NEWSBYJESSICA PICKETT

(Sometimes the job hunt feels like this. Photo credit: joiseyshowaa)

Throughout the proces you have to keep things in perspective - I always say that the goal is to just find a decent first job that will help position you for an ideal second job a year or two later. It also contains a large element of trial and error to help you find your niche; in my opinion, it's much better to explore different fields through professional experience before committing to graduate school, since the best school for you will likely depend on how your academic interests and professional aspirations evolve over time. (The possible exception is students who realized their passion for global health late in the game and lack any relevant studies or experience, in which case it may be worth exploring a one-year introductory MSc degree.)

All of this is based on my own relatively limited experience, though, and that of my many friends and colleagues in this field. What have you found helpful when looking for global health jobs? Please share your own advice in the comments!

editor's note: I agree completely with Jessica on the importance of looking for a decent first job, not one that's perfect. My first global health job was a program assistant position while I was in grad school. The second was an unpaid internship. The program assistant job helped me get the internship, and the internship led to pretty much every job I have had ever since.

(photo credit: faerie from a lost star)

So once you've developed these skills, hammered out a resume and decided what path to pursue (at least initially)...how do you actually land a job? The process is excruciatingly frustrating, especially for first-timers, and may require a downward adjustment of expectations. It's also quite scary, when all your friends have nailed down offers in the fall and your target jobs haven't even been posted yet. Here are a few guidelines:

• Seek out fellowship programs with early deadlines. Some of these include university-specific programs (e.g. the Hart Fellowship at Duke), but other programs are based out of the Population Reference Bureau, the Institute for Heath Metrics & Evaluation, the Poverty Action Lab and the new Global Health Corps.
• Apply for immediate online vacancies beginning approximately two months before graduation (e.g. March 1). The Global Health Council and Idealist.org both have great job boards, and most organizations post openings on their own websites. Do as much research as possible on the organization, and tailor your cover letter accordingly. But don't get your heart set on any one position - when I was graduating, I submitted nearly 50 applications...and only received one interview and job offer. It's very hard to differentiate yourself on paper when you're competing against people with a few years more experience.
• Above all, focus on informational interviews. Identify mid-level people who work in your preferred function or field (ideally but necessarily through an alumni connection or mutual contacts); if possible, it's always best to meet in person rather than by phone. Informational interviews can help you learn about different organizations and career paths, necessary qualifications, and people with similar interests. Often, they can also yield leads about upcoming vacancies as well.
• Similarly, it can never hurt to email your resume to the head of the department or program at your dream organizations to see if they anticipate any openings. Every so often, they may know that something is opening up before they post it - and in these cases, they may well prefer to avoid the official job search process altogether.
• Finally, you should plan to apply for internships in addition to long-term positions. Unfortunately, these days the majority of interns at many organizations have actually already graduated college, and indeed those internships can be a great way to get your foot in the door and differentiate yourself from other candidates with 1-3 years of experience and a graduate degree...who are also applying for the assistant/associate/coordinator positions.

(Cuban women looking jadedly at study abroad students. Photo credit: hoyasmeg)

Most people end up either specializing in one of the tracks I mentioned last week, or alternatively end up focusing on a specific health issues and shifting responsibilities within that narrow field. Some of the hottest topics these days include: health systems financing (including the role of the private sector); AIDS prevention and treatment; distribution of ACTs, bednets and other malaria products; MDR-TB (and related issues around biosecurity and prison health); vaccine and pharmaceutical development and delivery (going beyond the historic debate around trade and intellectual property); population and reproductive health; and nutrition. If you know where your heart lies, then it can pay enormous dividends to develop a specialization early on - in my case, I fell into vaccine and pharmaceutical markets early on, and have been fortunate enough to approach it in a wide range of capacities.

No matter what your chosen role or issue, though, there are several valued skills and areas of knowledge that will help you land a job and advance in the early stages of your career:

• Develop and maintain your language skills, especially French. Although this is particularly essential for program management positions, it can come in handy across the board. Personally, this is one of my biggest weaknesses, and I've found that it's much harder to learn languages outside the university setting.
• Learn how to develop a base of support through fundraising or marketing, even at a basic level. Everyone in global health has to compete for resources and attention, not just the folks writing up the grants. Knowing how to frame a compelling case for support pays dividends going far beyond the financial.
• Be comfortable with web communications platforms, including blogs and rudimentary HTML. Although this is typically within the communications and outreach domain, you'll be at a tremendous advantage if you can handle the basics on your own.
• Be familiar with current events and important journal articles. Change.org's blog is definitely the best place to start, but other great resources include GlobalHealthReporting.org; the Lancet, BMJ, PLoS, and other research journals. When I would interview job candidates, my favorite question was always "what is your favorite recent global health news item or research finding?" Have an answer ready!
• Get prior office experience no matter where it is. Employers don't want to have to teach you the basic ropes of professional etiquette, Microsoft Office, or the copy machine. In the best of all worlds, you could gain this through a global health-related internship, but it's also perfectly fine to have unrelated summer jobs if you can sufficiently signal your topical interests through coursework or academic research.
• Study abroad in a low- or middle-income country. Even if your own university's options are limited, you can almost certainly find a program through the School of International Training.
• Please, please take at least one course in introductory microeconomics. Almost everyone takes basic science courses in the course of their education, but economics often slips through the cracks despite its critical (and increasing) voice in the global health discourse.

