Here to Give • We Publish a List of "Top Charities" That We Recommend to Donors

For the electronic version of this document with working hyperlinks, see: http://www.givewell.org/2012-guide

Guide to GiveWell and its top charities

This document gives basic information about GiveWell and its current top charities. Much more information is available at our website, www.givewell.org

• Page 2 gives basic information about GiveWell: why we exist, what we do, and what our long-term vision is. • Page 3 gives some examples of cases in which charities tell appealing, compelling stories that don't hold up under close examination. We've encountered many of these stories in our work, and urge donors to approach their giving with critical thinking and not just good intentions. • Page 4 outlines our process for identifying top charities. • Pages 5-6 discuss the strengths and weaknesses of our 3 current recommended charities: Against Malaria Foundation (preventing deaths from malaria in sub-Saharan Africa), GiveDirectly (distributing cash to extremely poor individuals in Kenya), and Schistosomiasis Control Initiative (treating children for parasite infections in sub-Saharan Africa). • Page 7 lists some frequently asked questions about our process and our top charities.

1 For the electronic version of this document with working hyperlinks, see: http://www.givewell.org/2012-guide

About GiveWell

• Founded in 2007 by finance professionals trying to accomplish as much good as possible with their giving • Supported by donations from foundations and core supporters; GiveWell does not solicit from the general public • We seek to find outstanding giving opportunities (not to rate every charity) and to publish the full details of our analysis to help donors decide where to give • We publish a list of "top charities" that we recommend to donors. There are currently 3 charities on the list. We refresh the list annually. • Our guiding principle: "Where would (will) we give our own money to accomplish as much good as possible?" • Focus to date: evidence-backed direct aid. "How can I translate my dollars directly and verifiably into improved lives?" • We've found that many charities tell compelling stories, but that these stories often become less compelling as we dig into the details and evidence. • Beginning to explore other causes, such as funding scientific research. No giving recommendations in these areas yet. • We do in-depth investigations of top charities, including extensive interviews with staff, field visits and extensive reviews of academic literature • Radical transparency: we publish the full details of our process and the reasoning behind recommendations, updates on recommended charities including both good and bad news, notes from phone conversations, audio recordings of our Board meetings, a blog with regular content on our evolution, and more • There are other "charity evaluators" that rate large numbers of charities based on factors such as financial and governance indicators, but no other group that gives public recommendations based on evidence of impact, "good accomplished per dollar," funding needs, etc. • In 2011, tracked $5 million in donations given or committed as a direct result of our recommendations

Our value proposition: we put thousands of hours of work into finding the best giving opportunities we can. You can use our recommendations (and the full details of how we arrived at them) to inform your own giving for free.

Our vision: • Today, major foundations keep the substance of their work behind closed doors. New, or small, philanthropists have to start their learning from scratch. We picture a world in which there is a global, open, substantive conversation about how to best accomplish good with one's donations. • Today, donors reward charities mostly for storytelling ability and personal connections. We picture a world in which donors reward charities for effectiveness in improving lives.

More information about GiveWell: http://www.givewell.org/about

2 For the electronic version of this document with working hyperlinks, see: http://www.givewell.org/2012-guide

A Good Story is Not Enough

Charities tell many appealing, compelling stories. We've often found that these stories tend not to hold up upon closer examination, and we believe that claims of donors' having a positive impact should be taken with skepticism by default.

• Microlending (making small loans to poor borrowers in the developing world) is often presented as a way to help people escape poverty by giving them the capital to start or expand small businesses. However, in practice loans may be used differently from how people commonly imagine (for example, they are often used for consumption) and may offset this with harm as well (since they often involve annualized interest rates of over 30%, sometimes even over 100%). A recent set of high-quality studies has found little in the way of positive impacts for microlending, and many of the other frequent claims about this intervention have been debunked as well. More

• Disaster relief: major natural disasters tend to draw major media attention and outpourings of financial support. But because of the logistical challenges of disaster relief situations, more money may not mean a better relief effort - in fact, it may mean a worse one if it funds well-intentioned groups that use roads, fuel, and space for suboptimal activities. We argued that more money would not improve the relief effort for the 2011 Japan earthquake, and based on the relief effort for the 2009 Haiti earthquake, we think the question of whether more money would have meant a better effort is not easy to answer. More

• Corrective surgery: charities often advertise that a relatively small amount of money can pay for a corrective eye or lip surgery. But in our investigations, we've often found that there appears to be a limit to how many skilled surgeons are available, and it isn't clear that more donations would result in more surgeries. More

