 Thanks, Steve, and thanks to all of you for joining us today. We're going to have a panel on measurement, accountability, and innovation. And as I was reflecting on the title of the panel, I uncovered some of my biases against the term measurement, which sounds incredibly boring to me, and it has ever since I got into the public health sphere. And I really think we need to be very clear when we package measurement It's not just about measurement for measurement's sake. It's about measuring results, measuring impact, and not stopping there. It's actually doing something about the results that you find to do better. So data that results from measurement that drives decision making is what measurement is all about. If you don't have measurement, you can't have accountability. If you don't know you're underperforming, you can't do better, and you can't fire the person who isn't doing as well as they should. And so that, to me, is the important principle underlying this discussion today. And we have a fantastic, very well-experienced panel from the spheres of global health, global business, global media and communications, all of whom have relevant experience to share with the global health sphere. And I would say that this is a microcosm, if you will, of how we need to be doing global health. Individuals who jealously guard global health topics because they're the experts in the field are not going to do as well in their endeavors as those who open their minds to approaches that have been proven to be successful in other disciplines, whether that be business or any other discipline in which there is a very clear focus on doing the best that you can because people are measuring you. So in global health, measurement matters for a few things. First of all, showing that what you're doing makes a difference. The fields of medicine, public health and science are littered with projects that began with very good intentions, but when somebody finally got around to measuring whether those things were making a difference, they found that, in fact, they weren't relative to more traditional practices or at worst, they were actually doing harm. Secondly, measurement allows you to identify what's working and helps you to do better because you can identify lessons learned and you can take those lessons into other programs to improve their performance. Thirdly is the point about accountability. If you're going to tie somebody's compensation to performance, you have to be able to measure that performance. And this doesn't just apply to the health practitioner in a country. It applies to global institutions such as the Global Fund for AIDS, TB and Malaria or GAVI, the Global Alliance for Vaccines and Immunization. We should be measuring all partners to determine whether they are performing as well as they should. Fourthly, in this day and age where resources are severely constrained, measurement allows you to maximize efficiency and stretch every dollar as far as you possibly can because if you're asking others to pony up more resources for global health and you can't show that you got the most out of the resources you already have, you're going to have a much worse chance of getting any additional resources committed to your priority areas. And so demonstrating efficiency is critically important in global health. And then finally, the bottom line is that you've got to be measuring your progress if you're going to show that you're moving the dial against the Millennium Development Goals or any other goals that you have set for yourself. And so measurement allows us to collectively up our game and do better. Before I introduce my panel, let me just say that one anecdote from the Gates Foundation. This is an organization that I'm privileged to be a part of that has access to significant resources, albeit a drop in the bucket relative to the global need, and also a certain amount of influence. Now, one can invest a million dollars into an endeavor and save X number of lives. Let's say you save a thousand lives. And you may feel very good about that. And you should feel good about that. But if you don't have a benchmark to know how well you should be doing, given that amount of money, given the influence that you have to measure yourself against, you don't know if you might be massively underperforming. And so in global health, we suffer because we don't have what business takes for granted. Business has shareholders, shareholders that have a voice. If a company is underperforming, the leader of that company hears about it and he or she has to up their game or they're out of a job. In business, you have competition. In global health, we don't have competition. If you are a grantee, if you're an NGO working on the ground, if you're a donor, you really don't have anybody that you're being measured against to know whether or not you're doing better or worse than they are. And so the fundamental issue is that we actually do have shareholders. We have beneficiaries that are living in developing countries. The problem is that they don't have a voice. They can't actually influence our actions. And so we have to come up with other mechanisms to ensure that we are holding ourselves accountable. So with that, let me turn to our panel to begin by sharing their thoughts on measurement, accountability, and innovation. In a moment, I'll turn to Mike Merson, who's a director of the Global Health Institute at Duke. I'm not going to go through everyone's bio in detail. You have that in front of you in the interest of time. Then I'll turn to Rona Appelbaum, who's the vice president and chief scientific and regulatory officer at Coke. Then Pat Mitchell, who is the president and CEO of the Paley