Allocation of Funds Donated to the Top Charities Fund in Q1 2021

Please note that this page describes our understanding of our top charities' funding needs and plans as of April 2021, which is when we made the allocation decisions described below.

Published: August 2021; Last Updated: October 2022

How did we arrive at our allocation?

Principles we followed

The principles we followed in arriving at this recommended allocation are the same as those we followed and described in detail in 2019.

• Principle 1: Put significant weight on our cost-effectiveness estimates.
• Principle 2: Consider additional information that we have not explicitly modeled about an organization.
• Principle 3: Consider additional information that we have not explicitly modeled about a funding gap.
• Principle 4: Assess charities' funding gaps at the margin, i.e., how they would spend additional funding, where possible.
• Principle 5: Default to not imposing restrictions on charities' spending.
• Principle 6: Default to funding on a three-year horizon, modifying to preserve our options for the future where doing so is low-cost.
• Principle 7: Ensure charities are incentivized to engage with our process.

A note on how we discuss cost-effectiveness on this page

We often use GiveDirectly's unconditional cash transfers as a benchmark for comparing the cost-effectiveness of different programs. When discussing cost-effectiveness, we generally refer to the cost-effectiveness of a program in multiples of "cash." Thus, if a program is estimated to be "10x cash," this means it is estimated to be ten times as cost-effective as unconditional cash transfers.

Maximizing cost-effectiveness over time

GiveWell allocates funding on a quarterly basis. For each allocation decision, we try to maximize the cost-effectiveness of GiveWell-directed giving over time. We do this by:

• Funding opportunities above the cost-effectiveness threshold we expect to apply over the next couple of years. As of early 2021 this threshold is roughly 8x cash, but it is liable to change over time depending on the size and cost-effectiveness of new opportunities we identify and how much total funding we are able to direct to our recommendations.
• Not missing out on time-sensitive opportunities, i.e., opportunities that will not be available in the future or for which a delay in funding would cause delays in program implementation.
• Among opportunities that are not yet time-sensitive, favoring opportunities that are more certain, i.e., that we're less likely to change our mind about before the next time we make a funding decision.

External feedback

We aim to get feedback on our grantmaking from stakeholders other than our top charities, such as government officials, other implementers involved in delivering the program, or other organizations working in the relevant context. The goals of these conversations are to learn more about the context in which a program will be delivered, to confirm the need for additional support of the program, and to seek feedback on the activities that a potential grant to support the program would enable. The external conversations we had about the grants we made this quarter are listed below, in sections titled "Who we talked to about the grant." We value the insights we gained by speaking with these organizations and appreciate the time they spent answering our questions. We note that the views expressed on this page are our own.

Our allocation

Helen Keller International

We made a grant of $11 million to Helen Keller International to fund vitamin A supplementation (VAS) campaigns in Cameroon and Nigeria.

Nigeria

How we expect the grant will be used

We expect Helen Keller International to use $7.5 million of the grant to fund VAS campaigns in Nigeria in the second half of 2021 through the end of 2024. Helen Keller International plans to support VAS campaigns in four new states in Nigeria,1 bringing the total number of Nigerian states supported by GiveWell-directed funding to six.2

Helen Keller International intends to use this grant to support one state from the second half of 2021 through the first half of 2024, and the other three states from 2022-2024. Helen Keller International told us that it will need to increase its staff capacity in Nigeria in order to accomplish this, and it is unsure how quickly it will be able to do so. This is why it has proposed a staggered expansion, with plans to enter one additional state this year and the next three the following year.3 If increasing its capacity takes longer than expected, it's possible that Helen Keller International will use this funding to expand into new states more slowly than it currently plans.

We intend for Helen Keller International to use this grant flexibly to support VAS in whichever states it determines have the greatest need. At the time we made this grant, Helen Keller International had identified four Nigerian states that may need support for VAS campaigns4 and was planning to conduct state-level evaluations to confirm whether its support is indeed needed.5 In some of these states, VAS campaigns may be occurring without Helen Keller International's support. Helen Keller International will evaluate these states by conducting coverage surveys of these campaigns,6 and will choose to support only those states where surveys show that the campaigns are not reaching a high proportion of the target population. In other states, VAS campaigns may not be occurring at all without Helen Keller International's support. Helen Keller International will evaluate these states by conducting qualitative assessments of the state's partner landscape, VAS campaign history, and routine health services (through which VAS is also delivered) to come up with an estimate of what proportion of the target population is being reached.7 Again, Helen Keller International will choose to support only those states where it believes it can substantially increase the number of eligible children receiving VAS.

