The GiveWell Blog

Deciding whether to recommend fistula management charities

We’ve long been interested in fistula surgery as a potential GiveWell priority program. However, as with other surgery charities, we have struggled to identify an organization that meets GiveWell’s criteria. Now, we’re working with a group called IDinsight and are excited that we may be able to consider a fistula surgery organization as a potential GiveWell top charity.

Our longstanding interest in interventions to treat fistula can be attributed in part to the popular narrative presented about fistula–the condition, which is often associated with social ostracization–appears to cause a significant amount of suffering, and seems to be treatable. We’re not sure how representative the popular narrative is, but as donors, it has contributed to our continued interest in better understanding this intervention, along with the feeling that surgery charities in general may offer low-cost, life-changing impacts.


This post will discuss:

  • Fistula management, including surgery, as an intervention.
  • Our open questions and uncertainty around fistula management programs, particularly their costs.
  • Our plans to partner with IDinsight to help answer some of our questions about fistula management.

Update on our views on cataract surgery

We’re often asked why GiveWell doesn’t recommend any organizations that focus on providing surgeries. This post will describe:

  • Work we did previously to try to find surgery charities to recommend. In brief, our inability to identify organizations with room for more funding and high-quality monitoring data prevented us from recommending surgery charities in general.
  • Our current (rough, preliminary) view that cataract surgery’s cost-effectiveness may be competitive with that of our priority programs, and some of the major open questions we have about our estimate.
  • Organizations implementing cataract surgery programs that we’ve spoken with. They run a variety of programs, and our impression is that they do not yet have the type of high-quality monitoring information we’re interested in.
  • Our plans to move forward with IDinsight to improve our understanding of cataract surgery as an intervention.

Why GiveWell is partnering with IDinsight

This post will highlight GiveWell’s work with IDinsight, part of our Incubation Grants program to help grow the pipeline of potential future top charities and improve the quality of GiveWell’s recommendations. We previously highlighted the work of No Lean Season and Zusha!, Incubation Grant recipients and potential 2017 GiveWell top charities. Unlike these organizations, we don’t expect IDinsight to itself become a top charity. Instead, we hope it will help GiveWell support the development of more top charities and increase our understanding of the organizations we recommend.

IDinsight is an international NGO that aims to help its clients develop and use rigorous evidence to improve social impact. GiveWell is partnering with IDinsight to support organizations’ development of monitoring and evaluation information of the type we’re interested in. This is the first partnership of this kind for GiveWell.

Why we’re considering Zusha! as a potential 2017 top charity

This post will discuss Zusha!, a 2017 GiveWell top charity contender and GiveWell Incubation Grant recipient. We previously highlighted No Lean Season as a potential 2017 top charity originating from our Incubation Grants work.

GiveWell first learned about Zusha! in 2013 following our publication of a shallow investigation into road safety. In February, Good Ventures made a GiveWell Incubation Grant of $900,000 to support Zusha!. Also in February, two GiveWell staff members visited Zusha! in Nairobi to learn more about its work. We plan to share additional details from their site visit in the future; this post is meant to provide a higher-level overview of Zusha! as a potential GiveWell recommendation.

GiveWell Incubation Grants

GiveWell Incubation Grants have become an increasingly substantial part of our work, and our impression is that not everyone who follows GiveWell is familiar with this program. This blog post is intended to (a) briefly explain and outline our main goals and expectations for this work, and (b) share some updates on promising organizations that have been supported by Incubation Grants.

The goal of GiveWell Incubation Grants (previously known as GiveWell’s experimental work) is to support the development of future top charities and improve our understanding of our current top charities.