Location: Africa, India, developing nations globally

Focus: Economic stagnation/slow growth

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Growth Teams - Fierce Philanthropy Research Report

Date: March 21, 2026 Methodology: Todd Manwaring's Social Impact Evaluation Framework Organization: Growth Teams

PROMPT 1 -- Organization and Social Problem Summary

1. Social Problem: Economic stagnation/slow growth
2. Population: Developing country governments
3. Location: Africa, India, developing nations globally

PROMPT 2 -- Top 20 Negative Consequences

PROMPT 3 -- Intermediary vs Ultimate Outcome Classification

PROMPT 4 -- Positive Results Shared by Organization

PROMPT 5 -- Counterfactual Results

SUMMARY REPORT

Section 1 -- Our Recommendation

Growth Teams demonstrates strong understanding of economic growth challenges and has developed an innovative government coaching approach. However, their impact measurement lacks the rigor expected for evidence-based social impact work. While they show promising initial results in Rwanda and have created valuable research through the Export Boom Atlas, the organization has significant gaps in measuring counterfactual outcomes and lacks systematic impact evaluation protocols.

• 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

Growth Teams addresses a critical issue: too many developing countries have had slow or negative progress in their ability to successfully implement policies over the last few decades. When governments are not able to implement pro-growth policies then higher-income jobs will always be few and far between.

More than 90% of countries have experienced slow or negative growth in their state capability in the past 25 years.

This represents a fundamental challenge to economic development and poverty reduction globally.

Section 3 -- The Solution

Growth Teams helps developing country governments to problem solve for economic growth through structural transformation. They coach governments to solve problems that hold back firms, and as a result generate good jobs where people get richer. They help governments focus on the right, high-potential industries, identify the biggest barriers that hold back firms in those industries, and then take the right actions to unlock those constraints to economic growth.

Rather than producing externally-driven reports that collect dust on shelves, Growth Teams works side-by-side with government leaders and staff to take action on growth constraints.

Section 4 -- Key Outputs

Growth Teams Inc's revenue in 2022 was $356,898.

There is 1 employee and 1 volunteer at Growth Teams Inc.

The organization has created the Export Boom Atlas,

a new project that identifies, maps, and profiles major export booms in low and middle income countries since 1995, documenting 80+ cases.

Their work now spans places like Rwanda and Tanzania, and they recently co-hosted the Growth Summit with the Center for Global Development.

Section 5 -- Key Intermediate Outcomes

Growth Teams reports success in improving government policy implementation capacity in Rwanda.

A first step was to translate the strategic thinking – identifying GBS as a priority sector – into tangible actions to be taken. The RDB team researched the country's competitiveness in the sector, comparing costs across alternative sourcing countries. The result was a compelling articulation for why a GBS firm might consider setting up in Rwanda. The team at RDB identified criteria to filter the universe of GBS firms, built an investor pipeline of 80+ prospective investors, and facilitated country visits for interested players.

However, no counterfactual measurement was found to validate what would have happened without Growth Teams' intervention.

Section 6 -- Key Ultimate Outcomes

The primary concrete result shared is job creation in Rwanda's GBS sector.

Today, over 15 GBS firms, employing roughly 1,500 Rwandans in good formal jobs, are providing a range of business process outsourcing (BPO) and IT outsourcing (ITO) services to global markets.

Working side-by-side with Growth Teams, RDB has attracted two new global GBS firms to set up operations in Rwanda this year itself (with several more expected soon), helping to create 6,000 good jobs in the GBS sector by 2025.

However, these results lack counterfactual analysis to determine Growth Teams' specific contribution versus other factors.

Section 7 -- Continual Learning & Adaptation

Limited evidence was found of systematic learning and adaptation based on data. The organization has created research products like the Export Boom Atlas and has academic backgrounds in impact evaluation, but there is no evidence of formal feedback loops or systematic measurement systems that inform program improvements. The founders have backgrounds with RCT methodology but appear not to be applying rigorous evaluation methods to their own interventions.

Report prepared using Todd Manwaring's Social Impact Evaluation Framework for Fierce Philanthropy.

Location: Guatemala (expanding to El Salvador and Africa)

Focus: Chronic malnutrition from nutrient-poor corn

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Semilla Nueva - Fierce Philanthropy Research Report

Date: March 21, 2026 Methodology: Todd Manwaring's Social Impact Evaluation Framework Organization: Semilla Nueva (semillanueva.org)

PROMPT 1 -- Organization and Social Problem Summary

1. Social Problem: Chronic malnutrition from nutrient-poor corn
2. Population: Rural farming families and consumers dependent on corn-based diets
3. Location: Guatemala (expanding to El Salvador and Africa)

PROMPT 2 -- Top 20 Negative Consequences of Chronic Malnutrition from Nutrient-Poor Corn Among Rural Farming Families in Guatemala

PROMPT 3 -- Negative Consequences Classified as Intermediary or Ultimate Outcomes

PROMPT 4 -- Positive Results Shared by Semilla Nueva

PROMPT 5 -- Counterfactual Results Shared by Semilla Nueva

SUMMARY REPORT

Section 1 -- Our Recommendation

We recommend Semilla Nueva for donor consideration as an innovative, market-based approach to chronic malnutrition. The organization has developed the world's first commercial, biofortified (non-GMO) corn seed with meaningful nutritional improvements: 39% more zinc, 19% more iron, and 2.1x the protein quality of standard corn. The commercial model is elegant -- rather than trying to change what people eat, it makes what they already eat more nutritious, distributing improved seeds through existing market channels at competitive prices. By 2025, 55,000 farmers are growing biofortified corn that feeds 1.4+ million people. Government subsidy programs in Guatemala and El Salvador signal the potential for massive scale. However, the evidence base has important gaps. The organization's impact claims are primarily based on laboratory nutritional analysis and ex-ante modeling rather than measured health outcomes in consuming populations. There is no randomized or quasi-experimental study measuring actual zinc status, iron status, stunting, or other health outcomes in consumers of biofortified corn versus non-consumers. INCAP is collecting nutrition data from consuming families, which may eventually provide this evidence. The organization measures outputs (farmers reached, people fed) and intermediate nutritional content very well, but does not yet measure ultimate health outcomes (stunting, mortality, disease) or counterfactuals at any level.

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

Guatemala has one of the highest rates of chronic child malnutrition in the world -- 47% of all children are chronically malnourished, causing stunted growth and impaired brain development. The root cause is deeply tied to corn: for millions of rural Guatemalans, corn (maize) is the overwhelming dietary staple, consumed at nearly every meal in the form of tortillas, tamales, and atole. But standard corn has low nutritional value -- it is deficient in zinc, iron, and essential amino acids (particularly lysine and tryptophan) that are critical for child growth, immune function, and cognitive development. The result is that families who depend on corn-based diets are trapped in chronic nutritional deficiency even when they have enough calories. Zinc deficiency weakens immune systems, iron deficiency causes anemia, and protein quality deficiency limits physical and cognitive development. Malnutrition costs Guatemala over 9% of GDP ($8.4 million daily) in health expenses, educational delays, and lost productivity. The problem is intergenerational: malnourished mothers give birth to low-weight babies who face developmental disadvantages from birth. Traditional approaches to malnutrition -- dietary diversification, supplementation programs, fortified foods -- have proven difficult to sustain at scale in rural, corn-dependent communities.

Section 3 -- The Solution

Semilla Nueva takes a fundamentally different approach to malnutrition: rather than trying to change what people eat or supplementing their diets externally, the organization makes the corn itself more nutritious. Key elements:

1. Biofortified Seed Development: Using conventional plant breeding (not GMO), Semilla Nueva develops corn varieties with significantly higher nutritional content: 39% more zinc, 19% more iron, 30-80% more lysine and tryptophan (2.1x protein quality), while maintaining or exceeding traditional varieties in yield and climate resilience. Seeds are validated through world-renowned laboratories for nutritional content.
2. Commercial Distribution Model: Rather than distributing seeds for free (which creates dependency), Semilla Nueva partners with 11 seed companies to produce and distribute biofortified seeds commercially at competitive prices. Farmers adopt the seeds because they are agronomically competitive -- the nutrition is an embedded benefit.
3. Government Partnership for Scale: Guatemala and El Salvador are exploring significant biofortified seed distributions and subsidy support, potentially reaching 100,000+ farmers. This government adoption pathway could transform biofortified corn from an NGO initiative to a national food system feature.
4. Impact Measurement: Semilla Nueva uses an ex-ante impact model to estimate how many people consume biofortified corn and the nutritional deficiency reductions achieved. INCAP (the region's leading nutrition think tank) visits consuming families to collect food consumption and nutrition data.
5. Geographic Expansion: The model is expanding from Guatemala to El Salvador and, through partner organizations, to Africa -- wherever corn-dependent diets cause nutritional deficiency.

Section 4 -- Key Outputs

• World's first commercial, biofortified (non-GMO) corn seed
• 2 new seed varieties developed and launched (as of 2025)
• 11 partner companies producing and distributing seeds
• ~55,000 farmers growing and selling nutritious corn (2025)
• 1.4+ million people fed through corn grown by partner farmers (2025)
• 24,678 farming families reached in 2023
• 200,000+ people reached with improved nutrition (cumulative, earlier figure)
• Nutritional content: 39% more zinc, 19% more iron, 2.1x protein quality vs. standard corn
• Operating in Guatemala, expanding to El Salvador and Africa
• Government engagement: Guatemala and El Salvador exploring subsidy support for 100,000+ farmers
• Third-party studies commissioned for impact evaluation
• Cost-effectiveness analyses and financial reports published publicly
• Partnership with INCAP for nutrition data collection
• Founded: ~2010s, over a decade of operation

Section 5 -- Key Intermediate Outcomes

Semilla Nueva's intermediate outcomes center on nutritional content improvements and farmer adoption:

• Zinc content improvement: Biofortified corn contains 39% more zinc than standard varieties. Research indicates this level of improvement is sufficient to eliminate zinc deficiencies for women and children in rural, maize-dependent families.
• Iron content improvement: 19% more iron. Research indicates this produces a 50% reduction in iron deficiency in children and 100% reduction in women consuming biofortified corn.
• Protein quality improvement: 2.1x protein quality (30-80% more lysine and tryptophan). Research indicates this is sufficient to improve childhood growth.
• Farmer adoption: 55,000 farmers growing biofortified corn (2025), up from 24,678 families in 2023, demonstrating rapid commercial adoption.
• Consumer reach: 1.4+ million people fed through corn grown by partner farmers (2025).

