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Michelle Hutchinson

Giving What We Can aims to review its progress and plans every six months, and to publish the conclusions on the blog. This is the second of two blog posts, and contains a brief summary of our six month plan for the second half of 2013. In this period we are developing and trying out a system based around more personal contact and gradual involvement in Giving What We Can than we have previously employed.

Giving What We Can aims to move as much money as we can to the most effective charities we can find by growing our membership base of people giving at least 10% of their income to the most effective charities. Therefore, our key metric is the number of members we have. Over this period, we hope to gain sixty new members, which means increasing our average new member rate from eight per month to ten per month. The recent impact evaluation done on Giving What We Can estimated the return from gaining one member as being $17,000 to the most effective charities, counterfactually adjusted and time discounted (with a very large range).

During the coming period, Giving What We Can aims to focus primarily on outreach, and in particular on increasing the number of members it has, rather than on research. We will continue doing research into effective causes and charities, but cut back on more methodological research. We think we can have more impact working on outreach, given our progress over the last period.

Talking to members, we have found that individual conversation was crucial for convincing people of the importance of donating to the most effective charities, and doing so substantially. Following the media attention we received in December and January, membership growth was somewhat lower than we were expecting. Given that, we hypothesise that since joining Giving What We Can is a large commitment it would be more effective to have a lower bar to entry, and then encourage people to increase their giving more gradually. (

We are aiming to develop and try out a structured way to increase the number of people committed to giving to effective charities. Our current expectation for how that will work is the following. We would expect the first contact people have with us to be at an event that a representative of Giving What We Can speaks at, or through social media. We will then reach out to the people who show interest in effective giving, to answer their questions and chat with them more generally. We will aim to get people involved in a concrete way. For example, to sign up to 

. This allows people to become part of the community, to get into the habit of donating to effective charities, and hopefully to find that giving a proportion of their income is not the sacrifice it might appear to be. We will have regular contact with people signed up for 

, to support them and help them to maximise the good their donations do.

Our main aim in this period is to test out and improve the various parts of our outreach. During this development stage, our full-time team will remain small. The following describes how we intend to carry out the outreach. It is separated into its two main sections. They will be run by the Director of Communications, Steph Crampin, and the Director of Community, Ben Clifford, respectively.

The first stage of outreach is making people aware of Giving What We Can and effective giving, and attracting their interest. Over the coming period, our focus will be on generating interest among young professionals. We have a number of reasons for appealing to this audience in particular. They have immediate, measurable giving power, but also flexibility in their spending. In addition, a young professional vibe will appeal to students, while the reverse is not true. Therefore, this increases the breadth our appeal. To start off with, our geographic focus will be on London and Oxford.

We aim to generate interest by holding and speaking at events, as well as by producing interesting content for social media, in the form of blog posts and infographics. These channels are both personal, making clear that Giving What We Can is a group of real people who have made a commitment, and also highlighting that the idea of effective giving is relevant to the person reading or attending. In the past, this kind of personal contact seems to have been more effective than less personal but more widespread media.

We intend for these activities to drive traffic to the website. Therefore, the website needs to be user-friendly and modern, matching the expectations of young professionals audience. It also needs to have a clear path through it, encouraging people to get further involved if they are interested. To achieve these, we will improve the layout and design of the website. We will make it simpler, in order to make it more visually appealing and to create a clear pathway through it. We will implement personal dashboards, allowing people to track how much they have donated and how much good they have thereby done. (This is also important for impact tracking, as discussed in the previous blog post.)

In order to develop the system described above, we are investigating the most appropriate events to appeal to young professionals. This takes the form of research into the kinds of events which are held and attended in general among that demographic, and also trying out different types of events ourselves. At all these events, we distribute feedback forms in order to be able to work out to what extent the events interested and engaged people. The metrics we use to determine success in this area are number of events, number of people per event and number of people who provided us with contact details and reported their interest in future involvement.

Our surveys of both members and non-members indicated that personal conversation is very important when people are making decisions about significant donations. Therefore, the second part of our model is an emphasis on engaging people in dialogue. Our aim is to start conversations with people who are interested in donating to effective charities but unsure how to act on that interest. For example, people who have come to our events and expressed an interest, or who are discussing effective giving on social media. We would begin these conversations via email or messaging, and provide the option of continuing them over the phone or in person.

