We have refreshed our top charity rankings and recommendations. Our set of top charities and standouts is the same as last year’s, but we have introduced rankings and changed our recommended funding allocation, due to a variety of updates – particularly to our top charities’ room for more funding. In particular, we are recommending that Good Ventures, a foundation with which we work closely, support our top charities at a higher level than in previous years. This post includes our recommendations to Good Ventures, and gives our recommendations to individual donors after accounting for these grants.

Overall, we think the case for our top charities is stronger than in previous years, and room for more funding is greater.

Our top charities and recommendations for donors, in brief

Top charities

1. Against Malaria Foundation (AMF)
2. Schistosomiasis Control Initiative (SCI)
3. Deworm the World Initiative, led by Evidence Action
4. GiveDirectly

This year, we are ranking our top charities based on what we see as the value of filling their remaining funding gaps. Unlike in previous years, we do not feel a particular need for individuals to divide their allocation between the charities, since we are recommending that Good Ventures provide significant support to each. For those seeking our recommended allocation, we simply recommend giving to the top-ranked charity on the list, which is AMF.

Our recommendation takes the grants we are recommending to Good Ventures into account, as well as accounting for charities’ existing cash on hand and expected non-GiveWell-related fundraising, and recommends charities according to how much good additional donations (beyond these sources of funds) can do. (Otherwise, as explained below, Deworm the World would be ranked higher.) Thus, AMF’s #1 ranking is not based on its overall value as an organization, but based on the value of its remaining funding gap.

Standout charities

As with last year, we also provide a list of charities that we believe are strong standouts, though not at the same level (in terms of likely good accomplished per dollar) as our top charities. They are not ranked, and are listed in alphabetical order.

• Development Media International (DMI)
• The Global Alliance for Improved Nutrition’s Universal Salt Iodization program (GAIN – USI)
• Iodine Global Network (IGN), formerly known as ICCIDD
• Living Goods

Below, we provide:

• An explanation of major changes in the past year that are not specific to any one charity. More
• A summary of our top charities’ relative strengths and weaknesses, and how we would rank them if room for more funding were not an issue. More
• A discussion of our refined approach to room for more funding. More
• The recommendations we are making to Good Ventures, and how we rank our top charities after taking these grants (and their impact on room for more funding) into account. More
• Detail on each of our top charities, including major changes over the past year, strengths and weaknesses for each, and our understanding of each organization’s room for more funding. More
• The process we followed that led to these recommendations. More
• A brief update on giving to support GiveWell’s operations vs. giving to our top charities. More

Conference call to discuss recommendations

We are planning to hold a conference call at 5:30pm ET/2:30pm PT on Tuesday, December 1st to discuss our recommendations and answer questions.

If you’d like to join the call, please register using this online form. If you can’t make this date but would be interested in joining another call at a later date, please indicate this on the registration form.

Major changes in the last 12 months

Below, we summarize the major causes of changes to our recommendations (since last year).

Overall, the case for our top charities is stronger than it was in past years. The Deworm the World Initiative shared new monitoring and evaluation materials with us, so we are more confident than we were a year ago that it is a strong organization implementing high-quality programs. In addition, the extra year of work we have seen from AMF and GiveDirectly bolsters our view that they will be able to utilize additional funding effectively.

Our top charities have increased room for more funding. Last year, we expected donors following our recommendations to fully fill the most critical funding gaps of our top charities (excluding GiveDirectly) because they had limited room for more funding: GiveDirectly had a total funding gap of ~$40 million and our other three top charities had a total gap of ~$18 million. This year, all of our top charities have more room for more funding. We believe that GiveDirectly could absorb more than $80 million and other top charities together could collectively utilize more than $100 million. We do not expect donors following our recommendations to fully fill these gaps.

We are recommending that Good Ventures make larger grants to top charities. For reasons we will be detailing in a future post, we are recommending that Good Ventures make substantial grants to our top charities this year, though not enough to close their funding gaps.

Continued refinement of the concept of “room for more funding.” We’ve tried to create a much more systematic and detailed room for more funding analysis, because the stakes of this analysis have become higher due to (a) increased room for more funding across the board and (b) increased interest from Good Ventures in providing major support.

In past years, we’ve discussed charities’ room for more funding as a single figure without distinguishing between (a) the amount the charity would spend in the next 12 months, (b) the amount the charity needs to prevent it from slowing its work due to lack of funds, and (c) funding that would be especially important to the organization’s development and success (a dual benefit) in addition to expanding implementation of its program. This year, we’ve made three changes to our room for more funding analysis:

• We’ve made (a) an assessment of whether additional funds merely allow a charity to implement its program (“execution”) or (b) whether additional funds would be especially important to the charity’s development and success as an organization (“capacity-relevant”). We also explicitly note the role of incentives for meeting GiveWell’s top-charity criteria in our recommendations (we seek to ensure that each top charity receives at least $1 million, to encourage other organizations to seek to meet these criteria).
• We are explicitly assessing “execution”-related room for more funding based on our estimate of the probability that lack of funding will lead to a charity slowing its progress. We distinguish between Level 1, Level 2, and Level 3 “execution” funding gaps; a higher number means the money is less likely to be needed.
• We are now ranking “funding gaps,” not just ranking charities, because the first million dollars to a charity can have a very different impact from, e.g., the 20th million dollars. For example, if Charity A accomplishes more good per dollar with its programs than Charity B, we would rank Charity A above Charity B for a given type of gap (we would rank Charity A’s “Execution Level 1” gap above Charity B’s), but we might rank Charity B’s “Execution Level 1” gap (the amount of funding it will likely need) above Charity A’s “Execution Level 3” gap (the amount of funding gap it might, but probably will not, need to carry out more of its programs in the coming year).

