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Michelle Hutchinson

Giving What We Can is seeking a Director of Communications

In just five years, Giving What We Can has grown to over 660 members in 25 countries worldwide. The community has pledged over $330m towards ending poverty. We are looking for additional hires to build on this success.

Apply to be our Director of Communications.

As Director of Communications you will be raising the profile of evidence-based giving and creating thousands of prospective members for our Director of Community to follow up with.

Specifically, you would be responsible for:

Maintaining and improving the content on our website, and ensuring a clear pathway for people from landing on the website, through to engaging with us and donating to effective charities.

Organising appealing, professional events to attract interest in cost-effective giving.

Working closely with the Executive Director to shape the communications strategy and branding of the organisation.

We're a small team, so you'll also have the opportunity to be involved in recruitment, fundraising, publishing our findings in the media and whatever else most interests you.

Be at the heart of an inspiring community of people who care about others and really put their passion into practice

: We have members all around the world, all of whom are dedicating a large part of their income to helping people in the developing world as much as they can, and supporting each other in doing so. You would be getting to know these members, answering their questions, providing support to them and helping them to help others.

Work with friendly and intellectual staff:

 You’d be working alongside a talented, interesting and highly motivated team.

 Giving What We Can shares an office with the rest of the Centre for Effective Altruism and with the Future of Humanity Institute, which is part of the University of Oxford. There are always fascinating people around, and we often hold joint seminars and training sessions, as well as many social events.

Be part of a fast-growing organisation and social movement:

 It’s a hugely exciting place to be, and has opportunities for swiftly increasing responsibility

 Each new member of Giving What We Can saves around 10 lives, meaning that the right person in this job could help prevent over 100 unnecessary deaths each year!

This role combines great potential for impact with great potential for growth and learning. Over the past couple of years, Giving What We Can has reached millions of people with its message of committing to donate the most effective charities. By leading our outreach and media, and shaping our message, you can help to move tens of thousands of pounds to the most effective charities. As one of the key team members of a rapidly growing small organisation, you'll have a huge amount of responsibility, autonomy and room to grow.

If you work for Giving What We Can, you’ll be part of a focused team of intelligent, caring, enthusiastic colleagues who want to change the world, located in the beautiful Oxford.

We’re looking for someone who cares deeply about alleviating extreme poverty as effectively as possible and is excited to get others on board with that aim.

You’ll need excellent written and spoken communications skills, to enjoy interacting with large numbers of people and be very conscientious.

Some examples of experience that would be especially useful include journalism and on and off-line marketing – though we’re interested in anyone who can demonstrate the skills. Also helpful would be experience with Adobe CS or equivalents, Drupal and HTML/CSS.

Candidates will be selected on the following traits, and should aim to demonstrate them in their application:

Applications close midnight GMT on Friday the 12th December. We are offering a $1,000 reward for introductions to anyone we don’t already know who we end up hiring for the roles we are currently advertising.

We would be willing to negotiate a starting salary between £19,000 and £30,000, depending on experience.

See other job openings at the Centre for Effective Altruism.

Elina Naydenova

The Promise of the Safe Childbirth Checklist

This post is the first part of an exploration of 'Why sometimes less is more in maternal health'.

The Checklist story - a minimalist's approach

We, the human race, are doing a pretty good job at understanding ourselves - how our bodies work and how they fail. Currently, there are about 14,000 different healthcare diagnoses known to apply to us. Consequently, doctors are armed with 6,000 drugs and 4,000 medical and surgical procedures, which they use in multiple combinations. So medical errors come as no surprise... Medical practice has become incredibly complex and it really takes a village of multi-disciplinary specialists, who each bring a piece of the puzzle, to deliver medical solutions. And as if this wasn't difficult enough, the changing demographic and socio-economic landscape means that there are more of us to treat and we all expect miracles.

Fortunately, human ingenuity might have found just the right solution - 

 (I am sorry to disappoint any artificial intelligence proponents). A 

cost-effective tool for streamlining the implementation of evidence-based medical practice

, the checklist has gained popularity over the last 15 years. The underlying logic is astonishingly simple: minor missteps in clinical practice can accumulate to BIG problems, meaning higher mortality and morbidity rates, as well as higher costs, which a checklist can help avoid by guiding evidence-based decisions.

