TRIANGLE GLOBAL HEALTH CONSORTIUM

DECEMBER 2, 2009

FUTURES GROUP LLC

Farley R. Cleghorn MD, MPHChief Technical Officer & SVP

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FUTURES GROUP ORGANIZATION

Futures Group International, LLC

Chris LeGrand Chief Executive Officer

Futures Group International, LLC

Chris LeGrand Chief Executive Officer

Business Development Ed Abel

Business Development Ed Abel

Center for Policy & Advocacy

Sarah Clark, PhDVice President

Center for Policy & Advocacy

Sarah Clark, PhDVice President

Center for Health Systems & Solutions

Farley Cleghorn, MD, MPHActing

Center for Health Systems & Solutions

Farley Cleghorn, MD, MPHActing

Finance & AdministrationTim Schur

Finance & AdministrationTim Schur

Technical Operations

Farley Cleghorn, MD, MPHSenior Vice President & Chief Technical

Officer

Technical Operations

Farley Cleghorn, MD, MPHSenior Vice President & Chief Technical

Officer

Human Resources Nicole Kamaleson

Human Resources Nicole Kamaleson Operations

Jamie HoggOperationsJamie Hogg

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FUTURES GROUP INTERNATIONAL, LLC

GLOBAL PRESENCE Currently active in more than 30 countriesWorked in over 100 countries since 1971

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FUTURES GROUP INTERNATIONAL, LLC

WHAT ARE WE TRYING TO ACHIEVE?

WHAT ARE OUR OVERALL GOALS AT FUTURES?

TO:

• Improve access by the poor/Improve equity in health

• Develop & implement sustainable approaches

• Enhance local ownership

• Deliver Integrated or diagonal solutions

• Be evidence based

• Be rights based

• Adopt a Health Systems approach

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•Agile and nimble technical

assistance delivery organization

•Boutique multi-disciplinary group

•Responsive

•Not afraid of large amounts of data

•Leads with technical offerings

•Commitment to local staff

•Commitment to sustainability

FUTURES GROUP INTERNATIONAL, LLC

•Population Studies & Family

Planning

•Sexual & Reproductive Health

•Maternal and Child Health

•Gender

• Infectious Diseases– HIV and AIDS

– Malaria

– Tuberculosis

– Avian Influenza

– Other

What do others say about us? What distinguishes us?

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Policy & Advocacy

Policy Development and Implementation

Policy Analysis and Barriers

Legal and Regulatory

Advocacy and Coalition Building

Community Mobilization

Workplace Policy Development

Stigma and Discrimination

Gender Equity Promotion

Research and Strategic Information

Demographic Research

Qualitative Research

Quantitative Research

Operations Research

Surveys

Data Demand and Information Use (DDIU)

Program Monitoring

Program Evaluation

Surveillance

Health Markets & Private Sector Engagement

Public-Private Partnerships

Innovative Financing

Contraceptive Security / Commodities

Health Promotion and Behavior Change Communication

Market Analysis, Segmentation, and Growth

Product Marketing and Distribution

Supply Chain Management

Sol

utio

nsS

olu

tions

What are our technical services?

FUTURES GROUP INTERNATIONAL, LLC

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Modeling and Economic Analysis

Model Development

Model Application: Population and Reproductive Health

Model Application: HIV/AIDS

Economic Analysis

Health Financing

Costing

Resource Mobilization

Resource Allocation

Patient Monitoring and Management/HMIS

HIV Care and Treatment

HMIS Development and Implementation

Program Management

Project Management

Grants Management

Technical Program Design and Implementation

Management of Demand-Led Technical Support

Sol

utio

nsS

olu

tions

What are our technical services?

FUTURES GROUP INTERNATIONAL, LLC

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Strategic Consulting

Donor Coordination and Harmonization

Management Consulting

Strategic Planning

Program and Systems Design

Technical Support/Assistance

Sol

utio

nsS

olu

tions

What are our technical services?

