Integrating Private-Sector Tools Into Modern Global …mini-university.com/wp-content/uploads/2016/03/Series-1... · CERSI Fellow, Department of ... Reed Johnson F, Lancsar E, Marshall

Integrating Private-Sector Tools Into Modern Global Health Initiatives

Why integrate private-sector practices into global health?

Trends in global development demonstrate the growing importance

of private sector:

• Declining donor dollars

• New modalities of private sector investment and co-

investment

• New partners and stakeholders in geographies of interest

• Growing business case for investment in public health

SMART Learning Objective One

At the end of this presentation, the audience will

be able to summarize the importance of

integrating business practices into the global

health sector and define various models for

partnership with the private sector.

SMART Learning Objective Two


be able to provide a definition of stated-

preference methods and business cases and offer

an example of how they might be used in a global

health context.

SMART Learning Objective Three


be able to discuss the considerations and benefits

of conceptualizing end-users of health technology

as consumers.

Andrea BareSenior Advisor, Market DynamicsWilliam Davidson Institute

Anne Katharine WalesSenior Program ManagerInnovations in Healthcare

Lauren BrownCERSI Fellow, Department of International HealthJohns Hopkins Bloomberg School of Public Health

Deepti TanukuProgram Director, USAID-Accelovate ProgramJhpiego


Business Cases and Market Evaluations

Business Cases and Market Evaluations

Deepti Tanuku

USAID Global Health Mini University 2016

Washington, DC

March 4, 2016

9

Question:

What does it take to

bring a lifesaving

innovation from

introduction to scale?

10

Answer:

A lot. But, failure to

address market

realities is the leading

factor that derails

innovations

11

If you want to go from introduction to scaled use, Markets matter

Assessment Development Introduction Scaled Use

Problem Identification

and Priority Setting

Applied research to fill

implementation

knowledge gaps

Catalytic activity to

facilitate adoption of

product

Country-level program/

policy rollout/ diffusion into

sustained use

Fig 1: Accelerating the Path to Introduction and Use

1

From identifying a

problem to

developing an

appropriate solution

2 3

From developing a

solution to planning

for its introduction

into the “real world”

From planned product

introduction to its full

integration into policies

and programs

Source: USAID-Accelovate Program, 2014

12

If you want to go from introduction to scaled use, Markets matter (cont’d)

Assessment Development Introduction Scaled Use

Problem Identification

and Priority Setting

Applied research to fill

implementation

knowledge gaps

Catalytic activity to

facilitate adoption of

product

Country-level program/

policy rollout/ diffusion into

sustained use

Fig 1: Accelerating the Path to Introduction and Use

1

From identifying a

problem to

developing an

appropriate solution

2 3

From developing a

solution to planning

for its introduction

into the “real world”

From planned product

introduction to its full

integration into policies

and programs

Source: USAID-Accelovate Program, 2014

– Supportive Clinical Guidelines (WHO and Global)

– Inclusion of product on the WHO Essential Medicines List (WHO EML)

– Product registration with Global Regulatory Authorities (USFDA, EMA, etc)

– WHO Prequalification (as applicable)

– Supportive Clinical Guidelines (National)

– Inclusion of product on the Country Essential Medicines List (National EML)

– Product registration with National Regulatory Authority

– Confirmed commercial availability of product

– Identified procurement guidelines for (public and private sector)

– Identified supply chain and distribution channels

What goes into Business Case and Market Evaluations?

– Current market dynamics

– Total addressable market vs. current market (volumes, value)

– Market segments

– Cost and Cost effectiveness data (mean incremental cost2 per DALY averted)

– Quantitative assessment of demand

– Qualitative assessment of user preferences and drivers of adoption

– Willingness to Pay

– List of known manufacturers

– Local versus centralized manufacturing of product

– Max retail price versus subsidized or negotiated transfer price from manufacturer

What goes into Business Case and Market Evaluations? (cont’d)


Stated-Preference Methods in Global Health

Stated Preference Methods

in Global Health

Lauren Brown, MSPH

CERSI Fellow

Department of International Health

Johns Hopkins Center for Health Services and Outcomes Research

© 2014, Johns Hopkins University. All rights reserved.


