Note: This page summarizes the rationale behind a GiveWell grant to CHAI. CHAI staff reviewed this page prior to publication.
Summary
In February 2025, GiveWell recommended a $250,000 grant to CHAI to quickly plug very time-sensitive and high impact malaria funding gaps emerging from the USAID stop work order.
We are recommending this grant because we expect that the majority of funds will be spent on interventions we believe are cost-effective, we do not have the capacity to investigate each funding gap individually, and we view CHAI as a highly-aligned partner. Our main reservation about this grant is that the unpredictability of the USAID stop work order may limit its impact.
GiveWell recommended this grant via our policy for small discretionary grantmaking. As a small discretionary grant, this funding opportunity did not receive the same review as larger grants we recommend. Instead, we more minimally evaluated the case for the grant and any potential risks or downsides.
Published: February 2025
The organization
The Clinton Health Access Initiative (CHAI) is an international public health non-profit founded in 2002, which operates in more than 35 countries.1 GiveWell is the sole funder of the CHAI Incubator, a program within CHAI that exists to find, assess, and implement programs that have high cost-effectiveness and potential to scale.2 We view CHAI as a highly-aligned partner that is very knowledgeable about cost-effective funding gaps in the malaria landscape.
The grant
The purpose of this grant is to allow CHAI to quickly plug very time-sensitive and high-impact malaria funding gaps emerging from the USAID stop work order.3 We expect that the majority of funds will be spent on interventions we believe are cost-effective, such as seasonal malaria chemoprevention and insecticide-treated net (ITN) distribution, as well as malaria treatment.4 While we have communicated this preference to CHAI, we have ultimately left this funding allocation to CHAI’s discretion.
We have asked CHAI to focus on a list of high malaria burden countries as we think that opportunities in these countries will be most cost-effective.5 We anticipate likely cost categories will include things like: port fees, warehousing, fuel, trucking, meeting rooms, staff per diems or short-term contracts for individuals with critical expertise, campaign planning tools, staff trainings, community health worker stipends, or emergency drug procurements.
The case for the grant
We are recommending this grant because:
- We expect that the majority of funds will be spent on interventions we believe are cost-effective. GiveWell is confident that interventions such as seasonal malaria chemoprevention and ITN distributions are cost-effective; we expect the majority of funds to be spent on supporting these interventions, as well as malaria treatment.
- GiveWell does not have the capacity to investigate each funding gap individually. Each of these funding gaps are small and extremely time-sensitive. We expect that GiveWell investigating each gap individually would lead to delays, which would substantially reduce the impact of funds.
- We view CHAI as a highly-aligned partner. We have a history of effective collaboration with CHAI - most notably through the CHAI Incubator. We are confident that CHAI will use these funds in a way that aligns with GiveWell’s values.
- We hope to learn more about malaria funding gaps through this grant. We expect that, as we follow up with CHAI about which gaps they fill with these funds, we will receive detailed information and insights related to these gaps. This information could be helpful to inform future funding decisions.
Risks and reservations
Our main reservation about this grant is:
- The unpredictability of the USAID stop work order may limit the impact of the grant. It is possible that the impact of funds could be limited if certain parts of commodity supply chains are subject to the stop work order. For instance, the impact of funds that are intended for distribution of ITNs already on hand may be limited if the stop work order prevents the ITNs from being released from warehouses.
Plans for follow up
We will be following up with CHAI to understand which programs they ultimately fund. We will also have periodic calls with CHAI to discuss updates on these programs.
Sources
- 1
- "CHAI was founded in 2002 with a transformational goal: help save the lives of millions of people living with HIV/AIDS. Today, we support government priorities across many areas, including other infectious diseases, non-communicable diseases, women and children’s health, health workforce and financing, assistive technologies for disabilities, and the intersection of climate and health." CHAI, "About Us"
- “We now work with governments, donors, and other partners on more than 20 programs in over 35 countries across Africa, Asia, and Latin America.” CHAI, “Homepage”
- 2
"We are recommending a $10.4 million grant to the Clinton Health Access Initiative (CHAI) to support a new CHAI Incubator. The CHAI Incubator aims to scope and scale cost-effective interventions." GiveWell, Clinton Health Access Initiative – CHAI Incubator, 2022.
- 3
"Sec. 3. (a) 90-day pause in United States foreign development assistance for assessment of programmatic efficiencies and consistency with United States foreign policy. All department and agency heads with responsibility for United States foreign development assistance programs shall immediately pause new obligations and disbursements of development assistance funds to foreign countries and implementing non-governmental organizations, international organizations, and contractors pending reviews of such programs for programmatic efficiency and consistency with United States foreign policy, to be conducted within 90 days of this order." The White House, Executive Order: Reevaluating and Realigning United States Foreign Aid, 2025.
- 4
We do not usually fund malaria treatment; while we have some sense that it is highly cost-effective, we previously believed that there was very little room for more funding. Given the U.S. government’s ongoing reviews of U.S. foreign assistance programs, this may no longer be the case.
- 5
These countries are: Niger, Sierra Leone, Burkina Faso, Nigeria, Benin, Central African Republic, Guinea, South Sudan, Democratic Republic of the Congo, Liberia, Mali, Burundi, Côte d'Ivoire, Chad, Mozambique, Uganda, Cameroon, Equatorial Guinea, Togo, Angola, Malawi, Madagascar, Congo, Ghana, Guinea-Bissau, Zambia, Tanzania, and Gabon. These countries all have a malaria burden similar to or higher than that of Zambia; Zambia is a useful benchmark because it's at the bottom of the range where we have historically found funding gaps that meet our funding bar.
See national malaria burden data from the Institute for Health Metrics and Evaluation (IHME) Global Burden of Disease (GBD) study, included in our cost-effectiveness analysis of ITNs here.