I definitely don’t think it’s too much to expect from a self-reflection exercise, and I’m sure they’ve considered these issues.
For no. 1, I wouldn’t actually credit growth so much. Most of the rapid increases in life expectancy in poor countries over the last century have come from factors not directly related to economic growth (edit: growth in the countries themselves), including state capacity, access to new technology (vaccines), and support from international orgs/ NGOs. China pre- and post- 1978 seems like one clear example here- the most significant health improvements came before economic growth. Can you identify the ‘growth miracles’ vs. countries that barely grew over the last 20 years in the below graph?
I’d also say that reliably improving growth (or state capacity) is considerably more difficult than reliably providing a limited slice of healthcare. Even if GiveWell had a more reliable theory of change for charitably-funded growth interventions, they probably aren’t going to attract donations- donating to lobbying African governments to remove tariffs doesn’t sound like an easy sell, even for an EA-aligned donor.
For 2, I think you’re making two points- supporting dictators and crowding out domestic spending.
On the dictator front, there is a trade-off, but there are a few factors:
I’m very confident that countries with very weak state capacity (Eritrea?) would not be providing noticeably better health care if there were fewer NGOs.
NGOs probably provide some minor legitimacy to dictators, but I doubt any of these regimes would be threatened by their departure, even if all NGOs simultaneously left (which isn’t going to happen). So the marginal negative impact of increased legitimacy from a single NGO must be very small.
On the ‘crowding out’ front, I don’t have a good sense of the data, but I’d suspect that the issue might be worse in non-dictatorships- countries/ regions that are easier/ more desirable for western NGOs to set up shop, but where local authorities might provide semi-decent care in the absence of NGOs. This article illustrates some of the problems in rural Kenya and Uganda (where I think there’s a particularly high NGO-to-local people ratio).
I suspect GiveWell’s response to this is that the GiveWell-supported charities target a very specific health problem- they may sometimes try to work with local healthcare providers to make both actors more effective, but, if they don’t, the interventions should be so much more effective per marginal dollar than domestic healthcare spending that any crowding effect is more than canceled out. Many crowding problems are more macro than micro (affecting national policy), so the marginal impact of a new effective NGO on, say, a decision whether or not to increase healthcare spending, is probably minimal. When you’ve got major donors (UN, Gates) spending billions in your country, AMF spending a few extra million is unlikely to have a major effect. But I’m open to arguments here.
I definitely don’t think it’s too much to expect from a self-reflection exercise, and I’m sure they’ve considered these issues.
For no. 1, I wouldn’t actually credit growth so much. Most of the rapid increases in life expectancy in poor countries over the last century have come from factors not directly related to economic growth (edit: growth in the countries themselves), including state capacity, access to new technology (vaccines), and support from international orgs/ NGOs. China pre- and post- 1978 seems like one clear example here- the most significant health improvements came before economic growth. Can you identify the ‘growth miracles’ vs. countries that barely grew over the last 20 years in the below graph?
I’d also say that reliably improving growth (or state capacity) is considerably more difficult than reliably providing a limited slice of healthcare. Even if GiveWell had a more reliable theory of change for charitably-funded growth interventions, they probably aren’t going to attract donations- donating to lobbying African governments to remove tariffs doesn’t sound like an easy sell, even for an EA-aligned donor.
For 2, I think you’re making two points- supporting dictators and crowding out domestic spending.
On the dictator front, there is a trade-off, but there are a few factors:
I’m very confident that countries with very weak state capacity (Eritrea?) would not be providing noticeably better health care if there were fewer NGOs.
NGOs probably provide some minor legitimacy to dictators, but I doubt any of these regimes would be threatened by their departure, even if all NGOs simultaneously left (which isn’t going to happen). So the marginal negative impact of increased legitimacy from a single NGO must be very small.
On the ‘crowding out’ front, I don’t have a good sense of the data, but I’d suspect that the issue might be worse in non-dictatorships- countries/ regions that are easier/ more desirable for western NGOs to set up shop, but where local authorities might provide semi-decent care in the absence of NGOs. This article illustrates some of the problems in rural Kenya and Uganda (where I think there’s a particularly high NGO-to-local people ratio).
I suspect GiveWell’s response to this is that the GiveWell-supported charities target a very specific health problem- they may sometimes try to work with local healthcare providers to make both actors more effective, but, if they don’t, the interventions should be so much more effective per marginal dollar than domestic healthcare spending that any crowding effect is more than canceled out. Many crowding problems are more macro than micro (affecting national policy), so the marginal impact of a new effective NGO on, say, a decision whether or not to increase healthcare spending, is probably minimal. When you’ve got major donors (UN, Gates) spending billions in your country, AMF spending a few extra million is unlikely to have a major effect. But I’m open to arguments here.