Counterfactual note: Nutritional content improvements are laboratory-measured and validated. However, the health impact claims (zinc deficiency elimination, iron deficiency reduction, growth improvement) are based on ex-ante modeling and nutritional science rather than measured outcomes in consuming populations. INCAP is collecting food consumption and nutrition data from consuming families, which may provide measured intermediate outcomes in the future. No comparison to non-consuming control families has been published.

Section 6 -- Key Ultimate Outcomes

Semilla Nueva's evidence at the ultimate outcome level is limited:

• Childhood stunting: The organization states that nutritional improvements are "enough to improve childhood growth," but no direct stunting reduction data from program areas has been reported. Guatemala's 47% chronic malnutrition rate provides the baseline against which impact would be measured.
• Mortality: No childhood mortality data is measured or reported by the organization. The nutritional improvements reduce known risk factors for mortality but the organization does not track mortality outcomes.
• Disease incidence: No data on infectious disease incidence in consuming vs. non-consuming populations.
• Economic impact: The organization cites malnutrition's cost to Guatemala ($8.4M daily, 9% of GDP) but does not measure economic impact from its own intervention.
• Maternal health: Iron deficiency reduction claims for women (100%) are based on modeling. No direct maternal health outcome data (birth weight, pregnancy complications) reported.

Counterfactual note: No ultimate outcome counterfactuals exist. There is no randomized or quasi-experimental study measuring health outcomes (stunting, mortality, morbidity, cognitive development) in populations consuming biofortified corn versus those consuming standard corn. This is the most significant gap in the organization's evidence base.

Section 7 -- Continual Learning & Adaptation

Semilla Nueva demonstrates strong continual learning, particularly in its seed development and market strategy:

Iterative Seed Development: The organization has developed 2 new seed varieties, indicating ongoing breeding and improvement. Seeds are continuously evaluated for nutritional content, yield, and climate resilience through laboratory testing. The use of conventional breeding (not GMO) reflects a strategic choice based on market acceptance and regulatory realities in Central America.

Market-Based Model Evolution: The shift from direct seed distribution to a commercial model with 11 partner companies represents a significant strategic evolution. By embedding biofortified seeds within existing commercial seed supply chains, the organization created a sustainable distribution mechanism that doesn't depend on ongoing NGO involvement.

Impact Measurement Development: The partnership with INCAP for nutrition data collection from consuming families represents an investment in building a stronger evidence base. The use of an ex-ante impact model to estimate reach and nutritional impact, combined with published cost-effectiveness analyses, shows commitment to quantifying results.

Government Engagement as Scale Strategy: The engagement with Guatemalan and Salvadoran governments on biofortified seed subsidy programs represents a learning-driven pivot from farmer-by-farmer adoption to government-enabled mass adoption, potentially reaching 100,000+ farmers.

Geographic Expansion: Expanding from Guatemala to El Salvador and Africa (through partners) demonstrates confidence in the model's transferability to other corn-dependent contexts and a willingness to adapt to new markets.

Transparency: Public publication of cost-effectiveness analyses and financial reports indicates commitment to accountability and external learning.

Report prepared using Todd Manwaring's Social Impact Evaluation Framework for Fierce Philanthropy. Sources: semillanueva.org, One Day's Wages, MIT Solve, Cartier Philanthropy, Shockwave Foundation, openDemocracy.

Location: Salt Lake City, Utah

Focus: Chronic homelessness from addiction/trauma

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The Other Side Village - Fierce Philanthropy Research Report

Date: March 21, 2026 Methodology: Todd Manwaring's Social Impact Evaluation Framework Organization: The Other Side Village (theothersidevillage.com)

PROMPT 1 -- Organization and Social Problem Summary

1. Social Problem: Chronic homelessness from addiction/trauma
2. Population: Chronically homeless adults with addiction and mental health challenges
3. Location: Salt Lake City, Utah

PROMPT 2 -- Top 20 Negative Consequences of Chronic Homelessness Among Adults with Addiction and Mental Health Challenges in Salt Lake City

PROMPT 3 -- Negative Consequences Classified as Intermediary or Ultimate Outcomes

PROMPT 4 -- Positive Results Shared by The Other Side Village

PROMPT 5 -- Counterfactual Results Shared by The Other Side Village

SUMMARY REPORT

Section 1 -- Our Recommendation

We recommend The Other Side Village for donor support as an innovative and promising approach to chronic homelessness. The organization's early metrics are striking: 100% housing stability, 100% sobriety, 100% employment or vocational engagement, 538% income growth, and 75% health improvement -- all within the first year. The 4.9/5 resident satisfaction score and 80% Prep School retention rate further indicate a model that is working for its residents. The master-planned therapeutic community approach, combining permanent tiny-home housing with peer-led accountability, democratic self-governance, and embedded social enterprises, represents a fundamentally different strategy from traditional shelters or Housing First approaches. However, the evidence base has significant limitations: the organization is still early-stage (60 cottages completed, 32 residents at initial occupancy), and there are no counterfactual measurements of any kind -- no control groups, no matched comparisons, no external benchmarks. The 100% sobriety rate reflects a residency requirement (sobriety is mandatory), which introduces selection effects. The $85.2M cost savings figure is a model-based projection, not a measured outcome. As the Village scales toward its 500-600 resident target, building a rigorous evidence base with comparison data will be critical to validating these promising early results.

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

Chronic homelessness in Salt Lake City -- and across the United States -- represents one of the most intractable social problems in the country. Chronically homeless individuals, defined as those who have experienced homelessness for at least a year or repeatedly while struggling with a disabling condition, cycle through emergency shelters, hospitals, jails, and the streets without ever achieving lasting stability. In Salt Lake City, this population faces intersecting crises of addiction, untreated mental illness, and trauma. Traditional interventions -- emergency shelters, transitional housing, and conventional treatment programs -- often fail to produce durable outcomes because they address symptoms in isolation without creating the sustained community, accountability, and purpose that lasting recovery requires. The consequences are devastating for the individuals (premature death, overdose, untreated illness, victimization) and costly for the public (emergency room visits, policing, incarceration, and hospitalization). Studies estimate that a single chronically homeless individual costs public systems $30,000-$50,000 or more per year.

Section 3 -- The Solution

The Other Side Village is a master-planned therapeutic community in Salt Lake City designed to end chronic homelessness through four integrated components:

1. Permanent Housing: The Village provides 350-400 sq ft permanent cottages -- not transitional or temporary housing. Phase 1 includes 60 completed cottages, with plans for 500-600 residents at full build-out. Homes were built through partnerships with local schools, community volunteers, and inmates from Utah prisons, reducing costs while building shared investment.
2. Prep School: Before moving into the Village, residents complete a preparatory stabilization program focused on mental health, accountability, and life skills. The Prep School has an 80% retention rate and serves as the gateway to permanent Village residency. Residents must be chronically homeless, clean and sober, and committed to community rules.
3. Peer-Led Democratic Therapeutic Community: The Village is self-governing -- residents participate in neighborhood council meetings, make collective decisions, and hold each other accountable. Coaches live on-site to provide guidance. The model emphasizes that lasting change comes from peer relationships and community belonging, not top-down case management.
4. Economic Integration Through Social Enterprise: Social enterprises (Other Side Movers, Other Side Donuts) generate revenue for the Village while providing residents with real employment and vocational training. 100% of residents are engaged in employment or vocational training. A health clinic (mental health, dentistry) and grocery store are under construction, both offering additional employment opportunities.

Section 4 -- Key Outputs

• 60 housing units completed (Phase 1)
• 32 residents at initial occupancy (as of late 2025)
• 500-600 residents planned at full build-out
• 350-400 sq ft per cottage
• 80% Prep School retention rate
• Social enterprises: Other Side Movers, Other Side Donuts
• On-site coaches living in the community
• Neighborhood council and regular resident meetings
• Health clinic under construction (mental health, dentistry)
• Grocery store under construction (with resident employment)
• Homes built through partnerships with local schools, community volunteers, and prison inmates
• No cost to residents for housing
• $85.2M projected public cost savings over 20 years from Phase 1

Section 5 -- Key Intermediate Outcomes

The Other Side Village tracks several intermediate outcomes reflecting behavioral and life-skill changes among residents:

• Treatment retention: 80% Prep School retention rate, indicating that 4 out of 5 chronically homeless individuals who enter the preparatory program complete it and transition to permanent Village residency.
• Self-governance capacity: Residents participate in democratic community governance through neighborhood council and regular meetings, developing the decision-making and accountability skills needed for independent living.
• Social connection and belonging: 4.9/5 resident satisfaction score for happiness, safety, and wellbeing, indicating successful rebuilding of social bonds and community belonging that were severed during chronic homelessness.
• Dignity and purpose: Human First approach combined with daily work and service responsibilities provides residents with sense of identity and purpose. Peer mentorship model allows experienced residents to guide newcomers.
• Access to hygiene and basic needs: Private cottages with hygiene facilities replace the deprivation of street homelessness and shared shelter facilities.

Counterfactual note: No intermediate counterfactual measurements are reported. The organization does not compare intermediate outcomes against a control group or matched population receiving different interventions.