©2015, Johns Hopkins University. All rights reserved.

Stated preference methods1

A set of methods used by researchers, patient groups,

and policy makers to better understand and

communicate the priorities and preferences of

patients and stakeholders in medicine and public health

Stated preferences methods are grounded in both

economics and psychology theories of choice

Choice experiments include tasks that ask people to

rate, rank and choose between alternatives

Stated preference exercises employ both qualitative

and quantitative methods

2




Why stated preference methods?1

Conjoint analysis, discrete choice experiments and

best-worst scaling have increased in popularity as they

provide researchers, patient groups and policy makers

with a simple and empirical way to quantify the

preferences of patients and other stakeholders

Stated preferences methods are increasingly being

applied to understand and compare the priorities

and preferences of stakeholders in health programs

3




Advantages1

• May incorporate both qualitative and quantitative

methods

• Can be used with large, diverse populations,

including hard-to-reach patients and stakeholders

• Validity, reliability and generalizability of the findings

can be assessed

• Preferences of different sub-groups can be compared

• Groups of individuals with similar preferences can be

identified and described

4




Key stages2

Research Objectives

Attribute and Levels

Experimental Design

Data collection

Statistical analysis

Analysis

requirements

Choice question

format

5

2. Figure adapted from ISPOR (2013)

An example of the paired comparison conjoint analysis3

tasks.

3. Bridges et al. Health Policy Plan. 2011;26:298-306Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2010; all rights reserved.

Benefits of male circumcision

6

Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2010; all rights reserved.

a. Odds ratios for race-specific preferences.

b. P-values for the test of racial interactions.

c. Aggregated odds ratios.

Preferences for male circumcision3

73. Bridges et al. Health Policy Plan. 2011;26:298-306

Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2010; all rights reserved.

a. Odds ratios for race-specific preferences.

b. P-values for the test of racial interactions.

c. Aggregated odds ratios.

Preferences for male circumcision3

73. Bridges et al. Health Policy Plan. 2011;26:298-306

Stated preferences for priority setting in

the reduction of maternal mortality in

Kenya and Uganda




Oxytocin quality improvement

Problem: reduced and/or unknown effectiveness and

safety for patients at the point-of-use

Drug-of-choice to prevent post-partum hemorrhage (PPH)

• inexpensive and available

• WHO’s Essential Medicines List4

Quality may vary and deteriorate5. Compromises along

supply chain may include:

• improper manufacture

• weak regulation

• misaligned procurement

• poor quality control• improper transport and storage

9

4. WHO (2015); 5. Stanton et al (2012)




Stage 2: Attribute development

Research Objectives

Attribute and Levels

Experimental Design

Data collection

Statistical analysis

Analysis

requirements

Choice question

format

10




Project phases

Phases Methods

1. Characterize organizations, roles,

activities, processes and systems for

improving maternal health commodity quality

in Kenya and Uganda

Key-

informant

interviews

2. Elicit preferences for maternal health

commodities quality control and improvement

solutions in Kenya and Uganda

Group

survey

exercise

Population: Expert representatives in pharmaceutical

development and production; regulation and quality

assurance; procurement; supply chain management; and

health care service delivery

11




Source quality

WHO prequalified manufacturer

or SRA approved manufacturer

(international)

or national quality control

tested

Drug administration

nasal (inhale)

or sublingual (under tongue)

or oral (swallow)

or intravenous (inject)

or intramuscular (inject)

or vaginal (insert)

or rectal (insert)