Who we talked to about the grant

We discussed this grant with Helen Keller International. We also discussed the grant with Nutrition International's Nigeria team and UNICEF's Nigeria team, both of which support Nigeria's VAS program at the national and state level.

Case for the grant

We estimate the cost-effectiveness of this grant as 24x cash.8 However, this estimate relies on vitamin A deficiency (VAD) data we are highly uncertain about and would drop to 8x cash if we chose to use an alternative source of VAD data (see below). At 8x cash, this grant would still meet our cost-effectiveness threshold. Our cost-effectiveness model incorporates the following factors:

• Baseline vitamin A deficiency: Our estimate of the cost-effectiveness of VAS in Nigeria is heavily dependent on whether we use VAD prevalence data from the 2017 or 2019 version of the Institute for Health Metrics and Evaluation (IHME)'s Global Burden of Disease (GBD) Results Tool. Using the 2017 version of IHME's model results in a cost-effectiveness estimate of 24x cash, while using the substantially lower VAD prevalence rates in the updated 2019 version of the model results in an estimate of 8x cash.9 In our current CEA, we have chosen to continue using the 2017 version of the model, because we are highly uncertain about the methodological changes causing the discrepancy between the two versions and because the VAD prevalence rates in the 2017 version align more closely with results from a VAD survey that was conducted in Nigeria in 2001, which is the most recent survey we're aware of.10 Our understanding from a discussion with IHME is that it plans to make additional changes to its VAD model that will be reflected in the 2020 version, which we plan to review when it is available.
• Child mortality rates: Using data from IHME's Viz Hub, we took the average of the child mortality rates in the four states that Helen Keller International was planning to work in at the time we made the grant, weighted by the percentage of its budget that it planned to spend in each state. The weighted average child mortality rate in these four states is slightly lower than the child mortality rate for Nigeria as a whole.11 While Helen Keller International may decide to support a different set of states, we guess that this weighted average is a better approximation of the child mortality rate in the states it will ultimately support than the national average would be. This is based on our assumption that Helen Keller International wouldn't have proposed supporting states with lower-than-average child mortality rates if there were states with higher mortality rates that it was in a position to support.

Prior to 2021, VAS was delivered in Nigeria as part of a package of health services administered during biannual Maternal, Newborn, and Child Health (MNCH) weeks, which were financed through state governments using a loan from the World Bank's Saving One Million Lives Initiative.12 We have heard from multiple sources that this funding expired in 2020 or will expire in 2021. Therefore, our understanding is that, moving forward, in Nigerian states without a dedicated funding source for VAS campaigns, VAS will primarily be delivered through routine health services.13 Our understanding is that in Nigeria, routine delivery of VAS currently reaches far fewer children than are reached through MNCH weeks, so we expect support to campaigns to substantially increase the number of children who receive VAS. As described above, Helen Keller International is planning to confirm this by conducting state-level evaluations before initiating support.

We believe this grant is a time-sensitive funding opportunity. Helen Keller International told us that it could support VAS in one state in the second half of 2021 if it received the necessary funding soon. Helen Keller International also told us that securing funding quickly would allow it to begin scaling up its staff capacity in 2021 in preparation for expanding to additional states in 2022.14 Additionally, as described above, we expect that granting this funding now will allow us to request that Helen Keller International conduct baseline evaluations in expansion states prior to supporting campaigns.

Finally, the limited data we've seen on Helen Keller-supported VAS campaigns in Nigeria to date appears promising. In 2020, Helen Keller used GiveWell-directed funding to support a VAS campaign in Nasarawa state. A survey conducted after this campaign found that it delivered VAS to 93% of the target population, though we note that we have not yet reviewed this survey in depth.15

Risks and reservations

We are uncertain about the current funding landscape and baseline coverage levels for VAS in the four states Helen Keller International is planning to expand to. We believe the benefits of making this grant now outweigh the risks of waiting for more information, as waiting would delay Helen Keller International's capacity-building activities and slow down its expansion. We also believe that we will get additional information through Helen Keller International's investigative process and that we'll be able to work with Helen Keller International to redirect funding to more cost-effective efforts if additional funding for VAS turns out not to be needed in its four target states.

In addition, we remain highly uncertain about the prevalence of VAD in Nigeria and elsewhere, as demonstrated by the discrepancy between the VAD rates in IHME's 2017 and 2019 versions of its GBD Results Tool.

