I suspect the limiting factor on scalability here may be having people in-country who have the technical skills, access to information, and mindset to pull something like this off. I’m sure that saying no was excruciating. Potentially, one could scale (at some probable tradeoff for cost-effectiveness) after a while with algorithms. For instance, you might determine that providing transport and ancillary supports for moderate-to-severe malnutrition cases up to $150 is cost effective if the treatment was unlikely to happen otherwise.
Conditioned on who the likely donors are, I think using the GiveWell bar is too demanding. As you mentioned, this project hits the fuzzies hard. It’s quite legible to non-EA donors: identifiable beneficiary with a story,[1] very understandable theory of change. The amounts at play are small enough that a donor who gives $50-$100 would feel like a significant part of potentially changing that child’s life. This feels like an easy thing to share with people who are not EAs or even sympathetic to EA principles.
If the counterfactual is that the donor would have given the money to a big NGO, to almost any charity in their own country, or would have spent the money on non-charitable purposes, then the cost-effectiveness for this program would not need to be particularly high. So I’d be interested in hearing a little bit about cases number 4 through 6, which may give an idea of how much the cost-effectiveness might drop upon broader scope.
In many cases, you’d need to fund the treatment out of reserve funds and fundraise retroactively, but I don’t think that would be a major problem if transparently disclosed. Doesn’t seem to hurt the disaster-relief charities’ fundraising right after a natural disaster.
Yes lack of that combination of skills, information and mindset would definitely be a barrier. There’s plenty of people who could be trained in cost-effectiveness calculations though, and exactly like you say with the right algorithms and checks and balances. Great example of malnutrition—although in that case there might well be a good argument you are better off funding more RUTF or better malnutrition centers.
Love the insight about the GiveWell bar maybe being too demanding, food for thought indeed.
Onto the cases 4 through 6… Before getting to that there were some cases we dismissed almost out of hand, because the counterfactual of whether they would get the care without us seemed so tiny it was hard to even estimate.
A couple of the cases we thought about and refused were cancer treatment—which could be cost-effective in kids but these were adults. Cancer treatment in Uganda is very poor and expensive. The obvious factor which made situations far less cost-effective even if they were cured were just age, life saving treatment in kids.
Then there was other was treatment for a thyroid condition that might actually have been cost-effective but another local NGO ended up helping so we didn’t need to.
Then there were a couple non life-saving treatments that could maybe have been cost effective. One was eye surgery in a kid (not cataracts), and one a surgery to correct a broken bone that had left someone unable to work in the garden.
I hate to say it but it wouldn’t describe it as excruciating for us refusing to help, for a couple of reasons. First I treat many patients here that passively decide not to help (not people asking, just sick patients who can’t afford the best treatment option). I’m used to seeing people not get the care they need and I suppose I’m someonewhat numb to the implications. Not proud of that but hard to avoid.
Second we obviously get loads of requests for medical and non-medical things we turn down all the time, so we’re used to saying no a lot as well. In this case it was actually easier in a way, we were being sent cases of sick people that we never actually told we might helpe, so we didn’t actually have to refuse a personal cry for help.
Great example of malnutrition—although in that case there might well be a good argument you are better off funding more RUTF or better malnutrition centers.
I think there’s a real difference in funging risk between your intervention and funding ready-to-use therapeutic food (RUTF) or malnutrition centers.
If we donate to RUTFs or malnutrition centers, some of that may be offset by big NGOs and governments giving a little less. That’s pretty undesirable, given the relatively low value of what many of them would do with the extra money.
If we donate to the nine-month old’s family, there is the possibility that the $100 for transport would have been raised by the family and the surrounding community. But unlike in the NGO/government scenario, your added value in the scenario in which the family/community raised the money is hardly ~zero. There’s now counterfactually $100 more money in the pockets of (presumably) poor individuals, which is a good thing and is probably roughly equivalent to the impact of GiveDirectly distributing $100. Moreover, in that hypothetical, the infant’s family has probably exhausted its financial resources and gone into debt—factors that may reduce the risk of successful aftercare and a good ultimate outcome. So even the scenario where your donation was 100% subject to funging is not such a terrible outcome.
Cancer treatment in Uganda is very poor and expensive. The obvious factor which made situations far less cost-effective even if they were cured were just age, life saving treatment in kids.
My lay understanding is that successful treatment of pediatric cancers often allows for a ~normal lifespan and life, while even initially successful treatment of adult cancers often carries a significant 5-10 year mortality rate[1] and involves significant continuing morbidity (e.g., residual pain, lymphedema). So initial successful treatment of a pediatric cancer seems to be a more good result than initial successful treatment of an adult cancer, even if one disregards years of life saved.
In this case it was actually easier in a way, we were being sent cases of sick people that we never actually told we might helpe, so we didn’t actually have to refuse a personal cry for help.
I think this touches on another probable advantage to your model. I’ve read and heard that Westerners have to be careful doing relief work, lest their actions disrupt the processes the community has developed for mutual aid and support by instead leading everyone to look to the NGO to fix the problem with their money. This problem seems much less likely to develop under your system, as you had no application process to attract candidates, a large catchment area for selecting beneficiaries, and a very low rate of selection.