We discuss these ideas in greater depth below.

Summary of key considerations for top charities

The table below summarizes the key considerations for our four top charities. More detail is provided below as well as in the charity reviews.

Overall, our ranking of the charities with room for more funding issues set aside (just considering a hypothetical dollar spent by the charity on its programs, without the “capacity-relevant funding” and “incentives” issues discussed below) would be:

1. AMF and Deworm the World
3. SCI
4. GiveDirectly

However, when we factor in room for more funding (including the impact of the grants we’re recommending to Good Ventures), the picture changes. More on this below.

Room for more funding analysis

Capacity-relevant funding and incentives

Capacity-relevant funding: additional funding can sometimes be crucial for a charity’s development and success as an organization. For example, it can contribute to a charity’s ability to experiment, expand, and ultimately have greater room for more funding over the long run. It can also be important for a charity’s ability to raise funds from non-GiveWell donors, which can be an important source of long-term leverage and can put the organization in a stronger overall position.

We think of this sort of funding gap as particularly important to fill, because it can make a big difference over the long run; in particular, it may substantially affect the long-term quality of our giving recommendations.

“Capacity-relevant” funds can include (a) funds that are explicitly targeted at growth (e.g., funds to hire fundraising staff); (b) funds that enable a charity to expand into areas it hasn’t worked in before, which can lead to important learning about whether and how the charity can operate in the new location(s); and (c) funds that would be needed in order to avoid challenging contractions in a charity’s activities which could jeopardize the charity’s long-term growth and funding prospects.

Some specific examples:

• The grant that Good Ventures made to GiveDirectly earlier this year is capacity-relevant because it will be used for: (a) building a fundraising team that will aim to raise substantial donations from non-GiveWell donors, and (b) developing partnerships with bilateral donors and local governments to deliver cash transfers or to run experiments comparing standard aid programs to cash transfers.
• Early funding that GiveDirectly received was capacity-relevant because it enabled GiveDirectly to rapidly grow from a small organization moving a few hundred thousand dollars per year to a much larger organization moving more than $10 million per year. If this funding hadn’t been forthcoming, GiveDirectly might be much smaller today and have much less room for more funding.
• We now think that some additional funding to AMF and Deworm the World will be capacity-relevant because each organization has only operated in a very small number of countries and new funding will enable each to enter new countries. This will allow them to learn how to operate there, and demonstrate that they can do so, increasing our willingness (and likely that of other donors) to recommend more to these organizations in the future.

It’s hard to draw sharp lines around capacity-relevant funding, and all funding likely has some effect on an organization’s development, but we have tried to identify and prioritize the funding gaps that seem especially relevant.

Execution funding allows charities to implement more of their core program but doesn’t appear to have substantial benefits beyond the direct good accomplished by this program. We’ve separated this funding into three levels:

• Level 1: the amount we expect a charity to need in the coming year. If a charity has less funding than this level, we think it is more likely than not that it will be bottlenecked (or unable to carry out its core program to the fullest extent) by funding in the coming year.
• Level 2: if a charity has this amount, we think there is an ~80% chance that it will not be bottlenecked by funding.
• Level 3: if a charity has this amount, we think there is a ~95% chance that it will not be bottlenecked by funding.

Incentives: we think it is important that charities we recommend get a substantial amount of funding due to being a GiveWell top charity, because this ensures that incentives are in place for charities (and potential charity founders) to seek to meet our criteria for top charities and thus increase the number of charities we recommend and the total room for more funding available, even when they don’t end up being ranked #1. We seek to ensure that each top charity gets at least $1 million as a result of our recommendation, and we consider this to be a high-priority goal of our recommendations.

The charity-specific sections of this post discuss the reasoning behind the figures we’ve assigned to “capacity-relevant” and “Execution Level 1” gaps, but they do not provide the full details of how we arrived at these figures (and do not explicitly address the “Execution Level 2” and “Execution Level 3” gaps). We expect to add this analysis to our charity reviews in the coming weeks.

Funding gaps

The total (i.e., Capacity-relevant, Execution Levels 1, 2, and 3, and Incentive) funding gaps (in millions of dollars, rounded to one decimal place) for each of our top charities are:

• AMF: $98.2
• Deworm the World: $19.0
• GiveDirectly: $84.0
• SCI: $26.3

However, for reasons described above, the first million dollars to a charity can have a very different impact from, e.g., the 20th million dollars. Accordingly, we have created a ranking of individual funding gaps that accounts for both (a) the quality of the charity and the good accomplished by its program, per dollar (as laid out above), and (b) whether a given level of funding is capacity-relevant and whether it is highly or only marginally likely to be needed in the coming year.

The below table lays out our ranking of funding gaps. When gaps have the same “Priority,” this indicates that they are tied.

The table below includes the amount we are recommending to Good Ventures. For reasons we will lay out in another post, we are recommending to Good Ventures a total of ~$44.4 million in grants to top charities. Having set that total, we are recommending that Good Ventures start with funding the highest-rated gaps and work its way down, in order to accomplish as much good as possible.

