Dr. Pablos-Mendez joined the USAID leadership team with a vision to shape the Bureau for Global Health’s programmatic efforts to accomplish scalable, sustainable and measurable impact on the lives of people in developing countries as envisioned in President Obama’s Global Health Initiative. He talks to Impact about the benefits of public-private partnerships, USAID’s efforts to promote girls and women’s health and more.
What is the relationship between public health and economic growth?
Health status clearly is correlated with economic growth, and causality appears to go in both directions: Higher economic status leads to better health, and better health status enables greater economic growth. Healthier populations tend to have higher workforce participation, and the productivity of the workforce is higher in healthier populations. Each contributes separately to economic growth. Healthier populations live longer, which increases returns to investment in skills development, improving workforce participation and productivity. Evidence is growing that early childhood health status, especially nutrition, has effects on adult productivity and cognition. Health status is a form of human capital that contributes to productivity and, hence, economic growth.
From a private investment and donor standpoint, what financing models are the most sustainable and why?
The number of models available to both global health practitioners and private-sector actors has grown dramatically over the past decade and shows great promise for global health along the full development to delivery continuum. Mechanisms range from the traditional — including philanthropic investments on social returns and private-sector investments (debt and equity) focused solely on financial returns — to a range of emerging tools, such as impact investing, that blend social and financial returns to investors. Other mechanisms are being effectively used to shape markets, making them more attractive for private-sector investment. For example, the GAVI Alliance has implemented an Advance Market Commitment for pneumococcal vaccines incentivizing manufacturers to produce a sufficient supply of pneumococcal vaccines at a guaranteed price. All of these mechanisms must be evaluated and designed to maximize impact and generate returns for investors and innovators. To this end, USAID’s new Center for Accelerating Innovation and Impact is focused on identifying and implementing market-based tools to leverage new sources of capital to further drive sustainable improvements in global health.
As more middle-income countries become independent donors, what actions should they take to better address the health needs of their own populations?
As countries evolve to become health donors, it is critical that they ensure effective and efficient health systems at home that serve the continuum of needs (public health to tertiary care) in an economically viable way for both individuals and a country’s economy. Countries should ensure equitable access to quality services of the level and type their populations require. Resource mobilization, pooling and allocation should be done efficiently and in a manner that protects individuals and households from catastrophic expenditure on healthcare.
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Going forward, what gaps should corporations, or public-private partnerships, fill in the area of global health development?
Now, more than ever, corporations are finding ways to collaborate with NGOs, governments and others in the private sector to bring down traditional market barriers in global health. Across the value chain, the private sector plays a pivotal role in addressing key bottlenecks by leveraging its people, products and capital resources to drive innovation in developing markets. In doing so, private-sector participation in global health is increasingly resulting in both societal gains and gains to the firm’s bottom line – the creation of shared value. Moving forward, the pursuit of shared value will incentivize companies to utilize their core competencies to tackle the global health issues they are uniquely qualified to address.
Going forward, what gaps should private foundations fill in the area of global health development?
Private foundations have a rich history of achieving innovative, sustainable and replicable solutions to global challenges, such as poverty, global health, human rights and climate change. Foundations can take risks public donors cannot, while a public donor can provide continuity and credibility built up over time. Working together, foundations and the public sector can make powerful, catalytic change. USAID and foundations can collaborate through sharing of networks, expertise, resources and joint innovation to undertake challenges that no one organization can solve on its own. For example, the Global Alliance for Improved Nutrition, an alliance supported by USAID, the Bill & Melinda Gates,Rockefeller Foundations, and others, broadens and deepens impact in reducing mineral deficiencies among the world’s nutritionally vulnerable people.
USAID Administrator Dr. Rajiv Shah has said the agency’s “largest opportunities to improve human health… lie in extending our reach to the 80 percent who lack access to health facilities.” Can you provide an example of areas where you feel investments in innovation have the most potential to expand access to health care — particularly for girls and women?
Focused investments in “game-changing” innovations can dramatically improve health for the poorest by increasing their access to life-saving interventions and care, particularly at the community level. Low-cost innovations that are more easily administered by less-skilled health workers; point-of-care diagnostics; and approaches that use mobile phone technologies to provide services, information and monitor patient outcomes have the potential to vastly expand the reach of health-care workers and reduce some of the transportation, time and cost barriers that often prevent people from seeking care. USAID invests in innovations such as these through several different channels, including product development partnerships and Grand Challenge for Development programs. For example, through our Saving Lives at Birth Grand Challenge — a USAID partnership with the Gates Foundation, the Governments of Norway and the U.K., and Grand Challenges Canada — the partnership is funding the development of a needle-free and non-refrigerated treatment for post-partum hemorrhage, a leading cause of maternal death and a mobile interactive voice system that helps mothers to assess the signs and symptoms of newborn and maternal ill-health in the weeks before and after birth. These and other innovations can contribute to substantial and sustainable progress against maternal deaths at the community level. USAID also is investing in the development of 1-percent Tenofivir gel — a microbicide that empowers women to protect themselves against HIV. Using innovation to expand health care to girls and women is particularly important, as it creates a multiplying effect beyond the individual woman, extending benefits to her family and community.
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