Allocation of Funds Donated to the Top Charities Fund in Q2 2021

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

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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

In the second quarter of 2021, donors gave $14 million to the Top Charities Fund to be allocated to our top charities.

We allocated $9.4 million of this funding to New Incentives, which will allow New Incentives to continue scaling up its conditional cash transfers for infant immunization program in North West Nigeria through the end of 2021 and to maintain the program at that scale through 2023. We chose to prioritize this funding opportunity because it meets our cost-effectiveness threshold and because the funding gap was time-sensitive, given that the grant will fund activities beginning in the third quarter of 2021.

We decided to split our allocation of the remaining $4.6 million equally between the Against Malaria Foundation (AMF) and Malaria Consortium's seasonal malaria chemoprevention (SMC) program. We decided to split the balance between the two because we consider both to be strong contenders for funding, but lack strong reasons to favor either:

• We expect both organizations to use this funding to support countries with campaigns in 2023. These opportunities are similarly cost-effective and above our cost-effectiveness threshold.
• We do not expect additional funding now to substantially affect either organization's planning for or implementation of these campaigns. In both cases, the total funding needed for these campaigns is much greater than this grant amount.1 We therefore expect to direct much more funding to both organizations in 2021 and have not attempted to distinguish between the value of a grant of this size to either.

New Incentives

We made a grant of $9.4 million2 to New Incentives to fund the scale-up of its conditional cash transfers for infant immunization program in North West Nigeria in 2021 and to maintain the program at that scale through 2023.

How we expect this grant will be used

In November 2020, Open Philanthropy, a philanthropic organization with which we work closely, made a grant of $16.8 million to New Incentives on our recommendation. This grant was intended to enable New Incentives to scale up its program in North West Nigeria as quickly as it could in 2021, taking into account non-financial constraints, primarily staff capacity. At the time of the grant, New Incentives projected that it would be able to scale up its program to operate in 17 local government areas (LGAs) by the end of 2021.3 Since receiving that grant, New Incentives has been able to expand its program more quickly than anticipated.4 New Incentives now believes that if it had sufficient funding, it could scale up its program to operate in 35 total LGAs by the end of 2021.5

This $9.4 million grant is intended to cover New Incentives' operating costs for the additional 18 LGAs from the time of expansion in 2021 through 2023. This expansion will allow New Incentives to increase the total number of infants enrolled in the program in 2021-2023 from an estimated 600,000 to an estimated 1.1 million, covering roughly 45% of the total infants in the three Nigerian states in which the program operates: Jigawa, Katsina, and Zamfara.6 New Incentives told us that without this additional funding, it would not be able to expand its program beyond the initial 17 LGAs in 2021, and program expansion would pause in July 2021.7

Who we talked to about the grant

We discussed this grant with New Incentives. We also discussed the grant with two government officials (one from the federal government and one from the Katsina state government), and one UNICEF representative working in Jigawa, all of whom New Incentives selected for us to speak with and provided contact information for. Two of these individuals expressed explicit support for the continued scale-up that this grant would support. The other individual, while not opposed to continued scale-up, expressed some concerns about program sustainability if New Incentives were to cease its support to a state. (Our understanding is that New Incentives does not currently plan to cease support to any of the three states where it works.)8

Case for the grant

We estimate the cost-effectiveness of this grant as 9x cash.9 We have not substantially updated our cost-effectiveness model of New Incentives' program since recommending the $16.8 million grant in November 2020. The primary change we made to the model was to update the mortality data we use to estimate the impact of vaccination on mortality rates; we were formerly using data from the 2017 versions of the Institute for Health Metrics and Evaluation (IHME)'s Global Burden of Disease (GBD) and Local Burden of Disease projects, and are now using data from the 2019 versions. This update decreased our cost-effectiveness estimate for the program by about 10%.10 We chose not to update the following parameters in our model prior to making this grant:

