News

In this guest post, Kristina Gryboski—technical advisor for the Child Survival and Health Grants Program at the US Agency for International Development (USAID)—writes about the importance of partnerships to advance health research. This post is the third in a series highlighting USAID’s new strategy for global health research and development (R&D). It was adapted from a post that originally appeared on the IMPACT blog. Asking the right questions is the first step to generating both the “upstream” research needed to create new health products and the “downstream” evidence needed for the implementation of health policies and practices, as my colleague E. Callie Raulfs-Wang described in her March 12 blog. And fostering the right partnerships is crucial to determining the right questions. Partnerships facilitate both product development and operations research, or the testing of scalable solutions that overcome barriers to access, demand, and quality in real world settings. Product development and operations research work in a continuous loop to improve public health around the globe—for example, downstream operations research can help identify a specific vaccine, drug, or device needed in a particular community or setting, thereby informing the more upstream research needed to successfully create this tool. We’ve previously detailed how USAID has established effective partnerships with a range of sectors—governments, nonprofit groups, and philanthropic organizations—to advance the development of new health tools, like microbicides, HIV and AIDS vaccines, and tuberculosis diagnostics. Further down the research spectrum, investing in operations research to accelerate results is also a key strategy in the Global Roadmap of the Child Survival Call to Action. This pledge, signed by more than 160 governments, renewed their commitment to child survival and to eliminating all preventable child mortality in two decades, as USAID Administrator Rajiv Shah explained. USAID’s Child Survival and Health Grants Program (CSHGP) supports new operations research partnerships among nongovernmental organizations (NGOs), academia, and ministries of health to generate evidence about how to solve critical challenges in the implementation and scale-up of high impact maternal, newborn, and child health interventions. By working in partnership with ministries of health, studies are designed to meet the ministries’ expressed needs for evidence that would strengthen their systems. Solutions are tailored to local contexts, with relevance to global implementation challenges, such as how best to: integrate services within and across sectors; improve the continuum of care to maximize access and lower costs; ensure equity in access to health information and appropriate use of services; and strengthen systems’ capacity for accountability to communities. As USAID’s Jim Shelton commented in Nature magazine this year, promoting health literacy for preventive health behaviors such as hand-washing and breastfeeding, and deploying community-based interventions for services and health education, are among the priority public health approaches needed now for universal access to health. Some questions that must be addressed in order to operationalize these approaches include: How can community health workers more effectively reach households with timely information, case management, and referral? What are effective models for partnerships between health care providers and community agents/traditional caregivers to improve the continuum of care and increase demand for services through culturally appropriate and respectful care? How can data collected by communities be used as a communication and planning tool to improve the quality of care and accountability? The answers to these questions would facilitate the research goals of integrated maternal and newborn health, child health, and nutrition, as outlined in USAID’s Report to Congress: Health-Related Research and Development Strategy. As stated in the research goals for health systems strengthening (HSS), “Ensuring equitable access to high-quality essential health services requires an increase in the evidence base on how to best implement HSS interventions and promote uptake of best practices.” These partnerships have the potential to achieve more than the sum of their parts by bringing together perspectives and skills that yield rigorous, relevant, and practical evidence. At this year’s Global Maternal Health Conference in Arusha, Tanzania, presenters from CSHGP’s NGO partners in Peru, Liberia, Pakistan, and Ecuador shared experiences on bridging the gap between communities and health systems to meet the maternal and newborn health needs of their most vulnerable populations. These research projects are helping ministries of health learn how best to operationalize and improve current policies on providing culturally competent, respectful care, and are testing new systems for overcoming geographic and financial barriers to safe childbirth. These partnerships are meeting the evidence needs of ministries of health that are striving to implement policies that make access to care more equitable. Partnerships also help ensure that USAID supports the most effective and efficient research across the spectrum of global health, from developing and delivering new health tools to discovering the most effective policies and strengthening systems to improve health around the world. To learn more about some of these 30 research partnerships in 23 countries check out this brief .