When gaps are tied, we recommend filling them by giving each equal dollar amounts until one is filled, and then following the same procedure with the remaining tied gaps. See footnote for more.*

Our recommendations to Good Ventures and others

Summing the figures from the above table, we are recommending that Good Ventures make the following grants (in millions of dollars, rounded to one decimal place):

• AMF: $22.8
• Deworm the World: $10.8
• GiveDirectly: $9.8
• SCI: $1

We also recommend that Good Ventures give $250,000 to each of our standout charities. These grants go to the outstanding organizations and create additional incentives for groups to try to obtain a GiveWell recommendation.

After these grants, AMF will require an additional ~$27.5 million to close its Execution Level 1 gap (i.e., to make it more likely than not that it is able to proceed without being bottlenecked due to lack of funding). We rank this gap higher than any of the other remaining funding gaps for our top charities, as laid out in the table above.

We estimate that non-Good Ventures donors will give approximately $15 million between now and January 31, 2016. Because we do not expect AMF’s remaining ~$27.5 million Execution Level 1 funding gap to be fully filled, we rank it #1 and recommend that donors give to AMF. We rank the remaining charities for donors who are interested in having the greatest impact per dollar based on how highly their highest-rated remaining gap ranks in the table above. That results in the following rankings for individual donors:

1. AMF
2. SCI
3. Deworm the World Initiative
4. GiveDirectly

Details on top charities

We present information on our top charities in alphabetical order.

Against Malaria Foundation (AMF)

Our full review of AMF is here.

Background

AMF (www.againstmalaria.com) provides funding for long-lasting insecticide-treated net distributions (for protection against malaria) in developing countries. There is strong evidence that distributing nets reduces child mortality and malaria cases. AMF has relatively strong reporting requirements for its distribution partners and provides a level of public disclosure and tracking of distributions that we have not seen from any other net distribution charity.

In 2011, AMF received a large amount of funding relative to what it had received historically, so it began to focus primarily on reaching agreements for large-scale net distributions (i.e., distributions on the order of hundreds of thousands of nets rather than tens of thousands of nets). In its early efforts to scale up, AMF struggled to finalize large-scale net distribution agreements. At the end of 2013, we announced that we planned not to recommend additional donations to AMF due to room for more funding-related issues (more detail in this blog post).

In 2014, AMF committed most of its funds to several new distributions — some in Malawi, some in the Democratic Republic of the Congo (DRC) — and we recommended it as a top charity again.

Important changes in the last 12 months

In 2015, AMF carried out and/or monitored many of the distributions that it committed to in 2014.

Previously, our confidence in AMF’s ability to scale had been limited by the fact that it had only completed large-scale distributions with one partner (Concern Universal) in one country (Malawi). However, AMF carried out its largest distribution to date (~620,000 nets) with a new partner in the DRC in late 2014. We have not yet seen some key documentation from the large DRC distribution, but early indications suggest that the distribution generally went as planned, despite our concern that the DRC may have been an especially challenging place to work (more details here). We see this as a positive update that AMF will be able to carry out high-quality large-scale distributions in a variety of locations in the future.

AMF has continued to collect and share follow-up information on its past large-scale distributions, and this information seems to support the notion that these distributions are high-quality (i.e., that nets are reaching the target population and are being used). We provide a summary of these reports in our review.

Funding gap

AMF currently holds $18.5 million, and we estimate it will receive an additional $1.6 million before January 31, 2016 (excluding donations influenced by GiveWell) that it could use for future distributions. AMF has told us that it has a pipeline of possible future net distributions that add up to roughly $100 million beyond what it currently holds (details in our review).

We believe that AMF’s progress would be slowed due to lack of funding were it to receive less than $50.3 million in additional funding (this is its total capacity-relevant and “Execution Level 1” gap as presented earlier in the post). In particular, we view the first additional $6.5 million that AMF would receive as capacity-relevant (and thus particularly valuable) because it would enable AMF to fund a distribution in a 5th country with a 5th partner, generating additional information about its ability to expand beyond the contexts in which it has worked to date. (Note that AMF already has funds on hand to enter its 3rd and 4th countries.)

We arrived at the capacity-relevant and Execution Level 1 figure by noting that AMF has $70.4 million worth of deals it is actively negotiating (5 deals in 4 countries) that it can only continue with if it holds the funds to do so. Subtracting the $20.1 million we expect to be available (the $18.5 million it currently holds plus the $1.6 million we expect it to receive in the coming months) leaves a $50.3 million funding gap.

AMF failed to reach new distribution agreements in 2015; there is still significant uncertainty regarding AMF’s ability to finalize agreements with new partners and countries. Nevertheless, we see providing a large amount of additional funds to AMF as a reasonable bet, and see AMF as a very strong giving opportunity.

We think it is possible that in November 2016 (when we next expect to complete a full refresh of our recommendations), we will recommend significantly less funding to AMF. We consider the funding we’re recommending to AMF now to be a good bet, but a risky one, because AMF currently has a relatively limited track record: it has worked with only two partners in two countries. Because of the lag between the time we provide funding and the time net distributions take place (often 2 years) and the additional lag caused by the time it takes to monitor distributions, we may not have additional information about whether or not AMF’s additional distributions were successful for 2-3 years. Next year, it is possible that we will choose to recommend significantly less funding to AMF while we wait for additional data to become available.

