Early in 2009, we were extremely excited about The Carter Center. It seemed so strong that we devoted weeks to understanding it in depth.

As discussed in a blog post we made at the time, several of its programs work on extremely promising “neglected tropical disease control” activities, and there’s a truly unusual amount of disclosure from these programs. It appeared that the Carter Center is near the top of the heap both for what it’s doing and for how it’s sharing information. To boot, it was directly involved in one of the most cited global health success stories, the near-eradication of guinea worm.

The Carter Center also has several programs that don’t seem as promising. At first we nearly dismissed/overlooked these programs. But as we dug deeper, we realized that just because a charity emphasizes its best programs doesn’t mean it’s spending most of its funds on them. Oddly, the one piece of information we couldn’t seem to find anywhere on its website was how much of its budget was allocated to each program. The back-of-the-envelope calculations we did surprised us: the heavily documented river blindness program seemed as though it must be tiny, while the agriculture program hadn’t published anything since 2005 but appeared at that time to be taking up around 10% of the total budget.

We got in touch with The Carter Center and asked for a budget breakdown by program. We spoke to a senior representative and followed up with him 4 times. We even tried getting a connection of ours who has been a major Carter Center donor to ask for the information. It kept getting put off. Today we still don’t have this information.

To be honest, at this point we don’t know whether the “flagship” disease-control programs are at the core of the Carter Center’s work or act as more of a “hook” for donors while it focuses on things like fellowships for mental health journalism. And we have no sense of what a donor accomplishes by giving them a small gift (a gift that, however it’s officially designated, is likely effectively going to fund what the Carter Center wants it to fund due to the issue of fungibility).

To give a sense of the variety of program type and quality, here’s where we stand on a few select programs:

• Guinea worm eradication: as mentioned above, progress to date has been impressive. But the case for further funding is murky – the Carter Center proposes $10-15 million per year to fight the last vestiges of a disease that now affects very few people.
• Lymphatic filariasis control program: cheaply treating a horrible and neglected disease, this program is our favorite of the bunch, but we have no idea how large it is or whether more donations would result in expansion of it.
• Agriculture program: appears to be trying to bring the Green Revolution to Africa, but the last update was in 2005 and did not show encouraging results. The program’s “Staff” page appears only to list Dr. Norman Borlaug, whose accomplishments are truly astounding but who passed away earlier this year.
• Ethiopian Public Health Training Initiative: we’re very much in favor of training more public health professionals if it can be done capably. But this program is very thinly documented, in contrast to the direct disease control programs. Are participants in the program being assessed afterward to see if they’ve improved their skills? Are they contributing to Ethiopia’s health care system?

We wish the Carter Center were as transparent about its budget as it is about (some of) its program activities.