I’m glad you found this response helpful!
We expect to wait until the results of FEM’s RCT are available before deciding whether to recommend funding for the program itself; we do have some remaining uncertainties, and it's possible that additional work could lead to significant changes in our cost-effectiveness estimate. We also plan to continue our own research on family planning programs in general, which may affect our funding decisions in this area.
As our investigations progress, we’ll share updates on our website. Please feel free to reach out directly if you have questions in the meantime!
Donor Relations Associate
Thank you for raising these points! We’ve shared your thoughts with our research team for future consideration.
If you have any other questions or concerns about our work, please feel free to reach out to us!
Thanks for this comment. We are interested in potentially funding family planning programs, including Family Empowerment Media. Our research and grant decisions are independent of our outreach and fundraising plans. To clarify and add detail on some of the points above:
GiveWell recommended a $500,000 grant to Family Empowerment Media in March 2023. This funding would support a planned randomized controlled trial (RCT) of its program. We haven't yet published about this grant, but we plan to soon. (Our grant page publication often lags our funding decisions considerably, though this is something we're working to improve!)
We believe that FEM or other types of family planning–related programs may be very cost-effective—our current rough estimate for FEM's program (not the RCT of the program) puts it at 18-28 times as cost-effective as unconditional cash transfers—but we have a high degree of uncertainty about some of our inputs and expect that the results of FEM's RCT would help us address some of our uncertainties. We are also continuing to assess how to prioritize family planning programs among the many other promising programs we're investigating.
I hope that's helpful!
Best,Miranda KaplanGiveWell Communications Associate
We were very excited to learn of this trial, a much-needed step toward reducing deaths from tuberculosis. We applaud Gates and Wellcome for this sizable commitment of resources, which is, as Nick points out, necessary to gain adequate information about the vaccine's efficacy, but beyond the reach of most funders.
We have investigated TB-related funding opportunities, and we remain very open to funding either programs or research. However, we have several significant uncertainties about the programs we've explored so far and have not yet funded any at scale.
We are working on a report summarizing the evidence for mass TB screen-and-treat programs, which will provide more detail on our views specific to that type of program.
Yes, to clarify, MiracleFeet is selecting the on-the-ground evaluator that will conduct the monitoring in each location, although GiveWell will lightly vet MiracleFeet's choices and meet with each evaluator.
The primary purpose of the monitoring grant is to understand how many children are treated for clubfoot both with and without MiracleFeet's support. So, although MiracleFeet has records of children treated through facilities it's supported, we also want an assessment of baseline treatment coverage before MiracleFeet launches its program (or expands it, in the case of the Philippines). We do plan to incorporate some form of data audit as part of endline activities; we'll work out the details of that at a later date.
Thanks again for your interest in this and for taking the time to ask questions!
Thanks for your comments, your insight into this grant, and your support!
We do expect to get input from local hospital staff on existing treatment coverage through the baseline surveys. The monitoring grant will fund the creation of a sampling frame that includes both public and private health facilities, which we think will yield more complete data than contacting hospitals through our partners.
We agree that potential bias from external evaluators is a risk for the reasons you've mentioned. While we won't be involved in the selection of evaluators, we plan to do the following to mitigate that risk:
We don't think this will completely eliminate uncertainty about the quality of monitoring results, but we expect it will help. We also think there is some value to be gained from working with evaluators who have a strong familiarity with the local context.
Sorry for the delay in getting back to you!
In an ideal world, we would have included financial burden for tobacco in these rough calculations (which were mostly intended to narrow down what we'd focus on in our initial foray into public health regulation grants). But essentially, the last line of your response is the answer: because we value children's lives so highly, we expected that incorporating the financial burden of tobacco use would not be enough for us to prioritize it over lead. Lead specifically affects young children, and the gap in estimated spend per unit of burden ($0.07 for lead versus $0.24 for tobacco) is large. If we were doing a deeper investigation of tobacco policy as a possible funding area, we would aim to more thoroughly account for its harms.
As shown by the research conversation notes you link to, GiveWell lightly explored funding tobacco control policy advocacy in the past. Ultimately we decided to focus on other policy areas (alcohol policy, lead exposure, and self-harm from pesticide ingestion) that appeared more neglected. You can read more about our public health regulation research on this page—see "Cause areas we investigated at a shallow level and deprioritized," and this spreadsheet, linked from footnote 24, which gives our estimates of how much is spent on tobacco policy (and other causes we looked into) per unit of burden.
Thank you for the thought-provoking post!
Miranda KaplanGiveWell Communications Associate
Thanks for this thoughtful post, Tom. You’ve definitely raised some thoughts that have been on our mind recently, such as how GiveWell could systematically incorporate more external input into our grant-making process. We’ve taken some steps towards this, such as with a beneficiary survey in 2019, and seeking out more external experts, but we’d like to do more – it was really great to read through your recommendations.
We did want to clarify, however, that GiveWell’s approach to modeling cost-effectiveness and making grant recommendations is heavily context-specific. You’re right that we start with intervention-level analysis in order to get a rough sense of the cost-effectiveness of any given program. But, our next step is to modify our models with many charity- and context-specific data and only fund grant opportunities that are above our 10x bar. For example, when we’re considering making grants to Malaria Consortium's SMC program, we assess funding opportunities at the country level, taking into consideration the differences in malaria prevalence, demographics (age distribution), mortality rates, program costs, and the spending we might expect from other actors in each setting. The result is that the same program may clear our cost-effectiveness bar in some locations and not in others. For a recent example, see this page about a grant we recommended in January for Malaria Consortium; we decided to extend funding for its SMC program in Nigeria, Burkina Faso, and Togo (where estimated cost-effectiveness was near or above our bar), but provide only exit funding for Chad (which was below our bar).
If there’s reason to expect variations within countries, we also build out our model at the subnational level. For example, in 2022 we updated our model of Malaria Consortium's SMC program in Nigeria with state-level malaria prevalence and mortality data. While we don’t capture every variance one could expect, we're trying to adjust for the major variances that could exist in different contexts (and which therefore could affect our bottom-line grantmaking decisions).
We realize that this nuance isn’t captured in our external-facing marketing, and we’re working on updates to our website to address this. We really appreciate your engagement with our work; we aspire to account for context-specific variables in our grantmaking and appreciate the push to consider this further and to make this aspect of our work clearer.
Hi, Peter! So sorry I missed this question earlier and have been delayed in responding.
We've described in the above post what we know about R21 so far (see the second and third paragraphs from the end). To summarize, R21 has been shown to have high efficacy in protecting against malaria, but it's unclear to us so far how generalizable those results will be. R21 is also reportedly less complicated to manufacture, which could be helpful as demand for malaria vaccine is expected to outstrip supply - but we can't independently verify this. We'll keep monitoring the literature on R21, and we'll consider any funding opportunities as they come up.
GiveWell Communications Associate