There still appears to be a large global funding gap for bednets; a global bednet coordination group estimated that about 245 million additional nets would be needed in 2015-2017 (details in our review).

Key considerations:

• Program impact and cost-effectiveness. We estimate that bednets are ~10x as cost-effective as cash transfers. Our estimates are subject to substantial uncertainty. All of our cost-effectiveness analyses are available here. Our 2015 cost-effectiveness file is available here (.xlsx).
• Directness and robustness of the case for impact. We believe that the connection between AMF receiving funds and those funds helping very poor individuals is less direct than GiveDirectly’s and more direct than SCI’s or Deworm the World’s. The uncertainty of our estimates is driven by a combination of AMF’s challenges historically disbursing the funds it receives and a general recognition that aid programs, even those as straightforward as bednets, carry significant risks of failure via ineffective use of nets, insecticide resistance, or other risks we don’t yet recognize relative to GiveDirectly’s program. AMF conducts extensive monitoring of its program; these results have generally indicated that people use the nets they receive.
• Transparency and communication. AMF has been extremely communicative and open with us. We feel we have a better understanding of AMF than of SCI, and a similar level of knowledge about AMF as we have for Deworm the World, though our understanding is not as strong as our understanding of GiveDirectly. In particular, were something to go wrong in one of AMF’s distributions, we believe we would eventually find out (something we are not sure of in the case of SCI), but we believe our understanding would be less quick and complete than it would be for problems associated with GiveDirectly’s program (which has more of a track record of consistent intensive follow-up).
• Risks:
  • We are not highly confident that AMF will be able to finalize additional distributions and do so quickly. AMF could struggle again to agree to distribution deals, leading to long delays before it spends funds. We view this as a relatively minor risk because the likely worst-case scenario is that AMF spends the funds slowly (or returns funds to donors).
  • We remain concerned about the possibility of resistance to the insecticides used in bednets. There don’t appear to be major updates on this front since our 2012 investigation into the matter; we take the lack of major news as a minor positive update.

Our full review of AMF is here.

Deworm the World Initiative, led by Evidence Action

Our full review of Deworm the World is here.

Background

Deworm the World (www.evidenceaction.org/deworming), led by Evidence Action, advocates for, supports, and evaluates government-run school-based deworming programs (treating children for intestinal parasites).

We believe that deworming is a program backed by relatively strong evidence. We have reservations about the evidence, but we think the potential benefits are great enough, and costs low enough, to outweigh these reservations. Deworm the World retains monitors whose reports indicate that the deworming programs it supports successfully deworm children.

Important changes in the last 12 months

In 2015, Deworm the World continued to support the scale-up and monitoring of deworming programs in India and Kenya. One of its notable activities this year was providing technical assistance to the Indian national government in support of India’s first national deworming day: a program in which the government provided assistance to Indian states to implement school-based deworming on a single day to encourage more states to implement the program. The first national deworming day took place in February 2015, and 12 states participated in the program (more details here).

The quality of the monitoring that we saw from Deworm the World improved in 2015. Deworm the World continued to hire and train third-party monitors to directly observe deworming activities, and it slightly improved its estimates of how many children were treated. This information strongly suggests that the programs are generally operating as intended. More details in our review.

Last year, Deworm the World stated to us that it could not use significant additional funding to scale up deworming programs. Deworm the World now believes that it has identified countries where it could use additional funds to support the scale-up of deworming programs, beginning with a potential program in Punjab province, Pakistan (more). (Deworm the World also plans to use funds it already holds or expects to receive to expand into Ethiopia and Nigeria.)

Future donations to Deworm the World will likely be used outside of India, and in those cases governments may have less funding to support deworming. This may cause Deworm the World to pay a higher fraction of the overall cost of the program, making the potential for leverage of future donations more limited. Overall program costs may also be higher outside of India. More details in our review.

A significant organizational update is that Alix Zwane stepped down as Executive Director of Evidence Action in August; she left to join the Global Innovation Fund as CEO. Evidence Action has since hired Jeff Brown (formerly Interim CEO of the Global Innovation Fund) as Executive Director. Grace Hollister remains Director of the Deworm the World Initiative. Overall, our impression is that Dr. Zwane has been a highly effective leader of Evidence Action and her departure risks disruptions that could lead to us changing our view of the organization, though we would guess that this will not be the case.

In July, researchers published two new analyses of a key study regarding deworming (the most important piece of evidence we rely on), and the Cochrane Collaboration published an updated review of the evidence for mass deworming programs. The new papers did not change our overall assessment of the evidence on deworming. More in our blog post.

Funding gap

We believe that Deworm the World has significant opportunities to use additional funding to expand its program. We believe it may have opportunities to enter at least two more countries (in addition to Nigeria and Ethiopia, which it will be able to enter with funds it already has or expects to receive). We estimate its funding need using the two countries it is most likely to enter — Pakistan and Nepal — though note that in both cases, we see these as representative of the types of opportunities it may have, rather than the specific opportunities we expect it to take. Altogether, Deworm the World estimates that it would need $11.25 million to commit to fully funding three years of deworming programs in both countries. Because it holds (or expects to receive shortly) funding that will total $3.6 million, we estimate its funding gap for this work at $7.6 million.

