Geneva Health Forum Archive

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GHF2014 – LS02 – Evidence Informed Decision Making in Achieving UHC: the Role of Macro HTA

Evidence Informed Decision Making in Achieving UHC:
the Role of Macro HTA

Dr. Nick Drager
Honorary Professor, Senior Fellow, Global Health Programme, The Graduate Institute, Geneva
Mr. Adrian Griffin
Vice President, HTA Policy, Johnson & Johnson
Dr. Franz Pichler
Director, Global Public Policy, Eli Lilly and Company
Dr. John-Arne Røttingen
Norwegian Knowledge Centre for the Health Services
Dr. Eva Maria Ruiz de Castilla
Executive Director, Esperantra (NPO, Peru)

As a number of countries aspire to implement universal health coverage frameworks, many are looking at methods to best structure their health system to ensure citizens obtain the health services they need. Given cost constrained environments, many low and middle income countries have increasingly focused efforts on prioritization and determining value for investments in health. As such, a significant focus has turned towards the use of research evidence as a tool to support decision making. However, historically, this type of evidence has rarely been applied to support overall health system decision making. In the context of developed countries, a narrow interpretation has placed a significant emphasis on decisions related to coverage and reimbursement of healthcare technologies, such as medicines and diagnostics. 1 Healthcare technologies are only one of several inputs in the overall health system. The organization and delivery of a health care system is a complex matter, which requires a number of decisions regarding the resources necessary to ensure access to services, the mix of interventions required and the means to achieve optimal results.2 Limiting evidence based decision making to coverage decisions tends to obscure the potential role to apply to the overall health system as a whole, such as interventions that facilitate access, service delivery, and aim to improve quality of care.

Therefore, as countries embark towards universal health coverage, it is important that decisions related to coverage of health products and benefits packages are only one part of the discussion. Many low and middle income countries have extensive inefficiencies in their health systems, including issues related to service delivery, quality of care and treatment standards that transcend the need to focus specifically on coverage of health technologies to determine value for investments in health.

This session will explore the role of evidence informed decision making in achieving universal health coverage, looking specifically at the role of "macro" HTA as it is applied to overall health system efficiency and quality of care. This unique session will provide the audience with a view of different perspectives from various sectors in the healthcare space - patient, industry, academic and payer/NGO. Through live interaction, the audience will be able to participate and provide thought provoking questions/answers amongst the group to explore this innovative topic.


Nick Drager M.D., Ph.D
Honorary Professor, Senior Fellow, Global Health Programme, The Graduate Institute, Geneva

Former Director of the Department of Ethics, Equity, Trade and Human Rights and Senior Adviser in the Strategy Unit, Office of the Director-General at the World Health Organization- now is Honorary Professor, Global Health Policy, London School of Hygiene & Tropical Medicine; Professor of Practice, Public Policy and Global Health Diplomacy, McGill University; Adjunct Professor, Department of Epidemiology and Community Medicine, University of Ottawa; Adjunct Research Professor, Norman Paterson School of International Affairs, Ottawa; and Senior Fellow, Global Health Programme, The Graduate Institute, Geneva.

  • Work focuses on current and emerging issues related to global health, in the areas of global health security/diplomacy/governance, foreign policy and international trade and health including intellectual property and health.
  • Extensive experience working with senior officials in over 100 countries and major multilateral and bilateral development agencies in health policy development, health sector analysis, strategic planning and resource mobilization and allocation decisions and in providing strategic advice on health development negotiations and in conflict resolution.
  • Deep experience in global health diplomacy and high-level negotiations on international health security and development issues.
  • Represented WHO, serves as chair, keynote speaker at major international events and conferences; lectures and teaches at Universities in Europe, North America and Asia.
  • Editor/author of books, papers and editorials in the area of global health; global health diplomacy; trade and health including IP; foreign policy and health. Has an M.D. from McGill University and a Ph.D. in Economics from Hautes Etudes Internationales, (the Graduate Institute) University of Geneva.


AdrianGriffinAdrian Griffin
Vice President, HTA Policy, Johnson & Johnson

Adrian Griffin is Vice President, HTA & Market Access Policy at Johnson & Johnson.  He has been involved in the fields of health economics, outcomes research, and reimbursement policy within the healthcare industry for 16 years, with experience across the pharmaceutical, medical device, and diagnostic sectors.

Mr Griffin graduated in Medicinal Chemistry from University College London, obtained a post-graduate teaching qualification from Oxford University, and spent several years teaching chemistry before joining the UK’s Medical Research Council.  He then received his MSc in Health Economics at City University, London, before joining the healthcare industry.  Mr Griffin has held positions at GlaxoSmithKline, Pharmacia, and most recently Johnson & Johnson, where he has been since 2003.

In addition to undertaking outcomes research from the industry perspective, Mr Griffin has also served as a ‘decision-maker’, on the NICE Technology Appraisal Committee, where he has been a committee member for 10 years.  Mr Griffin is also active in numerous multi-stakeholder forums where key issues of HTA and access policy are debated and shaped, such as the HTAi Policy Forum, and initiatives that have brought regulators and HTA agencies together with companies, thus improving transparency and appreciation of different stakeholder perspectives.

Mr Griffin has contributed to several UK industry-government task-force and working groups, aimed at developing policy and processes to improve equitable access and uptake for patients to new innovations.

Within Europe, Mr Griffin has engaged through Company and Industry Association activities with EUnetHTA, with the aim of ensuring that what comes out of HTA collaboration across Europe is fit for purpose, with the ultimate aim of improving healthcare for patients.

Mr Griffin is currently on the Board of Directors of ISPOR, (the International Society for Pharmacoeconomics and Outcomes Research), and continues in his position as a member of the NICE Technology Appraisals Committee


Franz_Pichler2Franz Pichler, PhD
Director, Global Public Policy, Eli Lilly and Company

Franz Pichler has been Director, Global Public Policy at Eli Lilly and Company since 2012. This role encompasses development of external policy positions; provision of strategic advice; and external engagement around policy-related issues. A key focus of the role relates to the European environment, in particular with regards to Health Technology Assessment (HTA) and market access. He represents Lilly on the EuropaBio HTA and Market Access Group and the EFPIA HTA Task Force Steering Committee. He participates in the EUnetHTA Stakeholder Advisory Groups related to relative effectiveness assessment and methodological guidelines development. He is co-chair of the Medicines Adaptive Pathways to Patients initiative and is a participant of the Innovative Medicines Initiative (IMI) project ‘Incorporating real-life clinical data into drug development’ (GetREAL). He was a founding member of the HTAi interest sub group on HTA-Regulatory Interactions which he currently chairs. Franz joined Lilly after serving as the manager of the HTA Programme at the Centre for Innovation in Regulatory Science (CIRS) – a non-profit, independent medicines policy and research think tank. Prior to joining CIRS, Franz worked for over 10 years in molecular biology with specialties in functional genomics, population genetics and bioinformatics. He obtained his BSC in biology and PhD in population genetics at the University of Auckland in 1997 and 2002 respectively.