Cameroon

How we expect the grant will be used

We expect Helen Keller International to use $3.5 million of this grant to fund VAS campaigns in Cameroon in the second half of 2021 through the first half of 2024. Helen Keller International is planning to use this funding for campaigns in the Central, Littoral, West, and South regions of Cameroon.16 Our understanding is that these four regions do not have external funders for VAS campaigns.

Who we talked to about the grant

We discussed this grant with Helen Keller International and with UNICEF's Cameroon team. UNICEF has historically supported VAS campaigns in Cameroon, either by integrating VAS into scheduled nationwide campaigns for other health interventions or by supporting standalone VAS campaigns. Because conducting standalone campaigns is more costly than integrating VAS into campaigns for other interventions, UNICEF-funded standalone VAS campaigns have typically covered four prioritized regions of the country (North, Far North, East, and Adamawa), rather than aiming for nationwide coverage.17 UNICEF's funding for this work has been through a grant from Global Affairs Canada (GAC) that ran from 2016-2020 and supported VAS in multiple countries. Our understanding from several conversations with Helen Keller International is that GAC has not decided how much of this funding it will renew, but that a decrease in its overall VAS portfolio is likely.

Case for the grant

We estimate the cost-effectiveness of this grant as 28x cash.18 In addition, we believe this is a time-sensitive funding opportunity: VAS campaigns should ideally be conducted twice a year,19 but there is insufficient funding available to support two campaigns this year in Cameroon. The first VAS campaign of the year is being fully funded by UNICEF, which will integrate VAS with a scheduled nationwide vaccination campaign. GAC provided UNICEF with bridge funding to support this work while GAC decides how much funding to renew.20 The second VAS campaign of the year has not yet been funded for any regions of the country.21 While it is possible that UNICEF will receive additional funding from GAC for the second half of 2021,22 our understanding is that there is no other scheduled campaign into which VAS can be integrated. Consequently, our best guess is that UNICEF would use any additional funding from GAC to conduct VAS only in its four prioritized regions, leaving the four regions Helen Keller International is planning to support uncovered, regardless of GAC's decision.

We also believe that this grant will help Helen Keller International build up its capacity to deliver VAS in Cameroon and position it to fill additional funding gaps in other regions of the country in the future, should they arise. We are uncertain whether GAC will grant UNICEF sufficient funding to fully fund VAS campaigns in UNICEF's four prioritized regions during the next grant period, and there are two regions where VAS campaigns will not be supported by either UNICEF or Helen Keller International in the second half of 2021. It's possible that Helen Keller International could expand its support for VAS to cover these additional regions in Cameroon, as needed.

Risks and reservations

We are uncertain what the funding landscape for VAS in Cameroon will look like going forward. Consequently, we are uncertain whether this grant will displace funding from other funders who would have supported this work if we had not. We are aware that Nutrition International recently received a grant of roughly 29.5 million Canadian dollars for short-term support of VAS campaigns,23 and we are unsure whether any of that funding will be used to support Cameroon. As described above, we are also uncertain how much funding UNICEF will receive from GAC for VAS in the next four-year grant period. Because Helen Keller International told us that it believes GAC is likely to reduce its funding for VAS compared to the amount it provided from 2016-2020, we believe it is unlikely that this grant will substantially displace GAC funding.24 In our cost-effectiveness analysis, we incorporate a 30% probability that GAC or other philanthropic funders would fill this funding gap and a 10% probability that the government of Cameroon would fill this funding gap if we didn't make this grant.25

Sightsavers

We made a grant of $1.5 million to Sightsavers to partially fund deworming mass drug administration (MDA) in Chad in 2022-2024.

How we expect the grant will be used

We expect Sightsavers to use this grant to partially fund deworming MDA in 2022-2024 in six regions of Chad that it has classified as "Priority 1" regions. Sightsavers has recently conducted deworming in these six regions as part of the U.K. government's Ascend program.26 Sightsavers initially planned to treat eligible residents in all districts above a certain infection prevalence threshold and proposed a budget of $2.5 million for these six regions. Sightsavers now plans to trial rolling out an environmental suitability tool in Chad alongside the next round of MDA in these regions. This may impact treatment plans in the subsequent years. Sightsavers hopes this tool will enable more precise targeting of treatments at the sub-district level. It is possible this approach could lead to some areas no longer needing treatment and therefore some program savings.27 As such, we sized this grant at 60% of Sightsavers' initial budget, or $1.5 million.

Sightsavers' initial proposal also included supporting deworming MDA in ten additional "Priority 2" regions. Sightsavers has not worked in these regions but has identified them as being in need of deworming.28 We did not include support to these regions in this grant.

