Let me preface this article by saying that I am an international development professional who has been living and working in West Africa for years. I am a fan of the underlying principles of effective altruism, that we need to invest in charities that do the most good, but I am very concerned with the methods used for choosing these charities. I am not concerned that the charities are not accomplishing the goals that they claim to be, or that their method for assessing these outcomes are significantly at fault. My concern is that charities fail to invest in assessing the long term collateral harm of these interventions which often do harm which overrides the good which is done by these charities. There are three metrics which are ignored by charity ranking organizations such as GiveWell, which from my experience on the ground are crucial to actually having a positive permanent effect on communities. The are job creation, community autonomy, and dependence. Organizations such as AMF consistently hurt all three sectors, and reverse any good that their interventions do. I have a video on the subject here. (https://www.youtube.com/watch?v=cmzTAJUspc8) but I'll summarize the points here.
Job creation. I can't put this point better than Dambisa Moyo herself: “There’s a mosquito net maker in Africa. He manufactures around 500 nets a week. He employs ten people, who (as with many African countries) each have to support upwards of fifteen relatives. However hard they work, they can’t make enough nets to combat the malaria-carrying mosquito. Enter vociferous Hollywood movie star who rallies the masses and goads Western governments to collect and send 100,000 mosquito nets to the affected region, at the cost of a million dollars. The nets arrive, the nets are distributed, and a ‘good’ deed is done. With the market flooded with foreign nets, however, our mosquito net maker is put out of business. His ten workers can no longer support their 150 dependents (who are now forced to depend on handouts), and one mustn’t forget that in a maximum of five years the majority of the imported nets will be torn, damaged and of no further use.” When we fund charities that take jobs away from communities, we do more harm than good. The AMF does exactly that.
Freedom to Choose: Now, let's talk about autonomy, I'll enlist William Easterly for this one: “In foreign aid, Planners announce good intentions but don’t motivate anyone to carry them out; Searchers find things that work and get some reward. Planners raise expectations but take no responsibility for meet them; Searchers accept responsibility for their actions. Planners determine what to supply; Searchers find out what is in demand. Planners apply global blueprints; Searchers adapt to local communities. Planners at the top lack knowledge of the bottom; Searchers find out what the reality is at the bottom. Planners never hear whether the plan got what it needed; Searchers find out if their customers are satisfied." Effective altruism promotes organizations that plan, not organizations that search, because they focus on projects which apply across communities regardless of need. They do not build projects from the bottom up, they drop things from the top down. This harms developing democracies, and it does not allow for communities to decide what they need. Yes, systematically bottom up work is harder to do, but the effects are worth it.
Dependence: Organizations such as Give Directly may give some amount of choice to communities, but they drastically increase dependence on foreign aid. Here's my thought experiment: "Imagine that you are a parent and your daughter is getting bad grades at school. You hire a tutor and tell him you want him to ensure that your daughter gets better grades. The tutor asks if you would rather get her better grades through a data tested, efficient method with minimal cost required per grade, or a less efficient, more expensive method that might not get results and makes it harder to measure success. You pick the first, and immediately her grades improve. After a few months you ask the tutor what they have been doing. He explains that he was simply doing all the work for your child. Your goal was to improve your daughter’s grades, the most cost effective way to do that was to just do the work for her." This is exactly what many organizations, such as Give Directly do. They simply do the work for a community, instead of building capacity and increasing autonomy and dependence. This is great for the organization, since it ensures that the community will need aid forever, by destroying the infrastructure that the community previously used to make a living. If you get rid of the need for structures which produce food, or organizations which provide jobs, they will go out of business, so that when the community will be unable to return to them when the aid money eventually dries up.
Therefore I beseech you, include these criteria when assessing charities. Ask that charities produce everything with factories in local communities. Require that interventions be systematically bottom up. Make sure that charities are working themselves out of a job, instead of deepening the need for charity by creating dependence. It is an atrocity that so many people believe that they are doing god by donating to charities like AMF, when the people in these communities see that they are doing so much harm, and do not value the benefits that much. Malaria is treated like the flu here, and worldwide, they kill about the same number of people. People here don't want these interventions, they want jobs. The international community ignores this need, and instead takes away the few job opportunities available to these communities.
Thank you for the top level post. It's much easier to engage here than on the various comment threads.
I have some clarifying questions about your claims, and in particular I would like to have a better understanding of where and why you disagree with Givewell's/AMF's read of the situation. You say that they are simply ignoring these issues, implying that they would agree with you if they paid attention. I don't think this is true, as detailed on a point-by-point basis below.