Increased cost per dose

$0.00

or $0.10

or $0.20

Heat stability

Between 2-8oC

or between 2-25oC

or between 2-40oC

Administrator

Delivering woman

or unskilled birth attendant

(family member, friend)

or midwife/nurse

or physician

Accompaniments

Point-of-use testing

or temperature monitors

Potential features of ideal uteronic

12




Best-worst scaling

Best Worst

Heat stable (2-25oC)

WHO prequalified manufacturer

Intramuscular (inject)

administration

Comes with temperature

monitors

13




Stated Preferences

@ The Johns Hopkins University

Bloomberg School of Public

Health

John F.P. Bridges, PhD

http://www.jhsph.edu/research/affiliated-programs/stated-preferences/

International Society for Pharmacoeconomics (ISPOR)

http://www.ispor.org/workpaper/practices_index.asp

14

http://www.jhsph.edu/research/affiliated-programs/stated-preferences/

http://www.ispor.org/workpaper/practices_index.asp




References1. Bridges JFP, Wu AW, Segal J, Bandeen-Roche K, Bone LR, Purnell T, Cummings E, Janssen E, Zhou M.

White Paper #1: Stated-Preference Methods - an introduction to measuring the priorities and preferences of patients and other stakeholders in medicine. 24 Sept. 2015

2. Reed Johnson F, Lancsar E, Marshall D, Kilambi V, Muhlbacher A, Regier DA, et al. Constructing experimental designs for discrete-choice experiments: report of the ISPOR Conjoint Analysis Experimental Design Good Research Practices Task Force. Value in Health. 2013;16(1):3-13.

3. Bridges JFP, Selck FW, Gray GE, McIntyre JA, Martinson NA. Condom avoidance and determinants of demand for male circumcision in Johannesburg, South Africa. Health Policy Plan. 2011;26:298-306

1. WHO. WHO Model List of Essential Medicines; 19th List (Amenda). Geneva, 2015.

2. Stanton C, Koski A, Cofie P, Mirzabagi E, Grady BL, Brooke S. Uterotonic drug quality: an assessment of the potency of injectable uterotonic drugs purchased by simulated clients in three districts in Ghana. BMJ Open 2012;2:e000431.


Public Health Challenges; Private Sector Tools

Global Health Mini-University

Public Health Challenges;Private Sector Tools

Andrea Bare, William Davidson InstituteMarch 5, 2016

• Established at the University of Michigan in 1992

• Independent, non-profit research & educational organization

• Providing market-based solutions in emerging economies

• WDI Healthcare Initiative works across the healthcare value chain to:

– Enable well-functioning markets

– Strengthen supply chain systems

– Improve healthcare service delivery

The Ecosystem

• A network of many different actors who operate in the supply and demand of global healthcare markets (malaria, TB, HIV/AIDS, RHFP, NCDs) to achieve public health outcomes

The Actors

• Payers, Purchasers, Suppliers, Implementers & Facilitators

The Activities

• Demand generation and aggregation, market data collection and analysis, forecasting, budgeting, funding, purchasing, contract negotiation, product design and development

The Context for Private Sector Tools in Global Health

Private Sector Tools: Selected Market Interventions

• Market sizing and global demand forecasting

• COGS analysisInformation Driven

Interventions

• Volume guarantee

• Advance market commitmentRisk Sharing Interventions

• Pooled procurement

• Product variants standardization

Demand Consolidation Interventions

• International quality assurance system

• In-country regulation

Regulatory Interventions

• Direct subsidy/grant to manufacturers

• Channel subsidy

Direct Financing Interventions

Market Imperfections

Underlying Effects

Sub-Optimal Market

Outcomes

• 214,000,000 million new cases of malaria worldwide in 2015

– Africa 88%, SE Asia 10%, Eastern Mediterranean 2%

• 438,000 million deaths from malaria worldwide in 2015

– Children under five are especially susceptible: 2015 deaths estimated at 306,000 globally

• 2000-2015: incidence by 37% globally, 42% in Africa– Mortality rates by 60% globally and 66% in African region

