Co-Founder and Director of Mieux Donner
Reading time: 6 min
The world is not lacking in goodwill. It is overflowing with commitment, generosity and initiative. This is necessary when we consider the problems we face, but it is not always enough. What we also need today is a determination informed by solid evidence. So that every euro, every hour, every action really counts.
At Mieux Donner, we believe in making solidarity as clear as the world is complex. And ensuring that one day, focusing on impact becomes as natural as wanting to help.
After a brief introduction to evidence-based medicine, we will take an in-depth look at how effectiveness has been misused and what mistakes should be avoided. We will then see how these principles can be applied generously, with sincerity and a desire to help others.
A century ago, people died at the age of 40. Not because of a lack of care, but because of a lack of evidence. Every doctor acted with dedication, but without a common method. Then medicine underwent a paradigm shift: it began to test, compare and measure. This led to the birth of evidence-based medicine, which transformed human health.
The voluntary sector, meanwhile, often remains governed by intuition and urgency. Countless women and men act with admirable commitment, but without always knowing what works best. It is time to change these practices, with the same humility and rigour that medicine once had, without falling into the pitfalls that would undermine the goal of helping others.
When the government introduced fee-for-service billing (T2A) in hospitals, the initial intention seemed fair: to allocate resources more rationally, better recognise actual activity, and improve transparency.[1]
But in seeking to make hospitals “efficient” through financial indicators, the system ended up confusing economic efficiency with real impact on health.
The result: healthcare workers had to perform more tasks, more quickly, often at the expense of quality and human connection, despite the widely proven health benefits of such connection. Short-term costs were optimised, but long-term lives were not..[2]
T2A did not fail because it sought to measure. It failed because it measured the wrong thing.
Money is an excellent management tool, but a poor indicator of impact when it becomes the sole metric of value.
In the public sector, as in the voluntary sector, certain essential activities produce no immediate economic return: listening, prevention, dignity, human connection.
And yet, their absence comes at a very high cost, both humanly and collectively.
When performance is assessed solely on the basis of costs or volumes produced, incentives become distorted.
Hospitals, for example, have been encouraged to increase the number of billable procedures, some of which are unnecessary, while essential services such as psychiatry have been neglected.
The same danger exists in the voluntary sector.
If we confuse impact measurement with return on investment, we end up funding what is “visible” rather than what helps the most.
The pursuit of efficiency is not a danger in itself. The danger lies in using the wrong thermometers.
At Mieux Donner, we help donors identify the most effective charities.
Not the ones that communicate best. Not the ones that reach the most people. Not the ones with the biggest budgets.
Those that, with supporting data, truly transform lives will have a significant impact with additional resources.
We rely on independent evaluators and a transparent selection process to identify where generosity can make the greatest difference.
We do not believe in a moral hierarchy of causes, but rather in a hierarchy of effectiveness in the means of action. And we believe that making this data visible empowers those with good intentions rather than weakening them.
Our ambition is not to introduce cold, hard logic into the world of solidarity, but rather to enrich it with methods that can multiply our impact.
Those who are concerned about measurement are right to fear the coldness of numbers. But they sometimes forget that numbers, when used properly, are also instruments of compassion.
Measuring does not mean reducing human complexity to a column of data; it means refusing to look away when our efforts are not helping as much as they could.
In the end, it means:
If I could help twice as many, ten times as many, a hundred times as many people with the same resources, shouldn’t I at least try?
We do not believe that rigour detracts from humanity.
We believe it adds to it. Because it allows us to direct our generosity where it truly changes lives.
Some people fear that measuring performance will unfairly neglect small associations and promising new projects. However, a prioritisation approach based on solid evidence avoids these pitfalls.
When medicine became evidence-based, it did not stop innovating: testing new treatments, exploring the unknown, while relying on the most solid knowledge available at the time.
The voluntary sector can draw inspiration from this approach: learning from what works, supporting what really makes a difference, while keeping the door open to discovery. This is not unfair to less advanced or smaller projects.
It is even morally defensible to consider that it would be unfair to ignore efficiency. If we have the opportunity to help 100 people with the best means available, but refuse to try and end up helping only one person, would the real injustice not be towards the 99 people we were unable to help?
The history of medicine has shown that:
When science began to serve healthcare, compassion did not disappear.
It grew in strength.
The voluntary sector can undergo the same transformation.
It can retain its humanity, intuition and proximity, while drawing on what research teaches us about the world and human beings.
This is not a cold technocratic revolution, it is a generous revolution.
A revolution that says: if we can help more, why settle for helping a little?
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