We’ve published our take on what information we can find on philanthropy’s past successes and our observations on what foundations work on today (both with spreadsheets so others can examine our data), and we’ve published our framework for identifying a good cause. With these in mind, this post lists causes we’re planning to focus on over the short term.

We are not at all confident that these causes represent the most promising ones; we see our list of priority causes as a starting point for learning. By publishing our reasoning, along with all data we’ve used, we hope to elicit feedback at this early stage; in the course of investigating our priority causes, we expect to learn more about these causes and about the best way to choose causes in general. And we have prioritized our causes partly based on the potential for learning, not just based on how promising we would guess that they are. Also note that these causes do not represent restrictions - we will consider outstanding giving opportunities in any category - but rather areas of focus for investigation.

We currently believe that no established philanthropist engages in strategic cause selection - the practice of listing all the causes one might work on, and choosing them based on a combination of “potential impact” and “underinvestment by other philanthropists.” (This is not to say that no established philanthropist picks good causes - we believe many have picked excellent causes, perhaps through more implicit “strategy” - it is just to say that we know of no established philanthropist applying the sort of explicit strategic selection we envision.) So we believe we are in uncharted territory; thus, we expect to hit a fair amount of dead ends and to do a lot of revision and learning, but we also hope that strategic cause selection will eventually become a valuable tool for having maximal impact with one’s giving.

Summary of our priority causes (details follow):

• Global health and nutrition is an area we know well and believe has many good giving opportunities. It is our current top priority. We seek to find more opportunities for donors along the lines of our top charities; we also seek to learn from existing foundations about the best higher-risk projects they are unable to fund.
• Funding scientific research is a good conceptual fit for philanthropy, accounts for many of philanthropy’s most impressive success stories, and may provide bang-for-the-buck as good as or better than global health and nutrition.
• Meta-research is our term for trying to improve the systematic incentives that academic researchers face, to bring them more in line with producing maximally useful work. We believe there is substantial room for improvement in this alignment, and that this cause is therefore promising as a high-leverage way to get the benefits of funding research; current philanthropic attention to this cause appears very low.
• Averting and preparing for global catastrophic risks (GCRs) including climate change is a good conceptual fit for philanthropy and may provide bang-for-the-buck as good as or better than global health and nutrition. Today’s philanthropy appears to invest moderately in climate change, but very little in other GCRs.

We also briefly discuss popular causes that we aren’t currently prioritizing.

Based on our past work seeking outstanding charities, we feel that global health and nutrition is the strongest area within the category of “directly helping the disadvantaged.” It’s also an area that we know fairly well (again, because of our past work), so we expect to be able to find strong giving opportunities more quickly here than in areas we’re less familiar with. Because of this, global health and nutrition is our top priority for GiveWell Labs.

Our plans:

• As discussed at our 2011 research outline, we are investigating the idea of restricted funding to large organizations in order to fund proven, cost-effective interventions that we can’t fund otherwise. Our goal here would be to, in a sense, “create new top charities” - create funding vehicles that allow individual donors to deliver proven, cost-effective health and nutrition interventions. (One could think of this project as trying to create an “AMF for vaccines, nutrition, or other promising intervention.”)
• We are also interested in higher-risk, higher-upside projects within this area. We are aware of some major foundations that pursue these sorts of opportunities and have more investigative capacity and relevant background than we do. So our ideal would be to leverage these foundations’ investigative work, by working with them to identify the best giving opportunities that they have sourced but cannot fully fund. We are currently looking into the possibility of doing this. If it proves unworkable, we may seek other ways to investigate high-risk, high-upside opportunities in this area.

As discussed previously, we believe many of the most impressive “success stories” in the history of philanthropy are in the category of funding research, particularly biomedical research. We also find research funding to be a good conceptual fit for philanthropy, as well as something that could plausibly get better “bang for the buck” than global health and nutrition interventions (since it involves creating global public goods - once developed, a new insight can be applied on a global scale and potentially for a long time).

In philanthropy currently, it appears that biomedical research is a moderately popular area, while natural sciences are less popular but still have some philanthropic presence. Of course, much of the funding for (early-stage) research comes via government and/or university money, but we hypothesize that philanthropy may be able to play a special role in supplementing these systems, by specifically aiming to support the kind of work that the traditional academic system and government funders cannot or will not. (We believe that there may be ways in which the traditional system falls short of maximum value-added, as discussed in the next section.) When we look at the activities of current philanthropic players (see our notes on the biomedical research activities of the top 100 foundations), it seems possible to us that relatively few of these players are specifically looking to supplement or improve on the government and university systems (by contrast, we believe that many efforts within U.S. education and global health seek to improve on and contrast with government programs in these areas).

So we see funding research as a potentially high-impact area, and we’re especially interested in the possibility of opportunities that the government/university systems systematically underfund. In addition, funding research is fundamentally different from the sort of direct-aid-oriented work we’ve focused on in the past, and we feel that investigating it will be an important learning experience.

