The GiveWell Blog

My favorite cause for individual donors: Global health and nutrition

(updated on: ) | by Holden

My favorite cause used to be U.S. equality of opportunity. But over the years since we started GiveWell, I’ve become more and more convinced that the best giving opportunities for individual donors lie in the area of global health and nutrition.

Fundamentally, this area stands out because it involves a lot of interventions that have measurable, demonstrable, quantifiable benefits, yet also haven’t been funded to reach everyone who can benefit from them. (See our list.) It’s the only aid area I know of fitting this description. This has made charities working in this area a good fit for our criteria.

One might retort that this just shows our criteria to have the problem of focusing on what can be measured, rather than on what’s best, but I would disagree. I think that there are good reasons to believe that the cause of global health and nutrition really does contain the best – and not just the most easily understood – giving opportunities.

  • Global health and nutrition interventions have the most impressive track record in international aid, with the possible exception of funding scientific research. I believe (though we are still investigating this) that the same holds for aid in general. To some extent this may be an artifact of how measurable the goals are, but it’s still a point in this cause’s favor.
  • Global health and nutrition interventions are incredibly cheap on a per-person basis. We don’t have “cost per life saved” type figures for any programs outside of health, largely because the effects of these programs aren’t well-known enough. But consider that
  • Health and nutrition programs are particularly good at having clear goals and accountability, leading to learning over time. Because benefits can be quantified and predicted, targets can be set, and adjustments can be made when they’re not met. We’ve been placing more emphasis on the criterion of accountability, i.e., the likelihood that giving will lead to learning. Health and nutrition interventions stand out in terms of the likelihood that giving will lead to learning.
  • Room for more funding is relatively easy to gauge in the area of health and nutrition. We believe that one of the thorniest issues that a donor has to contend with is that of room for more funding. In an area like funding scientific research (which otherwise has much to recommend it as a charitable cause), it’s particularly hard to answer the question, “How does the value of the next study on the priority list – the one that no one else has funded and that my funding will make possible – compare to the value of the average study overall?” This isn’t nearly as much of an issue when delivering global health and nutrition interventions; the expected benefits of running an additional project tend to be easier to quantify.
  • Health and nutrition are fundamental to quality of life. In my view, the value of additional education – or additional income – depends a lot on the context, but health and nutrition are fundamental and universal needs. In addition, with economic empowerment or education interventions, I tend to worry about the difficulty of distinguishing “zero-sum benefits” (helping some people at the expense of others) from “positive-sum benefits” – a well-intentioned business training or education program could end up simply transferring power/wealth from some people in a community to others, and this could be very difficult to distinguish from actually improving these people’s productivity. I feel this is much less of a concern when it comes to health and nutrition.

What problems are best suited to having money thrown at them?

I’m not arguing that health and nutrition are the most important issues in the world. There are many changes in the world that I’d like to see and that I believe are worth fighting for. There are many fantastic uses of money outside the sector of global health and nutrition; many involve taking risks on building institutions and producing public goods. But when thinking about how individual donors can do good, my mind jumps to the easiest ways to have impact without having special insight – the problems that are most likely to be solved by “throwing money at them.” When this is the goal, being able to measure, demonstrate and quantify one’s impact is enormously helpful.

According to our analysis, ~$5 can buy a bednet or 10 years of deworming – either of which will have a substantial, quantifiable, definite impact on quality of life. That can empower a person who is better positioned than you are to address many of their other problems. I believe that for a donor interested in making the world better just by writing a check, this sort of value-for-money may not be available in any other cause.

Dissenting opinions on our top charities

(updated on: ) | by Elie

We feel very good about recommending that donors give to our top charities, and they’re where all GiveWell staff are – happily and confidently – giving our personal donations this year.

That said, we’re skeptical by nature, and internally, we keep thinking about and discussing the ways in which our top charities might not work out: i.e., the scenarios/circumstances in which giving to these charities doesn’t accomplish what we expect or our views change substantially in the next year about what donations to these charities accomplish.

If I were going to write the equivalent of a “dissenting opinion” for our top charities, it would be based on the issues below.

