GiveWell Conversations

This episode follows up on the November 26, 2025 episode of Planet Money, “Saving lives with fewer dollars,” which covered GiveWell’s evaluation of a grant to the Alliance for International Medical Action (ALIMA) to maintain primary healthcare, hospital services, and malnutrition treatment in two subdistricts of North Cameroon following unexpected aid cuts earlier this year. We recommend listening to the Planet Money episode first, as it provides important context. 

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Significant changes to foreign aid this year created challenges for implementing organizations—and for funders evaluating which programs to support with limited resources. The Planet Money team followed along as we assessed the effects of the cuts in real time, focusing on our evaluation of a potential grant to ALIMA to maintain nutrition and primary healthcare services in Cameroon. 

Following the announcement of the US government’s stop-work order and funding freeze in January, we created a rapid response research team and began assessing opportunities we thought were potentially highly cost effective. In March, we launched an investigation of the $1.9 million ALIMA grant, which we funded in June based on the team’s findings.

In this episode, GiveWell CEO and co-founder Elie Hassenfeld dives deeper into the grant investigation with Program Officers Rosie Bettle and Alice Redfern, discussing the timeline, modeling approach, and what ultimately led us to make the grant.

Elie, Rosie, and Alice discuss:

• The grant investigation timeline: GiveWell completed the investigation in about six weeks from start to finish. Typically, GiveWell grant investigations build on months or years of prior research. While we’ve researched and funded malnutrition programs in the past (including ALIMA’s programs), this program’s scope was wider—covering primary healthcare, disease surveillance, and hospital logistics.  
• How we adapted our modeling: As part of evaluating this grant, GiveWell attempted to estimate several parameters related to mortality, then used a series of simple models—rather than one comprehensive model—to estimate cost-effectiveness based on those parameters. These models, along with conversations with experts and other inputs, allowed the team to move quickly and respond to the urgent need. 
• An update on grant progress: With GiveWell’s funding, ALIMA’s program is now up and running again. The program has been adapted to incorporate mobile clinics, and ALIMA is on track to treat the number of children GiveWell expected. Based on a number of conversations, we believe that ALIMA’s programs are leading to increased care-seeking behavior. 

As GiveWell’s research team grows, that increased capacity and expertise allows us to evaluate a wider range of programs and adapt our approaches to better find the most cost-effective opportunities to help people. In this case, that growth enabled us to move quickly and navigate uncertainty to evaluate and fund ALIMA’s program.  

Visit our Foreign Aid Funding Cuts page to learn more about our response to this year’s aid cuts, visit the All Grants Fund page to learn more about how you can support this work, and listen or subscribe to our podcast for our latest updates.

This episode was recorded on December 3, 2025 and represents our best understanding at that time.

Despite significant progress over the past several decades, malaria remains a leading cause of death globally for children under five. This year’s cuts to foreign aid funding disrupted highly effective programs to prevent malaria, such as seasonal malaria chemoprevention (SMC).  

SMC provides antimalarial medication to children under the age of five during the rainy season when malaria transmission is highest, reducing their risk of dying from the disease. Malaria Consortium’s SMC program, which is one of the most cost-effective programs our researchers have identified, has been one of GiveWell’s Top Charities since 2016, and we’ve recommended more than $500 million in grants for the program since that time. 

SMC is only delivered during a specific period each year when malaria transmission is highest. The campaigns require careful planning and preparation on a specified timeline to ensure that the drugs are ready to distribute during that window. The funding freeze that started in January jeopardized 2025 SMC campaigns in several countries because of the disruption to funding for these time-sensitive pre-campaign activities. 

In this episode, GiveWell CEO and co-founder Elie Hassenfeld speaks with Program Officer Natalie Crispin about how GiveWell responded quickly and flexibly to ensure that SMC campaigns moved forward this year.

