Review of our research in 2017

This is the first of three posts that form our annual review and plan for the following year. This post reviews and evaluates last year’s progress on our work of finding and recommending evidence-based, thoroughly-vetted charities that serve the global poor. The following two posts will cover (i) our plans for GiveWell’s research in 2018 and (ii) GiveWell’s progress and plans as an organization. We aim to release our metrics on our influence on donations in 2017 by the end of June 2018.

Summary

We believe that 2017 was a successful year for GiveWell’s research. We met our five primary goals for the year, as articulated in our plan post from the beginning of the year:

Our primary research goals for 2017 are to:

1. Speed up our output of new intervention assessments, by hiring a Senior Fellow and by improving our process for reviewing interventions at a shallow level.
2. Increase the number of promising charities that apply for our recommendation. Alternatively, we may learn why we have relatively few strong applicants and decide whether to change our process as a result. Research Analyst Chelsea Tabart will spend most of her time on this project.
3. Through GiveWell Incubation Grants, fund projects that may lead to more top charity contenders in the future and consider grantees No Lean Season and Zusha! as potential 2017 top charities.
4. Further improve the robustness and usability of our cost-effectiveness model.
5. Improve our process for following the progress of current top charities to reduce staff time, while maintaining quality. We also have some specific goals (discussed below) with respect to answering open questions about current top charities.

We achieved our five primary goals for the year:

1. Our intervention-related output was greater than in any past year, although we still see room for improvement in the pace with which we complete and publish this work (more). We hired a Senior Fellow and published nine full or interim intervention reports in 2017, compared to four in 2016.
2. We increased the number of promising charities that applied for our recommendation (more).
3. We added two new top charities: Evidence Action’s No Lean Season (the first top charity to start as a GiveWell Incubation Grant recipient) and Helen Keller International’s vitamin A supplementation program (which joined our list as a result of our charity outreach work). We continued to follow our current Incubation Grant recipients and made several new Incubation Grants to grow the pipeline of new top charities (more).
4. We made substantial improvements to our cost-effectiveness analysis (more).
5. We reduced the amount of staff time spent on following our current top charities. We also completed 17 of the 19 activities outlined in last year’s plan (more).

We discuss progress on each of our primary goals below. For each high-level goal, we include (i) the subgoals we set in our last annual review, (ii) an evaluation of whether we met those subgoals, and (iii) a summary of key activities completed last year.

Goal 1: Speed up intervention assessments

In early 2017, we wrote:

In recent years, we have completed few intervention reports, which has limited our ability to consider new potential top charities. We plan to increase the rate at which we form views on interventions this year by:

• Hiring a Senior Fellow (or possibly more than one). We expect a Senior Fellow to have a Ph.D. in economics, public health, or statistics or equivalent experience and to focus on in-depth evidence reviews and cost-effectiveness assessments of interventions that appear promising after a shallower investigation. In addition, Open Philanthropy Project Senior Advisor David Roodman may spend some more time on intervention related work.
• Doing low-intensity research on a large number of promising interventions. We generally start with a two to four hour “quick intervention assessment,” and then prioritize interventions for a 20-30 hour “interim intervention report” (example). We don’t yet have a good sense of how many of these of these we will complete this year, because we’re unsure both about how much capacity we will have for this work and about how many promising interventions there will be at each step in the process.
• Continuing to improve our systems for ensuring that we become aware of promising interventions and new relevant research as it becomes available. We expect to learn about additional interventions by tracking new research, particularly randomized controlled trials, in global health and development and by talking to select organizations about programs they run that they think we should look into.

How did we do? Achieved our goal.

Due to our uncertainty about the capacity we could devote to intervention assessments, we did not have an explicit target for how many reports we expected to complete. In 2017, we published seven interim intervention reports, two full intervention reports, and completed ~30 quick evidence assessments (defined below). Our research output for 2017 was higher than 2016, when we published one full intervention report, three interim intervention reports, and completed 30 quick evidence assessments.

What did we do?

• Hired Caitlin McGugan as a full-time Senior Fellow to work on intervention reports.
• Completed quick evidence assessments (two to four hours spent reviewing the evidence base) for ~30 programs. (We plan to write more about this process, what we found, and how it informs our work in a future blog post.)
• Published two full intervention reports: (i) conditional subsidies for seasonal labor migration in northern Bangladesh (which led to a new top charity, No Lean Season) and (ii) surgery to repair obstetric fistula.
• Completed seven interim intervention reports, which are less intensive than full intervention reports, on antiretroviral therapy to treat HIV/AIDS, oral rehydration solution, Sayana® Press, SMS reminders for vaccination, distribution of eyeglasses in developing countries, interventions to promote handwashing, and oral pre-exposure prophylaxis (PrEP) for HIV.
• Substantially updated intervention reports on two of our priority programs: seasonal malaria chemoprevention (previously an interim intervention report) and vitamin A supplementation.
• Developed and implemented a system for (i) tracking new published research relevant to our priority programs and (ii) identifying new programs for evidence assessments.