AMF: insecticide-treated net distributions

Our #1-ranked organization is the Against Malaria Foundation (AMF). Our recommendation relies on the fact that there have been numerous randomized controlled trials (RCTs, i.e., high-quality studies) tying net distributions to reductions in childhood mortality, but there’s a question of external validity for these RCTs. Is it reasonable to assume that net distributions of the type AMF carries out will have the same sort of effects they’ve had in the studies? There are a couple of reasons to question whether they will.

In our analysis of the RCTs, we found one trial where researchers conducted random spot checks to people’s houses at 5 in the morning to make sure that nets were being used. In another case, researchers, themselves, installed the nets in participants’ homes. In general, we had the impression that researchers were working hard to make sure that nets were used as intended. While AMF’s distributions (and large-scale distributions in general) involve some measures for community education and monitoring of usage, we don’t think they’re comparable to what was done in the RCTs.

For nets to be effective, people need to use them appropriately and consistently. It’s not hard to imagine someone receiving a net one day, but over time not consistently using it well.

The best available data seems to indicate that on a large scale, people use their nets relatively consistently – in line with the usage rates seen in the RCTs (which did not, themselves, reach 100% usage). But the best available data isn’t as robust as we’d like it to be, particularly when it comes to the distinction between “reported usage” and “actual usage” (our best attempts to adjust for this indicate that it is not a major issue, but we aren’t working off much information).

Another way in which large-scale net distributions could fail to live up to the small-scale studies has to do with malaria transmission dynamics. It’s possible that mosquito populations and transmission dynamics have changed in the several years since the last small-scale study was done; it’s possible that the studies were done in areas that were unusually well-suited to seeing big drops in malaria come from nets; it’s even possible that widespread use of nets could lead to increasing resistance in mosquito populations over time. We haven’t seen any strong reasons to believe that any of these things are the case; in particular, we don’t believe that data on transmission dynamics is strong enough for the small-scale studies to have picked out particularly favorable settings. But it’s a definite point of uncertainty.

One point of reassurance here: as we observed previously, the malaria control community spends a huge amount of money on distributing nets. So if one of these concerns ends up being a huge problem, finding out about it (as we hope AMF will) could be hugely beneficial in and of itself, by helping the malaria community better execute distributions and/or better allocate resources.

SCI: deworming

Our evidence review of deworming concludes that there isn’t a particularly strong case that deworming has a significant impact on individuals’ life outcomes. The evidence boils down to (a) two well-respected but far-from-ironclad research papers on the long-term effects of deworming and (b) a large degree of evidence that deworming has a consistent (but limited) impact on haemoglobin levels (which are measured to determine anemia). Our positive view of deworming stems from the fact that although there is limited evidence of quality-of-life significance, the intervention is so cheap that it is likely to be a relatively good buy and may be a great buy.

Our view of deworming is highly susceptible to change based on evidence. A single pre-registered, large-sample RCT that did not find significant impacts on development for dewormed children would significantly adjust our view about the likely impacts of deworming. Combing through the data of one of the existing papers on deworming – which we plan to do in 2012 – could easily adjust our view of the intervention. In addition, despite the fact that SCI’s evidence of impact is as strong as we’ve ever seen in a charity, we still have our doubts about it.

Given this situation, it’s not hard to picture a world in which our view shifts substantially by the end of next year.

Both organizations

Both AMF and SCI partner with governments and NGOs to implement their prorgrams. This means that neither is in complete control of their activities and they could run into problems caused by, among other things, (a) lack of funding for the components of their programs that they don’t directly fund (more on this in Holden’s recent post about charitable leverage) or (b) governments changing their minds about working with each. Note that SCI has already had one program (in Zambia) where results have been quite disappointing and data remains thin.

Difficulty in dealing with partners is a significant risk in aid, and one we’ve learned about this past year from some of the challenges VillageReach is facing in its scaleup in Mozambique.

Putting the dissents in context

The above concerns are very real, but they’re much smaller than the concerns we have for any other charity in existence.

Some seem to believe that concerns ought to be hidden from donors, to encourage them to give. This may make sense for many donors. When dealing with our own audience, we feel much better asking you to give with eyes wide open: recognize that there are no guarantees, but that the things your money can accomplish – in terms of improving others’ lives – are incredible. We think that’s more than enough reason to give without regret.

Give now or give later?

