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In a previous blog post, we described how we use cost-effectiveness analyses when deciding which charities to recommend to donors.

Today, we published a report that discusses how GiveWell and other actors, such as governments and global health organizations, approach one of the most subjective and uncertain inputs into cost-effectiveness analyses: how to morally value different good outcomes.

For example, GiveDirectly, one of GiveWell’s seven top charities, increases recipients’ consumption, while the primary benefit we see from our top charity the Against Malaria Foundation is that it averts the deaths of young children. How can one make a direct comparison between the amount of “good” achieved by each of these charities?

GiveWell does this by assigning quantitative “moral weights” to different outcomes in our cost-effectiveness analyses. As a check on how sensitive our recommendations are to our moral assumptions, we investigated how others typically answer these questions in their cost-effectiveness analyses.

For a full discussion of the findings from our investigation, see our detailed report.

The summary of the report is:

We focus on the following questions:

• Why does GiveWell explicitly include moral weights in our cost-effectiveness analyses, and how do we decide on moral weights?
• Is there a “standard” approach to moral weights in cost-effectiveness analyses? How do other actors, such as governments and the World Health Organization, make these judgments?
• How much would GiveWell’s cost-effectiveness analyses change if we took a “standard” approach to moral weights?

In brief:

• We include moral weights in our cost-effectiveness analyses because they are an important part of any giving decision and we think it is valuable to be transparent about them. The moral weights that drive our cost-effectiveness estimates are based on our staff’s personal values.
• Governments and other prominent actors often use “value of a statistical life” estimates to compare the value of improving health relative to raising incomes. These estimates often imply that a year of healthy life is roughly 2-3x as valuable as a year of doubling someone’s income. However, there is little relevant research to inform such estimates in low- and middle-income country (LMIC) contexts; we understand that how income is valued relative to health may shift when a population is much poorer.
• There does not seem to be a standard approach for comparing the value of life at different ages; the most commonly used framework that we have seen (the disability-adjusted life year framework) explicitly does not provide judgments on this topic. Nevertheless, most other analyses that we have seen assume that averting death during childhood is about 1-2x more valuable than averting death during adulthood.
• Our initial analysis suggests that using relatively “standard” moral weight assumptions (i.e., the assumptions in the previous two bullet points) instead of our staff’s moral weights would not change our overall view of the relative cost-effectiveness of our current top charities. It may affect how we view some interventions in the future, particularly those that disproportionately focus on averting deaths for young children or adults. We plan to include explicit comparisons between staff moral weights and relatively “standard” moral weights in our analyses going forward.

For more detail, see the full report here.

The post How GiveWell and mainstream policymakers compare the “good” achieved by different programs appeared first on The GiveWell Blog.

In 2016, we tracked a total of $91.6 million given to our top charities as a direct result of our research.

In addition to this $91.6 million, we also directed $13.3 million to our Incubation Grants program.

A note about this report:

We have yet to complete all of the work necessary to publish our 2016 metrics report. There are a number of reasons the report has been difficult to produce this year. In our view the main factors responsible for this delay were the increasing number and complexity of the data sources used to track donors giving to our recommended charities and competing priorities that required the attention of the staff member who produced the 2016 report. The delay was not a result of a decreased dedication to transparency.

In mid-September, we committed to publishing an update on our key metrics (money moved and web traffic) by October 1st even if we were unable to complete our report by then. We have failed to complete our full report, and, today, are publishing an interim update consistent with our commitment.

Unfortunately, we don’t have an updated estimate about when we’ll publish our full metrics report. It is possible that it will take us several months or more to complete it. We view this as a major failing on our part, and we plan to correct this in the future.

For the purpose of this report, please note:

• We report on “metrics years” that run from February through January; for example, our 2016 data cover February 1, 2016 through January 31, 2017.
• We differentiate between our traditional charity recommendations, the work of the Open Philanthropy Project, and our work aiming to support the development of future GiveWell top charities. GiveWell and Open Philanthropy are now separate legal organizations, but during 2016 Open Philanthropy was part of GiveWell, so we report its grantmaking here.
• More context on the relationship between Good Ventures, Open Philanthropy, and GiveWell can be found here.

Summary of influence:

In 2016, GiveWell influenced charitable giving in several ways. The following table includes (a) donations from donors who cited our research when donating to a third party (or cited a source that recommended our top charities because of our recommendation), (b) donations to GiveWell that we granted to top charities and standout organizations, and (c) grants made on our recommendation, through GiveWell Incubation Grants and the Open Philanthropy Project.

Total money moved:

In 2016, GiveWell tracked $91.6 million in money moved to our recommended charities. Our money moved figure only includes donations that we are confident were influenced by our recommendations. In our full metrics report, we plan to include our best guess of the total funding that was given to our top and standout charities due to our research; the numbers in this blog post include only donations that we could specifically track as being due to our research. The methodology used to generate the numbers in this post was very similar to what is described in our 2015 metrics report, with the exception that, for 2016, we counted more donations through partner organizations such as Giving What We Can. We now believe that we should have included those donations last year.

Open Philanthropy gave an additional $13.3 million to the GiveWell Incubation Grants program, to support the development of future top charities, and GiveWell granted $400,000 in participation grants to organizations that applied for a top charity recommendation, from funding provided by Good Ventures for this purpose. We do not count either of these grant types in our headline money moved figure.

Money moved by charity:

Our seven top charities received the majority of our money moved. Our six standout charities received a total of about $3.1 million.

