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Stephanie Crampin

Stop the myth today

Myth: We give money to Africa and nothing changes.

This is just one of the false and dangerous ideas that Bill Gates sets out to tackle in his latest campaign against poverty. 

 of the Bill and Melinda Gates Foundation for 2014 sets out three common misconceptions about government aid, and presents arguments to show that they are mistaken. Not only that, these myths actively cause harm by discouraging people from donating, and thereby preventing poor people from making the progress needed to lift themselves out of poverty.

You can see the full series of Gates’ videos on our 

Gates tackles the first myth that ‘poor countries are doomed to stay poor’, by demonstrating that in fact, “the world is better than it has ever been”. In the last fifty years, there has been a significant improvement in infant mortality rates in many countries, and a huge improvement in welfare in countries such as China and Mexico that have moved from ‘developing’ into the ‘middle income’ bracket. The idea that we can’t do anything to help is harmful as it prevents us from investing our own funds in interventions that will greatly improve the lives of many people.

It’s important to combat these myths and, once the facts are in place, to think carefully about individual giving, and about where you personally can have the most impact. This is because it’s not just the Bill and Melinda Gates Foundation that can make a huge difference to people’s lives; by giving as little as 10% of your own income, you can dramatically and realistically improve the lives of thousands of people. Put plainly, the facts are:

We are spending less on aid than we think, and less than we think we should.

We can each make a great difference individually, and together we can end extreme poverty in this lifetime.

Corruption only makes it more important to give to the best charities.

We can help people in developing countries to help themselves, rather than depend on assistance.

The best health interventions are likely to reduce the problem of overpopulation rather than making it worse.

The best way to avoid the potential pitfalls of aid is to carefully consider which charity to give to. Find out which charities can best use your donation on our 

Peter Hurford

'Giving Games' and Giving What We Can: an Interview with Jon Behar

Jon Behar left a lucrative job at an investment management firm to pursue dreams of running philanthropic projects. Behar runs a startup called 

 which uses a model called "Giving Games". These games are run at colleges and other areas around the world and engage people in discussions about effective giving.

Rob Wiblin and I sat down to interview Jon Behar and learn more about Giving Games. Here's what we learned:

"Giving Games" are a way to get people engaged in discussing effective philanthropy by asking them to chose where to give a pot of money from two pre-selected choices;

These games can be used to experimentally test why people don't give more effectively and find ways to encourage them to give more and give better;

Donating to Giving Games could be an option to leverage an existing donation to a 

Our mission is simple and consistent with the mission of "Giving What We Can" - encouraging people to both give more generously and more effectively than they otherwise would. I aim to accomplish this by running "Giving Games", which is just a very simple way to engage people in conversations about effective giving. We gather people together and have a conversation about which charity they would like to give to from a few pre-selected options. The group is also given real funds to make a real donation, which gives participants a sense of ownership over the decision and also engages them in a conversation that encourages them to take a strategic approach to giving.

So far we've run about 25 Giving Games, most of which have taken place at colleges, though several were online and in other settings.

I see the model as a way to experimentally test why people fail to give effectively and see if we can find any methods to get them onto giving effectively. A Path That's Clear can test these things as hypotheses. Maybe people are afraid of putting up their own money? Well A Path That's Clear provides the money needed to make the decision. Maybe people don't have easy access to high-quality information on effective charities? A Path That's Clear can provide that information. Maybe people just think that "charity begins at home"? We can test that by running a Giving Game with a local non-profit and a non-profit working in the developing world.

What are some of the results of the Giving Games?

Right now, we're looking at the decisions players make to see if they actually give to more effective charities and see if they are thinking more about strategic giving. We do this through post-game surveys that ask players about their experiences and then also by getting feedback from the moderator of the Game.

The actual results of the Games are encouraging - in nearly all the games, the players have selected the more effective charity. But more importantly, players are indicating that their experience in the Game has changed how they think about philanthropy; they resolve to do more research and think about impact the next time they personally give.

We've also taken audio recordings of the Giving Games so I can listen in and the conversation flows freely. One of the driving factors for this is that we're not just getting a random group together, but rather a group with lots of existing social ties (club, sports team, dorm room floor, class) that are already comfortable with each other.

