Partners in Health's mission is to provide a preferential option for the poor in health care. Through its work in Haiti, Africa, Peru, Mexico, and Navajo Nation, PIH strives to bring the benefits of modern medical science to those most in need of them and to serve as an antidote to despair.
$40.6m annual program spend • Partners in Health (PIH), together with its sister organization, Zanmi Lasante (ZL), has worked side-by-side with the Haitian Government for more than 30 years in building and strengthening the country's public health system. The poorest country in the Western Hemisphere, Haiti suffers a harsh cycle of poverty and disease. Life expectancy at birth is just 63.5 years versus 79.3 in the United States. To help combat this inequity, PIH/ZL works closely with Haiti's Ministry of Health and is one of the largest nongovernmental providers of health care in the country, operating clinics and hospitals at 12 sites across the Central Plateau and lower-Artibonite. In 2013, PIH/ZL together with the Haitian Ministry of Health opened University Hospital in Mirebalais, a 300-bed, 205,000 square foot national referral and teaching hospital. The hospital, as with all PIH/ZL-supported facilities in Haiti, provides free access to health care for more than 1,200 outpatients per day. PIH/ZL employs a staff of approximately 5,200 Haitians, of which about 2,400 are community health workers. The CHWs PIH/ZL employs in each remote community help to aid the treatment of individuals living with tuberculosis and HIV. The following highlight some of the core aspects of PIH/ZL's work in Haiti: Innovations in health care delivery: Over its long history working in Haiti, PIH/ZL has established several innovative programs including cholera prevention and treatment; cancer prevention, detection and treatment; rehabilitative medicine; and mental health care; all demonstrating what is possible in providing the highest quality of care to the Haitian people. As an example, research publications on PIH/ZL's successful cholera vaccination campaigns supported the World Health Organization's decision to create a global stockpile of the oral vaccine. Additionally, PIH/ZL established a program focused on identifying and treating cancer across the Central Plateau and lower-Artibonite. Cervical cancer is one of the leading causes of cancer-related death in resource-limited countries. Haiti has both the highest rate of cervical cancer incidence and related mortality worldwide, affecting women between 15 and 44 years of age. According to the Ministry of Public Health and Population, there are a reported 94 cases per 100,000 women. From 2016 to 2018, ZL provided HPV vaccinations to more than 25,000 girls aged 9 to 13 across numerous communes including but not limited to St. Marc in the lower-Artibonite and Mirebalais and Belladere in the Central Plateau. Teaching and training: PIH/ZL has been developing human resources for health (HRH) capacity-building programs in Haiti for the last 15 years for physicians, nurses, and allied health professionals. With 7 years of experience developing high-quality residency programs using a biopsychosocial model, PIH/ZL now manages 6 residency programs and 2 fellowships. PIH/ZL has strategically worked in growing these programs to address areas with critical shortages of trained personnel with a specific focus on maternal and child health. Program leaders are working to ensure retention of graduates, specifically in rural areas. To date, 80% of the 89 clinicians who have graduated from their residencies have chosen to work in rural Haiti. In addition to residency programs, the PIH/ZL National Training Center has helped to design and coordinate a community-health curriculum and rotation for sixth year medical students (interns) and third year nursing students. This curriculum is designed to increase clinicians' understanding of the social causes of disease and their responsibility to combat inequity in the health system.
