IHI overview

50+ years of health development research

Governing Bodies and Organization

SWISS GOVERNMENT TANZANIAN GOVERNMENT

SDC Swiss

TPH COSTECH NMAIST NIMR MoH

BOARD OF GOVERNORS

ALL BoG MEMBERS PRIVATE CIVIL

SOCIETY ESRF

BOARD OF TRUSTEES

DIRECTORATE & MANAGEMENT COMMITTEE

IHI-SUPPORT DEPARTMENTS AND RESEARCH THEMATIC GROUPS

Founder Members

Associate Founder

Members

RMOs

4

Sentinel Panel of Districts (District Observatory)

Research Infrastructure Development

• BSL II labs Ifakara and Bagamoyo

• BSLIII lab Bacteriology and virology Bagamoyo

• Clinical Trial facility: Bioequivalence, drug & vaccines, food sup

• Expansion of entomology screen houses

• Entomological labs Cat 3 in Bagamoyo

• Population and facility based surveillance (SPD)

• Validated data management and storage facilities

• Training facilities for clinical and research studies

• Office and support centers in 7 location in Tanzania

Capacity Building

Translation of Research Results into Policy

Strategic Objectives

Organization of research and support structures

1. Biomedical Science

2. Environmental Health and Ecological Science

3. Interventions

4. Health System Science

5. Impact Evaluation

6. Policy Delivery

Operations Knowledge People Finance

Organisational Support

Clie

nt

an

d R

es

ea

rch

Ou

tco

me

s

Laboratory discovery /

development

Developing ideas to work

in practice

Testing in the field

Matching interventions to

the real world

Measuring outcomes: did

the intervention work

Taking it to scale within

reality and public policy

Research Lifecycle

Improved

population

health

EXHIBIT 2

Organization structure

8

Chief Research

Officer

Chief Financial

Officer

Chief of Professional

Development

Chief Knowledge

Officer

Chief Operations

Officer

IHI Circle of Fellows

Technology Branches:

Ifakara, Bagamoyo,

Dar, Rufiji, Kigoma,

Dodoma, Mtwara Internal Audit /

Compliance

Research Quality

Assurance

Board of Governors / Board of Trustees / Board Committees

Chief Executive Director / Deputy

Organisational structure

Biomedical Science

Environmental Health

& Ecological Science

Interventions

Health Systems

Science

Impact Evaluation

Policy Delivery

Data & Analysis

Centre

Personnel

Administration

Training & Prof.

DevelopmentCommunications

Knowledge Bank

Procurement

Transport Chief Accountant

Grant Support

Legal

Development &

Partnerships

Facilities

EXHIBIT 3

Vaccine

Malaria prevention using Insecticide Treated Nets

Exploratory studies in ‘95-7 Social Marketing in 1997 Long term effects-’99-2004 National scale 2001 National M&E 2002 GF Voucher scheme 2003 Universal coverage campaigns 2010

Policy relevant analysis: Use of Sulphurdoxine Pyrethamin for treatment of malaria

6%

Mkuzia

Mlimba

11.4%

12%

6.4%

21%

32.%

19.%

28

%

19.4

%

55

.2%

19.4

%

6%

19.2

% 5

0.7

%

16

.40

%

80

.3%

11.9

%

2.4

%

5.5

%

18.6

%

45.8

%

23.7

%

11

.9%

19.3

%

5.3

%

12%

40.2

%

47.8

%

4.1

%

32.3

%

13.4

%

54.3

%

3.4

%

10.2

%

86.4

%

Butimba

Kyela

22.5%

0%

95.9

%

Masasi

13.7

0%

75.4

%

0%

5%

10%

15%

20%

25%

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

year

severe cases following operational failure (CQ regimen)

IP admissions following operational failure (CQ regimen)

severe cases following operational failure (SP regimen)

IP admissions following operational failure (SP regimen)

2006: Coartem introduced as National policy

In children 5–17 months of age during 12 months of follow-up

• Vaccine efficacy against clinical disease: 55.8% (97.5% CI: 50.6-60.4)

