Saving lives with fewer dollars

Speaker 1 This message comes from NPR sponsor Sonos. Fill your home with incredible sound and unforgettable moments with a Sonos.
Right now, Sonos is offering up to 30% off during their Black Friday event.

Speaker 1 Shop now through December 1st, 2025 at sonos.com.

Speaker 1 This is Planet Money from NPR.

Speaker 2 This is a story of two groups of people doing life-saving work in totally different ways. One group up close with their hands, and the other with numbers at a desk.

Speaker 2 That first group provides basic health care and medical supplies in the far north region of Cameroon.

Speaker 2 Their doctors and nurses give vaccines, they monitor pregnancies, train patients to look out for signs of malnutrition with tools as simple as a little piece of tape, like a measuring tape with red, yellow, and green on it.

Speaker 2 So a mom can wrap it around her kid's arm and measure whether her kid is malnourished.

Speaker 3 So it's a very easy to use tool that we train the mothers to use on their children so that they get to identify malnutrition very early.

Speaker 2 Madeleine Tronso manages grants for the organization called ALIMA. It's an acronym.
It stands for the Alliance for International Medical Action.

Speaker 2 Last year in Cameroon, ALIMA treated almost 400,000 people.

Speaker 2 Lima has been able to do this work by staying far out of the fray during an armed conflict that has been going on for years, by building trust and also by managing difficult logistics.

Speaker 3 Sometimes there's no road.

Speaker 3 You face,

Speaker 3 say, potential attacks. It's scary, it's dangerous.

Speaker 2 To continue that work, Alema's Cameroon program was supposed to get $1.9 million this year from USAID.

Speaker 2 When the Trump administration announced it was gutting USAID, Madeleine had just gotten back from a visit to Alema's doctors and nurses up in the mountains in an area called Mokolo.

Speaker 3 They had malnourished children in the beds of the hospitals. They knew that if we had to discharge all of these children, then they will not get treated.

Speaker 3 So I just thought, oh my god, what if we have to stop all this?

Speaker 3 Who's going to be able to take over?

Speaker 7 And what was the answer?

Speaker 3 Well, the answer is

Speaker 3 The health system is not able to take in all those patients.

Speaker 8 And that means those patients just don't get care.

Speaker 9 Yeah.

Speaker 2 Alima's Cameroon project is one of thousands of programs helping millions of people around the world that all of a sudden this year stopped having money. Tens of billions of dollars gone.

Speaker 2 An estimated 620,000 people have already died for lack of care.

Speaker 2 So while people like Madeleine and Cameroon are triaging, choosing what clinics and what services to sustain, across the world, there's a parallel triage at the desks of that other group doing life-saving work, the other part of our story, the people with the numbers.

Speaker 2 They are a philanthropic group. They have money and have been trying to figure out if and how they can help.
But they have their own very particular way of doing things.

Speaker 2 They have a lot of math to do, all while racing against the biggest, worst, loudest ticking clock they could imagine.

Speaker 2 Hello, and welcome to Planet Money. I'm Mary Childs.
Today on the show, we get to be a fly on the wall while one organization tries to fill in a tiny part of the enormous hole left by USAID.

Speaker 2 The calculations they're making are ruthless.

Speaker 10 If I'm adding up the deaths averted, it's like 650 averted in total.

Speaker 9 Is that right?

Speaker 9 Yes, I think so.

Speaker 2 This group led us in as they tried to reconcile this chaotic and terrible moment with their particular procedures.

Speaker 12 Uh, Sorry, where is the agenda?

Speaker 13 I haven't spotted it yet.

Speaker 2 So week after week.

Speaker 3 Oh yeah, did I not send it? I'm sorry.

Speaker 2 We were able to watch up close as they wrestle through one decision, whether to give their money to the project in Cameroon.

Speaker 14 Boop, boop, boop. There you go.

Speaker 14 Boop.

