We are pleased to announce the results of our 2019 Partner Selection process. Our Top Picks for 2019 are: Against Malaria Foundation, GiveDirectly, Living Goods, Malaria Consortium’s Seasonal Chemoprevention Therapy Program, and Helen Keller International’s Vitamin A Program. Malaria Consortium and Helen Keller International are new additions to our Top Picks: we were very impressed with the cost-effectiveness and high quality of evidence supporting their programs, and are excited to promote the work they do in reducing under-5 mortality across the world. This post will give an overview of this year’s selection process, and each of our Top Picks for 2019.
Note: we have updated our giving platform so that new donors that sign up from today will have the option to give to our Top Picks portfolio for 2019. Existing donors who give to our Top Picks portfolio will have their donations split between our new Top Picks (i.e. including Malaria Consortium and HKI, but not Possible and Project Healthy Children) from April 1st. Donors who split their donation between all charities in our portfolio will also have their donations updated to the new portfolio from April 1st, but donations to individual charities will remain unchanged (see here for more details).
Our selection process
We have recently updated our charity selection process to use GiveWell's recommendations - a full explanation for this change can be found here. In brief, the process of selecting our charity partners has two stages (more details here).
GiveWell selects OFTW’s full portfolio using its selection methodology. This focuses on the evidence of effectiveness, cost-effectiveness, room for more funding, and transparency of organizations working to assist people living in extreme poverty.
OFTW chooses a subset of these organizations to be designated as OFTW Top Picks. OFTW selects Top Picks using four criteria: (1) Strength of evidence. (2) Cost effectiveness; (3) Direct impact and simplicity of programs; (4) Track record and cultural fit. We also have a preference for diversity in our portfolio, both in terms of geographic reach and activities of our charity partners, and have a preference for maintaining some consistency in our recommendations year-to-year.
The second stage comprises 4-6 weeks of research by a team of ~15 volunteers from OFTW chapters to determine which organizations in the full portfolio best meet the criteria of Top Picks. This year, we increased the rigor of our process by dividing the group into a qualitative team and a quantitative team. The qualitative team engaged with GiveWell’s charity reviews, research conversations, and intervention reports to assess how well each of GiveWell’s 16 top and standout charities score on our qualitative selection criteria. The quantitative team conducted extensive cost-effectiveness analyses on the interventions and charities under consideration, using GiveWell's cost effectiveness analysis.
The addition of the quantitative team allowed us to incorporate GiveWell’s Cost Effectiveness Analysis model (CEA) into our research. The CEA is a model that combines subjective inputs (e.g. discount rates to be applied for doubling consumption, or the relative moral values of doubling consumption vs. saving lives), existing literature on disease prevalence and intervention effectiveness, and cost/operational figures specific to reviewed charities. The quantitative team interacted with the CEAs for all GiveWell recommended charities by understanding how they work, highlighting and investigating key parameters and assumptions in the model, and collaborating with the qualitative team to try to make an assessment of our confidence in the estimated cost-effectiveness metrics. Additionally, moral weights were collected from the entire partner selection team and members of the OFTW executive committee to produce tailored cost-effectiveness numbers for the charities reviewed. Incorporating the CEA into our analysis was insightful in better understanding the cost-effectiveness estimates of our recommended charities.
* An example of GiveWell's CEA analysis - deducing a figure for the percentage of SMC attempted treatments that are actually delivered to children. This is used later in determining SMC cost-effectiveness.
Find out more about our charity selection process here.
Our 2019 partner selection committee
We were pleased to see the partner selection committee expand over previous years, and to see such wide representation from OFTW chapters: our team spanned four countries and three continents! Our selection team this year had fifteen members from various chapters: four from Columbia, two from Wharton MBA, and one each from Penn Law, Penn undergrad, Villanova, Vanderbilt, McGill, Concordia, Melbourne and Georgetown. As in previous years, the team was led by Dr. Rossa O'Keeffe-O'Donovan, a Research Fellow in Economics at the University of Oxford who specializes in development economics. Rossa was joined by Kevin Monogue of our Penn undergrad chapter, who oversaw the quantitative team, and Kennan McClung of our Columbia chapter, who oversaw the qualitative team. Find out more about the team and timeline here.