The post Interim update on GiveWell’s money moved and web traffic in 2016 appeared first on The GiveWell Blog.

Our goal with hosting quarterly open threads is to give blog readers an opportunity to publicly raise comments or questions about GiveWell or related topics (in the comments section below). As always, you’re also welcome to email us at info@givewell.org or to request a call with GiveWell staff if you have feedback or questions you’d prefer to discuss privately. We’ll try to respond promptly to questions or comments.

You can view our June 2017 open thread here.

The post September 2017 open thread appeared first on The GiveWell Blog.

Many donors who give through GiveWell’s website choose to donate to support “Grants to recommended charities at GiveWell’s discretion,” rather than selecting a specific recommended charity or charities as the target of their gift.

We periodically grant these “discretionary funds” to what we see as the highest-value funding opportunities among our top charities. We last granted discretionary funds in April; then, we granted $4.4 million to the Against Malaria Foundation and $0.5 million to the Deworm the World Initiative.

Since we last allocated funds, we received an additional $1.25 million in discretionary funds that we recently granted out. We also hold roughly $1 million in discretionary funds that we plan to grant out in the next month or two. We plan to grant all of this funding to the Deworm the World Initiative.

Recommendation for donors

We continue to recommend that donors give 100% of their donation to the Against Malaria Foundation (AMF). In other words, although we’re choosing to grant discretionary funds to Deworm the World, we don’t believe that donors who rely on our recommendations should adjust their giving at this time. We explain the rationale for this below.

Summary

This post will discuss:

• Why we believe Deworm the World has a pressing funding need.
• The benefits of granting discretionary funds to Deworm the World today.
• The risks of granting discretionary funds to Deworm the World today.
• Why we’re continuing to recommend that donors give 100% of their donation to AMF.

Deworm the World’s funding gap

Deworm the World recently told us that they have a pressing funding need. We model Deworm the World as the most cost-effective of our top charities (~10x as cost-effective as cash transfers). Last November, we recommended what we estimated was enough funding to make it 80 percent likely that Deworm the World would not be constrained by funding in the next year. (Due to donors following GiveWell’s recommendations, this recommendation generally tracks with what charities receive as a result.) The existence of a funding gap today thus surprised us.

We understand Deworm the World’s funding gap is driven by two primary factors. First, our estimate of Deworm the World’s room for more funding made assumptions about how much funding it would receive from other funders, and so far this year revenue has been lower than projections.

Second, global costs (salaries, office space, travel, etc. for staff based outside of countries where programs operate) were erroneously left out of our cost-effectiveness analysis for Deworm the World last year. Deworm the World did not include these costs in its list of ways it might spend money and we did not recognize that they were not built into the budget.

The existence of this gap, and some time-sensitive considerations discussed below, led us to decide to recommend the current discretionary funds go to Deworm the World. We also considered granting them to AMF, which is our current top recommendation for donors; we believe AMF has significant room for more funding. However, we decided that Deworm the World’s funding need was more pressing. We don’t expect this decision to change the total amount that AMF and Deworm the World each receive as a result of GiveWell’s recommendation in 2017, so the cost of not choosing AMF today is delaying when AMF receives this funding.

Benefits of granting discretionary funds to Deworm the World now

Deworm the World is currently in discussions with the government of Kenya to sign a memorandum of understanding (MOU) to continue its deworming program in Kenya for the next five years. Deworm the World had enough funding committed to the program to fund two years and believes that if it had a larger funding commitment, the government would see the MOU as a higher priority and might speed up the process to finalize the MOU. When we spoke with Deworm the World about additional funding in June and July, of particular concern were the upcoming elections in Kenya on August 8. Because elections tend to take government officials away from other work, Deworm the World feared that delaying the MOU process could delay its deworming work and, in a worst-case scenario, cause the 2017-2018 round of deworming in Kenya to be missed.

Though we understand from Deworm the World that the MOU was not signed prior to the elections, our expectation is that receiving this funding several months earlier than it otherwise would have will decrease the likelihood of Kenya missing a round of deworming.

In addition, Deworm the World may have opportunities this year to fund work in Pakistan and additional work in India (it currently works in only a portion of the states in India). Receiving additional funding now may allow Deworm the World to accelerate its work in those locations.

We have not completed a full room for more funding analysis of Deworm the World since last October and are unsure how much additional room for more funding Deworm the World has.

Risks of granting discretionary funds to Deworm the World now

We believe that granting GiveWell’s discretionary funds to Deworm the World now has the following risks:

• We may later come to believe that Deworm the World needed less than $2.25 million this year.

  We have not seen complete financial information from Deworm the World and we are unsure how much additional funding would be needed to bring them to the level of being 80 percent likely that they won’t be bottlenecked by funding (we generally target our most cost-effective top charities receiving this level of funding).

  Discretionary funds allocated now will reduce our estimation of Deworm the World’s 2017 end-of-year room for more funding, which we incorporate into our annual year-end recommendations. It’s possible, although we think highly unlikely, that once we see Deworm the World’s full financial information (which we expect to before our end-of-year recommendation decisions), we will conclude that the amount we want to recommend to them this year is less than $2.25 million.

  We don’t think this is likely; our best guess is that granting funds to Deworm the World today will accelerate when they receive funds from GiveWell but not change the overall amount of funding they receive in 2017 due to our recommendation.