• Cost per infant enrolled. Our model uses cost data from New Incentives' program from November 2017 through May 2020 to estimate the cost per infant enrolled.11 The data we've seen on the program's costs since June 2020 suggests that the cost per infant enrolled in the program has remained roughly similar to or lower than the estimate we use in our model.12 We decided not to update the cost estimates in our model prior to making this grant, because doing so would have required us to make significant adjustments to account for the fact that the program is currently undergoing a rapid scale-up period. During the scale-up period, we expect that start-up costs would skew the cost per infant enrolled upward. (Start-up costs may include hiring and training new staff, staff time and travel costs spent establishing new relationships with stakeholders, and underutilization of program services in the early stages of the program, i.e., if New Incentives sends staff to a clinic on an immunization day, but low community awareness of the program results in few caregivers bringing in their infants for vaccinations.) At the same time, the proportion of infants who are newly enrolling in the program (compared to infants who are older and further along in the immunization schedule) will be disproportionately high during the scale-up period, which would skew the cost per infant enrolled downward. This is because our model counts the number of children who are enrolled in a given period (i.e., when the caregiver receives the first cash incentive for the infant), while the full cost of serving that infant occurs over several months.13 We expect to get more reliable cost data from New Incentives in about a year, when we expect that New Incentives' program will be serving a more stable mix of infants at each stage of the immunization schedule. We will update our estimate of New Incentives' cost per infant enrolled at that time.
• Impact on vaccination rates. Our current model of the program primarily uses the results of a randomized controlled trial (RCT) of New Incentives' program to estimate the impact of the program on vaccination rates. We plan to update this estimate in the future using two additional sources of information:
  • The program data indicators we discuss in our review of New Incentives, such as retention of enrolled infants through the immunization schedule, vaccine stockouts, and the real value of cash transfers (accounting for inflation). As part of evaluating the case for this grant, we compared program data on these indicators during the RCT period and after the RCT period.14 The results for the post-RCT period were similar enough to the results from the RCT period that we decided not to make adjustments to the impact estimate in our model prior to making this grant.15 We plan to revisit these indicators in about a year.
  • Vaccination coverage assessments conducted before and after New Incentives begins operating its program in new LGAs. We expect that these surveys will give us more information about baseline vaccination rates and how vaccination rates change when New Incentives' program enters an area. We have collaborated with IDinsight and New Incentives to design these assessments. Baseline surveys in the LGAs where program expansion will be funded by this grant are scheduled to take place in September-October 2021. We have published a detailed description of the plans for these assessments here.
• Impact of rotavirus vaccine. When we built our cost-effectiveness analysis for New Incentives' program, we expected the rotavirus vaccine to be added to the routine immunization schedule in Nigeria shortly thereafter. Once the rotavirus vaccine is rolled out, we expect it to account for roughly 14% of the deaths averted in under-five children through the vaccines incentivized by New Incentives.16 However, as a result of delays in the vaccine rollout, the rotavirus vaccine has not yet been added to the routine immunization schedule in Nigeria, and New Incentives now guesses that it will not be added to the schedule in the states in which its program operates until 2022.17 We have decided not to remove the rotavirus vaccine benefits from our model at this time. This means that our model is currently overestimating the short-term cost-effectiveness of some or all of this grant, but it continues to be our best guess of the cost-effectiveness of the program in the medium term.

This funding opportunity was time-sensitive. New Incentives told us that without additional funding, it would pause expanding its program in July 2021 and would continue to operate at its current scale.18

Our decision to make this grant was also influenced by our qualitative assessments of New Incentives as an organization (see principle 2 above). New Incentives impresses us with its clarity of communication, thoughtfulness in responding to our questions, and attitude about self-improvement. On self-improvement, in particular, it seems to have been very proactive since we last recommended a grant to support its work. As we note in our review, government opposition is a potential risk to New Incentives' ability to operate its program. New Incentives has now developed and shared a stakeholder engagement plan with us, which sets out its goals and plans for strengthening its relationships with government and non-government stakeholders. Though we are not in a strong position to evaluate the quality of the plan, as we do not have expertise in this area, it seems to us that New Incentives is being proactive in mitigating this risk. When we last spoke to New Incentives on this subject, it was planning to seek feedback on its plan from several representatives of other development organizations.19 New Incentives also told us about a couple of meetings it has organized in the last several months that have resulted in state officials publicly affirming support for its program,20 which suggests to us that it is making some progress in this area.

Risks and reservations

It's possible that our cost-effectiveness estimate for New Incentives' program (9x cash) will fall below our cost-effectiveness threshold (currently 8x cash) in the future. One reason this might occur is that vaccination rates in the areas where New Incentives operates could be on an upward trajectory for reasons unrelated to the program. If this were the case, the number of infants that wouldn't be vaccinated in the absence of cash incentives would decrease over time, limiting the potential impact of New Incentives' program. As one suggestive data point, the results from the RCT of the program showed that vaccine coverage rates increased during the trial period in the control group, i.e., in areas where the program was not operating.21

Ultimately, we don't think this possibility is a strong reason not to support the scale-up of the program by making this grant. We think there is a strong case for achieving cost-effective impact by funding New Incentives' program right now, even if we will no longer believe the program is one of our best uses of funds in a few years. However, there are some ways in which we could be overestimating the cost-effectiveness of the program now by assuming that we will continue to support it for some time.

