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: 9,366
I would say the whole climate movement received a huge boost through Greta leading youth protests and being super visible including
Climate getting higher on the voting agenda, pushing governments to make commitments
More funding for research and actually implementing that clean tech
Those lobbyists you talk of having more of a wind behind them
Of course I think we can only attribute a tiny percentage of climate gains in that period to her being a figurehead front and center, but I think things have become harder since without an obvious person to rally behind.
And yes this is super subjective, just my opinion and no, I doubt there’s any data to back that up unfortunately.
I’ll straight up say I think figureheads and public leaders can be huge for movement growth even though there are risks. When Greta was front and center of the climatre movement I felt momentum was huge and even she decided to step back I think the momentum stall was really noticable.
I liked having Will Mckaskill to look to as a leader and high profile example with his giving style.
I see Rutger Bregnan and the attention he is getting in the media.
It might not be a comfortable thing but I think movements can benefit greatly from figureheads, although obviously there are risks for them, and the movement if they fail/fall for whatever reason.
I’ve done this a little and it has seemed like the right thing to do, but I haven’t always been impressed with the response.
EDIT: seen the definition properly and change my vote. If it is different that could damage reputation definitely let them know in advance unless there are factors that could compromise a source or is a really safety issue.
I don’t have great experience and knowledge here AT ALL as a caveat. Never “bow” to anything I say, my takes are often more on the “loose” than “rock solid” end of things :D.
I think if we can randomise things like socrecard studies and IMCI across hundreds of health facilities (done a number of times), then I don’t see why we can’t do the same with a supply chain interventions or governance interventions. The community Health worker movement has done some impressive large scale RCTs like this one. Perhaps 1-3 million dollars could make these studies happen without too much trouble. Give 10 randomised districts the governance/ intervention and 10 not, then just see if healthcare outputs improve. I actually think its easier than many other types of studies because
1. I think its good enough to measure outcomes in terms of facility level outputsd, so we don’t necessarily need community level morbidity/mortality data
2. Outcome measures (no. of patients treated, correct diagnosis) would be super easy and not expensive to measure compared with other studies. In many cases routinely collected DHIS data should be enough to answer the primary outcome question so we don’t even necessarily need much expense on data collection (a big study cost)
I would say from an RCT perspective if people crossed to another district because healthcare was getting that much better, that would be a strong sign that the intervention is working insanely well. If it was a financing type intervention, then making it close to cost-neutral between the intervention and control group. People are NOT very mobile in places like Uganda at least. Where I work in rural places Transport is often (if not usually) the biggest healthcare cost people incur.
I think the biggest reasons these studies haven’t happened more (there are some) are less practicality and more...
1. Most governance, financing and supply chain interventions are funded by bilateral aid not philanthropy, so they don’t usually think about rigorous testing. Instead they often spend quite large amounts of money on “baseline and endline surveys” which I think are often like pouring money down a sink. Or to be slightly more generous perhaps a direct cash transfer to the richest 1% of people in low income countries ;)
2. The kind of people who are into HSS interventions are often pretty religious about HSS being the “only” way to go and are also often RCT averse, so are less likely to commit time and resources to an RCT as part of their intervention.
Great insights there, hope to hear from you more on the forum!
Yes thanks to much I understand better now. I agree that Rwanda’s structure is resilient and enabled them to maintain service delivery during the pandemic. Uganda was terrible in this front, for a number of reasons. During the early lockdowns people died because of poor access—this is an article about a kid dying after we couldn’t refer them from one of our OneDay health centersI think resilience is important but I’m struggling to see how we can test for it in solid ways. In this case I think we have to really on case studies like Rwanda during covid like you say. As a side note like I mentioned in the article, over a 10 year period almost every development thing in Rwanda seemed to work well and bore fruit, and I consider them a success story more than necessarily a model for other countries. Takes a pretty savage dictator to stay on that tight path!
I would hope that many of the same interventions that bring resilience also bring more immediate benefits that would be measurable, but you’re right that won’t always be the case.
Love this question what a great one for DIY debate week (strong upvote). You definitely moved my needle a bit away from AI art, although I’ll continue to use it for the moment.
One strong disagreement is against these 2 points of yours, just from my wife’s recent experience
- “AI art has negative associations with quality and is often seen as being tacky “slop”, which might hurt messaging using AI art.”
