American Evaluation Association
October 16-19, 2013
Presenter: Amy Ratcliffe
Title: Use of a health impact performance metric to inform decision-making at a large global health organization
Authors: Amy Ratcliffe, Graham Smith, Lek Ngamkitpaiboon, Hongmei Yang
Global health organizations are challenged to report on the health impact of their work at scale. To establish the priority on health impact rather than outputs, PSI adopted the ‘disability-adjusted life year (DALY) averted’ as its core performance metric. The DALY averted represents the number of years of healthy life saved by each unit of product delivered or service provided. While disease burden is commonly expressed in DALYs, expressing impact as DALYs averted is much less common. Through a set of health impact models, each PSI product or service is assigned a country-specific coefficient that is multiplied by product or service numbers to come up with DALYs averted for a given period of time. This allows PSI to compare the projected health impact of its programs across countries, regions and interventions, to track progress toward measurable organizational targets, and to be accountable to donors and national governments for contributions to health improvement. This paper will provide an overview of the tools PSI uses to maintain the organization’s focus on the DALYs averted and tie this metric and others related to it, e.g. cost per DALY averted and program targets in DALYs averted, to programmatic decision-making.
Implementing organizations in global health are increasingly pressured to evaluate their own performance and be accountable to donors for achieving measurable health impact. For organizations working across multiple geographies and targeting a range of health outcomes, there is often an additional need to show impact on the aggregate as well as in specific contexts. Many health impact metrics present limitations for priority setting because they can’t easily be compared. The opportunity to avert a case of heart disease is difficult to weigh against the opportunity to avert a case of post-partum hemorrhage.
Using the DALYs averted metric allows PSI to compare opportunities and evaluate progress against internal benchmarks. This also allows decision-makers to set projected impact against burden of disease estimates as an external benchmark and to weigh decisions about what health conditions to target in a given country.
This paper introduces the tools and methodologies that PSI uses to support the DALYs averted metric. DALYs have been around for a while but few organizations use them to project impact and inform decisions in this way. Tracking impact as DALYs averted would allow other organizations to express their own contributions to health improvements, and improving accountability to donors and to the communities they serve.
The challenge of helping PSI staff understand and track DALYs averted has been overcome through easy-to-understand descriptions, routine communications, and monthly reports. These reports, which include ‘dashboards’, tracking tools and map visualizations, make projected DALYs averted accessible and meaningful so they are more likely to be used for everyday decisions.