• We may be underestimating the costs of the program in the short term. We base our cost per infant enrolled estimate on cost data from New Incentives' program between November 2017 and May 2020, when New Incentives was spending relatively little on start-up costs.22 If we assume that the start-up period makes up a small portion of the total time New Incentives works in a clinic, then the estimated benefits of the program will accrue over a long enough time period that including start-up costs in the model wouldn't make much difference to our overall cost-effectiveness estimate. However, these start-up costs would matter more if we thought the program would not last for long. Mitigating this concern is the fact, discussed above, that the cost data we have seen since the RCT period suggests that the cost per infant enrolled during New Incentives' rapid scale-up period has been comparable to the cost per infant enrolled during the RCT period. This suggests that start-up costs have been fairly low and likely wouldn't substantially affect our cost-effectiveness estimate if we included them in the model.
• It's possible that by creating a financial motivation to vaccinate infants, New Incentives' program will weaken intrinsic motivations for vaccinating infants. If the program is discontinued in an area, this could potentially lead to lower vaccination rates in this area than there would have been if the program had never been implemented there. As we write in our review, while we haven't thoroughly investigated this issue, we think it is unlikely that this consideration would significantly offset the program's benefits. However, if the program were only to last a few years, it seems likelier that this could have a greater effect on the overall impact of the program: because there would be less time for the benefits of the program to accrue, any negative effect would cancel out a greater proportion of the total benefits created. On the other hand, a shorter-lived program may mean that the program would have less of an impact on community members' motivations for vaccination.
• As discussed above, a portion of the benefits modeled in our cost-effectiveness analysis of the program are attributed to the benefits of the rotavirus vaccine, which hasn't yet been added to the immunization schedule in the areas where New Incentives works. We included these benefits in the model, even though this leads us to overestimate impact in the short term, in order to capture our best guess of the cost-effectiveness of the program in the medium term. However, if the program were to end sooner than expected, there would be less time for the benefits of the rotavirus vaccine to accrue, and we would have overestimated cost-effectiveness for a larger proportion of the program's lifespan than anticipated.

In addition, this grant may exceed New Incentives' true room for more funding. We think the grant could be larger than it needs to be because:

• In estimating charities' room for more funding, we typically subtract out the expected value of their future revenue, such as revenue not specifically recommended by GiveWell but received due to being a top charity, or revenue from non-GiveWell-directed sources. However, we did not do so for New Incentives when we calculated the size of this grant. As a top charity, New Incentives has received and will continue to receive some funding from people who consult our top charity list and choose to donate to New Incentives directly. Since New Incentives is a recent addition to the list, we don't yet have enough information to know how much funding we should expect New Incentives to receive from that funding stream in the near future. It's also possible that New Incentives will receive revenue from non-GiveWell-directed sources, such as by using the results of the RCT to fundraise from other philanthropic funders. However, New Incentives is not investing heavily in fundraising, and prospects for alternative philanthropic funding sources are very uncertain at this stage.23
• New Incentives told us that it has been spending less per infant enrolled recently than it had budgeted because of favorable exchange rates (US dollar to Nigerian naira).24 In estimating its funding gap, New Incentives used the conservative assumption that exchange rates would soon return to the levels it had originally projected.25 If this turns out not to be the case, then New Incentives' costs will be lower than budgeted, and it may not need the full $9.4 million to cover its costs for the activities that will be funded by the grant.
• When we evaluated the case for the $16.8 million grant we recommended in 2020, we looked carefully at New Incentives' budgeting assumptions, asked questions, and concluded that the assumptions seemed reasonable. Our understanding is that New Incentives updated this same financial model to calculate the size of its current funding gap, so we haven't carefully considered whether we agree with the modeling assumptions being used this time around. It's possible that closer inspection and discussion would have led to changes in that financial model that could have updated the budget we used to make this grant.

In making this grant, we've opted to err on the side of potentially overfunding New Incentives. This is because we want New Incentives to have the confidence to expand as quickly as non-financial constraints allow and because we expect that any surplus funding will be used during the next stage of program expansion or to fund the program beyond 2023, which we expect to be cost-effective uses of funds.

Room for more funding beyond this grant

New Incentives projects that it can roughly double in size in 2022 if it has the funding to do so (which goes beyond the scope of this grant).26 Given security concerns in some parts of Zamfara and Katsina and higher immunization rates in parts of Jigawa, it would likely expand to a fourth state in 2022 if it were to expand at that pace.27 We plan to continue discussing further expansion with New Incentives and will consider making additional grants in future allocation rounds.

Against Malaria Foundation

We made a grant of $2.3 million to AMF to fund long-lasting insecticide-treated net (LLIN) distributions in 2023.

How we expect this grant will be used

We estimate that AMF has room for more funding of about $45 million for supporting LLIN distributions in 2023.28 The funding opportunities AMF is considering supporting are:

• Purchasing additional LLINs to be delivered in nationwide campaigns in Togo and Uganda.29
• Filling the remaining funding gap for LLIN distributions in the Democratic Republic of the Congo (DRC). See here for our previous discussion of this funding opportunity. In short, LLIN distributions in DRC occur at the province level on a rolling basis, scheduled to reach each province every three years. The two main funders of LLINs in DRC, the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) and the President's Malaria Initiative (PMI), do not have sufficient funding to support an LLIN distribution in all of the country's provinces during the current three-year period. AMF has already committed funding to support multiple provinces where distributions did or will occur in 2021-23,30 primarily using GiveWell-directed funding. This opportunity is to fill the funding gap that remains for provinces scheduled to receive LLINs at the end of 2023.
• Shortening the length of time that passes between LLIN distributions in three Nigerian states where distributions are currently supported by PMI. See here for our previous discussion of this funding opportunity. In short, PMI supports LLIN distributions in 11 Nigerian states but does not have sufficient funding to support a distribution in each of those states every three years, which means that distributions are at risk of being delayed. By contributing LLIN funding to PMI-supported states, we believe that AMF reduces the length of time that elapses between distributions in these states. AMF has already committed funding to support two states in 2022.31 This opportunity is to support three additional states scheduled to receive LLINs in 2023.32

