Note: This page summarizes the rationale behind a GiveWell grant to Dimagi. Dimagi staff reviewed this page prior to publication.
Summary
In November 2023, GiveWell recommended a $49,722 grant to Dimagi to conduct scoping and develop a proposal for piloting its new healthcare platform, CommCare Connect, which aims to increase the take-up of key healthcare commodities, such as vitamin A supplementation and oral rehydration solution and zinc.
We are recommending this grant because we think it will allow us to address some of our uncertainties about CommCare Connect’s room for more funding, and could result in us funding an operational pilot in the future. We also have a strong qualitative impression of Dimagi, and are confident that the proposal will be responsive to our main questions.
Our main reservations are that the total room for additional funding identified by Dimagi may turn out to be relatively small, and that there is some chance Dimagi might have conducted this work absent our funding.
Published: April 2024
Table of Contents
The organization
Dimagi is a for-profit social enterprise that builds software to assist frontline workers (FLWs) in delivering frontline services in low- and middle-income countries, primarily through its CommCare platform.1 In 2022 Dimagi launched a new program, CommCare Connect, which pays FLWs (in this context, community health workers) for the verified delivery of services (such as vitamin A supplementation (VAS), oral rehydration solution (ORS) and zinc, or deworming pills).2 With this payment model, CommCare Connect could incentivize the distribution of these commodities in areas where coverage is low. The program is being rolled out gradually; as of late 2023, it has reached over 77,000 people in seven countries.3
The grant
We are highly confident that health commodities like VAS and ORS and zinc are cost-effective, and are keen to identify ways to increase their uptake in areas with low coverage. As a result, we are interested in exploring a future pilot grant to Dimagi to implement CommCare Connect in high-priority areas, with a focus on increasing coverage among children under five years old.
We are recommending a small planning grant to allow Dimagi to scope and develop the proposal for the pilot, which GiveWell would then consider funding. Dimagi expects to use this grant to pay for Dimagi staff time, travel costs, and consultancy fees.4 Grant activities will include desk research, outreach, and meeting with prospective partners. The proposal will include details on:5
- Implementation location(s), specifically Dimagi’s ability to target CommCare Connect to areas with high baseline mortality rates for children under five, low commodity coverage, an existing FLW network, and government support for CommCare Connect.
- The choice of health commodities to be delivered, specifically which commodities are well-suited for distribution via CommCare Connect given existing coverage rates and availability.
- The profile of partner frontline health organizations, specifically the types of attributes Dimagi looks for when assessing a frontline health organization’s fit for CommCare Connect. This could include metrics like the number of FLWs, number of health visits conducted per day, experience using mobile health platforms, and level of coordination with the public sector FLW system.
- The level of future room for more funding, given the estimated total addressable market for CommCare Connect. After estimating the number of areas that meet Dimagi’s criteria for CommCare Connect (e.g., high under-five mortality, low commodity coverage, existing FLW network, sufficient commodity stock), what does Dimagi estimate to be its total room for more funding over the next 10 years?
- Dimagi’s plan to assess fraud or collusion. CommCare Connect pays FLWs on a per child basis and uses a verification algorithm to confirm that the visits actually happened and to detect systematic fraud or error.
The pilot itself would focus on addressing our uncertainties around costs, verification, adverse outcomes, the total addressable market for the program, and Dimagi’s ability to recruit partner organizations.6 If we decide to fund the pilot and the pilot is successful, we would then consider funding the implementation of CommCare Connect on a larger scale, and an evaluation that would measure CommCare Connect’s effect on commodity uptake relative to the counterfactual.
The case for the grant
We are recommending this grant because:
- We think CommCare Connect could be a highly cost-effective funding opportunity, and this grant will allow us to learn more about its total addressable market. Our initial back-of-the-envelope calculation suggests that CommCare Connect could be significantly above our cost-effectiveness bar.7 This is because we think the program could increase counterfactual coverage of mortality-averting health products at a low cost, assuming it is able to target areas that meet certain conditions, such as a high baseline mortality rate, a low coverage rate for the commodity, an existing FLW network, and limited stockouts. At this stage, however, our cost-effectiveness estimate is highly speculative, because CommCare Connect has only been piloted at a small scale, and we do not yet have evidence that it can successfully target certain health commodities to children who would otherwise not receive them. If the pilot looks promising, this may lead us to make one or more highly cost-effective grants to Dimagi in future.
