Public Health Foundation of India Initiative

1
Public Health Foundation of India Initiative
CONFIDENTIAL

• Public Health Foundation of India

Brief Presentation
October 19, 2005
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discussion.
2
AGENDA

• Public Health Foundation of India (PHFI) concept
• Support for PHFI
• Next steps

3
PUBLIC HEALTH CHALLENGE IN INDIA NEEDS TO BE
ADDRESSED AT THE ROOT CAUSE LEVEL
Root causes are shortage in human resource
capacity and absence of support structures
India faces serious public health challenge

• Human resource shortage
• Serious shortage (10,000 professional/ year) of
  public health professionals across hierarchy of
  government machinery, in NGOs and in private
  sector
• Small scale and questionable quality of current
  schools of public health
• Absence of accreditation system to standardise
  public health education
• Absence of mechanism to motivate public health
  qualification as no meaningful career track
• Support structures inadequate
• Lack of surveillance system to gather and
  disseminate reliable health data
• Absence of high quality public health research
  agency
• Absence of credible entity that helps shape
  public health policy

• Scope for improvement of key health indicators
• Infant mortality at 67 is twice that of Chinas
  at 31
• Life expectancy at birth (62.9 years) lower than
  China (70.5 years)
• Increasing disease burden
• Increasing prevalence of communicable diseases
  (e.g., Dengue, HIV/AIDS)
• Emergence of non-communicable diseases
• Public health response could be improved
• Only 0.9 of GDP spend on public health versus
  1.8 by China
• Wide disparity in resource allocation not exactly
  correlated to need
• Utilisation of funds could improve (only 10-25
  on actual programs currently

Need a root cause based response
Annual number at deaths of children less than 1
year of age per 1,000 life births
4
PHFI IS LARGE SCALE RESPONSE TO ADDRESSING HUMAN
RESOURCE CAPACITY BUILDING IN PUBLIC HEALTH IN
INDIA
. . . six distinctive themes
Three pronged charter . . .

• Simultaneously addresses all aspects of
  professional capacity building supply
  enhancement, demand creation, applied research,
  creating standards for public health education

• Create capacity to train 10,000 people/year in
  public health
• Establish network of 5 world class schools of
  public health (new) IIPH
• Strengthen some of the existing schools of public
  health through technical support
• Create a pool of permanent faculty to sustain
  effort

• Orders of magnitude larger in scale compared to
  existing initiatives
• 100-150 students/year per school on long term
  programs
• 1,000 students/year per school on short term
  programs

• First of its kind public-private partnership with
  autonomous governance
• Government support but not control
• Professionally managed with an empowered and
  carefully constituted governing board represented
  by multiple public and private stakeholders
• Self governing, line of sight decision rights
  with executive officers
• Initial board members and first president
  nominated by Honourable PM after which self
  perpetuating centre of excellence

Autonomous governance (PPP)

• Programs offered will have field/forum approach
  unique to Indias needs in research,
  implementation etc.
• Long and short term programs with multiple
  degrees certificate to D.Ph., M.Ph., PhD

• Help in setting up an accreditation agency to
  standardise public health education in the country

• Strong technical/academic partnerships to provide
  world-class quality of education
• Partnerships with government and Public Health
  organisations to ensure visible on-the-ground
  impact

• Serve as influential think tank to the public and
  private sectors in shaping policy (eg catalyzing
  demand for public health professionals in the
  states)

• Leverages capabilities across existing centers of
  excellence
• Helps scale up capacities of other institutes

• 1st of its kind initiative to sustainably and
  scaleably address human resource capacity
• Could be one of the most visible and impactful
  public health initiatives internationally

Public Health Foundation of India
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PHFI DESIGNED TO BE AN AUTONOMOUS PUBLIC PRIVATE
PARTNERSHIP WITH A WELL DEFINED STRUCTURE
PHFI would have a well defined structure to
ensure autonomy
Each school that PHFI establishes will also have
a board

• Many members common with foundation board
• Few additional members e.g. from champion
  states around schools, academic partners, etc.

• Completely autonomous governing board of 11-17
  members headed by a chairman
• Responsible for overseeing functioning of
  foundation with clear decision rights (appointing
  Chairman, President, financial planning etc.)
• Representation from multiple stakeholder groups
  including government (but not controlled)
• Initial board members and first president to be
  nominated by PM. Subsequently, self-perpetuating

Governing Board of PHFI
Advisory Board of PHFI
Governing Board of School
Advisory Board

• 25 member advisory board
• Drawn by governing board
• Provide expertise/ counsel to No decision rights

President (ex-officio board member)
Director

• Fully empowered president
• Distinguished public health professional
• Full time dedicated to foundation

Program Deans
Area chairs
Admin Head
Centre1
Centre2
Program1
Program2
Administrative staff
Finance
Subject matter experts
HR
Maintenance
Support staff
Focus of this exercise is to identify potential
governing board members for the foundation (PHFI)
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PHFI WOULD ESTABLISH A NETWORK OF 5 SCHOOLS OF
PUBLIC HEALTH TO ADDRESS INDIAS NEEDS
INITIAL HYPOTHESIS,YET TO FINALISE
North and East
5
North
1

