Our goal with hosting quarterly open threads is to give blog readers an opportunity to publicly raise comments or questions about GiveWell or related topics (in the comments section below). As always, you’re also welcome to email us at info@givewell.org or to request a call with GiveWell staff if you have feedback or questions you’d prefer to discuss privately. We’ll try to respond promptly to questions or comments.
You can view previous open threads here.
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Tag Archives: givewell
August 2024 Updates
Every month we send an email newsletter to our supporters sharing recent updates from our work. We publish selected portions of the newsletter on our blog to make this news more accessible to people who visit our website. For key updates from the latest installment, please see below!
If you’d like to receive the complete newsletter in your inbox each month, you can subscribe here.
Why are GiveWell employees sampling ORS in our office?
Last week, GiveWell employees Erin, Katie, and Karthik sampled oral rehydration solution (ORS) in our Oakland office.
ORS is a type of fluid replacement (similar to Pedialyte) that saves lives by preventing diarrhea deaths. Diarrhea is a leading cause of death for children under five, but when ORS is given with zinc tablets, we estimate that diarrhea-related mortality is reduced by 60%.
We spend 50,000 hours each year researching cost-effective global health and poverty alleviation interventions. Much of this time is “desk work”—analyzing models in a spreadsheet, evaluating evidence from studies, or talking with partners and subject-matter experts over Zoom. But the closer we can get to an intervention, the better we can understand it. Whether that’s sampling ORS in our office or taking site visit trips to witness a seasonal malaria chemoprevention campaign, we are committed to “heads-up work” that takes us beyond the spreadsheets to deepen our knowledge of the programs we support.
Read about our recent grant to CHAI to distribute ORS in Nigeria here.
July Quiz Question + Answer
Last month’s quiz question: What is the approximate number of conversations with donors our outreach team had in 2023?
We define donor conversations as phone calls, meetings, or major donor events (emails are not included in our estimate). These conversations allow us to build meaningful relationships with donors, understand why they give, and connect them to the work their gifts support.
We estimate that our Outreach team had approximately 830 conversations with donors in 2023. Out of the 68 responses we received—with answers ranging from 7 to 10,000,000 conversations—the closest guess was 800! Congratulations to our winner, Victor Matta, who will receive a GiveWell hat as a prize!
Sign up for our newsletter and answer our monthly quiz question for your chance to win!
Research and Partner Roundup
GiveWell publishes new research pages on a grant of up to $4.8 million to the London School of
Raffles, Deworming, and Statistics
Sometimes statistics can help when it’s hard to decide what to do.
You’re at a local art fair, and they’re raffling off a car worth $10,000. Five hundred tickets are being sold, each for $10. Does it make financial sense to buy a ticket? (For the moment, let’s set aside other questions about raffles and just focus on the benefit for you, the potential ticket-buyer.)
You can use a statistical concept called “expected value” to help you decide. Expected value is calculated by multiplying the probability of each potential outcome by its value, then adding these results together to get the average result of an action.
Let’s figure this out—a car is on the line. First, we multiply the probability of each potential outcome by its value.
We might win the car. Assuming all tickets are sold, the probability of winning the car is 1 in 500, and the value of winning the car is $10,000.
1/500 x $10,000 = $20
We probably won’t win the car. The probability of not winning the car is 499 in 500.
499/500 x $0 = $0
Then, we add the results together to get the average result of an action.
$20 + $0 = $20
Thus, the expected value of purchasing a raffle ticket under the conditions specified above is $20. That $20 represents the average result of buying a raffle ticket. It’s twice the ticket’s cost, making the raffle ticket a pretty good bet. In any one instance, you probably won’t win, but if you repeatedly make these kinds of bets, over time you’re likely to come out ahead.
(One important note that we’ll come back to later: Because it’s an average, the expected value doesn’t indicate what we think will actually happen in any specific instance. In fact, in this case our action of buying a raffle ticket cannot generate the expected value. We cannot win $20. We can win the $10,000 car or nothing.)
You might be saying to yourself: I’m still not that convinced about buying a raffle ticket, but I’m even less sure how this relates to GiveWell’s funding decisions.
