Lessons from Building an EA Charity: New Incentives

Hi, it’s great to be here today.
New Incentives is an EA charity based in the US and Nigeria. Our main donor GiveWell supports us in the hope that we will become a GiveWell top charity.
What do we do? We use cash transfers to save lives in the largest African country, Nigeria
We give poor mothers small financial incentives if they vaccinate their children against deadly diseases.
This model is called a conditional cash transfer, as it combines cash with a condition. Conditions are often long-term goals in the fields of health or education. In our case we give cash transfers after an infant completes each of the five mandatory immunization visits in Nigeria.
In Nigeria as in all developing countries vaccinations are free. If vaccinations help save lives and are free, why do we need a cash transfer in the first place? Many hurdles for mothers to vaccinate their children. Often have to spend money for transport to access the clinic. Then they have to spend a full day waiting at the clinic instead of selling goods on the market and making money 3. Finally, women are often not aware about immunizations or have suspicions. Small cash incentives can help overcome all of these three hurdles.
Our donors and we are excited about the potential of this program According to early cost-effectiveness calculations by GiveWell, the program could be equally cost-effective as Malaria bed nets, potentially more. And it can be scaled considerably.
Nigeria has a population of 180 million. Almost none of the 36 states in Nigeria has at least half of infants fully vaccinated.
New Incentives operates in North West Nigeria, where the rate of fully vaccinated children is as low as almost nowhere in the world. Only 8% of infants are fully vaccinated.
Happy to share a few of the lessons learned over the past three years of building this charity in Nigeria And of course the learning continues every day…
The first lesson is: Don’t reinvent the wheel Many evidence-based interventions to fight poverty, but not enough organizations implement them Conditional Cash Transfers one of most well researched and proven intervention. Two decades of evidence. Started in Mexico and Brazil late 1990s. Adopted all around the world since. No NGO solely focused on them. Saw huge opportunity.
If you want to start your own EA charity, don’t start at 0 but check out the massive amount of evidence from randomized controlled trials that is out there. GiveWell is your best starting point for promising development interventions. If you want to dive into hundreds of randomized studies, check out J-PAL, IPA and 3ie. You might also want to look into Charity Science that put together an overview of effective interventions and is interested in finding new charity entrepreneurs. And if you are interested in health interventions, PubMed or the Cochrane Review are great resources.
As you know two key aspects of implementing an EA development intervention are: cost-effectiveness and scalability But it is not always that straightforward to combine the two, as our story shows.
Objective: Combine CCT with a highly effective health intervention. Found: Prevention of mother to child transmission of HIV. Colleague Svetha in 2014 moved to Nigeria where 1/3 of world wide transmissions happen. Paid mothers to give birth at clinic where they get drug to prevent HIV transmission to the newborn
Highly cost-effective program. Not scalable: numbers of pregnant women with HIV inflated for various reasons hundreds of small clinics with low beneficiary numbers. Difficult to serve only 1-2 pregnant positive women per clinic.
Pivot to extend program to cash transfers for delivery at a clinic for all women Program addresses neonatal mortality, infants dying in the first month after birth, major cause of mortality today and can be prevented through skilled delivery. Knew all depended on clinic quality. If not good enough mortality effect would be low. Tried to gather as much data as possible. Over 100 indicators per clinic. Could not make case that basic Nigerian clinics provided good enough quality to lower mortality.
Ended up with much better scalability but worse cost-effectiveness.
2016: find new program that would be better at combining cost-effectiveness and scalability. Old idea: cash transfer for immunizations. Moved to Northern Nigeria where immunization coverage extremely low Cash transfers for immunizations is the program we are scaling up now to over 100,000 infants.
You need both cost-effectiveness and scalability. And often it is not obvious by studying the literature whether you have both. You don’t know how many beneficiaries there are if you are not on the ground. You even know less whether and how you can serve them. Combine the best literature, the best health surveys like DHS, World Bank surveys, but also your own data collection and operations on the ground
Implementation is more important than the idea. Many good ideas. It’s about the implementation. Same for businesses: Friendster / Myspace. Facebook made the race. EA community has a focus on finding the best interventions. Lots of research. Absolutely necessary. But not sufficient for starting an EA charity. Theories often not helpful to answer a specific question. Contradictory. Small tests necessary. Very influenced by lean startup theory (Steve Blank).
Example: can rural women use mobile money? Went out to villages and handed mobile money codes to random women. Answer was yes. Successfully implemented for tens of thousands of payments. Then moved to North Nigeria with latest program. Pivot again. Most women don’t have access to mobile phones. So use cash now. Kind of ironic that we went backwards in this respect, from mobile money to cash, but it means we can serve the poorest of the poor. And mobile money example I just gave is an exciting implementation challenge. Most implementation challenges that make or break the organization are far more mundane: taxes, benefits, expense management
CCTs are extremely well researched and proven with numerous RCTs - unlike some other interventions where there is only 1-2 RCTs Usually necessary even if there are other RCTs. 1. Your context is different 2. How good is your program Good news: 1. Researchers interested: NGO interested in RCT and full transparency still rare. Chance is that you might found someone that manages your RCT. 2. First RCT 100,000 from the Gates founding (and got leading HIV researcher), admin data, proves that an RCT does not have to be expensive Latest RCT on cash transfers for immunizations is a multi-million dollar project
Building an EA startup you have to be a chameleon in two ways: First you need to be willing to work on various fields as the typical startup entrepreneur. From research, to admin, human resources, IT, marketing, fundraising. Exciting but you have to learn constantly. 2. Then when your organization grows you have to change again and become more of a leader, building a proper organization. You can’t do it all yourself anymore. Not sustainable. For this transition to be successful many resources can be helpful. We at New Incentives had the opportunity to participate in the startup accelerator Y Combinator. Helpful advice on growing an org Also have terrific advisers, e.g. from Director from Evidence Action /// an expert from the Centre for Global Develompent Lots of good reading material. High Output Management from former Intel CEO
To sum up, If you are the person that loves to implement an evidence-based development intervention If you are committed to balancing cost-effectiveness and scalability If you love implementation not just ideas and theory If you ever wanted to run your own randomized controlled trial And of course if you are a Chameleon Then consider starting an EA charity.

Lessons from Building an EA Charity: New Incentives

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