VIII Regional Meeting of the Observatories of HR in Health November 20-22, 2006 Lima, Peru

1. 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 Them Most

2. 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

3. 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

4. THE PROBLEM • Disability-Adjusted Life-Years Lost: Child health Acute lower respiratory infections HIV/AIDS Acute diarrheal illness Malaria Vaccine-preventable diseases Other neglected diseases Tuberculosis Poor nutrition Reproductive health Source: World Health Organization (2002 estimates)

5. 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 THE HOPE

6. 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

7. 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

8. 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 researchto develop new drugs, vaccines, and diagnostics Improve existing technologiesso they are more affordable and practical for developing countries OUR APPROACH

9. GRANTMAKING AREAS • Total global health grants, 1995-2005: $6 billion

10. 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

11. EXAMPLE: FIGHTING MALARIA • Foundation’s malaria strategy: • Expand access to current tools • Develop new drugs and vaccines • Engage industry Source: Medicines for Malaria Venture

12. 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

13. 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

14. BMGF INVOLVEMENT IN HRH Organizations and programs Activities supported BMGF support Global • 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 • Joint funding of $1.7 mill with NORAD over 2 years • ~$300,000 Regional • World Bank Africa region program* • PAHO • Knowledge development • Tools and technology, e.g.M&E systems • National policy setting • Regional Meeting of the Observatories Country-specific • Malaria Control and Evaluation Partnership in Africa • Supporting scale-up of malaria control, including HRH • TBD % ($35 mill over 9 years MACEPA total) * Focused in Ghana, Ethiopia, Zambia, Malawi and Rwanda Source: WB Africa Concept Note, GHWA Strategic plan and Board meeting document, Gates Foundation website

15. HRH productivity HRH creation and retention GATES FOUNDATION HRH FRAMEWORK Supply levers Demand levers Patient expectations • Training • Qualifying • Hiring • Retention • Quality of care • Medical knowledge 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 Improve standard of care (patient satisfaction will cause increased demand for care) Increase patient knowledge of disease and available services (awareness will increase demand) Optimal number of productively deployed HRH needed to satisfy all critical health needs Payment for services • Utilization • Distribution • Public/Donor • Private Improve output per HRH Optimize HRH “mix” Implement tracking systems/tools Improve infrastructure, supplies and technology Improve distribution of HRH in eg. Public vs. private and Urban vs. rural Fund the cost of care, e.g. payment of HRH wages, benefits*, public insurance programs, entitlement (remove access barriers to increase demand) Promote private arrangements to pay for care eg insurance (remove access barriers to increase demand) Source: Team analysis

16. HRH productivity HRH creation and retention EXAMPLES OF METRICS FOR ASSESSING IMPACT Supply levers Demand levers Patient expectations Training Qualifying Hiring Retention Quality of care Medical knowledge • 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 • Error rates • Suspended licenses • Adherence to best practice • Outcomes eg local vaccination rates • Patient compliance rates • Testing rates • Resource utilization e.g. drugs, HRH encounters Optimal number of productively deployed HRH needed to satisfy all critical health needs Payment for services Public/Donor Private Utilization Distribution • % salary increase/ HRH by type • Gov’t or donor healthcare spending • % of population enrolled in insurance or entitlement • Private sector healthcare spending • % of population insured (private) • # 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

17. 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