This year, Partners In Health (PIH) faced immense structural challenges in the fight for global health equity. As foreign aid became a target for federal funding cuts, our work became more important than ever.  

When other health clinics were forced to close, PIH continued to accompany people around the world when they needed us: helping a mother across a river to get home with her newborn baby, supporting someone taking their first steps after believing they would be paralyzed forever, fighting for systemic change at the United States Capitol, and providing personalized treatment for someone with tuberculosis (TB).  

In the collection of images below, see those moments and others documented by PIH photographers and staff across the 11 locations where we work.

"In 2025, photographing for PIH gave me moments I’ll never forget. Lesotho’s beauty hides its challenges—steep mountains, rough roads, and rivers with no bridges. I saw expectant mothers and mothers holding newborns cross by boat to receive care and PIH teams pulling vehicles through deep river currents to deliver services. It was my first time crossing by boat while the river was full, and I was nervous—but standing beside women who do this with quiet strength every day, I saw not struggle, but courage." - Justice Kalebe

"Every year I choose a photo that renews my purpose at SES. This one did it instantly. A mother embracing her daughter with a tenderness that even fills what's missing. Behind them, the Peru I know through the camera and from the heart: immense, complex, and beautiful, but with challenges that continue to shape the lives of many families. This image encapsulates what it means to accompany: to be present, to look with respect, to listen, and to recognize the dignity that sustains people even in adversity. It reminds me that the most powerful stories aren't always shouted; sometimes they're simply embraced. And in a country where there's still so much to be done in health and justice, it's worth staying here." - Diego Diaz Catire

"I was so grateful to capture just an ounce of Fynn's contagious energy at 8 a.m. in front of the United States Capitol building. Around 300 of us were preparing to walk into the halls of Congress to meet with our Senators and Representatives and ask for global health funding during a particularly divided time, and many of us knew we had conversations ahead that wouldn’t be easy.  

It felt a bit strange being in D.C. while the news was rolling in that the National Guard was soon to be deployed in the city, but the Advocacy team did such an excellent job reminding us of our purpose there and giving us hope. During this speech, Fynn made sure folks were prepared—knew where to go, what to say, who to meet with, what resources were available—and got everyone energized for what was sure to be a long day." - Kathrine Kuhlmann

"I've seen diabetes in very close family members since I was a child. The marks on Luis's legs are just as I remember them. Every time I have to support someone with diabetes, it feels different because it hurts. However, I see in Fabi, Diana, Santiago, and all my dear Community Health Workers like Aurita, Corita, Isabel, Cecilia, and Anita the support and necessary treatments that, for many reasons, I didn't see in those I remember most fondly." - Julio López

"Every story I document stays with me in a different way. I first met Valentine in the consultation room, where she was speaking with the ophthalmologist about her son’s progress. Listening to her share their story, I could sense the strength it took to reach this point. Later, when I saw her outside playing with her son, I noticed how she smiled at him, so full of love and patience. Regardless of everything she has faced, she never left his side and continues to give him that smile every day. In that moment, I wanted to capture what I was feeling: the quiet strength of a mother who keeps going, the bond that holds them together, and the hope that continues to grow through care and support." - Asher Habinshuti

"The story of Mateo is truly life changing. I could relate deeply to him when he shared what it felt like to be sick. The picture portrays resilience and a strong will to never give up. At times, Mateo went for two days without food but still made the effort to take his medicine. With no one around to check on him regularly, he went through it all alone, supported only by the dedication of health workers. His story reminded me that no matter how dark life gets, there’s always a reason to hold on. Mateo’s strength taught me that true courage is not the absence of problems, but the decision to keep fighting even when no one is watching." - Joseph Mizere

"Traveling and photographing patients’ home visits are moments I live for as a photographer. These visits let us capture real moments with people whose stories inspire our day-to-day work. This was one of those visits, but this time it was a special handover ceremony for a TB survivor.  

As we walked the narrow road towards Puluken, a small town outside the main city of Harper in Maryland County, Southern Liberia, I saw a sense of fulfillment on the faces of these remarkable women, despite the long miles we had traveled.  

I recall that Dr. Sarah and I had to overcome our fears of crossing the Hoffman River for the first time on this day to give little Pauline and her mother a home. This moment filled me with a sense of hope for the many people PIH continues to provide care for and reminded me that indeed “injustice has a cure.”  - Aminata K. Massaley

*Name changed by participant’s request

Omar Clay can’t go more than a few steps without being met with a hug, handshake, or question as he strides through the Newark Department of Health and Community Wellness.

He points people in the direction of free food while simultaneously picking up his phone to schedule an Uber ride for a patient. When he passes people in the department’s fluorescent halls, he asks them about follow-up appointments, how they are feeling, and whether their family members are doing well.

It’s all these small conversations that help make up essential, comprehensive care. For Clay, it’s just a typical day of work.

Clay, one of the department’s three community health workers (CHWs), is determined to get people access to the health care they deserve—sometimes this means organizing transportation to a doctor’s appointment, helping them find housing, or navigating insurance alongside them.

“We are—in real time—ensuring that our clients are getting exactly what they need as fast as they possibly can,” Clay said.

Partners In Health (PIH) believes in the power of community-based medical and social support. Programs involving CHWs, who are local residents that act as advocates and guides for their patients in the health system, are an essential part of providing comprehensive care and grew out of PIH’s work in Haiti. Now, PIH supports more than 12,000 CHWs worldwide.

In 2023, Partners In Health United States (PIH-US) leveraged its partnership with the Newark Department of Health and Community Wellness to support three community health worker positions, with funding through Acenda and the New Jersey State Department of Health. Since then, the CHWs have become a pivotal part of the community—and in recognition of their importance—the city has taken on supporting these roles financially.

A Day in the Life of a Community Health Worker in Newark

For CHWs, no two days are alike—but they are always busy.

Some days, Clay is at the department for hours with patients, learning about their medical needs or helping them work through paperwork between fielding calls from others.

Other times, Clay works to bring health care directly in front of the people who need it most.

A team made up of medical assistants, insurance navigators, and CHWs travels to different areas of Newark to operate mobile clinics. The clinic—a medical RV—is designed to have two examination rooms, a waiting area, and on-sight testing to get results back to patients within minutes.

The department partners with other groups to bring health care directly to people who often have limited access, including hosting clinics in the parking lots of city-run low-income housing complexes.

On November 14, the team spent hours with residents at one complex, testing their glucose levels, blood pressure, and providing free HIV testing.

While two CHWs with the Department of Health and Community Wellness—Clay and Jahaida Figueroa—operated the mobile unit, another CHW, Rose Rock, remained at the department to work with other patients.

Rock has a unique skill that helps her connect with patients and ensure they are listened to and understood: she speaks four different languages. At the department, she uses her skills in Haitian Creole, French, Spanish, and English to help community members.

Together, the CHWs make a robust team full of empathy and expertise. 

“I couldn't do it without them,” Clay said. “They couldn't do it without me. We are very much intertwined."

In addition to providing on-site care, CHWs use this as an opportunity to connect people with other health resources.

Figueroa offered residents the option to receive additional care from primary care physicians, pediatricians, and behavioral health professionals in the hours she spent at the mobile clinic.

If people need those services but have barriers to accessing them—whether they are overwhelmed by the process, unable to afford the visit, don’t have transportation, or another reason—CHWs step in to support them getting the care they need.

“It's hard to really put a classification on (the work), but basically the best way to say it is advocating and navigating through the healthcare system for our clients,” Clay said. “And not just health, because once you address the social determinants of health that it makes it very broad.”

When Clay references the “social determinants of health,” he is talking about the non-medical, environmental, and social factors that impact a person’s overall well-being, including housing, food, education, and employment.

“I feel like a lot of people don't understand how things in your daily living can affect your health and how it goes hand in hand,” Figueroa said. “When we help these people with rental assistance, food insecurity, housing insecurity, shelter placement and all of that, it puts them in a different...”

“It lowers their blood pressure,” Clay said.

“It can lower their blood pressure,” Figueroa echoed. 

‘My Angel’: Building Family Through Community Health

Andrew Adupoku calls Clay his “angel.”

Adupoku began coming into the department to get treatment for pain in his teeth.

When a doctor discovered he needed antibiotics, Clay connected him to a program in the department that exponentially lowers medication costs. And when Adupoku still came up short, Clay stepped in to cover the cost.

Another patient, Alexander, said Clay worked with him for a year to find permanent housing. Now, he is spending his first nights in his new home, finally out of a shelter.

In the meantime, Clay is tracking down pillows, sheets, and other supplies for the apartment.