It seems the implied premise here is that 100,000 nets is more than that region actually needed? For example if the region needs 200,000 nets per year, only currently has 50,000 being manufactured per year, and some foreign donors distribute 100,000 nets per year, then I would have thought there was a lot of room for the local factory. This goes double if the donated nets are targeted to the poorest areas, while the factory presumably will prefer to sell to the richer areas.
Far from Givewell ignoring this issue, they pay a lot of attention to how many more nets affected regions can usefully absorb in their analysis of AMF's Room For More Funding. They conclude that there is huge scope for more nets that AMF is unlikely to get close to filling any time soon, see below quote. If you disagree with them on this concrete level, it would be worth saying why.
I agree that if we get anywhere close to filling local net gaps, it's likely not worth displacing local capacity, or at the very least we should seriously weigh the downsides of doing so. Though unless I'm missing something the most obvious solution to this would be for AMF (or whoever) to buy the nets locally, it seems like the origin of the donations isn't actually the problem here, just where the nets are manufactured.
I'm not sure what you're trying to get at with your planners versus searchers quote. AMF does a lot of things that sound like a 'searcher' in your dichotomy. They look for local distribution partners whose methods vary by country, and also follow-up to check whether the nets are actually being used. Nor does it pick countries and areas at random, but rather on the basis of its assessment of need and in at least one major case in response to a request. Can you clarify more why you consider this a 'planning' approach?
Finally, reading your first two criticisms I was inclined to suggest Give Directly as something you might be willing to support. So I read your third section with interest, but I don't think I understand it.
I'm very confused by this section. For instance, by what mechanism do you propose Give Directly gets 'rid of the need for structures which produce food'? Unsurprisingly, giving people extra cash increases the amount of money they spend on food (among many other things):
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.
"for ten years you get payments, so you have no need to work in your field or sew clothes"
I don't believe that these cash payments, the equivalent of less than $1 a day, are sufficient to cause people to stop working. And the evidence is fairly clear from GiveDirectly's research that they do not have that effect. In fact by allowing people to invest in their education/health/business where previously they were credit constrained, they could fairly easily raise their work effort and productivity.
I personally do not live in a country where give directly operates, but I can speak to what people here with money they receive from similar programs, and what they tell the people who have them the money what they did with it. I have seen literally over a hundred families receive donations tell the organization that they spent it on everything from healthy vegetables to school fees when in fact they spent it on sugar, tea, larger celebrations, new sound systems and more. It is completely culturally acceptable to lie to strangers, especially if those strangers are giving you money. So I am skeptical of their statistics to say the least.
As for people refusing to do work when they have enough to get by, I live in a place where most people are subsistence farmers. Due to the lack of jobs, when there is no work to do on the farm, most people sit around and do nothing. If there are no jobs and people have enough to get by, they won't do anything. Why are there no jobs, because of organizations like AMF.
"I have seen literally over a hundred families receive donations tell the organization that they spent it on everything from healthy vegetables to school fees when in fact they spent it on sugar, tea, larger celebrations, new sound systems and more."
Even if that turns out to be true, this kind of spending could still help the country's economy and support local businesses. It seems like cash transfers to people in developing countries don't do enough harm to outweigh the positives associated with them. Your argument might still work for AMF, but I'm not so sure about GiveDirectly.
If you doubt the claim, I would encourage you to come live here for years and see what you think. But as for the claim about the economy, I would agree that GiveDirectly, would probably fall more in the "not doing as much good as it says" category in terms of jobs and economic development than the "actively doing harm" category. However, in terms of dependence I would argue that the harm outweighs the good. GiveDirectly clearly creates dependence of foreign aid by supplying communities with money for basic necessities for years and then cutting them off. These communities loose the ability to be productive after years of dependence, and will in fact end more dependent on aid than they started, since those people in the community who were working, did not need to, and so their tools and equipment will need to be replaced, or if they passed on, their expertise could be lost for good. The harm that GiveDirectly does is that it deepens the need for aid in these communities instead of lessening it. This is great for aid organizations, because it keeps them in business, but it is bad for communities because if the aid ever stops, they will be much worse off than before. An ethical aid organization should work itself out of a job, not increase the need for more organizations like itself.
Hi carneades, thank you for your post! It is great to see a post by an international development professional on effective altruism. As someone who did field work in Africa during PhD, I am sympathetic to what you conclude from your own observation. However, it is important to see what rigorous studies conclude and based on my reading of the literature I have some disagreements.