We expect AMF will use this grant to support one or multiple of these opportunities, but we are uncertain which activities in particular this funding will enable. Our understanding is that AMF is currently prioritizing these funding opportunities roughly equally.33 We therefore view this grant as a contribution to support AMF's overall portfolio. These opportunities are not currently time-sensitive (see the second principle for maximizing cost-effectiveness over time), but will become so over the coming months.34

Who we talked to about the grant

We have had multiple discussions with AMF about the opportunities listed above. We have also previously spoken to a member of the Global Fund's DRC malaria team about the funding gap for LLIN distributions in DRC.35

Case for the grant

AMF's overall portfolio is cost-effective. We estimate that the opportunities listed above are above our cost-effectiveness threshold: DRC (13x cash), Nigeria (15x cash), Togo (9x cash), and Uganda (17x cash).36 For DRC and Nigeria, these estimates include our recent work to model the cost-effectiveness of reducing the amount of time that passes between LLIN distributions.37

AMF has much more room for more funding above our cost-effectiveness threshold than will be filled by this grant. We consequently expect to direct much more funding to it in 2021. Because these funding opportunities are not currently time-sensitive, we don't believe that granting this funding to AMF now will have much impact on its planning until a few months from now. Instead, we're proposing this grant based on the third principle for maximizing cost-effectiveness over time: we are recommending this grant because we have a sufficiently high degree of certainty that a contribution to AMF's overall portfolio is above our cost-effectiveness threshold. We expect to do more work to refine our estimates of AMF's cost-effectiveness and room for more funding, which will inform the total amount of funding we ultimately direct to AMF this year.

Risks and reservations

We don't have a precise understanding of the marginal impact of this grant. As stated above, we are uncertain which specific activities this grant will support, and we don't expect it to have a significant impact on AMF's planning until a few months from now. We are recommending this grant because we have a sufficiently high degree of certainty that a contribution to AMF's overall portfolio is above our cost-effectiveness threshold.

AMF is planning to use its currently available funding to support an LLIN distribution in Chad in 2023.38 Our current estimate of the cost-effectiveness of this distribution is 7x cash, below our cost-effectiveness threshold.39 While we plan to do further investigation of this funding opportunity that could increase our final estimate, we currently believe it would be better for AMF to redirect some of its available funding away from its work in Chad in favor of the more cost-effective funding gaps listed above.

As discussed above, we have recently refined our cost-effectiveness models for LLIN distributions in DRC and Nigeria, but we have not reviewed our models for Togo and Uganda as closely. For the purposes of this grant investigation, we used existing cost-effectiveness models that we created previously to assess past distributions in Togo and Uganda. It's possible that further investigation of the funding opportunities in Togo and Uganda would lead to changes in the model, which could increase or decrease our cost-effectiveness estimates for these programs.

Malaria Consortium

We made a grant of $2.3 million to Malaria Consortium to fund SMC campaigns in 2023.

How we expect this grant will be used

We estimate that Malaria Consortium has room for more funding of about $100 million for SMC campaigns in 2022-24.40 Roughly $75 million of this total would be used to maintain its programs at their current scale (i.e., to reach a similarly sized target population of children as will be reached in 2021, after accounting for annual population growth) in Burkina Faso, Nigeria, and Togo in 2023-24.41 We estimate that Malaria Consortium's programs in these three countries meet our cost-effectiveness threshold. Malaria Consortium is also seeking funding to maintain its program in Chad, which is below our cost-effectiveness threshold (see below), in 2023-24.42

We expect that Malaria Consortium will use this grant to support one or multiple of these opportunities, but we are uncertain which activities in particular this funding will enable. Our understanding is that maintaining these programs at their current scale is Malaria Consortium's top priority for additional funding.43 These opportunities are not currently time-sensitive (see the second principle for maximizing cost-effectiveness over time), but will become so by the end of 2021.44

Who we talked to about the grant

We have had multiple discussions with Malaria Consortium about the opportunities listed above. In the context of investigating a grant we recommended to Malaria Consortium to support LLIN campaigns in Ondo and Anambra states, Nigeria, we spoke to Nigeria's National Malaria Elimination Programme about its overall relationship with Malaria Consortium. In 2019, we conducted a site visit to Malaria Consortium's SMC program in Burkina Faso and had conversations with multiple program stakeholders.

