IRD Global — Organizational Support (April 2023)

Note: This page summarizes the rationale behind a GiveWell grant to IRD Global. IRD Global staff reviewed this page prior to publication.

Published: October 2023

Summary

What we think this grant will do

IRD will use this grant to fund the following activities:

• consulting services to support the development of new strategy, governance, and business plans
• hiring of key staff
• adoption of new indirect cost recovery policies and software to support financial management
• addressing a deficit

We think supporting IRD's organizational development eventually could lead IRD to develop grant proposals for programs that GiveWell may decide to fund.

Why we recommended this grant

• We believe that IRD could become an unusually promising grantee for GiveWell. This impression is based on: its alignment with GiveWell on the importance of high quality evidence generation; its proven operational capacity in high burden, populous areas; initial indications of interest in prioritizing program cost-effectiveness; the fact that its leadership and staff are largely made up of individuals from the global South, which may provide them with important contextual knowledge and help address GiveWell blindspots; and the transparency it has demonstrated to GiveWell during the grant investigation. (more)
• Despite the organization’s promise, IRD is currently unable to meet its potential due to organizational challenges. These include inefficient organizational and governance structures, a lack of indirect cost allocation mechanism, and a deficit. (more)
• We believe the grant will enable IRD to more effectively engage with GiveWell as a grantee. We expect the grant activities noted above will help IRD address its organizational challenges in order to strengthen the organization and thus continue to implement programs that GiveWell can consider funding in the future. (more)
• This grant could lead IRD to develop programs with room for more funding above our cost-effectiveness bar. IRD's organizational strengths that we've described above (prioritizing cost-effectiveness, working on health programming in high-burden areas) make us optimistic it will find cost-effective opportunities for us to fund. (more)

Main reservations

• IRD could fail to maintain sustained attention and energy on developing and implementing plans for organizational change. This could occur if IRD’s leadership became distracted during or after the planning work by opportunities that seem promising but are outside their strategy or by ongoing legal action against the Global Fund. We have taken steps with IRD to mitigate this risk. (more)
• It is possible that IRD may not develop the practice of communicating “negative” information about its programs. GiveWell values grantees’ willingness to communicate transparently about their programs, including information that could reduce our assessment of a program’s cost-effectiveness. Thus far, IRD has not provided us with information that would lower our estimate of the cost-effectiveness of one of its programs. If IRD does not develop this practice, this could cause us to have an overly optimistic view of its programs or to be less likely to fund its programs because we’re worried we’re missing something. (more)
• IRD may be liable for the Global Fund’s legal fees if ongoing legal action resolves in the Global Fund’s favor. This could increase its deficit and distract IRD from organizational development planning or from developing and implementing cost-effective programming. (more)
• GiveWell does not have experience in supporting grantees through organizational development work, which could cause us to miss important considerations. Because of our collaboration with an external consultant on this grant investigation and follow up, we see this reservation as less important than those above. (more)

The organization

IRD Global describes itself as a “global health delivery and research organization” that works across health issue areas and approaches to scale interventions addressing “stubborn health challenges.”1 In addition to IRD Global, the organization has nine “Affiliates” which vary in terms of their organizational structure and how active they are in programming.2 We use “IRD” to refer to both IRD Global and Affiliates throughout this page.

GiveWell has recommended funding for IRD’s mobile conditional cash transfers for immunizations program in seven districts of Sindh Province, Pakistan, and IRD is a subgrantee of the GiveWell-recommended program providing technical assistance to the Government of Pakistan to implement deworming. In addition, GiveWell recommended a planning grant to IRD to support development of a proposal to test and scale a mass screen and treat program for tuberculosis, as well as an exit grant for that program after we decided not to move forward with a grant for an evaluation. Beyond these specific programs, our understanding is that IRD implements programs in many issue areas for which GiveWell believes there may be highly cost-effective interventions, including maternal and child health, infectious diseases, and digital health.3 IRD’s estimated income was $12m in 2022.4

The grant

GiveWell has recommended a three-year grant of up to $5,399,805 grant from Open Philanthropy to IRD Global for organizational support to allow it to address current organization challenges and become a stronger potential GiveWell grantee in the future.

IRD will use this grant to fund the following activities:

• consulting services to support the development of new strategy, governance, and business plans5
• hiring of key staff6
• adoption of new indirect cost recovery policies and software to support financial management7
• addressing its deficit8

We discuss each of these activities and how we expect that will help IRD address organizational challenges below.

