- Deworming schoolchildren, as discussed in a recent post, is ranked among the top programs in terms of “cost-effectiveness,” i.e., health benefits (in DALY terms) per dollar.
- Deworm the World has in the past been featured and, seemingly, implicitly endorsed by Poverty Action Lab,* which is one of the top sources of rigorous research on aid.
- Schistosomiasis Control Initiative and Deworm the World are rated as the top charities of Giving What We Can (a group that promotes both more generous and more intelligent giving).
We are positive on deworming as an intervention. But we feel that for individual donors, it is necessary to form confidence in charities, not just interventions. This is where our interest in NTD control hits major obstacles. This post goes through our questions and the difficulty we’ve had answering them, and focuses on charities focusing partly or fully on deworming.
As far as we can tell (details below), the major organizations focused on deworming work heavily with developing-world governments. They spend money on both advocacy and subsidies for government control programs. We therefore have the following questions:
- How do the charity’s funds break down between subsidies and advocacy?
- For subsidies:
- How much of the total spending on control programs has been covered by the charity, as opposed to the government?
- How has the government been audited to ensure compliance with terms and conditions? Note that the Stop Tuberculosis Partnership serves in a similar role to NTD charities, subsidizing (through drug grants) government tuberculosis control programs, and it has an extremely thorough auditing process to ensure that drugs are used appropriately, that reported statistics are meaningful, etc. It has in the past discontinued funding for noncompliance. How do NTD control charities compare?
- Does the charity intend to keep subsidies at the same level indefinitely, or does it intend for the government to take over activities? If the latter, what is its track record in accomplishing this very difficult task? Note that while we consider “sustainability” optional for some programs, we believe it is crucial for deworming, for reasons discussed previously.
- For advocacy activities:
- How much has been spent, what programs (and where) have been advocated, and to what results? What does the future advocacy plan and budget look like, and what might be expected from it? Cost-effectiveness of control programs is one question; the cost-effectiveness of advocacy funds could be another question entirely.
- To the extent that advocacy has succeeded, has it resulted in (a) more government funding for NTD control with no offsetting cuts, i.e., increases in total medical budgets; (b) more government funding for NTD control at the expense of other health spending; (c) more funding for NTD control, contingent on more donor subsidies?
- If (a), how has the increase in funding been financed? If (b), where have cuts been made, and to what extent has funding shifted from other worthy health spending? If (c), what are the answers to the key questions about subsidies (above)?
Schistosomiasis Control Initiative (SCI)
A key roadblock to evaluating SCI is that it does not share any information about its budget by program (past or planned). Last year, after failing to find this information on its website, we contacted Prof. Alan Fenwick, and after significant back-and-forth we were told that no budget information could be shared. This makes it impossible to answer key questions about the role of advocacy vs. subsidies, and where future donations are likely to go.
SCI also declined to answer our questions about impact of past work directly, instead suggesting that we search PubMed. We did so, and have also recently reviewed SCI’s updated website, summarizing what we found in this XLS file. Our conclusions:
- There is serious evidence of the impact of past projects, a credit to SCI and something that is rare among charities in general.
- SCI appears to have provided both funding and technical assistance in the past (and from phone conversations we also understand that it has done advocacy work). Without budget information, we do not know how its funds have broken down between these activities or the specifics of what has been paid for by SCI vs. governments.
- SCI appears to have exited at least 3 countries (of 8 that we have information on), and the extent to which its programming has been sustained – both in terms of finances and quality – by the government is unclear.
- We do not have information on how SCI audits government data and practices (though the direct evidence of impact is encouraging), or on the specifics of its advocacy work.
Deworm The World
We have essentially no information about Deworm the World.
- Its website includes no reports on expenses or on specific projects, past or present.
- It is not clear to us where Deworm the World’s focus lies. It states that it can “link” funders to projects, while linking to a page where people can donate directly to it. It has another link implying that donations directly fund projects on the ground. But Poverty Action Lab’s description* makes it sound like the organization focuses significantly on advocacy and public information as well.
- Last year, after failing to find substantive information on the website, we emailed the organization twice and received no response.
We consider Poverty Action Lab itself to be a model of transparency, posting exhaustive information on studies both completed and in progress. But Deworm the World is on the opposite end of the spectrum, providing no substantive public information as far as we can tell.
We have in the past been tempted to recommend Deworm the World simply on the strength of our respect for Poverty Action Lab. But ultimately, conducting research projects is a different enough challenge from working with governments on large-scale programs that we think that doing so would be the wrong move – both in terms of the incentives it would provide and the good it would accomplish.
*At the time this post was drafted, Poverty Action Lab discussed Deworm the World in various places on its site. However, the links have since broken as Poverty Action Lab redid its website. We have not been able to find any mention of Deworm the World on Poverty Action Lab’s new website.