PATH Finding

My post of last week on the announcement of the affiliation (or acquisition) of the non-profit global health disease drug developer, OneWorld Health, by the one of the world’s best-funded (about $1 billion from Gates Foundation since 2001), oldest (25 years), non-profit global health technology developer, Program for Appropriate Technology in Health (PATH), reminded me that I had written about PATH  about two years ago (“Where Does this PATH Lead?” 2/25/10).  I looked at PATH as an investor (which I am indirectly since PATH receives government grants and doesn’t pay taxes):  what’s the mission, is it being met, and will my investment yield the return I want.  From that perspective, I saw room for improvement:  a need to focus its mission, document how it is meeting its mission, clarify and publicize its performance measures, adopt a more centralized and less matrixed structure, and, since it passes through much of its revenue (grants and contracts), clarify how its grantees are selected and made accountable.  Unfortunately, I found few signs of improvement in the past almost two years.

For my admittedly superficial revisit I looked at PATH’s website, most recent annual report (2010 Annual Report), and its required report to the Internal Revenue Service (2010 Form 990).  PATH reported that it received $280 million in grant and contract revenue in 2010 making it well-funded compared to most global health technology development groups.  The five others I checked have less than one-fourth as much:

Organization Revenue ($ million) Data Source
Foundation for Innovative New Diagnostics 28 2010 Annual Report
Drugs for Neglected Diseases  Initiative 32 2010 Annual Report
Global Alliance for TB Drug Development 45 2009 Financials
Medicines for Malaria Venture 58 2010 Annual Report
International AIDS Vaccine Initiative 62 2010 Form 990

As I noted before, PATH does a lot of subcontracting ($67 million passed through to other organizations) and has a de-centralized structure (lots of programs, and departments) and generous compensation.  PATH’s 990 reported $76 million in salaries and benefits and that Christopher Elias, president and CEO, received $550K in compensation and the average of the compensation of fifteen managers was $267K (another eleven are listed).  PATH also seems to have a large stash of capital in that it has assets $318 million in “pledges and grants receivable” and owns $248 million in publicly traded securities, mostly corporate and government bonds, purchased with grant funds.  The latter seems unusual to me and with my limited accounting knowledge, I wasn’t sure how liquid are these assets or if they represented restricted (obligated) grant funds.

I was glad to see that PATH states it is assessing its progress in improving health (How PATH Measures Impact), and “to get a fuller picture of the performance of our organization as a whole over time, we are developing ‘cross-program indicators’- measurable steps toward interventions that improve health.”  But search the website as I may, I could find no information on the development of the indicators (what, who, when) or to what programs they have been or will be applied.  The Annual Report wasn’t much help in that it takes a very broad-brush approach to the organization’s many projects, so I tried to find a PATH publication that described or evaluated those “measurable steps,” specifically the manufacture, distribution, use, and outcome of use for any of PATH’s technologies (other than vaccines, see below) (Publication List).  I found none.  According to “PATH’s Framework for Product Introduction” document (Framework), PATH has had multiple collaborations with public, private, and commercial institutions that have resulted in the commercialization of 26 technologies, 19 of which are in use in more than 25 countries, but no details are given.  In “Technology Solutions by the Numbers” (Solutions), very brief descriptions are given for three diagnostic, two injection devices, and a vaccine monitor (which I posted on in “Technology Fix or Fixation?” 12/10/09) but no specifics are provided on who was manufacturing and distributing/selling these solutions and at what price, all very useful and relevant information for any organization or company trying to develop and introduce its own global health technology innovations.  “Together, PATH and its partners harness the efficiencies of the private sector, reaching poor and underserved populations with vital health interventions (Framework, page 3).”  If so, PATH should share the details so I can learn their approach.

To temper my rant though, I need point out that PATH’s vaccine development programs (the Vaccine Development Program, the Malaria Vaccine Initiative, and the Meningitis Vaccine Project) which account for about one-fourth of PATH’s staff and almost half of its budget, are making substantial progress in inventing needed vaccines and, in the meningitis program, have an approved vaccine in use (see my post on the Meningitis Vaccine Project, “Watch Out Big Pharma?” 12/16/10).  Under “Progress” on its Accountability page (Accountability), PATH has a link to an evaluation study of the vaccine programs done under a contract from the Gates Foundation (alert:  appearance of a conflict of interest).  I found it interesting that the study, done by the Boston Consulting Group (Vaccine Development Program Assessment), while generally praising the program’s “strong performance,” recommends that PATH increase biopharmaceutical industry representation in its advisory groups and, more to my point, integrate into its programs more “commercial considerations” like “such as modeling of cost effectiveness, impact, and projected cost of goods over the product lifecycle; anticipated acceptability among target users; and physical delivery considerations such as delivery channel capacity and cold chain requirements.”  Clearly these considerations are needed if the program’s vaccines are to be used and improve health.

More path finding PATH, please.

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