Goal 2: Increase the pipeline of promising charities applying for our recommendation

In early 2017, we wrote:

We would like to better understand whether we have failed to get the word out about the potential value we offer or communicate well about our process and charities’ likelihood of success, or, alternatively, whether charities are making well-informed decisions about their fit with our criteria. (More on why we think more charities should consider applying for a GiveWell recommendation in this post.)

This year, we have designated GiveWell Research Analyst Chelsea Tabart as charity liaison. Her role is to increase and improve our pipeline of top charity contenders by answering charities’ questions about our process and which program(s) they should apply with, encouraging promising organizations to apply, and, through these conversations, understanding what the barriers are to more charities applying.

We aim by the end of the year to have a stronger pipeline of charities applying, have confidence that we are not missing strong contenders, or understand how we should adjust our process in the future.

How did we do? Achieved our goal.

More charities entered our top charity review process in 2017, although it’s unclear whether this was due to our charity liaison activities. Five charities formally applied in 2017, compared to two in 2016, and four in 2015. One of those charities, Helen Keller International’s vitamin A supplementation program, became a top charity.

While we feel our relationships with well-regarded global health and development implementers and funders have improved, we continue to feel limited in our ability to understand whether there are funding gaps for evidence-backed, highly cost-effective work within large international NGOs and multilateral aid organizations such as the Global Fund to Fight AIDS, Tuberculosis and Malaria.

What did we do?

• We had at least one conversation with 42 organizations to introduce them to GiveWell’s work in 2017, compared to 16 in 2016.
• Where organizations running multiple programs expressed interest in applying for our recommendation, we had several calls with them to help determine whether they should apply and which of their programs would be the most promising fit for a top charity evaluation. We had not offered this proactive support to organizations in the past.
• We hosted two charity-focused events: (i) a conference call for charities with GiveWell senior staff to present an update on our work as it relates to charities and to give them a chance to ask questions directly of our senior team and (ii) a networking event for our recommended organizations in London.
• We attended seven conferences on global health and development issues to broaden our network and perspective in subject-matter areas that GiveWell has not historically worked on.

Goal 3: Maintain Incubation Grants

In early 2017, we wrote:

We made significant progress on Incubation Grants in 2016 and plan in 2017 to largely continue with ongoing engagements, while being open to new grantmaking opportunities that are brought to our attention.

Among early-to-mid stage grants, we plan to spend the most time on working with IDinsight and New Incentives (where our feedback is needed to move the projects forward), and a smaller amount of time on Results for Development and Charity Science: Health (where we are only following along with ongoing projects).

Another major priority will be following up on two later-stage grantees, No Lean Season and Zusha!, groups that are contenders for a top charity recommendation in 2017. For No Lean Season, a program run by Evidence Action, our main outstanding questions are whether the program will have room for more funding in 2018 and whether monitoring will be high quality as the program scales. We have similar questions about Zusha! and in addition are awaiting randomized controlled trial results that are expected later this year.

How did we do? Exceeded goal.

As expected, our work last year focused on following up on current grantees. No Lean Season, one of our later-stage grantees, graduated to top charity status and we made one grant to a new grantee, the Centre for Pesticide Suicide Prevention. We also made a number of grants to improve our understanding of the evidence base for our priority programs and deepened our partnership with IDinsight.

What did we do?

• Completed a full review of No Lean Season and named it a top charity. We are currently reviewing Zusha! in greater depth.
• Made Incubation Grants totaling $10.8 million in 2017:
  • $7.8 million to support the continued operation of previous grantees: Evidence Action, Zusha!, New Incentives, Charity Science Health, and the IDinsight embedded GiveWell team.
  • $3.0 million to new Incubation Grant recipients: the Centre for Pesticide Suicide Prevention, UC Berkeley for a long-run follow-up survey on the effect of deworming on consumption, and the Center for Effective Global Action at UC Berkeley to scope other randomized controlled trials (RCTs) for long-term follow-ups.

Goal 4: Improve our cost-effectiveness analysis

In early 2017, we wrote:

We plan to continue making improvements to our cost-effectiveness model and the data it draws on (separate from adding new interventions to the model, which is part of the intervention report work discussed above). Projects we are currently prioritizing include:

• Making it more straightforward to see how personal values are incorporated into the model and what the implications of those values are.
• Revisiting the prevalence and intensity adjustment that we use to compare the average per-person impact of deworming in places that our top charities work to the locations where the studies that found long-term impact of deworming were conducted. More in this post.
• Improving the insecticide-treated nets model by revisiting how it incorporates effects on adult mortality and adjustments for regions with different malaria burdens and changes in malaria burden over time.

