1. Linking Health Impact to the Business Decision-Making Process Kim Longfield Population Services International klongfield@psi.org Global Health and Innovation Conference Yale University April 13, 2014

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

3. PSI’s Mission page 3 PSI makes it easier for people in the developing world to lead healthier lives and plan the families they desire by marketing affordable products and services

4. PSI Uses the DALY to Inform Business Decisions page 4 Disability-Adjusted Life Year So, what is a DALY? A year of healthy life lost to death or illness

5. Methods page 5 Our modeling program (in a nutshell) 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 Coefficients updated every year with most recent data Coefficients multiplied by country-level sales, distribution, and service utilization figures

6. Doubled health impact by 2011, averted 22.8 million DALYs 79.7 million DALYs averted, 2007-2011 page 6 Past Performance: Impact by Health Area 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:

7. PSI Strategic Plan 2012 - 2016 RELEVANCE SCALE VALUE ::

8. page 8

9. PSI is 3% shy of Strategic Plan goal for DALYs averted 72.7 million DALYs averted, 2012-2013 page 9 Current Performance: Impact by Health Area Malaria 46% HIV/AIDS 27% Family Planning 23%

10. What business decisions are we facing now? page 10 Identifying funding sources that allow us to focus on BOD Considering whether our “relevance” target is right Identifying how new and impactful interventions fit within our portfolio Determining how to best integrate high BOD interventions into existing programs Identifying appropriate responses to evolving markets Re-considering whether our cost/DALY metric is correct Determining when it’s appropriate to attribute impact to our work, especially when strengthening markets and health systems

11. Lessons learned from using the DALY for business decision making page 11 Change management required for adopting a bottom-line metric and updating it Building and maintaining tailored measures can be resource intensive Accounting for combined effects, competing risks, or trade- offs can be difficult Capturing everything we do is impossible; there’s a temptation to attribute everything Data to inform decisions are sometimes limited

12. Conclusions page 12 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 – business decisions based on scale & relevance Greater diversification in interventions and country programs, but securing funding can be difficult More responsive to potential funding sources and alternative distribution strategies