Recommended Charities

What Is AMF?

Against Malaria Foundation was founded in 2005 and focuses solely on distributing long-lasting insecticide-treated mosquito nets in order to prevent malarial infection in 35 countries across Africa, Asia and South America.

AMF receives and reviews proposals from charities that need bed nets; when a proposal is approved it purchases and ships nets for the charity. It then publishes pre-distribution and post-distribution reports on its website.

Why choose AMF?

Delivering insecticide-treated nets is a proven program with high cost-effectiveness and a strong track record. Over 1 million people die of malaria each year, insecticide-treated nets can prevent these deaths at about $2300 per person, and it only costs about $5 per net delivered.2 AMF has unusually low costs and unusually strong monitoring and evaluation of their programs.

What is SCI?

SCI was founded in 2002 and was originally focused on the control of schistosomiasis (also knows as bilharzia, bilharziosis or snail fever). Since then it has expanded its program in order to treat the seven most prevalent neglected tropical diseases (NTDs). These are a collection of serious diseases that are cheap to treat or prevent, but have not attracted the attention of donors and are thus chronically underfunded. Six of the seven diseases are caused by parasitic worms that live inside the body and cause symptoms ranging from general malaise through to kidney damage, intestinal damage, disfiguration of the limbs, blindness, and death.

Why choose SCI?

SCI focus on the treatment of NTDs through the use of rapid impact packages, a combination package of four or five drugs. Generally, this involves supplying schools with the drugs, and training teachers in how to administer them. This is so cheap and effective that it has often been called the 'best buy in public health'. SCI currently works in Burkina Faso, Burundi, Mali, Niger, Rwanda, Tanzania and Uganda. With additional funding, they aim to expand coverage to other areas in Africa.

There are comparatively few charities that incorporate treatment of NTDs into their programs and even when they do, it is often just as a small part of their operations. For example, Helen Keller International , and the Carter Center both operate programs that focus on NTDs, but they also run many other programs, some of which are likely to be considerably less cost-effective.

There are only two donor-fundable charities that focus exclusively on NTDs: SCI and Deworm the World .

Independently of how good the cause is, the SCI website could be a model for other charities: it has significant amounts of detailed information, on the charity itself, how they are funded, as well as detailed descriptions of their programs in different countries. We were also able to have a personal meeting with Professor Alan Fenwick, the director of SCI. Some of the reasons that we recommend SCI for this intervention-type include:

• They focus solely on the developing world, and on administering Rapid Impact Packages.
• They undertake impact-assessments of the work that they do, and publish their results on the web. This is very rare among charities, and is to be encouraged: moreover, it suggests that they have good knowledge, learned from experience, about the best ways to implement programs.
• The people who work there are experts in their field, leading some of the academic research on neglected tropical diseases.

What is Deworm the World?

Deworm the World was founded as an initiative of the Young Global Leaders at the 2007 World Economic Forum, after an influential study by Michael Kremer and Edward Miguel demonstrated the remarkable educational benefits of deworming.3 They focus on the four neglected tropical diseases: schistosomiasis and the three soil-transmitted helminths. Deworm the World's primary activity is to provide substantial technical assistance to help Kenya and India's governments implement deworming programs. They also encourage governments in South America, Asia and Africa to adopt deworming programs and facilitate the provision of donated medications and technical assistance. They work in over 26 countries across the world.

Why choose Deworm the World?

There are comparatively few charities that incorporate treatment of NTDs into their programs and even when they do, it is often just as a small part of their operations. For example, Helen Keller International , and the Carter Center both operate programs that focus on NTDs, but they also run many other programs, some of which are likely to be considerably less cost-effective.

There are only two donor-fundable charities that focus exclusively on NTDs: SCI and Deworm the World. We highly recommend both of these charities.

Some major considerations relevant to whether to recommend donating to Deworm the World (both for and against) include the following:

• They focus solely on the developing world, and on the four NTDs that can be treated most cost-effectively.
• They have strong connections to the Poverty Action Lab , a research institute known for its dedication to the rigorous evaluation of aid programs.
• They have been assessed by Innovations for Poverty Action (another group focused on proving cost-effectiveness) and are considered to be one of their 'Proven Impact' charities.
• Deworm the World may have a larger potential upside than SCI, since (i) they focus primarily on deworming children and (ii) they provide technical assistance for deworming programs, where governments, rather than the donor, bears most of the cost of treatment. However, it is hard to be confident that these governments would not have done deworming programs without the influence of Deworm the World

What is Project Healthy Children?