• 663,000,000 million cases of malaria averted in sub-Saharan Africa since 2001 as direct result of ITNs, IRS, ACTs

Setting the Stage: Malaria

Source: WHO World Malaria Report 2015, Reported Estimates

Historical: LLINs for Malaria Prevention

Malaria & LLINs• 3.2B people at malaria risk in 2015

• Vector control main way to prevent and reduce malaria transmission

• WHO recommends LLIN coverage for all people at risk of malaria

Results For Development Project• June 2011, supported by BMGF

• Goal: Expand Access

• Analyze opportunities / drive actions to improve global LLINs marketplace

Market Landscape• 5M nets in 2004, 130M nets in 2011

• 90%+ of LLINs publicly funded

Two Primary Issues

1) Price-Focused Procurement

2) Fragmented Product Demand

Related Recommendations

1) Optimize Cost-Effective Procurement

2) Rationalize Net Specifications

Current: ACT & Artemisinin for Malaria Elimination

ACTs• Best available treatment

• Reduces development of resistance

Relies on Agricultural Supply• Produced via Artemisia Annua

• Agricultural supply is unstable; shortages and price fluctuations

• Complicates production planning for ACT manufacturers

Artemisinin Supply Planning• How will elimination scenarios

impact ACT and artemisinin demand?

• At what point does artemisinin demand start to decrease?

Information-Driven Solution

• Forecasting to reflect the intervention strategies for the 35 malaria elimination countries

Multiple Uncertainties

• Treatment strategies, prevalence and incidence data

Future: Tafenoquine & G6PD Diagnostics for Malaria

Primaquine: current drug

• Only radical cure for P. vivax malaria

• 14-day dose

• Haemolysis in G6PD deficiency

• WHO recommends routine testing of G6PD status prior to primaquine radical cure

Tafenoquine: new drug

• Development by GSK and MMV

• Single dose, haemolysis in G6PD deficiency

G6PD Diagnostic Development

• Point-of-care diagnostic is critical to support of primaquine; future commercialization of tafenoquine

Market Adoption & Utilization

• To insure that public and private health systems in malaria-endemic countries are prepared to support the adoption of G6PD diagnostic


Healthcare Innovation Partnerships

Healthcare Innovation PartnershipsHealthcare innovation overall and importance of partnerships in

scaling what works

Jan. 2016

43

Nonprofit organization founded by Duke

Medicine, McKinsey & Company, and the World

Economic Forum and hosted at Duke.

Aims to improve health worldwide by supporting

the scale and impact of promising innovations.

Supported by and collaborates with a global and

diverse group of organizations that are

committed to strengthening and increasing the

scale of health innovations.

44

Innovations in Healthcare operates a network of healthcare delivery

innovators

4

5

Source

Increases awareness of promising new strategies

to address health challenges by curating a

network of innovative solutions developed by

organizations from around the world.

Strengthen

Increases the capacities of these innovative

organizations by providing key resources and

connections.

Scale

Increases the scale of impact of these innovative

models and offerings by facilitating their adoption

in new contexts.

Study

Facilitates the development and dissemination of

focused insights and new evidence about these

innovations and their strategies to scale and

replicate.

1

3

2

4

45

We focus on sourcing, strengthening, scaling and ultimately studying

proven healthcare delivery innovations

4

6

4

6

We have curated a network of 67

organizations that:

Provide significant improvements in

cost, quality, and/or access, as

measured against comparable solutions

Address critical health needs

Can be implemented via a sustainable

business model

Our innovator network includes 67 proven enterprises working globally

What we look for in specif ic segments:

Healthcare

Technology

Low-Cost

Diagnostics

Healthcare Deli very

Health Financing

· High rates of user satisfaction and

user advocates (recognizing

various users

may be involved)

· Integration into

larger health system

· Data

control/privacy

· Easy to use (with minimal training

required)