  It’s also possible that receiving GiveWell discretionary funds now will, for example, allow Deworm the World to lay more groundwork in Pakistan this year and create new opportunities to fund deworming in Pakistan next year, thus increasing our estimate of Deworm the World’s room-for-more funding at the end of the year.

• If we decide at the end of the year that Deworm the World is no longer a top charity, we may not think it should have received $2.25 million a few months before. We think this is highly unlikely.
• Funding for and implementation of Kenya’s deworming program is complex. It involves the government of Kenya, multiple funders (including GiveWell-influenced donors, the Children’s Investment Fund Foundation, and the END Fund), and the Deworm the World Initiative, among others. We’d recommend any donor considering major gifts to Deworm the World before we publish our updated review of Deworm the World in November contact us one-on-one to discuss these considerations.

Recommendation to individuals

We continue to recommend that donors give to our current top recommendation: the Against Malaria Foundation. We are not changing the recommendation to donors because:

1. We are unsure how much additional funding we would like to see Deworm the World receive this year. Making it our new recommendation for donors could drive enough funding in the next few months to overshoot the total Deworm the World could effectively use in the near future.
2. The main benefit of giving to Deworm the World now, rather than at the end of the year, is to accelerate the timeline for the MOU in Kenya and possibly work in Pakistan and India. We anticipate that much of the funding driven by a GiveWell recommendation to donors (e.g., as we currently recommend giving 100% to AMF) would not reach Deworm the World until about the time when we will have completed a full room for more funding analysis of Deworm the World’s work, so we see limited benefit in changing our recommendation now, while we do see the cost noted above.

The post Why we’re allocating discretionary funds to the Deworm the World Initiative appeared first on The GiveWell Blog.

We’ve received several questions about donating in response to Tropical Storm Harvey. We wanted to share this post, which was originally published in 2013, with our advice for disaster relief giving. We’re unsure if bullet points #4 and #5 still apply, as it has been a few years since we last investigated giving opportunities for disasters, and we have mostly considered international disasters.

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:

• More on disaster relief: The DO’s and DON’Ts of Disaster Donations from Good Intentions Are Not Enough
• General advice on giving: our 6 tips for giving like a pro

The post From the archive: 6 tips on disaster relief giving appeared first on The GiveWell Blog.

One of our major goals for 2017 is “intervention prioritization,” our work to assess a large number of programs (interventions) as potential GiveWell priority programs we’d be interested in recommending charities working on.

Summary

This post will provide a brief overview of our intervention work this year, focusing on the interim and full intervention reports we’ve published in 2017.

Programs we plan to continue investigating:

• Sayana® Press
• Antiretroviral Therapy to Treat HIV/AIDS
• SMS Reminders for Vaccination
• Surgery to Repair Obstetric Fistula
• Interventions to Promote Handwashing

Programs we decided not to prioritize additional research on:

• Distribution of Eyeglasses in Developing Countries
• Oral Pre-exposure Prophylaxis (PrEP) for HIV

Intervention prioritization process

We aim to do low-intensity research on a large number of promising interventions as part of our intervention prioritization work. We typically start by spending a few hours assessing a program before deciding whether to move forward with a more intense (say, 20-40 hour) “interim intervention report.” If the program looks promising following an interim intervention report, we’ll move on to a full intervention report, which generally involves about 80-200 total hours of work. We may do additional research after this point, as well, as we did with David Roodman’s research on deworming, one of GiveWell’s priority programs, last year.

Priority programs

This section will discuss programs we have researched in 2017 and see as promising.

Sayana® Press

Sayana® Press is an injectable contraceptive in a prefilled single-use package. We decided to look into Sayana® Press after a charity described the program to us as a potential GiveWell priority program. Sayana® Press seemed promising because community health workers or recipients themselves may be able to administer it, which could make it a viable contraceptive for women without regular access to health facilities. Sayana® Press, a single injection of which is intended to provide protection for three months, also requires less frequent adherence than daily birth control pills. Our initial estimate suggests that family planning programs involving Sayana® Press have the potential to be be in the same range of cost-effectiveness as our current top charities.

After this review, we prioritized initial investigation of charities that work on family planning programs.

Read our report on Sayana® Press here.

Antiretroviral Therapy to Treat HIV/AIDS

Antiretroviral therapy (ART) refers to using a combination of drugs to treat (not cure) human immunodeficiency virus (HIV) to increase life expectancy for those who have the disease and to reduce HIV transmission rates. We prioritized investigating ART as we learned that it had become more cost-effective (due to falling prices) and because of our perception that despite significant funding for ART, funding gaps remain. If that were the case, we’d be interested in identifying giving opportunities that demonstrate they are filling such gaps, similar to how the GiveWell top charity the Against Malaria Foundation works in the insecticide-treated net space.

We’re in the process of having conversations with charities that implement ART programs to better understand whether a funding gap for direct delivery of ART exists. If there is room to fund marginal direct ART delivery, our key question will be around patient adherence rates to treatment when charities implement this program. We will want to see strong monitoring from charities to demonstrate that outcome.

Read our report on ART here.

SMS Reminders for Vaccination

We’re trying to grow the pipeline of potential future GiveWell top charities through our GiveWell Incubation Grant program. We funded Charity Science Health with an Incubation Grant for its program to send Short Message Service (SMS) messages to caregivers’ cell phones to remind them of upcoming vaccination dates for young children. We decided to investigate SMS reminders for vaccination as part of our ongoing review into Charity Science Health’s work and our impression that this intervention had the potential to be highly cost-effective.

