I'm a doctor working towards the dream that every human will have access to high quality healthcare. I'm a medic and director of OneDay Health, which has launched 53 simple but comprehensive nurse-led health centers in remote rural Ugandan Villages. A huge thanks to the EA Cambridge student community in 2018 for helping me realise that I could do more good by focusing on providing healthcare in remote places.
Understanding the NGO industrial complex, and how aid really works (or doesn't) in Northern Uganda 
Global health knowledge
 
great question Lucas! i think it's highly unlikely (verging on implausible) that this could make a GiveWell grant net negative - those particular charities do so much good, that even in the unlikely scenario that a GiveWell charity plucked many of their staff from high good-yielding jobs i struggle to imagine it could pull their work to net negative.
I also doubt it could lower their cost effectiveness by more than say 2x, but this is intuition. A 2x negative multiplier though would be significant and important.
Those staff they hire will also be replaced in time as well to some extent, which mitigates some of the harm
like I mentioned above in my reply though this problem could be remedied relatively easily by GiveWell chaities in most cases by making sure they pay less than high government salaries for most of all positions.
hey there interesting question! As a policy I would doubt it. interestingly sometimes NGO policies pay as minority of jobs at or below market rate. for example a NGO hospital close to my home pays everyone with a degree the same amount. So most of their staff then get 50 to 100 percent more than they market rate, but they struggle to even hire radiographers (there's a shortage) who get paid double other degree holders on the open market. The health center I work at (which pays 20% more than market) recently had to hire a radiographer paid twice as much as the in-charge of the facility!
At OneDay health we do something like that, although it's not an official policy. Although In management positions I'll be honest that we pay a bit more and say I'm partially guilty of my own accusations. Not even in the ballpark of many NGOs though.
Thanks so much for writing this @DavidNash. I think that this awkward but important negative externality is little discussed in EA Global health circles, and I've never seen seen this included as a negative adjustment in a cost-effectiveness analysis (would be tricky tho). Hiring the best people away from their burgeoning new business or a government job could cause a horrendous counterfactual of lost value - that of course you'll never see or know.
I think many NGOs unfortunately see their hiring situation a kind of failure of game theory. For the individual NGO the best option seems to be to hire the best worker they can for a high salary. NGOs don't co-operate and pay market wage, so most NGOs just defect and they all pay more. You then get a weird NGO world which operates on a different plane from the local market. When I talk to  NGO leader and they mostlyadmit that paying so much is bad for the reasons you outline, but then shrug and respond.
"what choice do we have to get the best staff"
I think in general though the NGOs are wrong even about having to pay this much to get super capable people. Unemployment rates are so high in LMICs, that there are thousands of super talented and capable people that would happily take a 30% or 50% lower salary that than they are paying - and with support and guidance would often do a great job. This might not be the case at top management level, but holds at most other levels of an organisation. 
Pushback - Government pays HIGH
One pushback I have, is that "There are also variations in government pay as well with some countries having relatively high pay for government workers" misrepresents the situation - government pay is usually much higher than the market.  In Uganda, government jobs are seen as the "Mecca" because they pay so much more than the market, and often at least as much as NGO jobs. Many NGOs then make the mistake of benchmarking to government salaries even though that doesn't represent market salaries at all. I think many government salaries are absurdly high in Uganda, and this matches the situation in other countries. This International Labour Org listshows that in most Sub-Saharan African countries government salaries average more than double the private market, which is kind of crazy...
 
And to back that up here's my experience of certificate nurse salaries in Uganda.
Goverment     - $350 monthly
NGO                 - $300 monthly (and you have to work harder than in government)
Us                     -  $130 monthly (junior staff)
Other private   - $100 monthly
I think your arguments against the problem are weak, you say "This could be wrong. Maybe NGO experience provides valuable skills people later use elsewhere. Maybe in contexts with few good jobs, NGOs are the best available option for keeping talented people in-country and employed. This seems like a straw man to me, because the counterfactual isn't hiring no-one, its paying people less. Why not just hire 2 people at slightly above the market rate rather than one for double the rate as is common practice. Then more people get the skills to later use elsewhere and more people get decent jobs which could keep them in-country.