How has the model changed, if at all, in response to these trials?

 against, not another charity, but rather the option of letting players keep the money themselves. In this game, people chose AMF, but this decision was probably too obvious and the discussion was not as deep as we would have hoped. Once we decided to make the conversation about two different effective charities or about testing critical notions like "giving begins at home", we found the conversations started really going somewhere.

What's your plan for scaling this up? Who are you going to target? And what is your plan for making this sustainable?

In the long-term, I'd like to institutionalize this process at as many schools, universities, and workplaces as I can, though our main focus is on colleges and universities. I want to embed this conversation about how one can do the most good and make this part of the college experience.

We ran a Giving Game at Brandeis University with 25 students as part of their orientation process. That could serve as a pilot to hopefully making the Giving Game or this type of discussion part of the welcoming process of all students. I have started to very recently partner with The 

 to run Giving Games under their brand. I also have a few other leads and I'm optimistic we'd be able to get other donors out there. Lastly, I also intend to run an experiment soon with some economists at George Mason University who study giving behaviour. We'll do a Giving Game in a laboratory setting without a social component, because the social component makes it very difficult to control for variables. We're going to try and test some of the really basic assumptions of the model.

What's nice about the model is that anyone can run a Giving Game. Any donor who wants to leverage their giving by running a Giving Game can do so. I want to encourage as many people as possible to take the idea and run with it.

How do you intend to pay this? Including costs of running?

Initially I'd been funding this out of pocket, but I'm excited about this partnership with The Life You Can Save which opens up a lot more resources. I think that the bulk of the cost will be covered by donations, especially once we get up to scale. Luckily, I think there are a lot of people who would potentially donate to Giving Games. Anyone who is already thinking of donating to a GiveWell top charity can accomplish the exact same donation while also funding us, basically for free, leveraging their impact.

Does the amount of money on the table affect things?

Not much. It does need to meet some sort of threshold to get people interested, usually in the $50 to $250 range. However, in an activities fair, for example, even asking people to decide about a dollar was enough to get them to engage.

What would cause you to give up with Giving Games? Do you have an exit strategy?

Ultimately, the hope is that we'll get people to give more and give better. I need to trust the data to see if we actually do that. If we do five experiments and they all indicate that Giving Games turn people into, say, selfish misanthropic people, I need to respect that. I want to be very conscious as we're setting up the impact measuring systems to measure both the potential positive impacts and the potential negative impacts as well. Therefore, I think we need to get better at systematically measuring our actual impact. The surveys we have in place are nice, but then you have to trust self-reports, and our surveys aren't long-term enough. The logistics here are difficult because we're talking about people in their teens and twenties and we care about how people will give over the next 60+ years.

Something I'd like to do is to get some actual donation tracking set-up, but this introduces privacy concerns. The bottom line is that we're going to have to come up with clever ways to get real-time windows into those long-term dynamics. I think this will be a continual process of ramping up and it will really be ongoing, basically have already been started in the past. The experiment at George Mason that I mentioned earlier will be a big step in the right direction and hopefully even this coming academic year we'll have significantly more ability to measure what we're doing.

What do you think is the greatest weakness of the approach?

I think there's a potential for crowding out. There is the problem of people giving better but giving less, which is a consistent finding in the existing literature. My gut feeling is that it is not going to be an issue and crowding out will be quite minimal because you're concerned about crowding out not in the immediate aftermath, but rather over the participants' lifetimes. Given that most participants have a positive reaction to the game, I don't expect it to be a big issue, but it merits closer investigation and hopefully the George Mason experiment will shed light on that.

Have you had any success getting people to become Giving What We Can members or 

we run Giving Games through Giving What We Can chapters

 where the chapter reaches out to random groups of students and asks them to participate. Generally, we've found that this does get those random people interested in participating in their local GWWC Chapter. But we don't have any evidence further than that and we don't know anyone who's taken the 

Can other people get involved in "A Path That's Clear"? If so, how?

. We love to get inquiries and we're eager to talk to folks and get people as involved as we can.

Roxanne Heston

What Typhoon Haiyan can teach us about compassion

__A couple of months ago, Typhoon Haiyan devastated thousands of lives in the Philippines, wrecking communities and tearing families apart. These people, unconnected to most of the world prior to the disaster, soon became the centre of our attention, as the rest of us shuddered to envision our own communities and families disappearing from around us.

