Note: This page summarizes the rationale behind a GiveWell grant to the Center for Global Development. Center for Global Development staff reviewed this page prior to publication.
Published: July 2024
In May 2024, GiveWell made a $197,000 grant to the Center for Global Development (CGD) for a research project to answer the question: “If the opportunities GiveWell funds are highly effective and relatively low cost, why aren't they already funded by other groups focused on saving lives?”1 The project will be led by Justin Sandefur, a Senior Fellow at the Center for Global Development.2
The CGD research team will answer this question primarily by conducting interviews with Ministry of Health officials in countries where GiveWell’s top charities operate, multilateral and bilateral funders, and other large philanthropic funders.3 They will focus on GiveWell’s four Top Charities: seasonal malaria chemoprevention from Malaria Consortium, insecticide-treated bednets from the Against Malaria Foundation, vitamin A supplementation from Helen Keller International, and cash incentives for routine infant vaccination from New Incentives.4
More details are in the proposal here.
We’re recommending this grant because:
- A key input in our grantmaking is our assessment of whether other funders would fund an opportunity if GiveWell did not. If the grants we investigate are likely to be funded without us, our funding is not improving outcomes as much as if they are very unlikely to be funded, which reduces the cost-effectiveness of the grant. We refer to this as funging. This is a major uncertainty in the analyses of our Top Charities.5 We think it’s plausible that this project could change our mind about how likely it is that other funders would step in and fund our Top Charities if we didn’t.
- CGD will look into reasons why these gaps may be left open by other funders. For example, recipient countries may prefer other health programs, rather than those supported by GiveWell’s top charities, because they view the programs GiveWell supports as less effective. We think this type of information could potentially update our views of programs we fund, too.
- More broadly, we’re interested in finding ways for individuals and organizations beyond GiveWell to review and critique major assumptions of our work. We think this project provides an opportunity for scrutiny both by CGD, an organization with expertise in global health and development, and by other funders and decision-makers in low- and middle-income countries.
- We think CGD is well-suited to conduct this work, given their connections and their ability to provide a critical, “outside view” on GiveWell’s work.
Our main reservations are:
- We’ve done some work on these questions already and want to make sure this project isn’t duplicative. To minimize this risk, CGD will review our existing work on why we think these gaps exist and speak to the Program Officers who lead grantmaking on our top charities.6
- We’ve sometimes had trouble learning about the likelihood that another funder would step in and fill a gap if we didn’t. We think it’s possible this same challenge would occur in this report. We still think it’s worth probing this further.
- Our main motivation for commissioning this research is to pressure test some key assumptions in our grantmaking and get scrutiny from experts beyond GiveWell. However, in their proposal, CGD notes that a potential outcome of this work is recommending other funders consider using GiveWell’s funding as a benchmark for their funding decisions (if they conclude these funding gaps are real and not filled due to donor constraints).7 We don’t want to alienate other decision-makers by mistakenly giving the impression that the aim of this study is to prove that their funding approach is wrong. We’ll work with CGD to ensure that the goals of the study are clearly communicated in interviews.
- Some funders or decision-makers may be hesitant to share their honest opinions or decision-making processes if they believe their responses will be made public. We’ll work with CGD to make sure interviewees understand the confidentiality measures in place and explore options like aggregating or anonymizing responses.
- Since GiveWell is commissioning and funding this research, there may be concerns about potential bias in the study design, execution, or interpretation of results. We’ll work with CGD to ensure they maintain independence throughout the research process.
This research will be conducted in 2024 over six months. We expect a report to be published by February 2025.
We recommended this grant based on a shallow investigation. Justin Sandefur proposed this project to us in a recent conversation, and we decided to fund it after asking several questions about the proposal and discussing it internally.
Sources
- 1
"To be sure, bed nets and vitamin A supplements represent the low hanging fruit in global health and development. But that is not a criticism; it’s the whole point. This modern crop of evidence-based charities targets low-cost, scalable programs with solid data behind them and fairly simple, linear theories of change: where vaccination coverage is low, pay people to vaccinate their kids so they don’t die of preventable diseases. Where intestinal worms are endemic, give kids deworming pills at school en masse so fewer kids get sick.
Paradox: why haven’t public institutions dedicated to saving lives done those easy things already?
From a public policy perspective, however, the ability of organizations like GiveWell to credibly save thousands of lives with small donations poses the question: why weren't these things happening anyway? If delivering bed nets is such obvious low-hanging fruit, then why hasn't the government of Guinea or the myriad official aid agencies operating in Guinea completely saturated the market with free bed nets already?”
Justin Sandefur, “The life (only) you can save” proposal to GiveWell, April 2024, p. 1. - 2
See Justin Sandefur’s profile on the Center for Global Development website here.
- 3
“As a starting point, we propose the following list of interviewees:
- Government: Ministry of Health officials in Nigeria and the DRC, which together span all four of GiveWell’s top charities.
- Multilaterals: Global Fund, World Bank, UNICEF, the European Commission
- Bilaterals: US Agency for International Development, UK Foreign and Commonwealth Development Office, Agence Française de Développement
- Other philanthropies: Gates Foundation
- Grantees: staff at the Malaria Consortium, Against Malaria Fund, Helen Keller International, and New Incentives."