I think NGOs could largelty solve this problem through benchmarking against similar private sector salaries, then maybe add 20%-30% to that. This should be a good balance where you can
1. Hire great staff
2. Retain your staff
3. Avoid misallocation of staff from other more (or similarly) important work
One positive development is that NGO salaries have reduced over the last few years, in Uganda at least. I think that NGO budgets have been tighter, and also NGOs have realised they don't actually need those high salaries to retain staff. Post USAID I hope this situation improves even more.
One area salaries are still stupid-high is in research projects run by foreign universities/institutions. I think foreign researchers are usually so far removed from local realities they have even less of a clue about the local economy than NGOs. At OneDay Health we've been involved in a couple of research projects recently, and salaries people in this field have been wanting are even higher than I've seen in NGOs - sometimes close to on par with Western Salaries. I actually cracked up laughing on the phone at one salary request (probably rude of me).
A parting shot
I want to call out EA-affiliated orgs as often no better than the average here. GiveWell funded Orgs like Clinton Health Access Initiative (CHAI) and PATH follow the pattern @DavidNash describes. When I balked at the high salaries in a CHAI Project here, @GiveWell responded with their unusually wonderful transparency.
"Our understanding is that salaries are set based on globally-benchmarked salary ranges and localized equity adjustments to account for organizational equitable pay standards and differential cost of living across different geographies. A portion of the compensation costs is also due to benefits (such as health insurance) that may be standard to each location.
To which I would respond - yes if that's the approach, you'll end up paying extremely high salaries and often pinch staff from similarly/more important work. Better to benchmark against the market, not "Organisational equitable pay standards". Also (by the by) I would doubt that health insurance is "standard" in any Sub-Saharan country.
This especially is a great take in a competitive job market which I hadn't thought about before - as much as it might be hard for some personality traits.
"Aim to be a spikier candidate - i.e., someone with some chance of being a fantastic hire, but lower confidence of being an average hire. If you’re getting to the mid-stages of many processes, there’s a chance you’re seen as a ‘good but not great’ candidate across the park. I see many very well-meaning, well-intentioned applicants like this - clearly value-aligned with AIM but without any standout traits that get me excited about their potential as a founder. Like with dating, it’s better to be a perfect fit for one role than a decent fit for every role: it’s much better to be a 2/10 for 5 hiring managers, and a 10/10 for 1 hiring manager, than a 6/10 for every process you go through. Don’t just aim to tick the boxes in your application submissions; highlight what makes you more unique in terms of your experience, knowledge, or approach to working. Can you bring a novel angle to the test task you’ve been presented, that might fall flat, but might also make you stand out?"
As much as I mostly agree with this, I selfishly want to soak up a little of your love and "entertainment" from time to time. I'm keen to keep the forum vibrant and nurturing to our souls, it's going to be hard to avoid fun from time to time.
So when the gratuitous, meaningless fun hits the forum, I might not be reporting to @Toby Tremlett🔹 and the fun police.... ;)
I really like this take on EA as an intellectual movement, and agree that EA could focus more on “the mission of making the transition to a post-AGI society go well.”
As important as intellectual progress is, I don’t think it defines EA as a movement. The EA movement is not (and should not be) dependent on continuous intellectual advancement and breakthrough for success. When I look at your 3 categories for the “future” of EA, they seem to refer more to our relevance as thought leaders, rather than what we actually achieve in the world. Not everything needs to be intellectually cutting edge to be doing-lots-of-good. I agree that EA might be somewhat “intellectually adrift”, and yes the forum could be more vibrant, but I don’t think these are the only metric for EA success or progress - and maybe not even the most important.