It is a bittersweet trend that has arisen in recent years in which the suffering of others far away brings us closer to them. The outpouring of funds, volunteers, and goods proves that our compassion can extend beyond physical and social barriers to help those most in need. Schools, congregations, and the like band together to do what they can for the victims - people, we quickly realize, who are in many ways like ourselves. Media images of distraught parents and desperate children poignantly hit home, showing families beside the ruins of houses or amongst what were once their own schools and congregations. For the weeks in which the suffering in the Philippines dominated news headlines, we empathized not with their specific plight, but instead on a more fundamental level: with their need for health, safety, and wellbeing.

Now a couple of months later, other concerns and festivities take up our attention, and the plights inflicted by Typhoon Haiyan have trickled from newscasts and discussions. Thoughts of those in the Philippines have been stowed as a memory of a movement, no longer stirring the compassion and union that spurred a movement initially. Although waning empathy is unfortunate, it is only inevitable that others' struggles slip out-of-mind as they fall out-of-sight.

It is incredibly valuable to remain resolute, in part because it is so easy to assume that our help is no longer needed. It is in the lull between disasters, when popular attention diverts to other matters, that it is most important we stay attuned, to reach out to our global community even when its voice in the media has become quiet. In the far aftermath of devastations, we can still relate to the care we felt for those who suffered and lend a hand to those around the world when few recognize a hand needs lending. With those memorable events in our heads and our hearts, we can reach out to those who could always use our help in obtaining the same simple necessities of health, safety, and wellbeing we afford our own.

Carolina Flores

The best gift you'll give this year

Christmas can inspire giving and sharing with our loved ones. Why not expand our generosity to the neediest people in the planet? Giving to effective causes allows us to make a big difference in the lives of others. To make giving easier this Christmas, we have created a page for Christmas donations, where you can also donate in someone else's name.

Despite the consumerist frenzy it has come to be associated with, there is something beautiful about the spirit of Christmas. Spending time with the ones closest to us, giving and receiving presents, sharing in common cheerfulness - these can all be wonderful displays of love for others. Why not spread this generosity all over the world, and reach out to those who are suffering in extreme poverty?

We are in a position to give so much: we can give health, life, education, and opportunities to thrive to people all over the globe. We can make Christmas an opportunity to make a difference in the lives of people who are suffering.

And how can we make the biggest difference? One of the ways to do so is to donate to effective charities - charities which, according to a large body of research, save the most lives with a donation. In this way, the generosity inspired by Christmas can have a real impact in improving others' lives. There is no better way of expressing compassion, solidarity and love than by giving to those who need it most. This is why no Christmas gift can be better than helping others.

Julia Heckenast

Should we be blind to the (economic) burden of onchocerciasis?

Neglected tropical diseases (NTDs) are having a serious impact on some of the world's poorest populations by depressing economic development. In this blog, we examine the economic impact of onchocerciasis, commonly known as river blindness, which is such a disease. Spread by blackflies, the sufferer's body is eventually infested with worms, causing a range of debilitating symptoms, including blindness.[1] The socioeconomic impact of the disease is complex, affecting individuals, village communities and the national workforce, with an estimated 1 million disability-adjusted life-years (DALYs) lost worldwide. Leaders of past successful control programmes declared victory over river blindness, but in reality, millions of people still remain at risk of the disease.[2] However, it is clear that unlike other diseases such as HIV/AIDS, successful elimination of onchocerciasis could be achieved more easily than we think.

The parasitic nematode causing the disease is rife in 27 sub-Saharan African countries, with around 37 million people infected, and 90 million more at risk.[3] The parasite was also imported through the slave trade to six Latin American countries.

To begin to understand the economic burden of NTDs, we searched key repositories of health-related publications including PubMed, the World Health Organisation (WHO) and Cochrane websites combining a variety of disease-related search terms with a selection of economic-related terms. Disease-related search terms included all of the 17 NTDs as defined by the WHO,[4] and economic-related search terms included words such as burden, cost and employment. Diseases with inexpensive treatments that affect the largest populations were prioritised, such as onchocerciasis. The economic burdens of NTDs in developing countries were reported in a total of 282 articles, which we then subdivided by disease area giving 22 articles for onchocerciasis. Of these, we were able to access 16 articles for our review.