Budget for grant activities

The total budget for this grant is up to $5,339,805, which includes funding in the following categories:

• “Governance," which includes leadership staff time and travel as well as consultancy fees for finalizing global governance structure plans.
• Strategic planning consultants and associated travel.
• Recruitment and new hires in operations, including a Chief Operating Officer (COO), Global Human Resources Officer, Procurement Officer, Governance Officer, and Communication Officer.
• Improvements to financial systems and controls, including the implementation of enterprise resource planning (ERP) software and consultancy fees to aid in the development of a global business model.
• Addition of a cost-effectiveness analysis team and the ability to pilot potentially cost-effective interventions.
• Deficit recovery.

We have planned for the grant amount to be released in three tranches.

• $1,550,179 will be released in year one.
• $2,131,048 will be released in year two, conditioned upon IRD making appropriate progress on organizational development. At this point, we expect that IRD will have agreed to a new governance, operating, and business model.
• $1,718,577 will be released in year three, conditioned upon IRD making appropriate progress on organizational development. At this point, we expect that IRD will have signed new affiliate agreements and selected an ERP vendor.

In addition to the funds provided to IRD, GiveWell has contracted with an external consultant, Beth Gertz, to assist us during the first year of this grant as we follow up on the work completed by IRD. We also expect this consultant to provide some assistance to IRD in the initial stages of this project in scoping work and selecting consultants for governance, strategic planning, and the development of a global business model. The consultancy fees for this individual will cost approximately $60,000 and are covered by GiveWell’s operating budget.

The case for the grant

We are recommending this grant primarily for qualitative reasons, including the following:

• We think IRD could become an unusually promising grantee for GiveWell based on its:
  • alignment with GiveWell on the importance of evidence;
  • proven operational capacity in high burden, populous areas;
  • initial indications of willingness to prioritize development of cost-effective programming;
  • leadership and staff from the Global South; and
  • transparency. More below.
• Despite the organization’s promise, IRD is currently unable to meet its potential due to organizational challenges, including:
  • inefficient organizational and governance structures;
  • a lack of appropriate indirect cost recovery policies and financial electronic systems to support IRD’s financial sustainability; and
  • a deficit. More below.
• We expect this grant to help IRD address those challenges in order to strengthen the organization and thus unlock its potential as a future grantee. More below.

In addition to our qualitative reasoning, we developed a rough threshold analysis which suggested multiple plausible paths by which this grant could meet our threshold for cost-effective funding. More below.

IRD appears to be an unusually promising potential grantee

We think IRD could become an unusually promising grantee for GiveWell based on the following:

• Alignment on the importance of high quality evidence generation. We have found IRD to be eager to generate robust evidence about innovative programs. For example, IRD was a core partner in a study on mobile conditional cash transfer (mCCT) for vaccines, which directly contributed to GiveWell’s decision to expand funding in this area.9 In two additional GiveWell-funded projects (an evaluation of IRD’s mCCT program and the development of a proposal for an evaluation of IRD’s zero TB program), we’ve observed productive collaborations between IRD and external researchers. High-quality evidence about program impact is central to GiveWell’s allocation recommendations, so IRD’s alignment on this sends a signal that IRD could be a strong potential grantee.
• Demonstrated operational capacity in high burden areas. IRD has demonstrated the ability to implement innovative and operationally complex programs, such as the electronic immunization registry Zindagi Mehfooz and a multi-country observational study to introduce new TB drugs.10 GiveWell has heard positive assessments of IRD’s program implementation from partner organizations with which it has worked.11 IRD has a current operational presence in three populous, relatively high burden areas: Bangladesh, Pakistan, and South Africa.12 Because population, population density, and burden of disease often correlate with cost-effectiveness of programs, we guess that there may be opportunities for IRD to implement interventions that are above GiveWell’s cost-effectiveness thresholds for recommending funding in these areas.
• Initial indications of interest in prioritizing program cost-effectiveness. IRD’s leadership shared with us that cost-effectiveness has not been a historical priority for their organization, largely because it does not align with other donor criteria. Over the course of this grant investigation, we’ve observed promising signs that developing cost-effective programming could become an organizational priority, including engagement with senior leadership in workshops to understand GiveWell methodology, a willingness to understand our cost-effectiveness models and tweak program design to maximize cost-effectiveness during our investigation for another potential program (IRD’s Zero TB program), and the inclusion in this grant’s budget of a staff member focused on developing IRD’s capacity to consider cost-effectiveness in programs across the organization.13 However, we do have some reservations about whether IRD will be able to learn to engage evenhandedly in our investigations by sharing thoughts on ways our models might overestimate (rather than underestimate) the cost-effectiveness of its programs (more below).
• Leadership and staff from the Global South. IRD’s leadership team is composed of individuals from the Global South. We think it is plausible that organizations with leaders from contexts similar to those they serve could use contextual knowledge to implement particularly effective programs.14 In addition, it is possible that GiveWell’s allocation recommendations suffer from blindspots created by lack of familiarity with program contexts. We hope that close collaboration with leaders from the Global South could help us become aware of and address biases that may result from GiveWell’s lack of contextual knowledge.
• Transparency and willingness to learn from mistakes. In discussions about the need for organizational support, IRD leadership have been unusually forthcoming about their own organizational weaknesses.