Intellectual progress moves in waves and spikes - times of excitement and rapid progress, then lulls. EA made exciting leaps over 15 years in the thought worlds of development, ETG, animal welfare, AI and biorisk. Your post-AGI ideas could herald a new spike which would be great. My positive spin is that in the meantime, EAs are “doing” large scale good in many areas, often without quite the peaks and troughs of intellectual progress.
My response to your “EA as a legacy movement set to fade away;” would be that only so far as legacy depends on intellectual progress. Which it does, but also depends on how your output machine is cranking. I don't think we have stalled to the degree your article seems to make out. On the “doer” front I think EA is progressing OK, and it could be misleading/disheartening to leave that out of the picture. 
 
Here’s a scattergun of examples which came to mind where I think the EA/EA adjacent doing machine is cranking pretty well in both real world progress and the public sphere over the past year or two. They probably aren't even the most important.
1. Rutger Bregman going viral with “The school for Moral ambition” launch
2. Lewis Bollard’s Dwarkesh podcast, Ted talk and public fundraising.
3. Anthropic at the frontier of AI building and public sphere, with ongoing EA influence
4. The shrimp Daily show thing…
5. GiveWell raised $310 million dollars last year NOT from OpenPhil, the most ever. 
6.  Impressive progress on reducing factory farming
7. 80,000 hours AI video reaching 7 million views
8. Lead stuff
9.  CE incubated charities gaining increasing prominence and funding outside of EA, with many sporting multi-million dollar budgets and producing huge impact
10. Everyone should have a number 10....
Yes we need to looking for the next big cause areas and intellectual leaps forward, while we also need thousands of people committed to doing good in areas they have already invested, in behind this. There will often be years of lagtime between ideas and doers implementing them. And building takes time. Most of the biggest NGOs in the world are over 50 years old. Even Open AI in a fast-moving field was founded 10 years ago. Once people have built career capital in AI/Animal welfare/ETG or whatever, I think we should be cautious about encouraging those people on to the next thing too quickly, lest we give up hard fought leverage and progress. In saying that, your new cause areas might be a relatively easy pivot especially for philosophers/AI practitioners.
I appreciate your comment “Are you saying that EA should just become an intellectual club? What about building things!” Definitely not - let’s build, too!” 
But I think building/doing is more important than a short comment as we assess EA progress.
I agree with your overall framing and I know you can’t be too balanced or have too many caveats in a short post, but I think as well as considering the intellectual frontier we should keep “how are our doers doing” front and center in any assessment of the general progress/decline of EA.
I agree with this comment in general, and think $100 would be a relatively small amount. For both EV and PR reasons though, I would think $1000ish would be reasonable.
If we were looking for PR firms to compete for a logo or a brand or similar then 10k might make sense, or even more. But the competition is labeled as a "Meme" prize which signals to me at least rougher, lower effort work with less longevity and sticking power than a fun and thought-provoking meme.
I really doubt a competition with any prize pool has more than a 5% chance of producing a meme with close to the strength of p(doom) or 1984, but am happy to be pointed to examples which might show otherwise.
Thanks for the wonderful insight. I'm 38 and have lived with my wife for the last 12 years in the EA hub of Northern Uganda. Although yes it's the perfect place to deeply understand and work on solving tricky development issues (come live with us!), I'll admit there are a few reasons why people might not want to move here permanently, including most you listed ;).
Although our experience has been that if you live somewhere long enough, the place can become home and then you get some of the best of both worlds....
Great comment and welcome to the forum! looking forward to hearing more of your thoughts :).
Only one small comment which may help understanding @Vasco Grilo🔸 can say if I'm representing him incorrectly. I agree that the uncertainty is so high here that it doesn't make sense to make strong practical recommendations. Vasco though is a mathematical utilitarian in a pretty pure form, so he's seemingly happy to make strong recommendations where there's little evidence and probabilities are close to 50/50. he'll then even change those recommendations immediately after doing some more calculations. I don't really understand how this can work in practice as communities of EA doers obviously can't switch from advocating eating less meat to advocating huge farms on the basis of an extremely uncertain BOTEc. I've made a similar point to you on as few of his posts in the past.