(updated on: ) | by Holden

People sometimes ask us whether they should give now, or save their money and give (including the interest/returns they accrue on their money) later. We don’t think there’s a clear answer. Here are the major issues as I see them, when thinking about my own giving. Bottom line – my favored strategy at the moment is to give regularly (a set percentage of my income each year).

Will tomorrow’s giving opportunities be better than today’s?
GiveWell’s progress may lead to better giving opportunities in the near future. I believe GiveWell’s research is the best available for identifying great giving opportunities; but GiveWell is still a very young organization, and we still have a lot to learn. It’s very possible that we’ll find much better giving opportunites in the future.

On the flip side, our growth and learning depends on growing our money moved. Giving to our top charities today helps this happen.

None of the best giving opportunities I see today are guaranteed to be good opportunities next year. In some cases (particularly VillageReach in 2010), giving now may be crucial to an organization’s development. Even when this isn’t the case, there’s always the possibility that the organization will improve its fundraising – or make a contact with a large funder – in the future, affecting its room for more funding.

Economic growth, increased giving, and smarter giving may mean that giving opportunities are worse in the far future. We’ve written before about the idea that the more good is being done by others, the fewer opportunities you have to do a lot of good with your own giving. We hope to see a day where no one is so poor/underserved that you can save their life by giving few thousand dollars.

Do I “earn interest” by saving now and giving later?

If I save, I earn interest/returns on my money; but if I give, the good I accomplish may “earn interest” too. Ideally, donations give people more power over their lives, which in turn leaves them better positioned to help others (in their community or elsewhere). We take seriously the idea that most problems may be better addressed by local communities than by outside aid; we focus our outside aid on the problems we feel it is best-suited to address.

In general, I would guess that the conceptual “interest rate on empowering people” is higher than the interest rate you earn when you save. This is because the same basic mechanism underlies both (having more resources today can allow a person to generate more resources for the future), but savers get paid directly for providing resources, while donors don’t (thus, there is likely more “unmet need” for donations than for savings). Given today’s interest rates, it seems particularly likely that the “interest rate on empowering people” is higher than the interest rate you earn when you save.

Other issues
Giving now means “putting my money where my mouth is.” I believe that having my own money at stake helps me think harder, more concretely, and more realistically about where I should be giving and what results I’m expecting from my giving. This in turn helps me learn over time.

I think the same applies, to a lesser extent, to donors who are relying on GiveWell’s research rather than doing their own – giving now may help you think through what questions to check GiveWell’s answers to, and consider how you feel about relying on GiveWell’s research vs. going in another direction.

If I postponed substantial giving for a long time, I’d worry that I was giving myself an excuse not to give at all.

Giving regularly and predictably is more helpful to the group(s) I’m supporting. In general, people tend to give the same donations each year,* and I believe that charities often plan around this fact. (We certainly do, both when considering our operating expenses and when considering our money moved.) Therefore, if you give irregularly (particularly if your donations go down over time), you are sending an inaccurate message to a charity and may be negatively affecting its ability to plan, unless you take specific efforts to communicate your plans (and even when you do so, this may create extra hassle for the charity).

Bottom line. In general, my preferred approach is to give relatively regularly; I think there are substantial disadvantages (discussed above) to deviating from this approach in either direction (giving a lot now and only a little later, or giving a little now with the intent of giving a lot later).

At some point I may spot a giving opportunity that seems like a true outlier, and focus my giving on that opportunity rather than giving regularly over time. To give one example of this – when we started GiveWell, we believed that our startup funds were critical, and thus we encouraged donors to give a large amount immediately even if it meant abstaining from giving for the next year or two. Several did exactly this, and I think in hindsight it was the right decision (their 2007 gifts were in fact critical for our getting off the ground, in a way that they wouldn’t have been a year later). So I do think there can be good reason to “over-give” now and hold back later, or to save now and give more later. But right now I don’t see any compelling argument for deviating from “give a set percentage of my income each year.”

*Our experience suggests this; the Money for Good study suggests it as well (see page 16).