In conversations, we will aim to answer any questions and concerns people may have. We will also suggest signing up to 

. Many of our members reported expecting it to be a sacrifice to donate 10% of their salary, but then not finding it so when they did it. That indicates it would be beneficial for people to set themselves a target for a set time, allowing them to discover that giving a percentage of their income won’t affect their life as much as they expected.

Again, our aim in this period is to try to find out what works. We will send out a certain number of messages to various different groups of people who have shown interest in effective charities, to see which are receptive. We intend to find out how well-received and how effective our 

 system is. It has been an option on the website for a while, but it has not previously been strongly promoted. We are therefore starting by talking to the people who have already signed up to it, to see how they have found it. We are also trying out promoting it at events, to see if that is successful. We keep track of the number of messages sent out and number of conversations had, in order to compare those against the number of people who sign up to Try Giving and the number of people who take the 10% pledge.

As described in the previous blog post, we have found that it is important to provide personal discussion and support, as well as a gradual way to increase levels of giving. Therefore, in this period we are developing and testing a method of outreach which incorporates these lessons. In particular, we are reaching out to people face to face and through individual messages, we are encouraging people to join 

, and we are finding the best ways to follow up on these.

Giving What We Can's Plans

Carolina Flores

The G8 contribution to governance is rated as good. According to the Ibrahim Index on African Governance, between 2006 and 2011, 70% of African countries improved overall governance indicators, despite uneven performance. Fighting corruption and ensuring that democratic processes are clear tackles some of the root causes of poverty and provides an enabling environment for economic growth, and for the development of fairer and more inclusive societies. As the G8 has the potential to offer expertise and guidance in governance, this is an important area of intervention.

the African Peer Review Mechanism (APRM),

the Extractive Industries Transparency Initiative (EITI).

The G8 provide respectively 70% and 60% of the funding for each of these projects. The Peer Review Mechanism promotes democratic processes, citizens' rights, and the rule of law in 30 out of 54 African countries. Though the amount spent by G8 countries on government and civil society sectors has increased from to between 2007 and 2011, the gross disbursement for anti-corruption sectors has decreased significantly.

The Extractive Industries Transparency Initiative involves companies, who publish what they pay for, governments, who publish what they receive, and civil society, to whom they are held accountable. This allows for checking where revenues are going astray. As many poor countries have very good resources but don't explore them effectively or sustainably due to corruption and poor management, this is of critical importance.

Some problems which need to be acted on are conflict resources (e.g. 'blood diamonds') and the enforcement of foreign bribery laws. The Overseas Development Office disagrees with the rating based on the fact that all the commitments are based on a narrow transparency agenda and not on broader development goals.

The report evaluates G8 work on peace and security as good, claiming that there has been excellent progress on the regional centres of excellence for peace support, on transport and on logistics. G8 members have donated over 60% of the funding for the peace and security sector. The pledge to train and equip 75 thousand troops for peace support operations was exceeded. G8 support has contributed to successful peacekeeping missions in African countries such as Mali, Somalia, and the Central African Republic. This has resulted in the African Union, African countries and regional organisations becoming able to lead the mediation and resolution of conflicts independently. There has also been a continuous investment on Disarmament, Demobilisation and Reintegration is countries in post conflict situations.

Maritime security has improved. The G8 has successfully supported efforts to:

build the capacity of African states to cooperate on this domain,

construct information-sharing mechanisms.

The Overseas Development Office also disagrees with the rating in this area, considering that the report is very unclear and uses inadequate benchmarking.

G8: KEEPING PROMISES?-Governance, Peace and Security

Rob Wiblin

, a project of the World Health Organization to encourage cost-effectiveness via both research and communication with policy-makers. Rob Wiblin and I sat down to interview Jeremy and learn about WHO-CHOICE. Jeremy's main points were:

WHO-CHOICE is about giving countries the tools needed to establish priorities in the health sector and make good, high-impact-for-money policy.

The landscape of global public health is starting to shift to a time where, more and more, "best buys" and "magic-bullet solutions" such as vaccines are fully funded. This is exciting because it means people are getting important treatments, but it is also daunting because the next generation of interventions will involve more complex technical work and clearer communication with the public.