How did we do? Achieved goal.

We made substantial progress on improving our cost-effectiveness analysis in 2017.

What did we do?

• Moved to a system of making more frequent updates to our cost-effectiveness analysis. This has made it easier to identify which specific factors are driving changes in the estimated cost-effectiveness of our top charities.
• Revisited how we think about leverage and funging (how donating to our top charities influences how other funders spend their money) and updated our cost-effectiveness analysis accordingly.
• Published a report on how other global actors approach the difficult moral tradeoffs we face.
• Prior to announcing our 2017 recommendations, we performed a sensitivity check on our cost-effectiveness analysis to identify how sensitive our final outputs were to different uncertain inputs. This has helped us identify which inputs we should prioritize additional research on, and we believe it has made our communication more transparent, particularly around our personal values.
• Revisited and updated our prevalence and intensity adjustments for deworming.
• Deprioritized improving how our insecticide-treated net model incorporates effects on adult mortality. A limited number of conversations with malaria experts made us less confident that there was informative research on the question that would improve the accuracy of our models.
• Deprioritized making adjustments for subnational regions with different malaria burdens because it would take substantial time to deeply understand the assumptions informing the subnational models we have seen. We believe this remains an important weakness of our model and that it limits our ability to make high-quality decisions about prioritization among different regional funding gaps.

Goal 5: Improve our process for following top charities

In early 2017, we wrote:

“In 2017, we plan to have a single staff member do most of this work and expect it to take a half to two-thirds of a full-time job. Three other staff will spend a small portion of their time, totaling approximately the equivalent of one full-time job, on this work.”

How did we do? Achieved goal.

We estimate that it took about 40 percent of the staff member’s time who focused on this work plus a small portion of four other staff members’ time, totaling at most and likely somewhat less than the equivalent of a full-time job (roughly half the time we dedicated to top charity updates in 2016).

We believe we maintained or increased the quality of the top charity updates, as we completed or made major progress on all but two of the activities and questions outlined in last year’s plan.

What did we do?

The table below summarizes our progress on each of the activities and open questions outlined in last year’s plan.