6 tips for giving like a pro

| by Elie

This time of year, just about every news agency publishes an article titled something like “6 tips to give wisely this holiday season.” (Examples here, here, and here.) The advice they give makes sense to a degree – make sure the charity isn’t a scam, check that the CEO’s salary doesn’t account for 90% of the charity’s budget, etc. – but it’s really targeted at someone who’s aiming to not waste his/her money. For donors interested in accomplishing the most good possible with their money, here are 6 tips to help you take your giving to the next level.

1. Be proactive. If you find yourself considering a gift to a charity that called you on the phone, you’ve already lost most of the battle to do as much good as possible. Your dollars will go furthest if you set time aside, think about all your options, and go find the best charity for your values. If you wait for charities to come to you, you’re just rewarding the ones that are most aggressive – not the ones that do the most good.

2. Be open minded about the cause you’re going to support. The amount you can accomplish with your donation varies widely from cause to cause to cause. We’ve written about this before in the context of giving to charities that work overseas instead of those that work domestically.

But, even if you’re not ready to shift your giving that much, you can improve your impact just by broadening your scope. Are you interested in supporting education in the US? Consider organizations that work outside your community as opposed to just considering local ones. Are you interested in supporting your local community? Consider multiple different categories of organization – job training programs, schools, food banks, etc. The more you’re open to different options, the more likely you’ll be to find and support outstanding – not just “acceptable” – organizations.

3. Ask organizations to make a case that their programs work. For example, if you pick a school, ask them why they think they’re improving academic performance for their students; ask them why they think they’re doing a better job than a similar school you could support; ask them for any data they have that supports their case. For more ideas about what to ask, refer to our do-it-yourself charity evaluation questions.

4. Ask organizations how they’d use additional funding. It’s one thing for an organization to have accomplished great things in the past. But, if you’re giving today, you really need to focus on what they’ll do in the future and how your donation (and other future donations) will make a difference.

Some organizations may have a pressing need for funds such that additional money this year will allow them to expand services. Others may already have enough in the bank such that your donation will only grow an already-safe level of reserves. Alternatively, the organization may be so small that money isn’t the bottleneck to expansion, and it can’t effectively expand even with more money.

We call this the concept of room for more funding, and it’s key to GiveWell’s assessment of our top charities.

5. When you give, give cash – no strings attached. You’re just a part-time donor, but the charity you’re supporting does this full-time and staff there probably know a lot more about how to do their job than you do. If you’ve found a charity that you feel is excellent – not just acceptable – then it makes sense to trust the charity to make good decisions about how to spend your money.

6. Check back a year later and see whether the organization met its commitments. When asking about the organizations about their room for more funding or evidence of impact, you (hopefully) heard about plans they had for the coming year. Check back to see how their activities – and results – match up.

These tips may making giving sound like a full time job. We think it is. You can leverage the work we’ve done, and save your own time, with a gift to one of our top charities. But if you’re interested in causes we haven’t been able to cover, the above tips will help you make the most of your generosity.

Leverage in charity

(updated on: ) | by Holden

The Schistosomiasis Control Initiative (SCI) told us earlier this year that it had received a donation of praziquantel (the more expensive of the drugs it uses for deworming) from World Vision. Since it already has the drugs, donations can pay just for delivery costs. Thus, SCI observed, your gift is “leveraged” – $1 in donations buys more than $1 in health programming, since the drugs are essentially “free.”

The Against Malaria Foundation (AMF) in some ways achieves leverage through the opposite strategy. It doesn’t pay for the costs of distributing nets or even shipping nets – it only pays for the nets themselves. Partners are charged with raising funding elsewhere for shipping and distribution (though they are required to do these things; nets aren’t granted without a distribution plan in place). By adhering to this policy, AMF puts other funders – including some government agencies – in a similar situation to SCI’s donors: the nets are essentially “free,” so $1 from these agencies buys far more than $1 in health programming. Because of this dynamic, these other funders (AMF argues, correctly from what we can see) are happy to provide this funding – so the original donor’s gift is “leveraged” too (by buying just a net, the donor gets “free” shipping/distribution costs).

How far could this logic be extended? What if a charity first raised money for travel expenses, then went to another donor and raised money for field staff arguing that “travel expenses are essentially free,” then went to another donor and raised money for supplies arguing that “field staff and travel expenses are essentially free,” etc.? What if a charity went to 50 million separate donors, asking each to give $1 contingent on each of the other 49,999,999 giving as well, arguing that this created 50,000,000:1 leverage for each of the $1 donors?