Our reasoning for making a grant that fills only part of the funding gap in Chad is that we were balancing competing considerations: on the one hand, we want to provide Sightsavers with sufficient funding to begin planning for deworming MDA in Chad, but on the other, we want to hold off on fully filling the funding gap until we have more information about its ultimate size. Once the budget for Priority 1 regions has been formally updated for sub-district targeting, we may provide additional funding to fill any gap that remains above the $1.5 million, if the amount we provided turns out to be an underestimate. At that point, we will also consider making an additional grant to support Priority 2 regions.

Who we talked to about the grant

We discussed this grant with Sightsavers. We discussed the possibility of funding a worm burden mapping survey in Chad, to be conducted prior to delivering deworming MDA, with the Expanded Special Project for Elimination of Neglected Tropical Disease (ESPEN) at the World Health Organization (WHO), the END Fund, SCI Foundation, and Evidence Action's Deworm the World Initiative (more details below). We also requested feedback on this grant from some of our other top charities:

• The END Fund, which has previously supported deworming MDA in Chad.29
• Malaria Consortium, which supports seasonal malaria chemoprevention (SMC) in Chad.
• SCI Foundation, another top charity that supports deworming.

Case for the grant

We estimate the cost-effectiveness of this grant as 14x cash.30 Our cost-effectiveness model incorporates the following factors:

• Cost per child dewormed: Based on Sightsavers' budget and the number of children it expects to treat, we estimate that Sightsavers' deworming program in Chad will cost $1.71 per child treated per year,31 which is more expensive than most other geographies in which GiveWell-directed funding has supported Sightsavers' deworming work.32 This is consistent with what our other top charities have told us about the relatively high operating costs of working in Chad.
• Worm burden: We apply an adjustment to our cost-effectiveness estimates of deworming programs to account for differences between the prevalence and intensity of worm infections in the geographies targeted by our deworming top charities and the prevalence and intensity of worm infections among the population studied in Miguel and Kremer 2004, the randomized controlled trial on which we base our estimate of deworming's impact on consumption.33 For Sightsavers' work in Chad, we use a relatively high worm burden adjustment. In other words, the data we have seen shows a relatively high worm burden in Chad compared to other locations we have funded.34 We find this data surprising, especially given that deworming MDA in Chad seems to be a low priority for other funders; we discuss our uncertainty about this data below.

Our understanding, based on multiple conversations with Sightsavers, is that deworming MDA is unlikely to be supported by other funders in the Priority 1 regions of Chad and that Priority 2 regions have not received deworming MDA at all in recent years. Priority 1 regions received deworming MDA in 2019 and 2020, funded by the U.K. government as part of its Ascend program.35 Our understanding is that the U.K. government has not prioritized funding standalone deworming MDA in areas that do not qualify for MDA for other neglected tropical diseases (NTDs); the deworming treatments it funded in recent years were added on to the onchocerciasis and lymphatic filariasis program it was funding in those areas.36 Recently, the U.K. government substantially decreased its budget for international aid, particularly for NTDs.37 Our understanding from speaking with several actors in the NTD community is that it is highly unlikely to continue to fund the Ascend project in its 2021-2022 fiscal year and fairly unlikely to scale back up its funding for NTDs after this year.

Risks and reservations

We initially had lower confidence in our worm burden adjustment for Chad because a) we had limited insight into the methodology used in the 2015 mapping survey from which we use data, and b) some areas that Sightsavers will treat were not mapped by that survey, so Sightsavers extrapolated prevalence in those unmapped areas from neighboring mapped areas. We initially considered funding a new mapping survey to gather more complete and higher-quality data. However, after discussing this idea with several other organizations (including some of our other deworming top charities and ESPEN), we decided not to move ahead for two reasons:

• We learned more about how the 2015 mapping survey was conducted and became more confident in its results. We determined that the worm burden data we use for Chad is of comparable quality to the data we use for other deworming programs we fund.
• We learned that conducting mapping at the sub-district level would be more expensive and time-intensive than we had initially expected and decided that the costs outweighed the benefits.

Given our increased confidence in this data and our desire to avoid delaying deworming treatment in these areas, we decided to move forward with a grant to support implementation of deworming MDA.

Separately, our understanding from multiple conversations is that Chad's ministry of health—which Sightsavers will support in delivering deworming MDA—is more constrained on staff resources than most other countries in the region. It seems possible that such constraints could reduce the quality of this program. The fact that Sightsavers has experience supporting MDA for deworming and other NTD treatments in Chad increases our confidence in its ability to deliver a high-quality program, as it brings prior knowledge about the operating environment and the types of support it needs to provide to the ministry.

