I’ve been remiss in blogging about serious things, and this post won’t help on that front. Real writing resumes next week…
I was looking for the Kenyan 2009 census data and came across that survey’s guide for enumerators (ie, data collectors) in PDF form, here. There’s an appendix towards the end — starting on page 60 of the PDF — that’s absolutely fascinating.
Collecting information on the age of a population is important for demographic purposes. But what do you do when a large proportion of people don’t have birth certificates? The Kenyan census has a list of prominent events from different regions to help connect remembered events to the years in which they happened.
This may well be standard practice for censuses — I’ve never worked on one — but the specific events chosen are interesting nonetheless. Here’s the start of the list for Kirinyaga County in Kenya:
So if you know you were born in the year of the famine of (or in?) Wangara, then you were 100 years old in 2009. Likewise, 1917 was notable for being the year that “strong round men were forced to join WWI”.
On the same note, the US birth certificate didn’t have an option for mother’s occupation until 1960! (That and other fascinating history here. Academic take here.) Also, there are 21 extant birth certificates from Ancient Rome.
The view from my (temporary) window, click for the zoomed in view:
This is at low tide — most of the sand in the distance is covered when it comes in. On the horizon on the right side you can see the line of ships heading into the Dar harbor
Also, Wednesday I was taking a Skype call with a colleague looking out this window and saw a whale in the distance. Having never really lived on the ocean before, that’s pretty cool.
There’s a LinkedIn group for Global Public Health that occasionally has good discussion. One example, albeit a sobering one, is the current discussion of employment opportunities after MPH. I’ve been meaning to write about jobs for a while because now that I’m on the other side of the picture — an employed professional with a job at a reputable organization, rather than a grad student — I find myself doing an increasing number of informational interviews, and saying much the same thing each time.
[First, some caveats on the generalizability of the advice below: first, folks with an MPH from another country often have less debt burden than Americans, so may find it easier to do long unpaid or underpaid internships. Second, folks from low- to middle-income countries are and should be more employable, especially in their own countries. Why? Because they have incredibly valuable linguistic and cultural talents (see Alanna Shaikh's recent post on this), so much so that an organization choosing between an outsider and a local with the same technical skills, communication skills, etc, should almost always choose the local. If they don't, that's generally a sign of a dysfunctional or discriminatory organizations.]
The problem is that there is something of an MPH bubble, especially in global health. The size of MPH classes has increased and – more importantly – the number of schools granting degrees has risen rapidly. Degrees focusing on global health also seem to be growing faster than the rest of the field. (I’d welcome data on class size and jobs in the industry if anyone knows where to find it.) This is happening in part because public health attracts a lot of idealists who are interested in the field because they want to make a difference, rather than rationally choosing between the best paying jobs, and global health has gotten a lot of good press over the last decade. Call this the Mountains Beyond Mountains Effect if you like.
If you know this, and still go into the field, and don’t have an MD or PhD that qualifies you for a different sort of job altogether, then you need to distinguish yourself from the crowd to be employable. I’m assuming your goal is to get a good job in global health, where “good job” is defined as a full-time professional position with a good (not necessarily big-name) organization, working on fulfilling projects and being paid well enough to live comfortably while paying off the loans that most American MPH grads will have. For some, though not all, a good job might also mean one that’s either based abroad or involves frequent international travel. If that’s the goal, then there are several ways to distinguish yourself:
- get some sort of hard, transferable skills. This can be research or M&E skills, especially quantitative data crunching ability, or it can be management/coordination experience with serious responsibility. Or other things. The key point is that your skillset should match jobs that are out there, and be something that not everyone has. A lot of MPH programs feature concentrations — or the lack thereof — that are more appealing to students than they are to employers. A biostatistics concentration will likely serve you better than a global health concentration, for instance, and with some exceptions.
