Schistosomiasis Control Initiative - August 2015 Update

We have published a more recent review of this organization. See our most recent report on the SCI Foundation, formerly known as the Schistosomiasis Control Initiative.

Published: August 2015

Note: though this update was published in August 2015, it is based primarily on information that we had received as of late April 2015. Since then, SCI shared three additional documents with us (SCI financial statements, 2013-14 and 2014-15, SCI's ICOSA Mid-Year Report to DFID, 2015 and SCI impact and coverage survey plans (May 2015 update)). We have mentioned these documents in this update where they may be related to the topics being discussed. We plan to analyze these documents more thoroughly before the end of this year.

Ongoing communication challenges On several occasions in 2015 the information we received from SCI was inconsistent or substantially different from what SCI had previously told us. We have so far been unable to get clear answers on what changed. Details: Reserves strategy: SCI previously told us that it would save significant reserves for future years to ensure the sustainability of its programs.1 In its current budget, it does not seem to plan to save unrestricted reserves.2 When we asked SCI about what had changed, SCI told us its reserve strategy was not fully worked out yet.3 It is therefore unclear to us how we should interpret the budget SCI provided. Unrestricted funds held as of March 2015: In April 2015, SCI shared a draft budget for 2015 that indicated it had a funding gap of $1.5 million (~20% of its unrestricted funding balance).4 In July 2015, it sent us a funding update that appears to show that it held $1.6 million more in unrestricted funding as of March 2015 than it previously reported. We asked SCI for clarification by email and have not yet received more information. (More) Budget revisions: In October 2014, SCI shared plans for how it would use additional funding in its next budget year.5 In its current budget, SCI has allocated substantially more to some programs than expected. In April 2015, we asked SCI about the increase in Ethiopia (its largest program), and it told us the additional funding would support more program staff and would not result in additional treatments.6 It is not clear to us what caused this change in plans. (More) Note that we have faced similar challenges evaluating SCI in the past.7 Financial update SCI's financial management We wrote in our November 2014 review that we had not seen complete information on how SCI has spent funds in the past. We continue to know relatively little about SCI's finances. Last year, SCI worked with two consulting firms to identify ways it could improve its operations. Both firms identified financial management as an area SCI should improve.8 SCI hired a new financial manager in January 2015.9 She told us that she has been learning SCI's financial systems and that due to the complexity of the system, she did not expect to be able to provide a detailed financial update until September 2015.10 Past spending In July 2015 (after we had drafted this update), SCI shared spending and income data for April 2013 to March 2015 (SCI financial statements, 2013-14 and 2014-15). We expect to need to analyze this data in depth and discuss it with SCI before having confidence in it.11 We plan to discuss this data with SCI in our next conversation.12 Unrestricted funding In December 2014, we wrote that we hoped SCI would receive $1 million from individuals as a result of our recommendation (in addition to $3 million from Good Ventures and $1 million from another donor, both of which had already been committed). We expected this would result in SCI having about $7 million in unrestricted funding (including its existing reserves and funds it raised from other sources).13 In April 2015, we noted that we had met our target; we had tracked $1.1 million in donations from individuals to SCI due to our recommendation. In March 2015, SCI reported to us that it held $6.5 million in unrestricted funding.14 In July 2015, SCI sent us a financial report that shows that its unrestricted funding balance as of March 2015 was $8.1 million.15 We do not know what the cause of this discrepancy is. It is unclear to us how much unrestricted funding SCI currently holds. Monitoring and evaluation We have seen limited new monitoring and evaluation studies assessing the impact of programs that SCI supports since our last update in November 2014. SCI shared an update on its plans for completing monitoring and evaluation studies.16 Many of its plans have been delayed. New monitoring and evaluation Remapping study from Yemen: The study concluded that the schistosomiasis control program in Yemen had significantly reduced