I recently met with the director of development for Boston University’s new Center for Global Health and Development (CGHD), an interdisciplinary program that is based in the School of Pubic Health but also calls on faculty from the other schools. Largely grant-funded, the researchers of the center conduct studies aimed at generating information to guide the policymaking of its sponsors or, presumably, governments whose policymaking the sponsors are able to influence. This type of applied research is part of the trend in “evidence-based decision-making” in setting health policy. As is my interest, one of my questions was how the Center measured its effectiveness, first, in improving the lives of the studies’ participants, and second, in changing policy. The first is a question of study design, what parameters are being measured over what time frame, and are subject to acceptance through scientific peer review. Measuring the second is much more slippery because, typically, those agencies sponsoring studies to change policies or programs also need to find the organizational and political will to change, which is often lacking (for example, see my posting of April 22 on the vacuum in the US government global health policy). Although many granting agencies, government and private, now sing the praises of evidence-based decision-making and performance-based grant-making, there doesn’t seem to be concerted effort to find and fund those programs that demonstrate that they work.
There is a start however: the Center for Health Market Innovations (CHMI ). Launched in June 2010, CHMI is (yet) another Gates- and Rockefeller-funded program and is administered by a Washington, DC-based international development consulting firms called the Results for Development Institute (RDI) (are contract consultants still called Beltway Bandits?). The CHMI mission is to create a “global knowledge platform,” which at this point is essentially a database of organizations and programs (called Implementers) that provide some type of health-related aid (called Health Market Innovations) in low- and middle-income countries. One aim of the database is for the users (Implementers, Funders, Policymakers, and Researchers) to form “strategic linkages” which is nice but not necessarily likely or productive. For me, the most important part of CHMI, but apparently yet-to-be implemented, will the analysis of the programs/innovations, including “impact evaluations” and “development of performance metrics” (CHMI Approach).
The database currently has lots of information on more than 400 programs, sliced and diced by type, focus, geography, target population, stage, funders, etc. and about 170 waiting to be added. Certainly the listing is useful in finding out who is doing what, but not how well they are meeting their goals (this need for comparative evaluation is also pointed out by one of the CHMI bloggers, Dr. Bhattachayya [CHMI August 10 Posting]). Also the database will need to be comprehensive to be useful. I’m guessing there are thousands of potential Implementers. For example, as I noted in my posting of April 15, a 2007 report by the groups, HIV/AIDS Monitor and the Center for Global Development, stated there are more than 100 US PEPFAR-funded groups working in three African countries on AIDS alone, each with multiple subcontractors (Following the Funding for HIV/AIDS). On the international side, the Global Fund to Fight AIDS, Tuberculosis, and Malaria lists 780 grantees (Fund Portfolio). So, 700 entries may be less than 20% of the total. CHMI encourages self-reporting, but the potential for evaluation may dissuade some programs from participating.
Of the Implementers in the database, those of most interest to me are the 50-plus for-profits (CHMI Browse) whose performance can be easily analyzed, in part, by standard indices of business (e.g., number of customers, revenues, cash flow). In fact, one of the motivations for starting CHMI was the innovations of for-profits: “The idea for CHMI came about following a 2008 study funded by the Rockefeller Foundation on the role of the private sector in health. One of the products of the study was the identification of several interesting health models that were delivering care and financial protection to the poor in innovative ways.” (quoted in a World Healthcare Congress blog, WHC Blog). In addition to finding out which of these innovations work, analysis of the companies’ business models would be helpful in guiding entrepreneurs wanting to start companies in the health marketplace.
I also noticed that the organizers have developed a useful set of descriptors for the programs that are, essentially, the business or operational aspects of the health markets (Definitions). It is always useful to have a common set of terms when trying to solve a problem involving multiple parties and viewpoints. Also, CHMI seems to recognize that a major failure of international aid has been its “north-to-south” direction and that the application of in-country resources is needed. CHMI will use four “analytic partners,” three of which are based in India, South Africa, and Vietnam (the fourth is at UCSF), “for the ongoing identification, documentation and in-depth analysis of Health Market Innovations” and plans to add new partners based in Kenya, Tanzania, Uganda, Rwanda, Indonesia, the Philippines, Pakistan, and the Andean region (Partners).
So far, so good, but I encourage CHMI to get on the stick with the evaluation part of their program; there are many sources for metrics (e.g., the investing criteria used by the Acumen Fund [Investments] which is represented by a CHMI advisor, Omer Imtiazuddin). They may also consider beefing up the business experience of their panel of advisers, or even hiring someone with a business background to review the for-profits.