Section 6 -- Key Ultimate Outcomes

The Other Side Village reports strong early ultimate outcomes across multiple dimensions:

• Housing stability: 100% of residents maintain permanent housing after one year. This represents a fundamental shift from the cycling through shelters and streets that defines chronic homelessness.
• Sobriety and recovery: 100% sobriety and recovery rate. Note: sobriety is a condition of residency and is maintained through peer accountability. This introduces selection effects -- residents who relapse presumably leave the community, which would maintain the 100% rate among current residents.
• Employment and income: 100% employment or vocational training engagement. 538% average income growth after one year. Social enterprises provide the primary employment pathway.
• Health improvement: 75% health stabilization improvement (physical and mental indicators) after one year.
• Public cost savings: $85.2M projected reduction in public costs over 20 years from Phase 1, from decreased emergency services, hospitalization, and criminal justice usage. This is a model-based projection, not a measured outcome.
• Safety: 4.9/5 resident satisfaction score for safety, indicating residents feel protected from the violence and exploitation they experienced during homelessness.

Counterfactual note: No ultimate counterfactual measurements are reported. There is no control group, matched comparison, or external benchmark study. The organization does not compare its residents' outcomes to those of similar chronically homeless individuals in traditional shelter systems, Housing First programs, or other interventions. The $85.2M cost savings figure is modeled, not measured against actual comparison data.

Section 7 -- Continual Learning & Adaptation

The Other Side Village demonstrates meaningful commitment to learning and adaptation, particularly for an early-stage organization:

Know-by-Name Phase 2: The Village participates in a shared outcomes framework ("Know-by-Name Phase 2") that refines exit criteria and performance measures collaboratively with partner organizations. This represents a systematic approach to defining and measuring success in coordination with the broader homelessness response ecosystem.

Prep School Model Development: The creation of the Prep School as a gateway to Village residency reflects learning about what chronically homeless individuals need before transitioning to permanent community living -- a stabilization phase that addresses immediate barriers (sobriety, accountability, life skills) before the longer-term community integration begins.

Phased Build-Out: The decision to start with 60 cottages (Phase 1) before scaling to 500-600 allows the organization to test and refine the community model at smaller scale before committing to full build-out. This phased approach creates natural learning cycles.

Infrastructure Expansion: The construction of an on-site health clinic (mental health and dentistry) and grocery store represents responsive adaptation to identified resident needs -- recognizing that housing stability alone is insufficient without accessible healthcare and nutritious food.

Social Enterprise Evolution: The development of multiple social enterprises (movers, donuts) reflects iterative learning about which businesses best serve the dual purpose of generating revenue and providing meaningful vocational training for residents.

Democratic Governance Model: Allowing residents to self-govern through neighborhood council and regular meetings creates a built-in feedback mechanism where resident voices directly shape community operations and policies.

Partnership-Based Construction: Building homes through partnerships with local schools, community volunteers, and prison inmates represents creative problem-solving that reduces costs while deepening community investment and creating additional rehabilitation opportunities.

Report prepared using Todd Manwaring's Social Impact Evaluation Framework for Fierce Philanthropy. Sources: theothersidevillage.com, fiercephilanthropy.org/blog/the-other-side-village, NPR, Utah Stories, BYU Magazine, HomeAid Utah.

Location: Salt Lake City, Utah and Denver, Colorado

Focus: Chronic criminal recidivism and addiction

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The Other Side Academy - Fierce Philanthropy Research Report

Date: March 21, 2026 Methodology: Todd Manwaring's Social Impact Evaluation Framework Organization: The Other Side Academy (theothersideacademy.com)

PROMPT 1 -- Organization and Social Problem Summary

1. Social Problem: Chronic criminal recidivism and addiction
2. Population: Adults (18-64) with histories of incarceration, addiction, and homelessness
3. Location: Salt Lake City, Utah and Denver, Colorado

PROMPT 2 -- Top 20 Negative Consequences of Chronic Criminal Recidivism and Addiction Among Formerly Incarcerated Adults in Salt Lake City and Denver

PROMPT 3 -- Negative Consequences Classified as Intermediary or Ultimate Outcomes

PROMPT 4 -- Positive Results Shared by The Other Side Academy

PROMPT 5 -- Counterfactual Results Shared by The Other Side Academy

SUMMARY REPORT

Section 1 -- Our Recommendation

We recommend The Other Side Academy for donor consideration. The organization demonstrates a compelling model for transforming the lives of individuals caught in cycles of incarceration, addiction, and homelessness. Its population arrives with an average of 26 prior arrests, 90% prior homelessness, and near-100% recidivism -- representing some of the hardest-to-serve individuals in the criminal justice system. The results are meaningful: 77% of graduates remain crime-free, 75% remain drug-free, 81% are employed at graduation, and the overall DCE (drug-free, crime-free, employed) rate is 69%, rising to 80% for those who complete 3+ years. The self-funded social enterprise model (no government funding, free to participants) is innovative and sustainable. However, the evidence base has important limitations: the 40% retention rate means these outcomes apply only to completers, and there is no external control group or matched comparison -- the organization uses pre-post comparisons against participants' own histories. Selection bias (who completes the 2.5 years) is unaddressed. For an organization of this type and size, however, the data tracking is strong and the results are encouraging.

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

In the United States, approximately 600,000 people are released from state and federal prisons each year, and within three years, about two-thirds are rearrested. In Salt Lake City and Denver, this cycle is compounded by intersecting crises of addiction and homelessness. The population served by The Other Side Academy arrives with an average of 26 prior arrests and a 90% prior homelessness rate -- individuals for whom the traditional criminal justice system, conventional treatment programs, and homeless services have repeatedly failed. Recidivism is driven not just by addiction and criminal behavior, but by the absence of vocational skills, pro-social relationships, self-governance capacity, and the basic life competencies needed to sustain stability after release. These individuals cycle through incarceration, addiction relapse, homelessness, and re-arrest at enormous cost to themselves, their families, and their communities. The negative consequences extend beyond the individuals: families are fractured, children grow up with incarcerated parents, neighborhoods bear safety risks, and taxpayers fund repeated incarceration without achieving lasting change.

Section 3 -- The Solution

The Other Side Academy operates a 2.5-year residential therapeutic community based on 70 years of therapeutic community research. The model's core insight is that lasting behavioral change requires intensive, immersive practice in a community of peers who share similar backgrounds. Key elements include:

1. Residential Therapeutic Community: Students live together for a minimum of 2.5 years (50% voluntarily stay for a third year). The community is self-governing -- students manage daily operations, hold each other accountable, and progress through increasing levels of responsibility and leadership.
2. Social Enterprise Vocational Training: Students work full-time in revenue-generating businesses -- moving and storage, thrift boutiques, a donut shop, furniture retail, and construction. These enterprises provide real vocational skills while generating revenue that covers most program costs, eliminating the need for government funding.
3. Pro-Social and Self-Governance Education: The program teaches conflict resolution, communication, decision-making, and personal management through daily practice in communal living. "Games" (peer confrontation exercises) and "Seminars" provide structured environments for developing interpersonal skills.
4. Peer-Based Model: Both students and staff come from the same backgrounds. Experienced peers (not traditional therapists) guide newer students, creating a credible and relatable mentorship model.
5. Self-Funded, No Government Funding: The program is free to participants and accepts no government money. Social enterprise revenue covers most costs, with the remainder from donations.

Section 4 -- Key Outputs

• 2.5-year minimum residential commitment (30 months)
• 40% retention rate (participants who complete the full program)
• 50% voluntary extension rate (graduates choosing to stay for a third year)
• Two locations: Salt Lake City, Utah and Denver, Colorado
• Social enterprises include: The Other Side Moving & Storage (5-star rated), The Other Side Thrift Boutique, The Other Side Donut Shop, The Other Side Builders, and The Other Side Designer Storage
• Zero government funding -- self-funded through social enterprises and donations
• Free to participants -- no cost to students
• Ages served: 18-64
• Population profile at entry: Average 26 prior arrests, 90% prior homelessness rate, near-100% historical recidivism
• Exclusions: Sex offenders, arsonists, dual-diagnosis requiring specialized counseling
• Founded: 2015 in Salt Lake City
• Data tracking period: 2015-2025 (internal records and surveys as of December 2025)

Section 5 -- Key Intermediate Outcomes

The Other Side Academy measures several intermediate outcomes reflecting behavioral transformation during the program:

• Vocational skill acquisition: All students work full-time in social enterprises throughout the 2.5-year program, gaining real-world work experience in moving/storage, retail, food service, and construction. 81% have full-time employment secured at graduation.
• Pro-social behavior development: The therapeutic community model provides daily practice in conflict resolution, communication, self-governance, and peer accountability. Students progress through increasing levels of responsibility and leadership within the community.
• Peer network replacement: Students replace antisocial peer networks with a pro-social community of peers who share similar backgrounds and are committed to behavioral change.
• Self-governance capacity: Students manage their own community, make collective decisions, and hold each other accountable -- developing the self-regulation skills that were absent during their criminal and addictive lifestyles.

Counterfactual note: No intermediate counterfactual measurements are reported. The organization does not compare intermediate skill development against an external control group.

Section 6 -- Key Ultimate Outcomes

The Other Side Academy tracks post-graduation outcomes through internal records and surveys (data as of December 2025):

• Crime-free rate: 77% of graduates remain crime-free post-program. Recidivism rate is 23% for graduates (rearrested after completing 2.5+ years). For those who stay 3+ years, the organization reports recidivism drops to approximately 12%.
• Drug-free rate: 75% of graduates maintain sobriety post-program.
• Employment rate: 81% of graduates have full-time employment at graduation.
• DCE (Drug-free, Crime-free, Employed) rate: 69% overall for all graduates. 80% for graduates who completed 3+ years.
• Housing stability: 90% of enrollees arrive homeless. Stable housing is provided throughout the program. Post-graduation housing data is not reported separately but is implied by overall DCE rates.

