A conversation with PATH on September 21, 2011

Note: This set of notes gives an overview of the major points made by PATH during a visit by Good Ventures and GiveWell staff to PATH's Seattle headquarters on September 21, 2011 to learn about its activities and funding needs.

What sets PATH apart

• Focus on developing technology and producing actionable research.
• Strong understanding of the role of technology — since PATH does significant work both in the field and in the laboratory, it is positioned to understand what technologies are needed and what technologies have promise.

Some of PATH's biggest success stories

• Vaccine vial monitor, Soloshot AD syringe and other technologies.
• Long-lasting, affordable Meningitis A vaccine recently developed.
• Leading an initiative to roll out immunizations against Japanese encephalitis throughout India.

PATH's Projects

PATH provided summary information on all its projects: a Board of Directors report on its largest 30, and a summary list of its other projects. Its largest projects:

• Malaria Vaccine Initiative, funded by the Gates Foundation.
• AIDSTAR project, funded by USAID; here PATH appears to be collaborating with multiple partners on multiple projects with a broad mandate of fighting HIV/AIDS.
• AIDS, Population, and Health Integrated Assistance (APHIAplus) project, funded by USAID — a broad-mandate program in Kenya, led by PATH with implementing partners Jhpiego, World Vision and Elizabeth Glaser Pediatric AIDS Foundation. Headings are "integrated service delivery," "social determinants of health," "economic strengthening," "food security," "education, life skills, and literacy," "safe water, sanitation, and improved hygiene," "protective services" and "social mobilization for health."
• Malaria Control and Evaluation Partnership in Africa (MACEPA) — a program with a broad mandate of fighting malaria, funded by the Gates Foundation.
• Pneumococcal Vaccine project, funded by the Gates Foundation.

Use of small unrestricted donations

PATH can share a summary breakdown of how unrestricted funds have been spent.

The PATH fund is used to fund smaller-scale requests from within PATH that can lead to larger projects. This fund is estimated to have $250-600k of room for more funding. Examples were provided to GiveWell:

• Literature reviews
• White papers
• Development of proposals for larger grants
• Small-scale testing of an approach to diabetes screening

Another use of unrestricted funds is to meet matching requirements on larger grants.

PATH can share information on past projects that it would have funded if it had the funds, or future projects that it would like to fund if it gets the funds.

PATH's Funders

PATH's biggest funders are the Gates Foundation (~57%) and USAID (~27%). Much of the Gates Foundation money passes through to partners. 

Use of large-scale unrestricted funding

On room for more large-scale unrestricted funding: the Reach campaign is PATH's effort to raise $50 million for PATH-driven (as opposed to donor-driven) initiatives. The Gates Foundation has put up $15 million in matching funds.

PATH will soon be providing a set of (paragraph-length) ideas for PATH-driven projects.

Two projects that are representative of the sort of project PATH would like to carry out are the MACEPA project and the recently announced partnership with BHP Billiton. The MACEPA project is a field project where PATH has a broad mandate to fight malaria; the BHP Billiton project is a field project where PATH has a broad mandate to improve the health and development of very young children.

One of the benefits of field projects (like the MACEPA project and the partnership with BHP Billiton) is that they serve as a kind of laboratory for PATH to take lessons from the field and apply them to its work in developing and adapting technology. Asked for examples of this, PATH discussed the following:

• People in very low-resource areas often don't have toilets but do have cellphones. They can be quite adept with technology.
• Health center works understand rapid diagnostic tests and can use them, but the budgets for testing are all at the city level.
• Telemedicine can have downsides — it can encourage nurses to stop using judgment and to rely on the physicians, who don't necessarily have enough capacity.

 Other possibilities for large-scale funding:

• Technology development. For example:
  • Better tools for dealing with obstetric and neonatal emergencies at the community level — existing tools are too expensive and complex for low-resource, low-infrastructure environments. These could include ways to prevent postpartum hemorrhage (and treat it if it occurs), ways to get women to referral care, simple anesthetic machines, simple ways to do Caesarean operations.
  • Technology for noncommunicable diseases — for example, effective ways to monitor hypertension.
  • ​These are areas that don't fall into any of the "silos" and thus are potentially going to be underfunded, although currently PATH can support preliminary work on various areas via a one-time grant from the Gates Foundation.
• Helping to strengthen vaccine manufacturing capacity in China.
• Educating pharmacists to better deal with various key health needs, including family planning, TB control, and avian influenza. PATH can share documentation on its impact in this category, in Kenya, Nicaragua, Vietnam and Cambodia.

PATH believes that the behavior change programs it focuses on, such as interpersonal communication, community theater and mass media outreach, are key interventions that are essential to uptake in many health programs, e.g. HIV/AIDS control, TB control, vaccine delivery, etc.  PATH recognizes the challenges of evaluating the long-term impact of BCC, and continues to seek methodologies that demonstrate direct impact of these approaches. PATH and GiveWell should continue a discussion of this challenging area.   We agreed to follow up on this offline.

PATH has an organizational commitment to monitoring and evaluation. Its work in this area is still relatively young and it hasn't yet reached the point where M&E reports are a primary tool for assessing the success or failure of a project. PATH has a strong M&E emphasis at the project level.  PATH is two years into an effort to measure its organizational impact across programs and projects.