John_Arne_Rottingen_squareDr. John-Arne Røttingen
Norwegian Knowledge Centre for the Health Services

John-Arne Røttingen is Director of the Division of Infectious Disease Control at the Norwegian Institute of Public Health; Professor of Health Policy at the Department of Health Management and Health Economics, Institute of Health and Society, Faculty of Medicine, University of Oslo; Visiting Professor at the Department of Global Health and Population, Harvard School of Public Health; and Institute Visiting Scholar at the Harvard Global Health Institute.

He is Associate Fellow at the Centre on Global Health Security, Chatham House; research associate of the European Observatory on Health Systems and Policies; Chair of the Board of the Alliance for Health Policy and Systems Research; member of the Scientific Oversight Group of the Institute for Health Metrics and Evaluation, University of Washington, Seattle; and member of the International Advisory Committee for the Global Burden of Disease study.

He has been Director General of the Norwegian Knowledge Centre for the Health Services; Oxford Scholar at Wadham College; and Fulbright Fellow at Harvard Kennedy School.

He received his MD and PhD from the University of Oslo, an MSc from Oxford University and an MPA from Harvard University.


EvaMaria_Ruiz_de_CastillaEva Maria Ruiz de Castilla, PhD
Executive Director, Esperantra (NPO, Peru)

Dr. Eva Maria Ruiz de Castilla is a co-founder and since 2006 Executive Director of ESPERANTRA, a not-for-profit cancer and chronic disease patient advocacy organization in Lima, Peru. Her work at Esperantra is to improve the quality of life of patients with chronic conditions, health promotion, and to advance the recognition of the rights of patients to achieve access to timely diagnosis, treatment, and follow-up care. She has been instrumental in a number of national initiatives focused on cancer, including the government’s Plan Esperanza launched in 2012 to provide basic cancer care coverage for the poorest and most vulnerable Peruvians.

In addition to her work with Esperantra, Dr Ruiz de Castilla consults part-time for various Peruvian ministries, including Health, Social Development, Housing, Women, and Water-Sanitation to help design and coordinate the country’s public-sector social assistance programs. From 2011 to 2012, Dr Ruiz de Castilla was Director General of the Peruvian Ministry of Health’s (MINSA) International Coordination office and before that served as MINSA’s Director General of Health Prevention and Promotion. She has in-depth experience working with donor country agencies and multilateral organizations such as the World Bank.

As a Board Member of the International Alliance of Patients’ Organizations (IAPO) since 2010, Dr Ruiz de Castilla has been a global leader in patient-based organizational capacity building and has led various workshops on patient empowerment and networking. Her experience and involvement with building the capacity of civil society organizations focused on cancer in Peru earned her the American Cancer Society’s “Excelencia Latina 2009” Award. In 2011, Dr Ruiz de Castilla was named a Global Cancer Ambassador by the American Cancer Society, and was invited by the World Health Organization to participate as a civil society representative during the UN High-Level Meeting on non-communicable diseases (NCDs).

Dr Ruiz de Castilla’s academic credentials include degrees in Industrial Engineering and a PhD in Economic Development at the EHESS in Paris, France, and in Political Science at the Sorbonne University Paris 1. In Europe, she consulted for the United Nations on food and agriculture issues for the southern common market (MERCOSUR). Dr Ruiz de Castilla has authored a number of publications and papers on social development, health, and citizen engagement, and has been invited to speak at more than 200 national and international congresses.

GHF2014 – PL05 – Integrating Health, Wellbeing and Sustainability

Dr. Carlos Dora
Department of Public Health and Environment, World Health Organization, Switzerland
H.E. Ambassador Michael Gerber 
Ambassador and Special Representative for Global Sustainable Development Post-2015, Swiss Agency for Development and Cooperation (SDC), Switzerland
Mrs. Pam Warhurst 
Founder and Chair, Incredible Edible Tordmorden, United Kingdom
Mrs. Meenakshi Raman
Third World Network, Malaysia
Mr. Rick Bell
Executive Director, American Institute of Architects New York Chapter, Center for Architecture, United States
Discuss how to better integrate the three dimensions of sustainable development and embed health into the post 2015 new development agenda.
The Millennium Declaration adopted by the heads of State at the Millennium Summit in 2000 has constituted the dominant development paradigm and organizing framework of the last decade. The Millenium Development Goals have substantially contributed to focus development co-operation efforts, strengthened the accountability requirement and mobilized support. With the Millennium Development Goals scheduled to come to an end in 2015, the international community is now taking stock of the substantial advances made as well as the unevenness and gaps in achievement. As we approach the 2015 deadline, unrelenting efforts are required to accelerate progress across all the goals but debates and global consultations about what will replace the MDGs have already taken place. In June  2012, on  the  occasion of the Rio+20 Conference on  Sustainable Development, another mandate  with  similar  aspirations  was  born:  the  Sustainable  Development  Goals  (SDGs). Whilst the MDGs primarily focused on social issues such as poverty, hunger, health and education in developing countries, SDGs will seek to strike a balance between all three dimensions of sustainable development, namely the economic, environmental and the social, and will be applicable for all countries.Health as a component of social progress is a key aspect of the debates, and is being framed as a precondition for, an outcome and a possible indicator of sustainable development.The position health might take into this new framework is still subject to various narrative exercises and a lot of uncertainty still remains of what will be the next development framework by 2015.Moving away from global statements and declarations, the session will convey a diverse panel of actors involved in development, urban planning and community mobilization to discuss the enabling environment needed at a global and local level to build healthier societies and preserve our environment.Some of the questions to be discussed include:

  • What kind of systemic global reforms would be required to secure an accommodating international environment for sustainable development in both developed and developing countries?
  • How can health serve as an indicator to measure sustainable development policies progress, achievement and impact?
  • How can local communities, people’s movements and citizens contribute in shaping healthier and more inclusive societies/cities?
  • How can urban design influence behavioral changes and promote healthy living?

Carlos Dora_squareDr. Carlos Dora

Carlos Dora, is a coordinator at the WHO HQ Public Health and Environment Department, leading work on health impacts of sector policies (energy, transport, housing and extractive industry), health impact assessment and co-benefits from green economy/climate change policies. He previously worked at the London School of Hygiene and Tropical Medicine (LSHTM), at the WHO Regional Office for Europe, at the World Bank, and with primary care systems in Brazil after practicing medicine. He serves in many science and policy committees, has an MSc and PhD from the LSHTM.  His publications cover health impact of sector and sustainable development policies, HIA and health risk communication.


Michael Gerber Jan. 2013H.E. Ambassador Michael Gerber

Perspective: Switzerland’s position on the new Sustainable Development Framework

Member of the Swiss Agency for Development and Cooperation (SDC), Mr Gerber was the Head of the SDC Analysis and Policy Section before being appointed Special Representative for Global Sustainable Development Post-2015 by the Federal Council with the rank of ambassador. In this position, he has been given the task of formulating Switzerland’s position on a Framework for Sustainable Development Post-2015 . Ambassador Gerber is also representing Switzerland in the Open Working Group on SDGs (Switzerland shares with France and Germany).


PL05_Pam_WarhurstMrs. Pam Warhurst

Perspective: How to empower ordinary people to take control of their communities through active civic engagement.

Pam Warhurst is a British community leader, activist and environment worker best known for co-founding the community initiative, Incredible Edible, in Todmorden, West Yorkshire.

