VIII Regional Meeting of the Observatories of HR in Health November 20-22, 2006 Lima, Peru Ensuring Life-Saving Advances in Health Reach Those Who Need.

VIII Regional Meeting of the Observatories of HR in Health

November 20-22, 2006Lima, Peru

Ensuring Life-Saving Advances in Health Reach Those Who Need Them Most

THE PROBLEM

Millions of people in developing countries die from preventable and treatable causes

› Last year:

› Newborn survival: Four million newborns died, unnecessarily

› TB: Nearly 2 million people died of TB

› Nutrition: Poor nutrition contributed to half of the 11 million deaths among children under age 5

Source: Lancet child survival series, 2003

THE PROBLEM

More research is needed to fight disease in the developing world

› Most new drugs treat diseases in rich countries

› Many existing tools are impractical for developing countries

THE PROBLEM

Disability-Adjusted Life-Years Lost:

97,335,000

91,374,000

84,458,000

61,966,000

46,486,000

43,650,000

36,389,00034,736,00034,417,00033,632,000

Child health

HIV/AIDS

Malaria

Other neglected diseases

Poor nutrition

Acute lower respiratory infections

Acute diarrheal illness

Vaccine-preventablediseases

Tuberculosis

Reproductive health

Source: World Health Organization (2002 estimates)

THE HOPE

We can dramatically improve health right now ...

› Simple, cost-effective tools

› Proven successes

› Scientific capacity

... but to succeed, it has to be a top priority

› Political will

› Resources

ABOUT THE FOUNDATION

Foundation’s global health mission:

› Help develop and deliver low-cost, life-saving health tools for people who need them most

We believe:

› All lives – no matter where they are lived – have equal value

› When health improves, life improves by every measure

OUR ROLE

We focus on:

› Finding solutions for the biggest, most neglected health problems in developing countries

› Bringing together a diverse mix of public and private players

› Measuring and sharing results

Accelerate access

› Demonstrate what worksthrough large-scale access programs

› Expand access to effective health tools

› Introduce and deliver vaccines, drugs, and diagnostics

› Develop new financing mechanisms

› Advocate for greater attention and resources

Support research

› Basic and clinical research to develop new drugs, vaccines, and diagnostics

› Improve existing technologies so they are more affordable and practical for developing countries

OUR APPROACH

GRANTMAKING AREAS

Total global health grants, 1995-2005: $6 billion

EXAMPLE: FIGHTING MALARIA

The problem:

› Malaria kills nearly 1 million children in Africa every year

› Tools to fight malaria fail to reach those who need them

› Growing resistance to cheapest drugs

EXAMPLE: FIGHTING MALARIA

Foundation’s malaria strategy:

› Expand access to current tools

› Develop new drugs and vaccines

› Engage industry

Source: Medicines for Malaria Venture

EXAMPLE: CHILDHOOD VACCINES

The problem:

› 27 million children do not receive basic vaccines every year

› Lack of reliable markets in developing countries

› Lack of infrastructure for delivering vaccines

EXAMPLE: CHILDHOOD VACCINES

Global Alliance for Vaccines and Immunization

› Create reliable markets for existing and new vaccines

› Invest in critical vaccine delivery infrastructure

› Dramatic results – millions of children immunized

Source: GAVI Alliance

BMGF INVOLVEMENT IN HRH

*Focused in Ghana, Ethiopia, Zambia, Malawi and RwandaSource: WB Africa Concept Note, GHWA Strategic plan and Board meeting document, Gates Foundation website

Organizations and programs

GlobalGlobal

Activities supported BMGF support

RegionalRegional

Country-specificCountry-specific

Global Health Workforce Alliance (GHWA)

International National Association of Public Health Institutes (INAPHI)

National and global policy setting Global, regional and national advocacy Knowledge development and sharing,

Capacity building of National Public Health Institutes including human resources

TBD to support regional, country and other initial activities

$20 million over 5 years

World Bank Africa region program*

PAHO

Knowledge development Tools and technology, e.g.M&E systems National policy setting

Regional Meeting of the Observatories

Joint funding of $1.7 mill with NORAD over 2 years

~$300,000

Malaria Control and Evaluation Partnership in Africa

Supporting scale-up of malaria control, including HRH TBD % ($35 mill over 9 years MACEPA total)

GATES FOUNDATION HRH FRAMEWORK

Source: Team analysis

Optimal number of productively

deployed HRH needed to satisfy all critical health

needs

Qualifying

Educate and train HRH at all skill-levels and functions to ensure adequate mix

Improve regulation (e.g. licensure, certification registration)

Hire into public health workforce or assist with establishing private practice

Encourage reverse flows

Reduce attrition due to illness, emigration, retirement, safety

Improve career progression

Increase patient knowledge of disease and available services (awareness will increase demand)

Supply levers Demand levers

Improve standard of care (patient satisfaction will cause increased demand for care)

HRH creation and retention

Improve output per HRH Optimize HRH “mix”Implement tracking systems/toolsImprove infrastructure, supplies and technology

Improve distribution of HRH in eg. Public vs. private and Urban vs. rural

HRH productivity

Patient expectations

Medical knowledge

Private

Promote private arrangements to pay for care eg insurance (remove access barriers to increase demand)

Payment for services

Public/Donor

Fund the cost of care, e.g. payment of HRH wages, benefits*, public insurance programs, entitlement (remove access barriers to increase demand)

Training Hiring Retention

Utilization Distribution

Quality of care

EXAMPLES OF METRICS FOR ASSESSING IMPACT

Optimal number of productively

deployed HRH needed to satisfy all critical health

needs

Qualifying

Number of enrollees/ grads

Faculty/ student ratios

Admission of minority students

Number of exchange participants

Number of newly licensed HRH

Number of newly licensed hospitals or schools

Speed of licensure process

HRH newly hired

Vacant posts Time to fill

vacant posts % of HRH

returned from abroad

Staff in underserved areas

Survey data on perception of HRH jobs

% HRH who emigrate or intend to

% HRH leaving to other sectors

# days absent/ year

Ratio of staff to managers

HRH lost to HIV

Survey data on job satisfaction

Patient compliance rates

Testing rates

Resource utilization e.g. drugs, HRH encounters

Supply levers Demand levers

Error rates

Suspended licenses

Adherence to best practice

Outcomes eg local vaccination rates

HRH creation and retention

# patient visits/ HRH # treatments delivered/

HRH Survey data of

comparing skill set to tasks performed

Density of HRH by area

Towns/villages without HRH

Distance to nearest HRH

Ratio of HRH in private vs. public practice

HRH productivity

Patient expectations

Medical knowledge

Private

Private sector healthcare spending

% of population insured (private)

Payment for services

Public/Donor

% salary increase/ HRH by type

Gov’t or donor healthcare spending

% of population enrolled in insurance or entitlement

Training Hiring Retention

Utilization Distribution

Quality of care

Summary

HRH = PEOPLE

“Peruvian Way”

Donor role:

› Unique contribution vs longterm capacity building

› Catalytic

› Build advocacy and awareness, globally

› Identify best practices

› Research and Evaluation