I wrote a draft on this a long time ago, thought I can publish it during draft amnesty, realized that it's pretty out of date and ended up spending a lot of time improving it. I'm confident about the questions and problems I raise here. I'm much less confident about what should be done about them or specific examples I provide.
These are my personal opinions, it doesn't reflect the opinions of any organizations I'm affiliated with. Thanks to Ben Anderson, Ceren Karabulut and Bahadır Şirin for feedback.

Two-sentence summary: Health progress at scale comes from stronger health systems, and there are probably cost-effective interventions to strengthen health systems in LMICs. EA has engaged little, and late, with finding what those interventions are in my opinion.

Actual Summary

EA has a strong track record of finding, funding, and founding cost-effective delivery NGOs, and has saved hundreds of thousands of lives in the process. It has a weak track record of conducting research, founding organizations, or funding programs aimed at effectively strengthening health systems that fail to serve people who need to be saved by philanthropists.

The historical record suggests that large-scale health gains usually from stronger health systems [...]

---

Outline:

(04:54) Section 0. Effective Charity and Effective Development Are Different Activities

(09:09) Section 1: Global Health Reflects the Distinction

(12:30) 2. What I Mean by Health Systems Strengthening

(18:38) 3. EAs Portfolio Converged on a Specific Approach, For Understandable Reasons

(22:58) 4. The USAID Cuts Revealed the Distinction in Practice

(27:48) 4.1: Methodology Interlude: Cost-Effectiveness of Unlocking Government Programs

(30:16) 5. Recent Diversification Is Good, But Came Late and Remains Narrow

(33:32) 6. Why This Gap Persists

(39:16) 7. Some Potential Directions

---

First published:

Source:

---

Narrated by TYPE III AUDIO.