I’m assuming that most of the cancers identified were not early-stage cancers due to limited levels of medical care and specialized diagnostic equipment.
I suspect the limiting factor on scalability here may be having people in-country who have the technical skills, access to information, and mindset to pull something like this off. I’m sure that saying no was excruciating. Potentially, one could scale (at some probable tradeoff for cost-effectiveness) after a while with algorithms. For instance, you might determine that providing transport and ancillary supports for moderate-to-severe malnutrition cases up to $150 is cost effective if the treatment was unlikely to happen otherwise.
Conditioned on who the likely donors are, I think using the GiveWell bar is too demanding. As you mentioned, this project hits the fuzzies hard. It’s quite legible to non-EA donors: identifiable beneficiary with a story,[1] very understandable theory of change. The amounts at play are small enough that a donor who gives $50-$100 would feel like a significant part of potentially changing that child’s life. This feels like an easy thing to share with people who are not EAs or even sympathetic to EA principles.
If the counterfactual is that the donor would have given the money to a big NGO, to almost any charity in their own country, or would have spent the money on non-charitable purposes, then the cost-effectiveness for this program would not need to be particularly high. So I’d be interested in hearing a little bit about cases number 4 through 6, which may give an idea of how much the cost-effectiveness might drop upon broader scope.
In many cases, you’d need to fund the treatment out of reserve funds and fundraise retroactively, but I don’t think that would be a major problem if transparently disclosed. Doesn’t seem to hurt the disaster-relief charities’ fundraising right after a natural disaster.
Thanks fantastic insights here.
Yes lack of that combination of skills, information and mindset would definitely be a barrier. There’s plenty of people who could be trained in cost-effectiveness calculations though, and exactly like you say with the right algorithms and checks and balances. Great example of malnutrition—although in that case there might well be a good argument you are better off funding more RUTF or better malnutrition centers.
Love the insight about the GiveWell bar maybe being too demanding, food for thought indeed.
Onto the cases 4 through 6… Before getting to that there were some cases we dismissed almost out of hand, because the counterfactual of whether they would get the care without us seemed so tiny it was hard to even estimate.
A couple of the cases we thought about and refused were cancer treatment—which could be cost-effective in kids but these were adults. Cancer treatment in Uganda is very poor and expensive. The obvious factor which made situations far less cost-effective even if they were cured were just age, life saving treatment in kids.
Then there was other was treatment for a thyroid condition that might actually have been cost-effective but another local NGO ended up helping so we didn’t need to.
Then there were a couple non life-saving treatments that could maybe have been cost effective. One was eye surgery in a kid (not cataracts), and one a surgery to correct a broken bone that had left someone unable to work in the garden.
I hate to say it but it wouldn’t describe it as excruciating for us refusing to help, for a couple of reasons. First I treat many patients here that passively decide not to help (not people asking, just sick patients who can’t afford the best treatment option). I’m used to seeing people not get the care they need and I suppose I’m someonewhat numb to the implications. Not proud of that but hard to avoid.
Second we obviously get loads of requests for medical and non-medical things we turn down all the time, so we’re used to saying no a lot as well. In this case it was actually easier in a way, we were being sent cases of sick people that we never actually told we might helpe, so we didn’t actually have to refuse a personal cry for help.
I think there’s a real difference in funging risk between your intervention and funding ready-to-use therapeutic food (RUTF) or malnutrition centers.
If we donate to RUTFs or malnutrition centers, some of that may be offset by big NGOs and governments giving a little less. That’s pretty undesirable, given the relatively low value of what many of them would do with the extra money.
If we donate to the nine-month old’s family, there is the possibility that the $100 for transport would have been raised by the family and the surrounding community. But unlike in the NGO/government scenario, your added value in the scenario in which the family/community raised the money is hardly ~zero. There’s now counterfactually $100 more money in the pockets of (presumably) poor individuals, which is a good thing and is probably roughly equivalent to the impact of GiveDirectly distributing $100. Moreover, in that hypothetical, the infant’s family has probably exhausted its financial resources and gone into debt—factors that may reduce the risk of successful aftercare and a good ultimate outcome. So even the scenario where your donation was 100% subject to funging is not such a terrible outcome.
My lay understanding is that successful treatment of pediatric cancers often allows for a ~normal lifespan and life, while even initially successful treatment of adult cancers often carries a significant 5-10 year mortality rate[1] and involves significant continuing morbidity (e.g., residual pain, lymphedema). So initial successful treatment of a pediatric cancer seems to be a more good result than initial successful treatment of an adult cancer, even if one disregards years of life saved.
I think this touches on another probable advantage to your model. I’ve read and heard that Westerners have to be careful doing relief work, lest their actions disrupt the processes the community has developed for mutual aid and support by instead leading everyone to look to the NGO to fix the problem with their money. This problem seems much less likely to develop under your system, as you had no application process to attract candidates, a large catchment area for selecting beneficiaries, and a very low rate of selection.
I’m assuming that most of the cancers identified were not early-stage cancers due to limited levels of medical care and specialized diagnostic equipment.