Saving lives with fewer dollars

Summary

Planet Money – "Saving lives with fewer dollars"

Air Date: November 27, 2025
Host: Mary Childs (NPR)
Topic: How lives are saved – or lost – when aid funding dries up and philanthropists try to bridge the gap by measuring maximum impact per dollar spent.

---

Episode Overview

This episode of Planet Money dives deep into what happens after a massive cut to U.S. international health aid. It follows two very different groups trying to save lives:

• On the ground: Medical teams providing primary care in the conflict-torn far north of Cameroon.
• Behind the scenes: Data-driven philanthropists at GiveWell, tasked with deciding which projects to fund by calculating “lives saved per dollar.”

The story illustrates the moral and practical challenges of triaging aid in the face of abrupt funding loss — and what it means to “do good” efficiently when resources are scarcer than ever.

---

Key Discussion Points and Insights

1. The On-the-Ground Crisis in Cameroon

[00:24-02:27]

• Alima (Alliance for International Medical Action) is providing critical healthcare in northern Cameroon: vaccines, malnutrition monitoring, and maternal care.
• Simple but effective tools, like malnutrition tape (a colored measuring band), let mothers check if their children are at risk.
  • Quote:
    "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." – Madeleine Trantau, Alima (01:01)
• Funding was slated from USAID ($1.9 million/year), but was suddenly lost due to policy cuts.
• The consequence is real: “If we had to discharge all of these children, then they will not get treated... The health system is not able to take in all those patients.” – Madeleine (01:59)
• Global context: Programs worldwide lost funding; an estimated 620,000 people have already died due to the gap.

---

2. Enter GiveWell: The Numbers Experts

[05:45-07:27]

• GiveWell: A philanthropically-funded group distributing hundreds of millions based purely on “lives saved per dollar,” via rigorous comparison and evidence.
• After the aid cuts, ex-USAID workers compiled a list of unfunded projects, landing on GiveWell’s desk.
• GiveWell’s Rapid Response Team, led by Taryn Maddox and researcher Rosie Bettel, must decide if the Cameroon project is the best use of $50 million they can deploy.
• They allow Planet Money to sit in as they examine the Cameroon application.

---

3. How Do You Measure a Life Saved?

[07:41-11:25]

• GiveWell usually prefers “clear data” and randomized controlled trials—simple-to-evaluate interventions (e.g., mosquito nets).
  • Cameroon, by contrast, is a complex conflict zone with multifaceted needs, tougher data, and high uncertainty.
• Team debates:
  • Is the Cameroon project more cost-effective than GiveWell’s usual “gold standard” alternatives (e.g., cash transfers)?
  • How do you calculate mortality rates when populations are displaced and data is unreliable?
  • Quote:
    "We’re taking all the benefits, like averting disability, improving somebody's income, improving someone's cognitive outcomes. Putting that all into one measure and calling it, like, an equivalent life saved." – Taryn Maddox, GiveWell (10:08)

---

4. Real-World Friction & Ethical Math

[13:31-17:25]

• Extensive debate about “child mortality math.” Lack of reliable information in conflict zones makes exact calculation almost impossible.
  • Quote:
    "If you're just, like, spreadsheet, spreadsheet, spreadsheet, model, model, model, without, of course, really thinking, like, hey, what is happening on the ground? You're liable to go equally astray in the opposite direction." – Rosie Bettel, GiveWell (15:11)
• Tension between ground realities and spreadsheet-based models.
• Anecdote: GiveWell once found that switching HIV tests to include syphilis testing saves “a thousand times more lives per dollar” than direct maternal mortality interventions — against intuition, but supported by data.
  • Quote:
    "I like having a framework that can discipline my compassion." – Taryn Maddox, GiveWell (17:25)

---

5. Culture Clash: Humanitarian vs. Effective Altruism Approaches

[18:34-20:23]

• Humanitarians: Focus on dignity, reducing suffering, and service to the most vulnerable, even if not the most “cost-effective” group.
• Effective Altruists: Seek maximum quantifiable life improvement per dollar, regardless of location or circumstance.
  • Quote:
    "It's the idea that people who are the victims of all of these conflicts... trying to provide the services that allow them to maintain some level of dignity." – Susan Shepard, Alima (20:09)