Our next steps will be to

• Seek out conversations with the major foundations that fund scientific research
• Ask researchers about under-invested-in opportunities, while conducting “meta-research” conversations (see next section)

In the course of our research on outstanding charities, we’ve come to the working conclusion that academic research - at least on topics relevant to us - is falling far short of its maximum value-added to society, largely due to problematic incentives. We laid out some of our views last year in Suggestions for the Social Sciences; we also think that GiveWell Board member Tim Ogden’s recent SSIR piece is worth reading on this topic.

In brief, we believe that (a) academic incentives do not appear fully aligned with what would be most useful (for example, replicating studies is highly useful but does not appear to be popular in academia); (b) academics rarely engage in practices - such as preregistration, and sharing of data and code - that could make their research easier for outsiders to evaluate and use in decisionmaking; (c) too much academic research is restricted to pay-access to journals, rather than being in a format and place that would allow maximum accessibility. Based on informal conversations, we believe these issues are present across academia generally, not just in the areas we’ve examined, though we intend to investigate more.

We have seen some philanthropy focused on (c). Two of the 82 foundations we’ve examined have program areas that we’ve categorized as “scholarship and open access”; the Wellcome Trust in the UK is also pushing for open access. However, we’re not aware of any foundation making a concerted push to improve (a) and (b), aligning academic incentives with what would be most useful to society.

As discussed in the previous section, we think of research as a highly promising and important area for philanthropy, based both on history and on the conceptual possibility of impact-per-dollar-spent. If problematic incentives are causing academic research to systematically fall short of its maximum potential value-added to society, investments in meta-research could have highly leveraged impact. That’s sufficient to think that this cause has some potential; the fact that it appears to be largely absent from today’s large-scale philanthropy increases its appeal.

We will write more in the future about our plans for investigating meta-research, which overlap strongly with our plans for investigating direct funding of research (the previous section). We are aiming to speak to a broad range of academics about whether, and how, the work being done in their fields - and the general practices of their field - diverge from what would add maximum value to society.

Foundations work to address a variety of threats - such as climate change, nuclear weapons proliferation, and bioterrorism - that could conceivably lead to major global catastrophes.

We see this work as an excellent conceptual fit for philanthropy, because the potential catastrophes are so far-reaching that it is hard to articulate any other actor that has good incentives to invest sufficiently in preparing for and averting them. (Governments do have some incentives to avert catastrophic risks, but catastrophic risk preparation has no natural “interest groups” to lobby for it, and it is easy to imagine that governments may not invest sufficiently or efficiently.) As with research, we find it plausible that opportunities in this area could have good “bang for the buck” relative to international aid, simply because they seek to avert such large catastrophes.

In philanthropy currently, working on climate change is moderately popular, but work on other risks is extremely rare. Out of 82 foundations we examined, two work on nuclear non-proliferation and one works on biological threats; none work on other potential threats.

One concern about this area is that gauging the success or failure of projects seems extremely difficult to do, even in a proximate way, because projects are so focused on low-probability events.

We are currently reviewing the literature on climate change and will be posting more in the future. We are also advising Nick Beckstead and a few volunteers from Giving What We Can as they collect information on the organizations working on GCRs other than climate change.

A long-term goal of ours is to learn more about policy advocacy, which is a general philanthropic tactic (an option for funding in almost any cause) that we know very little about. For the near future, we do not plan on recommending any policy advocacy funding; we plan on allocating small amounts of time to conversations with people in the space to learn more about how it works in general.

Our survey of the current state of philanthropy highlighted the following as particularly popular causes that aren’t listed above. We will be writing more about them; for now, we provide very brief thoughts and relevant links to some work we’ve done in the past.

• U.S./developed-world education: we perceive this as perhaps the most popular cause in philanthropy today. Many major foundations and philanthropists are working on it, and have worked on it in the past, yet progress seems slow on achieving - and rolling out - evidence-backed ways to improve educational outcomes. For more, see our report on U.S. charities.
• U.S. poverty alleviation (including health care): we see a lot of philanthropy focused in these areas today, yet we believe the bang-for-the-buck is poor relative to international aid. For more, see our report on U.S. charities, Your Dollar Goes Further Overseas, Poor in the U.S. = rich, and Hunger Here vs. Hunger There.
• Arts and culture. We don’t see GiveWell as having much potential value-added in this area. (We’ll be elaborating in a future post.)
• Animal welfare; environmental conservation (not including climate change-related work). Current GiveWell staff are primarily interested in humanitarian giving, and we don’t see these areas as being directly enough connected to humanitarian values to merit a high priority. At one point we advised a volunteer who did some work investigating animal welfare charities, and we may later discuss this work.
• Funding social entrepreneurs and social enterprise. We do not find this area promising; we will be writing about it more in the future. Also see Acumen Fund and Social Enterprise Investment and When Donations and Profits Meet, Beware.
• Developing-world aid outside of health and nutrition. From what we’ve seen so far, health and nutrition are the most promising areas within developing-world aid. However, we remain open on this point, and are certainly more interested in this area than in the other areas listed in this section. We’re particularly interested in learning more about the “transparency/accountability/democracy” sector, which is moderately popular among today’s foundations and which we currently know very little about. Also see our writeups on microfinance, developing-world economic empowerment, disaster relief, agriculture, and education (as well as our summary of why we prefer global health and nutrition).

