We completed our first year of research a few weeks ago, and are now starting up our second. (Our annual review and plan discuss what we’ve learned from our first year, and the many ways in which we’re changing our approach for year 2.)
We found some strong organizations the first time around, but our “bottom-up” approach (counting on our applicants to tell us about their activities) left us with a very partial picture of things. At this point we’re basically starting over, and trying to answer the following questions:
1. What are all the obstacles faced by people in different parts of the developing world?
I want to know as much as possible about the groups of people we’re helping (not just the diseases we’re fighting), because this helps us to (a) form better guesses about the most important problems to focus on; (b) focus on areas where a little aid goes a long way; (c) paint a picture for donors of what sort of difference a good program can make, beyond the usual idealized anecdotes or “cost per life/DALY saved” figures. (For example, when you save a life from malaria, what sort of a life is it? When you help improve someone’s income, what does that mean for what they’re able to buy?)
Ideally, we would know the following about as many different parts of the developing world as possible:
- Full details of the prevalence and severity of different health problems, including diseases (HIV/AIDS, tuberculosis, malaria, diarrhea, pneumonia, and NTDs), malnutrition (vitamin A deficiency, anemia, low weight-for-height and height-for-age), vision problems (including cataracts), and deformities (including cleft palate and obstetric fistula)
- Availability, and cost, of basic quality-of-life goods and services including health care, water, sanitation, electricity, financial services (savings, loans, insurance), and basic entertainment (televisions, radios, festivals).
- Availability, quality, and content of schooling.
- Common occupations, along with necessary skills/qualifications for each. I’m particularly interested in what it would take for someone to improve their occupation and income (are there plenty of opportunities if only they had basic help, along the lines of nutrition assistance or financial services? Or is the set of possible jobs highly limited?)
- What people most want to change about their lives, and what they most want help with.
I’ve been reading academic papers that answer some of these questions for certain areas using survey data; I’ve also talked to a couple of people who’ve spent significant time in the developing world, just to get a basic picture. I’ll share what I’ve learned so far in a future post.
2. What impact do different health problems generally have?
There are some diseases, such as AIDS, that we have a fairly good picture of in terms of their impact on quality/length of life. There are others – particularly the NTDs – that we know very little about. We need to examine enough medical literature to have a good sense of what possible symptoms are associated with different diseases, as well as a basic idea of how different health problems interrelate (for example, the extent to which malaria increases susceptibility to HIV/AIDS).
3. What are the most promising interventions and charities?
Answering #1 and #2, at least for some parts of the world, should have a major effect on how we think about #3, so we are focusing on #1 and #2 for now. The goal is to start with people and places, rather than programs. However, we want to make sure we’re checking out any particularly highly recommended, or otherwise promising, programs we come across (for example, recently we took a look at the Fred Hollows Foundation on several people’s recommendation).
We don’t expect to get anywhere close to “answering” all of the above questions, but that’s our framework for learning as much as we can to frame our investigations of charities. We have a lot of work to do. We’ll be sharing our findings as we go.