The END Fund’s Deworming Program

▲ Photo from The END Fund

Related research

Deworming children report

This is a Founders Pledge summary and interpretation of original research published by GiveWell, our research partner focused on global health and development. For GiveWell's full research see their review of The END Fund's deworming program. It was updated with additional information in May 2022 by Vadim Albinsky.

The END Fund supports programs that aim to control or eliminate neglected tropical diseases through a combination of technical assistance, fundraising, and grant-making. We recommend their deworming program, through which schoolchildren are treated with inexpensive drugs to reduce the harm caused by parasitic worms. This program differs from other deworming programs that we recommend in that it regrants funds, rather than using them directly. Therefore, the deworming organizations that the END Fund supports are not as carefully vetted as Unlimit Health, Sightsavers or Deworm the World.

What problem are they trying to solve?

More than a billion people suffer from parasitic intestinal worm infections. Two particularly common afflictions are schistosomiasis and soil-transmitted helminthiasis. Schistosomiasis is transmitted through water contaminated with the larvae of a parasitic worm, and affects roughly 206 million people.^¹ Soil-transmitted helminthiasis is transmitted through faeces and soil, and affects 1.5 billion people worldwide.^² Children living in severe poverty and without adequate access to sanitation are especially at risk, and there is evidence that worms negatively impact their development and reduce the income they earn later in life.^³

The negative effects of these diseases are almost always avoidable. While effective treatments exist, many people in low- and middle-income countries are unable to access them. Poverty, inequality, and a lack of awareness in low- and middle-income countries hamper the distribution of highly effective drugs.^⁴

What do they do?

The END Fund is a grantmaking body that supports efforts to treat or eliminate neglected tropical diseases. We specifically recommend their deworming program, which GiveWell has identified as especially cost-effective. The END Fund’s deworming work includes fundraising, identifying gaps in coverage, re-granting funds to other organisations, and monitoring grantees’ operations. Their level of involvement with partner organisations varies. More intensive interventions include capacity-building assistance, detailed planning support, technical assistance, and procurement support, while less intensive support includes review of program design, budget support, technical review, and networking support.^⁵ These programs primarily target children, as the negative impacts upon their schooling caused by schistosomiasis and soil-transmitted helminthiasis is of particular significance. Moreover, they can be easily targeted for treatment, through in-school mass drug administration.^⁶

For further information on The END Fund’s involvement in deworming programs, including a full list of implementation partners and specific interventions/case-studies, see GiveWell’s write-up on The END Fund.

GiveWell, our research partner in global health and development, recommends The END Fund as one of the most cost-effective global development organisations in the world. However, their financial support of the END Fund has been decreasing.
There is strong evidence that administration of deworming drugs reduces worm loads.
There is some evidence that reductions in worm loads lead to improved life outcomes.

Cost-effectiveness

Mass deworming pill distribution is an inexpensive and safe solution to parasitic worms. According to GiveWell, it costs around $0.81 to deworm a child in END Fund-supported programs, depending upon the location and specific program.^⁷ Due to the inexpensive nature of treatment, it is more cost-effective to distribute the medication to large groups of people, rather than testing to identify only those who are affected by the illness. GiveWell estimates that, excluding the cost of drugs (which are often donated) and in-kind government contributions, The END Fund is able to treat one person for approximately $0.46.^⁸

Evidence of impact

There is strong evidence that administration of deworming medication reduces worm loads. GiveWell has reviewed coverage surveys from programs the END Fund supports in 2016-17. These surveys have some methodological limitations and found variable coverage from location to location. GiveWell plans to review additional coverage surveys from more recent years and expects these surveys to provide additional evidence to answer the question of whether END Fund-supported programs are reaching a high proportion of children targeted.^⁹

While GiveWell believes that there is strong evidence that administration of deworming drugs reduces worm loads, the evidence for a causal relationship between reduced worm loads and improved life outcomes is less strong. For GiveWell’s full exploration of the evidence for deworming mass drug administration, see their report on deworming. Key studies discussed in GiveWell’s report include deworming experiments conducted in Kenya and Uganda by Miguel and Kremer (2004), Baird et al (2012), and Croke (2014). Each of these found improved life outcomes from deworming programs, but should not be considered entirely conclusive or representative due to the higher prevalence of worms in the regions studied than in most of the contexts in which deworming is carried out today.^¹⁰ It is unclear how similar the effects of deworming programs in other contexts will be. Still, the evidence is strong enough that GiveWell considers the mass administration of deworming medication to be a highly effective intervention in expectation.

GiveWell has more confidence in the track records of its other recommended deworming organisations: the Deworm the World Initiative, the SCI Foundation, and Sightsavers. In contrast, GiveWell's recommendation of the END Fund rests primarily on the expectation that the END Fund will be able to reach populations that the Deworm the World Initiative, the SCI Foundation, and Sightsavers are not likely to reach, for example by funding programs in conflict areas. This means that the END Fund possibly expands the amount of room for more funding for deworming. Historically, this has been the case with their Angola program. However, it is less certain that there are currently significant new opportunities for reaching populations in new regions.

Why do we trust this organisation?

This charity was recommended by GiveWell, our research partner for global health and development issues. GiveWell is a nonprofit dedicated to finding outstanding giving opportunities and publishing the full details of their analysis to help donors decide where to give.

Unlike charity evaluators that focus on assessing administrative or fundraising costs, GiveWell conducts in-depth research aiming to determine how much good a given program accomplishes, per dollar spent, in terms of lives saved or lives improved. Rather than try to rate as many charities as possible, they focus on the few charities that stand out according to a specific set of criteria, in order to find and confidently recommend high-impact giving opportunities.