Pam studied Economics at the University of Manchester. She has previously served as a member of the Board of Natural England, where she was the lead non-executive board member working on the Countryside & Rights of Way Bill. She is a Fellow of the Royal Society of Arts & Manufacturing, and chairs Pennine Prospects, a regeneration company for the South Pennines, and Incredible Edible Todmorden, a local food partnership. Pam has also been Deputy Chair and Acting Chair of the Countryside Agency, leader of Calderdale Council, a board member of Yorkshire Forward, and chair of the National Countryside Access Forum and Calderdale NHS Trust. Pam was awarded Commander of the Order of the British Empire award (CBE) in 2005 for services to the environment.

PL05_Meenakshi_Raman_squareMrs. Meenakshi Raman

Perspective: How to tackle the growing environment crises factoring international equity in the equation?

Mrs Raman is Legal Advisor and Senior Researcher at Third World Network (TWN) and is based in Geneva. She is also a Member of the Board of Friends of the Earth International and Honorary Secretary to Friends of the Earth Malaysia (Sahabat Alam). As Legal Advisor to the Consumers’ Association of Penang in Malaysia, she currently heads its Community Mobilization Section, which works with farmers and fisher folk. She has served as Chair of Friends of the Earth International (2004-2008), an international organization with 77 member groups. At Third World Network, Meenakshi currently coordinates the Climate Change Programme and has actively been involved in the intergovernmental climate negotiations, from Bali to Cancun. She has been monitoring and reporting on the negotiations and providing analysis and support both to developing country governments as well as to civil society participants. Upon graduation in 1982, Meenakshi and a colleague set up the first public interest law firm in Malaysia, which launched her legal practice assisting consumers. In the past 25 years, she has represented the organizations she works with at numerous conferences and presented papers on issues ranging from environmental and consumer protection, to climate change, agriculture and fisheries, and globalization and trade.

PS25_Rick Bell_squareMr. Rick Bell

I became an architect because of the inspirational oratory of professors including Vincent Scully and the physical example of buildings seen while attempting, at the age of 19, to hitchhike from Paris to Dakar. As an architect I've had three careers, first in the private sector, then at a public agency, and, most recently, in the not-for-profit domain. As a private architect, I mostly designed schools and libraries in a NYC-based firm that also did hotel projects worldwide. In the public sector, I served as chief architect and assistant commissioner of New York City’s public works department, responsible for 700 projects annually. And for the last twelve years I’ve led the New York Chapter of the American Institute of Architects and created its storefront Center for Architecture.

GHF2014 – PS23 – Inclusive Decision Making and Local Health Policy Development

Inclusive Decision Making and Local Health Policy Development
Ms. Monika Christofori-Khadka, Health Advisor, Swiss Red Cross, Switzerland
Equity and Local Government: Sao Paulo, Brazil
Dr. Vera Coelho, Coordinator, Citizenship, Health and Development Group, Brazilian Centre of Analysis and Planning, Brazil
Inclusive Decision-Making and Community Empowerment for Health and Well-being: The Health Promotion and System Strengthening Project in Tanzania
Dr. Kate Molesworth, Senior Public Health Specialist and Reproductive Health and Social Development Adviser, Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Switzerland
Strengthening Health Systems and Democracy Through the Empowerment of Rural Indigenous People for Rights Claiming in Guatemala
Dr. Walter Flores, Executive Director, Center for the Study of Equity and Governance in Health Systems, Guatemala

Khadka Profile PhotoMs. Monika Christofori-Khadka

Trained physiotherapist, working in several institutions in Germany.

1993-1996   Physiotherapist tutor in Tansen, Nepal

1999             Masters in Community Health, Liverpool School of Tropical Medicine, UK

2000-2005   Health Delegate in Bangladesh re-establishing and managing a MNCH programme of the Bangladesh Red Crescent  Society

2006-2012   Programme Coordinator for Kyrgystan, Nepal and China/Tibet with Swiss Red Cross, Switzerland

2010-2012   Masters in Health Economics, Policy and Management, London School of Economics, UK

Since 2013   Health Adviser of the Swiss Red Cross

VeraCoelhofoto (2)Dr. Vera Coelho

I have a PhD in social sciences in the area of “State and Public Policies” and I work at CEBRAP, an independent and interdisciplinary research center located in São Paulo, Brazil. I work with both qualitative and quantitative research methods, evaluating policies and coordinating comparative research projects in the areas of health systems, citizen involvement and pension reform. During the last twenty years I had some nice opportunities to combine professional responsibilities and personal interests as, for example, in 2008 when I went to the State of Gujarat in India to research the social justice committees at the panchayat, the local governance institutions. During my stay, I attended yoga classes, it was a great experience.

walter flores at IDRC-Beijing receptionDr. Walter Flores

Dr. Flores, a national from Guatemala, is a social scientist with over 20 years of professional experience. He holds a PhD and a Masters of Community Health from the Liverpool School of Tropical Medicine, UK.  His professional work has been carried-out in more than 20 countries from Latin America, Africa, Asia and Europe. His areas of expertise are:  health policy analysis, health equity, right to health, democratic governance of  public policies and community participation in public policies. Currently, Dr. Flores is the director of  Center for the Study of Equity and Governance in Health Systems), a civil society organization in Guatemala specialized in research, capacity building and advocacy around issues affecting indigenous and other marginalized populations (

GHF2014 – PS20 – Harnessing ICTs to Improve Tuberculosis Control

PS20 WEDNESDAY, 16 APRIL 2014 ROOM: 16 ICON_Fishbowl
Harnessing ICTs to Improve Tuberculosis Control
Dr. Lucicia Ditiu
Executive Secretary, Stop TB Partnership, World Health Organization, Switzerland
Communications Platform for Tuberculosos to Supplement Mainstream Media: India
Ms. Barathi Ghanashyam
Founder Editor, Journalists against TB, India
mTB by Front Line Workers in a Tribal District in India: A Pilot Study
Dr. Archana Trivedi
Union South-East Asia, The Union, India
Using Technology and Community Empowerment to Treat Tuberculosis
Dr. Shelly Batra
President and Co-Founder, Operation ASHA, India
Dr. Alberto Colorado
Patient Advocate, International Public Health Consultant, Advocates for Health International, United States
Mr. Andrew Codlin
Stop TB Partnership, World Health Organization, Switzerland

Ghanashyam Profile PhotoMs. Barathi Ghanashyam

Unconventional choices have shaped my personal and professional life.  Having chosen to eschew formal academics, I pursued the path of learning – learning what I wanted to, in the way I chose to – by reading, absorbing and applying what I learnt to real life situations.  I have also been deeply influenced by the intensive field trips I have undertaken into rural India in the course of my career as a development writer.  Living and interacting with rural communities have taught me to respect their traditional wisdom, the way they cope with lack of choices, the simplicity with which they find solutions to their complex problems and I have often been humbled into emulating their way of life – which is devoid of artifice of any sort.  My writing, because it resonates with field realities, is credible and important for development processes.

PS20_Archana_TrivediDr. Archana Trivedi

Medical Doctor married with two sons, served in Indian Army (Medical Branch) with 21 years of rich and dynamic work experience in the medical field with 7 years of hands on technical experience working in National Health Program on Tuberculosis. Have background of working for 7 years in Global Fund Projects with International Union Against Tuberculosis and Lung Disease, Catholic Bishop Conference of India, Catholic Relief Services and Indian Medical Association.