Our 2019 Top Picks portfolio
We give a more thorough overview of our new Top Pick charities, and why we are excited to recommend them, and a shorter update on our existing Top Picks (GiveDirectly, Against Malaria Foundation, Living Goods).
New Top Picks
Malaria Consortium’s Seasonal Malaria Chemoprevention Program
Malaria Consortium’s Seasonal Malaria Chemoprevention Program (SMC) distributes preventive antimalarial drugs to children under the age of 5 to prevent illness and death from malaria. The program consists of up to four treatment courses at monthly intervals during peak malaria transmission season in Nigeria and seven Sahelian countries.
Scope of the Problem
In 2017, 219 million people suffered from malaria, leading to a total of 435,000 malaria deaths. 70% of these deaths occurred among children under the age of 5: a child died of malaria every two minutes.
Malaria is preventable and treatable, but is still a serious public health concern in Burkina Faso, Nigeria and Chad, where Malaria Consortium works. Nigeria accounts for 25% of the world’s malaria cases.
There is an estimated gap of 12 to 18 million children in Africa who could benefit from SMC, but who are not currently included in SMC programs.
Malaria Consortium’s Solution
Malaria Consortium’s intervention comprises a maximum of four treatment courses of sulfadoxine-pyrimethamine (SP) and amodiaquine (AQ) at monthly intervals to children 3 to 59 months old during the high malaria transmission period in areas of acute malaria incidence.
SMC is recommended by the World Health Organization (WHO) as one of the most effective interventions for the prevention of malaria in areas where malaria transmission is highly seasonal and resistance to SP + AQ is low (Sahel regions of Africa).
The drug is administered via water-soluble tablets sweetened to improve their palatability to children.
The aim is to maintain therapeutic anti-malarial drug concentrations in the blood throughout the period of greatest risk to reduce the incidence of both simple and severe malaria disease and the associated anaemia and result in healthier, stronger children.
Evidence of Impact and Cost-Effectiveness
GiveWell estimate that Malaria Consortium’s cost of delivering the full four-month SMC treatment is $6.93. GiveWell estimates that it is 8.8 times as cost-effective as direct cash transfers.
SMC was associated with an 89% reduction in malaria incidence for 4 weeks after treatment, and 62% from five to six weeks after treatment, compared with children who had not received SMC or whose last dose was more than six weeks before.
There are significant positive spillover effects (externalities) of the treatment: Malaria incidence among the untreated population (over the age of 10) was 26% lower in areas where SMC was delivered compared to control areas.
Malaria Consortium estimate that they have prevented 60,000 malaria deaths and 10 million cases of malaria through their SMC program.
This is the first year that Malaria Consortium was under consideration for a Top Pick designation, as they are a new addition to our full portfolio following our switch to GiveWell’s recommendations. Although the addition of Malaria Consortium means that we do carry two charities which fight malaria in our Top Picks, we were very impressed by Malaria Consortium’s cost-effectiveness and the evidence backing their program. In addition, Malaria Consortium and Against Malaria Foundation generally work in different countries, and undertake different interventions to prevent malaria infections that are complementary to each other. We are confident that having two preventive programs -- one net-based, and one medicine-based -- increases the strength of our portfolio in the fight against malaria, which remains one of the leading causes of child mortality. Eradicating malaria will require many tools over the coming decades, and these are the two most effective interventions that we are aware of.
Malaria Consortium’s SMC Program growth, 2014 - 2017
Helen Keller International’s Vitamin A Supplementation Program
Helen Keller International's Vitamin A Program (HKI) runs programs that reduce malnutrition, avert blindness and alleviate poor vision in sub-saharan Africa by providing vitamin A supplementation (VAS) in Sub-Saharan Africa. HKI provides technical assistance, engages in advocacy, and contributes funding to government-run VAS programs.
