New Incentives
Impact score: 100
Location: Northern Nigeria
Focus: Low childhood vaccination rates
New Incentives -- Fierce Philanthropy Research Report
Date: March 21, 2026 Methodology: Todd Manwaring's Social Impact Evaluation Framework Organization: New Incentives (newincentives.org)
PROMPT 1 -- Organization and Social Problem Summary
- Social Problem: Low childhood vaccination rates
- Population: Infants and caregivers in underserved communities
- Location: Northern Nigeria
PROMPT 2 -- Top 20 Negative Consequences of Low Childhood Vaccination Rates Among Infants in Northern Nigeria
| # | Negative Consequence |
|---|---|
| 1 | Increased infant mortality from vaccine-preventable diseases |
| 2 | Measles outbreaks causing child death and disability |
| 3 | Polio infection leading to permanent paralysis |
| 4 | Diphtheria outbreaks in unvaccinated communities |
| 5 | Pertussis (whooping cough) causing infant respiratory failure |
| 6 | Tuberculosis transmission among unvaccinated infants |
| 7 | Caregivers lack knowledge of vaccination schedules and locations |
| 8 | Financial barriers prevent families from accessing clinics |
| 9 | Chronic malnutrition worsened by repeated preventable illness |
| 10 | Increased household healthcare expenditures from treating preventable diseases |
| 11 | Reduced economic productivity of families caring for sick children |
| 12 | Distrust of the health system reduces engagement with other health services |
| 13 | Vaccine supply stockouts at local clinics discourage caregivers |
| 14 | Reduced school enrollment and educational attainment due to childhood illness |
| 15 | Long-term cognitive and developmental impairment from disease complications |
| 16 | Overburdened healthcare facilities managing preventable disease outbreaks |
| 17 | Negative attitudes toward immunization perpetuate low vaccination culture |
| 18 | Geographic isolation limits access to routine immunization services |
| 19 | Loss of herd immunity increases community-wide disease vulnerability |
| 20 | Emotional and psychological toll on families from preventable child death |
PROMPT 3 -- Negative Consequences Classified as Intermediary or Ultimate Outcomes
Sorted by Intermediary Outcomes first, then Ultimate Outcomes.
| # | Negative Consequence | Outcome Type |
|---|---|---|
| 7 | Caregivers lack knowledge of vaccination schedules and locations | Intermediary |
| 8 | Financial barriers prevent families from accessing clinics | Intermediary |
| 12 | Distrust of the health system reduces engagement with other health services | Intermediary |
| 13 | Vaccine supply stockouts at local clinics discourage caregivers | Intermediary |
| 17 | Negative attitudes toward immunization perpetuate low vaccination culture | Intermediary |
| 18 | Geographic isolation limits access to routine immunization services | Intermediary |
| 11 | Reduced economic productivity of families caring for sick children | Intermediary |
| 10 | Increased household healthcare expenditures from treating preventable diseases | Intermediary |
| 1 | Increased infant mortality from vaccine-preventable diseases | Ultimate |
| 2 | Measles outbreaks causing child death and disability | Ultimate |
| 3 | Polio infection leading to permanent paralysis | Ultimate |
| 4 | Diphtheria outbreaks in unvaccinated communities | Ultimate |
| 5 | Pertussis (whooping cough) causing infant respiratory failure | Ultimate |
| 6 | Tuberculosis transmission among unvaccinated infants | Ultimate |
| 9 | Chronic malnutrition worsened by repeated preventable illness | Ultimate |
| 14 | Reduced school enrollment and educational attainment due to childhood illness | Ultimate |
| 15 | Long-term cognitive and developmental impairment from disease complications | Ultimate |
| 16 | Overburdened healthcare facilities managing preventable disease outbreaks | Ultimate |
| 19 | Loss of herd immunity increases community-wide disease vulnerability | Ultimate |
| 20 | Emotional and psychological toll on families from preventable child death | Ultimate |
PROMPT 4 -- Positive Results Shared by New Incentives
| # | Negative Consequence | Outcome Type | Positive Results Shared by Organization |
|---|---|---|---|