What would they do with more funding?

Funding opportunities

In May 2022, the END Fund communicated that they had more than $8 million in room for more funding for the year. The major programs with room for more funding were:^¹¹

$4.2 million to support deworming in Ethiopia
$1.2 million to support deworming in Nigeria
$1.2 million to support deworming in DRC
$1 million to support deworming in Angola
A number of smaller programs in the END Funds portfolio, with smaller gaps

What are the major open questions?

As noted above, the evidence for a connection between reduced loads in children and higher incomes later in life has been challenged. While GiveWell believes that the evidence is strong enough to make this intervention worth funding in expectation, there is a lot of uncertainty about the size of this effect.

The coverage surveys that GiveWell has reviewed from 2016-17 have shown variable results for the proportion of targeted children being reached by END Fund-supported deworming programs. This could have implications for the cost-effectiveness of donations to The END Fund.

Separately, GiveWell is uncertain whether restricted funding of The END Fund’s deworming program will increase the END Fund's grant-making for deworming, or whether it will push funding that would have gone to deworming to other NTD programs.

Message from the organization

“As a fund, our unique model enables us to act quickly and effectively, with a proven ability to leverage efficiencies of the private sector and foster strong partnerships. We are able to mobilize resources from a diverse range of investors and direct them to partners who can deliver them where they will have the most impact. These strategic investments will help end the most prevalent NTDs by 2030.”^¹²

More resources

Disclaimer: We do not have a reciprocal relationship with any charity, and recommendations are subject to change based on our ongoing research.

Notes

World Health Organisation. (2020).Soil-transmitted helminth infections. Who.int. Retrieved 18 February 2021 From https://www.who.int/en/news-room/fact-sheets/detail/soil-transmitted-helminth-infections ↩
Ibid. ↩
“This systematic review and meta-analysis of the cognitive and educational impact of Schistosoma infection in school-aged children supports the hypothesis that infection is associated with reduced school-attendance, with deficits in scholastic achievement and deficits in memory and learning domains of psychometrically evaluated cognitive function.” Ezeamama, A., Bustinduy, A., Nkwata, A., Martinez, L., Pabalan, N., Boivin, M., and King, C. (2018). Cognitive deficits and educational loss in children with schistosome infection—A systematic review and meta-analysis. https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0005524 ↩
“It was observed that 32.0%, 19.2% and 4.1% of the respondents had correct knowledge about the causes of schistosomiasis, malaria and STHs, respectively, whilst 22.1%, 19.2% and 5.8% knew correct measures to control schistosomiasis, malaria and STHs.” Midzi, N., Mtapuri-Zinyowera, S., Mapingure, N., Paul, N., Sangweme, D., Hlerma, G., Mutsaka, M., Tongogara, F., Makware, G., Chadukur, V., Brouwer, K., Mutapi, F., Kumar, N., and Mduluza, T. Knowledge attitudes and practices of Grade three primary schoolchildren in relation to schistosomiasis, soil transmitted helminthiasis and malaria. BMC Infectious Diseases, 11, 169. (2011). https://bmcinfectdis.biomedcentral.com/articles/10.1186/1471-2334-11-169 ↩
GiveWell. (2020). The End Fund’s Deworming Program: Levels of involvement in NTD programs. Givewell.org. Retrieved 18 February 2021 From https://www.givewell.org/charities/end-fund#Levels_of_involvement_in_NTD_programs ↩
“vIn Rwanda, where the END Fund provides light-touch support to biannual deworming programs for preschool- and school-aged children…” GiveWell. The End Fund’s Deworming Program: Levels of involvement in NTD programs. Givewell.com. Retrieved 22 February 2021. From https://www.givewell.org/charities/end-fund#Levels_of_involvement_in_NTD_programs ↩
The deworming programmes supported by the END Fund can deliver deworming programmes for roughly $0.81 per person. GiveWell. (2020). The End Fund’s Deworming Program: What do you get for your dollar?. Givewell.org. Retrieved 18 February 2021 From https://www.givewell.org/charities/end-fund#costeffectiveness ↩
GiveWell.(2020). The End Fund’s Deworming Program: What do you get for your dollar?. Givewell.org. Retrieved 18 February 2021. From https://www.givewell.org/charities/end-fund#costeffectiveness ↩
“We believe that there is strong evidence that administration of deworming drugs reduces worm loads...We have seen some monitoring from END Fund-supported programs that is similar to the monitoring that has increased our confidence in similar programs conducted by Deworm the World, SCI, and Sightsavers.” GiveWell. (2020). The End Fund’s Deworming Program: Does it work?. Givewell.org. Retrieved 18 February 2021. From https://www.givewell.org/charities/end-fund#Doesitwork ↩
“...one experiment (Miguel and Kremer 2004) finds that reducing worm infection loads during childhood can have a significant later impact on income. We find these studies to constitute evidence that is suggestive, though not conclusive or necessarily representative (the intensity of worm infections in this study was substantially heavier than the intensity of worm infections in most contexts where deworming is carried out today).” Givewell. (2018). Combination Deworming (Mass Drug Administration Targeting Both Schistosomiasis and Soil-Transmitted Helminths). Givewell.org. Retrieved 18 February 2021. From https://www.givewell.org/international/technical/programs/deworming ↩
Video call with the END Fund on May 12, 2022. ↩
The END Fund. (2021). Who We Are. end.org. Retrieved 18 February 2021. From https://end.org/who-we-are/ ↩

What problem are they trying to solve?
What do they do?
Why do we recommend them?
Why do we trust this organisation?
What would they do with more funding?
What are the major open questions?
Message from the organization
More resources
Notes