Justin Sandefur, “The life (only) you can save” proposal to GiveWell, April 2024, p. 2.
- 4
“We’d like to make this exercise as concrete as possible. So we’d propose starting with GiveWell’s list of Top Charities, and selecting interviewees with knowledge of these topics and contexts.
- “Medicine to prevent malaria” via the Malaria Consortium, working in Nigeria, Chad, Burkina Faso, Guinea, Mali, and Niger.
- “Nets to prevent malaria” via the Against Malaria Fund, working in DRC, Ghana, Guinea, Malawi, Papua New Guinea, Togo, Uganda, and Zambia.
- “Supplements to prevent vitamin A deficiency” via Hellen Keller International, working in Burkina Faso, Cameroon, Côte d'Ivoire, the Democratic Republic of the Congo (DRC), Guinea, Kenya, Mali, Niger, and Nigeria.
- “Cash incentives for routine childhood vaccines” via New Incentives, working in North West Nigeria.”
Justin Sandefur, “The life (only) you can save” proposal to GiveWell, April 2024, p. 3.
- 5
- Seasonal malaria chemoprevention:
“Are we crowding out other funders? We think there is a high chance (10% to 65% depending on the location) that SMC campaigns would be funded by other malaria funders in GiveWell’s absence. If this were the case, it would imply that our funding for SMC is less impactful than we think because it is not leading to an increase in the overall number of children treated with SMC. We attempt to adjust for this based on our analysis of malaria funding trends and conversations with national malaria programs and other funders, but our guesses about this are necessarily speculative. We are also uncertain about whether our funding will create a future expectation of continued SMC funding and reduce other funders’ future spending on SMC.
“Our current adjustment for diverting other actors’ funding away from SMC, which attempts to account for this factor, decreases cost-effectiveness by about 43% in Burkina Faso, and our 25th-75th percentile confidence interval is -64% to -23%. This implies that SMC is 11x to 24 times as cost-effective as direct cash transfers (“11x-24x”). We hope to improve our estimates on this question in the future by investigating whether funding gaps that we didn’t fill were covered by other funders, but we haven’t conducted this analysis systematically yet.”
GiveWell, Seasonal Malaria Chemoprevention- Insecticide-treated bednets:
“Other funders would replace GiveWell funding for ITN campaigns in our absence. The funding landscape for malaria programs is fairly crowded. We think there’s a chance that other funders would replace GiveWell’s campaign funding in our absence. We are also uncertain about whether our funding will create an expectation of continued funding and reduce other funders’ future spending on ITNs. Our current adjustment for other actors’ spending, which attempts to account for this factor, decreases impact by ~32% in Uganda, and our 25th to 75th percentile confidence interval for this adjustment is -58% to -14%, which implies a cost-effectiveness of 10x to 20x. We hope to improve our estimates on this question in the future by investigating whether funding gaps that we didn’t fill were covered by other funders, but we haven’t conducted this analysis systematically yet.”
GiveWell, Mass Distribution of Insecticide-Treated Nets (ITNs)- Vitamin A supplementation:
“We think of these adjustments as particularly uncertain inputs in our analysis. Our biggest areas of uncertainty are:
- Our analysis of how other actors will behave if we did not make a grant are necessarily subjective guesses, as we can only speculate about their future priorities and decisions.
- Our adjustments rely on estimates of the value of other programs that other actors might fund instead of VAS. We outline the estimates and our reasoning for them below, but these are rough estimates based on limited information. We have also invested considerably less time into producing these estimates than we have in our main cost-effectiveness analyses, and they should be thought of as rougher guesses.”
GiveWell, Vitamin A Supplementation
- New Incentives (conditional cash transfers for routine infant vaccinations)
“We think of these adjustments as particularly uncertain inputs in our analysis. Our biggest areas of uncertainty are:
- Our analysis of how other actors will behave if we do not make a grant are necessarily subjective guesses, as we can only speculate about their future priorities and decisions.
- Our adjustments rely on estimates of the value of other programs that other actors might fund instead of New Incentives’ program. We outline the estimates and our reasoning for them below, but these are rough estimates based on limited information. We have also invested considerably less time in producing these estimates than we have in our main cost-effectiveness analyses, and they should be thought of as rougher guesses.”
GiveWell, New Incentives (Conditional Cash Transfers to Increase Infant Vaccination)
- 6
For more information on our top charities and how we think our funding affects other actors’ spending, see the following links:
- Seasonal malaria chemoprevention report "Summary" section and “How does the program affect other actors’ spending?” section
- Insecticide-treated nets distribution report "Summary" section and “How does the program affect other actors’ spending?” section
- Vitamin A supplementation report "Summary" section and “How does the program affect other actors’ spending?” section
- Conditional cash transfers for routine infant vaccination report "Summary" section and “How does the program affect other actors’ spending?” section
- 7
“Stepping back, we see two main audiences for this work. The main audience is policymakers in developing-country governments and officials in foreign aid agencies making allocation decisions. If various hypotheses above hold true – especially #3 – then using GiveWell’s portfolio as a reference point and fleshing out the obstacles to public institutions filling the gaps currently filled by private philanthropy could help to improve how they gather and evaluate evidence and how they make resource allocation decisions.“
Justin Sandefur, “The life (only) you can save” proposal to GiveWell, April 2024, p. 3.