Funding this gap is capacity-relevant, and is therefore a high priority, because we would like to see Deworm the World try to work in additional countries beyond India and Kenya, where it has worked historically. Next year, Deworm the World will also enter Nigeria and Ethiopia (with funding already available), so it will likely end the year having had some experience in five or more countries. This could substantially increase Deworm the World’s long-term room for more funding.

A complicating factor in thinking about Deworm the World’s funding gap is that Deworm the World is part of a larger organization, Evidence Action. Funding for Deworm the World may be fungible with funding for Evidence Action’s other activities, such as its Dispensers for Safe Water initiative (which we believe to be substantially less cost-effective than deworming). Because of this, it is difficult to determine Deworm the World’s true funding gap, and it is possible that some additional funds given to support Deworm the World could effectively lead to additional funds for a non-Deworm the World project. We understand that Evidence Action has received approximately $2.4 million in unrestricted funding over the past year. Fully funding Deworm the World could potentially cause Evidence Action to redirect some or all of these funds to its other programs.

More details on all of the above are in our review.

Key considerations:

• Program impact and cost-effectiveness. We estimate that Deworm the World-associated deworming programs are ~10x as cost-effective as cash transfers. Our estimates are subject to substantial uncertainty. It’s important to note that we view deworming as high expected value, but this is due to a relatively low probability of very high impact. Most GiveWell staff members would agree that deworming programs are more likely than not to have very little or no impact, but there is some possibility that they have a very large impact. (Our cost-effectiveness model implies that most staff members believe there is at most a 1-2% chance that deworming programs conducted today have similar impacts to those directly implied by the randomized controlled trials on which we rely most heavily, which differed from modern-day deworming programs in a number of important ways.) Our 2015 cost-effectiveness file is available here (.xlsx).
• Directness and robustness of the case for impact. Deworm the World doesn’t carry out deworming programs itself; it advocates for and provides technical assistance to governments implementing deworming programs, making direct assessments of its impact challenging. We have seen evidence that strongly suggests that Deworm the World-supported programs successfully deworm children. While we believe Deworm the World is impactful, our evidence is limited, and in addition, there is always a risk that future expansions will prove more difficult than past ones.
• Transparency and communication. Deworm the World has been communicative and open with us. We believe that were something major to go wrong with Deworm the World’s work, we would be able to learn about it and report on it.
• Risks:
  • Deworm the World is part of a larger organization, Evidence Action. It is possible that some additional funds given to support Deworm the World could effectively lead to additional funds for a non-Deworm the World project due to fungibility. Also, changes that affect Evidence Action (and its other programs) could indirectly impact Deworm the World. For example, if a major event occurs (either positive or negative) for Evidence Action, it is likely that it would reduce the time some staff could devote to Deworm the World.
  • Deworm the World is now largely raising funds to support programs that will be carried out under a different model in new countries, which makes it harder for us to predict future success based on historical results and may make it harder to understand and quantify Deworm the World’s impact even after the program is completed.

Our full review of Deworm the World is here.

GiveDirectly

Our full review of GiveDirectly is here.

Background

GiveDirectly (www.givedirectly.org) transfers cash to households in developing countries via mobile phone-linked payment services. It targets extremely low-income households. The proportion of total expenses that GiveDirectly has delivered directly to recipients is approximately 85% overall. We believe that this approach faces an unusually low burden of proof, and that the available evidence supports the idea that unconditional cash transfers significantly help people.

We believe GiveDirectly to be an exceptionally strong and effective organization, even more so than our other top charities. It has invested heavily in self-evaluation from the start, scaled up quickly, and communicated with us clearly. It appears that GiveDirectly has been effective at delivering cash to low-income households. GiveDirectly has one major randomized controlled trial (RCT) of its impact and took the unusual step of making the details of this study public before data was collected (more). It continues to experiment heavily, to the point where every recipient is enrolled in a study or a campaign variation.

Important changes in the last 12 months

GiveDirectly continued to scale up significantly, utilizing most of the funding it received at the end of last year. It continued to share informative and detailed monitoring information with us. Overall, it grew its operations while maintaining the high quality of its program.

In August, Good Ventures granted $25 million to GiveDirectly to support potentially high-upside opportunities, such as (a) building a fundraising team that will aim to raise substantial donations from non-GiveWell donors, and (b) developing partnerships with bilateral donors and local governments to deliver cash transfers or to run experiments comparing standard aid programs to cash transfers.

GiveDirectly’s increased efforts to network with potential government and donor partners have led to some results in 2015. For example, GiveDirectly will be implementing cash transfers in a randomized controlled trial in Rwanda that will be funded by a bilateral aid donor and Google. The study will test cash transfers against another still-to-be-chosen aid program. GiveDirectly is currently in several preliminary conversations with partners for similarly large projects in the future.

Funding gap

GiveDirectly believes it could move a total of ~$94 million to poor households in the year following March 1, 2016, for which it expects to have ~$12.6 million available by March 1. We have classified ~$34.5 million of this as the total “Execution Level 1,” capacity-relevant, and incentive funding gap (more on what this means above). We arrived at this figure by assuming that GiveDirectly could double its operations in Kenya (from ~$16.5 million/year to ~$33 million/year) and scale up to ~$12.1 million/year in Uganda. This would cost a total of ~$45.1 million, of which GiveDirectly already has ~$10.6 million on hand (ignoring $2 million that we exclude due to donor coordination issues), which results in a ~$34.5 million gap.