Center for Media. And finally Rex Tillerson, who's the chairman and CEO of ExxonMobil. So Mike, let me turn to you first and have you give us a couple of minutes of thoughts on measurement, accountability, and innovation. I think we have two real challenges and they're addressed in the report, at least two. One, we have methodological challenges. As we heard from the deputy secretary today, the administration and I think our commission endorsed the fact that we need to measure impact of programs. That means deaths avoided, new infections avoided. It's not simply measuring how many people have a bed net or how many health workers have been trained or how many people have been treated, but showing impact. And I think this is something you've already addressed. And I think it's very important that we work together to come up with a set of indicators and ways of measuring them that demonstrate this impact. And then our second challenge I would say, and it's related, is an operational challenge. The commission heard some presentations about what it's like to be in the field having to produce data for different donors. And certainly, the situation is a little bit better than it was maybe five years ago when PEPFAR has worked to harmonize with other donors. But I think the commission certainly felt that to all extent possible the donors need to come up with a similar set of agreed upon monitoring and evaluation indicators for measuring the impact of programs that are agreed to with national governments and that everybody stick with these and not everybody add a few others. Because as we continue to do that we make it impossible in the field and we heard testimony to that in the work of the commission. So you'll see in the report we call for addressing both these methodological and what I would call operational challenges. And the third point I would make is, which has been alluded to already today, which is if we can have, I think Steve Morrison mentioned this, if we can have a 10 or 15 year horizon rather than a five year or God forbid one year horizon, then I think we can be more patient, we can plan better, and then we can look at our evaluation not producing results for tomorrow but producing results over a longer period of time. And if we have the confidence of the funding and the confidence that our programs will be around for a while, as long as we can demonstrate impact, I think this would go a long way to advancing the field. And I know that many of you are getting money year by year and we did talk about this at the commission and certainly you'll see in the report the strong recommendation that those of you out in the field implementing programs not be faced with these year by year deadlines because it's very hard to show impact on a yearly basis. But I think we need to be accountable to a common set of indicators but it doesn't mean we need to expect in reality, particularly with the problems we're dealing with, that we can achieve great success in one year. I think those are some initial thoughts. Great, thanks Mike. Want to turn to Rona? First, I'd like to say I agree with a lot of the things, many of the things, if not all of the things that have been said. The issue with process is absolutely key from the beginning into the end. And what I mean by that, it's absolutely essential to identify where you are and where you want to be and make it very clear to the point that's already been made that it's not going to be a quick fix. And in our society, everything, at least, especially in the business world, it's, you know, what is the next quarter results? They have a tendency to judge things on a three month basis. We can't do that. In global health, it's a long term. We have to be in it for the long term and we have to plan accordingly. At the same time, we have to also identify where those, you know, what the deliverables are and attempt to meet those outcomes. One of the points that was made very clear to me, and I was shocked to be perfectly honest, as it relates to the burden that's placed upon those organizations, those individuals that are trying to do the best job that they can, but their efficiencies and their effectiveness is impacted by the burden of reporting. It is so outrageous. Please see page 38 of the report where you see the spaghetti chart. And that's a nice term for it. When I was listening to the, you know, impassioned pleas, make it easier so we can do our job, which is absolutely spellbound binding for me. So I applaud the report and I applaud the experts who are making it very clear that we have to reduce that burden. We have to streamline it. We have to make sure that it's more efficient in order to get the job done that we need to do. There's a lot of... I'm so pleased to hear the commentary this afternoon as it relates to we all have a role to play. We can all learn from each other. And the idea of the embracing that I've felt and I've heard as it relates to the importance of public-private partnerships are absolutely essential. For a company like ours that's in over 200 countries, we can't do it alone. There's information that we have. There's lessons that we have learned that we would like to share. The outreach and the fellowship that we can glean and align and interconnect with in order to make things better. For our workforce out there, for our employees, for our consumers, and above all for ourselves would be absolutely essential. The things that we do in business are not strange. The applications that can be applied to what we need to do in the global health community are absolutely aligned. And to be able to do that more and more, to share our experiences, and in some instances share our resources, we would very much