On job creation, taking into account the environment in most poor countries in terms of infrastructure, legal environment and productivity of the labor force, it would be much more costly to produce bed nets there than importing from somewhere that can make it cheaper. So given the choices of (A) importing cheaper bed nets that can save many more children in the poor country, and (B) producing bed nets locally at much higher cost (and by the way one would need to sell it at much higher price, or put in large subsidy for its production, neither of which makes much sense) while creating not that many jobs, (A) seems much better. (And I said “creating not that many jobs” because you are talking about simply setting up a bed net factory to meet local demand; for significant job creation the country would need China-type export manufacturing but that would require transforming the whole economy in terms of the points mentioned above — infrastructure, legal environment and productivity of the labor force — rather than setting up and probably subsidizing a few unproductive bed net factories which seems like bad industrial policy.)
On need vs. demand for insecticide-treated bed nets, see this article linked to by Fluttershy, especially the 2nd point under "Points of possible disagreement”: "irrationality about one’s health is common in the developed world. In the developing world, there are substantial additional obstacles to properly valuing medical interventions such as lack of the education and access necessary to even review the evidence. The effects of something like bed nets (estimated at one child death averted for every ~200 children protected) aren’t necessarily easy for recipients to notice or quantify.” There is a chapter in the book "Poor Economics" that argues that poor people fail to implement health practices with high returns like treating their drinking water or getting vaccinated, not because they are less rational than people in rich countries. People in rich countries may do no better under the same circumstances, but governments in rich countries provide the infrastructure, nudges or mandatory requirements to make these practices much less costly or even compulsory. Also, there is not only evidence that free distribution of bed nets does not lead to decreased usage, but also that it increases demand and usage in the first year (initial demand is very sensitive to price) which causes people to learn about its benefits and demand more in the future.
On Give Directly, see this study on how people use the money they get. It’s ex ante unclear how people would use the money, but the study shows that credit (and savings) constraint is a really big problem in these people’s lives and people end up using their money to improve food security, invest in durable goods or businesses etc. There was no significant increase on alcohol or tobacco consumption (the study tried to rule out desirability bias including using list randomization questionnaire) or decrease in labor supply.
Of course the studies cited here aren’t perfect but they seem pretty well done to me (and many experts in the field), so I would trust them more than anecdotal evidence which could vary a lot from place to place.
Hey, thanks for the thoughtful response. Here are my thoughts:
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.
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.
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!
Hi carneades, in reply I just want to make 2 general points here:
Many things need to be done in the developing world, e.g.the ones you mentioned: protecting people against malaria, creating jobs, improving the quality of governments... The most effective intervention for one purpose could be not very useful for another, but that's still okay because it would be better than trying to do something that serves multiple purposes but is ineffective in all of them. (e.g. for protecting people against malaria, the most effective intervention could be distributing bed nets for free; for job creating, it could be improving the infrastructure and legal system; for improving the quality of governments it could be educating voters -- though for this to affect government provision of bed nets down the road would take many years and if we solely rely on this to protect people against malaria we would miss the opportunity to save many lives now compared to using the most effective intervention on this)
By saying the studies are good I mean the researchers take into account that respondents may not report the truth and seem to manage to find out the truth despite that. This is not just because I trust these famous economists to do a good job or I know some of them personally and know that they care about doing a good job, but I also find evidence from the papers. For instance in the Cohen and Dupas paper on free distribution of bed nets, it says (on p14, under "III.C Data") "During the home visits, respondents were asked to show the net, whether they had started using it, and who was sleeping under it. Surveyors checked to see whether the net had been taken out of the packaging, whether it was hanging, and the condition of the net." In the Haushofer and Shapiro paper on Give Directly, on p28 they talk about potential desirability bias on alcohol and tobacco and how they address it, and on p32 they mention assets including metal roofs and livestocks which surveyors could easily check (I don't think they mentioned surveyors checking this but the study is done by IPA in the same region I work in Kenya so I imagine it should have the high standard of work done by this organization and surveyors should check things when they can). In general economists don't like to rely on survey data precisely because people may lie, and in developing countries when this is often inevitable we try hard to get around the problem and mention how we address them in papers (otherwise you would get a lot of questioning from presentation audience, referees, etc. so there's plenty of incentive in academia to do that; e.g. I can imagine these two studies having survived such scrutiny).