---

6. Messy Data, Real Stakes, and Compromise

[22:21-27:09]

• GiveWell acknowledges “problem child” calculations: Multi-pronged interventions (from hygiene education to hospital staffing to peanut butter nutrition packets) are hard to attribute and quantify in impact.
  • Quote:
    "If all the doctors who are capable of training other doctors leave and don't pass on their knowledge… less community health workers would be being trained. All this kind of slightly difficult to quantify stuff." – Rosie Bettel, GiveWell (22:21)
• Alima, for its part, welcomes hard questions. “They asked for lots of data, it's true, but... when we have a donor asking so many questions… it means that they're interested; that they understand the urgency as well.” – Madeleine Trantau, Alima (23:06)
• Cameroon team is forced to reduce services: close health centers, cut educational and mental health programs. Real-world impact: Women giving birth outdoors if the clinic is closed.
  • Quote:
    "If the hospital is closed, you will deliver directly in the bush." (27:46)

---

7. The Global Aid Crunch

[28:14-29:04]

• Not just the U.S.: France, Germany, the UK, and others are tightening foreign aid budgets.
  • Quote:
    "Aid is just like less and less everywhere." – Madeleine Trantau (28:40)
• Many more organizations are competing for ever smaller pools of philanthropic money.

---

8. Final Hurdles: Verifying Ground Truth

[29:45-31:37]

• GiveWell struggles to independently verify data from the ground, given danger and instability—“ground truthing” is nearly impossible.
• Phone conversations with local hospital directors finally convince skeptical researchers: Alima’s exit would be “a catastrophe.”
  • Quote:
    "If Aleima pull out it will be a catastrophe." – Hospital director via Alice Redfern, GiveWell (30:30)
  • "The good thing is that Alima is pretty much the only driving force to bring anyone into the hospital." – Rosie Bettel (31:07)

---

9. The Decision, and Its Limits

[32:01-34:38]

• Taryn Maddox, after final review, makes the call: GiveWell awards Alima $1.9M for one year, replacing the lost USAID funding (June 3).
  • Quote:
    "We succeeded in proving that the intervention that we were proposing was cost effective." – Madeleine Trantau, Alima (33:23)
• But it’s only a partial victory: GiveWell started with a list of 140 defunded programs, and, as of the episode, had only been able to support 23 with $39M — out of tens of billions once spent by USAID.
• A chilling warning: As programs close, data (and visibility of suffering) disappears; “if there’s less aid, then it looks like there's less need, which is not the case.” – Madeleine Trantau (34:23)

---

Notable Quotes & Moments (with Timestamps)

• "If we had to discharge all of these children, then they will not get treated... The health system is not able to take in all those patients."
  — Madeleine Trantau, Alima project manager (01:59)
• "We’re taking all the benefits, like averting disability, improving somebody's income, improving someone's cognitive outcomes. Putting that all into one measure and calling it, like, an equivalent life saved."
  — Taryn Maddox, GiveWell (10:08)
• "I like having a framework that can discipline my compassion."
  — Taryn Maddox, GiveWell (17:25)
• "If the hospital is closed, you will deliver directly in the bush."
  — Joelle Kamete, Alima (27:46)
• "Aid is just like less and less everywhere."
  — Madeleine Trantau, Alima (28:40)
• "If Aleima pull out it will be a catastrophe."
  — Hospital Director via GiveWell (30:30)
• "We succeeded in proving that the intervention that we were proposing was cost effective."
  — Madeleine Trantau, on receiving the grant (33:23)
• "If there’s less aid, then it looks like there's less need, which is not the case."
  — Madeleine Trantau (34:23)

---

Takeaways

• The episode paints a vivid picture of what it means to ration lifesaving work in a world of diminishing resources — and the costs (data, dignity, lives) that are inevitable when governments pull back.
• It highlights the tension between the urgency and messiness of humanitarian work and the cold calculations of effective altruism.
• The story ends with a partial triumph — a year’s reprieve for a critical health project in Cameroon — but underscores just how much need is going unmet, and how invisible that need may become as the tracker data (and the people who produce it) vanish.