Speaker 15 This message comes from Vanguard. Capturing value in the bond market is not easy.

Speaker 15 That's why Vanguard offers a suite of over 80 institutional quality bond funds, actively managed by a 200-person global team of sector specialists, analysts, and traders.

Speaker 15 They're designed for financial advisors looking to give their clients consistent results year in and year out. See the record at vanguard.com slash audio.
That's vanguard.com slash audio.

Speaker 15 All investing is subject to risk. Vanguard Marketing Corporation, distributor.

Speaker 1 This message comes from Capital One with the Venture X card. Earn unlimited double miles, a $300 annual Capital One travel credit, and access to airport lounges.
Capital One, what's in your wallet?

Speaker 1 Terms apply. Details at capital One.com.

Speaker 2 In the days after USAID got gutted, private philanthropy groups everywhere were in a kind of panic trying to figure out how to help.

Speaker 2 And a few recently unemployed USAID workers used their newfound spare time to compile compile a list of all the projects that had just lost funding, from water sanitation in Yemen to researching bio-fortified maize in Guatemala.

Speaker 2 And that list landed on the desk of a philanthropic group called GiveWell.

Speaker 2 GiveWell donates hundreds of millions of dollars every year, and they have this very explicit goal, to make that money save or improve the most lives per dollar.

Speaker 2 through those ruthless calculations, through research and proof. So GiveWell assigned a special team of researchers and advisors to start sorting through the list, including Rosie Bettel.

Speaker 9 I was on our like rapid response team trying to like cougar up stuff between the cracks.

Speaker 2 GiveWell expected that they could spend about $50 million to try to fill in a little tiny part of that USAID hole. So Rosie and the rapid response team start zeroing in on a few specific projects.

Speaker 2 And one of them was Manilin and all those doctors and nurses in the mountains of Cameroon.

Speaker 2 So now GiveWell has to see, is this project a better choice than all of the other projects GiveWell could give their limited money to right now?

Speaker 2 And way back then in March, I asked GiveWell if they would record themselves as they try to sort that out.

Speaker 10 So I wanted to start this meeting actually for Mary from Planet Money, because I know you'll be listening to this recording.

Speaker 2 That's Taryn Maddox, the director of research, who, for my sake, starts the meeting laying out what she sees as the challenge GiveWell is diving into.

Speaker 2 The mismatch between GiveWell and their love of crispy, clear data and this project in Cameroon.

Speaker 10 We're facing a steeper learning curve in understanding the context because it's just terrain we don't know as well.

Speaker 2 So in this first meeting, GiveWell is mapping out what they will need to know.

Speaker 10 Actually, I'm curious, Rosie, if you can talk me through Like why this, why are we prioritizing this among the other opportunities that we looked at?

Speaker 9 So

Speaker 9 it's this region which is heavily affected by conflict.

Speaker 2 In many ways, this Cameroon program is emblematic of the kinds of things USAID had given money to. Big, multi-pronged programs in areas where there's conflict and poverty and malnutrition, disease.

Speaker 2 Or it funded programs promoting global stability or trade.

Speaker 2 And historically, GiveWell has operated more at the margins, looking for specific, efficient, and neglected projects so that they can prove with research and data and preferably randomized controlled trials that they are saving the most lives.

Speaker 2 The canonical example is buying mosquito nets to prevent diseases like malaria. The nets are super effective and super cheap.

Speaker 2 So, for this project in Cameroon, the GiveWell team is starting by trying to understand the most basic facts: how many people are in the area and at what rate do they die?

Speaker 10 Yeah, and these are populations that

Speaker 16 we think are just higher risk, higher mortality populations in general.

Speaker 9 Yeah, that's definitely something I really want to get into through this investigation.

Speaker 9 But like coming in, my sense would be, yes, they, more than the vast majority of people on the planet, really critically need like good health care like at this moment.

Speaker 2 And as they spend the rest of this first meeting on what they will need to find out, it could convince them to fund this grant or not.