If you have a strong economics background, are quantitatively minded, and also have interests in epidemiology, biostatistics, or computer programming, a career at WHO-CHOICE or a similar organization could be rewarding and impactful.

WHO-CHOICE is a program in the World Health Organization that helps countries decide priorities and figure out what they should be doing based on considerations of impact and cost-effectiveness. While other tools might be available to them to tell them how to do things, WHO-CHOICE is unique in this focus on establishing priorities.

RW and PH: What's your methodology for determining cost-effectiveness?

JL: Well, first I'd like to clarify that we don't look just at interventions that are considered cost-effective, but we try to include any activities that may be considered policy-relevant: either because they're highly cost-effective or the opposite. What we do is we get a list of things we'd like to look at that include best practices developed by WHO programmes and then add to it a list of things we feel we'd like to analyze - usually things that have tremendous upside if they turn out right, for example vaccines. We then begin to solicit the opinions of experts.

This kind of analysis usually involves epidemiological and clinical evidence of impact, oriented by clinical trials. We want to know what the impact on the population of interest is when you give a certain population a certain technology. What is the impact on a disease parameter that is of interest to us? Does it reduce fatality rates/disease rates/ remission rates? This gives our estimate of effectiveness. For cost, we add the costs of administration, training, and programme elements to the cost of operations as determined from best practice guidelines.

Right now it's exciting because WHO-CHOICE is working with a number of world-class disease modellers that are perhaps the best in the world. It could be a real coup to bring all this expertise together and demonstrate with the best available scientific evidence that there's a couple of interventions that are the best buys in the health sector.

What has been your most interesting or significant results so far?

It's hard to cherry-pick outstanding results. WHO-CHOICE isn't trying to astound people, but provide basic information about bread-and-butter interventions and orient people toward more effective interventions. However, there are a number of cases from my personal work that do stand out to me. First, we found that comprehensive cancer care that involves a full spectrum of prevention, detection, and treatment actually can be cost-effective. In fact, packaging these interventions together in one programme is as nearly cost-effective as just the most cost-effective part of the group. This is valuable information for considering programmes because ethical, medical, and social considerations often prevent splitting up the spectrum of care, so its good to have an economic argument that confirms this practice.

Another example is that in 2005, we published an analysis that implicitly determined the price at which an HPV vaccine could be sold and compete with current screening and prevention programmes in terms of cost effectiveness. It subsequently turned out that the price negotiated by the procurement agencies with the vaccine manufacturers for the HPV vaccine - a much lower price than the prevailing market price - was surprisingly close to the one suggested by WHO-led research. This leads me to suspect that we had an impact on these discussions, though it's difficult to know for sure and many other factors could equally have pointed in the same direction.

What have you found that has changed over the past ten years?

Lots has changed with technological and operational progress. For example, HIV treatment has changed a lot - it previously was all about school-based education, condom distribution, and reaching out to high-risk groups. But now we have cheap and affordable treatment programmes, and this is one example where treatment becomes prevention because if you get the viral load of HIV-positive people down low enough, through effective treatment, they cease to be as infective.

Malaria is another place where the game has changed a lot. We've seen a massive increase in the use of bed nets with both high coverage (the number of households with bednets) and high usage (the number of people actually sleeping under bednets). Ten years ago, this coverage was basically zero in most areas. Furthermore, there's a malaria vaccine coming out that's currently in phase three clinical trials.

However, we're shifting away from an era of "magic bullets", i.e. the model of disease elimination by single-dose vaccines conferring lifelong immunity. The HPV vaccine and the malaria vaccine won't provide lifelong immunity. Much of the 'low-hanging fruit' and quick fixes are gone, so the easy victories in global public health might be over. We seem to be heading now to the next frontier of progress, one that involves more complex methods and doesn't have any magic bullets. But the huge progress that is possible to make at this next stage, in cancers and cardiovascular disease and a whole host of non-communicable diseases, not to mention the unfinished battle against HIV/AIDS, TB and Malaria, this still could be an exciting message if it were conveyed effectively.

Malaria is of particular interest to Giving What We Can because we promote the Against Malaria Foundation so highly. But why does malaria treatment need to be promoted so heavily? Is there a funding gap?

