Re: [givewell] Informal summary of thoughts on international aid
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.
> Lee Crawfurd
> Economist (ODI Fellow)
> Ministry of Finance and Economic Planning
> Government of Southern Sudan
> 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
>> 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
>> 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
>> 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
>> 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.