(Steve Jobs and Bill Gates. Not exactly entry level. Photo Credit: Joi)

Editor’s note: Today we are kicking off a series on global health careers. A lot of readers have contacted me asking for advice about jobs and the job market, so I am trying to address that for you. Every Wednesday, I’ll feature a career post from me or a guest blogger, and an interview with a global health professional. If anyone would like to contact one of the people interviews, send me a message and I’ll do my best to connect you. The first career post comes from Jessica Pickett.

I spoke on a global health career panel several weeks ago, and was encouraged by how energized college students are about entering the field after graduation. Although it's certainly true that the supply of global health jobs is growing rapidly, I'm less confident that universities are preparing students well for the realities of the market - both in terms of what it takes to land an entry-level global health job, and what they can reasonably expect such a position to entail.

Broadly speaking, most global health jobs are based in Washington, Seattle, and Geneva (and to a much lesser extent, in New York, Boston and San Francisco). Most entry-level assistant, associate or coordinator positions in these cities pay starting salaries in the mid-$30's (and will almost certainly include at least a little bit of scheduling and photocopying), while paid positions abroad are few and far between. In general, junior staff members at nonprofit health organizations typically stay in their first job for 1-2 years at most, and frequent turnover is common at all levels.

Beyond these generalities, the requirements and responsibilities can vary widely, based on the specific type of career path (which Alanna has done a great job of describing in earlier posts), along with the typical graduate education. These include:

• Medical providers (usually with an MD or RN), who work at the front lines actually delivering health care to those in need
• Grant writers/fundraisers for US or European NGOs
• Program managers (the most common career path for an MPH), who can work on a wide range of projects with NGOs and USAID contractors, private foundations or the government. Another variation on the operational side can include working with public-private product development partnerships, supply chain logistics firms, or multilateral donors (which may place more value on an MBA or JD).
• Outreach, communications and event coordination at policy and advocacy organizations (including think tanks), consultancies and public relations firms, and development journals or foreign policy publications.
• Technical experts, academic researchers and/or consultants (usually favoring PhD's). Economists are highly valued at the World Bank, large foundations, and think tanks, while basic scientists and epidemiologists are in demand by pharmaceutical companies, product development partnerships, universities, and government research institutes.

(photo credit: otisarchives1)

In 2007, pharmaceutical companies and medical supply manufacturers donated more than $2.6 billion of in-kind contributions (not including taxes, transport, storage and in-country distribution costs). Although we could spend hours debating which of those costs should be included - not to mention whether it is appropriate to value the products at wholesale prices- it's inarguably a lot of drugs - almost all of which comprise ongoing development programs (unlike in previous years, where up to 13% of contributions were for tsunami recovery and other humanitarian relief efforts).

In fact, the widely heralded success of trachoma control and the prevention of river blindness can be directly attributed to partnerships with pharmaceutical manufacturers, who contributed both products and managerial expertise. Since 1988, Merck has participated in the Onchocerciasis Control Program to control river blindness in Africa. Through donations from Merck, OCP has distributed Mectizan (ivermectin) to more than 45 million people to prevent and treat the disease with just one annual dose - a total of 472 millions treatments since the program's introduction, valued in excess of $1.5 billion. This was made feasible in part by the financial offsets from the drug's wide use to treat parasitic infections among agricultural livestock in the US and other wealthy nations. Merck has committed to donate the drug indefinitely, and since 1998 has also contributed Mectizan to treat lymphatic filariasis (in combination with albendazole from GlaxoSmithKline) - and in doing so, has paved the way for other successful large-scale drug donation programs.

Trachoma is another one of the leading causes of global blindness, and has been the target of a global partnership with Pfizer, which contributes antibioitics to treat the disease in addition to supporting a broader program of santiation, face-washing and education to address the disease. In Morocco alone, Pfizer has donated 4.3 million treatments of the antibiotic azithromycin since 1999, valued at more than $72 million. Unlike the predecessor treatments requiring 4-6 week regimen, Zithromax was a topical eye ointment that only required one dose to treat active trachoma infections and prevent scarring (and thus also reducing transmission within the community). By simplifying the treatment process and eliminating side effects like stinging and blurred vision, compliance increased and access was vastly improved. Morocco is now on track to eliminate trachoma entirely, and the International Trachoma Initiative has built on this initial success by expanding to fifteen countries.

But as Alanna pointed out, there are inherent limitations to relying on donated drugs and medical equipment to solve the much deeper health systems issues that impede the development of a functioning market for pharmaceutical and other health products - from the obvious challenges of affordability and delivery infrastructure to the more insidious incentive misalignments facing health donors, national governments and pharmaceutical manufacturers. (See CGD's work on demand forecasting for a more in-depth discussion of these issues.) Donation programs are just a bandaid: in the long run, we need pharmaceutical companies to incorporate developing country markets into their actual business practices, and for the international community to support government efforts to build rationale systems for drug approval, procurement, distribution and financing.

