2018 PQMD Global Health Policy Forum
April 10-11, 2018
Summary of Conference Proceedings
Tuesday, April 10, 2018
The Role of Donations: Creating Dependency or Sustainability
Welcoming Remarks, Elizabeth “EJ” Ashbourne, Executive Director, PQMD
Welcome everyone and thank you for coming to PQMD’s annual Global Health Policy Forum. I am Elizabeth Ashbourne, PQMD’s Executive Director, now with PQMD for nearly three years of its 20-year history. Today, we have more than 100 global private sector, non-profit, humanitarian and government agency leaders from over 68 organizations participating in this 2 day program. We are grateful you are here.
I want to first give special thanks to the support that made this event possible. Our event sponsors are Johnson & Johnson, BD, Sanofi and AbbVie. I would also like to thank the PQMD team, our Board and members, along with our Advisory Council who have contributed their time, talent and experience to pulling this program together. And a special thanks to the speakers and moderators who are bringing this program to life over the next day and a half.
For those of you here for the first time, PQMD is a global alliance committed to advancing the role of donations worldwide, with 42 members representing leading international & U.S. based NGOs and global healthcare companies in the pharmaceuticals, medical products and devices. We were founded in 1999. Our work is guided by 5 pillars: humanitarian assistance, health systems strengthening, disaster response, guidelines and standards, and knowledge and innovation.
By virtue of our network, our members leverage their partnerships, expertise and resources to focus on building sustainability, promoting community resilience, supporting disaster preparedness and response capacity all while adhering to the highest standards of excellent in donation practices.
We have put together an agenda that draws on the experience and talents of our members and participants. As with our previous Forum in London last year, there will be no presentations or PowerPoints. The program is designed to be an exploration and discussion of key issues, topics and challenges facing global health, and the role of donations in disasters, helping migrating populations, addressing humanitarian crisis, and supporting health systems and partnerships. More intentionally, the panels and plenaries were designed to have participants and panelists explore the implicit tensions of trying to serve the needs of global health, global giving and health service delivery on all fronts. When you think about donations, you might think immediately of philanthropy, benevolence, doing good, corporate giving and service through NGOs and other partners. But in truth, there are tensions and hard choices around donations and our agenda seeks to reflect on the paradox.
Today’s discussion on the role of donations focuses on creating dependency or sustainability, and exploring the ability to create sustainable enabling environments. But do donations also come with the risk of disempowering and undermining the communities and countries they are seeking to serve? The tension is there and recognized, something I hope our distinguished panel will take on.
Tomorrow we will be talking about 2017 as a Pandemic of Disasters and again, you will no doubt hear about the tension of addressing urgent needs while working also to maintain humanitarian assistance and health system strengthening commitments – balancing the urgent needs of an avalanche of short term crises while also taking care of the long game. You will hear about this balancing act throughout the whole agenda and in every session. You will hear about it in the session about refugees and migrating populations and the tension of wanting to help – having the funds and products, and yet lacking the mechanism to follow patients from country to country. You will hear it in a plenary session on the nexus of philanthropy, where we will be talking about how to rationalize the interest in the global public good with the motives of shared value and the bottom line; in a session on metrics and impact evaluation which will discuss the tension around the need to know you are getting value for money, making a difference and having an impact, but where measurement can go overboard and become completely counterproductive to the donor and the recipient. There is an inherent tension in needing and wanting to balance the available resources to meet the shared mission of all our organizations. And, the truth is if it was easy, and we had a silver bullet – we would have used it.
My goal today is to suggest three points to frame today’s and tomorrow’s discussion, in other words: why this? Why now?
First, It is important to recognize the tensions, but as an inspiration for finding solutions and as motivation to innovate. International development is riddled with complexity. We are facing problems of monumental proportion disrupting access to health care and wellness. Not recognizing & understanding that tension – that struggle for balance – leads to unintended consequences in the face of addressing urgent needs, rather than holding the line on a long term plan. I believe that it is exactly these tensions that inspire solutions, drive us to innovate and ultimately leads to the partnerships and alliances that will be able to impact disasters, diseases, health systems and contribute to the global public good.
Second, understanding the overlap of humanitarian action, health system strengthening and shared values is vital. Donations do play a significant role in humanitarian assistance, disaster response and health system strengthening. While every sector involved looks at donations through a different lens, understanding the common ground, as well as the complementarity of our efforts, is key. I don’t need to tell you that the challenges of access to healthcare is a completely multi-sectoral problem so it will never be just about the medicines, the health products and devices or the health services alone. Our donation programs and all the work that goes with them is still only one tool in the health toolbox.
Third, for over 20 years PQMD has led the way in facilitating cross-sectoral coordination and collaboration. In fact, it has been the key to our success. Our members and beneficiaries have seen the benefit of building partnerships, leveraging resources and member expertise to accelerate access to health care and medicines. None of us can go it alone. We knew it in Katrina. We knew it in Haiti. We knew it in Nepal, not to mention fully understanding it in working with the Rohingya, refugees, Venezuela, famine, Syria, Sudan, Yemen – and all the humanitarian crises our members have responded to and continue to respond to today and in the future.
But then 2017 happened, with 330 natural events worldwide, hurricanes, floods, and earthquakes, where any fragile and not so fragile system and infrastructure was shaken to its core. So for any late bloomers to the idea that mature partnerships are essential, it couldn’t be more crystal clear. We sit here on the precipice of the next hurricane season in our hemisphere – the forecast is dismal but the people in this room are ready – ready to mobilize the relationships, partnerships, engagements, products, services, resources – essentially people, money and expertise – to take on whatever comes.
With that overview, I look forward to hearing the views of our panelists and hope that all of you will feel free today and tomorrow, to join in the conversation as it unfolds, exchange views, be contrarians but only in the most productive way, and participate actively in inspiring ideas and solutions to build a broader understanding of the global imperatives before us. Thank you.
Executive Forum: The Role of Donations: Creating Dependency or Sustainability
Description: This high level Forum explored the role of donations and their ability to create sustainable, enabling environments for the promotion of economic growth and prosperity. Guiding questions included:
How do donations become part of the path to sustainable health?
Do donations risk disempowering and undermining sustainable solutions?
What are the unintended consequences of donations?
What is the long term impact of donations assistance?
How do donors, agencies and organizations ensure that we are not creating dependency on donations, but rather moving down a path of sustainable improvement, using the right incentives and contributing to resilient health systems?
Can donations become a building block to support resilient health systems?
What does an exit strategy look like?
Session Chair: Mark Chataway, Chairman, Hyderus & Bairds CMC
- Jacob Gayle, President, Medtronic Foundation
- Amanda Glassman, Chief Operating Officer, Senior Fellow, Center for Global Development
- Jayasree Iyer, Executive Director, Access to Medicines Foundation
- Jane Nelson, Director, Corporate Responsibility Initiative at Harvard Kennedy School, Senior Fellow, Brookings Institution
- Michael J. Nyenhuis, President & Chief Executive Officer, Americares
- Bruce Wilkinson, President & Chief Executive Officer, CMMB
Medical donations continue to be a critical line of supply for local health centers and systems. When donations of excess/ad-hoc medicines are well-placed and supplement the local supply, they can fill critical gaps in a market and create an appetite for demand and local production. Low income countries continue to be extraordinarily dependent on aid. About 50% of medicines are being purchased by aid agencies, and when countries transition from low to middle income, the increase in government spending usually does not compensate for the loss in aid.
There is untapped potential for increased creativity, commitment and collaboration within companies and between companies, NGOs and governments in order to reach sustainable health solutions.
It is important to consider the systems into which donations are being placed.
Michael Nyenhuis, Americares:
Using a Health Center in Malawi as an example, Nyenhuis noted that sustainability and dependency can coexist with medical donations. He likened the situation to a medicine cabinet in the Health Center. The top shelf of the medicine cabinet is fully stocked with HIV and malaria drugs by globally funded programs. This shelf exemplifies dependency – reliance on an external supply of medicine, and sustainability – as long as these programs continue, they will have a sustained and consistent supply of drugs which would not otherwise be available. The second shelf of the medicine cabinet, where antibiotics and generics were stored, was almost empty. This shelf also exemplifies dependency – they rely entirely on an inconsistent supply of drugs from the Central Medical Store, and sustainability – they source their medicines from local suppliers. Ad hoc/excess inventory donations can be essential supplements to “second shelf” drugs if they are placed well to fill gaps in the local supply. This metaphor was subsequently referenced frequently throughout the following panel and plenary sessions.