We think that much of our discussion of donation matching applies here. If you take claims of “leverage” literally, you’re allowing other funders – the ones who gave pills, or nets, or covered distribution costs – to influence your giving merely through the structure of their gift. That in turn creates incentives for them to take gifts they would have made anyway, and structure them in a way that gets you to give more to the program of their choice. In fact, these other donors may even be taking advantage of you to pay for costs they would have been happy to cover themselves. Perhaps World Vision would pay for distribution, but knows that by giving “only pills” it can get others to pay for distribution. Perhaps AMF would pay for distribution if it had to, and doesn’t only because it believes it can get others to.

Understanding the true nature of leverage – who is the “leverager” and who is the “leveragee” – is difficult. When someone else is giving contingent on your giving, and this fact in turn influences your giving … sometimes this means that you’re getting them to give more (or differently) than they would have otherwise (in which case you’re the “leverager”) and sometimes it means the reverse (in which case you’re the “leveragee”). We don’t know of any easy/reliable way to tell which situation you’re looking at, and when.

With this in mind, our general principles for considering leverage are:

  • You can’t take “leverage factors” at face value, for largely the same reasons that you can’t take donation matches at face value.
  • It’s probably a good thing when the charity you support is engaging in some sort of “leveraging.” This means it’s putting thought into getting your funds to influence others’ funds. If you believe that you’re supporting the most impactful charity possible, this means that others’ funds may be moving from less impactful activities to more impactful activities. (Though the situation isn’t this simple: we believe that governments and other large funders often have a much better array of options for impactful giving than the individual donors we serve.)
  • The exact relationship between the claimed “leverage” and your actual impact is very non-straightforward. It may seem that you have more “leverage” when your $1 causes someone else to spend $9, as opposed to when it gets someone else to spend 10c. However, in the former situation, there’s a much higher probability that you are in fact the “leveragee” – that the other funder would cover the other 10% themselves if it weren’t for you, and you’re just saving them money. In general, it seems to us that the higher your claimed “leverage,” the greater the probability that someone else is in fact leveraging you.

    If anything, we would guess that your true impact is higher when the “leverage” is well under 100% (i.e., the other funder is giving less than $1 for each $1 you give), implying that the other party is likely providing funding because of the “leverage” they attain rather than because they would want to fund the project on their own. Once you have another major funder covering a major chunk of the costs, it becomes more important to ask whether they would be willing to cover all of them if the “leverage” from you and similar donors weren’t available.

When we do cost-effectiveness estimates (e.g., “cost per life saved”) we consider all expenses from all sources, not just funding provided by GiveWell donors. For SCI, we count both drug and delivery costs, even when drugs are donated. (Generally, we try to count all donated goods and services at market value, i.e., the price the donor could have sold them for instead of donating them.) For AMF, we count net costs and distribution costs, even though AMF pays only for the former. In the case of VillageReach, we even count government costs of delivering vaccines, even though VillageReach works exclusively to improve the efficiency of the delivery system.

We consider this approach the simplest approach to dealing with the issues discussed here, and given our limited understanding of how “leverage” works, we believe that this approach minimizes the error in our estimates that might come from misreading the “leverage” situation. As our understanding of “leverage” improves, we may approach our cost-effectiveness estimates differently.

Why you shouldn’t let “donation matching” affect your giving

(updated on: ) | by Holden

We know that donors love donation matching.* We know that if we could offer donation matching on gifts to our top charities this giving season, our money moved would rise. And we know that we could offer donation matching if we thought it was the right thing to do: there are donors planning six-figure gifts to our top charities this year who would almost certainly be willing to structure their gifts as “matches” if we asked. (It might not be possible to “match” all of our money moved, but we could almost certainly provide “matching” for a short period, which would motivate people to give during that period and would also provide us with some data on the impact of matching on our audience.)

But we’ve decided not to do this because we would feel dishonest. We’d be advertising that you can “double your gift,” but the truth would be that we just restructured a gift from a six-figure donor that was going to happen anyway. We’ve discussed whether we might be able to provide “true” donation matching – finding a donor who would give to our top charities only on condition that others did – but not surprisingly, everyone we could think of who would be open to making a large gift to our top charities would be open to this whether or not we could match them up with smaller donors. Ultimately, the only match we can offer is illusory matching.

