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
All this is true, but I think alumni groups like I mentioned could actually add as little stability and consistency to the quality of university groups. My parallel could be something like the Oxford or Cambridge Union or a range of university associations or clubs. The management changes every year but they maintain quality and prestige. That model could transfer to EA groups too to some degree, especially once they have gained some pedigree after being active for 15 or 20 years.
I largely agree, although I don't think we're trying to leverage money that hard in some areas areas. I do think there needs to be some strategy for leverage as well as a lot of opportunism as you say. Collaboration as I mentioned opens up opportunities as well.
Sometimes also it's not so hard to access pools of money, for example how many orgs are trying hard to access all that climate money?
This is an important argument and makes a lot of sense.
"I'd say there's a decent number of highly effective charities with very valuable IP that are too leveraged on the output of very few staff members."
I agree with this, apart from the word "too". I've got no issue with a few talented people carrying an organisation - I think that's just how both charity and business often work for a long long time. How much of Apple's value was in Jobs and Wosniacki even after they were worth billions? How much of their current value is still a legacy of the style and philosophy they built?
This next statement though I think makes sense in theory and I agree to some extent. But I've seen the opposite happen most of the time.
"Increased cost effectiveness over time usually comes from investment in quality assets (I'd include staff costs as assets - for management accounting purposes not for external financial reporting purposes)."
I think this is more the case in the business world as incentives are unfortunately so cooked in the charity world that as organisations grow , it's hard to avoid very poorly performing staff getting paid way too much and for too long. We need to invest in staff to grow an organisation, and it's probably just the right thing to do by our fellow human, but unfortunately I'm not convinced it always makes us more cost effective. I would be interested to hear what examples your have of charities that you think have become clearly more cost effective through investing unusually heavily in staff? Although this might be an unfair question so it's hard to separate that it out.
Often as well I've seen in my org in UgAnda, if I invest heavily in good staff (which we do) they are more likely to get a higher paying job in the NGO or government sector so often the investment doesn't pay off for us. I've seen a number of cases too not in our org where super talented staff were funded for extra study which then directly enabled them to get a better paying job somewhere else. It's complicated. In Western EA orgs where you might have the luxury of relying partly on value alignment this situation might be very different. There's loyalty here but often more to to individual people than a value structure or org.
In my experience with NGOs, staff salaries and "investment" in staff usually end up increasing often to the detriment of the cost effectiveness of the org. Again I'm not saying it's the wrong thing to do. Just observing.
I love the idea of alumni (and maybe even alumni groups) taking on responsibility for funding uni groups. This could be an inspiring and super sustainable way to keep then funded indefinitely and free up funding elsewhere. Imagine the inspiration when the two people who funded your group come to speak about the cool stuff they have thought/done/given since they left uni
I think the inspiration / comradery / multiplier effects here could hugely boost the cost effectiveness of alumni donations
Yep I agree with the Tech example, except even as you scale there you're likely going to need to continue to invest in government partnerships etc. After the initial investment there might be a real spike in cost effectiveness, which might then level out as growth continues.
I would consider the Goverment advocacy and to some extent technical assistance project more of a "hits based approach" (which is great) more than thinking about the framing of long term cost-effectiveness
I like these examples. Maybe someone could do a series of Graphs to illustrate how cost-effectiveness over time could work with different types of orgs? This could help donors and investors understand how their investment functions at different stages of org growth.
The value of re-directing 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..
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.