Jayasree Iyer, Access to Medicines Index:
Medical donations are a critical component to access to medicine. All players (NGOs, companies, governments) need to discuss what it means to have a longer term mission for a sustainable supply of medicines, integrating donations with local sources when applicable. There are challenges to building long term solutions. It is difficult for companies to commit to long term projects and ensure a long term supply of drugs, especially in protracted conflicts like war. There is internal tension within company departments over donations, ensuring prices and the supply of other medicines. Finally, donations are not part of companies’ overall strategy for access to medicine.
Amanda Glassman, Center for Global Development:
Low income countries are extraordinarily dependent on aid. About 50% of medicines are being purchased by aid agencies, and only a small amount being purchased by governments. In the shift from low income to middle income status, the increase in government spending on medicines does not compensate for the loss in aid. We need to pay attention to what governments are buying to ensure they are purchasing high impact, low cost drugs. With global procurement mechanisms, low income countries are not participating in voluntary mechanisms, such as buying into lower prices, and are continuing to buy high cost drugs on the market.
Jacob Gayle, Medtronic Foundation:
Donations create the risk of building a counter system that is not sustainable and takes away responsibility from local actors. Medical technology does not always have an equitable reach – many cannot afford the new technology that would improve their health. It is important to not only donate excess product, but consider developing product specifically for donation.
Bruce Wilkinson, Catholic Mission Medical Board:
The most marginalized have the hardest time getting access to quality medicine, particularly the “second shelf” drugs. We can use data to show that donations of medicines into the second shelf create the appetite for a larger market for producers. Huge tensions at the policy level and high needs at the clinic level limit access to the “second shelf’ medicines. He asked the group to consider how we use data and partnerships to bridge this gap?
Jane Nelson, Harvard:
There are three imperatives in corporate social responsibility:
- Strategic alignment of donation programs with other corporate activities and development priorities. There is a need for a stronger narrative between business strategy and donations. It is important to partner with NGOs around policy dialogue and advocacy. Using all the assets of a company, for example, innovative financing, co-investments, research and development, can enhance donation programs and support underserved populations.
- Due diligence and accountability. There should be mechanisms for due diligence and accountability in place for donation programs. There should be defined corporate, NGO and government responsibilities and grievance mechanisms in place to ensure accountability.
- Increasing systemic impact. There is untapped opportunity at the country level to develop some sort of health systems coalition between pharmaceutical companies, technology companies, NGOs, public institutions, financial companies and even agribusiness companies. Agriculture and environmental sectors have found success with these types of coalitions.
Topics for Continued Discussion
Trends in access to medicine, according to Iyer, include increased commitment to tropical diseases, continued commitment to humanitarian emergencies, multiple companies sharing the burden of ensuring medicine and supplies through donations, and chronic care, including during emergency settings. There is a fragile supply chain for antibiotics as players are leaving the market – it is a struggle to ask for antibiotic donations when companies themselves are struggling.
Jacob Gayle points out that partnerships between the private and public sector, and integrating medical donations into a long-term sustainable plan for increasing access to health care, are the keys to moving forward.
Are there further ways PQMD can explore engaging its private sector partners to provide technical assistance to local manufacturers to build up local health systems in addition to medical donations?
Work must be done to ensure donation programs do not build a counter system that is not sustainable and takes responsibility from local actors. Donation programs need mechanisms for due diligence and accountability, and there needs to be defined corporate, NGO and government responsibilities for donations and grievance mechanisms in place to ensure accountability.
Are there hybrid models that integrate donations and cash to bridge the gap between humanitarian support and sustainability? As one example, a company trained community health educators to spread awareness of health issues and create demand in the market for medicines. They complemented this with a donation program to provide drugs during the transition, and as a result they hope to pull people out of poverty and strengthen the local health system in the long run.
The Executive Forum discussed in depth the role of donations in creating sustainable health systems. And despite access to medicines deficits, critical drugs, medical devices, equipment, and supplies provide critical assistance to underserved or resource-limited settings that often lack the financial means or infrastructure to obtain them. In actuality, medical donations still fill a critical supply need for local health centers. An intentional donation program can fill gaps in the market and thus create market conditions for local, sustainable production. However, donation programs must ensure they do not create a counter system detrimental to local actors. Accountability and due diligence are important to donation program success, and all actors in a donation program must have clearly defined responsibilities. Reviews of current programs in peer sectors like nutrition and energy can inspire new approaches to donation programs. A theme introduced during the Executive Forum that would be repeated throughout the Global Health Policy Forum was the need for innovative partnerships between the private and public sector.
Wednesday, April 11, 2018
PQMD Global Health Policy Forum
The Role of Donations in Advancing Greater Access to Healthcare
Welcoming Remarks, Elizabeth “EJ” Ashbourne, Executive Director, PQMD
Welcome everyone and thank you for choosing to participate in PQMD’s annual Global Health Policy Forum. I am EJ Ashbourne, PQMD’s Executive Director. We have more than 100 global private sector, non-profit, humanitarian and government agency leaders from over 70 organizations participating in today’s program. We are grateful you here.
Before we start, I would like to say a few thank yous. We want to give special thanks to the support that made this event possible: Johnson & Johnson, BD, Sanofi and AbbVie. My team members – PQMD team, our board members and Advisory council who have contributed their time, talent and expertise to pulling this program together. And a special thanks to the speakers and moderators who are bringing this program to life.
For those of you here for the first time, PQMD is a global alliance committed to Advancing the role of donations worldwide, with 42 members representing leading international & U.S. based NGOs and global healthcare companies in the pharmaceuticals, medical products, and devices. We were founded in 1999 and our work is guided by 5 pillars: humanitarian assistance, health systems strengthening, disaster response, guidelines and standards, and knowledge and innovation. By virtue of our network, our members leverage their partnerships, expertise and resources to focus on building sustainability, community resilience and preparedness and response capacity and all while adhering to the highest standards of excellence in donation practices.
To bring you all up to speed, yesterday we were treated to a policy discussion around the role of donations and whether or not they create dependency and sustainability. Led by Mark Chataway, the panel featured senior representatives from: ATMI, Medtronic, CMMB, Harvard Kennedy School, Americares, and Center of Global Development. We had a fascinating and complex discussion that will be summarized in a post conference proceeding and posted on the website. That said and in short, the panelists discussed the deployment of donations as an incentive to create market mechanisms to support sustainable health systems. In addition, we also discussed, the risk of donations creating unintended dependency – derailing innovation and creating fragmented health outcomes.
So for today, the themes are humanitarian action, shared values and health system strengthening, all of which are vital to understand as they relate to donations. The panels and plenaries were designed to have participants and panelists explore the implicit tensions of trying to serve the needs of beneficiaries, communities, countries, implementing organizations and donors. And in thinking about the thread that ties this agenda together, I would encourage you to keep in mind the difficult choices around donations and doing good.
You will no doubt recognize that there are implicit tensions. There is an inherent tension in needing and wanting to balance the available resources to meet the shared mission of all our organizations. In all the sessions today, you will recognize the same balancing act. It is the successful balancing of this tension that I believe will result in innovating for sustainability. In addition and reinforced by the discussion we had yesterday, the challenges of access to healthcare demands a multi-sectoral response. It will never be just about the medicines, the health products and devices or the health services alone. Similarly, it is not about the medicines alone, and none of us can go it alone.
And that is why I am so excited to see new and old friends here today to share this exciting day. We have hopefully created a provocative program that will inspire you to join in the conversations, exchange views, and create lively debate and participate actively in generating ideas and solutions to build a broader understanding of the global imperatives before us. With that, I welcome our keynote speaker, Jeff Sturchio, President and CEO, Rabin Martin.