Counterfactual note: The organization uses pre-post comparisons -- comparing graduates' outcomes to their own prior histories (e.g., "recidivism from close to 100% to 12%" for longest-staying cohort). This is meaningful given the extreme baseline but is not a formal counterfactual. There is no randomized control group, matched comparison group, or external benchmark study. Additionally, the 40% retention rate introduces selection bias -- outcomes reflect only those who completed the full program, not all who enrolled.

Section 7 -- Continual Learning & Adaptation

The Other Side Academy demonstrates meaningful adaptation and learning, though its evidence is more operational than research-based:

Model Refinement Through Experience: The program is based on 70 years of therapeutic community research and has refined its model since its 2015 founding. The organization tracks outcomes over time (2015-2025 dataset) and the data shows that longer stays produce better results (69% DCE at 2.5 years, 80% at 3+ years), informing the recommendation that students stay for the optional third year.

Geographic Expansion: The organization expanded from Salt Lake City to Denver, adapting the model to a new market. This required establishing new social enterprises, building new community partnerships, and adapting to different regulatory environments.

Social Enterprise Innovation: The addition of new business lines over time (moving/storage, thrift boutique, donut shop, builders, designer storage, furniture boutique) reflects operational learning about which enterprises best serve the dual purpose of generating revenue and providing meaningful vocational training.

Data Collection Evolution: The organization maintains internal records and conducts surveys of graduates through December 2025, tracking DCE rates, recidivism, and retention. The existence of a results page with specific data suggests commitment to transparency, though the data collection methodology is not externally validated.

White Paper Development: The organization references an efficacy research white paper, suggesting investment in formalizing and sharing their evidence base.

Community Endorsements: The organization collects and shares endorsements from neighbors, business leaders, and local officials, indicating attention to community relationships and stakeholder feedback as inputs to program improvement.

Report prepared using Todd Manwaring's Social Impact Evaluation Framework for Fierce Philanthropy. Sources: theothersideacademy.com, theothersideacademy.com/results, Utah Business, Utah Stories, Gephardt Daily.

Location: 5805 Troost Avenue, Kansas City, Missouri 64110

Focus: Generational poverty limiting employment

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Pawsperity - Social Impact Research Report

Date: March 21, 2026 Methodology: Todd Manwaring's Social Impact Evaluation Framework Organization Website: https://pawsperity.org Location: 5805 Troost Avenue, Kansas City, Missouri 64110

PROMPT 1 - Organization and Social Problem Summary

1. Social Problem: Generational poverty limiting employment
2. Population: Single parents and families in poverty (including those with histories of addiction, incarceration, and domestic violence)
3. Location: Kansas City, Missouri

PROMPT 2 - Top 20 Negative Consequences

PROMPT 3 - Intermediary vs. Ultimate Outcome Classification

PROMPT 4 - Positive Results Shared by Pawsperity

PROMPT 5 - Counterfactual Results

SUMMARY REPORT

Section 1 - Our Recommendation

We give our recommendation for supporting Pawsperity because they demonstrate a clear understanding of the social problem they are addressing and measure meaningful outcomes that indicate their work is producing results. Pawsperity's model -- combining 810 hours of accredited professional grooming training with 92 hours of life skills education and comprehensive wraparound services -- represents a thoughtful, trauma-informed intervention targeting generational poverty among single parents in Kansas City. Their reported outcomes are compelling: 100% job placement within two months for 2024 graduates, average income growth from $8,300 to $47,000, and 90% employment retention. These are strong indicators of programmatic effectiveness. However, Pawsperity does not currently measure counterfactuals (comparing outcomes to a control group or similar population that did not receive the intervention), which limits the ability to attribute observed changes solely to their program. Despite this gap, the organization shows evidence of continual learning and adaptation, having evolved from "The Grooming Project" to Pawsperity, developed an ACCSC-accredited curriculum, created a replication model (the Pawsperity Package), and built an 18-month post-graduation Bridge Program.

Assessment Against 7 Key Criteria:

• 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

Pawsperity addresses generational poverty and systemic barriers to employment faced by single parents and vulnerable families in Kansas City, Missouri. These individuals often carry compounding disadvantages including histories of addiction, incarceration, domestic violence, and homelessness. Without marketable skills, stable income, or support networks, they remain trapped in cycles of poverty -- unable to secure housing, regain custody of children, access healthcare, or achieve long-term stability. Traditional workforce development programs tend to focus narrowly on technical skills while ignoring the holistic, systemic challenges that keep people in poverty. The pet grooming industry represents an underutilized pathway: it is growing rapidly (an estimated 100,000 new jobs projected over the next decade), does not require a GED, is accessible to those with felony records, offers flexible schedules suited to parents, and leverages the therapeutic benefits of the human-animal bond.

Section 3 - The Solution

Pawsperity operates the nation's only nonprofit grooming school dedicated to breaking cycles of generational poverty. Founded in 2016 by Natasha Herdman in Kansas City, Missouri, the organization delivers a trauma-informed job training model that uses professional dog grooming as a career pathway out of poverty. The intervention has three integrated components:

1. Professional Grooming Training (810 hours over 7 months): Five sequential five-week courses covering bathing, clipper work, scissor techniques, breed standards, speed development, and business fundamentals. The capstone requires students to groom 5-6 dogs per day and pass multiple breed-standard tests and written examinations. The program is accredited by the Accrediting Commission of Career Schools and Colleges (ACCSC), recognized by the U.S. Secretary of Education.
2. Life Skills Education (92 hours): Courses in financial literacy, budgeting, parenting, mindfulness, emotional regulation, resume development, portfolio creation, interview preparation, and customer service.
3. Wraparound Support Services & Bridge Program: During enrollment, students receive case management, housing assistance, food support, medical care, childcare, and transportation. After graduation, an 18-month Bridge Program provides ongoing job placement assistance, continuing education, and case management to ensure sustained employment and stability.

Section 4 - Key Outputs

• 185+ students graduated since the program's founding in 2016
• 810 hours of hands-on grooming instruction per student
• 92 hours of life skills coursework per student
• 7-month intensive program duration
• 5 sequential courses comprising the accredited grooming curriculum
• 18-month Bridge Program of post-graduation support per graduate
• ACCSC accreditation achieved (nationally recognized credentialing body)
• Wraparound services provided: case management, housing assistance, food support, medical care, childcare, and transportation
• Pawsperity Package developed for national replication of the model
• 76% of U.S. households own a dog or cat, validating labor market demand
• 100,000 estimated new grooming jobs projected over the next decade

Section 5 - Key Intermediate Outcomes

Pawsperity measures and reports several intermediate outcomes reflecting changes in knowledge, skills, and behavior:

• Marketable job skills acquisition: All graduates complete 810 hours of accredited grooming training and earn a professional credential recognized by the U.S. Secretary of Education via ACCSC. The capstone requires demonstrated competency across multiple breed standards and production speed of 5-6 dogs per day.
• Financial literacy improvement: Students complete dedicated coursework in financial literacy, budgeting, and business fundamentals as part of 92 hours of life skills training.
• Self-esteem and self-worth improvement: The organization reports improvements in self-esteem among program graduates, supported by the trauma-informed model integrating mindfulness and emotional regulation.
• Goal-setting and future orientation: Reports improvements in long-term goal planning capacity among graduates. The curriculum includes resume development, portfolio creation, and interview preparation to build forward-looking professional capacity.
• Professional network development: The 18-month Bridge Program connects graduates to employers, continuing education, and an alumni community, addressing social isolation.
• Educational credential attainment: The program does not require a GED for admission, providing an accessible credential pathway for those with educational deficits.

Counterfactual note: No counterfactual data is available for any intermediate outcomes. Pawsperity does not compare participant skill gains, self-esteem changes, financial literacy improvements, or network development against a control group or matched comparison population.

Section 6 - Key Ultimate Outcomes

Pawsperity measures and reports several ultimate outcomes reflecting changes in life condition and status:

• Employment: 100% of 2024 graduates were employed within two months of graduation. 90% employment retention rate overall. 75% of graduates remain working in the grooming industry specifically.
• Income/Economic stability: Average annual income increases from $8,300 at program entry to $47,000 post-graduation -- a 466% increase. The highest reported graduate salary is $100,000.
• Housing stability: Wraparound services include housing assistance during enrollment. Individual testimonials (e.g., Ashley Stillings transitioning from a homeless shelter to stable housing) indicate housing improvement, though no aggregate housing data is reported.
• Child custody and family reunification: The organization reports that graduates have regained custody of their children, though no aggregate data on custody outcomes is available.
• Reduced government dependence: The income increase to $47,000 average suggests movement away from government assistance. One graduate (Victoria) is documented transitioning from 18 years on disability via the Ticket to Work program. No aggregate data on benefits reduction is reported.
• Intergenerational poverty interruption: The significant income increase and graduate testimonials (e.g., affording children's extracurricular activities) suggest family-level economic improvement, though no longitudinal data on children's outcomes exists.

Counterfactual note: No counterfactual data is available for any ultimate outcomes. The pre-program income of $8,300 compared to the post-program average of $47,000 provides a within-group before-and-after comparison but does not constitute a true counterfactual, as there is no comparison to a similar population that did not receive the intervention. No data on comparative employment rates, housing outcomes, custody outcomes, or government assistance reduction for non-participants is reported.

Section 7 - Continual Learning & Adaptation

Pawsperity demonstrates several indicators of being a learning organization that adapts its model over time:

• Organizational evolution: The organization rebranded from "The Grooming Project" to "Pawsperity," reflecting a matured identity and expanded vision beyond a single project to a sustainable institution.
• Accreditation pursuit: Achieving ACCSC accreditation required meeting rigorous external standards for curriculum quality, student outcomes, and institutional operations -- a significant step that demonstrates commitment to external validation and continuous improvement.
• Bridge Program development: The creation of an 18-month post-graduation support program indicates the organization recognized that training alone was insufficient and that sustained wraparound support was needed to ensure long-term employment retention and stability.
• Curriculum refinement: The structured five-course sequence with progressive skill-building (from basic bathing to capstone production speed of 5-6 dogs/day) reflects iterative curriculum development informed by employer expectations and graduate performance.
• Replication model: The development of the "Pawsperity Package" -- including curriculum, instructor handbooks, video library, and operational guidance -- for other organizations to replicate the model nationally indicates the organization is codifying and externalizing its learnings.
• Trauma-informed evolution: The integration of mindfulness, emotional regulation, and trauma-informed practices into a technical training program suggests the organization learned from early cohorts that technical skills alone were not sufficient for its population and adapted accordingly.
• Industry alignment: Citing labor market data (76% pet ownership, 100,000 projected new jobs) demonstrates the organization monitors external conditions to validate its theory of change.