FUTURES GROUP INTERNATIONAL, LLC

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• This is how the name Futures was first derived!..\..\Modeling Working Group\Annex - Model Inventory.xls

– Started with fertility and contraceptive prevalence

• Futures models are part of the basis for UNAIDS HIV epidemic projection by region and country

• The Spectrum Suite:– AIDS Impact Model – what are the costs associated with the HIV epidemic in a country?

• Current PEPFAR need to cost ART and set targets for treatmentCurrent PEPFAR need to cost ART and set targets for treatment– Resource Needs Model and ALLOCATE – what is needed for response and where to put

available resources?– RAPID – What are the consequences of high fertility and rapid population growth on

development sectors?

• GOALS – helping countries to prioritize for greatest impact– Effects of shifting resources from Rx to prevention– Links policymaking and program planning with data analysis

Classic Offering-Projection Modeling for Health Programs

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• From social marketing to total marketing…

• Futures was a major implementer of USAID-funded social marketing programs (SOMARC)

• Offering has evolved to cover a broad set of private public partnership based health marketing:– PPP

• Driving best practice through engagement

• Service definition

– Market analysis & segmentation

• Willingness to pay

• Means testing & income analysis

– Costing (cost utility, cost benefit & cost effectiveness)

– Innovative financing schemes

• Voucher systems

• Subsidies

– Demand generation and behavior change communication

CLASSIC OFFERING REDEFINED

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• Patient Monitoring & Management– AIDS Relief HMIS

• Sexual & Reproductive Health– Men who have sex with men (MSM)

• Technical Support Units (TSU)– India TAST (DFID)

– China HIV/AIDS (GF/DFID)

– Kenya HAPAC (DFID)

• Pro-poor Approaches

Dynamic, and growing…

SOME RECENT REFINEMENTS OF OFFERINGS

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NEW OFFERING MARKET READY

NEED INHEALTH DEV

OPPORTUNITY SIZE DURABILITY

MSM: YES GREAT CURRENT SMALL SHORT

HealthInformatics:

YES GREAT CURRENT MODERATE EXTENDED

Integrated Health Delivery Framework: Health System

Strengthening

YES GREAT IMMINENT LARGE EXTENDED

Total MarketingApproaches:

YES GREAT IMMINENT LARGE EXTENDED

PRO-POOR APPROACHES

YES GREAT CURRENT LARGE EXTENDED

“NEW” TECHNICAL OFFERINGS

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Sound products based on experience in the field

Best Practices

Positive outcomes

www.iqstrategy.net

AIDS RELIEF DATA SYSTEMS

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• Comprehensive system based on longitudinal medical records

• Higher capacity site with greater data demand

• High volume site with multiple data entrants

• Some computer support preferred

• Scaleable, single desktop to large hospital network

• Basic system based on WHO registers

• Lower capacity site with lesser data demand

• High/low volume but only one data entrant

• No additional computer support required

• Currently multi-language

IQ STRATEGY

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Technical Centers

• Center for Policy and Advocacy (CPA)

• Center for Health Systems & Solutions (CHSS)

Centers Provide:• Technical Leadership• Project Management• Staff & Performance Management• Professional Development

TECHNICAL CENTERS

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HEALTH SYSTEMS

SYSTEM THINKING

A Futures Group Perspective?

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…10 STEPS TO SYSTEM THINKING FOR HEALTH

1. Convene Stakeholders

2. Collectively Brainstorm

3. Conceptualize Effects

4. Adapt and Redesign

InterventionDesign

EvaluationDesign

5. Determine Indicators

6. Choose Methods

7. Select Design

8. Develop Plan

9. Set Budget

10. Source Funding

System Thinking

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COMPLEX HEALTH SYSTEMS

QuickTime™ and a decompressor

are needed to see this picture.

Health Systems are Complex!