---

Important Segment Timestamps

• 01:00 – Explanations of malnutrition detection and project work in Cameroon
• 02:27 – Scale of global impact from USAID cuts
• 07:41 – GiveWell’s team faces unfamiliar context and data challenges
• 10:08 – Explanation of "life saved equivalent" calculations
• 15:11 – Rosie Bettel on balancing data and field realities
• 17:25 – The “cold math” of effective altruism and the moral tension
• 20:09 – The dignity aspect of humanitarian work
• 23:06 – Alima staff on donor scrutiny as a hopeful sign
• 27:46 – Real-world consequences of service cuts for patients
• 28:40 – Cuts to aid as a global trend
• 30:30 – Ground-level perspective: "If Aleima pull out it will be a catastrophe."
• 33:23 – Announcement that the grant came through
• 34:23 – The danger of aid reductions erasing evidence of need

---

This episode offers a richly detailed, honest look at life-and-death decisions in aid – and what “saving the most lives” really demands.

Transcript

[Sponsor/Advertisement Voice]

This message comes from NPR sponsor Charles Schwab. Financial decisions can be tricky. Your biases can lead you astray. Financial Decoder, an original podcast from Charles Schwab, can help. Download the latest episode and [e-mail] FinancialDecoder.

[Rosie Bettel]

This is Planet Money from NPR.

[Mary Childs (Planet Money Host/Narrator)]

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. That first group provides basic healthcare and medical supplies in the far north region of Cameroon. 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 so a mom can wrap it around her kid's arm and measure whether her kid is malnourished.

[Madeleine Trantau / Joel Kambale Kamete / Susan Shepard (Alima Project Staff)]

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.

[Mary Childs (Planet Money Host/Narrator)]

Madeleine Trantau manages grants for the organization called ilima. It's an acronym. It stands for the alliance for International Medical Action. Last year in Cameroon, Ilima treated almost 400,000 people. Ilima 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 also by managing difficult logistics.

[Madeleine Trantau / Joel Kambale Kamete / Susan Shepard (Alima Project Staff)]

Sometimes there's no road. You face potential attacks. It's scary. It's dangerous.

[Mary Childs (Planet Money Host/Narrator)]

To Continue that work, Lima's Cameroon program was supposed to get $1.9 million this year from USAID when the Trump administration announced it was gutting usaid. Madeleine had just gotten back from a visit to Alima's doctors and nurses in the mountains in an area called Mokolo.

[Madeleine Trantau / Joel Kambale Kamete / Susan Shepard (Alima Project Staff)]

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? And what was the answer? Well, the answer is the health system is not able to take in all those patients.

[Mary Childs (Planet Money Host/Narrator)]

And that means those patients just don't get care. Yeah. 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. An estimated 620,000 people have already died for lack of care. 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, 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. They have a lot of math to do, all while racing against the biggest, worst, loudest ticking clock they could imagine. 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. The calculations they're making are ruthless.

[Taryn Maddox]

If I'm adding up the deaths averted, it's like 650 averted in total. Is that right?

[Rosie Bettel]

Yes, I think so.

[Mary Childs (Planet Money Host/Narrator)]

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

[Rosie Bettel]

Sorry, where is the agenda? I haven't spotted it yet.

[Mary Childs (Planet Money Host/Narrator)]

So week after week. Oh yeah, Did I not send it? I'm sorry. We were able to watch up close as they wrestled through one decision, whether to give their money to the project or Cameroon.

[Taryn Maddox]

Boop, boop, boop.

[Mary Childs (Planet Money Host/Narrator)]

There you go.

[Sponsor/Advertisement Voice]

This message comes from Vanguard. Capturing value in the bond market is not easy. 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. They're designed for financial advisors looking to give their clients consistent results year in and year out. See the [e-mail] audio that's vanguard.com audio all investing is subject to risk. Vanguard Marketing Corporation Distributor this message comes from Capital One. With the Capital One Saver card, earn unlimited 3% cash back on dining and entertainment. Capital One what's in your wallet? Terms apply [e-mail] this message comes from NPR sponsor Veeam. AI promised intelligence, but it also exposed everything people couldn't see, like scattered data and hidden risks. Now there's a new way forward where protection, governance and AI trust move together. With Veeam Security AI, you can see your entire data estate in real time. Because when resilience, security, governance and AI trust come together, innovation moves safely and faster. Learn more about accelerating safe AI at.