• Great interventions with no "room for more funding": we've found that some of the most proven and cost-effective programs, such as immunizations and first-line tuberculosis treatment , are - fortunately - largely funded by major donors (including governments), and that there is no clear way to translate additional funding into additional people served by these programs. • Seductive cost-effectiveness figures: in 2006, a major report was released by a joint enterprise of the World Health Organization, National Institutes of Health, the World Bank, and the Population Reference Bureau with funding from the Gates Foundation. The report tried to estimate the "bang for the buck" of different health interventions, in terms of the cost per (equivalent of) healthy year of life saved. One of its most striking claims was that treating children for parasites (the intervention carried out by our current #3 charity) cost only $3.41 per "disability-adjusted life-year" (the unit used by the report), making it one of the very strongest health interventions. In 2011, we examined this figure as part of our investigations, and found that it came from a spreadsheet with multiple errors and was off by a factor of 100. The corrected figure was $326.43 per disability- adjusted life-year (not $3.41), implying mediocre cost-effectiveness. This number had been cited for years without (apparently) being vetted. More

3 For the electronic version of this document with working hyperlinks, see: http://www.givewell.org/2012-guide

Process For Finding Top Charities

Our criteria

Our focus to date has been evidence-backed direct aid. ("How can I translate my dollars directly and verifiably into improved lives?") We're starting to explore other causes, such as funding scientific research; we have no giving recommendations in these other areas yet, however. Currently, we seek charities with: • Strong evidence of positive impact on people's lives. We thoroughly review academic research and internal documents to assess the strength of evidence. More • Highly cost-effective activities , i.e. outstanding "bang for the buck" in terms of changing many lives (significantly) for relatively little money. More • Room for more funding. It isn't enough to identify a strong program; we seek to identify strong programs that can productively use more funding. Some of the best charitable programs are fully funded; we seek to find gaps that donors can help close. More • Transparency and accountability to donors. Recommended charities must be willing to share enough in-depth information about their work that we can assess them on the above criteria - both prior to our recommendation, and afterward. (We follow up regularly on past recommended charities and share both positive and negative developments.)

Narrowing the field down to find contenders for "top charity" status • In past years, we've cast as wide a net as possible, examining hundreds of charities sourced through tax records, major foundations' grantee lists, etc. More • We've looked for charities that publish evidence of impact, or charities that focus on programs that have strong independent evidence behind them. More • Based on examining many charities and reviewing academic literature, we've concluded that international aid offers the highest "bang-for-the-buck" for direct aid. More • Among international aid interventions, we've identified a small number with strong evidence bases, including distribution of insecticide-treated nets, treatment for intestinal parasites, and direct cash transfers. More • We now focus on finding charities (or other vehicles) that will use additional dollars to deliver one of these proven interventions. • There are some programs that are strongly supported by evidence, but that don't represent giving opportunities because the best opportunities to expand them are already funded. (I.e., additional dollars won't lead linearly to additional people served). Example: vaccines Evaluating potential top charities

Our process includes: • Extensive back-and-forth with the organization's executive management, drilling down into the full details of their process, performance data, future plans and funding needs • Several-day visit to the organization's operations in the field • In-depth review of any academic literature or other data that seems relevant to key questions about the organization's activities (e.g. Do insecticide-treated nets save lives when used properly? Do people generally use them properly? Are mosquitoes developing insecticide resistance?) • Full reviews of our top charities are linked from our top charities page

4 For the electronic version of this document with working hyperlinks, see: http://www.givewell.org/2012-guide

2012 Top Charities

Our Potential Program cost- confidence for Program Program evidence effectiveness in the innovation organization /upside Against Malaria Malaria control Very strong Very strong Very high High Foundation

Strong on short- Direct cash term consumption; Highly uncertain; GiveDirectly transfers to the Very high Very high moderate on may be strong very poor investment

Schisto- Deworming Highly uncertain, somiasis (treating Fairly strong though may be High Low Control parasitic strongest Initiative infections)

#1 - Against Malaria Foundation (AMF) - Preventing deaths from malaria in sub-Saharan Africa

• AMF focuses on distributing insecticide-treated nets, which are strongly proven to reduce malaria and save lives. This is the most evidence-backed intervention we know of that still has substantial funding gaps. • We estimate ~$2,300 per under-5 life saved, not including the many other benefits of reducing malaria. • AMF stands out for its transparency and accountability. It tracks each distribution from shipment to delivery, and collects follow-up data on whether people are using the nets and whether malaria cases decline. • AMF's CEO consistently raises the bar for collecting and sharing data, and gives strong answers to critical questions. AMF's advisory board provides subject-matter expertise on malaria control. • AMF is 7 years old with 2012 revenue of ~$3 million. More donations will mean more nets delivered, more data collected on their effectiveness, and greater potential for AMF to set an example for other net distributors and charities in general.

