The GiveWell Blog

Poor in the U.S. = rich

(updated on: ) | by Holden

A single-parent family of three in New York, making $8000 per year, makes under half the income level of the Federal poverty line and qualifies for food stamps, TANF (direct cash benefits) and Medicaid. (Details at our guide to U.S. public assistance)

And yet, at $2,667 per person per year, this family is wealthier than 70% of the people in the world. (See the Global Rich List calculator as well as the Giving What We Can version, which may be using more up-to-date data.)

In the poorest parts of the world, fewer than half have access to a latrine or toilet; only 17% own a television; and 19-45% lack access to a reliable source of clean water. In the U.S., practically everyone has all three. (Details.) As we wrote yesterday, the two areas have completely different concepts of “hunger.” And finally, while anyone in the U.S. can ultimately be served in an emergency room, people across the world die or suffer from health conditions for which proven solutions exist.

In the U.S., helping the less fortunate usually means tackling a thorny “equality of opportunity” problem such as improving education or helping struggling adults to find and retain jobs. These problems have a long history of failure and few proven approaches to them. By contrast, helping people overseas can mean delivering something as proven and life-changing as a bednet or tuberculosis treatment.

Hopefully, these observations give some context on why a charitable dollar goes so much further overseas. If you are looking to use your wealth to help those less fortunate, we believe it’s hard to argue the case for U.S. as opposed to international charity, unless you believe that American lives are orders of magnitude more valuable.

Hunger here vs. hunger there

(updated on: ) | by Holden

There has been a fair amount of buzz lately (examples here, here, here, here) about “food insecurity” in the U.S. According to the Reuters headline, one in seven Americans is short of food. In looking into the data, what has surprised us is how different the meaning of “hunger” is when we’re talking about the U.S. vs. the developing world.

Developing-world hunger: 30% of children underweight

Developing-world hunger is usually discussed in terms of incredibly severe indicators of hunger. For example, a 2008 Lancet study estimates that

  • 32% of under-5 children in developing countries are “stunted” (height-for-age severely below normal, such that only 2.3% of children should be “stunted” in a normal distribution)
  • 20% are “underweight” (weight-for-age severely below normal, such that only 2.3% of children should be “underweight” in a normal distribution)

  • 3.5% are “wasted” (weight-for-age even more severely below normal, such that only 0.13% of children should be “wasted” in a normal distribution).

These are indicators of severe, long-term consequences of constant undernutrition for young children.

Food insecurity in the U.S. means anything other than complete and constant food security

The recent USDA release that has formed the basis of the recent discussion of U.S. hunger states:

Eighty-five percent of American households were food secure throughout the entire year in 2008, meaning that they had access at all times to enough food for an active, healthy life for all household members. The remaining households (14.6 percent) were food insecure at least some time during the year, including 5.7 percent with very low food security—meaning that the food intake of one or more household members was reduced and their eating patterns were disrupted at times during the year because the household lacked money and other resources for food. (Emphasis mine)

The report’s summary specifies that food insecurity is usually temporary as opposed to chronic (pg 9) and that children are usually protected from food insecurity even in food-insecure households (pg 6-7).

The “food insecurity” categories are derived from people’s answers to questions like “We worried about whether our food would run out before we got money to buy more” and “We couldn’t afford to eat balanced meals” (full list on pg 3). The details of the answers are found on page 45:


These data imply that anything approaching the sort of hunger measured in the developing world is practically nonexistent in the U.S.

Note in particular the difference regarding children. In the developing world, as shown above, severe child hunger is rampant. In the U.S., even in “food insecure” families, it’s extraordinarily rare for children to go hungry even temporarily. And indeed, World Bank data estimates that 1.3% of U.S. children under 5 are “underweight” – less than the 2.3% that would be expected in a fully normal distribution.

Also note that the USDA report estimates costs for different levels of “food plans” (pg 55), and that its “Thrifty” plan – the cheapest – ranges from $21-$40 per week ($3-$6 per day) depending on age. In the developing world, meanwhile, over 2.5 billion people are estimated to live on less than US$2.50 a day total.

Bottom line

We have no intention of trivializing the situation of those in poverty in the U.S. But for a donor making choices, it can be stunning to see what a different meaning “hunger” takes on when applied at home vs. abroad. Do you value the lives of Americans so much more that you’d rather help people with the second kind of hunger than people with the first?