Elie and Natalie discuss:

• Planning for SMC campaigns: Prior to carrying out SMC campaigns, implementing organizations engage in an intensive and time-sensitive planning process to ensure that drug distributors are fully trained, the right quantity of preventive drugs is shipped to each community, and people are informed about upcoming campaigns.   
• GiveWell’s response to keep SMC campaigns on track: GiveWell considered funding for SMC in 11 countries where it had been funded by the US government, talked with stakeholders in 10, and ultimately provided funding guarantees for SMC planning activities in six countries. These grants ensured funding for pre-campaign activities if US government funds didn’t return—enabling implementing organizations to move forward with timely preparations while their funding was uncertain.
• Challenges, reflections, and lessons learned: While the work required for us to decide whether, when, and how to provide funding was more time-consuming than many of our grants, it strengthened our networks among SMC implementers and funders, and we believe our funding guarantees made a difference in ensuring that the campaigns were able to be carried out.

GiveWell has a long history of finding and funding highly cost-effective malaria programs. Our prior work on SMC enabled us to move quickly to protect lifesaving programs and keep campaigns on track until US government funding was restored. 

Visit our Foreign Aid Funding Cuts webpage to learn more about our response and how you can help, and listen or subscribe to our podcast for our latest updates.

This episode was recorded on November 17, 2025 and represents our best understanding at that time.

Our Beyond the Spreadsheets mini-series lets you ride along with our leadership team on their recent weeklong site visit to Malawi. Recorded daily during the trip, the series shares the behind-the-scenes experience of a GiveWell site visit through real-time reflections and clips of conversations. 

On day five, the GiveWell team visited a school in Lilongwe, where they spoke with school representatives and families of students in a nearby urban settlement. On day six, the GiveWell team stopped at a major hospital in Lilongwe to hear from hospital staff and an implementing partner about the impact of foreign aid funding cuts. 

New to the series? Start with day one here. 

Throughout the week, the team visited health clinics, schools, and local villages to speak with healthcare workers and community members who shared a glimpse into their lives. This mini-series offers a candid, day-by-day account of our learning process and some of the new insights and questions that will inform our future research.

This episode was recorded on August 3 and 4, 2025 during GiveWell's site visit to Malawi and represents our best understanding at that time.

Our Beyond the Spreadsheets mini-series lets you ride along with our leadership team on their recent weeklong site visit to Malawi. Recorded daily during the trip, the series shares the behind-the-scenes experience of a GiveWell site visit through real-time reflections and clips of conversations. 

On day four, the GiveWell team visited community projects funded by Spark Microgrants, including a maize mill and a sunflower oil mill, and spoke with residents about their impact. New to the series? Start with day one here. 

Throughout the week, the team visited health clinics, schools, and local villages to speak with healthcare workers and community members who shared a glimpse into their lives. This new mini-series offers a candid, day-by-day account of our learning process and some of the new insights and questions that will inform our future research. We invite you to listen, subscribe, and follow along!

This episode was recorded on August 2, 2025 during GiveWell's site visit to Malawi and represents our best understanding at that time.

Our Beyond the Spreadsheets mini-series lets you ride along with our leadership team on their recent weeklong site visit to Malawi. Recorded daily during the trip, the series shares the behind-the-scenes experience of a GiveWell site visit through real-time reflections and clips of conversations. 

On day three, the GiveWell team visited a rural health outpost where they met with health care workers to discuss the services they provide through village clinics and home visits—and the impact of foreign aid cuts on their work. Listen to day one and day two of the series here.

Throughout the week, the team visited health clinics, schools, and local villages to speak with healthcare workers and community members who shared a glimpse into their lives. This new mini-series offers a candid, day-by-day account of our learning process and some of the new insights and questions that will inform our future research. We invite you to listen, subscribe, and follow along!

This episode was recorded on August 1, 2025 during GiveWell's site visit to Malawi and represents our best understanding at that time.

Our Beyond the Spreadsheets mini-series lets you ride along with our leadership team on their recent weeklong site visit to Malawi. Recorded daily during the trip, the series shares the behind-the-scenes experience of a GiveWell site visit through real-time reflections and clips of conversations. 

