Country Director @ OneDay Health
5434 karmaJoined Oct 2018Working (6-15 years)Gulu, Ugandaonedayhealth.org



I'm a doctor working towards the dream that every human will have access to high quality healthcare.  I'm a medic and director of OneDay Health, which has launched 35 simple but comprehensive nurse-led health centers in remote rural Ugandan Villages. A huge thanks to the EA Cambridge student community  in 2018 for helping me realise that I could do more good by focusing on providing healthcare in remote places.

How I can help others

Understanding the NGO industrial complex, and how aid really works (or doesn't) in Northern Uganda 
Global health knowledge


Love this thanks for the insights, this definitely helps answer some of my questions about people like Weinar. When a couple of people I knew mentioned that article, I pointed them to what I think are better criticisms here in philosophy tube (also more fun)


I am encouraged though that a few people have written responses to Thorstad over the last couple of weeks. Not exactly blowing up on Twitter but some good engagement at least ;)

It is pretty clear that the longer the shrimp, the higher the moral weight. Long live the long shrimp orgs

Except they should maximize confusion by calling it the "Macrostrategy Interim Research Initiative" ;)

Answer by NickLaingApr 16, 202413

First, focus and drive to scale is very important. The "dream" as a small charity is to figure out how do your  one thing well (give mosquito nets, give money, incentives for vaccines ets.) then iterate, replicate and scale up. Bigger charities don't think that way and are comfortable just to "add" and "maintain" programs rather than drive hard for impact and scale. I doubt bigger charities would have the focus and drive to scale new initiatives compared to founders of small charities which have more energy and where the sky is the limit.

Second, new small charities can be lean  (bit of a cliche). On the other hand many big charities actually become more inefficient as they get bigger (I'm sure there are many exceptions) and already ogten have "locked in" many inefficiencies. My evidence for this is that the classic big charities which do lots of things (oxfam, save the children, world vision etc.) are some of the least efficvient charities around.

 Unfortunately as charities scale up, its often the opposite of business. You don't gain much from economies of scale, instead you add lots of middle management and each "unit-of-good" can become more expensive than it was when you were a smaller charity. I'm even struggling with this situation a bit with our charity at the moment.

I actually think the opposite should often be the case, bigger charities could split up or downsize, in order to focus on the one thing they are best at.

I'm talking mainly about the GHD space here by the way, don't know anything about animal charities.

I've written about this kind of thing a bit more here.




After reading a bit more, one potential issue here is that most of the white sorghum and cassava processed by this project (Anthony can correct me if I'm wrong) will be used for making alcohol, which could cause negative externalities through increasing alcohol production or reducing price, although this is hard to measure.

There could also be more local brewing as well using these crops.

Anthony what do you think about this potential negative to selling sorghum to the alcohol companies?

@Thomas Kwa in my eyes this is a hugely insightful (perhaps even spectacular) response, thanks for taking the time to think about it and write it. Perhaps consder writing a full post with these kinds of insights about benefits of CEAs.

That is If you can stomach spending more time away from your real job making sure that we still exist in 50 years to even talk about GHD ;).

Perhaps then in this case you just don't agree or disagree when it's 50/50? Looking at it now I also don't think my little CEA is plausible, I do think it perhaps got taken a bit too seriously though :D!

I also probably "disagree" with my analysis

Disclaimer I don't know much about the HPMOR thing - for example I didn't know it only tangentially plugged EA. I was just giving a 2 minute example of the kind of analysis you might do (obviously with better info then I had), and that it is possible to do that CEA. I wasn't trying to justify the grant at all my apologies if it came across that way!

Also I don't think this post is getting that hostile a response?

I understand the sentiment but disagree. For global health interventions, cost effectiveness analysis is doable and adds value. Most CE orgs and other aspirational cost effective orgs like my own have done some form of CEA as part of making their case

For Whytham Abby and Harry potter fan fiction that may be more difficult to do.

Although I think there should be far more CEAs across all fields. Like for Harry Potter giveout I would have done something like (obviously this is full hack)...

DISCLAIMER: I'm not saying this actual BOTEC is meaningful, I'm just giving it as an in example that these kind of CEAs are possible.

650 Students given books, I assume that of these 100-300 of these students will read them, and 0-5 will change their life trajectory towards giving or altruism to a small degree counterfactually due to the book. 0 to 2 will give 50,000 to 500,000 more over their lifetime and 0 to 5 will change their life direction and save 1 more life than they would have otherwise.

So cost effectivenss might be between 0 x $50,000 = 0 raised + 0 x 1 = 0 lives saved  and 500,000 x 2 = 1,000,000 dollars and 1 x 5 lives saved.

So the book handout might be somewhere between completely useless and raising $1,000,000 extra dollars for EA causes and saving 5 lives (I don't stand by this analysis, it's just a brief hack)

So compared with saving 6 children with nets it might be comparable-ish based on my 2 minute math. This kind of math might also have been done and not shared in the grant review!

Again, a disclaimer that I'm not trying to justify the grant here, just mocking up the basic mechanics of the kind of botec you could do.

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