Clay is there for his patients—no matter what they are going through. Building trust and offering exceptional service has been an essential part of his work. With this foundation, patients return again and again.

“That person will come back, and it could be nothing to do with what we offer,” Clay said. “'Oh, I'm having an issue with social security.’ And I'll look (at them) like, ‘Well, you know I don't work with social security, but you know what? I'm going to take my break. I'll take you over there and we'll sit down and we'll figure it out.’”

For the people dedicated to this work, it has become a lifestyle—and a family. Former patients call Clay their grandson or their children’s uncle, and clap him on the back as he roams through the department halls.

“All three of us (community health workers) have done these Uber rides hours after we've clocked out, sometimes hours before (we clock in),” Clay said. “And some of our clients have our personal number, so they're calling us Saturdays and Sundays.”

Clay always answers the call.

“What we're doing is eliminating those emergency room visits, the wasted medication, the wasted referrals,” Clay said.

For years, PIH-US has advocated for community health workers to be a fixture of the health care system in the U.S. so patients around the country can experience the accompaniment someone like Clay can provide. PIH-US, which grew from the U.S. Public Health Accompaniment Unit created during the COVID-19 pandemic, is set to conclude its public health advising work in the spring 2026. However, its legacy will live on, both in the CHWs already embedded in communities, and in the national CHW organizations we have worked to build in collaboration with our partners.

We are profoundly grateful for this incredible network of caregivers and our partners as they carry on this vital work.

In a year of global uncertainty and unprecedented challenges, Partners In Health (PIH) remained committed to demonstrating what’s possible in global health delivery. Amid ongoing attacks on foreign aid, PIH continued to advance health equity across four continents.

Standing firm in our mission, we provided a preferential option for the poor in health care. This year, that included: 2.2 million family planning consultations, 795,200 home visits conducted by community health workers, and 160,800 mental health visits across all PIH care delivery sites.

Throughout the year, media coverage spotlighted areas of our work—from the United States to Haiti to Rwanda. Here are some of our favorite moments from 2025:

1. The Boston Globe: New England aid groups slam Trump administration move to shut down USAID: ‘People will die’

Before the federal government officially halted operations carried out by the United States Agency for International Development, or USAID, humanitarian organizations—including PIH—warned of the devastating consequences this could have on the most vulnerable communities. In early February, The Boston Globe spoke with Dr. Joia Mukherjee, PIH’s chief medical officer, who warned that “people will die.” Read the full story. 

2. Forbes: Paul Farmer’s Moral Clarity Offers Hope, Amidst Chaos And Darkness

On February 20, PIH Trustee and TB expert Dr. Madhukar Pai wrote an essay on the third anniversary of PIH Co-founder Dr. Paul Farmer’s death. Pai recounted lessons learned from Farmer, including how to serve as an antidote to despair; and included reflections from a handful of leaders who worked closely with Farmer, such as PIH Co-founder Jim Yong Kim and PIH CEO Dr. Sheila Davis. Read the full story.

3. The Guardian: Tuberculosis could end if there’s more US public health funding, experts say

An article in The Guardian highlighted the largest Tuberculosis (TB) Hill Day to date, which involved about 250 advocates, experts, and survivors who attended 210 Congressional meetings in April. There was a major surge in grassroots support thanks to John Green, PIH trustee and bestselling author. Read the full story.

4. PIH: New Initiative Expands Access to Life-Saving Drug-Resistant Tuberculosis Treatment

In May, PIH and Unitaid launched a new initiative to improve care for people suffering from drug-resistant tuberculosis (DR-TB) in seven high-burden countries. Over the next three years, the project—called Accelerating Regimens and Care for DR-TB (arcTB)—will improve case detection, connections to preventive and curative services, and the quality and availability of treatment, especially among children and pregnant women. Read the press release.

5. AP: Haitians with HIV defy stigma as they publicly denounce USAID cuts and dwindling medication

In Haiti, foreign aid cuts caused clinic closures, putting thousands of people living with HIV at risk. The Associated Press spoke with Zanmi Lasante’s (ZL’s), as PIH is known in Haiti, Infectious Disease Director Alain Casseus about the potential implications of funding cuts and ongoing violence putting patients at risk. Read the full story.

6. Entrepreneur: John and Hank Green Built a Company That Gives Away 100% of Its Profits — Here’s How

Brothers John and Hank Green continue to support PIH through their advocacy and ventures like the Good Store. In August, Entrepreneur spotlighted their social justice efforts, which support PIH’s maternal health work in Sierra Leone and TB work in Lesotho. Read the full story.

7. NEJM: In Paul Farmer’s Beautiful Garden of Global Health Equity: Reflections on the Third Remembrance of His Passing

In a powerful reflection published in the New England Journal of Medicine, Didi Bertrand Farmer reflected on the life and legacy of Paul Farmer. In her essay, Didi uses Paul’s love of gardening as a metaphor for his lifelong commitment to advancing global health equity. Read the full essay.

8. Devex: From obstacles to outcomes: Transforming breast cancer care in Rwanda

In Rwanda, PIH–in collaboration with the Ministry of Health and The Pfizer Foundation—is transforming breast cancer detection, diagnosis, and treatment. Global news organization Devex published a story highlighting the impact of the Butaro Cancer Center of Excellence, the vital role of community health workers, and more.
Read the full story.

9. Government Makes History in Kono as President Bio Commissions Maternal Center of Excellence in Koidu.

On October 25, Sierra Leone proudly unveiled the Paul E. Farmer Maternal Center of Excellence (MCOE), a state-of-the-art facility designed to dramatically expand maternal services and set a new standard for care. A story published by the Ministry of Health recounts the ribbon-cutting ceremony led by President Julius Maada Bio and highlights the strong partnership with PIH. Read the full story.

10. Neighbor Thursday: Maternal mortality and neighboring in Sierra Leone

In November, epidemiologist Dr. Emily Smith wrote about the MCOE,   why it matters in Sierra Leone, and how dignity and human rights are centered as a design principle and human rights imperative. Smith spoke with Isata Dumbuya, PIH Sierra Leone’s director of reproductive, maternal, and neonatal health, and published a 34-minute recording of the conversation in her Substack newsletter. Watch the interview.

In New Bedford, Massachusetts, a quiet transformation is underway. What began as a collaboration between the city’s health department, the police department, Child and Family Services, and North Star, has become a model for how communities can respond to crisis with compassion, not punishment.

With support from PIH-US, the Equitable Approaches to Public Safety (EAPS) initiative is bridging the gap between public health and public safety by bringing clinicians and officers together to ensure behavioral health emergencies are met with care. Since its launch, EAPS has trained dispatchers and officers, built cross-sector data systems, and created a co-response protocol that pairs mental health professionals with officers in the field.

Between October 2024 and March 2025, over 1,500 emergency calls for behavioral health concerns came through New Bedford dispatch. Thanks to EAPS, clinicians co-responded to 230 calls and followed up directly on 64 more, ensuring individuals in crisis were connected to care instead of the criminal justice system. The results have been striking: within the first month of using the cross-sector data system, the number of calls doubled, as officers increasingly requested clinical support, leading to a 100% increase in diversions to care.

Sgt. David Jorge of the New Bedford Police Department has witnessed the change firsthand.

“Within the first month of implementing the [new] co-response process, the number of calls doubled, and the officers are now requesting clinicians at a higher volume than previously,” he said. “We’re making strong improvements and having a big impact on servicing calls for mental health.”

He credits the success to the hands–on, PIH–US-supported training and the clear understanding it fostered between police and behavioral health providers.

“It was really about training them on the difference between the two different agencies,” Sgt. Jorge explained. “Showing them the difference between a clinical and crisis situation, what needs a clinician, what needs an emergency response. That clarity has been key.”

Beyond the numbers, EAPS is rebuilding something even more vital: trust. Through regular outreach events and a consistent community presence, officers, clinicians, and peer recovery coaches are reconnecting with residents.

“We’re out there literally trying to build relationships,” Sgt. Jorge said. “When people see a familiar face—someone who speaks their language, who listens—they begin to see we’re here to help, not to fear. That’s been incredibly positive.”

Collaboration has been central to this success. With PIH-US’s support, the New Bedford Health Department has strengthened relationships between the police department and the partner agencies, NorthStar and Child & Family Services.

“PIH-US’s role in rebuilding these relationships is a contributing factor to driving the strength of the EAPS program,” Sgt. Jorge noted. “We’ve made tremendous headway working together, and the program is stronger because of it.”

The work is ongoing, with the team continually refining training and data-sharing processes. But the impact is clear: EAPS is changing how the city responds to behavioral health crises and reshaping how the community sees public safety.