like to do. And it's been a true pleasure in terms of being able and an honor to be able to apply those types of lessons to this report. So thank you. Thank you, Ronette. So valuable for a global health discussion to be informed by perspectives from the private sector and now from media and communications. So Pal, let me turn to you. Well, certainly there's no tool for transparency, accountability, effectiveness, and reporting of impact than global media. And as someone who's been in the field for some time and now leading a discussion on the role of the global media plays across the landscape, let me just offer some thoughts. One of the ideas that we know will never live in a time of greater connectivity. We've never been more informed of the citizens of the global community. We've never been more informed as people in the field trying to address global health challenges. So we'll have at our disposal an enormous landscape of technology and media that wasn't there for people, that can shine the light in dark places, that can tell the stories, that not only illuminate the challenges, but also talk very clearly and directly about the programs that are in place, hold them accountable for their results, and then also connect American U.S. taxpayers to the stories that they are actually funding in the field. The good news on this is the connectivity. Additional good news and emerging news is that these technologies are giving us some tools. There's some small-scale experiments that are turning out to be quite effective through mobile technology in places where women, particularly during childbirth and pregnancy, isolated and often illiterate women are getting life-saving information through mobile phones. We know that... We also know this new open-source software that allows stakeholders to get to disaster areas and deliver very thin-pointed aid where it's needed. So we see a huge opportunity in the global media landscape to deploy these new technologies at a much greater rate and with much greater effectiveness. Whatever that may mean. The bad news is that according to the global media monitoring report that's done every two years, a news and information source across all countries across all forms of media. Social media, Facebook, Twitter, etc. to the mainstream news reporting in newspapers, magazines, and on television. Less than 10% of these stories are about global health. Now, of course, there are the spikes when there's a disaster, when there's an earthquake, or when there's an epidemic, or a threat of a pandemic. So it really came from where you grew up and how you're acting today. How come Elaine's not in there? Doesn't she want to see her own company? You want this. Yeah, here you are. Here you go. Okay. Yeah, real quick, because I've got to really get going to the shuttle. Okay. Have the challenge, along with the health professionals, to find a way to tell the stories that are compelling and engaging in the capture of the world's attention. We've heard today already personal stories that tell the whole story. The one one story that doesn't tell the every minute around the world somewhere. We know empathy research tells us we have to tell the stories that way. One child, one woman, it's so much more effective in media learning to do this now. And I must say that the Gates Foundation has found a way to do that very effectively with their living proof testimony that took the effect of their global health programs and told them through the personal stories. So that is, again, an opportunity. So the good news is we have new ways of telling the stories. The bad news is they're not being told effectively and consistently enough. But I am an optimist based on the opportunities we have ahead, but a little bit impatient with my colleagues in media by not recognizing and fully deploying media as a power player and both putting into place and supporting a smarter and more strategic global health policy. Thank you, Pat. Let me now turn to Rex Tillerson from ExxonMobil. Rex, you got involved in the global health so you're in a big way. Love to hear your thoughts. Well, as a business person, measuring and evaluating is central to any achievement of really large long-term objectives. For us, our business is pretty long-term in the things I do. We deal with 10, 20-year time horizons. And so I think part of the real important element of this report and has been noted by Mike is that we now want to focus on these issues with a longer-term strategy in mind, a 15-year time horizon. And we know what the objectives are and we know what the results we're trying to achieve or we want to eradicate malaria. We want to reduce the incident of HIV, AIDS by two-thirds. We want to save 2 million women a year from dying in pregnancy. We want to save almost 2.5 million babies a year from dying in the first month of childbirth. So we know what the endpoint is, but in achieving a strategic plan you have to have a good set of metrics that'll allow you to understand whether you are progressing toward achieving those objectives over this 15-year period. They're going to guide and direct the programs that you undertake, the effectiveness of those, and how to improve the effectiveness of those programs. But equally important, they're also going to guide you on what you want to stop doing because there will be things that work, there will be things that don't work. And to continue pursuing things that are not taking you toward that objective or consuming both financial resources and human capacity resources as well. So measuring and evaluating is simple to achieving any of these long-term objectives. And Mike mentioned and the spaghetti chart has been mentioned. I think the first time I saw