A question of design: the role of donations in advancing greater access to health for all
Remarks at the 2018 PQMD Global Health Policy Forum
Jeffrey L. Sturchio
President and CEO, Rabin Martin
Good morning. Yesterday’s Executive Forum gave us great food for thought on the role of donations in advancing greater access to healthcare, the overall theme of our meeting, as EJ has just reminded us. The discussion yesterday rightly focused on what needs to be done to avoid dependency and to foster sustainability in response to both natural disasters and humanitarian emergencies, neither of which is in short supply.
What I’d like to do in these remarks is sketch an overarching framework focusing on the idea of resilience, which will be helpful in framing our collective conversation today. I realize that there are centuries of relevant experience gathered in this room, so I’m just hoping to suggest some themes that will resonate with you and catalyze discussion.
Last week, I heard a fascinating presentation by Tim Brown, the head of IDEO Design, who outlined the design process that he and his colleagues use to generate creative solutions to complex problems. He cited Nobel Laureate Herbert Simon, whose definition of design was “whenever we are shaping the world to meet our needs,” which seems relevant to the task before PQMD members. To do this successfully, Brown said, one begins by talking to people and understanding their needs. Often we then jump immediately to thinking of solutions to meet those needs. But the critical first step, he argued, is to frame the central question in the right way, then build prototype solutions, test them out, and learn through this process until you find something that works.
So let me start by trying to frame the central question for us, based in part on yesterday’s excellent conversation. This is where I think the notion of resilience provides important perspective. Margaret Kruk of the Harvard School of Public Health and Michael Myers of the Rockefeller Foundation and their colleagues have defined five key characteristics of resilient health systems, based in part on the global response to the 2014 Ebola outbreak in West Africa.
They define health system resilience as “the capacity of health actors, institutions and populations to prepare for and effectively respond to crises; maintain core functions when a crisis hits; and, informed by lessons learned during the crisis, reorganize if conditions require it.” Resilient health systems deliver “improved performance in both bad times and good.” Resilient health systems are aware, diverse, self-regulating, integrated and adaptive.
I don’t have time to expand on each of these factors, but the last one seems particularly important for our purposes today. Adaptive systems can adjust and enhance performance in times of crisis as well as in normal times, and they offer the opportunity of respond to a wide range of conditions, including the health needs of refugees and internally displaced persons, as well as a path for instituting benefits for populations after crises have passed.
This perspective on resiliency seems particularly appropriate for our thinking about how the PQMD network can improve the impact you’re having in responding to critical needs, building stronger health systems and improving population health.
One final definition that I think is also helpful. In a 2016 commentary on health system strengthening, universal health coverage, health security and resilience in the Bulletin of the World Health Organization, Joseph Kutzin and Susan P Sparkes cite the definition from the 2008 Talinn Charter on health systems for health and wealth: a health system is “the ensemble of all public and private organizations, institutions, and resources mandated to improve, maintain or restore health.”
I was struck by their insistence that health systems involve both public and private organizations working together to achieve the goal of better health for all. And I think that perspective – one that encourages us to think of health systems as ecosystems of different actors bringing complementary skills and resources together to achieve more than the sum of the parts – is also critical to the work that PQMD does to help create sustainable health systems.
So let’s pose the central framing question as: How can we best design resilient and sustainable health systems that draw on all available resources and expertise to improve health for all? I’d offer three critical themes to achieve this goal:
Among the issues that we discussed in yesterday’s Executive Forum was the often fragmented nature of response to natural disasters or humanitarian emergencies and the disparities in access – to medicines, to information, to other health care resources – that often characterize the countries in which PQMD members work. To address those disparities and fragmentation, we need to take a systems approach to thinking about solutions to the problems that medical donations are intended to help solve. The empty “second shelf” doesn’t sit in a vacuum – it is the outcome of a connected chain of policies, practices and players that deliver health care to those who need, with greater or lesser efficiency. But I sometimes feel that we’re like the blind person confronted with an elephant – everyone touches a different part of the animal, but we don’t really understand the problem we’re facing in full.
Thinking more systematically about the interconnectedness of health systems will help us understand how to address disparities in access to achieve more equitable outcomes, how to use incentives to encourage more useful behaviors and better allocation of scarce resources, and how to encourage more effective cross-sectoral coordination and collaboration to improve the resilience of the system’s response to stress and crisis. It’s not coincidental that the Global Health Security Agenda has started with its Joint External Evaluations to analyze the strengths and weaknesses of each country’s public health system – the foundation for enhanced prevention, detection and response to pandemics and other emerging health crises.
Jane Nelson made this point eloquently yesterday, and I completely agree about the importance of building coalitions and partnerships to implement cross-sectoral solutions that bring new thinking, new resources and new solutions to bear in ways that accomplish more together than individual members of a coalition can do on their own.
One of the most important lessons we’ve learned from a generation of work by PQMD members is that the most effective donation programs are those that are delivered through broad coalitions of partners, each of whom has a specified role within the network, all focused on achieving a common objective. Think for a minute about the Mectizan Donation Program, or the International Trachoma Initiative, or the Global Alliance to Eliminate Lymphatic Filariasis, or the effort to eliminate guinea worm, or polio eradication, to take just a few salient examples. These efforts have succeeded at a scale and scope, and level of sustainability, that skeptics predicted would never be possible – and they did so because they involve broad-based, cross-sectoral coalitions of partners in a coordinated effort to address key public health challenges.
Finally, a word about affected communities. Yesterday, Jeff Jordan asked an important question: Are we leaving the people out? That was provocative and right on target. At the end of the day, the ambitious efforts that PQMD members undertake to improve resilience and create more sustainable systems to respond to natural disasters and humanitarian emergencies won’t succeed unless they’re grounded in the needs and everyday realities of the communities that we hope to serve.
I’m reminded here of a body of work among development economists like Esther Duflo (who wrote Poor Economics with her colleague Abhijit Bhanerjee) and the book Portfolios of the Poor, by Daryl Collins and colleagues, which start from the principle that poor people have agency and are just as creative and resourceful about finding resources and making choices to meet their needs for food, shelter and health care as those with greater access to resources. We should be humble about learning from their experiences, exploring their solutions to the challenges they face in everyday life, and designing interventions that can bring additional tools and resources to bear in solving the needs they express – but not assume that our view, often from half a world away, is more likely to lead to sustainable change.
Again, this is a lesson learned from a generation of best practice by PQMD members and your partners, so in a sense I’m just highlighting something you already know. But it’s such a fundamental principle of the collective work we do that I thought it important to emphasize here.
I hope that these perspectives have been helpful to think about the big questions you face in trying to optimize the impact of your work to advance greater access to healthcare through humanitarian action, shared values and health systems strengthening. The role of cross-sector networks like PQMD is absolutely central to making the world a better place and helping us move toward more resilient and sustainable health systems.
Let me close with a quotation from Jono Quick, until recently the CEO of Management Sciences for Health, and the author of a new book on The End of Epidemics, which I recommend highly. Jono offers a set of seven principles for improving the pandemic preparedness, which offer a vade mecum of hard-won wisdom. I won’t list all seven – which include the importance of innovation and collaborative transformation, as well as investing in resilience. But I love his first principle: “Lead as though the house is on fire!” That captures perfectly the mix of urgency and passion that I know characterizes how each of you approach the challenges you face in your work. It also captures the indispensable role that PQMD plays in helping the global community meet the challenge of designing resilience into more sustainable health systems that will improve health outcomes not just for the many in need today, but also for generations to come.
 For more on Tim Brown’s views on design, see his talk at TED Global 2009, “Designers – think big!” at https://www.ted.com/talks/tim_brown_urges_designers_to_think_big/transcript; Tim Brown and Jocelyn Wyatt, “Design thinking for social innovation,” Stanford Social Innovation Review, 8, no. 1 (Winter 2010): 29‐43; and Tim
Brown, Change by Design: How Design Thinking Transforms Organizations and Inspires Innovation (New York: Harper Business, 2009).