With the global financial crisis, there has been more competition for resources and international donor funds for malaria have stabilized and slightly tailed off. Furthermore, trends and fashions in global health have moved on, and malaria is seen as maybe having had its day in the sun so it needs to move over and make room for other challenges.

Billionaires and sometimes also donor agencies like funding magic bullets because they are game changers - it's a nice thing to say you've done. But we need to change the paradigm from this kind of thinking to a more science-based, rationality-based, understandable, effectively communicated paradigm. We, as researchers, need to get our heads out of our books and tools and communicate these messages more effectively to decision-makers. A disease shouldn't need a compelling spokesperson, but rather be defended by scientific rationale with strong evidentiary consensus.

How did you end up working at WHO-CHOICE?

I actually landed at WHO-CHOICE by chance. I initially was studying for a masters in pure economics, but I didn't feel at home in the economics field. I was interested in working somewhere where I could apply my skills and was in the DC area with lots of medical groups, so I found it natural to apply my quantitative interests and skills as a technical writer in medicine, writing up case histories as research articles. I then came to work at WHO as an editor in the office of publications. This was in 1995 when WHO had a large Office of Publications with 5 technical editors, and they were with one exception all trained as scientists.

Over time though, WHO switched from a doctor-focused organization dominated by a medicalized paradigm of thinking to a more broadly policy-focused group, looking more critically and analytically at economics, epidemiology and statistics. I was interested in the idea that the social sciences and related fields have a key role, so made a transfer to work in that area. I was then immediately placed with other economists, doing what I'm doing now. I then did a PhD at a leading Dutch university and major WHO collaborator. In the Netherlands, a doctorate is a pure research degree, so I could do it essentially on the basis of publications, mostly just by writing up my WHO work.

What advice would you offer other people who want to work in this area?

If someone were to plan for a career at WHO-CHOICE, they should have an economics background and be quantitatively minded. It also would be good if they could demonstrate interest in the public health sphere, epidemiology, biostatistics, or maybe computer programming. It's good to have a PhD, but you also need real world experience. Typically people are public health specialists, but not necessarily someone with a medical degree as first degree.

If a person has all these things, it is easy to make a case for hiring them. Having said that, WHO is currently hiring externally only on a limited basis because of funding shortfalls and internal reorganization.

What are the benefits to working at WHO-CHOICE?

It's very motivating to be doing something you consider important. I just think I couldn't be as happy in the private sector, especially not after having tasted the excitement and value of the WHO. However you may criticise it as a 'bureaucracy', the WHO has great people doing great work, some of the best I've seen, and for the right kind of person that combination allows you to benefit personally from the exposure.

Interview with the World Health Organisation

Progress in education has been rated as satisfactory. The main focus has been funding to the Global Partnership for Education (GPE), which provides funding and technical support to help low income countries implement sound education plans. In 2011 and 2012, G8 members provided 49% of the contributions to this partnership. There has been some progress. GPE support has helped:

enrol nearly 23 million more children into school,

However, the report acknowledges that large funding gaps remain. As at least 250 million children cannot read or count, it is clear that the G8 has not been doing enough for education. According to the Overseas Development Office, the target the G8 sets for education is very unambitious: it represents only 2% of the education for all funding gap, while the G8 accounts for 70% of all aid.

G8: KEEPING PROMISES?-Education

The report also considers that progress in food security was good. This is based mainly on the L'Aquila Food Security Initiative (AFSI), and on the New Alliance for Food Security and Nutrition. AFSI is aimed at supporting agriculture and food security initiatives on a large scale, and includes commitments to country ownership, global coordination, transparency and accountability. Taking into account the dimension of the problem of hunger - 870 million people are unable to get enough food to meet daily energy needs, and around 1 billion people suffer from micronutrient deficiency - $22.2 billion was pledged for the period between 2009 and 2012. But, though the entire amount has been committed, only $16.4 billion was disbursed by April 2013.