For example, to address one typical such scenario, intravascular catheter-related infection, Dr. Peter Pronovost developed and implemented a simple checklist - the concept was then famously corroborated by Atul Gawane in his article 'The Checklist' [1].

The insertion of a line should be conducted in accordance with five steps (Figure 1) that reduce the chance of developing infection – at least one of those is commonly missed in hospital settings amounting to 80,000 line infections per year in the US [2]. Line infection prolongs the stay of patients in intensive care by at least a week, increasing costs; moreover, between 5% and 28% of line infections lead to death [2]. The implementation of the Pronovost checklist has demonstrated a swift decrease in infection rates (from 11% to 0% in the pilot study in ten days), substantial cost reduction, accompanied by (surprisingly) high staff compliance and a reported sense of empowerment [1].

Of course, the challenges in developing countries differ: even more people to treat, less resources, less highly trained professionals and less fancy medical gadgets. Nevertheless, the need for cost-effective, evidence-based interventions is overwhelming and standardising best practice might empower basically trained healthcare workers to deliver efficient medical solutions.

A Checklist to help combat maternal and neonatal mortality?

The absurdity of maternal mortality is that it takes the lives of 800 women every day and yet there are affordable interventions that can prevent most of these deaths [3,4,5]. A key strategy in tackling existing issues is moving the delivery room from the home to the hospital. Great progress has been achieved in this area, only to highlight that simply hospitalising births is not enough. What's missing is trained clinical staff and reliable medical facilities at these hospitals - the provision of good quality facility-based care remains a global challenge [6-10]. But this is where the checklist could make a difference! Why is it appropriate? Here are three great reasons [11,12]:

: the majority of deaths occur within 24 hours after birth

: the main causes of maternal and perinatal mortality are well documented and international guidelines for best practice exist

: proven interventions are affordable and consist of a multistage sequence of simple interventions.

In 2008, the World Health Organisation (WHO) developed the 

, a 29-item checklist designed to improve maternal care in a 

 way [13], originally in ten countries across Africa and Asia. The checklist contains reminders of 

 (haemorrhage, infection, obstructed labour and hypertensive disorders) as well as 

 during and after birth in resource-limited settings [14].

 The pilot study, in Karnataka, India, demonstrated 

 - 95% of the health workers adopted the use of the checklist. Furthermore, it was 

 - the delivery of essential practices increased from 10 to 25 out of 29 practices. Specific areas of improvement included: appropriate hand hygiene, adequate management of maternal infection and preeclampsia (a cardiovascular disease rooted in pregnancy), maternal blood loss assessment, cutting of the cord with a sterile blade, appropriate administration of oxytocin (medication used to induce labour and reduce bleeding), appropriate newborn thermal and resuscitation management.

 The Safe Childbirth Checklist can affect clinical outcome in three main ways: 

remind health workers of the crucial timing

identify gaps in existing clinical practice

Is it that simple - the realist's approach

 – e.g. the staff created a postpartum bay for observation of mothers and babies after birth, using an unused space; medical supplies were moved from remote storage into local stacks to better support labour ward workers. However, are these outcomes truly sustainable and scalable? The pilot studies were conducted in first-level referral centres in India with motivated local teams; plus behavioural changes could be driven by the awareness of being observed.

: a multi-centred randomized control trial in more than 100 hospitals has been set up to further evaluate the effectiveness and sustainability of the Safe Childbirth Checklist, with data collection conducted by Harvard School of Public Health between 2013 and 2016 [15]. And we are still to see a detailed quantitative analysis of its cost-effectiveness.

To play devil's advocate, the checklist excitement has been critically named a "Hitchcockian McGuffin", a false objectification of the problem that distracts from the true challenges of delivering safe care [16]. Checklists on their own could be equally unsafe if they are used to install a false sense of security, cloud judgement and consequently plant negligence - the very problem they were designed to tackle. Therefore, any checklist implementation programme should be designed around establishing a higher standard of baseline performance; it should empower clinical workers to improve their practice, minimise avoidable error but be careful not to drive complacency.

