The Prime Ministerial Consultation (a case study) (a case study) (a case study) University of Waterloo, September 2009 John Hoey MD [email_address] slideshare.net/hoeyj All resemblances to a particular person or country are entirely coincidental

University of Waterloo,

September 2009

John Hoey MD

[email_address]

slideshare.net/hoeyj

The Prime Minister is preparing his last days in office prior to calling an election. Although critics claim that what follows is a obvious gambit to gain votes in more liberal parts of the country, the PM insists his actions are entirely humanitarian. He has proposed that his country, for the first time in its short history meet international targets for humanitarian aid. At present his country donates 0.4% of GDP for humanitarian external aid. This is far from the agreed international target of 0.7%. And, most of his countries humanitarian aid is ‘targeted’. Thus, for example, the ‘gift’ of 100,00 lawnmowers from a manufacturer in Brockville, (name of country) to Nomadic tribes in the Gobi desert. The PM Proposes to contribute 0.7% of GDP for humanitarian aid, all of it untargeted. He wants the aid to be obvious. A condition is that it be restricted to 3 countries, those in most need.

He has asked an expert group to make a proposal on where to direct the aid. The expert group has submitted the proposal. The PM asks for your opinion on the countries selected. “Which ones should get the cash?” he says. You are a recent graduate from the University of Waterloo MPH program doing a summer internship at the office of the PM.

He has asked an expert group to make a proposal on where to direct the aid. The expert group has submitted the proposal. The PM asks for your opinion on the countries selected. “Which ones should get the cash?” he says. You are a recent graduate from the University of Waterloo MPH program doing a summer internship at the office of the PM.

Humanitarian Aid Calgary Group Proposal to PM Crude* *Crude Oil Deposits in trillions of barrels - Needing Development

*Crude Oil Deposits in trillions of barrels - Needing Development

Which countries would you choose? How would you choose?

Which countries would you choose? How would you choose?

80 60 40 20 GDP/Capita

80 60 40 20 GDP/Capita Life Expectancy Amartya Sen Development as Freedom, Random House, New York, 1999

Amartya Sen Development as Freedom, Random House, New York, 1999

Health ~ factors that influence well-being Medical Care Economy Environment Expertise Food, housing Physical Social Health Accesibility Justice Jobs Credit Genetics Neighbourhoods Law Security Culture School

We might have discussed - perhaps we did: Criteria for decision making in health 1. What tools are available? National health/death statistics Health survey data etc.. 2. Measures of efficacy/effectiveness of programs Multiple outcomes/competing or synergistic? 3. Cost effectiveness 4. Feasibility 5. Political risk/benefit 6. Sustainability 7. Models for program development and evaluation Some reference material Amartya Sen Development as Freedom, Random House, New York, 1999 Shepperd S. et al. Can we systematically review complex medical interventions? PLoS Med 6(8): e1000086. doi:10.1371/journal.pmed.1000086

We might have discussed - perhaps we did:

Criteria for decision making in health

1. What tools are available?

National health/death statistics

Health survey data

etc..

2. Measures of efficacy/effectiveness of programs

Multiple outcomes/competing or synergistic?

3. Cost effectiveness

4. Feasibility

5. Political risk/benefit

6. Sustainability

7. Models for program development and evaluation