Speaker 7 Okay, we'll check in soon. I'll look forward to seeing the investigation plan.

Speaker 2 Taryn is Rosie's boss, and when I spoke with her later, I learned on this rapid response team, it is her job to decide who gets money and who doesn't.

Speaker 14 Well, I manage the teams that decide where the money goes. I try to make sure that we're doing that, making those decisions in the highest quality way possible.

Speaker 2 Yeah. But you are kind of the buck stops.

Speaker 14 The buck stops with me. That's right.

Speaker 2 What GiveWell is looking for is the least expensive way possible to save the most lives or improve the most lives. In the unique language of GiveWell, they call it life-saved equivalent.

Speaker 14 So we're taking all of the benefits like averting disability, improving somebody's income, improving someone's cognitive outcomes.

Speaker 2 They assign precise numerical values to the benefits that a program provides so that they can compare how effective one kind of intervention is versus the next.

Speaker 14 Or putting that all into one measure and calling it like an equivalent life-saved. So that's a little bit of like nuance.

Speaker 2 And this type of calculation is unique to a little group of nonprofits and philanthropic organizations like GiveWell.

Speaker 2 They overlap with a philosophy called effective altruism, in which people try to, quote, do the most good based on the evidence.

Speaker 2 This arose with our newfound ability to gather and crunch vast amounts of data, which enabled more rigorous research. That transformed development economics.

Speaker 2 Everybody started doing randomized controlled trials, and this whole new way of thinking about aid was born. That is the context in which GiveWell started in 2007.

Speaker 2 And that's their promise to their donors who have handed their money to GiveWell because they also believe in this idea of saving or improving the most lives per dollar.

Speaker 2 But for all this to work, GiveWell has to have proof. So a couple days later, GiveWell asked the people running the Cameroon project to meet them on Zoom.

Speaker 16 We are recording this.

Speaker 10 If anyone's uncomfortable sharing externally, that's fine.

Speaker 9 Just shoot us a note or...

Speaker 2 First, the giveaway people want to know how urgent the needs are, and then they'll start to fill in the numbers they need.

Speaker 9 Okay, so if it's good. My first question is to get a sense of the current status of Alima's work in Cameroon.
Like, is everything still fully operational?

Speaker 9 Or are some parts of the program maybe not running like at the moment?

Speaker 18 No, they are not running in 100%.

Speaker 2 Joel Kambale Kamete is in charge of the program in Cameroon. And he says, yeah, we are already having to pull our doctors and nurses and staff.
Like in Makari, where they were in 14 health centers.

Speaker 18 Now we have only four health centers and one hospital. So it means from 14 health centers to four.

Speaker 2 And in Mokolo, their other location under discussion, they were in eight health facilities and now are down to just one, just the hospital.

Speaker 7 In Mokolo, if there's no other funding coming, then we'll have to shut down the project.

Speaker 2 Madeleine is in the meeting too, the one in charge of raising money for the Cameron project. And Rosie, the researcher from GiveWell, she asks Madeleine for more clarity on the demographics.

Speaker 2 This figure will go into one of Rosie's Givewellian calculations to get at the rate of lives being saved.

Speaker 9 So it's a mix of

Speaker 9 internally displaced people, host communities.

Speaker 16 Is that correct?

Speaker 7 So I can give you the population from Mokolo House District. That would be around 350,000 people.

Speaker 2 After their first meeting with the Cameroon group, the GiveWell team spends several weeks trying to compile the answers to some ruthless sounding questions, like how many children under five generally die in that area, and how many children will die without the Cameroon project's work.

Speaker 2 So the baseline mortality versus the counterfactual. And during GiveWell's internal meetings, Rosie and Taryn are doing this sort of unnerving child mortality math.

Speaker 11 When children die because of malnutrition, it's because it's usually because of a complication, right?

