Philanthropy is changing.
Today, just 3 percent of donors account for 78 percent of all charitable giving in the United States.¹ At the same time, the number of people giving to charity has declined for five consecutive years, with roughly 20 million American households no longer donating compared with the year 2000.²
For an organization that believes everyone has a role to play in building the world we want to see, these trends are hard to ignore.
Too much of today’s philanthropy depends on a small number of very wealthy donors. And that concentration shapes not just how much gets given, but where it goes and who gets to participate.
Nowhere does this matter more than in global health.
The biggest donations often go toward causes and institutions that already have visibility, strong networks, and access to funding. In 2024, the largest charitable gifts in the United States were often directed toward elite universities, major research institutions, and hospitals.⁴
Those gifts matter. They fund important work and advance discoveries that have the potential to benefit millions of people.
But they also reflect a common assumption that bigger donations always create bigger impact.
The reality is more complicated.
The size of a gift is not what makes it meaningful. What matters more is whether it actually reaches someone who needs it.
Our Watsi patients are often living in rural communities, facing extreme poverty, and dealing with conditions that rarely attract headlines. We cannot wait for the moment these lives and conditions become visible enough, urgent enough, or familiar enough to capture the attention of a handful of the world’s biggest donors.
A system where access to something as basic as healthcare depends on being noticed is not a system built for everyone.
But there is another model of giving. One that has existed for as long as people have cared for one another, which is to say always.
Before there were foundations, institutions, or large-scale philanthropy, there were people simply showing up for each other. Communities sharing what they had. Neighbors helping neighbors. Strangers stepping in because someone else needed support.
That instinct is still alive today.
And sometimes, a small act of generosity can completely change the course of someone’s life. Like it did for Thu Ta in Burma.
One life changed.
A few years ago, 22 people from around the world came together to help fund Thu Ta’s heart surgery.
We recently met Thu Ta, whose heart surgery was funded by the Watsi community. To make the trip, he crossed a river from the remote community he now serves in Burma.🛶
They had never met him. They did not know each other. But each person chose to show up, and together, their small acts of generosity gave Thu Ta the chance to heal and build a healthier future.
Today, deep in the jungles of Burma, Thu Ta is now showing up for others. He works to help people in his community access healthcare when they have nowhere else to turn.
That is the thing about generosity. It travels farther than we can imagine.
Why people give?
What inspires people to give is often much simpler than we assume.
People give because they want to help. Because they recognize something of themselves in another person’s story. Because being part of something bigger than themselves feels meaningful.
David, who was an early Kiva and social entrepreneurship supporter who found Watsi, shared:
Chris, a Watsi donor since 2017, put it simply,
“We have money. We should give.”
For Dean, a member of the Watsi community since 2013, generosity is something his family practices together. He involves his children in giving decisions to teach them about money and help them think about the kind of people they want to become.
For his family, generosity is something you pass on.
Valerie discovered Watsi after researching trustworthy organizations on Charity Navigator that help people directly. What stood out to her was the ability to see the people behind each donation and understand the impact her support could make.
“I began donating to Watsi because it offered a way to see directly the impact that my donations could make. Being able to see pictures of actual patients, with updates about their conditions and progress, really brings home to me how fortunate I am to have the healthcare that I do, while realizing that is not true for everyone. The relatively minimal cost of care allows donations to have such a large effect on both the patient and their family. That just makes me feel good. I have been making donations to the Universal Fund because it is so difficult to choose between patients. This way I still receive progress reports and know that my help will go where it is most needed. Watsi is an organization that I really appreciate, both for what they do for those in need, as well as allowing me to contribute in what small way that I am.”
Why do you give?
We have been thinking about this question at Watsi, and it is not "how do we raise more money?" even though the work requires that too!
We are inviting our community to answer it. With a story. A photo. A voice note. A few sentences about the moment giving became real for you, the moment you moved from thinking about someone else's situation to actually doing something about it.
That answer matters. Not just for us, but for the idea that generosity is a democratic act, available to everyone. A healthy life should not depend on who notices you. It can be made possible by thousands of people who decided, independently and together, that one life was worth something.
We'd like to know. Why do you give? Come tell us.
Notes & Sources
1. Fundraising Effectiveness Project analysis published by Stanford Social Innovation Review on the concentration of charitable giving in the United States.
2. Fundraising Effectiveness Project data on long-term trends in U.S. charitable participation.
3. Mark Dobosz, philanthropy commentary on donor concentration and nonprofit sustainability.
4. Chronicle of Philanthropy reporting on the largest charitable gifts of 2024.
5. The Lancet Commission on Global Surgery; Global Burden of Disease Study.
The Watsi Team
Everyone deserves healthcare.