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?

"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.

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.

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.

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.

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.

Thanks again. Here are my thoughts.

1. 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.

2. 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.

Hey, thanks for the thoughtful response. Here are my thoughts:

1. 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.

2. 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.

3. 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!

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.