Speaker 11 So we have like children that are very unwell because they're malnourished and then they have, they get pneumonia or they get a case of diarrhea and that just puts their little bodies like over the edge.

Speaker 10 And so I wonder if we might be double counting essentially because.

Speaker 2 These mortality figures are

Speaker 2 weirdly hard to come up with. And it's a conflict zone.
So a lot of the patients are displaced people or refugees. They're pretty mobile, so they don't come back for follow-up visits.

Speaker 2 So GiveWell needs information that basically doesn't exist.

Speaker 2 Throughout April, clock ticking, they keep trying to make sense of the numbers, like this one data point of how many kids under five die every year per 10,000 people.

Speaker 16 Oh, so I'm just looking at this row 15.

Speaker 16 730 total deaths per year.

Speaker 16 And then if we're averting 650 of those,

Speaker 11 I'm with you.

Speaker 2 Taryn and Rosie are parsing this data point and asking, is that with the Cameroon projects, doctors and nurses?

Speaker 2 Because that would mean without them.

Speaker 6 Is that potentially like a little bit higher still, which would seem like

Speaker 9 really gutting, right?

Speaker 16 Okay, so is this on the list for us to just ask them about tomorrow?

Speaker 9 I think it's not. And actually, I think it should be.

Speaker 2 In addition to not having all the numbers give well needs for this project, there's another missing component so far that's just as important, on-the-ground research.

Speaker 2 Rosie told me later, both are crucial.

Speaker 9 If you're just like spreadsheet, spreadsheet, spreadsheet, model, model, model, without, of course, like really thinking like, hey, what is happening on the ground?

Speaker 9 You're liable to go equally astray in the opposite direction, right?

Speaker 2 But where GiveWell might normally hire some trusted research firm to fly in and confirm the Cameroon project's numbers, to say, yes, this many people are there.

Speaker 2 Looks like the hospital does indeed employ 54 people. They cannot do that here because the area is so unstable.
Like two researchers were killed here a few years ago.

Speaker 2 GiveWell talks a lot about this in their meetings by themselves and with Alema. Like, should they commission a study?

Speaker 13 Is it safe in the area to run these types of surveys?

Speaker 7 The like hardest to reach area will be hard to cover, and that's usually where we have the worst

Speaker 7 figures.

Speaker 2 A comprehensive study like the kind they want would take a year to get done, all while that clock is still ticking.

Speaker 2 On the other hand, the GiveWell team is thinking, if we don't spend the time we need to complete on-the-ground research and our spreadsheet, spreadsheet, spreadsheet, how can we be sure we're backing the right project?

Speaker 2 Taryn told me she's learned that sometimes real, measured, evidence-based outcomes can be counterintuitive. Like this one time when she first joined GiveWell in 2019.

Speaker 14 I remember looking into two different interventions around the same time.

Speaker 14 One was

Speaker 14 an intervention that was designed to reduce maternal mortality.

Speaker 2 And the other was helping a government switch an HIV test for pregnant women to test for syphilis as well. So which should they fund?

Speaker 2 Preventing birthing mothers from dying or testing for syphilis in addition to HIV?

Speaker 14 When you do the math, maternal mortality is extremely rare. And

Speaker 14 syphilis is like not as rare if you find the right places. And then the effects of having syphilis are lifelong and horrible.

Speaker 14 And it came out like one program was like a thousand times more cost effective than the other one.

Speaker 2 Adding the syphilis test saved way, way, way more lives per dollar. So they did the same cold calculations you hear in all these meetings.
And that is the project they funded.

Speaker 14 That's like an illustrative moment, but that happens a lot, actually, like where you go in and you crunch the numbers and your strong intuitions end up being wrong.

Speaker 14 I like having a framework that can discipline my compassion.

Speaker 12 Are you ever like, oh, I can't, I'm gonna do this like syphilis HIV switch that's like so high yielding?

Speaker 2 Like, how do you not think about the mothers that you're not saving?

Speaker 14 No, you think about them. I mean, I don't.

