Summary
Overview
Planet Money follows the intersection of two groups doing life-saving work after USAID cuts gutted international aid funding: medical workers providing healthcare in conflict-affected northern Cameroon, and philanthropic analysts at GiveWell using data-driven methods to determine where their limited funds can save the most lives. The episode chronicles GiveWell's months-long evaluation process to decide whether to fund ALIMA's Cameroon health program with $1.9 million, revealing the challenges of evidence-based philanthropy in humanitarian contexts.
The Crisis: USAID Cuts Devastate Global Health Programs
When the Trump administration gutted USAID, thousands of programs helping millions worldwide suddenly lost funding. ALIMA's Cameroon health program, which treated nearly 400,000 people annually in conflict-affected areas, lost $1.9 million in expected funding. Madeleine Tronceau, who manages grants for ALIMA, faced impossible choices about which clinics to keep open and which patients would go without care, while the rainy season and malaria threat loomed.
- ALIMA provides basic healthcare, vaccines, pregnancy monitoring, and malnutrition screening in Cameroon's far north conflict zone, treating almost 400,000 people last year
- An estimated 620,000 people have already died from lack of care following USAID cuts
- ALIMA's Cameroon program was supposed to receive $1.9 million from USAID this year
- Health facilities began closing immediately - in Makari they went from 14 health centers to 4, in Mokolo from 8 facilities to just 1 hospital
" 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. So I just thought, oh my God, what if we have to stop all this? Who's going to be able to take over? "
" The answer is the health system is not able to take in all those patients. And that means those patients just don't get care. "
Enter GiveWell: The Data-Driven Philanthropists
GiveWell, a philanthropic organization that donates hundreds of millions annually, has an explicit mission to save or improve the most lives per dollar through rigorous calculations and proof. When former USAID workers compiled a list of defunded projects, GiveWell's rapid response team began evaluating whether to allocate approximately $50 million to fill part of the gap. The Cameroon project represented a significant challenge to their usual methodology, which relies on clear data and randomized controlled trials.
- GiveWell expected to spend about $50 million to fill a tiny part of the USAID funding hole
- GiveWell uses 'life saved equivalent' calculations that assign numerical values to all benefits to compare intervention effectiveness
- The organization arose from effective altruism philosophy and the transformation of development economics through randomized controlled trials
- GiveWell's canonical example is buying mosquito nets - super effective and super cheap
" I like having a framework that can discipline my compassion. "
" We're taking all of the benefits, like averting disability, improving somebody's income, improving someone's cognitive outcomes. We're putting that all into one measure and calling it like an equivalent life saved. "
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