| 7 | Caregivers lack knowledge of vaccination schedules and locations | Intermediary | Yes. RCT found 136% increase in caregivers knowing correct number of vaccines a child should receive by age 1. Treatment group caregivers had significantly higher knowledge of where to get vaccines and at what age the first injectable vaccine should be given. |
| 8 | Financial barriers prevent families from accessing clinics | Intermediary | Yes. Program provides conditional cash transfers totaling 11,000 naira (~$9.50) per child across six clinic visits, directly offsetting transportation and opportunity costs. 28.9+ million cash transfers disbursed. |
| 12 | Distrust of the health system reduces engagement with other health services | Intermediary | Yes. RCT showed modest improvements in vaccine attitudes among caregivers in treatment areas compared to control areas. |
| 13 | Vaccine supply stockouts at local clinics discourage caregivers | Intermediary | Yes. RCT found 180% increase in clinics avoiding stockouts (from 10% to 27%). Program staff conduct routine checks on vaccine quality and stock levels at clinics and encourage procurement when stock is low. |
| 17 | Negative attitudes toward immunization perpetuate low vaccination culture | Intermediary | Yes. RCT found caregivers in treatment areas had more favorable attitudes toward immunization. Awareness campaigns are a core program component. |
| 18 | Geographic isolation limits access to routine immunization services | Intermediary | Partial. Program operates in 5,862+ clinics across 14 states, expanding access points. GIS mapping and satellite data used to monitor enrollment against population targets. However, no specific measurement of reduced geographic barriers is reported. |
| 11 | Reduced economic productivity of families caring for sick children | Intermediary | No direct results shared. |
| 10 | Increased household healthcare expenditures from treating preventable diseases | Intermediary | No direct results shared. |
| 1 | Increased infant mortality from vaccine-preventable diseases | Ultimate | Yes. GiveWell estimates initial $17M grant averted ~7,900 deaths. Full $120M in grants estimated to avert ~45,000 deaths. Cost per death averted estimated at ~$2,100. Modeling shows fully vaccinated children have ~70% lower mortality risk than unvaccinated peers in Nigeria. |
| 2 | Measles outbreaks causing child death and disability | Ultimate | Yes. RCT found 62% increase in timely Measles 1 vaccination. 14 percentage point increase in measles vaccination coverage vs. control. Since 2020, measles case declines documented in Northwest Nigeria. |
| 3 | Polio infection leading to permanent paralysis | Ultimate | Partial. Polio case declines documented in program areas since 2020. Vaccination coverage increases include polio-relevant vaccines but no isolated polio-specific outcome data shared. |
| 4 | Diphtheria outbreaks in unvaccinated communities | Ultimate | Partial. Diphtheria case declines documented in Northwest Nigeria since 2020. Pentavalent vaccine (which covers diphtheria) showed 21 percentage point increase in coverage vs. control. |
| 5 | Pertussis (whooping cough) causing infant respiratory failure | Ultimate | Partial. Pentavalent vaccine (covering pertussis) showed 21 percentage point increase. No isolated pertussis-specific outcome data shared. |
| 6 | Tuberculosis transmission among unvaccinated infants | Ultimate | Yes. RCT found BCG vaccine coverage 16 percentage points higher in treatment vs. control clinics [95% CI: 12, 21]. |
| 9 | Chronic malnutrition worsened by repeated preventable illness | Ultimate | No direct results shared. |
| 14 | Reduced school enrollment and educational attainment due to childhood illness | Ultimate | No direct results shared. |
| 15 | Long-term cognitive and developmental impairment from disease complications | Ultimate | No direct results shared. |
| 16 | Overburdened healthcare facilities managing preventable disease outbreaks | Ultimate | Partial. Disease incidence reduced approximately 50% for preventable illnesses in Northwest Nigeria since 2020, which would reduce facility burden. No direct facility burden measurement reported. |
| 19 | Loss of herd immunity increases community-wide disease vulnerability | Ultimate | Yes. RCT found 108% increase in full vaccination coverage (from ~25% to over 50%). Program has enrolled 6.6+ million infants, encouraging 101+ million vaccinations, contributing to population-level herd immunity. |