Gap noted: While Pawsperity shows strong adaptive behavior, there is no published evidence of formal mechanisms for incorporating outcome data back into program design (e.g., published program evaluations, logic model revisions, or documented theory-of-change updates based on measured results). The organization would benefit from documenting how its outcome measurements specifically inform programmatic changes.

Location: Kenya, Uganda, and Burkina Faso

Focus: Preventable child and maternal deaths

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Living Goods - Fierce Philanthropy Research Report

Date: March 21, 2026 Methodology: Todd Manwaring's Social Impact Evaluation Framework Organization: Living Goods (livinggoods.org)

PROMPT 1 -- Organization and Social Problem Summary

1. Social Problem: Preventable child and maternal deaths
2. Population: Women and children under 5 in underserved rural communities
3. Location: Kenya, Uganda, and Burkina Faso

PROMPT 2 -- Top 20 Negative Consequences of Preventable Child and Maternal Deaths Among Women and Children Under 5 in Rural East/West Africa

PROMPT 3 -- Negative Consequences Classified as Intermediary or Ultimate Outcomes

Sorted by Intermediary Outcomes first, then Ultimate Outcomes.

PROMPT 4 -- Positive Results Shared by Living Goods

PROMPT 5 -- Counterfactual Results Shared by Living Goods

SUMMARY REPORT

Section 1 -- Our Recommendation

We highly recommend Living Goods for donor support. This organization demonstrates exceptional evidence of impact, backed by two independent randomized controlled trials -- the gold standard in impact evaluation. The first RCT, conducted by Innovations for Poverty Action (IPA) over three years (2011-2013), found a 27% reduction in under-5 child mortality, a 33% reduction in infant mortality, and a 27% reduction in neonatal mortality. The second RCT, conducted with the Abdul Latif Jameel Poverty Action Lab (J-PAL) at much larger scale across 13 districts, 500 villages, and over 12,500 households, confirmed a 28% reduction in under-5 child mortality -- demonstrating that the program's impact holds at scale. Living Goods operates at remarkable cost-effectiveness, achieving these mortality reductions at an estimated $68 per life-year saved and $3.09 per person served annually. In 2024, 11,429 CHWs reached 5.3 million people across Kenya, Uganda, and Burkina Faso. The organization's model of equipping community health workers with digital tools (SmartHealth app) and embedding them within government health systems represents a sustainable, scalable approach to reducing preventable deaths. While intermediate outcome counterfactuals are less rigorously documented than ultimate mortality outcomes, the overall evidence base is among the strongest in global health philanthropy.

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

In sub-Saharan Africa, preventable diseases -- malaria, pneumonia, and diarrhea -- remain the leading killers of children under five. Millions of women and children live more than 5 kilometers from the nearest health facility, making timely access to diagnosis and treatment impossible for many families. When a child falls ill with malaria, the window for effective treatment is narrow; delays of even a day can be fatal. Maternal mortality remains devastatingly high due to lack of antenatal care, home deliveries without skilled attendants, and undetected pregnancy complications. In the communities where Living Goods works in Kenya, Uganda, and Burkina Faso, these preventable deaths are driven by a combination of geographic isolation, weak health infrastructure, low health literacy among caregivers, and overburdened health facilities that cannot reach remote populations. The result is that millions of children die each year from diseases that are entirely treatable with basic, low-cost interventions -- if only care could reach them in time.

Section 3 -- The Solution

Living Goods recruits, trains, and equips community health workers (CHWs) -- predominantly women from the communities they serve -- to deliver essential primary healthcare door-to-door. The model has three integrated components:

1. Digitally-Equipped Community Health Workers: CHWs are equipped with the SmartHealth mobile app (co-developed with Medic Mobile), which guides them through symptom assessment protocols, tracks patient registrations and follow-ups, and captures real-time data at every touchpoint. CHWs receive three weeks of basic healthcare training from specialists in integrated community case management (iCCM), covering diagnosis and treatment of malaria, pneumonia, and diarrhea, as well as maternal and newborn health, immunization education, family planning, and nutrition screening.
2. Data-Driven Performance Management: The SmartHealth platform captures GPS-tagged, timestamped data on every patient interaction. Real-time dashboards flag high- and low-performing CHWs and regions, enabling supervisors and government officials to monitor coverage, identify gaps, and optimize resource allocation. Performance-based incentives align CHW effort with health outcomes.
3. Government Partnership and System Strengthening: Living Goods embeds its CHW networks within existing government health systems rather than creating parallel structures. This approach leverages government co-financing, builds institutional capacity, and creates a pathway to full government ownership and sustainability at scale.

Section 4 -- Key Outputs

• 11,429 community health workers supported across Kenya, Uganda, and Burkina Faso (2024)
• 5.3 million people reached with essential health services (2024)
• $3.09 per person per year cost of delivering care
• $68 per life-year saved (cost-effectiveness from RCT)
• 95% of deliveries occurred at health facilities in program areas
• 82% full immunization rate for children aged 9-23 months
• 50% of malaria cases managed at the household level by CHWs
• Three weeks of specialist healthcare training per CHW
• Monthly refresher trainings to maintain and increase CHW knowledge and confidence
• CHWs provide health education, diagnoses, medicines, health products, family planning counseling, antenatal and postnatal care support, immunization referrals, and nutrition screening
• SmartHealth mobile app deployed across all CHWs for real-time data capture and clinical decision support
• Annual budget: approximately $26 million USD
• Founded: 2007

Section 5 -- Key Intermediate Outcomes

Living Goods measures several intermediate outcomes reflecting changes in caregiver knowledge, health-seeking behavior, and system capacity:

• Caregiver health knowledge: More than 80% of caregivers in program areas reported receiving health and immunization information, with CHWs serving as the primary information source (56.3% of touchpoints in Kenya, 41.2% in Uganda). The first RCT found improved health knowledge in treatment villages compared to control villages, though specific knowledge metrics were not isolated as a standalone counterfactual.
• Care-seeking behavior and treatment timeliness: In Busia County, Kenya, a digital health project demonstrated that equipping CHWs with digital tools increased same-day diagnosis and treatment from 9% to 59% and malaria testing coverage from 51% to 75%. CHWs now manage half of all malaria cases at the household level.
• Facility-based delivery: 95% of deliveries in program areas occurred at health facilities, indicating strong behavior change among pregnant women toward skilled birth attendance.
• Immunization coverage: 82% of children aged 9-23 months in program areas were fully immunized.
• Health data infrastructure: The SmartHealth platform provides real-time visibility into CHW performance, patient coverage, and health trends across all program areas, enabling data-driven decision-making at every level.

Counterfactual note: While the RCTs measured intermediate behavior changes (e.g., increased health knowledge, increased follow-up visits for newborns, increased healthcare utilization) in treatment vs. control villages, these intermediate counterfactuals are not reported as standalone, isolated metrics. The strongest counterfactual evidence is concentrated at the ultimate outcome level (mortality reduction).

Section 6 -- Key Ultimate Outcomes

Living Goods demonstrates exceptionally strong ultimate outcome measurement, with gold-standard counterfactual evidence from two independent RCTs:

• Under-5 child mortality: First RCT (IPA, 2011-2013, 3 years): 27% reduction in under-5 child mortality, measured against randomized control villages. Second RCT (J-PAL, 13 districts, 500 villages, 12,500+ households): 28% reduction in under-5 child mortality at scale with 4,500 digitized CHWs serving 3.6 million people. Counterfactual: Both RCTs used randomized control groups as the counterfactual, representing the gold standard in impact evaluation. The second RCT confirmed the effect holds at scale across heterogeneous populations.
• Infant mortality (under-1): First RCT found 33% reduction in infant mortality. Counterfactual: Measured against randomized control villages.
• Neonatal mortality: First RCT found 27% reduction in neonatal mortality on a base of 27.8 deaths per 1,000 live births. Counterfactual: Measured against randomized control villages. Significantly increased follow-up household visits for newborns in treatment vs. control areas.
• Child mortality in crisis contexts: Living Goods documented a 46% reduction in child mortality in drought-affected areas, demonstrating program resilience during emergencies.
• Disease-specific treatment: CHWs treat malaria, pneumonia, and diarrhea at the community level through integrated community case management. Half of malaria cases are managed at the household level. While disease-specific mortality reductions are not isolated, they are captured within the overall under-5 mortality reduction measured in the RCTs.
• Cost-effectiveness: $68 per life-year saved (from first RCT). $3.09 per person served annually. Among the most cost-effective health interventions globally.

Section 7 -- Continual Learning & Adaptation

Living Goods demonstrates strong evidence of being a learning organization that systematically uses data and evidence to refine its model:

Evidence-Driven Model Evolution: The organization invested in two independent RCTs -- the first a proof-of-concept study (IPA, 2011-2013) and the second a scale validation study (J-PAL, 13 districts). The decision to conduct a second RCT at much larger scale demonstrates a commitment to testing whether results hold under real-world conditions, not just controlled pilot settings.

Digital Health Innovation: The co-development of the SmartHealth app with Medic Mobile represents continuous investment in technology to improve CHW effectiveness. The platform has evolved from basic tracking to comprehensive clinical decision support, real-time performance dashboards, GPS monitoring, and automated follow-up reminders. In Burkina Faso, the organization chose CommCare over the CHT platform used in Kenya and Uganda, demonstrating willingness to adapt technology choices to local context.