The available randomized controlled trial (RCT) evidence on the program, upon which GiveWell generally places high weight, varies quite a bit and we’re hesitant to generalize from the findings. We don’t expect to recommend SMS reminders for vaccination based on the existing evidence. In order to recommend Charity Science Health as a top charity, we would likely require additional independent evidence for the program or an RCT of Charity Science Health’s program in particular.

Read our report on SMS reminders for vaccination here.

Surgery to Repair Obstetric Fistula

In 2016 and 2017, we decided to revisit the evidence for promising corrective surgery programs, including the evidence for surgery to repair obstetric fistula.

An obstetric fistula is an abnormal opening between the vagina and bladder or rectum that typically results from prolonged obstructed labor. Our impression is that fistula can have a very negative impact on well-being and that some obstetric fistulas may be repaired with surgery.

We have a number of open questions about this intervention, including the success of surgery in (a) closing the fistula and (b) leading to improved psychosocial outcomes. Fistula management programs may also involve other activities, such as outreach to women with fistula, training surgeons, and counseling. We would like to better understand the impact of these activities on improving life outcomes as well as their cost.

We are working with IDinsight to closely examine a Fistula Foundation program to better understand the cost-effectiveness of this work. If the cost-effectiveness appears to be in the range of our other priority programs, we will then work with IDinsight to identify organizations with which they can develop improved monitoring to help us answer our remaining questions about patient outcomes.

Read our report on surgery to repair obstetric fistula here. We have also published a blog post on our work in this space.

Interventions to Promote Handwashing

We understand that washing hands can remove pathogens that transmit infectious diseases. We investigated a variety of interventions intended to promote handwashing, including hygiene education and the distribution of posters and leaflets.

We looked for RCTs of the impact of handwashing on reducing diarrhea, pneumonia, and worm infections, as well as the impact handwashing might have on improving nutrition (via reducing diarrhea). While we did see some evidence of a reduction in diarrhea incidence and pneumonia, we have not seen strong evidence for the impact of promoting handwashing on worm infections or nutrition indicators. Research was conducted on a variety of approaches to promote handwashing and the results were heterogeneous, such that we couldn’t draw generalizable conclusions from the literature.

To consider groups working on handwashing promotion for a potential GiveWell recommendation, we would need to learn more about their individual activities and monitoring, which could also give us better information with which to assess their cost-effectiveness.

Read our report on interventions to promote handwashing here.

Other programs considered

Distribution of Eyeglasses in Developing Countries

We reviewed the evidence for providing free or subsidized eyeglasses to individuals with poor vision. We saw some evidence that offering free corrective eyeglasses to children has some effect on test scores; we did not find strong evidence assessing whether distributing eyeglasses increased economic productivity in the short or long run. We decided not to move forward with our research and do not consider the distribution of eyeglasses a GiveWell priority program. If we were to come to the conclusion that increasing test scores reliably led to improved life outcomes, we would likely revisit our conclusion about eyeglasses interventions.

Read our report on eyeglasses distribution here.

Oral Pre-exposure Prophylaxis (PrEP) for HIV

Oral pre-exposure prophylaxis (PrEP) is the use of antiretroviral drugs by HIV-negative individuals to prevent HIV acquisition. We think the evidence that PrEP reduces HIV acquisition rates among high-risk individuals is strong, but we have not found evidence that large-scale charity programs have successfully increased PrEP coverage rates in sub-Saharan Africa. Our latest cost-effectiveness estimate for this program suggests that PrEP programs are less cost-effective than voluntary medical male circumcision (VMMC) for preventing new HIV infections, though there are a few key parameters about which we’re uncertain. We are not planning to prioritize additional work on this program at this time, but would revisit our conclusion if charities provided us with information that could substantially change our cost-effectiveness estimate for PrEP programs.

Read our full report on oral pre-exposure prophylaxis to prevent HIV here.

Conclusion

Reviewing a large number of interventions is a major research priority for GiveWell in 2017. A separate post will discuss our “intervention prioritization” work in detail.

The post Update on GiveWell’s intervention research in 2017 appeared first on The GiveWell Blog.

Though GiveWell donors typically indicate how they would like their donations to be designated—e.g., for the support of one or more specific recommended charities, or for granting at GiveWell’s discretion—we occasionally receive donations without any designation information. It is important to us that donors understand our process for handling these donations: as a general rule, we treat all undesignated donations as unrestricted gifts, which means they will most likely be used to fund GiveWell’s operating expenses.

In this post, we will:

1. Discuss undesignated donations more in-depth and outline our rationale for treating them as unrestricted gifts.
2. Explain how our thinking on processing these types of donations has evolved over time to better meet our donations processing goals—to make it easy for donors to communicate their designation preferences, be transparent about where donations are allocated, and keep our administrative costs low.
3. Provide information on how to make sure that, as a donor, your designation preferences are communicated to us.

If you have any questions about the designation of a future or past donation to GiveWell, please email us at donations@givewell.org.

What is an undesignated donation?

GiveWell grants most of the donations we receive to our top and standout charities. Donors usually indicate which organizations they prefer to support with their donation—we refer to this as a designation. On our donation forms, donors can choose one or more recommended charities, grants to recommended charities for granting at our discretion, or unrestricted (which we will likely use for GiveWell’s operating expenses).

Donors giving online through our website must select one or more designation options when making a donation. However, we occasionally receive donations through other payment methods—e.g., checks, wire transfers, securities donations, or donations through employer giving platforms such as Benevity—that do not include any designation information.

