Evidence Action — Coverage Surveys of Iron and Folic Acid Supplementation in Karnataka and Tripura, India (January 2024)

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

Published: March 2024

What we think this grant will do

IFA supplementation consists of providing oral supplements, in either syrup or tablet form, to reduce anemia. See our intervention report on iron supplementation for more details.

This grant supported Evidence Action to conduct baseline IFA coverage surveys in Karnataka ($55,000) and Tripura ($42,000) in the fall of 2023.1

Case for the grant

• We recommended this grant because we think these surveys will help us decide whether to make a larger grant to fund technical assistance to increase IFA coverage in two additional Indian states.
  We think IFA supplementation in India is a promising program. Since March 2018, we've directed ~$13.7 million to support Evidence Action's technical assistance program for IFA supplementation in five Indian states (Haryana, Jharkhand, Madhya Pradesh, Rajasthan, and Uttarakhand).2
  Our rough guess is that Evidence Action's IFA program in Karnataka and Tripura would be ~12 times as cost-effective as cash transfers, GiveWell's benchmark for comparing programs ("12x cash").3 This is above our cost-effectiveness bar for funding grants at the time of recommending this grant (10x cash). We estimated the funding gap over seven years for running the IFA program in these states would be around $5 million (~$4.9 million in Karnataka and ~$300,000 in Tripura).4

  However, we do not currently have reliable estimates of IFA coverage rates in Karnataka and Tripura, and we think these surveys will help us make progress on that. This would increase our confidence in the value of providing technical assistance to increase IFA uptake. (The lower the current coverage, the higher the potential impact.)

Risks and reservations

• Even if the surveys show low coverage, we might decide not to fund further expansion due to other uncertainties about the program’s impact. We have a number of uncertainties about the impact of Evidence Action’s program. In particular, we're uncertain about the effect the program will have on IFA coverage (see our page about the 2022 grant to support Evidence Action's IFA program for details). It’s possible we should have waited to learn more about the program’s impact before funding these baseline surveys. We decided to fund them now because Evidence Action told us this will help them make internal decisions around fundraising and staffing in these locations.5
• The cost for the Tripura baseline survey ($42,000) is high relative to how much funding we think it could influence (~$300,000). We decided to fund the Tripura baseline survey because the program seemed sufficiently promising at 12x cash, but we're uncertain whether this was the right call.

Plans for follow up

We expect to receive results from the baseline surveys in Karnataka and Tripura in the first quarter of 2024. We're unsure when we will make a decision about funding expansion into these states.

Internal forecasts

For this grant, we recorded the following forecasts:

Our process

• In June 2023, Evidence Action reached out to us about the possibility of conducting baseline surveys in states where the program could potentially expand.7 Evidence Action shared information about the budgets and timelines for these surveys.
• We completed a shallow cost-effectiveness and room for more funding analysis for the expansion states and approved moving forward with surveys in Karnataka and Tripura.

Sources

• 1

  Email from Evidence Action to GiveWell, August 24, 2023 (unpublished) .

• 2
  • In March 2018, we recommended funding ($320,000) to the Evidence Action Accelerator to scope a technical assistance (TA) program for IFA supplementation in India.
  • Based on the results of this scoping work, we recommended a grant (approximately $3.4 million) in December 2018 to Evidence Action to scale a pilot of the IFA TA program and a grant in March 2019 ($800,000) to evaluate the program.
  • In August 2022, we recommended funding (approximately $9.2 million) to support the IFA TA program across five states in India.
  • $320,000 + ~$3,400,000 + $800,000 + ~$9,200,000 = ~$13,720,000.

• 3

  Note that a) our cost-effectiveness analyses are simplified models that are highly uncertain, and b) our cost-effectiveness threshold for directing funding to particular programs changes periodically. See GiveWell’s Cost-Effectiveness Analyses webpage for more information about how we use cost-effectiveness estimates in our grantmaking.

• 4

  This is based on our estimate of Evidence Action's funding needs in the states where it currently operates. We then adjust this for the population size of Karnataka and Tripura. See GiveWell, Room for more funding calculations for IFA expansion states.

  $4,947,705 in Karnataka + $297,510 in Tripura = $5,245,215 total funding gap.

• 5

  Email from Evidence Action to GiveWell, September 14, 2023 (unpublished).

• 6

  Email from Evidence Action to GiveWell, September 14, 2023 (unpublished).

• 7

  Email from Evidence Action to GiveWell, June 2, 2023 (unpublished).