infection rates after 2-3 rounds of treatment.17 We have not yet examined this study in depth. It is our understanding that Yemen accounts for a small portion of SCI's past spending.18 Remapping study from Malawi: The study analyzed schistosomiasis and STH mapping data in five districts in Malawi in 2013. These districts had received four rounds of treatment by the time of the study. The study does not compare infection rates to a baseline.19 Without baseline data, it does not appear that this study provides additional evidence of SCI's impact in Malawi. (Note that assessing SCI's impact was not the goal of the study.) SCI's monitoring and evaluation plans Previously, SCI had told us that it expected to complete reports on three additional studies by January 2015. In May 2015, SCI told us that the expected completion dates for these reports had been delayed:20 A report on a coverage survey in Uganda had been expected in September 2014. As of May 2015, it was expected in June 2015.21 A report on a coverage survey in Malawi had been expected in November 2014. As of May 2015, it was expected in July 2015.22 A report on a baseline prevalence survey in Tanzania had been expected in January 2015. As of May 2015, it was expected in September 2015. Other monitoring plans also appear to have been delayed.23 We have not yet discussed the updated timeline with SCI and do not know what caused the delays. According to the updated timeline, several reports had been expected in the next few months:24 Coverage surveys: Uganda in June 2015 and Malawi (second survey) in July 2015 Baseline impact surveys: Mozambique, Tanzania, and Niger in September 2015 Follow up impact surveys: Malawi (second follow up) in August 2015 and Liberia in September 2015 We would guess that the studies that are scheduled to be available in the next few months will have a limited effect on our view of SCI's impact. This is because: We have significantly more information on the impact of the Malawi program than on the impact of other country programs.25 Additional reports from Malawi will be of more limited value in understanding SCI's overall performance than reports from countries we know little about. We would also guess that the Malawi program is particularly well-run (as evidenced by the number of studies it has completed). The Liberia program is also somewhat exceptional because it was put on hold during the Ebola outbreak.26 SCI previously told us that the Uganda coverage survey found low coverage rates.27 Baseline reports are primarily useful for understanding SCI's potential impact (high baseline prevalence means higher potential impact) rather than its actual impact. Additional monitoring In an attempt to learn more about the impact of SCI’s programs, we are planning a project with IDinsight and SCI to do additional monitoring of SCI-supported programs. We have published a few documents from the preliminary planning for the project: IDInsight notes from a conversation with GiveWell and SCI (January 2015) Preliminary concept note (March 2015) Project update (April 2015) GiveWell's non-verbatim summary of a conversation with Fiona Fleming and Daniel Gastfriend, April 2, 2015 Cost per treatment We do not have an updated estimate of SCI's cost per treatment delivered. Given our uncertainty about both the number of SCI-supported treatments (discussed below) and SCI's total spending (discussed above), we elected not to update our estimate of the cost per treatment. Treatments in last fiscal year SCI sent us preliminary data reporting that programs that it supported delivered a total of 26.1 million schistosomiasis treatments during its last budget year (April 2014 - March 2015).28 In addition, SCI estimated that an additional 6.7 million treatments were scheduled to be delivered in April 2015 (3.3 million treatments in Mozambique and 3.4 million treatments in Ethiopia).29 Data was not yet available for some countries.30 We do not have details on the sources of this data or whether there were any procedures for checking the accuracy of the reported numbers. We compared the treatments that SCI has preliminarily reported to the number of treatments that it had planned to deliver last year, as of September 2014. We have seen both planned treatments and reported treatments for twelve of its programs.31 Across these programs, SCI planned 32.5 million treatments and supported an estimated 25.6 million treatments (including the 6.7 million April 2015 treatments in Mozambique and Ethiopia).32 SCI's Planned and Reported Treatments (millions)33 Country Projections Reported Difference Mozambique 7.0 7.6 0.6 Malawi 5.6 4.3 -1.3 Ethiopia 3.7 3.4 -0.3 Cote d'Ivoire 5.4 2.8 -2.6 Tanzania 0.6 2.1 1.5 DRC 1.7 1.6 -0.1 Zanzibar 2.6 1.6 -1.0 Zambia 2.6 1.0 -1.6 Niger 2.1 