I have read several articles about looming famines later this year or next year as a consequence of the war in Ukraine (less wheat and less fertilizer exports) and possible droughts. I and other people raising money for EA-aligned charities (I'm running Effektiv Spenden) will be asked where to donate to fight this catastrophe. Maybe the "right" answer will still be that bednets, but most people won't follow that advise (I'm talking about 99.9% of people from outside of the EA-community). Any ideas on how to prepare an answer with a higher potential of engaging people with effective giving?

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Thanks for raising this question!

Undernourishment (not getting enough and the right types of caloric intake, a subset of malnutrition) is a massive issue currently, affecting 660 million people; especially in children,[1] it can have significant long-term health sequelae e.g. stunting. And you are right, as a consequence of the war in Ukraine, it is likely to get worse.

Although cash transfers do have a positive impact on degree and rates of undernourishment, it likely isn't the most directly cost-effective way of addressing this issue.[2]

There are a couple things that we could do (disclaimer: have read about this area before, spent 10 minutes on this):

  1. Fund and scale up CMAM programs around the world- A couple of reviews, including this pretty good one by Save the Children, rate community management of acute malnutrition or CMAM, as one the most cost-effective intervention. CMAM involves treating severe acute malnutrition (SAM), especially in young children, via therapeutic feeding in predominantly outpatient facilities.
  2. Cautiously increase funding in other interventions that are promising- There are several other interventions that may be very cost-effective for undernutrition and malnutrition- Large Scale Food Fortification, Multiple Micronutrient Supplementation for pregnant women, and small-quantity Lipid-based Nutrient Supplementation for children 6-23 months.  
  3. Work with governments to create healthier and more resilient food systems- this has a slightly longer ToC but can be quite effective e.g. Reductions in childhood stunting in Peru, from a rate of 29.8% in 2005 to 18.1% in 2011, have been attributed to improved policy and institutional coordination, pooled funding for nutrition and binding nutrition targets, as well as the creation of a civil society platform, the Child Malnutrition Initiative[3]
  1. ^
  2. ^

    There is mixed evidence here. Some studies have shown it to be reasonably cost-effective (e.g. this one in Pakistan, but this one in Burkina Faso did not)

  3. ^

    Directly from Aid Forum: http://www.aidforum.org/topics/food-security/four-ways-to-reduce-malnutrition/

I don't have an answer, but I appreciate you raising this ahead of time and think it would be great if we could have well thought out answers and resources for this. 

GiveDirectly are doing cash transfers in Yemen to help people there afford enough food to eat.

I wonder if the increased demand would result in increased prices and other people not being able to afford as much food? Perhaps the greater good for the population as a whole would be to focus on increasing the supply of food, if possible.

Not an answer, but I'm struck by the (probably correct) presumption that people will still see the "right" answer as bednets. It's not just a matter of optics: temporary emergencies (like the coming famines) seem very likely to offer the most cost-effective interventions, conditional on not being neglected. The reason is that 1) in the absence of the emergency, people would otherwise live long and healthy lives, 2) temporary emergencies often cost less to address than systemic issues. This is why during the height of India's COVID-induced oxygen shortages, oxygen interventions were (arguably) more cost-effective than GiveWell top recommendations, because most people who could be saved by an oxygen tank would have lived longer lives otherwise. So people should definitely not discount famine relief ex-ante as being less cost-effective.

I'm not sure it's actually the case that interventions in temporary emergencies are "very likely" more cost-effective. Emergencies often lead to an influx of funds that local organizations struggle to absorb, and it's difficult to allocate funds efficiently. This GiveWell blog on the topic is somewhat dated, but I think the main points still stand.

It seems like there are some considerations:

  • It's hard to predict exactly where and when the urgent need happens. There's many regions and countries that will suffer from famine. Their degree of suffering and need is uncertain and exquisitely dependent on local factors, so it's easy to misallocate aid (compared to a more longterm, chronic problem that can be approached more slowly).
  • Timing and limited window of need limits the "envelope" of raw cost effectiveness. By definition (but sadly many are sort of ongoing) emergencies last for only a short time. Because of the investment and planning required, it's not possible to create a very cost effective aid infrastructure in a short time, and even if you did, ultimately much of this investment will be wasted because of the limited duration. 

So these limit "raw cost effectiveness", maybe by a large factor. 

Another issue is that interventions can be miscarried with negative effects. One example is dumping a lot of food in a way that destroys local farmers. 


These are theoretical considerations about acting in emergencies. This isn't an argument against food aid or mean that they are less effective than bed nets.

I don't think it's normally useful to preemptively direct aid because of the predictability issues you point out (coming famines being an exception). My point is more that there is a large value to quickly reacting to emergencies that we will miss if we only focus on systemic issues.  

Aid infrastructure costs are a valid point, and that pushes the limit of how useful my point is as an abstract claim. I imagine that in many emergencies, a sufficiently effective infrastructure already exists and can be augmented if people put in a lot of effort (again leaning on the India COVID emergency example). But that's just my imagination and could definitely be wrong.

I don't think people see the "right" answer as bednets even today.

GiveWell maximum impact fund and the very similar EA global development fund seem to me to be more recommended choices, in part because of time-sensitive opportunities like you mention ( e.g. grants on covid-19 in 2020 )

As mentioned in another comment, the maximum impact fund is also funding malnutrition treatment

Sure, bednets was just a standin for systemic issues (including malnutrition). I think COVID was an outlier in EA responsiveness to a current crisis, and the more longstanding conventional wisdom is that emergencies are usually not neglected or tractable enough to be worth spending on compared to systemic issues. Doing Good Better definitely made that argument about the inefficacy of disaster relief.

You might also be interested in GiveWell's post on malnutrition: https://blog.givewell.org/2021/11/19/malnutrition-treatment/ 

Copying their conclusions:

Overall, we see malnutrition as a very promising area for funding and further research. It potentially offers $1 billion or more in funding opportunities at cost-effectiveness levels that are consistent with our top charities.

We have many open questions and a long road to go to answer them. We are currently investing significant energy into addressing our uncertainties, and we look forward to sharing more updates about our progress.

Also their grant to ALIMA
https://www.givewell.org/research/incubation-grants/ALIMA-malnutrition-Niger-June-2021 especially the "Case for the grant" section

Thanks a lot for this. Hope GiveWell will speed up there process (will contact them directly as well).

Edit: Removed broken link.

Thanks! Fixed (ironically your link is also broken with the . )

I know other people that are interested in GiveWell's research on malnutrition, I think it would be super interesting if you'll add a comment with your eventual findings! (Or even another post)

Would donations and interventions now, in anticipation of the potential famine, be more effective?

I think so. Not sure where to donate though.

I am no expert but by far the biggest org is the UN's World Food Program.

I don't see much reporting on them from Givewell but they get 4/4 from charity navigator.

I have not looked into it in detail (read: at all), but this comment is very negative on the World Food Program. Some people may appreciate a deeper dive however.

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