| 20 | Emotional and psychological toll on families from preventable child death | Ultimate | No direct results shared. |
PROMPT 5 -- Counterfactual Results Shared by New Incentives
| # | Negative Consequence | Outcome Type | Positive Results Shared by Organization | Counterfactual Results Shared |
|---|---|---|---|---|
| 7 | Caregivers lack knowledge of vaccination schedules and locations | Intermediary | Yes. RCT found 136% increase in caregivers knowing correct number of vaccines a child should receive by age 1. Treatment group caregivers had significantly higher knowledge of where to get vaccines and at what age the first injectable vaccine should be given. | Yes. RCT control group showed only 11% of caregivers knew correct vaccine count vs. significantly higher rates in treatment group. Knowledge differences measured against 167 randomized control clinics. |
| 8 | Financial barriers prevent families from accessing clinics | Intermediary | Yes. Program provides conditional cash transfers totaling 11,000 naira (~$9.50) per child across six clinic visits, directly offsetting transportation and opportunity costs. 28.9+ million cash transfers disbursed. | No direct counterfactual measurement of financial barrier reduction. The cash transfer is the intervention itself, not a measured outcome with control comparison. |
| 12 | Distrust of the health system reduces engagement with other health services | Intermediary | Yes. RCT showed modest improvements in vaccine attitudes among caregivers in treatment areas compared to control areas. | Yes. RCT measured attitudes in both treatment and control groups across 167 randomized clinics, showing treatment group had more favorable attitudes than control. |
| 13 | Vaccine supply stockouts at local clinics discourage caregivers | Intermediary | Yes. RCT found 180% increase in clinics avoiding stockouts (from 10% to 27%). Program staff conduct routine checks on vaccine quality and stock levels at clinics and encourage procurement when stock is low. | Yes. RCT control group: only 10% of clinics avoided stockouts. Treatment group: 27% avoided stockouts. Measured across randomized clinic pairs. |
| 17 | Negative attitudes toward immunization perpetuate low vaccination culture | Intermediary | Yes. RCT found caregivers in treatment areas had more favorable attitudes toward immunization. Awareness campaigns are a core program component. | Yes. RCT compared attitudes between treatment and control groups across 167 randomized clinics, demonstrating measured attitudinal improvement above counterfactual. |
| 18 | Geographic isolation limits access to routine immunization services | Intermediary | Partial. Program operates in 5,862+ clinics across 14 states, expanding access points. GIS mapping and satellite data used to monitor enrollment against population targets. However, no specific measurement of reduced geographic barriers is reported. | No counterfactual results. |
| 11 | Reduced economic productivity of families caring for sick children | Intermediary | No direct results shared. | No counterfactual results. |
| 10 | Increased household healthcare expenditures from treating preventable diseases | Intermediary | No direct results shared. | No counterfactual results. |
| 1 | Increased infant mortality from vaccine-preventable diseases | Ultimate | Yes. GiveWell estimates initial $17M grant averted ~7,900 deaths. Full $120M in grants estimated to avert ~45,000 deaths. Cost per death averted estimated at ~$2,100. Modeling shows fully vaccinated children have ~70% lower mortality risk than unvaccinated peers in Nigeria. | Yes. GiveWell's cost-effectiveness model uses counterfactual estimates of what vaccination coverage would have been without the program. Initial estimate: 4,300 deaths averted; revised to 7,900 based on updated counterfactual parameters including baseline unvaccinated rate (76%), vaccine-preventable mortality risk (6.1%), and indirect deaths multiplier (0.75). Control group baseline coverage of ~25% used as counterfactual. |
