A market based approach

Ira Magaziner is the Chief Executive Officer of the Clinton Health Access Initiative (CHAI) and the Chairman of the Clinton Climate Initiative (CCI). He is also on the board of the Alliance for a Healthier Generation and the Clinton Hunter Development Initiative. From 1993 through 1998, he served as Senior Advisor to President Clinton for Policy Development at the White House. In this capacity, he supervised the development and implementation of the administration’s policy for commercialization of the Internet and worked with First Lady Hillary Rodham Clinton on the development of the President’s Health Reform Initiative. Mr. Magaziner also chaired a joint National Economic Council/National Security Council Initiative to increase US exports and served as a member of the National Domestic Policy Council.

Mr. Magaziner is one of America’s most respected corporate strategists. Prior to his White House appointment, he built two successful consulting firms and worked for the Boston Consulting Group in Boston, London, and Tokyo, helping major corporations develop their business strategies.

Synopsis

The Clinton Health Access Initiative (‘CHAI’) delivers a unique business minded approach to address the key bottlenecks in health systems, resulting in sustainable strengthening of local public-sector capacity in Africa.

CHAI works to increase access to HIV/AIDS care and treatment through lowering the costs; making HIV/AIDS treatment available for children; preventing HIV infection from mothers to children; expanding access to healthcare in underserved areas; scaling-up and sustaining effective malaria control; accelerating uptake of life-saving vaccines; improving the efficiency and effectiveness of global health financing; and expanding human resources for health.

CHAI’s unique value proposition is to approach healthcare problems like business issues rather than public health ones: solving complex problems in healthcare are equally about managerial bottlenecks than medical/clinical shortcomings.

CHAI leverages partnerships and collaboration with the private sector to address the challenges governments face in healthcare. In working close with the private sector, CHAI is able to help address specific cost and investment challenges, deliver improvements in efficiency (e.g., improved service provision and management at reduced costs), and enhance service quality (e.g., increased expertise, more rapid and substantial investments in infrastructure and new medical technologies, a potential to attract and retain better performing staff).

Conclusion

Entrepreneurship, innovation and good governance/management for systems building is critical -> as is the convergence of science, technology and experiences.

CHAI’s programs cut across intervention areas and ultimately can contribute to health systems strengthening across Africa. CHAI’s focus is on specific areas of health, increasingly looking into broader systems strengthening, but the larger context of health, education and other critical areas must be addressed to ultimately create sustainable change in these developing countries.

These experiences, approaches and lessons learnt that are applicable to all.

Examples of CHAI’s approach and specific work areas/ accomplishments:

Access

CHAI’s approach to its [HIV/AIDS and malaria drugs and diagnostics] access work is based on the premise that private markets can be made to work more efficiently and effectively in the service of public interests.

By creating a buyers’ club (Procurement Consortium) and negotiating volume-based price reductions for anti-retroviral drugs based on the aggregated demand from participating countries, CHAI helped to transform the market from low-volume, high-margin to high-volume, low-margin. This model not only better serves the interests of patients in developing countries, but ensures that businesses remain profitable and have lasting incentives to set sustainable prices.

CHAI’s past achievements in HIV/AIDS (two examples):

Mhealth

 As both an advisor to over 70 governments and a market facilitator for health commodities, CHAI is uniquely positioned to identify bottlenecks preventing effective healthcare delivery in both the public and the private sector; and to assist governments to develop scalable strategic national plans for cost-effective and sustainable mHealth solutions that can be applied broadly across disease areas and health systems.

Example:

HP partnership in Kenya: HP is providing technology that will capture, manage and return early infant diagnosis (EID) HIV test results in just one to two days after results are ready – a significant improvement from the previous paper-based system, which took two to three months.

South Africa: Examples of collaboration and partnership between government and other entities (including business) in the current HCT campaign – Clicks, universities, NGOs etc.  The HCT campaign is an "entry intervention", but allows for cooperation on issues beyond just HIV.

New ARV tender: CHAI supported the South African government to cut the costs of HIV/AIDS drug procurement by US $700m over the 2-year tender period, which will allow to double the number of patients to be put on treatment.

Engagement with Private Sector – AMFm planning and roll-out