1.0 -1.1 Madagascar 0.3 0.2 -0.1 Uganda 0.4 0.0 -0.4 Liberia 0.5 0.0 -0.5 Total 32.5 25.6 -6.9 SCI told us that treatments were delayed in Liberia (due to the Ebola outbreak) and Côte d'Ivoire (delayed from November 2014 to May 2015).34 We have not discussed with SCI what caused the changes in other countries. Spending plans March 2015 budget In March 2015, SCI shared a draft budget for April 2015 to March 2016.35 SCI expects to spend about $15 million in total, using $7 million in restricted funding and about $8 million in unrestricted funding.36 For more details on how SCI is allocating its funds across its country programs, see SCI draft budget 2015-2016. Within each country program, we do not know how funds will be allocated across different activities (e.g., mass drug administrations, monitoring, and training staff) nor the breakdown between restricted and unrestricted funding. How do SCI's current plans compare to its room for more funding analysis from November 2014? We believe there is significant uncertainty in understanding SCI's plans, and we track how its plans change over time in order to better understand (a) the factors that can cause SCI to make adjustments and (b) the reliability of SCI's predictions. Quickly changing circumstances can make it difficult to predict in which countries SCI will be able to work; in other cases, the reasons for changes in SCI's plans have not been clear to us.37 There are a few notable differences between SCI’s planned budget (as of March 2015) and our prior understanding (as of November 2014) about how SCI would spend unrestricted funding: SCI appears to have changed its strategy for holding reserves. The budget indicates that SCI expects to spend all of its unrestricted funding in the 2015-2016 budget year, rather than holding a portion of funds received as reserves for future years.38 In November 2014, we expected that about a third of new unrestricted funding that SCI received would be held in reserve for 2016 to help ensure that programs could be maintained in the following year.39 In August 2015, SCI told us that it now expects to rely on funds received in 2015 to support programs in 2016;40 we do not know why SCI changed its strategy. SCI appears to have underestimated its funding need for certain programs. For example, we had expected that SCI would spend about $1.4 million this year in Ethiopia, but it is now allocating about $2.6 million to Ethiopia (SCI's largest allocation this year).41 Similarly, we had expected that SCI would spend about $800,000 this year in Tanzania, but it is now allocating about $2.1 million there.42 SCI told us that the updated Ethiopia budget will fund the same number of treatments that was planned initially.43 We do not know if other increases in programs' budgets are due to (a) previous estimates being too low or (b) changes in the number of treatments SCI expects to deliver. In our November 2014 report, we listed several countries where SCI would consider working or expanding its work if it had more funding. From discussions with SCI, we understood that SCI was likely to encounter political or logistical constraints in some countries. We expected that, if SCI were to receive sufficient funding for all of the work that we described in our November report as "probable" or "possible" funding opportunities, it would be able to move forward with some but not all of the opportunities. The budget SCI shared in early 2015 implies that SCI expects to be able to allocate funding to all of the "probable" and "possible" opportunities.44 We are uncertain whether (a) our expectations were wrong, (b) SCI has encountered fewer non-funding constraints than it expected, or (c) the budget should only be interpreted as possible allocations rather than expected spending. This spreadsheet compares our November 2014 analysis to SCI's draft budget for each program. Sources Document Source Accenture Development Partnerships, Programme and Financial Management Workshop (June 2014) Unpublished Alan Fenwick and Blandine Labry, SCI Director and Finance and Operations Manager, conversation with GiveWell, February 5, 2015 Unpublished Alan Fenwick, SCI Director, conversation with GiveWell, October 14, 2014 Unpublished Alan Fenwick, SCI Director, email to GiveWell, April 14, 2015 Unpublished Alan Fenwick, SCI Director, email to GiveWell, August 11, 2015 Unpublished Deloitte Draft Internal Audit Report 2012/2013 for SCI (January 2014) Unpublished GiveWell analysis of SCI preliminary treatment data 2014-2015 Source GiveWell's non-verbatim summary of a conversation with Alan Fenwick and Blandine Labry, April 27, 2015 Source Mapping of Schistosomiasis and Soil-Transmitted Helminths in Yemen, and the Push for Elimination Source Schistosomiasis Prevalence and Intensity