The socioeconomic burden of the disease can be felt on several levels. The early symptoms are often disabling, with itchy skin, muscle pain, reduced immune response, and visual impairment that can lead to blindness. We see the most drastic effects in small communities where most people are infected: up to 6.5% of the villages surveyed in Guinea were blinded.[5] After losing his sight, a previously healthy young man whose body was his only means to an income, is unable to work properly, can hardly walk beyond the village and spends the little he earns on health costs. His self-esteem and concentration suffer, and he is unlikely to ever get married or have a family.[5] Even without visual impairment, he would earn significantly lower wages.[6] For a child, the impact on their education damages their future prospects and leads to an estimated 17% drop in future income.[7] Whole villages are abandoned for fear of the disease, leaving acres of fertile land deserted, which has a knock-on effect on the wider economy.

This extensive impact of onchocerciasis is responsible for 1 million DALYs worldwide, which is a measure of healthy life-years lost due to disability and mortality.[2] This impact is three times that of the effect of asthma in the UK.[8] To counter this, several control strategies have tried to bring an end to the debilitating effects of the disease. Historically, both anti-vectorial and anti-parasitic measures have been used with some success. In 1974, the WHO started the Onchocerciasis Control Programme (OCP), poisoning blackfly breeding grounds in West Africa to try to interrupt parasite transmission. In some areas, children born after the initiation of the programme were no longer at risk.[2] A similar international programme, the African Programme for Onchocerciasis Control (APOC) was also established in 1989, with the help of pharmaceutical giant Merck, to begin mass distribution of the anti-parasite agent invermectin. By the end of 2005, over 40 million people living in 90,000 African villages affected by onchocerciasis had been treated. The cost of this programme was estimated to be only $0.74 per person, making this a highly cost-effective approach.[2]

The success of these programmes has consigned onchocerciasis to the bottom of the public health agenda at a time when consolidating these achievements and ensuring long-term success would be critical. It is clear from our research that control of onchocerciasis needs to be extended to wider areas, and that elimination is feasible. For example, one study estimates that three NTDs, including onchocerciasis, could be eliminated from Latin America and the Caribbean by 2020 for $128 million. In Nigeria, which has the highest rate of infection in the world, onchocerciasis could be eliminated in just a few years for an annual cost of less than $1 per person. Having said that, new programmes need to be designed to be sustainable and supported by communities in order to make onchocerciasis a disease of the past.

By Julia Heckenast, working pro bono on behalf of Costello Medical Consulting, with a wider team at Costello Medical Consulting

1. Jamison D, Breman J, Measham A, et al. Priorities in Health. The World Bank, 2006.

2. Basanez MG, Pion SD, Churcher TS, et al. River blindness: a success story under threat? PLoS Med 2006;3:e371.

3. African Programme for Onchocerciasis Control [APOC]. Final communiqué of the 11th session of the Joint Action Forum (JAF) of APOC, Paris, France, 6-9 December 2005. Ouagadougou (Burkina Faso): APOC. 2005.

4. Souery D, Papakostas GI, Trivedi MH. Treatment-resistant depression. Journal of Clinical Psychiatry 2006;67:16.

5. Evans TG. Socioeconomic consequences of blinding onchocerciasis in west Africa. Bull World Health Organ 1995;73:495-506.

6. Workneh W, Fletcher M, Olwit G. Onchocerciasis in field workers at Baya Farm, Teppi Coffee Plantation Project, southwestern Ethiopia: prevalence and impact on productivity. Acta Trop 1993;54:89-97.

7. Martin G, Grant A, D'Agostino M. Global health funding and economic development. Globalization and health 2012;8:8.

8. Murray J. UK health performance: findings of the Global Burden of Disease Study 2010. The Lancet 2013.

Costello Medical

The Economic Impact of Cysticercosis

In this blog we take a look at the economic impact of a parasitic worm infection responsible for a large proportion of epilepsy cases in the developing world. The disabling nature of the disease translates into a huge economic burden on both a personal scale for the sufferer and for the countries where the disease is prevalent. By demonstrating the value to be gained from disease elimination we hope to demonstrate the importance of investment in appropriately funded and designed control and eradication programmes.

