The GiveWell Blog

Why ongoing assessment of top charities leads to more impact: HKI’s vitamin A supplementation program

Charities must meet rigorous requirements to make our list of top charities. However, a common misconception about our work is that our assessment process ends with the naming of a top charity. Not so! We continually examine our top charities—in fact, four staff members are devoted to ongoing assessment of our top charities. We collect information to update our assessment of our top charities’ track records and to evaluate the effectiveness of their spending plans.

Continuous assessment is critical because we direct donations to our top charities on an ongoing basis. Donors can make a gift anytime throughout the year, and we want to ensure their support is directed to the charity or charities that will best use it. We formally assess where funds can be best used each quarter when we allocate “Grants to recommended charities at GiveWell’s discretion” (discretionary funds).

We allocate discretionary funds based on our understanding of charities’ spending plans and their estimated cost-effectiveness. This is heavily informed by our understanding of the cost-effectiveness of the charities’ past work and track record to date. Although our understanding of charities’ spending plans is a key part of our allocation decision, we don’t restrict discretionary funds to a particular purpose within the program we recommend. Organizations may reallocate GiveWell-directed funding as new information becomes available.

This post will highlight how this combination of continual assessment and flexible funding leads to positive outcomes by sharing the recent example of our work with Helen Keller International (HKI)’s vitamin A supplementation (VAS) program, one of GiveWell’s top charities.

HKI’s vitamin A supplementation program

In late 2019, we allocated discretionary funding from GiveWell donors to HKI to support VAS campaigns in Bauchi State, Nigeria, from 2020 to 2022. VAS campaigns target preschool-aged children and are most impactful in areas with high rates of vitamin A deficiency. The World Health Organization recommends that children in these areas receive vitamin A supplements two to three times per year.[1] We recommend HKI’s VAS program because we believe that VAS reduces children’s mortality from infectious disease.[2]

HKI told us in July 2019 that VAS campaigns were ongoing in Bauchi State but that a 2018 government survey found very low coverage rates there. At the time of the survey, only 30% of individuals targeted for VAS in Bauchi State received it. HKI proposed to help government-run VAS campaigns in Bauchi State achieve higher coverage rates.[3]

HKI had a strong track record of impact and we estimated that its work in Bauchi State would be highly cost-effective. We decided to grant discretionary funds to HKI’s VAS program. Although we expected $2.4 million of GiveWell-directed funding to be used in Bauchi State, we did not formally restrict HKI to spending it there.[4]

Before it began GiveWell-supported work in Bauchi State, we asked HKI to conduct a baseline survey to measure coverage achieved by a November VAS campaign.[5] Our goal was to have a benchmark against which to assess the difference in VAS coverage due to HKI’s assistance in 2020 to 2022. This would help us assess HKI’s track record in the future.

HKI conducted the survey in December and found a surprisingly high coverage rate of 86 percent. It learned that another organization, Catholic Relief Services (CRS), had supported the November campaign in Bauchi State. We don’t know for sure, but CRS’ support may have led to the much higher coverage rate. HKI was not aware of CRS’ support prior to the survey.[6]

Whether due to CRS or not, if the same conditions that led Bauchi State to have high coverage in December continue going forward, the value of HKI assisting VAS campaigns there is much lower than HKI and we originally estimated.[7]

HKI proposed to redirect the funding that it would have otherwise spent in Bauchi State to another state in Nigeria, Nasarawa State, believed to have low VAS coverage—and to conduct a survey before working there, as well.[8]


Without the Bauchi State coverage survey leading to a change in course, GiveWell donors’ support may have had little impact. It seems plausible that Bauchi State may not have needed more funding, as it already had a high VAS coverage rate.

This experience illustrates how we assess whether our top charities are using additional funds well and how we support them in doing so. Our request for a baseline survey in Bauchi State to inform our assessment of HKI’s track record showed us and HKI that the funds would not be spent as effectively as expected and enabled HKI to redirect those funds to have more impact. We make similar requests of all eight of our top charities.


  • Bill Goodykoontz on April 30, 2020 at 2:22 pm said:

    Is it just me or does this sound disorganized and even wasteful on the part of HKI? Shouldn’t they have known of Catholic Relief Services’ work and been in some sort of coordination with them, or have I misconstrued the situation, in which case I apologize.

  • Catherine (GiveWell) on May 1, 2020 at 1:53 pm said:

    Hi Bill,

    We don’t think this was wasteful. The baseline survey, which was relatively inexpensive, prevented potentially low-impact spending by providing HKI with information about what was happening in this area, which led HKI to update its plans to have more impact. It would have been potentially wasteful to have not done the survey and carried out VAS campaigns in Bauchi State when there was already significant coverage. Instead, HKI will be able to allocate its funding where it is needed more. We see that funding redirection based on new data as a win!

    We’re unsure what to make of HKI not being aware of CRS’ work in this area. We plan to ask them to share more about this at a forthcoming check-in.

  • Ofhsoupkitchen on May 14, 2020 at 8:24 pm said:

    Absolutely! According to the WHO, vitamin A deficiency (VAD) is the leading cause of preventable blindness in children and increases the risk of disease and death from severe infections. We should support this campaign.

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