 Margaret E. Kruk, Michael Myers, S. Tornorlah Varpilah, Bernice T. Dahn, “What is a resilient health system? lessons from Ebola,” The Lancet, 385 (9 May 2015): 1910 – 1912; see also Margaret E. Kruk et al., “Building resilient health systems: a proposal for a resilience index,” BMJ (Clinical Research edition), 357 (23 May 2017): j2323: doi.org/10.1136/bmj.j2323
 Joseph Kutzin and Susan P. Sparkes, “Health systems strengthening, universal health coverage, health security and resilience,” Bulletin of the World Health Organization, 94 (February 2016): 2.
 E. Bell, J. W. Tappero, K. Ijaz et al. “Joint External Evaluation—development and scale-up of a global multisectoral health capacity evaluation process,” Emerging Infectious Diseases, 2017;23(13). doi:10.3201/eid2313.170949.
 Abhijit V. Banerjee and Esther Duflo, Poor Economics: A Radical Rethinking of the Way to Fight Global
Poverty (New York: Public Affairs, 2011); Daryl Collins, Jonathan Morduch, Stuart Rutherford, and Orlanda
Ruthven, Portfolios of the Poor: How the World’s Poor Live on $2 a Day (Princeton, NJ: Princeton University Press, 2009).
 Jonathan D. Quick, with Bronwyn Fryer, The End of Epidemics: The Looming Threat to Humanity and How to Stop It (New York: St. Martin’s Press, 2018).
Plenary: A look at 2017: Disasters as a Pandemic
Plenary Description: Disasters as a Pandemic: How we handled the worst year ever? The panel explored 2017’s rapid succession of on-going natural disasters and public and private organizations ability to respond and cope with the needs of multiple communities across the U.S., Caribbean and Latin America. The panel examined lessons learned from 2017 disaster response efforts by NGOs and corporate healthcare stakeholders. While NGO and corporate engagement in natural disaster response is considered an imperative, 2017 posed a unique challenge for both sectors. With the immediate succession of events, NGOs were challenged by logistics, available resources and staff capacity. Global healthcare companies were challenged to respond to both community needs with donations and cash, while addressing serious issues with their own staff and operations. Companies and NGOs were driven to innovate in the aid affected regions to protect staff, their businesses and the communities in which they work. This panel further examined the interface between disaster preparedness, response and longer term commitments to support reconstruction and renovation.
Moderator: Jeff Sturchio, Rabin Martin
o Claire Hitchcock, Director, Community Partnerships, GlaxoSmithKline
o Ky Luu, Chief Operating Officer, International Medical Corps
o Andrew MacCalla, Director, International Programs & Emergency Response, Direct Relief
o Jim Mitchum, President & CEO, Heart to Heart International
o Rabih Torbay, President, Project HOPE
o Melissa Walsh, Sr. Director, Global Philanthropy & Vice President, AbbVie Foundation
Natural disasters are not contagious, but can feel that way. In 2017, there were over 330 natural catastrophic events which generated economic losses of over $350 billion around the globe. These PQMD members, both in corporate and NGO sectors, responded to disasters in the United States and around the world. Members were involved in responses to Hurricanes Harvey, Irma, Maria, and Jose, the wildfires in California, the earthquake in Mexico, the mudslides in Columbia and Peru, the East Africa famine, flooding and mudslides in Sierra Leone, the refugee crises in Syria and Yemen, and the Rohingya refugee crisis in Myanmar. 2018 is expected to be just as challenging.
Panelists described their organization’s experience with addressing multiple events in 2017. Given the current frequency and scale of disasters, simply responding to emergencies, wherever they occur, is not sustainable. Resources of the humanitarian community continue to be stretched, with an estimated 128 million people expected to need humanitarian aid this year. It is essential that NGOs, companies and governments alike build disaster preparation capacity for local health systems and be ready to adjust to pursue sustainable health solutions.
To that end, maintaining focus on people and communities is repeatedly cited to achieve comprehensive and effective disaster response. Training of likely affected people in disaster response is effective because they are first to respond and have the motivation to repair their communities. Local communities have a sense of social identity, and have the social and community capital to pool their resources and address the issues most important to the community’s survival. Training local staff empowers them and creates a sense of ownership in disaster response efforts. Jim Mitchum, CEO of Heart to Heart, shared how their indigenous Haiti staff, trained after Hurricane Matthew, was invaluable in responding to Hurricane Maria in Puerto Rico because of their past experiences, knowledge, and networking savvy.
Establishing partnerships prior to a disaster is critical to building local health systems and improving sustainable solutions. The diverse capabilities and resources of NGOs and corporations are important for disaster response. Claire Hitchcock from GlaxoSmithKline shared that collaboration is a way forward, and the onus is on organizations in the health sector to bring in other sectors that also want a clear role in emergency response. GSK’s disaster response strategy also now includes long term programs focusing on training workers and strengthening health systems.
The resources of corporations, including financial, logistic, product and human, can support disaster response efforts through their established partners. Their business presence also supports community survival. Melissa Walsh of the AbbVie Foundation, one of the largest employers in Puerto Rico, stated that her company became a conduit for conversations about employee needs, protecting business, and supporting other members of the community after Hurricane Maria. Corporate employees were enthusiastic supporters and donors during the 2017 disasters. Capturing an inherent corporate culture of giving back builds momentum for corporate contributions to disaster response. In addition to gaining enthusiastic employee support, corporations are inspired and have the ability to provide funds and preposition products.
NGOs cited the availability of medicines and product from established corporate partners as invaluable to their 2017 disaster response efforts, along with long term NGO relationships with local staff, governments, and in-country organizations. Rabih Torbay, CEO of Project HOPE pointed out that when a disaster is over, the people on the ground will respond first. His statement highlighted that training of local health staff in disaster preparedness and response must continue, and international organizations and groups responding alongside, must remember they are guests in affected areas. Our job, as NGOs is to support and guide based on the affected community’s needs.
Building local capacity can be difficult because local organizations do not always have the necessary systems, including compliance and warehousing, in place, according to International Medical Corps’ Ky Luu. NGOs continue to be predominant actors in disaster response. Measuring and monitoring the resilience of communities must improve to determine preparedness, and then assist them with planning for future disasters and crisis.
Partnerships build the necessary bridge between short term and long term success in disaster response. NGOs, companies and governments must collaborate with increasing scale and sophistication in order to ensure comprehensive and effective responses to disasters. We know which communities are most disaster prone, and we can make sure that the relationships to respond are in place, so we are ready when there is an emergency. Prepositioning products with established partners has also proven to be critical for urgent response operations.
While there are many things that the global community is getting right, there is a sense that we have still not figured out how to address the most critical urgent needs. While we have reduced the amount of disaster-related deaths, we still need to improve communication, coordination and sharing information. Andrew MacCalla of Direct Relief shared a personal anecdote about evacuating his family during the Thomas Fire in California. It reminded the group, that while we focus on global disaster response, we also need to be prepared for disasters that can impact us locally and personally. Additionally, NGOs and corporations must be good stewards of money donated during a disaster. Responsible spending and reporting should be standard.
2017 provided an unprecedented year for disasters and disaster response. PQMD members learned valuable lessons through their disaster response efforts. Training local health care workers in disaster preparedness strengthens local health systems and builds a sustainable outcome. Partnerships, especially those formed long before disaster strikes, are critical and essential to short term and long term disaster response. The extensive resources and capabilities of corporations support the efforts of their NGO partners and provide a community presence in affected areas.
While partnerships are impactful in disaster response, improvements are still needed in sharing information during times of crisis. Further understanding the characteristics of resilient communities is also needed. Responders must remember to act as guests in affected areas and support efforts of local organizations. Ultimately, all disaster response efforts should strive to ensure the health and survival of vulnerable communities worldwide.
Panel 1.1 Refugees and Human Mobility: The challenges of providing aid to migrant populations
Panel description: With a multitude of global crises, international aid organizations are challenged by the increasing needs of populations on the move. This panel aimed to shed light on the role and challenges of donations and continued engagement in such efforts around the world. It illuminated ongoing refugee crises in light of mobile populations, changing geopolitical and socioeconomic dynamics and varying levels of donor engagement. The panel discussed response pathways to support ongoing efforts and the challenges of health service delivery, donations and material aid provision.
