Katriel Friedman: The Benefits of Starting Your Own Charity

When you start a char­ity, you clearly want to do good di­rectly — but you also have an op­por­tu­nity for other forms of im­pact, from build­ing the effec­tive al­tru­ism (EA) move­ment to gen­er­at­ing knowl­edge that can be shared with many other peo­ple. In this talk, Ka­triel Fried­man, CEO of Char­ity Science Health, dis­cusses his or­ga­ni­za­tion’s ex­pe­riences with the in­di­rect benefits of char­ity en­trepreneur­ship.

Below is a tran­script of Ka­triel’s talk, which we’ve lightly ed­ited for clar­ity. You can also watch it on YouTube or read it on effec­tivealtru­ism.org.

The Talk

This talk is go­ing to be a bit of a se­quel to a talk that [my co-founder] Joey Savoie gave at EA Global Lon­don in 2018.

Slide02

Joey’s talk was about char­ity en­trepreneur­ship as a promis­ing ca­reer path for EAs. He ar­gued that startup char­i­ties [could] have greater po­ten­tial for im­pact than the most promis­ing ex­ist­ing in­ter­ven­tions, mainly be­cause so many ideas are un­tried or un­der-tried — and very few or­ga­ni­za­tions have been founded based on our rigor­ous search for the most promis­ing in­ter­ven­tions.

He also spoke about mul­ti­ple in­di­rect or pass-through benefits of start­ing a char­ity. For ex­am­ple, they at­tract money, at­ten­tion, and pas­sion to re­ally promis­ing is­sue ar­eas [even for other or­ga­ni­za­tions in the area]. Or per­haps, through trial and er­ror, they teach us im­por­tant les­sons about what works and what doesn’t work.

Over the last year, Eric Housen [Housen is the COO of Char­ity Science Health] and I have been grad­u­ally tak­ing the helm of Char­ity Science Health, liv­ing in In­dia, and steer­ing the or­ga­ni­za­tion through what you might think of as its early teenage years. Ninety-nine per­cent of the time, we fo­cus on our di­rect im­pact: How we can send more mem­o­rable mes­sages to moth­ers and save more chil­dren from deadly, painful dis­eases like measles, pneu­mo­nia, and di­ar­rhea?

How­ever, [in this talk] I’m step­ping back to ask what we can learn about some of the in­di­rect effects of char­ity en­trepreneur­ship.

Slide03

I’ll go through them broadly and share whether these benefits have ma­te­ri­al­ized in our ex­pe­rience or not.

First, to get us all on the same page, I’ll provide a quick overview of what Char­ity Science Health does and how we got to this point. I’ll then break down some [in­di­rect benefits of start­ing a char­ity] into three broad cat­e­gories:

Slide04


1. Ways that char­ity en­trepreneur­ship might strengthen po­ten­tial fu­ture pro­jects;

2. Ways that char­ity en­trepreneur­ship might re­struc­ture the fund­ing en­vi­ron­ment to be fa­vor­able to highly effec­tive pro­jects; and

3. How char­ity en­trepreneur­ship might gen­er­ally sup­port build­ing the EA move­ment.

Fi­nally, I’ll say a few words about how we can get in­volved as a com­mu­nity to sup­port char­ity en­trepreneur­ship through the Char­ity Science Net­work.

Overview of Char­ity Science Health


Slide05

Char­ity Science Health (CHS) was born out of a re­search pro­ject that the found­ing team and an army of vol­un­teers con­ducted. They set out to find the most promis­ing in­ter­ven­tions in global health that only needed a ded­i­cated en­trepreneurial team to take them for­ward.

Slide06

At the very top of the list was short mes­sage ser­vice (SMS) re­minders for im­mu­niza­tion, and so the Char­ity Science teams spun up CSH to im­ple­ment the idea.

The rea­sons SMS re­minders were so promis­ing are that (1) there is ro­bust ev­i­dence for their im­pact and (2) they are ex­tremely cheap to im­ple­ment.

Slide07

We found six ran­dom­ized con­trol­led tri­als (RCTs) show­ing that the effect, on av­er­age, of re­ceiv­ing re­minders was an in­crease in the im­mu­niza­tion rate of about ten and a half per­centage points. And to send our whole suite of re­minders only costs us about six cents.