- get solid international experience, preferably a year or more. Professional experience in public health — even with a lesser-known organization — is much more valuable than experience teaching, or studying abroad. Travel doesn’t count much, and it’s better to have experience in the region you’re interested in working in. There’s a huge catch-22 here, as you need international experience to get it, so that many global health folks start off doing work they’re critical of later in their careers.
- relatedly, speak an in-demand language, though this will only help you to work in the region where it’s spoken.
- have professional work experience. Even if it’s not in global health, having worked an office job for a year or two makes you more desirable to employers. No one wants to be your first employer, so folks who go straight to an MPH may find themselves less employable than peers who worked for a bit first.
- go to a top school, which signals that you’re smarter or better qualified than others (this often isn’t true, the key part is the signalling, and the networks you acquire). Also, graduates of top schools often get good jobs in part because those schools select people with good work experience, skills, and connections to begin with, so that a superior candidate at a school that’s perceived to be a second or third-tier school can do just fine.
- avoid debt (which often conflicts with ‘go to a top school’) to give yourself the flexibility to work for less or for nothing at first, until you can do the above.
Any one or two items from this list probably won’t cut it: you need to acquire several. For example, I’ve known peers with a solid technical degree from a top school and some international experience who still struggled to get jobs at first because they had never had a regular office job before grad school. Also, the relative importance of each will vary according to the subfield of global health you’re interested in. For instance, learning languages might be more important for an implementation person (program coordinator or manager) or a qualitative researcher than it is for a data cruncher.
I used to be pre-med, until I realized I was more interested in policy and did not want to be a clinician, and the path to doing so in the US is long and expensive. Like many former pre-med students who decided not to go to medical school, it took me a while to figure out what I wanted to do, and how to do that without an MD. A couple years post-undergrad I found myself working a job that was interesting enough but not what I ultimately wanted to do, and unable to get a first job in global health without the requisite skills or longer international experience, and I didn’t have the resources to just up and move abroad on my own. So, I went to go to grad school with a technical focus (epidemiology) at a top school, and then used the practicum requirement to build more international experience (Ethiopia). The combination of school and work experience gave me solid quantitative skills because I chose to focus on that each step of the way. But, it also meant taking on quite a bit of debt, and the international practicum would have required even more had I not had generous funding from the econ/policy degree I did. This has worked out well for me, though that same path won’t necessarily work for everyone — especially if you have different interests from mine! — and I think it’s instructive enough to share.
The upside of this bubble is that organizations often hire well-educated, experienced people for even entry level position. The downside is that people from less privileged educational or financial backgrounds often get blocked out of the sector, given that you might have to volunteer for an extended period of time to get the requisite experience, or take on a lot of debt to get a good graduate degree.
In conclusion, getting an MPH — and trying to break into global health — is a personal decision that might work out differently depending on your personal goals, the lifestyle you’re looking for, and your financial background. But if you do get one, be aware that the job market is not the easiest to navigate, and many MPH grads end up unemployed or underemployed for a stretch. Focus on acquiring the skills and experience that will make organizations want to hire you.
I’ve put together a list of tips and suggestions for travelers, drawing on advice from colleagues and friends. It’s geared towards public health or development folks who work in and often travel between low-income countries, as opposed to backpackers, tourists, etc. The document is in Google Drive so I can continuously update it with suggestions — feedback is appreciated.
Another good resource is How to work in someone else’s country by Ruth Stark, which is written with global health consultants in mind, and contains useful packing advice and good general rules for cross-cultural work. Chris Blattman has written quite a bit about this; see especially his posts on air travel, air travel pt 2, packing, and packing pt 2.
