[keeda]

This is a common refrain of many people, but I believe it is rooted in a fundamental misunderstanding of philanthropy and charities in general. They don't really exist to "fix" problems, they are mostly a band-aid over the structural issues that lead to social problems. The long-term solutions to most of these problems involve policy changes rather than "spot fixes"

Like, funding a homeless shelter or the Trevor Project won't fix the problems causing homelessness or LGBTQ teen suicides. But there are enough people with immediate problems who we do want to support them somehow until policy changes happen, if ever.

You're right that the Gates Foundation is one of the few that has achieved some lasting changes, but I would say that is because their MO is quite different from what many NGO's do. This is based on second-hand knowledge from somebody who works there, so I'm not sure if they do this exclusively, but they strongly prefer to partner with the local governments to introduce highly targeted interventions.

This simultaneously makes it extremely slow and frustrating to operate (especially in countries with dysfunctional governments, which is where help is most needed) and ironically reduces the leverage of money (which is a problem when you have a mandate to spend X% of your money annually!) but also means that whenever any change happens it is generally structural and long-lasting.

There are many other organizations that operate with similar long-lasting principles, but it seems to me most focus on immediate, short-term support, which may be a function of the limited funding and skills of the people available to them.

[rayiner]

> They don't really exist to "fix" problems, they are mostly a band-aid over the structural issues that lead to social problems. The long-term solutions to most of these problems involve policy changes rather than "spot fixes"

Non-profits are 12% of GDP, over $3.5 trillion. Excluding hospitals, universities, and churches, leaves over $2 trillion in non-profit expenditures. Of that, about $300 billion comes from the government. That is more than enough money to solve structural issues.

My dad spent his career in non-profits working on public health in third world countries. These NGOs were able to work with highly dysfunctional foreign governments to achieve real and measurable improvements in some of the poorest countries in the world. Which is why it blows my mind that non-profits spending vastly more money domestically can’t work with e.g. the government of Baltimore to deliver meaningful improvements to the abysmal literacy rates in that city, or work in infant morality in inner cities.

The key difference it seems to me is the lack of accountability in domestic non-profits. The U.S., EU, Japan, etc., care how their foreign aid dollars are used. Every project is evaluated for effectiveness in quantitative terms. That culture of measured accountability seems entirely absent in domestic non-profits.

[laughing_man]

It doesn't surprise men to find we spend trillions on nonprofits and get little in return. There is an enormous amount of corruption. More than forty years ago I knew a woman who was cold calling people to raise money for research into a canine disease.

If you donated a dollar, she got fifty cents. Her boss got twenty five cents, the company got their cut, the university took a little, so did the department and the professor. By the time it came down to some poor grad student looking at slides there was only a penny or two going to pay him/her. This kind of thing combines the worst of both government and private business.

[rayiner]

Yes, and it’s not just what you’d call outright corruption. A lot of the people who work at non-profits are family members of wealthy people. If you’re a Fortune 500 CEO and your kid isn’t qualified to become a “captain of industry,” you can donate to some non-profit and get them a job there. It’s a socially acceptable way of dealing with “excess elites.” But the consequence of that is that these non-profits aren’t run in a results-driven way. These CEOs aren’t scrutinizing the numbers of the non-profit their nephew works at versus the non-profit some other CEO’s nephew works at, to see who is helping more people more cost effectively. The result is a kind of soft corruption of organizations that get lots of donor funding through social networks but which don’t use that money very effectively. Not because it is being diverted as such, but because nobody is trying very hard.

[gnerd00]

depends on your lawyers.. the reporting requirements in the USA are real. What the report says, who is named.. a much broader topic.

[keeda]

> That is more than enough money to solve structural issues.

But that's the thing, the money is not helpful when it comes to policy issues. As the Gates Foundation MO and your dad's experience probably shows, lasting change comes down to political will. I can only surmise that the reason more US non-profits don't achieve lasting change is because they are not able to or they are not trying to.

