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ICCDR, Rotary International, AMREF, and Population and Community Development Association

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  • Elie Hassenfeld
    The Gates Foundation awarded these 4 organizations its annual Award for Global Health (past recipients include The Carter Center, BRAC, and The Aravind Eyecare
    Message 1 of 1 , Jan 21, 2009
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      The Gates Foundation awarded these 4 organizations its annual Award for Global Health (past recipients include The Carter Center, BRAC, and The Aravind Eyecare System), so we thought it'd be good to look at them and see if any seemed like potential recommendees. This is part of our work to identify potential organizations that are likely worth a "deep dive" investigation that I talked about at http://groups.yahoo.com/group/givewell/message/39.

      In brief: ICCDR,B is somewhat promising (in the 2nd group in my email linked above), but would take a long time to evaluate, going through the docs on their website. I think AMREF is even less likely (in the fourth group from my email above) we'd recommend (though possible), and evaluating it would require spending a lot of time going through their site. I doubt we'd recommend Rotary, given the type of organization it is. PCDA could be good (it's unclear what role they played in Thailand's successful HIV reduction program), but as far as I can tell they don't provide any monitoring of current activities directly on their website.

      Org summaries
      1. ICCDR,B - not clear to me whether they're primarily a research organization or an implementer that conducts good research and evaluation of its activities. There's a lot of information and citation on the website (in publications and the annual report), but I haven't found anything reasonably concise that summarizes their activities.
      2. Rotary - Rotary is a fundraising and service community organization. Members contribute money (to polio eradication or other projects)and volunteer (e.g., helped coordinate distribution of supplies after Katrina.) They have and continue to contribute money to polio eradication (through fundraising, volunteering (unclear exactly what they did), and advocacy (http://www.rotary.org/en/ServiceAndFellowship/Polio/RotarysWork/Pages/ridefault.aspx). It's unlikely we'd recommend Rotary, so not worth pursuing further.
      3. AMREF -  It seems like a "do everything, everywhere" NGO. They run lots of relatively small-scale projects to attack substantially different problems (e.g., HIV/AIDS prevention or addressing gender-based violence). I can't find a clear approach (like the Carter Center has); similarly, the connection between AMREF activities and "proven" interventions isn't obvious. They definitely publish a lot of reports on their activities; what's available on their website is a lot better than what's available on almost any other website we've seen. And, the reports provide negative assessments of programs. But, we'd have to read all the reports and assess the results in aggregate (ourselves) to evaluate whether we have confidence in the organization as a whole since, without a clear orgnaizational strategy, it's not clear how they'll use additional resources.
      4. PCDA - They provide all types of services, health and povery reduction, (BRAC-like) to Thailand. Gates credits them to some degree with Thailand's successful AIDS reduction program (http://www.gatesfoundation.org/gates-award-global-health/Pages/2007-population-and-community-development-association.aspx), but PCDA isn't mentioned in either the DCP or the Center for Global Development case study (http://www.cgdev.org/doc/millions/MS_case_2.pdf), though a paper of his (I think) is cited as footnote 21 there. They list all their projects, but no links to project reports. It's possible that they have information in-house that they could provide us with, but doesn't appear to be on their website.
      More detail on ICCDR,B and AMREF

      ICCDR,B (aka Centre for Health and Population Research, aka International Centre for Diarrhoeal Disease Research)

      A. Summary

      Research organization and hospital based in Bangladesh. Bottom line: it's really hard to tell the degree to which they're primarilly a research and evaluation organization or whether they're an implemented who heavily researches and monitors what they do/could do. They definitely do both, to some degree. There's a ton of papers, citations, information on their website which we would have to go through to get a sense for what they're doing.