Speaker 17 Oops.

Speaker 14 No, it's okay. I'm sorry.
This is going to be bad audio. You think about them.

Speaker 14 And so I think that the best that we can do is say, we have this limited pot.

Speaker 14 We're going to use this the best way we possibly can.

Speaker 2 The GiveWell team goes into their next meeting with the Cameroon team, hoping to sort out some of the data that's not making sense to them.

Speaker 2 You can really hear these two groups trying to speak each other's languages. Taryn from GiveWell is talking to Susan Shepard from Alema and the Cameroon Project.

Speaker 16 We've heard about this like two children per 10,000

Speaker 17 mortality. Right.

Speaker 19 Yeah, I knew this was going to become a key point for you guys.

Speaker 19 Is this the first time you guys are trying to do a project evaluation in a humanitarian context?

Speaker 2 I was just thinking. A humanitarian context, meaning there's armed conflict, there are refugees and displaced people.
These are places where doctors without borders work and before this year, USAID.

Speaker 2 And Susan explains: there's a whole decades-long history of data crunching in regions like these.

Speaker 2 Measuring mortality and trying to, there are different ways of doing it, and it causes us, you know, endless discussions because like she says, the demographic and health surveys that everyone uses across the industry, those measure by live births per year.

Speaker 19 But humanitarian projects use the number of deaths per 10,000 people per day. I have never found a way to join those two to find out.
Yeah, I have never.

Speaker 19 I just say, okay.

Speaker 2 In another meeting, Taryn from GiveWell asks Susan a question that kind of goes to the heart of the difference and approach between the two groups.

Speaker 5 Why is service provision kind of targeted at places with conflict as opposed to just really high rates of mortality?

Speaker 11 Yeah,

Speaker 20 it's kind of the humanitarian.

Speaker 2 Susan again gives a bit of a history lesson, explaining that humanitarian aid, including this Cameroon project, is focused on reducing mortality, but not just that.

Speaker 8 I think it's the idea that

Speaker 20 people who are the victims of all of these conflicts, they're forced to flee or they're forced to move, you know, trying to provide the services that allow them to maintain some level of dignity.

Speaker 22 Gotcha. Okay, thank you.

Speaker 2 On the last day of April, the GiveWell team meets on its own again to go through their current back of the envelope calculations, which they call Botex.

Speaker 22 And I would like to start with the mortality coverage one.

Speaker 9 Yes. Okay, so like,

Speaker 9 so to give an overview, Botec, back of the envelope calculation, relatively simple.

Speaker 2 Rosie has fed all the information she's managed to collect into three different models, three ways of slicing the data to see how the Cameroon projects work impacts mortality in the populations they serve.

Speaker 2 One big thing they ask themselves, which I think of as very effective altruism, is: do these Cameroon programs work better than just giving people money?

Speaker 2 And Rosie tells Taryn that all three of her models are spitting out the same basic answer.

Speaker 2 They all say yes, a fair amount better, which Taryn says, which is pretty surprising, I think, considering how different the approaches are.

Speaker 2 Still, for GiveWell to fund a project, they usually want it to beat cash transfers by even more than what Rosie's calculations show so far. But she is still doing her maths.

Speaker 9 I've got like three Botex at the moment, but one is currently in my like problem child.

Speaker 2 Her problem child, because it's hard to calculate how effective the Cameroon program is when they're doing so many different kinds of interventions at once, from prenatal care to pediatric medicine to vaccines, sanitizing water.

Speaker 2 So it's hard to attribute an outcome to any one given intervention. For example, very often moms bring kids in to get those nutrient-dense packets of basically peanut butter paste.

Speaker 2 And while they're in there, the staff can run other diagnostics. They can give kids vaccines, get them malaria treatment.

Speaker 2 They can train the moms to look for signs of malnutrition themselves with that tape. And Rosie says there's actually another downstream effect.
They are also educating other medical staff.

