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: 9,916
Who said EA was dying?
I have 1400 contacts on my EAG London spreadsheet!
Yeah I know it’s a bit of a lame datapoint and this is more of a tweet than a forum post but hey.… 😘
Drug prices in the US are often absurdly high and not super relevent to other Developed countries, let alone low income countries. New Zealand for example buys medications through a different system, usually far far cheaper than the US does.
And its almost an unrelated parralel drug market in places like Uganda compared with the US, with competing Indian companies competing to sell drugs here, its amazing how cheap they are here really. Some examples
1. Amoxicillin 100 tablets 250mg $1.50
2. Doxycline 100 tablets 100mg $2.20
3. Diclofenac gel (Voltaren Gel) $0.50
4. Iv fluids 500ml (all types) $0.50
5. 1 vial of 1g Ceftriaxone (amazing broad spectrum antibiotic (0.25)
I’m not worried prices will go up here because of an odd Trump emergency order.
I’m not sure it’s “misuse” of voting exactly, I think people should vote how they want. I just think this downvoting pattern is unfortunate for encouraging discourse and a diversity of views.
I think the eating them during it was one of the main keys to keeping it real and palatable
As it were...
@tobycrisford 🔸 unfortunately on mamy animal welfare threads, more extreme dissenting views get downvoted to oblivion without strong up votes (like mine and yours) to compensate. This pattern seems mostly to apply to animal welfare threads unfortunately, and I think more discourse would be encouraged if animal welfare supporters didn’t obliterate dissenting views.
Only a handful of us, including myself and @Henry Howard🔸 engage with different perspectives on these animal welfare threads and I think it would be more useful if these kind of comments were encouraged, even if only to better understand what many (probably most) non EA people might be intuiting and thinking when they see these arguments.
I’m mostly not engaging with these threads because I often don’t find the engagement particularly rewarding unfortunately. I’ll keep trying from time to time :D
I think @Henry Howard🔸 s 2 points are very important, even if you don’t necessarily agree with them.
This is one of the most useful videos about effective altrutism I’ve seen. The humor is on point and accessable with zero preachiness! Can’t believe both this and Rutger were on the Daly show in the last week.
In the last week I feel that “generally shareable” EA content has had a huge boost.
Hey there @GiveWell do you have a write up of these grants or cost-effectiveness analysis that I can look at, even a brief one? I couldn’t find anything through you or Openphil? I’ve read the podcast transcript so far. Full disclosure I might (if I have the time) write a critical response to this in the weekend.
Yes it’swhat it would have been based on the original cuts. Things completely different now that funding for medication has been restored. The predictions of malaria and HIV deaths resulting from the cuts would now be slashed I would guess by over 80 percent I think because the numbers were based on medication shortages.
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!
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?
I have no idea about this particular case, but there are difficult comms tradeoffs to be made.
If your are working for an advocacy org, sometimes it might be important to make messaging compromises to build alliance and get policy through. I can see a good argument that a public comment like this could make others work at the org a lot harder, so it might not be the best job for him in that case. People need to be saying stuff like he said, but maybe in a different org?
Truth seeking is important. So is building alliances.