GiveWell sorts through hundreds of funding opportunities, looking for the ones that are most cost-effective. We decide among multiple programs that differ from one another, not just in terms of the conditions they treat, the interventions themselves, or the locations they
Bringing the Economic Benefits of Reading Glasses into Focus
It started in my early forties, and it’s only gotten worse since then. At first, it was a mild annoyance, but now it affects my quality of life and makes it harder to get things done. I’m definitely not alone—almost every middle-aged person I know has the same problem—and maybe you do too: a condition called presbyopia, a type of age-related vision loss that makes it difficult to see things clearly at close distances.
Luckily, the condition is easily and inexpensively treated with reading glasses, widely available at nearly every corner drug store in the United States. Reading glasses work well, and they’re cheap enough that I have them stashed around my house so a pair is always in reach. But an estimated 510 to 826 million people around the world have presbyopia but do not have corrective glasses.1See Bastawrous, Kassalow, and Watts 2024. jQuery(‘#footnote_plugin_tooltip_15147_1_1’).tooltip({ tip: ‘#footnote_plugin_tooltip_text_15147_1_1’, tipClass: ‘footnote_tooltip’, effect: ‘fade’, predelay: 0, fadeInSpeed: 200, delay: 400, fadeOutSpeed: 200, position: ‘top right’, relative: true, offset: [10, 10], });
What we know and what we don’t know
We think that providing reading glasses to people who need them is a promising way to improve their employment opportunities and increase their economic well-being. It makes intuitive sense that being able to see better would improve people’s ability to work, particularly for vision-intensive jobs such as crop cultivation and inspection, manufacturing, or retail work.
We’ve looked at two studies of programs that distribute reading glasses—one of tea pickers in India and one of workers in a variety of vision-intensive occupations in Bangladesh, such as tailors and carpenters—and they both suggest that distributing reading glasses has a positive economic effect for the people who receive glasses.2Reddy et al. 2018, Sehrin et al. 2024. jQuery(‘#footnote_plugin_tooltip_15147_1_2’).tooltip({ tip: ‘#footnote_plugin_tooltip_text_15147_1_2’, tipClass: ‘footnote_tooltip’, effect: ‘fade’, predelay: 0, fadeInSpeed: 200, delay: 400, fadeOutSpeed: 200, position: ‘top right’, relative: true, offset: [10, 10], }); Based on those studies, we think it’s likely that providing workers with reading glasses would be a cost-effective use of funding. However, we’re uncertain about how cost-effective it would be, as the studies don’t provide all the information we need.
For example, the study in India was only 11 weeks long, so it wasn’t able to assess the effect of having reading glasses over a longer time frame. It focused on productivity,
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
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.
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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
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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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.
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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
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
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
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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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
The hardest part about fundraising for GiveWell
May marked my three-year anniversary as a Philanthropy Advisor at GiveWell. It’s a job I adore (as I’ve written about here and here), and I’ve recently been tasked with the exciting process of interviewing candidates for our growing team.
One of the best questions I’ve been asked in this process is: What’s the hardest part about fundraising for GiveWell? The short answer: GiveWell is funding constrained, but we can’t point at a specific opportunity and say, “If you donate now, here’s the impact your donation will actually cause.”
Instead, our answer is fairly abstract, and pretty far from traditional fundraising language. We tell donors that we would spend additional money on opportunities at or above our cost-effectiveness bar (which translates to saving a life for about $5,000), but we’re unable to explain in advance precisely what we will allocate additional funds to. That answer isn’t as compelling as telling someone a vivid story about how their money alone would allow us to fund a great program we’ll otherwise have to decline, but it has the advantage of being completely accurate and true.
It’s natural that people aligned with GiveWell’s approach would ask about the true impact their funds unlock, and also about what would happen if they don’t give. After all, these are key questions1To learn more about how we fund, check out our “How We Work” blog series. jQuery(‘#footnote_plugin_tooltip_14984_1_1’).tooltip({ tip: ‘#footnote_plugin_tooltip_text_14984_1_1’, tipClass: ‘footnote_tooltip’, effect: ‘fade’, predelay: 0, fadeInSpeed: 200, delay: 400, fadeOutSpeed: 200, position: ‘top right’, relative: true, offset: [10, 10], }); we think about as a funder. Donors make careful decisions about how much to give, when to give, and where to allocate gifts according to their priorities; to make those decisions, they need to know what we’d do with their money and what we would be prevented from doing if they don’t donate.