that in one of our commission meetings may have been when Bob Rubin who just joined us held that chart up and we were all kind of horrified by this requirement that donor nations and donor agencies were putting on host government's recipients and we said, well gee, that just can't be right. A lot of those are the inputs, they're not really measuring what you're trying to achieve. And a lot of them were designed to meet the donor's requirements, not carrying us toward the objective. So I think one of the that was one of them, a great learning for me was to see how could this possibly be coming from the business community. The importance of evaluation really cannot be over-emphasized and there was a recent article in the Lancet which I thought just really nailed this. The title is evaluation, the top priority for global health. And I'm just going to quote a couple of lines out of it. Evaluation must now become the top priority in global health. A massive scale up in global health investments during the past decade has not been matched by an equal commitment to evaluation. This complacency is damaging the entire global health movement. Without proper monitoring and accountability, countries, donors, and taxpayers have no idea whether or how their investments are working. Evaluation matters, evaluation is science, and evaluation costs money. It's time that the global health community embraced rather than evaded this message. So it is going to require some dedication of financial and human resources in this area, but it is going to return huge dividends in the effectiveness of how the remaining dollars in human resources are utilized to achieve the objective. Now in the commission's report, there is a recommendation on getting at some very hard, fundamental results-oriented measures and agreement on metrics. Coming to a common set of metrics, as Mike mentioned as well, but also a recommendation that an independent, authoritative group be established to develop the evaluation process and to carry out that evaluation process. It could be within an existing agency. It can build on some of the measures that are already in place, some progress that has been made through PEPFAR, but let's establish what those set of metrics are. Let's have an independent body track those and report out those to donor countries, but to the congress. The people that are going to make this money available are going to want to know what are we getting. And there can never be a more important time now when you want to have this funding available in good times and in bad times and challenging times, you want this funding to be maintained uninterrupted because an interruption in the funding or financing, you lose a lot of ground. You give a lot of ground back on progress that's been made in so many of these areas when you have this interruption. These metrics are going to be vital to ensuring that the long-term financing is available to achieve this 15-year plan. Thanks, Rex. That was fantastic. I think we have a little bit of time left according to the recent information I just got. I don't know that I'll be able to ask all the panel members questions individually, but I want to get through as many as possible. Rona, in global health particularly in the vaccine sphere we always talk about how Coke has been able to reach places that nobody else can and you talk about 200 countries that Coca-Cola is in that's just astounding to me. There are some challenges in global health that I think would really benefit from the lessons learned of your experience and specifically, aside from the Colchain example that I just referenced where you actually have refrigeration capability presumably that goes all the way out to very peripheral regions. We have other challenges that relate to maintaining quality of health services and quality of the commodities like flasks. Now oftentimes we have to rely on local partners to ensure that quality. What lessons have you learned about working with local partners working in the country to ensure a certain minimum but very high level of quality in both services and commodities? It's a great question. And to start off with just to be perfectly clear the standards for whether it's our safety or our quality of our product. It's the same with the United States or whether it's in India or South Africa or Nairobi. But one of the things that we've learned over the last 23 years is it's not necessarily going to be dictated and done by Atlanta. What time? We will think globally but we'll act locally and doing what we need to do in the country is absolutely essential. Over 85% of our workforce is outside of the United States. So what does that take? That takes the necessary time needed to map what those processes are, what the critical requirements are and the resources are. But it's the investment in those local individuals because they are the community, they are our business there. That's absolutely essential. What are the capabilities that we need, the competencies that we need and the capacity of the workforce that we have to have in country that's going to make the difference to make sure they're adequately trained and they're adequately enforced in terms of making decisions that they have the necessary tools and we have the necessary infrastructure and it doesn't always have to be the Cadillac. As you know being in the producing countries when I was in the cocoa industry we'd get coke anywhere. Banta it was great. We'd drink coffee in the morning in the afternoon until 5 o'clock and we'd have beer, we'd have Banta and we'd have Coca-Cola because it was a safe product but it wasn't as if they always had trucks to bring it there. They would use their bicycles, they would