We’ve recently published our updated charity recommendations, featuring two top charities (Against Malaria Foundation and Schistosomiasis Control Initiative) that score well on all of our criteria. In this post, we discuss how we decided which of these two charities to rank #1 and which to rank #2.

Both charities are executing health programs that deliver significant and very cheap help to people in the developing world. Both have strong track records and transparency, as well as concrete plans for how to use future donations.

Here’s what we see as the major relative pros and cons:

SCI has a more complete and convincing case that its past activities have had the intended outcomes.

• AMF has consistently gotten nets delivered to communities – and given the strong evidence on the impact of nets, this in itself is stronger evidence of impact than for nearly any other charity we’ve seen – but there are still some gaps in the picture. We aren’t sure whether, or for how long, nets are used properly, and we don’t have data on what has happened to malaria prevalence (though our research on nets in general has led us to believe that neither of these is a huge concern). AMF has made credible commitments to future data collection on both of these fronts (and has collected some data for the former).
• By contrast, SCI’s evidence shows substantial drops in disease prevalence. This evidence has some issues (which we discuss in the review), but overall we find it convincing.

This consideration is balanced somewhat by the fact that we are more confident in the quality-of-life significance of reducing malaria than of reducing parasitic infections.

AMF has more upside.

• It’s smaller, and appears to be earlier in its development (having just begun its first larger-scale distribution); the chance that GiveWell-influenced money can be crucial in its development is therefore higher.
• It’s working in an area – distribution of nets – where (a) an enormous amount of money is spent each year* (b) data on long-term usage and malaria prevalence following distributions still looks to us to be pretty thin. Well-executed and well-documented distributions could be valuable as pilots and as information for the hundreds of millions of dollars worth of other distributions going on.

We have more confidence in AMF as an organization. Both AMF and SCI are outstanding on this front: both are transparent and accountable with strong track records, and both have answered all our questions well. However,

• We’ve consistently (for more than a year now) found AMF noticeably easier to communicate with, and found it to address our concerns noticeably more clearly and directly. With AMF, we are more confident that we have gotten our questions fully answered, that we won’t later hear about something we should have heard about before, and that we will be able to learn about how our funds end up being used and whether things end up going well or poorly.
• SCI’s evaluation is outstanding, but may have been driven by its major funders (the Gates Foundation; DFID). With AMF, we are more convinced that the organization itself is committed to skeptical self-questioning, evaluation and improvement based on evaluation.
• Very broadly, all GiveWell staff agree that we have more general confidence in AMF’s operations and management than SCI’s. This is a completely subjective judgment call that isn’t attributable to any particular event – it’s just a general feeling based on the hours of conversations we’ve had with both organizations. This leads us to be more confident that AMF would make decisions we would ultimately agree with or understand in the face of new circumstances.

We are sufficiently confident in the people behind both SCI and AMF to feature them as top charities, but our confidence for AMF is higher, and if we kept this information to ourselves we wouldn’t feel that we’re telling donors the whole story. Ultimately, it’s hard to be 100% sure of how your money will be used before you give it; confidence in the people you’re giving to is an important factor.

We are more confident in malaria-related research than in deworming-related research. This is as topic we’ll be writing about more in the future. In brief,

• We have done extensive research on both nets and deworming. Studies on the former have consistently raised fewer unanswered questions and red flags than studies on the latter.
• Despite the work we’ve done, we still have many unanswered questions about both deworming and nets.
• We would guess that our unanswered questions will result in fewer negative adjustments for the nets, because we find the research – and by extension, the researchers – around nets to be more reliable.

The most important deciding factor for us comes down to a combination of cost-effectiveness and room for more funding.

• We believe that in general, the vast bulk of SCI’s expenditures go toward deworming children rather than adults (see the example of Yemen), and that this is a good thing because a major part of the case for deworming is the possibility of developmental impacts for people treated in childhood.
• We believe that deworming children is cost-effective – perhaps not quite as cost-effective (by our estimations) as net distribution, but close enough to make it a non-obvious call between the two.
• However, the activities that SCI would fund with additional dollars (in the range of what we’re likely to be able to send their way) look a bit different. Note that in Mozambique, the plan is to take children who have already been selected for planned every-other-year deworming and instead deworm them every year; we have little information to shed light on the likely marginal benefit here. Other potential activities include deworming selected and particularly at-risk adults. Overall, we feel that these activities will still accomplish substantial good, but that they’re unlikely to be as cost-effective as standard deworming of children.

Bottom line. SCI is among the best giving opportunities we’ve ever seen, and we recommend it to donors. However, GiveWell staff unanimously find AMF to be an even stronger opportunity.

There are obviously a lot of judgment calls here, and we are hoping to move substantial donations to each organization so that we can follow the progress of each and learn more for the future (we see this opportunity to learn as a major value in and of itself, in terms of making us better able to maximize the impact of future donations).

*See pages 12-13 of the World Malaria Report: in 2009-2010, the Global Fund and PMI alone spent ~$1.5 billion a year on malaria control, of which about 1/3 was for nets specifically.