This is not to say they are deliberately being ineffective, e.g. consider that inner city infant mortality rates have socioeconomic and racial factors, so solving that would require "solving" poverty and racism. Offhand, I really can't see how non-profits would be able to address these with even billions of dollars.

Of note, a sibling comment mentions the book "Winner Takes All" and links its wikipedia page which has this quote:

> The Aspen Consensus, in a nutshell, is this: the winners of our age must be challenged to do more good. But never, ever tell them to do less harm. The Aspen Consensus holds that capitalism's rough edges must be sanded and its surplus fruit shared, but the underlying system must never be questioned. The Aspen Consensus says, "Give back," which is of course a compassionate and noble thing. But, amid the $20 million second homes and $4,000 parkas of Aspen, it is gauche to observe that giving back is also a Band-Aid that winners stick onto the system that has privileged them, in the conscious or subconscious hope that it will forestall major surgery to that system – surgery that might threaten their privileges. The Aspen Consensus, I believe, tries to market the idea of generosity as a substitute for the idea of justice."

Not saying I agree entirely, but that is the kind of thing that could lead to billions in spending without achieving lasting structural changes.

[rayiner]

> As the Gates Foundation MO and your dad's experience probably shows, lasting change comes down to political will

Lasting change comes down to data-driven programs that work and the money to implement them. As long as you’re not asking for money and meet the community you’re working with where they are,[1] politics is mostly a red herring. My dad worked on projects that achieved incredible results in Bangladesh, for example, even though the government of the country was a complete clusterfuck the entire time.

> socioeconomic and racial factors, so solving that would require "solving" poverty and racism.

The way to eat an elephant is one bite at a time. There may be overarching “factors” that contribute to a result, but there’s usually an immediate cause of a problem that you can tackle directly with an effective program.

Mississippi, for example, is now #3 in the country for NAEP 4th grade reading and math scores for black students. It’s #1 for reading and #2 for math for Hispanic students: https://mdek12.org/wp-content/uploads/sites/59/2025/01/NAEPR.... Mississippi didn’t “solve poverty and racism.” It implemented a program that identified the immediate cause of certain problems and fixed them.

[1] Effective programs avoid creating political problems. When my dad was designing maternal health programs for Bangladeshi villagers, he met them where they were instead of where he thought they should be. For example, it turns out rural women wouldn’t use newly built clinics for giving birth because they didn’t trust “big city doctors.” So the program developed relationships with local midwives and traditional healers, who the women already trusted, and had them get training from the doctors and refer high risk pregnancies to the clinics while handling routine deliveries in the traditional way.

[keeda]

> Mississippi didn’t “solve poverty and racism.”

It didn't solve maternal mortality rates either, where it ranks dead last amongst the states: https://www.marchofdimes.org/peristats/reports/mississippi/r...

> Lasting change comes down to data-driven programs that work and the money to implement them. As long as you’re not asking for money and meet the community you’re working with where they are,[1] politics is mostly a red herring.

Kind of, but my point is it's not just a function of throwing money at the problem, because "meeting where the community is" typically a) is just the first step towards overcoming structural issues; b) requires properly skilled staff; and c) involves politics in some form. Like I would bet most of the things your dad had to do often had to be supported by the local power structures (e.g. being blessed by the village headman.) They may not even have had official policies to be changed, but for sure certain ways of doing things were institutionalized.

I know someone posted in a poor, rural corner of India whose primary "KPI" is improving the maternal mortality rate in their region, and meeting the community is only the first step in solving problems that include -- in addition to the problems you mention -- chronic malnutrition, unawareness of potential pregnancy complications, lack of appropriate medical facilities, lack of infrastructure to access any that exist, and, most insidiously, age-old biases about how "things should be" where women are at the bottom of the social totem pole. Each of them is a separate structural issue and most of them cannot be changed by working with the community alone.