My recent post asking for tips on what to read on Tanzania and Dar es Salaam yielded some great emails. I’ve compiled the recommendations and am sharing them back here:
- James Brennan, Taifa: Making Nation and Race in Urban Tanzania
- Brennan, Burton, and Lawi, Dar es Salaam: Histories from an Emerging African Metropolis
- Maddox and Giblin, In Search of a Nation: Histories of Authority & Dissidence in Tanzania
- Work by Joe Lugalla
- North of South
- Empires of the Monsoon
- Novels by Aniceti Kitereza
- An Ice Cream War
- Bjerk, Paul K. “Sovereignty and socialism in Tanzania: the historiography of an African state.” (PDF)
- Lal, Priya. “Self-Reliance and the State: The Multiple Meanings of Development in Early Post-Colonial Tanzania.”
- The East African got a lot of recommendations.
- Also, Pambazuka, Mwananchi/The Citizen, and Nipashe/The Guardian.
No recommendations so far, alas. Anyone?
- quick local bite: Chef’s Pride on Morogoro Road
- Lukas Bar on Chole Road
- Al Basha (good Lebanese food)
- Badminton Club and Retreat (Indian)
Travel and sights:
- In Dar: The National Museum (on Sokoine Street). I actually visited this already and found it quite interesting, especially the exhibits on history and rock art.
- “Zanzibar and Pemba are affordable and gorgeous and filled with history”
- “Mikumi is a less expensive game park if that is your thing”
- Arusha and Kilimanjaro
- Kariakoo market (with good Swahili or a guide)
- Udzungwa Mountains National Park (with camping gear)
- “The coolest map remains the really simple photocopied black-and-white line one of the city center that every hotel gives out for free.”
- Get a dictionary and go “to one of the many school supply shops to buy some elementary school Swahili books. These are books designed to teach Swahili to students in the interior who are only generally only hearing Swahili at school (sometimes church), and they’ll definitely get you up to speed.”
- Live Lingua has the Peace Corps’ Swahili resources.
I will try not to generalize too much — a la Thomas Friedman — from conversations with taxi drivers to entire cultures or the state of nations, but I thought these three were worth sharing:
- In Zambia in October, I was asked “In America, who pays the the other family for a wedding, the man’s family or the woman’s family?” He was aghast that the answer was “neither,” although on further discussion of American wedding rituals I conceded that the bride’s family does pay more of the costs. This then led to many interesting conversations throughout my work in Zambia.
- In Kenya this week, I listed to a 20-minute explication on US foreign policy on the International Criminal Court. This lopsided knowledge, where non-Americans almost always seem to know more about US policy than Americans know of other countries’ policies, is always a bit surprising, but also an indication that US decisions are felt around the world.
- In Tanzania last week, I was asked where I’m from. I respond “the US,” and often get “which state?” but “Arkansas” yields blank stares. So, I typically say “Arkansas… it’s next to Texas” or “Arkansas… it’s where Bill Clinton was governor before he became president.” This time I went with the latter explanation. The driver paused, and said “Bill Clinton… Yes, I think I know that name. He is Hillary Clinton’s husband, yes?” Progress, there.
When I moved to Ethiopia I posted a bleg (blog request) asking for reading suggestions: blogs, novels, history, academic papers, etc., and got some very useful feedback — some in the comments and some by email.
I’m moving to Dar es Salaam this week, where I’ll be continuing my work with CHAI but living a bit closer to the projects I’m working on. I’m interesting in reading broadly about Tanzania, and also specifically about Dar. I’d love to hear any suggestions you have for the following:
- History books – Dar-specific, Tanzania-specific, or regional
- Academic papers
- Blogs / news / RSS to follow
- Swahili resources (I already have several books and audio guides, but I’m curious what media others have watched or activities you’ve done that facilitated learning Swahili)
- Must-see travel destinations, must-eat foods, must-do activities
- Cool maps
- Tanzania data sets / sources I should be familiar with?
I may report back with my own ideas after I’ve settled in a bit.
Lesotho is underrated as a travel destination:
(That’s Maletsunyane Falls.)