“The mental health co-response has been incredible,” said Sgt. Jorge. “The feedback from the community, the officers, and the agencies has been really beneficial. We’re seeing more positive outcomes because of this work and it’s only getting better.”

What a year it’s been: for global health, for foreign aid, for movement building, and for fostering community.  

This year, Partners In Health (PIH) staff remained steadfast in the midst of an incredibly challenging global health landscape. As clinics shuttered and health services were scaled back due to federal foreign aid cuts, PIH remained as a beacon of hope for patients around the world and a resource for support, education, and camaraderie for our global network of staff, advocates, and supporters.  

We didn’t shy away from sharing the devastating impact of the United States government’s decisions to cut foreign aid funding, and we simultaneously persevered in clinics around the world to accompany our patients who need us now more than ever. Join us in reflecting on this tumultuous year with the stories, videos, and social posts that were the most popular in 2025.  

At the third annual Paul Farmer Symposium on Global Health Equity, hundreds of individuals across clinical care, research, and education gathered—in person and virtually—to honor Dr. Paul Farmer’s legacy.

Farmer co-founded Partners In Health (PIH) in 1987 and led the organization until his unexpected passing in 2022. Every year since, we’ve gathered to honor him and explore how we can advance his vision for health equity. The November 18 event was centered around mental health, a topic that Farmer cared deeply about.  

Below, we’ve highlighted four reflections about PIH's beloved Co-founder, shared during the symposium:

1. In 1981, Paul Farmer wrote a letter to his mentor about mental health research.

Farmer’s longtime mentor, Dr. Arthur Kleinman, shared that mental health was one of Farmer’s original interests. On June 26, 1981, Farmer wrote a letter to Kleinman about studying transcultural psychiatry with the plan of going to Senegal or the Ivory Coast to conduct research. The professor whom Farmer was working with at the time was severely ill, noted Kleinman. If he had not been sick, Kleinman suggests it’s possible that Farmer’s career would have been centered around mental health.

“At the very start of things, he was aware of why mental health was important,” said Kleinman, Esther and Sidney Rabb Professor of Anthropology at Harvard University and professor of psychiatry and global health and social medicine at Harvard Medical School (HMS).

2. Paul Farmer deeply understood social forces and respected lived experiences.

In 1996, Paul Farmer published a paper in Dædalus, the Journal of the American Academy of Arts and Sciences, addressing the question: “By what mechanisms do social forces ranging from poverty to racism become embodied as individual experience?”

“Despite being an expert in understanding these social forces, Paul’s touchstone and ground truth was always the lived experience for those who suffered due to those forces,” said Dr. Joseph Rhatigan, associate professor of medicine and global health and social medicine at HMS and associate chief of the Division of Global Health Equity at HMS. “His ethnographies are written with a deep respect, in fact, a reverence for the ways individuals struggle daily to endure their mental and physical suffering.”

In the paper, Farmer highlights the life histories of Acéphie Jospeh and Chouchou Louis, two Haitians living in poverty, whose lives were cut short by forces beyond their control.

“Despite the enormity of these forces, Paul was the eternal optimist and perpetual clinician,” said Rhatigan.

This year’s symposium content was inspired by a mental health-focused issue of Dædalus, published in 2023, which explores the frontiers of knowledge and issues of public importance—and cites Farmer and PIH throughout the articles. 

3. Paul Farmer’s teachings and lessons continue to inform global health delivery.

Farmer often talked about the importance of health system strengthening in the context of the “five S’s”: staff, stuff, space, systems, and social support.

During the symposium, Professor Theresa S. Betancourt spoke about training non-specialist workers to do home visits to strengthen families, promote early childhood development, and prevent intergenerational violence in Rwanda.

“We see [home visitors’] trajectories improve over time when you take an intentional approach. That is the five S’s, the social support, backed by the systems and the human resources strategies,” said Betancourt, Salem Professor in Global Practice at Boston College School of Social Work and director of the research program on children and adversity.  

“I learned a lot in my years with Paul, and Jim Kim, and others in global health delivery and [take] that to my work on mental health,” said Bentancourt.

4. Paul Farmer’s optimism and beliefs guide PIH, every day.

During the closing remarks, PIH Chief Executive Officer Dr. Sheila Davis reminded us that transformation is possible—and together, we can carry forward Farmer’s work.

“We know that Paul is with us today, as he is every day. And as the past week, as the executive directors and leadership council of PIH came together, I knew Paul was with all of us and echoed in all of the plans and optimism we have for the future,” said Davis. “Our call to action is to let that belief guide us to see health as a human right and accompaniment as the way we achieve it.”

The 2025 Paul Farmer Symposium on Global Health Equity was hosted by PIH, the Department of Global Health and Social Medicine at Harvard Medical School, the Division of Global Health Equity at Brigham and Women’s Hospital, and the Harvard Global Health Institute.

Evaline Ngige dreaded public speaking for years.

Then, last month, she presented a speech to the president of Sierra Leone, dignitaries, and dozens of visitors.

“Welcome to the mother’s dormitory,” Ngige, nurse manager for Partners In Health (PIH) Sierra Leone, confidently said during a guided tour of the Maternal Center of Excellence, following the inaugural ceremony. “The space provides women with a safe, dignified space to stay, allowing them to remain close to their babies without the burden of daily travel.”

Once shy and afraid, Ngige credits her newfound confidence and abilities to the Global Nurse Executive Fellowship (GNEF). During the yearlong program, fellows hone their leadership skills, from working with a public speaking coach, giving presentations, identifying their leadership style, improving human and finance management, and more.

“GNEF really contributed a lot. They prepared us well,” says Ngige, a third cohort graduate. “We are not the same people. I take pride that I’ve changed. I feel ready for anything.”

Since 2017, the fellowship has facilitated the development of culturally humble and confident nursing and midwifery leaders who address current and emerging global health challenges by transforming health systems and, ultimately, improving population health.

Each year, the fellowship selects at least 10 participants from among senior and executive nurse leader applicants at PIH clinical sites around the world. Through cross-site collaboration, fellows gain theoretical knowledge and practical skills to succeed in executive positions.

Throughout the program, participants learn about three keys areas of leadership: self, others, and systems. The weeklong “leading self” intensive—designed to increase self-awareness and identify leadership style—was especially impactful for Mphatso Sayenda, nurse educator for PIH Malawi and fourth cohort GNEF graduate.

Sayenda was surprised to find she didn’t know herself as well as she thought. Through self-reflection during the program, she learned her strengths, areas for improvement, and how to adapt to effectively lead others.  

Previously a strict leader, she says her mindset was “work, work, work,” dismissing breaks and enjoyment. Now, Sayenda has a new perspective: “I learned that it’s good that sometimes we give room for people just to have the social time that helps the team to come together.”

She put her new learnings into action while introducing one of her GNEF projects, centered around routine urine testing for women. Instead of immediately diving into work, she took time to get to know the midwives carrying out the initiative, ensure they were on board with the work, and found time to have fun along the way.

“Celebrate the small wins,” suggests Sayenda.

International partnership, support

By knowing oneself, GNEF fellows can be more effective when “leading others”—the focus of the second, weeklong intensive in the program. This portion includes building and maintaining partnerships, and leveraging diversity and difference.  

“Leadership means being someone who can create something that people can positively follow,” says Sayenda. “It also means being able to captivate the good initiatives that people have and bring them to light, so that together you are able to bring positive change in terms of patient care.”

Afterall, patients are “our bosses,” in Malawi and across all PIH care delivery sites. At PIH, we believe any meaningful social progress is only born out of true solidarity and partnership. That partnership includes patients, and extends to national governments, local districts, public and private sectors, academic institutions, advocacy groups, and others—all of whom believe health care is a human right.  

PIH’s broad perspective on partnerships was eye-opening for Martha Kutsamba, district nursing and midwifery officer for Malawi’s Ministry of Health and fourth cohort GNEF graduate.

Previously, she believed leadership meant leading the nurses in her district—and no one else. 

“After undergoing the fellowship, the vision now broadened,” says Kutsamba. “I also need to be concerned with what happens in the entire system."

By being involved with other departments, together they can continually learn and improve. GNEF also expanded her network to fellows from various countries, ultimately impacting her professional development and PIH Malawi’s nursing staff.

“Collaborating with the fellows from other countries has impacted my leadership a lot,” reflects Kutsamba. “Most of the time in the African countries, our challenges sometimes are kind of similar, but maybe the approaches that we use to address those issues could be different depending on your capabilities.”

In Sierra Leone and Liberia, PIH addressed the nursing shortage by recruiting recent nursing graduates into newly formed mentorship roles. Kutsamba learned of that work from Marshall Sackey, a GNEF graduate and nursing lead for PIH Liberia.  