This is a recipe for ter­rific cost-effec­tive­ness.

Slide08

In­deed, GiveWell’s pre­limi­nary cost anal­y­sis of the pro­gram found a cost per life saved of about $1,500. That’s ac­tu­ally a bit con­ser­va­tive be­cause it re­flects the very bot­tom of the range of the stud­ies that we eval­u­ated, and is a higher cost per en­rol­l­ment than what we have sub­se­quently demon­strated with some of our part­ners.

The core task for CSH is to en­roll care­givers as cheaply and as scal­ably as pos­si­ble. There­fore, we started out by list­ing en­rol­l­ment strate­gies and try­ing them out, quickly pi­lot­ing what would work, and pick­ing the strate­gies that seemed to be the most promis­ing. We’ve been grad­u­ally re­fin­ing those and find­ing ways to make them more re­li­able, cheaper, and more scal­able.

Slide09

As we run out of great ideas for how to im­prove these strate­gies, we’re go­ing to solid­ify our pro­gram and con­duct an RCT. That will hap­pen at some point in the next six months. If the re­sults come back as strong as we’re hop­ing, that will sig­nal that it’s time to ap­proach GiveWell, ask to be con­sid­ered for “top char­ity” sta­tus, and be­gin the work of scal­ing up across In­dia.

We’ve learned that two strate­gies are the most vi­able.


Slide10

The first is go­ing door to door in slums and villages, try­ing to find as many moth­ers as we can and giv­ing them the chance to sign up for the pro­gram. The sec­ond is tap­ping into health records kept on pa­per reg­isters in health fa­cil­ities or in digi­tal databases by the state gov­ern­ments, and us­ing those to di­rectly en­roll care­givers in our pro­gram. At this point, we’ve reached 250,000 fam­i­lies across six In­dian states.

Slide11

Just in the last few weeks, we’ve made some ex­cit­ing [progress] with state gov­ern­ments in In­dia’s fed­eral sys­tem. It’s the states that have pri­mary re­spon­si­bil­ity for cit­i­zens’ health, and so these gov­ern­ments are ei­ther shar­ing data with us already or al­low­ing us to go into health fa­cil­ities, digi­tize records, and up­load them into our sys­tem for send­ing mes­sages.

Hope­fully, [that overview] will provide some­thing of a foun­da­tion for what comes next.

How char­ity en­trepreneur­ship strength­ens fu­ture projects



Slide12

The cat­e­gory of in­di­rect benefits that I have the most to say about is how char­ity en­trepreneur­ship strength­ens other pro­jects, so that’s where I’ll start.

Startup char­i­ties cre­ate net­works that fu­ture pro­jects in the same area can po­ten­tially tap into. We’ve seen this go both ways.

Slide13

At CSH, we have benefited greatly from net­works set up by peo­ple like the For­tify Health team and the Good Food In­sti­tute. And we’re also quite con­fi­dent that the gov­ern­ment re­la­tion­ships we’ve forged — the work­ing re­la­tion­ships with state health offi­cials, who are the mid-level offi­cials likely to stick around over the long term — could be ac­cessible and rele­vant to other teams work­ing in the same area who have the same val­ues and pri­ori­ties.

Slide14

A lot of these re­ally valuable con­nec­tions are ac­tu­ally busi­ness re­la­tion­ships. We’ve found good con­trac­tors. And we’ve found a few teams that have been in­stru­men­tal in shep­herd­ing along the pro­cess of work­ing with the Bihar Health Depart­ment. Bihar is a state with three mil­lion births per year, which pro­vides a sense of what the scale of In­dia is like. Another per­son we’ve found has deep ties to ev­ery­one in the In­dian gov­ern­ment and is able to tell us any­thing we want to know about the ini­ti­a­tives peo­ple are work­ing on.

Slide15

So, to me it seems clear that these net­works are a benefit of do­ing startup char­i­ties.

Slide16

Another benefit is that startup char­i­ties might be an un­com­monly good train­ing ground for EAs. This is a bit of a bold claim, but [I’ve re­peat­edly no­ticed that] there are skills that come with be­ing an EA-al­igned or­ga­ni­za­tion that would be hard to pick up work­ing for other NGOs.