Also regarding your point of how things on the ground could appear to be completely different from the truth if you don't know the community well enough, in my experience typically local surveyors understand the context well enough to be able to explain to us foreigners what is happening. I agree that this could be a problem for some donors/organizations/studies that aren't very careful, so I can only say that this won't be a big problem if things are done well (which should be the case for charities recommended by GiveWell but I don't know about others).
(I spent 5 months in a town in western Kenya, not super integrated into the local community or fluent in the local language so take this with a grain of salt if you want, but I do know very well how this kind of studies and surveys work since I did one myself.)
Thanks again. Here are my thoughts.
Certainly there are many different kinds of interventions that we can implement. Some interventions are mutually exclusive, others are not. Toms shoes comes and donates shoes to a community, where another organization is attempting to improve small businesses, particularly tailors, some of the few professionals in very small communities. The donation puts many local tailors out of business. Therefore, we either need to develop interventions which are not mutually exclusive or choose between interventions. If we want to do the first, organizations like AMF should help local businesses instead of destroying them. If we want to do the second, we should choose between interventions by asking the people what they need, not deciding what we think is best without ever talking to the people on the ground. If they don't want us to save their lives at the expense of job opportunities, we should not. People should have the right to choose their own interventions, especially when those interventions can do their communities harm. If you want to go in without the community's consent, the least that you can do first is do no harm.
As for the studies, at the end of the day I'm a philosophical skeptic all the way down (which means that I have so serious concerns about the relation between truth and the scientific method, for legitimate philosophical reasons, such as the problem of induction , and the problem of underdetermination, check out the Stanford Encyclopedia of Philosophy for more on that) but we can put that aside for now. As for the trust, I trust the people that live here about what they need, and what they are doing more than I trust foreigners who don't spend much time with the people, famous economists or not. Your quote about nets fails to address a number of concerns, such as communities that put up nets whenever they see the inspectors coming (you would be surprise how many people do this), and the fact that most people here hang out outside until well after peak mosquito biting time, so even if they sleep under a mosquito net, and are fully truthful in an interview, since they don't actually understand or appreciate the importance of bed nets, and someone values something much less when they get it for free. Checking for a metal roof seems like a clear method, but there are so many more which could be lied about. Livestock wanders freely here, and is rarely kept in any kind of pen, and only the people that live in a village really know who owns what. I'm not saying that all of their metrics are necessarily off, I'm saying that I'm not convinced that they are correct. As for the academic criticism, I'm concerned that the people that provide the scrutiny are, unfortunately, not the people with an in-depth experiential understanding of the cultural practices of these communities. I am also concerned that there is a gap between something being able to survive academic criticism, and providing a fully accurate picture of the state of affairs here.
As for the final point, why do you think that the local surveyors are able to solicit truthful responses any more than foreigners? If those local surveyors did not grow up in the same tiny area of the village, the families will lie through their teeth. I have lived here for years, and I am close to fluent in a local language and I have seen families lie to every census worker that comes through, local or foreign. I have also seen translators blatantly lie to researchers about what respondents say. Truth is not valued here. Unless you do speak the language and have lived with a family for quite some time, there's no way for you to know if they actually sleep under a bed net, if they actually exclusively breast feed, or if they really own that goat. As noted before, I cannot say that this happens everywhere as Africa is a big place, and cultures differ drastically. Perhaps in East Africa there are different cultural practices which make it easier to conduct research, but here even the Government cannot correctly take a census.
Thanks for taking the time to engage in in this discussion. I hope that you reconsider donating to charities which ignore what communities actually want in favor of providing cheap, but ultimately harmful interventions.
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.
This isn't really true. Yes, probably there is some job replacement so that the jobs don't literally disappear 1-for-1. But there will probably be fewer jobs, and I don't think it's easy to say (without doing some research) whether it's 0.1 or 0.5 or 0.9 fewer jobs for each malaria net maker that goes away.
Mostly agree, though it's worth noting that the multiplier can also be greater than one if money gets shifted to an industry that creates more jobs per dollar than the malaria nets.
The question then is why don't we, instead of ignoring what the people actually want, invest in companies which could create jobs for them (because that's what they are asking for)? Why does effective altruism care so much about saving lives that it would rather many people live in abject dependence, where their only purpose in life is to have all of their problems solved by foreigners, than to have fewer people pull themselves up by their bootstraps and solve their problems themselves? If what we care about is actually giving jobs, why not promote charities which do create jobs and fight health problems at the same time? Why not build the capacity of local workers to tackle their own challenges? By promoting charities which care about number of people saved over actually getting those people out of poverty, EA only perpetuates the cycle that they claim to be fighting against. If you are really concerned about job creation, the charities promoted here are not the best. But if you only care about saving people and keeping them dependent so that the effective altruists of tomorrow can save them again, donate away.