Our current process and how our thinking has evolved

As a general practice, when a donor does not communicate a designation to us, we treat their donation as unrestricted funding. If the donor has provided us with an email or physical address, we send them an email or letter and ask if they would prefer to have their donation designated differently.

Our initial process when receiving undesignated donations was to designate them according to the donor’s past giving history (when applicable). For example, if a donor had previously given in support of Against Malaria Foundation and Schistosomiasis Control Initiative, we would designate their subsequent donations accordingly.

However, in practice, we learned that the process of determining a donor’s pattern of giving is often time-consuming and prone to error. Donors may support a variety of charities with donations in varying amounts, and since our recommendation for what charities to support changes over time, it is reasonable to expect that donors’ preferences for where to allocate their gifts would also change from how they’ve given in the past. Due to the subjective nature of this process, we found it required a significant amount of time and resources to be spent on donations processing and auditing.

Another option for undesignated donations that we considered was allocating these gifts to our discretionary fund for recommended charities. We believed that donors might expect undesignated donations to go toward GiveWell’s most up-to-date recommended allocation. We have not systematically surveyed donors, but our impression from speaking with donors in the past is that some donors expected undesignated donations to support our recommended charities (at our discretion), while others preferred that we decide whether to allocate their donation to our operations or to our recommended charities.

A desire for a more standardized and transparent process led us to our current approach. Allocating gifts without clear designations towards unrestricted funds simplifies our donations and accounting processes, which in turn lowers the administrative cost of these processes. It also provides donors with more agency to choose another designation, if they wish—we are less likely to grant out unrestricted gifts to one or more of our recommended charities before donors have a chance to follow up on our no-designation email or letter and request a different designation.

How to communicate or modify a designation

To ensure that your donation to GiveWell is designated according to your preference, please be sure to email us back at donations@givewell.org if you receive an email or letter from us that indicates your donation did not include a specific designation.

To ensure that your designation preferences are communicated to us at the time when we receive your donation:

• Be sure to fill out and enclose this form with each check you send. It is also helpful to add a note about the designation on the check itself. (If you are a recurring check donor and find it burdensome to fill out the check form with each donation, you may communicate your designation preferences for future donations via email at donations@givewell.org. Some online banking platforms will also allow you to add a memo to a recurring check payment that will appear on each check.)
• If giving by bank transfer, please fill out this form before donating and indicate your designation preference.
• If donating securities, please fill out this form before donating and indicate your designation preference.
• If donating through an employer giving platform such as Benevity, be sure to select the charity or charities you would like to support, or indicate this in the comment section along with your donation.
• If you are donating through a donor-advised fund (managed by, e.g., Vanguard or Schwab Charitable), please be sure to include your designation in the paperwork you submit to recommend a grant to GiveWell. You may also communicate your designation to us via email at donations@givewell.org. Note that we treat donations from donor-advised funds that are designated “Where it is needed most” as unrestricted funding.
• When submitting paperwork for a matching donation from your employer, be sure to specify how you would like the match to be designated. We treat all employer matches without a clear designation as unrestricted funding.

Donors are always welcome to email us at donations@givewell.org with any questions about the designation process or to communicate a designation for their future donations.

The post Our approach to processing undesignated donations appeared first on The GiveWell Blog.

This post will provide a brief overview of GiveWell’s progress in a number of areas so far this year. In summary,

1. Research: We are making progress on reaching charities that might be a good fit for a GiveWell recommendation and asking them to apply. We are also moving forward with GiveWell’s intervention prioritization goals.
2. Operations: The separation of GiveWell and the Open Philanthropy Project was a major organizational priority in the first half of the year and was finalized on June 1. We’ve also increased the specialization on the operations team and outsourced some of GiveWell’s operations work.
3. Outreach: Outreach is now a major organizational priority. We hope to develop a strategy for significantly increasing money moved to our recommended charities by September.

We hope you will let us know if you have any questions about our work this year in the comments.

Research

Our work on research now falls into two primary categories: Traditional top charities work, consisting of research into promising programs and evaluations of charities implementing them as potential GiveWell top charities, and GiveWell Incubation Grants, our work to grow the pipeline of potential top charities and improve our understanding of our current recommended charities.

Top charities

• Encouraging charities to apply for a GiveWell recommendation.

  In recent years, we were surprised by how few charities reached out to GiveWell to apply for a recommendation. We guessed that some part of this may be driven by (a) a lack of understanding of GiveWell’s research priorities and which organizations we might be interested in recommending, and (b) a lack of understanding or misconceptions about GiveWell’s charity review process or the value added of a GiveWell recommendation in increasing a charity’s funding.

  We took two steps to address this problem in 2017. First, GiveWell Research Analyst Chelsea Tabart is now serving as GiveWell’s “charity liaison.” In this role, Chelsea connects with groups that may be a good fit for a GiveWell recommendation to learn more about their work and to encourage them to apply if a fit seems promising, and to explain GiveWell’s review process and value added. Second, we published a blog post on why we think more charities should consider applying for a GiveWell recommendation. We are now considering a number of charities as potential top-charity contenders and attribute this in part to taking the steps described above.

• Intervention prioritization.

  A major goal this year is to assess a large number of interventions as potential GiveWell priority programs. This “intervention prioritization” work involves surveying the literature for a variety of interventions to identify the most cost-effective and evidence-backed programs.