Slide17

For ex­am­ple, think­ing about cost-effec­tive­ness is just not that com­mon in NGOs. Al­most ev­ery con­ver­sa­tion I have with an­other non­profit con­sists of some­one brain­storm­ing ways we could make our pro­gram more ex­pen­sive. It might have a bit more of an im­pact, but they want to add train­ings, fol­low-ups, and aware­ness-rais­ing.

I re­cently listened to a pod­cast with Chris Blattman, a Univer­sity of Chicago pro­fes­sor in the Har­ris School of Public Policy [see this blog post for more con­text on Blattman’s views on cost-effec­tive­ness].


Slide18

He has decades more ex­pe­rience deal­ing with this topic. [I was grat­ified to hear him say] that this [prob­le­matic urge to in­crease pro­grams for cur­rent benefi­cia­ries] is uni­ver­sal among NGOs. At CSH, we try to re­sist the temp­ta­tion to fa­vor our cur­rent benefi­cia­ries over our po­ten­tial fu­ture benefi­cia­ries [who might be reach­able thanks to the cur­rent pro­gram’s low cost].

Slide19

We have re­ally struc­tured pro­cesses for mak­ing de­ci­sions. Al­most ev­ery time we make an im­por­tant de­ci­sion for the or­ga­ni­za­tion, we cre­ate a spread­sheet and slap a scor­ing func­tion on it. We weigh ev­ery im­por­tant crite­rion and do our best to quan­tify each one.

Slide20

One of the qual­i­ta­tive things I’d hate to quan­tify is how much faster Eric and I are grow­ing as a re­sult of work­ing at this or­ga­ni­za­tion than we would have in our coun­ter­fac­tual roles. [Laughs.] But it seems ex­tremely plau­si­ble to me that be­cause we and our team mem­bers are in an or­ga­ni­za­tion with­out pre­set ways of work­ing — and with strong ties to peo­ple writ­ing and think­ing a lot about ra­tio­nal­ity — it’s a much more fer­tile learn­ing en­vi­ron­ment than [or­ga­ni­za­tions] we might have ended up in oth­er­wise.

Slide21

In ad­di­tion to helping in­di­vi­d­u­als learn skills, startup char­i­ties give fu­ture pro­jects an op­por­tu­nity to learn about what works and what doesn’t. We like to think that this is in our or­ga­ni­za­tional DNA. We are called Char­ity Science be­cause we like to run ex­per­i­ments. And we’ve been cel­e­brated pub­li­cly for [proac­tively] ac­knowl­edg­ing mis­takes.

Slide22

The other thing to say on this topic is that we’ve cer­tainly learned from ex­am­ples of or­ga­ni­za­tions like For­tify Health, which figured out how to ad­dress some le­gal con­cerns in­volv­ing reg­u­la­tions of for­eign con­tri­bu­tions to NGOs in In­dia. I think we were able to adopt [their method] it more quickly than they did [be­cause they’d already done it]. That solved so many op­er­a­tional prob­lems for us and re­ally re­duced our le­gal risk as an or­ga­ni­za­tion. [Mean­while,] the les­sons we’ve learned at CSH have be­come the back­bone of the Char­ity En­trepreneur­ship in­cu­ba­tion pro­gram.

Slide23

I think it’s fair to say that this kind of learn­ing is both sig­nifi­cant and in­evitable with startup char­i­ties.

Slide24

The fi­nal way that startup char­i­ties sup­port fu­ture en­deav­ors is by in­spiring other founders to cre­ate them. This is some­thing that has definitely hap­pened in the case of CSH.

Slide25

Bren­dan [Eap­pen] and Nak­ita [Pa­tel] have gone on the record ac­knowl­edg­ing that the ex­am­ple of CSH played an im­por­tant part in their de­ci­sion to launch For­tify Health. Char­i­ties ev­i­dently beget other char­i­ties.

