Published: August 2016
[Added December 19, 2016: GiveWell's experimental work is now known as GiveWell Incubation Grants.]
Note: this page summarizes the rationale behind a grant to New Incentives made by Good Ventures. New Incentives staff reviewed this page prior to publication.
Summary
As part of GiveWell’s general effort to support the creation of future top charities, in March of 2016 Good Ventures granted $300,000 to New Incentives to support its conditional cash transfers program. New Incentives plans to use these funds to continue its growth through the end of 2016.
Table of Contents
After we had prepared this page (though prior to it being published), New Incentives shared the midline results of its currently ongoing randomized controlled trial with us; we have not yet incorporated these results into our view of the organization.1 Also see the writeup of our January 2014 grant in support of New Incentives.
The intervention
New Incentives operates a conditional cash transfer (CCT) program in Nigeria to incentivize pregnant women to deliver in a health facility and to seek treatment to prevent mother-to-child transmission (PMTCT) of HIV. New Incentives gives cash transfers to pregnant women with HIV or other high-risk factors for enrolling in its program, delivering in a clinic, and, if the mother is HIV-positive, having her newborn tested for HIV.
New Incentives originally intended its CCT program to focus primarily on PMTCT for HIV-positive women.2 However, under this model the program did not reach enough HIV-positive pregnant women to justify its operating costs, and in 2015, New Incentives expanded its program to target both HIV-positive women and HIV-negative women with at-risk pregnancies.3
Grant details
As part of GiveWell's experimental efforts to support the development of future top charities, Good Ventures gave $300,000 to New Incentives to cover approximately half of program costs in 2016. The Lampert Family Foundation made a grant of $300,000 to New Incentives as well.
New Incentives expects these grants to allow it to continue growing on its current trajectory. By the end of 2016, New Incentives expects to enroll roughly twice as many women per week as it was enrolling per week in January 2016.4
This grant allows New Incentives to operate and scale until we can see the results of a (currently ongoing) randomized controlled trial (RCT) of New Incentives' program.5 We expect that New Incentives’ case for being a future top charity would depend in large part on promising results from this RCT.
Good Ventures previously gave New Incentives $100,000 in both 2014 and 2015 to support expansion of its CCT program.
Track record
Facility delivery
We have not looked closely at the evidence of effectiveness for facility delivery of high-risk pregnancies. As a consequence, we are highly uncertain about the effectiveness and cost-effectiveness of New Incentives' program. Because of the time-sensitivity of New Incentives' funding needs (see below), we did not reach confident conclusions about these questions before making a grant decision.
New Incentives' program retention has improved over time. As of May 2016, approximately 63% of at-risk pregnancy program beneficiaries had delivered in a clinic, and approximately 51% of PMTCT program beneficiaries (i.e. beneficiaries who are HIV-positive) had delivered in a clinic, compared with 24% in November 2014.6
An RCT is underway to evaluate the effect of New Incentives' program on the number of women who deliver in a facility, with results expected to be published in mid-2017.7
New Incentives as an organization
New Incentives is run by CEO and Founder Svetha Janumpalli and Co-Founder and Chief Strategy Officer Patrick Stadler.8
Since our last grant to New Incentives, the organization has grown to employ several staff in addition to Mrs. Janumpalli and Mr. Stadler.9 New Incentives hired staff to fill five types of positions:10
- A field manager, who reviews data, manages expenses, and conducts trainings at new clinics
- Senior field officers, who enroll women, collect data, and audit the work of field officers
- Field officers, who enroll women and collect data
- Relationship officers, who run the New Incentives hotline and conduct follow-up calls to confirm that women have received their cash transfers
- Field volunteers, who work part-time enrolling women and verifying data such as whether a woman has delivered or not
Because New Incentives is a relatively young organization that has to date operated at a small scale, its ability to continue scaling remains an open question. New Incentives demonstrated strong week-over-week growth in enrollment in 2015 and early 2016.11
Overall, we have a strong positive impression of New Incentives as an organization:
- We have communicated well with its leadership.
- New Incentives has provided thoughtful, detailed answers to our critical questions.
- We have never seen New Incentives hesitate to share information on its program (unless it had what we considered to be a good reason).
