GiveBetter x SF

Fistula Foundation

Conditional whole-organization value of a $100,000 unrestricted gift

Research time: ~20 min on GPT-5.6 Sol Medium
  • Research — organization and evidence review.
  • Modeling — cost-effectiveness analysis.
  • Historical estimate for research done before time tracking.

Published: September 8, 2026.

Donate

Summary

What do they do? General support pays for the complete organizational system; only the fistula-repair clinical stream is quantified. Perineal tears, training and network effects receive no separate benefit credit. More

Why this approach interests us

  • A focused organization finances surgical access through local partners. Durable continence improvements have observational support.

Our main reservations

  • No preference-utility or current marginal waiting-time study anchors the key bridge. Partial recovery, repeat operations, donor replacement and non-fistula costs materially reduce credit.

What do you get for your dollar?

Conditional central donor cost is $76,286 and gross resource cost $101,944 per 10 overseas QALYs. These are explicit best-estimate assumptions, not a measured unrestricted-gift result or guarantee of room. Total central is above the $100k screen; no parameter was retuned to pass. Inspect formulas, inputs and sources. The giving link lists official giving options; restricted campaigns and matching claims are not credited in this unrestricted-gift model.

central total / 10 qalys
$101,944 gross resources — $76,286 donor; 13.109 net overseas QALYs per $100,000 whole gift. Total central narrowly misses the $100k screen.
sf / bay direct health
0 / 0 modeled QALYs — No finite positive local ratio. Indirect effects unknown and uncredited, not asserted absent.
matched whole cost
$1,189 historical → $1,487 central — 2024 whole expense/output ratio, then explicit 1.25 marginal/current cost prior; no second overhead factor.
current funding room
Unknown — Prior 50% funding additionality is not proof of a ready unfunded tranche.

1. What do they do?

General support pays for the complete organizational system; only the fistula-repair clinical stream is quantified. Perineal tears, training and network effects receive no separate benefit credit.

Keep every dollar

Whole historical expenses include program, management and fundraising; expansion cost uplift remains explicit.

Deduplicate and allocate

Count distinct care episodes, then fistula share. Other operations still cost money.

Compare with available care

Financial additionality and finite waiting-time advantage remove different counterfactuals.

Value finite health

Signed utility by disjoint recovery states, survival, decay and one discount; subtract separate harms.

Scope of this review. No life saved, newborn health, lifetime 40-year cure, income-to-QALY or DALY=QALY shortcut.

2. Monitoring and information sharing

Rural Ethiopian repair patients

External observational follow-up. Reported long-term dry/partial/persistent states support incomplete recovery.

Our assessment. Small uncontrolled cohort, loss to follow-up and portfolio differences; no direct QALY measurement.

Ethiopian repair survivors

Cross-sectional survivor quality of life. Substantial ongoing poor quality of life reported.

Our assessment. Do not assume surgical closure restores full social or mental health.

Whole organization, all operations

Primary annual report and filing. Matched historical full cost $1,189 per reported surgery.

Our assessment. Accounting grant timing and repeat cases mean not current marginal price; uplift and unique share are priors.

3. Qualitative assessment

A focused organization finances surgical access through local partners. Durable continence improvements have observational support.

Key reservations

  • Clinical outcome and utility transfer are not randomized evidence of this donor gift.
  • Five-year treatment advantage and 50% financial additionality are the decisive unmeasured priors.
  • Annual expense/output ratio may mismatch grant accrual and surgical delivery; current marginal multiplier addresses this only provisionally.
  • Zero credit for perineal tears is an evidence exclusion, not proof they have no benefit; their procedure harms and full resource costs remain.
  • Gross resource envelope adds outside resources to nominal activity even under funding replacement. It is not net induced public expenditure or net societal cost.

Benefits not included in our estimate

  • Perineal-tear durable health
  • Training and future surgical capacity beyond modeled episodes
  • Mortality or newborn survival improvement
  • Income, caregiver relief and social benefits outside the utility bridge
  • Downstream fiscal savings
  • SF/Bay indirect knowledge, altruism or spillover health

4. What do you get for your dollar?

A finite morbidity stream with the whole gift retained

67.269 nominal surgeries × .85 unique episodes × .50 additionality = 28.589 added episodes. Of these, 22.872 are modeled fistula cases.

