The GiveWell Blog

GiveWell’s top charities for giving season 2013

Our top charities for this giving season are GiveDirectly, Schistosomiasis Control Initiative (SCI), and the Deworm the World Initiative (DtWI) (led by Evidence Action). The first two have been recommended previously. The third is a new addition, and we encourage readers to see our full review.

We’ve had extensive internal discussions about how to rank these three giving opportunities against each other. These discussions have been particularly challenging this year because:

  • The three have extremely different strengths and weaknesses, in our view. Much of the decision between them comes down to judgment calls about how to weigh factors such as (a) estimated cost-effectiveness of a charity’s activities (SCI appears strongest here, in isolation, though some staff discount this observation because of the low robustness of our estimates); (b) potential leverage (DtWI has a potential advantage here, as it focuses on influencing government spending rather than covering all costs with its own funds); (c) a direct and robust case for impact (we believe GiveDirectly is strongest on this front); (d) “upside,” in terms of potential for the charity’s growth to have far-reaching effects beyond the direct impact of its services. (We think all three have some “upside” but see GiveDirectly as particularly promising in terms of its potential to improve the aid community’s understanding of, and interest in, cash transfer programs.)
  • The amounts of money given on the strength of our recommendations could be substantial, and so the question of “what do further donations accomplish?” can have complex answers: for example, the first million dollars to a charity can be quite different in their expected impact from the second million. We lay out what we know about each charity’s funding gap below.

For each charity, we have set out a “minimum target” that we very much hope to see it raise. The targets have no precision to them, but roughly speaking, we see more value in donations up to the minimum target for each charity than in donations beyond the minimum target for any of them. (In other words, if two of the charities had hit their minimum target and the third had not, we would prefer additional donations to go to the third charity until it hit its minimum target.) We believe that each charity will hit its minimum target. We would also be happy to see each charity raise funds beyond its minimum target, and expect that this will happen to some degree.

The minimum targets consider both the nature of the funding gap and the goal of providing positive incentives via rewarding charities that exemplify the values GiveWell is seeking to promote, such as transparency, strong monitoring and evaluation, and full participation in GiveWell’s evaluation process. We believe that all three top charities are outstanding in these respects and thus hope to move substantial funds to each, though we also feel there are some differences on this front that contribute to our differing minimum targets.

When it comes to donations beyond the minimum target, we haven’t reached a clear conclusion on which charities should be prioritized, and feel that donors will decide – reasonably accurately – which charities are the best fit for their own worldview and values with the guidance we provide. Accordingly, we have decided not to provide numerical rankings this year.

Please note that there will be some additional content coming out within the next 1-2 weeks:

  • Good Ventures is planning to announce its own plans re: grants to top charities. We expect this announcement to come this week and expect that it may influence donors’ choices.
  • We are planning to write about the evolution of our criteria for recommending charities, which are being modified from what they were in previous years. This content will not be directly relevant to the choice between charities (this post attempts to summarize all relevant considerations).
  • We are also planning to have individual staff members (who feel comfortable doing so) announce their plans and their reasoning for their own personal giving. In general, the most popular choice internally is GiveDirectly.

The rest of this post lays out what we see as the key considerations regarding the funding gap, strengths and weaknesses of each recommended charity.

GiveDirectly
Funding gap

We provide the details of GiveDirectly’s funding gap in our review. In brief, GiveDirectly has told us that, to facilitate its planning, it aims to raise $40 million, the amount it budgets for 2014 and 2015. It hopes to spend $14 million in 2014 and $26 million in 2015.

As of the writing of this blog post, GiveDirectly has allocated or committed over $5 million to cash transfer campaigns (the vast majority of these funds in the past year), utilizing most of the funds it has received to date from donors.

Our understanding is that the majority of additional donations will go directly to cash transfers, which themselves are part of GiveDirectly’s (a) experimentation with its operational model as it expands and (b) experiments into the impacts of different models of cash transfer programs.

We hope that GiveDirectly is able to close a sizable portion of its funding gap, and have set a “minimum target” of $2.5 million, about half of what it has spent in the last year. We would be relatively comfortable with its receiving up to $20 million, though as it received more funds we would begin to prefer that those funds be allocated elsewhere.

Details on GiveDirectly’s room for more funding

Strengths and weaknesses

  • Program impact and cost-effectiveness. Cash transfers are relatively strongly evidence-backed, and are in the range of our other priority programs’ cost-effectiveness, but our best guess is that cash transfers are 2-3x less cost-effective than the deworming programs carried out by SCI. Details at our updated cost-effectiveness spreadsheet. Our estimates are subject to substantial uncertainty.
  • Monitoring and evaluation. All the programs implemented by our top charities are evidence-backed, but GiveDirectly is the only one that has a randomized controlled trial (finding strong results) of its own implementation of its program. Thus, GiveDirectly has been evaluated in a more rigorous way than our other top charities. We also feel that we have seen stronger evidence of successful execution of its program than for our other top charities.
  • Directness and robustness of the case for impact. We believe there is a highly direct and robust connection between GiveDirectly’s receiving funds and those funds reaching very poor individuals. We believe GiveDirectly to be the strongest of the recommended charities on this front.
  • Transparency and participation in our process. GiveDirectly has been exceptionally open with us, enabling us to understand the full details of its work.
  • Scale. Were GiveDirectly to receive the full level of support it is seeking, this would result in a significant increase in scale. We view this both as a risk and an opportunity. As of the end of 2013, GiveDirectly was distributing cash at a rate of approximately $3.6 million per year; it hopes to reach close to $15 million by the end of 2014. GiveDirectly has scaled up successfully in the past; it had been distributing cash at a rate of $360,000 per year at the end of 2012. For donors who believe GiveDirectly can effectively scale up, this represents an opportunity to provide early-stage funding to an organization that may eventually grow to be much larger. For donors who are skeptical of GiveDirectly’s ability to scale, providing such funds may appear unreasonably risky (though only after the first $5-10 million in support; the first $5-10 million would be consistent with the size GiveDirectly has been to date). Full GiveDirectly review

Schistosomiasis Control Initiative (SCI)
Funding gap

SCI has told us that it hopes to raise at least $4 million for work it plans to undertake in 2014 and believes it could effectively absorb up to $10 million (though some of this spending would spread into 2015). This work would mostly consist of direct implementation of deworming.

Since November 2011, when we first recommended SCI, SCI has received approximately $4.6 million in unrestricted funds. It has spent $2.9 million, committed an additional $1.2 million and approximately $1 million remains unallocated, including approximately $500,000 it had in reserve prior to our recommendation (more).

We have set a “minimum target” of $1 million for SCI, which is consistent with the levels of GiveWell-attributable funding it has received in the past. We would be relatively comfortable with its receiving up to $10 million, though as it received more funds we would begin to prefer that those funds be allocated elsewhere.

Details of SCI’s room for more funding

Strengths and weaknesses

  • Program impact and cost-effectiveness. Our best guess is that SCI’s deworming program is more cost-effective than cash transfers by a factor of 2-3x and 1-2x as cost-effective as DtWI’s deworming program. Details at our updated cost-effectiveness spreadsheet. Our estimates are subject to substantial uncertainty.
  • Monitoring and evaluation. We recently became aware of major limitations to the studies we had previously been relying on as evidence of SCI’s impact. We will be reviewing further evidence that SCI sent us in response; we had not previously focused on collecting such evidence because of our impression that the studies we were using were sufficient. The program SCI works on (deworming) is relatively strongly evidence-backed.
  • Directness and robustness of the case for impact. We believe that the connection between SCI’s receiving funds and those funds’ reaching very poor individuals is more direct than DtWI’s but less direct than GiveDirectly’s. SCI has spent (and plans to spend) a sizable amount of its budget directly carrying out deworming programs, but it also spends funds on a variety of activities related to deworming (e.g., advocacy, operational research).
  • Transparency and participation in our process. From 2009 (when we first made contact with SCI) through mid-2013, we struggled to communicate well with SCI. Since August 2013, our communication with has SCI has improved substantially. We still do not feel that we have the same level of visibility into SCI’s operations as we do into those of our other top charities, and this is a major factor in the relatively lower “minimum target” we have set for SCI as opposed to other top charities, though we are optimistic that this will change in the next year.
  • Scale. Were SCI to receive $5 million, it would represent an increase in the amount of funding it processes. SCI has spent (or committed) approximately $2 million in unrestricted funds in each of the past two years and is currently primarily funded by a 5-year, ~$15 million grant from DFID. It is currently under consideration for a 4-year, $15-18 million grant from DFID. In sum, SCI has been operating at a level of approximately $6 million/year and may soon be operating at a level of approximately $10 million/year (due to the DFID grant). An additional $5-10 million would increase its scale further.