in Relation to the Proximity of Lake Malawi Source SCI advisory board financial report (June 2014) Source SCI draft budget 2015-2016 Source SCI financial statements, 2013-14 and 2014-15 Source SCI impact and coverage survey plans (May 2015 update) Source SCI report to GiveWell (September 2014) Source SCI's ICOSA Mid-Year Report to DFID, 2015 Source Additional documents SCI shared additional documents with us, some of which are internal reports rather than formal publications. Document Source Knipes et al. 2014 (abstract only) Source Longitudinal Cohort Study for Monitoring and Evaluation of the Malawi National Schistosomiasis and STH Control Programme Source SCI budget allocation meeting minutes (March 2015) Source SCI Control of schistosomiasis and soil-transmitted helminths in Ethiopia, internal report (November 2014) Source SCI Cote d'Ivore coverage survey protocol (2014) Source SCI Cote d'Ivore coverage survey protocol, French (2014) Source SCI Cote d'Ivore mapping protocol, French Source SCI Final Report to Gates Foundation, excerpt (February 2012) Source SCI Funded control of NTDs in Madagascar, internal report (2014) Source SCI Malawi coverage survey protocol, draft (October 2012) Source SCI Malawi mapping protocol Source SCI Newsletter (December 2014) Source SCI organogram, internal report (January 2015) Source SCI Schistosomiasis Control in Yemen Progressing from Control of Morbidity to Elimination as a Public Health Problem (July 2014) Source Worrell and Mathieu 2012 Source (archive) 1 "Before starting a new program, SCI wants to have funding for a pilot but also for some amount (perhaps double the pilot) for scale-up in future years." Alan Fenwick, SCI Director, conversation with GiveWell, October 14, 2014 More in our November 2014 review 2 Note that this is based on the lack of an explicit line for reserves in its budget and the unrestricted funds closing balance being negative. SCI draft budget 2015-2016 3 "Looking ahead to the next three years, SCI is still determining the budget reserve it needs. This amount should be about 25% of unrestricted funds received from British donors and U.S. donors, which might be approximately £400,000. This figure does not include unrestricted funds from three large donors." GiveWell's non-verbatim summary of a conversation with Alan Fenwick and Blandine Labry, April 27, 2015. 4 SCI draft budget 2015-2016 Its negative closing balance of £952,175 converted to USD at an exchange rate of 1.55 (based on Google Finance on April 29, 2015) is $1,475,871. The closing balance of £952,175 is 18.5% of its "Balance to be funded by unrestricted" of £5,140,368 5 We relied on these in our room for more funding analysis. 6 "The program began a few weeks ago, and will provide schistosomiasis treatment for 7.5 million individuals. The budget is approximately £1.7 million, with a treatment cost of approximately 25 pence/individual. Given the country’s size, SCI had to allocate more funding than it expected to additional staff costs." GiveWell's non-verbatim summary of a conversation with Alan Fenwick and Blandine Labry, April 27, 2015 7 Note on communication issues in our review of SCI Discussion in our November 2012 update on SCI 8 Accenture Development Partnerships, Programme and Financial Management Workshop (June 2014). Challenges that were found include: "Insufficient financial reporting produced to enable decision making" (Slide 4) "Insufficient data to enable forecasting funds needed and plan for funds transfers" (Slide 4) "Insufficient reports to create and review actual expenditure with programme managers" (Slide 4) "Lack of financial policies and guidance" (Slide 4) "Insufficient capacity in finance, data management and analysis" (Slide 4) Deloitte Draft Internal Audit Report 2012/2013 for SCI (January 2014). Recommendations include addressing issues with: "The preparation of financial information and statements for stakeholders" (Pg 3) "The clarity and consistency of SCI transactions records" (Pg 3) "The budget setting and budget monitoring process" (Pg 3) "Approving and checking potential donors / donations and implementing a donations management system" (Pg 3) "Reconciling expected income to actual income received" (Pg 3) "Reconciling project/programme expenditure to supporting documentation" (Pg 3) 9 Alan Fenwick and Blandine Labry, SCI Director and Finance and Operations Manager, conversation with GiveWell, February 5, 2015 10 GiveWell's non-verbatim summary of a conversation with Alan Fenwick and Blandine Labry, April 27, 2015. 11 See the reasons we listed for doubting the accuracy of SCI's financials in our November 2014 review. It's unclear if this report could have issues similar to those we've seen in the past. 12 Also, in May 2015, SCI sent us a report that includes some spending data (SCI's ICOSA Mid-Year Report to DFID, 2015, Pgs 21-24, 28). We do not know how comprehensive or representative this data is. We plan to review this report before our next update. 