Have ability to work and liaise effectively with government agencies, civil society organizations, private sector, people affected with diseases and synergize with other stake holders.  Also have persuasive and innovative skills supported by thorough research, to achieve best accruals for health projects. Have ability to conceptualize and lead health projects from front in strict disciplined environment. Adept in program management to include planning, coordination, execution and monitoring & evaluation of project.

At present position in Union South-East Asia The union, implementing project to involve qualified and non-qualified private practioners to promote TB care and control. Developed mobile application to track and trace TB patients. Currently scaling up mobile application under World Bank IDM project and Grand Challenges-TB Care along with Dimagi (USAID funded project).

Batra PhotoDr. Shelly Batra

I started my professional journey as a young surgeon, of which I was dazzled by the glamour, fame and money that was part of being a doctor. Very soon I came to a cross road and decided to take the road not taken. So, on one side there were the dazzling lights, the success and the glamour but the other route was an uphill path; rocky and thorny and all around was the stench of disease and death and all I could hear were the sighs of the sick and dying; that is the road I have chosen.

Mr. Andrew Codlin

I worked along the Texas-Mexico border studying the interaction of diabetes and pulmonary infections (influenza and tuberculosis) for two years.  I then moved to Karachi, Pakistan, where I spent 3 years implementing TB case finding initiatives focused on the private healthcare sector. All of  my programs had a significant mHealth component and I worked with other TB REACH grantees to adapt our successful strategies for other country contexts.

GHF2014 – PS19 – Improving Access to Essential Medicines

Improving Access to Essential Medicines
Dr. Gilles Forte
Department for Essential Medicines and Health Products, World Health Organization, Switzerland
Strengthening Health Systems to Achieve Access to Essential Medicines
Ms. Alessandra Ferrario
Research Officer, Department of Social Policy, London School of Economics and Political Science, United Kingdom
Dr. Nicholas Banatvala
Noncommunicable Diseases and Mental Health Dept., World Health Organization, Switzerland
Dr. Nils Billo
International Union Against TB and Lung Disease, Switzerland
Ms. Maria Kathia Cárdenas
CRONICAS Centre, Universidad Peruana Cayetano Heredia, Lima, Peru
Dr. Julie Sarah Torode
Deputy CEO and Advocacy & Programmes Director, Union for International Cancer Control (UICC), Switzerland
Mr. Mario Ottiglio
Director, Public Affaires and Global Health Policy, International Federation of Pharmaceutical Manufacturers & Associations IFPMA, Switzerland
Ms. Margaret Ewen
Coordinator, Global Health Projects (Pricing), Health Action International (HAI), The Netherlands
This session at the Geneva Health Forum 2014 will aim to discuss the experience from different countries looking at barriers and facilitators to achieving the 80% target in different contexts and use this experience to see if lessons can be learnt on a global level and inform the implementation of concrete actions by different actors to reach this target. Following the presentation of country experiences different global actors will respond to the challenges presented as detail how they could see the problems being solved at what roles different stakeholders can play.

PS19_Gilles_ForteDr. Gilles Forte

Dr. Gilles Forte is the Coordinator of the “Essential Medicines and Health Products Policy, Access and Use team” at WHO headquarters. He is also Secretariat of expert committees on selection and use of medicines and on drug dependence.

Dr. Forte leads the development of guidance and tools for improving and monitoring WHO Member States policy, governance, access and use of medicines and health products, including for NCDs. Prior to this, he coordinated WHO medicines policy work in the WHO African Region.

Dr. Forte oversaw WHO collaboration with Countries of Central and Eastern Europe while based in the EURO Office in Copenhagen. He was also Medicines Policy and Supply officer for the WHO emergency operations in the former Yugoslavia. He is one of the authors of the WHO Guidelines for Drug Donations and has developed a series of emergency medical kits including for NCDs. Dr Forte has extensive experience of the NGO sector, having worked with a number of aid agencies involved in development and humanitarian programmes in Africa and Eastern Europe.

Trained in hospital pharmacy and public health, Dr. Forte holds a doctorate in pharmacy and a Master’s degree in pharmacology and nutrition. He has also held senior posts in the French public health system and at the national centre for scientific research.

Alessandra_Ferrario3Ms. Alessandra Ferrario

Alessandra Ferrario is a Research Officer in health policy at London School of Economics. Her research focuses on access to medicines and non-communicable diseases. One of her current research projects looks at improving budget impact and cost-effectiveness of pharmaceutical products through the introduction of managed entry agreements (MEAs). Over the past two years she has been working with the World Health Organization on issues around availability, affordability and quality of medicines in the Republic of Moldova.

Alessandra is also studying the burden and management of diabetes, both from a health and economic perspective, as part of a multi-country study in low- and middle-income countries. In previous projects she has investigated the determinants of price and utilisation differences for prescription medicines across OECD countries and issues related to good governance for medicines in low and middle income countries. She holds an MSc in Health Policy, Planning and Financing (LSE/LSHTM), MSc in Epidemiology (Swiss Tropical and Public Health Institute, University of Basel) and BSc in Molecular Biology (University of Basel).

Nick Banatvala_squareDr. Nicholas Banatvala

Dr Nick Banatvala is currently Senior Adviser to the Assistant Director General (Noncommunicable Diseases and Mental Health) at WHO in Geneva. Current responsibilities include leading development of a global coordination mechanism for the prevention and control of  NCDs, spearheading a newly set up UN NCD Taskforce and leading WHO’s global training programme to build capacity on NCDs for senior policy makers in middle and low-income countries.

Prior to this, Nick was Head of Global Affairs at the Department of Health in England where he led the development and implementation of the UK Government's first-ever global health strategy, its strategy for working with WHO and DH’s bilateral engagement with emerging economies. Before that, he headed up DFID’s work on global health initiatives and scaling up health services. This included leading on the health inputs for the 2005 G8 Gleneagles communiqué. He has represented the UK on a number of international initiatives, including the Global Fund to Fight AIDS, TB and Malaria and GAVI. Prior to this, Nick worked for DFID on health programmes in Pakistan, Afghanistan and the Middle East. Nick has experience of the NGO sector, having worked with the UK aid agency Merlin on development and humanitarian programmes.

Nick trained in paediatrics and infectious diseases and then did public health and epidemiologic research in the UK and at CDC, Atlanta. Nick has also held senior posts in UK public health. Nick has sat on government, non-government and academic boards, as well as national and international committees. He has undertaken consultancies for a number of agencies including the World Bank.

PS19_Nils_BilloDr. Nils Billo

Dr. Nils E. Billo, MD, MPH was Executive Director of the International Union Against Tuberculosis and Lung Disease (The Union) from 1992 to June 2013.

Under the leadership of Dr. Billo, The Union has grown into a leading international health organisation, with more than 10,000 members and subscribers in 152 countries, and some 300 staff and consultants working from Paris and regional and country offices in 13 countries. The Union's mandate has expanded to include not only tuberculosis and lung disease, but also some of today's most vital interrelated public health issues, such as child lung health, HIV/AIDS, the pandemic of diseases caused by tobacco use and non-communicable diseases (NCDs).