When facing the same problem in Malawi, Kutsamba and others created a similar initiative. “And it worked,” she said proudly, noting some of the nurses are now full-time employees.

Global leaders, lasting change

Carrying out such initiatives are part of the third and final, weeklong intensive centered around “leading systems.” This area focuses on applying knowledge and developing a capstone project to address systemic problems.

Though the capstone presentation signals the end of the fellowship, projects are sometimes carried out long-term—such as Sayenda’s project to increase the testing of pregnant women for asymptomatic bacteriuria infections at Lisungwi Community Hospital in Malawi.  

Upon graduation, fellows are well-equipped to lead. GNEF alumni have gone on to demonstrate their improved leadership capacity through promotions, publications, quality improvement projects, and international acknowledgement. A whopping 76% of GNEF alumni are involved in governing bodies at the regional, national, and international level.

“GNEF, I believe, is kind of a wakeup call to nursing and midwifery and taking full ownership in terms of leadership. At the global level, we can feel represented,” says Sackey. In some instances, nurses may feel the only place for them is at the bedside, caring for patients. However, they’re well-positioned to serve elsewhere.  

“A nurse that has served at a bedside, if that person is sent to an executive level, understands what it takes in terms of decision making to impact the care delivery process,” says Sackey. “GNEF is a golden path for nurses and midwives that are coming up in leadership." 

Partners In Health (PIH) Lesotho has appointed ‘Mathemba Radebe as its new executive director. Her appointment marks a historic milestone as she becomes the first Mosotho woman to lead the organization in this role.

Radebe’s journey with PIH Lesotho began in July 2017 as a pharmacist for the National Health Reform program. In July 2020, she transitioned to pharmacy and medical supply chain manager, where she oversaw inventory management, maintained quality standards, and led planning, forecasting, and budgeting. Her leadership in this role was critical in ensuring the consistent availability of essential medicines across PIH Lesotho supported sites.

In April 2023, she was appointed deputy executive director, where she worked closely with leadership teams to strengthen operations, drive program growth, and guide strategic priorities. With a strong background in program leadership and strategic management, Radebe has consistently shown her ability to bridge technical expertise with visionary leadership.

We sat down with Radebe to reflect on her journey with PIH Lesotho, her vision for the organization’s future, and the values that continue to guide her as a leader. Below, edited and condensed, are her responses: 

How has your journey with PIH shaped your professional growth and prepared you for this leadership role?

When I joined PIH in 2017, I immediately immersed myself in its mission, which is the idea of being a preferential option for the poor and delivering high-quality care through modern technologies. That vision fascinated me because it went beyond service delivery; it was about building resilient, sustainable health systems.

I began under the National Health Reform program as a supply chain officer and district pharmacist; it was an 11-month contract. The work was deeply hands-on. I offered technical support to pharmacy teams, worked on budgeting and forecasting, and helped stretch available resources to support our clinicians on the frontlines.

That experience grounded my leadership. It taught me that pharmacy is not just about medicines. It’s about systems, accountability, and problem solving. Later, when I became the pharmacy and medical supply chain manager, I started seeing how pharmacy fits into the larger PIH mission: ensuring every patient gets the care they deserve, no matter where they live.

You’ve held roles ranging from pharmacist to supply chain manager, and most recently deputy executive director. Which experiences have been most pivotal in shaping your leadership approach?

My pharmacy background trained me to think in systems. Procurement, inventory management, and risk mitigation, especially during crises, all require strategic thinking.

When COVID-19 hit, that mindset became essential. I served on the COVID-19 task team, helping ensure our staff had what they needed, from ventilators to protective gear. At a time when people were afraid to even meet patients, I was out training teams on equipment use and safety. That period stretched me beyond my comfort zone and shaped my courage, empathy, and collaborative spirit.

Later, as deputy executive director, I learned to view the organization as a whole. I had to connect communications, operations, and all the programs into one cohesive system. That role taught me the importance of transparency, cross-functional collaboration, and inclusive decision-making—values I’ll carry into this new chapter.

PIH Lesotho has a strong legacy in health reform and innovation. How do you envision building on that foundation to drive impact in the years ahead?

Leadership is a relay. You take the baton, honor the legacy, and add your own twist.

Having been part of the previous leadership team, I share the legacy we’re continuing. My vision is to scale up what already works while driving innovation. That includes expanding our use of artificial intelligence-based diagnostics, digitizing more of our systems, and strengthening data-driven decision-making.

But, the heart of impact is people. Our staff are the drivers of our mission. You can have the best systems in place, but if your team isn’t healthy or motivated, the mission stalls. So, one of my top priorities is staff wellness: ensuring that our people are capacitated, supported, and inspired to deliver excellent care.

We’ll also deepen our collaboration with the Ministry of Health and partners to ensure that our efforts align with national priorities and truly serve our communities.

Leadership often requires balancing strategy with compassion. How do you intend to inspire and support the PIH Lesotho team while meeting the evolving needs of the communities you serve?

I like to say, “conspire to inspire,” meaning two people or two groups working together for the inspiration.  Leadership is not a solo effort; it’s about creating shared purpose.

For me, this means investing in people. Invested not just financially but through mentorship, growth opportunities, and feedback. I want to build a motivated, connected workforce that feels empowered to lead from wherever they are.

We’ve already made progress through wellness activities like corporate challenges and intersite games—initiatives that remind our staff that we’re one family. Going forward, I want to strengthen communication channels, ensure transparency in decision-making, and provide safe psychological spaces where people can speak freely and be heard.

We’re operating in a time of change, including expense reduction and shifting priorities, but our mission remains the same: to deliver dignified, reliable, and compassionate care. My role is to keep the team inspired and aligned with that purpose. 

Looking back on your journey, what message would you like to share with young professionals, especially women in global health, who aspire to leadership positions like yours?

Lead with care and a clear sense of purpose. Whatever your role may be—nurse, technician, or manager—do it with excellence and integrity.

Know your worth, but also be willing to give. Leadership is about service. Be resilient, stay teachable, and make yourself available for opportunities to learn and contribute.

When I was appointed deputy executive director, it wasn’t something I planned. I had just completed my studies at the University of Global Health Equity and said to my supervisor: “Please use me wherever you need me.” That openness changed my path.

And finally, lead with empathy. People are going through so much; kindness costs nothing but can open every door. Forgive yourself, practice self-care, and remember that leadership is not about perfection; it’s about progress, humanity, and heart.

Stepping into the highest position in the organization is both an honor and a responsibility. What are your top priorities as you begin this new chapter?

My top priority is continuity and ensuring that the strong systems and strategies already in place continue to serve our patients effectively.

Secondly, I want to foster innovation and collaboration across all departments, clinical and non-clinical alike. Everyone has a role to play in achieving our mission.

And finally, integrity. I want to lead with openness and accountability by always asking myself one question: “How are we improving the lives of the patients we serve?” Because that’s why PIH exists, and that’s what will continue to guide me every single day.

On her way to collect her report card, Fatmata Foday, a 23-year old student and expectant mother, suddenly fell and couldn’t get back up.

Her symptoms worsened over time, leading her to seek care at Partners In Health (PIH)-supported Jojoima Community Health Center in Sierra Leone. There, Foday—who was four months pregnant—was diagnosed with extrapulmonary tuberculosis (TB), a form of TB that’s located outside the lungs. In her case, the infection affected her spine, leaving her unable to move her legs.

Jojoima Community Health Center is one of 179 facilities supported by the Quality Essential Health Services and Systems Support Project (QEHSSSP), an initiative led by PIH Sierra Leone in partnership with the country’s ministry of health and funded by the World Bank. QEHSSSP aims to expand and improve access to quality maternal and child health services across five rural districts, ensuring that patients like Foday receive vital services regardless of their location. 
 
At the heart of QEHSSSP’s success are the “five S’s”—staff, stuff, space, systems, and social support—which are the essential foundations of a strong, stable health system. Each of these elements shaped Foday’s journey of recovery.

Staff

Due to QEHSSSP, Jojoima is now staffed by clinicians and midwives who receive continuous training, mentorship, and supervision. “After a virtual consultation with one of our specialists, we started her [Foday] on anti-TB medication and she began to improve,” explains Augustine Amara, a surgical community health officer. Ongoing mentorship and on-the-job coaching for clinicians like Amara ensure that complex cases can be handled effectively, even in rural facilities. Last year alone, 1,780 clinicians participated in trainings covering topics such as short- and long-term family planning and emergency response during childbirth—strengthening care for patients like Foday when they need it most.

