1. Use of a health impact performance metric to inform decision-making at a large global health organization Amy Ratcliffe Graham Smith Lek Ngamkitpaiboon Hongmei Yang Presented by Katia Peterson American Evaluation Association October 19, 2013

2. Background  66 developing countries  More than 60 products and services

3. PSI uses modeled projections of health impact to target and track progress page 3 Projected Impact ETC… IUDs inserted Condoms sold We measure outputs, like the number of condoms sold or IUDs inserted We project impact based on those outputs

4. What is a DALY? page 4 Disability-Adjusted Life Year A year of healthy life lost to death or illness

5. Coefficients multiplied by country-level sales, distribution, and service utilization figures Models developed to project impact of products and services Methods page 5 PSI’s health impact calculated over 10-year period (2002-2011) Outputs from models are coefficients DALYs averted routinely reported by program area, geographic region, and country Net cost per DALY is calculated based on all DALYs averted and all PSI costs minus revenue

6. Doubled health impact by 2011, averted 22.8 million DALYs 79.7 million DALYs averted, 2007-2011 page 6 Results: PSI Impact by Health Area, Global Malaria 58% HIV/AIDS 24% Family Planning 15%

7. page 7 Results: PSI Impact by Regions

8. Calculating Cost Effectiveness page 8 NET COST PER DALY AVERTED = Gross Costs – Program Income DALYs Averted Global net cost per DALY: $16.36 Southern Africa: $13.65 LAC: $125.25 West and Central Africa: $8.37 East Africa: $17.70 Asia and Eastern Europe: $36.89 2012

9. Limitations of Using DALYs Averted page 9 Building and maintaining tailored models is resource intensive Current models do not consider combined effects, competing risks, or trade-offs between different intervention options Data for model development sometimes limited

10. Conclusions page 10 PSI’s adoption of DALYs Averted shifted the organizational focus from product sales to BOD and helped the organization double its health impact More targeted strategy – decisions now based on scale and relevance Using the DALY averted combined with cost analysis allows us to identify opportunities for efficiency Projecting health impact from outputs provides a stable metric to track over time

11. Questions? 1 1 2 0 1 9 T H S T R E E T, N W | S U I T E 6 0 0 W A S H I N G T O N, D C 2 0 0 3 6 P S I. O R G | T W I T T E R : @ P S I H E A LT H Y L I V E S | B L O G : P S I H E A LT H Y L I V E S. C O M PSI metrics@psi.org