Ariel Pablo-Mendez

Speaker: Dr. Ariel Pablos-Méndez, Assistant Administrator, Global Health Bureau, USAID

When: Thursday, 15 December 2011, from 6:00pm – 7:30pm

Where: Johns Hopkins SAIS, Rome Building, Suite 806, Massachusetts Ave., N.W. 
Washington, DC 20036

Event description: Focusing on USAID's global leadership in strengthening health systems, Dr. Pablos-Méndez, will be discussing his vision to shape USAID's Bureau for Global Health's programmatic efforts to accomplish sustainable, scalable and measurable impact on the lives of people in developing countries. A recent appointee, he hopes to further advance the goals and reformatory recommendations expressed in the Presidential Policy Directives (PPD), Quadrennial Diplomacy and Development Review (QDDR) and USAID Forward (USAID Forward Overview). By fostering new working relationships and maintaining existing partnerships, Dr. Pablos-Méndez will direct the Bureau's activities and approach toward a standard of technical excellence.

Dr. Pablos-Méndez is an experienced public health physician. He most recently served as Managing Director at The Rockefeller Foundation where he led the Foundation's global health strategy on the transformation of health systems in Africa and Asia. He first joined the Rockefeller Foundation in 1998, spearheading public-private partnerships in research and development for diseases of poverty, the Foundation's strategy on AIDS care in Africa, and the Joint Learning Initiative on Human Resources for Health. Dr. Pablos-Méndez also served as Director of Knowledge Management at the World Health Organization (WHO) in Geneva, where he established WHO's first eHealth unit.


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Dr. Ariel Pablos-Méndez of the USAID Global Health Bureau celebrated health systems progress and outlined challenges that lay ahead, at a meeting of the D.C. Health Systems Board.

During his talk, Dr. Pablos-Méndez spoke to three main themes:
                          1. Recapping USAID leadership in health systems in recent decades.
                          2. The need to adapt to an environment of new challenges and opportunities, we are at an inflection point in the economics of global health beyond Washington.
                          3. The next chapter of USAID’s efforts in global health will include new platforms for health systems.

Dr. Pablos-Méndez opened by hailing a new era of declining HIV infections, decreasing fertility rates, improved maternal and child health, and increasingly favorable health policies. The speaker declared that we have the tools to protect against death from preventable causes and to narrow the gap between ideals and reality, but that the job is far from done.

He called for increased country ownership and continued progress towards health systems improvements in order to reach ambitious targets and sustain those gains. Public health provision will need to move beyond medical care and health services alone to include financial protections and new strategic frameworks that adapt to an evolving set of global challenges.

Dr. Pablos-Méndez described four decades of health systems initiatives by USAID and partners, with notable early achievements from the 1972 World Fertility Survey and the first Demographic Health Surveys in 1984 to the expansion of social marketing, immunization, health financing and health sector reform initiatives throughout the 1980s and 90s. According to Pablos-Méndez, health systems advances have been solidly grounded in evidence-based decision making and picked up speed with the 2006 World Health Report—ushering in action-oriented frameworks fueled by multilateral collaboration, global workforce development and powerful open-source datasets and toolkits.

In recent years, vertical programs have given way to strengthened supply chains, national health accounts have increased country ownership of health financing, and health systems assessments have increased stewardship across multiple sectors. And in many settings, community-based approaches have proven themselves key elements of a health system to expand coverage of service delivery and behavior change communication.

To respond to shifting epidemiology and economic transitions in developing countries, Dr. Pablos-Méndez called for flexibility, innovation and collaboration.

In the 1960s, development assistance from bilateral organizations represented over 70% of capital flow into developing countries, but due to growing trade in the global economy, dependency on foreign aid has sharply declined and this figure has dropped to only 13%.  While growing economies represent greater opportunity for national investment, health expenditures are projected to grow faster than GDPs, thereby presenting a challenge to develop sustainable financing solutions. Countries will have growing needs to address systems inefficiencies, inequitable access to healthcare and catastrophically high expenditures faced by segments of the population. They will face expanded private sector healthcare accompanied by issues of regulation to assure quality of services provided.

In anticipation of these shifts, Dr. Pablos-Méndez explained that US Global Health Initiative (GHI) will focus its efforts towards strengthening systems, fostering ownership and encouraging leadership, including greater domestic investment in healthcare. Interventions will be integrated across health areas and will move from a disease model to serving the needs of a patient. Smoking, obesity and basic prevention will gain prominence, and health financing will become increasingly central to country plans. To foster cross-border learning, the Health Systems Office of USAID will act as a hub of knowledge management on complex systems, service delivery, governance, financing, training and professional development. Additionally, GHI promises to streamline PEPFAR and PMI and encourage greater interagency collaboration for a more strategic health response to the challenges of our times.

Following Dr. Pablos-Méndez's formal address, he fielded questions from the audience. The early discussion highlighted a need for greater evidence linking health systems interventions to measurable health outcomes, such as a recent study from Ghana showing increased healthcare visits and decreased mortality for populations covered by national insurance versus the uninsured. In another example of efforts to establish a clear evidence base, Dr. Pablos-Méndez noted that the Global Health Bureau will hold a summit to examine the impact of financial incentives on maternal health outcomes and identify which knowledge gaps remain. The DHS and National Health accounts are other excellent contributors to the evidence base, but the need for global goals and indicators for health systems efforts remains and could be addressed in the 2015 revisions of the Millennium Development Goals.

Concern was raised about the growing enthusiasm for treatment—particularly with the success of treatment as prevention for HIV—and the potential for that enthusiasm to distract from health systems initiatives or deplete their budgets. Dr. Pablos-Méndez recognized that this is a valid concern, but reminded attendees that community health workers need to be able to refer their patients to medical services and that treatment adherence will be impossible to sustain without a functional health system to assure drug supplies. He also echoed his earlier sentiment that meeting global health benchmarks can only be considered a success if those gains are sustained, and that this will only be possible with health systems strengthening.

One participant noted the risks of health market disorganization coupled with large numbers of informal private providers giving healthcare of variable quality around the world, and asked the speaker whether USAID has a strategy to approach these issues or a vision of how this might shift over time. Dr. Pablos-Méndez and his colleague from USAID agreed that there is a growing need for stewardship of mixed systems and that it will require public sector acceptance of this role and a philosophical shift towards greater data capacity and stronger alliances with national and international partners. Beyond stewardship, public sector leaders need to be better equipped to develop contracting agreements with the private sector and to monitor and manage those relationships to deliver high quality programs and services. The Rockefeller Foundation has recently advanced this discussion through a high level working group and the W.K. Kellogg Foundation has demonstrated in Latin America that public and private working relationships can function well. Thailand has also demonstrated that as general governance improves in a country, so does public sector capacity to manage private providers.

The discussion concluded by reemphasizing that country leadership and creative, flexible initiatives are essential to meeting the global health challenges of the future and that basic management principles and health systems structures will form the backbone of any successful strategy. 

Report compiled by: Michelle Geiss, JHSPH with help from Jeff Knezovich, IDS.