On day two, the GiveWell team met with district health officials to learn about the impact of foreign aid funding cuts and visited a local hospital to review health data. Listen to day one here. 

Throughout the week, the team visited health clinics, schools, and local villages to speak with healthcare workers and community members who shared a glimpse into their lives. This new mini-series offers a candid, day-by-day account of our learning process and some of the new insights and questions that will inform our future research. We invite you to listen, subscribe, and follow along!

This episode was recorded on July 31, 2025 during GiveWell's site visit to Malawi and represents our best understanding at that time.

Our Beyond the Spreadsheets mini-series lets you ride along with our leadership team on their recent weeklong site visit to Malawi. Recorded daily during the trip, the series shares the behind-the-scenes experience of a GiveWell site visit through real-time reflections and clips of conversations. New episodes will be released weekly over the next month, and you can subscribe to be notified when each episode is published. 

At GiveWell, the vast majority of our work is desk-based research—analyzing evidence and modeling program outcomes. Site visits are a small part of what we do, but they add crucial on-the-ground context that raises important questions, challenges our assumptions, and makes our research stronger.

We had two main goals in visiting Malawi. First, we wanted to understand the effects of foreign aid cuts firsthand in a country that may be particularly hard hit. Second, we wanted to see livelihoods programs like GiveDirectly and Spark Microgrants in action, providing insight as we expand our focus on interventions that aim to increase people’s economic well-being.

On day one, the GiveWell team visited Zingwangwa Health Center and two villages that had recently received unconditional cash transfers through GiveDirectly.

Throughout the week, the team visited health clinics, schools, and local villages to speak with healthcare workers and community members who shared a glimpse into their lives. This new mini-series offers a candid, day-by-day account of our learning process and some of the new insights and questions that will inform our future research. We invite you to listen, subscribe, and follow along!

This episode was recorded on July 30, 2025 during GiveWell's site visit to Malawi and represents our best understanding at that time.

Foreign aid funding cuts are reshaping the global health landscape, creating urgent funding gaps and forcing difficult prioritization decisions across health systems worldwide. To understand the real-world effects, it’s essential to hear from the organizations working on the front lines with government partners to navigate the funding crisis. The Clinton Health Access Initiative (CHAI) is a large global health nonprofit and an important GiveWell partner in this work.

In this episode, GiveWell CEO and co-founder Elie Hassenfeld speaks with CHAI CEO Dr. Neil Buddy Shah about how the aid cuts are affecting vital health programs and what it takes to build a strategic response. They discuss the hidden complexities of the funding landscape, the difficult choices governments are being forced to make, and what this pivotal moment could mean for the future of global health.

Elie and Buddy discuss:

• The “gap identification” challenge: In many countries, a significant portion of the national health budget comes from foreign aid, and the funding cuts revealed a surprising vulnerability—many national health ministries don’t have a comprehensive map of who funds what within their own systems. The first step needed was a complex data-gathering exercise to identify where the gaps emerged.
• A strategic response to the crisis: CHAI is helping governments implement a three-pronged response. This includes (1) driving efficiencies to make existing funds go further, (2) reprioritizing budgets to protect the most essential services, and (3) advocating for increased domestic health funding.
• The long-term view: While the cuts are already causing significant drops in areas like HIV testing, the most severe health consequences are expected to hit in the coming years. The crisis represents a major shakeup of the funding and delivery system that has defined global health for 20 years, creating a critical opportunity to rethink what should come next.

The conversation reveals both the immediate crisis and long-term transformation occurring in global health. While governments are working to maintain some vital services through improved efficiency and reprioritization, these measures cannot compensate for the scale of funding reductions. GiveWell is working closely with partners like CHAI to understand the complexities of this new funding landscape and direct funding where our research shows it can have the greatest impact.

Visit our Foreign Aid Funding Cuts webpage to learn more about our response and how you can help, and listen or subscribe to our podcast for our latest updates.

This episode was recorded on August 20, 2025 and represents our best understanding at that time. 

