We are excited to announce that for the first time in a while, Giving What We Can is changing its recommendations! Below we describe what is happening and answer some natural questions that flow from that.
What is happening with our recommendations?
We are splitting our recommendations into two different categories, and adding a new one to the list - Project Healthy Children.
AMF and SCI will become our ‘High-confidence recommendations’. They have been vetted extensively by GiveWell, and have a high probability of achieving a lot of good with your money.
Project Healthy Children and Deworm the World will be classified as ‘Opportunities for leverage’. There are two reasons to separate them in this way: their projects have not been scrutinised in the same level of detail as AMF and SCI, and by its nature their approach - influencing health policies in developing countries - is harder to concretely evaluate. If successful, both might achieve more good per dollar than AMF and SCI. However, it is hard to know how likely they are to do so.
We are also going to list other organisations such as
What does Project Healthy Children do?
Project Healthy Children sends experts to low-income countries, now 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 fortification standards forwards.
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.
What are some promising things about Project Healthy Children?
What are your most significant remaining questions about PHC?
Would you personally give to Project Healthy Children on the information we have?
I will be making a donation to PHC for two reasons. One is that I am optimistic they are having a large impact on people’s health. The second is that I hope it will encourage their further involvement with our research. The value of the information we hope to get from them is significant. If they pass further scrutiny they could be a target for large donations from both us and other effectiveness-focussed donors, which would allow them to operate in many more countries which would benefit from fortification.
What should influence my decision about whether to give to a low or moderate risk recommendation?
If you prefer a high probability of some impact, or are naturally skeptical about organisations claiming to have a large impact by influencing government policy, then our ‘low-risk recommendations’ will be more appealing to you. If you are particularly persuaded by the material available about PHC and DtW, inclined to give them the benefit of the doubt, and comfortable with variable results, then you will be more inclined to give to those groups.
What are our next research steps?
As described above we are collecting information which will give us a more comprehensive view of PHC’s record of success, will aim to speak with other organisations working on micronutrients, and will scrutinise the evidence used to support high benefit to cost ratios of fortification. Further research could both lead us to endorse PHC with greater confidence, or drop it from our list. Those who would like to know more, or offer relevant information, can reach us at research [at] givingwhatwecan [dot] org.
What is GiveWell’s attitude to Project Healthy Children and Deworm the World?
We asked GiveWell about its views on these organizations. GiveWell responded as follows:
"Both Deworm the World and Project Healthy Children are near the top of the list of organizations we would be interested in considering were they interested in working with us. In both cases, we think there are significant unanswered questions about the organizations' track records that lead us to expect higher impact per dollar from our top 3 charities (AMF, GiveDirectly and SCI) relative to these 2.
We would be interested in evaluating both PHC and DTW if they were ready to go through our charity evaluation process. (In fact, we reached out to both organizations earlier this year suggesting that they engage with us.) In addition, in the case of DTW, we've done considerable work on the evidence for deworming and feel comfortable in our assessment of the evidence. We have only done minimal work on the evidence for the types of nutrition programs that PHC implements and, based on our past experience, we feel that this in-depth assessment of the independent evidence for program effectiveness would also be an important step in any assessment we would make.
We agree that both organizations have the potential for leveraged impact, but we think it's worth noting that there are many other organizations in many different categories about which the same could be said. Within developing-world health, there are many other organizations that seek to leverage government resources (examples include Micronutrient Initiative, GAIN, ICCIDD, and many more) and there are also many organizations that seek to pioneer fundamentally new approaches to old problems, which if adopted widely could have extremely magnified effects (some examples can be found on the Skoll Foundation website). We also believe that our top charities have their own opportunities for magnified/leveraged impact (see the section just below the "strengths/weaknesses table" of our 2012 top charities announcement). More broadly, there are many organizations in many causes that work on policy advocacy, scientific research aimed at technological breakthroughs, field research aimed at better informing aid, systems change, culture change, and other interventions that could have enormous effects from a cost-per-DALY perspective. Donors seeking higher-risk, higher-reward charities have many options."
My response to this would be:
Preferring more strictly vetted charities is a defensible position. Whether you think DtW or PHC can outperform other organisations will be affected by how strongly you assume a charity of this kind doesn’t work until comprehensively proven otherwise. However, given the potential to increase our impact several-fold relative to AMF, I think we should take their approach very seriously both in our further research, and when considering where to give. The risk that PHC turns out to be worse than the alternative has to be balanced against the fact that it could be much better.
While I agree with GiveWell that it is possible that the other organisations listed offer even larger leverage, the research we have done gives us greater confidence in PHC at this point than any of the others listed. The probable existence of other, better, as-yet-unidentified options isn’t relevant for someone deciding between AMF or PHC today.