We started to answer (1) in our discussion of foundation “success stories.” This post addresses (2). We first discuss the data sets we have used, which we are making publicly available and linking from this post. We then make some observations from these data sets.

• Dollar allocation data. The Foundation Center maintains a database of grant amounts, dates, descriptions and more for over 100,000 foundations (over 2.4 million grants). It also tags these grants by category in ways that we’ve found helpful. The Foundation Center provided us with a breakdown by category of 2009-2010 grants that it had selected as an efficient representative sample, totaling about $20 billion, which would be equivalent to about half of 2010 foundation giving according to the Foundation Center). We went through the 923 categories provided by the Foundation Center and applied our own tags to these categories, resulting in a breakdown of spending by 33 “GiveWell categories” (106 total subcategories). When we were unclear on the nature of a Foundation Center category (or simply found one interesting), we pulled the top 100 grants for that category using our paid subscription to Foundation Directory Online.

  “GiveWell categories” simply refers to a set of tags we created, because we found it to be helpful in thinking about the breakdown of giving from our perspective. When we discuss dollar allocations to different categories in this post, we are referring to “GiveWell categories” and not to the categories maintained by the Foundation Center. There may be some cases in which GiveWell defines a term differently from the Foundation Center, meaning that our figure for that term will be different from what the Foundation Center publishes (for example, we break out “museums” as a separate category from “arts and culture,” so the figure we would give for foundation spending on “arts and culture” is different from the figure the Foundation Center would give). This does not mean that there is actually a contradiction between our data and Foundation Center’s; we are using Foundation Center’s data and consider their reported funding allocations to be correct according to their term definitions.

  We provide a spreadsheet that includes both the data provided directly to us by Foundation Center (”FDO categories”) and the breakdown according to our own category definitions (”GiveWell categories”). It also makes it possible to see exactly how we defined “GiveWell categories” and thus how these might be different from “FDO categories.”

  Dollar allocation data (XLS)

• Data from the top 100 foundations’ websites, compiled by Victoria Dimond (GiveWell volunteer) and Good Ventures, which has been working closely with GiveWell on GiveWell Labs. Victoria and Good Ventures visited the websites of the top 100 independent foundations in the U.S. (we generated this list using Foundation Center data; we found sufficiently informative websites for 82 of the 100) and created a spreadsheet with the names and descriptions of their program areas and sub-program areas. We then created summary sheets that rank program area types based on how many foundations work on them, and rank foundations by their “unusualness” (the extent to which they work on program areas that few other foundations work on).
  Program Areas for Top 100 U.S. Foundations (XLS)

In categorizing giving for both of these, we deliberately used categories tailored to our own interests (rather than trying to come up with a universally useful taxonomy). For example, since we have pretty well-defined views on the best ways to help the disadvantaged, we tended to lump many different things together under headings such as “Helping the disadvantaged” or “U.S. poverty” (this includes human services, youth development services, and more). By contrast, we tended to separate out any kind of work we found particularly interesting. So if you are seeking a picture of how foundations give for your own purposes, you may consider going back to the raw data (which we provide in the files linked above) and creating your own categories.

Popular areas (according to GiveWell’s taxonomy)

Highly popular areas include:

• U.S. education (K12/preschool) - 46 of 82 foundations in the “top 100 foundations” set list this as a program area; it accounts for over 7% of giving (in dollar terms) according to dollar allocation data.
• U.S. higher education (scholarships, increasing access to higher education, or general/capital support) - 25 of 82 foundations, around 8% of giving according to dollar allocation data (the latter is harder to interpret on this point since it may include other activities within higher education).
• U.S. poverty alleviation - 42 of 82 foundations, ~ 5% of giving according to dollar allocation data (this figure was obtained by adding human services and youth development, both of which appear primarily focused on the U.S.; other areas should also be partially counted, but they are a mix of international and U.S. giving) according to dollar allocation data.
• Arts & culture: 30 of 82 foundations; ~5% of total giving according to dollar allocation data.
• Environment (conservation): 25 of 82 foundations, ~4% of total giving according to dollar allocation data.
• Health care and biomedical research funding (including support of hospitals): 17 of 82 foundations work on health care delivery and 14 of 82 work on biomedical research. This category (in which research and delivery can be difficult to separate) accounts for ~20% of total giving according to dollar allocation data.
• Climate change and/or energy: 14 of 82 foundations work in these areas, though they account for only ~1% of total giving according to dollar allocation data.

This set of areas accounts for about half of all of the giving in the dollar allocation data (and much of what remains is difficult to categorize). It includes every area that is listed by 9 or more of the 82 foundations we examined.

International causes

Causes focused on helping other countries - or international relations - appear less common than the above causes, but are still fairly common. Each of the following are included in the work of 8-9 of the 82 foundations we examined:

• Developing-world poverty
• Developing-world health
• Developing-world transparency/accountability/democracy
• Foreign policy analysis

Total “international affairs” tagged giving is around 3% of all giving (in dollar terms) according to dollar allocation data, though this includes many international-aid grants that may be tagged as university support (for relevant research), health, agriculture, etc.

