This is a great question! There is a great lack of good cost-effectiveness estimates of large multilaterals such as UNICEF. The problem is that they are extremely difficult to create for the reasons outlined in the Givewell article you linked.
Different vaccine programs carried out by GAVI, for example, vary massively in cost-effectiveness. HPV vaccines donât look as cost-effective as rotavirus vaccines, so depending on where additional funding will be spent the cost-effectiveness will vary quite a bit!
At aidpolicy.org we have been toying with ranking of multilaterals on $/âdaly in style of Givewell, but not only would it be a massive undertaking, the resulting estimates would have very high error bars to the point that we worry nobody would take them seriously.
There are some rankings such as the QUODA by CGD, which can give you a sense of the relative effectiveness of multilaterals (For $/âdaly purposes I would primarily look at their prioritization and evaluation criteria), but you wonât be able to use the QUODA to compare a multilateral with Givewell.
Iâm near certain the 1$/â7 months claim is incorrectâor at least calculated with much fewer caveats than Givewellâs CEAs. My best guess is that UNICEF is significantly less cost-effective than givewellâs charities. Between any mega-charity and Givewellâs maximum impact fund, I would recommend Givewell for individual donors.
As @freedomandutility points out, the question Givewell is trying to answer is: âwhat is the most impact you, an individual, can have on the margin with your donationsâ. This answer is not necessarily going to be the same for a government with ten billion to spend. Even a single medium-sized government could cover Givewellâs entire funding gap and have plenty left over. Finding something as cost-effective as Givewellâs which can effectively absorb $100b is not easy!
I donât mean to say this to justify the current system, I believe governments and multilaterals alike are doing a less-than-stellar job with their development efforts. Were a government to actually fully fund Givewell, Givewell should just lower their bar and recommend additional charities.
One idea Iâve been toying with is for individual donors to donate to subnational government agencies for capacity building in low-income countries (e.g. donate to the public health department of a city). It has been exceedingly easy to donate to causes like the recent conflict in Ukraine, or donate to the US government, but there doesnât seem to be many opportunities for individual donors to give to subnational government agencies. Iâm not sure how to go about implementing this idea, but I think it could be highly effective if done correctly.
One small other point I will add is that this already happens a LOT, through a couple of mechanisms which include (this is just what Iâve seen in Uganda)
Supplementary funding for programsâfor example AMF give money to local government health departments to help them distribute nets
Results based funding for government health centers, for example paying the local government providers money for every delievery they do.
Straight programme fundingâpeople like World vision and Save the children sometimes deposit money in local government accounts for implementing /â supervision of health programs
I would say this stuff is huge bikkies, but it is ongoing. Personally here in Northern UGanda Iâm generally not a big fan of this approach (inefficiency, corruption, money just goes to supplement already largeish salaries) but the idea isnât bad. In other places it might work better.
This is an interesting idea, but it would be challenging to ensure that the subnational government didnât reduce its own spending. Maybe it would work with some sort of capital expense that wouldnt counterfactually occurâif it has a neutral effect on costs going forward (a productivity-enhancing capital expense could lead to reduced operational expenses to obtain the same level of public health services).
Ah, ok. Thatâs a fair point. There is a substitution effect. My main intuition here, though, is that extremely effective NGOs like BRAC basically provide a parallel public health /â social safety net for people, yet often-times what would be great is if the government itself was able to provide these services. There is a substitution effect no matter what organization you donate to. For example, I would bet money that public health departments where Against Malaria is more active counterfactually spend less on malaria prevention than otherwise.
e.g. hereâs an excerpt from Stefan Derconâs recent book, Gambling on Development:
Success in delivering effective health services stands out, and although the government expanded services, the most dynamism at scale was offered by NGOs. The role of BRAC (originally the Bangladesh Rural Advancement Committee) was pivotal. In 1990, it developed a model of community health workers, some paid but many volunteers, who offered advice but were equipped with basic health and sanitary products they were allowed to sell. By 2005, BRAC workers were outnumbering government community health workers. With other NGOs following suit, more than three-quarters of health workers are now supplied by NGOs. BRAC alone reached up to 110 million people with health information and basic services, such as detecting the vast majority of malaria and tuberculosis cases in the country.
As far as your example on counterfactual fundingâwe could gauge what the government was spending on malaria prevention before AMF started up operations in the area, and what it was spending after. If pre-AMF spending on malaria prevention in an area were low, that sets the ceiling on how much AMF spending could be crowding out local government spending in that area. I think GiveWell tries to account for crowding out local funding.
You could give money to the subnational government earmarked for a specific purpose that youâre confident that the government wouldnât have counterfactually funded. However, that burdens the developing country public health services with managing your and 100 other donor earmarks, and potentially destroys some of the advantages of working within the public system.
Perhaps you could try a fancier earmark, conditioning a grant for more health workers on the government funding as many workers as it had before. But thatâs going to require even more monitoring, and you may also be locking the government into spending its own money in a way thatâs suboptimal to meet your grant terms.
If you donât earmark to something that wouldnât have otherwise been funded, you risk an equivalent reduction in public spending and the net effect of your donation going to better roads or something (not trivial, but just a general donation to the government). Thatâs a 100 percent slippage.