Against Malaria Foundation

We allocated the remaining funding, roughly $1 million, to the Against Malaria Foundation (AMF).

How we expect the grant will be used

We expect that AMF will use this grant to fund long-lasting insecticide-treated net (LLIN) distributions in the Democratic Republic of the Congo (DRC) in 2023, which we estimate to be 13x cash.38 We estimate that AMF's room for more funding for DRC in 2023 is about $2.9 million,39 such that this grant will only fill part of its funding gap. However, we also believe that even if we didn't make this grant, AMF would very likely fill this entire funding gap in time to fund the LLIN distributions in 2023 (in other words, before the point at which insufficient funding would cause distributions to be delayed or would negatively impact planning for these distributions).40 Therefore, we believe the actual effect of this grant will be to free up $1 million of AMF's future revenue to use for other LLIN campaigns.

Who we talked to about the grant

We conducted an in-depth investigation of AMF's funding gap for LLIN distributions in DRC in advance of grants and funding recommendations we made in January and February 2021. During Q1, we spoke with AMF to understand the impact of those allocations on its room for more funding for DRC distributions and to begin investigating its funding opportunities in other countries, described below.

Case for the grant

As discussed in our previous allocation page, we believe that one impact of AMF's funding in DRC is to reduce the amount of time that passes between LLIN distributions, thereby causing people to receive LLINs sooner than they otherwise would. We discuss the context behind this understanding and how we model the cost-effectiveness of reducing the time interval between distributions in our previous allocation page and in our cost-effectiveness model changelog.

As discussed above, we believe the likely outcome of this grant is that it will allow AMF to use $1 million of its future revenue on LLIN campaigns other than its DRC campaigns in 2023. We believe that AMF's work in each of the countries it is considering supporting with this revenue would be above our cost-effectiveness threshold of 8x.41 Based on conversations with AMF, we expect that AMF will consider the following opportunities:

• Reducing the interval between distributions in Nigeria in 2023, which we estimate to be 15x cash.
• Renewing funding in countries where AMF has worked in the past:
  • Togo (9x cash) and Uganda (17x cash): AMF last funded distributions in Togo and Uganda in 2020.42 Our understanding is that distributions in these countries occur every three years, so there may be a need for AMF to support these countries again in 2023.
  • DRC 2024: We guess that AMF will be looking to continue funding DRC past 2023.
• Potentially funding work in a country AMF hasn't worked in before. AMF requested that we keep the country confidential at this stage in its discussions with the government's malaria program. This country overall has malaria rates that differ significantly across the country, and AMF is investigating whether there are any gaps in areas that have malaria rates similar to those in other countries where it works.

Risks and reservations

We could have chosen to hold this funding until we knew exactly how AMF would use it. However, we expect that AMF will likely use additional funds to support opportunities that are above our threshold for cost-effectiveness and that it will take our feedback about potentially low-cost-effectiveness opportunities into consideration. Therefore, we see little downside in making this grant now. In addition, we believe having funding sooner may help AMF to accelerate its discussions with partner governments, which in turn may improve its ability to plan for the distributions listed above or may free up some of its capacity to identify additional distributions in need of support.

One open question we have about AMF's support to countries is how its process and monitoring requirements affect the quality of the distributions it supports. AMF believes that these requirements, which it claims enable a level of oversight necessary to ensure that a high proportion of LLINs reach their intended recipients, are a key piece of its value added as a partner. On the other hand, we have heard from others that these requirements are burdensome for country governments and may discourage them from accepting AMF's support. We do not currently have a well-informed opinion on this issue and plan to investigate it further, but were unable to do so in advance of this grant decision.

Other grants we considered

Sightsavers—additional regions in Chad

As described above, Sightsavers has proposed scaling up its deworming work to additional regions in Chad. Because Sightsavers' budget and targeting strategy for this work were being revised at the time we made these grants, we preferred to wait for more information before committing to supporting a larger program. We will keep this opportunity on our list for consideration in future allocations.

Helen Keller International—Kenya

Helen Keller currently supports VAS campaigns in several counties in Kenya using funding from GAC and Effective Altruism Australia.43 Helen Keller expects to need additional funding to maintain this support beyond 2021.44 We estimate that Helen Keller International's VAS work in Kenya is 7x cash, which is just below our threshold for cost-effectiveness.45 We will keep this opportunity on our list for consideration in future allocations.