IRD is facing organizational challenges that meaningfully constrain its ability to engage with GiveWell

Across multiple conversations with GiveWell, IRD has identified several core challenges which constrain its ability to develop new cost-effective programming opportunities and engage with GiveWell. The primary constraints include:

• Organizational and governance structures have not kept up with growth. Our impression from multiple discussions with IRD leadership is that as IRD has grown, the organizational and governance structures that worked well when it was a smaller organization are no longer optimal. These structures have led to a lack of clarity regarding the processes through which IRD Global and Affiliates participate in governance and strategy discussions and decisions.15
• A lack of appropriate indirect cost policy and systems to support IRD’s financial sustainability. IRD has identified a need to develop appropriate indirect cost recovery policies and to implement an enterprise resource planning software (ERP) in order to support continued growth in IRD’s programs and revenues.
• The need to address an existing financial deficit.

Activities funded by this grant could address organizational challenges

Based on our review of IRD’s organizational development proposal and input from an external consultant, we believe that the activities funded under this grant are feasible, and, if implemented, are likely to address IRD’s core strategy, governance, and revenue issues in a way that allows IRD to more effectively engage with GiveWell.

The core activities of the grant and how they will address known organizational challenges are outlined below.

Retaining external consultants

IRD will retain external consultants to help support the development of effective global strategy, business, and operating models (including the development of an indirect cost recovery policy) as well as Global and Affiliate governance frameworks.16

Our impression from multiple discussions with IRD leadership is that its directors are skilled program implementers with limited knowledge about the optimal organizational and governance structures to run a large organization. This has led to the development of inefficient structures. For example, IRD has a complex organizational structure including IRD Global and nine Affiliates, which have differing organizational and governance structures, and the processes through which these entities participate in governance and strategy discussions and decisions are not well defined.17 Additionally, IRD Global does not have an external board.18 This structure is inefficient, may open IRD up to risk, and likely distracts senior leadership away from high-level organizational concerns.

We expect that the governance work that IRD will undertake as part of this grant will help establish a standardized Global and Affiliate governance framework,19 reducing the risk of real or perceived impropriety. The development of a cost recovery policy will help IRD address its deficit.

Hiring key staff

IRD will hire key staff, including a project manager to coordinate grant activities, a COO, and a cost-effectiveness analysis (CEA) team leader:

• The project manager will support the directors in coordinating the various external consultants for this work and maintaining project timelines,20 allowing directors to focus on the substantive parts of the organizational development work.
• The COO will lead global operations, freeing up director capacity that is currently spent on those issues.21
• The CEA team leader will help grow IRD’s organizational focus on cost-effective programming,22 potentially enabling it to be a more effective “co-creator” of cost-effective programming with GiveWell.

Commissioning an ERP

IRD will commission an ERP software system for IRD Global and Affiliates. IRD currently uses Quickbooks which it reports is insufficient for its growing needs.23 Investment in a more robust system should increase operational efficiency and reduce financial risk.

Deficit relief

Grant funding will also provide deficit relief. We expect that providing deficit relief will allow IRD leadership to focus more time on strategic future program development, rather than on addressing the deficit.

Multiple plausible paths to cost-effectiveness

We developed a rough threshold analysis which suggested multiple plausible paths by which this grant could meet our threshold for cost-effective funding. For example, if, as a result of this grant, we funded $6m in programming annually for five years that we expected to be 12 times as cost effective as unconditional cash transfers, then this grant would meet our current cost-effectiveness threshold for funding.24 The grant could also meet our current funding threshold if it resulted in less funding at higher cost-effectiveness levels or larger funding opportunities over a shorter period of time.25

We believe it is plausible for this grant to result in this level of cost-effective room for more funding for the following reasons:

• We are currently funding IRD to implement approximately $5m annually in cost-effective programming through its mobile conditional cash transfers for immunizations program in Pakistan, and we have discussed other potential funding opportunities that, though we decided against funding, we found promising. This increases our confidence that IRD will be able to bring us additional promising opportunities with substantial room for more funding in the future.
• As discussed above, IRD has shown itself to be well aligned with GiveWell on the importance of high quality evidence generation, demonstrated operational capacity in high burden areas, and indicated interest in prioritizing program cost-effectiveness.