I apologize for being harsh, but these interventions are hurting real people. I see it every day. And people who have absolutely no stake in it keep donating to these harmful organizations thinking that they are doing good, when in fact they are doing harm. Come to Africa, listen to the people. Ask them what they want. You will increase more happiness by giving them jobs to better their own health, than you will by keeping them dependent and keeping more alive.
a) But malaria really kills about as many people as the flu every year, but I doubt anyone would say that flu vaccines are the best way to improve the economy, or even that they have an appreciable effect. Everyone here considers malaria another version of the flu. Professionals don't call in sick with the flu for a few days, they call in sick with Malaria, and most of them are fine. Do you think that any American politician would advocate closing down several factories in the Midwest (which are the sole means of support for towns there, if it would mean that slightly fewer people would get the flu? Not a chance. Politicians in democracies that are not flooded with aid actually listen to their people (at least more than politicians where I live do).
b) The problem is that, since countries like mine have absolutely no industry (because aid organizations like AMF run them all out of business) it is not spent in a way that every cent goes back to the local population. It is spent on imports, where certainly some money is going to the distributor, but most of the money is going overseas, away from the people that most need it. The jobs are created, in other countries. This might be great for the corporation that makes AMF's nets, but it is horrible for the people on the ground.
Malaria prevention helps job creation about as much as having foreigners give out flu vaccines helps job creation at home. Sure you might prevent a couple of cases of the flu, but it is nothing compared to closing down a factory and destroying the livelihood of many people.
"have absolutely no industry (because aid organizations like AMF run them all out of business)"
This is not why they have no industry. Trade does not cost jobs overall, at most it relocates who does what between and within countries. I'd read a book like Why Nations Fail for a better explanation of why some countries struggle to develop complex industries (governance and economic institutions).
In any case, importing nets results in people manufacturing them using proper economies of scale in countries like Vietnam, Thailand, China and Tanzania (where AMF buys its nets), which is also valuable.
Closing yourself off to foreign inputs is no path to economic development.
Two thoughts, there's a difference between trade, where the consumers get to choose what they are buying and aid, where they have no choice whatsoever. If you start, say an import business to provide people with a certain good that they can only get abroad, you are certainly providing jobs, and you are catering to the needs and wants of the people. Instead of having jobs producing the goods, people have jobs storing and selling them. Perhaps fewer jobs, but jobs nonetheless. I'm not talking about trade, I'm talking about aid. The difference is that aid is temporary, AMF goes in, employs a lot of people to help distribute nets, and then leaves them to cut costs. They don't give the same long term employment that an import business or local factory might provide. I'm not arguing against trade, I'm arguing against unsustainable aid like AMF.
As for economic development, if we consent to the thesis that it is based on the strength of institutions, aid does not help those either. Aid does several things, it makes politicians beholden to foreign donors instead of the people, by tying conditions to money or goods to come into the country. This harms political institutions since the laws of the country are based not on what the people actually want, but on what foreigners think is good. This leads to laws that are on the books solely to appease international donors, but which are never enforced on the ground. Furthermore, and more appropriate to AMF, it leads to the perception of the people that it is the responsibility of foreign organizations to solve problems, not the government. This means that they do not hold their elected officials accountable, which inevitably weakens these institutions.
I'm not saying we should close ourselves off to foreign imports, which provide steady jobs, I'm saying we should stop giving money to organizations which donate goods and take away local jobs, of people who could either be working in a factory, or simply importing those same goods. If we supported these businesses instead, we could get similar outcomes without hurting the communities.
I think your arguments could be very impactful if substantiated further. You claim that AMF, for example, is net-negative ("Organizations such as AMF consistently hurt all three sectors, and reverse any good that their interventions do"). At present, your arguments are largely qualitative. Could you quantitatively demonstrate how AMF is net-negative?
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.
If there is an absence of accurate data, why should we believe that supporting AMF destroys more jobs than it creates?
It sounds like it is (anecdotally) easy to point to some people who have been hurt by distribution of free bed nets (local producers), but if there are economic benefits from reducing malaria, then any job gains will likely be spread amongst many sectors. You won't be able to identify such job gains through anecdotal evidence.