While we’ve done substantial investigation into the first two causes listed above, the second two have largely not been on our radar. Some of the largest foundations emphasize their work in these areas.

Less popular causes (according to GiveWell’s taxonomy)

Among the causes that are less popular, we find the following particularly interesting (not necessarily promising, but worth noting for later discussion). Here we focus on the “top 100 foundations” set since less-popular causes like this are difficult to isolate in dollar allocation data.

• Natural sciences and mathematics, excluding biomedical sciences - 7 of 82 foundations list program areas in this category.
• Immigration (advocacy and integration) - 4 foundations.
• Promoting specific topics in higher education - 4 foundations. (We note that many of philanthropy’s putative success stories are in this category.)
• Developing-world education - 3 foundations.
• Reproductive health/rights - 3 foundations.
• Social entrepreneurship - 3 foundations.
• Mitigation/prevention of global catastrophic risks other than climate change. 2 foundations focus on nuclear nonproliferation, while one focuses on biological threats; the total giving for this category according to dollar allocation data is 0.1% of all giving dollars.
• Scholarship and open access - 2 foundations.
• Education and technology - 2 foundations.
• Information access (cellphones, Internet) - 2 foundations.
• Social sciences - 2 foundations.
• Disease surveillance - 1 foundation.

1. First, broad program areas or “causes” - such as “U.S. education” and “environment” - are chosen. This step is almost entirely “from the heart” - no systematic review is conducted, but rather the philanthropist (or foundation President) chooses areas s/he is passionate about.

2. Foundation staff speak to relevant people in the field and lay out a foundation strategy. This process may lead to direct identification of potential grantees or to RFPs/guidelines for open applications.
3. Foundation staff continually work with and evaluate grantees and potential grantees.

(Our recent conversation with Paul Brest of the Hewlett Foundation, which funds GiveWell, gives one example.)

Steps #2 and #3 make sense, and seem likely to lead to at least reasonable results if carried out by people who listen well and keep their minds open. We see some potential room for improvement in terms of documentation and transparency - we believe that our own commitment to writing up and sharing our reasoning and results (rather than just discussing them internally) leads us to better-considered decisions and generates information that can inform other givers as well.

However, our working hypothesis is that the biggest room for improvement lies in step #1 - picking causes. This is where existing philanthropists seem to be least thoughtful and to ask the fewest critical questions; yet this is where we’d guess the bulk of variation in “how much good a philanthropist accomplishes” comes from.

So as we work on GiveWell Labs, we’re interested in seeing whether we can approach the “What cause should I work on?” question in a more systematic, thoughtful way, and get better results (in terms of overall good accomplished). This is what we refer to as “strategic cause selection.” We have just started this effort, and we expect a long time and multiple iterations before we feel we have a truly strong and effective approach; this post lays out our approach so far, as a starting point.

We’ve started our work on strategic cause selection by trying to understand the following two things:

• The history of philanthropy. What are philanthropy’s biggest success stories, and why did they succeed? What has gone well and what has gone poorly, and why? Are there patterns what successful philanthropy looks like?

  We have previously posted our analysis of the single best source we know of on this question, a set of 100 “philanthropic success stories” published as a companion volume to The Foundation: a Great American Secret. We’ve been looking for all the books we can find on the history of philanthropy (there don’t seem to be many, which itself suggests that there isn’t much interest today in strategic cause selection) and intend to review several of them.

• The current state of philanthropy. What are the causes that today’s major foundations work in? What sort of work are they doing in these causes?

  We are currently examining data from the Foundation Center’s database of foundation grants, and will be publishing our analysis in the future. We are also systematically reviewing the websites of the top 100 foundations (looking at what their causes are and how they describe them) and will be discussing this as well.

Reflecting on the examinations above, we’ve started to maintain a list of qualities that seem, logically, to make for a “good philanthropic cause.” We expect this list to evolve significantly in the future. For the moment, here are the qualities we look for in a philanthropic cause:

• An articulable vision for the world as it could and should be, and a large gap between this and the world as it is now. (This quality may seem obvious, but we include it for completeness; one can think of it as a measure of how “big” or “ambitious” a cause is.) For example, the cause of global health and nutrition involves the following gap: it should be the case that the vast bulk of the world’s population receives adequate nutrition (certainly enough to prevent being clinically underweight or stunted), as well as any medical treatment/preventive measures that are relatively cheap and effective. We know that this vision of the world is possible, because it describes large parts of the world (such as the U.S.) today. Yet we also know that today’s world is very far from this vision - there is a lot of room for improvement, which philanthropy can pursue. Other causes involve a vision of the world that may or may not be possible (e.g., a world in which no one dies of cancer).
• A shortage of “constituents” who can achieve change through non-philanthropic ends. As we’ve written before, most of the good in the world is accomplished through methods other than philanthropy. A good cause should be accompanied by a clear explanation of why the sought-after change cannot happen through for-profit work (people who need help pay for it directly), constituent-led government work (people who need help exercise political pressure to get it), or local philanthropy.

  As we noted previously, philanthropy commonly works on (a) helping the people with the least money and power; (b) basic research, top-level education reform, and other global public goods with long time horizons. Both of these seem to lack non-philanthropic constituents.