Risks and reservations

Our main reservations about this grant are:

• IRD could fail to maintain sustained attention and energy on developing and implementing plans for organizational change. It is possible that the grant will not result in meaningful organizational change if IRD does not maintain focus on organizational development during the planning phase or reverts to old ways of working afterward. More below.
• GiveWell values grantees’ willingness to communicate transparently about their programs, including information that could reduce our assessment of a program’s cost-effectiveness. It is possible that IRD may not develop the practice of communicating “negative” information about their programs. Thus far, IRD has not provided us with information that would lower our estimate of the cost-effectiveness of one of its programs. If IRD is unable to point out assumptions we might be getting wrong about future opportunities that would lower our estimated cost-effectiveness of those opportunities, it could reduce our confidence in the promisingness of the opportunities we explore with them. More below.
• IRD may be liable for the Global Fund’s legal fees if ongoing legal action resolves in the Global Fund’s favor. If that were the case, we expect that the cost of those legal fees would increase IRD’s deficit, which could distract IRD from organizational development planning or from developing and implementing cost-effective programming. More below.
• GiveWell lacks experience in this type of grantmaking. GiveWell does not have experience in supporting grantees through this kind of organizational development work, which could cause us to miss important considerations. Because of our collaboration with an external consultant with experience consulting on social impact strategies and operational effectiveness, we see this reservation as less important than those above. More below.

Lack of sustained attention on organizational change

Our impression is that for the planning funded by this grant to be meaningful, IRD’s leadership will have to a) meaningfully engage in the planning process and b) actually use it to guide decision making. We think IRD’s leaders are likely to do this because:

• IRD’s leadership has requested funding to carry out these activities to address their own perceptions of IRD's organizational needs, rather than these activities being suggested by GiveWell.
• In conversations, IRD has repeatedly stressed that it sees these activities as critical to enable IRD’s continued growth.

However, it is possible that the grant will not result in meaningful organizational change if IRD does not maintain focus on organizational development during the planning phase or reverts to old ways of working afterward. We think that the primary risk here is that IRD’s leadership could be distracted during or after the planning work by program opportunities that seem promising to them but are “off strategy” (e.g., because they don’t have sufficient scope for indirect cost recovery or because they don’t match IRD’s core business models) or by ongoing legal action against the Global Fund.26 If IRD’s leadership is unable to maintain programmatic focus or discipline about indirect cost recovery, then IRD might still lack the staff capacity to develop programs which GiveWell might eventually fund on the basis of cost-effectiveness.

We are trying to mitigate this risk within the grant through follow up plans described below.

IRD may not learn to engage evenhandedly in investigations

Another reservation is that IRD may not learn to engage evenhandedly in our investigations, and in particular to bring up points that we may be missing that would imply a lower-than-modeled cost-effectiveness. This could cause us to have an overly optimistic view of their programs or to be less likely to fund their programs because of concerns about biased information.

We rely on implementing organizations to share information with us about the ground truth of their programs. In general, we expect that grantees are more optimistic about their programs than we are, and we make crude adjustments to account for this; however, our most seamless grantmaking relationships involve the grantee sometimes pointing out facts which adjust our cost-effectiveness estimates downward. This increases our confidence that we’re not getting a completely biased picture of the program.

Thus far, IRD has not provided us with information that would lower our estimate of the cost-effectiveness of one of its programs. We see this as typical; grantees face strong incentives to view their programs in an optimistic light. However, if IRD is unable to point out assumptions we might be getting wrong about future opportunities that would lower our estimated cost-effectiveness of those opportunities, it could reduce our confidence in the promisingness of the opportunities we explore with them.

IRD may be liable for Global Fund’s legal fees

In its legal action against the Global Fund’s Office of the Inspector General, IRD has put up collateral to pay the Global Fund’s legal fees in the event that a judgment is found in favor of the Global Fund.27 We are unsure how likely it is that the case will resolve in the Global Fund’s favor. If that were the case, we expect that the cost of those legal fees would increase IRD’s deficit, which could distract IRD from organizational development planning or from developing and implementing cost-effective programming.

