1 The countdown for the Millennium Development Goals: can improvement science help achieve the MDG targets? M. Rashad Massoud, MD, MPH, FACP Director, USAID Applying Science to Strengthen and Improve Systems Senior Vice President, Quality and Performance Institute University Research Co., LLC – Center for Human Services, USA Edward Kelley, PhD Director ai Service Delivery and Safety Department World Health Organization, Geneva, Switzerland S ESSION A1: C HANGE ON A G LOBAL S CALE International Forum on Quality & Safety in Healthcare Palais des Congrès, Paris, April 8 – 11

USAID Applying Science to Strengthen and Improve Systems Objectives After this session, participants will be able to discuss: The MDG goals and their importance to global health The status of achieving the MDGs globally The challenges in attaining the MDG targets How improvement science can contribute to achieving the MDG target The post-2015 global health agenda currently being developed 2

USAID Applying Science to Strengthen and Improve Systems Millennium Summit 2000

USAID Applying Science to Strengthen and Improve Systems The Millennium Development Goals 1.Eradicate extreme poverty and hunger 2.Achieve universal primary education 3.Promote gender equality and empower women 4.Reduce child mortality 5.Improve maternal health 6.Combat HIV/AIDS, malaria, and other diseases 7.Ensure environmental sustainability 8.Develop a global partnership for development

USAID Applying Science to Strengthen and Improve Systems Health MDGs 4, 5 and 6 Source: United Nations

USAID Applying Science to Strengthen and Improve Systems 6 Source: United Nations 2013 Health MDGs Scorecard GOALS AND TARGETS AfricaAsia Oceania Latin America & the Caribbean Caucasus & Central Asia Northern Sub- Saharan Eastern South- Eastern SouthernWestern

USAID Applying Science to Strengthen and Improve Systems What is the problem: WHO “The reality is straightforward. The power of existing interventions is not matched by the power of health systems to deliver them to those in greatest need, in a comprehensive way, and at an adequate scale.” — Margaret Chan Director General World Health Organization 7

8 “… Between the health care we have and the care we can have lies not only a gap, but a chasm…” “… The problems come from poor systems – not bad people…” The Issue of Quality in Health Care Institute of Medicine, USA

USAID Applying Science to Strengthen and Improve Systems What is the problem: World Bank “The enormous investments that have been made in global health should have led to what we might have called a science of implementation and execution… …We have just not focused on the enormous complexity of delivering health care in a way that keeps people healthy ” — Jim Kim President, World Bank 9

USAID Applying Science to Strengthen and Improve Systems USAID Health Care Improvement Project FY2014 Activities 10

USAID Applying Science to Strengthen and Improve Systems 11 USAID Applying Science to Strengthen and Improve Systems Project FY2014 Activities

USAID Applying Science to Strengthen and Improve Systems Contributions to Achieving the MDGs in FY14 12 MDGCountries where ASSIST and HCI activities contribute in FY14 Haiti, Kenya, Malawi, Mozambique, Nigeria, Tanzania, Uganda Afghanistan, Georgia, Kenya, Malawi, Mali, Mozambique, Nigeria, Tanzania, Uganda Afghanistan, Burundi, Cote d’Ivoire, Georgia, Haiti, India, Kenya, Madagascar, Malawi, Mali, Mozambique, Nicaragua, Nigeria, South Africa, Swaziland, Tanzania, Uganda Afghanistan, Botswana, Burundi, Cote d’Ivoire, Ethiopia, Georgia, India, Indonesia, Kenya, Madagascar, Mali, Nicaragua, South Africa, Tanzania, Uganda, Ukraine Botswana, Burundi, Cote d’Ivoire, Ethiopia, Haiti, India, Kenya, Lesotho, Malawi, Mozambique, Nicaragua, Nigeria, Pakistan, South Africa, Swaziland, Tanzania, Uganda

USAID Applying Science to Strengthen and Improve Systems

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USAID Applying Science to Strengthen and Improve Systems Average # monthly births: 1,024 AMTSL coverage and post-partum hemorrhage rates in 41 target facilities, Kayes & Diema Districts, Mali, Oct – Dec Mali: AMTSL & post-partum hemorrhage management 15