Full SCI review

Deworm the World Initiative, led by Evidence Action (DtWI)
Funding gap

DtWI has told us that it would like to receive $2-3 million to give it the flexibility to pursue opportunities that are not directly funded by other donors. It has also told us that Evidence Action, its parent organization, has a funding gap over the next 2 years of $5-7 million.

Because our analysis has focused on DtWI, we have focused on its funding gap.

We would like to see DtWI close much or all of its gap so that it can have an adequate supply of unrestricted funding, and we have set a minimum target of $2 million. We see significantly less value in funds beyond that point, and particularly past the $3 million mark.

Details of DtWI’s room for more funding

Strengths and weaknesses

  • Program impact and cost-effectiveness. In isolation, our best guess is that DtWI’s deworming program is likely less cost effective than SCI’s (about 50-100% as cost effective) and GiveWell staff differ about its cost-effectiveness relative to cash transfers (1.5-3x as cost effective). This is because worm infections appear less prevalent and (particularly) less intense where DtWI works than where SCI works. However, DtWI focuses on influencing government spending rather than covering all costs with its own funds, and we think it is therefore appropriate to give it some degree of credit for “leverage” – making your dollars go further than they otherwise would. Estimating the degree of “leverage” is highly subjective; our best guess is that it should add a multiplier of about 3 to the cost-effectiveness, making DtWI more than competitive with other top charities on this front. Details at our updated cost-effectiveness spreadsheet.
  • Monitoring and evaluation. We believe DtWI’s self-evaluation to have been less rigorous than that of GiveDirectly, though we are hopeful that it will improve going forward. (As noted above, we are currently revisiting the quality of SCI’s self-evaluation.)
  • Directness and robustness of the case for impact. DtWI is a technical assistance/advocacy organization, and therefore the chain from donation to person helped is the least direct of any of our top charities. This is the flip side of DtWI’s potential “leverage” – because it focuses on influencing and assisting other players rather than on direct implementation, its value-added per dollar spent is quite plausibly higher but also harder to pin down.
  • Quality of communication. From 2009 (when we first made contact) through early 2013, we struggled to communicate well with DtWI. Since early 2013 (which coincided with DtWI changing its leadership), our ability to communicate with DtWI improved substantially. We now feel that we have as much visibility into DtWI’s operations as we do any of our other top charities.
  • Scale. Our understanding is that $2-3 million in unrestricted funds will provide DtWI with flexibility that will be helpful as it grows. Because DtWI requests $2-3 million, we would expect that any funds it receives above $2-3 million would likely effectively support Evidence Action more broadly (e.g., its Dispensers for Safe Water program, which we have not examined although we have published a report on water quality interventions, and potentially other initiatives that it might launch).
  • Fungibility. DtWI is an initiative led by its parent organization, Evidence Action. There is some possibility that funds given due to this recommendation effectively support Evidence Action and its Dispensers for Safe Water program (or future initiatives) rather than DtWI. If donors are particularly concerned about this, they should carefully consider their support of DtWI.

Full DtWI review

A note on Against Malaria Foundation (AMF)
As discussed in this blog post, we are not recommending AMF to donors this year due to lack of short-term room for more funding. AMF currently has access to approximately $12 million that it has yet to commit to funding distributions.

We believe that it is not unlikely that AMF will reach an agreement to use the bulk of its funds in the next 6 months, and therefore would not be surprised if donors choose to continue supporting it.

We will continue to follow AMF’s progress and reconsider its recommendation status if/when it finalizes a distribution.

Full AMF review

Rethinking SCI’s evidence of impact

We’ve recently encountered some new (to us) information about studies we have relied on in our evaluation of the Schistosomiasis Control Initiative (SCI), which is one of our top charities (and will remain one after our upcoming refresh). We won’t be able to fully investigate all the implications of this information by the end of giving season, but at this point we provisionally hold that:

  • We are less confident in SCI’s track record of reducing worm infection prevalence than previously. In assessing SCI’s track record, we have relied on a set of studies showing dramatic drops in worm infection prevalence and intensity coinciding with SCI-run deworming programs; we now believe that most of these studies do not show what we had thought they showed. Specifically, it appears that most of the studies we’ve relied on involved treating children for worms as part of the study (i.e., children who tested positive for infection were treated by research personnel), so improvements measured over time could be attributable to the activities of the people carrying out the study rather than necessarily to the coverage of the national control program. We do not believe this represents an error or purposeful deception – the lead author on the study straightforwardly confirmed this issue to us and defended it based on ethical considerations. However, we believe that the published version of the study was (perhaps unintentionally) not clear on this point.
  • We plan to review other evidence of SCI programs’ effectiveness; we have not focused on collecting such evidence because of our impression that the studies we were using were sufficient. It is now a high priority for us to solicit and review such evidence. On November 28 (in response to a draft of this post sent Nov. 11), SCI sent us reports for Burundi and Niger that, on preliminary review, look strong and encouraging to us, though we have not been cleared to share the reports publicly and have not yet done a thorough examination. We plan to review these further and to solicit other monitoring and evaluation data.
  • We plan to continue recommending SCI through this year’s giving season. We feel that SCI represents an outstanding giving opportunity, one of the best we are aware of for donors seeking to support evidence-backed programs serving the global poor. More

New information about studies of national deworming programs
In our 2012 review of SCI, we emphasized a set of panel studies in which children at multiple sites were tested for infection (schistosomiasis and in some cases other conditions) before the start of an SCI-led control program, then followed up and tested again one and two years later. The studies show a fairly consistent picture of dramatic drops in disease prevalence. We acknowledged multiple limitations to these studies, but felt that they gave relatively strong suggestive evidence that the SCI-led control programs had had their intended effects.

We recently discovered – via an investigation that started when Sally Murray and Rob Wiblin of Giving What We Can alerted us to the paper, Does mass drug administration for the integrated treatment of neglected tropical diseases really work?: assessing evidence for the control of schistosomiasis and soil-transmitted helminths in Uganda – that in one of these studies (Kabatereine et al. 2007), when children tested positive for infection in the course of the study, they were then directly treated. We confirmed this point over email with Dr. Narcis Kabatereine, the lead author of the study. In the discussion that followed, SCI stated:

The data in Uganda in this study was collected as part of the initial studies supported by the Bill and Melinda Gates Foundation to evaluate the feasibility and impact of mass drug administration for SCH. Due to the nature of the study, which involved drawing of blood and ultrasonography, ethical considerations demanded that treatment had to be offered by investigators. Findings from these and additional studies confirmed the link between SCH infections and morbidity. Data from these studies also provided very valuable information on other aspects of SCH control. Ongoing monitoring and evaluation protocols in Uganda and all other SCI assisted countries were able to use a different methodology and did not require the treatment of all positive cases. (Children in sentinel sites are tested approx. 1 month prior to MDA so that any positive cases will be treated as part of the MDA. This ensures that the sentinel sites accurately reflects the impact of the programme as a whole but also does not leave known positive children untreated, which would be unethical.) Therefore from 2006 onwards studies assessing the impact of SCH mass treatment did not include the treatment of identified positives and therefore were not subject to the theoretical bias that may have been inherent in the original protocols.

On November 28 (in response to a draft of this post sent Nov. 11), SCI sent us reports for Burundi and Niger following the post-2006 methodology that, on preliminary review, look strong and encouraging to us, though we have not been cleared to share the reports publicly and have not yet done a thorough examination. We plan to review these further and to solicit other monitoring and evaluation data.

We feel that a study using the original methodology (not the post-2006 methodology) – treating children who test positive for infection – could easily find the observed declines in schistosomiasis, even if there were no national control program running at all, because such declines could be caused by the practice of treating children for infection as part of the study (and then following up with the same children in later years). Therefore, we believe that the results of such a study cannot be taken as a reflection of the quality or success of a national control program such as those led by SCI.

We were previously unaware that Kabatereine et al. 2007 had involved treating children as part of the study. Dr. Kabatereine pointed out to us in an email that the study did intend to communicate this, pointing to the quote that opens the “Findings” section: “We enrolled 4351 children from 37 schools, of which 2815 (64.7%) were traced and treated at one year follow-up and 1871 (43.0%) at two year follow- up.” Dr. Kabatereine also stated that phrases such as “Anthelmintic treatment delivered as part of a national helminth control programme” imply “Anthelmintic treatment delivered as it is done in a national helminth control programme” (e.g., same drugs, same dosage and frequency).

