GiveWell Conversations

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.

In this discussion, Alex Bowles, a program officer focused on malaria vector control, and Rosie Bettle, a senior researcher with a background in biopsychology, reveal the precarious state of malaria funding. They highlight the alarming potential cuts from major donors, notably a 20-30% reduction in U.S. foreign aid. The duo emphasizes the urgent need for strategic adaptations to prevent stockouts of essential malaria diagnostics in countries like Nigeria, as these funding uncertainties could jeopardize years of progress against this deadly disease.

Julie Faller, Senior Program Officer at GiveWell, joins the discussion on enhancing livelihoods programs. She delves into GiveWell’s new focus on evaluating economic empowerment versus health outcomes, highlighting the importance of community perspectives. The conversation explores innovative funding approaches, the spillover effects of cash transfers, and the necessity for tailored interventions. With a renewed emphasis on moral weights in grant decisions, Faller advocates for flexible funding to increase impact, ensuring that diverse needs are met in the ever-evolving landscape of charitable efforts.

Alex Cohen, Principal Researcher at GiveWell, sheds light on the looming cuts to global health funding, predicting a staggering 50% reduction in U.S. aid. He discusses the potential $20 billion annual funding gap and its impact on vital programs like malaria prevention and HIV treatment. The episode highlights the strategic approaches needed in navigating these uncertainties, emphasizing prioritization and adaptability to protect the most effective health initiatives. Cohen's insights offer a crucial look into the future of global health philanthropy.

Alice Redfern, a Program Officer at GiveWell specializing in global health, discusses significant cuts to U.S. HIV/AIDS funding. She explores the impact of potential reductions on prevention programs targeting high-risk populations. The conversation highlights the need for innovative strategies to compensate for gaps in funding, especially for new treatments like lenacapavir. Redfern emphasizes the urgency of finding cost-effective opportunities to combat transmission and maintain stability in ongoing outreach initiatives.

Dan Brown, a Program Officer leading GiveWell's new areas team, discusses the impact of U.S. funding cuts on global health programs. He explains the creation of Technical Support Units (TSUs) to assist Ministries of Health in six African countries, highlighting their role in enhancing local capacity and decision-making. Brown emphasizes the tailored approaches of TSUs in navigating funding challenges and ensuring the sustainability of essential health initiatives. The conversation also touches on the importance of qualitative factors in grant-making amidst these drastic changes.

The US government has historically spent approximately $12 billion to $15 billion annually in foreign assistance dedicated to global health. The funding cuts announced in the first few months of 2025 disrupted the global health landscape and created the possibility of enormous funding gaps that are still coming into focus. In response, GiveWell has approved around $18 million in grants to support urgent needs—but why has our research led us not to grant more funds yet?In today’s episode, the third in our series examining the impact of these cuts, GiveWell CEO and co-founder Elie Hassenfeld is joined by Director of Research Teryn Mattox to explore this question. Building on our previous conversations about program disruptions and emergency responses, they dive into the nuanced reality of the current funding landscape and GiveWell’s evidence-based approach to grantmaking during uncertainty.Elie and Teryn discuss:Increased need on the horizon: While current impacts haven’t been as severe as the 90% cuts that we initially feared, forecasts suggest that US global health aid may be cut by approximately 50% in fiscal year 2026. We anticipate the most significant funding gaps will likely emerge later. For example, a new fiscal year begins for the US government after September 2025, and the administration will have greater flexibility to enact reductions to global health spending it has discussed.Reinstatement of many critical programs: Many initially terminated contracts, particularly in high-impact areas that we know well like malaria programs, have been reinstated in the short term. A rough analysis suggests that more than 80% of malaria programming has been reinstated for the time being, including some of the most cost-effective programs we’ve identified, which has reduced the immediate need for emergency funding.Expanding our search for emerging opportunities: We think the shifts in US government funding have likely created new, highly cost-effective opportunities. We’re rapidly exploring new areas that have been hit hard by these funding cuts, such as integrated health programs (which deliver multiple services to communities) and family planning. While it takes time to get up to speed before we can make cost-effective grants in these new areas, we are aiming to move more quickly than is typical by leaning on learning over time versus building a high degree of confidence first.GiveWell is actively identifying funding opportunities and recommending grants to help with urgent situations, but we are now primarily concerned with predicting and planning for likely significant cuts in the upcoming US government fiscal year, and with gathering the resources needed to respond. We’ve formed a “rapid response team” to quickly assess urgent funding gaps, and we are considering a “learn by giving” approach in promising new areas to build organizational knowledge while addressing immediate needs.Visit our USAID Funding Cuts webpage to learn more about our response and how you can help, and listen or subscribe to our podcast for the latest updates.This episode was recorded on April 15, 2025 and represents our best understanding at that time.

In this conversation, Natalie Crispin, a global health expert and Program Officer at GiveWell, joins Elie Hassenfeld to discuss the urgent challenges facing seasonal malaria chemoprevention (SMC) in light of U.S. aid cuts. They delve into how SMC campaigns work, ensuring children under five receive preventive medicines, and how paused USAID funding has disrupted critical preparations for upcoming campaigns. Natalie and Elie highlight funding gaps and the logistical hurdles organizations face, underscoring the vital need for timely resources to combat malaria effectively.