On a side-note, there is a blog post on the AMF website from 5 years ago discussing this issue of where they buy their nets. It would be interesting to hear if anything has changed since then.
https://www.againstmalaria.com/Newsitem.aspx?newsitem=Where-do-we-buy-our-nets-from
It's worth noting that AMF supplies long-lasting insecticide-treated bednets, which appear to be the most-effective type. If local producers are not producing this type, then the absence of AMF et al may lead to greater local jobs, but only in the production of bednets that aren't as good at reducing malaria.
It is a good question, why, if the data is flawed or dubious, should you believe that there is economic harm taking place? I would return to the point of choice. If foreigners do not have sufficient data to determine that a particular intervention would do more good than harm, I see no reason that they should have the right to override the will of the community. If we cannot get correct data as to which interventions would help a community the most, why can we not instead simply ask the community what they want? If anyone knows what they need, it would seem that the community would. I'm not certain that more harm than good is being done, but I have seen enough anecdotal evidence of poorly conducted studies and visible harm, that I am quite concerned. It seems that in the absence of sufficient evidence we should revert to the will of the community.
As for benefits unidentifiable in anecdotal evidence, if we go under the assumption that studies here are inherently flawed, then these benefits will not be able to be measured until the society develops to a point where such studies provide accurate and useful data. Therefore all we have to go on are questionable studies and anecdotal evidence. Once again leading to an impasse and it seems that the tie should go to what the communities themselves actually want. In terms of the question about the economic benefits of reducing malaria, certainly they exist, the question we are asking is which benefits are greater, reducing rates slowly by supporting the sustainable growth of local businesses which are combating malaria, or reducing rates quickly while harming local businesses, limiting the choices of local populations, and increasing dependency on foreign aid? I think a strong case can be made for the former, but if we fail to analyze charities based on the amount of choice they give to populations and the level of dependency they create, we won't even be asking this question.
As for the question of where AMF buys their nets, in my mind it is less about the fact that they are buying them in foreign countries, and more about the fact that they are using money to buy goods instead of train individuals and build capacity. If they wanted to help out a net import and distribution business which employs, perhaps fewer people than a factory, but still is providing sustainable income to families, to distribute to a wider populous, or train them how to run educational programs about bed net use to increase demand, that would be helpful, because when AMF left, the infrastructure would remain and the people on the ground could keep doing the work themselves. The problem is that their current practices do not employ locals or leave in place any sustainable systems so that when they are gone, the people are left with no income, nets that will fail in at most five years, and no way to replace them. If they believe that the long lasting nets could not be made in country, that does not mean they should donate them, simply that they should help train an import business to bring in the higher quality nets, and educate the people about the importance of using those particular nets. There are so many better ways they could be spending their money, which comes back to the original point, Effective Altruism should focus on sustainable solutions which get the local communities to run and implement them, not one time fixes which fall apart as soon as the organization leaves.
"It is a good question, why, if the data is flawed or dubious, should you believe that there is economic harm taking place? I would return to the point of choice. If foreigners do not have sufficient data to determine that a particular intervention would do more good than harm, I see no reason that they should have the right to override the will of the community."
We have good evidence and reason to believe that bednets reduce the incidence and burden of malaria. The big question is over the economic impact, not so much the health impact.
So it seems we can be confident we're improving health, but less confident of the impact on jobs. We have two scenarios:
(a)Without bednets/AMF: people will die and suffer from malaria and there is an uncertain impact on jobs.
(b)With bednets/AMF: fewer people will die and suffer from malaria and there is an uncertain impact on jobs.
In fact, there is some evidence to suggest reducing malaria can boost economic growth and productivity: http://effective-altruism.com/ea/pd/longterms_effects_of_malaria_on_labour/
But ok: let's consider your anecdotal evidence. Based on this, how many jobs do you think have been displaced by the existence of AMF within a given country? How many people do you realistically think need to be employed to produce the bednets needed by a country? Do you have any figures, estimates, or even guesses for the number of people employed as bednet manufacturers in any country?
"We have good evidence and reason to believe that bednets reduce the incidence and burden of malaria. The big question is over the economic impact, not so much the health impact."
But we don't have good evidence that bednets are in fact being used in these communities and are actually actively reducing malaria rates, and I have experiential evidence that communities are not using these nets, and both families and health workers are lying to researchers when they come through about net use and malaria prevalence. Are some families using them, possibly. Is it significantly fewer than what AMF claims, I would argue yes.
