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.
"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 ... (read more)