We Must Reassess What Makes a Charity Effective

Thanks for the thoughtful response. There's a difference between demand and need. Need is the number of people that could use nets but do not. Demand is the number of people that actually want nets. The problem is that the need for nets is significantly higher than the demand. Oversupply decreases the demand for nets, no one will pay for something that is being given out for free. If you want people to actually use a net, you need to create demand, not just fill a need. Most people here literally put up their nets when they see the people that are coming to survey a village on the road. They lie about whether they sleep under a net, and spend most of peak mosquito biting time outside talking, not sleeping, so nets are left ineffective. Imagine that instead of buying many nets and shipping them in, AMF invested in local companies that produce nets to employ more people, expand their business, while simultaneously going to communities and sensitizing them about the importance of bednet use. This would increase demand as well as fill need. And, importantly it would be sustainable, AMF would eventually work themselves out of a job instead of killing off all of the local competition, and making the society completely dependent on their bed nets.

If I understand your point, you are claiming that, since bed net distributions are targeted to the poorest, the factories, which cater to the richer populations, would not have a problem. I have three concerns with this claim. First it represents a fundamental misunderstanding of the sheer level of corruption that perpetrates many of these societies. In order to get resources to the poorest, (at least where I live, which is admittedly pretty high on the corruption index) you must give them to the wealthy who control the distribution centers, the ports, and the laws, and simply to be culturally appropriate and respectful. Second, this still does not address the problem that there is not actually a demand for these nets in the poorest communities, they don't want it, so of course they are going to sell it at a cheaper price than the factory can produce to the people that actually want it. Third, organizations which come into these countries rarely are able to distinguish the extreme poor from the moderately well off. Most people will pretend to be poor here in order to get handouts. I have seen families hide their television in the hopes of getting an organization to donate to them. Organizations frequently fail to actually give to the people that need it the most.

As for searchers and planners, the problem is, once again the difference between need and demand. AMF goes into areas that need nets, they don't go into areas that want nets. They go into areas that want jobs, electricity, or clean water. They don't sit down with the community and say, what do you need the most? A new market? Okay we will get that for you. They sit down with a community and say, you need bed nets, we are going to give you bed nets. If you say that you don't need them, we will go to the next village and give them bed nets instead. I have seen it. They do assessments of how many people get malaria in an area, not what people want if given the choice. The only comparable thing for someone that has not lived here is the flu. Have you gotten a flu shot every single year? Why not? People die of the flu at about the same rate as they die of malaria every year. Maybe because you think that other things are more important. These communities do too. Governments and organizations may request funding and nets, but I have spoken to many communities up and down this country, and never have they said that the thing that they need is bed nets, or malaria reduction. This is top down because AMF is not talking to the actual recipients of the aid, they are talking to intermediary organizations or governments, who ignore the needs of the people, just as much as AMF.

As for Give Directly, here's what I'm talking about. Imagine that you are a village tailor. You don't make enough as a tailor to support your three wives and 20 children (no that's not an exaggeration) so you are also a subsistence farmer. Give Directly comes in and provides you with money. You use these funds to supply your immediate needs. Give Directy proudly claims "This year we plan to provide entire communities of people with a basic income: regular cash payments that are enough for them to live on, for more than 10 years." Imagine you are one of the recipients, for ten years you get payments, so you have no need to work in your field or sew clothes. Your equipment breaks, villagers go to other tailors and you loose market share. Other people that need it more use your farms, and you let them, because culturally, those that have more must give to those that have less. Now ten years later, you were able to "eat your money" as they say, but now you have no business, no farm, and no more free income. You are worse off than you were before.

The video goes into these individual points in greater depth. What I fail to see is why effective altruists should not focus on programs that build capacity, provide jobs, actually listen to what the people want, not what international organizations determine that they need, and increase independence, instead of making recipients more and more dependent on foreign aid. I would be surprised if others who have actually lived in these communities for any substantial amount of time would disagree. The problem is that those that evaluate these charities are so far removed from the actual needs of the people, and the consequences of their actions, that they don't realize the harm that they do.

Hey, thanks for the thoughtful response. Here are my thoughts:

1. A may seem better from an international perspective, but if you ask the people here if they would rather have a factory and more jobs, something they could be proud of, a reason for young people to not leave the country in droves, and the feeling that they are able to solve their own problems, or more bed nets, they would pick A every time. I have asked many communities across the country in Community Analysis surveys what they need, they often say electricity, clean water, better roads, and consistently the most popular answer is more jobs. But I have never seen a community ask for bed nets, or a cure for malaria. To them, it is like the flu. The point is that, just because it seems better to you, it does not mean that it is what people want, and who are you to tell people in countries that you have never visited what they need? I agree that it would be more work to subsidize a factory, but the benefits to the morale of the people, (something which is hard to quantify beyond the percent of people that die trying to illegally immigrate to Europe) would drastically outweigh the costs, and you would be listening to what the people actually want instead of deciding for them.

