Hi Tony—This is Mark Walsh, a GiveWell researcher on the team responsible for pressure-testing GiveWell's research processes and conclusions. Thank you for this thoughtful write-up!

At a high level, I agree with the central thesis: we've underinvested in monitoring and evaluation, relative to other components of our analysis. Like you mentioned in your post, we've been working to fix that, and I wanted to share a little bit more on what we've done so far, what we're planning, and some other related gaps in our work.

We think this kind of external engagement with our research is valuable and makes our work better. We'd welcome feedback on the steps we've taken so far and where we should consider doing more.

What we’ve done

Over the past year, we've been working on what we call "M&E red teaming"—a systematic review of the monitoring and evaluation practices of our largest grantees, motivated by the same concerns Tony raises. We're planning to publish our findings soon but wanted to give a brief overview.

From June to December 2025, we dedicated teams of 3-4 research staff to work full-time for roughly 3 weeks each on six program areas: our four top charities plus water chlorination and malnutrition treatment. For each program, we evaluated many of the dimensions Tony highlights in his monitoring checklist: the independence of data collectors from program staff, the neutrality of the sampling frame, the objectivity and precision of measurement approach, data quality checks and backchecks, timeliness of data, triangulation with independent sources, and whether the program is taking timely action to address any issues raised by monitoring.

Since completing the red teaming, we've been doing the following to make improvements:

• Setting coverage survey standards. We've drafted coverage survey standards that cover survey firm independence, surveyor workloads, sampling protocols, backchecks, objective verification of key outcomes, and data-sharing timelines. We're starting to solicit feedback on these from grantees to learn more about what's feasible.
• Making several independent monitoring grants. Since August 2025, we've made 14 grants for independent monitoring and evaluation (see list of grants). For example:
  • We funded four research organizations (Asante Research Institute, Innovations for Poverty Action, ORB, and Universite de Kinshasa) to conduct vaccination coverage surveys in South Sudan, Nigeria, Ethiopia, and the Democratic Republic of the Congo.
  • We funded Marakuja to conduct a survey of net coverage, usage, and malaria burden in the Democratic Republic of the Congo.
  • We funded Innovations for Poverty Action to conduct a survey of net coverage and usage, seasonal malaria chemoprevention coverage and adherence, vitamin A supplementation coverage, and vaccination coverage in Nigeria.
  • We funded IDinsight to conduct coverage surveys, health facility data quality checks, and stakeholder interviews to evaluate malnutrition programs in Northern Nigeria.
• We required each of the 12 implementing partners funded through our chlorination Request for Information to contract with external survey firms and funded the Aquaya Institute to provide guidance on best practices (e.g., chlorination measurement, E. coli measurement, sampling frames, etc.) and regular quality control checks during the data collection period. In November 2024, we also funded Aquaya to directly monitor and evaluate the in-line chlorination pilot of Uduma.
• Ensuring grantees are adequately monitoring critical activities. We've made it standard practice to identify the critical activities required for the desired impact and to ensure grantees have plans for monitoring these in real-time and addressing issues quickly.
• Better data on population and program costs: The red teaming highlighted these as two other areas that are central to implementation that we think we’ve underinvested in. To address this, we have funded independent population estimates in key countries, are developing budget and financial reporting templates for some program areas, and are working on internal guidance and tools for grantmakers (e.g., a dashboard with alternative population estimates and rules of thumb for when/where to trust what estimates). 

As Tony suggests, we think the right way to evaluate these investments is based on the value of the information we’ll gain and the impact we think it will have on our future grantmaking decisions. That means that we are more likely to fund expensive M&E in large grantmaking areas for GiveWell (or areas with a lot of room for more funding) and where we have more uncertainty so expect the M&E to affect our grantmaking a lot. For example, we’ve funded expensive independent coverage surveys of insecticide-treated nets and vaccinations programs because we direct a lot of funding to these programs. On the other hand, we are trying to take a rigorous but lighter-touch approach in cases where there is less funding at-stake, or where key uncertainties (e.g., whether an organization can establish partnerships or hire effectively) can be resolved more cheaply before investing in expensive M&E.

What’s next

Over the next several months, we're planning to finalize and roll out our coverage survey standards with grantees; analyze the results from the independent surveys, enhanced M&E, and population/costs work we've commissioned; and dig further on more of these areas (e.g., investigating better ways to monitor the impact of our grantees on disease morbidity and mortality).