GiveWell’s ability to find and fund highly cost-effective health programs relies on a foundation of credible data. A key source of that data, the Demographic and Health Surveys (DHS), recently had its primary funding from USAID discontinued. This creates the potential of a significant challenge for GiveWell’s research—and for evidence-based grantmaking across the global health sector.

In this episode, GiveWell CEO and co-founder Elie Hassenfeld speaks with Senior Researcher Adam Salisbury to explore the implications of this funding gap. They discuss how the DHS program works, why it’s essential for informed decision-making, and how GiveWell is responding to the growing limitations of public health data.

Elie and Adam discuss:

• The surprising source of global health data: In many countries where GiveWell works, basic health metrics like child mortality rates aren’t comprehensively tracked in official registries. The DHS program fills this data gap by conducting vast, in-person surveys that ask women to recall their children’s birth and survival histories. This method provides the primary data for mortality estimates in low- and middle-income countries.
• Why good data is difficult to get: The DHS is resource-intensive, costing tens of millions of dollars per year to administer in-person, house-to-house surveys across more than 50 countries. Enumerators must travel to remote areas where unreliable internet and postal systems necessitate this approach. The logistical complexity and high cost are primary reasons the surveys in any given country often happen only once every five years.
• GiveWell’s approach to repairing data gaps: With USAID funding discontinued, GiveWell is considering whether to support these surveys directly, coordinating with other global health partners who share similar interests. GiveWell is also funding targeted data collection to address questions the DHS doesn’t cover, such as bed net durability or how people in low-income countries value consumption versus health gains.

The loss of funding for DHS creates a significant gap in global health infrastructure that affects decision-making across the sector. GiveWell is working with other global health organizations to explore sustainable solutions, while considering the trade-off between funding programs that help people now and funding research that guides future effective giving. 

Visit our All Grants Fund webpage to learn more about how you can support this work, and listen or subscribe to our podcast for our latest updates.

This episode was recorded on August 13, 2025 and represents our best understanding at that time.

As GiveWell’s research team grows, that increased capacity and expertise allows us to evaluate a wider range of programs to find the most cost-effective opportunities to help people. Over the past year and a half, we’ve been investigating a new research area—family planning services that help people decide whether and when to have children. 

Family planning programs have particularly complex challenges around targeting, logistics, and ensuring informed and voluntary choice. However, GiveWell's increasing research capacity now positions us to take on new and complex investigations like this. We’ve been reviewing evidence, consulting with experts, modeling the benefits of contraception, and conducting initial grant investigations, focusing on programs that aim to increase access to and use of modern contraception. This work is especially timely as anticipated cuts to foreign assistance could significantly reduce existing family planning support, creating substantial new funding gaps.

In this episode, GiveWell CEO and co-founder Elie Hassenfeld speaks with Senior Research Associate Dilhan Perera about the complexity of evaluating family planning programs. They explore the types of programs GiveWell is considering, the unique challenges this area presents, and key questions we’re working to answer.

Elie and Dilhan discuss:

• Types of family planning programs: GiveWell is investigating several approaches, including direct service delivery to underserved communities, programs that provide counseling, and supply chain interventions that work with health facilities to prevent stockouts of contraceptives.
• The complexity of evaluation: Unlike programs such as malaria prevention that target a well-defined population and try to maximize coverage, family planning programs must account for individual preferences and avoid coercing people into using contraception they don’t want. This requires more sophisticated monitoring systems to prevent coercion, which raises the overall cost and complexity of effective program delivery.
• Operational challenges and trade-offs: Programs must often choose between reaching the most underserved communities (which are often remote and expensive to reach) and working within existing health facilities. The challenges in either approach include making sure people are accurately informed about their family planning options and navigating supply chain issues like stockouts. 

We’re actively considering a handful of funding opportunities in family planning. Our goal is to make initial grants that will not only have a direct impact but also help us learn more about this type of intervention, helping us better compare these programs against other funding opportunities.

Visit our All Grants Fund webpage to learn more about how you can support this work, and listen or subscribe to our podcast for our latest updates.

This episode was recorded on June 24, 2025 and represents our best understanding at that time.