USAID Applying Science to Strengthen and Improve Systems 16 Uganda: Applying Chronic Care Model to improve coverage, retention, and clinical outcomes Examples of Changes  Used SM progress tool and tally sheets to record Pt SM progress  Introduced a VHT referral form to give to patients when sent to a facility  Each patient enrolled is introduced to a VHT in catchment area  SM groups formed

USAID Applying Science to Strengthen and Improve Systems Integrating Content and Organization of Care 17

Associates in Process Improvement 18

USAID Applying Science to Strengthen and Improve Systems Improvement Principles & Frameworks Fundamental Concept of Improvement: “Every system is perfectly designed to achieve exactly the results it achieves” Principles of Improvement: –Understanding work in terms of processes and systems –Developing solutions by teams of health care providers and patients –Focusing on patient needs –Testing and measuring effects of changes –Shared Learning 19

USAID Applying Science to Strengthen and Improve Systems Employee Engagement (…or lack thereof)

21 | UN High-Level Panel on Post 2015 Agenda Appointed by the UN Secretary General Consulted: – 5000 civil society organizations in120 countries in every region – 250 companies in 30 countries, with annual revenues exceeding $8 trillion – Thematic, regional, and country consultations all over the world – Survey results from over half a million individuals on priorities for the future The Panel has recommended five transformative shifts and 12 illustrative goals. If the 12 goals are all carried out, the five transformative shifts would be achieved UN Member States are currently in the process of developing the agenda Source: United Nations

22 | UN High Level Panel: Five Transformative Shifts 1.Leave No One Behind 2.Put Sustainable Development at the Core 3.Transform Economies for Jobs and Inclusive Growth 4.Build Peace and Effective, Open and Accountable Institutions for all. 5.Forge a New Global Partnership Source: United Nations

23 | Sustainable Development Goals (SDGs) Rio 20+ Held in Brazil June nd, 2012 Agreed that the two processes (MDG and sustainable development goals) should be closely linked An open working group(30 member nation) was mandated by the Rio+20 to prepare a proposal on SDGs for consideration by the Assembly at its 68th session Source: United Nations

24 | The 12 Illustrative Goals 1.End Poverty 2.Empower Girls and Women and Achieve Gender Equality 3.Provide Quality Education and Lifelong Learning 4.Ensure Healthy Lives 5.Ensure Food Security and Good Nutrition 6.Achieve Universal Access to Water and Sanitation 7.Secure Sustainable Energy 8.Create Jobs, Sustainable Livelihoods and Equitable Growth 9.Manage Natural Resource Assets Sustainably 10.Ensure Good Governance and Effective Institutions 11.Ensure Stable and Peaceful Societies 12.Create a global enabling environment and catalyze long-term finance Source: United Nations

25 | "What good does it do to offer free maternal care and have a high proportion of babies delivered in health facilities if the quality of care is sub-standard or even dangerous?" Margaret Chan, World Health Assembly - May 2012 Safety & Quality: At the core of UHC!

26 | UHC Definition (WHO, 2010) All people are able to use needed health services (including prevention, promotion, treatment, rehabilitation, and palliation), of sufficient quality to be effective; The use of these services does not expose the user to financial hardship

Convergence of primary care, equity and health systems agendas

28 | Improving Services in the post MDG World Priorities for strengthening service delivery post 2015 : – Empowering communities, families and patients as core to UHC and post MDG agenda – Strengthening accountability and stewardship – Designing, coordinating and improving services at point of care – Setting priorities and national quality policies

29 | Potential Impact by 2030 By 2030 the world would have: 1.2 billion fewer people hungry and in extreme poverty 100 million more children who would otherwise have died before they were five 4.4 million more women who would otherwise have died during pregnancy or childbirth 1.3 billion tons of food per year saved from going to waste 470 million more workers with good jobs and livelihoods 200 million more young people employed with the skills they need to get good work 1.2 billion more people connected to electricity 190 to 240 million hectares more of forest cover $30 trillion spent by governments worldwide transparently accounted for Average global temperatures on a path to stabilize at less than 2° C above pre-industrial levels 220 million fewer people who suffer crippling effects of natural disasters Source: United Nations