The Disease Control Priorities Project: Accomplishments and Future Challenges Dean T. Jamison University of Washington Presentation at Priorities 2010 Boston, MA 24 April 2010

The Disease Control Priorities Project (DCPP) Future Challenges 2 Outline

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DCPP by the Numbers 2 = Number of Books 4 = Number of years 13 = Number of Editors 78 = Number of Chapters 350 = Number of Authors 500 = Number of additional contributors 6 million = Number of dollars 4

Don’t buy this book! 5

Future Challenges 6

Cost-effectiveness Analysis and Health System Planning: Problems with Where we are Today Insufficient attention to the instruments of policy Insufficient attention to the platforms that carry interventions Insufficient attention to non-incremental interventions (focus is on ICER) 7

Cost-effectiveness Analysis and Health System Planning: Problems with Where we are Today Insufficient attention to urgency of intervention Failure to consider financial risk protection Limited consideration of health system capacity constraints 8

Instruments of Policy IEC Taxes and subsidies Regulation and legislation Direct finance (number and location of providers) R&D 9

Intervention Delivery Platforms Primary Care Hospitals Public Health Inter-sectoral Support 10

District Hospital 11 Medical and pediatric service TB treatment; AMI and stroke treatment, IMCI for severe cases, complicate malaria Surgical, obstetric and trauma service Delivery, trauma, other ‘essential” surgical services

Specialized Hospitals 12 Multi-specialty referral hospital As for district hospital but also a broad range of more complex cases Single specialty hospitals Psychiatric, TB, cancer, obstetric fistula repair

Support Platforms 13 Platform Examples 1. Disease, risk factor and demographic NHANES; DHS; Censuses; Sentinal surveillance surveillance systems 2. Education and training of health Medical, dental and nursing schools; professionals in-service training 3. Monitoring and evaluation of Effective coverage surveys Interventions, expenditures and(commencing); appropriate household consequences of ill-health surveys 4. R&D Basic scientific to operational research; product development and evaluation 5.Insurance systems Mandatory health insurance in almost all countries of OECD

Analyzing the burden of a health problem to identify control and research needs 14

Temporal Character of Interventions 15 Temporal Character Examples 1. Urgent 2. Moderately time sensitive 3. Not time sensitive 4. Ongoing C-Section for obstructed labor Malaria treatment AMI treatment Immunization TB Treatment Elective surgery (cataract replacement; obstetric fibula repair) Dietary and other behavioral change Medical management of AIDS, vascular risk, diabetes, psychiatric disorders

The Focus of CEA 16 Note: The shaded box represents the domain of traditional cost-effectiveness analysis.

The Focus of CEA, II 17 Note: The shaded box represents the domain of traditional cost-effectiveness analysis. Locus of Intervention Consequence of intervention Health Non-Health Outside Health System Inside Health System Water supply Food transfers Sanitation Basic education Carbon tax ‘Nuisance’ health problems (eg. seasonal flu) Cosmetic procedures Enhanced functioning (mental, physical, sexual) Contraception General GBA