2. But why do governments in richer countries implement these kinds of programs? Surely it is because the people in that country are more educated, and vote in leaders, or vote for initiatives which inevitably improve their health. Programs like AMF which cut the voter out of the loop do significant damage to democracies. When politicians are beholden to foreign companies and governments for aid instead of their people for votes, they will serve the interests of the foreign organizations, not the people. If the appeal is made to the government, not the people, then he people fail to see the importance of the intervention, and it is not sustainable. We should be educating people so that they ask their government to implement these changes, not cutting the people out of the equation for the sake of saving costs, and thereby cutting young democracies off at the knees. I would be surprised if bed net distributions would actively decrease use of nets, but I have seen many communities actively attempt to deceive researchers about their use of bed nets because they know what "the right answer" is and they know what they need to say to get the foreigners to give them more things. So while I doubt that use decreased, I'm skeptical that it increased at the rates touted by these organizations. My question is, why could we not instead do campaigns solely focused on increasing demand, so that people would actually ask their governments for these interventions. This might lead to people holding their officials (who are actually, at least in principle answerable to the people) responsible for health interventions, as opposed to foreign organizations who are answerable to their donors.

3. I do not live somewhere where Give Directly works, but there are similar programs where I live. Though the study was interesting, my central concern is that, at least here, lying to strangers is not merely culturally acceptable, it is expected, especially when those strangers are foreigners. Therefore any answers given by families on the baseline or endline surveys are certainly in question (especially since people here simply tell you what they think you want to hear). To give you a sense, we have local staff here who conduct surveys in villages, and it is difficult for them to even accurately find out the primary language of the village, without spending several weeks there since everyone just speaks to you in the language you start speaking to them in until they trust you more. Simply, if the people there are anything like the people here, I would be surprised if they took sufficient precautions to rule out desirability bias. The point about labor supply is interesting, but the study does note that it was unable to study true long term effects of these interventions. Give Directly is promoting providing villages money for ten years, from my understanding, the study did not analyze the effects of such actions over long periods of time anything more than four months "this variation in the present study is not sufficient to obtain reliable estimates for the evolution of the treatment effect over time" those are the interventions that I am concerned with, and those are the ones which could do more harm.

In your concluding sentence you make three points that I would like to address. First you claim that the studies are well done, second you claim that they should be trusted over anecdotal evidence, and third you claim that this may vary from place to place.

4) To the first point, simply because a study is well done, it does not make it true. You can do everything in your power to stop someone from lying to you, or telling you just what they think you want them to hear, but, at least where I am unless you live for weeks with a community, they will lie to you. I have seen so many researchers get survey answers from families that I am aware are false, simply because that is the culture here. Just because something is well done, it does not mean that it is true.

5) Yes, the information that I present is anecdotal, but in a culture where it is expected that you lie to strangers, that is all that we have. The problem is that so few donors actually come and experience the reality of what the organizations they support are doing, and even when they do, it is often for such a short time, or they are sufficiently insulted from the community that they fail to experience the catastrophic failures of the programs they are supporting (especially since they are often there seeing only what the program wants them to see). Due to the culture of lying to strangers here, I would trust an anecdote form someone that knows a community well over a well thought out study any day. Maybe that is just because I have seen so many studies here get things so wrong. How long were you here? Where? What kind of research did you do?

6) I would like to end in agreement, so to your last point, I think you are correct. My experience is limited to where I live, and West Africa is certainly different from East Africa in many ways. Problems that we face here, may not be significant concerns over there. I share these concerns and experiences because it seems to me that the majority of the people in this forum have spent little time in the actual communities that receive donations from these organizations. Those communities are unable to speak for themselves (usually no internet), so I am simply trying to give them a voice and explain why they would disagree so drastically with many of the proposed interventions. Thanks for sharing these articles and views. I have committed my life to doing the most good in the world, and from my experience organizations promoted by Give Well are not the best way. All the best!

Want to add this to #1:

a) Death & sickness are bad for the economy. It's pretty uncontested that more people use malaria nets than when they are provided for free (can link research on this if necessary). When someone is sick, it's time that they can't spend in the labor force. When someone gets sick a lot as a child, it affects them so that they are a less productive worker in the future. When your child is sick, you have to spend time taking care of them that could have otherwise been hours you earned a wage, spent on goods, etc. So in that regard, this is probably an outweighing factor to a couple jobs.

b) Even if malaria nets don't effect wages and productivity at all, the money that would have gone to the malaria net maker doesn't just disappear, it's simply spent somewhere else. So jobs don't go away, they are just created in other areas.

