TRIANGLE GLOBAL HEALTH CONSORTIUM DECEMBER 2, 2009 FUTURES GROUP LLC Farley R. Cleghorn MD, MPH Chief Technical Officer & SVP

2 FUTURES GROUP ORGANIZATION Futures Group International, LLC Chris LeGrand Chief Executive Officer Futures Group International, LLC Chris LeGrand Chief Executive Officer Business Development Ed Abel Business Development Ed Abel Center for Policy & Advocacy Sarah Clark, PhD Vice President Center for Policy & Advocacy Sarah Clark, PhD Vice President Center for Health Systems & Solutions Farley Cleghorn, MD, MPH Acting Center for Health Systems & Solutions Farley Cleghorn, MD, MPH Acting Finance & Administration Tim Schur Finance & Administration Tim Schur Technical Operations Farley Cleghorn, MD, MPH Senior Vice President & Chief Technical Officer Technical Operations Farley Cleghorn, MD, MPH Senior Vice President & Chief Technical Officer Human Resources Nicole Kamaleson Human Resources Nicole Kamaleson Operations Jamie Hogg Operations Jamie Hogg

3 FUTURES GROUP INTERNATIONAL, LLC GLOBAL PRESENCE Currently active in more than 30 countries Worked in over 100 countries since 1971

4 FUTURES GROUP INTERNATIONAL, LLC WHAT ARE WE TRYING TO ACHIEVE? WHAT ARE OUR OVERALL GOALS AT FUTURES? TO: Improve access by the poor/Improve equity in health Develop & implement sustainable approaches Enhance local ownership Deliver Integrated or diagonal solutions Be evidence based Be rights based Adopt a Health Systems approach

5 Agile and nimble technical assistance delivery organization Boutique multi-disciplinary group Responsive Not afraid of large amounts of data Leads with technical offerings Commitment to local staff Commitment to sustainability FUTURES GROUP INTERNATIONAL, LLC Population Studies & Family Planning Sexual & Reproductive Health Maternal and Child Health Gender Infectious Diseases –HIV and AIDS –Malaria –Tuberculosis –Avian Influenza –Other What do others say about us? What distinguishes us?

6 Policy & Advocacy  Policy Development and Implementation  Policy Analysis and Barriers  Legal and Regulatory  Advocacy and Coalition Building  Community Mobilization  Workplace Policy Development  Stigma and Discrimination  Gender Equity Promotion Research and Strategic Information  Demographic Research  Qualitative Research  Quantitative Research  Operations Research  Surveys  Data Demand and Information Use (DDIU)  Program Monitoring  Program Evaluation  Surveillance Health Markets & Private Sector Engagement  Public-Private Partnerships  Innovative Financing  Contraceptive Security / Commodities  Health Promotion and Behavior Change Communication  Market Analysis, Segmentation, and Growth  Product Marketing and Distribution  Supply Chain Management Solutions What are our technical services? FUTURES GROUP INTERNATIONAL, LLC

7 Modeling and Economic Analysis  Model Development  Model Application: Population and Reproductive Health  Model Application: HIV/AIDS  Economic Analysis  Health Financing  Costing  Resource Mobilization  Resource Allocation Patient Monitoring and Management/HMIS  HIV Care and Treatment  HMIS Development and Implementation Program Management  Project Management  Grants Management  Technical Program Design and Implementation  Management of Demand-Led Technical Support Solutions What are our technical services? FUTURES GROUP INTERNATIONAL, LLC

8 Strategic Consulting  Donor Coordination and Harmonization  Management Consulting  Strategic Planning  Program and Systems Design  Technical Support/Assistance Solutions What are our technical services? FUTURES GROUP INTERNATIONAL, LLC

9 This is how the name Futures was first derived!..\..\Modeling Working Group\Annex - Model Inventory.xls..\..\Modeling Working Group\Annex - Model Inventory.xls –Started with fertility and contraceptive prevalence Futures models are part of the basis for UNAIDS HIV epidemic projection by region and country The Spectrum Suite: –AIDS Impact Model – what are the costs associated with the HIV epidemic in a country? Current PEPFAR need to cost ART and set targets for treatmentCurrent PEPFAR need to cost ART and set targets for treatment –Resource Needs Model and ALLOCATE – what is needed for response and where to put available resources? –RAPID – What are the consequences of high fertility and rapid population growth on development sectors? GOALS – helping countries to prioritize for greatest impact –Effects of shifting resources from Rx to prevention –Links policymaking and program planning with data analysis Classic Offering-Projection Modeling for Health Programs

10 From social marketing to total marketing… Futures was a major implementer of USAID-funded social marketing programs (SOMARC) Offering has evolved to cover a broad set of private public partnership based health marketing: –PPP Driving best practice through engagement Service definition –Market analysis & segmentation Willingness to pay Means testing & income analysis –Costing (cost utility, cost benefit & cost effectiveness) –Innovative financing schemes Voucher systems Subsidies –Demand generation and behavior change communication CLASSIC OFFERING REDEFINED

