Tactical Philanthropy:

Sooner or later, donors are going to start being willing to pay for advice on how to give. This will transform philanthropy.

I agree that donors should be willing to pay for advice on how to give. I certainly would have done so back when I was in the for-profit sector, if I could have found an advisor I had confidence in for a price I could afford.

But it’s conceivable that donors – especially small donors – will never have to pay for philanthropic advice, because someone else will pay to give them that advice. To give a simplified example: say that you care passionately about the cause of K-12 education, but know little about it. Now say that for $1,000, you can fund a philanthropic researcher to produce a report for other donors whose gifts to K-12 education charities will total $10,000. That means you have the choice of giving $1,000 directly to a K-12 charity (though you don’t have much to go on in picking one), or spending that $1,000 to “redirect” $10,000 of uninformed giving to the charities recommended by researchers.

The latter can be a pretty good deal. Unlike in investing, in philanthropy it makes perfect sense to pay for the privilege of redirecting other people’s money. (In fact, this practice is already widespread – large donors often fund fundraising campaigns, with the aim of raising money from others, and lots of people are happy to fund advocacy charities that are ultimately aiming to redirect government funding.)

Picture a world where some donors use philanthropic research for free, and other donors pay for that research with the knowledge that it’s redirecting the first group’s money. This isn’t the only, or necessarily the most aesthetically appealing, way for philanthropic research to get funded. But it’s a perfectly good deal for all parties involved (the donors that get the free research and the donors that pay to improve others’ giving). It’s a model that couldn’t work in for-profit investing, but when it comes to philanthropy where donors are seeking to create public goods rather than add to their own wealth, I see nothing unsustainable about this setup.

That’s the basic arrangement we’re currently pursuing. We are seeking GiveWell Pledges from donors who might be happy to use our research, but don’t necessarily want to pay for it. Meanwhile, a different set of donors pays our operating expenses, in the hopes that we’ll be able to move money from the first group.

In theory, you can fight HIV/AIDS by teaching safe sexual behavior; fight diarrhea by promoting hygienic practices; reduce child mortality by educating mothers; etc. However:

• Research on the effectiveness of these sorts of programs is thin; and programs that combine documented effectiveness with clear replication models are, so far as we can tell, rare to nonexistent.
• Changing people’s behavior isn’t straightforward. For an example, consider the finding – regarding hygiene education – that “The interventions promoting the single hygiene practice of washing one’s hands with soap tended to achieve greater reductions in disease than those that promoted several different behaviors … numerous messages dilute each other in the minds of the target audience” (see DCP pg 785 – references given there).

If it’s true that education works best when it’s focused, that means that planning an education program right means not just identifying behaviors that need changing, but analyzing which changes would be most beneficial. That’s a complex undertaking, and so is changing how people from another culture live their daily lives.

I’m generally not very optimistic about this category of intervention given what we know about it. Handwashing programs appear to be pretty well-documented and are a possible exception.

Both the Disease Control Priorities report (DCP) and Copenhagen Consensus (CC) acknowledge malnutrition as an extremely widespread and damaging problem, and both discuss a variety of interventions including breastfeeding promotion, vitamin supplementation, and fortification.

Yet both give hardly any space to the idea of direct food aid, i.e., providing healthy food (or the money necessary to purchase it) directly to people in poverty. CC states that such interventions are “cost-effective but more costly [than other interventions],” and that “because of the emphasis on costs and cost-effectiveness levels we focus on [other interventions such as supplementation] only” (Pg 6). DCP’s chapter on malnutrition (551-565) mentions direct aid only in one paragraph, in the context of comprehensive child nutrition programs, and states that “No consensus exists on when or how to include supplemental food to reduce undernutrition, and inefficient targeting is frequently a key constraint to effectiveness” (556).