· Limited

maintenance

required

· Significantly

improved

capabilities across multiple

health needs

· High rates of provider and

patient satisfaction

· Evidence based

quality of care

· High rates of customer renewal

· Understanding of lifetime value of

customer and

ability to market and provide

services profitably

What we look for in key regions:

Kenya

India

Mexico

US

· Reliable patient

or clinic payments

· Integration with (or interest in)

broader public or

government services

· Patient

satisfaction

· Maximization of

data for impact

· Partnership with

government for payment and

provision of service

· User satisfaction

AND end payer interest

· Evidence based evaluation

What we’re seeing as driving factors in healthcare delivery success

Market

Landscapes &

Ecosystems

Characteristics

of Innovative

Models

Scaling

Strategies

Translation of

Innovative

Models

Studies of individual or

groups of innovative

organizations and their

defining characteristics

Studies of the

relationships between

innovative models and

their scaling challenges

and strategies

Studies of the aspects of

innovations and replication

environments that are most

conducive to translation

Studies to uncover emerging

innovations and ecosystem

factors in specific regions and

markets

Research and knowledge development is a critical component of our work. We produce

white papers, case studies, and other resources that offer up ideas and strategies for

strengthening healthcare around the world.

48

Our work focuses on scaling existing health enterprises and also learning

from and applying these learnings to all our work

Gold Supporters

Founding Members

Silver Supporters

Bronze Supporters In-kind Supporters

49

Innovations in Healthcare works with over 15 healthcare foundations,

pharma and med devices companies focused on improving healthcare

The Social Entrepreneurship Accelerator at Duke (SEAD) is a global health enterprise

accelerator executed by partners within and outside Duke University, including Innovations

in Healthcare.

Launched in 2012, SEAD is a USAID-supported effort that mobilizes a community of

practitioners, investors, policymakers, faculty, staff, and students to identify, assess, build

capacity of, and scale health and healthcare enterprises in developing countries around

the world (focused now on India and East Africa).

Through SEAD, a subset of Innovations in Healthcare innovators have the opportunity to

participate in a rigorous program of engagement and evaluation designed to help them

scale their impact.

50

Innovations in Healthcare is a core partner in the SEAD program – three

year, accelerator program

Partnerships Are

Essential to Scale!

52

Strategic Planning

Performance

Management

Should I franchise to maximize my impact? Is acquisition the

right path?

How can I collect data in a cost effective way to prove my

impact? What about measuring clinical quality?

Product/ Service

Innovation Development

What product changes should I make to best serve my

customers?

Organizational Leadership

& TalentHow do I hire, train and retain talented clinical staff?

Leveraging the Ecosystem What’s the best way for me to partner with a pharma company?

The government? Another innovator?

Funding & Investment How can I best position my organization for a series A round?

What’s limiting growth? Successful partnerships are incredibly important

Localization

Entrepreneurial approach

Focus on core competencies

Focus on broad value

creation

Long-term commitmentSenior leadership

commitment

2015 report on Social Business Strategies revealed that for long-term

successful partnerships, corporations should look for the following:

Advice for corporates interested in partnering with innovators

1. Know what you want from your partner

2. Know your partner

3. Build trust-based relationships

4. Align goals to create a win-win

5. “Get on the ground”

6. Be patient

Advice for innovators looking to partner with corporates

Highlight opportunities for

governments to save money

Ink the deal and be willing to invest

in structure

Actively pursue relationships at all

level of government. Relationships

are key.

Advice for innovators looking to partner with government

56

Successful partnerships in Innovations in Healthcare’s network

For more information please contact:

Anne Katharine Wales, Senior Program Manager:

[email protected]

Website: www.innovationsinhealthcare.org

Facebook: www.facebook.com/innovationsinhealthcare

Twitter: @innovationsinhc

QUESTIONS

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Integrating Private-Sector Tools Into Modern Global …mini-university.com/wp-content/uploads/2016/03/Series-1... · CERSI Fellow, Department of ... Reed Johnson F, Lancsar E, Marshall