| 2 | Measles outbreaks causing child death and disability | Ultimate | Yes. RCT found 62% increase in timely Measles 1 vaccination. 14 percentage point increase in measles vaccination coverage vs. control. Since 2020, measles case declines documented in Northwest Nigeria. | Yes. RCT control group measles vaccination rate measured as counterfactual. Treatment group showed 14 percentage points higher measles coverage [95% CI: 10, 18]. Control group baseline measles timely vaccination rate was 53%. |
| 3 | Polio infection leading to permanent paralysis | Ultimate | Partial. Polio case declines documented in program areas since 2020. Vaccination coverage increases include polio-relevant vaccines but no isolated polio-specific outcome data shared. | No direct counterfactual for polio-specific outcomes. |
| 4 | Diphtheria outbreaks in unvaccinated communities | Ultimate | Partial. Diphtheria case declines documented in Northwest Nigeria since 2020. Pentavalent vaccine (which covers diphtheria) showed 21 percentage point increase in coverage vs. control. | Yes. RCT control group Penta 1 coverage used as counterfactual. Treatment group showed 21 percentage points higher Penta 1 coverage [95% CI: 16, 26]. |
| 5 | Pertussis (whooping cough) causing infant respiratory failure | Ultimate | Partial. Pentavalent vaccine (covering pertussis) showed 21 percentage point increase. No isolated pertussis-specific outcome data shared. | Partial. Pentavalent vaccine counterfactual applies (21 pp increase vs. control), but no pertussis-specific disease outcome counterfactual. |
| 6 | Tuberculosis transmission among unvaccinated infants | Ultimate | Yes. RCT found BCG vaccine coverage 16 percentage points higher in treatment vs. control clinics [95% CI: 12, 21]. | Yes. RCT control group BCG coverage measured as counterfactual. Treatment group showed 16 percentage points higher coverage [95% CI: 12, 21]. |
| 9 | Chronic malnutrition worsened by repeated preventable illness | Ultimate | No direct results shared. | No counterfactual results. |
| 14 | Reduced school enrollment and educational attainment due to childhood illness | Ultimate | No direct results shared. | No counterfactual results. |
| 15 | Long-term cognitive and developmental impairment from disease complications | Ultimate | No direct results shared. | No counterfactual results. |
| 16 | Overburdened healthcare facilities managing preventable disease outbreaks | Ultimate | Partial. Disease incidence reduced approximately 50% for preventable illnesses in Northwest Nigeria since 2020, which would reduce facility burden. No direct facility burden measurement reported. | No direct counterfactual for facility burden. |
| 19 | Loss of herd immunity increases community-wide disease vulnerability | Ultimate | Yes. RCT found 108% increase in full vaccination coverage (from ~25% to over 50%). Program has enrolled 6.6+ million infants, encouraging 101+ million vaccinations, contributing to population-level herd immunity. | Yes. RCT control group full vaccination coverage of ~25% serves as counterfactual, vs. treatment group at over 50%. 108% relative increase measured against randomized control. GiveWell household surveys also compare program and non-program areas at scale. |
| 20 | Emotional and psychological toll on families from preventable child death | Ultimate | No direct results shared. | No counterfactual results. |
SUMMARY REPORT
Section 1 -- Our Recommendation
We highly recommend New Incentives for donor support. This organization demonstrates an exceptional commitment to evidence-based programming, rigorous impact measurement, and continual learning. New Incentives operates one of the most thoroughly evaluated interventions in global health philanthropy, backed by a randomized controlled trial conducted by independent researchers (IDinsight), ongoing monitoring by GiveWell, and transparent public reporting of both successes and challenges. Their conditional cash transfer program for childhood vaccination in northern Nigeria has been independently estimated to avert deaths at a cost of approximately $2,100 per life saved, making it one of the most cost-effective charitable interventions in the world. The organization has successfully scaled from 70,000 children in 3 states (2020) to over 1.5 million children in 9 states (2023) while maintaining program quality, and it proactively addresses risks including fraud, vaccine stockouts, and security concerns through data-driven adaptation.