$17.2m annual program spend • Together with our Rwandan sister organization, Inshuti Mu Buzima (IMB), Partners in Health (PIH) focuses on bringing high-quality health care to three rural districts that previously had some of the country's worst health outcomes. This year with the Ministry of Health, PIH/IMB provided primary and secondary care services to a population of roughly 1,000,000 through three hospitals and 43 health centers, with the help of over 5,000 community health workers. In areas such as cancer care, non-communicable diseases, neonatology, and maternal health, PIH continues to introduce innovations that are tested, refined, and taken to scale nationally. By pioneering smart investments in healthcare delivery in Rwanda, PIH/IMB has changed the lives of millions of people. This year alone PIH/IMB supported 4,686 patients in managing chronic illnesses such as asthma, diabetes, hypertension and heart failure. As research and advancing scientific knowledge are primary organizational priorities, PIH/IMB also organizes writing groups for various clinical areas and consequently published 9 peer-reviewed articles on innovative approaches to care. These groups seek to grow research capacity among local clinicians and cover topics ranging from research basics and best practices for data collection to analysis and writing research papers. In the past year, 3 IMB-supported hospitals had 52,854 outpatient visits, 20,791 hospitalizations and 9,351 deliveries. 9,006 of the patients seen had weak social safety nets and financial barriers to accessing healthcare. They were supported with housing, therapeutic food, school fees and health insurance through PIH/IMB's program on social and economic rights and right to healthcare program. The PIH/IMB Cancer Center of Excellence that was launched in 2012 in collaboration with the Rwandan Ministry of Health and Dana Farber Cancer Institute, has expanded and grown enormously with the formal opening of new ambulatory cancer treatment facility that is used to provide outpatient care to cancer patients, as well as the equipping of its pathology laboratory with the state of the art equipment. Since the opening, the center has received over 7,500 patients. There are currently 2,647 active cancer patients receiving care at PIH-supported facilities and the Cancer Center for Excellence is now building capacity for early detection of breast cancer, cervical cancer screening, palliative and end-of-life care. This year PIH/IMB constructed a new training center and maternity ward in Rwinkwavu and equipped and renovated a pediatric ward in Kirehe District. Additionally, PIH/IMB's All Babies Count (ABC) program continues to provide facility and community-based interventions aimed at reducing maternal and neonatal mortality in Rwanda. PIH/IMB has facilitated Neonatology Cross-Site Learning Exchanges and Retreats for all 10 supported hospitals and a Cross-Site Quality Improvement Leadership Learning Session for 7 PIH-supported districts. Through these efforts, PIH/IMB have helped facilities improve their outcomes such as Butaro Hospital which reduced neonatal death from birth asphyxia from 37% to 7%. PIH/IMB also completed its first outcomes assessment of the Pediatric Development Clinic (PDC) which has been improving children's health and developmental outcomes - with greater achievement of developmental milestones, a 36% reduction in reported health complications, and an 11% reduction in chronic malnutrition (stunting) among preterm and low birth weight infants enrolled in PDC by age 1-3 years.
$11.4m annual program spend • Expand New Drug Markets for TB (endTB) is an implementation and research partnership among Partners in Health, Medecins Sans Frontieres, and Interactive Research & Development. The project is funded by UNITAID. The goal of endTB is to reduce morbidity and mortality from multidrug-resistant tuberculosis (MDR-TB) through the development of scalable, effective treatment regimens that are less toxic, shorter, and less expensive than the current standard of care. This project also includes two clinical trials to evaluate all-oral, shortened drug regimens that contain the new and repurposed TB drugs. These clinical trials will provide important evidence about the effectiveness of different combinations and treatment durations of these drugs. A shorter treatment regimen will make MDR-TB treatment easier for patients and significantly reduce health system costs. Enrollment into one of the clinical trials began in 2017. The second clinical trial is expected to start enrolling in 2019. By the end of FY18, cumulative enrolment in an observational research study of patients (prescribed bedaquiline or delamanid) to monitor their progress and evaluate safety and efficacy reached 2,419 patients from the 17 participating countries. Enrolment into one of the clinical trials was ongoing in 4 countries and reached 116 patients by June 2018. The project also contributed evidence to the WHO's 2018 Guidelines Development Group review of MDR-TB regimen composition. Current MDR-TB treatment requires multiple drugs taken for 18-24 months; a shortened regimen requires daily injections for 4 months with toxic drugs that can cause deafness and other serious side effects. The first new anti-TB drugs in 40 years, bedaquiline and delamanid, as well as repurposed TB drugs, linezolid and clofazimine, have raised expectations for improved, simpler treatment. Yet, access to these drugs has been hampered by low demand, barriers to availability, and both concerns about safety and treatment guidance. endTB advances its goal through increased access to new and repurposed drugs for MDR-TB today, as well as thorough rigorous scientific research on scalable regimens for the future. Since 2015, endTB has increased access to drug regimens that contain new and repurposed drugs in 17 countries by helping to overcome barriers to importation and encouraging the adoption of the new TB drugs into national MDR-TB treatment guidelines. The project plans to enroll more than 2,600 patients from the 17 participating countries in an observational study of patients (prescribed bedaquiline or delamanid) to monitor their progress and evaluate safety and efficacy. Analysis is in progress and further analysis will be completed when the research team completes data collection in 2019.