Dr. Billo completed his medical training at the University of Basel, Switzerland and holds a Master's of Public Health from the University of California, Berkeley. He was a member of the Stop TB Coordinating Board and past president of the Forum of International Respiratory Societies (FIRS), which organised the 2010 Year of the Lung campaign. Before joining The Union, he was head of the Epidemiology Section of the Federal Office of Public Health in Switzerland.

Dr. Billo is currently working as Senior Consultant for The Union.

PS06_Maria Kathia CardenasMs. Maria Kathia Cárdenas

Maria Kathia Cárdenas, BA, MSc(c), is a Peruvian investigator at CRONICAS Center of Excellence in Chronic Diseases at Universidad Peruana Cayetano Heredia (UPCH). Maria Kathia graduated from Economics and studied a Master in Epidemiological Research at UPCH through a Fellowship supported by The National Heart, Lung and Blood Institute (NHLBI) . Prior to her move to CRONICAS, she worked in areas devoted to Economic Evaluation of Projects and Public Policy in Social Development at two larger economic and development Think Tanks in Peru: Centro de Investigación de la Universidad del Pacífico and Instituto de Estudios Peruanos. Her area of interest is Health economics applied to chronic diseases.

She is the co-investigator in a research that received a seed grant award from NHLBI on lifestyles and cost of hypertension and she managed a health-system study looking into overcoming barriers to access care and treatment for chronic non-communicable diseases in Peru funded by the Alliance for Health Policy and Systems Research, World Health Organization. Currently, she is in charge of the economic evaluation of a large study launching a salt substitute to reduce blood pressure at the population level supported by the NHLBI under The Global Alliance for Chronic Diseases.

PS19_Julie_TorodeDr. Julie Torode

Based in Geneva, Julie Torode is Deputy CEO and Advocacy & Programmes.

Director of the Union for International Cancer Control (UICC).

In addition to managing some of the UICC flagship publications such as the TNM classification series and the International Journal of Cancer, Dr Torode has been instrumental in developing and instigating the UICC road map spanning global advocacy and 5 lead programmes. Influencing policy at the highest level includes leading UICCs campaign ahead of the High Level Meeting on NCDs in 2011, as well as UICCs work as founding federation of the NCD Alliance and the women’s task force on NCDs and health with partner organizations from the NCD, HIV-AIDs and reproductive health space. Recent work includes establishing programme leads on the Global Access to Pain Relief Initiative and Cervical Cancer Initiative as well as a review of the UICC fellowships and training offer. Dr Torode leads UICCs strategic relationships with key partners IARC (Global Initiative on Cancer registry Development), IAEA (PACT partnership) and WHO (joint work plan as NGO in official relations) as well as UICC members active in international cancer control.

Prior to joining UICC, she spent the last 10 years in Germany working in the pharmaceutical industry including phase I-IV clinical research - with a particular focus on breast and ovarian cancers, professional relations management and working with patient groups in oncology. She has a special interest in cancer prevention and palliative care. Dr Torode holds a PhD in Organic chemistry from the University of Liverpool.

PS19_Mario_Ottiglio_squareMr. Mario Ottiglio

Mario Ottiglio is Director at the IFPMA where he has been working since 2007 in positions of increasing responsibility. Mario leads on global health policy, coordinates IFPMA Members’ policy positions and conveys them to government and UN Specialized Agencies officials.

Mario also heads IFPMA’s public affairs and communications efforts, developing partnerships and promoting active dialogue with key stakeholders from governments, multilateral organizations, and civil society.

Prior to joining the IFPMA, Mario worked as a consultant for both the private sector and governments. Mario holds an MA in Political Science from the Naples Eastern University and is an Italian national.

PS19_Margaret_Ewen_squareMs. Margaret Ewen

Margaret is a pharmacist working on medicine price, availability and affordability issues at Health Action International (HAI) in Amsterdam.

In partnership with the World Health Organization, a methodology manual for measuring medicine prices, availability, affordability and price components was first published in 2003 (with a second edition published in 2008). To date, Marg has led or assisted more than 100 medicine price and availability surveys in all regions of the world, and provided pricing policy advice to numerous national governments.

She is currently looking at prices and affordability of NCD medicines in some Middle Eastern countries, and developing a methodology to compare prices of locally produced and imported medicines. Prior to joining HAI, Marg was a senior advisor at the Medicines Regulatory Authority (Medsafe) in her home country of New Zealand.

GHF2014 – PS13 – Integrated Approaches to HIV Management

PS13 TUESDAY, 15 APRIL 2014 ROOM: 15 ICON_Fishbowl
Integrated Approaches to HIV Management
Dr. Alexandra Calmy, Head, Unit of HIV/AIDS, Division of Infectious Diseases, Geneva University Hospitals, Switzerland
Integrating HIV Commodity Supply Chains for Prevention of Mother to Child Transmission Scale Up in Nigeria
Ms. Chioma Nwuba, Logistics Advisor, HIV/AIDS Program Management, HIV/AIDS Supply Chain Management Systems, John Snow Inc., Nigeria
Administrative Integration of HIV Monitoring And Evaluation: A Case Study From South Africa
Dr. Mary Kawonga, Senior Specialist /Lecturer, Department of Community Health, Wits School of Public Health, South Africa
Ms. Shona Wynd, Expert on Community Health Care Workers, UNAIDS, Switzerland
Eighteen years after the advent of highly active antiretroviral therapy, 10 years after antiretroviral therapy massive roll-out in high prevalence countries, the success of HIV treatment have been confirmed everywhere, worldwide. Most national programs however are fragmented. For example, mother to child transmission services are not necessarily linked with ART adult delivery systems, TB screening, diagnosis and treatment services are disconnected from HIV services in most TB/HIV high prevalence countries etc. Civil society, communities and patient-centred care have been central to the AIDS response from the outset and will continue to be essential to scaling up the response.  We will aim to explore how HIV services can form a continuum of care and address challenges around improving integrated service delivery as we move towards achieving the 3 Zeros (zero new deaths due to AIDS, zero new infections and zero discrimination) and UHC.

Alexandra_CalmyDr. Alexandra Calmy

Dr. Alexandra Calmy is a medical doctor, trained in internal medicine and in Infectious diseases (FMH), and holds a PhD in clinical research PhD in HIV/AIDS obtained in Sydney, Australia (Prof Andrew Carr, 2005-2008). She is currently an associate Professor and head of the HIV/AIDS Unit in Geneva University Hospital.

Dr. Calmy’s research interest is in the public health and humanitarian response to HIV/AIDS, specifically the provision of antiretroviral therapy and management of side effects in resource limited settings. She has worked  as a medical doctor with Médecins Sans Frontières in Cambodia in 1996 and has subsequently supported MSF’s HIV/AIDS work for more than 10 years.