The New Alliance - launched in 2012 - is a commitment to lift 50 million people in sub-Saharan Africa out of poverty in the next ten years through:

accelerating responsible investment in African agriculture,

Six African partner countries have joined. This initiative has a strong focus on private sector investment, with commitments from more than 80 companies having been received already. As remaining challenges, the report mentions integration of gender objectives and more measure of the impact of programmes on smallholder farmers. The report has come under strong criticism in this area. According to Oxfam, the non-delivery of a quarter of the funds pledged to the L'Aquila Food Security Initiative, and the lack of progress on public on public investment in agriculture show a lack of commitment to ending hunger. Furthermore, the New Alliance, which focuses solely on private investment, can hardly replace public funding, and its focus on corporate-led agriculture over publicly-funded small, farmer-led initiatives risks undermining poor people's land rights and access to natural resources.

G8: KEEPING PROMISES?-Food Security

Based on the progress on maintaining political momentum and increasing funding for this sector, the rating attributed to this area is good. In 2011, the G8 contributed $4.7 billion to water and sanitation programmes and increased the number of partnerships with developing countries. This represents a 16% increase in aid compared to 2010, and ¾ of the total OECD donations for this type on intervention.

But big problems remain to be solved, and much needs to be done for the 2.5 billion people-nearly half the population in developing regions, and over a third of the world's population - who do not have access to improved sanitation facilities, and in particular for the 1.1 billion (15% of the global population) who have no sanitation facilities at all.

The Overseas Development Institute claims that the poor progress towards the Millennium Development Goal shows that the G8 have paid little attention to this area. DevEx stresses that the majority of the money in this area seems to go into building large infrastructure, and not into basic systems; and on countries which are political allies and strategic partners of the G8, instead of on the countries in the most need.

G8: KEEPING PROMISES?-Water and Sanitation 

Stephanie Crampin

On Tuesday 22nd October 2012, Giving What We can researchers Rob Wiblin (CEO of the Centre for Effective Altruism) and Chloe Kane (Giving What We Can researcher) took part in a Skype conversation with Alix Zwane (Executive Director of Evidence Action: an organisation pioneering 

, as well as Deworm the World, another of our recommended charities), and Karen Levy (Evidence Action’s Regional Director). You can see the highlights of the conversation below.

Dispensers for Safe Water is a charity that Chloe and the research team investigated as part of a larger project, the report of which can be read 

. They found that the new programme looked very promising, and of a comparable level of effectiveness to Against Malaria Foundation, and our other top charities. We took part in this Skype call to find out more about what Dispensers for Safe Water do and to answer questions such as how much funding they need, what they measure and why when recording their success, and more general information about why the dispensers programme is favourable to other WASH-related interventions such as promoting handwashing.

We were impressed by what we heard, and learned a lot, including the following key facts: Dispensers for Safe Water has a goal of "reaching twenty five million people by the end of 2018. The intention of the programme is to become sustainable from carbon revenue by this time.” This is because they are "taking advantage of the increased cost-effectiveness that comes from operating at scale. So every additional resource has more and more leverage, towards that goal." They track that the dispensers working, and full of chlorine. While lacking specific “health evidence on dispensers, they have health evidence on chlorine, and are currently measuring adoption. The two of those things together give meaningful information” which is used to calculate the programme’s effectiveness, and which has so far provided very promising results.

Evidence Action is a new organisation, and expects to have an 

 and donations system by early November 2013. Giving What We Can will report further on their work, and expects GiveWell to do so as well, so look out for more details!

You can download a full transcript of the interview 

Video interview with Evidence-Action

Christopher Hogg

Giving What We Can’s mission statement, staring at me from the wall of our office as I write this, is to “move money to the world’s most effective charities”. Working out what these are though can be tricky, as us at the research team have found out over the past week in delving into the literature of schemes involving 

Handwashing promotion programs (teaching people the importance of using soap properly) compare very favourably to our recommended interventions (in terms of $/

There is not much data relating to the success of WASH schemes, and the methodology is weak, hence at present we will not recommend charities to the same extent as our 

, soap manufacturers are in a position, unique to this sector, to fund handwashing campaigns in a manner that benefits both themselves (in profits) and society (in increasing health).

Washing your hands can make you both happy and healthy.

In most instances diarrhoea is caused by consuming bacterial contaminants, often through fingers or food. Washing hands 

 at important periods of the day (such as after defecation and before eating) removes these contaminants from the surface of the skin, cutting the risk of diarrhoeal disease by 40-50% (Curtis and Cairncross, 2003).

