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. ***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.

Natalie Crispin, a seasoned program officer at GiveWell, shares her insights on the crucial Seasonal Malaria Chemoprevention (SMC) program. She discusses the impact of recent foreign aid cuts and the urgent need for careful planning to deliver antimalarial medications to vulnerable children. Natalie explains the logistical challenges of coordinating across multiple countries and the flexibility of funding mechanisms that allowed campaigns to proceed despite disruptions. The conversation highlights the program's effectiveness, with significant lives saved per dollar spent.

Explore the vibrant lives of families in urban Malawi, highlighting the contrast between rural and peri-urban experiences. Learn about schooling aspirations and the challenges of access to health care amidst foreign aid cuts. Discover the impact of inflation on wages, seasonal farming versus steady urban income, and the nuances of food insecurity. The discussions reveal how community dynamics evolve, shedding light on the human cost of funding disruptions and the importance of ongoing support in improving livelihoods.

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.

Julie Fowler, a Senior Program Officer at GiveWell, shares insights from her firsthand experience during a site visit in Malawi. She dives into the challenges posed by recent cuts to foreign aid and their subtle, delayed impacts on healthcare. Conversations with district health officials reveal the complexities of local decision-making and difficulties in supply chains. Julie emphasizes the importance of data in understanding shifts in services like viral load testing and the broader implications for health systems amidst funding changes.

Taryn Maddox, Director of Research at GiveWell, shares her insights from a site visit in Malawi. The conversation explores the impacts of foreign aid cuts on local health services and the urgent need for viral load testing amid staffing shortages. Maddox reveals how residents of GiveDirectly villages are improving food security and investing in small businesses thanks to cash transfers. The discussion also highlights significant challenges like critical drug shortages and the importance of understanding on-the-ground realities for effective aid.

Neil Buddy Shah, CEO of the Clinton Health Access Initiative, delves into the drastic effects of foreign aid cuts on global health systems. He discusses the critical 'gap identification' challenge faced by health ministries—a lack of comprehensive funding maps compromises essential health services. Shah details CHAI's strategic response to navigate these challenges, emphasizing data-driven adaptations and government partnerships. The conversation also touches on the need for efficiency and innovative strategies to maintain vital healthcare, especially in countries like Burkina Faso and Nigeria.

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.

Dilhan Perera, a Senior Research Associate at GiveWell, dives into the complexities of evaluating family planning programs. He discusses the challenges posed by logistical issues and the necessity for informed choice in access to contraception. The conversation highlights the urgency of funding in light of potential cuts to assistance, and how diverse contraceptive options can meet various needs. Dilhan also emphasizes the importance of strategic improvements to navigate accessibility and enhance reproductive health in underserved communities.