Systems

After two weeks at the facility, Foday’s husband discharged her against medical advice. “He told me that he wanted to take me to an herbalist because he believed it was a ‘native’ problem,” recalls Foday. By native, she was referring to his belief that the illness was caused by spiritual forces, a common myth in Sierra Leone and other countries, which PIH is actively dispelling through community education. “Everyone at the hospital tried to counsel Fatmata and her husband but it didn’t help,” emphasizes Aminata B. Kamara, a midwife at Jojoima Community Health Center. 

But when Foday returned around 28 to 30 weeks into her pregnancy—this time “in a wheelchair, malnourished, and complaining of urine retention,” as Kamara describes––Jojoima's strengthened systems ensured she could be readmitted swiftly. Improved referral pathways between health centers, community health workers (CHWs), and district hospitals now allow for smoother coordination of care, while strengthened record keeping and facility management mean that patients like Foday are never lost to follow up. 

Space

By the time Foday reached full term, she was admitted to Jojoima’s renovated maternity ward—one of many safe and functional spaces newly established under QEHSSSP to provide dignified, around-the-clock patient care. Due to her paralysis, she underwent a cesarean section (C-section) to safely deliver her baby. Facility infrastructure has been thoughtfully redesigned to optimize patient flow and uphold infection prevention and control standards, and ongoing maintenance ensures that essential services such as water, electricity, and fuel remain reliable to support continuous, high-quality care delivery.

Stuff

After the C-section, Foday slowly began to regain mobility, able to lift her legs and arms again. Access to essential tools and resources—such as anti-TB medication, oxygen cylinders, and surgical supplies—made her recovery possible. Thanks to QEHSSSP, these items are now consistently available at Jojoima. The oxygen cylinders are supplied from the oxygen plant at Kailahun Government Hospital—saving time, money, and resources. Previously, it took at least one week to fill the cylinders; now, it takes three days. Other critical supplies—such as gloves, face masks, infant radiant warmers, and doppler fetoscopes for monitoring babies’ heartbeats—are consistently stocked, ensuring that both mothers and newborns receive the services they need and deserve.

Social Support

Alongside medical treatment, a key part of Foday’s recovery was the dedication of the nursing team. Nurse Fatmata, who coincidentally shares the same name, took her care to heart and became personally invested in her healing journey. “She helped me bathe, washed and braided my hair. She would take me outside in a wheelchair so I could get some fresh air,” shares Foday. Through QEHSSSP, Jojoima now provides basic necessities and nutritional support for mothers and children, including guidance on cultivating home gardens using the hospital garden as a learning space. These efforts reflect PIH’s philosophy: to treat the whole patient, not just their condition.

Foday’s story is one of many that clinicians at Jojoima Community Health Center encounter every day. In the first quarter of 2025 alone, the health center recorded over 2,000 visits in the outpatient department and performed over 100 deliveries. Once a quiet rural clinic, Jojoima is now bustling with activity. It’s proof that with the right staff, stuff, space, systems, and social support, quality health care is always possible.  

As QEHSSSP continues to evolve, its goal remains the same: to improve maternal and child health for Sierra Leoneans, no matter where they live.

 Read more about QEHSSSP on Sierra Leone’s website. 

In 2021, Elvis Espinosa was diagnosed with multidrug-resistant tuberculosis (MDR-TB) and warned by his clinicians in Peru that the road ahead wouldn’t be easy. His treatment consisted of a routine of up to 16 pills a day, accompanied by painful injections. Even after months of diligently adhering to this regimen, Espinosa felt no relief and was rapidly losing weight—dropping from his usual weight of 183 pounds to just 95.  

Espinosa’s disease had progressed to an even more complex form of tuberculosis (TB), pre-extensively drug-resistant TB (pre-XDR TB), which is resistant to several additional medications, and he began to lose hope. He returned to his birthplace—La Oroya—with his family to say goodbye to the place he grew up, thinking he would soon die.

Then, an initiative from Socios En Salud, as Partners In Health is known in Peru, changed everything.

An Innovative Approach to Tuberculosis Treatment

At the height of Espinosa’s illness, the Socios En Salud team met him at a local health clinic, reviewed his TB records, and proposed a new treatment plan. He would only need to take four pills a day—a groundbreaking all-oral regimen that had been recommended by PIH-led research.  

The six- to nine-month regimen of four all-oral drugs—bedaquiline, delamanid, linezolid, and clofazimine—was found to be a shorter, safer, and more tolerable treatment for the most resistant form of TB, compared to standard treatment of up to 18 months with injectables and severe adverse effects that hadn’t been helping Espinosa.  

With each month of the new regimen, his body finally began to recover. Around the world, clinicians were seeing similar results in their patients experiencing drug-resistant TB (DR-TB).  

To build on the success of this improved treatment for patients like Espinosa, and accelerate its implementation in countries with a high burden of TB, Partners In Health and Unitaid launched the Accelerating Regimens and Care for DR-TB (arcTB) project to strengthen diagnosis, prevention, and treatment in Belarus, the Democratic Republic of Congo, Kazakhstan, Liberia, Pakistan, Peru, and South Africa.

The arcTB Project

With catalytic funding of $7.3 million from Unitaid—an organization long committed to advancing innovation in the fight against DR-TB—arcTB is led by PIH in collaboration with a consortium of leading global health partners. Médecins Sans Frontières, IRD Global, and Stellenbosch University are PIH’s consortium partners for the implementation of arcTB, delivering patient-centered care across the seven high-burden countries. Programmatic and diagnostic capacity will be enhanced through the technical expertise of Harvard Medical School and the Institute of Tropical Medicine Antwerp, supporting the rollout of the latest WHO-recommended tools and strategies for DR-TB care.

Despite being preventable and curable, tuberculosis remains the world’s deadliest infectious disease, killing 1.3 million people annually. Alarmingly, only one in four DR-TB patients are diagnosed and successfully treated—highlighting the need for investments like arcTB.  

Over the next three years, arcTB will enhance case detection, connect patients to preventive and curative services, and improve the quality and availability of treatment, especially among children and pregnant women. In arcTB, every person diagnosed with active DR-TB will be offered the latest all-oral DR-TB treatments that Espinosa received.

“Too many patients are lost at every point along the care cascade—from recognizing symptoms to accessing testing to receiving the right treatment,” said Dr. Michael Rich, senior health and policy advisor at PIH. “arcTB is about breaking down those barriers—bringing testing closer to communities, simplifying treatment, and ensuring that care is not just available, but compassionate and complete. When countries get this right, TB can decline by more than 10 percent per year. That’s not just progress—that’s a path to elimination.”

Already, Partners In Health teams in Kazakhstan, Liberia, and Peru have begun strategizing alongside local partners and ministries of health to implement the work outlined in the arcTB project. As the project continues to grow over the next few years, advances in TB treatment will reach those around the world who need them most.

arcTB is building on PIH’s legacy of innovative DR-TB care, from its cutting-edge care for DR-TB patients in Peru’s slums in the 1990s to its leadership in developing new and improved treatment regimens in the 2020s. arcTB marks the next step in PIH’s mission to ensure impoverished and marginalized people everywhere—like Elvis Espinosa—have access to the best TB care, bringing us closer toward a TB-free world. 

Samuel Musabimana was losing hope.  

What began as frequent night sweats and fevers quickly turned into extreme weight loss. The 28-year-old father dropped from 83 to 62 kilograms (183 to 137 pounds) over just a few months, prompting him to go to the hospital.

Musabimana, originally from Rwanda, had been living and working as a motorcycle taxi driver in Uganda for several years. He went from clinic to clinic with no diagnosis while his health continued to deteriorate.

Then, he began losing the feeling in his legs.

Musabimana began to struggle to get out of bed in the morning. He tried to continue working but soon lost the use of his lower limbs.

When he visited medical professionals in Kampala, Uganda's capital, doctors asked if he had been in an accident—his MRI scans showed that multiple bones in his back were broken—but he hadn’t, and got no closer to a diagnosis.

Eventually, he made the difficult decision to return home to Rwanda, now paralyzed from the waist down and convinced he was going to die.

“I told myself, if I am going to die, let it be near my family, not as a burden to strangers,” Musabimana said.

"Partners In Health Gave Me Back My Life"

With the help of church members, Musabimana made his way back to Rwanda and was admitted to the University Teaching Hospital of Kigali (CHUK), the country’s first and biggest health care institution.

He remained there for six months, and doctors eventually determined Musabimana needed to see a specialist—but that it would take three months to get an appointment.

In the meantime, Musabimana was referred to a hospital closer to his home, the Partners In Health (PIH)-supported Kirehe District Hospital, so he could live with his sister while he waited.

There was another problem, though.  

The months of intense care and hospitalization had totally depleted Musabimana’s savings. He was running out of options to continue his care.

