Run the Room Can it really not be done? ↓ In 2000, a year of antiretroviral therapy cost about $10,000 per patient. Health ministries across Africa built treatment plans underneath that number and reached the same conclusion: treating everyone was unaffordable. That was a reasonable conclusion. Then in February 2001, the Indian generics manufacturer Cipla offered governments and NGOs a three-drug combination for $350 a year. Nine months later, the Doha Declaration confirmed that the generic...
10 days ago • 1 min read
Run the Room What if you’re not risk-averse, but leverage-blind? ↓ There's a lot of hullabaloo about the billions of dollars now flowing into philanthropy from the AI boom. And while there's plenty of speculation about where it will go, there's also an emerging consensus: a lot of it (a lot!) will go toward "GiveWell"-style giving: interventions with strong evidence, measurable outcomes, and a reasonably clear answer to the question, “What did this dollar buy?” And this prompts a much larger...
17 days ago • 3 min read
Run the Room And the three things you need first ↓ I had requested forty-seven one-to-ones through the app before I arrived. Volunteers, most of them a few years out of university, directed traffic at the stairwells for free. Nobody was late. It was the last weekend of May and I was at a conference put on by effective altruists. Last week I wrote about our tendency to confuse choosing a simpler problem with making the solution easier. A lot of people assumed it was an underhanded indictment...
24 days ago • 2 min read
Run the Room The difference between simple and easy. ↓ Everyone with a keyboard has had opinion on foreign aid over the last 18 months. And lately, those opinions have been converging on one word: Simple. Cut the overhead, skip the systems, hand out stuff you can count. And I get the appeal—simple is legible, simple is fundable, and simple photographs well. But here's the problem: We often confuse choosing a simpler problem with making the solution easier. And simplifying the wrong thing can...
about 1 month ago • 2 min read
Run the Room Our sector makes the wrong things easy ↓ I was raised in the church of self-sacrifice—Paul Farmer and Jesus Christ, take your pick of saint. The gospel was plain: good work should cost you, and the more it costs, the holier it counts. So I paid. For years I lived and worked in rural Liberia—no power grid, no phone signal, not even a gas canister—settling in a region so dangerous even UN peacekeepers wouldn't patrol. I called any discomfort proof I was serious. I ran myself...
about 1 month ago • 2 min read
Run the Room The case for winning something small ↓ When something big won't move, the problem is usually that it's too big. A large, worthy goal invites everyone to imagine all the ways it will fail. You lay out the vision, and instead of momentum you get a hundred reasons it's “unrealistic.” No budget! No mandate! Not the right time! The bigger the goal, the easier people find it to dismiss. So we often do what determined people do: make the case again. Sharper, more enthusiastic, more...
about 2 months ago • 1 min read
Run the Room Make the right thing the easy thing ↓ A group of community health workers were waiting for us—five of them when they'd started, ninety by the time I walked in. They were chanting their demands, pay and protection and recognition, and they didn't drop their voices for the guests. I'd flown in to talk strategy. They were already living it. Over the last month I've described three problems: • Translation tax —people back whoever's fastest to understand.• Decision gravity —people...
about 2 months ago • 1 min read
Run the Room How to end decision drift ↓ "It's the oldest story in the world. One day you're 17 and planning for someday. And then quietly, and without you ever really noticing, someday is today. And then someday is yesterday. And this is your life." So said a famous teenage soap opera character. And he's right: drift is a real thing. And it applies to more than just the sand melting through the hourglass: most of the changes you're proudest of won't be reversed...they'll just slowly drift...
about 2 months ago • 1 min read
Run the Room The law of gravity ↓ Every organisation has decision gravity: whatever takes the least effort is what eventually happens—regardless of what anyone decided, intended, or believes is important. I spent the first part of my career not understanding that, and it nearly derailed me. I started out in Liberia, where only a handful doctors served four million people. The person keeping a village alive was usually a woman with no medical training and no salary, going door to door,...
2 months ago • 1 min read