We’ve classified some of this as a “capacity-relevant” funding gap for our purposes (making it higher priority). First, we view the ~$12.1 million it would hope to spend in Uganda as capacity-relevant, in the sense that providing it could make a major difference to GiveDirectly’s long-term development. GiveDirectly told us that operating in Uganda is more challenging than in Kenya and that it expects to learn a significant amount as it grows. It is therefore planning to grow more slowly in Uganda than it did in Kenya. GiveDirectly made two arguments for Uganda being important for its long-term trajectory:

1. If GiveDirectly lost the ability to operate in Kenya, this would significantly diminish its ability to move funds out the door. Operating in Uganda is an important hedge against this risk.
2. Kenya is a particularly easy environment in which to operate because of the existence of M-PESA, a powerful and ubiquitous provider that enables GiveDirectly to transfer funds to recipients via mobile phones. The mobile payments network is significantly less developed outside of Kenya. As such, Uganda offers an important test case for operating in a more standard environment, which could be particularly valuable to GiveDirectly as it encourages aid agencies and country governments to expand direct cash assistance.

It’s harder to estimate how much of the Kenya funding needs are properly classified as “capacity-relevant” (an important distinction for our purposes, as discussed above). We guess that were GiveDirectly to be operating at a level 50% its current size (such that it only spent ~$8.25 million/year in Kenya), it would be able to build capacity from that level to its current level (and beyond) as quickly as it did in its recent past. We therefore classify ~$8.25 million of the ~$16.5 million it hopes to spend in Kenya as “capacity-relevant” and ~$8.25 million as “execution.” We note that we are highly uncertain about these estimates and that were GiveDirectly to receive no additional funding, this would cause it to contract in Kenya and lay off some of its middle management, an action that would cause it to incur reasonably high costs; we think much more contraction than that would be significantly more challenging for GiveDirectly as an organization.

Based on the above, and based on GiveDirectly’s existing available funds (with some adjustments for coordination issues, along the lines of this discussion from last year) we estimate that GiveDirectly has ~$9.8 million worth of unfunded opportunities that we ought to classify as capacity-relevant or incentive funding. (We arrive at this estimate based on: ~$20.35 million (total amount we classify as capacity-relevant from Kenya and Uganda) – ~$10.6 million (funds on hand, excluding donations we ignore due to coordination issues) = ~$9.75 million.)

Longer-term, we expect to continue to view funding ~$8.25 million in Kenya as capacity-relevant support and would expect to consider future expansion in Uganda (up to the current level of Kenya, i.e., ~$16.5 million/year) capacity-relevant, as well. Once GiveDirectly reaches ~$16.5 million in Uganda and proves that it can operate at that level, we only expect to view ~$8.25 million as capacity-relevant and hope that it can raise funds from other sources to support its work.

More details in our review.

Key considerations:

• Program impact and cost-effectiveness. Our best guess is that deworming or distributing bednets achieves ~10x times more humanitarian benefit per dollar donated than cash transfers. Our estimates are subject to substantial uncertainty. All of our cost-effectiveness analyses are available here. Our 2015 cost-effectiveness file is available here (.xlsx).
• Directness and robustness of the case for impact. GiveDirectly collects and shares a significant amount of relevant information about its activities. The data it collects show that it successfully directs cash to very poor people, that recipients generally spend funds productively (sometimes on food, clothing, or school fees, other times on investments in a business or home infrastructure), and that it leads to very low levels of interpersonal conflict and tension. We are more confident in the impact of GiveDirectly’s work than in that of any of the other charities discussed in this post; we believe that cash transfers face a lower burden of proof than other interventions.
• Transparency and communication. GiveDirectly has always communicated clearly and openly with us. It has tended to raise problems to us before we ask about them, and we generally believe that we have a very clear view of its operations. We feel more confident about our ability to keep track of future challenges than with any of the other charities discussed in this post.
• Risks:
  • GiveDirectly has scaled (and hopes to continue to scale) quickly. Thus far, it has significantly increased the amount of money it can move with limited issues as a result. The case of staff fraud that GiveDirectly detected is one example of an issue possibly caused by its pace of scaling, but its response demonstrated the transparency and rigor we expect.

Our full review of GiveDirectly is here.

Schistosomiasis Control Initiative (SCI)

Our full review of SCI is here.

Background

SCI (www3.imperial.ac.uk/schisto) works with governments in sub-Saharan Africa to create or scale up deworming programs (treating children for schistosomiasis and other intestinal parasites). SCI’s role has primarily been to identify recipient countries, provide funding to governments for government-implemented programs, provide advisory support, and conduct research on the process and outcomes of the programs. Despite SCI sharing a number of spending reports with us, we do not feel we have a detailed and fully accurate picture of how SCI and the governments it supports have spent funds in the past. We don’t feel that SCI has ever purposefully been indirect with us, but we have often struggled to communicate effectively with SCI representatives. We still lack important and in some cases basic information about SCI’s finances, and we find this problematic.

We believe that deworming is a program backed by relatively strong evidence. We have reservations about the evidence, but we think the potential benefits are great enough, and costs low enough, to outweigh these reservations. SCI has conducted studies in about half of the countries it works in (including the countries with the largest programs) to determine whether its programs have reached a large proportion of children targeted. These studies have generally found moderately positive results, but have some methodological limitations.

Important changes in the last 12 months

SCI reports that it has continued to scale up its deworming programs and that it has supported some programs in new countries, though we have limited monitoring information from these programs (e.g., we have not seen monitoring from its programs in Ethiopia, Sudan, Madagascar, and the DRC).