Gawande, A. The Checklist, The New Yorker, Annals of Medicine, 2010

Pronovost, P., Needham, D., Berenholtz, S. et al. An Intervention to Decrease Catheter-Related Bloodstream Infections in the ICU. N Engl J Med, 2006, 355(26), pp. 2725-2732

Hogan, M. C., Foreman, K. J., Naghavi, M., et al. Maternal mortality for 181 countries, 1980-2008: a systematic analysis of progress towards Millennium Development Goal 5 2010

Rajaratnam, J. K., Marcus, J. R., Flaxman, A. D., et al. Neonatal, postneonatal, childhood, and under-5 mortality for 187 countries, 1970-2010: a systematic analysis of progress towards Millennium Development Goal 4 2010

Cousens, S., Blencowe, H., Stanton, C., et al. National, regional, and worldwide estimates of stillbirth rates in 2009 with trends since 1995: A systematic analysis 2011

Ekirapa-Kiracho, E., Waiswa, P., Rahman, M. H., et al. Increasing access to institutional deliveries using demand and supply side incentives: Early results from a quasi-experimental study 2011

Harvey, S. A., Blandón, Y. C. W., McCaw-Binns, A., et al. Are skilled birth attendants really skilled? A measurement method, some disturbing results and a potential way forward 2007

Koblinsky, M., Matthews, Z., Hussein, J., et al. Going to scale with professional skilled care 2006

Friberg, I. K., Kinney, M. V., Lawn, J. E., et al. Sub-Saharan Africa's mothers, newborns, and children: How many lives could be saved with targeted health interventions? 2010

Van Den Broek, N. R., Graham, W. J. Quality of care for maternal and newborn health: The neglected agenda 2009

Tamburlini, G., Yadgarova, K., Kamilov, A. and Bacci, A. Improving the Quality of Maternal and Neonatal Care: The Role of Standard Based Participatory Assessments 2013

WHO, UNICEF, UNFPA. Trends in maternal mortality: 1990-2008 2010

Weiser, T. G., Haynes, A. B., Lashoher, A., et al. Perspectives in quality: Designing the WHO surgical safety checklist 2010

Spector, J. M., Agrawal, P., Kodkany, B., et al. Improving quality of care for maternal and newborn health: Prospective pilot study of the who safe childbirth checklist program 2012

Safe Childbirth Checklist Programme: an overview, World Health Organization, WHO/HIS/PSP/2013

Bosk, C.L., Dixon-Woods, M., Goeshel, C.A. and Pronovost, P.J., 2009. Reality check for checklists. Lancet, 374(9688), pp. 444-445

Giving What We Can is seeking a Director of Research

As Director of Research, you would lead our efforts to find the charities most effective at alleviating extreme poverty and advise the Giving What We Can community in their donation decisions.

Determining which charities we should recommend – based on both the effectiveness of the interventions the charities carry out, and how well those organisations implement them.

Understanding the broader landscape of top charitable interventions and organisations, in order to advise our members when deciding where to donate

Presenting the research in compelling ways in order to encourage people to donate to the most effective charities, both via our website and presentations.

We are a small team, so you'll also have the opportunity to be involved in recruitment, fundraising, publishing our findings in the media, and whatever else most interests you.

This role combines great potential for impact with great potential for growth and learning. In determining which charities Giving What We Can recommends, you will be influencing a rapidly expanding pool of donations, already over a million pounds each year, in order to help those in extreme poverty as much as possible. As one of the key team members of a rapidly growing small organisation, you'll have a huge amount of responsibility, autonomy and room to grow.

If you work for Giving What We Can, you’ll be part of a focused team of intelligent, caring, enthusiastic colleagues who want to change the world, located in the centre of beautiful Oxford.

We’re looking for someone who cares deeply about extreme poverty and is fascinated by the question of how we can most quickly eradicate it.

You'll need a combination of research skills honed on messy real-world problems, and clear written communication. The ideal candidate would also have excellent presentation skills and experience dealing with media in order to be able to take their research to a wide audience.

Some examples of experience that would be especially useful include: economics, journalism, graduate study (particularly in the Social Sciences or Philosophy), monitoring and evaluation in the charitable sector - though we're interested in anyone who can demonstrate the skills.