When I read this New York Times piece back in August, I was in the midst of preparation and training for data collection at rural health facilities in Zambia. The Times piece profiles a group called Global Pulse that is doing good work on the ‘big data’ side of global health:
The efforts by Global Pulse and a growing collection of scientists at universities, companies and nonprofit groups have been given the label “Big Data for development.” It is a field of great opportunity and challenge. The goal, the scientists involved agree, is to bring real-time monitoring and prediction to development and aid programs. Projects and policies, they say, can move faster, adapt to changing circumstances and be more effective, helping to lift more communities out of poverty and even save lives.
Since I was gearing up for ‘field work’ (more on that here; I’ll get to it soon), I was struck at the time by the very different challenges one faces at the other end of the spectrum. Call it small data? And I connected the Global Pulse profile with this, by Wayan Vota, from just a few days before:
The Sneakernet Reality of Big Data in Africa
When I hear people talking about “big data” in the developing world, I always picture the school administrator I met in Tanzania and the reality of sneakernet data transmissions processes.
The school level administrator has more data than he knows what to do with. Years and years of student grades recorded in notebooks – the hand-written on paper kind of notebooks. Each teacher records her student attendance and grades in one notebook, which the principal then records in his notebook. At the local district level, each principal’s notebook is recorded into a master dataset for that area, which is then aggregated at the regional, state, and national level in even more hand-written journals… Finally, it reaches the Minister of Education as a printed-out computer-generated report, complied by ministerial staff from those journals that finally make it to the ministry, and are not destroyed by water, rot, insects, or just plain misplacement or loss. Note that no where along the way is this data digitized and even at the ministerial level, the data isn’t necessarily deeply analyzed or shared widely….
And to be realistic, until countries invest in this basic, unsexy, and often ignored level of infrastructure, we’ll never have “big data” nor Open Data in Tanzania or anywhere else. (Read the rest here.)
Right on. And sure enough two weeks later I found myself elbow-deep in data that looked like this — “Sneakernet” in action:
In many countries a quite a lot of data — of varying quality — exists, but it’s often formatted like the above. Optimistically, it may get used for local decisions, and eventually for high-level policy decisions when it’s months or years out of date. There’s a lot of hard, good work being done to improve these systems (more often by residents of low-income countries, sometimes by foreigners), but still far too little. This data is certainly primary, in the sense that was collected on individuals, or by facilities, or about communities, but there are huge problems with quality, and with the sneakernet by which it gets back to policymakers, researchers, and (sometimes) citizens.
For the sake of quick reference, I keep a folder on my computer that has — for each of the countries I work in — most of the major recent ultimate sources of nationally-representative health data. All too often the only high-quality ultimate source is the most recent Demographic and Health Survey, surely one of the greatest public goods provided by the US government’s aid agency. (I think I’m paraphrasing Angus Deaton here, but can’t recall the source.) When I spent a summer doing epidemiology research with the New York City Department of Health and Mental Hygiene, I was struck by just how many rich data sources there were to draw on, at least compared to low-income countries. Very often there just isn’t much primary data on which to build.
On the other end of the spectrum is what you might call the metadata of global health. When I think about the work the folks I know in global health — classmates, professors, acquaintances, and occasionally thought not often me — do day to day, much of it is generating metadata. This is research or analysis derived from the primary data, and thus relying on its quality. It’s usually smart, almost always well-intentioned, and often well-packaged, but this towering edifice of effort is erected over a foundation of primary data; the metadata sometimes gives the appearance of being primary, when you dig down the sources often point back to those one or three ultimate data sources.
That’s not to say that generating this metadata is bad: for instance, modeling impacts of policy decisions given the best available data is still the best way to sift through competing health policy priorities if you want to have the greatest impact. Or a more cynical take: the technocratic nature of global health decision-making requires that we either have this data or, in its absence, impute it. But regardless of the value of certain targeted bits of the metadata, there’s the question of the overall balance of investment in primary vs. secondary-to-meta data, and my view — somewhat ironically derived entirely from anecdotes — is that we should be investing a lot more in the former.