[Mary Childs (Planet Money Host/Narrator)]

[e-mail] in the days after USAID got gutted, private philanthropy groups everywhere were in a kind of panic trying to figure out how to help. And a few recently unemployed USAID workers used their newfound spare time to compile a list of all the projects that had just lost funding for from water sanitation in Yemen to researching biofortified maize in Guatemala. And that list landed on the desk of a philanthropic group called GiveWell. GiveWell donates hundreds of millions of dollars every year. And they have this very explicit to make that money save or improve the most lives per dollar 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.

[Rosie Bettel]

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

[Mary Childs (Planet Money Host/Narrator)]

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 and one of them was Manuelain and all those doctors and nurses in the mountains of Cameroon. So now givewell has to is this project a better choice than all of the other projects GiveWell could give their limited money to right now? And way back then in March, I asked GiveWell if they would record themselves as they try to sort that out.

[Taryn Maddox]

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

[Mary Childs (Planet Money Host/Narrator)]

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 the mismatch between GiveWell and their love of crispy clear data. And this project in Cameroon, we're facing.

[Taryn Maddox]

A steeper learning curve in understanding the context because it's just terrain we don't know as well.

[Mary Childs (Planet Money Host/Narrator)]

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

[Taryn Maddox]

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?

[Rosie Bettel]

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

[Mary Childs (Planet Money Host/Narrator)]

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. Or it funded programs promoting global stability or trade. 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. The canonical example is buying mosquito nets to prevent diseases like malaria. The nets are super effective and super cheap. 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?

[Sponsor/Advertisement Voice]

Yeah.

[Taryn Maddox]

And these are populations that we think are just higher risk, higher mortality populations in general.

[Rosie Bettel]

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

[Mary Childs (Planet Money Host/Narrator)]

They spend the rest of this first meeting on what they will need to find out that could convince them to fund this grant or not.

[Taryn Maddox]

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

[Mary Childs (Planet Money Host/Narrator)]

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.

[Taryn Maddox]

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.

[Mary Childs (Planet Money Host/Narrator)]

Yeah, but you are kind of the buck stops.

[Taryn Maddox]

The buck stops with me.

[Mary Childs (Planet Money Host/Narrator)]

That's right. 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.

[Taryn Maddox]

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

[Mary Childs (Planet Money Host/Narrator)]

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, or.

[Taryn Maddox]

Putting that all into one measure and calling it, like, an equivalent life saved. So that's a little bit of, like, nuance.

[Mary Childs (Planet Money Host/Narrator)]

And this type of calculation is unique to a little group of nonprofits and philanthropic organizations like GiveWell. They overlap with a philosophy called effective altruism, in which people try to do the most good based on the evidence. This arose with our newfound ability to gather and crunch vast amounts of data, which enabled more rigorous research that transformed development economics. 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. 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. 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.

[Taryn Maddox]

We are recording this. If anyone's uncomfortable sharing externally, that's fine. Just shoot us a Note first.

[Mary Childs (Planet Money Host/Narrator)]

The GiveWell people want to know how urgent the needs are, and then they'll start to fill in the numbers they need.

[Rosie Bettel]

Okay, so if it's good. My first question is to get a sense of the current status of Aleema's work in Cameroon. Like is everything still fully operational or are some parts of the program maybe not running? Like at the moment? No, they are not running in 100%.

[Mary Childs (Planet Money Host/Narrator)]

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. Now we have only four health centers and one hospital. So it means from 14 health centers to four. And in Mokolo, their other location under discussion, they were in eight health facilities and now are down to just one.

[Madeleine Trantau / Joel Kambale Kamete / Susan Shepard (Alima Project Staff)]

Just the hospital in Mokolo. If there's no other funding coming, then we'll have to shut down the project.

[Mary Childs (Planet Money Host/Narrator)]

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

[Rosie Bettel]

So it's a mix of internally displaced people, host communities, is that correct?

[Madeleine Trantau / Joel Kambale Kamete / Susan Shepard (Alima Project Staff)]

So I can give you the population from Mokolu House district that will be around 350,000 people.