GiveWell lacks experience in this type of grantmaking

GiveWell does not have experience in supporting grantees through this kind of organizational development work. It’s possible that we are missing important factors affecting:

• How feasible IRD’s plans are. We’ve tried to guard against this possibility by bringing in an external consultant to assess IRD’s plans.
• How likely IRD’s plans are to be successful. We know that success with this funding is not guaranteed, but we do not have much experience to draw on to calibrate our views for how likely it is.

Because of our collaboration with Beth Gertz, who has experience consulting on social impact strategies and operational effectiveness, we see this reservation as less important than those discussed above.

Plans for follow up

As part of our investigation into this grant, we asked IRD to propose concrete process indicators and timelines by which those indicators would be met. GiveWell and our consultant Beth Gertz reviewed the process indicators and felt that they were manageable and would serve the purpose of identifying and addressing delays and interdependencies.28 GiveWell and IRD will meet quarterly to discuss progress on those indicators.

This grant is not eligible for renewal.

Internal forecasts

For this grant, we are recording the following forecasts:

Confidence	Prediction	By time
95%	IRD will complete at least 25% of its year 1 process indicators by the end of Q5 of the grant. (Process indicators vary in complexity and the degree to which they are reliant on other actors. We have high confidence that IRD will be able to complete simple process indicators that do not rely on others.)	July 2024
85%	IRD will complete at least 50% of its year 1 process indicators by the end of Q5 of the grant.	July 2024
50%	IRD will complete at least 75% of its year 1 process indicators by the end of Q5 of the grant.	July 2024
35%	IRD will fulfill at least 90% of its year 1 process indicators by the end of Q5 of the grant. (Process indicators vary in complexity and the degree to which they are reliant on other actors. We have lower confidence that IRD will be able to fully complete complicated process indicators or those that rely on others.)	July 2024
98%	IRD will complete at least 25% of its year 2 process indicators by the end of Q9 of the grant. (Process indicators are cumulative, so this includes year 1 process indicators.)	July 2025
90%	IRD will complete at least 50% of its year 2 process indicators by the end of Q9 of the grant.	July 2025
85%	IRD will complete at least 75% of its year 2 process indicators by the end of Q9 of the grant.	July 2025
60%	IRD will complete at least 90% of its year 2 process indicators by the end of Q9 of the grant.	July 2025
75%	GiveWell funding to IRD programs (excluding those programs already being funded as of April 2023) will be greater than $5m annually.	Dec 31, 2029
35%	GiveWell funding to IRD programs (excluding those programs already being funded as of April 2023) will be greater than $15m annually.	Dec 31, 2029

Our process

• IRD developed a proposal for the grant, including key activities, timeline, and budget.
• GiveWell reviewed the proposal in collaboration with Beth Gertz and provided feedback to IRD.
• GiveWell held a meeting with IRD and Beth Gertz to discuss the proposal.29
• IRD sent GiveWell a revised proposal.
• GiveWell developed a threshold analysis to aid us in determining whether scenarios that would lead to this grant being cost-effective were plausible. (see above)
• IRD developed process indicators to track progress on grant activities.
• GiveWell reviewed the process indicators in collaboration with Beth Gertz.
• Our reasoning for recommending this grant was reviewed by multiple GiveWell staff members.

Sources

Document	Source
Chandir et al. 2022	Source
GiveWell, IRD Global — Mobile Conditional Cash Transfers for Immunizations (October 2021)	Source
GiveWell, IRD Global — Zero TB Exit Grant (March 2023)	Source
GiveWell, IRD Global (Electronic Immunization Registry and Mobile-Based Conditional Cash Transfers to Increase Vaccination)	Source
GiveWell, IRD Global and Johns Hopkins University — Planning Grants for RCT of Zero TB Program (August 2022)	Source
GiveWell, IRD operational funding threshold analysis BOTEC, 2023	Source
GiveWell, University of Chicago — Evaluation of Mobile Conditional Cash Transfers (November 2021)	Source
Global Fund Office of the Inspector General, Global Fund Grant in Pakistan Prohibited practices compromised procurement in a tuberculosis program, 2021	Source
IRD, "Our team"	Source (archive)
IRD, “Press release: Update on IRD’s legal action against the Global Fund,” February 10, 2023	Source (archive)
IRD, Operational Support Budget, 2023 (unpublished)	Unpublished
IRD, Organizational Development Proposal, March 17, 2023 (unpublished)	Unpublished

• 1

  “IRD Global is a global health delivery and research organization. We leverage process and technology innovations to develop, implement, and scale cost-effective, evidence-based, and high-impact solutions to stubborn health challenges. We work to increase access to new and rapid diagnostics and to improve efficiencies in mass screening and immunization registration, data collection, and monitoring and evaluation. We work to improve treatment access and adherence, and improve communication between healthcare providers and patients through innovative partnerships with communities, governments, private providers, universities, and other non-governmental organizations. Our teams have pioneered open source information technology innovations in mass health screening and immunization registration mobile health applications, interactive SMS systems, digital conditional cash incentives for patients, caregivers and health workers, electronic medical records, and civil registration and vital statistics systems for low resource environments.