      A. What they do

      ICDDR,B: International Centre for Diarrhoeal Disease Research, Bangladesh, is a non-profit, international research, training and service institution based in Dhaka, Bangladesh. Originally established as the Cholera Research Laboratory in 1960, today the Centre's work encompasses a full spectrum of issues related to child health, infectious diseases and vac­cine sciences, reproductive health, nutrition, population sciences, health systems research, poverty and health, HIV-AIDS and safe water. The Centre remains the only international health research centre based in a developing country. http://www.icddrb.org/pub/publication.jsp?classificationID=59&pubID=2359

      "Services provided to the Bangladeshi community, particu­larly the poor, at the Centre's Dhaka and Matlab Hospitals." http://www.icddrb.org/pub/publication.jsp?classificationID=59&pubID=2359

      B. Track record
      1. Credited with in developing and testing Oral Rehydration Therapy (http://rehydrate.org/ors/25years-saving-lives.htm), an effective intervention to prevent deaths from diarrhea (http://www.givewell.net/node/38#OralRehydrationTherapyORT)
      2. Developed, tested and implemented a family planning method MCH-FP (http://www.icddrb.org/pub/publication.jsp?classificationID=59&pubID=2359) cited by the DCP (Pg 1084) as an experimental program
      3. Claims: "The Centre's combined programmes in child health and family planning have contributed to a 75% reduction in the annual number of childhood deaths in the last 25 years in its Matlab field area."  (http://www.icddrb.org/pub/publication.jsp?classificationID=59&pubID=2359)
      C. Information on ongoing activities

      ICCDR has programs (information from the 2006 annual report, available at http://www.icddrb.org/pub/publication.jsp?year=2006&classificationID=46), which focus on providing services and conducting research in many health areas (e.g., child health, nutrition, HIV/AIDS, etc.).

      The annual report lists the details of all the individual projects/research studies in each category, see for example Pgs 71-74. Many of these programs are just research ("Risk factors for sclerema in infants with diarrhoeal disease"); others are trials evaluating a specific program ("A double-blind, randomized, placebo-controlled, parallel group study to assess the efficacy, safety, and tolerability of crofelemer (SP 303) in the treatment of cholera in adults"); it also provides some information on ongoing acivities ("The MCHS runs the largest, fixed-site immunization centre in the country to provide 6 EPI vaccines and hepatitis B vaccine to children aged less than 2 years and tetanus toxoid to girls/women aged 15– 45 years.") Though, it's not clear to me whether we could find the technical papers or more monitoring detail of these programs.

      The annual report lists all the papers published by ICCDR,B staff. It's unclear whether these are evaluating ICCDR,B activities or researchers evaluating programs implemented by other organizations.

      D. Other

      Were we to still do the "regions" approach, I think the research available here would be very helpful. For example, ICCDR's papers on demographic and health trends in Bangladesh over the last 40 years provide insight into changes in some primary factors: fertility rate, child mortality, and contraception use (http://www.icddrb.org/pub/publication.jsp?classificationID=64&pubID=9407).

      AMREF -
      African Medical and Research Foundation

      AMREF seems to be a "do everything, everywhere" NGO. They run lots of relatively small-scale projects to attack substantially different problems. I can't find a clear approach (like the Carter Center has); similarly, the connection between AMREF activities and "proven" interventions isn't clear to me. Bottom line: They definitely publish a lot of reports on their activities; what's available on their website is a lot better than what's available on almost any other website we've seen. And, the reports provide negative assessments of programs. But, we'd have to read all the reports and assess the results in aggregate (ourselves) to evaluate whether we have confidence in the organization as a whole since, without a clear orgnaizational strategy, it's not clear how they'll use additional resources.

      A. Monitoring and evaluation of ongoing activities

      They provide the following types of information on their website:
      The technical papers do provide negative assesments. The one I opened (an adolescent health program to prevent HIV/AIDS http://amref.org/silo/files/impact-evaluation-mema-kwa-vijana.pdf) found (this paper is also cited by the DCP on pgs 1115-6):

      There was no evidence of any consistent impact of the intervention on biological outcomes in either direction.... The incidence of HIV in the comparison communities was lower at 2.21/1,000 person years, than had been estimated in advance. Overall, there were 45 incident cases, of which only 5 were in males. The adjusted incidence of HIV in females was 24% lower in the intervention communities, but this was not statistically significant (RR=0.75, 95% CI 0.34,1.66).

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