Over the next year, we plan to focus on improving our understanding of developing-world aid and finding the best options for donors interested in this area. We believe that the extreme conditions in the developing-world mean there are many opportunities for donors to change lives significantly with relatively simple, cheap interventions.

Our research goals fall into 3 broad categories:

1. Find charities carrying out proven interventions.
   • We are going through the ~800 US-registered charities with annual budgets of >$1 million, and creating a directory of what activities they carry out (from what we can get from their websites and annual reports). Much of this work is being done with the help of volunteers, and we are currently seeking to hire a Research Analyst to help further with it.

   • Independently, we are going through academic literature and identifying the most promising interventions – interventions that (a) have been thoroughly studied and proven, and/or are particularly “straightforward”; (b) have high cost-effectiveness in terms of lives saved, cases of extreme suffering averted, etc. We have mostly completed this literature review for health, and haven’t yet started for economic empowerment or education programs. Some of our top interventions, along with how we identified them, are listed under Top interventions below.
   • We will use this information to put together rough, heuristic ratings for charities based on whether they are carrying out proven activities. Top charities will be investigated more thoroughly.
2. Review the literature on general questions about international aid. Our questions are listed under General questions about international aid below.
3. Study two particular regions in depth, including visiting them. We will likely pick regions based on where particularly comprehensive, well-reputed charities work. One will be in Africa (highest need) and another in India or Bangladesh (high need, but possibly greater economic opportunities). The goal is to have a more concrete picture of what life is like and what aid looks like from the ground; the picture won’t be a universal one, but may change the way we think about the rest of the report.

Top interventions

We’re combing academic literature, particularly the Disease Control Priorities Report, for interventions that are (a) proven and (b) cost-effective.

When we call an intervention “proven,” we mean (from this blog post):

• It has been previously carried out and carefully, publicly evaluated (often through academic research) in a way that provides strong empirical evidence for its positive impact on people’s lives. (A future post will further discuss our position on the “evaluation hierarchy” and what sorts of evidence we think are necessary under different circumstances.)

• The conditions under which it has been evaluated match the conditions under which it is likely to be carried out again, in as many relevant ways as possible.

We have some preference for interventions that are “straightforward”: a lower burden of proof is necessary to extrapolate from their past effects to their future effects. For example, we consider a vaccination program more straightforward than a sex education program, because it’s easier to track who got vaccinated than whether people changed their sexual behavior. More on the “straightforward” idea at this blog post.

“Cost-effective” can mean different things to different donors, because different donors have different idea of what sorts of life change are most “valuable.” We’re looking for activities that are highly cost-effective (high “bang for your buck”) by each of the following metrics (from this blog post):

1. DALYs averted. Although it isn't our favorite measure of value, the Disability-Adjusted Life-Year is a widely used metric that considers all forms of mortality and morbidity. Some donors may feel most comfortable aiming to avert as many DALYs as possible for their donation.
2. Economic benefits. Health problems impose an economic burden, not just a moral one. There are sometimes attempts (such as the "benefit:cost ratio" used by the Copenhagen Consensus and some versions of the social return on investment metric) to combine economic and moral benefits into a single figure, measured in dollars.
3. Life-years saved - for those who put a lot of weight on being alive vs. not alive (and less weight on quality of life). Interventions that focus on infant mortality are likely to be cost-effective in terms of saving life-years.
4. Lives saved.
5. Adult lives saved. It is common to value adult lives more than children's lives. In addition, adults are more likely to have dependents, making their deaths arguably more tragic (in a way that DALYs could capture in theory, but that DALY estimates generally don't capture in practice).
6. Cases of extreme suffering prevented/rectified. This goal has several subcategories, for different conceptions of what constitutes extreme suffering. One that jumps to mind is fistula (and other deformities associated with ostracization).
7. People brought to a normal standard of health and potential productivity. In some ways the opposite of the cause immediately above, in that it focuses on helping those with high potential rather than helping those with high need. (There are different places one could draw the line for "normal health and potential productivity" - is it enough to prevent/cure someone's blindness, or is it also important that they be adequately nourished and have reasonable job opportunities?)
8. Unwanted pregnancies averted / population growth slowed. Some donors might see births averted as a negative; others might feel that it is the key to better quality of life and sustainability.

At this point, our top health interventions are (roughly in order of priority):

• Vaccination
• Deworming (annual drug treatment that kills parasites)
• Micronutrient supplementation: iodine, iron/folate, Vitamin A
• Micornutrient fortification: iodine, iron, vitamin A
• Onchocerciasis treatment (ivermectin – annual drug treatment)
• Distribution of insecticide-treated bednets
• DOTS for tuberculosis
• Drug treatment for malaria
• Leishmaniasis treatment
• Skin disease treatment (scabies, pyoderma)
• Breastfeeding support/promotion
• Hygiene (handwashing) promotion
• Growth monitoring and counseling
• Tobacco taxation
• Traffic safety interventions
• Emergency medical care
• Treatment of cardio conditions using aspirin and beta-blockers
• African trypanosomiasis treatment

General questions

In addition to the charity-specific investigations mentioned above, we are reviewing academic literature on the following general questions (also listed at this blog post):

1. What is the evidence that aid works/has worked at all? That it has caused reductions in infant mortality, economic growth, or anything else?
2. Has aid worked better in some parts of the world than others? Are there any broad patterns in where and when aid works (as opposed to what interventions)?
3. Can we expect health aid to create economic growth? Can we expect economic aid to work in areas where health is poor?
4. Why have some parts of the world emerged from poverty while others haven't? Is there anything aid can do to make the former more likely? (#2 is about whether aid has accomplished proximate goals like improving health - #3 asks what the biggest success stories are and whether there's any plausible case that aid *could* accelerate them.)
5. What are the risks of aid causing harm, and what evidence is there for their severity? Possibly ways that aid can cause harm include:
   • Overpopulation due to declining mortality
   • Crowding out government aid; encouraging governments to remain corrupt
   • Talent drain: turning all of Africa's brightest into health/aid workers
   • Economic distortion: outcompeting private farmers and for-profit aid companies with subsidized prices
6. What is the current allocation of aid across the world? How much of it is going to programs that don't work or aren't proven? How much of it is going to programs that appear overfunded?
7. How can one determine whether an intervention is funded to capacity?