Seven-Point Evaluation:
- a. Understands the Social Issue
- b. Has Intermediate Outcome Goals
- c. Has Ultimate Outcome Goals
- d. Measures these Intermediate & Ultimate Outcomes
- e. Measures Intermediate Counterfactuals
- f. Measures Ultimate Counterfactuals
- g. Evidence of Continual Learning & Adaptation
Section 2 -- The Social Problem
Northern Nigeria has among the lowest childhood immunization rates in the world and some of the highest child mortality rates. Approximately 40% of child deaths under age five in Nigeria are caused by vaccine-preventable diseases. Every 20 seconds globally, someone dies from a disease that could have been prevented by a vaccine, and the burden falls disproportionately on communities in northern Nigeria where systemic barriers -- including long travel distances to clinics, financial constraints, distrust of the health system, vaccine supply shortages, and low awareness of vaccination schedules -- prevent caregivers from completing routine immunization for their children. At baseline, only about 25% of infants in program areas were fully vaccinated. This creates cascading consequences: preventable disease outbreaks, childhood disability, chronic health conditions, lost economic productivity, and devastating family grief from avoidable child death.
Section 3 -- The Solution
New Incentives implements a conditional cash transfer (CCT) program integrated into Nigeria's existing public health infrastructure. The intervention has three core components: (1) small cash incentives totaling approximately 11,000 naira (~$9.50) disbursed to caregivers across six clinic visits, conditional on their child receiving scheduled vaccinations; (2) awareness campaigns that educate caregivers about vaccination benefits, schedules, and locations; and (3) vaccine supply chain support, where program staff check vaccine quality and stock at clinics on routine immunization days and encourage procurement when supplies are low. The program partners with federal and state health agencies and operates within government clinics, strengthening rather than replacing existing systems. The cash incentives address both the direct financial barriers (transportation costs, lost wages) and create behavioral motivation for caregivers to complete the full vaccination schedule.
Section 4 -- Key Outputs
Key outputs that provide context to the scale and operational reach of New Incentives' solution include:
- 6,615,642 infants enrolled in the program to date
- 28,968,367 cash transfers disbursed to caregivers
- 101,093,707 vaccinations encouraged through the program
- 85.67% retention rate through the full vaccination cycle
- Operations expanded from approximately 100 clinics in 3 states during the RCT to 5,862+ clinics across 14 Nigerian states
- 9,000+ health workers trained annually
- Cost per infant enrolled decreased from $34.54 (2019) to approximately $17-18 (2024), a 53% reduction
- Total incentive per child: 11,000 naira (~$9.50) across six visits
- Monthly clinic verification visits conducted by program staff
- GIS mapping and satellite data used to monitor enrollment against population targets
- Unannounced audits conducted on 15-20% of operational days for quality assurance
Section 5 -- Key Intermediate Outcomes
New Incentives measures several intermediate outcomes with counterfactual rigor through its randomized controlled trial (167 clinics, 5,173 children, conducted by IDinsight from 2017-2020):
- Caregiver vaccination knowledge: 136% increase in caregivers knowing the correct number of vaccines a child should receive by age 1. Counterfactual: Only 11% of control group caregivers had this knowledge, establishing a clear causal effect of the program on knowledge gains.
- Caregiver attitudes toward immunization: Treatment group caregivers showed measurably more favorable attitudes toward vaccination compared to control group caregivers. Counterfactual: Attitudes measured in both treatment and control groups across 167 randomized clinics, confirming the program caused attitudinal improvement beyond what would have occurred naturally.
- Vaccine supply availability: 180% increase in clinics avoiding stockouts, rising from 10% to 27%. Counterfactual: Only 10% of control group clinics avoided stockouts, demonstrating the program's supply-side impact is additive to existing government efforts.
- Financial barrier reduction: 28.9+ million cash transfers disbursed, directly addressing the financial barriers that prevent clinic attendance. This is the mechanism of the intervention rather than a measured outcome with control comparison.
- Health system trust: Modest but measured improvements in engagement with the health system among treatment area caregivers compared to control areas.