Cost-effectiveness
We have not looked closely at the evidence for the effectiveness of programs seeking to increase the number of at-risk pregnancy deliveries in medical facilities, and so we are highly uncertain about the cost-effectiveness of New Incentives' program. It is possible that, after conducting further research on the efficacy of facility delivery, we will decide that New Incentives is unlikely to be a strong contender for a future top charity recommendation.
Room for more funding
According to a budget that New Incentives sent us in February 2016, New Incentives held about $180,000 in uncommitted funds at the beginning of 2016, as well as about $46,000 already committed to beneficiaries.12 This compares to a total of approximately $165,000 that New Incentives spent on its program in 2015.13
Without additional funds, New Incentives projected that it would run out of money by early April 2016.14 New Incentives told us that it did not have other promising potential funding sources for its 2016 funding gap, apart from Good Ventures and the Lampert Family Foundation. It expects to raise approximately $80,000 of its 2016 need from other donors.15
New Incentives told us that it could maintain its current size until the end of 2016 with $475,000 in additional funding.16 We opted to meet New Incentives' full request, so that the organization could continue to grow; we expect that the extra funds will provide additional information about the organization's ability to scale, which will modestly improve the likelihood of New Incentives becoming a top charity in an upcoming year.
Major questions for further investigation
Certain answers to any of the following questions could lead us to conclude that New Incentives would not be competitive for a future top charity recommendation.
- Effectiveness and cost-effectiveness:
- Does the program successfully increase the proportion of HIV-positive and at-risk pregnant women who deliver in a facility?
- In cases of at-risk pregnancy, does delivering in a facility have a demonstrable impact on health outcomes for the mother and baby?
- Is New Incentives' program cost-effective enough to be competitive with the programs implemented by our current top charities?
- Monitoring and evaluation: Will we be able to use New Incentives' monitoring and evaluation data to determine whether its program is working, and to track its progress over time?
- Implementation risk: Will New Incentives be able to continue scaling its program successfully? Will New Incentives be able to build an organization that can operate effectively at scale?
We intend to continue investigating the effectiveness and cost-effectiveness of New Incentives' program soon after making this grant, focusing particularly on the evidence base supporting facility delivery. If that work indicates that New Incentives could be a promising contender for a future top charity recommendation, we intend to follow up with calls every few months to keep updated on New Incentives' progress. We plan to review preliminary results from New Incentives' RCT as they are made available (likely beginning in late summer 2016). We also plan to review documents New Incentives sends us and publish updates on this grant every six months.
If further work on the evidence base for New Incentives' programs (facility delivery, PMTCT, and CCT) suggests that New Incentives is unlikely to become a top charity candidate (e.g. due to uncompetitive cost-effectiveness), we would most likely deprioritize further work on New Incentives.
Internal forecasts
We are experimenting with recording explicit numerical forecasts of the probability of events related to our decision-making (especially grant-making). The idea behind this is to pull out the implicit predictions that are playing a role in our decisions, and to make it possible for us to look back on how well-calibrated and accurate our past predictions were. For this grant, we are recording the following forecasts (made during our decision process):
Top charity predictions
- New Incentives is a top charity in 2016: 10%
- New Incentives is a top charity in 2017: 12.5%
- New Incentives is a top charity in 2018: 15%
Cost-effectiveness predictions
- Our 2017 cost-effectiveness estimate for New Incentives is at least twice as good as our 2017 estimate for unconditional cash transfers: 67%
- Our 2017 cost-effectiveness estimate for New Incentives is at least five times as good as our 2017 estimate for unconditional cash transfers: 15%
- Our 2017 cost-effectiveness estimate for New Incentives is at least ten times as good as our 2017 estimate for unconditional cash transfers: 5%
Charity predictions
- New Incentives brings in at least $250,000 from a funder other than Good Ventures and the Lampert Family Foundation by the end of 2018: 25%
- New Incentives still operates in 2019: 40%
Sources
- 1
- 2
More details on New Incentives' PMTCT program here.
- 3
- "Due to the focus on a highly cost-effective approach with a small target group, scaling the CCT for PMTCT by itself is a challenge... Expansion to smaller clinics in Akwa Ibom or to other Nigerian states entails administrative costs that would increase the overhead ratio of New Incentives and dilute its mission to provide cash transfers that result in health benefits at a reasonable cost.