Moderator: Erica Tavares, Sr. Director, Institutional Advancement, International Medical Corps
- Martha Newsome, President & CEO, Medical Teams International
- Ambassador William Garvelink, Chief Compliance Officer, International Medical Corps
- Jodi Nelson, International Senior VP of Policy and Practice, International Rescue Committee
- Adele Paterson, CEO and Head of Corporate Partnerships, International Health Partners
- Eric Rasmussen, CEO, Infinitum Humanitarian Systems
Panelists and their organizations all have experience working worldwide with refugees and mobile persons, bringing comprehensive services to the most vulnerable. Services include working with partners to facilitate product donation and providing health services to the most vulnerable. Organizations work in conflict and fragile contexts as well as areas where refugees are fleeing.
More than 65 million people are displaced from their homes, more than any time since UNHCR started recording numbers. Nearly 2/3 of that number are displaced within their own country. It is estimated those displaced with be out of their homes for 10-20 years.
Fragility means governments are not capable of governing effectively. There is a tendency to see violence, conflict and displacement in these situations. IRC and other partners provide assistance and work in partnership with local communities, local governments and private sectors to ensure access to quality health care.
Great progress has been achieved in global health, supported by public and private investment. At the same time, gaps remains in vaccination in fragile contexts. Health programs are chronically underfunded – not all situations are “front page” and not receiving adequate funding and attention. Sustainability is undermined by inconsistent funding, reinforcing and widening existing gaps. . Organizations are outsiders in these difficult contexts, which makes working with partners already registered in the countries productive. Additionally, the fragility of government and health systems means governing effectively is severely compromised. What’s more, there is a tendency to see violence, conflict and displacement in these situations. IRC and other partners provide assistance and work in partnership with local communities, local governments and private sectors to ensure access to quality health care.
For example, the current refugee crisis in Bangladesh poses overcrowding, sanitation and shelter issues. The refugee population fled a traumatizing situation. Their health care prior to fleeing was poor and access to medicines and vaccination was difficult. Responding organizations like Medical Teams International are working with partners registered in-country to address disease outbreaks. They are establishing diarrhea treatment units and providing primary health care, seeing nearly 1,000 patients a week. There are supply and stock out challenges and difficulties keeping community health workers supplied.
Government constraints pose challenges on import of supplies. The drug supply chain is difficult in vulnerable situations. Another major factor continually impacting refugee responses is the weather. There is grave concern about the monsoon season’s impact on the Rohingya refugee crisis.
UNHCR and IOM provide assistance to refugees. For internally displaced people, no UN agency is mandated for response. Most governments do not provide assistance to Internationally Displaced Persons (IDPs). There is a need to provide assistance to host community to avoid political and ethical issues. Communication is key between governments and local officials to address the displaced.
Innovation is valuable to reaching those in vulnerable situations. Working with community health workers is a key conduit. Community health workers are resilient and may even travel with community as they resettle.
Training refugees to return to their countries as health workers is an interesting innovation. Developing innovative tools useful for illiterate community health workers is effective.
Concerns with mitigation and internal risks has led some organizations to increase screening, focus on procedures, inspect warehouses, check inventory, communicate with locals and increase visits from headquarter representatives.
Government support of reintegration is important, and there is increased refugee support from US private companies in response to the current administration.
Global health has improved through public and private partnerships. Unique challenges still remain with reaching those displaced from their homes. There are gaps in vaccination, underfunded health programs, disease concern and even weather issues when working with refugees and internally displaced persons. Working with partners is essential in providing access to care for those in fragile environments. Innovations in training and tools and promising reintegration programs are addressing the continuing challenges of providing aid to refugee and migrating populations.
Panel 1.2 Sacrificing the good for the perfect: What does the good look like when measuring the impact of donations?
Panel description: Increasingly, implementers and donors are trying to figure how to measure the impact and effectiveness of their investments or programs in order to steer resources to where they can do the most good. But which measures of good are the best indicators and in what context, for long term health development, disaster relief, and humanitarian action? This panel discussed in depth how research and data inform our decision making and where are the effective feedback loops to incorporate the data into programming that contributes to improved results.
Moderator: Jeff Richardson, Expert Global Health Advisor
- Michael Thatcher, President and CEO, Charity Navigator
- Andy Stergachis, Professor and Associate Dean, School of Pharmacy, University of Washington
- David Logan, Co-founding Director, Corporate Citizenship
- Jeffrey Jordan, President & CEO, Population Reference Bureau
Outputs, outcomes and impact are the foundations of metrics. Examples of outputs are numbers of trainees and number of donated products. Outcome examples are improvement in knowledge of trainees and improvements in access to medicine. Outcomes can be both long and short term. Impact can be life years lost or gained, quality of life economic evaluations.
There are few studies that measure the impact of medical donations.
It is important to acknowledge competition when speaking about metrics/impact and being transparent. Metrics are important to learning and improving programs, but we cannot let the numbers become tyrannical. When different organizations collaborate on a project, are we measuring individual impact correctly and honestly?
Some programs are short term, so we should not be trying to collect long-term impact data from those programs. Partnering with academia can be effective when measuring long term impact.
Bi-directionality of numbers between funders and implementers – are donors asking for the right numbers and are implementers providing numbers that are honest and accurate of real progress?
The sweet spot of metrics are those metrics beneficial to companies, beneficial to organization, and above all, beneficial to the beneficiaries. What can be measured, however, is not always worth measuring. Metrics should take into account the cost and time involved in gathering the metrics, what question is being answered by the metrics, and the validity of the metrics themselves. Blending NGO and company knowledge can help find the sweet spot.
How can we measure metrics to improve humanitarian response without negatively impacting beneficiaries or programs? Charity Navigator measures transparency, overhead and accountability within organizations, at no cost to the organizations themselves, to provide donors with metrics to guide their donations.
Metrics can go a step further and go back into the community, so that they can interact with the data and make improvements based on it.
Motivation is key to metrics in private sector. Companies engage organizations for three reasons: positive work of organizations, ideas of community and social investment, and commercial initiatives. It is important to remember that when companies engage with organizations, they are giving away the money of others. Metrics are a means of being responsible to shareholders. That said, companies are still behind in measuring metrics. According to a recent survey of corporate donation programs, only 56% of companies measured their inputs, 43% measured outcomes, and only 23% measured long term impact. Companies also need to realize that cost is involved in obtaining metrics.
There is a need to determine ways to incentivize busy and overworked health workers to take the time to participate in monitoring and evaluation. Organizations should be willing to fund the framework for the metrics upfront, not as an afterthought, in order to achieve the data and outcomes you are looking for.
Open data collection and data sharing will be key to improving the metrics themselves, and their impact on improving behavior of organizations and beneficiaries. There is a need to link records over time and across databases.
At a minimum, we must ensure that the collection of data is not detrimental to the beneficiaries. Bringing metrics back to impacted communities is an important next step so metrics can impact improvements and change.
The foundations of metrics are inputs, outputs, outcomes and impacts, and the best metrics are those that are beneficial to organizations, companies, and beneficiaries. Despite the billions of dollars of donated products, devices and services, surprisingly here have been very few studies on the impact of medical donations. In measuring and monitoring, it is important to remain transparent and accountable and not allow the numbers to dictate all efforts, keeping in mind that what can be measured is not always worth the time and investment to measure. Metrics should be defined and funded to collect the desired data upfront and not as an afterthought. Impact evaluations should be an integral part of every program and be designed to allow the community to interact with the data and make improvements through a well-designed feedback loop. Metrics provide valuable information for all those engaged – companies, organizations and beneficiaries – and should be shared with donors, recipients and the communities involved for better, sustainable outcomes.
Plenary: Philanthropy at the nexus of shared values and the common good
Description: Our understanding of global health and its relationship to corporate social responsibility has grown and evolved over time. In fact, every day we hear more and more about the role of philanthropy to drive social change, help build sustainable futures and be a force for good. Yet, there is an obvious tension that still exists between the corporate bottom line and the interest to do good. Similarly, the public sector has a responsibility to support the global public good, and one might posit that the only way to that is to engage partners, particularly the private sector. Panelists discussed their corporate approaches to philanthropy and how such efforts contribute to the common good and improved business interests, with the hope of increased access to health. Panelists specifically explored philanthropy as the nexus of shared value/profit, corporate responsibility, and its role in advancing the global public good.