[Mary Childs (Planet Money Host/Narrator)]

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. 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.

[Taryn Maddox]

When children die because of malnutrition, it's because it's usually because of a complication.

[Mary Childs (Planet Money Host/Narrator)]

Right?

[Taryn Maddox]

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. And so I wonder if we might be double counting essentially because these mortality.

[Mary Childs (Planet Money Host/Narrator)]

Figures are 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. So GiveWell needs information that basically doesn't exist 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.

[Taryn Maddox]

Oh. So I'm just looking at this row. 15, 730 total deaths per year. And then if we're averting 650 of.

[Madeleine Trantau / Joel Kambale Kamete / Susan Shepard (Alima Project Staff)]

Those, I'm with you.

[Mary Childs (Planet Money Host/Narrator)]

Taryn and Rosie are parsing this data point and asking, is that with the Cameroon project's doctors and nurses? Because that would mean without them, is.

[Rosie Bettel]

That potentially like a little bit higher still? Which would seem like really gutting. Right.

[Taryn Maddox]

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

[Rosie Bettel]

I think it's not. And actually I think it should be.

[Mary Childs (Planet Money Host/Narrator)]

In addition to not having all the numbers GiveWell needs for this project, there's another missing component so far that's just as important on the ground research. Rosie told me later both are crucial.

[Rosie Bettel]

If you're just like, spreadsheet, spreadsheet, spreadsheet, model, model, model, without of course, really thinking like, hey, what is happening on the ground? You're liable to go equally astray in the opposite direction.

[Madeleine Trantau / Joel Kambale Kamete / Susan Shepard (Alima Project Staff)]

Right.

[Mary Childs (Planet Money Host/Narrator)]

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, 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. GiveWell talks a lot about this in their meetings by themselves and with Aleema, like, should they commission a study? Is it safe in the area to run these types of surveys?

[Madeleine Trantau / Joel Kambale Kamete / Susan Shepard (Alima Project Staff)]

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

[Mary Childs (Planet Money Host/Narrator)]

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

[Taryn Maddox]

Into two different interventions around the same time. One was an intervention that was designed to reduce maternal mortality.

[Mary Childs (Planet Money Host/Narrator)]

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? Preventing birthing mothers from dying or testing for syphilis in addition to hiv?

[Taryn Maddox]

When you do the math, maternal mortality is extremely rare, and syphilis is, like, not as rare. If you find the right places. And then the effects of having syphilis are lifelong and horrible. And it came out like one program was like a thousand times more cost effective than the other one.

[Mary Childs (Planet Money Host/Narrator)]

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.

[Taryn Maddox]

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

[Mary Childs (Planet Money Host/Narrator)]

Are you ever like, oh, I can't, I'm going to do this? Like syphilis, HIV switch, that's like so high yielding. Like, how do you not think about the mothers that you're not saving?

[Taryn Maddox]

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

[Mary Childs (Planet Money Host/Narrator)]

Oops.

[Taryn Maddox]

No, it's okay. I'm sorry, this is going to be bad audio. You think about them. And so I think that the best that we can do is say we have this limited pot. We're going to use this the best way we possibly can.

[Mary Childs (Planet Money Host/Narrator)]

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

[Taryn Maddox]

We've heard about this, like two children per 10,000 mortality, right?

[Madeleine Trantau / Joel Kambale Kamete / Susan Shepard (Alima Project Staff)]

Yeah. I knew this was going to become.

[Mary Childs (Planet Money Host/Narrator)]

A key point for you guys.

[Madeleine Trantau / Joel Kambale Kamete / Susan Shepard (Alima Project Staff)]

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

[Mary Childs (Planet Money Host/Narrator)]

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. And Susan explains there's a whole decades long history of data crunching in regions like these, measuring mortality and trying to.

[Madeleine Trantau / Joel Kambale Kamete / Susan Shepard (Alima Project Staff)]

There are different ways of doing it and it causes us, you know, endless discussions.

[Mary Childs (Planet Money Host/Narrator)]

Like she says, the demographic and health surveys that everyone uses across the industry, those measured by live births per year.

[Madeleine Trantau / Joel Kambale Kamete / Susan Shepard (Alima Project Staff)]

But humanitarian projects use number of deaths.