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. The US Centers for Disease Control and Prevention (CDC) has released a new global health strategy for 2012 to 2015. The strategy includes four broad goals the agency would like to achieve in that timeframe, and it also includes a focus on global health research and capacity building in developing countries. The CDC “aspires to create a world where people live healthier, safer, and longer lives,” the strategy says, adding, “The agency will draw upon innovation and research to meet these combined challenges and assure even greater health impact in the future.” A recent CNN interview with Dr. Peter Hotez, dean of the National School of Tropical Medicine and president of the Sabin Vaccine Institute, highlights the growing emergence of neglected tropical diseases in US populations. Citing poverty as the overriding factor, Dr. Hotez explained that neglected tropical diseases such as Chagas disease, cisticercosis, toxocariasis, and dengue fever are contributing greatly to the burden of disease in the US. President Obama has signed the Food and Drug Administration Safety and Innovation Act into law. The bipartisan bill reauthorizes both the Prescription Drug User Fee Act and Medical Device User Fee Act, and adds health technologies for rare diseases to the list of product categories that may qualify for accelerated FDA review. The US Agency for International Development and the National Institutes of Health have launched a new grant program that promotes research to help end preventable child deaths and promote child survival in developing countries. Called the Partnerships for Enhanced Engagement in Research Health, the program will provide up to $450,000 over three years to each awardee to support collaborations that address research-to-practice barriers in child survival. At last week’s London Summit on Family Planning, the Bill & Melinda Gates Foundation announced that it will spend more than $1 billion over the next eight years to increase access to contraceptives in the developing world and to support research for new methods of birth control. Additionally, public-private partnerships at the summit made announcements regarding increased access to and research for contraceptives in sub-Saharan Africa and South Asia.

In this guest post, Claire Wingfield—product development policy officer at PATH—writes about a new paper that examines partnerships between the public and private sectors to advance global health innovation, research, and development. For more than 30 years, PATH has been working to advance innovative global health solutions. Partnering is a core part of PATH’s strategy and is fundamental to how we develop and deliver high-impact, cost-effective technologies. Our partners come from international health agencies, governments, universities, other nongovernmental organizations (NGOs), and private-sector companies. Each partnership is unique, but no matter who the partner is, the collaboration must be mutually beneficial and fulfill our mission to improve the health of people around the world. Public-private partnerships provide a forum for maximizing complementary areas of expertise. They improve knowledge of the most pressing global health needs and lead to solutions that improve health equity. By strengthening the capacity of different sectors, these partnerships accelerate the development and introduction of the most promising technologies for those most in need. Finally, forging new cross-sector partnerships with public institutions and commercial entities enable organizations like PATH to maximize the limited global health resources of both sectors—financial, technical, and structural—to reduce costs and avoid redundancy in our efforts to ensure the affordability of much-needed global health technologies. For instance, in many low-income countries, where budget resources are stretched thin, health systems may not be able to ensure the safety of health tools and products. This leads to situations where the very injections meant to prevent or treat disease can end up causing it instead because under-resourced, overburdened health care programs reuse or fail to properly sterilize contaminated injection equipment. Recognizing the tremendous negative impact that unsafe injection practices can cause, PATH researched how to improve injection practices to reduce the risk of transmitting bloodborne diseases such as HIV and hepatitis B in low-resource settings. The US government, through the US Agency for International Development, provided funding to PATH, enabling us to develop and patent a design for an auto disable (AD) syringe that automatically locks after a single injection. A partnership between PATH, the US government, and Becton, Dickinson and Company led to the development of SoloShot™, the world’s first commercially available auto-disable syringe. Credit: PATH/Eric Becker While PATH had the scientific and technical know-how to design the technology, a commercial partner was needed to validate the design, support large-scale production, and enable widespread distribution. PATH licensed the technology to Becton, Dickinson and Company (BD), the world’s largest