Case for the grant

Malaria Consortium's overall portfolio is cost-effective. We estimate that the opportunities in Burkina Faso, Nigeria, and Togo listed above are above our cost-effectiveness threshold: Burkina Faso (15x cash), Nigeria (10x cash), and Togo (9x cash).45

Beginning in 2021, Malaria Consortium will be supporting the governments of Burkina Faso and Nigeria in delivering a fifth cycle of SMC (in addition to the usual four) in locations that are eligible for an additional cycle.46 We estimate that delivering a fifth cycle is about 60% as cost-effective as delivering each of the standard four cycles.47 Our cost-effectiveness estimates for Malaria Consortium's programs in Burkina Faso and Nigeria have been updated to incorporate the costs and benefits of delivering this additional cycle, using projections provided to us by Malaria Consortium of the proportion of its target population it expects to reach with five SMC cycles in 2021-24.48

Malaria Consortium has much more room for more funding above our cost-effectiveness threshold than will be filled by this grant. We consequently expect to direct much more funding to it in 2021. Because these funding opportunities are not currently time-sensitive, we don't believe that granting this funding to Malaria Consortium now will have much impact on its planning. Instead, we're proposing this grant based on the third principle for maximizing cost-effectiveness over time: we are recommending this grant because we have a sufficiently high degree of certainty that a contribution to Malaria Consortium's overall portfolio is above our cost-effectiveness threshold. We expect to do more work to refine our estimates of Malaria Consortium's cost-effectiveness and room for more funding, which will inform the total amount of funding we ultimately direct to Malaria Consortium this year.

Risks and reservations

We don't have a precise understanding of the marginal impact of this grant. As stated above, we are uncertain which specific activities this grant will support, and we don't expect it to have a significant impact on Malaria Consortium's planning. We are recommending this grant because we have a sufficiently high degree of certainty that a contribution to Malaria Consortium's overall portfolio is above our cost-effectiveness threshold.

We estimate that the cost-effectiveness of Malaria Consortium's SMC program in Chad, the fourth country in its current portfolio, is 6x cash, below our cost-effectiveness threshold.49 As we've written previously, we are in discussions with Malaria Consortium about possibilities for responsibly reducing its involvement in Chad, likely without fully withdrawing its support. Malaria Consortium's most recent budget projections include plans to scale back its support in Chad beginning in 2023,50 though it still has a funding gap of $8 million for Chad for 2023-24.51 Despite the lower cost-effectiveness of SMC in Chad, we aren't restricting this grant to support SMC exclusively in the other three countries in Malaria Consortium's portfolio because:

• In alignment with Principle 5, listed above, we generally want to avoid restricting how Malaria Consortium uses funding within SMC, to allow it to respond more flexibly to changes in funding needs.
• Funding SMC in Chad at a lower level of support in the future may make the program more cost-effective (for example, if the program is more finely targeted to highly cost-effective areas). It's also possible that our cost-effectiveness threshold will be lowered below 6x cash in the future. We are interested in keeping this program as a funding option in case either of these possibilities comes to fruition. We think that withholding funding for SMC in Chad now could undermine our ability to fund it in the future, because it would take time for Malaria Consortium to restart the program and scale it back up.
• We don't want to cause harm by reducing funding for the program too rapidly.

Other grants we considered

Sightsavers—additional regions in Chad

In the previous allocation round, we wrote about Sightsavers' proposal to scale up its deworming work to all at-risk regions in Chad. At the time, we made a grant that only partially funded Sightsavers' work in Chad. We chose to wait until we had more information about Sightsavers' targeting strategy for the program and what additional funding would be needed, beyond our initial grant, before fully funding the program. Separately, we are also considering funding research on the long-term outcomes of deworming, and it's possible, though unlikely, that Chad will be a setting in which we pursue that research. This further increases our uncertainty about the program's ultimate design and budget. We do not yet have sufficient information on these subjects to make a funding decision. We will keep this opportunity on our list for consideration in future allocations.

Sightsavers—Senegal

Sightsavers is seeking $1.2 million to support deworming mass drug administration (MDA) in parts of Senegal over three years.52 Our preliminary analysis of this proposed work concluded that the cost-effectiveness of the program would be below our cost-effectiveness threshold.53 We have deprioritized further work on this funding gap, leaving some questions not fully resolved around:

• Worm burden data for Senegal. Our cost-effectiveness estimates for deworming programs are highly sensitive to the worm burden adjustments we use in our model. These adjustments are intended 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 RCT on which we base our estimate of deworming's impact on consumption.54 We are uncertain about whether we are correctly interpreting the worm burden data we have for Senegal, which is less straightforward than the data for most other locations we have considered.
• The funding landscape for deworming in Senegal. We are uncertain about the likelihood that deworming would be funded in these areas in the absence of Sightsavers' proposed program. We've spoken with two people familiar with the funding landscape for neglected tropical diseases (NTDs) in Senegal, and those conversations suggested that we would need to do additional investigation to arrive at an accurate understanding of the funding landscape.

