139 karmaJoined Aug 2015


Thanks for raising this point, Nick, and for the many good arguments you’re making!

Out of all the forms of labor emigration, I find physician and nurse migration to be the most concerning. I’d stress that the idea proposed in our report doesn’t focus on skilled workers (only as a potential later extension, needing careful consideration), so it largely avoids this concern. We focus on low- and mid-skilled workers, as those are poorer to begin with, much more numerous, and there’s an oversupply of them in many LMICs (as opposed to shortages).

I did spend a little bit of time looking into the literature on brain drain and didn’t arrive at a clear conclusion. There are many factors pointing in different directions, and whether the overall effect is net positive or net negative may vary between countries and professions.

Aside from the considerations that you and David mentioned, there are also remittances, the effects of return migration (the rates of which vary a lot) and associated "brain gain", or the fact emigrating physicians are more likely to come from well-staffed urban areas. E.g. this (very old) article by Clemens and McKenzie says that, in Kenya, some 66% of physicians live in Nairobi where only 8% of the national population lives. They argue that low incentives to work in rural areas are a much bigger problem than the total supply of physicians (and how that supply is affected by emigration).

Concerning the CGD, I’m actually quite excited about their efforts to push for so-called global skills partnerships in the skilled space. Within these programs, countries like the UK would pay countries like Nigeria to train nurses and have agreed quotas on how many nurses can stay vs migrate. This seems like a more sophisticated solution to the issue than saying “nurse emigration is good.” Here is their proposal specifically for Nigeria.

In any case, this is not a topic that we at CE decided to focus on at this point. If we do look into skilled migration in the future, we will do a much more thorough dive (and will be keen to get your input!).

Hi Gemma, thanks for sharing! That platform indeed has several similarities with our proposed nonprofit idea (though also some differences, such as our focus low- and mid-skilled workers and on a specific country of origin rather than a specific destination country). Exciting to see more work being done in this otherwise quite neglected space!

To add, we at Charity Entrepreneurship have been experimenting with using Dagger/Carlo for our cost-effectiveness analyses of new charity ideas. We've put together this (very rough, work-in-progress) guide on how to use Dagger – sharing in case others find it helpful.

Hi Nick, thank you very much for your thoughtful feedback! I researched the syphilis idea so will address those questions.

1. The dual tests have recently become very cheap too, costing some $0.95 each (largely thanks to CHAI's work in this area). In our understanding, this is only some $0.15 more expensive than a single HIV test – though I'm sure prices will vary geographically. If there are places where the dual tests are more expensive than two separate rapid tests, then I agree that the dual tests wouldn't make sense there.

2. You are right that changing the existing system (including updating diagnostic algorithms and training the relevant health workers) is one of the main challenges and one of the reasons why this idea has not already been implemented more widely. However, it seems that what is currently lacking is technical assistance for countries' health systems to make this switch – and this is exactly the sort of implementational work that we think strong charity entrepreneurs can do well!

Thank you for a very thoughtful reply! (and for the sharing those papers :))

Great post. I have had multiple conversations lately about people's disappointing experiences with some EA org's hiring processes, so this is a timely contribution to the Forum.

A lot of your recommendations (structured interviews, work samples, carefully selecting interview questions for relevance to the role) are in line with my prior understanding of good hiring practices. I am less convinced, however, that behavioural interviewing is clearly better than asking about hypothetical scenarios. I can see arguments both for and against them but am unsure about which one is the net winner. 

For instance, behavioural interviews may be favourable because past behaviour tends to be a strong predictor of future behaviour and because they ask about actual behaviour, not idealised situations and behavioural intentions. On the other hand, they may introduce noise, as some capable applicants will not have very good examples of "past situation X" (and vice versa), and they may introduce bias because they judge applicants based on their past behaviour, not their current capabilities.

What are your top arguments in favour of behavioural interviews? Are you aware of any high-quality studies on this topic? Your section on behavioural interviews doesn't have any references...