Charity Entrepreneurship’s research into large-scale global health interventions
Every year at Charity Entrepreneurship, we try to find the best interventions to launch impact-focused charities through our Incubation Program. As a research-driven organization, we try to continuously improve our research methodology and process to ensure a robust and comprehensive analysis of the interventions under consideration. In our last research round (late 2022- early 2023), we focused on the area of large-scale global health. In this post we share with you our insights on the objectives, research framework, and selection criteria that have guided us in identifying and recommending the most impactful ideas in this space.
Why “large-scale” global health?
There is evidence to suggest that the larger a charity scales, the less cost-effective it becomes. This tradeoff likely applies to most cause areas, but it is most evident in the global health and development space. In this diagram from an Open Philanthropy talk, we can clearly see this correlation mapped out:
Source: Open Philanthropy’s Cause Prioritization Framework Talk (min. 22:12) The diagram shows GiveWell's top-recommended charities from 2020 clustered on the 10x cash line, each having the ability to spend approximately $100 million or more, annually. GiveDirectly is located on the 1x cash point, having the capacity to spend approximately $100 billion annually. This has lead us to two considerations::
Firstly, it suggests that those who prioritize evidence-based, impact-driven philanthropy may identify highly effective, yet challenging-to-scale interventions that surpass the efficacy of GiveWell's top recommendations. However, identifying such interventions may be challenging.
Secondly, it means that Charity Entrepreneurship needs to determine how to balance cost-effectiveness and scalability when recommending potential high-impact interventions.
During our 2020 and 2021 research round in the global health and development space, our primary focus was on maximizing cost-effectiveness. We honed in on policy charities in particular, which are likely to reside in the top left quadrant of the scalability versus cost-effectiveness graph; such organizations may be many times more effective than current top recommendations by GiveWell, but have limited capacity to absorb additional funds. For instance, HLI estimates here that LEEP, the longest-running policy charity incubated by Charity Entrepreneurship, is approximately 100 times more cost-effective than cash transfers. In 2022, we made the strategic decision to shift our focus from maximizing cost-effectiveness, to maximizing scalability.This decision was made given the apparent high level of funding available from organizations such as GiveWell. We challenged ourselves to seek out the most promising new charity ideas that could scale to absorb $5 million or more in funding within five years, while also maintaining the same level of cost-effectiveness as current top GiveWell recommendations (10x cash, ~$100/DALY).
Our research process
In late 2022 and early 2023, we conducted a six-month research round with a team of four staff members, as well as several research fellows, to identify the most promising new charity ideas. Our approach prioritized ideas that met the following criteria, in order of importance:
Surpassed our benchmark of 10x cash, and could scale to absorb $5 million
Had strong evidence supporting their efficacy
Were likely to perform well as a new charity
Were varied (so not all our ideas are the same)
Were highly cost-effective and scalable
Our research process began by compiling a list of over 300 ideas. We then gradually narrowed down the list through a series of research rounds, each of which examined the best options from the previous round in greater depth. To evaluate the potential of each intervention for future charity entrepreneurs, we utilized a variety of decision-making tools, including group consensus, weighted-factor models, cost-effectiveness analyses, quality of evidence assessments, case study analyses, and expert interviews. For a more detailed overview of our research process, please refer to our Research Process 2021 | CE page. While our approach was rigorous and exploratory, it was not exhaustive– we did not research all 300 ideas in depth. Therefore, our decision not to pursue a particular charity idea to the point of writing a full report should not be interpreted as a judgment that the idea is without merit. Our long list The 300 ideas in our list were each evaluated with a score, indicating the likelihood of recommendation.It is important to exercise caution when interpreting these scores, as there may be some externalities that affect their accuracy. For instance, some ideas may have lower scores than warranted because we already know someone is working on starting that idea. In such cases we hold off on investigating the idea. You can see our long list of 300+ ideas at: Large-scale global health (LSGH) research 2022 - Summary of ideas and progress _ public version Some ideas on this list were contributed by people and organizations outside of Charity Entrepreneurship. We have not credited every idea, but are highly grateful to those who added ideas and supported our research at all stages. In addition to the extensive list of 300+ ideas, our research team and partners conducted mini-projects on family planning and education. Through these focused investigations, we were able to identify two additional ideas that met our rigorous criteria and add them to our final list of potential charity ideas.
Our shortlist and the final ideas
You can see our tabulated summary of our top 10 ideas here: 2022 Large-scale global health (LSGH) _ Decision-making spreadsheet _ public version Top ideas we looked into and recommended for launch:
Antenatal clinic based syphilis screening and treatment to tackle congenital syphilis – recommended
Scaling up Oral Rehydration Solution and Zinc co-packs for the treatment of diarrhea in under-5-year-olds – recommended
Scaling up Kangaroo Care for low-birthweight infants – recommended
Fixing stock-outs of contraceptives [Family planning idea] – recommended
Top ideas we considered but not recommended for launch:
Fluoridation of salt to prevent tooth decay - considered
Child Contact Management and Treatment for TB - considered
Lesson plans [Education idea] – not yet published as we may revisit this idea, please contact us for access to our current draft.
Improving oxygen access for childhood pneumonia - considered
Vouchers for point-of-use water chlorination (Moved over from health security) - considered
Preventing violence against women and girls (VAWG) through community activist social empowerment - considered
We have already written about our recommended ideas here: CE: Announcing our 2023 Charity Ideas. Apply now! - EA Forum. We will be publishing more posts on this forum, including information about our other ideas, in the coming months.
We wish to express our deep gratitude to the research team for their remarkable effort and dedication in conducting this research. We extend our appreciation to Akhil Bansal, Morgan Fairless, James Che, Filip Murar, and Vicky Cox. Moreover, we would like to acknowledge the invaluable contributions of our research fellows, Miri Muntean and Moritz Von Knebel, as well as Leonie Falk of Woodleigh Impact for her excellent research on education interventions. We are also grateful to the many others who have contributed to this research in various ways, including the experts who provided their expertise and guidance in specific areas. Each of these individuals is recognized and thanked in the report specifically related to their contributions. This research would not have been possible without the generous support of all of these individuals, and we are deeply appreciative of their contributions.