Speaker 9 If all the doctors who are capable of training other doctors leave and don't pass on their knowledge, then what happens like three or four years down the line,

Speaker 9 less community health workers would be being trained, all this kind of

Speaker 23 slightly difficult to quantify stuff.

Speaker 6 Yeah.

Speaker 22 The things that you mentioned, I could see accruing to child health and child survival.

Speaker 2 Do you know what I mean? Rosie and Taryn wrap that meeting on the last day of April. And well into May, the Give Well rapid response team is researching, crunching numbers, asking more questions.

Speaker 2 And to me, this seemed like it might be be exhausting for the Cameroon team. But Mandelan told me later, they did not mind.

Speaker 3 They asked for lots of data, it's true. But I mean, when we have a donor asking so many questions and really wanting to understand the situation in the field,

Speaker 4 we

Speaker 3 keep hope because it means that they're interested, that they understand the urgency as well.

Speaker 2 On May 21st, they get on another Zoom and Givewell asks another round of questions, including one that I cannot tell tell you how many times I heard Rosie ask.

Speaker 23 I was wondering, is there any more mortality data

Speaker 23 from Cameroon that we could check out?

Speaker 7 Yeah, well, it's really difficult to have data on Cameroon, especially updated data.

Speaker 2 Madeleine explains the most recent survey they have is old and their internal data is informal. It's not a proper assessment, but they can send it.

Speaker 6 Okay, well, thank you for your interest.

Speaker 7 Maybe if we have like one quick question from our side, is maybe

Speaker 7 an idea of the deadlines that you have on your side.

Speaker 7 Do you think you'll be able to give us an answer by the end of the month or give us at least an indication of the potential budget or what would be possible on your side?

Speaker 3 We would be interested to know more.

Speaker 2 Rosie responds with questions of her own, like, do you need an answer by a certain date? Madeleine says, for the patience, the more we wait, the worse it will be.

Speaker 2 And eventually, Madeleine asks her question in the language of GiveWell.

Speaker 2 What is the probability that we will get this money? And Rosie answers.

Speaker 6 Please don't hold me to this. If I had to put a number on it right now, I'd probably be like

Speaker 24 55%, 60%.

Speaker 2 55 to 60% sure that this grant is going to come through.

Speaker 24 That kind of amount, like we're still very much considering, but we're not certain yet.

Speaker 7 Okay. Yeah.
It's also for us just to know on which grandstone we might

Speaker 7 we might rely on for next year and for the upcoming months as well

Speaker 6 but yeah okay

Speaker 2 so it is may 21st it's been more than three months since the news that usaid was getting shut down the cameroon project has already had to pull doctors and nurses from health centers across the far north And the rainy season has just started, meaning mosquitoes and malaria.

Speaker 2 After the break, will GiveWell give them the money?

Speaker 15 Support for this podcast and the following message come from Built, where you can earn points on your monthly rent payment.

Speaker 15 But did you know they make it possible for you to get more outside of your home too?

Speaker 15 By paying rent through Built, you earn flexible points that can be redeemed toward hundreds of hotels and airlines, a future rent payment, your next lift ride, and more.

Speaker 15 Earn points on rent and around your neighborhood wherever you call home by going to joinbuilt.com slash money.

Speaker 15 This message comes from ADT. You're ready for the holidays.
The turkey's in the oven, the sides are perfectly seasoned, and out-of-towners have a place to crash for the night.

Speaker 15 All that's left to take care of is your peace of mind.

Speaker 15 With ADT's professionally installed home security systems, you get protection that helps you feel safe so you can focus on the pie you forgot to bake. When every second counts, count on ADT.

Speaker 15 Visit ADT.com.

Speaker 1 This message comes from Superhuman, the AI productivity suite that gives you superpowers everywhere you work.

Speaker 1 With Grammarly, Mail, and Coda coming together, you get proactive help across your workflow so you can outsmart the chaos. Experience AI that proactively helps you go from to-do to done faster.