Section 6 -- Key Ultimate Outcomes
New Incentives demonstrates strong ultimate outcome measurement, with several outcomes supported by counterfactual evidence:
- Child mortality reduction: GiveWell estimates the initial $17 million grant averted approximately 7,900 deaths -- nearly double the initial projection of 4,300 deaths. The full $120 million in grants is estimated to avert approximately 45,000 deaths. Counterfactual: GiveWell's model uses control group vaccination coverage (~25%) and baseline parameters (76% unvaccinated rate, 6.1% vaccine-preventable mortality risk) to estimate deaths that would have occurred without the program. Cost per death averted is estimated at ~$2,100, roughly twice as cost-effective as initially projected.
- Full vaccination coverage: 108% increase, from approximately 25% in control areas to over 50% in treatment areas. Counterfactual: Measured directly against 167 randomized control clinics in the RCT.
- Measles vaccination: 62% increase in timely Measles 1 vaccination; 14 percentage point increase vs. control [95% CI: 10, 18]. Counterfactual: Control group timely measles vaccination rate was 53%. Measles case declines documented in Northwest Nigeria since 2020.
- BCG (tuberculosis) vaccination: 16 percentage point increase vs. control [95% CI: 12, 21]. Counterfactual: Directly measured against randomized control group.
- Pentavalent vaccine (diphtheria, pertussis, and other diseases): 21 percentage point increase vs. control [95% CI: 16, 26]. Counterfactual: Directly measured against randomized control group. Diphtheria case declines documented in program areas.
- Disease incidence reduction: Approximately 50% reduction in preventable disease incidence in Northwest Nigeria since 2020 scaling began.
- Herd immunity contribution: Over 101 million vaccinations encouraged across 6.6+ million enrolled infants, contributing to population-level coverage thresholds needed for community protection.
Section 7 -- Continual Learning & Adaptation
New Incentives demonstrates strong evidence of being a learning organization that systematically uses data to refine its theory of change and intervention over time:
Data-Driven Scaling: The organization employs daily data collection, analysis, and decision-making processes. They conduct household surveys before entering new areas and every six to twelve months to assess coverage increases, comparing program and non-program areas to estimate impact at scale.
Operational Adaptations Based on Evidence:
- Expanded from a "hub and spoke" staffing model to a localized staffing model as the program scaled, responding to operational data showing the need for more distributed management.
- Introduced measles second-dose incentives in January 2022, responding to evidence that extending the incentive schedule would increase confidence in sustained program impact.
- Adapted enrollment protocols to include infants who received first vaccines during COVID-19 shutdowns, responding to pandemic disruptions.
- Focused geographic expansion on areas with lower security threats, informed by quarterly security assessments and incident tracking.
Anti-Fraud Evolution: As repeat enrollment rates rose from 5% (2020) to approximately 11% (2023), the organization progressively introduced facial recognition processes, GPS check-ins, staff attendance photo requirements, biometric matching, unannounced audits (15-20% of days), and metadata analysis -- demonstrating iterative response to identified risks.
Supply Chain Learning: Real-time vaccine supply data is gathered from the ground level, with coordination across clinic hierarchies to ensure availability. This directly addresses a critical theory-of-change assumption that was validated during the RCT (stockout reduction).
Cost-Effectiveness Learning: The cost per infant enrolled decreased from $34.54 to approximately $17-18, driven by economies of scale and efficiency improvements that the organization and GiveWell continue to investigate.
External Evaluation Integration: The organization funded and participated in an independent RCT by IDinsight, integrates GiveWell's ongoing cost-effectiveness analysis and lookback reviews into its planning, and responds to identified concerns (e.g., government skepticism about program dependency). GiveWell's 2025 lookback found the program roughly twice as cost-effective as initially projected, and these updated parameters feed back into future grant decisions.
Technology Adoption: The organization has committed to developing AI-powered systems and applications for real-time operational insights as it continues to scale.
Report prepared using Todd Manwaring's Social Impact Evaluation Framework for Fierce Philanthropy. Sources: newincentives.org, GiveWell.org, IDinsight RCT results, Fierce Philanthropy existing report.
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