Taking up the challenge of driving scale-up of safe blood. John Pitman International Blood Safety Forum March 24, 2017

Size: px

Start display at page:

Download "Taking up the challenge of driving scale-up of safe blood. John Pitman International Blood Safety Forum March 24, 2017"

Ira Brooks
5 years ago
Views:

1 Taking up the challenge of driving scale-up of safe blood John Pitman International Blood Safety Forum March 24, 2017

2 Disclosures Cerus employee Former program manager at CDC/PEPFAR

3 Summary Changing landscape for foreign aid Sobering analysis of the changing landscape for foreign aid Right place, right time, right program Challenges with monitoring and measuring progress Targets not evidence based Revenue generation models/opportunities Technology to address infectious disease risks & supply Managing deficits following withdrawal of PEPFAR funds Apples to bowling ball problem Benchmarking

4 Defining scale Safety Adequacy Quality Access Sustainability Financial Human resources National? Regional? Facility? Individual? Health worker? Patients? Many needs limited resources

5 Number of whole blood units collected per year 12 PEPFAR-supported countries, AFRO region

6 Number of whole blood units collected per year 12 PEPFAR-supported countries, AFRO region

8 Scale through others eyes Lantos-Hyde Act (2003): First PEPFAR authorization (F) assistance to ensure a safe blood supply and sterile medical equipment; 2008: PEPFAR re-authorization (B) the maintenance of a safe blood supply; 2013: PEPFAR re-authorization (H) A description of partner country and United States-funded HIV/AIDS prevention programs and policies, including (i) an assessment by country of progress towards targets set forth in subparagraph (B), with a detailed description of the metrics used to assess (I) programs to prevent mother to child transmission of HIV/AIDS, including coverage rates; (II) programs to provide or promote voluntary medical male circumcision, including coverage rates; (III) programs for behavior-change; and (IV) other programmatic activities to prevent the transmission of HIV; (ii) antiretroviral treatment as prevention; and (iii) a description of any new preventative interventions or methodologies.

9 Changing global health landscape USG funding for global health, 2001: $1.7 billion Kaiser Family Foundation. Fact Sheet: U.S. Funding for Global Health: The President s FY 2014 Budget Request. In: Kaiser Family Foundation; 2014.

10 hanging global health landscape SG funding for global health, 2014: $9 billion Kaiser Family Foundation. Fact Sheet: U.S. Funding for Global Health: The President s FY 2014 Budget Request. In: Kaiser Family Foundation; 2014.

11 Visualizing impact (thanks to Hans Rosling ) NBSEbf8rhSb9j6ECB4XkoI58GgRV8eiUYhwiRfws/ pubchart?oid= &format=interactive

12 Crowding out : A real phenomenon Source: WHO Global Database on Blood Safety

13 Where does it all go? (PEPFAR blood safety funding, ) Year 2012 Program Management for SI Strategic Information for HSS Program Management for HSS Food Supplements Condoms 0.1% Non-ARV drugs and reagents 0.2% Other investment expenditures 0.3% Building rental and Utilities 0.4% Vehicles 0.5% HIV Test Kits 1.5% Antiretroviral drugs (ARVs) 1.8% Consultants (External) 2.5% Construction & renovation 2.5% Equipment and furniture 4.0% Training (in-service) 4.9% Other supplies 7.5% Other site recurrent expenditures 8.1% Travel / Transport 13.6% Other General & Administrative 22.0% Personnel 30.2% Blood Safety Total Source: ( Grand Total 0.1% 9.9% 0.3% 0.9% 2.4% 0.2% 5.5% 2.1% 7.2% 3.5% 7.7% 6.3% 10.9% 18.0% 25.1% 0.2% 0.6% 1.4% 0.2% 6.4% 0.4% 0.2% 2.4% 1.5% 3.0% 1.0% 4.7% 1.9% 9.8% 5.8% 12.4% 17.7% 30.5% 0.6% 1.3% 2.2% 0.6% 4.5% 0.8% 0.9% 0.6% 0.5% 1.7% 1.4% 10.2% 3.4% 10.9% 5.1% 11.2% 13.8% 30.4% $325,610 $755,569 $1,451,558 $383,859 $20,932 $10,296,167 $741,644 $1,056,640 $2,860,836 $1,470,276 $641,050 $5,971,577 $3,039,243 $11,424,675 $5,859,523 $15,548,200 $10,915,459 $20,846,766 $31,225,242 $50,150,495 $174,985,321 Avg. %/year 0.2% 0.4% 0.8% 0.2% 5.9% 0.4% 0.6% 1.6% 0.8% 0.4% 3.4% 1.7% 6.5% 3.3% 8.9% 6.2% 11.9% 17.8% 28.7%

