There are interventions that we believe are – or may be (pending a literature review) – very well supported by evidence, that we’ve been unable to find charities focused on. In 2012, we put a significant amount of effort into trying to find ways donors could pay for further delivery of these interventions, even if it required working with a large organization (such as UNICEF or GAVI) rather than with a small charity dedicated to the intervention in question. Good Ventures played a major role in these investigations and was particularly helpful in getting engagement from these larger organizations.
The bulk of our efforts focused on immunizations – which we consider to have the strongest evidence base of any intervention we know of – and micronutrient supplementation (particularly salt iodization and vitamin A supplementation, which we perceive as the most evidence-supported micronutrient interventions; writeups on these interventions are forthcoming).
Despite substantial effort, we did not find any such giving opportunities. The basic pattern we saw was that:
- Government and multilateral funders provide substantial funding for these interventions.
- It often appears that the greatest obstacle to universal coverage is a logistical bottleneck rather than a simple lack of funding for more direct execution.
- We asked persistently for areas where more funding was needed to do more direct delivery. In many cases, we were told that there were opportunities, but then (a) these opportunities became funded by others while we were investigating them, or (b) we tried to follow up on these opportunities and ultimately were met with unresponsiveness, and/or concluded that funding was not the primary bottleneck to progress in these cases.
Overall, this pattern of observations fits a model in which the most proven, cost-effective interventions are often already being appropriately funded by the international community (though not in every single case; LLIN distribution is the clearest exception we’ve found).
Unfortunately, many of the details of our investigations cannot be shared, because the organizations we worked with sometimes shared information only under condition of confidentiality. What we can share is the following:
- Immunizations. Our immunization landscape writeup shares most of what we’ve learned about immunization funding. In brief, it appears that developing-world governments fund much of the basic costs of routine immunization, while GAVI provides substantial support for routine immunizations, newer more expensive vaccines, and campaigns (additional opportunities for children to receive a few key vaccines, as a way to reach children missed by the routine vaccination system and to provide additional doses to increase immunity to the targeted diseases). GAVI exceeded its fundraising target for 2011-2015 as of June 2011 (with much of the funding coming from developed-world governments, as seen on page 4 of this PDF) and is currently raising funds for 2016 and beyond (as discussed in this conversation (DOC)). We looked into several other organizations, speaking with UNICEF, the World Health Organization, and several campaign-focused organizations, and in no cases found the sorts of funding opportunities we were looking for.
- Salt iodization. We investigated two apparent funding opportunities in depth: (a) a project with GAIN in Ethiopia, in which we concluded that the key issue to be resolved was not one of funding (more detail at the link), and (b) the possibility of funding in Eastern Europe (which a conversation with UNICEF highlighted to us), which we investigated but have not produced publicly available information on.
- Vitamin A supplementation. It appears to us that the Canadian government is a major funder of vitamin A supplementation (for example, it recently granted ~$150 million for this purpose), and that UNICEF is a major supporter/implementer (see this link). We spoke with UNICEF and others in an attempt to find areas where more funding was needed to directly deliver more vitamin A supplementation, and were unable to identify such funding opportunities. The details are mostly confidential, with the exception of an initial conversation with UNICEF.
- Other programs. Our 2012 efforts also included looking into the evidence behind zinc supplementation (both therapeutic and non-therapeutic), which had been highlighted to us as an area with large funding gaps by the Micronutrient Initiative. We concluded that the evidence case and likely cost-effectiveness were inferior to those of our top charities’ interventions.
For the time being, we’ve provisionally concluded that
- The path of trying to fund the most proven interventions, when we can’t find charities that focus on them, doesn’t appear promising in the short term. This is partly because a lack of charities focusing on an intervention may be correlated with a lack of room for more funding to deliver the intervention directly; it is also because we’ve found it very difficult to work with and learn from large diverse organizations. We do expect to return to this path at some point, but we don’t expect to make it a major priority over the coming year.
- In general, it appears that the most proven interventions do attract substantial funding from governments and others. There are some funding gaps (the best example being bednets); but overall, it appears that the most proven, cost-effective interventions are often already being appropriately funded by the international community.