At the Kirehe District Hospital, a doctor told him about Inshuti Mu Buzima (IMB), as PIH is known in Rwanda, and the organization’s Right to Health Care (RTHC) program. RTHC ensures that people living in poverty can access medical services without financial barriers.

Through the RTHC program, PIH covered the cost of Musabimana’s medications, provided transportation to and from hospitals, and arranged advanced diagnostic services. With this financial support, Musabimana was eventually able to return to CHUK, where he finally received his diagnosis.

Musabimana had extra-pulmonary tuberculosis, a form of the disease that impacts parts of the body outside the lungs.

“I still remember the day the doctor told me that he had found the diagnosis,” Musabimana said. “I was happy to finally know what I was suffering from, and I had hope again when they told me it was a curable disease.”

Despite being entirely preventable and treatable for decades, tuberculosis (TB) remains the world’s deadliest infectious disease. Expensive treatment costs driven by long-held patents, a lack of health care infrastructure after decades of colonialism, and low health care worker capacity means that millions of people die needlessly from TB every year.

After his diagnosis, Musabimana immediately started a treatment regime.

Now, more than two years have passed between the beginning of his symptoms and receiving the correct diagnosis. Today, after consistent medication and physiotherapy, Musabimana is no longer confined to bed. He can walk short distances, carry up to four kilograms (nearly nine pounds), bathe, cook, and manage basic daily tasks on his own—activities he once thought impossible.

“Partners In Health gave me back my life,” he said. “Even if we had sold everything we owned, we could not have afforded the care I received. I am who I am today because of PIH. For that, I will always be thankful.”

From 2024 to 2025 alone, PIH’s Right to Health Care program has supported more than 1500 patients across three districts in Rwanda, providing financial, social, and logistical support to ensure that health care is truly a human right for everyone.

Saulos Metio was walking around a market in Zalewa, a town bordering Neno and Blantyre districts in southern Malawi, when a stranger approached him—and began telling him about a place where he could get a free medical examination.

The stranger, site supervisor Igneous Katema from the nearby Partners In Health (PIH)-supported Zalewa Health Centre, was struck by Metio’s appearance. Despite being in his 60s, Metio weighed only 35 kilograms (approximately 77 pounds). Katema also couldn’t help but notice how unusual Metio’s breathing sounded, and how tired he seemed.

Katema was in the thick of celebrating Global Health Justice Week, a campaign inspired by the legacy, teachings, and impact of PIH’s co-founder, the late Dr. Paul Farmer, when he first met Metio. Farmer believed in bringing high-quality medical care to those who need it most—and spent his life working tirelessly to identify and treat patients all over the world.

That week, Abwenzi Pa Za Umoyo (APZU), as PIH is known in Malawi, was also conducting a tuberculosis (TB) awareness campaign in Zalewa. Despite being completely preventable, treatable, and curable, TB remains the world’s deadliest infectious disease. TB kills over 1 million people every year—a number so large it can feel incomprehensible.

In 2023, 10.8 million people contracted TB, according to estimates from the World Health Organization. Approximately 25,000 of them were in Malawi, one of the world’s poorest countries.

After Katema’s intervention, Metio decided to visit the health center and was then taken to a portable X-ray machine that APZU procured in 2024 with funding from the Embassy of Japan. There, he learned he had joined countless others before him—he had active TB.

Metio couldn’t stop coughing, had night sweats, and felt utterly exhausted.

“I was having trouble breathing,” he said. “So, when the doctors said it was TB, I wasn’t too surprised.”

With the support of PIH, Metio began treatment immediately. He also quit smoking and halted his alcohol consumption at the advice of his doctors.

Metio had also been struggling to eat enough food. Without proper nutrition, it is nearly impossible to make a full recovery from tuberculosis. Beyond PIH’s focus on building stronger health care systems and helping people access treatment, the organization also knows social support is essential to successful recovery.

Metio was soon enrolled in a PIH program to provide him with food to supplement his treatment. In the five months since, he has made drastic improvement—and recently finished treatment. The pain and exhaustion from active TB no longer rule his days.

Beyond being able to maintain his home, he has also begun to find piecework around Zalewa again, allowing him to earn an income and regain his livelihood.

No one should die of treatable illnesses. The more than 1 million people who die from TB every year have lives, passions, and interests just like Metio, but may not be lucky enough to have someone like Katema looking out for them. With your help, PIH can continue offering high quality health care, starting with those who need it most.

The Paul E. Farmer Maternal Center of Excellence (MCOE) has been designed around women’s needs and safety. Named in honor of Partner’s In Health’s (PIH) late co-founder, Dr. Paul Farmer, the facility reflects his lifelong commitment to health care as a human right and belief that hospitals should be spaces of both healing and beauty—values woven into the new center’s design.

In a setting affected by resource constraints and histories of exploitation, experiences in a hospital not only determine health outcomes but directly shape community trust. From a floor plan mapped around a patient’s journey, to landscaped outdoor spaces that foster comfort and safety. The MCOE sets a new bar for maternal and neonatal care in Sierra Leone. “It introduces design features informed by world-class clinical expertise while being carefully adapted to Sierra Leone’s context,” explains Isata Dumbuya, Partners In Health (PIH) Sierra Leone’s director of reproductive, maternal, and neonatal health.

By centering dignity as both a design principle and a human rights imperative, the Ministry of Health (MoH) together with PIH Sierra Leone and Build Health International (BHI), who led the construction, are making it clear that maternal deaths are preventable with the right investment and commitment.

Designing Care

From the triage area to the birthing center, and the south and north wards, the layout of the buildings that make up the MCOE is organized around medical urgency—including the severity and complexity of a case—and what Gerard Georges, BHI’s director of architecture at calls “clarity of circulation.” He explains, “Staff needed to access patients easily, but it was just as important that patients and visitors could move through the campus in an orderly, intuitive way.” Outpatient services are located near the entrance of the campus and the birthing center is in its own cluster because it’s a highly technical space that includes operating rooms and the first neonatal intensive care unit (NICU) in Sierra Leone. This required installing heating, ventilation, and air conditioning  systems for infection control and comfort.

Shaping Privacy

In an environment where vulnerability is often at its highest, the design team sought to balance visibility for clinical safety with the dignity of privacy. Windows were placed high enough to allow natural light in without exposing patients to the outside. In the birthing center, half height walls and closable curtains offer mothers a sense of separation and privacy. In addition, a private courtyard near the labor unit gives expectant mothers a peaceful outdoor space to walk, rest, or find relief during early labor.

Given the stigma often surrounding reproductive care for young people, privacy was a central concern that went into the design of spaces intended for educational and youth services.  

“The goal was to create a space that felt discreet without being hidden, accessible enough to reduce shame, and protected to ensure comfort,” emphasizes Allison Adamson, an architect and health care planner at BHI.

As a result, the adolescent and youth friendly services clinic will have subtle signage and decorative screen walls to create a private and welcoming atmosphere.

The same level of care was given to designing areas for women experiencing loss. A second ward and private delivery room was created to give grieving mothers separation from the main postnatal areas.

While privacy was essential in some areas, other parts of the facility were designed to foster community, reflecting the value of social connection in Sierra Leone. “Recognizing that cultural norms around waiting and gathering differ from those in the U.S., the design team created a large, open-air covered area to allow patients and families to wait and socialize comfortably while maintaining a clear view of check-in stations,” explains Georges.

Light, Air, Beauty

Just as the buildings were thoughtfully organized to support clinical care, nature was intentionally integrated to emphasize natural ventilation, natural lighting and views of greenery.  

The inpatient wards, where most mothers spend their recovery, offered an opportunity to design something unique. In a quiet space at the back, the design team stretched the buildings around the courtyard and oriented the views inward toward a green space. Many of the plants and trees were donated by community members and are being nurtured in a nursery, awaiting transplanting.

“We hoped to create an environment that patients, staff, and visitors could feel proud of. Each department was designed so that no matter where you are, there is a view of nature,” notes Georges.  

Dr. Paul Farmer, PIH’s beloved co-founder, was an avid gardener who planted flowers and vegetables at care delivery sites around the globe. Before his passing in 2022, he visited the MCOE site and encouraged the creation of gardens so patients could heal in surroundings that honored both nature and dignity. This vision—rooted in his belief that care delivery sites should embody beauty as well as medical excellence—lives on in the center’s courtyards and green spaces.

Responding to Local Realities

Informed by lessons from the Ebola epidemic, the MCOE places a strong emphasis on infection control. Each ward features an isolation room with its own toilet and dual access. Nurses enter from inside the ward while separate exterior doors allow patients entry and exit. In addition, upgraded laundry and waste disposal systems will also help maintain hygiene.