I expect we'll learn a lot as we go about what's feasible and what information is actually most valuable. I'm sure our approach will change as we learn more about both the cost and potential impact of this information. That being said, I think we are on the right track. 

A broader gap

I also want to flag that we think the issues Tony raises are part of a broader gap. It's not just that we need better quantitative monitoring—we also need to invest more in understanding what's actually happening on the ground with the programs we fund.

We've been trying to gather more "local insights" on our work. This involves site visits, qualitative research, conversations with local experts, and other ways of testing our desk-based assumptions against what’s happening on the ground. One example is funding the Busara Center for Behavioral Economics to observe vitamin A supplementation delivery in Nigeria and interview households, front-line staff, and government officials about the program.

We're still figuring out which approaches are most useful but think shifting more of our research effort "beyond the spreadsheet" in the ways Tony is describing is directionally right and something we’re making progress on. As I said at the start, we welcome feedback on our work so far—and on our future progress as it occurs.

GiveWell Updates

• In our 2025 grantmaking year, GiveWell approved $418 million across 131 grants to 69 organizations—the most grants we’ve made in a year so far.
  
  Through years of deliberate groundwork, we’ve been growing our research capacity and scope in order to direct substantially more funding to the most impactful opportunities we can find. Last year’s grantmaking reflects this growth, and we will be continuing an intensive effort this year to scale our ability to partner with donors to help people in need. 

• GiveWell recently launched two new RFIs to expand our funding in vaccination and iron fortification and supplementation programs. Submissions for both RFIs are due March 27.
  • Vaccination outreach RFI: Seeking targeted outreach or mobile vaccination programs that aim to increase uptake of routine vaccinations for children under 2 in the DRC, Nigeria, or Somalia.
  • Anemia control RFI: Seeking programs that reduce iron deficiency anemia through large-scale iron fortification, supplementation, or biofortification in Africa. 

• GiveWell aims to find and fund programs that will do the most good per dollar, and we regularly evaluate results to decide whether to continue our support. Sometimes, even if a program we fund is doing a lot of good, it may not have the impact per dollar we expected. 
  
  In our latest podcast episode, GiveWell CEO and co-founder Elie Hassenfeld and Senior Program Officer Erin Crossett discuss how we responded when early data on Evidence Action's Dispensers for Safe Water in Malawi and Uganda indicated the program wasn't reaching as many people as estimated.

• GiveWell is hiring a Salesforce Administrator to deliver exceptional technical support to our internal users and drive continuous improvements to the systems that power our life-saving work. 

GiveWell Updates

• Seasonal malaria chemoprevention is one of the most cost-effective programs GiveWell has identified—but in eastern and southern Africa, we have substantial uncertainties about drug effectiveness. That’s why we’re funding the CHAMP trial, which is, to our knowledge, the largest individually randomized trial of malaria chemoprevention drugs ever conducted. 
  
  In our latest podcast episode, GiveWell CEO and co-founder Elie Hassenfeld and Senior Researcher John Macke discuss what we hope to learn and how it could shape our malaria grantmaking. Subscribe here for the latest updates.

• GiveWell is often thought of for its Top Charities, but over the last several years, we’ve been substantially broadening our work. We’ve developed new ways to identify potential grantees, funded research to fill gaps in our understanding, and explored new program areas where we believe cost-effective opportunities exist but other funders aren’t investing. 
  
  In a recent podcast episode, GiveWell CEO and co-founder Elie Hassenfeld and Senior Program Officer Julie Faller discuss how our research approach has evolved and what it means for the future of our grantmaking.

• GiveWell is hiring for several positions including:
  • Program Associate
  • Research Analyst
  • Senior Malaria Researcher
  • Senior Researcher

We are only considering full-time candidates for this role.

There is currently no application deadline, but we review applications on a rolling basis, so we encourage you to apply as soon as possible if interested. Thanks for your interest in the Research Analyst position!

Hi there - thanks for your interest in GiveWell! We don't currently offer informational calls, but we'd encourage you to check out our open roles and apply to any that seem like a good fit for your background and interests.

Hi Nick,

Thanks for noting that section of the post could have been clearer! We’ve edited the article to clarify that New Incentives went from serving 70,000 to 1.5 million children per year.