I don’t deny that non-illusory matching may exist in some other circumstances. A couple possibilities:

  • Coordination matching. A charity needs to raise a specific amount for a specific purpose. A large funder (the “matcher”) is happy to contribute part of the amount needed as long as the specific purpose is achieved; therefore, the matcher makes the gift conditional on other gifts.
  • Influence matching. The matcher wishes both to support a particular charity and to encourage others to give to that charity. Therefore, the matcher makes a legitimate commitment to give only if others do, in an attempt to influence their giving.

In both of these cases, it may seem at first glance that a one-to-one match really does “double” your donation, but I don’t think it’s quite that simple.

Regarding coordination matching – I would guess it’s relatively common for a funder to say privately, for example, “I’ll give $100,000 if you can raise the remaining needed $900,000.” But there are a couple of problems when it comes to advertising this situation as a “match.” First, saying “every $9 you give will be matched with $1 from a major donor” wouldn’t be very psychologically compelling – matches rarely go below the 1:1 threshold. Second, even if the funder were providing enough for a 1:1 match, it still wouldn’t be quite true that each $1 was matched with another $1: the match would occur only in the case that the total amount needed was raised. So while “coordination matching” is a possibility, we would guess that it rarely explains the “each $1 you give will be matched by $1” campaigns commonly used in fundraising.

Influence matching is something I think impact-maximizing donors ought to be concerned about. In the short run, influence matching makes it true that your $1 donation results in $2 donated to the charity in question. But it also means that you’ve let the matching funder influence your giving – perhaps pulling you away from the most impactful charity (in your judgment) to a less impactful one – just by the way they structured their gift. By giving, you are rewarding this behavior by the matching funder, and you may be encouraging them to take future unconditional gifts and turn them into conditional gifts, because of the ability to sway other donors.

Perhaps, rather than giving your $1 to the charity the matching funder is pushing, you should fight back by structuring your own influence matching – making a conditional commitment to the highest-impact charity you can find, in order to pull other dollars in toward it.

For the average donation match, it’s unclear to what extent the match represents illusory matching vs. coordination matching vs. influence matching. My guess is that coordination matching is by far the least common (since it requires such a specific set of circumstances to hold) and that illusory matching is the norm (since this is generally the easiest to offer, and since donors don’t tend to distinguish between the different types when they decide where and how much to give).

Corporate matching programs sometimes match only gifts to specific charities; in this case I think it’s best to think of them as “influence matching.” If the company offered matching to any charity (as some companies do) and/or simply made gifts to the charities of its choice, it would no longer be pushing its employees to support specific charities. If you are employed at a company offering matching only on specific charities, I recommend pushing for a change in policy (to unconditional gifts to charities and/or unconditional matching for employees, as other companies do) rather than perpetuating a dynamic where your company’s corporate philanthropy team decides where you give.

In general, I advise donors seeking to maximize their impact to simply support the most impactful charity possible, and not to factor in the presence or absence of donation matching either way. If you support a less impactful charity due to the presence of a match, you may be having more total impact, but you also may be having substantially less (in the case of illusory matching) and/or contributing a dynamic that leads to less effective giving broadly (a risk both for influence matching and illusory matching).

GiveWell may offer donation matching sometime in the future. If so, we will be explicit about whether it is influence matching or coordination matching (we wouldn’t be comfortable offering illusory matching, except perhaps as a joke – i.e., “If you’re thinking of giving to another charity just because of a donation match, let us know and we’ll get your donation to a top-rated charity matched”). If we do implement influence matching, it will be to (a) fully neutralize the effect of other matches on impact-oriented donors, further encouraging them to support the most impactful charities possible; (b) raise money from non-impact-oriented donors who are happy to have their donation “matched” despite the logic above.

*“Donation matching” refers to when a large funder offers to give $X to a particular charity for every $Y other people give – for example, “For every $1 you give to this charity, a large funder will contribute another $1, doubling your impact!” For more, see the 2007 study on donation matching by Dean Karlan.