So while I agree that thereâs likely some substitution effect in all cases, the magnitude of that effect (as well as the administrative difficulty and cost of mitigating the risk) could vary by an order of magnitude.
Thatâs not to say you couldnât find a way to do what youâre suggesting without incurring more-than-AMF levels of substitution effects . . . only that I think it would be rather challenging.
This is a great question! There is a great lack of good cost-effectiveness estimates of large multilaterals such as UNICEF. The problem is that they are extremely difficult to create for the reasons outlined in the Givewell article you linked.
Different vaccine programs carried out by GAVI, for example, vary massively in cost-effectiveness. HPV vaccines donât look as cost-effective as rotavirus vaccines, so depending on where additional funding will be spent the cost-effectiveness will vary quite a bit!
At aidpolicy.org we have been toying with ranking of multilaterals on $/âdaly in style of Givewell, but not only would it be a massive undertaking, the resulting estimates would have very high error bars to the point that we worry nobody would take them seriously.
There are some rankings such as the QUODA by CGD, which can give you a sense of the relative effectiveness of multilaterals (For $/âdaly purposes I would primarily look at their prioritization and evaluation criteria), but you wonât be able to use the QUODA to compare a multilateral with Givewell.
Iâm near certain the 1$/â7 months claim is incorrectâor at least calculated with much fewer caveats than Givewellâs CEAs. My best guess is that UNICEF is significantly less cost-effective than givewellâs charities. Between any mega-charity and Givewellâs maximum impact fund, I would recommend Givewell for individual donors.
As @freedomandutility points out, the question Givewell is trying to answer is: âwhat is the most impact you, an individual, can have on the margin with your donationsâ. This answer is not necessarily going to be the same for a government with ten billion to spend. Even a single medium-sized government could cover Givewellâs entire funding gap and have plenty left over. Finding something as cost-effective as Givewellâs which can effectively absorb $100b is not easy!
I donât mean to say this to justify the current system, I believe governments and multilaterals alike are doing a less-than-stellar job with their development efforts. Were a government to actually fully fund Givewell, Givewell should just lower their bar and recommend additional charities.
One idea Iâve been toying with is for individual donors to donate to subnational government agencies for capacity building in low-income countries (e.g. donate to the public health department of a city). It has been exceedingly easy to donate to causes like the recent conflict in Ukraine, or donate to the US government, but there doesnât seem to be many opportunities for individual donors to give to subnational government agencies. Iâm not sure how to go about implementing this idea, but I think it could be highly effective if done correctly.
Thanks George and Jason all good points
One small other point I will add is that this already happens a LOT, through a couple of mechanisms which include (this is just what Iâve seen in Uganda)
Supplementary funding for programsâfor example AMF give money to local government health departments to help them distribute nets
Results based funding for government health centers, for example paying the local government providers money for every delievery they do.
Straight programme fundingâpeople like World vision and Save the children sometimes deposit money in local government accounts for implementing /â supervision of health programs
I would say this stuff is huge bikkies, but it is ongoing. Personally here in Northern UGanda Iâm generally not a big fan of this approach (inefficiency, corruption, money just goes to supplement already largeish salaries) but the idea isnât bad. In other places it might work better.
This is an interesting idea, but it would be challenging to ensure that the subnational government didnât reduce its own spending. Maybe it would work with some sort of capital expense that wouldnt counterfactually occurâif it has a neutral effect on costs going forward (a productivity-enhancing capital expense could lead to reduced operational expenses to obtain the same level of public health services).
Ah, ok. Thatâs a fair point. There is a substitution effect. My main intuition here, though, is that extremely effective NGOs like BRAC basically provide a parallel public health /â social safety net for people, yet often-times what would be great is if the government itself was able to provide these services. There is a substitution effect no matter what organization you donate to. For example, I would bet money that public health departments where Against Malaria is more active counterfactually spend less on malaria prevention than otherwise.
e.g. hereâs an excerpt from Stefan Derconâs recent book, Gambling on Development:
As far as your example on counterfactual fundingâwe could gauge what the government was spending on malaria prevention before AMF started up operations in the area, and what it was spending after. If pre-AMF spending on malaria prevention in an area were low, that sets the ceiling on how much AMF spending could be crowding out local government spending in that area. I think GiveWell tries to account for crowding out local funding.
You could give money to the subnational government earmarked for a specific purpose that youâre confident that the government wouldnât have counterfactually funded. However, that burdens the developing country public health services with managing your and 100 other donor earmarks, and potentially destroys some of the advantages of working within the public system.
Perhaps you could try a fancier earmark, conditioning a grant for more health workers on the government funding as many workers as it had before. But thatâs going to require even more monitoring, and you may also be locking the government into spending its own money in a way thatâs suboptimal to meet your grant terms.
If you donât earmark to something that wouldnât have otherwise been funded, you risk an equivalent reduction in public spending and the net effect of your donation going to better roads or something (not trivial, but just a general donation to the government). Thatâs a 100 percent slippage.
So while I agree that thereâs likely some substitution effect in all cases, the magnitude of that effect (as well as the administrative difficulty and cost of mitigating the risk) could vary by an order of magnitude.
Thatâs not to say you couldnât find a way to do what youâre suggesting without incurring more-than-AMF levels of substitution effects . . . only that I think it would be rather challenging.