Performance Management System: Real-time dashboards that automatically flag high- and low-performing CHWs and regions represent a systematic feedback loop between data collection and operational improvement. Performance-based incentives align CHW behavior with health outcomes.

Government Integration Strategy: The shift from operating as a parallel health delivery system to embedding within government health systems reflects strategic learning about sustainability and scale. Leveraging government co-financing creates a pathway to institutional ownership that independent NGO delivery cannot achieve.

Geographic and Contextual Adaptation: Expanding from Uganda to Kenya and then Burkina Faso required adapting the model to different health system contexts, languages, disease burdens, and government structures. The documented 46% mortality reduction in drought-affected areas demonstrates the program's resilience and adaptability in crisis contexts.

Monthly Training Cycles: CHWs attend monthly refresher trainings to update their knowledge and skills, creating a continuous learning cycle at the frontline level.

Scale Validation: The second RCT was specifically designed to test whether the program's impact diminishes at scale -- a critical question that most NGOs never rigorously investigate. The finding that mortality reduction actually increased slightly (from 27% to 28%) at scale provides powerful evidence of the model's robustness.

Report prepared using Todd Manwaring's Social Impact Evaluation Framework for Fierce Philanthropy. Sources: livinggoods.org, IPA RCT results, J-PAL RCT results, The Life You Can Save, Living Goods 2024 Year-End Report.

Location: Ifanadiana District, southeastern Madagascar

Focus: Preventable deaths from weak health systems

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Pivot Madagascar - Fierce Philanthropy Research Report

Date: March 21, 2026 Methodology: Todd Manwaring's Social Impact Evaluation Framework Organization: Pivot (pivotworks.org)

PROMPT 1 -- Organization and Social Problem Summary

1. Social Problem: Preventable deaths from weak health systems
2. Population: Rural population of ~200,000 in a remote district
3. Location: Ifanadiana District, southeastern Madagascar

PROMPT 2 -- Top 20 Negative Consequences of Preventable Deaths from Weak Health Systems Among Rural Populations in Southeastern Madagascar

PROMPT 3 -- Negative Consequences Classified as Intermediary or Ultimate Outcomes

PROMPT 4 -- Positive Results Shared by Pivot

PROMPT 5 -- Counterfactual Results Shared by Pivot

SUMMARY REPORT

Section 1 -- Our Recommendation

We strongly recommend Pivot for donor support. This organization demonstrates one of the most rigorously evaluated health system strengthening programs in sub-Saharan Africa. Working in partnership with Harvard Medical School researchers and Madagascar's Ministry of Public Health since 2014, Pivot has built a model health district in Ifanadiana, achieving a 30% reduction in under-5 mortality over 10 years -- during a period when national health indicators in Madagascar deteriorated significantly. The evidence base is exceptional: a decade-long longitudinal cohort study (IHOPE) with 1,522 households, five survey waves, and 94-96% follow-up rates, published in PLOS Medicine. While not a randomized controlled trial, the quasi-experimental design with within-district comparison areas and national trend data provides strong counterfactual evidence. The program shows statistically significant improvements across virtually every major health indicator: vaccination coverage, facility births, antenatal and postnatal care, care-seeking behavior, and health equity. Critically, these gains were sustained through devastating crises including one of the strongest cyclones ever recorded, plague and measles outbreaks, and COVID-19. The phased expansion model -- now scaling to the broader Vatovavy Region (~1 million people) at the government's request -- demonstrates both sustainability and government ownership. At approximately $60 per capita, the model provides a concrete proof-of-concept for comprehensive health system strengthening in the world's poorest settings.

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

Madagascar is one of the poorest countries in the world, with health indicators that have been declining for over a decade. Per capita health expenditure fell from $20 to $16 between 2009 and 2022. National vaccination coverage for children 12-23 months dropped from 62% to 49%. Facility delivery rates barely increased (35% to 39%). Malaria incidence and mortality increased over 75% versus 2015 levels. In Ifanadiana District in southeastern Madagascar, the situation was even worse: under-5 mortality was over twice the national average when Pivot began work in 2014. The district's approximately 200,000 people are spread across remote, mountainous terrain where many communities are 15+ kilometers from the nearest health facility -- accessible only on foot. Health facilities were understaffed, undersupplied, and poorly maintained. Community health workers were absent. When children fell ill with malaria, pneumonia, or diarrhea, families had neither the knowledge nor the access to seek timely care. The result was devastating preventable mortality -- children dying from diseases that are entirely treatable with basic interventions, mothers dying from complications detectable through routine antenatal care, and communities trapped in a cycle of illness, poverty, and loss.

Section 3 -- The Solution

Pivot implements comprehensive health system strengthening (HSS) in partnership with Madagascar's Ministry of Public Health and researchers from the Blavatnik Institute at Harvard Medical School. The approach addresses the entire health system rather than targeting single diseases or interventions:

1. Health Facility Strengthening: Pivot supports 15 PHC2s (primary health centers), 6 PHC1s (community health posts), and 1 district hospital with staffing, supplies, infrastructure, and quality improvement. The goal is to build functional, well-equipped facilities staffed by competent health workers.
2. Community Health Worker Network: CHWs are deployed to reach populations living beyond 15km from health facilities. For these remote populations, CHWs provide the majority of primary care consultations, achieving 1.5-2 consultations per capita per year -- comparable to facility-based care rates.
3. Demand-Side Interventions: Health education and community engagement to increase care-seeking behavior, vaccination uptake, facility delivery, and antenatal/postnatal care utilization.
4. Research and Monitoring: The IHOPE longitudinal cohort (1,522 households, ~8,000 individuals) provides continuous population-level health monitoring, enabling real-time course correction and rigorous impact evaluation. This research partnership with Harvard Medical School ensures the evidence base meets the highest academic standards.
5. Government Partnership and Scale: The model is designed for government ownership and scale. Following the district-level proof of concept, Pivot is now expanding to the broader Vatovavy Region (~1 million people, 3 districts) at the Ministry of Public Health's request.

Section 4 -- Key Outputs

• 200,000 people served in Ifanadiana District
• ~1 million people in expansion region (Vatovavy, 3 districts)
• 15 PHC2s, 6 PHC1s, 1 district hospital supported
• Community health workers deployed to remote communities (>15km from facilities)
• 10 years of continuous operation (2014-2024)
• ~$60 per capita health system cost (2018)
• IHOPE longitudinal cohort: 1,522 households, ~8,000 individuals, five survey waves, 94-96% follow-up rates
• 1,600 households targeted per survey wave
• 4,063-4,380 children under-5 analyzed per mortality wave
• 4,800 households surveyed for regional baseline (23,000 individuals, 2023)
• Published research: PLOS Medicine (October 2025) and multiple peer-reviewed publications
• Partnership: Harvard Medical School Blavatnik Institute, Madagascar Ministry of Public Health
• Phased expansion: Phase 1 (2014-2016, 4 communes), Phase 2 (2017-2020, 3 additional communes), Phase 3 (2021, all PHC2s)

Section 5 -- Key Intermediate Outcomes

Pivot demonstrates strong intermediate outcome measurement with quasi-experimental counterfactual evidence across multiple indicators:

• Care-seeking behavior (under-5): OR 1.89 (95% CI [1.19, 3.00]) for facility-level effect. Nearly doubled odds of seeking care at public providers. Counterfactual: measured relative to non-program areas within the quasi-experimental design.
• Care-seeking (all ages): OR 1.84 (95% CI [1.30, 2.59]). Counterfactual: measured against comparison areas.
• Health center consultations per capita: Rate ratio 2.14 (95% CI [1.98, 2.32]) for all ages. Under-5 rate ratio 1.48 (95% CI [1.37, 1.61]). Counterfactual: pre-post comparison with concurrent comparison area trends.
• Vaccination coverage (12-23 months): OR 1.96 (95% CI [1.14, 3.36]) for program-specific effect. Counterfactual: national vaccination rates declined from 62% to 49% during same period, providing strong contextual counterfactual.
• Antenatal care (1+ visit): OR 2.61 (95% CI [1.46, 4.68]). Counterfactual: quasi-experimental comparison.
• Facility births: OR 2.14 (95% CI [1.17, 3.92]). Counterfactual: national facility delivery rates barely changed (35% to 39%), while program areas showed significant improvement.
• Postnatal care within 48 hours: OR 2.08 (95% CI [1.14, 3.79]). Counterfactual: quasi-experimental comparison.
• Health equity: Relative concentration index declined for nearly all coverage indicators, indicating reduced relative inequality between rich and poor in access to health services.

Section 6 -- Key Ultimate Outcomes

Pivot demonstrates strong ultimate outcome measurement with quasi-experimental counterfactual evidence from a 10-year longitudinal cohort:

• Under-5 child mortality: 30% decrease over 10 years (2014-2023). Mortality decreased approximately 20-30 deaths per 1,000 live births in program catchment. Starting point was over twice the national average; by study end, rates converged with national averages. Counterfactual: U5 mortality increased in the comparison area (rest of district) and nationally during the same period. The divergence between program and non-program areas within the same district provides strong quasi-experimental evidence. Published in PLOS Medicine (October 2025).
• Infant mortality: Consistent decreases across the 10-year study period in program catchment. Counterfactual: comparison area saw increases through 2021, then decline after HSS expansion -- demonstrating a dose-response relationship between intervention timing and mortality reduction.
• Neonatal mortality: Decreased 20-30 deaths per 1,000 live births in program catchment. Counterfactual: rest of district saw increases, with further increase after 2021 when HSS expanded -- the new areas showing improvement after receiving the intervention reinforces causal inference.
• Health system resilience: Mortality reductions sustained through devastating cyclone damage, plague and measles outbreaks, COVID-19, and ongoing political turmoil. Counterfactual: national health indicators deteriorated during these crises while program area maintained gains, providing natural experiment evidence of system resilience.
• Co-coverage index (5+ interventions): OR 2.23 (95% CI [1.11, 4.50]) for program-specific effect, indicating comprehensive improvement across multiple health service dimensions simultaneously.

