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 35 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.
Understanding the NGO industrial complex, and how aid really works (or doesn't) in Northern Uganda
Global health knowledge
The value of switching non-EA funding to EA orgs might still be under-appreciated. While we obsess over (rightly so) where EA funding should be going, shifting money from one EA cause to another "better" ne might often only make an incremental difference, while moving money from a non-EA pool to fund cost-effective interventions might make an order of magnitude difference.
There's nothing new to see here. High impact foundations are being cultivated to shift donor funding to effective causes, the “Center for effective aid policy” was set up (then shut down) to shift governement money to more effective causes, and many great EAs work in public service jobs partly to redirect money. The Lead exposure action fund spearheaded by OpenPhil is hopefully re-directing millions to a fantastic cause as we speak.
I would love to see an analysis (might have missed it) which estimates the “cost-effectiveness” of redirecting a dollar into a 10x or 100x more cost-effective intervention, How much money/time would it be worth spending to redirect money this way? Also I'd like to get my head around how much might the working "cost-effectiveness" of an org improve if its budget shifted from 10% non-EA funding to 90% non- EA funding.
There are obviously costs to roping in non-EA funding. From my own experience it often takes huge time and energy. One thing I’ve appreciated about my 2 attempts applying for EA adjacent funding is just how straightforward It has been – probably an order of magnitude less work than other applications.
Here’s a few practical ideas to how we could further redirect funds
I would imagine far smarter people have thought about this far more deeply, but there might still be room for more exploration and awareness here.
That's a good shout thanks Ian. From having a brief look, I would say they're decent examples of orgs that have maintained their cost-effectiveness fairly well but I really doubt they've become much more cost-effective over time. They've done this through continuing to do 1 thing and 1 thing well which I love. In AMF's case the cost have nets have come down which helps their cost effectiveness, but that's not much to do with specialisation or economies of scale within their org specifically..
This is a fantastic post and I (unusually) think I agree with basically all of it.
Although I agree with this in principle...
"principles of specialisation and economies of scale from the for-profit world suggest we might expect growth in outputs to outpace increases in budget size."
I can't think of many non profit organizations that I'm convinced become more cost effective as they grow, especially when compared with the first 100k-300k they spend. It's often very hard in the non profit world to take advantage of efficiencies. Also there's a problem I think as funding increases orgs kind of find ways to spend it to justify those donations.
Often bigger scope means more middle management, higher salaries at the top and less efficiency, while also as organisations grow with mission creep and widening of scope can also often introduce interventions which might be less cost-effective than what they did originally.
Many non profits as they grow claim second order effects to justify these extra costs, like influencing government or building up other organizations doing similar things. The community health worker organizations are classic for this.
I agree with your comment about Scott's support for the org, but I think he unnecessarily sullies and misrepresents the org along the way. Why not just explain what the org does and then tell about Alexander's response to it, as the focus is on Alexander.
Like your say regardless of what you think about the orgs methods, they aren't an org which has eugenic intentions and shouldn't be tarred by that brush in the article.
Again to say I probably don't agree with what the org does, but have a lot of compassion for her founder because she has genuinely given much of her life towards looking after children others don't want, and this org came out of trying to solve that issue.
I love your framing of this cost and agree with your central thesis, that cash transfers to families with sickle cell might be more cost effective than general cash transfers, while not necessarily being the most cost-effective option. It may well be the most cost-effective of the projects you reviewed as well, so kudos for getting in behind this.
My criticism is more that if the NGO has a great database and connection with families with sickle cell, why not use that infrastructure and the money to help the kids medically in ways more effective than a cash transfer? Buying mosquito nets, deworming and I would argue giving proper medical treatment for sickle cell are more cost-effective than cash transfers.
In this case I would boldly predict you could do more good by actually providing the best medical care you could with that money rather than giving it to the family. Also in sickle cell where medical catastrophes are basically guaranteed, cash transfers might well get used up BEFORE catastrophes happen which would be tragic.
I'm assuming this stuff below is not readily publicly available in Cameroon - some of it might well be then you didn't
If I had 47 dollars a month to help kids with sickle cell I would set up accounts with local health facilities to provide these services for each kid.
1) Pay for the basic monthly meds for sickle cell (pen-V, folate, malaria prevention, pain relief) ($8 a month)
2) Most of these kids would benefit from hydroxyurea ($10 a month)
3) Send a motorbike to pick the kid to take to hte health center AS SOON as they get sick - fast access to healthcare is critical in sickle cell ($5 per month)
4) Administrating the project ($15 a month assuming something like one/two people administrating 20 families)
5) A pool of money which pays for catatrophic hospital admissions when needed ($9)
I might be missing something or overstepping with this suggestion but that's my hottish take ;) For background I'm a doctor here in Uganda with a decent amount of experience with Sickle cell.