I’m a doctor working towards the dream that every human will have access to high quality healthcare. I’m a medic and director of OneDay Health, which has launched 53 simple but comprehensive nurse-led health centers in remote rural Ugandan Villages. A huge thanks to the EA Cambridge student community in 2018 for helping me realise that I could do more good by focusing on providing healthcare in remote places.
NickLaing
Karma: 9,618
Quick note I think this is GiveWells reasoning not @Meghan Blakes the OP. She might want to respond though regardless.
On a super basic level, poverty and malnutrition among famers and fishers has reduced worldwide during the last 50 years of so while these agro conglomerates have been in action. Of course this doesn’t mean the agro conglomerates aren’t doing harm—they could have been slowing the impovement during this time.
Thanks Meghan I’m keen to meet up with Anisa in EA Global! Our OneDay Health centers provide some contraception in remote areas in Uganda. Although its not our no.1 focus we’re keen to improve our family planning coverage.
I think for many orgs, including all programatic costs ,$20 for a year of family planning (the preliminary GiveWell bar) might not be the easiest bar to meet. What are your thoughts on this?
I love this idea actually nice one!
Thanks for writing this and huge kudos for thinking so deeply about your future at such a young age!
I live on what most would consider little money and can assure you that one can live very happily like that! I however work to help people directly. rather than earning to give away so that’s a bit different than your plan. I can see the good that comes from our work every day, while those great people who earn money to give it away are a bit more removed,. Living simply and giving a lot away can be immensely rewarding, though of course challenging due to it being so against societal norms.
There’s a book “Strangers Drowning” I would recommend which has some great case studies of people living in fairly extreme ways in line with their strong convictions.
All the best for your next few years of school and ongoing journey thinking about how to do good with your life :).
“familiar” with the forum might be an understatement? 😋
Is there a world where 30% Tariffs on Chinese goods going into America is net positive for the world?
Could the Tariff reduce consumption and carbon emissions a little in the USA, while China puts more focus more on selling goods to lower income countries? Could this perhaps result in a tiny boost in growth in low income countries?
Could the improved wellbeing/welfare stemming from growth in low income countries + reduced American consumption offset the harms caused by economic slowdown in America/China?
Probably not—I’m like 75% sure the answer is no, but thought the question might be worth asking...
Nice one—I listened to 26 minutes (was great) then got stuck behind a pay wall :D
Thanks so so much for this fantastic response, really appreciate it and this helps clarify a few things :). I don’t have anything significant to add, but a few comments.
- On the measurement issue, yeah I 100% agree that downstream effects are the ones that need be measured. If its a procurement reform, then I would agree the primary outcme would be to reduce stockouts. This might be one of the easier RCTs to do (depending on the system). I would ave thought in many cases randomising by district and following up over 1-2 years should answer the question pretty clearly? I agree some reforms it might be hard to find a clear outcome measure, but on procurement/supply chains it mighe be doable in many cases.
- Yes I agree with community health workers in terms of producing great flow-on effects, although like you said wit those exemplar countries like Bangladesh its difficult to know how much to attribute those changes to CHWs. Also the E”xemplars” case study pointed to a bunch of health interventions, not just CHWs which probably contributed to the amazing improvements there, including Access to health centers, maternal health vouchers, procurement changes etc. I really like the “Exemplars in Global Health” studies.
- Small critique I think saying “In Bangladesh, for example, CHWs played a transformative role not only in delivering services but also in shifting norms around family planning, increasing female education, and building trust in the formal healthcare system, all of which helped increase demand for institutional care over time.” could be true but we can’t say it with much confidence at all. Especially saying they played a “transformative role” seems like overreach. How can we seperate the effect of the CHWs from all the other amazing health system inputs Bangladesh was imputting?
- You’re right that sometimes countries want to move fast and don’t care much about research. That’s great if they are funding things themselves. I think if its being externally funded, its is on the funder to make sure research happens in cases where it is important/possible. If we’re funding it, we’re doing an RCT to test it—take it or leave it. Its an under-appreciated point that governments everywhere and especially in low income countries are often not interested in evidence at all. I’ve been blown away by the extent of it here in Uganda.
- On the vaccine point, I’m not sure $33 per extra person vaccinated (from the Meriggi study) would ever worth it for covid (maybr for some other disease). As a side note I think it was a huge waste of resources to try (and fail) vaccinate most Africans for covid. I think it should have just been older people and those with comorbidities vaccinated,( wrote a bit about Covid in Uganda here)
-I think with Health Systems Strengthening, especially when it comes to areas like Governance and supply chains, the question of whether there are “gaps” isn’t always the most important. Yes there are gaps—huge gaps that need addressing. The bigger question is whether we have a consistently effective method to address those gaps.
The gaps are enormous throughout Health Systems, and I think even more than with other interventions cost-effective tractability is the big question.
On a completely unrelated note, this graph from the Bangladesh Exemplars study is one of the coolest I’ve ever seen :D :D :D.
It’s true how many people actually give away so much money as they make it?
This is one of my favorite posts this year, as cooling as it is. You’ve articulated better than I could some of the discomforts I have. Great job.
Appreciate that brother. Personally I don’t mind disagree votes—there’s plenty there that could reasonably be wrong/disagreed with. Its the karma downvoting that surprises me more :D. In saying that I’ve been downvoted for more benign statements ;).
I think the fellowships look great, but as paid internships I would have thought they would have been the best way to collaborate with them for a pretty small number of people?
I also think that EA feels super nerdy and these ideas deserve a broader audience.
I think there’s merit in discussing and collaborating, and even keepign something seperate.I do think though that even if they do manage to gather a significant “movement” or “community” around SMA it will end up overlapping/melding with the EA community in significant ways. The concepts are just so aligned that it would be hard to keep the communities separate. Percent overlap will be high especially after a few years.
