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Re: [givewell] Informal summary of thoughts on international aid

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  • Holden Karnofsky
    Thanks for the thoughts, everyone. A few responses: Lee: our focus is on finding successful charities (in keeping with our mission of helping donors), but we
    Message 1 of 5 , May 7, 2009
      Thanks for the thoughts, everyone.  A few responses:

      Lee: our focus is on finding successful charities (in keeping with our mission of helping donors), but we agree about the importance of experimentation and the desirability of funding it.  You may be interested in this blog post: http://blog.givewell.net/?p=311

      • The organizations you mention are both on our list for a closer look, but from what we've seen to date, they don't appear to have compelling evidence of impact.  I also don't think that "bottom-up" is necessarily a good way to distinguish them from the organizations we recommend.  (PSI and Stop TB both integrate local people and leave room for local practices in their programs, and both are responding to needs they've identified.  I'm not sure whether these things are more or less true of KickStart/IDE.)
      • We consider water quality to be an "intermediate" outcome - encouraging in that it shows that part of the project has gone well, but not the same as demonstrating something like reduced diarrhea, which we see as a worthwhile end in itself.  (By contrast, we consider clean water valuable only insofar as it leads to significantly better health and/or quality of life - something that may not be the case in areas that have serious non-water-related sanitation problems.)
      • New, experimental projects may be worthwhile, but we think that they should ideally be funded only by those who have strong relevant expertise and the ability to evaluate them up close, and that they should stay small when possible until their viability and impact can be demonstrated.  We're going to make a blog post on this topic shortly.
      Phil: we are working on writing up the details of the points you mention.  We find it most efficient to merge the high-level summary with the well-referenced details as a last step.  The Carter Center is not currently on our short list because we have still not gotten the information we've requested about their financials, and without this information, we can't assess the weight of their stronger vs. weaker programs.  The programs range from quite strong to quite weak, in my opinion.