  We have made good progress on intervention research in 2017. (We plan to write about our progress in more detail in a future post.) We completed 50 quick evidence assessments in the first half of the year and published interim intervention reports on:

  • Sayana Press
  • Distribution of eyeglasses in developing countries
  • Antiretroviral therapy to treat HIV/AIDS
  • Interventions to promote handwashing
  • SMS reminders for vaccination.

  We also published an intervention report on surgery to repair obstetric fistula.

GiveWell Incubation Grants

We continue to expand our work on GiveWell’s Incubation Grants program:

• Partnership with IDinsight. We continued our partnership with IDinsight. IDinsight is working on a number of projects with GiveWell, including cost-effectiveness and monitoring assessments of surgery charities (cataract and fistula), running a randomized controlled trial of New Incentives’ pilot program to provide incentives for immunizations, and helping one of our top charities, the Against Malaria Foundation, improve its monitoring.
• Considering new top charities via GiveWell Incubation Grants. We’re considering some GiveWell Incubation Grant recipient charities as potential 2017 top charities. We’ve published blog posts on Zusha! and No Lean Season as contenders for a recommendation at the end of the year.

Recruiting

We hired Caitlin McGugan as a Senior Fellow and James Snowden started working with us as a research consultant. We hope they will increase GiveWell’s output of intervention reports. We also have one summer research analyst, Scott Weathers, working with us.

Operations

The separation of GiveWell and the Open Philanthropy Project was a major priority for GiveWell’s operations team in the first half of 2017. The separation was finalized on June 1.

The operations team continues to increase in specialization (historically, GiveWell operations work has been done by generalists on staff). We hired Maryana Pinchuk to serve as a Donations Manager and Erin Wolff as a Donations Relations Assistant; a search for a Controller to manage our finance and accounting is underway. We have also started to work with new vendors to outsource some operations work, which we hope will increase our available staff capacity and improve the quality of our operations.

Outreach

Outreach is now a major organizational priority for GiveWell. In the past, we focused very little on efforts to reach new potential donors with GiveWell’s work. Now, we think outreach is more of a limiting factor than research—the high-value funding gaps we’ve identified exceed the amount of donations we expect to direct to those gaps.

We have developed a list of ideas for how to significantly increase the money GiveWell directs to our recommended charities, and are planning to work on the most promising ideas over the next few months. For example, we think there may be relatively low-intensity steps to take in areas like podcast advertising; in February, we advertised on a small number of podcasts and plan to do so again based on the cost of running advertisements and the additional donations to top charities we tracked as a direct result of those ads.

We are also trying to hire another Research Analyst, Outreach Focus to expand our capacity to communicate with donors and other individuals who rely on GiveWell’s research.

The post Mid-year update on GiveWell’s progress appeared first on The GiveWell Blog.

We’ve long been interested in fistula surgery as a potential GiveWell priority program. However, as with other surgery charities, we have struggled to identify an organization that meets GiveWell’s criteria. Now, we’re working with a group called IDinsight and are excited that we may be able to consider a fistula surgery organization as a potential GiveWell top charity.

Our longstanding interest in interventions to treat fistula can be attributed in part to the popular narrative presented about fistula. The condition, which is often associated with social ostracization, appears to cause a significant amount of suffering, and seems to be treatable. We’re not sure how representative the popular narrative is, but as donors, it has contributed to our continued interest in better understanding this intervention, along with the feeling that surgery charities in general may offer low-cost, life-changing impacts.

Summary

This post will discuss:

• Fistula management, including surgery, as an intervention.
• Our open questions and uncertainty around fistula management programs, particularly their costs.
• Our plans to partner with IDinsight to help answer some of our questions about fistula management.

Surgery charities and GiveWell

We recently published a blog post describing our work to better understand charities that implement cataract surgery programs and to assess whether they might be a fit for a GiveWell top-charity recommendation. As we discussed in that post, surgical interventions in general seem to intuitively appeal to donors due to their potential to offer inexpensive, large impacts on quality of life. However, our uncertainty about surgery charities’ room for more funding and monitoring information has generally led GiveWell to deprioritize research on charities implementing these programs in the past.

Now, as part of GiveWell’s Incubation Grants program to grow the pipeline of potential future top charities and improve our understanding of our current top charities, we’re researching organizations that work on cataract surgery and fistula surgery as potential future top charities.

This post focuses on the latter. Although both interventions are surgical, fistula surgery is distinct in a number of ways from cataract surgery and other interventions GiveWell recommends. Fistula surgery may be a major, invasive procedure. In addition, the largest negative effects of fistula may be psychological, economic, and social, rather than physical.

Fistula management as an intervention

An obstetric fistula, or gynecologic fistula, is an abnormal opening between the vagina and the bladder or rectum. Obstetric fistula is often caused by prolonged obstructed labor, where pressure from the fetus on the mother’s pelvic bone cuts off blood flow to soft tissues, which then die, leading to a hole through which urine or feces may leak through the vagina. Fistula can have physical, economic, and psychological consequences, including social isolation.

Fistula may be treated with surgery to close or partially close the opening. (In some cases, small fistulas may not require surgical treatment; in other cases, the damage may be too extensive for surgical repair.) Job counseling and life skills training aimed at social reintegration may also be part of fistula treatment. “Fistula management” describes all of these interventions, including surgery.

Our very rough cost-effectiveness estimate for fistula surgery is $1,400 per successful surgery performed. The severity of suffering, combined with the cost per surgery, may mean that fistula surgery is in the same range of cost-effectiveness as GiveWell’s current priority programs.