Given the program's uncertain cost-effectiveness and small budget size compared to other funding gaps that top charities have brought to our attention, we have decided not to spend more time on this grant investigation at this time.

Helen Keller International—Kenya

Helen Keller International currently supports vitamin A supplementation campaigns in several counties in Kenya using funding from Global Affairs Canada (GAC) and Effective Altruism Australia.55 Helen Keller expects to need additional funding to maintain this support beyond 2021.56 We estimate that Helen Keller International's vitamin A supplementation work in Kenya is 7x cash, which is just below our threshold for cost-effectiveness.57 We will keep this opportunity on our list for consideration in future allocations.

SCI Foundation

In June 2021, we received updated information from SCI about its funding needs over the next three years. We are currently reviewing this information. We will keep this opportunity on our list for consideration in future allocations.

Sources

Document	Source
AMF, "AMF agrees to fund 8.1 million nets for distribution in Nigeria in early 2022," 2021	Source (archive)
AMF, "AMF agrees to fund a further 16.4 million nets for distribution in DRC in 2023," 2021	Source (archive)
AMF, "AMF funds 16.2 million nets for distribution in the Democratic Republic of Congo (DRC) in 2020/21," 2019	Source (archive)
AMF, "AMF funds a further 12.9 million nets for distribution in the Democratic Republic of Congo (DRC) in 2022," 2021	Source (archive)
AMF, "AMF funds a further 16.4 million nets for distribution in the Democratic Republic of Congo (DRC) in 2021/early 2022," 2020	Source (archive)
AMF, "AMF funds a further 6.8 million nets for distribution in the Democratic Republic of Congo (DRC) in Q4 2021," 2021	Source (archive)
AMF, "Immediate funding gap (for approved distributions)"	Source (archive)
AMF, Spending opportunities, 2021	Unpublished
GiveWell, "New Incentives (Conditional Cash Transfers to Increase Infant Vaccination)"	Source
GiveWell, "New Incentives"	Source
GiveWell, 2021 cost-effectiveness analysis (AMF Chad)	Source
GiveWell, AMF room for more funding analysis, 2021	Source
GiveWell, Malaria Consortium room for more funding analysis, July 2021 (internal only)	Unpublished
GiveWell, New Incentives CEA supplemental information, June 2021	Source
GiveWell, New Incentives cost analysis, 2020	Source
GiveWell, New Incentives costs through April 2021	Source
GiveWell, New Incentives monitoring and evaluation 2017-2020 and plans for future evaluation (May 2021)	Source
GiveWell, SMC fourth to fifth round calculations, July 2021	Source
GiveWell, Summary of 2020 worm burden adjustment model	Source
Global Fund, conversation with GiveWell, January 15, 2021	Unpublished
Helen Keller International, Room for more funding report, July 2020 (redacted)	Source
Hollander, "Why we’re excited to fund charities’ work a few years in the future"	Source
Malaria Consortium, Ranking of SMC spending opportunities, 2021	Source
New Incentives, 2021-2023 financial forecasts, 2021	Source
New Incentives, conversation with GiveWell, April 13, 2021	Unpublished
New Incentives, conversation with GiveWell, March 16, 2021	Unpublished
New Incentives, Financial model, 2021	Unpublished
New Incentives, Program updates, 2021	Unpublished
New Incentives, Stakeholder relations goals, 2021	Unpublished
Peter Sherratt, Executive Chairman, AMF, email to GiveWell, May 25, 2021 (redacted)	Source
Rob Mather, Founder and CEO, AMF, email to GiveWell, July 20, 2021	Unpublished
Sightsavers, Senegal deworming program 2021-2024 budget, 2021	Source

• 1

  See the "Case for the grant" sections for AMF and Malaria Consortium on this page.

• 2
  New Incentives told us that the funding gap for this work was $11,586,386 as of April 2021.
  • "Updated 2021 - 2023 Financial Forecast (as of 05-Apr-2021).... Additional spending opportunities: $11,586,386 to enroll 406,372 infants in the CCTs for RI Program (assuming an average cost of $28.82/infant for infants enrolled in 2021 - 2023)." New Incentives, 2021-2023 financial forecasts, 2021, p. 2
  • We subtracted $220,000 from this total to account for donations we received in Q1 2021 that have already been granted to New Incentives, and donations we received in Q2 2021 and were still holding for New Incentives as of June 30, 2021. We then subtracted $2 million from the total to account for a private donor who we know is planning to give that amount directly to New Incentives.

• 3

  See the "Spending opportunities" section of our charity review of New Incentives: "We expect that New Incentives will use its available and expected funding to scale its program to 17 local government areas (LGAs) in 2021 and maintain that scale in 2022-2023, with an estimated program reach of almost 600,000 infants across three years."

• 4

  New Incentives, conversation with GiveWell, March 16, 2021

• 5

  "The model used for 1,089,848 infants has the following differences in comparison to previous projections shared:

  • Expansion to 35 LGAs in 2021 (instead of 17), and then maintaining steady state in 2022-2023."