She is a member of WHO working groups on the writing and the implementation of guidelines related to the treatment of HIV in developing countries since 2001, head of CSS6 committee at the “Agence National de Recherche sur le SIDA” (ANRS), member of the scientific board of the Swiss HIV Study Cohort (SHCS), and the Federal commission of Sexual Health in Switzerland. She is also a reviewer for numerous well recognised medical journals and has published over 100 articles in peer-reviewed medical journals.
PS13_NwubaMs. Chioma Nwuba

Chioma Nwuba is a Logistics Advisor - HIV/AIDS Program Management at John Snow Incorporated. She implements programs in West Africa aimed at strengthening health systems, preventing mother to child transmission of HIV and development of indigenous capacity to support HIV/TB prevention, care, treatment and commodity supply chain management.

She is currently studying online for a Masters in Public Health degree at the Texila American University, Guyana, South America.

Kawongs Profile PhotoDr. Mary Kawonga

Dr. Mary Kawonga was born and raised in Zambia, completed her medical degree there and practiced for a few years before she decided to move to South Africa. She moved to South Africa soon after that country’s first democratic elections in 1994, and looked forward to new and exciting possibilities in the ‘new’ South Africa. After practicing as a clinician in public sector hospitals she decided to pursue a career in community medicine rather than paediatrics and enrolled in a residency programme in community medicine at the University of Natal in the beautiful coastal city of Durban. On completing her four year residency programme in 2000, she moved to the less beautiful city of Johannesburg where she has since lived and worked as a community medicine specialist. In her current position Dr. Kawonga wears two hats. The first is as a public health medicine consultant with the provincial health department providing technical support to health managers on policy implementation and planning and monitoring health services and programmes. The second is as a lecturer with the University of the Witwatersrand School of Public Health involved in undergraduate and postgraduate teaching and supervision, and research. She is currently enrolled for a PhD at her university. Her doctoral thesis explores methods for measuring tensions and synergies between disease-specific programmes and health systems at sub-national level.

Mira Shiva

MiraShiva200x150Dr Mira Shiva

Chairperson, Health Action International Asia -Pacific Founder, People's Health Movement

Born to a Gandhian mother and a forest conservator father, a qualified doctor herself, Dr Mira Shiva chose to live the life of an activist. Single by choice in a man's world, Shiva has not just left her mark but has successfully made a difference to society…

Her journey started from Ludhiana in 1968, when she was doing her MD from Christian Medical College. When Dr Mira Shiva was a student, she observed women were dying during child birth and the college was making efforts to prepare doctors for situations like these. It was in this college that Shiva met Dr Betty Cowan, a Professor of Medicine and Community Health who later became her inspiration. "In her I found a person motivated by community health concerns," says Shiva.

Turning point

Shiva happened to be in Bihar in 1979-80 when there was an outburst of tuberculosis in the area. "There was a spread of tuberculosis and there were no anti TB drugs available in that area. All irrational hazardous combinations were flooding the market. That was the time that I felt the pain in my heart and thought that I must take this up with the chemical ministry," recalls Shiva. This marked the major turning point in her life.

Thereafter, Shiva has never looked back. She knew what she wanted to do next. Confident in her thoughts, she followed her mind. "I always wanted to become a doctor and practice medicine but I also wanted to serve human kind," she says.

Making a difference

Shiva has made many remarkable efforts in order to make this world a better place to live in. She has been associated with civil society bodies and has been part of many government committees representing the voice of masses.

Shiva was a member of the Drug Pricing Review Committee in 2001, as well as the Chemicals Ministry and the R& D Committee in the same year. Besides, she has played an important role as a member of various bodies like the Central Council for Health, National Population Commission, National Advisory Committee on Assisted Reproductive Technologies and National Human Rights Commission. She was also on the Task Force on Safety of Food and Medicine and was Chairperson of the Task Force on Consumer Education. Shiva is also associated with civil society bodies like Health Equity and Society, All India Drug Action Network and Health Action International Asia Pacific. She is a founder member of Peoples Health Movement and a steering committee member of Diverse Women for Diversity.

But is it easy for a woman activist to fight for rights of women and poor people amidst powerful men? "There are always men to de-legitimise my presence but I am always too firm to make my way and tell them my purpose to be there. The fact that I happened to be a woman is not so important to me," declares Shiva. She has rather learned from her experience to handle people and she feels it is important for every woman to do so too. "It is important to understand that you are saying what you are saying and being a woman does not mean that you are asking for a favour," she adds.

For namesake

The lady, who named herself after Mira Bai, says that she knew that she was born to become a rebel. "I named myself after Mira Bai because people tried to kill her in three different ways but failed. I draw my inspiration from there," she says. However, born to a family with liberal thoughts, Shiva gets her strength from her Gandhian mother, who was a writer and faced odds in her life as well, as well as her grandfather, who had set up a school for girls in rural areas. Her parents were very supportive of her decisions and gave her the freedom to choose. "I got it as a sanskar that I am no less than others and that there is no difference between a boy and a girl. If you underestimate me as a girl you are asking for trouble," she declares.

But women often face attacks on their identity from a patriarchal society. So did Shiva. "I have been repeatedly addressed as ‘Mrs Mira Shiva’ and by people who know my status but each time I used to make it a point to raise my voice and correct them …I will tell them I am not Mrs Mira Shiva but Dr Mira Shiva…It has something to do with my identity and it is important to me. People try to weaken you through such means. They would tell me that I am acting non-professional and speaking for a certain section which is not true," she says. Shiva points out that men occupying positions of power expect women to follow instructions and agree with them on whatever they say, so she was naturally not like by them. But she wonders, had she been born a man , then would the reaction from men be similar? The question remains unanswered …

Health as an indicator of sustainable development: How health can contribute to and benefit from sustainable policies.