Our open questions

We recently published an intervention report on the evidence for surgery to repair obstetric fistula. We have a number of remaining questions that we’d like to answer before making a recommendation of an organization implementing a fistula management program. Key aspects of this intervention that we’d like to better understand include:

Outreach and cost-effectiveness

It may be challenging to identify and diagnose potential fistula cases. Fistula most often occurs in women who are located in very geographically remote areas or who are too poor to access health systems for delivery care in the event of prolonged obstructed labor. Women located in very remote areas may be hard to reach in general; women with obstetric fistula may be very hard to reach in particular, because they may be more likely to be socially disconnected or unreachable through regular community health systems.

In addition, fistula may not be well known, post-birth complications may be stigmatized, or the symptoms may not be recognized. It may be shameful for women to discuss fistula symptoms; for that reason, we’re unsure whether information about incontinence would be provided to a researcher or surveyor. Even in cases where symptoms are shared, they can be caused by other urological issues, complicating diagnosis of fistula.

We’d like to better understand what the most cost-effective methods of outreach to women with fistula are. We understand that outreach activities have included media outreach; training health workers, nurses, midwives, and doctors in fistula identification to strengthen referrals to treatment; and having women who have had treatment for fistula help identify and encourage women with fistula in their communities to seek medical care. We’re not sure what approach to outreach is most cost-effective.

How cost-effective are fistula management programs?

We’re unsure how the above outreach contributes to the overall cost per patient of fistula treatment. In addition to outreach activities, our impression is that fistula surgery programs often involve training surgeons and the purchase of equipment. We remain very unsure about the costs and benefits of these activities.

Fistula management programs may also involve a number of non-surgical interventions for patients. Some fistula centers offer rehabilitation activities for patients, such as counseling or job training. We’re not sure how common these types of rehabilitation are or what other types of support might entail, or how effective they are at improving social or economic outcomes; this could have a large impact on our overall estimate of fistula management charities’ cost-effectiveness.

What is a ‘successful’ surgery, and what proportion of surgeries are successful?

Obstetric fistulas vary in their size and suitability for surgical repair. For women who do receive surgical treatment, a “successful surgery” may not lead to continence. We’re unsure what proportion of operations successfully close fistulas due to a lack of available data in this space.

Among women whose surgeries do result in continence, we’re unsure of the extent to which that leads to positive social, economic, and psychological outcomes in turn. A major open question is whether operations that succeed in closing a fistula will address any possible social impacts of fistula.

In addition, the prolonged obstructed labor that caused the fistula could also lead to other health complications, such as infertility, scarring, and neurological damage. Repair of the fistula would generally not address these other issues, which could also have social and economic as well as physical consequences.

We are thus very interested in monitoring a) the success of surgery in repairing fistulas and b) the social and economic outcomes for women who receive fistula surgery with or without non-surgical interventions such as counseling. We have not looked closely at the studies that have been done on post-surgical outcomes, although our impression is that most studies in this space have been small. As the economic and social consequences of fistula may be among the greatest burdens of those who have fistula, we are particularly interested in understanding the impact surgery has on those outcomes.

Our plans with IDinsight

GiveWell partnered with IDinsight, an international NGO that focuses on providing clients with information to increase their social impact, as part of our work on GiveWell Incubation Grants. The “GiveWell embedded team” at IDinsight is working with us on a project to better understand the potential of fistula management organizations to become GiveWell top charities.

IDinsight plans to begin this work by focusing on the cost-effectiveness of fistula management, including surgery, as an intervention. It plans to work closely with Fistula Foundation, an organization that funds fistula treatment in Asia and Africa, to understand its costs per surgery for one country to help inform GiveWell’s assessment of the cost-effectiveness of fistula management programs in general. (Even though information from a single country will have limitations in its applicability elsewhere, we think starting at this scale is the right first step.)

If this intervention appears cost-effective—competitive with our current priority programs—following this initial phase of work, then IDinsight will likely work with GiveWell to identify one or more fistula management charities with which to develop and implement a high-quality monitoring system. With additional, high-quality monitoring information, we may better be able to understand whether a fistula management charity should be included in GiveWell’s list of top charities.

We expect this work to take several years, due to the amount of time required to set up and gather data from a new monitoring system, and do not expect this to impact GiveWell’s charity recommendations in 2017.

The post Deciding whether to recommend fistula management charities appeared first on The GiveWell Blog.

We’re sometimes asked whether we think GiveWell’s top charities are the “best,” in some absolute sense of the word, or whether we’d ever advise that a donor give to an opportunity outside of our recommendations. This post aims to clarify how GiveWell thinks about different giving options and their suitability for different types of donors.

We believe that GiveWell’s top charities offer donors an outstanding opportunity to do a lot of good and are the best option for most donors. However, some donors—those with a very high degree of trust in a particular individual or organization to make this decision, donors with lots of time (in excess of 50 hours per year, and likely more) to consider their giving decision, or donors whose values point strongly toward a particular cause outside of the ones GiveWell covers—may find opportunities to have a greater impact per dollar than GiveWell’s top charities. Note that we think these characteristics are likely to be necessary, but not sufficient, for finding these types of opportunities; we still expect good giving to be hard, and spending, for example, 50 hours per year on research isn’t necessarily going to yield better opportunities.

In this post, we describe relevant considerations for donors in greater detail.