But the GiveWell research process doesn’t lend itself to easy answers to these questions. So indulge me, if you will, in an extended metaphor:
I’m at the grocery store shopping for a huge dinner party. I choose everything on my list, get to the checkout, and realize I don’t have enough money to cover my selections. I choose a few things to put back, and then the kind bystander behind me magnanimously steps up to
June 2024 open thread
Our goal with hosting quarterly open threads is to give blog readers an opportunity to publicly raise comments or questions about GiveWell or related topics (in the comments section below). As always, you’re also welcome to email us at info@givewell.org or to request a call with GiveWell staff if you have feedback or questions you’d prefer to discuss privately. We’ll try to respond promptly to questions or comments.
You can view previous open threads here.
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May 2024 updates
Every month we send an email newsletter to our supporters sharing recent updates from our work. We publish selected portions of the newsletter on our blog to make this news more accessible to people who visit our website. For key updates from the latest installment, please see below!
If you’d like to receive the complete newsletter in your inbox each month, you can subscribe here.
Fun Fact
In the past 12 months, GiveWell has recommended grants in 20 countries across Africa and Asia! See the countries represented on the map below.
Created by mapchart.net
Meet Our New Hires
We’ve shared several hiring announcements with you recently, and we’re excited to introduce you to two new GiveWellians!
Meet Araceli Steger, our new Head of People, and Uri Bram, our new Head of Communications. Araceli joins us from Tegus, an investment research platform where she was Vice President of People. Uri was most recently the CEO of The Browser newsletter, curating the most interesting writing on the web every day.
We’re thrilled to have Araceli and Uri on board! Thank you for sharing our job announcements with your networks and helping us find exceptional people to join our team.
Research and Partner Roundup
GiveWell publishes new research pages on $500,000 grant to Family Empowerment Media for the production of small-scale radio transmitters and $896,000 bridge grant to Development Innovation Lab for continued research on the effect of water chlorination on mortality. New Incentives publishes new blog post about vaccine hesitancy. Malaria Consortium hosts panel on role of philanthropy in fighting malaria featuring GiveWell’s Alicia Weng.
The post May 2024 updates appeared first on The GiveWell Blog.
Mobile vaccination with New Incentives
In this blog post, we’re crossposting the work of one of our grantee organizations and top charities: New Incentives, which gives cash incentives for parents and caregivers in Northern Nigeria to take advantage of standard childhood vaccines that are freely available from government clinics. Recently, New Incentives wrote about the experiences of their staff member Idris and a mobile vaccination team on one particular Saturday morning in Kano State, Nigeria.
While most of the vaccinations that New Incentives incentivizes occur at stationary clinics, mobile vaccination teams exist to serve mothers such as Alawiyya, aged 20, who says she lost so much blood during the recent home birth of her child, now three weeks old, that she wasn’t able to walk the few miles to the nearest clinic so baby Aliyu could be vaccinated.
At GiveWell, we direct funds based on careful, rigorous examination of quantitative evidence from academic trials and other on-the-ground research. We worry that simple stories can be misleading, often because they cherry-pick the best-case outcome of a program while obscuring its general impact. They can also result in charitable funding being directed toward more photogenic causes, even when the need might be greater elsewhere.
Nonetheless, we hear from some of our donors that stories and photos help bring the impact of their donations to life, and we think that this vivid example of New Incentives’ work is a great way to experience that. We also think that understanding the logistical details of how programs are implemented, and the varied and specific challenges they face, helps make clear why GiveWell’s detail-oriented, evidence-centric approach is so important.
For example, on this particular day, this mobile vaccination team was able to vaccinate more babies than expected in Alawiyya’s village, Jijiyawa, but only one baby out of the expected five in another village, Yan Gizo. Carefully tracking how many of the eligible babies ultimately get vaccinated is crucial for figuring out how cost-effective the program is.
So we wanted to share the stories of Idris, Alawiyya, and this particular mobile vaccination team on this particular Saturday morning, even while flagging that it’s just one of the 5,900 clinics and 11,130 mobile vaccination sessions that New Incentives staff participated in during January 2024. The plural of “story” is not data, but the stories do
GiveWell’s Research Council
As GiveWell grows and matures as an organization, we’re excited to continue learning from others in our field. We believe that actively seeking feedback on our work enables us to do more good. In May 2023, we launched a Research Council, a small group of experts we can consult on research questions and grant investigations.