We now see that the phrase “traced and treated” in the above quote should have raised a flag for us. However, this phrase could have referred to treatment by the national control program (“and treated” seems to refer only to followup rounds, not to the first round of measurement), and it appears in what we see as an unexpected place in the paper: in the opening of the “Findings” section, where the emphasis appears to be on how many children were examined and followed up in each round and what the results were. As far as we can tell, this issue is not noted in any of the sections on methodology or ethics. In addition, the introduction and conclusion of the paper do not mention this issue and strongly seem to us to imply that the intent of the paper was to examine the impact of the national control program, as opposed to the impact of treatment delivered along the same protocol as the national control program. We are inclined, therefore, to chalk the fact that we did not notice this issue up to a lack of clarity in the paper, rather than to a shortcoming on our part. We recognize that others may disagree. For reference, a link to the paper in question is available here.

The upshot is that we no longer see studies such as this one as demonstrating the effectiveness of a national control program as implemented.

We plan to review other evidence of SCI programs’ effectiveness; we have not focused on collecting such evidence because of our impression that the studies we were using were sufficient. It is now a high priority for us to solicit and review such evidence. On November 28 (in response to a draft of this post sent Nov. 11), SCI sent us reports for Burundi and Niger that, on preliminary review, look strong and encouraging to us, though we have not been cleared to share the reports publicly and have not yet done a thorough examination. We plan to review these further and to solicit other monitoring and evaluation data.

Continuing to recommend SCI
This represents a potentially substantial update regarding the evidence of SCI’s track record; we will need to reassess the case for its track record thoroughly. The fact that we weren’t aware of crucial information about how at least one study was conducted reflects concerns we have earlier noted (here and here) about communication difficulties with SCI.

However, we plan to continue recommending SCI through this giving season, because:

  • We would still guess, given all the information we have – including the new reports we have seen as well as our impression that school-based deworming programs are among the more straightforward interventions (the latter is based partly on site visits and partly on several years of ongoing conversations with deworming-focused charities) – that the programs led by SCI are relatively effective.
  • Our criteria for top charities are shifting to put more emphasis on potential leverage (which we feel we have made progress in understanding) and less emphasis on organization-specific monitoring and evaluation. We will be writing about this more in a future post. By our modified criteria, SCI remains outstanding.

We have substantial work to do in rethinking the evidence regarding SCI’s track record. With that said, we continue to feel that SCI represents an outstanding giving opportunity, one of the best we are aware of for donors seeking to support evidence-backed programs serving the global poor.

Change in Against Malaria Foundation recommendation status (room-for-more-funding-related)

Note: AMF has reviewed a draft of this post. We believe AMF’s willingness to let individual donors follow along with it – both the successes and the struggles – is highly unusual in the charity world, and an extremely important and positive quality.

Since naming the Against Malaria Foundation (AMF) as our #1 charity in late 2011, we have tracked $10.6 million in donations made to it as a result of our recommendation. In that time, AMF has held the funds while attempting to negotiate a net distribution to spend them on. It has not yet finalized a distribution large enough to spend the bulk of these funds (though it has funded a smaller-scale (~$1 million) distribution in Malawi).

We have been following its negotiations, and this post discusses why AMF has been unable to finalize a sufficiently large distribution. At this time, we plan not to recommend more donations to AMF until and unless it commits the bulk of its current funds to net distributions. Note that this decision does not reflect a negative view of AMF, but rather reflects room for more funding related issues. We note that AMF does not share our view on a lack of room for more funding. AMF’s take is available here. 

In the course of investigating and discussing why AMF was unable to finalize a distribution, we have noted some of what we believe to be mistakes on AMF’s part (more below). We are unsure of how serious these mistakes are, and they are not the driver of the change in recommendation status. We stand by our earlier decision to recommend AMF as our #1 charity, and if and when AMF commits the bulk of its current funds, we will revisit its status and likely recommend it again.

AMF’s response: We disagree with significant parts of GiveWell’s analysis. It is straightforward to find people who want and need nets. We could distribute all the nets we can buy if we were prepared to tolerate high rates of theft. We feel a strong duty to our donors to wait until we can use the funds without significant net losses. This means working carefully with distribution partners who share this goal.

Until recently, it looked as though a finalized distribution might be imminent. Since AMF’s prospects for a distribution in Sierra Leone fell through in September 2013, both we and AMF have been intensifying our efforts to diagnose potential problems, and so much of the content in this post reflects information that is new to both us and AMF.

The rest of this post discusses the following:

  • Why has AMF been unable to finalize a sufficiently large distribution? AMF’s past distributions have been relatively small in scale, compared to the types of distributions it is looking at now (the need to increase scale is driven by the increase in funding that GiveWell’s top recommendation has brought about). To find a sufficiently large distribution requires negotiating with the national malaria control programs of countries in sub-Saharan Africa, which we perceive to have some discretion in which funders they work with, and which we perceive to be choosing funders based on a variety of factors including size and reporting requirements. It also requires coordinating with other major funders. AMF has substantial reporting requirements, yet in some cases is able to fund only a relatively small piece of a given country’s distribution. As such, there may be fundamental reason for other parties to the distribution to prefer not to work with AMF if they can obtain nets from another source. We believe that this is the most important and fundamental explanation. We also believe that other factors AMF controls, and which it should have handled differently, may have played a role (see two points down). More
  • Does this indicate a lack of global funding gap for insecticide-treated nets? We don’t believe that the struggles to date were a function of the lack of a global funding gap. Over the time period in question, our analysis – based on population-at-risk as compared to number of nets distributed – continued to show a sizable gap; several of AMF’s negotiations proceeded to advanced stages; and our understanding from the conversations we’ve had is that AMF’s negotiations proceeded as far as they did because of an acute desire for more nets. Going forward, we believe that the global funding gap may be smaller, which may steepen AMF’s challenges in terms of negotiating distributions. More
  • Has AMF made mistakes? What could it have done better? In 2012, both we and AMF agree that AMF did not investigate enough possibilities at once, and we believe that it improved on this front in 2013. This year, the picture is less clear, as AMF has seemed very close on more than one occasion to having a distribution finalized.
    • AMF states – and we would guess – that the most important factors have been AMF’s relatively small size (compared to other net funders) and its relatively strong reporting requirements (which we broadly support). Broadly speaking, we would not characterize either of these fundamental factors as mistakes, with a caveat (see next bullet point)
    • While some aspects of AMF’s strong reporting requirements are an important part of its value added, other aspects of its requirements may have been excessive. More details below.
    • We believe that AMF’s preference for funding nets (as opposed to other costs such as shipping and evaluation) may have played a role. We see some justification for this preference but also believe that we are – at least partly – in persistent disagreement with AMF on the matter.
    • Finally, we believe that AMF’s communication style has been problematic and that it would benefit from investing more time in building relationships in the malaria control community. The level of reporting sought by AMF makes it likely to meet resistance from organizations with different standards, creating a challenge that we think AMF should have handled better (and is taking steps to handle better in the future).