We agree that the extra lives saved (“indirect deaths” in our analysis) is an interesting question. Both the magnitude of the adjustment and the exact mechanisms (i.e., which other causes those deaths are coming from in the GBD bucket) are major sources of uncertainty in our model, and we don’t currently specify what other deaths are being averted through vaccination in our analysis. We may follow up with a post to share more about our work on indirect deaths in the future.

Thanks again for the feedback!

Hi Nick,

Thank you for providing this feedback! My name is Vicky, and I am a Research Associate at GiveWell, on the vaccines team. We really appreciate these kinds of rough sense checks on our work and thought this was a great approach. 

Our lookback includes children enrolled across multiple years of programming (roughly covering 2020 to 2026) whereas the enrollment figures in your estimate only include a single year of program operations.

• Our lookback aims to roughly capture the impact of our grants which cover New Incentives’ operations from 2020 through 2026. The estimated 1.5 million children enrolled that you cite is based on a single operating year, 2023.^[1] We think New Incentives will enroll closer to 6.3 million children between 2020 and 2026.^[2]
• Using the same assumption that roughly 81% of children enrolled would be counterfactually vaccinated absent the program,^[3] we estimate that roughly 1.2 million children would be counterfactually vaccinated by the program from 2020 through 2026.^[4]
• This implies an upper bound of roughly 60,000 deaths averted with your approach (assuming 5% of deaths in unvaccinated children might be preventable as an upper bound).^[5]
   

We think this difference–the assumed number of children enrolled with GiveWell funding—is the main reason the upper bound you estimated for the number of deaths averted appears significantly lower than the estimates in our lookback, although we’re still exploring other potential discrepancies between the numbers in your approach and our estimates.^[6]

Thanks again for your engagement!

1. ^{^}

   In 2023, New Incentives reported enrolling 1,518,904 children across 9 states. See New Incentives, 2023 Annual Report, p.8-9

2. ^{^}

   We estimated this by taking the total amount of funding (roughly $120 million) divided by the cost per child enrolled (roughly $19 per child enrolled) between 2020 and 2024. This assumes that the cost per child enrolled between 2025 and 2026 will remain similar to the historical weighted average.

   • We have not published our most recent estimates yet, but you can see our approach to estimating cost per child enrolled based on data from 2020 through 2023 here.
   • New Incentives publishes enrollment figures here. When calculating the cost per child, we adjust their estimates to account for potential repeat enrollments. 
3. ^{^}

   The 81% in our public report is based on a single state, Bauchi, and the exact percentage differs across states depending on baseline coverage and New Incentives’ expected impact in that state. In addition, we've made some internal updates to the model since the last version of our intervention report was published.

^{^}

6.3 million * (1 - 81%) = roughly 1.2 million children counterfactually vaccinated by the program.

^{^}

1.2 million children counterfactually vaccinated * 5% risk of dying from causes that might be preventable through vaccination = 60,000 deaths potentially averted as an upper bound.

• The 5% risk of dying parameter is derived from two assumptions in your post:
  • 12.5% of unvaccinated kids might die from non-birth/neonatal and non-malarial causes.
  • 40% of non-birth/neonatal and non-nalarial deaths could potentially be vaccine-preventable.
  • 12.5% * 40% = 5%

^{^}

Across states where the New Incentives program operates, we estimate that unvaccinated children experience roughly a 3% to 8% chance of dying from vaccine-preventable diseases and that vaccination reduces their risk of dying by roughly 50%, which appears more in-line with your estimates. For more on how we estimate these, see our public report here.

Show all footnotes

Thanks for sharing your critique of our recent grants with Open Philanthropy for technical support units (TSUs). We really appreciate this thoughtful pushback! We've recommended (and are considering) a number of grants to help respond to the current situation with cuts in US foreign health assistance. So, getting critiques like yours is helpful since it encourages us to pause and consider whether we’re making the right tradeoffs in these grants. While we share some of your perspectives on the uncertainties of this work, we're still excited about our decision in this case.

While this grant’s impact is particularly uncertain, we see this as a difference in degree, not kind, compared to other grants we recommend. Most of our funding still goes to Top Charities - proven programs backed by strong evidence and our cost-effectiveness analysis. But we also recommend opportunities through the All Grants Fund. The goal of this fund is to find and fund what we believe are the highest-impact uses of marginal dollars, even when those opportunities are riskier or harder to model. This grant fits squarely in that approach. We’ve funded technical assistance from the All Grants Fund before, alongside grants that are uncertain for other reasons. For example, sometimes we're trying to generate new evidence, while at other times we're recommending high expected value bets even when we know we’re unlikely to get a definitive answer on their impact.