Malaria Consortium—Burkina Faso and Nigeria

We estimate that Malaria Consortium has room for more funding of $3.7 million for its SMC programs in Burkina Faso (15x cash) and Nigeria (10x cash) in 2023.46 We exclude Chad, the other country in which Malaria Consortium has room for more funding, from this estimate, because we estimate Malaria Consortium's SMC work in Chad to be 6x cash, below our cost-effectiveness threshold (as we wrote in November 2020, we are discussing with Malaria Consortium the possibility of scaling down its work in Chad).47 We chose not to prioritize this funding gap in the current allocation because it is not currently time-sensitive, though it will become so by the end of 2021.48 We will keep this opportunity on our list for consideration in future allocations.

Sightsavers—Senegal

Sightsavers is seeking funding to support deworming MDA in three regions in Senegal. In our current CEA, we estimate the cost-effectiveness of this program to be 4x cash, below our cost-effectiveness threshold.49 However, this estimate relies on worm burden data that we are somewhat uncertain about, and Sightsavers has recently provided us with more information about the data that could increase our estimate of the program's cost-effectiveness. Our analysis of this opportunity is ongoing, and we will keep it on our list for consideration in future allocations.

SCI Foundation

At the time we made these grants, we decided to wait for updated information about SCI’s funding needs over the next three years, scheduled to be shared in June 2021. We will keep this opportunity on our list for consideration in future allocations.

New Incentives

In November 2020, we recommended a grant of $16.8 million to New Incentives to scale as quickly as would be feasible in 2021, based on its expectations at the time. New Incentives recently told us that it has been able to scale up more quickly than it anticipated and that it now expects to pause expansion in July 2021 if it does not receive more funding. New Incentives estimates that it would need $11.6 million in additional funding to continue expansion as quickly as would be feasible through the end of 2021.50 We are in the process of evaluating that grant.

Sources

Document	Source
AMF, 2020 Togo distributions	Source (archive)
AMF, 2020 Uganda distributions	Source (archive)
David Doledec, Regional Program Manager and Kenya Country Director, Helen Keller International, email to GiveWell, April 14, 2021	Unpublished
GiveWell, 2020 worm burden adjustment, moderate infection equivalent model	Source
GiveWell, Helen Keller Nigeria supplemental calculations, 2021	Source
GiveWell, Room for more funding analysis for AMF, March 2021	Source
GiveWell, Room for more funding analysis for Malaria Consortium's SMC program, Q1 2021	Source
GiveWell, Sightsavers cost per child dewormed analysis, 2020	Source
GiveWell, Summary of 2020 worm burden model	Source
GiveWell's non-verbatim summary of a conversation with Helen Keller International and UNICEF, January 26, 2021	Source
Helen Keller International, Post-event coverage survey report, Nigeria - Benue state, 2020	Source
Helen Keller International, Post-event coverage survey report, Nigeria - Nasarawa state, 2020	Source
Helen Keller International, Room for more funding report, July 2020 (redacted)	Source
Nutrition International, "Canada invests in nutrition as part of global COVID-19 response," 2020	Source (archive)
Rigby, "UK government cuts almost wipe out funding to tackle neglected diseases," 2021	Source (archive)
Sightsavers, Chad wishlist 5 narrative, 2020	Source
Wirth et al. 2017	Source (archive)

• 1

  David Doledec, Regional Program Manager and Kenya Country Director, Helen Keller International, email to GiveWell, April 14, 2021

• 2

  Helen Keller International currently supports VAS in Benue and Nasarawa states. See the "Spending opportunities" section of our report on Helen Keller International's VAS program: "In 2020, Helen Keller began supporting VAS mass campaigns in Nasarawa, Nigeria, and it has proposed expanding its support to five additional states over the next three years; our November 2020 recommendation to Open Philanthropy (see above) provided funding for expansion to the first of these states, Benue."

• 3

  David Doledec, Regional Program Manager and Kenya Country Director, Helen Keller International, email to GiveWell, April 14, 2021

• 4

  These states were Adamawa, Akwa Ibom, Cross River, and Taraba. David Doledec, Regional Program Manager and Kenya Country Director, Helen Keller International, email to GiveWell, April 14, 2021

• 5

  Unpublished conversation with Helen Keller International, May 4, 2021

• 6

  Helen Keller International has previously done so at our request in two other states. In Bauchi state, the results of the coverage survey showed that a high proportion of the target population was already being reached. As a result, Helen Keller International chose not to expand support to that state. Before conducting a VAS campaign in Benue state, Helen Keller International conducted a coverage survey of a government-supported VAS campaign and found 45% coverage. This result confirmed that only moderate VAS coverage was being achieved in Benue, and Helen Keller International has subsequently initiated support to the state. (We have not reviewed this survey in depth.) Helen Keller International, Post-event coverage survey report, Nigeria - Benue state, 2020, Table 4, Pg. 17

• 7

  We discussed this plan in a conversation with Helen Keller International on May 4, 2021.

