1. Putting Health Metrics Into Practice: Using the Disability-Adjusted Life Year (DALY) for Strategic Decision Making Kim Longfield Brian Smith Rob Gray Lek Ngamkitpaiboon Nadja Vielot 9 th World Congress on Health Economics Sydney, Australia July 8, 2013

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

3. What is a DALY? page 3 Disability-Adjusted Life Year A year of healthy life lost to death or illness

4. Methods page 4 PSI’s health impact calculated over 10-year period (2001-2011) Models developed to estimate impact of products and services Outputs from models are coefficients DALYs averted routinely reported by program area, geographic region, and country Case studies used most up-to-date country-level coefficients (2011) Coefficients multiplied by country-level sales, distribution, and service utilization figures

5. Doubled health impact by 2011, averted 22.8 million DALYs 79.7 million DALYs averted, 2007-2011 page 5 Results: PSI Impact by Health Area, Global Malaria 58% HIV/AIDS 24% Family Planning 15% Recognized gains in health impact through free distribution Expanded “relevance” to target new health conditions: acute respiratory infections (pneumonia), TB, nutrition Scaled up successful interventions Actions Taken:

6. Burden of Disease (BOD) 5.3 million DALYs averted, 2007-2011 Just 7% of PSI’s overall health impact Greater examination of burden of disease page 6 Results: PSI Impact by Region, Asia/EE Actions Taken: Included “relevance” metric in regional strategic plan Started identifying new funding sources Pilots in TB diagnosis and treatment, hypertension, tobacco control, cervical cancer screening and treatment Integrated high BOD interventions into existing programs Expanded facility-based interventions Largest increases in DALYs averted: Child Survival24% Malaria21%

7. BOD actually concentrated in pneumonia, unmet need for family planning (FP), nutritional deficiencies, TB Between 1999 and 2006, focus was primarily on HIV and malaria prevention Secured funding to launch projects in FP (IUD), maternal health (Miso), nutrition (Micronutrient Sprinkles), WASH, and TB Increased capacity of staff in new health conditions Developed capacity of private sector for new interventions Better targeted HIV and malaria interventions Continue to seek funding for pneumonia and other high BOD areas Results: PSI Impact, Laos page 7 Burden of Disease Actions Taken: Shifted strategic direction

8. Performance: PSI/Laos hovered at bottom of list of DALYs-averting countries Lower condom distribution reduced health impact for HIV/AIDS and FP page 8 Condom distribution dropped for general population; condom use among key populations rose DALYs averted in 2011 started to increase due to new FP and TB interventions Growth expected to continue with new interventions in FP, nutrition, WASH, and TB Results: PSI Impact, Laos

9. Limitations of Using DALYs Averted page 9 Change management required for adoption of metric and updates to estimates Building and maintaining tailored models is resource intensive Current models do not consider combined effects, competing risks, or trade-offs between different intervention options Capturing health impact for behavior change communication (BCC) requires population-based surveys 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 Greater diversification in interventions and country programs, but securing funding can be difficult More responsive to potential funding sources and alternative distribution strategies

11. DALYs Averted are just one of several factors for decision making Strategic advantage Logistical feasibility Policy environment Funding

12. Thank You Kim Longfield Director, Research & Metrics Brian Smith Vice President and Senior Regional Director, Asia and Eastern Europe Lek Ngamkitpaiboon Data Analyst Rob Gray Country Representative, Laos Nadja Vielot Senior Research Assistant klongfield@psi.org