Helen Keller

Organisation

Helen Keller Intl is a nonprofit founded in 1915 and headquartered in New York. It works on malnutrition and on preventable blindness and vision loss in countries across Africa and Asia, and runs school vision screenings in the United States. This page covers one of its programmes only: vitamin A supplementation (VAS) for children aged 6 to 59 months in sub-Saharan Africa. That programme, and not the organisation as a whole, is what GiveWell recommends as a top charity.

The problem: vitamin A deficiency

Vitamin A is essential to immune function, epithelial health and vision. Without enough of it, measles, diarrhoeal disease and respiratory infection become more severe and more often fatal, and children develop night blindness, xerophthalmia and, at worst, the permanent blindness of keratomalacia. In the areas where the programme's cost-effectiveness is modelled, an estimated 28 % of children are deficient.¹

Deficiency takes hold where diets contain few animal-source or fortified foods, infection is common and basic health services are hard to reach. In such settings the WHO recommends two to three doses a year for children aged 6 to 59 months.² Measurement remains difficult: surveys rely on biochemical markers and clinical signs, and are not routinely available in every country.

Approach

Helen Keller Intl does not run the campaigns itself. It funds government-run programmes and provides technical assistance. Two rounds a year is the norm, door-to-door in most countries and through fixed sites with outreach in Nigeria.² Micro-planning starts roughly six weeks before a round; training runs as a train-the-trainer cascade, social mobilisation over five days around the campaign start, and supervision jointly with the health authorities.

Dosing is 100,000 IU for children aged 6 to 11 months and 200,000 IU for those aged 12 to 59 months, given by cutting the capsule and squeezing the contents into the child's mouth. Community distributors are part of the public health system or are paid a stipend. The capsules themselves are donated by Nutrition International with funding from the Government of Canada. Which organisation covers which region is coordinated with UNICEF and Nutrition International through the Global Alliance for Vitamin A. Deworming, polio mop-up immunisation or screening for acute malnutrition are often co-delivered. As polio campaigns become less frequent, and VAS can no longer be attached to them cheaply, stand-alone structures matter more.

Impact

The evidence comes from randomised trials, pooled in a Cochrane meta-analysis whose result depends on the model used: a 12 % reduction in mortality under fixed effects, 24 % under random effects.³

How much of that still holds is the decisive open question, because the trials it rests on were run in the 1980s and 1990s. GiveWell re-examined them in 2026, looking among other things at publication bias and dosing frequency, and now models a 1 % to 11 % reduction in the settings it funds rather than the 4 % to 12 % it used before. Even after that correction it puts its most recent grant to Helen Keller Intl at 25 times its own benchmark.⁴ The programme report on GiveWell's site still carries the older figures.

The programme is cost-effective because delivery is so cheap: about $1 per capsule, roughly $2 per child per year. For the funding it directed in 2022 to 2024, GiveWell estimates an average of $3,500 per life saved.¹ Estimates diverge widely between countries, because deficiency rates, baseline mortality and delivery costs all differ sharply.

Reach is the second driver. Across the coverage surveys reviewed, median coverage is 85 % of the target population, with a low of 61 % and a high of 94 %; two thirds of surveyed campaigns hit the 80 % the organisation aims for.² Helen Keller Intl reports distributing more than 94.4 million capsules across 14 countries in 2025.⁵

Transparency

Helen Keller Intl publishes its coverage surveys, its cost data and what it knows about other actors' contributions. The surveys use two-stage cluster sampling and electronic data capture, and independent monitors and supervisors revisit around 10 % of households to check the answers.²

GiveWell is explicit about the limits of that data. Usually only one of the two annual rounds is surveyed, sometimes only some regions, and not chosen at random; implementing teams sometimes know in advance where measurement will happen, and the organisation itself reported a case of managers giving extra attention to such an area. Surveys tend to fall outside the rainy season, and caregivers' answers are subject to recall and social desirability bias. GiveWell therefore discounts reported coverage by 17 %. On costs, it judges the figures for four countries implausibly low, most likely because other actors' spending is missing, and substitutes an average of $1.02 per capsule there.²

In GiveWell's qualitative assessment the organisation sits mid-range among top charities on most of eight criteria and stands out on none; GiveWell records that it has been less concerned than GiveWell about the monitoring problems above.² A lookback published in May 2025 on a 2021 expansion into new Nigerian states found the money reached fewer children than expected, because Helen Keller Intl bears a higher share of total programme costs than had been assumed, and that GiveWell would in hindsight have made a smaller grant.⁶

Current projects

Burkina Faso, Cameroon, DR Congo, Guinea, Mali, Niger and the Nigerian states of Adamawa and Taraba (July 2026 to June 2027): $22.7 million of a $23.6 million grant recommended in December 2024, continuing the twice-yearly campaigns.⁷

Niger State, Nigeria (January 2025 to December 2027): $900,000 to build up campaigns in a newly added state.⁷

Madagascar (2023 to 2027): $6 million over four years for campaigns across six regions.⁸

GiveWell withdrew funding for Côte d'Ivoire and the Nigerian states of Benue and Ebonyi at the end of 2024, because estimated cost-effectiveness there fell below its bar.⁷

Why we fund Helen Keller Intl

What speaks for this programme is that it survived scrutiny that went against it. GiveWell took the evidence apart again in 2026 and revised the expected effect downward, and the cost-effectiveness still comes out at a multiple of its own benchmark. Few programmes can be recalculated that way, and fewer come through it.

That recalculation is possible because Helen Keller Intl releases the coverage and cost data it feeds on, including the parts that make the organisation look bad. Together with fifty years of experience in this specific intervention and working relationships with the health ministries of the countries funded, that is why Wealth for the World pays out to this organisation.

Footnotes

1. GiveWell, "Our Top Charities". givewell.org ↩ ↩²

2. GiveWell, "Helen Keller Intl's Vitamin A Supplementation Program". givewell.org ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶

3. GiveWell, "Vitamin A Supplementation". givewell.org ↩

4. GiveWell, "Podcast Episode 27: Scrutinizing One of Our Longest-Funded Programs". blog.givewell.org ↩

5. Helen Keller Intl, "Combatting Vitamin A Deficiencies". helenkellerintl.org ↩

6. GiveWell, "Lookback: Grant to Helen Keller Intl for Vitamin A Supplementation in new Nigerian states". givewell.org ↩

7. GiveWell, "Helen Keller Intl, Vitamin A Supplementation (December 2024)". givewell.org ↩ ↩² ↩³

8. GiveWell, "Helen Keller Intl, Vitamin A Supplementation (Madagascar, April 2023)". givewell.org ↩