14 We have to make a business case What are the other arguments beyond it s the right thing to do and it feels good

15 Engaging new donors Olde School Bi-lateral / multi-lateral donors Donations (cash, materiel, services) Corporate sponsorships Bank loans New School Corporate investments in employee health & safety National security arguments Funds supported by foundations, wealthy individuals

16 Business Cases Value propositions First rule(s) of private sector outreach: Know what you want: Be specific Know what your target wants: Be relevant Know what you can deliver: Be competent Know your exit strategy Second rule of private sector outreach: Don t give up on the public sector: Diversify

Common Ground Case Study Invest in publicby: health1) responded the company establishing an incident management system, 2) instituting procedures for the early recognition and isolation control of

17 Common Ground Case Study Invest in publicby: health1) responded the company establishing an incident management system, 2) instituting procedures for the early recognition and isolation control of Ebola patients, 3)Epidemic enforcing adherence to (0.09% vs. 0.23% incidence)control guidelines, and 4) standard Ebola infection providing differing levels of management for contacts depending on their exposure, including options Maintain facilities. for voluntary quarantine in the home or in dedicated economic productivity

18 Hat in hand:(there s Outside-the-box fundraising a cottage industry for that ) Introductions relationship building Fund logistics & infrastructure Example: The END Fund (many smaller donors; central mgt.)

19 Integration with other health programs Moving beyond HIV/AIDS Maternal and Child Health (MCH) A natural fit Poor communication between blood and MCH communities at the policy and program levels Be careful what you ask for

Case study: Expanded access to Comprehensive Emergency Obstetric Care

prevent maternal and perinatal mortality and morbidity.

women or infants where it is not required.

20 Case study: Expanded access to Comprehensive Emergency Obstetric Care Lancet Glob Health 2015; 3: e26070 When medically justified, a CS can prevent maternal and perinatal mortality and morbidity. There is no evidence, however, showing the benefits of the procedure for women or infants where it is not required. CS is associated with short- and long-term risk, which can extend beyond the current delivery and affect future pregnancies.

21 Case study: Malaria Blood center role in symptomatic malaria surveillance?

22 science the [**] out of it.

23 Clear role for science & technology Expanding the donor pool role for additional safety measures (e.g., PRT) Open source software Validating open source lot release algorithms Online tech support Remote identification of problems can reduce on-site visits Big data & small facilities Can data from US medical centers US produce useful decision-making algorithms for low-resource clinicians? Engineering solutions Can gravity replace electrical centrifugation? Role for smartphones?

24 Conclusion Many ways to define scale Data needed to identify targets & set goals The pie is changing (size & proportions) Engaging new partners (public & private sectors) Sustaining science & technology

25 We all are motivated by deep impulses and deep appetites to serve It s only when the emergency becomes articulate that we can locate that willingness to serve. Leonard Cohen, 2016

Financial Resources for HIV: PEPFAR s Contributions to the Global Scale-up of Treatment

Financial Resources for HIV: PEPFAR s Contributions to the Global Scale-up of Treatment Joint WHO & UNAIDS Consultation with Pharmaceuticals and Stakeholders November 05 2012 Lara Stabinski, MD, MPH Medical