  Our programs cover maternal and child health, infectious diseases, non-communicable diseases, mental health, neglected tropical diseases, youth engagement, big data analytics, and digital health. We integrate targeted health campaigns in our programs to communicate key public health information and to influence behavior change.” IRD, Organizational Development Proposal, March 17, 2023 (unpublished), p. 3.

• 2

  “IRD Global is a Singapore-based not-for-profit registered in accordance with the Singapore Companies Act and is governed by four Permanent Directors (PDs). We have a total of nine Affiliates. Four Affiliates are currently actively implementing programs: Bangladesh, Pakistan, South Africa, and the Philippines – the first three are incorporated in the respective countries, while Philippines is a subsidiary of IRD Global. Three Affiliates – Indonesia, Nigeria and Zimbabwe – had significant funding streams that ended just prior to or during the COVID pandemic, and are currently dormant. Grant negotiations for projects in these countries are ongoing. The UAE entity is primarily an operational hub that has also served as a base for projects carried out in the Middle East in the past. There is an ongoing dispute with the IRD Vietnam’s Board that is currently under arbitration. … IRD Global’s efforts at the country level focus on connecting Affiliates with our global partners and providing technical expertise, access to networking mentoring and funding opportunities to meet their unique needs. IRD Global PDs serve as Board members at some Affiliates. IRD Global is also responsible for the pre-incorporation process for new Affiliates, which includes managing the entity until in-country staff are onboarded, ensuring that the new entity meets all local laws and regulations, and providing initial funding. At times, IRD Global has stepped in to bridge-finance Affiliate payroll in between grant funding.” IRD, Organizational Development Proposal, March 17, 2023 (unpublished), pp. 4-5.

• 3

  “Our programs cover maternal and child health, infectious diseases, non-communicable diseases, mental health, neglected tropical diseases, youth engagement, big data analytics, and digital health. We integrate targeted health campaigns in our programs to communicate key public health information and to influence behavior change.” IRD, Organizational Development Proposal, March 17, 2023 (unpublished), p. 3.

• 4

  “We have rapidly grown over the last few years and our annual income was USD12M in 2022,
  which represents a growth of 50% compared to 2021” IRD, Organizational Development Proposal, March 17, 2023 (unpublished), p. 14.

• 5

  References to consulting firms for governance, strategic planning, and financial systems & controls in IRD, Operational Support Budget, 2023 (unpublished).

• 6
  • “PD Saira Khowaja will lead this project and will be supported by a full time Project Manager who will manage the process and logistics and serve as a liaison to consulting firms.” IRD, Organizational Development Proposal, March 17, 2023 (unpublished), p. 8.
  • “Outputs will include: The recruiting and hiring of a CEA team leader and a Research Associate to develop an organizational strategy to strengthen CEA capacity by Q10.” IRD, Organizational Development Proposal, March 17, 2023 (unpublished), p. 13.
  • “Outputs will include: Recruiting and hiring of COO by Q1.” IRD, Organizational Development Proposal, March 17, 2023 (unpublished), p. 15.

• 7

  “Outputs will include … The roll out of the negotiated and adopted ICR policy by Q5 … The roll out of ERP to Global and Affiliates by Q12.” IRD, Organizational Development Proposal, March 17, 2023 (unpublished), p. 15.

• 8

  IRD, Organizational Development Proposal, March 17, 2023 (unpublished)

• 9

  Results from the study were unpublished at the time we made the grant to IRD for mCCTs in October 2021. In our grant page, we cite our intervention report, which refers to a three-year trial in Korangi.

• 10
  • “We developed Zindagi Mehfooz (Safe Life), a user-friendly and adaptable electronic immunization registry that integrates multiple systems to improve immunization coverage. More than 8 million children and 2.5 million women are enrolled in the registry, and over 92 million vaccinations have been recorded.” IRD, Organizational Development Proposal, March 17, 2023 (unpublished), p. 3.
  • “As a consortium partner on the endTB project, we implemented a multi-country observational study to introduce new TB drugs - free of cost - to over 2,700 multidrug-resistant tuberculosis (MDR-TB) patients in 17 countries across 4 continents. This study informed the 2019 MDR-TB guidelines updated by the World Health Organization. In addition, the endTB consortium is leading two major multi-country clinical trials to find more effective, shorter, all-oral, less-toxic treatment regimens for all forms of drug-resistant TB.” IRD, Organizational Development Proposal, March 17, 2023 (unpublished), p. 4.