Speaker 1 Unleash your superhuman potential today. Learn more at superhuman.com/slash podcast.
That's superhuman.com/slash podcast.

Speaker 2 So, in Cameroon, Joelle and Madeleine are waiting to find out if they will get the money to continue doing their work.

Speaker 2 In the meantime, they were already having to make decisions they did not want to make.

Speaker 2 They cut all the mental health programs and educational programming, like nutrition and hygiene best practices and information about where to get the project's help for free.

Speaker 2 The health facilities were open less, Joel says, and that has its own cost. If people make the trek and the hospital's closed at that moment, they give up.
Even someone about to give birth.

Speaker 18 If the hospital is closed, you will deliver directly in the bush.

Speaker 2 A mother will deliver her baby outside somewhere without any medical care. And they have learned she'll kind of give up on the hospital, on the health facilities altogether.
She won't try again.

Speaker 2 I asked Madeleine if she ever loses hope.

Speaker 3 No, we don't lose hope. Otherwise, we would just stop working.

Speaker 6 No, we always have hope

Speaker 3 to find more support. I mean,

Speaker 8 that's not a not, cannot accept that.

Speaker 6 Okay, okay.

Speaker 3 No, the situation is so dire in the field that we cannot just lose hope.

Speaker 2 But she says that is getting harder and harder. Because while the USAID situation was acute and unexpected and devastating, it was the most extreme example of a larger trend.

Speaker 2 Countries all over the world are reducing how much money they allocate to international aid.

Speaker 3 So it's not just the US, it's also France, it's also Germany, it's also the UK, it's everyone. So it's really Ed is just like

Speaker 3 less and less everywhere.

Speaker 2 There are lots of reasons why. It's largely a worldwide move towards tightening budgets, austerity politics, and also spending more on defense.

Speaker 3 It's not the top priority anymore.

Speaker 2 Which makes the Cameroon project one among so many more organizations looking for funding, competing for money from organizations like GiveWell.

Speaker 2 And through most of May, the GiveWell team continues to have two hang-ups about choosing the Cameroon project. One, given their imperfect data, are they overestimating lives saved or improved?

Speaker 2 And two, how can they be sure of any of this data without independent on-the-ground confirmation? One of the researchers, Alice Redfern, keeps pushing on that.

Speaker 13 Have you managed to speak to anyone that's not Alema, but is in the area?

Speaker 9 No, I've asked Alema. I feel very unsure about how to get this without Alema.

Speaker 2 Alice is like,

Speaker 2 we got to figure this out.

Speaker 13 This piece of just taking so much on face value from them when we have at least some reservations about it,

Speaker 13 that probably is the sticking point for me. So I can see

Speaker 19 if I can

Speaker 13 source a reliable contact.

Speaker 2 That'd be great. Finally, on May 30th, Alice speaks in French with the director at one of the hospitals, Alema's Cameron Project staffs.

Speaker 2 This is the closest they can get right now to what Rosie calls ground truthing. Talking to someone on the ground, in the police.

Speaker 9 And of course, this is one person's opinion.

Speaker 23 You don't want to over-update.

Speaker 9 But he was so much blunter than I was expecting.

Speaker 16 Like, the word he used was

Speaker 9 if Alima pulls out, it will be a catastrophe.

Speaker 2 It would be a catastrophe. Because he told Alice, Lima's Cameroon project is key to so much of what the hospital does.

Speaker 2 Right away, Alice hops onto Zoom to update Taryn on what the hospital director told her about the impact of Alima's doctors and nurses on patients.

Speaker 13 The thing is that Alima is pretty much the only driving force to bring anyone into the hospital. So even more of them would just not get any care at all without Alema.

Speaker 5 And that's because

Speaker 5 without them, there's not really much to offer at the hospital. Is that why?

Speaker 13 One, there's not much to offer at the hospital.