Slide26

How char­ity en­trepreneur­ship af­fects the fund­ing environment


Slide27

Char­i­ties can’t ex­ist for long with­out start­ing to have an effect on the fund­ing en­vi­ron­ment. Where an or­ga­ni­za­tion gets its money is a big part of de­ter­min­ing its net im­pact. There­fore, it’s im­por­tant to think about or­ga­ni­za­tions that take their fund­ing from sources with the same val­ues and pri­ori­ties as the EA com­mu­nity, or in the im­pact philan­thropy space — as well as or­ga­ni­za­tions or ini­ti­a­tives that are funded by donors with other val­ues, pri­ori­ties, and rea­sons for pro­vid­ing sup­port.

Slide28

When it comes to donors, the core am­bi­tion of CSH and the other Char­ity Science Net­work char­i­ties is to im­prove the [qual­ity of] EA dona­tion op­por­tu­ni­ties available to donors. Ob­vi­ously, I can’t say yet whether we will ac­com­plish this, but it’s im­por­tant to us to be able to [in­crease the like­li­hood of this out­come]. That’s why we’re go­ing to do an RCT.

We also want our RCT to be ac­com­panied by a pre-anal­y­sis plan. One of the pit­falls we’re wor­ried about is the grow­ing con­sen­sus that promis­ing in­ter­ven­tions get good re­sults at a small scale, but when they’re scaled up, those re­sults evap­o­rate.

Slide29

To ad­dress that, we’ve been in fre­quent con­ver­sa­tions with IDin­sight and GiveWell. We’ve thought about set­ting a min­i­mum size that we have to be be­fore we eval­u­ate [our im­pact]. I think what we’re lean­ing to­ward right now is set­ting up rules to fire­wall our [work on study­ing our im­pact, so that it isn’t in­terfered with by] our lead­er­ship. We also might be able to get de­cep­tively pos­i­tive re­sults by pick­ing a ge­og­ra­phy that’s fa­vor­able for us — one with low back-to-baseline im­mu­niza­tion rates or high fe­male liter­acy. [To try to avoid that], we’re go­ing to map out ev­ery place that we would want to reach at scale and pick some­thing closer to the me­dian [on im­mu­niza­tion rate, liter­acy, and other rele­vant fac­tors] as our tar­get study area.

We also think care­fully about mon­i­tor­ing. We want to make sure we don’t break the pro­gram as we be­gin scal­ing. We’ll mea­sure im­mu­niza­tion rates in our en­rol­l­ment pro­cess and do phone sur­veys of a sam­ple of peo­ple to make sure that they un­der­stand the mes­sage. We’ll know if some­thing breaks and we’re no longer hav­ing the effect we [did pre­vi­ously]. At CSH, we have the free­dom to make de­liber­ate choices to en­sure that effec­tive­ness-minded donors know where we stand rel­a­tive to our com­peti­tors.

Slide30

That said, startup char­i­ties have a big­ger net im­pact when they find donors who have other val­ues and other mo­ti­va­tions for sup­port­ing them [out­side of effec­tive­ness alone].

Slide31

It’s not yet clear whether we’ll be able to do this. I think that we haven’t had to do very much fundrais­ing as a re­sult of the gen­eros­ity of this com­mu­nity and GiveWell. We’ve just be­gun em­bark­ing on that jour­ney. We do have one piece of ev­i­dence: Even with­out giv­ing any at­ten­tion to fundrais­ing, a foun­da­tion found us on­line and offered us a sub­stan­tial grant over the course of three years.

Slide32

An even fur­ther-reach­ing effect that char­ity star­tups could have on the fund­ing en­vi­ron­ment is to cat­alyze the in­ter­est of fun­ders in en­tirely new is­sue ar­eas.

Slide33

In the case of CSH, this is prob­a­bly a bit of a stretch. We work in im­mu­niza­tion, and truth­fully, the biggest global health donor has already gone all in on im­mu­niza­tion.

Slide34

So frankly, [get­ting even more in­ter­est] is a bit of a tall or­der [for us].

Slide35

How char­ity en­trepreneur­ship might sup­port build­ing the EA movement


Slide36

The fi­nal broad cat­e­gory is ways in which we can strengthen the EA move­ment. [My co-founder] Joey [Savoie] sug­gested that one way startup char­i­ties do this is that they cre­ate in­sti­tu­tions that pre­serve the prin­ci­ples and val­ues of the EA com­mu­nity — even as in­di­vi­d­u­als [within those in­sti­tu­tions ex­pe­rience] value drift or [leave to] fo­cus on other pro­jects.

