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 35 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: 8,018
Thanks Tyler, I was wrong as I didn’t expect that to happen so fast—good to see I wonder what people were in Rubio/Tump’s ear to help tip them over that line
Sorry I wasn’t talking specifics of agencies, I just meant congress cutting their funding, will edit thanks!
I really doubt we have the info yet even for a BOTEC. The situation will vary wildly from org to org and country to country. The best place people to comment here might be staff in USAID conduits like Chemonics and ABT associates, who would know the financial situation at scale for USAID funded orgs in low income countries.
I think this is an OK ask, but the bigger long term issue is that PEPFAR stays funded after the review—that seems to me both a bigger deal and perhaps more tractable than “unpausing” right now. It seems pretty unlikely that decision would be reversed but I don’t know much about the US political system or Trump’s way of operating
You’re right that the funding has stopped, although there will be a bunch of dedicated money in foreign accounts which will keep paying many people. There will be chaos though. For example we have 3 nursing staff under a contract paid by USAID and I’d be very surprised if they just don’t get paid now (I’ll tell you in a week).
What I mean by 1 (sorry I phrased it wrong at first, is that HIV meds in Uganda are still available and probably in other supported countries for the next few months. Its only after the pause that the shit will really hit the fan if USAID decides to permanently stop funding.My ask would be to ensure PEPFAR funding continues after the pause.
Wow that’s interesting! I have no inside information but would have guessed like 70-80 percent chance that funding for HIV meds would continue but maybe I’m way off the mark
Thanks @Omnizoid for highlighting this important moment. I’ve received a bunch of Whatsapp messages from Ugandan friends who are very very worried about what this might mean not only for patients (the main issue), but also for jobs and the livelihood of many local NGOS.
One small comment is that I think the title might be slightly misleading. If these steps happened (none of which have happened yet), then millions could die. But I think all these steps all happening is pretty unlikely
Congress (edit) does actually stop PEPFAR funding permanently—I think they are just reviewing it at the moment. Medication supplies for ARV drugs are still there for the next 3 months , there’s just a chance they’ll stop it after that period. (Unlikely)
Other countries don’t fill in the funding gap if the US pulls out permanently (Unlikely)
Low income country Governments don’t reprioritise funding and free HIV treatment comes to a halt in some countries (Unlikely) - although there could be a large negative effect on other health services if countries were forced to pull money from other healthcare towards ARV treatmen.
And to reiterate, thanks for the article and its still a very very big deal
Thanks so so much for this insight and sharing, yes it’s raw but not boring in the slightest and I think it’s exactly the kind of thing we need to hear on the forum here.
What do you think immigration policies should be from your country?
I haven’t and doubt you will but interested to hear if there are any examples!
It’s true we’ve discussed this already...
Yep I completely agree with all that and would always write a letter for anyone! The kind of things he might be talking about I think are a bit more extreme like.
Funding people to masters courses especially at foreign universities.
Actively making connections with people in Western countries helping people get jobs and study opportunities there.
Helping people write really really good foreign visa and scholarship applications, putting a lot of time and effort into them and even potentially co-writing sections with people.
I’ve done all these things to varying extents and am less inclined to do so now to the same extent given the questions of the OP.
This is not a discussion about anyone forcing anyone to do anything (noone has suggested that), but the original question was about the degree we should potentially fund and support the best workers in our orgs to emigrate. This is a hugely important question, because from experience in Uganda with enough time and resources I could probably help almost any high level qualified and capable person to emigrate but is that really the best thing for me do?
As things stand every country in the world has huge restrictions on emigration, which does often “force” people to stay where they were born, something no one in this discussion thread has the power to do.
The most talented people from low income countries are often much better placed to improve up their own country than we are from richer countries, due to cultural knowledge and connections. In saying that I do agree that far more people from high income countries could be doing a lot of good living and working in low income countries.
One quick response I have is that Poland is a bit of a straw man—much smaller numbers go back to very por countries like Nigeria.
I think this is a huge and under-recognised problem with migration—that the very best people who could have made the biggest difference transforming their country end up leaving, mostly doing far less transformative and “cruxy” work in western countries. I live in Uganda and have seen the same phenomenon.
The strongest pro-immigration argument is usually that we should support migration because remittances are so important and the good done by that can overcome the harms of “brain drain”. If the very best people leave though, I think the negative effect can be enormous.
Also see my comment here on this article by Lauren, along very similar lines.“The best people leave, people that could be innovating, inspiring, leading and starting the best businesses that could grow the country. When you skim off the top 1%, you can “replace” them by training others, but you can’t replace their natural brilliant traits that could have led them to transform their countries.”
https://www.laurenpolicy.com/p/why-brain-drain-isnt-something-we
This issue was also discussed a little in the comments about my wee piece here.
https://forum.effectivealtruism.org/posts/9TnGxtSjjdpeufaqs/is-nigerian-nurse-emigration-really-a-win-win-critique-of-a
Its OK man because Sam has promised to donate 500 million a year to EA causes!
Yep that matches perfectly. Much of that though will be very very tiny solar lamp only though. 98 percent in Bangladesh is completely insane and super cool.
This is actually crazy and encouraging in Uganda where this feels a long way off, amazing to see!
This is a really interesting idea and would obviously need a relatively uncorrupt country that is on board with the project.
To some extent this kind of thing already happens, with aid organisations focusing their funding on countries which use it well. Rwanda is an interesting example of this over the last 20 years as they have attracted huge foreign funding after their dictator basically fixed low level corruption and organized the country surprisingly well. This has led to dis proportionate improvements in healthcare and education compared with surrounding countries, although economically the jury is still out.
The big problem in my eyes then is how do you know it’s your interventions baking the difference, rather than just really good governance—very hard to tease apart.
I agree that we might overestimate the downsides, but those psychological and status benefits you mentioned are real benefits and can’t be discounted I don’t think.
Let’s hope he understands the power of the dark side.