[Mary Childs (Planet Money Host/Narrator)]

Per 10,000 people per day.

[Madeleine Trantau / Joel Kambale Kamete / Susan Shepard (Alima Project Staff)]

I have never found a way to join those two to find out. Yeah, I have never. I just say, okay.

[Mary Childs (Planet Money Host/Narrator)]

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

[Taryn Maddox]

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

[Madeleine Trantau / Joel Kambale Kamete / Susan Shepard (Alima Project Staff)]

Yeah, it's the, it's kind of the humanitarian.

[Mary Childs (Planet Money Host/Narrator)]

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.

[Madeleine Trantau / Joel Kambale Kamete / Susan Shepard (Alima Project Staff)]

I think it's the idea that people.

[Mary Childs (Planet Money Host/Narrator)]

Who are the victims of all of these conflicts, they're forced to flee or.

[Madeleine Trantau / Joel Kambale Kamete / Susan Shepard (Alima Project Staff)]

They'Re forced to move, you know, trying to provide the services that allow them to maintain some level of dignity.

[Mary Childs (Planet Money Host/Narrator)]

Gotcha.

[Taryn Maddox]

Okay, thank you.

[Mary Childs (Planet Money Host/Narrator)]

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.

[Taryn Maddox]

And I would like to start with the mortality coverage. 1.

[Rosie Bettel]

Yes. Okay. So like, so to give an overview, BowTech back the envelope calculation, relatively simple.

[Mary Childs (Planet Money Host/Narrator)]

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. 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? And Rosie tells Taryn that all three of her models are spitting out the same basic. They all say, yes, a fair amount better, which Taryn says, which is pretty.

[Madeleine Trantau / Joel Kambale Kamete / Susan Shepard (Alima Project Staff)]

Surprising, I think, considering how different the.

[Mary Childs (Planet Money Host/Narrator)]

Approaches are 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.

[Rosie Bettel]

I've got like three BOW techs at the moment, but one is currently my, like, problem child.

[Mary Childs (Planet Money Host/Narrator)]

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

[Rosie Bettel]

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, less community health workers would be being trained. All this kind of slightly difficult to quantify stuff.

[Mary Childs (Planet Money Host/Narrator)]

Yeah, yeah. The things that you mentioned, I could.

[Taryn Maddox]

See accruing to child health and child survival.

[Mary Childs (Planet Money Host/Narrator)]

Rosie and Taryn wrap that Meeting on the last day of April and well Into May, the GiveWell Rapid Response Team is researching, crunching numbers, asking more questions. And to me, this seemed like it might be exhausting for the Cameroon team, but Madeleine told me later they did not mind.

[Madeleine Trantau / Joel Kambale Kamete / Susan Shepard (Alima Project Staff)]

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

[Mary Childs (Planet Money Host/Narrator)]

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

[Rosie Bettel]

I was wondering, is there any more mortality data from Cameroon that we could check out?

[Madeleine Trantau / Joel Kambale Kamete / Susan Shepard (Alima Project Staff)]

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

[Mary Childs (Planet Money Host/Narrator)]

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.

[Madeleine Trantau / Joel Kambale Kamete / Susan Shepard (Alima Project Staff)]

Okay, well, thank you for your interest. Maybe if we have like one quick question from our side is maybe an idea of the deadlines that you, that you have on your site. 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? We would be interested to know more.

[Mary Childs (Planet Money Host/Narrator)]

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. And eventually, Madeleine asks her question in the language of GiveWell, what is the probability that we will get this money? And Rosie answers.

[Rosie Bettel]

Please don't hold me to this. If I had to put a number on it right now, I'd probably be like 55%, 60%.

[Mary Childs (Planet Money Host/Narrator)]

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

[Rosie Bettel]

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

[Madeleine Trantau / Joel Kambale Kamete / Susan Shepard (Alima Project Staff)]

Okay.

[Rosie Bettel]

Yeah.

[Madeleine Trantau / Joel Kambale Kamete / Susan Shepard (Alima Project Staff)]

It's also for us just to know on which grandstone we might, we might rely on for next year and for the upcoming months as well.

