Our Recommendation
New Incentives is a high‑evidence, highly cost‑effective organization that uses conditional cash transfers to dramatically increase infant vaccination coverage in northern Nigeria, with gold‑standard RCT evidence and strong external validation. For donors seeking maximum lives‑saved per dollar through a focused, measurable intervention, New Incentives is one of the strongest available options.
New Incentives' Fierce Certification score is 120/100 based on our criteria:
✔ Has Ultimate Outcome Goals (50 pts)
✔ Measures Intermediate Outcomes (10 pts)
✔ Measures Ultimate Outcomes (15 pts)
✔ Shows Continual Learning & Adaptation (25 pts)
✔ Measures Intermediate Counterfactual (10 pts)
✔ Measures Ultimate Counterfactual (10 pts)
The Social Problem
New Incentives addresses low routine childhood vaccination rates leading to preventable child deaths in northern Nigeria. In this region, coverage of key infant vaccines has historically lagged national targets, leaving many children unprotected against measles, pertussis, tetanus, and other deadly diseases. Weak demand, travel costs, opportunity costs for caregivers, and practical barriers at clinics all contribute to under‑immunization and the continued burden of vaccine‑preventable disease.
The Solution
New Incentives’ solution is to offer small, conditional cash transfers to caregivers when their infants receive specific routine vaccinations at government clinics, directly addressing the economic and behavioral barriers to completing the schedule. The program enrolls infants, tracks their vaccination status, and pays caregivers upon completion of key doses, while working within existing public health facilities and aligning with government immunization policies. The intervention is tightly focused, evidence‑driven, and designed for high cost‑effectiveness, with constant monitoring of cost per enrolled child and per fully vaccinated child.
Key Outputs
Key outputs include:
- Infants served: as of late 2024, New Incentives reports serving about 6.7 million infants with its cash‑for‑vaccination program.
- Geographic expansion: the program has scaled from ~70,000 children in 3 states in 2020 to ~1.5 million children annually in 9 states by 2023.
- Transfers delivered: tens of millions of conditional cash transfers have been made to caregivers at vaccination visits, though the exact number varies by period.
- Cost per child enrolled: cost per enrolled child has fallen from about $39 in 2020 to roughly $18 in 2024, due to economies of scale and operational efficiencies.
These outputs demonstrate both reach and improving cost‑efficiency as the program scales.
Key Intermediate Outcomes
New Incentives’ main intermediate outcome is full vaccination coverage:
- A large RCT found a 108% relative increase in full vaccination coverage for key routine vaccines in treatment clusters compared with control clusters.
These are backed by rigorous counterfactual evidence from the RCT.
- Monitoring data show high enrollment and completion rates, with frequent impact reports by state documenting trends in doses delivered and coverage improvements.
Key Ultimate Outcomes
Ultimate outcomes focus on child mortality and health:
- GiveWell and Founders Pledge estimate that the program is roughly 9–38 times as cost‑effective as direct cash transfers, with updated models suggesting it is about twice as cost‑effective as originally thought, driven largely by lower cost per child enrolled.
- These models use the RCT’s coverage effects, baseline disease burdens, and vaccine efficacy to estimate deaths averted per dollar relative to a no‑program counterfactual.
While New Incentives itself highlights “lives saved” and cost‑effectiveness, the detailed counterfactual mortality estimates are primarily produced by external evaluators.
Continual Learning & Adaptation
New Incentives demonstrates a strong learning culture:
- Its “Pilot. Test. Scale.” mantra reflects a deliberate sequence of small‑scale trials, RCT testing, and then rapid—but monitored—scale‑up.
- It publishes regular impact and financial reports, responds to external re‑analyses (e.g., GiveWell’s error correction and updated cost‑effectiveness), and adapts its operations to improve cost per infant and program efficiency.
- The organization refines its site selection, enrollment, and payment processes based on data and partner feedback, while remaining tightly aligned with the evidence that its core mechanism—conditional cash transfers—moves the needle on vaccination.
Altogether, New Incentives embodies our desired cycle: an explicit theory of change, implementation disciplined by that theory, rigorous counterfactual evaluation, and iterative adaptation guided by data and external scrutiny.
Written by
