Thanks for posting this. As far as agency and dignity, I think there are two potential cruxes here:
I’d submit that the predominant beneficiary of GiveWell-style programs (like bednet provision) is actually children under 5, not older family members. (At least this is what GiveWell’s rationale for the programs would lead us to conclude.) Children under 5 lack agency in the sense that cash vs. bednets would make a difference in their agency. Either way, someone else—either parents/caregivers or aid workers -- is making the choice of how they benefit from aid for them.
There might be reasons to think one or the other substitute decisionmakers would make a better choice for the young child, but the young child’s agency and dignity wouldn’t seem to be major factors here. Thus, while I think it is right to say that unconditional cash transfers promote agency and dignity, I would not say that bednet provision reduces them.
I can also see agency/dignity tradeoffs when comparing unconditional cash transfers to conditional cash transfers (e.g., cash for vaccinating your child) or what I’ll call indirect cash transfers. The former is a strong test case for conditional cash transfers . . . but I think a fair one since it describes a GiveWell top charity. A toy example of the latter would be a program that provided glasses to improve worker productivity, and thus worker salaries.
At least in the cash-for-child-vaccination scenario, I would concede that the strings attached slightly reduce parent/caregiver agency and dignity. However, I would suggest the resultant increase in vaccination rates improves young-child agency in two ways. If the child dies from malaria, he or she loses the potential to exercise agency in the future. The same is true to the extent a child has a non-fatal case of malaria that limits his or her future functioning.
In the eyeglasses toy model, I’m not sure if there is a clear difference between giving someone $5 and giving them a $5 set of eyeglasses that raises their income by $5. On the one hand, in the direct-cash scenario, the beneficiary can choose not to wear glasses and still receive a benefit. On the other hand, some people would experience earning $5 from their work as more dignified than being given $5 as an act of charity. Either way, the beneficiary got $5, whether it was in the form of a check or the form of eyeglasses.
That toy model is, of course, not very realistic. But it seems plausible that programs could have a public-health effect and a secondary cash effect. The example that comes to mind is @NickLaing’s work with OneDay Health [cost-effectiveness sketch here, with the COI disclosure that I assisted with parts of it.] While the primary impact is modeled through saving lives of under-5s who would not have counterfactually been treated (or treated early enough), there’s a secondary indirect cash effect for patients who would have counterfactually sought care several hours away. Their transportation costs and lost income are lower, which seems equivalent to giving those patients’ families a small amount of cash.
All that is to say that it may be possible to conceptualize some other programs as cash-transfer programs with some different positive spillover effects than unconditional cash-transfer programs. That perhaps isn’t the fairest mode of analysis to the other programs, whose primary intended effects are being categorized as spillover effects.
But it might facilitate comparisons that are slightly more apples-to-apples than merely transforming impact scores using a set of moral weights. Suppose a conditional cash-transfer program moved 65% as much money into recipients’ hands than an unconditional one [number totally made up]. We can then think about whether the bundle of positive spillover effects of the conditional program is sufficiently greater than the bundle for the unconditional program to justify the loss in efficiency.
Thanks for posting this. As far as agency and dignity, I think there are two potential cruxes here:
I’d submit that the predominant beneficiary of GiveWell-style programs (like bednet provision) is actually children under 5, not older family members. (At least this is what GiveWell’s rationale for the programs would lead us to conclude.) Children under 5 lack agency in the sense that cash vs. bednets would make a difference in their agency. Either way, someone else—either parents/caregivers or aid workers -- is making the choice of how they benefit from aid for them.
There might be reasons to think one or the other substitute decisionmakers would make a better choice for the young child, but the young child’s agency and dignity wouldn’t seem to be major factors here. Thus, while I think it is right to say that unconditional cash transfers promote agency and dignity, I would not say that bednet provision reduces them.
I can also see agency/dignity tradeoffs when comparing unconditional cash transfers to conditional cash transfers (e.g., cash for vaccinating your child) or what I’ll call indirect cash transfers. The former is a strong test case for conditional cash transfers . . . but I think a fair one since it describes a GiveWell top charity. A toy example of the latter would be a program that provided glasses to improve worker productivity, and thus worker salaries.
At least in the cash-for-child-vaccination scenario, I would concede that the strings attached slightly reduce parent/caregiver agency and dignity. However, I would suggest the resultant increase in vaccination rates improves young-child agency in two ways. If the child dies from malaria, he or she loses the potential to exercise agency in the future. The same is true to the extent a child has a non-fatal case of malaria that limits his or her future functioning.
In the eyeglasses toy model, I’m not sure if there is a clear difference between giving someone $5 and giving them a $5 set of eyeglasses that raises their income by $5. On the one hand, in the direct-cash scenario, the beneficiary can choose not to wear glasses and still receive a benefit. On the other hand, some people would experience earning $5 from their work as more dignified than being given $5 as an act of charity. Either way, the beneficiary got $5, whether it was in the form of a check or the form of eyeglasses.
That toy model is, of course, not very realistic. But it seems plausible that programs could have a public-health effect and a secondary cash effect. The example that comes to mind is @NickLaing’s work with OneDay Health [cost-effectiveness sketch here, with the COI disclosure that I assisted with parts of it.] While the primary impact is modeled through saving lives of under-5s who would not have counterfactually been treated (or treated early enough), there’s a secondary indirect cash effect for patients who would have counterfactually sought care several hours away. Their transportation costs and lost income are lower, which seems equivalent to giving those patients’ families a small amount of cash.
All that is to say that it may be possible to conceptualize some other programs as cash-transfer programs with some different positive spillover effects than unconditional cash-transfer programs. That perhaps isn’t the fairest mode of analysis to the other programs, whose primary intended effects are being categorized as spillover effects.
But it might facilitate comparisons that are slightly more apples-to-apples than merely transforming impact scores using a set of moral weights. Suppose a conditional cash-transfer program moved 65% as much money into recipients’ hands than an unconditional one [number totally made up]. We can then think about whether the bundle of positive spillover effects of the conditional program is sufficiently greater than the bundle for the unconditional program to justify the loss in efficiency.