- “The upside of using AI art doesn’t seem to be very high: subjectively it mostly seems like it’s used for decorations. ”My wife recently made 20 large really high quality photorealistic AI images to help her with trainings moving towards a conflict mediation here in Uganda. The images demonstrated land conflicts, interpersonal violence and depicted a range of emotions people could have been experiencing. They were so realistic nearly all the participants thought they were even real people… This tool was super useful for the training and conflict meeting. She would never have considered (or been able to afford) paying someone to make these images, so without AI images wouldn’t have bee used and value would have been loss
Quality can be high, and Upsides can be also high at times as well.
I love your clear and concise writing, the arguments come through smoothly and without fuss. I feel like I learned a lot more about this topic in a short time—looking forward to seeing more from you on the forum!
Thanksd @Dee Tomic. I’m interested in what you mean by “resilience” exactly, I’m guessing you mean a Health system which continues to perform at a high standard when put under some stress? I think this is unfortunately really hard to test—how can we know what to attribute any reslience to? Its an important part of a health system, but hard to test. Community Health workers though should show other major effects which are testable besides reslience.
if you’re talking the covid pandemic, then the narrative around a strong “Pandemic response” in East Africa was largely a myth—at least measured by outocomes. Covid spread was hardly prevented at all by the seemingly harsh control measures taken. Most people in East Africa caught Delta within 3 months of it being in the country, and most Omicron within 2 months. The epi curves are insane, they are straight out of a textbook showing uncontrolled spread of a disease. While the virus ripped through the population It was just good fortune that the population was young and didn’t have many cardiovascular comorbidities, so while most people cught covid the mortality rate was super low. We wrote a small piece on this situation in Uganda which is interesting (the epi curves are nuts), and I remember when I checked at the time the Epi curves were almost exactly the same in Rwanda and Kenya.
https://www.researchgate.net/publication/378869273_Does_epidemiological_evidence_support_the_success_story_of_Uganda’s_response_to_COVID-19
I’m also interested that you think Rwanda’s investment in community health workers didn’t show immediate returns. This is an area I dont know about, but I was under the impression that community healthworkers did help the country reduce malaria mortality and improve access to care overall in a relatively short time after they were implemented. Again I’m not an expert at all here
You’re right that the effect of data systems are hard to measure in an RCT, that’s certainly one of the exceptions to the rule.
Thanks for the reply—I was just trying to make a small point, which I still think is missing from your analysis about a large objective uncertainty difference when comparing between causes rather than within. I might be missing it in your text but I can’t see it mentioned at all, maybe you considered it but didn’t write about it explicitly?
All good either way its not the biggest deal!
Thanks @David_Moss I might be barking up the wrong tree here, but I think I’m talking about a different perhaps more basic point? I agree there’s the ethical commensurability factor, but I’m not talking about moral intuintions, or domain specific knowledge, but about concrete reality—even if that reality is unknown. I’m saying that cross-cause comparison increases objective (not subjective) uncertainty by orders of magnitude.
Let me try again and lets see whether I’m bringing something new or not
Lets say (for arguments sake) we are 90% sure that a chicken’s moral weight is between 0.01 and 0.9 that of a human’s. When comparing chicken welfare interventions this uncertainty becomes irrelevent or cancels out as we will be comparing like with like—whether the moral weight is 0.01 or 0.9 doesn’t matter as we compare as this remains constant betewen both interventions, even as we don’t know what it is.
Again if we compare human interventions that save kids lives, while comparing the exact DALY value of saving a life (whether 20 or 80) doesn’t matter, because this will remain constant between interventions.
But when we try to compare a chicken welfare to a human intervention, the uncertainties of both interventions compound in the comparison. The 4x uncertainty in the human interventino and 100x uncertainty in the animal welfare intervention compound.
To put it another way, in many cases moral weight doesn’t matter for within cause comparison, but it becomes critically imporant between causes.Of course I’m. not saying we shouldn’t do cross-cause comparison, but I think this huge objective increase in uncertainty here is an important if fairly basic point to recognise.
This article misses what I think is the biggest weakness with cross-cause prioritisation, which is that uncertainty is hugely increased comparing across causes, compared to within
For example if you are comparing an example which pits two chicken welfare campaigns against each other, the uncertainties about chicken sentience or welfare ranges don’t matter because you are comparing Lilke with like.
