Putting Health Metrics Into Practice: Using the Disability-Adjusted Life Year (DALY) for Strategic Decision Making

9th World Congress on Health Economics,
Hosted by the International Health Economics Association (iHEA)
Sydney, Australia
7 July 2013

Putting Health Metrics Into Practice: Using the Disability-Adjusted Life Year (DALY) for Strategic Decision Making
Authors: Kim Longfield, Brian Smith, Rob Gray, Lek Ngamkitpaiboon, and Nadja Vielot

Background: Implementing organizations in global health are pressured to be accountable for performance. Many health impact metrics present limitations for priority setting; they do not permit comparisons across different interventions or health areas. In response, Population Services International (PSI) adopted the disability-adjusted life year (DALY) Averted as its bottom-line performance metric. While international standards exist for calculating DALYs to determine burden of disease (BOD), PSI pioneered the application of DALYs Averted to measure the impact of health interventions. This paper describes how the adoption of DALYs Averted influenced organizational strategy and presents the advantages and constraints of using the metric.

Methods: Health impact data from 2001-2011 were analyzed by program area and geographic region to measure PSI’s performance against its goal of doubling health impact between 2007-2011. Analyzing 10 years of data permitted comparison with previous years’ performance. A case study of PSI’s Asia and Eastern European (A/EE) region, and PSI/Laos, is presented to illustrate how the adoption of DALYs Averted affected strategic decision making.

Results: Between 2007-2011, PSI’s programs doubled the total number of DALYs Averted from 2002-2006. Most DALYs Averted were within malaria, followed by HIV/AIDS and family planning. The performance of PSI’s A/EE region relative to other regions declined with the switch to DALYs Averted. As a result, the region made a strategic shift to align its work with countries’ BOD. In PSI/Laos, this redirection led to better targeted programs and an approximate 50% gain in DALYs Averted from 2009-2011.

Conclusions: PSI’s adoption of DALYs Averted as its bottom-line metric shifted the organization’s strategic direction away from product sales and toward BOD. Now, strategic decisions are based on “BOD-relevance,” the share of the BOD that its interventions can potentially address. This switch resulted in more targeted strategies and greater program diversification. Challenges remain in convincing donors to support projects in disease areas that are relevant to a country’s BOD, and in developing modeling methodologies. The global health community will benefit from the use of standard health impact metrics to improve strategic decision making and to more effectively respond to the changing global burden of disease.