This year, SCI has shared a few more coverage surveys that found reasonably high coverage of its programs.

We have continued to have communication challenges with SCI. In particular:

• We have a limited understanding of SCI’s work because we still lack important and basic information about how SCI spends money. SCI recognizes that its financial management system is disorganized, and some spending reports that SCI has sent us have contained errors.
• We have struggled to gain a confident understanding of how SCI will use additional funds, and we cannot check how its funds were used after the fact because we lack information about its spending. In some cases, SCI has not spent additional funds as expected and it is unclear what caused the shift (more detail on one example in our August 2015 update).

In July, researchers published two new analyses of a key study regarding deworming (the most important piece of evidence we rely on), and the Cochrane Collaboration published an updated review of the evidence for mass deworming programs. The new papers did not change our overall assessment of the evidence on deworming. More in our blog post.

Funding gap

SCI estimates that it would use the following amounts of unrestricted funding in each of the next three years (in millions of US dollars):

• April 2016 – March 2017: $9.5
• April 2017 – March 2018: $13.6
• April 2018 – March 2019: $13.3

Our impression is that GiveWell-influenced donors contribute most of SCI’s unrestricted funds.

Our best guess is that, excluding the funds SCI may receive due to GiveWell’s recommendation, SCI will hold approximately $1.5 million in April 2016 that it could allocate to the above gaps. Also, after SCI set its fundraising targets, a funder committed $6 million over the next three years ($2 million per year) to deworming programs in Ethiopia, with which SCI is involved. Our best guess is that this funding reduces SCI’s “Execution Level 1” and incentive funding gap for the coming year from $9.5 million to $5.9 million. (We arrive at this estimate by subtracting ~$1.5 million and another $2 million from the total Level 1/incentive gap for the coming year).

We do not classify any of this as “capacity-relevant” because we have little understanding of how it will be spent, and we do not expect to be able to understand how it was spent after the fact, either.

More details on SCI’s funding gap are in our review.

Key considerations:

• Program impact and cost-effectiveness. Our best guess is that deworming programs implemented by SCI are ~5x as cost-effective as cash transfers. Our estimates are subject to substantial uncertainty. It’s important to note that we view deworming as high expected value, but this is due to a relatively low probability of very high impact. Most GiveWell staff members would agree that deworming programs are more likely than not to have very little or no impact, but there is some possibility that they have a very large impact. (Our cost-effectiveness model implies that most staff members believe there is at most a 1-2% chance that deworming programs conducted today have similar impacts to those directly implied by the randomized controlled trials on which we rely most heavily, which differed from modern-day deworming programs in a number of important ways.) Our 2015 cost-effectiveness file is available here (.xlsx).
• Directness and robustness of the case for impact. SCI doesn’t carry out deworming programs itself; it advocates for and provides technical assistance to governments implementing deworming programs, making direct assessments of its impact challenging. We have seen some evidence demonstrating that SCI-supported programs successfully deworm children, though this evidence is relatively thin. Nevertheless, deworming is a relatively straightforward program, and we think it is likely (though far from certain) that SCI-supported deworming programs successfully deworm people. We have had difficulties communicating with SCI, which has reduced our ability to understand it. We have also spent significant time interviewing SCI staff and reviewing documents over the past 6 years and have found minor but not major concerns.
• Transparency and communication. We don’t feel that SCI has ever purposefully been indirect with us, but we have often struggled to communicate effectively with SCI representatives. Specifically, (a) we had a major miscommunication with SCI about the meaning of its self-evaluations (more) and (b) although we have spent significant time with SCI, we remain unsure how SCI has spent funds and how much funding it has available (and we believe SCI itself does not have a clear understanding of this). Importantly, if there is a future unanticipated problem with SCI’s programs, we don’t feel confident that we will become aware of it. This contrasts with our other top charities, which we feel we have a strong ability to follow up on.
• Risks: There are significantly more unknown risks with SCI than our other top charities due to our limited understanding of its activities.

Our full review of SCI is here.

Standouts

As we did last year, we recommend four organizations as “standouts.” These charities score well on some of our criteria, but we are not confident enough in them to name them top charities. This year, we retain the same four standout organizations: Development Media International (DMI), the Global Alliance for Improved Nutrition’s Universal Salt Iodization program (GAIN-USI), the Iodine Global Network (IGN), and Living Goods.

We followed all four of these charities in 2015, but have only published an updated review for DMI. We expect to publish updated reviews for GAIN-USI, IGN, and Living Goods in the near future.