 (NTD) identified by the WHO and is caused by the larval stages of the tapeworm species Taenia solium, which affects both man and pigs. [1, 2] The disease remains a big issue in many developing countries, mostly affecting the health and livelihoods of the poorest populations within a country.[3] The fact that the disease is entirely preventable, makes its impact on health and economy even more devastating. Epileptic seizures, chronic headaches and memory loss are all common symptoms of infection that contribute to the morbidity of the disease.[4] The disabling nature of these symptoms translates into a huge economic burden to the sufferer in the form of expenses needed for treatment and productivity losses,[4] making disease control essential yet desperately lacking.

For people living in developing countries around the world, one of their only economic productivity assets is often their body. The economic shock of a debilitating illness, like cysticercosis, can drive a sufferer into abject poverty.[5] Although data on the global disease burden of cysticercosis is limited, it is estimated that there are approximately 50 million people in the world living with the infection and that epileptic seizures occur in 50-70% of all symptomatic cysticercosis cases.[4]

To begin to develop a better picture of the economic burden of cysticercosis across the globe, we searched key repositories of health-related publications including PubMed, the World Health Organisation (WHO) and Cochrane websites combining a variety of disease-related search terms with a selection of economic-related terms. Disease-related search terms included all of the 17 NTDs as defined by the WHO, and economic-related search terms included words such as burden, cost and employment. Diseases, like cysticercosis, with inexpensive treatments that affect the largest populations were prioritised. A total of 282 articles met our inclusion criteria, which we then subdivided by disease area giving a total of [9] articles for cysticercosis. Of these, we were able to access 8 articles for our review. The locations of these studies included East Asia, South Africa, West Cameroon, Mexico and Peru.

Table 1 shows annual economic losses arising from cysticercosis according to different developing countries across the globe. These estimates are always in the tens of millions and suggest that T. solium cysticercosis results in considerable costs for regions that are already economically constrained.[6] We hope that these figures:

Highlight the importance of introducing efforts to reduce T. solium prevalence;

Demonstrate the economic value to be gained from T. solium eradication;

Place the disease in perspective relative to other health issues in these different countries;

Could assist stakeholders in allocating scarce health and agricultural resources in their respective countries.

Table 1. A comparison of annual economic losses arising due to human/pig cysticercosis according to country.

At this point, it is also important to note that T. solium does not only produce a severe disease in humans but also causes widespread economic losses to the pig industry.[10] In Mexico, for example, porcine cysticercosis caused loss of more than half the national investment in swine production,[11] and the losses that arise as a result of the destruction of meat are estimated at $43 million per year.[9] In less developed countries, pigs are an important source of money for farmers due to them being cheap and more easily marketable than other animals such as cows.[10] T. solium transmission is maintained in rural areas where pigs have access to untreated human sewage or faeces. By simply improving sanitation and controlling domestic pig farming, many developed countries have eradicated cysticercosis.[10] So why has this not occurred in developing countries? A lack of socioeconomic development impedes a country's chance of control and elimination and unfortunately the near future holds limited hope for further socioeconomic advancement. As a result, investment in intervention measures to control and eradicate cysticercosis are desperately needed and should be appropriately targeted to the places that need them most.

While the annual costs presented in this blog are eye wateringly high enough, they are only estimates, and unfortunately it is likely that the majority are underestimates. This could be for a number of reasons, for example, Praet et al (2009) make estimations based on epilepsy as the only symptom of cysticercosis and Rajkotia et al (2007) do not discriminate between leisure time and idle time due to job loss; thus productivity losses have probably been underestimated. Also, the study by Rajkotia et al (2007) does not estimate the losses arising from the reduced future potential earnings among cysticercosis patients who cannot return to work after infection with the parasite; a figure that stands at approximately two-thirds of wage-earners. Of these sufferers, only 61% were then able to re-engage in wage-earning activities.[4]

To further increase the chance of eradication, future work should attempt to estimate the burden of cysticercosis on a global level and identify priority areas for action. This early attempt at collating country specific costs revealed that the cost of inactivity due to disease, influenced by salaries, plays the largest role in the monetary burden of T. solium cysticercosis. If we could gain access to accurate country-wide salary levels and disease prevelance this would certainly improve our chances of gaining a more accurate indication of the total economic burden of T. solium cysticercosis that could be summed across the globe. These accurate global estimates are essential for highlighting the gains that could be made, not only in terms of people's health but also in terms of money saving, by eliminating these diseases.