Acumen Fund and social enterprise investment

(updated on: ) | by Holden

Seth Godin makes an appealing case for “social enterprise investment” along the lines of The Acumen Fund:

When two people trade, both win. No one buys a bar a soap unless the money they’re spending for the soap is worth less to them than the soap itself.

When someone in poverty buys a device that improves productivity, the device pays for itself (if it didn’t, they wouldn’t buy it.) So a drip irrigation system, for example, may pay off by creating two or three harvests a year instead of one.

…

How does Acumen Fund create these markets? The answer is patient capital. The companies that are selling solar lamps to replace kerosene or water purification systems in tiny villages, or housing projects for peasants in Pakistan or even ambulance services in Mumbai fully intend to make a profit, but the venture capitalists on Sand Hill Road aren’t in a hurry to invest in them. The investments are a little too risky, take a little too long or a little too unproven to take a chance on.

So Acumen finds these entrepreneurs on site in the developing world, funds them, teaches them and pushes them to build really big organizations. A to Z has literally thousands of people in their modern factory creating malaria bed nets in Tanzania. And so it grows.

There are reasonable arguments that this sort of larger-scale financing is far more promising than microfinance, which typically focuses on tiny microenterprises that are unlikely to achieve large scale and create jobs. If we could find a strong charity in this area, we’d be excited to recommend it. But as with other areas, we try to go beyond the story and ask critical questions, and so far we have found no organization – including the Acumen Fund – that appears to answer them.

Our main question in this area pertains to an investor’s track record. We’d expect large-scale investing to have a success rate well under 50%, but we’d want to see at least an example or two of real success in the past, consisting of any of the following:

  • An investment that has been shown to improve the lives of customers (for example, tracking bednet use in areas served by A to Z).
  • An investment that has been shown to create jobs, i.e., employ people with previously low incomes.
  • A financial return. (Note that it isn’t enough to point to a “portfolio” member and observe that it’s a successful, self-sustaining business. Anyone can make a loan or grant to an already-successful business; this doesn’t mean they’re having an impact.)

Given Acumen Fund’s reputation for (a) general excellence and (b) focus on evaluation (see the Acumen Fund discussing these issues here and here), we would have expected them to produce such examples. But after evaluating them for our economic empowerment grant, we have concluded that:

  • They do not directly track social impact of the organizations they invest in.
  • They do not have information on the effects of their investments on jobs.
  • They have declined to share information on the performance of their loans, and have not yet exited any equity investments.

A couple of other concerns:

  • At least one of their investments, VisionSpring, has a major charitable solicitation component (for example, they have applied for funding from us). Acumen’s loan could end up getting repaid by donations, which wouldn’t go well with the idea of “patient capital to create self-sustaining institutions.”
  • Their documents are largely at too general and vague a level to give a concrete sense of how their investments are going.

Given this situation, it’s hard to see the organization as more than an experiment at this point. No matter what its team’s credentials, there is the enormous question of how developed-world business experience translates to the goal of making good and socially impactful investments in the developing world.

As with other unproven charities, it seems to us that Acumen should be primarily funded by those who are very close to the relevant people and issues, until it is able to demonstrate not just a good story but some real results. Other similar organizations seem to be similar cases.

The Global Fund and transparency

(updated on: ) | by Holden

We recently complained that “UNICEF provides no information about where the money goes and what projects are in progress.” Some might feel that this complaint comes from unrealistically high standards of transparency, especially for organizations such as UNICEF. How is an organization spending $2.7 billion a year supposed to report its activities?

Our answer would be: “like the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) does.” (Page 55 of its 2008 annual report shows that its budget size is very close to UNICEF’s at $2.7 billion.)

GFATM provides an online program search of all its activities. For any grant it has given (example), you can see (if completed) the grant proposal, grant agreement, and reports on progress. In other words, you can see how much has spent and how (and whether) progress has been tracked.

GFATM recently released the kind of document we have never seen from any other charity approaching its size: an overall evaluation of its activities and impact. Not a general discussion of the organization; not a “meta-evaluation” discussing the quality of past evaluations; a discussion of the overall impact of all of GFATM’s activities across the world. Furthermore, this report was in no way a fundraising document; it was frank about the fact that inadequate evidence exists for GFATM’s impact to date (see the discussion at our review).

GFATM comes under a lot of criticism, even from its own evaluators. We ourselves have many reservations about its work, as our review establishes. But we have seen very few charities – and no other charities approaching its size – that can make as strong a claim to being a transparent organization and a learning organization.