use a boat they would use a mule, they would use whatever they could. Again realizing that this was a shelf-stable product and not perhaps as sensitive as some of the the vaccines. But at the same time as you increase your innovation you then get refrigerated units that can still be on the back of a bike, on the back of a mule or in your boat when you're taking it down and you're taking it down one of the rivers. So to that point it's been, we aren't where we are it didn't happen immediately, it happened over a hundred and twenty three year period so it wasn't done overnight but this is an opportunity in terms of sharing those best practices and those lessons learned with the global health community to make a difference because when the global health is the best it can be where we operate it's going to be better for our business we're going to have a healthier sustainable business because the work forces that we need, we rely upon that make Coca-Cola what it is is dependent upon global health. So I think there's a lot of opportunities for us to work together share experiences share learnings and it's the only way that it's going to get done. That's great thanks Pat one of the one of the issues around accountability we talked about measurement here and measuring an individual or an institution's performance from a top down command and control perspective is one way to ensure that you maximize performance. Another way to improve performance of actors in the system is to increase demand particularly demand amongst the public if individuals who are of little means become aware that there are options to get quality affordable health services then they will begin to demand that from the public sector and the private sector being in media and communications you're all about informing individuals about the art of the possible what do you see as the potential role for media and communications in increasing demand and ultimately increasing accountability I'm so glad you mentioned that because I always like to it's so easy to blame media and just say media never covers the stories that are important and honestly what we do is we all know it covering anything complicated or complex and we just got to find a simple way to tell the story but there's a media organization but there's also a consumer and what has changed in global media now is power shifted the power is shifted from the people in top down mainstream media making decisions about what gets covered, what stories are reported to coming up from grassroots consumers people with cell phones or blogging in social communities and on Twitter they are themselves delivering a different kind of demand that information and you see it in communities and I was in a remote village in Kenya not long ago and the one person who had the mobile phone in the village and there was one and it happened to be a woman and she was going I said did you know that that clinic is she was passing out the information and then putting a demand and an expectation of the health clinic that was there that they do in fact deliver what she had found out the mobile phone was possible so it creates a different kind of accountability and really the consumer is a way to go and we have that power in our hands in a different way and I think the steps that we began to talk about at the commission is how we take something as wide ranging and as long-term as this and start to find some strategies where we can build social media communities around the demand and most importantly for our conversation today helping make those connections to US taxpayers who are funding and we are now being asked to step up their funding what's happening and we know that we can get those reports to run from the ground that's new that's powerful let me turn to my partners here and see how we're doing on time wrap up okay a couple of references have been made to the spaghetti chart so this Byzantine system of reporting to multiple different donors you know we have made a strong image here around the importance of measuring results and accountability but if we're having this conversation in an attempt to influence how the US government manages its investments and the same dialogue is happening in capitals around the country where bilaterals are deciding how to spend their funds we may not be solving any problems here we may actually be creating additional bureaucracy in fact we do you've thought a lot about this do you have any initial thoughts on how we can streamline and actually make this a value added it's a tough question because many of the bilaterals are beholden to their parliaments or legislatures to account for the funding and like we have seen in this country sometimes the congress has certain preferences for use or money and then the congress changes and a different party takes over and those preferences change and the poor countries have to figure all that out so this is a very tough issue where I think there's a growing consensus and the question I think is whether the US when we heard from the deputy secretary if the US really wants to invest diplomatically in a common set of reporting indicators it'll make a huge difference but that's that's got to come down to the ambassadors and it's got to be real and many of the organizations in this room which receive resources from PEPFAR or the new global health initiative whatever it is they have to know that they have to believe that this is really going to happen I don't know any way around it it's better but it hasn't happened yet the UN agencies are also part of this we have these new look at the Millennium Development Goals which the current Millennium Development Goals go until 2015 I think you know that there's