BEIJING SYMPOSIUM: Measuring private sector impact on a DALY basis
In the continuing quest to devise more effective, cross-organisational indicators to measure the impact and value of private sector healthcare delivery, the DALY (Disability Adjusted Life Year) model is beginning to gain greater traction. Originally developed by Harvard University for the World Bank in 1990, the DALY indicator measures the overall disease burden of an individual as expressed in the number of years lost due to ill health, disability or early death. Today, it is increasingly used to measure the longitudinal protective benefits of health programmes (both public and private) in the form of calculating the number of ‘DALYs averted’ (i.e. healthy life years saved). But what is it about the DALY model that makes it particularly attractive / effective for measuring the impact of the private sector in health?
According a lively session hosted by members of the Social Franchising Community of Practice (www.sf4health.org) at the University of California San Francisco, the DALY model has great potential in enabling the comparable measurement of impact between organisations, programmes and countries / regions – a task that has proven considerably challenging given the extraordinary diversity and fragmentation of private sector organisations that currently deliver health interventions. The tendency of providers to focus their impact metrics around the more easily quantifiable outputs (# clients served, # of clinics operating, etc.) has also further undermined both the impetus of these providers to collaborate and the capacity of donors to accurately decide which of the many interventions on offer give them the biggest bang for the their buck.
The DALY model might therefore represent a panacea for health evaluation in this sense, as it is in theory applicable across all kinds of health programmes and can provide comparative analytical data relating not only to impact (# of DALYs averted) but also cost-effectiveness (cost per DALY averted) and even incremental impact (# of additional DALYs averted through a programme after taking into account those already secured through existing interventions).
This is undoubtedly good news for donors, in providing them with a new tool through which to accurately compare and contrast the myriad of worthy programmes on the funding menu. It was even suggested during the session Q&A that multi-donor collaborations such as HANSHEP have a leadership role to play in promoting the standardisation of DALY indicators across their programme portfolios, and in simplifying and aligning reporting requirements across the donor community.
Of course, as all of the panellists at the session were careful to point out, no measurement tool is ever perfect and the DALY model itself also has a number of limitations that warn against isolating it as a stand-alone indicator of programme value. As an aggregative measure, it depends above all on the availability of good quality contextual data around (for example) disease prevalence rates, nutrition, gender and life expectancy. DALYs are also country, disease and age-specific – an anti-malarial mosquito net programme will result in many more DALYS averted in Rwanda than Cambodia for example, due to the greater prevalence of malaria in the former. DALY models can also take up to three months to develop while these contributing datasets are collected and analysed, and require updating at least on an annual basis in order to remain accurate. The number of organisations with the expertise to calculate or articulate their interventions in terms of the DALY model is also still small, and points to the need for widespread capacity building initiatives should this approach continue to gain currency in the development marketplace.
But these are relatively early days for the DALY model, and the fact that it is an imperfect science should not dissuade anyone of its evident importance for measuring the impact of health interventions going forward. Moreover, with technology continually enhancing the collection and communication of accurate data at local and national levels, the process of generating DALY calculations is likely to become easier all the time, enabling more effective decision-making and target-setting in both the public and private sectors.
This is the second in a series of daily blogs from the Second Global Symposium on Health Systems Research held in Beijing from 31 October – 3 November, and contributed by the HANSHEP Programme Manager with a view to generating further discussion and debate. For more information on the Symposium, including links to the programme and the session presentations referred to in this blog, please visit www.hsr-symposium.org.