Moderator: Doug Fountain, Expert Global Health Advisor
- Kevin Etter, Director, Humanitarian Relief and Resilience Program, UPS Foundation
- Kim Keller, Senior Manager, Global Community Investment, Johnson & Johnson
- Jenna Daugherty, Divisional Vice President, Global Social Responsibility and VP, Abbott Fund
- Carmen Villar, Vice President, Social Business Innovation, Merck
- Jennifer Farrington, Senior Director, Social Investing & Vice President, BD Foundation
The tension between doing good and shareholder responsibility can be bridged by initiatives focused on creating shared value. There are several examples of meeting a business challenge and at the same time solving a societal need:
-BD’s response to increase in needle stick injuries in early 1990s resulted in the signing of the Safety Needle Stick Act, improving public health and increasing profit for BD’s safety syringes.
-Abbott worked with an NGO to train farmers in India, specifically women, in animal husbandry to improve the quality of local milk that went into their nutritional milk supplement. Within a year, quality of milk product and income of farmers nearly doubled.
-UPS, with the Rwandan government, Zipline and GAVI partnered to improve blood delivery in Rwanda with drones. Zipline provided the drones and UPS and GAVI provided the funding. As a result, GAVI and UPS were able to conduct research on drone and their commercial and medical viability; the Rwandan government improves blood delivery; Zipline built their business; and the Rwandan people have better access to healthcare.
Merging the business imperative with the company’s philanthropic aspiration is challenging. Companies are working more closely with NGO partners to align values and shared aims to improve high quality care and programmatic impacts. Companies are being responsive to shareholder appeals to invest responsibly and show a social benefit, which is in turn changing the way companies do business. The shared value models meet the demands of both of these pressures. The new mainstays in corporate philanthropy are creative and innovative partnerships. Checkbook philanthropy, while less strategic, has a lot to offer if partners can think creatively about health solutions: distribution, scaling, staff training, data philanthropy, money for intellectual property and innovation and technical support.
Part of the decrease in traditional philanthropic support is because of technology. Through technology, individuals can give directly to the causes they support, so companies are no longer aggregators and distributors of funds. NGOs may need to rethink their corporate partnerships and frame their work in more business contexts.
NGOs can play an important role in bridging the gap between the public and private sector. As an example, during the Ebola crisis, CDC Foundation was fundamental in the CDC’s response, as CDC had a one year funding cycle and did not have funds initially to pay for needs as the crisis began. CDC Foundation was able to raise money from the private sector and from corporate partnerships to support the CDC’s initial response to the Ebola crisis.
Corporate volunteer programs offer many company sponsored skilled volunteers for community NGO work. Their contributions can spark innovation and local solutions to NGO challenges. . Such initiatives represent a unique opportunity for companies to build resilience in disaster prone countries, rooted in the idea of shared values. In these countries, companies can train and prepare communities for disasters, while building the market for their products in some of the fastest growing economies in the world. In locations where companies have a local presence, building resilience directly benefits both the community and the business.
There is untapped potential in shared value models that fundamentally allow business-NGO partnerships to co-create global social impact. While it is a relatively new philosophy, companies, civil society and governments are exploring ways to re-define global health roles, stakeholders and innovative health delivery models that acknowledge a shared aim and that value leveraging sectoral resources. There are opportunities to explore social impact investing. Companies can determine if they can invest internally to sustain how they earn and give money and/or product. Companies could also create incentives to give partners funding and/or product donations to meet their objectives.
Another topic for exploration is whether foundations and NGOs can contribute to funding private sector innovation. The Gates Foundation, PATH and Abbott developed a rapid malaria diagnostics test which may have been impossible to develop without the partnership.
Business, with their expertise in distribution channels, scaling, bringing products to market, etc., have a potential role to contribute these services towards achievement of the Sustainable Development Goals.
It was noted that partnerships between corporations and NGOs are continually innovating to leverage their respective intellectual capital, capacity, networks, experience and infrastructure. This is especially reflected in the cross-sectoral necessity to push for shared values partnership models. Additionally, panelists stated that the challenge to galvanize private sector technical expertise in the humanitarian context to help improve the quality and resilience of local health systems remains both an opportunity and expectation.
Panelists felt that even if practical application and operational interface may differ from country to country, operating from similar values and building shared tools will strengthen response capacity and impact at both institutional and individual level.
There is an increased need for innovation and creativity in the partnerships between corporations and NGOs – a necessity as corporations continue to push for shared value models. This is also a way to bring the technical expertise of the private sector into the humanitarian context to help improve the quality of local health systems and build resilience. In the end, NGOs must be willing to collaborate and explore new forms of partnerships and companies must be willing to form long-term partnerships in order to achieve their long term impact goals.
Panel 2.1 Disaster Agency Actors
Description: This panel explored global and multi-sectoral response efforts from varying relief agencies. The panel members shared experiences, resource deployment and partnership strategies necessary in their response to disasters both domestically and internationally. The panel also shared their organizational mechanisms to appropriately address emergency management phases of mitigation, preparedness, response and recovery.
Moderator: Eric Rasmussen, CEO, Infinitum Humanitarian Systems
- Nicolette Louissaint, Executive Director, Healthcare Ready
- Robert Glenn, Director, Private Sector Division, FEMA
- Laura Wolf, Branch Chief, Critical Infrastructure Protection, Office of Emergency Management, HHS/ASPR
- Brian Kelly, Head of Community Stabilization Unit, International Organization for Migration
Disaster agencies learned many lessons during 2017. Most prominent among them is the recognition to bridge the needs of the public sector and the capacities of the private sector. It is important to develop systems and tools that will be in place before a disaster occurs that set the groundwork for efficient and coordinated disaster response. There is a necessity to align on where the needs are, where the resources are and getting the resources to the community faster and in advance of events. It is also important to anticipate impacts, have productive, bidirectional conversations.
Post disaster, it is critical to restore infrastructure and enable business resumption. Super Storm Sandy provided lessons on these issues in particular. There is a complexity to the assistance FEMA can provide and ways for the private-INGO sector to engage with such governmental actors.
Infrastructure is important. When electrical power networks are down, it can hamper the provision of providing health services. There are new requirements in some states for generator capacity in nursing homes.
Spending funds quickly does not mean spending funds well. Also, shared values does not equal shared expertise. Coordination is important.
The complexity of providing FEMA assistance should be reduced to make the process more efficient and less stressful for those in need after a disaster. The private sector should have simple tool kits to use in disaster response.
Through the lessons of multiple disaster incidents in 2017, many needs in disaster response were identified:
-to build a culture of preparedness
-to learn how to align where needs and resources are
-to deliver resources to communities faster and in advance of events
-to coordinate with other agencies to avoid flooding in of resources
-to develop better planning practices so one-off situations do not distract from larger issues
-to recognize mutual professionalism among agencies providing relief
The high number of disasters, both domestically and internationally, in 2017 allowed disaster response agencies to identify many issues in coordinated, effective disaster response. More coordination is needed to bridge the gap that exists between the needs of the public sector and the vast capabilities of the private sector. Preparedness and planning can build systems in place before a disaster and can improve response efficiency. Infrastructure and business restoration are important to response success. Mutual respect and communication between agencies must continue to improve as disasters continue to be inevitable. Finally, reinforcing cross-sectoral mechanisms and networks prior to a disaster event can build pathways that later enhance coordinated NGO-business disaster response to crises.
Panel 2.2 Health System Strengthening: How partnerships support a public health ecosystem
Description: Against the backdrop of WHO’s health system strengthening framework developed in 2008 and the UN Sustainable Development Goals launched in 2015, building healthcare systems and community resilience aligned with national health ministries are vital. The panel shared approaches that have bolstered country operational capacities in terms of supply chain, healthcare workforce and increased access to medicines.