We provide brief updates on these charities below:

• DMI. DMI produces radio and television programming in developing countries that encourages people to adopt improved health practices. It is a standout because of its commitment to monitoring and the possibility that it is implementing a highly cost-effective program. DMI has recently completed a randomized controlled trial of its program. Last year, we had midline results from this trial, which generally looked promising.In November 2015, DMI privately shared preliminary endline results from the RCT. These results did not find any effect of DMI’s program on child mortality, and found substantially less effect on behavior change than was found in the midline results. We (understandably) cannot publicly discuss the details of the endline results we have seen, because they are not yet finalized and because the finalized results will be embargoed prior to publication. DMI believes that there were serious problems with endline data collection (note that we have not yet tried to independently assess this claim). With the support of the trial’s Independent Scientific Advisory Committee, DMI is planning to conduct another endline survey in late 2016, with results available in 2017.We are impressed by DMI’s openness with us about its results (and its willingness for us to share the high-level summary), and we hope to have discussions with DMI about how it might be able to work toward becoming a top charity in the future. Our full review of DMI is here.
• GAIN-USI. GAIN’s Universal Salt Iodization (USI) program supports national salt iodization programs. There is strong evidence that salt iodization programs have a significant, positive effect on children’s cognitive development. GAIN-USI does not work directly to iodize salt; rather, it supports governments and private companies to do so, which could lead to leveraged impact of donations or to low impact, depending on its effectiveness. Last year, we wrote, “We tried but were unable to document a demonstrable track record of impact; we believe it may have had significant impacts, but we are unable to be confident in this with what we know now. More investigation next year could change this picture.” In 2015, we continued our assessment of GAIN, focusing on its work in India and Ethiopia, including a site visit to Ethiopia in July.Overall, we tried but were unable to establish clear evidence of GAIN successfully contributing to the impact of iodization programs. This is primarily due to (a) the difficulty in attributing impact to specific activities that GAIN carried out and (b) challenges we have had communicating with GAIN about its work. We have not yet completed our final report on GAIN but hope to publish it in the near future. We have published notes from some of the conversations that were part of this research and they are available here. Our 2014 review of GAIN is here.
• IGN. Like GAIN-USI, IGN supports (via advocacy and technical assistance rather than implementation) salt iodization, and as with GAIN-USI, we tried but were unable to establish clear evidence of IGN successfully contributing to the impact of iodization programs. Unlike GAIN-USI, IGN is small, operating on a budget of approximately $0.5-$1 million per year, and relies heavily on volunteer time. We are planning to post an updated review in the near future. Our 2014 review of IGN is here.
• Living Goods recruits, trains, and manages a network of community health promoters who sell health and household goods door-to-door in Uganda and Kenya and provide basic health counseling. They sell products such as treatments for malaria and diarrhea, fortified foods, water filters, bednets, clean cookstoves, and solar lights. Living Goods completed a randomized controlled trial of its program and measured a 27% reduction in child mortality. We estimate that Living Goods saves a life for roughly each $10,000 it spends, approximately 3 times as much as our estimate for the cost per life saved of AMF’s program. We spoke with Living Goods and reviewed documents about their progress in 2015. We do not have major updates to report but are planning to post an updated review in the near future. Our 2014 review of Living Goods is here.

Our research process in 2015

This section describes the new work we did in 2015 to supplement our previous work on defining and identifying top charities. See the process page on our website for our overall process.

This year, we did not put a substantial amount of senior staff time into new top charities research work because (a) we were largely focused on building capacity, and (b) we reallocated a significant amount of capacity to the Open Philanthropy Project (see our post on our plans for 2015 for more details).

We focused the bulk of our research capacity for top charities work on staying up-to-date on our recommended charities. We also did an intensive evaluation of GAIN-USI, including a site visit (more details forthcoming).

We completed investigations of vitamin A supplementation and maternal and neonatal tetanus immunization campaigns. Both programs seem potentially competitive with our other priority programs, but we were not able to identify charities that worked on these programs that were willing to apply for a recommendation. We also made substantial progress on investigating several other programs, such as measles immunization, meningitis A vaccination, folic acid fortification, voluntary medical male circumcision for the prevention of HIV, and “Targeting the Ultra-Poor” (or “Ultra-Poor Graduation”) programs.

We stayed up to date on the research for bednets, cash transfers, and deworming.

We did not conduct an extensive search for new charities this year. We feel that we have a relatively good understanding of the existing charities that could potentially meet our criteria, based on past searches (see the process page on our website for more information). Instead, we solicited applications from organizations that we viewed as contenders for recommendations. A March post laid out which organizations we were hoping to investigate and why.

We did some initial research on several charities that we had not investigated before, but we did not complete the reviews in time for our 2015 recommendations. The organizations that we began investigating were:

• END Fund
• Episcopal Relief & Development’s NetsforLife® Program
• Project Healthy Children
• Sightsavers.

We plan to complete these reviews in 2016.

Giving to GiveWell vs. top charities

We have grown significantly over the past few years and continue to raise funds to support our operations. This includes work on GiveWell’s top charities and the Open Philanthropy Project.

We plan to post an update on our funding situation before the end of the year.

The most up-to-date information available on this topic is linked from our June 2015 board meeting. The short story is that we are still seeking additional donations and encourage donors who feel they are sufficiently confident in our impact to give to us.

Footnotes:

* For example, if $30 million were available to fund gaps of $10 million, $5 million, and $100 million, we would recommend allocating the funds so that the $10 million and $5 million gaps were fully filled and the $100 million gap received $15 million.

This rule is material to the three gaps tied at priority level 2. It causes us to recommend that Good Ventures’ last $28.3 million to recommended charities is used to fully fill GiveDirectly’s $8.8 million capacity-relevant gap and Deworm the World’s $3.2 million Execution Level 2 (possible capacity-relevant) gap, but only fill $16.3 million of AMF’s Execution Level 1 gap.

** This gap can’t be cleanly classified because we think the funding is relatively unlikely to be needed, but if it is needed, it is likely to have capacity-relevant effects. Thus, it is technically classified as Execution Level 2, but we think it has similar value to Execution Level 1.