syringe manufacturer. BD brought product development expertise to advance the technology beyond proof of concept, manufacturing capabilities to produce a global supply, and distribution channels to ensure the availability of the technology in the public and private sectors. The US government’s investment in the product’s development—harnessed many times over by BD’s own investment in the device—enabled PATH and BD to pursue an aggressive distribution program that led to SoloShot™, the world’s first commercially available AD syringe. A major boost to the introduction and use of AD syringes occurred when the United Nations Children’s Fund and the GAVI Alliance began purchasing and distributing AD syringes for their programs. The US government also accelerated the adoption of the technology by aggregating demandthrough the US President’s Emergency Plan for AIDS Relief (PEPFAR) program. Because injection safety was one of PEPFAR’s top priorities, the US government procured more than 250 million AD syringes for 11 countries through the Making Medical Injections Safer project over its five-year life. Since 1992, more than six billion vaccinations have been delivered using SoloShot™ in more than 40 countries. Studies have shown that transmission of bloodborne diseases caused by dirty needles has been reduced by 90 percent in programs using some form of AD syringe. Creating partnerships that harness the assets of the private sector and the public sector together is a powerful means to ensure impact, scale, and sustainability for the world’s most vulnerable populations. The partnerships help align the strengths and requirements of each sector to ensure that appropriate technologies and innovations reach communities and individuals with the greatest need.

Earlier this week, both the House and Senate passed a budget package to fund the government through the remainder of fiscal year (FY) 2013, thereby averting a government shutdown when current funding expires on March 27. The new compromise funds most accounts roughly at FY2012 levels, with an across the board cut of 0.092 percent. As a reference, the Centers for Disease Control and Prevention's Center for Global Health budget was $349 million in FY2012, while the National Institutes of Health was funded at $30.69 billion. In addition, global health programs at the State Department and US Agency for International Development (USAID) were funded at $8.167 billion. The budget package also makes some key changes to certain programs. For instance, global health programs at the State Department and at USAID, including those that fund global health research and development (R&D) initiatives, are increased over FY2012 levels by roughly 5 percent—potentially to counteract the effects of sequestration. The bill also gives greater flexibility to the Department of Defense to manage sequester cuts to its budget. It also leaves the sequester largely in place, instead of replacing it with balanced budget cuts, as many advocates in the global health community were hoping lawmakers would do. The bill now goes to President Obama’s desk, and he is expected to sign it. Budget negotiations in Congress will have far-reaching effects on global health R&D efforts at agencies such as CDC, DoD, NIH, and USAID. Photo credit: PATH/Evelyn Hockstein. If and when Obama signs the final FY2013 budget package into law, the funding levels will still be subject to sequestration—meaning that the final levels are really anywhere from 5 percent to 9 percent lower. For instance, USAID’s global health programs would see an overall cut of $193 million. While this is better than the $428 million cut it was facing before the Senate stepped in, it could still have a large impact on global health and R&D programs that fall under USAID. The House also passed its version of an FY 2014 budget resolution, which would replace sequestration with budget caps for the next decade. The House resolution would move most of the budget cuts away from the Department of Defense and onto non-defense accounts, including most global health R&D programs, and would balance the budget over the long term. The Senate has introduced its own budget resolution, which could pass today or tomorrow. The Senate version is very different from the House version, as it would make balanced cuts to both defense and non-defense programs and protect non-defense programs from the drastic cuts seen in the House budget. The Senate version does not include a plan to balance the budget in the short- or long-term, but contains a significant reduction in spending over the next decade. Although replacing sequestration with an actual budget plan is widely approved of, advocates for both domestic and global health programs believe that the House budget resolution would be devastating for key health and humanitarian programs. Therefore, as Congress makes decisions on FY2014 spending bills, lawmakers should use a balanced approach when allocating budget cuts (as seen in the Senate version), and increase support for global health and R&D when possible. Additionally, as agencies receive their final FY2013 budgets, they should ensure that global health and R&D programs are protected.