Direct food aid seems to me to deserve much more attention, specifically because it is a potential solution to several of the most difficult types of malnutrition to address:

• Iron deficiency, which can cause anemia and impair cognitive development (DCP 553-4), is extremely difficult to address through supplementation or fortification because of how frequently iron needs to be ingested (DCP 558). Might frequent consumption of meat be an easier sell than frequent consumption of supplements?
• Protein-energy malnutrition can result in emaciation and stunted height (30-50% of under-5 children sub-Saharan Africa and South Asia suffer from these problems – see DCP Pg 552). As this condition results from insufficient calorie consumption, it does not appear to be treatable through vitamin supplements. Breastfeeding may ensure adequate calories for infants, but what about afterward?
• There is also always the possibility that our understanding of nutrition isn’t sufficient to name all of the necessary nutrients, and that the best way to give someone a diet that works as well as ours is to give them similar food (rather than simply identifying what seem to be the essential nutrients and providing those).

Direct food aid programs have come under fire due to the practice of obtaining the food from the developed world, which may cause economic distortion and problems for developing-world farmers. But this problem doesn’t seem inherent to direct food aid, only to programs that insist on using developed-world surplus food; a program that bought what it could from nearby farmers, and provided the rest from overseas, would not obviously cause more distortion than other aid programs.

Direct food aid programs may be costly and complex, but they may also be the only way to ensure truly adequate nutrition in some parts of the world. Why aren’t they getting more attention from otherwise thorough analyses?

According to the Disease Control Priorities Project, expanding vaccination is an excellent fit for donors who want proven, cost-effective, scalable ways of helping people. According to this table (more detailed version on page 401 of the full report), both South Asia and sub-Saharan Africa have relatively low levels of existing coverage (50-58%), and vaccinating more children could save lives for about $200 each. If saving lives is in fact your priority (and we know it isn’t for all donors), that’s hard to beat.

The most promising nonprofit I know for implementation is the GAVI Alliance, which we have yet to thoroughly evaluate.

I get two very different pictures of how aid funding works, depending on whether I’m looking at my options as a donor (as I’ve been doing for the last couple of years) or reading papers intended for policy makers (Disease Control Priorities report, Report of the Commission on Macroeconomics and Health).

The latter sources focus almost entirely on the granting of aid to developing-world governments by “donors” including “bilaterals, multilaterals, global programs, foundations, and large NGOs” (pg 249) – i.e., megadonors (not people like me). Pgs 247-250 discuss the coordination problems caused by different donors’ earmarks and reporting requirements as well as the potential advantages of “ensuring the countries, not donors, drive the coordination” (249). The WHO Commission on Macroeconomics and Health takes a similar perspective, endorsing a top-down plan to be implemented in partnership with governments, using the Poverty Reduction Strategy Papers they create.

Yet as a donor, I’ve never looked at or discussed the possibility of giving money to developing-world governments. I’ve dealt with U.S. public charities, and the proposals they send (large list here) involve their own projects carried out by their own staff. We’ve never discussed their role in helping to carry out the kind of large-scale plans endorsed by the WHO commission. A quick glance at CARE’s Form 990 reveals that only 18% of its expenses are grants of any kind, so they certainly don’t appear to be directing the majority of their aid to governments.

It’s possible that the link goes the other way: the DCP report mentions governments’ hiring NGOs (Pg 252). But if the NGOs are contractors, not agenda-setters, where does an individual’s donation fit in?

Either way, it doesn’t help that few NGOs have been able to give us a clear explanation of what they do (in particular, how their top-level agendas are set).

Complicating the matter further are “alliances” such as GAVI and The Global Fund. These appear to be partnerships aiming to consolidate and coordinate funding, and they fund both governments and NGOs. Does that make them a more appropriate recipient of gifts than typical NGOs? How does the Global Fund to fight AIDS, Tuberculosis and Malaria coordinate with the Roll Back Malaria Partnership and Stop TB Partnership, which appear to have largely overlapping goals but still all solicit donations individually?

Let’s say I’m a donor who trusts the WHO Commission and just wants to be as helpful as I can, without imposing my opinions about particular diseases and priorities. Should I give to the WHO? To a developing-world government? An alliance? An NGO? We’re getting a better handle on the situation and starting to break down the options, but as of yet we still haven’t seen clear answers to these sorts of questions.