• A shortage of strong other philanthropic actors. We have been told before that a philanthropist wishes to stay away from global health, since the Gates Foundation is probably finding most of the best opportunities and the ones it doesn’t fund are likely to be worse. This reasoning is partly valid, though mitigated by the point below.
• Good performance by the other strong philanthropic actors. If the other strong funders in a cause area seem to be consistently funding excellent projects and/or getting excellent results, this gives some reason to believe that there is room for more strong philanthropy in the cause.

In future posts, we will list some of the causes we find most promising; we will also give our views on some of the most popular causes in today’s philanthropy.

• David Roodman summarizes the most rigorous research on microfinance. There are now five randomized controlled trials on microlending that have at least published some preliminary results; it looks like there is very little in the way of direct poverty reduction or wellbeing improvements, though there is positive impact on “stimulating enterprise.”
• Charles Kenny discusses a recent study that randomized heavy subsidies of cookstoves in India, and found that “Households failed to use the stoves regularly or appropriately, did not make the necessary investments to maintain them properly, and use ultimately declined further over time,” leading to no significant positive impact. According to Mr. Kenny, this result is consistent with previous literature on the matter. On the other hand, Aid Thoughts points to another study in Senegal reporting, after one year, that “households receiving an improved cooking stove used less wood, spent less time cooking meals, reported better indoor air quality and (for women, who presumably did all the cooking) were significantly less likely to have respiratory disease symptoms, eye problems. Nearly all recipients of a stove used it at least seven times a week.” We note that the latter study discusses only one-year effects, while the India study found “a meaningful reduction in smoke inhalation in the first year [but] no effect over longer time horizons.” Note that we haven’t carefully examined these papers and that cookstoves are not a focus of ours, but since the recent studies are both fairly rigorous we thought it was worth noting them and their conflicting results for interested readers.

Funds spent to date

• SCI has made grants of $100,000 and $80,000 to Yemen and Senegal respectively for deworming drug delivery.
• SCI has granted about $25,000 to Tanzania to treat 153,000 children in one region.
• As part of discussions with the government about starting a national deworming program, SCI spent approximately $13,000 to support a conference on the deworming in Ethiopia.
• SCI has spent about $99,000 of the unrestricted funding on various organizational expenses such as travel and one staff member’s salary.

Plans for funds raised due to GiveWell’s research

SCI is currently planning to fund the delivery of donated schistosomiasis drugs to 1.5 million children in two regions of Ethiopia, and support disease mapping in other parts of the country. SCI is currently waiting on a budget from Ethiopia, but we estimate this project will cost a few hundred thousand dollars. SCI has told us that it expects these treatments to be delivered by the end of 2012.

SCI has also committed $100,000 to fund treatment of adults in one district of Burundi.

SCI is exploring the possibility of supporting deworming programs in Zimbabwe and the Democratic Republic of Congo. In addition, it may use unrestricted funding to provide additional treatments in Tanzania and Malawi, which are primarily supported by a large grant from the British government.

Comparing current plans to past plans

In November 2011, SCI told us that it would primarily use additional funds to expand deworming programs in Mozambique, Malawi, and Senegal. Recently, SCI told us that these are no longer the countries it expects to focus on with the funds raised through GiveWell. What has changed:

• SCI told us that it raised sufficient funding from other sources to support the Senegal program and that it never intended to expand the program beyond paying for delivery of drugs that were already available from the World Health Organization. We had been under the impression that SCI would expand this program further if it raised the money to do so, but it appears that we had a miscommunication with SCI on this point.
• In 2010, SCI received funding from the British government to support deworming programs in 8 countries, including Mozambique and Malawi. SCI recently decided that programs planned for two of the countries weren’t feasible, and shifted the money it expected to spend in these two countries to the Mozambique program.
• There may be other changes that we are not including here. We are not confident in our understanding of why SCI changed its plans.

Comments on SCI’s plans

First, SCI expects to spend almost all of the funds it has received due to GiveWell’s recommendation for a single round of treatment (save 15% of the funds, which it will hold for future treatments). Because multiple deworming treatments appear necessary for long-term impact (though the evidence on how many treatments are needed is thin), we are concerned that spending nearly all the funds now, could reduce SCI’s expected impact.

Second, our position is that treating children accounts for the majority of impacts from deworming. We are not confident in the impact of treating adults in Burundi.

GiveWell’s current top-rated charities focus on proven, cost-effective health interventions. These interventions appear to solve certain problems (malaria, parasites) quite well, while making no direct attempt to solve other problems (economic growth, education, gender equity, and more). One of the common lines of objection we get to these recommendations goes something like: “Why should I put all my money into fighting malaria, ignoring other important problems? Isn’t it unethical to ignore the other essential needs?”

We believe this objection commits the common fallacy of viewing the developed-world donor as the only person who can improve things for the beneficiaries. One term for taking this mentality too far is “Whites in Shining Armor” - often, in the media and in nonprofits’ communications, global poverty is presented as a simple fight between local problems and developed-world heroes. The problem is that as outsiders, we often have very poor understanding of the true dynamics behind overseas problems - and by attempting to solve problems that we understand poorly, we can make things worse.

