It is that time of the year again. No, I don’t mean that absolutely wonderful time of the year when the sun starts to shine, the birds are singing, the buds are forming on the trees, and the grass turns green (which basically describes this entire week in CT). It is that time of the year again when students start (in earnest) to look for summer internship opportunities in global health. My inbox has been full of inquiries from my current and past students as well as from students from around the world. As much as I would love to reply to all of your emails, there are just too many of them to give personalized responses to all of them (I probably received 30 this week alone), and in general my response is usually the same. So instead, this year I will put some thoughts up here on my blog, and I will share this with you when you write (or save yourself the email).

First off: what kind of opportunities are out there? Yes, it is true that many global health organizations have summer internships. What is not necessarily true is that there are a lot of them, that they are well paying, that they are in developing countries, and that they are easy to find. Many summer internships opportunities are quite informal in nature, which makes them hard to find. Most summer internships that I know of are usually with the US-based outfit of the organization, so your dreams of spending the summers in Kenya or China, while possible, should not be the norm. That is OK, you can still learn a lot and gain lots of experience. This should be the goal of an internships.

If you are a graduate student, I would encourage you to think about taking a summer internship even if it does not pay to help you gain experience that will help you land a job after your graduate. Yes, I know many of you are broke, and being paid seems essential, but honestly, in the grand scheme of things, once you have factored in the opportunity cost of going back to school, paying tuition, paying rent (especially if you live in New York), and other factors, the difference of a few thousands dollars (which is about as much as you can expect to make during the summer in a paid internship) is not as important as the opportunity to gain real experience and to network with organizations that might be able to hire you someday. Easy for me to say, I know, but if you were to ask me whether you should take an unpaid internship, my answer would likely be yes, if it is a good opportunity with a good organization.

Where can you find information on summer internships? That is a harder question. By now, most organizations that have formal internship programs likely have their internship positions posted on their websites. I would start there. Come up with a list of organizations that you know of, ideally in your area, and see what they have available. A lot of organizations, in particular organizations in New York send me links to postings. I send all of those to my google groups jobs list, which you can sign up for here, and I usually tweet about it as well.

Many organizations don’t have formal internships, but they might be open to accepting students informally for unpaid internships. If that is the case, I would contact the organizations directly, with a short, but well written email that describes who you are, your area of interests, and some short background information on your skills (including software languages if looking for a research internship) and experiences. I would also attach a cover letter and your resume to this email. Don’t be surprised if you don’t get a response, but there is very little cost to you of sending out these emails. Some academics also hire in this way, so if you have interests in gaining some research experience (again, likely unpaid) you can try this out as well. Try all of your personal connections. My first internship in global health was an informal and unpaid internship with the Global Fund in Geneva. I set it up through a friend, no one knew who I was or what I was doing there, it cost me a fortune to be there, I worked night and day – but it was one of the best experiences of my life.

If you are part of a University, more than likely there will be some sort of on campus career expo or session. I would encourage you to go to these. There is also likely some sort of job posting board on campus. It can’t hurt to try there as well. I would also encourage you to go to your favorite professor’s office hours, if you have not done so yet, and talk to them about your areas of interest so that if they see internships come their way, they may be likely to send them your way. If they don’t know you, they won’t know what you are looking for, and they won’t be able to recommend you for any opportunities.

Some universities also provide some financial support to students who undertake unpaid summer internships that help advance their careers. Wagner, where I work, has recently started the Wagner Experience Fund, which provides $5,000 grant to students who are interested in taking unpaid internships with non-profit organizations. Again: get the right internship first and worry about the finances later.

Should you accept any internship? Probably not. For some organizations, summer interns are code for slave labor. If they are looking for slaves to work on real projects that require you to apply some of the skills you have been learning in school, then by all means say yes. But if they are really looking for people to do menial tasks, it might not be worth your time. When you talk to the organization offering the internship, be clear about the types of opportunities you are looking to find, what kinds of skills you currently have that can be exploited, and be clear on what your role will be and what deliverables will be obtained. If it sounds like something you could have done out of high school, you might want to keep looking, but otherwise, paid or not, it might be a great opportunity. I would also say going to work for a good organization, that is an organization with a good reputation in the global health world, might be worth sacrificing a bit on roles, since it might still look good on your resume down the road and if you put in a lot of effort, small roles might become big ones.

Finding a summer internship in global health is never easy. But rarely do opportunities fall out of the sky and land at your door. You won’t find one without effort, and it takes time and effort to find a good internship. Good luck!

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On the road to onchocerciasis elimination

On March 6, 2012, in onchocerciasis, by Karen Grepin

As many of you know, I have done some work over the years with the Neglected Tropical Diseases (NTDs) including some work with the African Programme on Onchocerciasis Control (APOC). Although I have not been actively involved with much research in the area, I love keeping up to date with what has been going on in the field.

A new study, published by some former colleagues this month in Parasites and Vectors (c’mon, I know you all read it too) suggests that not only might the models adopted by APOC for the control of River Blindness be effective at achieving control but that they might also be able to achieve something even more impressive: elimination.

APOC has now been supporting programs in some countries for over 15 years, which is an eternity by global health standards. In some of these distribution communities researchers have been able to go in and measure the prevalence of onchocerciasis and found that it is in fact zero…not close to zero…but actually zero cases. Period. This is exciting stuff.

At the outset of these programs, no one really knew what would be achievable, how long it would take to achieve results, and whether something like elimination was really in fact possible from drug distribution alone. Long-term commitment to the program from donors and implementing countries, realistic goals and a governance structure commitment to re-evaluation, strong regional leadership from the APOC program (especially under Uche Amazigo, one of the authors of this paper) and a commitment to ongoing monitoring and evaluation were really what were key.

I think that is the lesson here: results don’t happen over night, but when the programs are given time to achieve them and the right systems are in place to monitor and measure them, great things can happen.

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A big debate in the aid circles these days is whether conditioning financial support on performance actually improves performance relative to just providing resources (or even giving aid in the first place!). Though there has been a lot of discussion and debate about this issue, there have actually been few large scale evaluations of such programs, this paper being perhaps the best known exception.

New evidence – in the form of an NBER working paper – out of Indonesia, the country that some say every villager is studied and surveyed a few times a year, provides some more evidence that this appears to be the case. As I am working under a series of deadlines this week, I did not have time to give a deep review, so I will leave you with the abstract for you to decide for yourself.

This paper reports an experiment in over 3,000 Indonesian villages designed to test the role of performance incentives in improving the efficacy of aid programs. Villages in a randomly-chosen one-third of subdistricts received a block grant to improve 12 maternal and child health and education indicators, with the size of the subsequent year’s block grant depending on performance relative to other villages in the subdistrict. Villages in remaining subdistricts were randomly assigned to either an otherwise identical block grant program with no financial link to performance, or to a pure control group. We find that the incentivized villages performed better on health than the non-incentivized villages, particularly in less developed areas, but found no impact of incentives on education. We find no evidence of negative spillovers from the incentives to untargeted outcomes, and no evidence that villagers manipulated scores. The relative performance design was crucial in ensuring that incentives did not result in a net transfer of funds toward richer areas. Incentives led to what appear to be more efficient spending of block grants, and led to an increase in labor from health providers, who are partially paid fee-for-service, but not teachers. On net, between 50-75% of the total impact of the block grant program on health indicators can be attributed to the performance incentives.

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