This is just one of many bandaids in global health, though, and I think our treatment of the subject requires more careful consideration. While we don't want to delude ourselves into mistaking a bandaid for a cure, there is also a very real risk of making the best the enemy of the good. It is relatively easy to point out all of the problems with the current development programs (just ask Bill Easterly), and much, much harder to propose better alternatives. Drug donation programs may not do much, but not only are they better than nothing, they also helped buy pharmaceutical companies an initial seat at the global health table back before it was fashionable. And that does have the potential to revolutionize global health. So now let's build on those partnerships to find a way for companies to sell their products - cheaply, affordably, but also rationally distributed and for appropriate indications - and happily accept the donated products as a stop-gap measure in the meantime.

The past decade has borne witness to a massive increase in funding for global health priorities. Billions of dollars have been devoted to AIDS, tuberculosis, malaria and other infectious diseases, catalyzed in large part by the generous contributions of the Bill & Melinda Gates Foundation. In fact, global health has a long history of philanthropic support since the legacy of the Rockefeller Foundation’s work at the turn of the last century.

But while private philanthropy may have ushered in the golden age of global health, the field has become increasingly crowded with many other funders as well – each with their unique set of strategic objectives, political considerations, legal restrictions and financial structures. This groundswell of support has made possible otherwise unthinkably ambitious aims– from the goal of providing ARVs to all AIDS patients to the proposed eradication of malaria. However, it also presents unique challenges to ensure that the new money is used effectively and achieves maximum impact.

While individual philanthropists and family foundations have heeded the calls to support global health en masse, they have largely been relegated to the sidelines with little or no thoughtful guidance on how they could effectively leverage their unique (albeit smaller) resources to complement existing funding sources. Left to their own devices, then, they have mostly either: 1) jumped onto the “big three” bandwagon, where their money is pooled with and overshadowed by larger funders (and often further diluting their influence by dividing their funds across multiple organizations with similar missions); or 2) founding a one-off clinic or new NGO without attempting to address the underlying problems or engage other actors. Neither of these paths is optimal. Instead, mid-sized private philanthropists should target their funds to meet the gaps left by other donors.

First and foremost, there are relatively few sources of fast, flexible funding, even (or especially) in relatively low quantities. Currently, there are more avenues for an NGO to raise $1 million than to raise $10,000. Although a mid-sized donor may not be able to offer the same long-term predictability or sustainability provided by traditional foreign assistance, they are far better placed to offer a timely injection of much-needed capital without requiring recipients to wade through burdensome bureaucratic processes designed for large-scale government programs. Note that this is particularly true in politically challenging environments where ties to bilateral donors may be strained.

There is also very little appetite for risk in the current institutional context. But by focusing only on the things that we know work, the major donors leave little opportunity to discover what works better. Private philanthropists should lead the charge in the “success discovery” process by focusing on the evaluation and scaling up of innovative community programs, particularly outside the saturated fields of HIV and malaria. Just one example of such a program is Seva Mandir’s pilot project in Udaipur, India, where immunization rates increased by approximately 40% when mothers were offered a small amount of beans when they brought their child in to be vaccinated. Private philanthropists should support similar small-scale providers and local NGOs – in tandem with J-PAL and other impact evaluation efforts – to identify and assess programs that should be scaled up….and accept that this will also inevitably mean discovering some failures along the way.

Third, the financial structure of most large donors is at odds with the stated aim of long-term sustainability. Individual donors and family foundations are better able to simply find someone who does something well and let them do more of it. This can mean increasing coverage area and population through a large, one-time contribution that covers the upfront fixed costs of expanding to an additional site, assuming that the project has an income stream that will cover recurrent costs. Alternatively, a donor could seek to increase the impact over time by creating an endowment to sustain a program that is already at scale (or where there is a natural rate of increase). In either case, by working with a reliable recipient organization that has already demonstrated success, philanthropists should be able to minimize reporting requirements by providing overall budget support whereby the specific allocation of funds is left to the recipients’ discretion. This is in contrast to the heavy reporting burden and narrowly defined project support that is characteristic of most grant processes.

And lastly, global health donors are subject to the universal law of inertia. Without external influence, they have little incentive to change their funding priorities: research in a vacuum will never affect policy. But getting behind early successes and funding the dissemination of those findings – through publications, conferences, and targeted advocacy efforts – a relatively little money can go a long way in galvanizing a broad base of much larger donors. One example of this at work is the support of a few individuals within the World Economic Forum’s Young Global Leaders Forum for international deworming efforts. Even one of the now-largest multilateral donors, the GAVI Alliance, was initially started by a wealthy individual who was shocked to discover that vaccines rates remained abysmally low (long before the Gates Foundation evolved into the behemoth it is today). With that in mind, philanthropists should not only fund potential and proven successes themselves, but should also play a catalytic role by advocating on their behalves to the rest of the global health community.