We fundamentally believe that progress on most problems must be locally driven. So we seek to improve people’s abilities to make progress on their own, rather than taking personal responsibility for each of their challenges. How can we best accomplish this?

A common and intuitively appealing answer is letting locals drive philanthropic projects. This answer has some appeal for us; we have written before about, and given a small amount of money to, “low-insulation charities” that seem adaptive, locally connected, and overall driven by local needs rather than donors’ plans. At the same time, we have noted some major challenges of doing things this way. Which locals should be put in charge? There are inherent risks that the people who least need help will be best positioned to get involved with making the key decisions. In our reflections on our visit to India, we noted that some organizations seemed to consist simply of local elites making ad-hoc decisions, and that to truly reach those who most need help seemed to require being “systematically bottom-up,” a more complex and difficult approach.

Another approach to “putting locals in the driver’s seat” is quite different. It comes down to acknowledging that as funders, we will always be outsiders, so we should focus on helping with what we’re good at helping with and leave the rest up to locals.

Here I think an analogy to helping friends and family is somewhat illustrative. I try to help my friends and family in domains that I’m relatively knowledgeable about (for example, computer issues) and I tend not to put much effort into helping in other areas I’m not so knowledgeable about (for example, picking clothes) even if the latter are more important issues for them. I know I appreciate when my friends and family deal with me this way, and I don’t appreciate people who are determined to help me in domains that they don’t understand very well (even if these domains are very important to me).

We believe that the track record of outside aid points to health and nutrition as the areas that developed-world outsiders understand best and are best-positioned to help with.

It’s not that we think global health and nutrition are the only important, or even the most important, problems in the developing world. It’s that we’re trying to focus on what we can do well, and thus maximally empower people to make locally-driven progress on other fronts.

One more approach to “putting locals in the driver’s seat”: give to GiveDirectly to support unconditional cash transfers. We feel that global health and nutrition interventions are superior because they reach so many more people (per dollar), but for those who are even more concerned than we are about the trap of “whites in shining armor,” this option has some promise.

The charts below present basic information about our growth in money moved and web traffic thus far in 2012.

Website traffic tends to peak in December of each year (circled in the chart below). Growth in web traffic has remained strong.

Growth in money moved has remained strong as well. The majority of the funds GiveWell moves comes from a relatively small number donors giving larger gifts. These larger donors tend to give in December, and we have found that growth in donations from smaller donors throughout the year tends to provide a reasonable estimate of the growth from the larger donors by the end of the year.

Below, we show two charts illustrating growth among smaller donors.

Thus far in 2012, GiveWell has directed $228,351 to our top charities from donors giving less than $10,000. This is approximately 3x the amount we had directed at this point last year.

Most donors give less than $1,000; the chart below shows the growth in the number of smaller donors giving to our top charities.

Overall, 760 donors have given to GiveWell’s top charities this year (compared to 274 donors at this point last year).

In total, GiveWell donors have directed $631,879 to our top charities this year, compared with $456,567 at this point in 2011. For the reason described above, we don’t find this number to be particularly meaningful at this time of year. One major difference between 2011 and 2012 is that in 2011, Ken Jennings allocated the $150,000 he won participating in a Jeopardy! contest against IBM’s Watson to VillageReach.

We’ve just published an update on VillageReach’s progress. This post provides highlights from that update. In brief, progress has been discouraging on multiple fronts; VillageReach has made significant changes to its project plan and budget as a result; its resulting cost-effectiveness is likely to be substantially less strong than originally anticipated. All of these observations are made possible by VillageReach’s continuing transparency and commitment to collecting meaningful data. We always prefer discouraging observations to no observations.

VillageReach’s scale-up of its pilot project has hit multiple setbacks:

• Obstacles getting the program running. The program has run into significant obstacles in the two provinces in which VillageReach has been operating since late-2010/early-2011. The primary problem has been accessing funds from non-VillageReach sources to pay the health workers who implement the program. Lack of funding for these workers led them to stop implementing the program and no vaccine deliveries were made in either province for several months in the mid-to-late 2011. Work in two additional provinces has begun but is now significantly behind schedule. VillageReach has decided, going forward, to step in and provide funding itself when necessary; it reports that in the four months following this change, distributions occurred to all health centers on time.
• Increased expected costs. Actual costs have been higher than expected and VillageReach now projects roughly twice the costs it initially did. This is a primarily a function of (a) actual costs exceeding expectations and (b) increased expected costs due to VillageReach’s deciding to fill gaps, when necessary, left by other funders to ensure the project runs smoothly.
• Scaled-back future plans. Because of these problems, VillageReach has significantly scaled back its plans for the project, intending for the time being to work in 4 provinces rather than 8.

We now believe that VillageReach has room for more funding of approximately $1.5 million for 2012. This represents a change from our October 2011 statement that VillageReach did not have short-term room for more funding; the change is primarily due to the passage of time and some changes in the timing of expected expenditures rather than to any major change in VillageReach’s total projected costs.

