Effective donations for COVID-19 in India

Life You Can Save just published a blog on the India Covid situation. https://www.thelifeyoucansave.org/blog/india-covid-19-crisis-where-to-donate/

This is one of the first EA organization post on this topic that I have come across.

Jeff Coleman writes:

Back of napkin math shows that funding oxygen intervention for India is currently more effective than even top rated interventions from @GiveWell...

Hat tip to Dr. Rohin Francis for identifying the specific opportunity in his excellent video on the crisis India is currently facing: https://twitter.com/MedCrisis/status/1387428737583550468… 

I've used numbers from https://covid.giveindia.org/healthcare-heroes/… because they were very specific and can handle int'l donations easily.

They claim able to deploy funds within 1-2 weeks. Where details were lacking I checked with an MD I know who has been treating COVID in northern Canada to estimate the impact of various interventions, assuming effective triage and that each item is already a choke point.

My starting assumptions were:

Avg patient age 50 yo, giving post-survival life expectancy of ~25 years
70 ₹ to 1 USD
Avg 28 oxygen-days needed to save a patient
40 USD to add one year of life expectancy via Givewell top charities

All assumptions highly conservative. Exchange rate is pre-adjusted to cover payment processing and conversion. Patients are actually skewing younger right now. 4 weeks of oxygen to save just one patient actually assumes triage inefficiency. 40 USD is cheapest estimate given.

Next I took all listed items and calculated the number of days the equipment needs to be in usage to beat GiveWell cost effectiveness. Results:

Oxygen plant: 37 days
Oxygen concentrators: 22 days
Bipaps: 72 days
Ventilators: 600 days

For the first 3 these are rock solid.

For oxygen tanks there are recurring costs. If we assume all costs borne by the donor we get:

B type oxygen cylinder: 33 days
D type oxygen cylinder: no breakeven

However if refills are paid for locally we have to unadjust the exchange rate, giving:

B: 30 days
D: 180 days

If we were to further claim that local refill payments are unlikely to compete with charitable giving, and just remove them entirely, we get:

B type: 12 days
D type: 10 days

Note that this assumes that only one of plants or cylinders limits care, rather than both.

In summary:

Almost all interventions planned by this oxygen campaign will outperform GiveWell top charity recommendations given highly conservative assumptions about effectiveness, length of crisis, etc.

Ventilators and D type cylinders are the weakest interventions but...

...given the long service time of this equipment even these are likely to prove relatively effective in the event that all chokepoints for other interventions could be met. India also has a strong record of redeploying unneeded equipment to other countries for later crises.

Please check my math and support via ACH or credit card if you agree: https://covid.giveindia.org/healthcare-heroes/… There is ~600k USD of funding room left in this campaign. If met we can continue down Rohin's list. I welcome corrections regarding rates/assumptions/etc. My full working is below.

Here are the breakdowns for how I did each calculation. The full .ods spreadsheet can be downloaded from https://file.io/EDsyrhSJMDWA to check the underlying math. Images assume no oxygen cylinder refill cost to donors, but spreadsheet does not.

Effectiveness is hard to judge, I tried to estimate both the risk of a patient who would need that intervention and the amount of impact the intervention would have. Ventilators fair poorly because patients on them die up to half the time in spite of multi-week treatment.

The least obvious assumption I made is probably that D type oxygen tanks would be used for high flow rate treatment exclusively, so even though they are 4 times bigger they run out 4x as fast, while only being twice as effective at saving lives as B type cylinders are.

Oxygen concentrators come out looking really good in all-cost effectiveness, but of course it probably comes down to what is actually available and how quickly it can be produced/obtained.

An important question here is what the marginal impact of donation actually is. E.g. will the Indian government step in to sufficiently fund oxygen supply to the point where it is logistically rather than financially limited? I welcome any insight that anyone can offer here.

Note that the speed of government response is a major factor. If the government can't buy all available oxygen supply at these prices within ~5 weeks, then donating will still outperform it for some of the interventions, assuming they are locally available within 2 weeks.