[Mary Childs (Planet Money Host/Narrator)]

But yeah, okay, so it is May 21. 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. After the break, will GiveWell give them the money?

[Sponsor/Advertisement Voice]

This message comes from LinkedIn ads. One of the hardest parts about B2B marketing is reaching the right audience. That's why you need LinkedIn ads. You can target your buyers by job title, company role, seniority and skills. All the professionals you need to reach in one place. Get a $250 credit on your next campaign so you can try it yourself. Just go to LinkedIn.com nprpod that's LinkedIn.com nprpod Terms and conditions apply only on LinkedIn ads. This message comes from Apollo Global Management, who believes the global industrial renaissance is transforming the world. Over the next decade, industries like energy, infrastructure and technology will need an estimated 75 to $100 trillion to modernize and meet demand. Long term projects need long duration capital. That's where Apollo steps in. With scale, flexibility and a focus on growth. They're partnering with companies to drive the future one innovation at a time. Learn [e-mail] Renaissance this message comes from Schwab. Everyone has moments when they could have done better. Same goes for where you invest. Level up and invest smarter with Schwab. Get market insights, education and human help when you need it.

[Mary Childs (Planet Money Host/Narrator)]

So in Cameroon, Joelle and Madeleine are waiting to find out if they will get the money to continue doing their work. In the meantime, they were already having to make decisions they did not want to make. 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. The health facilities were open less, Joelle 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, if the hospital is closed, you will deliver.

[Sponsor/Advertisement Voice]

Directly in the bush.

[Mary Childs (Planet Money Host/Narrator)]

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. I asked Madeleine if she ever loses hope.

[Madeleine Trantau / Joel Kambale Kamete / Susan Shepard (Alima Project Staff)]

No, we don't lose hope. Otherwise we would just stop working. No, we always have hope to find more support for the situation.

[Mary Childs (Planet Money Host/Narrator)]

That's not a. Cannot accept that.

[Taryn Maddox]

Okay, okay.

[Madeleine Trantau / Joel Kambale Kamete / Susan Shepard (Alima Project Staff)]

No, the situation is so dark and in the field that we cannot just lose hope.

[Mary Childs (Planet Money Host/Narrator)]

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

[Madeleine Trantau / Joel Kambale Kamete / Susan Shepard (Alima Project Staff)]

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 less and less Everywhere.

[Mary Childs (Planet Money Host/Narrator)]

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

[Madeleine Trantau / Joel Kambale Kamete / Susan Shepard (Alima Project Staff)]

It's not the top priority anymore.

[Mary Childs (Planet Money Host/Narrator)]

Which makes the Cameroon Project one among so many more organizations looking for funding, competing for money from organizations like GiveWell. And through most of May, the GiveWell team continues to have two hangups about choosing the Cameroon project. One, given their imperfect data, are they overestimating lives saved or improved? 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. Have you managed to speak to anyone that's not a lemur but is in the area?

[Rosie Bettel]

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

[Mary Childs (Planet Money Host/Narrator)]

Alice is like we gotta figure this out. This piece of just taking so much.

[Rosie Bettel]

On face value from them when we.

[Mary Childs (Planet Money Host/Narrator)]

Have at least some reservations about it. That probably is the sticking point for me. So I can see if I can source a source of reliable contact.

[Rosie Bettel]

That'd be great.

[Mary Childs (Planet Money Host/Narrator)]

Finally, on May 30, Alice speaks in French with the director at one of the hospital's Aleema's Cameroon project staffs. Bonjour, Madame.

[Madeleine Trantau / Joel Kambale Kamete / Susan Shepard (Alima Project Staff)]

Bonjour, doctor.

[Mary Childs (Planet Money Host/Narrator)]

This is the closest they can get right now to what Rosie calls ground truthing, talking to someone on the ground in the place.

[Rosie Bettel]

And of course this is one person's opinion you don't want to over update. But he was so much blunter than I was expecting. Like the word he used was like if Aleema pull out it will be a catastrophe.

[Mary Childs (Planet Money Host/Narrator)]

It would be a catastrophe because he told Alice, Lima's Cameroon project is key to so much of what the hospital does. Right away Alice hops on a zoom to update Taryn on what the hospital director told her about the impact of Ilima's doctors and nurses on patients there. The good thing is that Alima is.

