What we fund, #1: We fund many opportunities outside our top charities

By GiveWell @ 2024-03-22T20:54 (+47)

This is a linkpost to https://blog.givewell.org/2024/03/19/what-we-fund-1-grantmaking-scope/

Author: Isabel Arjmand

This post is the fourth in a multi-part series, covering how GiveWell works and what we fund. We'll add links to the later posts here as they're published. Through these posts, we hope to give a better understanding of what our research looks like and how we make decisions.

• How we work, #1: Cost-effectiveness is generally the most important factor in our recommendations
• How we work, #2: We look at specific opportunities, not just general interventions
• How we work, #3: Our analyses involve judgment calls

GiveWell aims to find and fund programs that have the greatest impact on global well-being. We're open to funding whichever global health and development opportunities seem most cost-effective. So while our top charities list is still what we're best known for, it's only part of our impact; we also dedicate substantial funding and research effort to opportunities beyond top charities.

In 2022, 71% of the funds we directed supported our four current top charities, and 29% were directed to other programs.^[1] However, most of our research capacity goes toward programs other than our top charities. This is because (a) most programs we direct funding to aren't top charities (we have four top charities but directed funding to about 40 other grantees in 2022),^[2] and (b) it requires more effort to investigate a program we know less deeply. 

In this post we’ll share:

• The overall scope of our grantmaking
• Why we dedicate funding and research capacity to programs other than our top charities
• The types of opportunities we support

You can support the full range of our grantmaking via the All Grants Fund.

The scope of our work

Our research is focused on global health and development programs. We believe this is an area in which donations can be especially cost-effective.

Much of our funding goes to health programs, especially programs that reduce deaths from infectious diseases among young children living in low- and middle-income countries. We've found donations to such programs can make a particularly large impact; babies and young children are much more susceptible to infectious disease than adults, and diseases like malaria, diarrhea, and pneumonia can be prevented fairly cheaply. The evidence for health programs is often strong relative to other areas, and it's more likely to generalize from one context to another.

While the majority of our funding goes to programs that support child health, that isn't our exclusive focus. For example, we also consider programs that aim to improve household income or consumption, such as One Acre Fund's tree program and Bridges to Prosperity. In addition, many of the child health programs we support may also have other benefits, like reducing medical costs, increasing later-in-life income, or improving adult health.

Why make grants outside top charities?

Our top charities continue to be our top recommendations for donors who prioritize confidence in their giving. They have strong track records of delivering programs at large scale and the capacity to absorb more funding, and we've followed their work for years.

We have such strict criteria for top charities that we'd be limiting our impact if we only recommended funding to them. Some highly cost-effective programs might not meet those criteria, and we don't want to artificially constrain the impact we can have. For example, r.i.ce.'s kangaroo mother care program isn't operating at a large enough scale and we haven't funded it long enough for it to be a top charity. However, we think the program will cost-effectively improve the lives of low-birthweight babies, so we made a grant to support it.

Initially, our non-top charity grantmaking was confined to incubating new top charities. We had some success with that strategy; for example, we made seven "incubation grants" to support New Incentives earlier in its development before ultimately naming it a top charity. Some of the other programs we fund now might become top charities in the future. But, many of the grants we recommend are outstanding opportunities that we don't necessarily believe will ever become top charities. This might be because the benefits of the program are too uncertain (e.g., deworming) or because the program can't be scaled flexibly enough (e.g., technical assistance provided to governments to support high-quality program implementation until governments can maintain it on their own). We want to support those avenues for impact too!

The spectrum of opportunities we fund

Below, we highlight some of the types of opportunities we've supported. These categories aren't mutually exclusive or comprehensive, but give a broad sense of opportunities we recommend.

Some of our funding goes to interventions or organizations that are newer to us in areas we're already familiar with. For example, two of our top charities (the Against Malaria Foundation and Malaria Consortium's seasonal malaria chemoprevention program) focus on malaria prevention, but we are also reviewing and funding other tactics for preventing malaria, such as perennial malaria chemoprevention and vaccines. Other funding goes to areas that we haven't been researching as long, like water quality (here and here) or maternal and neonatal health (here and here).

Incubating new programs

Sometimes, we read about programs in the academic literature that seem potentially cost-effective but that aren't currently being implemented at scale. With highly aligned partner organizations, we can scope exciting opportunities together, then these partners can pilot and scale the most promising ones.

We've funded two of these partnerships: Evidence Action's Accelerator and the Clinton Health Access Initiative (CHAI)'s Incubator. We're considering a variety of potential programs across these two partnerships. So far, we've made two grants to Evidence Action for a syphilis screening and treatment program that started within the Accelerator (see grant pages here and here). We've also made one grant to CHAI for a program that distributes oral rehydration solution and zinc for diarrhea treatment; that grant will also support a randomized controlled trial to assess the program's impact. 