We have not yet determined where VillageReach should rank on our top charities list. Its commitment to transparency and meaningful data collection - which have allowed the discouraging observations above - are major points in its favor, in our view, and we will likely attempt to ensure that it continues to have enough funding (something we believe we have ample time to do at the moment).

We are also more deeply examining the original evidence of effectiveness for VillageReach’s pilot project. Our standards for evidence continue to rise, and our re-examination has raised significant questions that we intend to pursue in the coming months. The deeper examination comes about because:

• Our research process has changed. In 2009 and 2010, VillageReach’s impact assessment was the best we had ever seen from a charity. Our research process has evolved, and there are now questions we would have asked of VillageReach in 2011 that we did not ask back in 2009-2010. For instance, we have always known that factors other than VillageReach’s work may have led to the increase in immunization coverage in Cabo Delgado between 2003 and 2008, but our investigation of this question was limited to (a) asking VillageReach whether other NGOs had significant operations that might have caused this and (b) looking at country-level immunization rates across Africa to see whether the change was part of a general trend. We now place more weight on other factors - particularly province-level government commitment - that could have led to this change. We intend to investigate this question and learn more about what else might have been happening in Cabo Delgado during the period of VillageReach’s pilot project.
• New information is available. This data includes: (A) health surveys released in 2010 that measure immunization rates in Mozambique. These surveys offer another source for data relevant to VillageReach’s project that was not available when we first assessed the pilot project. (B) In preparation for its scale-up, VillageReach returned to Cabo Delgado (the province in which it ran its pilot project) and conducted its own survey of immunization rates there. The newest survey raises questions about the impact of the pilot program and we will be conducting and publishing further analysis in the coming months. So far, we’ve conducted a re-analysis of VillageReach’s stockout and vaccination rate data.

As the first charity we directed significant funding to, VillageReach represents one of our best available learning opportunities. This is particularly true due to VillageReach’s continuing transparency and commitment to collecting meaningful data - qualities we believe are rare and outstanding. We intend to continue to take full advantage of this learning opportunity, even if it means publishing more discouraging news.

VillageReach has been reviewed by GiveWell since mid-2009, and was recommended as its #1 recommendation for two years, until November 2011. In providing this updated review of our work in Mozambique, we see a need to explain the context for what we do.

Two key principles define the organization:

1. our mission is to save lives and improve health by increasing access to quality healthcare for remote, underserved communities; and
2. an emphasis on measurement, results and transparency in reporting its plans, challenges, failures and results.

The organization was established in 2000, and for years directed all of its efforts at a demonstration project in Mozambique. During the past three years, the scope and scale of VillageReach has increased dramatically: we are engaged in numerous new projects supported by our donors, foundations, USAID and other international development organizations. All of this additional work to improve health systems was borne out of the initial experience we gained in working on the initial Mozambique demonstration project.

Our interest in transparency is common to many of our donors and core to GiveWell’s mission. In our case, we see the need for new approaches to improving health systems in low-income countries that can yield greater impact at lower cost. Our focus is to strengthen existing health systems through improvements in health system capacity (supply chain, management and personnel training), information technology (to improve the quality of data reported from the field) and the creation of social businesses (that create shared infrastructure to improve transportation, energy supply and communications for rural health facilities and surrounding communities).

We focus on the last mile of the health system, where a lack of human resource capacity and infrastructure can limit the ability of the system to serve its communities. Instead of looking top-down, we see greater improvements being made possible by looking bottom-up. To highlight the benefits of this approach, it is clear to us that we must be objective in publicly documenting both the challenges and successes the approach records, and to draw attention to the need to allocate more global health resources to improving access to healthcare.

There are naturally risks in trying new approaches in search of significant rewards. We accept that there are risks and that we will not succeed all the time; but, we believe that through taking chances, sometimes making mistakes, learning and adjusting, we will achieve results for communities whose basic need for healthcare have been left unmet for too long. We believe many of our supporters share our vision.

For the Mozambique expansion, we tested the sustainability of the system with a new approach under which local governmental health authorities assume responsibility to operate and fund the distribution system. What we found, is that when government funding is erratic, the vaccines are not distributed. As a result, the availability and quality of healthcare becomes erratic, and ultimately the communities we seek to serve suffer. We evaluated the program, saw that there were too many months when vaccines were not getting distributed adequately, and quickly decided to intervene to achieve our primary goal. Because improving health outcomes is a higher priority for us than sustainability, we have agreed – at the cost of about $25,000 per province per year - to step in to fill gaps in government funding when necessary to ensure the distributions occur on a regular basis as we develop new approaches that can smooth the government’s funding streams. This sort of adaptation is important to achieving results, and since this change we’ve seen the vaccine distributions happening every month.

It’s also in our best interests to expose the challenges in what we are attempting to do as much as the successes. We’re looking for system change in global health: our effort is to lead by example and document the results. This system change perspective hasn’t been covered by GiveWell because the focus is more purely on transparency and measureable success.

VillageReach’s view is there is a lot of innovation in global health but insufficient effort to ensure the innovations reach the underserved. We’re engaged in improving health systems in order to save lives, but the broader goal is to see governments and other organizations doing this type of work because the need extends well beyond VillageReach’s modest resources. Some contributors clearly prefer to support only organizations they deem to be successful, but many of our supporters are interested in our approach because we’re trying to achieve something that’s difficult and unpredictable, but still worthy and representing a needed change.