A better life is our comparison unit of 10 additional quality-adjusted life years (QALYs), potentially spread across people. These are uncertain estimates, not measured returns or verified donation offers.

How we calculate the estimate

Whole-gift health bridge: N = gift / (whole annual expense / annual surgery count × marginal-cost multiplier); E = N × unique share × funding additionality. Q = E × fistula share × (pDry×uDry + pPartial×uPartial) × finite discounted survival/decay years − E×procedure harm − independent harm.
28.589 × .8 × .1429545 × 4.140417 − .428841 = 13.108625 overseas QALYs; gross resources $133,634.61.

Model inputs and assumptions
expense per surgery 2024
Observed derived (range: See labeled numeric range in confidence; null/harm cases below). Matched 2024 whole expenses / all reported surgeries; includes administration, fundraising, training, outreach and tears. Accounting average, not causal marginal quote. Observed derived.
marginal cost multiplier
Best-estimate prior 1.25; range 1–2.5 (range: See labeled numeric range in confidence; null/harm cases below). 2024-to-2026 prices, remote/complex expansion and accounting/output mismatch; not estimated inflation. No second overhead haircut. Best-estimate prior 1.25; range 1–2.5.
unique patient fraction
Prior .85; range .65–1 (range: See labeled numeric range in confidence; null/harm cases below). Reported surgeries may include repeats; only unique care episodes receive first-treatment outcome stream; repeat surgery remains fully costed. Prior .85; range .65–1.
fistula fraction
Current provider reports 20% tear cases; working share .8, range .6–.9 (range: See labeled numeric range in confidence; null/harm cases below). Do not apply fistula trial outcomes to perineal tears. Their costs and potential benefits retained/uncredited. Current provider reports 20% tear cases; working share .8, range .6–.9.
financial additionality
Prior .5; range .15–.85, null0 (range: See labeled numeric range in confidence; null/harm cases below). Capacity added beyond public hospitals, NGOs, reserves and donor replacement. Not patient waiting-time catch-up. Current room unknown. Prior .5; range .15–.85, null0.
dry fraction / partial fraction
Conservative full operated cohort anchor 21/44 dry, 13/44 partial; favorable transfer .75/.20 (range: See labeled numeric range in confidence; null/harm cases below). Nielsen: 38/44 followed, 37 classified urinary states. All 10 others receive zero durable health (3 persistent, 6 lost, 1 unclassified). No RCT or current portfolio rate. Cautious .4/.3 is a joint transfer scenario, not a lower confidence bound on both fractions. Conservative full operated cohort anchor 21/44 dry, 13/44 partial; favorable transfer .75/.20.
dry utility gain / partial utility gain
Explicit preference-utility priors .25/.08, ranges .1–.35 / 0–.15, signed -0.1/-.05 diagnostics (range: See labeled numeric range in confidence; null/harm cases below). QoL questionnaires and DALY disability weights are not direct QALYs. Recovery does not imply restored social health; no separate mental-health or income credit. Explicit preference-utility priors .25/.08, ranges .1–.35 / 0–.15, signed -0.1/-.05 diagnostics.
advantage years
Prior5, range1–10, null0 (range: See labeled numeric range in confidence; null/harm cases below). Hard cap on advantage over later public/NGO treatment or recovery, not patient lifetime; actual no-gift waiting-time distribution unavailable. Prior5, range1–10, null0.
delay years / annual mortality / annual effect decay
Priors .5/.01/.03; ranges 0–2 / 0–.03 / 0–.15 (range: See labeled numeric range in confidence; null/harm cases below). Delay to care, finite survival and recurrence/declining effect after long-term outcome anchor. No lifetime extension or maternal-death benefit. Priors .5/.01/.03; ranges 0–2 / 0–.03 / 0–.15.
procedure harm q
Prior .015 per added distinct episode; range0–.1 (range: See labeled numeric range in confidence; null/harm cases below). Gift-date PV total acute harms from every operation/repeat in an added unique episode, including tears; not a per-operation rate. Excludes durable-state worsening. Full present harm without subtracting delayed alternative repair harm is conservative. Prior .015 per added distinct episode; range0–.1.
independent harm q
Central0, adverse1 (range: See labeled numeric range in confidence; null/harm cases below). Gift-date PV health loss outside patient treatment stream, e.g. displaced other scarce care; no activity multiplier. Do not double count procedure harm. Central0, adverse1.
external resource per nominal surgery
Prior$500; range0–1500 (range: See labeled numeric range in confidence; null/harm cases below). Unreimbursed public hospital/noncash staff, patient travel/time, family care, including unsuccessful/repeat/tear procedures. Add on all nominal surgery equivalents. Gross resources, not net induced societal spending. Prior$500; range0–1500.