Giving to GiveWell’s top charities

GiveWell was founded to serve donors with limited amounts of time to make giving decisions. GiveWell’s co-founders, Elie Hassenfeld and Holden Karnofsky, were in this situation when they started GiveWell as a side project in 2006. They found that determining where to give effectively was a full-time project and quit their jobs to start GiveWell in 2007.

GiveWell’s top charity recommendations serve all donors. We rely on evidence and detail our rationale for making a recommendation publicly, so donors can vet our work; a strength of our recommendations is their falsifiability. We believe our top charity recommendations serve donors who want to give as effectively as possible and have only limited time to determine where to donate, and (prior to GiveWell) no trusted person or entity to outsource their thinking to, particularly well. Our criteria and recommendations were designed with this type of donor in mind:

• Our top charities are largely uncontroversial and relatively straightforward ways to do a lot of good—for example, by providing direct aid such as insecticide-treated nets to prevent malaria and cash transfers to very poor households. There is room for debate on the evidence behind these interventions and their cost-effectiveness, but the basic case for them—and the fact that they are likely to do more good than harm—is subject to little debate, so a donor can feel fairly confident in these basics without needing to do their own research.
• GiveWell publishes the full details of our charity analyses so that donors can review and vet our work, and so that donors with very limited time can trust that any major problems would likely be caught by others (with more time).
• Because we lay out the entire case for the charities online, donors can spot-check any particular part of it to get a sense of whether we’re thinking reasonably about the issues that seem most salient to them.
• Our top charities have room for more funding. In other words, we believe additional marginal donations to these organizations enable them to do more good.

Our guess is that most donors that use GiveWell fit this profile (want to give as effectively as possible and have only limited time to determine where to donate, and no other trusted person or entity to outsource their thinking to).

Below, we discuss alternative donor profiles:

(1) Donors with limited time and a high amount of trust in a person or organization to inform their giving decisions

This group of donors has limited time to spend on making a giving decision and has an organization or person (other than GiveWell or GiveWell staff) they personally trust to make or inform this decision. In this case, they may defer to that person or organization’s recommendations.

(2) Donors with lots of time

Donors with a lot of time to spend on giving decisions (50+ hours per year) may be able to find opportunities that GiveWell hasn’t. For example, a donor might know someone who is starting a charity and feel, based on their research, that supporting their project at an early stage might be a particularly leveraged way to do good. A donor with lots of time may also be very familiar with a particular cause and feel highly confident in a particular organization and its need for funding. These donors may want to compare alternative opportunities to GiveWell’s top charities. They may also want to actively vet GiveWell’s recommendations as part of their research process.

Donors with lots of time may also wish to apply a different strategy to their giving. GiveWell largely recommends charities where sufficient evidence exists to make a fairly robust estimate of the expected value of a donation. Donors with much more time to spend (maybe even significantly more than 50 hours per year) thinking about where to give may want to take a “hits-based giving” approach—having a high tolerance for philanthropic risk, so long as the overall expected value is sufficiently high. This is the approach the Open Philanthropy Project, which was incubated at GiveWell, has taken, and we believe doing this well requires a lot of work, as the Open Philanthropy Project discussed in a blog post last year (emphasis original):

Aim for deep understanding of the key issues, literatures, organizations, and people around a cause, either by putting in a great deal of work or by forming a high-trust relationship with someone else who can. If we [the Open Philanthropy Project] support projects that seem exciting and high-impact based on superficial understanding, we’re at high risk of being redundant with other funders. If we support projects that seem superficially exciting and high-impact, but aren’t being supported by others, then we risk being systematically biased toward projects that others have chosen not to support for good reasons. By contrast, we generally aim to support projects based on the excitement of trusted people who are at a world-class level of being well-informed, well-connected, and thoughtful in relevant ways.

Achieving this is challenging. It means finding people who are (or can be) maximally well-informed about issues we’ll never have the time to engage with fully, and finding ways to form high-trust relationships with them. As with many other philanthropists, our basic framework for doing this is to choose focus areas and hire staff around those focus areas. In some cases, rather than hiring someone to specialize in a particular cause, we try to ensure that we have a generalist who puts a great deal of time and thought into an area. Either way, our staff aim to become well-networked and form their own high-trust relationships with the best-informed people in the field.

I [Open Philanthropy Project Executive Director Holden Karnofsky] believe that the payoff of all of this work is the ability to identify ideas that are exciting for reasons that require unusual amounts of thought and knowledge to truly appreciate.

(3) Donors with values that differ from GiveWell staff

Donors who hold different values than the majority of GiveWell staff, or who place more weight on a particular cause outside of the causes covered by GiveWell, may find other giving opportunities to be more attractive for reasons beyond the time/trust framework articulated earlier in this post. For example, individuals who place a very high value on farm animal welfare may wish to give a large proportion of their donation, if not all of their donation, to organizations working in that cause.

We’re happy to speak with you about giving decisions.

If you’re not sure which considerations apply to you, please reach out. We’re always happy to talk through giving decisions.

The post Are GiveWell’s top charities the best option for every donor? appeared first on The GiveWell Blog.

Our goal with hosting quarterly open threads is to give blog readers an opportunity to publicly raise comments or questions about GiveWell or related topics (in the comments section below). As always, you’re also welcome to email us at info@givewell.org or to request a call with GiveWell staff if you have feedback or questions you’d prefer to discuss privately. We’ll try to respond promptly to questions or comments.

You can view our March 2017 open thread here.

The post June 2017 open thread appeared first on The GiveWell Blog.