Moderator: Verónica Arroyave, Senior Director, Global Health Policy, PQMD
- Rick Santos, President and CEO, IMA World Health
- Michael Bzdak, Global Director, Global Community Impact, Johnson & Johnson
- Sonak Pastakia, Jefferson Science Fellow, USAID
- Joël Calmet, Sr. Director Communication, Sanofi-Pasteur
- Rachel Cohen, Regional Executive Director, North America Office, DNDi
Our current idea of partnerships has to change. Both corporations and NGOs can lead the change, and NGOs should feel empowered to think of partnerships in new ways. As companies evolve from a “profit-first” model, the goals of businesses, NGOs and governments are becoming more aligned. There are opportunities for newer, bigger and better partnerships, including social impact funds, problem solving competitions, research and development, and so on.
Long term commitments to partnerships will ensure their success. Long term partnerships allow programs to adapt and solve problems as they arise. A sense of mutuality is essential to ensuring the health and durability of long term partnerships.
Panelist Rachel Cohen provided an in-depth example of a successful partnership in health system strengthening:
Poor communities face three problems with drug quality and availability: 1) the medicines they need do not exist due to a lack of a commercial market for them 2) the medicines they need are prone to disease resistance 3) the medicine that is available is not affordable.
As a result, DNDI worked to create a new model to discover, develop, and deliver treatment specifically for the most marginalized. With African sleeping sickness, DNDI, in partnership with Sanofi-Pasteur, the DRC Ministry of Health, Gates, MSF, and others, developed a treatment that is affordable, oral, and treats both stages of the disease without the need for a spinal tap.
- The only way this was possible was because DNDI was able to utilize the labs, manufacturing facilities, and other capacities of its partners
- DNDI playing the role of a conductor— capitalizing and building upon the unique strengths of its partners, making sure that the needs come from the ground up, ensuring that the targets are clear, and thinking about intellectual property, access, and affordability up front, not as an after thought
- Alongside, they developed clinical research platforms that are regional and disease specific, to bring together clinicians, researchers, and regulators to talk about regulatory capacity and the needs of the communities regarding the disease—these forums allow for DNDI to constantly ensure their projects are addressing the most pressing needs/gaps of communities as they develop.
Panelist Sonak Pastakia provided another example from his time in Kenya running a project to screen patients for diabetes/hypertension. He found only 30% of patients went to get follow up care. In turn, they integrated micro finance and agricultural education into their screening program, forming micro financing groups to provide micro financing training alongside diabetes treatment. The result: they doubled the percentage of patients who came back, and all of those patients were able to pay for the services because they had access to micro finance support. 73% stayed in care for over a year, all paying for services and helping to build the local market for chronic medicines.
Partnerships must be holistic. There should be planning and investing in program design during the early stages of partnerships. It is important to partner not only with national governments, companies, and NGOs, but also with local organizations and communities themselves.
There is need to strengthen accountability mechanisms between partners. There is room for improvement in this regard. On a micro level, partners should hold each other accountable.
The goals of the private and public sector are becoming increasingly aligned, and the faster we embrace this alignment and capitalize on the unique strengths of both of these groups through innovative partnerships, the faster we will reach those goals. Admittedly, partnerships are complex, multi-sectoral and multi-faceted in character all while increasingly interconnected in the broader global health context. Understanding holistic global health action requires assessing sectors and their corresponding collaborative capacity for health delivery. As a part of this broader constellation of trends, NGO-corporation collaboration has grown markedly. Taken together with the widespread embrace of cross-sectoral partnerships, these trends have broadened the scope of INGO and business relationships, as well as encouraged new pathways for engagement. Such partnerships require significant investments of will, reputation, time, resources, and a cohesive framework and agenda. These collaborations fall apart without compelling shared aims, trust, reciprocity norms, learning, and self-regulating governance. In consequence, building mechanisms to evaluate adoption, access, risk management, implementation, and acceptance within the community along the continuum of a partnership, from the initial design phase all the way through to the final delivery, is essential. Innovation of the partnerships themselves can be as impactful as innovative products. Ultimately, the most successful partnerships will be grounded in: solution based and ground up approaches, patient-focused, innovation, cross-sectoral collaboration, trust, long term commitments, and a sense of mutuality, transparency, and shared aim.
Panel 3.1 Healthcare Models Targeting Sustainability
Description: For those who work in sustainable health, sustainability can be elusive. Most disease-specific programs seek to build or strengthen comprehensive health service delivery milestones by increasing access to health and medicines. This panel had a robust discussion around models of sustainability that provide both temporary and permanent pathways for improved health outcomes.
Moderator: Bill Lin, Expert Global Health Advisor
- Darren Back, Senior Director, Social Investments & Global Health Programs, Pfizer
- Ken Gustavsen, Executive Director, Corporate Responsibility, Merck
- Meredith Donegan, Area Vice President, International Programs, Operation Smile
- Anne Peterson, Senior Vice President, Global Programs, Americares
- Neeta Bhandari, Acting Deputy Director, Private Sector Engagement, U.S. Department of State
The deeper one’s partnership is with NGOs, governments, and local organizations, the more sustainable the program will be. Forming partnerships with national governments is critical to ensuring that health programs and outcomes are sustainable by ensuring that they are in line with national health objectives.
Within donation programs, strong partnerships with local organizations and implementing partners ensures that the supply of medical supplies meets the demand and vice versa.
Thinking about health holistically and integrating surveillance and treatment models together can help improve the sustainability of health programs and their outcomes. For example, if you work to treat a person for malnutrition, but they die a year later due to cholera, is this really a sustainable health solution?
Improving health systems can help address a range of health risks simultaneously, and thinking about how diseases/treatments are related can help to accelerate overall improvements in health and health care access.
Panelists provided several examples of programs that build sustainability. Pfizer, knowing that health care delivery in developing nations is driven partly by the private sector, developed its Global Health Innovation Grants program through its foundation. Americares is integrating health clinic strengthening through their donation programs, providing clinical infrastructure and efficiency support as well as creating referral pathways between their mobile clinics and trusted local providers. Operation Smile hires local staff and works closely with local medical staff to build local medical capacity while they work to eradicate cleft lip and cleft palate within the current population. Local staff are then able to keep up with new cleft lip and cleft palate cases as they arise.
The sustainability of health initiatives and their outcomes relies on ensuring that local and national health systems have the ability to maintain progress after the initial program ends. Building local health capacities and aligning goals with national health capacities are two ways to ensure sustainability. Within donation programs, forming strong and long-term partnerships with NGOs, local organizations, and health facilities ensures the supply of medicines does not exceed or fall short of the demand. The more mature the partnership, the more time both parties will have to correctly evaluate and predict what medical donations are most essential and effective.
Panel 3.2 Unintended Consequences of Donations: Dependency, Incentives, Resiliency
Description: This panel discussed how donations can become a tool for resilient and sustainable healthcare solutions. Panelists examined the program side of donation and their impact on creating dependency and/or leveraging the right incentives to build resilience in healthcare systems. Additionally, panelists shared anecdotal partnership examples of how donations are bridging health needs to support building strong, country-led health systems.
Moderator: Mark Chataway, Chairman, Hyderus & Bairds CMC
- Pat Garcia-Gonzalez, President and CEO, Max Foundation
- Doug Jackson, President and CEO, Project C.U.R.E.
- Dennis Cherian, Senior Director, Health, World Vision
- Edward Wilson, Director, Center for Health Logistics, John Snow Inc.
Panelists shared multiple anecdotes and examples of unintended consequences of their organization’s donation programs. Unintended consequences are primarily positive. Providing appropriate resources, medicines, and personal protection equipment to community health workers can lead to a positive unintended consequence of motivating those workers to address needs in their communities and improve the level of care they provide their community. Providing health care resources and facilities that are well planned and well-funded can provide long term positive outcomes. Focusing on providing cancer treatments in lower income countries provided the positive unintended consequence of the development of a large cancer survivor support system.
Hospitals still need to sustain themselves and not rely on donations and donors for the long term. Providing services and products as a donation can impact business models, both negatively and positively. To truly improve care, there is a need to recognize local economic drivers and providers of health services and health products and how donations might disrupt demand, regulatory capacity, sales and availability of locally available product and services.