Scope of the Problem
Vitamin A is an essential nutrient that serves many purposes in the body; in particular, the immune and visual systems require it to function properly. Essential nutrients must be obtained through diet since the body cannot produce them on its own.
Vitamin A deficiency (VAD) is caused by poor diets and can result in stunting, anemia, xerophthalmia (dry eyes, which can lead to blindness), increased severity of infections, and death. Infants, children, and pregnant or lactating women with low vitamin A intake appear to have a particularly high risk of the negative health impacts caused by VAD.
The WHO estimates that 250 million preschool children around the world are vitamin A deficient, predominantly in Africa and South-East Asia.
Of these, the WHO estimates that 250,000 - 500,00 become blind due to Vitamin A deficiency, half of whom die within 12 months of losing their sight.
Helen Keller International (HKI) supports programs focused on reducing malnutrition and averting blindness and poor vision in countries in Africa and Asia; it also provides vision screenings and distributes eyeglasses at schools in the United States.
We recommend HKI's VAS programs for preschool-aged children, due to its evidence of impact and cost effectiveness.
Evidence of Impact and Cost-Effectiveness
GiveWell estimate that HKI’s cost to deliver a vitamin A supplement is $1.35.
GiveWell estimates that VAS is 6.4 times as effective as direct cash transfers.
This is the second year that HKI’s VAS program was under Top Pick consideration, having been added to our full portfolio in January 2018. It nearly made the list last year, but narrowly lost out to Project Healthy Children, due principally to our team’s excitement over PHC’s Sanku small-scale fortification program. However, as a result of including more rigorous cost-effectiveness analysis in this year’s process and placing more weight on GiveWell's research and recommendations, we ultimately decided to include HKI this year over PHC, as we think that the direct evidence for VAS’ efficacy is stronger than that for food fortification programs.
Continuing Top Picks
GiveDirectly uses mobile-phone technology to provide unconditional cash transfers to some of the poorest households in Kenya, Uganda, and Rwanda. GiveDirectly has been in our Top Picks portfolio since 2017, and we continue to think that they represent an outstanding giving opportunity for our members. They are among the most transparent organizations we are aware of, and are consistently testing various aspects of their program in collaboration with high quality, independent academic researchers, including a recently started basic income study. A working paper from January 2018 estimates that the positive effects of their main cash transfer program on consumption, asset holdings, food security and psychological wellbeing are persistent three years after the cash transfer. Follow-up research (not yet publicly available) estimates that there are little to no negative effects of the cash transfer program on people who do not receive the transfers (i.e. there is no evidence of large negative spillover effects or externalities). GiveWell notes that GiveDirectly will use additional funding for its standard cash transfer program and to help refugees in Uganda and Rwanda. GiveDirectly believes it could spend roughly $141 million in 2019 and $195 million in 2020, if it had sufficient funding to do so, for which there is strong evidence of large positive effects, and that they could productively use more than $100m in additional funding in 2018-2019. Overall, we continue to give a strong recommendation for GiveDirectly to our members. You can read more detail about GiveDirectly on GiveWell's website.
Living Goods trains and supports a network of Community Health Promoters (CHPs) in sub-Saharan Africa and Asia to distribute health-promoting products such as diarrhea treatments, safe delivery kits and water filters. We have recommended Living Goods since 2015, and have been consistently impressed with their strong evidence of impact and ability to scale their program to reach new people each year. An independently executed randomised trial that was carried out on their program was published in 2017, and estimates that their program causes a 27% reduction in child mortality. They are planning to release a new impact evaluation focused on scaling up their program later in 2019.
Living Goods' model of using community health promoters to sell health-promoting products allows them to provide for hard-to-access rural areas, and to scale very quickly. They are actively looking to expand their program to new countries, and are exploring opportunities in Nigeria, Ghana, Kenya, Uganda, Zambia, Myanmar, and India. Their market-driven model, and their innovation (for example, by using smartphone apps to improve diagnosis) make them a good cultural fit for OFTW and popular among our members. You can read more detail about Living Goods here.