13 See our December blog post 14 SCI draft budget 2015-2016 £4,188,193 converted to USD at an exchange rate of 1.55 (based on Google Finance on April 29, 2015) is $6,491,699. In late 2014, we expected that if SCI received $5 million from GiveWell-influenced donors (including $3 million from Good Ventures and $1 million from another major donor), it would have about $7 million in unrestricted funding. (See our December blog post.) After SCI received $5 million from GiveWell-influenced donors, it reported in April 2015 that it had about $6.5 million in unrestricted funding. We did not follow up on the $500,000 difference in these estimates because the difference seemed relatively small. 15 The report shows that SCI held £5,232,150 ($8,109,833 converted to USD at an exchange rate of 1.55 (based on Google Finance on April 29, 2015)) in unrestricted funds at the end of its 2014/2015 financial year, SCI financial statements, 2013-14 and 2014-15. As discussed above, we are uncertain how reliable this report is. 16 SCI impact and coverage survey plans (May 2015 update) 17 Mapping of Schistosomiasis and Soil-Transmitted Helminths in Yemen, and the Push for Elimination. "After 2-3 rounds of treatment a prevalence re-mapping survey was conducted to map the distribution of infection and provide an overview of the programme’s impact on NTD prevalence from baseline levels in 2010." Pg 9. "Overall, the survey showed a significant reduction in the number of infected districts from 2010, with 64 fewer districts now harbouring any SCH infection and an average prevalence of 3.2% (Table 13). This decrease is a notable achievement, with no longer any districts classified as high-risk and 86.3% fewer districts moderate endemic, many of which are now either low endemic or free from infection. Even with a reduced threshold of ≥30% instead of ≥40% for high-risk prevalence, only 3 districts from Ta`izz governorate fell into this category with borderline moderate endemicities. Furthermore, the number of infected districts classified as low-risk has increased from 41 (14.9%) in 2010 (24) to 186 (88.2%) in 2014 showing that most of the country is now categorised as having low infection levels." Pg 41. 18 The best data we have indicates that 1.8% (about $163,000) of SCI's spending from unrestricted funds was in Yemen. See our November 2014 review of SCI. We do not know how much restricted funding SCI received for Yemen; we know that Yemen was not supported by SCI's major grants from USAID, Gates Foundation, or DFID (USAID and Gates Foundation grants discussed in our November 2014 review and DFID grant in SCI advisory board financial report (June 2014), Pgs 8-9) but that SCI has received about ~£220,000 in funding from the END Fund (two grants for £91,673 and £139,053. SCI advisory board financial report (June 2014), Pgs 3-4). 19 Schistosomiasis Prevalence and Intensity in Relation to the Proximity of Lake Malawi. Details of the study: "A re-mapping survey was carried out by randomly selecting 15 schools from five lakeshore districts after stratifying for distance from the lake to allow analysis of distance and prevalence. 30 children from each school, 15 boys and 15 girls, aged 10-14 were randomly selected and tested for s.haematobium using the urine filtration technique and s. mansoni and Soil Transmitted Helminths’s (STH) by Kato Katz. Questionnaires regarding frequency of water contacts were also answered by the children to establish if there was a link between frequency of water contacts and presence of infection. This data was used to derive district-level prevalence estimates, which can be used to inform on-going treatment programs in these areas." Pg 8. "Five districts located on the shore of Lake Malawi are endemic for s. mansoni and s. haematobium and have received four rounds of annual treatment with Praziquantel and Albendazole since 2009 (MoH report)." Pg 9. "It has been determined, by the MoH and their partners at the Schistosomiasis Control Initiative (SCI), that these five districts should be re-mapped a year earlier (i.e., in 2013 rather than 2014) due to poor quality of the original mapping data and the financial opportunity to do so." Pg 9. 