However, rates of handwashing with soap (HWWS) are low. This is not caused by a lack of (clean) water, or indeed a lack of soap. Rather, the soap available is used to wash clothes and not hands (Aunger et al, 2010). Therefore what is required prevent the disease are education schemes that encourage behavioural and attitude changes towards soap.

Tip-toeing into the Pool of Private Public Partnerships...

Traditionally donor funded NGO programmes, such as Charity Water and Water Aid, provide these schemes, often in combination with infrastructural improvements. The (too) few studies that exist on standalone schemes have been shown in 

I wish to stress that private companies which have both a financial and PR incentive, can implement schemes which have the same, if not better results. Unilever is one of these companies, whose Lifebuoy soap brand has the potential to be well publicised and used across the world.

It worked in the past. Could similar adverts eradicate diarrhea in the developing world?

The Lifebuoy soap brand began in Victorian England and is known in North America for its adverts which 

. Its focus is now on the developing world where it is one of Unilever’s top selling products, bought from markets in Ghana to 

, the brand states its main aim: “to change the hygiene behaviour of one billion consumers across Asia, Africa and Latin America, by promoting the benefits of handwashing with soap at key occasions”. At present, no NGO lists this as a single aim. Though we are cautious, given that too often big businesses say one thing, but do another (for example 

Coca Cola’ climate change campaign in contradiction to its relation

), there are two reasons to be optimistic about their strategies in relation to the wider WASH sector.

First, their focus on cost-effectiveness. Giving What We Can’s take on the charity sector is to treat donations in a similar way to business investment, a 

 but which we wholeheartedly defend. Just like its advertising campaigns, the promotion schemes are designed to get the largest impact for the money the company invests in. It makes sense in a competitive market. When Unilever saw that by working with governments, local NGOs and schools to “train the trainers”, it saved the company funds but delivered equal results in Indonesia, it sought to extend the scheme to other countries.

Second, Lifebuoy appears to collect good evidence on the impact of its schemes. This kind of self evaluation is what we want to see 

. The Lifebuoy brand has conducted its own Randomised Control Trial in Mumbai, keeps sales data on its soaps through consumer surveys, and are even developing three dimensional sensors in some of their soaps to monitor their use, a method which, due to its unobtrusive nature, is perhaps more accurate than the current norm of participant observation (Vindigni et al, 2011).

It will be good to see more transparency in Unilever’s data. Their website does not show, or may not have, these evidence reports mentioned above. If Giving What We Can are going to support schemes such as this, being able to see the data and analysing it for ourselves is crucial. Perhaps this is where the private sector collides with the public sector, as companies are notoriously secretive about releasing knowledge which may provide a competitor a route into the market.

We would also like to see the company investing more money on these schemes. Unilever funds are diverted away from the Lifebuoy schemes to other brands, which add less health benefits to the world. There is a growing market for soap in Africa and Asia, and potential for lots of money to be made, although the risks at present seem to be too great for the soap companies to invest.

Money for (new) soap? Large companies must be persuaded that there is large enough demand for soap in developing countries such as India to make investment worthwhile.

An advocacy organisation could therefore be needed who can show and persuade private companies to divert funds to the developing world. Currently I do not know of any group which does this, but please 

 or add a comment below. There is an urgent need for more hygiene promotion schemes, and with the funds, knowledge and incentive of private companies, these can be successfully run without donations. Hopefully I have shown you that this change can be realistically achieved surprisingly soon. Part of the solution of moving money to the world’s most effective charities may well be putting more power to the world’s most effective companies.

Aunger et al, 2010: “Three kinds of psychological determinants for hand-washing behaviour in Kenya” Social Science & Medicine 70 (pp 383-391).

Curtis and Cairncross, 2003: Effect of washing hands with soap on diarrhea risk in the community: a systematic review. Lancet Infect Dis 3(5): 275–81.

DCP2 Report. Cairncross, Valdmanis (2006) “Water supply, sanitation, and hygiene promotion” In: Disease Control Priorities in Developing Countries (2nd Edition). New York: Oxford University Press. 771-792

DfID, 2013: “Water, Sanitation and Hygiene Evidence paper” Department for International Development May 2013.