GFATM proves that neither size nor celebrity support need stop a charity from being clear about what it’s working on and how it’s going.

Two charities, one microfinance institution

(updated on: ) | by Holden

We’re looking for a good option for U.S. donors interested in supporting microfinance. We’ve been examining the largest, most prominent U.S.-registered charities in this area: Grameen Foundation, Unitus, Accion, Women’s World Banking, Opportunity International and FINCA. All of these are large organizations that list a variety of “partner” microfinance institutions.

One thing that might surprise a donor in this area is that sometimes the “partnerships” overlap. For example, Women’s World Banking lists Enda Inter-Arabe in its network, and so does Grameen-Jameel (which itself is a joint venture of the Grameen Foundation). Neither organization’s profile mentions the other.

Grameen Koota lists the Grameen Foundation and Unitus (among others) as donors and lists Unitus and Accion as consultants. Unitus’s page on Grameen Koota doesn’t mention Accion; Accion’s doesn’t mention Unitus; the Grameen Foundation sounds like its relationship is currently more consultant-like than donor-like.

As you can see from the profiles linked above – and as we’ve found from talking to the large microfinance charities – most (not all) of their activities consist of consulting or “technical assistance,” rather than founding, directly supporting or investing in microfinance institutions. The relationship between them and their “partners” often appears relatively limited, and it’s difficult to pin down who’s responsible for what.

Focusing on technical assistance and consulting isn’t necessarily a bad thing – perhaps U.S. expertise is just what these institutions need to serve more clients and serve them better. But we aren’t sure this is the case – it’s also possible that the U.S. charities have sprung up because of strong donor demand for the “story” of microfinance, and are consulting because they have more than they can productively spend on investing and creating.

What we know is that it’s inherently hard to gauge a charity’s impact when its main activities consist of free (or heavily subsidized) technical assistance. Even if we had all the information we want about the partner MFIs themselves, we’d still need to understand the extent to which help with business planning or product design made a difference to them.

So far, we haven’t seen many signs that the U.S. charities are critically asking this question, or making it possible to hold them accountable for the answer.

Denying the choice

(updated on: ) | by Holden

GiveWell spends a lot of time on the question, “Should I give to charity A or charity B?”

One of the things that has surprised us about the world of charity is how many people insist on answering, “Both” or “You can’t/shouldn’t be asking that question.” To them, all that matters is whether a charity does some good, not how much good it does or how it compares to other options.

One statement of the idea comes from none other than the Jeffrey-Sachs led WHO Commission on Macroeconomics and Health (footnote 24):

Many have asked the Commission what to do if the donor money is not made available—in essence, how to triage with less money. We are asked to prioritize millions of readily preventable deaths per year, since we have already narrowed our focus to a small number of conditions that have an enormous social burden and that have low-cost interventions that are at least partially effective. Not only is this kind of triaging ethically and politically beyond our capacity, but it is also exceedingly hard to do in sensible way. Those who hope for a simple answer, for example to focus on the cheap interventions (immunizations) while putting off the expensive interventions (higher-cost prevention programs and antiretroviral therapy needed to fight AIDS) to a later date, misjudge the practical choices we face. The AIDS pandemic will destroy African economic development unless controlled; to fight measles but not AIDS will not begin to meet Africa’s human and economic needs. It would be wrong to go to the other extreme as well, and let the legitimate need to fight AIDS end up starving the cheaper interventions, so we advocate both. Moreover, the infrastructure developed to fight AIDS will support the infrastructure needed to fight measles, especially if strengthening such complementarities is explicitly built into the AIDS control effort. It is vastly more fruitful to design and finance a comprehensive program that addresses many critical health needs than to pick and choose the apparently inexpensive items.

More examples of this mentality can be seen in recent comments to our blog by John, Yael and Steve.

Our response to these comments is simple. Most donors have a certain amount they are willing to give, and that amount is less than enough to fully fund even one of the world’s underfunded humanitarian initiatives.

We don’t believe that any problem that people suffer from should be ignored or trivialized. We do believe that individual donors must choose which to address, and that they should be factoring in questions like “What evidence is there that my money can even do anything to address this problem?” and “How cost-effectively can I create change by giving my money here?”

In their personal and business lives, people constantly make tradeoffs on a limited budget. Imagine if a salesman tried to argue, “How can you choose between this car and that one? They’re both wonderful cars and each would make the other more useful. You should buy them both!”

Yet in the world of charity, the basic and undeniable idea of triage is constantly denied.