    More

  • How is AMF responding to the distribution challenges? We believe AMF is taking the most appropriate action under the circumstances, which is to solicit a greater degree of involvement from some of the highly experienced people on its Malaria Advisory Group (MAG). We believe that these people will bring an outside perspective, credibility, and experience with the malaria community, and we are optimistic that they will be able to diagnose and respond to AMF’s obstacles. In addition, at AMF’s CEO’s encouragement, some of AMF’s trustees – particularly Peter Sherratt and Richard Lane, who he feels have relevant experience of working with governments and in development – are planning to become more involved in investigating and negotiating potential distributions. This may further help to address problems related to communication style. More
  • What will happen to the money donated to AMF if AMF can’t finalize a distribution? AMF remains committed to spending its funds on one or more distributions, and if necessary will distribute nets in multiple smaller distributions over a longer period of time. We asked AMF what its plans would be if this approach too proved infeasible (which we consider to be unlikely but possible). AMF responded that the probability of this is too low to merit planning for this given the continuing prevalence of malaria and a significant global net gap. More
  • What is GiveWell’s current view of AMF? Why is GiveWell planning to withdraw its recommendation? We feel AMF has made mistakes and remain in disagreement on some points (more below), but we continue to feel overall that AMF is an outstanding organization in terms of aiming to bring a unique level of accountability to one of the most proven, cost-effective interventions that exists. We are aware that this emphasis on accountability inherently involves challenges when dealing with partners who do not share the same vision of appropriate data collection and reporting. We are still hopeful that AMF will negotiate one or more suitable distributions, and we believe that continuing to hold the funds it has is important to maintaining its negotiating position. More. However, given the significant amount of time that has passed, it now seems to us that there is a substantial risk that AMF will not accomplish this in the near future, and that having more funds to commit would steepen rather than lessen its challenges. (It’s possible that AMF’s challenges would be lessened if it were to receive a very large amount of money – in the range of $30-40 million, which would allow it to fund an entire country’s distribution on its own – but we believe that donations in the range of our projected money moved will increase the number of distributions AMF needs to find while still not making a big enough difference to its size to improve its negotiating position substantially.) Therefore, we believe it is most prudent to donate elsewhere until and unless AMF commits the bulk of the funds it currently holds, at which point we will revisit its ranking.
  • Did GiveWell err in its previous recommendation of AMF? What has GiveWell learned from AMF’s struggles? We feel that our prior recommendation of AMF was appropriate, and that the struggles we’ve seen have come mostly from previously recognized (though underestimated) risks. However, we feel that our investigations and communications could have been better, and we have updated our views on a number of fronts. Specifically, (a) we should think harder and communicate more clearly about cases in which our recommendation could bring about a change in the scale of a charity, and the potential difficulties associated with this; (b) we should put more effort into ensuring clear communication between the donors coming to our website and the charities receiving funds from them, in terms of donor preferences about how their funds are to be spent; (c) we should put more effort into interviewing people and organizations who have worked with the organizations we’re investigating, as part of our broader efforts to evaluate people and organizations holistically; (d) we need to be highly cognizant – and to effectively communicate – that as of today, there don’t appear to be any “sure bets” with quantifiable outcomes in charity, especially when it comes to directing relatively large amounts of money. More

This post is partly based on conversations we had over the last few weeks in order to investigate the key factors in AMF’s struggles to negotiate distributions. Some of these conversations remain confidential, but we have posted notes from Don de Savigny of AMF’s Malaria Advisory Group.

Why has AMF been unable to finalize a sufficiently large distribution?
Prior to becoming GiveWell’s top-rated charity, AMF funded a number of relatively small distributions carried out by nonprofit organizations. Its largest distribution was the one that was in progress when we first upgraded its ranking to #1: a 270,000-net distribution in Malawi with Concern Universal as a partner, which we wrote about in our March 2012 and September 2012 updates. Since September 2012, AMF has had a total of approximately $9 million in revenues, of which we believe approximately $7 million can be attributed to GiveWell’s recommendation, and the amount it now holds could pay for about 4 million nets – substantially more than it has distributed in the past. Accordingly, AMF has sought to partner directly with a government on a large-scale net distribution, and has not yet finalized such a distribution.

We have discussed the details of negotiations with AMF, but the extent to which this information can be made public is limited. AMF’s future distribution tracker shows the state of possible distributions as of June 2013, and we have discussed some additional detail in previous updates (September 2012, February 2013).

Generally, it seems to us that a given government is, at any given point in time, deciding between multiple options for providing nets for a distribution (including forgoing enough support to do a complete distribution, and instead leaving some areas uncovered). When deciding whether to work with a funder, the following factors all may come into play:

  • The size of the funder. President’s Malaria Initiative (PMI) and The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) are particularly large funders that can potentially fund the bulk, or entirety, of a country’s net needs, and so working with them is likely to be particularly worthwhile. While AMF’s level of funding is too large to continue focusing exclusively on distributions of the size it has funded three times in Malawi (several hundred thousand nets per distribution), it is only large enough to fund the bulk of the nets a country needs when dealing with countries with gaps of ~4 million nets or fewer.
  • The funder’s requirements in terms of data collection and reporting. A major part of AMF’s appeal, according to our criteria, is its unusual interest in publicly sharing as much data as possible, particularly regarding successful delivery and usage of nets and any changes in malaria case rates pre- and post-distribution. However, AMF’s requests for such data may lessen its appeal for major potential partners for a variety of reasons – in particular, (a) costs and administrative hassles involved with collecting and releasing the data; (b) potentially limited capacity for data collection; (c) potential embarrassment from making the data public (in case the data does not give a favorable picture of how the distribution went).
  • The funder’s other requirements and requests about how the distribution is to be executed. In particular, AMF has offered to pay for nets but has generally not offered up front to pay for non-net costs – including shipping, distribution and data collection – which is something we discuss more below.
  • Overall degree of comfort and familiarity with the funder. AMF is new to partnerships of this nature, which may reduce the degree of comfort. In addition, AMF may have caused some interpersonal tension, discussed more below.

We aren’t able to disentangle these factors with confidence and say which have been the major ones in AMF’s difficulty finalizing a distribution.

AMF believes that the primary factor is its concern over theft and its reluctance to provide nets without strong measures in place to ensure that they will arrive safely and be distributed to the right people. It believes its insistence on transparency and detailed accountability has caused it to encounter significant resistance from some others in the aid community who have less focus on this area. We are not as confident that we can identify the primary factor, though we do believe that AMF’s emphasis on transparency and accountability (which we broadly support) creates inherent challenges.

Does this indicate a lack of global funding gap for insecticide-treated nets?
In the past, we have analyzed population-at-risk data and distribution data to estimate the global net gap, concluding that it is quite large. We are currently in the process of finalizing our refresh of this analysis, and we believe that we will again project a gap, although the fact that nets have gotten cheaper over time – as well as increased funding from other sources – means the estimated gap is likely to be substantially smaller than previous estimates.

We believe that the total number of nets available over the past couple of years has been insufficient to cover the full population at risk. In addition, the partial progress AMF has made in arranging distributions (see notes from Don de Savigny for more) does not, to us, imply a world in which nets are easily available. AMF has encountered multiple countries in which the available funding did not seem sufficient to cover the full planned distribution, and in which AMF was requested to fill the gap.

Going forward, we believe that the global funding gap may be smaller (more), which may steepen AMF’s challenges in terms of negotiating distributions, though it appears that some degree of funding gap will remain.

Has AMF made mistakes? What could it have done better?
As stated above, it’s difficult to disentangle the factors that have led to large-scale distributions’ not going forward so far. In some cases we feel that these factors are unavoidable (AMF’s size) and/or reflect AMF’s strengths from our perspective (its interest in collecting and publishing data on distributions). We also wish to note that AMF has completed many smaller-scale distributions (up to several hundred thousand nets) in the past, and we feel that its struggles can fairly be attributed to the increase in size that has come with our recommendation. With that said, there are some cases in which we feel that AMF has made mistakes, and/or in which we continue to disagree with AMF. Much of the thinking here has been driven by recent conversations with people who have worked with AMF; some of these conversations remain off the record, but we have posted notes from Don de Savigny of AMF’s Malaria Advisory Group.

Excessive requirements

Broadly, we support AMF in its attempts to secure strong and public reporting on its distributions, even though doing so may make it more difficult for such distributions to be negotiated.

With that said, it appears to us that AMF’s requirements should have been rethought and adjusted more than they were, at the point when AMF made the transition from partnering with nonprofits to partnering directly with governments. Don de Savigny of AMF’s Malaria Advisory Group was among the people who noted this concern. We believe that AMF now plans to adjust its approach.

A couple of specific notes:

  • While we have previously been enthusiastic about AMF’s requests for malaria case rate data, we now believe that the costs of requesting this data may outweigh the benefits. Our view has changed because (a) we have come to believe that this data is highly unreliable (more at our conversation notes from August 15th); (b) we have been told that some countries simply do not have the capacity to collect this data, at least without funding to support their health-system infrastructure more broadly. AMF does believe that if possible an attempt should be made to track the impact of nets in this way, but also recognizes the case for flexibility on this point.
  • We still believe that other data AMF seeks (regarding delivery, condition and usage of nets) is valuable and important, and its raising questions around such data may already have had some impact on discussions in the malaria control community (more at our conversation notes from Don de Savigny of AMF’s Malaria Advisory Group).

Preference for funding only nets

AMF prominently states that donations from the public are used exclusively for buying nets. It believes that it must make good on this promise.