http://whqlibdoc.who.int/hq/2012/WHO_HTM_NTD_2012.1_eng.pdf

http://www.who.int/mediacentre/factsheets/fs376/en/

Choffness E R. Relman D A. The causes and Impacts of Neglected Tropical and Zoonotic Diseases: Opportunities for Integrated Intervention Strategies: 

http://www.ncbi.nlm.nih.gov/books/NBK62507/pdf/TOC.pdf

Rajikotia Y. Lescano A G. Gilman R H. Cornejo C. Garcia H H. Economic burden of neurocysticercosis: results from Peru. Transactions of the Royal Society of Tropical Medicine and Hygiene. 2007; 101: 840-846.

Matin G. Grant A. D'Agostino M. Global health funding and economic development. Globalization and health. 2012; 8: 8.

Carabin H. Krecek R C. Cowan L D. Michael L. Foyaca-Sibat H. Nash T. Willingham A L. Estimation of the cost of Taenia solium cysticercosis in Eastern Cape Province, South Africa. Tropical Medicine and International Health. 2006; 11:906-916.

Fan P C. Annual Economic Loss Caused by Taenia saginata asiatica Taeniasis in Three Endemic Areas of East Asia. Southeast Asian Journal of Tropical Medicine and Public Health. 1997; 28: 217-221.

Praet N. Sperbroeck N. Manzanedo R. Berkvens D. Nforninwe D N. Zoli A. Quet F. Preux P-M. Carabin H. Geerts S. The Disease Burden of Taenia solium Cysticercosis in Cameroon. PLoS Neglected Tropical Diseases. 2007; 3: e406.

Flisser A. Taeniasis and cysticercosis due to T solium. In: Sun T, ed. Progress in clinical parasitology. New York: CRC Press, 1994: 77-116.

Garcia H H. Gonzalez A E. Evans C A W. Gilman R H. Taenia solium cysticercosis. The Lancet. 2003; 361: 547-556.

Murrell KD. Economic losses resulting from food-borne parasitic zoonoses. Southeast Asian J Trop Med Public Health 1991; 22 (suppl): 377-81.

Michelle Hutchinson

Arms, Tobacco and Comic Relief

's investment in tobacco, alcohol and arms firms has caused widespread outrage. But is it possible that the hype caused by Panorama could do even more harm than the initial investments themselves? We should be wary of highlighting only the negative aspects of charities, and neglecting the immense good they can do.

 on the 10th of December that 'Millions of pounds donated to Comic Relief have been invested in funds with shares in tobacco, alcohol and arms firms'. Comic Relief raises millions of pounds every year through large-scale events such as Red Nose Day and Sport Relief. This means it hold tens of millions of pound at a time, some of which is invested in the stock market before it is donated to the charities it supports. Doing so is important to make sure that they have as much money to help their beneficiaries with as possible. Among the investments they made in 2009 were ones to the alcohol, tobacco and weapons industry.

It's true that on the face of it, this is contradictory to Comic Relief's stated mission: they claim in their Mission Statement to want to help 'people affected by conflict' and to 'reduce alcohol misuse and minimise alcohol-related harm'. They're also committed to fighting tuberculosis, which can be related to smoking. However, it's not clear that these investments do contradict Comic Relief's mission. It may be that the increased donation they can make to fighting tuberculosis outweighs the harm their investment in the tobacco industry did (for example). On the other hand, it's very difficult to know precisely how much harm the latter caused.

A factor which has been discussed very little so far is how donor behaviour may change in response to this type of scandal. Knowing that a charity's investments appear to be unethical (whether intentionally or not), a lot of people may well be moved by thoughts like 'My donations aren't helping, they may even be harming. So it is not worth donating to charity at all'. As a result, they may give less or stop giving at all.