To conflate AMF and bednets is to miss the whole point. There will be bednets without AMF. Those bednets will go to communities that actually want them and would pay for them, and support local jobs either in factories or import businesses. With AMF, the communities that want bednets will still get them, so there's no impact there, and communities that don't want them will not use them, so there's no impact there. The only appreciable impact is the loss of jobs and infrastructure to get nets to those that want them without AMF's help.
As for the claim about reduced malaria rates increasing household income, the study you quote claims that shocks like drastic malaria reduction would reduce household incomes for 30 years and significantly increase populations. In a country like this where there are already too few jobs and most people are barely getting by, that could be catastrophic. Most communities might not survive to see the eventual increase in household income, which comes as much from higher rates of education as anything else according to the study.
To the final point, I don't have the statistics, as noted above, I'm skeptical of any statistics that are coming out of this part of the world, because of the culture around telling strangers what they want to hear. Without accurate information, I feel, once again we must default to what the people actually want, as if anyone knows what they need, they do.
Which brings up a concern. You, and it seems most of the interlocutors here have failed to address to question of choice. The question of freedom. There is no dispute that AMF ignores the requests of communities. That they insist on top down development initiative instead of systematically bottom up initiatives. This is harmful because it does not give people a voice in what is done to them. It destroys the ideals of democracy and self determination. And it is the reason that people don't use the bed nets, because they don't care about what you think is valuable, because you never asked them what they want. Interventions which come from the community will be more effective, period. Because the community will actually need them and use them. Effective Altruism fails because it does not realize that the effectiveness of a program is contingent on how invested a community is in that program, and the community's investment is contingent on you actually asking them what they need.
"But we don't have good evidence that bednets are in fact being used in these communities and are actually actively reducing malaria rates"
Yes we do. For example, this systematic review considers 22 randomised controlled trials which look at morbidity and mortality from malaria: https://www.ncbi.nlm.nih.gov/pubmed/15106149
Note the difference in outcomes between insecticide-treated nets and untreated nets. Locally-produced nets are likely to be untreated, which aren't very effective.
This study finds that the impact of scaling-up supply of bednets across several countries is consistent with the findings of previous trials: https://www.ncbi.nlm.nih.gov/pubmed/21909249
Are you happy to accept this evidence?
"Are some families using them, possibly. Is it significantly fewer than what AMF claims, I would argue yes."
What claims do AMF make about use?
Let's back up, because you are continuing to ignore two of my arguments against AMF, that they create dependency, and that they limit freedom. I'm skeptical of the studies for many reasons, everything from a lack of professional ethics of local translators and surveyors, to the troubles of conducting longitudinal studies with children in compounds which often have different children staying in them from day to day, to dissimilarities between what AMF does and what is done in these studies, to philosophical concerns that I have with any such studies that I have from a methodological standpoint. However, the claim I make at the top of the article is that we need to reassess the criteria that we use for determining an effective charity, while debating whether or not the interventions of AMF do what they claim to do may help us to determine if it is inevitably effective, it misses the central point, that effective altruists ignore metrics like job creation, freedom and dependence when evaluating charities.
You still have failed to address the problem of choice. Why can you not care less about what the people want? Why do you think that money gives someone the right to determine how others live their lives? Should we live in a world where only those with money have the right to choose what happens to everyone? That's the world AMF promotes. By giving to charities that ignore the voices of the populations on the ground you perpetuate the culture of corruption, ubiquitous in modern politics (especially here). People here feel powerless to change their own destinies, because you decided their destiny for them. You condemn them to a generation of poverty with the hope that their economy will recover, when maybe they don't want that. If I told you that you could live in poverty for 30 years and based on some economic models which may or may not apply you can improve in your income modestly afterward would you agree? If someone you had never met decided that you should live in poverty for 30 years to eventually see a possible increase in income, do you think that they would be right to make that decision for you?
Please stop cheery picking one or two points which are tangential to the actual argument, and answer this: why should we ignore the will of the people? What gives you the right to decide for them? Did they elect you? Do you know them? Have you ever even visited the places that you are making choices for? Why does wealth give you the right to dictate how people you have never met overcome poverty?
"Please stop cheery picking one or two points which are tangential to the actual argument"
Your argument is only based on anecdotal evidence. I'm happy to address many of your points, but if you're not actually willing to accept a significant amount of evidence as to the health benefits, I don't see why you expect us to accept your anecdotal evidence concerning jobs.
I'm happy to discuss the question of choice, though you seem to also oppose Give Directly, which precisely provides people with more choice.