One way to frame this trade-off is to ask, when considering a research project or academic institute or whatnot, whether the money spent on that project might result in more value for money if it was spent instead training data collectors and statistics offices, or supporting primary data collection (e.g., funding household surveys) in low-income countries. I think in many cases the answer will be clear, perhaps to everyone except those directly generating the metadata.
That does not mean that none of this metadata is worthwhile. On the contrary, some of it is absolutely essential. But a lot isn’t, and there are opportunity costs to any investment, a choice between investing in data collection and statistics systems in low-income countries, vs. research projects where most of the money will ultimately stay in high-income countries, and the causal pathway to impact is much less direct.
Looping back to the original link, one way to think of the ‘big data’ efforts like Global Pulse is that they’re not metadata at all, but an attempt to find new sources of primary data. Because there are so few good sources of data that get funded, or that filter through the sneakernet, the hope is that mobile phone usage and search terms and whatnot can be mined to give us entirely new primary data, on which to build new pyramids of metadata, and with which to make policy decisions, skipping the sneakernet altogether. That would be pretty cool if it works out.
- If you’re in DC this Wednesday, Charles Kenny is giving a talk to launch his new book, The Upside of Down: Why the Rise of the Rest Is Good for the West. Charles’ previous book (Getting Better) was a good read and he’s been churning out interesting journalism since (sample here). You might describe the general theme of Charles’ writing as “not everything is all that terrible,” which is remarkable because so much of the writing — at least the smart writing — on international development could be summarized as “really, everything is quite terrible.”
- Newspapers are biased (study) towards covering medical articles that aren’t as good. (Via the always interesting Justin Wolfers.) Another way of reading this is that the higher quality papers are typically RCTs, but many of the questions that are most interesting to the lay public can only be answered with large observational studies. Those studies are more likely to give answers that won’t hold up to further study, and more likely to be dreadfully overhyped by their authors and by journalists.
- Angus Deaton reviews Nina Munk’s book on Jeff Sachs. Sachs is not impressed. Two thoughts: 1) I love that Deaton connects it to the Anti-Politics Machine, which is one of the best books on development and what I kept thinking of on reading The Idealist. 2) A three-way conversation between Sachs, Deaton, and Michael Clemens would be fascinating, in part because Deaton and Clemens are both Sachs critics, but differ strongly on RCTs — Clemens has written about how the Millennium Villages could be evaluated with them, and Deaton wouldn’t be impressed even if they were.
- Elizabeth Pisani (author of the Wisdom of Whores) has a new book soon on Indonesia.
- Some humor: What if meetings were all like conference calls, and The Onion describes the new American Dream.
- Bill Gates shared this graph on Twitter, showing how the distribution of log GDP per capita has changed from a bimodal “camel” distribution to a single dome today. (It might be even more informative to look at the same numbers with and without China, which accounts for much of the departure from absolute poverty):
Much has been said on this debate, and sometimes it feels like it’s hard to add anything new. But since having a monosyllabic first name seem sufficient qualification to weigh in, I will. First, this part of Ken’s post resonates with me:
I think most reasonable people would agree that Sachs kind of oversold his big push idea in The End of Poverty. Or may be this was just a result of his attempt to shock the donor world into reaching the 0.7 percent mark in contributions. In any event it is unfortunate that the debate on the relative efficacy of aid left the pages of journal articles in its current form. It would have been more helpful if the debate spilled into the public in a policy-relevant form, with questions like: under what conditions does aid make a difference? What can we do to increase the efficacy of aid? What kinds of aid should we continue and what kinds should we abolish all together? (emphasis added)
Lee Crawfurd wrote something along these lines too: “Does Policy Work?” Lee wrote that on Jan 10, 2013, and I jokingly said it was the best aid blog post of the year (so far). Now that 2013 has wrapped up, I’ll extend that evaluation to ‘best aid blog post of 2013′. It’s worth sharing again:
The question “does policy work” is jarring, because we immediately realise that it makes little sense. Governments have about 20-30 different Ministries, which immediately implies at least 20-30 different areas of policy. Does which one work? We have health and education policy, infrastructure policy (roads, water, energy), trade policy, monetary policy, public financial management, employment policy, disaster response, financial sector policy, climate and environment policy, to name just a few. It makes very little sense to ask if they all collectively “work” or are “effective”. Foreign aid is similar. Aid supports all of these different areas of policy….