Author(s) Natalie Mrak1, Callum Brindley2
Affiliation(s) 1Development studies, The Graduate Institute for International and Development Studies, Geneva, Switzerland, 2Development Studies , The Graduate Institute for International and Development Studies, Geneva, Switzerland.
Country - ies of focus Switzerland
Relevant to the conference tracks Environment and Sustainability
Summary This study highlights how health can be a cross-sectoral indicator for the proposed 2015 sustainable development goals. The impacts of environmental changes on human wellbeing have been clearly established but insufficient work has been done to show how sustainable policies can also benefit health. This study recommends health indicators that can be used to measure sustainable progress in the sectors of water, food, energy, housing and transportation within the urban environment. It also provides suggestions on accountability and governance mechanisms that should put be in place at local, national and global levels to ensure that everyone takes responsibility for sustainable development.
Background Growing concerns about the impact of environmental changes on health have emerged as middle-income countries have adopted the consumption and greenhouse gas emission behaviours of high-income countries. The same economic trajectory that has created a global marketplace dependent on increasing volumes of production, consumption and the long-distance transport of goods, has also led to the overexploitation of finite natural resources, energy shortages and the overburdening of the natural environment. The affects from this trajectory not only pose challenges to the sustainability of the environment but to human health as well. About 24 per cent of the global burden of disease and 23 per cent of deaths are attributable to environmental causes and around 36 per cent of the disease burden in children is caused by environmental factors. Despite this information, health has been an omitted aspect in climate policies. The collective health benefits that can be gained from a low carbon economy have been overlooked when they can actually be motivation for further cutting greenhouse emissions. Emphasizing the joint benefits could make reducing greenhouse emissions attractive since they serve as a means towards achieving both public health and climate goals.
Objectives The primary objective of this study is to demonstrate how health is a cross-sectoral theme of sustainable development that can be used to motivate behaviour change. The secondary objective is to show how human wellbeing will be impacted if sustainable approaches to development are not pursued. Since the MDGs were established in 2000, tremendous progress has been made to improve health outcomes but this progress will become compromised if measures are not taken to improve the current state of the environment. Everyone will be impacted but particularly the poorest and most vulnerable whose already scarce access to public goods could be further compromised as governments grapple with economic devastation as result of changes in the climate and environment. Urban areas will continue to grow, unable to accommodate their expanding population, which could lead to increased food insecurity as dry arable rural lands become incapable of producing crops. Prolonged drought conditions and increased occurrence of natural disasters could also lead to water insecurity. This situation, combined with poor housing conditions, unsustainable energy sources and carbon-motorized transport will negatively impact health and the environment. The tertiary objective is to show how policies across diverse sectors can improve human wellbeing and the environment. Health can be used to measure the effectiveness of policies in various sectors as well as benefit from policies that also improve the environment. In order to tackle the health risks that environmental changes pose, an integrated, cross-sectoral approach needs to be taken since human wellbeing is not only affected by such factors as health systems as but also other factors like pollutants and physical activity. The additional objective is to analyse the opportunities and challenges to promoting more sustainable behaviour. Everyone can contribute to a sustainable future from healthcare workers to businesses as well as governments and civil society. The post-2015 development agenda provides an opportunity to implement accountability mechanisms that do not currently exist. As cities become centres of human settlement, there is also a need to implement environmental-friendly policies that enhance rather than detract from economic growth.
Methodology The main question of this study is to see how health is a cross-sectoral indicator of sustainable development. The study was conducted between June and September 2013. The search strategy sourced reports and articles primarily published by the United Nations, especially the WHO, UNICEF and UNEP as well as the below leading health and development journals. We reviewed only articles published in English and concentrated on the period from 1990 to 2012. Our principal search terms were: “health” AND “sustainable development”; “environmental burden of disease”; “healthy environment”; “urban health”; “healthy cities”; “health” and “results-based management”; “health indicators.” In total, we closely reviewed over 100 reports and articles. To analyse the literature, the following questions were posed:• How can health and sustainable development be linked?
• How is health positioned in the post-2015 development agenda and the sustainable development goals debate?
• What are the strengths and limitations of indicators
• What current health indicators exist and what are their merits?
• What lessons can be drawn from the WHO’s Healthy Cities programme?
• How can inter-sectoral cooperation be promoted?The study looks at sustainable development within the context of urban areas, focusing on five key areas – food, water, energy, households and transport. Cities were selected as the geographic area of focus since their populations are expected to continue to increase over the course of this century. The five areas of focus were selected on the basis of their strong cross-sectoral communications with health and the burden of disease from their associated risk factors. The study demonstrates how the relationship between health and sustainable development can be thought of in three ways: health contributes to the achievement of sustainable goals, health can benefit from sustainable development and health is a way to measure progress across all three pillars of sustainable development policy.
Results The results of the study clearly demonstrate that health is an integral part of sustainable development whose contributions should be considered more seriously in the post-2015 development agenda discussions. First, climate change is contributing to the increased incidence of natural disasters and disease outbreaks, increasing the global burden of disease. Second, urban areas will endure great burdens as a result of climate change, which will be primarily due to the increased migration to cities. Third, there are measures that can be implemented across sectors, which can reduce greenhouse gas and pollutant emissions as well as improve human well-being. Last, this study also found that while there is an abundance of data on health as an indicator of sustainable development and the distinctiveness of each country’s context make it difficult to discern which existing indicators are most practical and useful, there are a series of assessments that can be carried out to develop a fit-for-purpose complement of indicators. The below tool outlines the method for conducting these assessments by focusing on a country’s:• Burden of disease
• Level of economic and social development, and
• Environmental condition and pressuresTables of indicators by income-level for the health-sustainable development nexus were created. It was found that each indicator has the following four strengths;

• Relates closely to both health and sustainable development
• Relies on data that is easily accessible and reliable
• Communicates clearly a development challenge
• Facilitates practical policy interventions

The primary limitation of this study was the lack of first-hand qualitative data which is due to the top-down approach of the study. A complementary bottom-up study containing ethnographic work could help confirm these findings and provide a people centered-approach to seeing how health is an integral part of sustainable development.

Conclusion Health can be a useful focal point to promote inter-sectoral cooperation at the local level but there is unfortunately no set of health indicators that are relevant to all contexts. A drawback to the work that has been done on health as an indicator of sustainable development in urban settings has been the emphasis on the quantitative aspect of indicators. This has made it difficult to single out a set of best practices and to actually see whether these interventions improve well-being. As urban populations continue to expand in the coming decades, new approaches to urban planning need to be taken which engage a variety of stakeholders and adapt to the dynamic nature of cities. Small-scale interventions in urban areas can be key to providing insights into what does and does not work. To ensure the work on health and sustainable development continues, health needs to be an integral component of the post-2015 development agenda. The sustainable development goals of the post-2015 agenda will not be achieved if a concerted effort is not made to assist low and middle-income countries in developing and implementing renewable energy techniques as their populations and economies continue to grow in the coming decades. Mechanisms should be created that not only transfer funds but knowledge and technology as well. Governance mechanisms need to be set in place, which marry policy and scientific evidence and impose accountability. Increasing public awareness of the intricate relationship between public health and the environment could help promote sustainable behaviour and raise attention to the need of holding all stakeholders accountable. Ultimately, there needs to be commitment at all levels of government and society in order for sustainable development to become a reality.

Protecting the Health of International Labor Migrants through Intersectoral Action from a Source Country Perspective: The Philippines