It's a glaring omission, but for crypto donations see @CryptoRelief_ as well! Reliable org who has already deployed 1M USD worth of funds directly towards oxygen concentrators: https://twitter.com/sandeepnailwal/status/1388813415309737986…

 I'm just trying to draw in the #EffectiveAltruism community as well!

Thanks to Jacob Eliosoff for pointing me to this thread!

From here.

I looked through some charities and tried to assess their efforts.  I ended up looking at what activities they were carrying out, how much detail they provided about their activities, the quality of any financial reporting/quality reporting processes they seemed to have and how easy it seemed to be to access financial breakdowns.  The exercise became more of a "gut feel" analysis than I would have liked but was still tremendously useful - I'm open to suggested edits/additions, and will touch on some of the further research I would have liked to have done at the end.

• PATH: a Seattle based charity - has an India Oxygen Drive.  https://www.path.org/p/india-medical-oxygen/.  Their site has good, clear financial reporting and decent rating on charity navigator.  However if you donate to them, it's not entirely clear where the money will go - their website states that "Donations to PATH are allocated to a variety of programs and projects, depending on current needs and emerging health issues." Overall rating: 7/10
• GiveIndia COVID response fund:  https://covid.giveindia.org/  I especially like that they let you choose the cause you want to donate to and have a thorough list (e.g. oxygen, food, cash).  Their website provides detail on what they plan to do (e.g. partner with local NGOs to set up oxygen generation plants and provide oxygen concentrators/cylinders) and how much each item is expected to cost.   Charity Navigator didn't rate them highly when last assessed because of a low "independent audit" score and not having enough independent board members.  They advertise a strict "due diligence framework of verifying all demand and supply channels are completed", and the financials section of their website seems to me to be transparent enough, with auditor reports and detailed breakdowns of costs.  Overall rating: 8/10.
• International Association for Human Values "Help India Breathe Again": https://www.iahv.org/in-en/donate/  Strange charity name but they seem to be doing good work, having partnered with famous spiritual leader Ravi Shankar's Art of Living Foundation. The website outlines a detailed plan for oxygen concentrators and ration kits, and they post photos of their distributions on Facebook. They make it pretty clear that: "all proceeds will be used in procuring and distributing ration kits" and elsewhere that "100% of your contributions will be utilized for the COVID relief work".  Charity Navigator gave them a decent rating (under their old rating system) and their website seems to back this up.  Their financials page also seems pretty good with independent auditor reports that have detailed breakdowns (e.g. salary vs travel expenses vs advertisement).  However the financials only seem to show up to 2018. Overall rating: 7.5/10.
• SEWA International USA:  https://www.sewausa.org/Covid-19-India-FAQs They are shipping oxygen concentrators, ventilators and other equipment.  They have specific reports on how many oxygen concentrators have been sent (400), with many more ordered.  They advertise a 4-star rating from Charity Navigator.  They publish the independent auditor reports on the financials section of their website and appear to only spend a small proportion of funds on fundraising and adminstrative expenses. Overall rating: 7.5/10
• Project HOPE: https://www.projecthope.org/project-hope-responding-to-covid-19-surge-in-india/04/2021/
  They are responding by helping to procure PPE, oxygen supplies, ICU equipment, ventilators etc.  They proudly advertise that they meet various charity accountability standards, and are ranked by Charity Navigator, BBB and others.  Their financials section publishes accounts, independent audits and annual reports and it looks like they spend less than 15% on administration/marketing.  I especially like that they run a health policy journal (but found surprisingly little estimation of the impact of their projects last year, even in their annual report).  Overall rating: 8/10

I've seen these charities recommended on social media:

• GiveIndia's COVID-19 page (multiple fundraisers)
• Hemkunt Foundation
• Mission Oxygen
• Donate Oxygen India
• Feeding India
• Khalsa Aid

I'm not familiar with any of these charities, but I think medical interventions seem especially helpful. Also, some of these charities provide economic relief in the form of food or cash to people in India who've been affected by the COVID-19 crisis, and that seems valuable too.

A nonprofit called Noora Health that operates in India and Bangladesh has pivoted to several Covid-related interventions. Given their pre-Covid work, they are positioned well to provide information and to train family members to help care for Covid patients.