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 53 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
Sometimes I wish I could do Math like @titotal
Great analysis and love the use of small words and simple sentences, gives simple people like me the best chance of understanding.
Are big Orgs better than individuals/small orgs at achieving things?
This is a response to @Mo Putera's quick take - on the notion that Big, elite, established orgs are more likely to succeed compared with individuals and smaller orgs. He looked at Scott Alexander's grants and saw that individuals were more likely to fail compared with bigger orgs. "One disappointing result was that grants to legibly-credentialled people operating in high-status ways usually did better than betting on small scrappy startups (whether companies or nonprofits)."
First, yes on a basic level Individuals and small startups will have a lower probability of making their thing work than bigger organisations, for a few reasons.
- Less leverage on the issue they are trying to on (less relationships/connections built)
- Lack of institutional knowledge and experience
- Less organisational/relational cushions to lean on or fall back on when there are setbacks- either the individual has the skills/drive/luck to make it work or they don't
- Sometimes small orgs are going for bigger/moonshotty stuff that will have a high baseline failure rate no matter who is doing at it.
This is why I love Charity Entrepreneurship's approach to starting new things, which mitigates many of these disadvantages
1. A team of researchers who pre-select causes/issues that are likely to be tractable.
2. Careful selection process looking for ability/resilience/commitment etc.
3. A 2 month incubation process learning about org building, M@E, operations etc.
4. Ongoing formal support both from the CE team and wider community after getting started
Many of the individuals/small orgs Scott Alexander gives to don't have that support.
BUT Big Orgs may Lie more and Look the other way.
I also think that bigger organisations are FAR MORE likely to exaggerate their success than EA aligned individuals and small orgs. Big orgs fail ALL THE TIME on their projects (I see it all the time here in Uganda), and you almost never hear about it.
Admitting failures is unfortunately A huge negative for big orgs as it will attract media attention and donors will stop giving. Incentives are so wired against admitting even small shreds of failure
So they usually don't tell us.
Some evidence for this is the standout Give Directly, who carefully outline their problems, mistakes and failures. including over a million dollars stolen in DRC. And I'm sure they still miss plenty. GiveDirectly are one of the least corruption/failure prone orgs due to their simple model of just sending people money, and yet still have plenty of failures/fraud to report. So what about all the other big orgs which will have far higher levels of failure/corruption than GiveDirectly? They either cover it up or don't look. World Vision, Care, Save the children etc. fail at likely most of what they do and have big corruption issues, yet where are the reports? Even GiveWell funded orgs AMF and Malaria Consortium don't report their no-doubt-many failures and corruption issues as far as I know.
I've seen enormous failure/corruption from big orgs in just my tiny patch of Northern Uganda but you'll very rarely see these reported. In some cases when I expose corruption/uselessness to big NGOs I agreed to stay quiet on it so at least they would fix some of their issues.
Also big orgs often overstate how much difference more marginal money can make - there are many forms of subtle/soft" double counting that occur, through telling everyone who gives them money that they are funding the highest impact stuff, but that's a whole 'nother mini-essay...
So yes, the variance is far higher with individuals/small orgs and they do probably fail more, but don't just trust the rhetoric of big orgs either.
Ok I almost see that (downgraded to weak downvot) I think I see this post as being about their overall process rather than details. There's not one number in this post so they don't seem to be engaging on that level
If this was a post was about the details of their methodology then I think getting into the details you mention would make more sens.
This is true, and I've appreciated it personally. I've been pleasantly surprised how people have responded to a couple of things I've written, even when they didn't know me from a bar of soap. I think this was unlikely to happen in academia or in the high brow public health world where status games often prevail like you said.
There is still though an element of being "known" which helps your ideas get traction. This does make sense as if someone has written something decent in the past, there's a higher chance that other things they write may also be decent, so we are more likely to give their next idea a read. This is why we follow certain people on Substack and Twitter and don't just read things at random (to state the obvious).
So I think there can still a hill to climb a the beginning to get good ideas seen, especially for very new people.
I think 1-2 years is a reasonable window to test for 1 year of funding. I think some benefits of the grant would remain beyond that, but only a small percentage. Direct networking, marketing, website improvement etc. need people working directly to increase funding and I struggle to see how those benefits would persist if no-one was working and the money stopped?
How do you imagine the benefits might continue past 2 years?
This makes straightforward sense to me, and I love the diversity of funding here - from Instagram influencer to the most traditional charity evaluator!
Will be interested to see how these orgs manage over the next couple of years - although with fundraising I would imagine there is a lot of circumstance and luck involved as well, it would be possible to work hard and make the right moves sometimes without much success.
I know this isn't the point of the post, but to add New Zealand is objectively the most beautiful country in the world, and no-one has ever disagreed with me. Before I moved to Uganda, my home in Christchurch was 20 minutes to the beach, and one hour to snow capped hills where one could wander for days and never see another human.
I assume Godzone is just as incredible 12 years later.
#Justsayin #Soldiermindset
Yeah I think he might be combining/ conflating both the elitism and the bigger org issues actually. Based on "grants to legibly-credentialled people operating in high-status ways usually did better than betting on small scrappy startups" and "there were a lot of promising ACX community members with interesting ideas who were going to turn them into startups any day now, but who ended up kind of floundering".
It makes me sad too, but I do agree on the traditionally impressive credentials front. There are definitely diamonds in the rough but they ain't so easy to find!