Charitable Donation Advice
Charitable Donation Advice is a recurring education effort. We work hard for our money, and we want it to work hard for the world, too! So, we learn more about our favorite causes so that we make informed charitable donation that make an impact. This was a recent discussion in our Poverty Busters Giving Circle.
Best Choices for Global Health
There are some cheap, easy technologies and treatments that can drastically improve health in the developing world. For example, a child who grows up with a $14 bed net and avoids malaria will earn 50% more as an adult. A cheap chlorine tablet can decrease child mortality by 75% and diarrhea by 95%. A nearly free oral re-hydration solution (ORS) of salt and sugar is the most effective solution in treating dehydration caused by diarrhea.
But wait a minute…
In Zambia, where chlorine is cheap and readily available, only 10% of the population uses it.
In India, only 1/3 of children under 5 with diarrhea receive (ORS).
What’s going on?
Don’t they care about their health?
Human beings are complex creatures, and Poverty Busters’ mission is to fund projects that make a difference. If we’re donating our hard earned money, then it better work hard for the world. If we’re buying mosquito nets, then the charity distributing them should be doing so in a way that makes sure that people actually USE them!
We’ve been reading Poor Economics, and last month we talked about health care. And we discovered three factors when it comes to choices poor people make about their health.
Information: AKA How Do We Know What Works?
Here in the West, among a population of well-educated people with access to the best medical information, there is a raging debate about the legitimacy of immunization. Now imagine being poor, having limited schooling, being either illiterate or limited literacy, and having very little access to newspapers, professional journals, and the internet. How is this person supposed to know that the best treatment for diarrhea is an Oral Re-hydration Solution (ORS) of salt and sugar?
In many parts of the world, it’s believed that the best way to treat an illness is through the blood. That means, they go to a doctor looking for a shot. When they receive an ORS packet from their doctor, they don’t believe it’s going to work so they don’t take it. When they get better (as they would have done regardless), they think I got lucky this time, but next time I need a better doctor. So, next time they go to a private doctor, who may have little to no medical training and is interested in keeping their patients happy, and gets a shot of anti-biotic. When they get better (as they would have done regardless), their confidence in shots increases.
Beliefs about how health works may have nothing to do with the real world.
Limited Options: Why the Traditional Healer Is Important
In many communities there is a vibrant community of traditional healers. Depending on your point of view, traditional healers may or may not be legitimate, but what’s important is why a person may choose to visit a traditional healer when they have a major medical issue like HIV, cancer, or a stroke. The community’s belief that traditional healers can cure diseases makes it acceptable to visit the healer, but it’s the lack of other options that drive the poor to their doors.
When a major medical problem hits a home, many poor people, having little savings, find they need to sell their assets or borrow high rate loans in order to afford to visit the doctor and then additional high rates loans to afford the medications. When they cannot afford the loans or the loan payments, they don’t get to the doctor or they don’t continue with their medications. When that door closes, they still have a need to feel like they’ve done all they can do, and so they turn to their local traditional healer.
It’s their poverty that causes them to avoid cheap, preventative care and their beliefs that drive them to seek out expensive and not necessarily effective cures.
Remember that gym membership you bought in January? How many times did you go before you stopped? This is what human beings do. In the moment, we postpone small costs and avoid small inconveniences because we imagine a time in the future where we won’t mind incurring that small cost or bearing that inconvenience.
Does this sound familiar??? I could go to the gym, but I have to find a parking spot. Tomorrow is Friday, and there are fewer people at the gym. I’ll go then. Or this… I shouldn’t eat this doughnut, but I’ll go to the gym tomorrow.
This is human nature, and it has important consequences for our health. It’s easier to postpone the purchase of chlorine tablets today. It’s easier not to stand in line at an immunization center for important shots. So, some of these easy, cheap solutions that can drastically improve health are not used because they cost money and are inconvenient.
The Solution: Consider Human Nature In Implementing Programs
“We should recognize that no one is wise, patient, or knowledgeable enough to be fully responsible for making the right decisions for his or her own health. For the same reason that those who live in rich countries live a life surrounded by invisible nudges, the primary goal of health care policy in poor countries should make it as easy as possible for the poor to obtain preventative care, while at the same time regulating the quality of treatment that people can get,” write the authors of Poor Economics.
It might be tempting to blame the poor for not being responsible or say, “If they only knew how important chlorination was then they would do it”. But that ignores the human nature that we all share. We are fortunate to live in a country, where we don’t have to think about safe drinking water. Someone has made that easy for us. My water is safe. Similarly, safe drinking water should be easy for the poor, and one method of having a chlorine dispenser at the village well which delivers the right quantity of chlorine with one turn of the knob drastically increased the use chlorine in one community.
When we’re looking at funding a project, we want to ask, “Has this charity structured the implementation to ensure success despite our human nature? Have they made it easy and convenient? If it can’t be made easy and convenient, are they providing an incentive to overcome our natural inclination to avoid pain?”