My sense is that expanding the program at this site (or keeping it alive and well for more years at this site) has increasing returns, because we spread the administrative costs over more babies. In fact, knowing we have the funding runway to keep the program healthy lets us hire higher-quality staff with multi-year commitments. But expanding to another district would have huge fixed costs, even if the marginal cost is identical once it is up and running. We would still have a lot of our learning-by-doing, and we would have the paperwork, software, and protocols that we have developed, but we would fundamentally need some new relationships and a new entrepreneurial leader to captain that ship. We don’t currently have that person, but there is no in-principle reason that they could not be found and hired someday. More broadly, running this program has caused us to realize that cost-effectiveness in EA, philanthropy, and development economics has not paid enough attention to what microeconomic theory knows about fixed, variable, marginal, and average costs all being different. It’s on the to-do list to write about that someday.
There are three margins of behavior: The families, the government-salary doctors, and the nurses who are privately hired by the program. The families would counterfactually be bringing most babies home to poor odds. We believe the doctors are working harder and doing more, because the returns to their efforts are improved by the collaboration with the nurses and families. So what about the nurses? Government nurse jobs, for now, remain very hard to get (it’s a bad equilibrium where there both are not enough nurses and not enough public facilities to hire them). So these nurses would likely work somewhere in the private sector. Who knows the tiny general equilibrium effect on statewide nurse wages (!) but the quality of healthcare and neonatal survival for babies born in private facilities is worse, on average, than public facilities in this context, so on the margin shifting activity from private to public facilities would be likely to save lives.
If I understand the question, my own view is the opposite: all else equal, saving a neonate is 60 person-months better than saving a five year old. But I personally suspect this isn’t a huge practical deal: The uncertainties and variance in cost-effectiveness are plausibly much larger than one-part-in-three.
Thanks so much for your response, that all makes sense!
You’re understanding question 3 correctly—GiveWell’s moral weights look like the following, which is fairly different from valuing every year of life equally.
Thanks so much for asking!
My sense is that expanding the program at this site (or keeping it alive and well for more years at this site) has increasing returns, because we spread the administrative costs over more babies. In fact, knowing we have the funding runway to keep the program healthy lets us hire higher-quality staff with multi-year commitments. But expanding to another district would have huge fixed costs, even if the marginal cost is identical once it is up and running. We would still have a lot of our learning-by-doing, and we would have the paperwork, software, and protocols that we have developed, but we would fundamentally need some new relationships and a new entrepreneurial leader to captain that ship. We don’t currently have that person, but there is no in-principle reason that they could not be found and hired someday. More broadly, running this program has caused us to realize that cost-effectiveness in EA, philanthropy, and development economics has not paid enough attention to what microeconomic theory knows about fixed, variable, marginal, and average costs all being different. It’s on the to-do list to write about that someday.
There are three margins of behavior: The families, the government-salary doctors, and the nurses who are privately hired by the program. The families would counterfactually be bringing most babies home to poor odds. We believe the doctors are working harder and doing more, because the returns to their efforts are improved by the collaboration with the nurses and families. So what about the nurses? Government nurse jobs, for now, remain very hard to get (it’s a bad equilibrium where there both are not enough nurses and not enough public facilities to hire them). So these nurses would likely work somewhere in the private sector. Who knows the tiny general equilibrium effect on statewide nurse wages (!) but the quality of healthcare and neonatal survival for babies born in private facilities is worse, on average, than public facilities in this context, so on the margin shifting activity from private to public facilities would be likely to save lives.
If I understand the question, my own view is the opposite: all else equal, saving a neonate is 60 person-months better than saving a five year old. But I personally suspect this isn’t a huge practical deal: The uncertainties and variance in cost-effectiveness are plausibly much larger than one-part-in-three.
Thanks so much for your response, that all makes sense!
You’re understanding question 3 correctly—GiveWell’s moral weights look like the following, which is fairly different from valuing every year of life equally.