We aimed to create a Council whose collective experience includes:
Deep familiarity with specific areas GiveWell researches
Substantial time working and/or living in the geographic areas where we fund work (low- and middle-income countries, primarily in Africa and South Asia)
Conducting research, especially randomized controlled trials (RCTs), on global health and development programs
Taking effective programs from pilot to scale
Working in partnership with major funding institutions and with country governments, especially the governments of countries where we support programs
So far, we’ve held three meetings with this full group to share further details of our research process and how we set our cost-effectiveness threshold. During these meetings, Council members provided helpful feedback about ways we might improve our research.
Additionally, we’ve asked Council members for their recommendations for how to approach tricky questions in our grant investigations and on bigger-picture considerations we might be missing. For example, we spoke with Council members about whether an organization’s request for additional funding seemed reasonable, about vaccination rates, and about ways to improve how we work with organizations and governments. We’ve also asked Council members for referrals to other experts on specific topics of interest.
This Council is a new initiative for getting external feedback. For this first iteration, we’ve invited people who are familiar with GiveWell’s work, all of whom have some current or previous affiliation with organizations to which GiveWell has recommended funding. We wanted to start with a small group of advisors we already knew in some capacity; depending on how this initiative goes, we might expand in the future to include a wider set of experts. We’ll also continue to seek input on our research from external advisors and experts beyond this Council.
While seeking external feedback is an important part of our process, all GiveWell funding and organizational decisions are made solely at our discretion and may not reflect the views of external contributors, and vice-versa.
Currently, our Research Council includes six members, listed below and on this page.
Amrita Ahuja is Vice President
Givewell Blog | http://feeds.feedburner.com/TheGivewellBlogMaking our work more readable
Perhaps you noticed that our most recent blog post included a bit of whimsy and even a joke footnote. Our blog is changing slightly, and you can expect more of that!
When GiveWell first started blogging, the blog was a place to share broad thoughts on philanthropy and generate conversation. While we’re not planning to revert to the tone of our early blog posts (which we consider a mistake), we are trying to publish more on our blog and to make what we publish more readable. Our blog posts will be as accurate as ever, but we’re hoping that a more conversational tone will be easier to engage with.
This blog refresh stems from an organization-wide emphasis on legibility. This focus is related to our deeply held value of transparency. For people outside of GiveWell to truly evaluate the conclusions that drive our recommendations, our work needs to be not only public but also understandable.
In GiveWell’s dictionary:
Transparency [ tran·spah·ruhn·see ]: literally making information available
Legibility [ leh·juh·bi·luh·tee ]: making a decision easy to understand and agree or disagree with
Making our work more legible takes many forms. For example, alongside our main cost-effectiveness models, we now also publish shorter versions that are easier to digest (and can be used to identify key factors in our estimates).
If you’d like to see the difference for yourself, compare the full version, the simplified version, and the summary version of our cost-effectiveness analysis for a 2023 grant to Malaria Consortium.
We’ve also made grant pages (like this one, on identifying and treating a congenital condition called clubfoot) easier to follow by including a more extensive summary that lays out the case for the grant, provides a summary of our cost-effectiveness analysis, and identifies our key reservations. We think our previous grant pages (like this one, on malnutrition treatment) were generally less readable, and that key information that informed our reasoning was harder to find.
One of the ways we plan to maintain strong legibility is through the work of our newly established “cross-cutting” research subteam. An explicit goal of their work is making our research more accurate, transparent, and legible. For example, they’ve led efforts on “red-teaming,” an exercise in which GiveWell researchers not otherwise involved in a particular grant or program investigation search for
Consider the Eggplant
By: Chandler Brotak, Isabel Arjmand, and Uri Bram
Norman Borlaug, the “father of the green revolution,” transformed agriculture (and won a Nobel Peace Prize) for developing new wheat varietals that resisted diseases and greatly increased yields.