Charity	Goals and open questions from 2017 plan	Did we meet our goal?	What did we do?
Evidence Action’s Deworm the World Initiative	“We have now followed these groups for several years and do not have major outstanding questions about them. We plan to ask for updates on financial information, monitoring results, and room for more funding and have regular phone calls with them to learn about operational changes that might lead us to ask additional questions.”	Yes	We had regular phone calls, received up-to-date financial information, updated room for more funding, and reviewed new monitoring information from Nigeria, Vietnam, Kenya, and Ethiopia (see rows 11-20 and an overview of what we learned).
GiveDirectly	“We have now followed these groups for several years and do not have major outstanding questions about them. We plan to ask for updates on financial information, monitoring results, and room for more funding and have regular phone calls with them to learn about operational changes that might lead us to ask additional questions.”	Yes	We had regular phone calls, received up-to-date financial information, updated room for more funding, and reviewed new monitoring information from Kenya (1, 2). (Overview of what we learned.)
Schistosomiasis Control Initiative	“We have now followed these groups for several years and do not have major outstanding questions about them. We plan to ask for updates on financial information, monitoring results, and room for more funding and have regular phone calls with them to learn about operational changes that might lead us to ask additional questions.”	Yes	We had regular phone calls, received up-to-date financial information, updated room for more funding, and reviewed new monitoring information from 2016 programs in a number of countries. (Monitoring information, overview of what we learned.)
Against Malaria Foundation (AMF)	“Will AMF’s monitoring processes be high quality?”	Yes	We commissioned IDinsight, an organization with which we are partnering as part of our Incubation Grants program, to observe post-distribution surveys in Malawi and Ghana and report their findings.
	“Going forward, AMF aims to fund larger distributions and commit funding further ahead of when a distribution is scheduled to occur than it has, for the most part, done in the past. Will this increase the extent to which AMF funds displace funds from other sources, or will there continue to be evidence that AMF’s funds are largely adding to the total number of nets distributed?”	Partial	We learned relatively little about the displacement/fungibility question because AMF signed relatively few new agreements to fund long-lasting insecticide-treated net distributions in 2017. There was an update to how AMF will be tracking displacement, described in the second paragraph here.
	“In order to estimate AMF’s room for more funding, we will seek out information on the location and size of funding gaps for mass net distribution campaigns from AMF, the African Leaders Malaria Alliance, and possibly other funders of nets. As we have in the past, we will use this information in conjunction with conversations with AMF about non-funding bottlenecks to its ability to fill various gaps.”	Yes	We got updates on AMF’s room for more funding, as summarized in this post.
The END Fund’s deworming program	“We have not yet seen monitoring on par with that from our other top charities from the END Fund. We expect results from coverage surveys from END Fund programs this year. Will these surveys be high quality and demonstrate that the END Fund is funding successful programs?”	Yes	We saw some monitoring from END Fund programs; previously our recommendation of the END Fund was based on specific monitoring plans that we found credible (more here).
	“We have not yet tried to compare the cost-effectiveness of the END Fund to our other top charities in our cost-effectiveness model. We will be seeking additional information from the END Fund about cost per treatment and baseline infection rates”	Yes	We significantly improved our understanding of the END Fund’s cost per treatment and the baseline prevalence in areas where the END Fund works. We completed a cost-effectiveness analysis, though we continue to have lower confidence in our estimates than we do for the deworming organizations that we have recommended for several years.
	“Questions around room for more funding: the extent to which funding due to GiveWell’s recommendation increases the amount that the END Fund spends on deworming versus other programs, actual and projected revenue from other sources, and what deworming grantmaking opportunities the END Fund expects to have.”	Yes	We estimated the extent to which funding due to GiveWell’s recommendation increases the amount that the END Fund spends on deworming versus other programs, discussed here.
	“We visited the END Fund’s programs in Rwanda and Idjwi island, DRC in January 2017 and will publish notes and photos from our visit shortly.”	Yes	We posted notes and photos from our site visit here.
Malaria Consortium’s seasonal malaria chemoprevention program	“Further research on the evidence of effectiveness, cost-effectiveness, and potential downsides of seasonal malaria chemoprevention (SMC) (due to time constraints we have not yet completed a full intervention report, though we felt sufficiently confident in the intervention to recommend Malaria Consortium).”	Yes	We reviewed each of the RCTs included in the Cochrane review for seasonal malaria chemoprevention, and possible negative/offsetting impacts. We updated our interim intervention report to a full intervention report and added new information to our cost-effectiveness analysis. Our key conclusions did not change substantially and SMC remains a priority program.
	“Getting a better understanding of the methodology Malaria Consortium uses for estimating coverage rates.”	Yes	We spoke with Malaria Consortium to understand how they measure coverage and updated our cost-effectiveness analysis to account for different levels of coverage in the Malaria Consortium program relative to the headline results of the RCTs in the Cochrane review (conversation notes here).
	“Completing a more in-depth room for more funding analysis for the program for 2018 than we did for 2017.”	Yes	We completed a significantly more in-depth room for more funding analysis than we had previously (more here).
	“We may visit a Malaria Consortium seasonal malaria chemoprevention program in summer 2017.”	No	We did not conduct a site visit.
Sightsavers’ deworming program	“We expect to make limited progress this year because the first deworming mass drug administration funded with GiveWell-influenced funds is not expected to take place until September at the earliest and monitoring results aren’t expected until early 2018. Because Sightsavers has done fairly little deworming in the past year, we don’t expect to be able to learn much from its ongoing programs.”	Exceeded	In 2017, as expected, we learned relatively little about the performance of Sightsavers’ deworming programs, because programs funded with GiveWell-directed funds were at early stages. We did not expect to receive any monitoring results from programs funded with GiveWell-directed funds; however, Sightsavers shared a coverage survey from Guinea with us earlier than expected. The survey found middling coverage results.
	“Getting more information from Sightsavers about baseline prevalence and intensity of worm infections in the areas it is working, to inform our cost-effectiveness analysis.”	Yes	We significantly improved our understanding of Sightsavers’ cost per treatment and the baseline prevalence in areas where Sightsavers works (which is used in our cost-effectiveness analysis).
	“Using Sightsavers’ budget for the projects and planned treatment numbers to improve our estimate of the cost per treatment – another input into our cost-effectiveness analysis.”	Yes	We significantly improved our understanding of Sightsavers’ cost per treatment and the baseline prevalence in areas where Sightsavers works (which is used in our cost-effectiveness analysis).
	“Completing a room for more funding analysis for 2018.”	Yes	We completed a room for more funding analysis (more here).
Standout charities	“We plan to have at least one phone call with each of these groups to discuss whether anything has changed that might lead us to reopen consideration of the organization as a potential top charity”	Yes	We spoke with each standout charity. Conversation notes here: Development Media International, Food Fortification Initiative, Global Alliance for Improved Nutrition’s Universal Salt Iodizational program, Iodine Global Network, Living Goods, and Project Healthy Children.

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