Last year, we became concerned that AMF’s preference for funding only net purchases (and not other costs associated with distributions, such as shipping, monitoring and evaluation) might be an obstacle to distributions’ moving forward. We spoke with Rob Mather about the matter, and got the impression in our conversation that (a) this had not been a major obstacle to moving forward; (b) if it became such an obstacle, AMF would raise money specifically for this purpose. Good Ventures’s 2013 donation was specifically marked as available for non-net costs; Rob was reluctant to mark other donations in this way and stated that he did not see a need, and we didn’t perceive it as a major issue, so we didn’t pursue the matter further. We also note that AMF has paid for non-net costs in its Malawi distributions, so it is clear to us that its reluctance to fund such costs is not absolute.

This year we have encountered one case of AMF’s offering to fund additional nets, with another funder’s then arranging to reallocate their funding from nets to non-net costs, specifically net use monitoring costs. (AMF did not feel able to offer funding for non-net costs when it was not funding nets.) This has highlighted to us that we previously underestimated the degree of AMF’s reluctance to fund substantial non-net costs, and with it, the potential consequences.

AMF has stated strongly to us that it does not believe its not offering to fund non-net costs is a major factor in agreements’ not being finalized. We remain unsure of whether AMF’s reluctance to fund non-net costs is a major factor (or any factor) in its struggles to finalize a distribution, but it seems to us that this is a strong possibility.

Having spoken further with AMF, we’ve been given two arguments in favor of avoiding paying for non-net costs:

  1. AMF has no in-country presence to effectively monitor non-net costs. It is easier to track and audit the use of funds (in a way that e.g. avoids bribery) in the case of net purchases than in the case of other costs (particularly costs of distribution and evaluation). AMF has the technical capacity for the former, but not for the latter, for which it believes in-country presence or a highly accountable in-country partner is vital. AMF seeks to ensure that major (i.e., government) funders with substantial in-country staff take responsibility for tracking and auditing non-net expenses, and believes that the most practical way to do this is to ensure that major funders allocate their funds to non-net costs. This issue may also have legal implications: AMF has received professional audit guidance that paying for substantial non-net costs could incur legal requirements to audit the funds that would go beyond AMF’s technical capacity. We are unsure of how significant an issue legal requirements represent, and plan to look into the matter further; overall, we believe this could potentially be a strong argument for behaving as AMF has, but remain uncertain. Note that this argument pertains to tracking expenditures and ensuring appropriate use of funds, which is different from evaluating e.g. usage and impact of nets (an area in which we feel that AMF has higher standards than government funders).
  2. Many of AMF’s donors prefer that their funds be restricted in this way, and because of the commitments given on AMF’s website, AMF has an obligation to assume by default that this is what its donors prefer. (AMF also notes that a) it believes it has paid for non-net costs when not doing so would hold up a distribution and the other pieces are in place; b) it has approached larger donors, and is prepared to approach other large donors, to ask whether specific donations could be allocated to non-net costs if such a need arose.) In response, we have communicated strongly to AMF that we do not believe the bulk of GiveWell-attributable donations should be restricted in this way, and we have offered to survey donors we have contact information for if it would help resolve the matter.

At this point, we believe there may be good justification for AMF’s reluctance to fund non-net costs, but we also believe that at least part of the reluctance comes from AMF’s perception of donors’ preferences – and thus from a failure on our part to ensure that donors coming from our website communicate their preferences to AMF. We believe that this is at least partially a matter of persistent disagreement: AMF sees value (when communicating to the broader public) in the simplicity and tangibility of “100% buys nets,” while we believe this is not valuable where GiveWell-directed donors are concerned.

Problematic communication style

AMF has pushed for what we see as new levels of information and public accountability, and this creates natural challenges and calls for building relationships in the development community. To this point, we believe that AMF has handled these challenges suboptimally, in the following respects:

  • AMF has done relatively little in-person interaction with potential partners, as opposed to communication by email and phone.
  • AMF has had a very direct communication style, and may have failed to pick up on (and encourage) communications from people whose style may be less direct. We feel that this dynamic may have led to AMF’s failing to detect potential problems as quickly as it could have – in particular, we were told that AMF should not have been as surprised as it was by the Sierra Leone distribution’s falling through. The sources from which we’ve drawn this view unfortunately remain confidential.

We recognize that the same quality that has made AMF particularly easy for us to communicate with (a highly direct communication style) may be a drawback in its relations with some potential partners.

We believe that AMF is taking appropriate steps (more below) to improve on this front.

The upshot of the above three factors is that AMF may have been perceived as overly demanding by potential partners – coming in as an outsider, asserting substantial requirements without offering to directly reimburse the costs of its requests, and appearing less open to negotiation than it was in reality.

With that said, we doubt that the above factors have been the primary explanation for AMF’s struggles to finalize a distribution. We see its small size and emphasis on strong and transparent data sharing as fundamental obstacles, and we’re cognizant that it’s been willing to negotiate on other factors. We believe that the above issues have largely been a function of transitioning from one sort of partner (nonprofits on smaller-scale distributions) to another (government partners on large-scale distributions), and as discussed below, we believe that AMF broadly is taking appropriate steps to improve on these matters.

How is AMF responding to its difficulties?
We believe that Rob Mather, AMF’s Founder and CEO, is at least as eager to see a distribution finalized as we are, and is highly concerned about the delays.

When he was unable to finalize a distribution last year, he committed to building a bigger pipeline of potential partners (details), and we believe he followed through well on that goal, as he explored a significantly larger number of options in 2013.

This year, the main step Rob is taking in reaction to the delays is to solicit greater involvement from his Malaria Advisory Group, specifically Don de Savigny, Bob Snow, and Abdisalan Mohamed Noor. The Malaria Advisory Group normally provides input on AMF’s distributions (examples), but is not employed or paid by AMF, and the individuals in question are well-credentialed malaria scholars (see bios for Don de Savigny, Bob Snow and Abdisalan Mohammed Noor).

We believe this is the appropriate action to take. These individuals are likely to command respect both from Rob and from the malaria community at large, and they will hopefully consider both AMF’s interest in strong reporting and arguments from the malaria community about what level of reporting is excessive, without having strong incentives to put more weight on one or the other. Therefore, their findings are likely to have the best combination of neutrality and respect from both parties that seems feasible in this situation.

Rob has also encouraged several of AMF’s trustees – particularly Peter Sherratt and Richard Lane, who he feels have relevant experience of working with governments and in development – to become more involved in investigating and negotiating potential distributions.

Finally, we have provided written feedback to AMF and its advisors and trustees, and will be sending them this post as well.

Ultimately, we expect AMF to reach reasonable resolutions on its reporting requirements and on the issue of how best to communicate them. We are less sure that we will end up in sync with AMF on the question of non-net costs, but we believe there are legitimate arguments for its perspective on this matter and will respect whatever it ultimately decides on this front, while making clear that AMF should not consider donor preferences to be a major argument for restricting its funds (at least concerning donors going on GiveWell’s recommendation).

What will happen to the money donated to AMF if AMF can’t finalize a distribution?
We have encouraged unrestricted donations to AMF, so in most cases we feel it is ultimately up to AMF how to use the funds. (AMF believes it is bound by its public commitments to use the funds to buy nets unless specifically agreed otherwise.) Our impression is that AMF will:

  • Commit the funds to a country-wide distribution that meets high standards of data collection and sharing.
  • Distribute nets in multiple smaller distributions over a longer period of time.

In either case, we feel that the substantial delay in committing funds represents a substantial negative development, though we also feel that dollars spent well with a delay (as we believe they will be in either case) are better than dollars spent poorly.

We asked AMF what its plans would be if this approach too proved infeasible (which we consider to be unlikely but possible). AMF responded that the probability of this is too low to merit planning for this given the continuing prevalence of malaria and a significant global net gap.

What is GiveWell’s current view of AMF? Why is GiveWell planning to withdraw its recommendation?
We continue to feel overall that AMF is an outstanding organization in that it is aiming to bring a unique level of accountability to one of the most proven, cost-effective interventions that exists.

However, a sizable risk has emerged that AMF will not be able to find enough distributions to commit the funds it has, and increasing that amount would steepen this challenge (though perhaps not if AMF raised such significant new funding that it became comparable in size to other major funders in relevant countries). Therefore, we are planning to recommend that people looking to give now donate elsewhere, until and unless AMF demonstrates an ability to put together large enough distributions to commit the funding it has now. We note that AMF does not share our view on a lack of room for more funding. AMF’s take is available here. 

We feel that AMF has made some mistakes, noted above. We are somewhat concerned that AMF is perceived as an “outsider” and – through some combination of communication style and perceived reluctance to fund non-net costs – has been making a poor impression on potential distribution partners. We believe that AMF is taking appropriate steps to diagnose and address these issues, despite some potential disagreements, particularly on the question of non-net costs. We remain unsure of the relative importance of AMF’s mistakes and the fundamental challenge of asking for unusual levels of transparency and accountability (and note that AMF feels the latter is the primary factor).