20 Our previous expectations were based primarily on this timeline that SCI had shared with us in September 2014. We had already expected that the report from Liberia would be postponed because the program was delayed due to Ebola. Alan Fenwick, SCI Director, conversation with GiveWell, October 14, 2014 We previously discussed coverage surveys from Côte d'Ivoire (unpublished), Malawi (pdf here), and Uganda (unpublished) and an impact report from Malawi (pdf here) in our November 2014 review. SCI sent us this update in May 2015: SCI impact and coverage survey plans (May 2015 update). It appears that SCI will be conducting many studies this year but does not plan to have many new reports complete in the next few months. Because we received this after an initial draft of our update, we have not yet discussed this with SCI. We plan to provide more details on this timeline in our next update. SCI has not sent us any completed reports or further updates since May 2015. See this section of our November 2014 review for more detail on which monitoring reports we have seen. 21 We discussed coverage survey data from Uganda in our November 2014 review; we are unsure if this reports on the same or different data. 22 This is a second coverage survey in addition to the one we discussed in our November 2014 review. 23 Based on comparing this (older) timeline to this update: SCI impact and coverage survey plans (May 2015 update) A follow-up impact survey in Côte d'Ivoire was pushed back from September 2014 until May or November 2015. A baseline impact study in Mozambique that SCI thought was complete now requires re-work such that it is expected to be finished in September 2015. A follow-up impact survey in Tanzania was pushed back from 2014 until November 2015. Coverage surveys in Ethiopia and DRC were pushed back from January 2015 until later in the year. A coverage survey in Mozambique was pushed back from April 2015 until July 2015. A coverage survey in Tanzania was pushed back from November 2014 until 2016. A coverage survey was planned in Niger for November 2014 and is now scheduled for June 2015. We are uncertain how to interpret some of the other updates. For example, it appears that impact surveys in several countries (Ethiopia and DRC) are now split into several pieces. 24 SCI impact and coverage survey plans (May 2015 update). 25 See for example: Data from panel studies Data from coverage surveys Observations from a site visit to Malawi 26 Alan Fenwick, SCI Director, conversation with GiveWell, October 14, 2014. 27 See our November 2014 review of SCI. 28 GiveWell analysis of SCI preliminary treatment data 2014-2015. SCI told us that it expected to be able to share updated treatment data in May 2015. GiveWell's non-verbatim summary of a conversation with Alan Fenwick and Blandine Labry, April 27, 2015. In May 2015, SCI sent us a report that includes treatment data that may be more updated (SCI's ICOSA Mid-Year Report to DFID, 2015, e.g. Pgs 9-10). This data is generally consistent with the data discussed in this update, but it includes an additional ~250,000 treatments in both Côte d'Ivoire and Niger. We plan to go through this document in more detail before our next update. As of July 2015, we have not seen final treatment data covering all of SCI's programs. 29 GiveWell's non-verbatim summary of a conversation with Alan Fenwick and Blandine Labry, April 27, 2015 SCI's program in Mozambique was scheduled to deliver 3.3 million treatments in April. SCI's ICOSA Mid-Year Report to DFID, 2015, Pg 9 SCI's program in Ethiopia was scheduled to deliver an estimated 3.4 million treatments in April. SCI's ICOSA Mid-Year Report to DFID, 2015, Pg 9 30 Treatments that were delivered in Rwanda and Burundi have not yet been reported. Alan Fenwick, SCI Director, email to GiveWell, April 14, 2015 SCI planned to deliver 660,000 treatments in Burundi and 200,000 treatments in Rwanda. SCI report to GiveWell (September 2014), Annex 1, Pgs 7-8 We are unsure if any treatments were delivered in Sudan. SCI planned to deliver 4.5 million treatments in Sudan (SCI report to GiveWell (September 2014), Annex 1, Pgs 7-8). Sudan is not included in the preliminary data, and we have not heard an update on the program there. 31 SCI reported that it supported 7.2 million treatments in Yemen, but we did not see planned treatments for this program, so we did not include those treatments in this comparison (GiveWell analysis of SCI preliminary treatment data 2014-2015 and SCI report to GiveWell (September 2014), Annex 1, Pgs 7-8). As noted above, we have also seen planned treatments but not reported treatments for some programs, such as Rwanda, Burundi, and Sudan. 