To support safe, reliable care, the facility is also equipped with essential infrastructure upgrades. An on-site water treatment plant ensures access to clean water throughout the facility for patients to bathe, staff to wash medical supplies and more. New electrical systems including a connection to the national grid, back-up generators, and voltage regulators, help guarantee uninterrupted power for critical care. To conserve energy for lighting and medical equipment, the design omitted nurse call systems but included central nurse stations with clear sight lines to every patient. The design also addresses the challenges of distance, access, and the emotional needs of families, particularly those with newborns in critical care. Many mothers travel long distances to reach the hospital in rural Kono District, and babies can stay in the NICU for weeks, so the MCOE includes a dormitory for mothers with babies that require extended neonatal care.  

“With 17 beds and a communal kitchen, the space allows women to be close to their infants without the burden of daily travel or sleeping in public areas on campus,” adds Adamson.  

The communal kitchens also support infection control through improved sanitation and food safety, while serving as a hub for nutritional education led by nurses and nutritionists. In addition to the dormitory, the facility features a kangaroo mother care room to support skin-to-skin contact, breastfeeding, and bonding under the supervision of nursing staff.

The MCOE is a bold commitment to the future of health care in Sierra Leone. Everyone connected to this facility is affirming that Sierra Leonean women and families are not an afterthought. Through hands-on training, the MCOE will prepare the next generation of Sierra Leonean doctors, nurses and midwives, equipping them with the skills to deliver compassionate and expert care. “We will work to ensure the hospital is accredited as a rural teaching hospital to signal long-term investment in quality and a standard of care that aligns with global benchmarks,” says Dumbuya.

This year, as foreign aid was abruptly pulled back, global health programming faced a severe funding shortfall. Officials in the U.S. Government claimed they were cutting wasteful and fraudulent spending and improving our foreign aid approach through an “America First” policy. However, in practice, these reforms left millions of people around the world without access to lifesaving care, with no warning or safety net.  

These attacks on global health funding have laid bare an acute-on-chronic crisis. The rapid removal of aid has caused an acute emergency—risking the lives of millions—that demands urgent action. However, we cannot ignore the underlying, chronic inequities that made this crisis possible. The current aid system often obscures the structural forces at play that create the need for aid in the first place.  

While many have called for aid reform without a clear strategy, Partners In Health (PIH), alongside Congressional global health champions, has developed a “north star” for global health politics: the Paul Farmer Memorial Resolution, which can guide policy and practice for decades to come.

On Thursday, July 31, 2025, a coalition in the U.S. House of Representatives and U.S. Senate announced the reintroduction of the Paul Farmer Memorial Resolution, first introduced in the fall of 2022. Led in the House by Representatives Jan Schakowsky, Raul Ruiz, and Pramila Jayapal and in the Senate by Ed Markey, this coalition is proposing what they've termed a "21st-century global health strategy," grounded in the life's work of the late Dr. Paul Farmer.  

“In this moment of crisis, we need Paul’s vision for global health justice more than ever. Thankfully, that vision is captured in this resolution,” said Shelia Davis, PIH CEO, in a press release from Representative Schakowsky. “It provides us with a much-needed roadmap for global cooperation based on solidarity and justice by getting to the root causes of unnecessary suffering and death, or what Paul called ‘structural violence’. This includes greatly improving development assistance for health but also going well beyond aid to address ongoing extractive colonial arrangements, which preclude local investments in health systems.”

A fundamental problem in global health is the low level of aspiration among people in power, borne partly out of a misunderstanding of the causes and solutions to health care inequity. Dr. Farmer termed these chronically low aspirations  "being socialized for scarcity on behalf of others." The resolution represents Congress's most serious effort yet to address this issue.

An Aspiration for Health Equity

Over 100 million people die each decade because they lack access to basic health services—what Dr. Farmer often referred to as "stupid deaths." This resolution aims to provide an ambitious roadmap toward global health equity and universal health coverage to prevent needless deaths in the future.

In 2021, about 4.5 billion people were not fully covered by essential health services. The spending gap to achieve universal health coverage in low- and lower-middle-income countries is around $400 billion annually. With adequate funding, expanding universal health coverage to 1 billion more people could avert over 24.4 million deaths in five years. Such investments also yield significant economic gains. High-impact health interventions in low- and middle-income countries can generate up to $9 for every $1 invested.

"Many of the poorest developing countries presently lack the tax capacity to mobilize the necessary resources to close the universal health coverage financing gap," the resolution states, "meaning unnecessary deaths will continue in these settings for the foreseeable future without external donor financing or dramatic increases in domestic tax capacity."  

The Paul Farmer Memorial Resolution

To realize health for all, the resolution proposes:

• Reforms to global cooperation by:
  • Addressing the sovereign debt crisis through initiatives to restructure and eliminate unsustainable and unjust debt burdens
  • Advancing a strong UN Tax Convention and other measures to end illicit financial flows and other forms of transnational tax abuse
  • Developing new medical technologies for diseases of poverty and ensuring their availability as global public goods
  • Supporting initiatives to advance global labor rights
  • Democratizing international financial and trade institutions
• Reforms to global health assistance by:
  • Increasing global health funding to enable the U.S. to finally meet the decades-long global cooperation aid target of 0.7% Gross National Income
  • Focusing on strengthening public national health systems, especially via multilateral institutions

A Financing Solution

The resolution calls for both increased global health funding and global economic reforms to achieve these objectives. Contrary to popular belief, and especially now, following severe funding cuts under the current administration, the U.S. has room to significantly expand development spending.

As the resolution states, "Relative to the size of the United States economy, the United States' official overseas development spending is low at 0.17 percent of gross national income in 2020, placing the United States 24th out of the 29 country members of the Organization for Economic Cooperation and Development's Development Assistance Committee.”

For those concerned that foreign aid constitutes wasteful spending, the resolution emphasizes that reform, not retreat, is the solution. Global health spending should strengthen public institutions in alignment with national health plans, not funnel money to private contractors. Funding should prioritize historically neglected areas such as hospital and clinic construction, new medical and nursing schools, clinician salaries, and research and development of medical technologies for diseases of poverty.

Why Aid is Our Responsibility  

In the current global economic architecture, poor countries effectively develop rich countries, rather than the other way around. Research estimates that upwards of $2 trillion more flows out of poor countries than into them each year—more than ten times the entire global aid budget.

If the goal is to help poor countries build strong health systems, development efforts must also end the economic harms that prevent low-income countries from mobilizing their own resources for health spending in the first place.  

The resolution lays out a variety of policy areas where the U.S. can use its legal and diplomatic power to make the global economy more fair, just, and democratic—a powerful and fitting legacy for Dr. Farmer.

After a year of planning, everything was ready. The proposal, the team, the implementation plan, the patients. Socios En Salud (SES)—as Partners In Health is known in Peru—had been working alongside local and international partners to build VENSALUD: a project designed to serve thousands of Venezuelan migrants and refugees in Lima and Callao.

The ambitious proposal included mobile clinics, telemedicine, community screenings, social cohesion spaces, educational campaigns, and referral pathways to the national health system to support the well-being of Venezuelan migrants and refugees. For SES, VENSALUD wasn't just about filling a gap, but about building a bridge to a more equitable health system for those who are almost always left out.

The goal of VENSALUD was to directly reach 7,486 people in Lima and Callao with medical care, health education, and community engagement opportunities.  

“To sustain the project beyond the initial funding from the United States government, the project would also train health care personnel, promote integration between migrants and host communities, and establish institutional networks,” said Santiago Palomino, head of the Noncommunicable Diseases program at SES.

But then, the Trump administration announced drastic cuts to foreign aid, and the project was halted before it could even begin.

In mid-2025, the U.S. Department of State, through its Bureau of Population, Refugees, and Migration (PRM), decided not to renew funding for VENSALUD. A single document—an omission from the list of approved grants—was enough to dismantle more than a year of planning.  

The program, ready to serve an often-overlooked community, was immediately frozen.

This loss of funding wasn't simply an institutional loss for SES. The suspension—which represents a miniscule portion of the billions of dollars removed from foreign aid all over the world—meant an interruption to addressing the urgent needs of a highly vulnerable population in Peru. With the loss of just one program, health care, for thousands, once again became a distant promise.

Designed to Meet an Urgent Need

There are over 1.5 million Venezuelan migrants and refugees in Peru. More than 65% are women, many of whom are of reproductive age or have children and families to support. The figures reveal a highly precarious situation: one in four migrants with noncommunicable diseases (NCDs) suffer from hypertension, and more than 68% of these cases do not receive treatment and can turn fatal.  