But this is not the right response. The message we should draw from this scandal is that we need to know how our donations are being used. We have the potential to do a lot of good with our donations in the long run. That's true most of all if we carefully assess the effectiveness of the charities we give to. But even donations to organisations like Comic Relief have the potential to do a lot of good, and make progress towards combating extreme poverty. Comic Relief benefits from strong brand awareness (allowing them to raise truly astounding amounts to combat global poverty - over £100 million in a year!!) and economies of scale (allowing them to use that money efficiently). They also fund (among many other things) some of the most cost-effective causes that are working to combat global poverty, including 

This scandal reminds us to consider the impact of our donations. It should also make us reflect on the donor scepticism and therefore negative impact that can be the result of a report such as this. I hope this will motivate more people to think carefully about their donations, rather than turn their back on giving to charity altogether. We all have the potential to do a lot of good through charity if we want to!

Andreas Mogensen

Why we continue to recommend the Against Malaria Foundation

Just over two weeks ago, GiveWell (GW) chose to remove Against Malaria Foundation (AMF) from its list of top charities, citing concerns about AMF’s room-for-more-funding (RFMF). (See GW’s blog post 

.) Having considered this issue and spoken with both AMF and GW, we at Giving What We Can have decided not to remove AMF from our own list of recommended charities, as we continue to believe that AMF represents one of the very best opportunities for those who want to give now. However, Giving What We Can and GW do not really disagree on this issue as much as it might appear. Read on to learn more.

The decision by GW to remove AMF from its list of top charities was made based on concerns related to RFMF. These concerns have arisen in light of AMF’s failure to finalize large-scale distributions over the two-year period in which AMF have been GW’s #1 recommended charity; GW drew particular attention to the recent failure of AMF to negotiate distribution of nets in Sierra Leone. Summarizing their position, GW write: “given the significant amount of time that has passed, it now seems to us that there is a substantial risk that AMF will not accomplish [one or more suitable distributions] in the near future, and that having more funds to commit would steepen rather than lessen its challenges. … Therefore, we believe it is most prudent to donate elsewhere until and unless AMF commits the bulk of the funds it currently holds, at which point we will revisit its ranking.”

GW also criticise certain aspects of AMF’s approach to negotiating distributions, which they believe may have hindered progress. For example, GW suggest that the stringent monitoring and evaluation requirements set out by AMF for potential partners are in some cases too strong. However, GW note that AMF have already taken steps to address concerns of this kind.

AMF were kind enough to speak to us at length about their views on GW’s decision and AMF’s plans for the immediate future. Many details relating to these plans are confidential, and are not discussed in following. Overall, AMF’s position is that GW have underestimated the value of additional funds donated to AMF.

AMF are highly confident that they will have allocated all present funds within the next 6 months. They are currently involved in a number of negotiations. Some of these negotiations have made significant progress and one pre-registration survey is already beginning. Some of these distributions are sufficiently large that AMF could potentially be facing a significant funding gap early in the new year. Consequently, AMF is presently seeking funding of an additional $5m to be able to fund those distributions it is currently discussing that will require a decision before the end of March 2014.

AMF offered a number of reasons to suppose that current negotiations are more likely to succeed than those in which they have been involved in the recent past, particularly Sierra Leone. For example, a smaller number of partners are involved, meaning that negotiations are simpler and more likely to follow through. In addition, AMF suggested that, on the outside chance that longer delays are experienced in disbursing funds, they saw no reason to believe that a distribution of nets carried out in the near future would be significantly less effective. Thus, even if AMF do continue to experience delays in securing large scale distributions, we should expect that money donated now will eventually be used to fund net distributions relevantly similar in cost-effectiveness to what we’ve come to expect from AMF. AMF pointed to the large gap that exists, (and is projected to continue to exist) between the need for nets and the funding available.

What we’ve learned from speaking further to GW

Besides contacting AMF, we’ve gained considerable insight from speaking to GW about their decision, particularly GW Co-Founder Elie Hassenfeld. I found it notable that GW’s views about AMF, as expressed in conversation, were not quite as pessimistic as their blog-post on the 26th of November had led me to expect. GW believe it is more likely than not that AMF will disburse all funds within the next 6 months. They believe that it is definitely defensible to give to AMF at present, though the better policy would be to wait and see whether AMF succeeds in those negotiations which are expected to be finalized within the first quarter of 2014. Furthermore, GW have suggested that part of the reason for their decision to remove AMF from their list of top charities has to do with the public significance of their recommendations and the incentives provided to charities by managing these recommendations as they currently do.