So it's not just weighing job creation vs. malaria prevention, it's that malaria prevention probably helps job creation.

Just because an argument is generic, does not make it incorrect. And, to be clear, they are not arguments against all types of developing world charity, simply those which ignore the impact that they have on communities by increasing dependence, destroying jobs, and limiting freedom.

As for local mosquito net factories, if you lost your job just because some foreign NGO wanted to eliminate the flu (which kills about as many people as malaria every year), and you got absolutely no say in it, you might be singing a different tune. Why should a foreigner, get to decide that flu shots are more important than putting people to work? Why should you, a foreigner, get to decide that trying to eliminate a problem that most people here see as no more harmful than the flu, is more important than a local business and people's jobs? You don't know these people, what gives you the right to steal their jobs because you know better than they do?

Furthermore, on the first point, the problem is that when organizations are donating everything to these communities, food, medicine, nets, clothing, etc. they have no opportunities to grow their own industries. What is so wrong about asking the AMF to get nets that are made in the country that they will help? Why must we get nets shipped in and employ foreigners, at the expense of jobs in developing countries? Because if we actually built up an industry in the country, everyone at AMF would be out of a job. So long as they keep the country dependent on their mosquito nets, they will stay in business.

As for the second claim, here's some further context: for searchers and planners, the problem is, the difference between need (what some outside group decides people are in need of) and demand (what people actually want). AMF goes into areas that need nets, they don't go into areas that want nets. They go into areas that want jobs, electricity, or clean water. They don't sit down with the community and say, what do you need the most? A new market? Okay we will get that for you. They sit down with a community and say, you need bed nets, we are going to give you bed nets. If you say that you don't need them, we will go to the next village and give them bed nets instead. I have seen it. They do assessments of how many people get malaria in an area, not what people want if given the choice. To understand, think back to the comparison to the flu. Have you gotten a flu shot every single year? Why not? Maybe because you think that other things are more important. These communities do too. Governments and organizations may request funding and nets, but I have spoken to many communities up and down this country, and never have they said that the thing that they need is bed nets, or malaria reduction. This is top down because AMF is not talking to the actual recipients of the aid, they are talking to intermediary organizations or governments, who ignore the needs of the people, just as much as AMF.

Finally, here's a quote from Give Directly "This year we plan to provide entire communities of people with a basic income: regular cash payments that are enough for them to live on, for more than 10 years." They do not just give one time cash payments.

If you want to understand where I am coming from more, I would suggest spending time living in one of these communities served by these organizations. Maybe you will have a different experience to mine. But where I am, these organizations do more harm than good.

Part of the problem is that in countries like mine there is next to no data, and the data produced by international organizations is often wrong or grossly misleading. It is culturally inappropriate to even ask simple questions like, how many people live here, or how old is that child, and most locals will lie and tell you whatever you want to hear to give a donation, not because they are bad people, but because lying, especially to strangers, is culturally acceptable here, if not outright expected. Part of the reason is that these communities have been living off of harmful aid like this for so long that they understand the only way that they can survive is to convince the donors that they need money. In this culture of dependence, accurate statistics about populations are next to impossible to come by unless you live in that community for a significant period of time.

If you want specific data on the harm of these programs on a larger scale, check out William Easterly's book White Man's Burden, or Dambisa Moyo's book, Dead Aid. Personally I can only offer anecdotes of so many people that I have seen hurt by aid. Really, my best advice is to come live here, you will see first-hand the harm of programs like this and frankly there is no accurate data, even the stuff that AMF puts out.

Thanks for you comment. I speak specifically to AMF and bed net distributions because those are what I have first hand experience with. The argument is not that, if your only goal is to save lives, the AMF does not succeed at this (though I could tell many a story of communities who just put their bed nets up when the observers come around or the cultural practice of most people here of staying outside chatting well into the peak mosquito time, but that is an aside). The argument is that we should have other goals than just saving lives, such as creating jobs, letting people choose their own development initiatives, and decreasing dependence.

The question for you is which part of the argument do you object to? The claim that AMF destroys jobs, limits freedom, and creates dependence, the claim that we should evaluate charities based on these three criteria, or the claim that this means that AMF does net harm? If your only concern is with the last claim, but you would agree with the first two, there are other organizations which focus on capacity building and behavior change which succeed where AMF fails. I am not a critic of all aid, simply aid whose main focus is giving physical objects, ignoring what people actually want, and making everyone dependent on it, instead of training people, allowing them a say in their development, and working themselves out of a job.