Section 7 -- Continual Learning & Adaptation

Pivot demonstrates exceptional commitment to continual learning, representing one of the strongest learning organizations in global health:

Embedded Research Partnership: The partnership with Harvard Medical School's Blavatnik Institute is not a one-time evaluation but an ongoing, embedded research program. The IHOPE longitudinal cohort has conducted five survey waves over 10 years with 94-96% follow-up rates, providing continuous population-level feedback on health outcomes.

Phased Implementation Based on Evidence: The three-phase expansion within Ifanadiana District (Phase 1: 4 communes 2014-2016, Phase 2: 3 additional 2017-2020, Phase 3: all PHC2s 2021) represents deliberate, evidence-informed scaling. Each phase expansion was informed by results from previous phases.

Dose-Response Learning: The phased design created a natural experiment: when Phase 3 expanded to previously non-program areas, those areas began showing mortality reductions -- confirming the causal link between the intervention and outcomes, and providing evidence that the model is transferable within the district.

Publication and Knowledge Sharing: Multiple peer-reviewed publications, including PLOS Medicine (2025), demonstrate commitment to contributing to the global evidence base for health system strengthening. This transparency enables external scrutiny and cross-context learning.

Government-Requested Scale-Up: The Madagascar Ministry of Public Health requested expansion to the entire Vatovavy Region (~1 million people, 3 districts), representing government validation of the model's effectiveness and sustainability. A population-representative baseline survey of 4,800 households (23,000 individuals) was conducted in 2023 to establish regional baselines.

Resilience Through Crises: The program maintained mortality reductions through multiple devastating crises (cyclone, plague, measles, COVID-19, political turmoil), demonstrating the system's robustness and the organization's adaptive capacity. The ability to sustain gains during crises provides evidence that the health system strengthening is structural, not dependent on stable conditions.

Science for Sustaining Health: Pivot explicitly frames its work as "advancing a science for sustaining health," suggesting a commitment to developing replicable, evidence-based approaches rather than just delivering services.

Report prepared using Todd Manwaring's Social Impact Evaluation Framework for Fierce Philanthropy. Sources: pivotworks.org, PLOS Medicine (October 2025), PMC/NIH, IRD le Mag', Cartier Philanthropy, Partners in Health, Medical Xpress.

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Noora Health - Fierce Philanthropy Research Report

Date: March 21, 2026 Methodology: Todd Manwaring's Social Impact Evaluation Framework Organization: Noora Health

PROMPT 1 -- Organization and Social Problem Summary

1. Social Problem: Inadequate family caregiver training

2. Population: Patients recovering from surgery, childbirth, or illness and their family members; healthcare workers in low- and middle-income countries

3. Location: India, Bangladesh, Indonesia, Nepal (primary); potential for global expansion

PROMPT 2 -- Top 20 Negative Consequences

PROMPT 3 -- Intermediary vs Ultimate Outcome Classification

PROMPT 4 -- Positive Results Shared by Organization

Dry cord care increased by 4% and skin-to-skin care by 78%

following the intervention, indicating improved comprehension and practice of medical instructions.

Skin-to-skin care rose from 4.8% to 9.2% between the control and intervention groups, corresponding to a 78% odds increase when adjusted.

| | 13 | Missed warning signs of complications | Intermediary | Partial.

Outpatient visits increased by 27% (RR=1.27, 95% CI 1.10 to 1.46) in the CCP group

, suggesting improved health-seeking behavior when warning signs are recognized. However, direct measurement of warning sign recognition is not explicitly reported. | | 10 | Limited health knowledge among family members | Intermediary | Yes.

Results of a 188 patient-caregiver dyad study suggest significant associations between participation in the Care Companion Program (CCP) and increased health knowledge, with complications reduced from 34.4% to 14.5% between the control and intervention groups, corresponding to a 71% odds reduction when adjusted.

| | 18 | Limited caregiver confidence in caregiving ability | Intermediary | Yes.

Measures show improved confidence in practicing behaviors at home.

Organization reports measuring caregiver confidence but does not provide specific percentages. | | 8 | Lack of recognition of family caregivers in healthcare systems | Intermediary | Yes.

In two states, the Care Companion Program was recognized by the Indian ministry of health as a replicable and innovative practice in public health.

Additionally,

WHO and Noora Health signed a three-year Memorandum of Understanding (MoU) to enhance global support for family caregivers during the 78th World Health Assembly in Geneva in May 2025.

| | 7 | Low treatment adherence by caregivers | Intermediary | Partial.

Over a four year period, the organization trained more than 163,646 caregivers in COVID-19 response

, but specific treatment adherence metrics are not directly reported. | | 12 | Ineffective nutritional care during recovery | Intermediary | No direct results shared. While curriculum includes nutritional training, specific improvements in nutritional care practices are not reported with measured outcomes. | | 11 | Poor infection prevention practices at home | Intermediary | Yes.

Dry cord care improved by 4% (RR=1.04, 95% CI 1.02 to 1.06) in the post-intervention group as compared with preintervention group.

This demonstrates improved infection prevention through cord care practices. | | 14 | Delayed care-seeking behavior | Intermediary | Yes.

Outpatient visits increased by 27% (RR=1.27, 95% CI 1.10 to 1.46),

indicating improved care-seeking behavior. | | 9 | Caregiver anxiety and psychological distress | Intermediary | Partial.

The program is proven to reduce anxiety for family caregivers,

but no specific quantitative measures of anxiety reduction are provided. | | 1 | High rates of post-surgical complications | Ultimate | Yes.

71% reduction in 30-day post-surgical complications in cardiac care patients.

Complications reduced from 34.4% to 14.5% between the control and intervention groups in a 188-person cardiac surgery study, corresponding to a 71% odds reduction when adjusted.

| | 2 | Elevated hospital readmission rates | Ultimate | Yes.

Newborn readmissions reduced by 56% (RR=0.44, 95% CI 0.31 to 0.61)

in the postintervention group.

A 54% reduction in readmissions for maternal and newborn care, and in the cardiac space, about a 23% reduction

was observed. | | 3 | Increased newborn mortality and morbidity | Ultimate | Yes.

A study published in PLOS Global Public Health showed an 18% reduction in newborn mortality risk for families attending Care Companion Program sessions, saving 9.2 babies per 1,000 live births.

18% reduction in neonatal mortality.

| | 4 | Poor maternal health outcomes post-delivery | Ultimate | Yes.

Mother complications reduced by 12% (RR=0.88, 95% CI 0.79 to 0.97)

in the postintervention group across maternal and neonatal health outcomes. | | 5 | Preventable healthcare complications at home | Ultimate | Yes.

Newborn complications reduced by 16% (RR=0.84, 95% CI 0.76 to 0.91)

in the postintervention group. | | 6 | Inadequate post-discharge care knowledge | Ultimate | Yes. Demonstrated through multiple outcome improvements:

skin-to-skin care by 78% (RR=1.78, 95% CI 1.37 to 2.27)

and improved health-seeking behaviors. | | 16 | Healthcare worker burnout from lack of family support | Ultimate | No direct results shared. Organization reports that

hospital staff borrowed Noora's communication model for health campaigns,

suggesting some system-level impact, but caregiver burden reduction is not directly measured. | | 17 | Inefficient use of healthcare system resources | Ultimate | Partial.

The organization works in partnership with healthcare systems to embed CCP as a tool that supports better care delivery without being dependent on Noora Health delivering care day-to-day,

suggesting systems efficiency improvements, but specific resource efficiency metrics are not directly reported. | | 19 | Preventable mortality from avoidable conditions | Ultimate | Yes.

Noora Health's program has been shown to reduce cardiac surgery complications by 71% and neonatal mortality by 18%.

| | 20 | Health inequity for patients in under-resourced settings | Ultimate | Partial.

The organization has built strong partnerships with state governments of Andhra Pradesh, Goa, Haryana, Himachal Pradesh, Karnataka, Madhya Pradesh, Maharashtra, Odisha, and Punjab in India, as well as the national government in Bangladesh

, reaching underresourced public health systems, but equity outcome metrics are not directly reported. |

PROMPT 5 -- Counterfactual Results

Study compared intervention group to preintervention group with 95% confidence intervals reported (RR=1.78, 95% CI 1.37 to 2.27 for skin-to-skin care),

but design appears to be pre-post rather than controlled trial.

Organization commits to measuring through quasi-experimental and pre-post studies by condition area,

indicating quasi-experimental design. | | 13 | Missed warning signs of complications | Intermediary | Partial. Outpatient visits increased by 27% | Partial.

The study of 7,900 new mothers compared behavior change with 95% CIs (RR=1.27, 95% CI 1.10 to 1.46),

indicating quasi-experimental design with comparison group. | | 10 | Limited health knowledge among family members | Intermediary | Yes. 71% odds reduction in complications with adjusted confidence intervals | Partial.

Study of 188 patient-caregiver dyads with adjusted confidence intervals reported (71% odds reduction),

suggesting controlled or matched comparison group, but exact study design not fully specified. | | 18 | Limited caregiver confidence in caregiving ability | Intermediary | Yes. Improved confidence measures | No counterfactual results. Only internal measurement reported without comparison group. | | 8 | Lack of recognition of family caregivers in healthcare systems | Intermediary | Yes. Ministry recognition and WHO partnership | No counterfactual results. These are policy/partnership outcomes, not experimental comparisons. | | 7 | Low treatment adherence by caregivers | Intermediary | Partial. COVID-19 training numbers reported | No counterfactual results. No comparison group data provided. | | 12 | Ineffective nutritional care during recovery | Intermediary | No direct results shared | No counterfactual results. | | 11 | Poor infection prevention practices at home | Intermediary | Yes. 4% improvement in dry cord care with confidence intervals | Partial.