• districts covered 141
• BMO/year covered 487 (for training)
• Other criteria to assess
• Near centre of learning
• Access
• Apetite/readiness ofstate government

• districts covered 116
• BMO/year covered 190 (for training)
• Other criteria to assess
• Near centre of learning
• Access
• Apetite/readiness ofstate government

Jammu Kashmir
Himachal Pradesh
Punjab
Uttaranchal
Arunachal Pradesh
Haryana
Sikkim
Nagaland
Uttar Pradesh
Assam
Rajasthan

• Flagship initiative is to set-up 2 new schools of
  public health in supportive states (North and
  South?)
• Parallelly, demand would be catalysed in states

Meghalaya
Manipur
Bihar
Tripura
Mizoram
West Bengal
Gujarat
Jharkhand
Madhya Pradesh
East
3
Chattisgarh

• districts covered 124
• BMO/year covered 244 (for training)
• Other criteria to assess
• Near centre of learning
• Access
• Apetite/readiness ofstate government

Orissa
Maharashtra
West
4
Andhra Pradesh

• districts covered 109
• BMO/year covered 166 (for training)
• Other
• Near centre of learning
• Access
• Apetite/readiness ofstate government

Karnataka
South
2

• districts covered 100
• BMO/year covered 300 (for training)
• Other criteria to assess
• Near centre of learning
• Access
• Apetite/readiness ofstate government

Tamil Nadu
Kerala
Is also approx. the number of district health
officers who need to be trained annually BMO
Block Medical Officer Source Team analysis
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CATALYZING DEMAND FOR PUBLIC HEALTH PROFESSIONALS
IN THE STATE GOVERNMENTS IS CRUCIAL
Description

• Identifying candidates in the state health system
  for short and long term programs (primary health
  care officers to state health officers)
• Sponsoring the education of the candidates
• Ensuring the candidates return to the state
  health system after education

• Ring-fencing dedicating candidates for a year
  after education on specific high-value
  initiatives
• Creating a cadre for public health and mandating,
  supporting public health qualification
• Modifying the compensation structure to make
  public health a more attractive profession

Key elements

• Provide land for and host a school of public
  health in the state
• Provide research opportunities for foundation on
  specific state relevant public health research
  topics
• Potentially partner with multi/bi-lateral,
  development agencies to co-sponsor public health
  education of people in the health system

Source National consultation McKinsey Co.
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DETAILED MULTI-INSTITUTE FINANCIAL MODEL HAS BEEN
WORKED OUT
ESTIMATES
Overall Rs.500 crore (5 schools)
Per school (Rs.95 crore)
Set-up cost

• Buffer (Rs.25 crore)
• To support first 3 years

Infrastructure (Rs.45 crore)

• Corpus (Rs.250 crore)
• Steady state interest income

Corpus (Rs.50 crore)

• Rs.500 crore (110 mn) project overall in next
  5-7 years
• Majority of funding (85) outside government
• Government funding is symbol of support
• Self sustaining from year 3 onwards

• Infrastructure (Rs.225 crore)
• 2.75 lac built up area

Foundation
Revenue model
Cost model
Operating Model (Annual)
Rs.1-2 core/year
Rs.22 crore/year/school
Rs.18-20 crore/year/school
Facilities
Corpus Income
Mainte-nance and infrast-ructure
Salaries and staff
Tuition
Faulty and staff
Research
Research and consultancy
100 Rs.500 crore
Fund raising plan (for set up)
Indian government
Corporations
Individuals
Private health foundations
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AGENDA

• Public Health Foundation of India (PHFI) concept
• Support for PHFI
• Next steps

10
PHFI CONCEPT WAS EVOLVED IN A COLLABORATIVE
MANNER WITH INPUTS FROM VARIOUS STAKEHOLDERS
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THERE IS WIDE SUPPORT FOR AND ENTHUSIASM ABOUT
PHFI
Constituency
Support

• Prime Ministers office very supportive and agreed
  to nominate initial governing board, President
• Planning Commission has given in-principle
  approval
• Health Ministry championing initiative and
  funding
• Department of Science and Technology offered
  technical and financial support
• State Governments - sponsor candidates, host
  schools, make policy changes to absorb products
• Civil Society Groups and Academic Institutions in
  India for collaborative research and faculty
  exchange

• Unanimous support from multiple stakeholders
• Could be one of the most visible public health
  initiatives internationally

• Association of Schools of Public Health (ASPH)
  agreed to provide technical research and faculty
  support
• US Dept. of HHS very supportive of initiative
• Other International Schools of Public Health for
  curriculum design, visiting faculty Harvard,
  Johns Hopkins
• Global Forum for Health Research research
  linkages
• Multi and Bi Lateral Agencies exploring
  tri-partite funding between agency, state and
  foundation to sponsor candidates
• Private Health Foundations, NRIs financial
  support

12
AGENDA

• Public Health Foundation of India (PHFI) concept
• Support for PHFI
• Next steps

13
CLEAR NEXT STEPS AGREED UPON WITH HEALTH MINISTRY