New Incentives could address this scaling challenge by complementing its CCT for PMTCT with a moderately to highly cost-effective CCT for High-Risk Pregnancies program (CCT for HRP)." New Incentives - Conditional Cash Transfers for High-Risk Pregnancies - For examples of pregnancy risk factors that at-risk pregnancy program beneficiaries may have, see New Incentives - Overview of Clinical Medical Treatments.
- "Due to the focus on a highly cost-effective approach with a small target group, scaling the CCT for PMTCT by itself is a challenge... Expansion to smaller clinics in Akwa Ibom or to other Nigerian states entails administrative costs that would increase the overhead ratio of New Incentives and dilute its mission to provide cash transfers that result in health benefits at a reasonable cost.
- 4
"While only 10-20 women per week were enrolled in early 2015, the average for January 2016 was 80 women per week. Based on detailed expansion plans, we expect to increase the number of women enrolled per week to 175 by the end of 2016." New Incentives - Funding Proposal 2016
- 5
"Monitoring data by New Incentives shows that facility delivery doubles thanks to the cash transfers. This data will likely be backed up by midline results of the New Incentives RCT available by mid-June (measuring facility delivery with .95 statistical significance) and final results in 2017." New Incentives - Funding Proposal 2016
- 6
- "Beneficiaries receive another CCT after New Incentives confirms through clinic registers that they have given birth in a clinic. This is the most crucial point of the program, as the babies get a dose of nevirapine, an anti-retroviral drug (ARV), immediately after birth. Before New Incentives' program, delivery rates at the clinic were 20-30% (of women who register for ANC at the clinic). New Incentives has made several changes to its program to increase that rate to 54%, approximately double the baseline delivery rate, according to a small before-and-after assessment conducted by the Ministry of Health." GiveWell's non-verbatim summary of a conversation with New Incentives and the Lampert Family Foundation on September 3, 2015
- Retention rates for May 2016 drawn from New Incentives - Summary of Key Program Statistics on May 19, 2016. These rates are calculated for the period of January 2015 to May 2016.
- For retention rates in November 2014, see our previous page about New Incentives.
- 7
"Monitoring data by New Incentives shows that facility delivery doubles thanks to the cash transfers. This data will likely be backed up by midline results of the New Incentives RCT available by mid-June (measuring facility delivery with .95 statistical significance) and final results in 2017." New Incentives - Funding Proposal 2016
- 8
- 9
- "New Incentives has a nine-member field staff which includes seven staff in Akwa Ibom and one field officer in each of two other states." GiveWell's non-verbatim summary of a conversation with New Incentives and the Lampert Family Foundation on February 5, 2016
- New Incentives had 14 staff as of April 2016. See GiveWell's non-verbatim summary of a conversation with New Incentives on April 14, 2016.
- 10
- GiveWell's non-verbatim summary of a conversation with New Incentives and the Lampert Family Foundation on February 5, 2016
- GiveWell's non-verbatim summary of a conversation with New Incentives on April 14, 2016
- 11
- At the beginning of 2015, New Incentives was enrolling approximately 10-20 new beneficiaries a week. In early 2016, New Incentives has been consistently enrolling approximately 70-90 new beneficiaries each week. A main driver of this growth was the program expansion targeting HIV-negative, "at-risk" pregnant women.
- New Incentives - PMTCT and ARP Program Dashboard, "Total Enrollments Per Week" sheet
- 12
See New Incentives - 2015 and 2016 Budgets, "2016 Budget" sheet, cells C3 and C4.
- 13
See New Incentives - 2015 and 2016 Budgets, "2015 Budget" sheet, cell C50.
- 14
"New Incentives expects to need $867,000 for its programs in 2016, which would include $570,000 for CCTs and $295,000 for administrative expenses. It currently has $127,000 cash on hand to allocate to its programs, and is slated to run out of funding at the end of March or beginning of April." GiveWell's non-verbatim summary of a conversation with New Incentives and the Lampert Family Foundation on February 5, 2016
- 15
"We plan for the remaining $80,000 to be covered by additional donors. A fundraising meeting in Silicon Valley will be held on April 2016 and an application to the Global Innovation Fund submitted in February/March." New Incentives - Funding Proposal 2016, pg. 2
- 16
"If we cannot raise at least $475,000 this year, operations at our existing clinics would have to be severely cut back. This would not only stall our growth trajectory, but also constitute a major setback." New Incentives - Funding Proposal 2016, pg. 2