• 11

  Two conversations with organizations that have worked with IRD (unpublished).

• 12

  “We have a total of nine Affiliates. Four Affiliates are currently actively implementing programs: Bangladesh, Pakistan, South Africa, and the Philippines.” IRD, Organizational Development Proposal, March 17, 2023 (unpublished), p. 5.

• 13

  IRD, Operational Support Budget, 2023 (unpublished)

• 14

  “As an organization initiated and based in the Global South, we are uniquely positioned to develop and implement contextual interventions that are well integrated into existing health systems.” IRD, Organizational Development Proposal, March 17, 2023 (unpublished), p. 19.

• 15

  “IRD’s governance structure has developed organically in response to the stepwise growth of the network. Resources have been allocated to building a governance team, who have in turn made efforts to develop and streamline policies. It is important to recognize that each Affiliate country setting has unique regulatory and governance requirements, making local leadership and involvement essential. We believe that this country level “ownership” is essential for successful governance. In turn, this local ownership has to be linked to a strong global framework, allowing IRD to work in a context-specific yet integrated manner. At present, there is limited understanding around the Global-Affiliate relationship, and the process through which these entities participate in governance and strategy discussions and decisions. Efforts to strengthen – and perhaps re-design – IRD’s governance structure will need to address these complex requirements. This task is beyond the capabilities of our current team.” IRD, Organizational Development Proposal, March 17, 2023 (unpublished), p. 9.

• 16

  References to consulting firms for governance, strategic planning, and financial systems & controls are from IRD, Operational Support Budget, 2023 (unpublished).

  • “Outputs will include … The roll out of the negotiated and adopted ICR policy by Q5.” IRD, Organizational Development Proposal, March 17, 2023 (unpublished), p. 15.
  • “A consulting firm with niche expertise will be hugely beneficial to review our current governance model and work with the governance team, PDs, and Affiliate leadership to explore different models, understand their pros and cons, reach consensus on what would best suit our needs, and advise our legal and finance teams in drafting and executing updated agreements that address all elements of the Global-Affiliate relationship.” IRD, Organizational Development Proposal, March 17, 2023 (unpublished), pp. 10-11.

• 17
  • “IRD Global is a Singapore-based not-for-profit registered in accordance with the Singapore Companies Act and is governed by four Permanent Directors (PDs). We have a total of nine Affiliates. Four Affiliates are currently actively implementing programs: Bangladesh, Pakistan, South Africa, and the Philippines – the first three are incorporated in the respective countries, while Philippines is a subsidiary of IRD Global. Three Affiliates – Indonesia, Nigeria and Zimbabwe – had significant funding streams that ended just prior to or during the COVID pandemic, and are currently dormant. Grant negotiations for projects in these countries are ongoing. The UAE entity is primarily an operational hub that has also served as a base for projects carried out in the Middle East in the past. There is an ongoing dispute with the IRD Vietnam’s Board that is currently under arbitration.” IRD, Organizational Development Proposal, March 17, 2023 (unpublished), p. 5.
  • “IRD Global’s efforts at the country level focus on connecting Affiliates with our global partners and providing technical expertise, access to networking mentoring and funding opportunities to meet their unique needs. IRD Global PDs serve as Board members at some Affiliates. IRD Global is also responsible for the pre-incorporation process for new Affiliates, which includes managing the entity until in-country staff are onboarded, ensuring that the new entity meets all local laws and regulations, and providing initial funding. At times, IRD Global has stepped in to bridge-finance Affiliate payroll in between grant funding.” IRD, Organizational Development Proposal, March 17, 2023 (unpublished), p. 5.
  • “IRD’s governance structure has developed organically in response to the stepwise growth of the network. Resources have been allocated to building a governance team, who have in turn made efforts to develop and streamline policies. It is important to recognize that each Affiliate country setting has unique regulatory and governance requirements, making local leadership and involvement essential. We believe that this country level “ownership” is essential for successful governance. In turn, this local ownership has to be linked to a strong global framework, allowing IRD to work in a context-specific yet integrated manner. At present, there is limited understanding around the Global-Affiliate relationship, and the process through which these entities participate in governance and strategy discussions and decisions. Efforts to strengthen – and perhaps re-design – IRD’s governance structure will need to address these complex requirements. This task is beyond the capabilities of our current team.” IRD, Organizational Development Proposal, March 17, 2023 (unpublished), p. 9.