Poorly accountable, very costly, slow results

Function based on the demand and specifics of the country

Integrate interventions that can be scaled upOffer sustainable results

Make a higher impact because of synergies

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…UNLESS YOU STRENGTHEN…

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FROM HS TOWARDS HSS

The challenge of Health System Strengthening from a policy making perspective consists on how to close the gap:

• Between the building blocks and real interventions

• Between theories and practical results

• Between past and the future

Action oriented operational framework:

What can be done in order to strengthen

health systems functions?

System-wide actions that reconcile

horizontal with vertical disease - specific approaches

and offer sustainable diagonal solutions in achieving

national goals

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FUTURES APPROACH TO HSSV

ER

TIC

AL

AP

PR

OA

CH

HORIZONTAL APPROACH

"strategy in which explicit intervention priorities are used

to drive the required improvements into the health

system, dealing with more generic HS functional issues…”

DIAGONAL A

PPROACH

DISEASE SPECIFIC

HEALTH SYSTEMSPECIFIC

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DISENTAGLING HSS - POSITIONING

Single disease intervention

Related diseases/

intervention cluster

Cross Cutting Elements

More

(Inputs)

Better

(most govt)

New

(mainly non govt)

From additional Inputs to Reform the health system

Fro

m s

ingl

e di

seas

e to

cro

ss c

uttin

g H

ealth

Sys

tem

ele

men

ts

Source: Adapted from Berman, Health Nutrition and Population, World Bank, June 2009

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INTEGRATED HEALTH DELIVERY FRAMEWORK

Health Systems Strengthening 4-point framework·         Stewardship

o        Policy o        Legal Frameworko        Policy Marketing

·         Resource Use    o        Health Financing – develop the work we’ve already done in India on ITAP (contracting out public health facilities), Kenya HAPAC (Medium Term Expenditure), HPI (costing) etc into a full health financing offering. o        HIS – IQCare& IQ Strategy- develop into a broader component of HISo        Human Resources o        Health Management

·         Health Services o        Family Medicineo        Medical Educationo        Pharmao        Quality Assurance and Improvemento        EBMo        HIV/AIDSo        TBo        Safe Motherhoodo        Rep health

·         Population and Community Involvemento        Community action for health (including BCC, etc)o        Mobilizing and strengthening civil society

Health System Strengthening:

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HHS RECENT TRENDS - USAID

Strategic approach based on evidence and experience to targetthe most critical health systems function needs and elements

The challenges:

• Identify and strengthen critical parts of health systems in the local context • Address the major local drivers of human health• Collaborating with partner country, private sector, and other donors to reach a minimum standard across each core function• Help countries reach functionality in all six core areas

USAID assistance strengthens health systems across: • Disease-specific programs• Multiple health areas• The entire system

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谢谢谢谢bedanktbedankt tesekkürletesekkürle

Ευχαριστώ Ευχαριστώ takk takk

DziękujęDziękuję

ShukriyâShukriyâ kiitoskiitos

aitähaitäh

tacktack

ありがとうありがとう

DDankeankeObrigadaObrigada

GrazieGrazieMuchas graciasMuchas gracias너를 감사하십시요너를 감사하십시요

mange takmange tak

díkydíky

tack så mycket tack så mycket Thank you

köszi köszi

hvalahvala

ĎakujemĎakujem

شكشكا اًر� ًر�

תודהתודה

СпасибоСпасибо

MulţumescMulţumesc

Thank yuThank yu

salamatsalamat

faleminderitfaleminderit

děkuji vamděkuji vam

nandrinandri

ДякуюДякую

köszönömköszönömanugurihiitosumianugurihiitosumi

dhanya-waaddhanya-waad

dhanya-waaddhanya-waad

go raibhgo raibh maith agatmaith agat

MerciMerci

ačiûačiû Terima Kasih

ManyMany THANKS for Your AttentionTHANKS for Your AttentionAsantesanaSiyabonga

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Contributors

• Technical staff throughout the organization

– 150 US based

– 350 international

– Jorida Zeneli MSc, Bocconi University, Milan