now a beginning effort by the secretary general of a dialogue to talk about what the next set of these Millennium Development Goals will be this is a good time for the donor community to step back and say are we serious are we going to try to come up with a common set we tried indicators in HIV there was this 3-1 but you'd go to the field and there would be the 3-1 and then you get countries reporting on this common set of indicators and then the US wanted a little bit more and the UK wanted a little bit more and it turned out there was a common set of indicators but then everybody had their add-ons so the question in my mind is truthfully whether the US wants to invest diplomatically to make this happen I don't know a way around it the US has the most money invested in this field and if they are willing to throw their weight around and make it happen it can happen there's going to need to also be development of new methods and metrics to measure some of these impact indicators it's not going to be that easy as I mentioned earlier it's easier to look at an indicator or as Rex said an input then to really look at impact but I think if we get groups together around the table from different constituencies and get serious about it hopefully the spaghetti chart it'll be reduced to macaroni maybe but I think we need to have some commitment to make it happen and it'll be historic if it does but it would be a great contribution of the global health initiative I'm going to turn to Rex for my last question and that is Rex we talked briefly about the fact that institutions in global health don't have the traditional measures of accountability to say a business would you've managed a huge corporation what are the other principle strategies tactics that you would suggest to leaders of global health organizations that they should consider bringing into their operations in order to increase the level of accountability throughout the enterprise well I think you have to engage all of the interested parties from as I mentioned from the US government the multilateral agencies to other donor agencies but you also have to engage the recipient of the recipient country and a lot of these measures can best be defined by engaging with where the rubber meets the road what is it that we're looking for inside those countries where this effort is directed that will tell us whether we're being effective so to develop this really does require a great deal of collaboration from the donor agency or country all the way down to the recipient and it's going to require some capacity building within these countries for them to be able to provide those you know respond to those metrics that we're asking for we were having a conversation the other day about malaria which we're very interested in and how we can tell you how many bed nets were distributed every year but we can't tell you how many children between the age of birth and five years are infected with parasite they may not have malaria but they got the parasite we'd really like to know that because that tells us whether we're beating the parasite in terms of infection rates and in terms of vector transmission but it means we've got to build some capacity for that to occur for that to be measured it means we've got to build it into an integrated health system so that when a mother brings her child in for some other reason nothing to do with malaria well we've got them there we draw a little blood we do a malaria test we got it it's in the database so we need to integrate it with a lot of the other health programs that deal with mothers and children and a lot of this this infant care that we've talked about but it does involve a great deal of collaboration and that's the way we do it in the business community we work down throughout our organizations and when we enter developing countries with our own business model we're putting in place metrics for our business partners that are in those countries as well so we do a lot of training a lot of conversation around here's why we're measuring this here's why it's important and in terms of unraveling the spaghetti chart it is going to be a huge challenge but I think the central question everyone has to ask themselves for their piece of information on that spaghetti chart is you tell me what that tells you about eradicating malaria and then I'll tell you if you can have that information or not and if you cannot directly connect that to the result you don't need that information it's going to take that kind of discipline and that's what we have to do in the private sectors have the discipline to say no we're not going to gather that information because it doesn't really take us to our objective and you have to get that same mentality I think within this process as well and so tough Mike but it means we're going to have some tough leadership the United States has put a lot of money out there in this game they need to change the paradigm and lead and I think some other people will follow thanks for that Rex I think we've heard some great messages and guidance from our panel today I told you at the beginning there was a time when I thought measuring was pretty boring measurement itself is frankly a little bit boring but the reality is that it's really it's really really I'm sorry I had to say it it's really really important because if you're not measuring if you're not measuring you don't know that you're having an impact and I think that point has been highlighted in some way shape or form by every individual on the panel today it's the critical element that allows all of us forces all of us to up our game so I hope you all leave today convinced of that fact thanks very much to my panel members