32 GiveWell analysis of SCI preliminary treatment data 2014-2015 SCI report to GiveWell (September 2014), Annex 1, Pgs 7-8 Prior to including the April 2015 treatments in Mozambique and Ethiopia in this comparison, we observed a difference between planned and reported treatments of about 14 million. We asked SCI about this difference. SCI told us that the short delays (which we believe includes the 6.7 million treatments in Mozambique and Ethiopia) were a major cause of this gap and that the remaining gap between planned and reported treatments did not reflect a significant problem delivering treatments. GiveWell's non-verbatim summary of a conversation with Alan Fenwick and Blandine Labry, April 27, 2015 33 Projected data cover April 2014 - March 2015; Reported data cover April 2014 - April 2015. GiveWell analysis of SCI preliminary treatment data 2014-2015 34 In April 2015, we asked SCI about Côte d'Ivoire: "SCI had planned to treat approximately 3.5 million individuals in Cote d’Ivoire in November 2014. 1.6 million individuals were treated in December 2014. The remaining treatments were rescheduled for April 2015, but these have not yet taken place due to a university partner’s delay in taking baseline measurements at some sentinel sites. As soon as these measurements have been taken, about 1 million additional treatments will be administered." GiveWell's non-verbatim summary of a conversation with Alan Fenwick and Blandine Labry, April 27, 2015 (Note: these ~2.6 million delayed treatments only account for a portion of the 3.5 million planned treatments, and we are uncertain what explains the remaining shortfall.) Previously, we knew that the program in Liberia, where SCI planned 500,000 treatments, was postponed due to Ebola (Alan Fenwick, SCI Director, conversation with GiveWell, October 14, 2014). 35 SCI draft budget 2015-2016 36 SCI draft budget 2015-2016 £9,758,863 converted to USD at an exchange rate of 1.55 (based on Google Finance on April 29, 2015) is $15,126,238. Restricted funding (grants or contracts) of £3,527,874 secured and £1,090,621 in pipeline converted to USD at an exchange rate of 1.55 is $7,158,667; unrestricted balance needed of £5,140,368 converted to USD at an exchange rate of 1.55 is $7,967,570. 37 Further context provided here: November 2014 review June 2014 update 38 Note that this is based on the lack of an explicit line for reserves in its budget and the unrestricted funds closing balance being negative. SCI draft budget 2015-2016 39 See our November 2014 review. 40 SCI provided this explanation: "This is due to optimistic income trends and so income this year will create a reserve as the year continues." Alan Fenwick, SCI Director, email to GiveWell, August 11, 2015. 41 Current allocation: SCI draft budget 2015-2016 £1,708,967 converted to USD at an exchange rate of 1.55 (based on Google Finance on April 29, 2015) is $2,648,899. Our November 2014 expectation was that this program would require about $1.4 million. See GiveWell analysis of SCI room for more funding, which lists existing funding of $80,000 and $602,019 as well as 2015 room for more funding of $800,000 (using an exchange rate of 1.6; using a comparable exchange rate of 1.55 results in a total of $1,435,706). 42 Current allocation: SCI draft budget 2015-2016 £1,333,686 converted to USD at an exchange rate of 1.55 (based on Google Finance on April 29, 2015) is $2,067,213. Our November 2014 expectation was that this program would require about $800,000. See GiveWell analysis of SCI room for more funding, which lists existing funding of $208,000 as well as 2015 room for more funding of $592,000 (using an exchange rate of 1.6; using a comparable exchange rate of 1.55 results in a total of $775,000). 43 Both budgets are intended to fund the delivery of about 7 million schistosomiasis treatments. GiveWell's non-verbatim summary of a conversation with Alan Fenwick and Blandine Labry, April 27, 2015 Spending $2.6 million for 7 million treatments would imply an SCI program cost per treatment of $0.38 (without including SCI's headquarter costs and the costs to other partners). This is roughly consistent with our previous analysis of SCI’s average cost per treatment, which estimated an average cost per treatment of about $0.50. (We estimated a total cost per treatment of $1.23, of which SCI would spend about 40%, including headquarter costs; the local government and drug donations account for the other 60%. See our previous analysis and this spreadsheet.) Our previous understanding that $1.4 million would support 7 million treatments in Ethiopia implies an SCI program cost per treatment of about $0.20 (without including SCI's headquarters costs and the costs to other partners). 44 See our detailed program comparison. We wrote in our November 2014 review of SCI that we expected that "country programs may face many different non-funding related constraints." In particular, we listed Ethiopia, Mozambique, and Malawi as "probable" opportunities for further spending and DRC, Madagascar, Sudan and Tanzania as "possible" opportunities. SCI's budget allocates unrestricted funding to all seven countries. See column "Implied allocation of unrestricted funds (assumes no change in restricted funds since Oct 2014)" in the spreadsheet.