      On Mon, May 4, 2009 at 11:37 AM, Phil Steinmeyer <psteinmeyer@...> wrote:
      > Pretty solid summary, overall.
      > Of course, I'd like to see it extensively referenced and/or with the ability
      > to click through on specific points to get more detailed information.  In
      > particular, you may need to document some of the failures and in general go
      > to greater lengths to pop some of the ideas that SEEM appealing on the
      > surface to donors, but don't necessarily hold up well when implemented.
      > I'm also interested in the details of the charities that work, and a little
      > surprised that The Carter Center didn't make your (very) short list, but
      > willing to look at the details. 
      > ----- Original Message -----
      > From: Lee Crawfurd (MoFEP)
      > To: givewell
      > Sent: Saturday, May 02, 2009 11:09 AM
      > Subject: Re: [givewell] Informal summary of thoughts on international aid
      > Overall I think this is a really good summary. It definitely resonates with
      > my experience here in Sudan, where many of the aid projects are complete
      > garbage, but the clear success story is the health sector - where NGOs
      > basically run the entire health system.
      > One thing I think you omit from this discussion is the value of
      > experimentation when it is properly evaluated. Organisations should be
      > congratulated for doing work which hasn't been proven to be effective if
      > they are rigorously evaluating it and therefore creating new evidence about
      > what is and is not effective.
      > Admittedly there probably isn't that much of this going on, but the message
      > to NGOs should be either
      > A) do something that we know works, or
      > B) do something and properly find out if it works, and then share that
      > information, even if the project is proven not to work
      > hmmm, I'm just reading that back and it sounds like a difficult sell to
      > potential individual donors.
      > cheers,
      > Lee
      > --
      > Lee Crawfurd
      > Economist (ODI Fellow)
      > Ministry of Finance and Economic Planning
      > Government of Southern Sudan
      > lee.crawfurd@...
      > Zain: +249 (0)914897740
      > Gemtel: +256 (0)477256753
      > 2009/5/1 Holden Karnofsky <Holden@...>
      >> Here's a very informal, loose summary of my "big picture overview" of our
      >> upcoming research report.  This is based less on any particular vision for
      >> the website than on the conversations I have with people and the points I
      >> usually emphasize in those conversations.  It's not referenced.  I wrote it
      >> up as something to throw out there and get people's initial thoughts on, as
      >> well as a reference point to see how well our report in progress reflects
      >> the big picture.
      >> --
      >> International aid is a great cause, but also a dangerous one.
      >> Great because it involves helping by far the world's lowest-income people.
      >> That means your donation - whatever size it is - means far more to them,
      >> bottom line, than it can mean to anyone in the U.S.  
      >> Charities in the U.S. are mostly trying to untangle very
      >> hard-to-understand dynamics of poverty such as the achievement gap in
      >> education.  Charities in Africa are often giving basic medical treatment to
      >> someone who can't afford it.  
      >> We've got a table that shows just how big the difference is, in the US the
      >> best program we've found is $10k/yr for a 2-year program that has positive
      >> effects but not huge effects on people's lives, in Africa we're in the range
      >> of $1000 to save a person's life.
      >> Dangerous because it involves a completely different part of the world.  
      >> The distance makes it very hard for you as a donor to really tell what an
      >> organization's doing or hold it accountable, unless it's voluntarily
      >> providing a ton of information to help you do so.  There are horror stories
      >> of money simply getting swallowed up and not reaching the people and
      >> programs it was supposed to.  There are also stories of programs where the
      >> plan in the brochure just looks nothing like the action on the ground.  The
      >> World Bank once pointed to a "success story" of an Internet-access program
      >> in an area where computers couldn't even stay on because of the lack of
      >> reliable electricity.
      >> And the cultural distance means that you have to be careful and humble
      >> about how much you know about these communities and what you can do for
      >> them.  
      >> We are always seeing charities (and donors) convinced that they know the
      >> "root causes of poverty" and that a well or a community mobilization program
      >> will catalyze a whole community's pulling itself out of poverty for good.
      >>  But the track record of projects like these - and larger scale efforts to
      >> attack poverty at its roots - is not encouraging.  We've had 50 years of
      >> huge coalitions of international aid organizations trying one theory or
      >> another of the "root causes of poverty" and they haven't solved poverty.
      >> Understanding the local economy seems like a very difficult undertaking
      >> but that doesn't stop lots of charities from being convinced that they do.
      >>  They try to train farmers to grow cash crops, but what if the market
      >> collapses due to export restrictions (as it did in one well-documented
      >> case)?  Or what if the people aren't even farmers (this happened in another
      >> well-documented case)?  Similar concerns apply to education - how much do we
      >> really know about the impact of math skills on a person's life outcomes in
      >> rural Rwanda?
      >> And going into a foreign community and imposing your plans on it isn't
      >> just risking "no benefit," it's risking "harm."  Set salaries too high and
      >> you'll pull away people who could be doing perfectly productive things in
      >> their own economies, driven by local needs.  Throw too much cash into an
      >> area without accountability and you could be reducing the government's
      >> accountability.
      >> So what should you do?  Find a charity such that
      >> What they're doing is doable.  It's worked before.  We've got enough giant
      >> international aid agencies trying to be the first to crack the root causes
      >> of poverty.  You don't have their ability to understand the theories and the
      >> history and you don't have to throw your money into that pot.  You can fund
      >> something that's got a long history of working and that still has a lot of
      >> room to be scaled up elsewhere.
      >> You can tell what they're doing.  Lots of charities do enormous numbers of
      >> unconnected projects and many seem to be essentially driven by their
      >> funders.  You don't need to be funding that.
      >> They're obsessively documenting that the money is reaching its intended
      >> target and having its intended outcomes.  You can look at the information
      >> and see that this is happening the way it's supposed to and it's helping
      >> people.
      >> In looking for charities that work this way, we've found that:
      >> Health is the strongest sector.  It could be because health is easier to
      >> measure and document than other areas.  It could be because Western medical
      >> knowledge translates better to another culture than Western knowledge of
      >> business/community mobilization/education.  Whatever reason - health is
      >> something that donors can help with.  You may care more about other
      >> problems, but you should also consider what you can do about those problems
      >> and in many cases there isn't evidence that you can do very much (as a
      >> donor).
      >> Many of the "sexy" health interventions are overrated.  ART (AIDS
      >> treatment) costs many times as much as tuberculosis treatment, and
      >> tuberculosis treatment permanently cures tuberculosis.  Water projects are
      >> popular but there are many cases of wells falling into disrepair and few
      >> cases of charities that provide the followup to check whether this is
      >> happening.  Even if a project successfully improves water quality, it may
      >> not improve health much - the major waterborne diseases are transmitted in
      >> many other ways, and water without other sanitation improvements doesn't
      >> necessarily make a dent.  Insecticide-treated bednets are an exception to
      >> this point; their use has a strong track record, though it isn't entirely
      >> clear how much a standard net distribution program resembles the programs
      >> that are known to have worked.
      >> Vaccines are simple, doable, and have worked countless times before.
      >>  Slightly less straightforward but also with excellent track records and low
      >> costs are mass drug administration and tuberculosis treatment.  Vitamin
      >> fortification is promising.
      >> The charities that best meet our criteria are StopTB and PSI (hopefully
      >> more forthcoming).  Both of these charities are doing relatively
      >> straightforward, life-saving things and monitoring all the info you'd wnat
      >> to monitor to be confident they're actually saving lives.  With either of
      >> these charities we're ballparking around $1000 to save a life.

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