I expect you to write an unnecessarily long response to this.
These are pretty unoriginal generic arguments against developing-world charity. I think you should do more research on how these arguments apply GiveWell charities and engage with the existing arguments they have made for why their charities are cost-effective. Local mosquito net industries are clearly not an important driver of economic growth that they would outweigh the benefit of large reductions in malaria. The second point is just a quote about a bad charity methodology with almost no explanation for why GiveWell charities do what Easterly criticizes. The third point is just wrong. GiveDirectly gives one-time cash transfers to individuals, not ongoing aid.
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.
Are you against buying goods from other countries when it's cheaper to get them from there, rather than manufacturing them domestically?
If you aren't, you also shouldn't be against a country receiving free bed nets. Receiving free goods from another country is just an extreme instance of goods being cheaper to buy from overseas (in this case for $0), which benefits the recipient country.
If we could get free clothes, free cars, free food, and so on from overseas, that would be awesome. People and capital are freed up to produce other good/services domestically rather than the ones which are now available at no cost.
AMF usually buys the nets from overseas because it's cheaper to get them from there - where enormous factories have economies of scale to produce them cheaply. That's where the locals should get them from as well if they want to buy them on the open market for personal use.
"never have they said that the thing that they need is bed nets, or malaria reduction"
In thats the case they can just not accept the nets, no harm done.
I am against it when unemployment is so staggering in a country that young people leave en mass because they have no future. I am against it when there is literally no industry in a country and a single factory could make a world of difference. I am against it when the people in the country do not have a choice in the matter, when they cannot say, oh I would rather buy a bed net to support my local business here than to buy one from a foreign company, and instead they are forced to take bed nets for free, destroying any possibility of fair competition.
As for the claim that if we could get free things from abroad, it would be great, have you ever lived somewhere were you get everything for free from aboard? I do. Over 95% of my country's budget is straight aid. Everything is subsidized or donated. And it is horrible, no one has a job, (if you get free clothes, anyone that works at a clothing store is out of work, if you get free food anyone that works on a farm, or at a restaurant is out of work) so there is no capital lying around for you to do something with. We can't produce anything here, because no one wants to invest in a developing country, they would rather help by donating their money to keep these harmful charities alive.
If AMF spent a little more money and helped to create factories in the countries that they worked, they would actually help the local economies, prevent brain drain, and allow people to help themselves, the problem is that then, everyone at AMF and the foreign factory would be out of a job, since the people in the country could handle it themselves. It is better for them to perpetuate the problem and increase dependence since that will keep them in business. Spending a little more could make a world of difference. And this is exactly the problem with only assessing charities on certain factors while ignoring others.
How can locals get something from abroad? Most retail companies do not ship here, and even if they did it would be drastically out of anyone's price range. But not if they were made locally.
As for no one requesting bed nets, imagine that you go door to door in a town that makes matchsticks giving out free matchsticks for life. Imagine also that this town is sufficiently poor that if they can get something for free they don't have a choice. If you asked them, they would say they needed more jobs, but you did not ask them what they wanted. You give out matchsticks and eventually the factory, the only source of income for many families here, shuts down. You did harm. People here can't afford to refuse something that is given for free, and it hurts them in the long run. Why would it be so hard to use your money to give the community what they actually wanted? What gives you the right from afar to decide what a place you have never seen or visited needs? Why do you think that you know more about their lives than they do? Every day I see the harm that these organizations do, but since the recipients have no voice in these forums, the donors keep on doing their worst and patting themselves on the back for it.
It's worth pointing out past discussions of similar concerns with similar individuals.
I'd definitely be happy for you to expand on how any of your points apply to AMF in particular, rather than aid more generally; constructive criticism is good. However, as someone who's been around since the last time we had this discussion, I'm failing to find any new evidence in your writing—even qualitative evidence—that what AMF is doing is any less effective than I'd previously believed. Maybe you can show me more, though?
Thanks for the post.
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.
Good to read!
I appreciate you posting on this forum, carneades. Your take on international development is in line with economic principles and what I've learned from people from Africa and India. EA badly needs this type of debate. What I am not hearing from you or others who take your point of view, however, is solutions. While your general criticisms of international aid are valid, what are the solutions? How do we help people in poor countries to develop and be more independent? There are charities like One Acre Fund that seem to only have a positive impact because increasing self-sufficiency. Should poverty philanthrobucks focus on those? What specific charities or interventions would you recommend?