• 8

  See the most recent version of our cost-effectiveness analysis here.

• 9

  Calculations using the 2019 GBD data exist in a spreadsheet we are not currently planning to publish.

• 10

  Wirth et al. 2017, Table 1

• 11

  GiveWell, Helen Keller Nigeria supplemental calculations, 2021

• 12

  Unpublished conversation with Helen Keller International's Nigeria team, April 19, 2021

• 13

  The Nigeria teams of Nutrition International and UNICEF have confirmed our understanding of the situation.

• 14

  Unpublished conversation with Helen Keller International, April 6, 2021

• 15

  Helen Keller International, Post-event coverage survey report, Nigeria - Nasarawa state, 2020, Table 4, Pg. 17

• 16

  David Doledec, Regional Program Manager and Kenya Country Director, Helen Keller International, email to GiveWell, March 23, 2021 (unpublished)

• 17
  • GiveWell's non-verbatim summary of a conversation with Helen Keller International and UNICEF, January 26, 2021, sections "How VAS is implemented in Cameroon" and "Prioritization by region," Pgs. 2-3
  • "UNICEF has supported VAS campaigns in four priority regions since 2016, including the Far-North and North (but also Adamawa and East)." Helen Keller International, Room for more funding report, July 2020 (redacted), Pg. 11

• 18

  See the most recent version of our cost-effectiveness analysis here.

• 19

  See the "What is vitamin A supplementation?" section of our review of Helen Keller International's program: "To prevent childhood morbidity and mortality, WHO recommends vitamin A supplementation (VAS) every four to six months for all children aged 6 to 59 months in areas where VAD is a public health problem."

• 20
  • "Using funds from Global Affairs Canada (GAC), UNICEF will contribute to cover operational costs for the first campaign of the year, which will be administered via a National Immunization Day in April in all 10 regions."
  • "UNICEF did not know how the first campaign of 2021 would be funded as recently as the end of December 2020; two weeks after that, it learned of the opportunity to integrate VAS into the April National Immunization Day and was able to get top-up funds from GAC."

  GiveWell's non-verbatim summary of a conversation with Helen Keller International and UNICEF, January 26, 2021, Pgs. 3-4

• 21

  "For the second campaign of the year, UNICEF does not have funding to cover operational costs, nor a confirmed national campaign in which to integrate VAS delivery." GiveWell's non-verbatim summary of a conversation with Helen Keller International and UNICEF, January 26, 2021, Pg. 3

• 22

  "UNICEF is unsure whether it will receive funding for VAS from GAC in the future, or how much." GiveWell's non-verbatim summary of a conversation with Helen Keller International and UNICEF, January 26, 2021, Pg. 4

• 23

  Nutrition International, "Canada invests in nutrition as part of global COVID-19 response," 2020

• 24

  "Funding for vitamin A supplementation (VAS) continues to deteriorate in sub-Saharan Africa (SSA) in 2020 and the situation has been exacerbated by COVID-19, which is causing some donors to divert funds from VAS to the pandemic response. For example, UNICEF has been a major donor of VAS, but in a growing number of countries, their support has dwindled or ceased. In countries where UNICEF support continues, the amount of funds is not enough to ensure national coverage of VAS campaigns. The Global Affairs Canada (GAC) grant to UNICEF, which ends in December 2020, has provided VAS support to 15 countries. It is uncertain whether and the extent to which GAC will renew its VAS support to UNICEF." Helen Keller International, Room for more funding report, July 2020 (redacted), Pg. 3

• 25

  See the most recent version of our cost-effectiveness analysis here.

