Healthcare Globalization:

1
Healthcare Globalization USAID
E. Anne Peterson, MD, MPH Assistant
Administrator, Bureau for Global Health February
27, 2002
2
Global Trends

• Sharing of Disease
• Sharing of Risk - International Health is now
  everyones business
• Increased resources for global diseases
• Sharing of expertise
• Sharing of People Resource
• Sharing of Best Practices policies
• Global ways of doing business

3
Global HealthA Priority for USAID
Development and Child Health Assistance
(CSH/DA) FY 2001 Total 2.3 Billion
Foreign Assistance
FY 2001 Total 7.8 Billion
4
Population, Health and NutritionFY 2001 - All
Accounts
HIV/AIDS
330
Infectious
Diseases
23
138
10
Vulnerable
Children
2
30
Child Survival and Maternal Health 396
UNICEF
28
8
110
29
Population
424
1.4 Billion in 67 countries and regional projects
5
USAID Strengths

• Practical field experience
• Implementation of interventions
• Research basic, operational, health systems,
  evaluation
• Global Leadership Policy guidance
• Transfer of Success stories
• Partnerships to leverage
• Partnerships to implement

6
GH Critical Functions

• Guide Field Implementation
• Through local partners, technical policy
  assistance
• Global Leadership
• Internationally (Global Fund, GAVI..)
• Within country MOH, NGOs
• Research and Evaluation
• Basic science - vaccines, microbicides
• Operations research - what will really work?
• Evaluation - national program level

7
Information leads to policy transferFamily
Planning Reduces the incidence of Abortion
Abortions/1000 women in Hungary
contraceptive use
8
Saving Childrens Lives Through Family Planning
in Selected Countries Reductions with Birth
Spacing
200
Time Between Births
lt24 Months
2-3 Years
4 Years
165
141
136
110
93
100
Infant Mortality Rates
87
81
80
77
70
58
56
42
40
39
0
Tanzania
Brazil
Bangladesh
India
Zambia
1999
1996
1996-7
1998-9
1996
Source Demographic and Health Surveys 1990-2000
(Macro International Calverton, MD)
9
USAID Practical Field Experience

• Immunizations about 75 full coverage
• measles deaths reduced by over 50
• Polio cases reduced by over 98
• ORT Use 75 Globally
• Reduced Diarrheal Disease Mortality by 50
• Expanded Vitamin A Delivery in 60
  Countries-Potential 25 increase in CS
• Decrease in Malnutrition in Asia and LAC
• Estimated gt25 Million lives saved since 1985

10
Infant Mortality Rate(Least Developed Countries,
1950-2005)
Infant Mortality Rate (per 1000 births)
Source World Population Prospects, The 1998
Revision, Vol. I Comprehensive Tables United
Nations, 2000. Medium variant projections
11
Operations Research neededMaternal Health

• Use of skilled attendants at birth increased by
  18 between 1989-99
• USAID research showed 40 lower maternal
  mortality due to low-dose vitamin A
  supplementation
• Regional training centers for treating obstetric
  emergencies established in Africa, Asia, LAC
• Standards for managing maternal and newborn
  complications developed and distributed world wide

12
Success Transfer Behavior change worksSexual
Debut delayed, Uganda
13
HIV Prevalence Among 13 to 19-year-olds in
Masaka, Uganda 1989 to 1997
5
girls
4
boys
3
HIV prevalence ()
2
1
0
1989/90
1990/91
1991/92
1992/93
1993/94
1994/95
1995/96
1996/97
Source Kamali et al. AIDS 2000, 14 427-434
14
Global Ways of Doing BusinessUSAID Partners

• Development Partners
• Major Bilateral Donors
• United Kingdom (DFID)
• Canada (CIDA)
• Japan, Common Agenda
• Multilateral Donors
• Host Country Govts
• Commercial Private Sector
• Nongovernmental and Private Voluntary Orgs
• Foundations
• Universities
• Individuals

• USAID Partners
• Country Missions
• Regional Missions
• Regional Bureaus
• Host Country Institutions

15
Major Partnerships Initiatives
U.S. Government Led
Multilateral
Global Trust Fund UNGASS for Children
UNGASS for HIV/AIDS Stop TB Roll Back
Malaria MIM (Multilateral Initiative on
Malaria) Border Action Against Malaria
(Regional Mekong River delta) IPAA (UNAIDS
International Partnership Against AIDS in
Africa) ICPD5 (International Conf. on
Population Development)
GAVI (Global Alliance for Vaccines and
Immunization) Micronutrient Coalition Malaria
Vaccine Development Program HIV/AIDS Expanded
Response Interagency Working Group
for International AIDS Polio Eradication
Common Agenda
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Principles for Globalization

• First, do no harm!
• Transfer of American expertise, protocols
  personnel is not automatically beneficial
• Limited resources 20 per capita annually on
  health
• ethical dimension to setting priorities
• Every counts. High impact criteria
• Adaptation Op research needed.
• Choice of technologies
• Information technology -
• Customer focus
• Do work in Partnership