It is actually possible for donation program to sustain patients and be sustainable. Donations can make business sense for a company with new, innovative and approved medicines to donate. It is possible to convert donations to a sustainable commercial endeavor.
Accountability is important for donation programs. Governments must be held accountable to make necessary structural changes to support the long term success and sustainability of a donation program. There should be greater accountability with health workers and community leaders to assess needs. Accountability measures support the strengthening of health systems. Building coalitions of public/private NGO partners is helpful to best understand how they can satisfy health needs.
Thorough needs assessment during planning of a donation program is import to ensure situations do not become dumping grounds nor impact local innovation. As Jackson put it, “you can’t Skype this stuff – you have to go there.” Needs assessments ensure infrastructure is in place to support donated products and equipment.
There is an opportunity to incorporate mobile technology at point of care data so the donation program supply chain can operate more effectively. The availability of good data through technology allows the supply chain to run with the best information possible.
More conversations are needed about pharmacies. They provide an opportunity to create demand for quality product. There is a need to improve channels so communities are not dependent on local drug sellers perhaps offering drugs at high cost, with substandard product.
Donation programs work when they become part of a system and a strategy is in place for their use and support.
With increasing pressure in recent decades to make sustainable development investments, protecting the environment, engaging stockholders and communities in increasing access to healthcare, the need to advance quality medical donations worldwide has become ever more critical. That said, NGOs stakeholders play increasingly important roles as implementing partners in the delivery of health services and material aid in both long-term initiatives and in providing humanitarian aid in disaster events. Additionally, they are vital conduits for intervention, expertise and opportunities to mobilize corporate sector resources in disaster response efforts across the globe. That said, there is wide-spread recognition that providing donations of medicines, equipment and supplies can trigger unintended consequences. While many of these consequences are positive, care must be taken to not disrupt local economies or innovations. There are many opportunities to incorporate technology into donation programs, especially in the supply chain. Properly addressed and planned donation programs can become commercially sustainable endeavors. Such considerations have encouraged major health product donors, NGOs and governments alike to embrace and support extensive, in-person needs assessments to better understand country’s needs and accountability standards to sustain and guide donation efforts. In the end, donation initiatives are successful when they are incorporated into existing and supported systems.
Key Takeaways from PQMD Global Health Policy Forum
- Donations of medicines, devices, equipment and supplies provide critical assistance to underserved settings.
- All players (NGOs, companies, governments) in a medical donation program need to discuss what it means to have a longer term mission for a sustainable supply of medicines, integrating donations with local sources when applicable. Sustainability and dependency can coexist with medical donations.
- Accountability and due diligence are important to donation program success. It is important to consider the systems into which donations are being placed.
- Work must be done to ensure donation programs do not build a counter system that is not sustainable and takes responsibility from local actors. There needs to be defined corporate, NGO and government responsibilities for donations and grievance mechanisms in place to ensure accountability.
- Low income countries are extraordinarily dependent on aid. About 50% of medicines are being purchased by aid agencies, and only a small amount being purchased by governments. We need to pay attention to what governments are buying to ensure they are purchasing high impact, low cost drugs.
- There are three imperatives in corporate social responsibility: 1. Strategic alignment of donation programs with other corporate activities and development priorities 2. Due diligence and accountability. 3. Increasing systemic impact.
- Trends in access to medicine include increased commitment to tropical diseases; continued commitment to humanitarian emergencies; multiple companies sharing the burden of ensuring adequate medicine and supplies through donations; and chronic care, including during emergency settings.
- PQMD should explore further ways to engage its private sector partners to provide technical assistance to local manufacturers to build up local health systems.
- There is untapped potential for increased creativity, commitment and collaboration within companies and between companies, NGOs and governments in order to reach sustainable health solutions.
Plenary: Disasters as Pandemic
- 2017 provided an unprecedented year for disasters and disaster response and PQMD members learned valuable lessons through their disaster response efforts.
- Training local healthcare workers in disaster preparedness strengthens local health systems and builds a sustainable outcome.
- Partnerships, are critical to short term and long term disaster response. Corporate resources and capabilities support the efforts of their NGO partners and provide a community presence in affected areas.
- Improvements are still needed in sharing information during times of crisis. All disaster response efforts should strive to ensure the health and survival of vulnerable communities worldwide.
Panel 1.1: Refugees & Human Mobility: The challenges of providing aid of migrant populations:
- Global health has improved through public and private partnerships, but unique challenges remain with reaching those displaced from their homes
- Working with partners is essential in providing access to care for those in fragile environments
- Innovations in training, tools and reintegration programs are having a positive impact on providing aid to refugee and migrating populations
Panel 1.2 Sacrificing the Good for the Perfect: What does “good” look like when measuring the impact of donations?
- Foundations of metrics are inputs, outputs, outcomes and impacts
- Best metrics are those that are beneficial to organizations, companies, and beneficiaries.
- Very few studies on the impact of medical donations.
- Impact evaluations should be part of every program
- Metrics provide valuable information for all those engaged – companies, organizations and beneficiaries – and should be shared with donors, recipients and the communities involved for better, sustainable outcomes.
Plenary: Philanthropy at the nexus of shared values and the common good
- Partnerships between corporations and NGOs are continually innovating to leverage their respective intellectual capital, capacity, networks, experience and infrastructure.
- Operating from similar values and building shared tools will strengthen response capacity and impact at both institutional and individual level.
- There is an increased need for innovation and creativity in the partnerships between corporations and NGOs.
Panel 2.1 Disaster Agency Actors
- The frequency of disasters, both domestically and internationally, in 2017 provided many lessons learned in coordinated, effective disaster response.
- More coordination is needed to bridge the gap that exists between the needs of the public sector and the vast capabilities of the private sector.
- Reinforcing networks prior to a disaster event can build pathways that enhance coordinated response.
Panel 2.2 Health System Strengthening: How partnerships support a public health ecosystem
- The goals of the private and public sector are becoming increasingly aligned.
- NGO-corporation collaboration has grown markedly. Such partnerships require significant investments of time, resources, and a cohesive framework and agenda.
- Successful partnerships are: solution based and ground up approaches, patient-focused, innovation, cross-sectoral collaboration, trust, long term commitments, and a sense of mutuality, transparency, and have a shared aim.
Panel 3.1 Healthcare Models Targeting Sustainability
- Sustainability of health initiatives and their outcomes rely on ensuring that local and national health systems have the ability to maintain progress after the initial program ends.
- Forming strong and long-term partnerships with NGOs, local organizations, and health facilities will ensure the supply of medicines does not exceed or fall short of the demand.
- Mature partnerships provide both parties with ample time to correctly evaluate and predict what medical donations are most essential and effective.
Panel 3.2 Unintended consequences of donations: Dependency, Incentives, Resiliency
- The need to advance quality medical donations worldwide has become ever more critical.
- NGO stakeholders play increasingly important roles as implementing partners in the delivery of health services and material aid in both long-term initiatives and in providing humanitarian aid in disaster events.
- Donations of medicines, equipment and supplies can trigger unintended consequences. While many of these consequences are positive, care must be taken to not disrupt local economies or innovations.
- Properly addressed and planned donation programs can become commercially sustainable endeavors.
- Donation initiatives are successful when they are incorporated into existing and supported systems.
This piece was compiled by PQMD Communications Assistant Sarah Viscardi under the direction of PQMD Executive Director EJ Ashbourne and PQMD Director of Communications and Disaster Response Jennifer Liles, with assistance from Verónica Arroyave, former Senior Director, Global Health Programs, PQMD. Additional support provided by PQMD Office Manager Gretchen Warwick and PQMD Community of Practice Director Jennifer Zolkos.
Extensive note taking and content support provided by Davis Nordeen, Resource Development Assistant for International Medical Corps. Note taking assistance during the Global Health Policy Forum provided by Ritika Bhattacharya and Dr. Farooq Salangi, both graduate students at George Washington University’s Milken Institute School of Public Health, and Lynn Jennings, former Senior Director of Institutional Giving and Partnerships at Project HOPE.