Where the whole $100,000 unrestricted gift goes

  • central: Total resources: $101,944/10 QALYs. All-region QALYs 13.10862523; donor $76,286/10 QALYs; gross resources $133,635. Full $100,000 gift retained. SF/Bay direct QALYs 0/0; local ratios unavailable. SF/Bay indirect unknown/uncredited. Status: positive.
  • favorable: Total resources: $8,229/10 QALYs. All-region QALYs 147.0737200; donor $6,799/10 QALYs; gross resources $121,022. Full $100,000 gift retained. SF/Bay direct QALYs 0/0; local ratios unavailable. SF/Bay indirect unknown/uncredited. Status: positive.
  • cautious: Total resources: $25,494,941/10 QALYs. All-region QALYs 0.05571429664; donor $17,948,714/10 QALYs; gross resources $142,043. Full $100,000 gift retained. SF/Bay direct QALYs 0/0; local ratios unavailable. SF/Bay indirect unknown/uncredited. Status: positive.
  • fast public catchup: Total resources: $500,923/10 QALYs. All-region QALYs 2.667767136; donor $374,845/10 QALYs; gross resources $133,635. Full $100,000 gift retained. SF/Bay direct QALYs 0/0; local ratios unavailable. SF/Bay indirect unknown/uncredited. Status: positive.
  • low additionality: Total resources: $339,813/10 QALYs. All-region QALYs 3.932587570; donor $254,286/10 QALYs; gross resources $133,635. Full $100,000 gift retained. SF/Bay direct QALYs 0/0; local ratios unavailable. SF/Bay indirect unknown/uncredited. Status: positive.
  • higher complete cost: Total resources: $229,546/10 QALYs. All-region QALYs 6.554312616; donor $152,571/10 QALYs; gross resources $150,452. Full $100,000 gift retained. SF/Bay direct QALYs 0/0; local ratios unavailable. SF/Bay indirect unknown/uncredited. Status: positive.
  • low utility bridge: Total resources: $326,669/10 QALYs. All-region QALYs 4.090821591; donor $244,450/10 QALYs; gross resources $133,635. Full $100,000 gift retained. SF/Bay direct QALYs 0/0; local ratios unavailable. SF/Bay indirect unknown/uncredited. Status: positive.
  • no funding additionality: Total resources: No finite positive ratio. All-region QALYs 0.000000000; donor No finite positive ratio; gross resources $133,635. Full $100,000 gift retained. SF/Bay direct QALYs 0/0; local ratios unavailable. SF/Bay indirect unknown/uncredited. Status: zero.
  • zero health and harm: Total resources: No finite positive ratio. All-region QALYs 0.000000000; donor No finite positive ratio; gross resources $133,635. Full $100,000 gift retained. SF/Bay direct QALYs 0/0; local ratios unavailable. SF/Bay indirect unknown/uncredited. Status: zero.
  • no durable health with procedure harm: Total resources: No finite positive ratio. All-region QALYs -0.4288413319; donor No finite positive ratio; gross resources $133,635. Full $100,000 gift retained. SF/Bay direct QALYs 0/0; local ratios unavailable. SF/Bay indirect unknown/uncredited. Status: harm.
  • signed worsening: Total resources: No finite positive ratio. All-region QALYs -6.347447540; donor No finite positive ratio; gross resources $133,635. Full $100,000 gift retained. SF/Bay direct QALYs 0/0; local ratios unavailable. SF/Bay indirect unknown/uncredited. Status: harm.
  • independent harm zero activity: Total resources: No finite positive ratio. All-region QALYs -1.000000000; donor No finite positive ratio; gross resources $133,635. Full $100,000 gift retained. SF/Bay direct QALYs 0/0; local ratios unavailable. SF/Bay indirect unknown/uncredited. Status: harm.
  • no fistula allocation: Total resources: No finite positive ratio. All-region QALYs -0.4288413319; donor No finite positive ratio; gross resources $133,635. Full $100,000 gift retained. SF/Bay direct QALYs 0/0; local ratios unavailable. SF/Bay indirect unknown/uncredited. Status: harm.
  • all external resources donor paid: Total resources: $101,944/10 QALYs. All-region QALYs 9.809303752; donor $101,944/10 QALYs; gross resources $100,000. Full $100,000 gift retained. SF/Bay direct QALYs 0/0; local ratios unavailable. SF/Bay indirect unknown/uncredited. Status: positive.
  • no discount: Total resources: $93,358/10 QALYs. All-region QALYs 14.31416323; donor $69,861/10 QALYs; gross resources $133,635. Full $100,000 gift retained. SF/Bay direct QALYs 0/0; local ratios unavailable. SF/Bay indirect unknown/uncredited. Status: positive.