Funding programs with high expected value but more uncertainty

Some programs may be as cost-effective as our top charities, or even more cost-effective, but they aren't backed by strong enough evidence for us to list them as top charities (see the second criterion here).

For example, we've supported deworming programs for many years, and we estimate them to be highly cost-effective: deworming programs are very inexpensive, and we think there’s a small chance they may lead to large income gains later in life. So, we continue to fund deworming programs where they look competitively cost-effective, despite our uncertainty about the impact (as described in this 2016 blog post).

Strengthening organizations

It can be hard for nonprofits to raise enough unrestricted funding. We're open to supporting particularly promising organizations to strengthen their own operations (rather than just to carry out specific programs), thus enabling them to have more impact over the long term.

In April 2023, we recommended a grant to IRD Global for organizational support. We hope this funding will enable IRD to address organizational challenges and propose more work we're excited to fund (we're already funding IRD's program to promote childhood vaccination in Pakistan). We similarly recommended an unrestricted grant to Evidence Action in 2019, and we've funded several of its programs since then, including the Accelerator and water chlorination programs mentioned above.

Seizing outstanding one-off opportunities

Sometimes we make grants to support relatively low-cost opportunities that seem plausibly high-impact but that we haven't investigated as deeply. Our senior grantmakers can collectively recommend a total of up to $10 million in "small discretionary grants" each year (more details here). The case for these grants is often primarily qualitative, like this grant for research on the potential spillover effects from unconditional cash transfers or this grant for youth empowerment fellowships.

Supporting government partnerships

Some of the opportunities we fund are for technical assistance, in which an organization works closely with the government to support the high-quality implementation of a government-run program. Many of the organizations we fund—including all of our top charities—work with governments in some capacity; but that collaboration is the core of technical assistance programs.

We've recommended two grants to Evidence Action for a program supporting syphilis screening and treatment in Liberia, Cameroon, and Zambia (see grant pages here and here). Evidence Action works with governments to switch from HIV-only tests to dual HIV-syphilis tests as part of routine antenatal care, and to reliably provide antibiotic treatment when people test positive. 

Switching to a dual test and providing penicillin might seem relatively straightforward, but there are many parts to the process. For example, substantial logistical coordination is required before penicillin can be administered to patients: 

• The government needs to purchase penicillin from manufacturers.
• The penicillin needs to be shipped to the country, then timely transportation to individual health centers is required to limit stockouts. 
• Staff at the health centers need to be trained to educate patients and administer the medication. 
• And, finally, patients need to be willing to accept the treatment. 

Ministries of Health are often constrained by lack of funding and staff capacity, such that support from partners like Evidence Action is valuable.

Learning more about programs

We sometimes make grants in order to learn more about a particular health program. When we find a promising new program, we investigate it before making a grant, but we don't aim to definitively answer every open question; that wouldn't be feasible. Moreover, some programs may be fairly new, may have been implemented only on a small scale, or may have a comparatively thin base of evidence supporting their effectiveness. In such cases, our grants may be aimed at learning more.   

Funding monitoring and evaluation

In 2023, we recommended a grant to MiracleFeet to implement its clubfoot program. This program is different from most others we fund—it's a health program, but it's for treatment rather than prevention, and clubfoot is a disability rather than a potentially fatal disease. At the time we made the grant, we estimated that MiracleFeet's programs were close to but slightly below our standard cost-effectiveness bar. But we thought that we could learn more as we followed along after making a grant. We wanted to see how many additional children received treatment as a result of the program, so we funded a monitoring and evaluation grant along with the implementation grant in order to specifically address that question.

Funding rigorous trials

In other cases, we fund research, often but not exclusively randomized controlled trials, to generate additional academic evidence about a program. That research can be valuable to us in more confidently deciding which opportunities to recommend in the future, and it also adds to the scholarly literature available on the program.

For example, in 2023 we supported a randomized controlled trial to measure how much the use of oral rehydration solution (ORS) and zinc increases when they are provided free to households. We think providing ORS and zinc is a promising way to reduce childhood mortality from diarrhea, but we aren't yet sure how effectively we can increase usage. So, in addition to funding the Clinton Health Access Initiative to implement this program in Bauchi, Nigeria, we're funding an independent evaluation to measure its effects on usage so that we can form a stronger view on the program's cost-effectiveness and consider whether to extend and scale our support.

***

For a full view of grants we've recommended, see this table, which is updated as we publish grant pages.

If you're excited to support programs like these, we recommend our All Grants Fund, which goes to the opportunities we think are most impactful, regardless of program or location.

1. ^{^}

   This is based on the funding we directly recommended or granted to other organizations from February 1, 2022, to January 31, 2023, as well as funding that we believe was influenced primarily by our research and recommendations.

2. ^{^}

   See pages 15 and 16 of our 2022 metrics report.