Full review of AMF

#2 - GiveDirectly - Distributing cash to extremely poor individuals in Kenya

• GiveDirectly's goal: for every $1 of total expenses, deliver 90c directly into the hands of the extremely poor, no strings attached. • This intervention is simple, but highly unconventional. We looked for years for a charity focused on direct cash transfers in the developing world, and GiveDirectly (founded mid- 2011) is the only one we're aware of. • Direct cash transfers are the most heavily studied non-health intervention we know of. The evidence says that they increase short-term consumption, especially of food, and there is suggestive evidence that they may be invested at very high financial rates of return (e.g. ~20% per year). • GiveDirectly stands out for transparency and accountability. It collects and shares substantial data to verify the delivery of cash transfers and examine how they're used. It has two high-quality studies ongoing to gauge long-term impacts of its work.

5 For the electronic version of this document with working hyperlinks, see: http://www.givewell.org/2012-guide

• GiveDirectly's executives are academic economists. They are committed to evaluation and transparency and consistently give thoughtful answers to critical questions. • Some find direct cash transfers instinctively unappealing; others believe the burden of proof should be on charities to explain why their work does more good than delivering cash directly. We believe GiveDirectly has the potential to shed light on the question of how cash transfers should be delivered and how they compare to traditional aid. • GiveDirectly is a young organization. More donations will result in more cash transfers (90c delivered for every dollar donated) and will give GiveDirectly the chance to experiment and expand faster.

Full review of GiveDirectly

#3 - Schistosomiasis Control Initiative (SCI) - Treating children for parasite infections in sub-Saharan Africa

• SCI focuses on deworming: treating people for intestinal parasites. These parasites are very rarely fatal, but may have subtle developmental impacts: two high-quality studies make the case that people who are dewormed in childhood earn substantially more, much later in life. • Deworming is extremely inexpensive, in the range of 50c per person treated. It often gets less attention than life-saving interventions, and funding gaps remain. • SCI has repeatedly driven national deworming programs, and published data showing success in reducing parasite prevalence. • SCI is not as strong as our top two charities in terms of transparency and accountability, but it is still outstanding in the context of charities in general.

Full review of SCI

More discussion of the relative strengths and weaknesses of these three charities

6 For the electronic version of this document with working hyperlinks, see: http://www.givewell.org/2012-guide

Frequently asked questions

On insecticide-treated nets: is there really a need for more nets, given all the attention they've gotten? Do people consistently use their nets?

• We have reviewed data on net distributions as compared with populations at risk for malaria, and we believe there is a very large remaining funding gap. • Usage of nets remains a concern of ours, but the best available evidence suggests that most people do use the bednets they receive. Multiple studies associate nets with cost- effective reductions in malaria burden and child deaths; these studies generally saw usage rates in the 60-80% range; and the best available evidence suggests that usage rates of 60-80% are common. In addition, Against Malaria Foundation collects its own data on net usage and has found positive results so far.

On cash transfers: do recipients spend the money from transfers wisely/productively, or on unproductive uses such as alcohol/gambling?

The academic evidence we've seen, while not conclusive, indicates that cash transfers are largely spent in beneficial ways. The most robustly established use of cash transfers is on food (i.e., shifting toward a higher quality diet). There are also multiple high-quality studies arguing that recipients spend cash transfers on productive investments with high long-term returns, leading to improved long-term incomes.

Attempts to monitor alcohol expenditures have found that these expenditures increase, at most, proportionally with overall expenditures.

GiveDirectly's own (more informal data) suggests that major uses of the transfers include food, livestock (which may be a method of storing value for the long term), and metal roofs (which may be a method of storing value as well as reducing the need for regular repairs to a mud hut/thatch roof).

What are the benefits of deworming children (treating them for parasites)?

Treating children for parasitic infections (deworming) is extremely inexpensive (~$0.50 per person treated, including all costs), and there is some evidence linking it with substantial developmental benefits (people dewormed in childhood may attend school more and earn more later in life); the evidence is not as strong as for insecticide-treated nets but is still far above what we've seen for most charitable interventions. Evidence regarding shorter-term health benefits is mixed.