• 26

  "Priority 1: SCH/STH MDA in our existing Ascend West operational regions of Logone Occidental, Logone Oriental, Mayo Kebbi Est, Mayo Kebbi Ouest, Moyen Chari, and Tandjile. Having previously operated within these 6 regions we have identified them as our first priority area to scale up SCH/STH interventions." Sightsavers, Chad wishlist 5 narrative, 2020, Pg. 2

• 27

  Unpublished conversation with Sightsavers, April 1, 2021

• 28
  • "Priority 2: SCH/STH MDA in Bahr El Gazel, Batha, Chari Baguirmi, Guéra, Hadjer Lamis (except the district of Mani due to security issues), N'Djaména, Ouaddai, Salamat, Sila and Wadi Fira. The above 10 regions are not covered by Ascend West as they are not co-endemic for oncho or LF, the MoH have advised there are currently no other funders of this work. This planned work will cover all regions where there is currently little or no insecurity and where these two diseases are a public health problem." Sightsavers, Chad wishlist 5 narrative, 2020, Pg. 2
  • See the list of Priority 2 regions in the "Previous MDA Rounds" table, Sightsavers, Chad wishlist 5 narrative, 2020, Pg. 9.

• 29

  "In 2017, The END Fund and ESPEN funded a round of SCH/STH MDA in 7 regions of the country, while in 2018, another round of SCH/STH MDA was conducted by The END Fund in 3 of those 7 regions." Sightsavers, Chad wishlist 5 narrative, 2020, Pg. 1.

• 30

  See the most recent version of our cost-effectiveness analysis here.

• 31

  This estimate includes both Sightsavers' Priority 1 and Priority 2 regions. Our cost per child dewormed estimate for the six Priority 1 regions that will be supported using this grant is $1.83. See our calculations here.

• 32

  See here for the full range of these estimates.

• 33

  See here for more detail on how we use worm burden adjustments.

• 34

  See this spreadsheet, row "Sightsavers_Chad," column "Final worm burden adjustment."

• 35

  Sightsavers, Chad wishlist 5 narrative, 2020. See the table on Pg. 9.

• 36

  "Ascend West chose to incorporate the deworming MDA (despite SCH/STH not being one of their priorities) in their own plans for the regions and districts co-endemic to Oncho/LF just for two years (2019 and 2020). Ascend West have no intention to continue these SCH and STH treatments beyond 2020, meaning there is a funding gap for SCH/STH in these regions in 2021." Sightsavers, Chad wishlist 5 narrative, 2020, Pg. 9

• 37

  Rigby, "UK government cuts almost wipe out funding to tackle neglected diseases," 2021

• 38

  See the most recent version of our cost-effectiveness analysis here.

• 39

  GiveWell, Room for more funding analysis for AMF, March 2021

• 40

  Unpublished conversation with AMF, March 18, 2021

• 41

  See the most recent version of our cost-effectiveness analysis here for cost-effectiveness estimates of AMF's 2023 funding gaps described in this section.

• 42
  • "4 of Togo's 5 Regions, 2020, Togo. Summary: Nets: 4,016,530 LLINs; When: Oct 20-Jan 21; Distributed by: NMCP/Various." AMF, 2020 Togo distributions
  • "All 4 Regions, 2020, Uganda. Summary: Nets: 13,031,880 LLINs; When: Nov 20-Mar 21; Distributed by: NMCP/Various." AMF, 2020 Uganda distributions

• 43
  • "In 2019, Helen Keller also received funds from Effect:hope, a Canadian organization supported by GAC, to run its VAS programs in Kenya and Cote d’Ivoire between April 2019 and March 2020." Helen Keller International, Room for more funding report, July 2020 (redacted), Pg. 4
  • We discussed the funding relationship between Helen Keller International and Effective Altruism Australia in calls with Helen Keller International on November 5, 2020, and April 6, 2021.

• 44

  We spoke to Helen Keller several times in 2020 and early 2021 about the fact that it would face a funding gap for its work in Kenya in the near future. More specifically, we have learned from Helen Keller's 2021 room for more funding report, which is not yet published, that the GAC grant will end in March 2022, while the Effective Altruism Australia grant will end in June 2022. These grants contribute to Helen Keller's support of VAS programming in 11 counties in Kenya.

• 45

  See the most recent version of our cost-effectiveness analysis here.

• 46

  See GiveWell, Room for more funding analysis for Malaria Consortium's SMC program, Q1 2021, sheet "RFMF projections," rows 12 and 14, for room for more funding figures. See the most recent version of our cost-effectiveness analysis here for cost-effectiveness estimates.

• 47

  See the most recent version of our cost-effectiveness analysis here.

• 48

  Malaria Consortium told us it will need to order SMC drugs for its 2023 campaigns by late 2021 or early 2022. Malaria Consortium, email to GiveWell, July 23, 2020 (unpublished)

• 49

  See the most recent version of our cost-effectiveness analysis here.

• 50
  • New Incentives, Conversation with GiveWell, April 13, 2021 (unpublished)
  • New Incentives, Comments on a draft of this page, August 13, 2021 (unpublished)