most cost-effectively, and what additional evidence we need to gather in order to make that determination.
In this blog post, we detail our current approach to our water portfolio, explore the areas we’re excited to investigate next, and share the work we’re doing this year to deepen our understanding of the sector. Through this work, we aim to make more highly cost-effective grants that bring clean water to many more people around the world.
Where are we now?
So far, our grants have focused on improving water quality, rather than access. This is because we think there is a strong link between water quality and health outcomes, and that other donors in the sector are generally more focused on access. Because water quality is relatively neglected, we think there is plenty of room for us to make an impact.
Based on our review of a recent meta-analysis, we estimate that chlorination, a common approach to water treatment, reduces all-cause mortality in children under five by 12%. (The meta-analysis itself reports a much larger effect; our reasoning for using a smaller effect size in our grantmaking can be found here.) This estimate means that in certain locations, the water quality programs we currently support look highly cost-effective, even relative to other opportunities in other sectors that GiveWell could choose to fund.
Since we began our water portfolio, our support has focused on two main interventions: chlorine dispensers and in-line chlorination. We funded Evidence Action to install chlorine dispensers in Kenya, Malawi, and Uganda and in-line chlorinators in Malawi, and to work with state governments to provide in-line chlorination in India. We have also funded exploratory work on providing vouchers for a free supply of chlorine, which can be redeemed in shops and health clinics. When we made these grants, we estimated that these programs looked anywhere between 4 and 22

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Let’s Go Beyond ‘One Foundation’: The Promise of Changing Practices in Philanthropy

For every time someone in philanthropy says, ‘if you know one foundation, you know one foundation,’ they have heard tenfold the call from nonprofits for more general operating support and […]
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The fungibility question: How does GiveWell’s funding affect other funders?

How do GiveWell’s funding decisions influence the actions of governments, funders, and other organizations? Answering this question is an important part of figuring out which global health programs are most cost-effective and thus which we should support. We’ve already written about two key factors in our cost-effectiveness estimates: the cost per person reached and the overall burden of the problem. But those are only part of the equation.
We also consider what others are likely to do in response to our choices. For example, does our funding displace money the local government had planned to allocate to the program? Or would our funding make other funders more excited to join us in making sure the program is implemented?
Wedding registries provide a loose analogy about how one person’s decision might influence another’s: If great-aunt Sally already bought the toaster on the list, you’re probably not going to buy the lucky couple another one. The money she spent on the toaster has displaced the funding you had planned to allocate to the toaster: this is what we call “fungibility.”
In contrast, if the spouses-to-be have signed up for flatware service for 12 and other guests have purchased only 6 settings, you might prioritize filling out the remainder of the set, to be sure that the couple doesn’t run out of spoons at their upcoming dinner parties. In that case, the guests who purchased the first 6 settings are “crowding in” funding from you: this is what we call “leverage.”
Let’s think about how this might apply to health programs. Suppose we’re considering a $10 million grant for a program to increase childhood vaccination in (fictional) Beleriand. GiveWell’s initial cost-effectiveness estimate showed that the program was almost 20x as cost-effective as unconditional cash transfers. (We use cash transfers as a benchmark for comparing different programs.) This estimate makes the program initially seem like a good candidate for funding, as it surpasses our current cost-effectiveness threshold of 10x.
But what if there was a possibility that the government would have funded the program if GiveWell hadn’t? Because money is fungible, our $10 million grant would displace funds that may have been allocated by the government, freeing up the government to spend its $10 million in some other way. The arrival of the funding has

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Promoting Charitable Donations and Volunteering Through Nudge Tools From the Perspective of Behavioral Economics: A Systematic Review

Nonprofit and Voluntary Sector Quarterly, Ahead of Print. Few research has attempted to synthesize the effects of nudge tools in promoting prosocial behaviors through the lens of behavioral economics. This systematic review synthesizes empirical evidence of various types of nudges and their effectiveness in promoting charitable donations and volunteering. We identified 67 eligible studies with 117 experiments reporting eight nudge tools. We found that the studies focused mainly on three types of nudges (including reframing, referring to descriptive norms, and changing social consequences). We revealed that decreasing physical/cognitive effort, providing reminders, anchoring, and referring to descriptive norms effectively promote charitable donations; only reframing effectively promotes volunteering. Changing social consequences, connecting decisions to benefit or cost, and referring to descriptive norms are not effective in promoting volunteering. This review offers implications for practitioners implementing nudge tools in promoting charitable donations and volunteering. The data supporting the findings of this study are available in the Open Science Framework (https://osf.io/kg836).