- We have a strong qualitative impression of Dimagi, and we think the proposal we receive will be well-suited to GiveWell’s needs. Based on both our direct experience of communicating with Dimagi and the feedback we have received from experts who have worked with Dimagi before, we believe Dimagi is well-aligned with GiveWell’s values of transparency and impact.
Reservations
Our main reservations about this grant are:
- The total room for additional funding may turn out to be relatively small. To date, CommCare Connect has only been piloted at a relatively small scale. In the course of developing the proposal, it is possible that Dimagi may learn that the total addressable market for the platform is much smaller than envisioned. In this scenario, there would be no path to major additional funding opportunities as a result of this grant.
- Dimagi is a for-profit organization, and it is possible it would have funded this work without our support. Since CommCare Connect is a relatively new program, Dimagi is still seeking to learn how to put it to best use. Given this, Dimagi may have conducted this research regardless of our interest.
Plans for follow up
We plan to check in regularly with Dimagi as it develops its proposal, which we will then use as the basis for evaluating a potential additional grant for piloting CommCare Connect.
Internal forecasts
For this grant, we are recording the following forecast:
| Confidence | Prediction | By time |
|---|---|---|
| 40% | GiveWell will fund a follow-on grant to Dimagi for CommCare Connect. | May 2024 |
Our process
We had multiple conversations with Dimagi to better understand this funding opportunity and to resolve a number of our uncertainties about the grant. We also spoke to several experts to learn about Dimagi as an organization and gauge the potential of CommCare Connect as a program.
Sources
- 1
- “Dimagi is a global social enterprise enabling impactful frontline work through scalable digital solutions and expert services … at least 50% of people lack access to essential health services. We help bridge this gap by empowering Frontline Workers to deliver critical services to communities in need.” Dimagi, “About Dimagi”
- CommCare Connect is a software-as-as-service mobile health platform that allows community health workers to track and maintain patient data. It is designed “to provide opportunities for Frontline Workers to learn, deliver, verify and be paid for high-impact interventions”. “In our long-term vision, individual workers will create free accounts on CommCare Connect and gain access to opportunities to deliver high-impact interventions, such as participating in vaccine campaigns, leading educational programs, or disseminating important information to households about early childhood development or family planning. Every opportunity on CommCare Connect will require the worker to use a provided mobile application to ensure accurate and verifiable delivery of the intervention, as well as payment to the worker.” Dimagi, “Delivering Child Health Campaigns with CommCare Connect”.
- 2
- “The CommCare Connect initiative launched towards the tail end of 2022”
- “Built on top of CommCare, CommCare Connect is an innovative platform that allows Frontline Workers and organizations to opt into paid and purposeful work”
- “Dimagi and its partners have used the CommCare Connect platform to deliver a wide range of interventions. The platform has successfully facilitated Child Health Campaigns (Vitamin A and Deworming)”
Dimagi, “CommCare Connect: A Year in Review”.
- "The CommCare Connect Child Health Campaign includes delivering Vitamin A and deworming tablets, screening & referral for malnutrition, and an option to include other impactful and localized interventions such as Oral Rehydration, Zinc supplementation, or chatbots with useful information (e.g. nutrition advice)."
Dimagi, “Delivering Child Health Campaigns with CommCare Connect”.
- 3
“We’re thrilled to share that CommCare Connect has already made a big impact. Through partnerships with 12 incredible organizations, we have reached over 77,000 clients in 7 countries, including Kenya, India, Nigeria, Tanzania, Zambia, Uganda, and Malawi. We’ve also been able to distribute a total of $161,000 in direct payments to Frontline Workers and organizations for these services.” Dimagi, “CommCare Connect: A Year in Review”.
- 4
For more information on the budget breakdown, see Dimagi, “Planning Grant Budget”.
- 5
Dimagi, review of this page (March 28, 2024).
- 6
Dimagi, review of this page (March 28, 2024).
- 7
See our back of the envelope calculation here: GiveWell, “Dimagi CommCare Connect BOTEC”. 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. As of late 2023, our bar for directing funding is programs that are about 10 times as cost-effective as unconditional cash transfers. See GiveWell’s Cost-Effectiveness Analyses webpage for more information about how we use cost-effectiveness estimates in our grantmaking.