We will continue to work to reach the underserved, documenting what worked, as well as what didn’t.

John Beale
Director, Strategic Development &
Group Lead, Social Business Group

Background

Historically, AMF had distributed bednets in the following way: on-the-ground organizations applied to AMF for nets; after AMF reviewed and approved proposals, it would ship nets to the charity; finally, AMF would check in to see whether the nets had been distributed and were being used.

In early 2011, AMF changed its model. It received significant funding, which allowed it to proactively identify opportunities for net distributions rather than reacting to charities’ requests. In mid-2011, it decided to provide about 250,000 nets (at a cost of a little over $1 million to AMF) to the Ntcheu district in Malawi as part of a national net distribution.

Note: In addition to the costs incurred by AMF, Concern Universal, AMF’s distribution partner in Malawi also incurred costs. We estimated these costs in our review, but are currently working to update our estimate of Concern’s costs because we believe that we underestimated Concern Universal’s costs in our original AMF review. We don’t believe our estimate of total costs per net will change significantly.

The Malawi distribution

In October 2011, three GiveWell staff members visited the Ntcheu district while pre-distribution activities were taking place (such as surveying local households to determine who needed nets and how many each household needed). Concern Universal, the organization distributing AMF-provided nets in Ntcheu, started the distribution in mid-December and now (as of mid-March) Concern Universal has reported that it had distributed 242,745 nets to households in the district, out of the 251,720 nets provided by AMF. For its final distribution location in late March/early April, Concern Universal requires another 16,574 nets, which AMF is sending. (More information in our full, detailed update.)

Concern has posted weekly reports on its progress on AMF’s website, which not only share data on weekly nets distributed but also share problems identified during distributions. Concern reports highlight a number of instances of attempted theft and fraud by the health workers (HSAs) Concern has employed to distribute nets. In one case, Concern believes that an HSA fabricated the existence of two villages in order to steal the nets. Neither we nor AMF are surprised by attempted fraud, and we are glad that Concern’s process has identified such instances.

We cannot be sure whether Concern has identified all instances of malfeasance. That said, we believe that Concern’s process for identifying attempted fraud (along with AMF’s oversight of Concern and our monitoring of the entire process) is robust and therefore, we would be aware of significant problems. (More information in our full, detailed update.)

AMF’s 2012 plans

• AMF currently has access to approximately $3.5 million in received (or committed and soon to be received) funding. Approximately $2.3 million of this comes from GiveWell-directed donors.
• Malawi is currently in the midst of a national net distribution, which has been delayed. (AMF-funded distributions are not delayed; the rest of the national distribution is.) Rob Mather told us that Malawi estimates it needs 5.8 million nets, of which it has access to 5.2 million (4.7 million from the Global Fund and approximately 500,000 from the President’s Malaria Initiative). It therefore has a gap of 600,000 nets, and AMF is in discussions with the NMCP to see if AMF will provide these nets.
• Rob Mather has told us that he is not yet ready to provide these nets. He (a) has not yet seen sufficient data to convince him that there is, indeed, a gap of 600,000 nets, and (b) he is not yet convinced that AMF funding, as opposed to funding from other partners (e.g., Global Fund), is needed. In the event that Malawi does provide this information, AMF would provide additional nets for the Malawi distribution. AMF has therefore reserved $2.5 million of its funding while it assesses the need for nets in Malawi.
• AMF will likely reach a decision about Malawi in either the next few weeks – if the decision is not to provide further nets for Malawi - or in the next 3-4 months if it looks like funding further nets is possible. Three to four months is the timeframe required to collect data from the National Malaria Control Program and from the field to determine the net gap. Coordination with the Global Fund and President’s Malaria Initiative is also required. In the event of a positive outcome, Mr. Mather expects that the nets would be distributed before the rainy season in November. In the event that AMF decides not to contribute further to the Malawi effort, it believes that there are strong needs for nets exist in campaigns in Ghana, Mali, Togo and several other countries.
• One of AMF’s broad goals in its interactions with the Global Fund and the National Malaria Control Program in Malawi is improving the way that net distributions are conducted. Mr. Mather believes the AMF/Concern Universal approach in the Ntcheu district distribution follows best practice for pre-distribution data collection, distribution oversight, and post-distribution monitoring (described in our AMF review). As AMF’s influence increases (due to increased funding ability), it hopes to influence other players involved in bednet distribution to adopt the Ntcheu distribution as a model.

Expected future revenue

AMF told us that it has no current commitments for significant future revenue, but is in discussions with donors who could potentially make 7-figure donations. We are currently comfortable with AMF receiving up to ~$15 million over the next year. This figure would be about half of what would be needed to close the net gaps for Malawi, Mali and Ghana (according to our most conservative estimates published in our coverage analysis), and would constitute a significant “step up” for AMF’s size - a somewhat risky but overall strong opportunity for donors. We would have to revisit the question of AMF’s room for more funding if it were to raise more than $15 million.