  New Incentives, 2021-2023 financial forecasts, 2021, p. 1

• 6

  New Incentives, Financial model, 2021

• 7

  "New Incentives plans to stop expanding to new LGAs at the end of July 2021 if Funding Commitments are not in place to support enrolling more than 683,476 infants during 2021 - 2023, an average of 18,985 infants enrolled per month (this average does not take into account when an LGA is expanded to and catch-up infants)." New Incentives, 2021-2023 financial forecasts, 2021, p. 1

• 8
  • Conversation with anonymous UNICEF representative, May 14, 2021 (unpublished)
  • Conversation with anonymous federal government official, May 19, 2021 (unpublished)
  • Conversation with anonymous state government official, May 21, 2021 (unpublished)

• 9

  See here for the most recent version of our cost-effectiveness analysis, "New Incentives" tab, "Cost-effectiveness in multiples of cash transfers, after accounting for leverage/funging" row.

• 10

  See "Change 2: Updated estimates from the Institute of Health Metrics and Evaluation (IHME) in our New Incentives CEA" in the September 28, 2021, version of our cost-effectiveness changelog. See here in the spreadsheet tracking the effects of each change on our cost-effectiveness estimates.

• 11

  See "Source: spending across months" tab in GiveWell, New Incentives cost analysis, 2020.

• 12

  See here in GiveWell, New Incentives cost analysis, 2020, and here in GiveWell, New Incentives costs through April 2021.

• 13

  See here in our 2020 New Incentives cost analysis. These calculations are based on incentive disbursements for infants receiving the BCG vaccine, which is administered at birth and coincides with enrollment in New Incentives' program (see the chart included under "Meta-analyses of vaccines' effects on disease for children under five" in our review of New Incentives' program).

• 14

  See this section of GiveWell, New Incentives monitoring and evaluation 2017-2020 and plans for future evaluation (May 2021).

• 15

  See here in GiveWell, New Incentives monitoring and evaluation 2017-2020 and plans for future evaluation (May 2021).

• 16

  See here in GiveWell, New Incentives CEA supplemental information, June 2021.

• 17

  This guess is based on the fact that an official in the National Primary Health Care Development Agency (NPHCDA) in the Nigerian Federal Ministry of Health recently told New Incentives that the proposal to add the rotavirus vaccine to the routine immunization schedule had been approved by Gavi's Inter-agency Coordinating Committee. The NPHCDA official thought that some Nigerian states would introduce the rotavirus vaccine in the fourth quarter of 2021 and that the rest would introduce it during the first half of 2022. New Incentives, conversation with GiveWell, April 13, 2021

• 18

  "New Incentives plans to stop expanding to new LGAs at the end of July 2021 if Funding Commitments are not in place to support enrolling more than 683,476 infants during 2021 - 2023, an average of 18,985 infants enrolled per month (this average does not take into account when an LGA is expanded to and catch-up infants)." New Incentives, 2021-2023 financial forecasts, 2021, p. 1

• 19

  Pratyush Agarwal, Co-Founder and COO, New Incentives, email to GiveWell, March 31, 2021 (unpublished)

• 20

  We received this information via written program updates from New Incentives provided to us on May 7, June 11, and July 2, 2021, which we are not planning to publish.

• 21

  See this section of our review of New Incentives' program: "The self-reported data in the RCT show a large and surprising increase in vaccination rates in control clinics from baseline to endline. At baseline in 2017, vaccination coverage rates in control areas were roughly 15%-25% across vaccines; at endline, they were around 60%."

• 22

  See "Source: spending across months" tab in GiveWell, New Incentives cost analysis, 2020.

• 23

  We are aware that New Incentives has applied for a $1.1 million philanthropic grant, but do not yet know the outcome of that grant application. Conversation with New Incentives, May 11, 2021 (unpublished)

• 24

  New Incentives, conversation with GiveWell, March 16, 2021

• 25

  New Incentives, conversation with GiveWell, May 11, 2021 (unpublished)
  

• 26

  New Incentives, conversation with GiveWell, April 13, 2021

• 27

  New Incentives, conversation with GiveWell, April 13, 2021

• 28

  See here in GiveWell, AMF room for more funding analysis, 2021.

• 29

  See here in GiveWell, AMF room for more funding analysis, 2021.

• 30

  See:

  • AMF, "AMF funds 16.2 million nets for distribution in the Democratic Republic of Congo (DRC) in 2020/21," 2019
  • AMF, "AMF funds a further 16.4 million nets for distribution in the Democratic Republic of Congo (DRC) in 2021/early 2022," 2020
  • AMF, "AMF funds a further 6.8 million nets for distribution in the Democratic Republic of Congo (DRC) in Q4 2021," 2021
  • AMF, "AMF funds a further 12.9 million nets for distribution in the Democratic Republic of Congo (DRC) in 2022," 2021
  • AMF, "AMF agrees to fund a further 16.4 million nets for distribution in DRC in 2023," 2021

• 31

  See AMF, "AMF agrees to fund 8.1 million nets for distribution in Nigeria in early 2022," 2021.