Elie expressed some degree of skepticism with respect to the likelihood that AMF’s current negotiations will yield fruit, appealing to AMF’s underwhelming track record over the previous two years. He did not wish to rule out, however, that current negotiations might have properties that are more likely to lead to success and noted that AMF has made positive steps to address some of GW’s critical comments.

Having considered the issue, Giving What We Can has decided to keep AMF on its list of recommended charities. We believe that, for donors looking to give to charity now, AMF remains among the very best opportunities for doing good. Whereas the concerns regarding RFMF raised by GW shouldn’t be taken lightly, we do not believe, based on what we’ve learned, that these are sufficiently serious that the expected value of donating to AMF should not continue to rank very highly. That having been said, we give considerable credence to the view that those who are not committed to giving now may do well to wait and see whether AMF’s current negotiations are successful (but see below).

The question of when to give is a difficult issue that we’ve addressed on a number of occasions (

). I typically give at the beginning of each month, and I’m inclined to believe that there’s value in establishing a rhythm of this kind in terms of ensuring that we follow through on our commitment to give. However, there are other reasons that may lead us to believe that it is better to give later: in particular, we may have better evidence.

Fortunately, there’s a way to give now and give later, all at the same time. As we discussed in 

 earlier this week, it’s possible to give now to the Giving What We Can Trust while choosing to delay the disbursement of one’s donation. Absent this kind of recommendation, the Trust pays out quarterly to our recommended charities. The best strategy may therefore be to give now to the Trust, indicating that you would like your donation to be spent in accordance with Giving What We Can’s recommendations when the Trust pays out at the beginning of the second quarter of 2014, at which point we expect to know a lot more about AMF’s room for more funding.

How to run the most effective charity in the world

On Thursday 5th December I attended a panel discussion on what makes a charity effective, hosted by the African Development Project at Imperial College London. The speakers included the directors of two of Giving What We Can's top charities: Rob Mather of the Against Malaria Foundation and Prof Alan Fenwick of Schistosomiasis Control Initiative, as well as Caroline Fiennes of Giving Evidence; an organisation which advises donors and charities on improving performance by making evidence-based decisions.

The discussion began with each speaker talking about what makes an effective charity, before opening to questions from the floor.

Rob presented a four-point overview of what he believes makes AMF so effective, and stressed that these principles can be adopted by pretty much any charity to become more effective:

Focus on impact should drive what you do. This means measuring results and reporting your findings.

Efficiency drives how you do it. When setting up AMF, Rob was keen to get things for free where possible, approaching people he knew at businesses to enlist their help, for example PWC, which audits the charity for free.

Accountability ensures that promises are delivered. AMF checks that nets have been distributed as intended, and that they continue to be used. The key to ensuring that nets are distributed and used as intended is engaging with communities and stakeholders and educating them about the whole process: why the nets are important and how they will prevent malaria.

Transparency builds confidence among stakeholders. Thanks to the Internet, it's very easy for charities to be transparent and Rob argues that they should present their accounts in a user-friendly way.

Alan talked about how and why SCI is so effective.

, but as this funding began to dry up, SCI was spotted by 

 and Giving What We Can. Alan believes that smaller charities such as SCI and AMF are more effective than some of the biggest, most famous charities. The key reason SCI is so effective is that donations are highly leveraged: it has persuaded a big pharmaceutical company to donate all the drugs needed, so what donors are actually paying for is for SCI to advocate with ministers in recipient countries and to educate people on why they need the drugs. For example, schistosomiasis is not really a problem in cities, so ministers there might overlook the importance of the drugs.

Giving Evidence works across the whole of the charitable sector and Caroline argues that GiveWell's method of analysis, focusing on QALYs, only works well for a certain kind of charity. There are many organisations doing vital work towards things like systemic and societal change which can't be measured in this way. She gave the example of Stonewall, which advocates for gay rights, arguing that you can't evaluate its work in terms of units of good achieved. Caroline took issue with the concept of "the most effective charity in the world" arguing that different charities are needed to achieve different things. That said, she does think it is essential to compare charities as we have finite resources and an effectively infinite need.

If you are interested in getting a comprehensive picure of Caroline's views on effectice giving, she recently published a book on the topic. You can read our review of her book 