Author(s) Ramon Lorenzo Luis Guinto1
Affiliation(s) 1None, None, Manila, Philippines.
Country - ies of focus Philippines
Relevant to the conference tracks Social Determinants and Human Rights
Summary This source-country perspective study examines how intersectoral action can be harnessed to protect the health of international labor migrants. With nearly 10% of its citizens living overseas, the Philippines, with its decades-long history of institutionalized labor migration, has established structures and processes that ensure migrants' rights and welfare. While best practices exist, there is room for improving intersect oral action to  address migrants' health, such as strengthening the Department of Health's coordinating role, developing monitoring and evaluation mechanisms, and emphasizing health in bilateral labor agreements with destination countries.
Background With nearly 10% of its citizens living overseas, the Philippines has been a key provider of migrant labor force to over 200 countries in hundreds of occupational categories and employment arrangements, in addition to a sizeable number of immigrants. The progressive growth of international migration of Filipinos has been significantly attributed to a wide institutionalized network of government organizations with respective legal mandates and programs. The country’s international labor migrants have greatly contributed to the growth of the country’s gross domestic product especially in recent decades. While much has been documented about the social and economic dimensions of international migration in the Philippines, little is known about the health of Filipino workers overseas – and the structures and mechanisms that govern migration health. Furthermore, much of the available migration health literature analyse the situation in destination countries, so a source country perspective is of critical importance and usefulness for developing sound migration health policy in today’s increasingly mobile world.
Objectives Since both migration in general and migration health in particular are complex issues that require action across a wide range of stakeholders, this study will examine how intersectoral action can be harnessed to protect the health of migrants, particularly international labor migrants. While most studies looked at destination countries, this study will present experience and lessons in addressing migration health from a source country such as the Philippines. In this study, policies, programs, institutions, and mechanisms that support the health of "Overseas Filipino Workers" or OFWs will be mapped and described. As a result of this situational analysis, challenges and opportunities in the Philippines approach to migration health will be identified, and priorities and activities that the government and other stakeholders can undertake in order to advance the health of Filipino migrants overseas will then be proposed.
Methodology In order to guide the direction of this qualitative analysis of migration health governance in the Philippines, a conceptual framework was developed, which provided a strong emphasis on the principle of intersectoral action for health. An extensive desk review of relevant literature, including existing policies, was initially conducted. This was followed by a multi-stakeholder analysis using key informant interviews and focused group discussions as primary methods of data collection. Various organizations that represent various stakeholder groups (government, private sector, civil society, and intergovernmental organizations located in the Philippines) were pre-identified according to the findings of the literature review and served as key sources of information. During the interviews and group discussions, a discussion guide was used to ask the participants about key themes that reflect the different phases of the whole migration process (pre-departure, travel, interception, destination, and return) as well as the migration health action points articulated in the World Health Assembly resolution 61.17 on the health of migrants: monitoring migrants’ health, existence of policy-legal frameworks, building migrant-sensitive health systems, and participating in local and international partnerships and networks. Data gathered from both literature review and multi-stakeholder analysis were individually analyzed and then triangulated.
Results There exist a limited number of studies that have been conducted to assess the health needs of Filipino migrants overseas. However, much of the available grey literature indicate mental health problems as a common cause of illness among OFWs, while HIV-AIDs is becoming a growing concern, especially among returnees. Such a dearth of robust information is indicative of a weak information system that is supposed to monitor the health status and needs of migrants. In terms of policy-legal frameworks, the Philippines has instituted a number of laws that protect the rights and welfare of international labor migrants, which also cover some health-related aspects. Meanwhile, most of the existing migration health services are provided during the pre-departure phase of the migration process (i.e. pre-departure medical assessment). On the other hand, there is a limited amount of health supportive services that address the health needs of returning Filipinos. The Philippines is also a signatory to a number of international frameworks that commit to advancing migrants’ health, both at the international and regional levels. Interestingly, government institutions that craft policies, regulate actors, and provide services related to migration health lie outside of the health sector (i.e. labor), while at present, the Department of Health plays a minimal role (i.e. implementing quarantine among returnees suspected with contagious disease). While no concrete or clear mechanism exists to coordinate migration health-related efforts, there are some interactions occurring between various government agencies in order to implement certain functions.
Conclusion The existing structures and mechanisms that protect and ensure the health rights of Filipino labor can provide the template for a more concerted whole-of-government approach to migration health. While certain migration health policies and services do exist, there remain gaps in some key action areas recommended by the WHA resolution, especially in terms of monitoring migrants’ health and establishing migrant-sensitive health systems. The Department of Health should therefore assume a greater coordinating and technical role to support the migration health-related functions already performed by various non-health government agencies and other stakeholders. Furthermore, as international labor migrants interface with health systems of destination countries, source countries such as the Philippines should strengthen their diplomatic functions so they can negotiate for better provision and protection of health for their citizens residing overseas. Finally, the cause of advancing the health of international labor migrants offers an opportunity for governments, most especially countries that serve as sources of international workforce, to implement meaningful intersectoral action for health.

Lessons from the Commercial Sector: How Integration Can Transform Public Health Supply Chains

Author(s) Carmit Keddem1, Nadia Olson2, Carolyn Hart3, Joseph McCord4.
Affiliation(s) 1Center for Health Logistics, John Snow, Inc., Boston, United States, 2USAID | DELIVER PROJECT, John Snow, Inc., Washington, DC, United States, 3Center for Health Logistics, John Snow, Inc., Washington, DC, United States, 4USAID | DELIVER PROJECT, John Snow, Inc., Washington, DC,United States.
Country - ies of focus Global
Relevant to the conference tracks Health Systems
Summary Successful health programs require an uninterrupted supply of health products provided by a well-designed, well-operated and well maintained supply chain. By applying a new approach to end-to-end integration, adapted from the commercial sector, health managers can ensure that public health supply chains deliver an adequate supply of essential health commodities to the clients who need them.
What challenges does your project address and why is it of importance? Health programs can succeed only if people have access to the essential health products they need. Although many countries have strengthened their public health supply chains and, thus, improved product availability in recent years, they continuously face new challenges. Countries are under increasing pressure to deliver a rising volume of products to support expanding health programs and respond to greater demand from donors for accountability and sustainability. New technology and commercial sector approaches can help countries build dynamic supply chains that respond to these changes and yield health and development benefits.
How have you addressed these challenges? Do you see a solution? JSI has researched and applied commercial sector approaches to public health supply chains, including supply chain integration, and has seen significant results. While public health systems in resource-limited settings are very different than private companies, public health supply chain managers face many of the same challenges as commercial supply chain managers did many years ago. Over the past few decades, commercial sector supply chains of major corporations, including Apple, Proctor & Gamble, Wal-Mart, and Dell, have undergone a major transformation to become cost-effective, agile, and responsive to consumer needs. This occurred in an environment where consumers were expecting wider choice and better service from retailers, and increasing globalization encouraged companies to build international, outsourced supply chains with increased management complexity. With the right approach, integration can be as transformative for public health as it has been in the commercial sector – leading to more cost-effective and reliable supply chains that effectively deliver health products to clients and contribute to better health outcomes.When adapted for public health, supply chain integration involves linking the actors managing health products from the top to the bottom of the supply chain, or from end-to-end, into one cohesive organization, which oversees all supply chain functions, levels, and partners, ensuring an adequate supply of products to clients. Lessons from the commercial sector teach us that integration is more than merging health program supply chains - for example putting malaria and HIV and AIDS products on the same truck. JSI has worked to design and strengthen various public health supply chains according to the principles of supply chain integration by better linking people, information, and activities from where products are made to the people who need them.
How do you know whether you have made a difference? In Zimbabwe, after applying supply chain integration principles to integrate key products into a well-functioning family planning supply chain, stockout rates for nevirapine tablets decreased from 33 percent to 2 percent and supply chain costs were reduced. This, ultimately, resulted in 35 percent more mothers treated to prevent mother-to-child transmission of HIV.
Have you or the project mobilized others and if so, who, why and how? JSI, through various supply chain projects, works with government, civil society, academic and funder organizations to strengthen public health supply chains worldwide. We have incorporated supply chain integration concepts into our system strengthening approaches in various countries – from a supply chain orientation of animal health specialists in Indonesia, to pre-service training in Tanzania, to guiding the supply chain system design process for essential medicines in Nigeria.
When your donor funding runs out how will your idea continue to live? Strengthening supply chain systems requires significant investment and resources, but can reap significant long-term benefits for health programs and the broader health system. While supply chains required sustained investment, designing public health supply chains according to the principles of supply chain integration will improve their efficiency and effectiveness in the long-term, protecting the investment in commodities and the supply chain system and leading to more sustainable health solutions.