The same goes to comparing 2 AI existential risk interventions. Whether AGI is imminent or not will often not affect the decision between the 2 interventions—the better intervention often remains better whether AGI is 5 or 50 years away.
Whereas if you compared chicken welfare to human welfare, then the enormous uncertainties kick in and it becomes very difficult to meaningfully compare the two. Whether the chicken’s relative moral weight is. 01 or 1 makes all the difference in the comparison.
Because of this If we are uncertainty averse, then cross cause prioritisation becomes much less attractive.
Am hoping the new “made me laugh” reaction might help on the humour and levity front, but haven’t seen it used much yet outside of April Fools.
I disagree, giving habits are important to cultivate early, from a habit perspective even if from a dollar utility perspective you may be right.
Important to consider though!
Vote power should scale with karma
I think it should scale but less than it does now. The power goes to my head....
In all seriousness I thin + 2 for a new user strong upvote and +8 for a high Karma user is too much of a gap. Maybe +4 or +5 would be enough? I know this is a specific case, but I feel sometimes deep in an animal welfare threads you can make a reasonable comment and be downvoted to oblivion pretty quickly by a couple of heavy downvotes. But I would say that....
As anecdata here’s an example of a fairly reasonable comment from a few hours ago that would be negative karma without my strong upvote....
“The best reason not to involve the criticised person or org is if doing so would in practice stop you from posting your criticism. You can always ask the mod team for support if this is the case. Simply email forum...”
One of the biggest reasons I’ve considered, is just time delay. Posts on the forum disappear from the front page quickly, and memory fades quckly as well. For example right now I’m about to post a response to RP’s great analysis on Health Systems Strengthening interventions. Only part of is is criticism and not really very heavy. I probably won’t send it to them because I think I need to give 3 days really for a fair response, and its already over a week after the initial post so I’m already late.
If most of it was criticism, I would send it to them first
This is a tricky one with no clear solutionI don’t think
“If you can’t muster up an ounce of charisma, you will not be an effective leader”
I agree with this, in terms of human leadership. I think with people without much charisma can and should be in leadership positions, but thecharisma is 100 percent necessary so they need other leaders around them who possess that!
This article gave me 5% more energy today. I love the no fear, no bull#!@$, passionate approach. I hope this kindly packaged “get off your ass priveleged people” can spur some action, and great to see these sentiments front and center in a newspaper like the Guardian!
https://www.theguardian.com/lifeandstyle/2025/apr/19/no-youre-not-fine-just-the-way-you-are-time-to-quit-your-pointless-job-become-morally-ambitious-and-change-the-world?CMP=Share_AndroidApp_Other
Questions would just be finding out what the cost-effectiveness of money from current individual donors, philanthropies, Gates Foundation was, then calculating the difference if it went to the most cost-effective rganisations.
At Risk of violating @Linch’s principle “Assume by default that if something is missing in EA, nobody else is going to step up.”, I think it would be valuable to have a well researched estimate of the counterfactual value of getting investment from different investors (whether for profit or donors).
For example in global health, we could make GiveWell the baseline, as I doubt whether there is a ll funding source where switching as less impact, as the money will only ever be shifted from something slightly less effective. For example if my organisation received funding from GiveWell, we might only make slightly better use of that money than where it would otherwise have gone, and we’re not going to be increasing the overall donor pool either.
Who knows, for-profit investment dollars could be 10x −100x more counterfactually impactful than GiveWell, which could mean a for-profit company trying to do something good could plausibly be 10-100x less effective than a charity and still doing as much counterfactual good overall? Or is this a stretch?
This would be hard to estimate but doable, and must have been done at least on a casual scale by some people.
Examples ( and random guesses) of counterfactual comparisons of the value of each dollar given by a particular source might be something like....
1. GiveWell 1x
2. Gates Foundation 3x
3. Individual donors NEW donations 10x
4. Indivudal donors SHIFTING donations. 5x
5. Non EA-Aligned foundations 8x
6. Climate funding 5x
7. For-profit investors. 20x
Or this might be barking up the wrong tree, not sure (and I have mentioned it before)
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 acces to that knd 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 on the forum @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 option can be for co-founders or co-leaders to be one person with more funding/research connections from a high-income country, 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 the 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.