17-18 November Istanbul, Turkey

Effective International Collaboration 2015

Collaborating with the Business Sector for Positive Health Impact

Gary Cohen Executive Vice President & President, Global Health & Development BD (Becton, Dickinson and Company)

Background

• Over 30 years experience in medical technology with BD; a global company with 47,000 employees in over 50 countries

• Expertise in drug delivery, infectious disease, immunisation, health system strengthening, health and human rights

• Extensive engagement in cross-sector collaboration

• Official roles in the business sector, nonprofits, foundations and international agencies

• Devotion to addressing the world’s health needs via collaboration, particularly in vulnerable populations

Methods for Societal Impact from Business Sector

Corporate Philanthropy Providing charitable donations of cash or in-kind products and services Example: Donating vaccines and devices to immunize children

Corporate Social Responsibility Deploying business resources and competencies to achieve positive societal impact not directly linked to commercial outcomes Example: Training laboratory workers in developing countries

Shared Value Creation Utilizing commercial business models to address unmet societal needs Example: Developing new innovations to address newborn mortality

Advocacy & Policy Alignment Supporting changes in laws or regulations for positive societal impact Example: Policy guidelines to improve safety for patients & workers

Shared Value Creation

• Shared value initiatives are developed with an explicit intent to address unmet societal needs

What Distinguishes Shared Value Initiatives from Traditional Business Initiatives?

• Shared value initiatives are often pursued in collaboration with other sectors

• Focus is on major societal needs prioritized by governments and leading organizations

Millennium Development Goals

Safe Immunisation – Shared Value

• HIV/AIDS & hepatitis were spread due to device reuse

• UNICEF & WHO sought technology to address problem

• BD & PATH co-developed first ‘auto-disable’ syringe, entered field trials in 1988, launched 1991

• Took eight years for widespread use: - Joint policy statement WHO/UNICEF/IFRC - Substantial cost reduction 11c to 5c - GAVI funding for global immunization

• Initiatives for tetanus and measles immunization supported use of auto-disable technology

• Over 6.5 billion BD auto-disable devices supplied since 1999 for safe immunization of children

Safe Immunisation – Corporate Philanthropy

Safe Immunisation – Advocacy & Policy Change

Lab System Strengthening – Shared Value

• In late 1990’s, access to ART severely limited in the highest prevalence countries (mostly in Africa)

• Global funding mechanisms established in 2002/2003

• Lab tests essential for effective ART, particularly CD4 and viral load, but lab capacity very limited in Africa

• BD entered into access pricing agreement with Clinton Foundation (CHAI) in January 2004

• BD implemented extensive CD4 training; over 8000 lab technicians trained to date in over 60 countries to date

• CD4 testing became widely accessible in resource-poor countries

• New point of care CD4 instrument recently launched

Lab System Strengthening – CSR

• In 2007 BD, PEPFAR and CDC formed 5 year public-private partnership with $20 million funding commitment

• Renewed in 2012 for 5 additional years as “Labs for Life”

• Implemented in high HIV and TB burden locations in Uganda, Kenya, Ethiopia, Mozambique and India

• BD deploys expertise and training through internal volunteer recruitment mechanism

• Improved access to specialized testing services for MDR-TB, particularly in HIV co-infected patients

• Identified 14% of TB retreatment cases in Uganda as MDR

• Reduced TAT for TB testing from 3 weeks to 3 days in Uganda

• Supported development of a national laboratory quality assurance strategic plan in Mozambique

Maternal/Newborn Mortality – Shared Value

289 K + 10 million

2.7 M

+ 2.6 million

Maternal/Newborn Mortality – Shared Value

• Intra-partum complications contribute to ~40% of maternal mortality and ~25% of newborn mortality

• Severe co-morbidities from prolonged 2nd stage labour; infection, fistula, incontinence, fetal demise, fetal asphyxia

• Present extraction methods -- forceps, vacuum and caesarian section -- introduce varying risks

• BD Odon Device™ invented by auto technician from Argentina

• Winner of ‘Saving Lives at Birth: Grand Challenge for Development’ competition

• Presented to BD by WHO at Davos in January 2012

• In development including clinical studies to demonstrate safety and efficacy

• Engaging in extensive cross-sector collaboration to bring this to scale and make it accessible in high burden populations

Collaborating for Positive Health Impact

• Philanthropy, CSR and shared value creation are all important methods for companies to achieve positive societal impact.

