Friday photos: Lesotho

Lesotho is underrated as a travel destination:

(That’s Maletsunyane Falls.)


01 2014

Data: big, small, and meta

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.

Monday miscellany

  • 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 WestCharles’ 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):


01 2014

Friday photos: Cape Town

From back in November:

And a few panoramas from the same trip:


01 2014

A more useful aid debate

Ken Opalo highlights recent entries on the great aid debate from Bill Gates, Jeff Sachs, Bill Easterly, and Chris Blattman.

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.


01 2014

Year in review – infographic style!

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: EthiopiaCosta RicaCape 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.


01 2014

Monday miscellany

I’m hoping to start writing posts other than link round-ups soon, but I’ve been swamped the last few month with fascinating work and travels in the US, Nigeria, Zambia, South Africa, and Lesotho. Not to mention the latest Hunger Games movie is giving me lots of ideas for a follow-up to my original survival analysis!  More on that soon. In the meantime:




12 2013

Monday miscellany: just give people money edition

Unconditional cash transfers (i.e., just giving people money) are the talk of the blogosphere right now:

The post that comes closest to my own feelings is from Matt Collin of Aid Thoughts: “When every argument begins with ‘is it better than cash?'” Here’s an excerpt:

…there are a range of public goods (or semi-private goods which have substantial externalities) which we can imagine might increase welfare a great deal more than a cash transfer of equivalent cost: schools, health facilities, roads, a functioning police force. Basically, any semblance of a local or national state. How many of you would vote for your own government to transfer its entire budget evenly across the population and then shut down all its operation for good? It certainly would make it easier to pay the rent next month, if your apartment complex hadn’t been burned down by the marauding hordes yet.

A bandwagon

It’s great, read the whole thing. I wouldn’t go as far as Matt in saying that there is a “current bias towards cash transfers”, but otherwise I agree. There’s growing evidence that cash transfers, conditional or not, work pretty well. That means they’re probably better than many forms of institutional aid, some of which don’t have evidence of working at all. That doesn’t mean they’re better than all forms of institutional assistance, or that all forms are even directly comparable to cash. Many public services in health — I’m thinking especially of vaccination and other investments in preventative health — are unlikely to materialize in response to cash transfers alone. In short, I think it’s useful for both individual and institutional donors to think in terms of portfolios: considering giving cash directly, but also simultaneously investing in the public provision of services.

Some older, related posts:


10 2013

Monday miscellany


08 2013

Spreading the word

If you haven’t already read Atul Gawande’s latest New Yorker piece on why some ideas spread fast and other spread slow, get to it:

 In the era of the iPhone, Facebook, and Twitter, we’ve become enamored of ideas that spread as effortlessly as ether. We want frictionless, “turnkey” solutions to the major difficulties of the world—hunger, disease, poverty. We prefer instructional videos to teachers, drones to troops, incentives to institutions. People and institutions can feel messy and anachronistic. They introduce, as the engineers put it, uncontrolled variability.

But technology and incentive programs are not enough. “Diffusion is essentially a social process through which people talking to people spread an innovation,” wrote Everett Rogers, the great scholar of how new ideas are communicated and spread. Mass media can introduce a new idea to people. But, Rogers showed, people follow the lead of other people they know and trust when they decide whether to take it up. Every change requires effort, and the decision to make that effort is a social process.

Much of the material is Gawande’s essay won’t be new if you’re already interested in or working on maternal and child health, but Gawande presents it incredibly well. His comparison of spreading social innovation with the work of salesman also reminded me of another parallel: the parallels between diffusing secular, health-enhancing ideas and missionaries’ evangelistic techniques.

If that last sentence scares you off, hold on a moment for some background. I grew up in a small religious town in Arkansas and my first trips to developing countries were as a missionary. Over time my interests shifted from the preaching and teaching side of things to the medical side, and eventually to health and development policy as an entirely secular pursuit. When I first got to grad school for public health this resulted in some awkward moments, as many conversations would start with “so what first interested you in global health?” If I led with “well, I grew up wanting to be a missionary” I would often get one of two reactions: immediate skepticism of my motivations from my secular liberal classmates, or enthusiastic endorsement of my work (as they misunderstood it) from religious classmates. All that to say: while I think there are very good general reasons to keep public health and missionary efforts as separate as possible, both in theory and praxis, there are several things we secular liberals can still learn from the more devout.

One example is the neverending debates amongst evangelists between those who seek technological shortcuts and those who stick with old-fashioned person-to-person contact. This is a frequent topic at missions conferences (if you didn’t know such conferences existed, it might be an interesting google). You can view the rise of Christian radio broadcasts, followed by Christian TV and televangelists, as the great technological shortcuts: they give a single preacher the ability to reach millions, and if the message is just as good as when delivered in person, why shouldn’t it be just as effective? Some people are persuaded by televangelists, of course, but the effectiveness of the individual doesn’t scale easily to mass media. Likewise, in recent years there’s been much enthusiasm for social media and its potential to save more souls — but the results rarely pan out.  So despite all of the advances in mass and social media, most evangelists still harp on the importance of individual contact, of building relationships. One of the most effective (in terms of growth rate) groups in the world are Mormons, who, no coincidence, devote years of effort to one-on-one contact.

Gawande’s essay tells the story of how BRAC precipitated oral rehydration solution in Bangladesh, and I couldn’t help thinking of their campaign  as a sort of especially successful roving gospel meeting. And here’s Gawande’s closing, where he talks with a nurse who was convinced by a younger, less-experienced trainer to adopt some best practices for safe childbirth:

 “Why did you listen to her?” I [Gawande] asked. “She had only a fraction of your experience.”

In the beginning, she didn’t, the nurse admitted. “The first day she came, I felt the workload on my head was increasing.” From the second time, however, the nurse began feeling better about the visits. She even began looking forward to them.

“Why?” I asked.

All the nurse could think to say was “She was nice.”

“She was nice?”

“She smiled a lot.”

“That was it?”

“It wasn’t like talking to someone who was trying to find mistakes,” she said. “It was like talking to a friend.”

Shortcuts are nice: in public health, unlike evangelism, it’s usually actions rather than beliefs that ultimately count, so I’m all for technological shortcuts when they’re available and effective. But they’re too few and far between, and much of the low-hanging fruit in global health has already been picked. To climb the next step require a lot more effort at improving the “messy and anachronistic”  processes of people and institutions.


08 2013