We wouldn’t guarantee that AMF would immediately become recommended again upon committing the bulk of its funds. The findings that come out of its Malaria Advisory Group’s increased involvement, and the exact circumstances under which a distribution is finalized, would affect our view. However, if and when AMF does commit the bulk of its funds, we will reconsider its ranking and will likely recommend it again.

Did GiveWell err in its previous recommendation of AMF? What has GiveWell learned from AMF’s struggles?
We’ve been reflecting on this episode and trying to draw lessons from it. While we still have some reflecting to do, at this point some lessons we believe we can take away are:

  • We should think harder and communicate more clearly about cases in which our recommendation could bring about a change in the scale of a charity. We were always aware that our recommendation would substantially increase the funds available to AMF, but initially we didn’t recognize that this would fundamentally change the character of the distributions it was partnering on (see our 2011 review). By our 2012 review, it had become clear that ability to finalize a distribution was a major risk factor, but on balance we decided it was a relatively minor one. We think it’s a good thing to substantially increase the funding of outstanding charities, challenging them to reach a new level of scale. Such an endeavor has potential “upside” of turning a limited organization into one with more absorptive capacity, as long as we don’t multiply the funds available by too high a number in too short a time. In the case of AMF, we feel that the increase in funds was appropriate – enough to bring it to a new level of scale, but not much more than that. However, it needs to be strongly noted, both internally and externally, that such a “step up” involves major risk. We don’t feel that we were clear on the nature of the risk here internally or that we communicated enough about it externally. In the future, when we are recommending that a charity be allowed to substantially increase its scale, we will make more effort to note the major risks that this will entail – and this will apply to this year’s top charities as well.
  • We need to ensure clear communication between the donors coming to our website and the charities receiving funds from them, in terms of donor preferences. This is the second time that a recommended charity has expressed to us that it assumes – by default – that its donors wish their funds to be restricted in certain ways. (The other case involves GiveDirectly; in that case we had clear communication up front and ensured that our donate page clearly distinguishes between “flexible funds” and “typical funds,” with the latter being more restricted). We strongly prefer to avoid restrictions on donations, and we don’t want our recommended charities to feel bound by donor preference for anything other than optimal positive impact.
  • We should look for ways to deepen and improve our evaluations of people. We’ve previously noted that we place some weight on our evaluations of the people running an organization, and we’ve also expressed reservations about doing so (“we’re wary of putting too much weight on informal, intangible impressions that are likely to end up being ‘tests of how similar charity representatives are to us’ rather than ‘tests of how well-suited charity representatives are to do their work.’ It seems easy for evaluations of people to end up being driven by charisma, by similarity to the evaluator, and/or by characteristics that don’t translate well to nonprofit work.”) We still believe that Rob is an outstanding individual, and we don’t want to place too much weight on complaints about his communication style when these could easily be motivated by frustration with other aspects of AMF, particularly its data disclosure requests. We also believe that the concerns on this front are being addressed appropriately. That said, the complaints have highlighted the point (which we previously noted) that our evaluations of people may overweight their similarity to us, particularly in communication style, and that our evaluations can miss substantial ways in which qualities that make a charity good at communicating with us can be unhelpful (or even drawbacks) for its ability to do its work. We want to find other methods of evaluation that can enrich our understanding of this aspect of an organization, such as the idea in the next point.
  • We should put more effort into interviewing other organizations and individuals who have worked with our recommended (or potential recommended) charities. We feel that some important considerations have been raised by our discussions with others in the malaria control community about their interactions with AMF. In general, an organization’s reputation among those it works with is important. This may also be a consideration in favor of highly credentialed organization leaders (who are less likely to come across as outsiders); this is something that we haven’t previously placed much weight on.
  • In general, we need to be highly cognizant – and to effectively communicate – that as of today, there don’t appear to be any “sure bets” with quantifiable outcomes in charity, especially when it comes to directing relatively large amounts of money. Many of those who write about GiveWell or use it to donate seem to be under the impression that our top charities represent “sure thing” options allowing a donor to save or improve a known number of lives per dollar given. Yet every year brings new observations about the complexity of giving and about the caveats to seemingly straightforward value propositions. We’ve written before (in 2011) that there is no such thing as a “sure thing” in giving, but we think this point merits further discussion, and we plan to discuss it more in a future post.

With all of that said, we don’t regret our prior recommendation of AMF and believe it was appropriate. AMF had a substantial track record of conducting multiple distributions, including one large distribution, with a level of public disclosure and tracking that no other net distribution charity (and few other charities of any kind) can match. Over 2 years, we have directed enough funding to it to multiply its funds available by several-fold, in the hopes that it would be able to operate at a larger scale; given our other options for recommended charities and the upside if this happened successfully, this was a risk worth taking. It still may be a risk that turns out well, as AMF continues to take steps to improve and to overcome its challenges; it was a risk that has led to substantial learning on our part, which has only been possible because of AMF’s strong transparency and direct communications; and even if AMF is not ultimately able to find appropriate distributions, the result will be delayed (not wasted) donations, as discussed above. We continue to strive to improve, but we stand by our earlier decision to recommend AMF as our #1 charity, and there is a strong possibility that we will do so again in the future.

Finally, we’d like to acknowledge AMF’s willingness to be open and transparent throughout this process. It has reviewed a draft of this post, and we believe its willingness to let individual donors follow along with it – both the successes and the struggles – is highly unusual in the charity world, and will prove enormously beneficial in the long run.

How to approach policy-oriented philanthropy

[Added August 27, 2014: GiveWell Labs is now known as the Open Philanthropy Project.]

As noted previously, we’ve been working on improving our broad understanding of the role that philanthropy can play in influencing and informing policy. One of my goals has been to hear different perspectives on how one should (for maximum effectiveness) approach policy-oriented philanthropy: what sorts of issues one should look to get involved in vs. steer clear of, what sorts of organizations make the most sense to support, etc.

This post lays out:

  • Several different visions of policy-oriented philanthropy and what it does best, based on conversations that we’ve had.
  • Some preliminary impressions of which (mostly U.S. federal) policy issues might be promising areas for a new philanthropist.
  • Key questions we still have on this front, and plans for moving forward from here.

Different visions of policy-oriented philanthropy
An essay by Steven Teles and Mark Schmitt (also discussed in the previous post on this topic) lays out one vision of policy-oriented philanthropy: that of engaging in very long-time-horizon (a decade or more) efforts to build the capacity of relevant organizations, so that when the right political moment comes – which can happen at unpredictable times and in unpredictable ways – the stage is set for maximal positive change. This view was reinforced by our conversations with the two authors as well as with Frank Baumgartner.

Under this view, it seems that one should not put too much weight on the apparent “political tractability” of the change one seeks. Political tractability can change quickly and unpredictably. Moreover, while a particular desired policy change might be unrealistic, there may be as-yet-unforeseen opportunities to improve dramatically on the status quo by advocating for subtle changes in legislation, stopping problematic new legislation, etc. Thus, rather than ask “Is the change I want feasible?” a philanthropist should ask “Can I strengthen the groups that share my general perspective?”

Broadly speaking, this vision seems to imply that a philanthropist should seek out constellations of interest groups that “should have more capacity than they do,” given the importance of the issues they work on. And since dramatic victories can be won even when the victors have far fewer resources than their adversaries (a point made by Prof. Baumgartner), one should not necessarily steer clear of issues with strong opposition; if anything, one should steer clear of areas in which the side one agrees with is already well-developed and well-resourced, leaving less room for further philanthropic impact.

One could apply this sort of thinking to choosing between issue areas (for example, tax policy vs. drug policy), or – as Prof. Teles encouraged us to do – one could focus more broadly on strengthening the infrastructure around one’s preferred general ideology. (Prof. Teles has written about the role of conservative foundations in strengthening the voice of conservatism in American policy in general.)

I think this viewpoint has much to recommend it: long-term building of interest groups’ capacity may be something that philanthropy is uniquely well-suited to do, and the case studies that have been cited make it clear how this approach might pay greater dividends than shorter-term attempts to influence debates whose interest groups and other parameters are already well-defined. With that said:

  • We haven’t vetted the case studies cited in support of this viewpoint.
  • We believe that very-long-term planning is inherently more difficult than shorter-term planning, and runs the risk that the change one achieves is not the change one hoped for. There are certainly cases in which I could imagine strengthening the capacity of interest groups that – today – agree with me on the desired direction of desired policy change, but will disagree with me by the time they have an impact.