Stephanie Crampin

Promising news for deworming

 on the long-run effects of childhood deworming on children’s performance in literacy and numeracy. The results are positive, and particularly striking, as they tackle some of the key misgivings we have had with deworming as an intervention, and reinforce our confidence in deworming charities as effective investments to combat poverty.

, previous work on the effectiveness of deworming children has relied on a 2004 study on the Rockefeller Sanitary Commission’s campaign to eradicate hookworm in the American South in the early 20th century, and on a series of studies in Kenya. The latter studies arbitrarily selected groups of children to receive school-based deworming, and compared those groups to others which received less deworming treatment. While these increase our confidence in the long term benefits of deworming, there have been reservations about the health and school test results improvements that deworming provides, as well as concerns about publication bias, articulated by Olga Kuznetsova in 

One of the main concerns that we have had concerning deworming has been that, although deworming has been shown to increase school attendance, it was much less clear whether it had any effect on the performance of those receiving the treatment. What this new study shows is that children who had been treated scored better than those in control groups by about ⅓ of a standard deviation, with effects more profound for mathematics than for English literacy. To quote the study, “The effect is robust to a wide range of alternate specifications and inclusion of socioeconomic control variables, and to placebo treatment test. Girlsand children from the poorest income quintiles experience relatively larger gains.”

GiveWell plan to look at this study in more depth, but for now it give us confidence in the efficacy of deworming, and thus reinforces our recommendation of the 

Endgame for Polio? 

Polio cases have decreased by more than 99% over the past 25 years, in part due to the efforts of the Gates Foundation, which galvanized the global community to end polio. Further, the success of India in becoming polio-free provides the last three countries, where polio is still endemic, with optimism. However, political and security reasons have raised difficulties in ensuring that polio eradication will be accomplished by 2018.

Polio is an infectious disease transmitted through contaminated water and food. It attacks the nervous system, leading to paralysis, which may result in permanent disability, and it can be lethal. The lack of a cure and the lack of symptoms of the disease in most cases of infection have made polio eradication an incredibly difficult endeavour.

The first major step towards tackling the disease was made in 1988 when the World Health Assembly launched the Global Polio Eradication Initiative (GPEI) with the aim of eradication of polio by 2000 . At the time, wild poliovirus was endemic in 125 countries and about 350,000 people were paralyzed by polio every year.

The efforts of the global community have been immensely successful, resulting in the Americas being polio-free by 1994, followed by the Western Pacific Region (including China) in 2000, and Europe in 2002. The launch of comprehensive vaccinations programmes played a decisive role in this extraordinary progress.

Since the launch of the GPEI, the incidence of polio has decreased by more than 99%, while the number of countries which remain polio-endemic has been reduced to 3 (Afghanistan, Nigeria and Pakistan).

In 2012, the world recorded the lowest number of reported cases of polio in its history, while India became another polio-free country. Such promising news gave hope that the world’s struggle to eradicate polio might be over in the very near future. However, the final stages of the initiative have been more challenging that it initially seemed, resulting in the announcement of a new six-year strategy: 

The Polio Eradication and Endgame Strategic Plan 2013-2018

Detect and interrupt all polio transmission

Contain polio and certify the interruption of transmission

The example of India gives strong evidence that international efforts (led by the WHO, the Gates Foundation, the Rotary Club and UNICEF) will start to pay off in the near future. India faced many challenges which made the implementation of a comprehensive immunization scheme particularly problematic. These included:

Reluctance of sections of society, in particular parts of the Muslim community, to accept the polio vaccine.

In 2009, there were 741 reported cases of polio in India, more than in any other country in the world, according to the Global Polio Eradication Initiative. This led experts to predict that India would be the last country to stop polio.

‘Micro-planning’ played a major role in bringing India closer towards the goal by making the approach to immunization more systematic. Collecting data about particular places - including areas to be covered by each vaccination team on each day, names of the vaccinators, and of the community workers assigned to the area along with the vaccine - was at 

UNICEF increased the effectiveness of the campaign by setting up the Social Mobilisation Network for Polio in 2001 in the northern Uttar Pradesh state, one of the areas with highest incidence. The workers focused on increasing routine immunization coverage, and promoting habits that reduce the chance of infection (for example, exclusive breastfeeding up to six months, better hygiene and sanitation, and diarrhoea management with Zinc and ORS).