Uncertainty. Scenarios are not confidence intervals. Central is conditional, not probability-weighted certainty. Correcting missing outcomes to failure raises central total above $100k without retuning. Cautious total $25.49m; one-year catch-up $500,923; favorable $8,229. Zero and negative health retain full costs and suppress positive ratios.

5. Funding and previous grants

Current incremental capacity/funding gap unknown. Validate unique patients, marginal spending, alternative treatment timing and outcomes before committing.

No verified unfunded 2026 tranche. Positive prior permits research ranking, not a guarantee a gift adds care. Public capacity and other NGOs are baseline. Independent donor displacement and eventual patient catch-up are different counterfactuals.

This review does not establish a verified marginal funding offer or a complete history of grants.

Donate

Opens the organization’s giving page. A general donation may not fund the specific activity modeled here; confirm allocation with the recipient.

6. Sources

  1. 2024 annual report, expense table and surgery count. Fistula Foundation. Primary report, PDF pages 6 and 11. Matched year expenses/output, not marginal causal price.. Published: 2025; retrieved: September 8, 2026.
  2. 2024 Form 990. Fistula Foundation. Primary filing pp.1,2,10. Confirms whole expenses, program/admin/fundraising and entity.. Published: 2025; retrieved: September 8, 2026.
  3. FAQs. Fistula Foundation. Provider cost scope, portfolio mix, partner monitoring and entity. $624 is not whole-organization cost; 20% tear share is not a matched 2024 allocation.. Published: Undated current page; retrieved: September 8, 2026.
  4. Community-based long-term follow-up after fistula repair. Nielsen et al., BJOG. Primary observational cohort, 38/44 followed at 14–28 months; clinical counts sum37. No untreated random control or preference utility.. Published: 2009; retrieved: September 8, 2026.
  5. Long-term quality of life after fistula repair. Aynalem et al.. Primary observational counterevidence: 182 respondents, 84.1% classified poor overall QoL. Not a causal no-benefit estimate.. Published: 2022; retrieved: September 8, 2026.
  6. Estimating costs and cost-effectiveness for obstetric fistula repair. Uganda cost-effectiveness study authors. Primary economic model, not trial. Lifetime no-surgery DALYs and historical microcosts exclude infrastructure and indirect costs; neither used as QALYs/current whole-org cost.. Published: 2018; retrieved: September 8, 2026.
  7. 2025 output announcement. Fistula Foundation. Provider reports 19,577 surgeries and $28m raised in 2025. Confirms activity; funds raised are not spent matched costs or current funding gap.. Published: March 26, 2026; retrieved: September 8, 2026.

Annual expenses: years and sources

Average annual expenses (three consecutive fiscal years): Not available. Organization size is separate from the modeled cost-effectiveness of a donation.

Fistula Foundation

Three years of organization-level expenses have not yet been verified for this report. No other organization or fiscal sponsor budget has been substituted.