• 32

  The additional states are Benue, Plateau, and Zamfara states. See here in GiveWell, AMF room for more funding analysis, 2021.

• 33

  AMF told us over email that it views all 2023 LLIN distributions to be of similar priority and time-sensitivity. Rob Mather, Founder and CEO, AMF, email to GiveWell, July 20, 2021
  

• 34

  AMF says that the ideal lead time to support a distribution is 23 months. Based on its description of the activities it undertakes during its planning process, our guess is that only 18 months is needed for locations where AMF has worked before or has existing partnerships; this is the case in all countries AMF is considering supporting. Planning for distributions scheduled in 2023 will thus need to begin in late 2021 or early 2022.
  

• 35

  Global Fund, conversation with GiveWell, January 15, 2021

• 36

  See here for the most recent version of our cost-effectiveness analysis, "AMF" tab, row "Cost-effectiveness in multiples of cash transfers, after accounting for leverage/funging."

• 37

  See here for the most recent version of our cost-effectiveness analysis, "AMF" tab, row "Adjustment for program impact being to move distributions closer together."

• 38

  See here in GiveWell, AMF room for more funding analysis, 2021. See also the cell note here.

• 39

  See this spreadsheet, "AMF" tab, "Chad (weighted average of regions)" column, "Cost-effectiveness in multiples of cash transfers, after accounting for leverage/funging" row.

• 40

  GiveWell, Malaria Consortium room for more funding analysis, July 2021 (internal only)

• 41

  Malaria Consortium's total 2022-2024 room for more funding in each of these countries is as follows: $14.6 million in Burkina Faso, $55.1 million in Nigeria, and $2.5 million in Togo. GiveWell, Malaria Consortium room for more funding analysis, July 2021 (internal only)

• 42

  GiveWell, Malaria Consortium room for more funding analysis, July 2021 (internal only)

• 43

  "Ranking of SMC spending opportunities:

  1. Implement a “basic” SMC delivery model following current WHO policy recommendations in areas of Burkina Faso, Chad, Nigeria and Togo where SMC implementation started within the last two seasons (to ensure continuous SMC implementation for a minimum of three years);
  2. Implement a “basic” SMC delivery model following current WHO policy recommendations in all areas of Burkina Faso, Chad, Nigeria and Togo currently supported by Malaria Consortium’s SMC programme;
  3. Continue to implement a “high-quality” SMC delivery model following current WHO policy recommendations in all areas of Burkina Faso, Chad, Nigeria and Togo currently supported by Malaria Consortium’s SMC programme for which alternative funding sources are not available"

  Malaria Consortium, Ranking of SMC spending opportunities, 2021, p. 1

• 44

  Our understanding from multiple conversations is that Malaria Consortium needs to have sufficient funding for its 2023 programs by the end of 2021 in order to procure SMC drugs in time for 2023 campaigns.

• 45

  See here for the most recent version of our cost-effectiveness analysis, "Malaria Consortium" tab, row "Cost-effectiveness in multiples of cash transfers, after accounting for leverage/funging."

• 46
  • Burkina Faso: "11 health districts (30% of the target population) implement 5 cycles."
  • Nigeria: "3 states (Kogi, Nasarawa, Plateau; 46% of the total target population) implement 5 cycles."

  GiveWell, Malaria Consortium room for more funding analysis, July 2021 (internal only)

• 47

  See here in GiveWell, SMC fourth to fifth round calculations, July 2021.

• 48

  See "Source: Workings" tab in GiveWell, SMC fourth to fifth round calculations, July 2021.

• 49

  See here for the most recent version of our cost-effectiveness analysis, "Malaria Consortium" tab, row "Cost-effectiveness in multiples of cash transfers, after accounting for leverage/funging."

• 50

  GiveWell, Malaria Consortium room for more funding analysis, July 2021 (internal only)

• 51

  GiveWell, Malaria Consortium room for more funding analysis, July 2021 (internal only)

• 52

  See Sightsavers, Senegal deworming program 2021-2024 budget, 2021. The total budget from April 2021 through March 2024 is $1,239,124.

• 53

  See here for the most recent version of our cost-effectiveness analysis, "Sightsavers" tab, row "Cost-effectiveness in multiples of cash transfers, after accounting for leverage/funging."

• 54

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

• 55
  • "In 2019, Helen Keller also received funds from Effect:hope, a Canadian organization supported by GAC, to run its VAS programs in Kenya and Côte 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 unpublished conversations with Helen Keller International on November 5, 2020, and April 6, 2021.

• 56

  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 vitamin A supplementation programming in 11 counties in Kenya.

• 57

  See here for the most recent version of our cost-effectiveness analysis, "Helen Keller International" tab, "Cost-effectiveness in multiples of cash transfers, after accounting for leverage/funging" row.