A common concern is about the impact of aid on growth… Some aid is specifically targeted at growth – such as financing infrastructure or private sector development. But much of it is not. One of the few papers which looks at the macroeconomic impact of aid and actually bothers to disaggregate even a little the different types of aid, finds that the aid that could be considered to have growth as a target, does increase growth. It’s the aid that was never intended to impact growth at all, such as humanitarian assistance, which doesn’t have any impact on growth.
I like to think that most smart folks working on these issues — and that includes both Sachs and Easterly — would agree with the following summaries of our collective state of knowledge:
- A lot of aid projects don’t work, and some of them do harm.
- Some aid, especially certain types of health projects, works extremely well.
The disagreement is on the balance of good and bad, so I wish — as Ken wrote — the debate spilled into the public sphere along those lines (which is good? which is bad? how can we get a better mix?) rather than the blanket statements both sides are driven to by the very publicness of the debate. It reminds me a bit of debates in theology: if you put a fundamentalist and Einstein in the same room, they’ll both be talking about “God” but meaning very different things with the same words. (This is not a direct analogy, so don’t ask who is who…)
When Sachs and Easterly talk about whether aid “works”, it would be nice if we could get everyone to first agree on a definition of “aid” and “works”. But much of this seems to be driven by personal animosity between Easterly and Sachs, or more broadly, by personal animosity of a lot of aid experts vs. Sachs. Why’s that? I think part of the answer is that it’s hard to tell when Sachs is trying to be a scientist, and when he’s trying to be an advocate. He benefits from being perceived as the former, but in reality is much more the latter. Nina Munk’s The Idealist – an excellent profile of Sachs I’ve been meaning to review — explores this tension at some length. The more scientifically-minded get riled up by this confusion — rightfully, I think. At the same time, public health folks tend to love Sachs precisely because he’s been a powerful advocate for some types of health aid that demonstrably work — also rightfully, I think. There’s a tension there, and it’s hard to completely dismiss one side as wrong, because the world is complicated and there are many overlapping debates and conversations; academic and lay, public and private, science and advocacy.
So, back to Ken’s questions that would be answered by a more useful aid debate:
- Under what conditions does aid make a difference?
- What can we do to increase the efficacy of aid?
- What kinds of aid should we continue and what kinds should we abolish all together?
Wouldn’t it be amazing if the public debate were focused on these questions? Actually, something like that was done: Boston Review had a forum a while back on “Making Aid Work” with responses by Abhijit Banerjee, Angus Deaton, Howard White, Ruth Levine, and others. I think that series of questions is much more informative than another un-moderated round of Sachs vs Easterly.
It’s been about six months since I wrote a real blog post other than a link round-up. One of my 2014 resolutions is to write more regularly — either for this blog or for myself — and I’m calling on you, blog readers, to hold me to it.
In the meantime, I wanted to share a bit about what it was that kept me too busy to blog. It was a jam-packed year between finishing school, starting a new job, and traveling for fun and for work. At some point in the fall I made a pie chart of where I had spent time so far in the year, and that led to the idea of doing a holiday greeting card in the form of an infographic. I put one together over the holidays and share it with friends and family — it’s supposed to be a bit over the top and tongue in cheek, and it might just become an annual tradition, though future versions will have much better metrics. Click for the PDF:
I also updated the Photography page with links to these albums from 2013: Ethiopia, Costa Rica, Cape Town, and Lesotho. I’m sure there’s a better way to present some of these, so suggestions in the comments for integrating photography into a blog are welcome.