You might well wonder: if it’s possible for wheat, is it possible for other crops? Consider the eggplant: a popular purple fruit/vegetable that can be made into everything from hongshao qiezi to baba ghanoush. It’s beloved by many people worldwide, and also by a cute but destructive moth larva:
An eggplant fruit and shoot borer larva inside an eggplant fruit. Photo credit: Chirag85 – Own work, CC BY-SA 4.0, via Wikimedia Commons
The “eggplant fruit and shoot borer,” as the name suggests, bores into the shoots and fruit of eggplants, damaging the crops. A new varietal, Bt eggplants, was developed by the Maharashtra Hybrid Seed Company (Mahyco), and later supported by partnerships with USAID, Cornell University, and local partners.1Shelton et al. 2019, pp. 4-5. jQuery(‘#footnote_plugin_tooltip_14850_2_1’).tooltip({ tip: ‘#footnote_plugin_tooltip_text_14850_2_1’, tipClass: ‘footnote_tooltip’, effect: ‘fade’, predelay: 0, fadeInSpeed: 200, delay: 400, fadeOutSpeed: 200, position: ‘top right’, relative: true, offset: [10, 10], }); This varietal is genetically modified to create proteins which are toxic to these little menaces, but safe for humans and the environment.
So: could encouraging the adoption of Bt eggplants create a purple revolution that meets GiveWell’s bar for outstanding programs?
Based on preliminary research, we don’t believe so.
Two of the major considerations in our evaluation framework are whether the intervention is cost-effective and whether we believe it has room for more funding.
For cost-effectiveness, we attempt to quantify the costs and benefits of each intervention we investigate. In the case of Bt eggplants, the main effects of the program that we consider are increased yields and decreased costs for eggplant farmers. A randomized controlled trial conducted in Bangladesh from 2017-2018 found that Bt eggplants increased yields by about 50% and reduced pesticide costs by about 40%,2GiveWell, Bt eggplant adoption short note jQuery(‘#footnote_plugin_tooltip_14850_2_2’).tooltip({ tip: ‘#footnote_plugin_tooltip_text_14850_2_2’, tipClass: ‘footnote_tooltip’, effect: ‘fade’, predelay: 0, fadeInSpeed: 200, delay: 400, fadeOutSpeed: 200, position: ‘top right’, relative: true, offset: [10, 10], }); increasing their total profits by about 60%.3GiveWell, Genetically modified eggplants BOTEC jQuery(‘#footnote_plugin_tooltip_14850_2_3’).tooltip({ tip: ‘#footnote_plugin_tooltip_text_14850_2_3’, tipClass: ‘footnote_tooltip’, effect: ‘fade’, predelay: 0, fadeInSpeed: 200, delay: 400, fadeOutSpeed: 200, position: ‘top right’, relative: true, offset: [10, 10], });
At GiveWell,
A major initiative to scale up water chlorination in India
We recommended a $38.8 million grant to Evidence Action to support the Indian government in providing clean water by setting up in-line chlorination in two states, Andhra Pradesh and Madhya Pradesh.
This isn’t a grant designed to directly deliver a service or commodity; instead, Evidence Action will use the funding to work in close partnership with state and local governments, providing technical assistance to support the delivery of the program. Providing all rural households with access to clean, piped water is a major priority for the Indian government. In-line chlorination, which uses a device to automatically disinfect water by adding chlorine as the water passes through a pipe, is a way to make drinking water safe.
We believe this grant may not only increase access to chlorinated water in the states it directly supports, but also inspire other states to adopt similar practices. A core part of the program’s theory of change is that governments in locations outside the grant area may take up a program they might not otherwise adopt. This is the first very large grant we’ve made where that’s been an important consideration. We think the upside is unusually high—if successful, this grant could eventually lead to tens or even hundreds of millions of additional people receiving safe water—but it’s also riskier than most of our grants, as there are a number of ways the program could fail to have the desired impact. Our hope is that this grant will reduce mortality and improve health at a very large scale.
The rest of this post describes the importance of clean water, the benefits of partnering with government, why we think this opportunity has such a large potential upside, our estimate of the program’s cost-effectiveness, and some of our uncertainties. You can read the full rationale for the grant here.
Why is clean water important?
Consuming contaminated water can lead to intestinal infections that are sometimes fatal. The evidence we’ve reviewed suggests that improving water quality also reduces mortality from causes not directly linked to water quality, such as respiratory infections (more here).
We estimate that this program will reduce overall mortality by about 4% among people reached with in-line chlorination. Given that we anticipate the program may reach tens of millions of people over the course of around a decade, the impact