While I’m generally sympathetic to GiveDirectly’s position (I really like their work on so many fronts and think that cash outperforms so many interventions), it seems intuitive to me that it often won’t outperform the very best interventions until we have a lot more funding supply (and I applaud their ambition for increasing that funding supply).
I often think of interventions like bednets as analogous to vaccines (something else that is often distributed for free when there’s a widespread disease instead of sold for cash) for a few reasons:
Stopping the spread: Much like vaccines, bednets are not just about protecting an individual but also the wider community. They achieve this by disrupting the lifecycle of malaria parasites and thereby stopping their spread. This is somewhat similar to how vaccines work to achieve herd immunity, protecting even those who are not vaccinated.
Undervalued goods: Both bednets and vaccines are often undervalued by the very people who would benefit from them. This behavioural quirk might explain why people don’t always buy bednets even when given cash. Similarly, vaccines are often more likely to be used when provided for free, underscoring the importance of removing cost barriers to accelerate their uptake.
Economies of scale & availability: When bednets or vaccines are distributed en masse to an entire region, not only do economies of scale make each unit more cost-effective, but availability also increases. If the purchase of these products were to rely solely on individual decisions made by recipients of cash transfers, there might be insufficient demand to justify large-scale supply, potentially leading to lower availability and higher costs per unit. This contrasts with targeted interventions, where bulk purchasing and distribution can ensure both cost-effectiveness and widespread availability.
For these reasons I’m very glad that COVID vaccines were provided for free in my country instead of charged for and people given the equivalent amount of cash.
Cash transfers are a fantastic tool with broad utility but lack the targeted impact that you can get with specific interventions like bednets or vaccines for the reasons above.
I deeply understand the appeal of cash transfers and the autonomy they offer to recipients and think that they are something that can truly scale but feel like there are compelling and reasonably intuitive reasons for why interventions like providing bednets might be more effective at saving and improving lives.
If the purchase of these products were to rely solely on individual decisions made by recipients of cash transfers, there might be insufficient demand to justify large-scale supply, potentially leading to lower availability and higher costs per unit.
One might even say that providing complete autonomy of choice between bednets and cash to recipients is impossible at a constant funding level. If one could do a widespread distribution of bednets for $2 a person in an area, it should often be feasible to distribute $2 (less administrative costs) to each person instead. However, if bednets now cost $3 because the efficiencies of mass distribution have been lost, then “receive a bednet for free” is no longer something the beneficiary can actualize. In other words, without increasing the funding to allow for “choose between $2 cash or a $3 bednet,” replacing bednets with cash doesn’t really give those who prefer bednets the freedom to choose bednets.
While I’m generally sympathetic to GiveDirectly’s position (I really like their work on so many fronts and think that cash outperforms so many interventions), it seems intuitive to me that it often won’t outperform the very best interventions until we have a lot more funding supply (and I applaud their ambition for increasing that funding supply).
I often think of interventions like bednets as analogous to vaccines (something else that is often distributed for free when there’s a widespread disease instead of sold for cash) for a few reasons:
Stopping the spread: Much like vaccines, bednets are not just about protecting an individual but also the wider community. They achieve this by disrupting the lifecycle of malaria parasites and thereby stopping their spread. This is somewhat similar to how vaccines work to achieve herd immunity, protecting even those who are not vaccinated.
Undervalued goods: Both bednets and vaccines are often undervalued by the very people who would benefit from them. This behavioural quirk might explain why people don’t always buy bednets even when given cash. Similarly, vaccines are often more likely to be used when provided for free, underscoring the importance of removing cost barriers to accelerate their uptake.
Economies of scale & availability: When bednets or vaccines are distributed en masse to an entire region, not only do economies of scale make each unit more cost-effective, but availability also increases. If the purchase of these products were to rely solely on individual decisions made by recipients of cash transfers, there might be insufficient demand to justify large-scale supply, potentially leading to lower availability and higher costs per unit. This contrasts with targeted interventions, where bulk purchasing and distribution can ensure both cost-effectiveness and widespread availability.
For these reasons I’m very glad that COVID vaccines were provided for free in my country instead of charged for and people given the equivalent amount of cash.
Cash transfers are a fantastic tool with broad utility but lack the targeted impact that you can get with specific interventions like bednets or vaccines for the reasons above.
I deeply understand the appeal of cash transfers and the autonomy they offer to recipients and think that they are something that can truly scale but feel like there are compelling and reasonably intuitive reasons for why interventions like providing bednets might be more effective at saving and improving lives.
One might even say that providing complete autonomy of choice between bednets and cash to recipients is impossible at a constant funding level. If one could do a widespread distribution of bednets for $2 a person in an area, it should often be feasible to distribute $2 (less administrative costs) to each person instead. However, if bednets now cost $3 because the efficiencies of mass distribution have been lost, then “receive a bednet for free” is no longer something the beneficiary can actualize. In other words, without increasing the funding to allow for “choose between $2 cash or a $3 bednet,” replacing bednets with cash doesn’t really give those who prefer bednets the freedom to choose bednets.