A couple of possible alternative approaches:

  • One could seek out issues in which it looks like a change (from the status quo) is already imminent, and hope that these provide more latitude to influence exactly what sort of change takes place. One person I spoke with (notes forthcoming) advocated taking on issues such as drug policy, criminal justice policy, and policies relating to NSA surveillance: in all three of these cases (he argued), the status quo appears largely untenable and vulnerable to change, and some extra funding could cause a “tipping point” – or change the shape of the solution that is eventually settled on. (Good examples of the latter goal can be seen in our conversation with Mark Kleiman, who feels – on both drug policy and criminal justice policy – that there are multiple paths to change, some better than others.)
  • One could put very high weight on political tractability, seeking out issues – even if they aren’t the most important issues, in isolation – where one can expect concrete results on a relatively short time frame. One funder that may be following a strategy along these lines is Pew Charitable Trusts, whose document on evaluation presents a very different picture from the essay linked above from Teles and Schmitt – implying a general expectation of tangible results on ~5-year time frames.

The first approach in this section is the one we’ve seen most commonly and articulately advocated, though we continue to search for “policy generalists” who can engage with this question and provide more perspectives.

Preliminary impressions of several issues
As part of our initial explorations, we’ve asked around about issues that might represent particularly good opportunities for a philanthropist to accomplish good. Below, we give overall impressions on several issues (not all of which we consider promising) based mostly on conversations with Steven Teles, Mark Schmitt, Gara LaMarche, Frank Baumgartner and Dylan Matthews (as well as informal impressions and observations). As with previous posts, “success” refers to impact on policy and not necessarily to positive social impact, and we don’t necessarily have confident views on the “right side” of the issues below; we report on issues that have been cited to us as opportunities for positive social impact, and focus on the change that advocates for working on these issues have supported.

  • Immigration policy. The ongoing debate in Congress over immigration reform has attracted significant attention and funding on both sides of the issue; the Alliance for Citizenship is a coalition of pro-reform groups. With that said, (a) there is relatively little in the way of groups dedicated to labor mobility as opposed to questions around e.g. the path to citizenship; (b) if an immigration reform bill passes, it is likely to leave a lot of latitude to the rulemaking process, and there may be opportunities for impact via lobbying rulemakers.
  • Criminal justice reform. This cause has been highlighted to us as an unusually tractable political cause, in which results at a sub-federal level might be expected within a few years (more at our conversation with Steven Teles). While there are several funders with substantial budgets in this area, there appears to be very little in the way of funding and infrastructure around the sorts of ideas promoted by Mark Kleiman, which we find intriguing.
  • Drug policy. The momentum (in terms of public opinion and recent state-level policy changes) around relaxing restrictions on marijuana may create opportunities for impact, either in terms of accelerating the relaxation of restrictions or affecting the specifics of new regulatory frameworks.
  • Climate change mitigation. It’s clear (see our writeup on climate change philanthropy) that there is a relatively large amount of philanthropic involvement in this issue already. Some expressed the view that it is still a promising area for a new philanthropist because of weaknesses in the current players’ strategies (some of which were alleged in a paper by Theda Skocpol that we’ve been pointed to more than once).
  • Factory farming. It seems that animal welfare-oriented groups in general are well-funded and -organized, though it also appears that they do not focus on factory farming. Steven Teles noted that working to change the discussion around factory farms’ general image and influence could have multiple benefits (for example, it could also lead to progress on the issue of farm subsidies, which have been criticized as harming the global poor).
  • Foreign aid. The “generalists” we spoke to didn’t seem familiar with this area. Center for Global Development representatives expressed mixed feelings on whether there is room for more philanthropy on this front.
  • Intellectual property reform. Several people we spoke to felt that current intellectual property protections are too restrictive, that this is an important issue, and that there is relatively little in the way of funding and interest groups pushing for them to be less so.
  • Structural political reform, including addressing the role of money in politics. We got mixed messages on the promise of this topic. Some of the people we spoke to were highly skeptical about the prospects for creating much positive change through campaign finance reform; Steven Teles argued that well-organized, well-funded groups are likely to be disproportionately influential regardless of finance regulations, a view that makes sense in context of our previous observations on the role of money in politics. He was more enthusiastic about the goal of “improving quality of governance” (by e.g. improving the quality of regulatory agencies’ staffs), and others (e.g., Gara LaMarche) expressed somewhat more optimism about finance reform.
  • Undermining “rent-seeking” policy. This is a very broad category of mostly sub-federal-level policy changes that Steven Teles expressed enthusiasm for: loosening government restrictions on matters such as who can act as dentists, taxi drivers, etc. Prof. Teles gave us the impression that there are currently fairly strong interest groups defending such restrictions, and very little in the way of groups working against them, since the benefits of freer competition would be highly diffuse (there’s no particular interest group that would benefit as strongly from them as the pro-restriction interest groups suffer from them).
  • Science funding. Government funding of scientific research has broad bipartisan support, and there are a fair number of interest groups representing universities and patients associated with particular diseases and conditions. The budget of the National Institutes of Health roughly doubled under Bill Clinton but has been fairly stagnant since.
  • Marriage equality. The defeat of DOMA is part of one of the great recent success stories of policy-oriented philanthropy. Success in securing equivalent marriage rights for homosexuals and heterosexuals is not complete, but given the state of public opinion and other factors, it looks likely that it will become so.

Our plans going forward
So far, we haven’t found a large number of people who will engage broadly (and knowledgeably) with us about the role of philanthropy in influencing policy, and about the relative merits of different issues as laid out above. We plan to continue looking for such people, largely via referrals, and to continue publishing conversation notes from our discussions with them. We’ve also been given a significant amount of recommended reading that we plan to explore to further develop our basic feel for policymaking and philanthropy’s potential role in it.

In particular, we hope to gain more perspectives and information on a couple of key questions:

  • What’s the best time frame for a policy-oriented philanthropist to have in mind? Does the potentially magnified impact of very long-term capacity-building make up for the higher level of uncertainty?
  • To what extent it is important for us to seek out grantees that are highly aligned with our views, as opposed to roughly aligned (e.g., on the same side of the status quo?) We could imagine doing net harm to our goals by building the capacity of groups that are aligned with us in today’s environment, but not tomorrow’s. On the other hand, the higher degree of alignment we seek, the fewer options we can expect to have.
  • What information is available about the track record of policy-oriented philanthropy?
  • What issues are most promising for a new philanthropist to enter, and why?

In the meantime, however, we plan to move forward with investigations of specific issues that have been highlighted as promising in our investigations so far. We feel that we may learn more about the above questions via issue-specific investigations and conversations than via more general ones.

6 tips on disaster relief giving

Our general advice on disaster relief giving:

1. Give cash, not clothes (or other goods). Giving away unwanted items makes donors feel good, and relief agencies can be under substantial pressure to accept their gifts-in-kind. But shipping and sorting these gifts can be a substantial expense and hassle, and such gifts can literally get in the way. If you have items you don’t want, consider selling them and donating the proceeds. Gifts-in-kind burden relief organizations with figuring out how to use what they have; cash allows them to quickly get what they need. More

2. Support an organization that will help or get out of the way. Logistics can be a major challenge in disaster situations. For example, when we followed up on the Haiti earthquake relief effort a year after the incident, we found that much of the disaster relief money had still not been spent, and that ~80%+ of the rubble had still not been cleared. A highly professional, experienced organization with a pre-existing presence in the affected country will likely help where it can, and stay out of the way where it can’t. But a less professional organization could easily detract from the relief effort.

3. Give proactively, not reactively. Don’t give to a charity just because it calls you on the phone, advertises on your Google search or otherwise connects with you first. That rewards the most aggressive organizations instead of the most competent and responsible ones. Instead, give not just money but thoughtfulness – take the time to find the best giving option you can.

4. Allow your funds to be used where most needed – even if that means they’re not used during this disaster. Disasters attract a great deal of media attention and money, yet in many cases the biggest challenge is logistics. The result can be that money isn’t the limiting factor in the immediate relief effort. We found evidence of this both for the 2010 Haiti earthquake and the 2011 Japan tsunami.

That doesn’t mean money isn’t needed. The rebuilding effort can be very expensive. Beyond that, there are many disasters – and cases of everyday suffering – that aid organizations struggle to address, without being able to raise nearly as much funding for them as they can for a media-dominating disaster. It’s common for charities to use a disaster as an opportunity to raise funds for their other work.