Speaker 2 Two, another piece that i have not appreciated the nutrition services that alima offers is a major draw for people to go to the health facilities and he was saying that you take that away mothers won't come for antenatal care alice tells taryn she is still uncomfortable with how much uncertainty is embedded in their calculations But this conversation with the hospital director finally made her believe some of the numbers she was skeptical about before.

Speaker 5 Hopefully, we can close this. I feel like we learned a lot over the last couple of weeks, so that's pretty cool.

Speaker 2 Taryn later told me that she did have a moment where she was sort of like, oh crap, we just may not be able to fund this project.

Speaker 14 Was like, we're probably not going to get good data. But then, the like flip side of that was that I think that's why this is probably pretty high impact.

Speaker 14 Alima has done so much work to gain access to these really difficult places. So, it was like a mind shift.

Speaker 2 So, okay, maybe this time we just won't know everything, but we can use this to learn. And that learning would save more lives in the future.

Speaker 2 And listening to all of this over the past seven months, one lesson already seems clear, that saving the most lives gets a lot harder when you don't have a local government taking care of the basics.

Speaker 2 or international governments pitching in on the big picture stuff like stability and safety.

Speaker 2 Over the weekend, Taryn reviews all the information they've collected and on Tuesday, June 3rd, she clicks the yes button.

Speaker 2 They approve the grant for $1.9 million for Alema's work in the far north of Cameroon to fill in the entire hole left by USAID for one year.

Speaker 2 These two groups, one working with numbers, the other with their hands, they found a way to work together. And GiveWell's grant allowed the Alema workers in Cameroon to restart what they had paused.

Speaker 13 They say that I'm really happy about it.

Speaker 3 We succeeded in proving that the intervention that we were proposing was cost-effective.

Speaker 2 Joel is happy too, but he also is thinking about next year.

Speaker 18 Alima will continue to push and to look for other private actors to maintain

Speaker 18 those projects.

Speaker 2 So this is a relatively happy ending, but it is not the norm. GiveWell started with a list of 140 programs that had lost funding.

Speaker 2 And as of today, they have given money to 23 of those, $39 million so far to fill a hole of tens of billions that USAID has left.

Speaker 2 Many, many more aid programs in countries everywhere are having to shut down or reduce services. And Madeleine says that creates another problem.

Speaker 2 It's about information, exactly the kind donors like GiveWell need. As aid programs get shut down, information gets lost.

Speaker 3 Then it means that no one one will get the information out of where it's happening. And then, when we don't have the information, then we don't think anything is happening.

Speaker 3 So, the risk I would say is that if there's less aid, then it looks like there's less needs, which is not the case.

Speaker 2 All around the world, there is more need, and we're just not going to know.

Speaker 2 Today's episode of Planet Money was produced by Sam Yellowhorse Kessler. It was edited by Marianne McCune, fact-checked by Vito Emanuel, and engineered by Jamie Keeley with help from Robert Rodriguez.

Speaker 2 Our executive producer is Alex Goldmart. If you want more economics, you can sign up for our excellent weekly newsletter by local hero Greg Rosalski.
npr.org slash planetmoney newsletter.

Speaker 2 I'm Mary Childs. This is NPR.
Thanks for listening.

Speaker 15 This message comes from EasyCater, a business tool for food, helping organizations order food for meetings and events from favorite restaurants, set up meal programs for their employees, and manage food spend all in one place at easycator.com.

Speaker 1 Support for NPR and the following message come from Warby Parker, the one-stop shop for all your vision needs. They offer expertly crafted prescription eyewear, plus contacts, eye exams, and more.

Speaker 1 For everything you need to see, visit your nearest Warby Parker store or head to warbyparker.com.

Speaker 15 This message comes from NPR sponsor, Capella University. With Capella's FlexPath Learning Format, you can set your own deadlines and learn on your schedule.

Speaker 15 A different future is closer than you think with Capella University. Learn more at capella.edu.