Abstract

Imagine you were running a medical non-governmental organization (NGO) established to preserve the lives of poverty-stricken people in resource poor countries. Your NGO is also usually among the first to provide emergency assistance in case natural emergencies such as tsunamis strike. However, you did notice that agencies evaluating your efficiency1 give you a below-average ranking. That is a worry to your fundraising staff, mostly because you rely on donations and such ratings are said to impact eventually negatively, on your capacity to raise cash. You investigate what the problem is, and it turns out that the ratings agency is critical of your policy of responding mostly in cases of high-impact disasters such as earthquakes, floods or civil wars, because they invariably require a highly resource intensive intervention. The agency's verdict is that, on the same capital outlay, you could preserve more lives in developing countries if you aimed at establishing medium- to long-term health delivery solutions, including setting up primary health care facilities, beginning vaccination programs, and other such relatively low-cost means. Chartering private jets to fly emergency teams in response to disaster also preserves lives deserving to be rescued, the ratings agency says, but it demonstrably results in a substantially lower number of lives preserved than you could preserve if you dropped such actions in favor of working toward better health care delivery infrastructure in the countries you usually serve.