• All three methods can work in combination to comprise a viable, high impact strategy to help address unmet societal needs.

• Unlike philanthropy and CSR, there is no scale limit to shared value creation.

• Public private partnerships are an art, not a science, many will fail, important to understand the factors that drive success.

• Collaboration requires trust. Care must be taken to choose partners, including companies, where motivations and goals are well aligned.

• The launch of the SDGs enables companies to engage around well defined goals and targets that are relevant to their areas of capability.

• All these methods and approaches are applicable to addressing cancer.

Dr Sania Nishtar  Why being conscious of and managing

conflict of interest is important?

What is a Conflict of Interest?

 Conflict of interest arises in situations when a person or an organization is involved in multiple interests and a risk arises that the individual’s decision making or judgement or actions in a primary area of interest will be influenced by a secondary interest.

  Primary interest, key goal of a professional activity   Health of a patient   Integrity of research   Duties of public office

  Secondary interest   Financial gain   Desire for professional advancement and the   Wish to do favours for family and friends

Conflict situations and examples:

! Accepting personal gratuities: ! An employee receives a “free” large-screen TV from

a vendor seeking a contract with the organization. “Just try it and see if you like it. No obligations.”

! Conflicting allegiances ! The Purchasing Director steers procurement

decisions to favor a company where a family member works.

Conflict situations and examples:

! Using or disclosing confidential information ! An NGO’s employee uses confidential donor list to

solicit gifts for another community non-profit organization.

! Maintaining roles that conflict ! A cabinet member FastTrack's non-priority projects,

which benefit his company on which he is still active

•  Employees, trustees, those in advisory positions, consultants

•  Policy-makers •  Public office holders •  Decision-makers in sensitive areas at the

interface between the public and private sector

 The presence of conflict of interest does not mean the occurrence of impropriety  The existence of conflict of interest means that there is a risk that judgement may be compromised, it does not mean that a lapse has actually occurred

Approaches for managing conflict of interest  “Prohibition” model is based on a

presumption against relationships that might present a conflict;  "Disclosure and peer review" model rests on presumption that such relationships are unavoidable but manageable.

 Example of institutional approaches to Conflict of interest  World Health Organization Conflict of interest guidelines and procedures  Declaration of Interests for WHO experts

Mechanisms for dealing with conflict:   Voluntary, Disclosure, financial distancing, self-regulation,   Institutional, Defining categories of acceptable activities, implementing oversight of those activities, defining categories of unacceptable activities, implementing prohibitions and sanctions.

Personal reflections, voluntary self regulation

Personal reflections, voluntary self regulaation

hWp://www.sanianishtar.info/pdfs/HOP\Compendium_Final.pdf!

Personal reflections, financial distancing and disclosure

Are my actions in alignment with my personal values and those of the institution I represent?

Am I being honest about all facets of the situation? Do the right people know what’s going on?

Do my actions feel right? Do they reflect a basic understanding of generally accepted standards of right and wrong?

Think you have a conflict? Consider these questions…

Institutional approach to COI   Institutional COI policies and procedures   Definitions, including what is a significant financial

interest to be reported   Periodic disclosures and ad hoc disclosures when

potential conflicts arise and their review   Conflict management plans and responsible

individuals with accountabilities   Processes to ensure that management plans are

enforced to manage, reduce, eliminate conflicts

2015 Sustainable Development Goals: the rationale for attention to partnerships…

The changing landscape for NCDs   2011, United Nations High level Meeting   2012, a target of reducing the number of premature deaths from NCDs   In 2013, countries agreed to a Global NCD Action Plan  WHO Global NCD Action Plan 2013-2020  WHO GCM/NCD

Partnerships and NCDs   Disease domain integration, (4 diseases, 4 risks)

  System level integration as part of approaches to UHC (public health and health systems)

  Inter-sectoral approaches (trade, commerce, education, finance, agriculture, sport, built environment, local government)

  Multi-sectoral approaches (government, civil society, private sector, professional associations)

  Incorporating contemporary evidence-based concepts with this approach

Aligning points of interest with a large number of actors

European"Center"for"Development"Policy"Management,"July"2012"

Principles of COI management  Serving the public interest  Supporting transparency and scrutiny.  Promoting individual responsibility and personal example  Engendering an organisational culture which is intolerant of conflicts of interest