Summary

The Deworm the World Initiative (DtWI), led by Evidence Action, received approximately $2.3 million as a result of GiveWell’s recommendation last year. While there were some deviations, it largely allocated these funds as we expected.

DtWI now has limited room for funding; it is currently seeking to raise an additional $1.3 million to support its activities in 2015 and 2016. We expect it to allocate approximately 30% of the additional funds it receives for work related to expanding school-based, mass deworming programs and funding related operating expenses (including impact evaluation related expenses), and will allocate other funds to priorities that are less directly connected to expanding and evaluating deworming programs (investigating ways to combine other evidence-based programs with deworming rollouts, supplementing a project supported by another funder).

We currently expect to release updated recommendations by December 1st. We think it is likely that the Deworm the World Initiative will remain on our top charities list.

How did DtWI spend the money it received due to GiveWell, and how does this compare to our expectations?

GiveWell directed approximately $2.3 million to the Deworm the World Initiative since we added it to our top charities list in December 2013.

At the time of our recommendation, we expected DtWI to spend additional funds in the following ways; we did not have precise estimates for how much it would spend in each category:

Some portion to provide reserves for DtWI, both to make the organization more resilient and to allow it to respond to high impact opportunities

Some portion to allow DtWI to offer a lower-intensity level of assistance to regions that didn’t require its standard level of assistance

Some portion to support expansion to new states in India

It has allocated these funds as follows (years when we expect funds to be spent in parentheses; 2014 means funds have been spent):

$881,000 – ongoing reserves. Our understanding is that DtWI does not have plans to spend these funds in the near future. Instead, these funds make DtWI more robust as an organization: for example, it is less likely to need to significantly shift priorities in order to fundraise and it is more likely to be able to respond quickly to high-impact opportunities it identifies.

$509,000 – expansion into new countries (2015 and 2016). This includes preliminary work in Ethiopia, Indonesia, Philippines to support possible future work and $104,000 for prevalence surveys and technical assistance to the government and partner organization in Vietnam.

$430,000 – ongoing work in India (2014 and early 2015). This will fund a follow-up prevalence survey in Bihar to assess the impact of three rounds of deworming on worm prevalence and intensity, and enable expansion to preschool children there, as well as contribute to the third round of the Rajasthan and Delhi programs.

$207,000 – contribution to elimination research primarily funded by the Children’s Investment Fund Foundation (CIFF) and the Bill and Melinda Gates Foundation (BMGF) (2015-2017). CIFF and BMGF provided approximately $1.6 million in funding to the Deworm the World Initiative and the London School of Hygiene and Tropical Medicine to conduct research on the feasibility and cost effectiveness of breaking transmission of soil-transmitted helminths. Breaking transmission would potentially require a different approach (likely covering more than just school-aged children) than DtWI’s standard school-based deworming model.

$151,000 – DtWI overhead (2014). These funds support DtWI as an organization but are not directly programmed (e.g., a portion of Alix Zwane’s, the Executive Director of Evidence Action salary, Evidence Action financial staff, etc.). Note that DtWI estimated $151,000 based on allocating 15% of programmed GiveWell-sourced funding to DtWI overhead. DtWI said it could more explicitly track these funds but would be time consuming to do so. We agreed that more detailed accounting was not necessary.

$129,000 – additional staff (2014). In 2014, DtWI hired (a) a deputy director to support its programming worldwide and (b) someone to focus on its impact evaluation. The latter hire is likely to be doing work on the breaking transmission work discussed below. We allocate some of this line item to expansion and related operating expenses and some to research.

Overall, DtWI’s funding decisions seem reasonable to us and are broadly consistent with what we anticipated.

46% ($1,067,000) supported expanding deworming programs and funding related operating expenses (including impact evaluation related expenses). This includes the deputy director who supports the organization as a whole but is necessary to expanded work in India and other new countries and half of the salary for the impact-evaluation-focused new staffer since he works on programmatic and technical support across DtWI.

38% ($881,000) supported ongoing reserves.

10% ($241,000) supported research that we had not anticipated (including the other half of the new staffer since he is spending a significant part of his time on this research).

6% (151,000) supported DtWI as a whole.

How would DtWI spend additional funds?

The Deworm the World Initiative seeks an additional $1.3 million to support its activities in 2015 and 2016. DtWI expects to spend $377,000 of the $1.3 million (29%) it seeks on work related to expanding school-based mass deworming programs and funding related operating expenses (including impact evaluation related expenses). More specifically, these activities would be:

$230,000: staff to support expansion in India, new countries, and related operating and evaluation expenses. This line item is the salary for the deputy director and part of the salary for the impact evaluation focused staff member described above.

$144,000: DtWI overhead (described above).