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Adopting a Mental Health Mindset Will Help Both Funders and Nonprofits Thrive

You are exhausted, a next-level fatigue. Your body is so tired, but your mind can’t stop. It pings from what is right in front of you — grant deadlines, board […]
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Funders: Let’s Stop Making Nonprofits Choose Between Balanced Budgets and Burnout

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Increasing impact by combining programs

The idea has obvious intuitive appeal: If you’re already sending community healthcare workers door-to-door in (say) remote parts of Sierra Leone to deliver routine childhood vaccines, why not have those healthcare workers deliver chlorine for disinfecting drinking water, or oral rehydration solution for treating dehydration from diarrhea?
After all, if you’re already spending money on the fixed costs of delivery, why not provide other programs at the same time? You’d be able to amortize the costs across multiple goods and offer additional benefits to the community. (If you’re getting groceries delivered, it’s more efficient to have one driver deliver your eggs and milk and vegetables all together than to have separate drivers going round delivering each one separately.)
GiveWell is very interested in these “layered interventions,” and we are excited to support them wherever they cross our cost-effectiveness threshold. But we’ve discovered it’s harder than you might think to find ways to combine programs effectively.
If layered interventions are so intuitively appealing, what makes them more challenging in practice? In short: for a layered intervention to work, two different commodities need to be relevant to the same people, at the same time, on the same schedule, with compatible delivery logistics.
Often, layering just doesn’t work. For example, when distributed via a mass campaign, malaria nets are usually distributed to all households in a community every three years. It probably wouldn’t make much sense to use those campaigns as opportunities for childhood vaccination because most routine early childhood vaccinations are scheduled to be administered by trained health care workers during the first 18 months of life. The timing and processes don’t line up.
It might seem like deworming campaigns, in which children are given medication to kill parasitic worms, might layer with seasonal malaria chemoprevention, in which children are given medication to prevent malaria. But there are challenges there too: deworming happens once or twice a year in areas with high worm burden; in contrast, seasonal malaria chemoprevention happens once a month for several months during the malaria season in areas where malaria is highly seasonal. The timing and locations don’t necessarily line up.
However, sometimes layering works well and is quite cost-effective:

Combination deworming. We’ve supported deworming programs (for example, here and here) that provide two different kinds of medicine at the same

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Here We Go Again (and Again and Again): Let’s Stop Looking for the One ‘New Approach’ to Philanthropy

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Researcher spotlight: Erin Crossett, GiveWell Program Officer

Our research team spends over 50,000 hours a year looking for cost-effective organizations and interventions to save and improve lives, with the goal of producing the world’s top research on where to give. This interview with Program Officer Erin Crossett provides a glimpse into the world of GiveWell research.

Q: What made you interested in joining the GiveWell research team?
A: I really cared about working at a place where evidence of real impact was the key determinant of what we investigated and what we funded. I think a lot of organizations nominally care about impact, and the term “impact” gets thrown around a lot. But I think it really means something at GiveWell—it’s a core part of the GiveWell research DNA, and that’s very motivating.
Q: What grant are you most proud of contributing to during your time at GiveWell?
A: Actually the first grant I made at GiveWell: a grant to the Development Innovation Lab (DIL) at the University of Chicago to launch what we hoped would be a large, multi-site randomized controlled trial of water quality interventions. The trial was powered to detect mortality, looking at the effect of vouchers (coupons to redeem for free chlorine) and in-line chlorination (chlorine provided via an automatic dispenser added to an existing water pump) on all-cause mortality in children under five.
This grant was exciting for a number of reasons—it’s really rare to be able to run trials that are powered to detect mortality because it requires a really big sample size, and logistically, it’s quite complex to run a trial of that size. So the fact that we could do it, or even that we just took the first step to do it, is very exciting.
Before I joined GiveWell, a couple researchers on the team did a lot of work to make our first investments in clean water, but we were really uncertain about the effect of chlorination on all-cause mortality. This trial could reduce some of that uncertainty and potentially lead us to invest significantly more in water quality interventions. If the results are less promising than we thought, that could instead lead us to direct money to other interventions that are more cost-effective. So this research has real implications for how we direct large amounts of money. We would also learn

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Uncovering Local Knowledge in Grassroots Associations: An Illustration of the Critical Reflexive Approach

Nonprofit and Voluntary Sector Quarterly, Ahead of Print. Grassroots associations (GAs) are the “keepers” of collective local knowledge yet uncovering that local knowledge remains challenging for nonprofit researchers. In this study, we propose the utility of reflexivity for nonprofit scholars conducting research aimed at accessing local knowledge within GAs and illustrate its use in practice through collaborative autoethnography (CAE). From block clubs to mutual aid groups, grassroots associations provide a space for members to come together, share insights, build community, and are important repositories of local knowledge. However, GAs remain the “dark matter” of the nonprofit sector—understudied and undertheorized. We discuss the difficulties nonprofit researchers face in accessing the local knowledge of resident within grassroots associations. We then present our CAE methodology and conclude by recommending that scholars interested in accessing local knowledge engage in reflexive praxis attuned to power and positionality. This study contributes to expanding our work with and knowledge of grassroots associations within nonprofit studies.

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