[Rosie Bettel]

Pretty much the only driving force to.

[Mary Childs (Planet Money Host/Narrator)]

Bring anyone into the hospital. So even more of them would just not get any care at all without Alema.

[Taryn Maddox]

And that's because without them there's not really much to offer at the hospital.

[Mary Childs (Planet Money Host/Narrator)]

Is that why one, there's not much to offer at the hospital. 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.

[Rosie Bettel]

Mothers won't come for antenatal care.

[Mary Childs (Planet Money Host/Narrator)]

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.

[Taryn Maddox]

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

[Mary Childs (Planet Money Host/Narrator)]

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.

[Taryn Maddox]

It was like, we're probably not going to get good data. But then the flip side of that was that I think that's why this is probably pretty high impact. Aleema has done so much work to gain access to these really difficult places. So it was like a mind shift.

[Mary Childs (Planet Money Host/Narrator)]

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. And listening to all of this over the past seven months, one lesson already seems that saving the most lives gets a lot harder when you don't have a local government taking care of the basics or international governments pitching in on the big picture stuff like stability and safety. Over the weekend, Taryn reviews all the information they've collected. And on Tuesday, June 3, she clicks the yes button. They approve the grant for $1.9 million for Aleema's work in the far north of Cameroon to fill in the entire hole left by USAID for one year. 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 Alima workers in Cameroon to restart what they had.

[Madeleine Trantau / Joel Kambale Kamete / Susan Shepard (Alima Project Staff)]

Paused that they signed it. I'm really happy about it. We succeeded in proving that the intervention that we were proposing was cost effective.

[Mary Childs (Planet Money Host/Narrator)]

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

[Sponsor/Advertisement Voice]

Alima will continue to push and to.

[Mary Childs (Planet Money Host/Narrator)]

Look for other private actors to maintain those projects. 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. 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. Many, many more aid programs in countries everywhere are having to shut down or reduce services. And Madeleine says that creates another problem. It's about information, exactly the kind donors like GiveWell need. As aid programs get shut down, information.

[Madeleine Trantau / Joel Kambale Kamete / Susan Shepard (Alima Project Staff)]

Gets lost, then it means that no 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. So the risk, I would say, is that if there's less aids, then it looks like there's less needs, which is.

[Mary Childs (Planet Money Host/Narrator)]

Not the case all around the world. There is more need, and we're just not going to know. Today's episode of Planet Money was produced by Sam Yellow Horse Kessler. It was edited by Marianne McCune, fact checked by Vito Emanuel and engineered by Jimmy Keeley with help from Robert Rodriguez. Our executive producer is Alex Goldmark. If you want more economics, you can sign up for our excellent weekly newsletter by Local hero. Greg Wazalski, npr.org planetmoneynewsletter I'm Mary Childs. This is NPR. Thanks for listening. This message comes from Vital Farms who works with small American farms to bring you pasture raised eggs. Farmer Tanner Pace shares why he chose to collaborate with Vital Farms when he brought pasture raised hens to his small Missouri farm. Probably the best thing about being a.

[Madeleine Trantau / Joel Kambale Kamete / Susan Shepard (Alima Project Staff)]

Vital Farms farmer is working with a.

[Mary Childs (Planet Money Host/Narrator)]

Group that is not just motivated for one thing. They're motivated for the well being of the animals, for the well being of the earth. They care about it all, you know, and that means a lot to me. To learn more about how Vital Farms farmers care for their hens, visit vitalpharms.com.

[Sponsor/Advertisement Voice]

This message comes from Vanta. What's your 2am security worry? Is it do I have the right controls in place or are my vendors secure? Enter Vanta. Vanta automates manual work so you can stop sweating over spreadsheets, chasing audit evidence and filling out endless questionnaires. Their trust management platform continuously monitors your systems, centralizes your data and simplifies your security at scale. Get [e-mail] that's V A N T.

[Mary Childs (Planet Money Host/Narrator)]

A dot com this message comes from NPR sponsor Shopify. Start selling with Shopify today. Whether you're a garage entrepreneur or IPO ready, Shopify is the only tool you need to start, run and grow your business without the struggle. Go to shopify.com npr.