One recent paper suggests that an estimated additional $200–328 billion per year is required for the various measures of primary care and public health interventions from 2020 to 2030 in 67 low-income and middle-income countries and this will save 60 million lives. But if you look at just the amount needed in low-income countries for health care - $396B—and divide by the total 16.2 million deaths averted by that, it suggests an average cost-effectiveness of ~$25k/death averted.
Other global health interventions can be similarly or more effective: a 2014 Lancet article estimates that, in low-income countries, it costs $4,205 to avert a death through extra spending on health[22]. Another analysis suggests that this trend will continue and from 2015-2030 additional spending in low-income countries will avert a death for $4,000-11,000[23].
For comparison, in high-income countries, the governments spend $6.4 million to prevent a death (a measure called “value of a statistical life”)[24]. This is not surprising given the poorest countries spend less than $100 per person per year on health on average, while high-income countries almost spend $10,000 per person per year[25].
GiveDirectly is a charity that can productively absorb very large amounts of donations at scale, because they give unconditional cash transfers to extremely poor people in low-income countries. A Cochrane review suggests that such unconditional cash-transfers “probably or may improve some health outcomes.[21] One analysis suggests that cash-transfers are roughly equivalent as effective as averting a death on the order of $10k .
So essentially cost-effectiveness doesn’t drop off sharply after Givewell’s top charities are ‘fully funded’, and one could spend billions and billions at similar cost-effectiveness, Gates only has ~$100B and only spends~$5B a year.
Your idea that “cost-effectiveness doesn’t drop off sharply after GiveWell’s top charities are funded” depends heavily on the effectiveness and scalability of GiveDirectly’s unconditional cash transfers.
I think EAs tend to be overly certain about GiveDirectly’s effectiveness and scalability, given that the Cochrane review that you mention is unable to conclude much about unconditional cash transfers.
What do we know about the scalability of the charities other than GiveWell though? I kind of suspect “No room for more funding” is very much a short-term thing, and if more funding came in programmes could be scaled up to more regions over a period of months and years, Hiring a few more people, building more infrastructure.
My impressions was that the top charities are scaling as fast as they can. Hopefully soon they’ll have room for hundred of millions of dollars of more funding.
Could you post this as a new forum post rather than a link to a Google doc? I think it’s a question that gets asked a lot and would be good to have an easy to read post to link to.
Agree! Hauke, let me know if you’d want me to do that on your behalf (say, using admin permissions to edit that previous post to add the doc content) if it’ll help :)
Edited to include the text. Did only a little bit of formatting, and added the appendix as is, so it’s not perfect. Let me know if you have any issues, requests, or what not :)
This is a great question, and the same should be asked of governments (as in: “why doesn’t the UK aid budget simply all go to mosquito nets?”)
A likely explanation for why the Gates Foundation doesn’t give to GiveWell’s top charities is that those charities don’t currently have much room for more funding (GiveWell had to rollover funding last year because they couldn’t spend it all. A recent blog posts suggests they may have more room for funding soon https://blog.givewell.org/2022/07/05/update-on-givewells-funding-projections/)
A likely explanation for why the Gates Foundation doesn’t give to GiveDirectly is that they don’t see strong enough evidence yet for the effectiveness (particularly in the long-term or at the societal level) of unconditional cash transfers (A Cochrane review from this year suggests slight short-term benefits: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011135.pub3/full)
Does anyone know why the Gates Foundation doesn’t fill the GiveWell top charities’ funding gaps?
One recent paper suggests that an estimated additional $200–328 billion per year is required for the various measures of primary care and public health interventions from 2020 to 2030 in 67 low-income and middle-income countries and this will save 60 million lives. But if you look at just the amount needed in low-income countries for health care - $396B—and divide by the total 16.2 million deaths averted by that, it suggests an average cost-effectiveness of ~$25k/death averted.
Other global health interventions can be similarly or more effective: a 2014 Lancet article estimates that, in low-income countries, it costs $4,205 to avert a death through extra spending on health[22]. Another analysis suggests that this trend will continue and from 2015-2030 additional spending in low-income countries will avert a death for $4,000-11,000[23].
For comparison, in high-income countries, the governments spend $6.4 million to prevent a death (a measure called “value of a statistical life”)[24]. This is not surprising given the poorest countries spend less than $100 per person per year on health on average, while high-income countries almost spend $10,000 per person per year[25].
GiveDirectly is a charity that can productively absorb very large amounts of donations at scale, because they give unconditional cash transfers to extremely poor people in low-income countries. A Cochrane review suggests that such unconditional cash-transfers “probably or may improve some health outcomes.[21] One analysis suggests that cash-transfers are roughly equivalent as effective as averting a death on the order of $10k .
So essentially cost-effectiveness doesn’t drop off sharply after Givewell’s top charities are ‘fully funded’, and one could spend billions and billions at similar cost-effectiveness, Gates only has ~$100B and only spends~$5B a year.
Your idea that “cost-effectiveness doesn’t drop off sharply after GiveWell’s top charities are funded” depends heavily on the effectiveness and scalability of GiveDirectly’s unconditional cash transfers.
I think EAs tend to be overly certain about GiveDirectly’s effectiveness and scalability, given that the Cochrane review that you mention is unable to conclude much about unconditional cash transfers.
What do we know about the scalability of the charities other than GiveWell though? I kind of suspect “No room for more funding” is very much a short-term thing, and if more funding came in programmes could be scaled up to more regions over a period of months and years, Hiring a few more people, building more infrastructure.
My impressions was that the top charities are scaling as fast as they can. Hopefully soon they’ll have room for hundred of millions of dollars of more funding.
I wrote a post about this 7 years ago! Still roughly valid.
Could you post this as a new forum post rather than a link to a Google doc? I think it’s a question that gets asked a lot and would be good to have an easy to read post to link to.
Agree! Hauke, let me know if you’d want me to do that on your behalf (say, using admin permissions to edit that previous post to add the doc content) if it’ll help :)
Yes, that’s fine.
Edited to include the text. Did only a little bit of formatting, and added the appendix as is, so it’s not perfect. Let me know if you have any issues, requests, or what not :)
This is a great question, and the same should be asked of governments (as in: “why doesn’t the UK aid budget simply all go to mosquito nets?”)
A likely explanation for why the Gates Foundation doesn’t give to GiveWell’s top charities is that those charities don’t currently have much room for more funding (GiveWell had to rollover funding last year because they couldn’t spend it all. A recent blog posts suggests they may have more room for funding soon https://blog.givewell.org/2022/07/05/update-on-givewells-funding-projections/)
A likely explanation for why the Gates Foundation doesn’t give to GiveDirectly is that they don’t see strong enough evidence yet for the effectiveness (particularly in the long-term or at the societal level) of unconditional cash transfers (A Cochrane review from this year suggests slight short-term benefits: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011135.pub3/full)