What We Do

Integrated Delivery

Strategy Overview

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A family planning consultation at the Virangana Avanti Bai Hospital in Lucknow, India.

A family planning consultation at the Virangana Avanti Bai Hospital in Lucknow, India.

Our Goal:

To accelerate the delivery and increase the impact of the foundation’s investments in drugs, diagnostics, and other products and services that improve the lives of people in the developing world.

The Challenge

At A Glance

Life-saving drugs and diagnostic tools are expensive in the developing world, can take years to introduce into low- and middle-income countries, and are difficult to make widely available.

Efforts to prevent disease and improve health are often uncoordinated and fail to capture the potential benefits of shared investments and infrastructure.

Integrated, efficient delivery channels and stronger country primary healthcare systems are critical to improving global health.

We coordinate and integrate the delivery efforts of foundation programs and their partners in the field in the areas of health, agriculture, financial inclusion, and sanitation.

Our Integrated Delivery strategy is led by Dana Hovig, director, and is part of the foundation’s Global Development Division.

Efforts to prevent disease and improve health are often uncoordinated in the developing world. Even when life-saving drugs and diagnostic tools can be made affordable enough for poorer countries, they can take years to become widely available due to lack of efficient and effective delivery systems.

Without a systematic effort to improve coordination and create shared delivery channels, health programs will remain fragmented and resources will be wasted on redundant systems. Country primary healthcare systems, which are the primary means of delivering health interventions in developing countries, also urgently need improvement. At the same time, opportunities for coordination across health and development sectors (between health and agriculture, for example) are underexploited.

We largely know what to deliver and what solutions are “effective.” The international health and development sectors have developed best practices, life-saving interventions, and drugs and treatments that work when they are used in the right way and at the right time. However, less attention has been paid to performance management and achieving greater efficiency, productivity, and accountability in service delivery channels and health systems.

The Opportunity

Global partnerships and infrastructure have helped achieve major gains in vaccine coverage. The vaccine system has benefited from coordinated investments in products, launch capacity, and markets; delivery platforms that serve multiple programs across multiple geographies; and integration with country health systems that deliver essential health services.

Drugs, diagnostics, and other interventions need the same kind of coordinated delivery and shared infrastructure—starting with product design, market research, launch planning, innovation introduction, and efforts to achieve large-scale coverage and impact.

Our Strategy

The Bill & Melinda Gates Foundation is an active funder of delivery programs in developing countries. Since 1999, we have invested US$7 billion in the delivery of non-vaccine health solutions, accounting for about 30 percent of all foundation grants to date. We anticipate maintaining our commitment to delivery in the future.

A mother feeds oral rehydration solution to her child in Dhaka, Bangladesh.

A mother feeds oral rehydration solution to her child in Dhaka, Bangladesh.

However, like many of our partners in global health, we have realized that our delivery efforts for specific diseases and specific health products can lead to fragmentation. Unless we coordinate delivery efforts across our foundation programs, help strengthen entire country health systems, and help build integrated delivery channels that include both public and private-sector providers, we cannot achieve our ambitious global health and development goals.

The Integrated Delivery team was established in 2012 with a mandate to enhance the impact of delivery investments made by the foundation’s various program teams in the health and development sectors. We provide technical support to those teams and their partners to help speed the delivery and improve the effectiveness of life-saving and life-improving interventions. We also make investments to improve delivery systems more broadly.

Our team is guided by the following priorities:

  • Integrate systems and coordinate investments where it makes sense
  • Focus on measurable results
  • Start by understanding the customers—individuals, families, and communities—and consider their needs in the design of products, programs, system improvements, and investments

Areas of Focus

Product Design and Delivery

We help foundation teams and their partners conduct market research and market testing so products and tools can be designed to meet user needs. We also help support the launch and distribution of those products, which range from contraceptive devices to HIV diagnostic tests, nutritional supplements, and tuberculosis drugs.

One example is our work in helping to plan the introduction of a new diagnostic tool and new treatment for sleeping sickness (human African trypanosomiasis). The existing diagnostic method involves a painful procedure at a hospital, and the treatment is based on an arsenic compound, which causes terrible side effects and has a 5 percent death rate. A new diagnostic tool that the foundation is co-developing is pending approval and requires only a finger prick and no lab analysis. A new treatment that completely cures the disease with 10 pills in 10 days is also pending approval. The launch and targeted delivery of the new diagnostic tool and drug will make elimination of sleeping sickness feasible within our lifetimes.

Integrated Programs and Platforms

We support efforts to design and build delivery platforms that serve the needs of multiple programs across multiple geographies. We have identified five delivery platforms, or “public goods,” that we aim to strengthen.

An outreach worker uses a cell phone to register a mother and child near Accra, Ghana.

An outreach worker uses a cell phone to register a mother and child near Accra, Ghana.

  • Community health worker programs. We provide funding, technical assistance, and performance evaluation tools to country community health worker programs to improve their quality, reach, and impact.
  • Supply chains. We help countries design more effective supply chains.
  • Information and communications technology (ICT). We invest in ICT systems that can help strengthen the delivery of primary healthcare and other interventions and facilitate information-sharing and behavior-change initiatives.
  • Behavior change. We are exploring what more the foundation can contribute on the “demand side” to motivate healthier behaviors and increase the use of life-saving tools and technologies.
  • Data systems. We invest in data systems that improve primary care systems, delivery measurement and accountability, and performance management of health systems.

One example is our investment in improving child health in Burkina Faso by strengthening community health worker productivity and performance. The effort includes providing health workers with electronic devices to help them accurately identify childhood illnesses, increase their adherence to established treatment guidelines, and strengthen the ability of district health teams to use data to manage health workers and track their performance.

Strengthening Primary Healthcare Systems

People who live in countries with strong primary care systems are healthier overall. For the poorest people, the primary care system is their main source of healthcare.

A health extension worker in Ethiopia teaches about nutrition, breastfeeding, and vaccinations.

A health extension worker in Ethiopia teaches about nutrition, breastfeeding, and vaccinations.

We invest in strengthening country healthcare systems that provide treatment, prevention, promotion, and other essential services. Our focus countries currently include Ethiopia, India (Bihar and Uttar Pradesh), and Nigeria. We take a “whole systems” approach that includes both the public and private sectors. We respect and honor the choices that people in low- and middle-income countries make in terms of where they seek health services, and we aim to strengthen the quality of public, private, nonprofit, and faith-based service providers.

In India, for example, the foundation has invested in improving the performance management of the Bihar government’s primary care system via mobile training tools for community health workers; developing digital systems for recording patient data, tracking performance, managing and supervising health workers, and monitoring family planning and routine immunization coverage; and developing digital payment systems for healthcare. We also offer technical support to improve the quality of care and promote accountability.

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