Against Malaria Foundation
The Against Malaria Foundation (AMF) distributes long-lasting insecticide-treated mosquito nets in order to prevent malarial infection in 35 countries across Africa, Asia and South America. We have recommended AMF since our founding in 2014, and remain very enthusiastic about their program. There is a huge amount of evidence that bednets reduce malaria infections and therefore child mortality, and their distribution is likely largely responsible for the 47% reduction in mortality rates from malaria since 2000. AMF is an exceptionally well-run organisation: it is incredibly transparent, extremely efficient and has excellent management.
As with last year, concerns remain over the issue of insecticide resistance developing over time, which may reduce the effectiveness of bednets in preventing malaria. However, GiveWell notes that there is not high quality evidence on this issue, and concludes that although insecticide resistance may reduce the effectiveness of bednets, they are still a highly effective intervention. Moreover, AMF has begun distributing bednets treated with an alternative insecticide, is currently conducting a study on the topic to learn more and is working with partners to develop new kinds of insecticide treated nets (ITNs). We believe that the continued free distribution of bednets plays a crucial role in the reduction (and eventually elimination) of malaria, and AMF is the best charity that we are aware of undertaking this work. You can read more detail about AMF here.
Two charities that just missed out on the Top Picks portfolio
Project Healthy Children
We added Project Healthy Children (PHC) to our Top Picks for the first time last year. We were, and remain, very enthusiastic about the cost-effectiveness of their program and the innovative, sustainable model of their small-scale Sanku program: PHC expect to be independent of philanthropy conditional on receiving approximately $25 million over the next seven years. However, this year we placed more emphasis on the strength of evidence of impact and estimated cost effectiveness of a program, and relied more heavily on GiveWell's research. As a result, we think that HKI's vitamin A supplementation program scores more highly on our criteria than PHC and a better bet for donor dollars intending to reduce under-5 mortality. We will continue to monitor PHC’s progress, and as new evidence becomes available, we expect them to be strong contenders for our Top Picks again next year.
Schistosomiasis Control Initiative
Schistosomiasis Control Initiative (SCI) oversees and implements cost-effective deworming treatments to children through local school programs in 15 countries across sub-Saharan Africa. SCI has been in our overall portfolio since our inception, and was a Top Pick from 2014-2016 before being replaced in 2017. Our team was quite enthusiastic about SCI’s cost-effectiveness and its potential to improve lives on a broad scale, but we think that deworming programs score less highly on a few of our criteria than our Top Pick charities. In particular, the strength of evidence of the impact of deworming is debated by epidemiologists and economists, with GiveWell concluding that there is a small chance of a very large impact through an effect on later life incomes. These effects are not particularly direct or simple to explain, as the mechanism is believed to come through increased school attendance, which may increase productivity and wages in later life. As such, we decided not to add SCI as a Top Pick for 2019. We do expect SCI to be strong contenders for Top Picks consideration next year, and look forward to continuing to support them as part of our full portfolio.
Our 2019 partner selection team carried out excellent research and analysis -- including very high-quality work on our new cost-effectiveness component -- and selected a great list of charities for our Top Picks portfolio. We'd like to thank each of the members for their hard work over the last ~6 weeks:
Vanessa Feng, Columbia University
Ethan Hastings, Columbia University
Brandon Juvani, Columbia University
Pimnipa Kang, Columbia University Teachers College
Ivar Skaar, Concordia University
Luisa Marcucci, Georgetown University
Louma Kraytem, McGill University
Nicolle Stracar, Penn Law
Stefano Gunawan, University of Melbourne
Aaron Groff, UPenn
Kent Twardock, Wharton MBA
Joanna Zheng, Wharton MBA
Keshav Kundassery, Vanderbilt University
Janelle Giovenco, Villanova University
Kennan McClung, Columbia University
Kevin Monogue, UPenn
Rossa O'Keeffe-O'Donovan, University of Oxford