$500,000: evaluation of new evidence-based programs that leverage deworming. We have limited detail about what this would entail. One idea that DtWI has investigated is the possibility of distributing bednets along with deworming pills in schools as an alternative distribution mechanism to national net distributions. Another is including hand-washing educational programming alongside deworming days. This line item includes $50,000 to support DtWI’s evaluation of its hygiene and deworming program funded by Dubai Cares and $50,000 to enable DtWI to hire a senior epidemiologist.

$230,000: staff to support evaluation of DtWI’s work in Kenya. This work is primarily funded by CIFF. DtWI believes that additional resources can improve significantly the quality of the analysis done regarding the cost effectiveness of breaking transmission. This line item includes $100,000 to support the impact evaluation focused staff member described above.

$170,000: implementation support for the integrated deworming, sanitation and hygiene education program in Vietnam, in partnership with Thrive Networks.

Why is DtWI seeking additional funds primarily to support research and evaluation rather than scale up? What changed in the past year?

In 2014, two events affected DtWI’s projection of the additional funding it would require to scale up in India:

The Children’s Investment Fund Foundation (CIFF), a major foundation that had supported DtWI’s programs in Kenya, agreed to a 6-year, $17.7 million grant to support DtWI’s expansion to additional states in India and technical assistance to the Government of India for a national deworming program. At the end of 2013, DtWI believed it was reasonably likely that it would not receive this grant and had not anticipated how quickly it would come through. With these funds, DtWI does not require significant additional funding to support its India expansion. The new Indian government expressed interest in conducting a single deworming day nationally with increased national attention and resources. Advocating for such a policy and assisting the national government in creating a plan became the major focus of DtWI’s India work in 2014, which both reduced the amount of time it was able to spend generating interest in heavy DtWI involvement in new states, and also required little funding since there were few costs of that project aside from staff time. DtWI believes that the first national deworming day will likely happen in February 2015.

Together, these changes led DtWI to the conclusion that funding is no longer the bottleneck to reaching more people in India.

More broadly, we believe that if donors close both the $1.3-million 2-year funding gap of DtWI and the ~5-$8-million funding gap of the Schistosomiasis Control Initiative (SCI), another deworming organization we recommend, funding will not be the primary bottleneck to deworming programs’ scaling in general. Overall, our impression is that there is currently more funding available for scaling up deworming programs than capacity at organizations to utilize funds for scaleup.

Dr. Zwane believes that DtWI’s research agenda is important for two reasons:

She believes it is possible that this research will demonstrate that other approaches to deworming are more cost-effective, such as eliminating worms from areas to avoid the need for mass treatments, or combining deworming with other interventions such as bednet distributions or hygiene education. She would like DtWI to consistently provide useful information to funders and policymakers and undertaking this research will enable it to continue doing so.

Notes on other deworming implementers and funders

It is not unlikely that GiveWell-directed donors will close the funding gaps of both DtWI and Schistosomiasis Control Initiative in the coming few months. Because of this, we also asked Alix Zwane (Executive Director of Evidence Action) about other implementers and funders working on deworming.

Implementers

Dr. Zwane told us DtWI and SCI are the two primary organizations that focus primarily on expanding countrywide deworming programs. Other organizations work on deworming but are not as directly focused on scaleup with government partners to her knowledge. There are other NGOs that work on other neglected tropical diseases (e.g., SightSavers) and school health (e.g., Partnership for Child Development), but Dr. Zwane is less familiar with the reach and scope of the service delivery they support.

Organizations that do a smaller amount of deworming implementation include UNICEF, Micronutrient Initiative and Vitamin Angels, which have begun adding deworming pills to their vitamin A supplementation programs, and WaterAid, which adds deworming to some of its water and sanitation programs.

IMA World Health, Helen Keller International, Sight Savers International, The MENTOR Initiative, and possibly others implement deworming programs supported by the funders discussed below. We have yet to speak with these organizations and have little information about their deworming programs or funding needs.

According to Dr. Zwane, the Global Network for Neglected Tropical Diseases works primarily on advocacy and does not focus on deworming, specifically, while Children without Worms coordinates partners globally and does not work on providing technical assistance for program delivery directly currently to her knowledge.

Funders

Major funders of deworming service delivery include the following: Dubai Cares, The END Fund, CIFF, the UK government’s Department for International Development (DFID), Michael and Susan Dell Foundation, and the US government’s USAID.

According to Dr. Zwane, these funders are interested in supporting scale-up, and she believes that DtWI will be in a strong position to raise funds for scale up from them if and when funding becomes a bottleneck. These funders are less likely to fund the types of activities to which DtWI has allocated GiveWell-directed funding.

A longer list of organizations working on deworming is available in this document, from a recent meeting of groups that are part of the STH Coalition.