We agree that the evidence base for TSUs is thin. In general, we think it’s challenging to evaluate technical assistance programs because 

• particular programs might not have very convincing controls or comparators and
• technical assistance packages can vary widely so aggregating results from many programs might not be that informative, even if they’re targeting the same outcome

So even if the review that Nick cites had found good evidence for past TA programs, we still might not feel sure that it would generalize to the TSUs we recommended funding. 

But as discussed above, we don’t consider high uncertainty to be a dealbreaker in grants funded from the All Grants Fund. We still think it can be worth funding TA (see, e.g., our maternal syphilis grants) and we’re very interested in building up our ability to learn about programs like this over time. (We’re working on a project looking back on a subset of technical assistance grants we’ve funded, but don’t have a publication date for that yet.) 

While we don't have detailed theories of change, we still think it's plausible that TSUs could be impactful. We are excited about this grant because we think it could help governments to make difficult prioritization and program adaptation decisions in countries affected by US government funding freezes and cuts. We expect that the details of how this could look will vary by country and so we don’t feel confident that any particular mechanism will cash out in impact. But for example, we think TSUs could help governments to: 

• Adapt programs away from more expensive models implemented with USG support to more cost-efficient models (e.g., by integrating disease-specific verticals or moving from international to local implementing organizations)
• Target programs (e.g., to certain regions or populations) based on cost-effectiveness analyses
• Crowd in philanthropic or other funding by identifying funding gaps 

While we think the above examples are plausible, we agree that the theory of change for these programs is not tightly specified. However, we spoke with senior Ministry of Health officials in each country about this grant, and overall governments voiced support and demand for the proposed TSUs and were eager to have CHAI and PATH's support on this work. We also think both organizations are well-placed to support this work, as both have supported on malaria-specific TSUs in the past, have teams with specific focus on health systems and health financing, and have established relationships with the governments they’re supporting. 

Budget - Thank you for sharing your estimates - this is helpful for us as we continue to update how we review budgets. We’ll share a high level budget breakdown for this grant with our public grant write-ups (which are coming - see below!). One quick clarification (which wasn’t clear in the podcast) is that costs for Nigeria reflect support in seven states as well as national support. 

Outside of that, we think that the higher budget reflects both higher salaries and a higher non-salary budget share (to account for travel, coordinating stakeholder engagement, and support from global technical teams). Our understanding is that salaries are set based on globally-benchmarked salary ranges and localized equity adjustments to account for organizational equitable pay standards and differential cost of living across different geographies. A portion of the compensation costs is also due to benefits (such as health insurance) that may be standard to each location.

Learning - We agree that we should try to learn about the impact of these grants and also agree with commenters and Nick’s revision that an RCT isn’t an appropriate strategy. We’ve asked CHAI and PATH to track and report out on the following. 

• Process indicators (staff hiring, government engagement, TSU recommendations made and implemented);
• Case studies of how government prioritization decisions are made;
• Promising funding opportunities identified through the TSU work;
• Contexts where cost-effectiveness considerations are or aren't helpful for government decision-making. 

We’ll attempt to triangulate these reports through speaking with other stakeholders, though we expect we’ll still have substantial uncertainty about impact given the lack of counterfactuals. 

No CEA and grant write up. These are coming! We typically have a lag between making grants and publishing our write-ups, but wanted to share about this grant sooner because we’ve received a lot of interest in our response to the funding cuts. We expect to publish pages for CHAI and PATH (including a rough BOTEC) by the end of June. 

Urgency. We see the urgency here as being specifically related to governments’ needs to adapt to frozen or cut US health assistance: we heard when investigating this grant that governments were already beginning this planning process and that lighter touch versions of the support offered by TSUs were already being provided on nights and weekends by CHAI staff in certain countries. We also think this kind of grant is inherently uncertain and it didn’t seem likely that we’d reduce that uncertainty by spending additional time investigating. So, with apparent demand for support at the time and since we didn't think waiting would lead to a better decision, we chose to recommend funding relatively quickly.

Hi Nick,

Thanks for reaching out and for your interest in these grants. We're currently working on grant write-ups that we plan to publish soon, but unfortunately, we don't have anything available to share just yet.