We recommend giving to an organization that does outstanding work around the world (not just in the affected area), with no strings attached.

5. Give to organizations that are transparent and accountable. In general, we’ve found that relief organizations disclose very little about what activities they undertake and how they spend relief funds (more at our reports on the 2010 Haiti earthquake and the 2011 Japan tsunami). In general, when a disaster strikes, the first organizations we turn to are:

  • Doctors Without Borders (MSF), which has distinguished itself with well-above-average transparency in both of the cases listed above. In the case of the 2011 Japan tsunami, it straightforwardly disclosed that it was not seeking more funding for use in the relief effort, and was one of the only organizations to do so. We believe it’s worth rewarding MSF for its unusual transparency, and if it doesn’t use your money on this disaster, it will likely use it to address a less-publicized crisis.
  • The local Red Cross. The Red Cross generally takes a leading role in a relief effort and (it seems to us) is assigned credit/blame for how the overall effort goes, to a greater degree than other nonprofits. The American Red Cross will often redirect donations to the local Red Cross, minus a sometimes-substantial fee.

We wrote more about these two options when we made recommendations about how to respond to the 2011 Japan earthquake/tsunami.

6. Think about less-publicized suffering. Every day, people die from preventable and curable diseases, in many cases because they lack access to proven life-savers such as insecticide-treated nets. Their day-to-day suffering isn’t well-suited to making headlines, and they generally don’t attract the attention and dollars that disaster relief victims do – yet we believe that donations targeting these populations do more good than disaster relief donations.

If a recent disaster has given you a strengthened desire to reduce suffering and help others, consider asking whether you might be able to broaden this desire and make it part of your everyday life. Consider joining the community of effective altruists seeking to make their hours and their dollars go as far as possible toward making the world a better place. GiveWell’s role in that community is to put thousands of hours of research into identifying the best giving opportunities possible – not the ones that make the news, but the ones that will make your dollars go the farthest.

For more advice, see:

The track record of policy-oriented philanthropy

[Added August 27, 2014: GiveWell Labs is now known as the Open Philanthropy Project.]

As noted previously, I’ve been working on improving our broad understanding of the role that philanthropy can play in influencing and informing policy. One of the questions I’ve been focused on is “What is the track record of policy-oriented philanthropy?” Specifically:

  • Are there compelling cases in which a major policy change can be partially or fully credited to philanthropic efforts?
  • How often have philanthropic efforts succeeded in bringing about change? Often enough to imply a good “return on investment?”

I’ve concluded that answering these questions reasonably well could require an enormous, long-term effort. This is true both because the questions are inherently difficult to answer – many of philanthropy’s claimed impacts on politics are highly long-term and diffuse, such that it is difficult to confidently isolate impact – and because there has been little academic work on the subject.

Below, I first list salient examples I’ve seen in which philanthropy is believed (by some) to have had an important impact on public policy. I think the nature of these examples illustrates some of the challenges with isolating the impact of philanthropy. I then discuss our understanding of the current state of the literature on this topic, and what we would do to make more progress. For the purposes of this post only, “success” is defined as causally impacting public policy, not as having positive social impact, since the goal is to determine how and when philanthropy has been effective in changing policy (the question of how policy should be changed is a different question).

Potential cases of philanthropic impact on public policy

Many of the claimed success stories of policy-oriented philanthropy involve long-term (sometimes 10+ years), diffuse impacts. Pages 4-8 of The Elusive Craft of Evaluating Advocacy, by Steven Teles and Mark Schmitt (both of whom we’ve spoken with – see conversations notes for Teles and Schmitt) give a good feel for this kind of story, and cover some of the cases we’ve frequently heard reference to: the role of Atlantic Philanthropies and others in laying the groundwork for the Affordable Care Act, the role of (presumably philanthropy-backed) church and student groups in “claw[ing] back the application of the death penalty,” the repeal of the “Don’t Ask, Don’t Tell” policy, and impact of the conservative Federalist Society, which is claimed to have magnified the impact of other organizations on law. We excerpt the part about health care reform, as an example:

The effort that culminated in 2010 was the work of decades, including a previous, high-profile failure in the early 1990s, multiple waves of state-based reform and numerous incremental efforts at the national level. Advocates invested hundreds of millions of dollars on initiatives ranging from media initiatives such as encouraging television producers to include stories of the uninsured, multiple coalition-building projects, university- and think tank-based research and well-funded grassroots initiatives.2 The basic outlines of reform policies were worked out well in advance, in advocacy groups and think tanks, who delivered a workable plan to presidential candidates. Key interest groups who could block reform, such as small business, had been part of foundation-supported roundtables seeking common ground for years. Technical problems had been worked out. And tens of millions of dollars had been set aside as long ago as 2007 for politically savvy grassroots advocacy initiatives targeted at key legislators. After a very long slog, the outcome was the Affordable Care Act.

Another very long-term, diffuse impact that has been cited to us is the case of the Robert Wood Johnson Foundation’s efforts to reduce tobacco use.

  • Activities included funding research on the impact of policy on tobacco use (page 13), funding early-career researchers in the hopes of developing a stronger set of professionals focused on the issue (page 17), creating the Campaign for Tobacco-Free Kids (page 17), and indirect support for state-level lobbying (page 20).
  • The program started in 1991 and had reached ~$20 million per year by 1993 (page 12), but its goals – changing policy to be more discouraging of tobacco use and ultimately reducing smoking rates, particularly among minors – don’t seem to have shown much progress until after 1996 (see pages 36-38 for policy change indicators, page 26 for smoking rate data).
  • Given the number of different initiatives RWJF created and invested in, the number of states it worked in, and the long-term nature of some of its investments (building organizations, funding research and researchers), evaluating the extent to which its funding can be “credited” for reductions in tobacco use could be an extremely challenging project.
  • The Foundation spent ~$700 million in this area over time (page 12); if one assumes it reduced the number of smokers by 10 million (its evaluation estimates 5.3-14.2 million, page 28), then the total cost of the program was ~$70 per “person stopped from smoking,” which would compare favorably to our estimate of ~$80 per life-year gained for our top charity if smoking causes one to lose multiple years of life. The point of this calculation isn’t to praise the program – we haven’t vetted these figures and realize there are a substantial number of questions here – but to illustrate that the sort of claims made about policy impact imply potential competitiveness with our top charities.

We have also seen claims of shorter-term, more tangible impact of funders and nonprofits on public policy, though usually at smaller scale. Change Philanthropy goes through several such cases, including a movement in which lawsuits were brought against states alleging that they needed to invest more in education to comply with their own constitutions. The Center for Lobbying in the Public Interest also lists smaller-scale success stories. I’ve heard multiple informal claims that online advocacy groups had tangible, extremely rapid impact on halting (a) passage of the Stop Online Piracy Act (b) construction of the Keystone XL pipeline.

Assessing the ROI of policy-oriented philanthropy

While we’ve seen many claims of impact, none appear easy to assess. Moreover, the most prominent and largest-scale claimed impacts generally appear the hardest to evaluate.

We’ve asked multiple people (including Frank Baumgartner, Mark Schmitt and Steven Teles) whether there is a literature that might help us in this endeavor. It appears that we aren’t going to find any work systematically looking across a large number of philanthropic efforts to change policy, such that we could get an idea of aggregate return-on-investment. We may be able to find case studies on specific policy changes.

We don’t see a clear or easy path to assessing the question, “Can policy-oriented philanthropy have a high enough probability of success to make the cost-effectiveness competitive with our top charities?” We expect our History of Philanthropy project to generate better information on particular, high-profile claimed successes (perhaps via reviewing existing case studies, perhaps via generating new ones focused on the role of philanthropy). If it does, we may consider a more systematic project aiming to catalogue and investigate the policy-oriented work of a representative set of foundations. But it could be a long time before we have useful estimates of the “good accomplished per dollar” of policy-oriented philanthropy, and in the meantime, we will be moving forward on exploring good opportunities within policy-oriented philanthropy.

Reason to be optimistic about ROI

One rough, heuristic-based reason that I’m optimistic about policy-oriented philanthropy (in terms of “impact per dollar”) is that it generally seems like a given amount of money “means more” in the context of policy-oriented work than in other contexts.

There are many reasons that this comparison could be unfair or irrelevant, but it syncs with my general impression that the amount of money it takes to be a “significant player” is smaller in policy-oriented work than in direct aid or scientific research.