Improvement in dry cord care (RR=1.04, 95% CI 1.02 to 1.06)

with adjusted comparison, suggesting quasi-experimental design. | | 14 | Delayed care-seeking behavior | Intermediary | Yes. 27% increase in outpatient visits with confidence intervals | Partial.

Outpatient visits increased by 27% (RR=1.27, 95% CI 1.10 to 1.46)

with 95% CI, indicating comparison group analysis. | | 9 | Caregiver anxiety and psychological distress | Intermediary | Partial. General statement about anxiety reduction | No counterfactual results. No comparative study data provided. | | 1 | High rates of post-surgical complications | Ultimate | Yes. 71% reduction in cardiac complications | Yes.

Study of 188 patient-caregiver dyads showed complications reduced from 34.4% to 14.5% between control and intervention groups, corresponding to a 71% odds reduction when adjusted.

Study design compares control to intervention group with adjusted analysis. | | 2 | Elevated hospital readmission rates | Ultimate | Yes. 56% newborn readmission reduction; 54% maternal/newborn; 23% cardiac | Yes.

Newborn readmissions reduced by 56% (RR=0.44, 95% CI 0.31 to 0.61) in a 7,900-person study.

Study interim findings showed 54% reduction in newborn readmissions among those who received training,

with quasi-experimental design comparing trained to control groups. | | 3 | Increased newborn mortality and morbidity | Ultimate | Yes. 18% reduction in neonatal mortality from PLOS study | Yes.

Published study in PLOS Global Public Health showing an 18% reduction in newborn mortality risk for families attending Care Companion Program sessions.

Study involved comparison of program participants to non-participants. | | 4 | Poor maternal health outcomes post-delivery | Ultimate | Yes. 12% reduction in mother complications with confidence intervals | Partial.

Risks of mother complications reduced by 12% (RR=0.88, 95% CI 0.79 to 0.97)

with 95% CI and adjusted analysis, indicating comparison group design. | | 5 | Preventable healthcare complications at home | Ultimate | Yes. 16% reduction in newborn complications with confidence intervals | Partial.

Newborn complications reduced by 16% (RR=0.84, 95% CI 0.76 to 0.91)

with 95% CI and adjusted analysis, suggesting quasi-experimental design. | | 6 | Inadequate post-discharge care knowledge | Ultimate | Yes. Improvements in care practices with confidence intervals | Partial. Multiple outcomes reported with 95% CIs and adjusted analysis

(4,984-person study with adjusted odds increases/reductions)

, indicating quasi-experimental methodology. | | 16 | Healthcare worker burnout from lack of family support | Ultimate | No direct results shared | No counterfactual results. | | 17 | Inefficient use of healthcare system resources | Ultimate | Partial. Partnership and embedding approach described | No counterfactual results. No comparative analysis of system efficiency provided. | | 19 | Preventable mortality from avoidable conditions | Ultimate | Yes. 71% cardiac complications reduction; 18% neonatal mortality reduction | Yes.

Cardiac surgery study (188 dyads) with control and intervention group comparison showing 71% adjusted odds reduction.

PLOS Global Public Health study showed 18% reduction in newborn mortality risk,

comparing program participants to comparison group. | | 20 | Health inequity for patients in under-resourced settings | Ultimate | Partial. Partnership with public systems in multiple states mentioned | No counterfactual results. No comparative equity analysis or matched facility comparison provided. |

SUMMARY REPORT

Section 1 -- Our Recommendation

Noora Health demonstrates strong commitment to improving health outcomes through family caregiver training. The organization has published multiple quasi-experimental and pre-post studies showing substantial impacts on both intermediate outcomes (knowledge, confidence, behaviors) and ultimate outcomes (readmissions, complications, mortality). However, the evidence base, while promising, relies primarily on quasi-experimental designs rather than gold-standard randomized controlled trials. The organization is actively measuring outcomes across multiple condition areas and has achieved recognition from governmental health ministries and WHO. The organization shows early evidence of learning and adaptation through curriculum refinement and expansion into new condition areas. To strengthen Fierce Philanthropy's confidence in this organization, more rigorous randomized controlled trials and stronger counterfactual evidence would be valuable, particularly for maternal and neonatal outcomes where they claim largest impact.

Fierce Philanthropy Checklist:

• 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

There is a power imbalance in the global healthcare system where those who care most for patients — their loved ones — are left out of patient healing. Families and their patients often leave healthcare facilities anxious, confused, and ill-equipped to care for their loved ones, leading to preventable complications and, in some cases, death.

In India and Bangladesh, physicians spend less than 2.5 minutes in India and less than one minute in Bangladesh to convey important care instructions to patients.

Caregivers often lack the information, medication, best practices, and hygiene they need to care for their loved ones. This leads to poor outcomes in maternal and neonatal health, health complications, high readmission rates, and suboptimal use of health system resources.

In South Asia alone, nearly 1.5 million children under five die every year from causes that could be averted through health practices actionable at home.

Section 3 -- The Solution

Noora Health's core innovation is the Care Companion Program (CCP), which trains family caregivers and patients with skills they need to care for themselves and their loved ones. Noora Health delivers fit-for-purpose, high-quality, accessible training for post-surgery, post-delivery, and general recovery and care.

The program works in four steps: (1) First, Noora Health partners with state and national healthcare systems to implement CCP in their facilities; (2) They train "Master Trainers," three to four health providers at each facility who become local champions of CCP; (3) Noora supports healthcare staff to train family caregivers, providing condition-specific, skills-based sessions as they wait in facility wards, halls or waiting rooms; (4) Finally, they reinforce caregiver behavior with remote engagement services, supplementing sessions with reminders, educational content and live chat support, typically through WhatsApp.

The program has been adapted for several major medical conditions, including maternal and newborn care, cardiology and cardiac surgery, oncology care, general medical and surgical care, tuberculosis and COVID-19.

Section 4 -- Key Outputs

Since 2014, Noora Health has equipped over 30 million family caregivers and patients across Bangladesh, India, Indonesia, and Nepal through its innovative training programmes.

As of Q3 2025, Noora Health has trained 30,200+ healthcare workers and 43 million+ caregivers and patients across 12,800+ partner facilities.

Every day, Noora Health supports health systems in training more than 45,000 caregivers and patients across thousands of facilities throughout India, Bangladesh, Indonesia, and Nepal.

The organization employs 201-500 staff members and is headquartered in San Francisco, California, with primary operations in India, Bangladesh, and Indonesia.

Section 5 -- Key Intermediate Outcomes

Noora Health demonstrates substantial improvements in intermediate outcomes related to caregiver knowledge, confidence, and health behaviors:

Dry cord care increased by 4% and skin-to-skin care by 78%

following the intervention.

Outpatient visits increased by 27% (RR=1.27, 95% CI 1.10 to 1.46),

indicating improved health-seeking behaviors. The organization reports measuring caregiver confidence and knowledge improvements but provides limited specific quantitative data for these measures beyond the behavioral practice improvements.

Counterfactual Evidence on Intermediate Outcomes:

The organization commits to measuring outcomes through quasi-experimental and pre-post studies by condition area.

The reported intermediate outcome improvements appear to come from quasi-experimental designs with comparison groups, as evidenced by the 95% confidence intervals reported, though full study methodology details are not universally transparent in publicly available materials.

Section 6 -- Key Ultimate Outcomes

Noora Health demonstrates robust improvements in ultimate health outcomes:

Cardiac Surgery:

A study of 188 patient-caregiver dyads showed complications reduced from 34.4% to 14.5% between control and intervention groups, corresponding to a 71% odds reduction when adjusted.

Maternal and Newborn Health:

In a multi-state study, newborn complications reduced by 16% (RR=0.84, 95% CI 0.76 to 0.91), mother complications by 12% (RR=0.88, 95% CI 0.79 to 0.97) and newborn readmissions by 56% (RR=0.44, 95% CI 0.31 to 0.61).

Mortality:

A study published in PLOS Global Public Health showed an 18% reduction in newborn mortality risk for families attending Care Companion Program sessions, saving 9.2 babies per 1,000 live births.

Counterfactual Evidence on Ultimate Outcomes:

The organization's studies found greater changes in complications and readmissions than changes in newborn and maternal care practices. The apparent difference in effect may be because different care practices have varying influence on complication risk.

The reported ultimate outcomes appear to come from quasi-experimental designs with comparison groups, with 95% confidence intervals and adjusted analysis reported. However, the organization has not published full-scale randomized controlled trials; rather, it relies on quasi-experimental designs with control/comparison groups.

Section 7 -- Continual Learning & Adaptation

Evidence fuels everything the organization does. As they look to the future, they are doubling down to make their approach even more data-driven and rigorous.

The organization monitors reach and program quality, and evaluates behavior and health outcomes for patients, caregivers, and health systems. They are committed to measuring through quasi-experimental and pre-post studies by condition area and conduct ongoing, high-quality research to understand the impact of their approach on health outcomes, refine their programs and services, and build evidence for health-systems change.

The organization is planning a cluster randomized study with two stages: a pilot evaluation across 30 public health facilities, followed by a large-scale RCT across 140 public health facilities in India,

focusing on maternal and neonatal health outcomes. This represents movement toward higher-quality counterfactual evidence.

Evidence of adaptation includes:

Expansion of condition areas to include maternal and newborn care

,

Recognition of TB family care model by India's Prime Minister as one of five key initiatives to end TB in India by 2025, with the organization contributing to national guidelines,

and

publication of qualitative research in PLOS Global Health highlighting program perceptions and a PLOS Global Public Health study on mortality reduction.

The organization has expanded into new countries (Indonesia in 2021, Nepal in 2024) and adapted curricula for new conditions based on evidence findings.

Report prepared using Todd Manwaring's Social Impact Evaluation Framework for Fierce Philanthropy.