Slide37

It’s hard to say in the short term whether CSH is do­ing any­thing like this. I hope that CSH and the apart­ment from which four of us live and work con­tinues to be a hub for EAs.

Slide38

I also hope that in­tense con­tact with the hard­core EAs of CSH causes our team mem­bers and our close con­tacts to be­gin tak­ing these ideas more se­ri­ously. We cer­tainly have staff who now read EA con­tent and hadn’t pre­vi­ously heard of the term “effec­tive al­tru­ism.” But to be frank, we haven’t had any­one pledge to give what they can or be­come a veg­e­tar­ian, at least not to our knowl­edge. So, we’re still work­ing on that.

Slide39

Sup­port­ing char­ity en­trepreneur­ship over­all


Slide40

Over­all, I want to ask: Does any of this mat­ter?

I would like to say that at­tract­ing non-EA fund­ing will jus­tify the whole pur­pose of these startup char­i­ties. I think it’s an open ques­tion whether the or­ga­ni­za­tions that are re­ally effec­tive at im­pact will prove to be re­ally effec­tive at sto­ry­tel­ling and fundrais­ing out­side of the EA com­mu­nity. We now have this grow­ing crop of startup char­i­ties that are well on their way to hav­ing to deal with that.

Slide41

And so we’ll be able to say much more about that in the fu­ture. What I can say is that we have seen re­ally con­vinc­ing ev­i­dence that build­ing these net­works is an im­por­tant effect of startup char­i­ties. And we’ve seen these net­works grow re­li­ably wher­ever char­ity en­trepreneurs are at work. This is what emerges to me as the biggest pass-through benefit.

Slide42

What can we, as a com­mu­nity, do to pro­mote char­ity en­trepreneur­ship? CSH and Char­ity En­trepreneur­ship each have op­por­tu­ni­ties to ac­com­plish more with the sup­port and in­volve­ment of the com­mu­nity.

Slide43

CSH, for the first time in a while, has room for more fund­ing. Over the course of the next 18 months, in or­der to con­tinue press­ing for­ward with an [im­pact eval­u­a­tion] and our ini­ti­a­tives with the state gov­ern­ments in In­dia, we will need about $460,000 be­yond what we can ex­pect to re­ceive from GiveWell, as well as an aca­demic part­ner to fi­nance an RCT of our pro­gram.

If you have any leads on peo­ple who can help me un­der­stand the non­profit fundrais­ing en­vi­ron­ment or who might be in­ter­ested in hear­ing more about this work, they would be enor­mously benefi­cial in helping save lives in In­dia.

If you your­self are in­ter­ested in learn­ing about start­ing a non­profit, or have friends who would like to learn more about it, take a look at char­i­tyen­trepreneur­ship.com and sign up for the mailing list.

Slide44

The in­cu­ba­tion school is draw­ing a strong pool of can­di­dates for their cur­rent co­hort, so there’s very likely to be an­other in­cu­ba­tion pro­gram in the next year.

If you’d like to talk to me, my email ad­dress is ka­triel@char­i­ty­science.com.

Thanks very much. I’m re­ally ex­cited to hear your ques­tions.

Moder­a­tor: Thanks for this talk. It’s an am­bi­tious topic to try to take on. Some­one in the au­di­ence has a ques­tion: If you think that some of the in­ter­ven­tions that you’d be push­ing for are as effec­tive as they seem, is it eth­i­cal to run an RCT?

Ka­triel: This is an ex­cel­lent ques­tion. It’s a core part of the re­search ethics that they teach you when you’re be­ing trained to run an RCT — whether you can run them if you have equipoise (i.e., are cer­tain that an in­ter­ven­tion works).

Now, that has be­come a bit of a joke in the im­pact eval­u­a­tion space, I think be­cause no one knows how to quan­tify the cer­tainty that you need be­fore you can can make this de­ci­sion. And you can al­most always make an ar­gu­ment that equipoise ex­ists.