• Vaccine efficacy against severe disease: 47.3% (95% CI: 22.4-64.2)

October 18, 2011

In children 6–12 weeks of age during 12 months of follow-up

• Vaccine efficacy against clinical disease: 31.3% (97.5% CI: 23.6-38.3)

• Vaccine efficacy against severe disease: 36.6% (95% CI: 4.6-57.7)

November 9, 2012

The DMF outlines information and processes required for timely and informed

decisions when an approved malaria vaccine becomes available – [ A tool to

aid systematic planning ]

Need for early country-level planning

Introduction of a Malaria Vaccine

Decision Making Framework

Molecular epidemiology

Immunology

…other research questions

Clinical trials on new

TB treatment regimens

or new TB vaccines

-Training (2010: 4PhD 4MSc started) -Public health service

Evaluation of new

TB diagnostics

&

Tuberculosis Research at IHI

Tuberculosis Research future direction

• Clinical TB vaccine and drug development – phase II and III trials • Supported by EDCTP, TB Alliance and probably Aeras/GSK (TB vaccine

phase II-III

• Early Bactericidal Activity studies • Evaluate new anti-TB drugs (compounds) if they have activity against

TB - TB Alliance

• Interrelation TB – Diabetes Mellitus • Epidemiology, Pharmacokinetic, Immunology, Mtb genetic background

Strengthening health system: equitable access to quality health systems

Inter-linked and mutually dependent key themes:

Delivery of essential and quality health services

Financial - increase the understanding of health insurance mechanisms in promoting health system equity and addressing the needs of vulnerable groups

Human resources – improving productivity of health workers & getting services closer to the people (through task shifting/ sharing, community health workers & use of cell phone technology)

Governance and decision-making – strengthening of health facility governing boards to increase accountability

Health facility assessment & health information system

17

Tool 3

Clinical skills

Tool 4

Management

Tool 2

Job expectations

Tool 1 Infrastructure &

Equipment

Tool 6

Client satisfaction

• Implementation research in population of over 1 million

• Innovations • Volunteer community intervention designed for scale-up in Tanzanian

context

• Paid community health workers with accredited curriculum ready for scale up

• Community-linked supervision & support

• Foot size proxy for birth weight

• Cluster-randomized controlled evaluation

Human resource: Community health workers for MNCH

Health accounts for resource allocation

• District Health Accounts tool and PlanRep2 Maps district budgets and expenditures in relation to burden Helps align spending with priorities Improves transparency and accountability

20

Social Determinants of Health – early stages

• Strengthening systems and building research capacity in researching for SDH in LMIC ; potential for future collaboration with FIOCRUZ

• SDH conceptualization and ‘contextual’ analysis integrated and embedded in ongoing institutional priority research areas

• Monitoring Equity in Tanzania (part of a regional initiative led by EQUINET)

21

Gap areas for future focus

• Strategies for promoting accountability for improved quality of health care for all in need at all levels of the system

• Global influences and their impact on national health systems

• Contextualizing lessons learned- what works and what does not under which circumstances – SDH and innovation.

• Impact of changing demographics and fragile systems – needs of elderly, double burden of disease, urbanization.

Knowledge Forums

23

• April : Malaria Control Forum 2011, 2012

• Oct 2011: Monitoring & Evaluation SPD

Dissemination of INESS & Malaria Vaccine trial results

Knowledge Products and Policy

Training activities

• Partnership with universities

• Skills training for stakeholders

• Platform for MSc and PhD

• 33 MScs, 30 PhDs, Post doctoral training

• A unique programme in the region to be offered under NM-AIST, Arusha

• 2 year academic/research programme

• Strong involvement of internationally renowned subject experts

• Dissertation and a publishable scientific paper manuscript

• Use of problem based learning

• Practical hands on training using IHI research platforms

• Three streams of specialization

Training: Masters in Public Health Research

National

MDG 4

Possible

Latest point is

within the forecast