• 18

  No board is listed on IRD's website.

• 19
  • “Integral to this process will be a review of the role of the PDs as the legal guarantors of IRD Global and how best to align their governance role with their technical and executive roles. Options will be considered for restructuring of the Board for a wider representation that will provide guidance to IRD while maintaining its core ethos and its agility and responsiveness to opportunities.” IRD, Organizational Development Proposal, March 17, 2023 (unpublished), p. 9.
  • “A consulting firm with niche expertise will be hugely beneficial to review our current governance model and work with the governance team, PDs, and Affiliate leadership to explore different models, understand their pros and cons, reach consensus on what would best suit our needs, and advise our legal and finance teams in drafting and executing updated agreements that address all elements of the Global-Affiliate relationship." IRD, Organizational Development Proposal, March 17, 2023 (unpublished), pp. 9-10.
  • “This will provide a framework for the subsequent steps of preparing and implementing Affiliate agreements. Accomplishing these objectives will ensure the IRD Global and Affiliates operate as a cohesive network with the highest levels of transparency and accountability, as well as fulfilling all legal and regulatory requirements in all geographies.” IRD, Organizational Development Proposal, March 17, 2023 (unpublished), p. 10.

• 20

  “PD Saira Khowaja will lead this project and will be supported by a full time Project Manager who will manage the process and logistics and serve as a liaison to consulting firms.” IRD, Organizational Development Proposal, March 17, 2023 (unpublished), p. 8.

• 21

  “The COO will play a critical role in assessing the overall resource needs across all support functions that will enable the 5 year strategic plan to be successfully delivered and integrated into routine organizational operations. Outputs will include: Recruiting and hiring of COO by Q1” IRD, Organizational Development Proposal, March 17, 2023 (unpublished), p. 15.

• 22

  “We propose to bring on a full-time CEA team leader to evaluate our existing programs, work with our technical and operational staff to embed CEA into IRD's program prioritization and design processes, and pilot CEA interventions.” IRD, Organizational Development Proposal, March 17, 2023 (unpublished), p. 13.

• 23

  “IRD is committed to introducing an ERP system to strengthen management, monitoring, accountability, and transparency within Global and across Affiliates. Currently, IRD uses Quickbooks across the network, but this software is not appropriate for the current and future needs of the organization given its limited capabilities and manual internal controls. This results in cost inefficiencies and has a significant impact on productivity and accuracy of financial records. With organizational growth rapidly outpacing the current capacity of our management tools, we need to invest in a comprehensive ERP system. An integrated ERP will help us plan, budget, predict and report on financial results with greater accuracy and efficiency, track employee performance, identify staff training and development priorities, support recruitment, engage in better procurement planning, ensure timely generation and flow of data for decision-making, provide greater data integrity, and more effectively link project outcomes to financial outcomes.” IRD, Organizational Development Proposal, March 17, 2023 (unpublished), p. 14.

• 24

  As of mid-2023, we expect to direct funding to programs that are 10 or more times as cost-effective as unconditional cash transfers, or "10x."

• 25

  See two potential alternate examples of paths to cost-effectiveness for this grant on the “example scenarios” sheet of our threshold analysis.

• 26

  Note that IRD’s leadership has emphasized that they’re continually weighing IRD’s organizational interests against the cost of ongoing legal action and that they will stop pursuing this case if it appears to be tipping in the wrong direction.

• 27

  “Since the filing of IRD’s application for interim relief in May 2021, the Global Fund adopted a strategy of seeking to avoid the merits of the matter at all costs during the High Court proceedings. Despite having received the application and defending it in court, the Global Fund challenged the jurisdiction of the court, and claimed that there was improper service of the application. It also sought to forestall proceedings by forcing IRD to put up substantial sums as collateral for the Global Fund’s legal costs. On 6 February 2023, pursuant to the Global Fund’s procedural objections, the High Court dismissed the case based on lack of requisite jurisdiction. IRD has already launched an application seeking to appeal the judgement to the Supreme Court of Appeal or a Full Bench of the High Court.” IRD, “Press release: Update on IRD's legal action against the Global Fund,” February 10, 2023.

• 28

  Beth Gertz, Independent Review of IRD’s Final Organization Development Proposal for GiveWell Funding, March 24, 2023 (unpublished).

• 29

  IRD and Beth Gertz, conversation with GiveWell, February 21, 2023 (unpublished).