In the case of CSH, I think we re­ally do have suffi­cient un­cer­tainty for an RCT. This is a be­hav­ior change in­ter­ven­tion. And I gave you a pretty fa­vor­able ac­count of why we should be con­fi­dent, but when­ever you take a be­hav­ior change in­ter­ven­tion to a new con­text, there are rea­sons that it might break down. Peo­ple may not re­spond to it in the ways you ex­pect. And that’s why GiveWell has in­sisted that be­fore they give se­ri­ous con­sid­er­a­tion to CSH as a top char­ity they would want to see an RCT in the In­dian con­text.

[Gen­er­ally], we fo­cus on be­ing im­ple­menters. I apol­o­gize if I gave [the im­pres­sion] that this [talk rep­re­sented] a far-rang­ing and bal­anced re­view. I re­ally wanted to offer some­thing that was more of a ten­ta­tive re­port from the field. We gen­er­ally take the view that we will let peo­ple like GiveWell make a clear-eyed as­sess­ment of what’s valuable.

Moder­a­tor: One of the in­di­rect value-adds you men­tioned is grow­ing a net­work. How might start­ing a char­ity in In­dia cre­ate a use­ful net­work for some­body start­ing a char­ity el­se­where? Can you de­scribe how that net­work func­tions?

Ka­triel: That’s a great clar­ify­ing ques­tion. I was ab­solutely talk­ing about a net­work that’s helpful to other pro­jects in In­dia — work­ing in the Ma­ha­rash­tra and Bihar states, for ex­am­ple. I think that it’s rea­son­able when you’re con­sid­er­ing a startup char­ity to think very care­fully about the re­sources that you’ll be able to draw on — and whether you can draw on peo­ple like Varun Desh­pande, the ad­vi­sor to the Ma­ha­rash­tra chief minister.

Varun Desh­pande is the In­dian pres­ence for the Good Food In­sti­tute [and an­other EA Global speaker]. He is a phe­nom­e­nal, charis­matic pres­ence and has a his­tory of ac­com­plish­ing amaz­ing things like set­ting up a cel­lu­lar agri­cul­ture re­search cen­ter. He has found some­one who un­der­stands the EA com­mu­nity’s ev­i­dence-based way of think­ing and who sits in a po­si­tion of tremen­dous poli­ti­cal in­fluence in In­dia. This ad­vi­sor, when I first in­ter­acted with him, sent me an email that said, “What you’re do­ing is ter­rific, and if you get stuck any­where in this state or if any­one gets in your way, just let me know and I will un­stick you.”

The fact that Varun and I have this close tie means that he’s able to un­cover peo­ple like that who will be ac­cessible and rele­vant to me. That’s pretty amaz­ing.

Moder­a­tor: For some­body who is in­ter­ested in go­ing through the Char­ity En­trepreneur­ship school, what are some of the top things that they’d re­ally like to see some­body start a char­ity on?

Ka­triel: I’m not qual­ified to an­swer that ques­tion. I re­ally urge you to watch the char­ity en­trepreneur­ship talk that Joey gave at EA Lon­don 2018 .

Moder­a­tor: If some­one were to try to ei­ther in­te­grate into the ex­ist­ing net­work or try to build a net­work of their own, what are some key pieces of ad­vice that you would give them (as­sum­ing they have no back­ground in this area)?

Ka­triel: This is a ques­tion from some­one who’s try­ing to de­velop a net­work that will be effec­tive for char­ity en­trepreneurs? That’s how I’ll in­ter­pret it.

This is a re­ally ex­cel­lent ques­tion. One of the things that I’ve heard peo­ple com­ment­ing on (and no­ticed my­self at EA Global this time) is that the com­mu­nity is be­com­ing in­creas­ingly effec­tive in its think­ing about policy, and more tied to se­nior poli­cy­mak­ers. So com­ing to EA Global is prob­a­bly not a bad start.

For me, the most trans­for­ma­tive thing in my ca­reer was en­ter­ing a pub­lic policy mas­ter’s pro­gram that had a lot of in­cred­ibly effec­tive and thought­ful peo­ple. To me, the key benefit of that mas­ter’s pro­gram was see­ing how oth­ers or­ga­nize their lives around the goal of hav­ing a bet­ter, big­ger im­pact in the world. I got to meet them. And those peo­ple have spread out into the world and be­come the seeds of a re­ally vi­tal and far-reach­ing net­work.