Perhaps in his homeland the Netherlands this might be possible though as most likely there will be more uptake there.
Also he’s praising AMF, collaborating with AIM and doing events with Singer and GWWC so it would be a little odd for them to use what EA has generated to big up themselves, wile not wanting EA to do the same the other way around at all? This seems unlikely they would want this but maybe I’m missing something.
Rutger Bregman is taking the world by storm at the moment, promoting his book and concept “Moral Ambition”. Yesterday he was on the Daily show!. It might be the biggest wave of publicity of largely EA ideas since FTX? Most of what he says is an attractive repackaging, or perhaps an evolution of largely EA ideas. He’s striking a chord with the mainstream media, in a way that I’m not sure Effective altruism ever really has (but I wasn’t there in the early days). I would also hazard a guess that his approach might resonate especially well with left-leaning people.
I was wondering if there’s anything EA’s could be DOING at the moment to take advantage of/leverage this unexpected wave of EA-Adjacent publicity. Things like...
1. Help with funding advertising, or anything else he might needs to ride the wave—these opportunities don’t come often. He may well not need money though...
2. Using his videos and ideas as “ins” or advertising to university EA groups or other outreach. I know he’s going to talk at Harvard uni soon—what is the group there’s response?
3. Incorporating some of his language and ideas into how EA presents itself. Phrases like “Moral ambition”, and the “Bermuda triangle of talent” seem like great phrases to adopt into our “lexicon” as it were.
Thoughts?
I think even if there’s only mild support until watching shots, having an organization and infrastructure ready to ramp up the moment a warning shot hits could be critical—restart than scrambling to organize when it does occur.
I agree with point 2 to some extent but not point one. We have direct evidence from multiple randomized controlled trials that show us without much doubt that the best interventions are 10-100x more cost effective at saving lives than many others. Like @Cody_Fenwick says maybe not 1,000
Just because an intervention is complex doesn’t necessarily mean the outcome is complex as well. Many complex interventions are more measurable than we think.
I discuss this a littler more here https://forum.effectivealtruism.org/posts/w44oxwXpRkzyEEEHr/the-best-health-systems-strengthening-interventions-barelyHere’s some good reflections as well from Kevin Starr from Mulago foundation along similar lines
https://www.mulagofoundation.org/articles/in-numbers-we-trustYes there are interventions which are hard to measure, but not as often as we might think.
I agree with most of you say here, indeed all things being equal a person from Kenya is going to be far more effective at doing anti-poverty work in Kenya than someone from anywhere else. The problem is your caveats - things are almost never equal...
1) Education systems just aren’t nearly as good in lower income countries. This means that that education is sadly barely ever equal. Even between low income countries—a Kenyan once joked with me that “a Ugandan degree holder is like a Kenyan high school leaver”. If you look at the top echelon of NGO/Charity leaders from low-income who’s charities have grown and scaled big, most have been at least partially educated in richer countries
2) Ability to network is sadly usually so so much higher if you’re from a higher income country. Social capital is real and insanely important. If you look at the very biggest NGOs, most of them are founded not just by Westerners, but by IVY LEAGUE OR OXBRIDGE EDUCATED WESTERNERS. Paul Farmer (Partners in Health) from Harvard, Raj Panjabi (LastMile Health) from Harvard. Paul Niehaus (GiveDirectly) from Harvard. Rob Mathers (AMF) Harvard AND Cambridge. With those connections you can turn a good idea into growth so much faster even compared to super privileged people like me from New Zealand, let alone people with amazing ideas and organisations in low income countries who just don’t have access to that kind of social capital.
3) The pressures on people from low-income countries are so high to secure their futures, that their own financial security will often come first and the vast majority won’t stay the course with their charity, but will leave when they get an opportunity to further their career. And fair enough too! I’ve seen a number of of incredibly talented founders here in Northern Uganda drop their charity for a high paying USAID job (that ended poorly...), or an overseas study scholarship, or a solid government job. Here’s a telling quote from this great take here by @WillieG
“Roughly a decade ago, I spent a year in a developing country working on a project to promote human rights. We had a rotating team of about a dozen (mostly) brilliant local employees, all college-educated, working alongside us. We invested a lot of time and money into training these employees, with the expectation that they (as members of the college-educated elite) would help lead human rights reform in the country long after our project disbanded. I got nostalgic and looked up my old colleagues recently. Every single one is living in the West now. A few are still somewhat involved in human rights, but most are notably under-employed (a lawyer washing dishes in a restaurant in Virginia, for example”
https://forum.effectivealtruism.org/posts/tKNqpoDfbxRdBQcEg/?commentId=trWaZYHRzkzpY9rjx
I think (somewhat sadly) a good combination can be for co-founders or co-leaders to be one person from a high-income country with more funding/research connections, and one local person who like you say will be far more effective at understanding the context and leading in locally-appropriate ways. This synergy can cover important bases, and you’ll see a huge number of charities (including mine) founded along these lines.
These realities makes me uncomfortable though, and I wish it weren’t so. As @Jeff Kaufman 🔸 said “I can’t reject my privilege, I can’t give it back” so I try and use my privilege as best as possible to help lift up the poorest people. The organisation OneDay Health I co-founded has me as the only employed foreigner, and 65 other local staff.
Thanks Meghan yes I’ll definitely organise a meeting with Anisa!
It seems to me like it would be challenging for a big international organistion to manage $5 for a year of protection including all management and overheads (often the biggest cost for NGOs), but if that’s in the ballpark that’s really impressive.
Do you have a public calculation you can share at all? All good if not!