, which protects against both type 1 and type 3 polio, contributed significantly to the good results. However, it was the communications strategy that lay at the heart of India’s victory. Traditionally, a reluctance to vaccinate a child when sick was one of the key reasons for children to miss vaccinations. A 

 showed a rise in the percentage of caregivers willing to vaccinate their child when sick – from 66.6% to 83.3% in Uttar Pradesh (UP) and from 76% to 90% in Bihar, while the percentage of respondents from the high-risk areas (HRAs) of UP who said they had heard negative rumours about polio drops fell from 29.5% in 2010 to 19.1% in 2011.

The Polio Eradication and Endgame Strategic Plan 2013-2018 sets out the strategy to deliver a polio-free world by 2018. The Gates Foundation played a leading role in bringing the global community into action, by pledging US$1.8 billion to this cause at the Global Vaccine Summit in 2013. A group of countries promised another US$ 2.2 billion towards the Strategic Plan’s US$ 5.5 billion six-year budget.

The difficulty of conducting effective vaccination programmes in conflict-ridden areas might turn out to be a difficult obstacle to overcome. In Nigeria, nearly half of the polio cases were located in Borno and Yobe states. Those areas, controlled by Boko Haram, a jihadist organisation, have been difficult to access. For example, during a polio vaccination campaign in May 2013, more than 295,000 children (18% of the under- five population) could not be immunized in Borno. Meanwhile, violent incidents that have taken place since Boko Haram gained control, including 

the death of nine female vaccinators in north Nigeria

, has made it harder to recruit vaccinators.

A similar situation is taking place in Pakistan, where it is estimated that 56 people, including vaccinators and police providing security, have been killed in attacks conducted by tribal rebels since December 2012. A 

 to vaccinate more than 700,000 children fell short of the target by nearly 300,000 children due to inability to deliver the medicaments to unsafe areas of the country. The correlation between insecurity and the recorded number of polio incidences clearly indicates the violence is a major threat that may derail the plan to eradicate the polio by 2018. In 2014, the number of reported cases of polio in Pakistan has already escalated to 160 – the highest number among the last three endemic countries.

Furthermore, the disease has spread to countries which had been polio-free in recent years. The on-going conflict in Syria (which was, 

, free of polio in 2009) has made it one of the countries most threatened by the spread of the disease. It is estimated that vaccination rates in Syria fell from 91% of children before the war to an estimated 68% in 2012. The number is expected to be much lower for rebel-controlled areas, where most of the cases have been reported so far. The efforts to contain the spread of the disease should be at the top of the priority list of the states’ authorities.

To ensure that the recent resurgence of polio will not be a major setback for the campaign, the 

WHO has declared a public health emergency

 and urged the countries which are most likely to export the virus to immunize adults travelling abroad. The results are yet to be seen. However, given the lax border control in many areas where polio has re-emerged, the most straightforward solution is the mobilization to eradicate the virus from the last 3 endemic countries, thus preventing the spread of it to other countries, and finally putting an end to the long battle with polio.

Even if the global community does not succeed in eradicating polio by 2018, the campaign has had an enormous social and economic impact. On top of saving 10 million children from paralysis, the polio eradication campaign has aided the fight against other preventable diseases. For example, National Immunization Days were used as a platform to distribute vitamin A supplements. Meanwhile, the economic benefits of the Global Polio Eradication Initiative, presented in the study 

‘Economic Analysis of the Global Polio Eradication Initiative’

, were estimated at US$40-50 billion, while the provision of vitamin A can have an impact of as much as US$ 90 billion. The latter campaign would not have been nearly as effective if it had not been conducted with the comprehensive polio vaccination schemes. There is potential to replicate the logistical and administrative aspects of the campaign to tackle other preventable diseases.

Blog

Giving What We Can is seeking a Director of Communications

The Promise of the Safe Childbirth Checklist

Giving What We Can is seeking a Director of Research

Promising news for deworming

Endgame for Polio?

An AIDS-free generation? A summary of the discussion held on the Guardian Development Blog

Integration of neglected tropical disease control - how to eliminate schistosomiasis on a tight budget

A Look at Capital Flight from the Developing World

Tuberculosis: The Potential for Cost-Effective Intervention

Donating in the face of corruption