Lucy Bernholz

First came GlobalGiving, DonorsChoose and Kiva. These platforms brought crowd giving/lending to new heights. They also represent a trajectory of increasingly narrow area of focus for the platforms – GlobalGiving funds development projects internationally, DonorsChoose focuses on US classroom teachers’ needs, and Kiva ‘kickstarted’ the crowdfunding of microloans. More recently, Dave Eggers and the good folks at 826 National launched a platform to fund college aid called ScholarMatch.

2013 may be shaping up as the year of crowdfunding medical needs. There are least three (send me others) new sites that provide access to funding for urgent medical needs. One of them, Watsi, has received a lot of attention for being the first non-profit included in the Y Combinator accelerator – a badge of honour at least in Silicon Valley. Another, Samahope, which funds surgical procedures, comes from the brains behind SamaSource – a pioneer in digital micro job creation. The third, Kangu, focuses specifically on helping women have healthy pregnancies and births.

I had a chance to meet with Grace Garey of Watsi, so I have a better sense of how that program works than the others. What struck me about Watsi is its commitment to make transparent all the information about the process, the patients, the clinics, the funding. This is a big deal – especially since we are talking about people’s healthcare. It raises issues of what kinds of health information are individuals willing to share? How do you present enough information to attract funding and protect the dignity of the individual? What will happen to all that data as Watsi grows? (It has already served more than 200 people in just a few months.) That’s 200+ life changing medical treatments. By virtue of their involvement at Y Combinator you know they’re interested in getting big (‘scale’ being the buzzword you are looking for). Watsi is already working with its medical partners on ‘informed consent’ and patient waivers. These patients may well be more informed than many Americans are about their own medical care. They may also be more in charge of the consent they give. But what rights to their data will they have down the road?

It seems critical to me that these platforms be ‘patient-centric’ by design. These are peoples’ lives we’re talking about here. Sure, the donor experience is important, but the possibility for horrible power dynamics to emerge between donor and recipient seem that much more magnified in a situation in which a compelling story is key to motivating a donation. Watsi is very attuned to these issues and working hard not to structure a marketplace of sob stories. Being incredibly clear about what’s actually being funded (the medical practitioner, not the patient) is part of that. Finding ways to keep the doctors/nurses in control of the timing of any medical action (and not contingent on funding) is another piece of the puzzle (one which Watsi has already addressed).

In addition to the plenitude of intimate issues raised by sites like these, there are also larger policy issues. The growth of microfinance has had positive results and there are significant concerns with how it influences commercial lenders with purely financial motivations or shapes national policies and state investments in functioning financial systems. With any philanthropic activity there is the question (if the holy grail of ‘scale’ is reached) of letting public funders off the hook and leading them to invest less in a social safety net, not more. Which is, given the attention deficit disorder of both individual and institutional funders, a real problem.

Watsi, and I assume Kangu and Samahope, have the potential to become powerful new sources of data. Just by browsing Kangu’s website, for example, I can now tell you that prenatal care and an attended birth costs $253 in Uganda. As more and more people are served by these systems, their data on costs, quality, efficiencies and health outcomes could become quite valuable.

These medical crowdfunding site are fascinating to me. In many ways, they are returning us to the time before national health services and social security, when turning to one’s community for financial assistance with medical needs or college costs was the norm. Of course, global connectivity is changing our definition of who constitutes ‘one’s community,’ but another way of seeing these services is as mutual aid on steroids. (And minus some of the mutuality – will a Ugandan woman ever contribute to the costs of maternal care for an American? I suppose it’s possible, Kiva now facilitates many loans between ‘developing’ countries).

What do you think is the next frontier for social sector crowdfunding?

Lucy Bernholz is the author of the blog philanthropy2173, where this article first appeared.