Project Healthy Children sends experts to low-income countries, from now on exclusively in sub-Saharan Africa, to hasten and increase the quality of mandatory micronutrient fortification of staple foods such as wheat and maize flour, sugar and oil. They place advisors within recipient governments to offer encouragement, coordination across agencies and technical assistance, depending on what is required to push forward mandatory fortification standards. A significant fraction of people in recipient countries experience worse health due to insufficient intake of iron, vitamin A, iodine, zinc and folic acid. These deficiencies cause the greatest harm in children and pregnant mothers. Ensuring that commonly-consumed foods contain these nutrients should improve population health. It is the most recent of our recommendations, and also the most tentative. Read more about their approach, and food fortification.

Why give to Project Healthy Children?

• They are promoting an approach - micronutrient fortification of staple foods  - that costs very little per person reached, typically under $0.30 per year for ongoing fortification with the most important nutrients. Micronutrient intake is regarded as a top priority health issue for the developing world by the Copenhagen Consensus and the World Health Organisation.
• Increased micronutrient consumption is highly likely to reduce the severity of deficiency.
• They have operated, and probably will continue to operate, in countries with high levels of micronutrient deficiency.
• They operate on a tight budget. A single member of staff lives in each country for 3-6 years and is paid a modest income. This individual, with support from two central staff members in the US, can run a full country program to completion for only a few hundred thousand US dollars.
• If they achieved a comprehensive national mandatory fortification scheme in any given country, this would affect millions of people. The cost to PHC per person reached with fortified foods per year would be in the order of 1 cent.
• We have spoken with four contacts in affected countries who have had dealings with PHC. Their names were provided by a technical fortification expert recommended by PHC. All had a positive view of the competence of PHC staff, felt they were filling a useful gap not filled by other organisations, and were respected and appreciated by recipient governments.
• We have heard that some of the countries PHC has operated in, or are considering opening new offices is, are not yet making progress on food fortification.
• Our qualitative impression from dealing with them is one of overall competence.
• They have described learning from mistakes made in Honduras in the early days of the organisation, and have dramatically shifted approach in response.
• They claim to put a lot of research into deciding in which countries to open offices, weighing up the chances of success and the number of people assisted, among other characteristics. Documents they have sent us appear to back this up.
• As a result of all of the above, their approach could generate big health gains for each dollar they spend. A ‘naive’ cost effectiveness calculation might be as follow:
  • $450,000 for a country program
  • The country has a population of 10 million
  • They have a one in three probability of the program successfully leading to comprehensive iron fortification to combat anemia
  • If they succeed, they will bring forward the initiation of fortification by six years
  • Iron fortification would on average improve health by 0.3% for each person in the country (source), considering both the level of harm caused by anaemia and its prevalence.
  • This leads to an estimated  ~$7 per DALY averted, or ~140 DALYs for each $1000. If this were correct, it would be a higher expected impact than AMF or SCI, and obviously be extremely exciting.
  • While this is a plausible calculation, I expect that it will turn out to be over-optimistic. Experience shows that the more you learn about an intervention the more likely it is to ‘regress to the mean’, and be less impressive than you initially thought. The question is how much we should adjust back estimates such as this to account for our remaining uncertainty. This is in large part a judgement call, which is why we are putting forward this information so that donors can make their own judgement.

What are your most significant remaining questions about PHC?

• We have not yet scrutinised the literature on how much ill-health is caused by anaemia. GiveWell have suggested that the evidence on this used by the WHO and other groups may not be comprehensive or reliable.
• There are conflicting reports regarding the impact of vitamin A and zinc deficiencies on child health. These may be subject to the ‘decline effect’ where high initial estimates are not replicated in future research. For instance, these two papers - which have been contested - did not replicate the impacts of previous research. Furthermore, progress has been made on vitamin A supplementation and salt iodisation in recent years, so rates of deficiencies may not be as high today as in the past.
• We do not have a clear record of their apparent impact across all of the countries in which they have operated. As such, the positive stories we have heard in Rwanda and Malawi may not be representative. We expect to receive further information about this issue in the near future.
• Larger organisations such as UNICEF, USAID, Hellen Keller and GAIN also work on micronutrient nutrition. Previous successes that appear to be caused by PHC may be in part due to the work of other organisations. However, I would note that PHC has given compelling responses to questions about their overlap with other groups.
  • They claim that UNICEF does not do their style of fortification policy work.
  • USAID provides funding for programs, but also does not do work on fortification policy with governments.
  • GAIN and Helen Keller run more similar projects, but PHC is careful not to open offices where they already have matters covered. GAIN usually focusses on the largest countries, which creates a niche for PHC in providing experts for small, challenging or otherwise neglected countries in need of fortification.
  • Note that even where a country would otherwise achieve fortification, PHC can still have impact by increasing the number of nutrients used, the share of the population covered, and the enforcement of the policy.
  • We hope to speak with representatives from these organisations in the near future to confirm all of these claims.