11 Patient Monitoring & Management –AIDS Relief HMIS Sexual & Reproductive Health –Men who have sex with men (MSM) Technical Support Units (TSU) –India TAST (DFID) –China HIV/AIDS (GF/DFID) –Kenya HAPAC (DFID) Pro-poor Approaches Dynamic, and growing… SOME RECENT REFINEMENTS OF OFFERINGS

12 NEW OFFERING MARKET READY NEED IN HEALTH DEV OPPORTUNITYSIZEDURABILITY MSM:YESGREATCURRENTSMALLSHORT Health Informatics: YESGREATCURRENTMODERATEEXTENDED Integrated Health Delivery Framework: Health System Strengthening YESGREATIMMINENTLARGEEXTENDED Total Marketing Approaches: YESGREATIMMINENTLARGEEXTENDED PRO-POOR APPROACHES YESGREATCURRENTLARGEEXTENDED “NEW” TECHNICAL OFFERINGS

13 Sound products based on experience in the field Best Practices Positive outcomes AIDS RELIEF DATA SYSTEMS

14 Comprehensive system based on longitudinal medical records Higher capacity site with greater data demand High volume site with multiple data entrants Some computer support preferred Scaleable, single desktop to large hospital network Basic system based on WHO registers Lower capacity site with lesser data demand High/low volume but only one data entrant No additional computer support required Currently multi-language IQ STRATEGY

15 Technical Centers Center for Policy and Advocacy (CPA) Center for Health Systems & Solutions (CHSS) Centers Provide: Technical Leadership Project Management Staff & Performance Management Professional Development TECHNICAL CENTERS

16 HEALTH SYSTEMS SYSTEM THINKING A Futures Group Perspective?

17 …10 STEPS TO SYSTEM THINKING FOR HEALTH 1.Convene Stakeholders 2.Collectively Brainstorm 3.Conceptualize Effects 4.Adapt and Redesign Intervention Design Evaluation Design 5.Determine Indicators 6.Choose Methods 7.Select Design 8.Develop Plan 9.Set Budget 10.Source Funding System Thinking

18 COMPLEX HEALTH SYSTEMS Health Systems are Complex! Poorly accountable, very costly, slow results Function based on the demand and specifics of the country Integrate interventions that can be scaled up Offer sustainable results Make a higher impact because of synergies

19 …UNLESS YOU STRENGTHEN…

20 FROM HS TOWARDS HSS The challenge of Health System Strengthening from a policy making perspective consists on how to close the gap: Between the building blocks and real interventions Between theories and practical results Between past and the future Action oriented operational framework: What can be done in order to strengthen health systems functions? System-wide actions that reconcile horizontal with vertical disease - specific approaches and offer sustainable diagonal solutions in achieving national goals

21 FUTURES APPROACH TO HSS VERTICAL APPROACH HORIZONTAL APPROACH "strategy in which explicit intervention priorities are used to drive the required improvements into the health system, dealing with more generic HS functional issues…” DIAGONAL APPROACH DISEASE SPECIFIC HEALTH SYSTEM SPECIFIC

22 DISENTAGLING HSS - POSITIONING Single disease intervention Related diseases/ intervention cluster Cross Cutting Elements More (Inputs) Better (most govt) New (mainly non govt) From additional Inputs to Reform the health system From single disease to cross cutting Health System elements Source: Adapted from Berman, Health Nutrition and Population, World Bank, June 2009

23 INTEGRATED HEALTH DELIVERY FRAMEWORK Health Systems Strengthening 4-point framework · Stewardship o Policy o Legal Framework o Policy Marketing · Resource Use o Health Financing – develop the work we’ve already done in India on ITAP (contracting out public health facilities), Kenya HAPAC (Medium Term Expenditure), HPI (costing) etc into a full health financing offering. o HIS – IQCare& IQ Strategy- develop into a broader component of HIS o Human Resources o Health Management · Health Services o Family Medicine o Medical Education o Pharma o Quality Assurance and Improvement o EBM o HIV/AIDS o TB o Safe Motherhood o Rep health · Population and Community Involvement o Community action for health (including BCC, etc) o Mobilizing and strengthening civil society Health System Strengthening:

24 HHS RECENT TRENDS - USAID Strategic approach based on evidence and experience to target the most critical health systems function needs and elements The challenges: Identify and strengthen critical parts of health systems in the local context Address the major local drivers of human health Collaborating with partner country, private sector, and other donors to reach a minimum standard across each core function Help countries reach functionality in all six core areas USAID assistance strengthens health systems across: Disease-specific programs Multiple health areas The entire system

25 谢谢 bedankt tesekkürle Ευχαριστώ takk Dziękuję Shukriyâ kiitos aitäh tack tack ありがとう Danke Obrigada Grazie Muchas gracias 너를 감사하십시요 mange tak díky díky tack så mycket Thank you köszi hvala Ďakujem شكرًا תודה Спасибо Mulţumesc Thank yu salamat salamat faleminderit děkuji vam nandri Дякую köszönöm köszönöm anugurihiitosumi dhanya-waad dhanya-waad go raibh maith agat Merci Merci ačiû Terima Kasih Many THANKS for Your Attention Asantesana Siyabonga

26 Contributors Technical staff throughout the organization –150 US based –350 international –Jorida Zeneli MSc, Bocconi University, Milan