The mental health of this migrant community is also a concern. Regional studies show that between 20% and 60% of Venezuelan migrants and refugees experience symptoms of anxiety or depression, exacerbated by discrimination, economic insecurity, and the constant fear of deportation. Without access to comprehensive health care services, these conditions will continue to cause unnecessary, preventable suffering.  

For sexual and reproductive health, SES found that the gaps in care were also severe. Pregnant migrant and refugee women accessed, on average, only 3.7 prenatal checkups—less than half of what is recommended by the World Health Organization (WHO). VENSALUD's proposal included mobile clinics, rights-based educational campaigns, and targeted family planning services specifically for young women in vulnerable situations.

In response to these realities, VENSALUD planned mental health screenings for more than 2,900 people, as well as comprehensive health assessments—including screenings for NCDs and sexual and reproductive health checks—for more than 3,200 more.  

“These clinical actions would be complemented by community interventions designed to reduce migration stress, support prevention campaigns, and provide access to specialized care,” Palomino said.

A Remedy, Disrupted

With over a million dollars in funding initially allocated by the U.S. government, VENSALUD incorporated international models such as HEARTS—a strategic approach to improving cardiovascular health recommended by the WHO—and Invested in Diabetes—a study comparing standardized and patient-driven shared medical appointments for people with diabetes. These models were then adapted to the realities of the migrant population through a multidisciplinary approach, even providing lifesaving services through shared telemedicine appointments.

The project also went beyond the clinic. It brought together a diverse institutional ecosystem: units of the Ministries of Health in North, Central, and South Lima; local organizations; and local governments in three key districts: Independencia, Los Olivos, and San Martín de Porres.

“It was designed to be a vehicle for social integration,” Palomino said. “It included migrant-led communication campaigns, community spokespeople, and media actions to counter xenophobia.”

The cancellation of VENSALUD’s funding—implemented by the Trump administration—had an impact beyond the patients as well. As Diana Huamán, project coordinator at SES, explained: the cutoff meant the immediate dismissal of key personnel, including migrant professionals who were also in vulnerable situations. Jobs, care, and support all vanished in an instant.

Moreover, contracts with suppliers were terminated, procurement was halted, and institutional coordination with the Ministry of Health and municipalities was broken.  

“Purchasing processes were abruptly interrupted, and in several cases, contracts had to be terminated,” Huamán said. “The relationship built with the [Ministry of Health] was affected, given the cancellation of joint activities.”

Had it been able to progress, the project would’ve also trained 60 healthcare professionals in NCD care and 120 people in health advocacy, established citizen participation spaces with 450 people, and conducted cultural interventions with more than 700 community members.

A year of planning and preparation was undermined by individuals thousands of miles away, who don’t have to bear the consequences.

A History of Success

This was not the first time Socios En Salud was focused on the urgent health needs of migrant and refugee communities. In the past several years, SES has implemented a series of humanitarian health projects with international partners, creating successful, replicable models for urban migrant contexts in Peru.

Between 2021 and 2023, also with funding from the PRM, SES deployed a mobile health program in Lima that provided comprehensive care for tuberculosis, COVID-19, mental health, and sexual health. Initially designed to reach 10,000 people, the project ultimately served 14,600, increasing its monthly reach sixfold in just six months.

In collaboration with the International Organization for Migration (IOM) and the U.S. CDC, SES also led the first bio-behavioral study on HIV and syphilis among Venezuelan migrants in Peru, testing more than 6,600 individuals and successfully linking hundreds of confirmed cases to treatment in the public health system.

Other initiatives included cash transfer programs with UNAIDS and the Global Fund, clinical and social support for migrants living with HIV, and, most recently, community health campaigns that continue to serve hundreds of migrants in Lima and Callao. In 2024, SES even secured new PRM funding for a two-year program (2025–2026) to strengthen Peru’s national health system through integrated services for noncommunicable diseases, mental health, and sexual and reproductive health.

This track record demonstrates that SES not only had the readiness and partnerships to carry out VENSALUD, but also the proven capacity to deliver impact at scale for highly vulnerable populations. However, even this wasn’t enough to protect this project from the widespread funding cuts this year.

Still Pursuing the Right to Health

Despite this interruption from the PRM, SES remains committed to carrying out the mission of this project—with or without support from the U.S. government. The organization continues to actively seek new funding and partnerships with public and private partners to resume the path it had already carved out, in service of the thousands of Venezuelan migrants and refugees living in Peru.  

VENSALUD was not just a project put on hold—but the real possibility that health care would cease to be an exception for migrants and refugees and become an accessible, sustained guarantee.

The plans were ready. The need was clear. Yet, without reliable funding, the work remains to be done. 

This week, the New England Journal of Medicine (NEJM) published a powerful reflection by Didi Bertrand Farmer on the life and legacy of PIH Co-founder Dr. Paul Farmer.

In her essay, “In Paul Farmer’s Beautiful Garden of Global Health Equity: Reflections on the Third Remembrance of His Passing,” Didi uses Paul’s love of gardening as a metaphor for his lifelong commitment to advancing global health equity.  

“Through his contributions to global health, mainly through the work of Partners in Health (PIH), he showed us that tending to our world is like tending to a garden, a place that — when nurtured with care — could yield health, justice, and opportunity for all.”

Paul often incorporated gardens into PIH clinics around the world, recognizing that beauty and nature could provide dignity, solace, and healing. Didi recalls:

“Under the warm sun of the Rwinkwavu District Hospital in Rwanda, a country where our family served for 10 years, on any given day, I would spot Paul working side by side with his colleagues and a team of men and women moving giant rocks, planting trees and thousands of plants and flowers, and carving out a pond near the inpatient ward and the training center. My desk scissors would frequently disappear, borrowed for trimming plants or cutting flowers into beautiful bouquets for patients’ wards and even for my desk. These gardens became not only a source of beauty but of knowledge and economic opportunity, as former patients and family members gained employment tending to them.”

Originally written in February 2025, the piece reminds us that through education, partnership, and plants, Paul left a garden for us to tend to. “Paul’s garden was never meant to be his alone. It is ours now to protect, nurture, and expand.”

Read the full article on the NEJM website.

Editor’s Note: This blog was originally published in Spanish on Socios En Salud’s blog.

Elvis Espinosa is fascinated by music. Above all, he loves the huaynos genre of his native La Oroya, a mining town nestled at an altitude of more than 3,000 meters in the department of Junín.

Two decades ago, he migrated to his current home in the Carabayllo district, north of Lima, where he keeps an alto saxophone. He often sits next to his eldest son—now 16—and plays a few notes, more for the intimate pleasure of remembering than for the precision of the melody.

But, just four years ago, holding that saxophone seemed like an impossible, almost unthinkable task.

In 2021, Espinosa was told he’d recovered from COVID-19, although he was experiencing persistent symptoms that worried him.  

“I kept coughing harder, I started spitting blood, and then I went to a medical center,” he recalls. The diagnosis came as a blow: tuberculosis.

Unfortunately for Espinosa, treatment wasn’t going to be simple. The clinicians explained to him that he was facing a variant that was resistant to first-line medications, known as multidrug-resistant tuberculosis (MDR-TB).  

Treatment for this form of TB consisted of a routine of up to 16 pills a day accompanied by painful injections that, despite their severity, provided no relief. Week after week, his body shrank: from his usual weight of 183 pounds, he dropped to just 95.

Although the physical toll was undeniable, Espinosa says the feeling of worthlessness was what weighed him down the most. Before his diagnosis, Espinosa had acquired a new piece of land where he dreamed of building a house. After becoming sick, he was unable to work, without income to support his wife and two children. The land that was once a dream transformed into a mountain of unpayable debt, and depression began to dominate his life.

“I was like that for a year. I thought I was getting better, but four, five, six months would go by, and nothing,” he said. “I kept bleeding, there was no recovery."

In December of that year, he traveled with his family to La Oroya, believing this would be his last return to his birthplace. His disease had progressed to an even more complex form, pre-extensively drug-resistant TB (pre-XDR TB), resistant to several additional medications and much more difficult to treat.

There seemed to be no hope for improvement. Until a clinical trial, implemented in Peru by Socios En Salud, as Partners In Health is known locally, literally came knocking.

From the Lab to the Neighborhood: How endTB-Q was Born

In clinical terms, pre-XDR TB is defined as rifampicin-resistant (RR) or multidrug-resistant (MDR) tuberculosis, which also presents resistance to fluoroquinolones, or broad-spectrum antibiotics. This makes pre-XDR TB a more complex form to treat than RR/MDR-TB, which still offers better cure rates.

“This combination offered fewer treatment options,” said Dr. Jimena Ruiz, coordinator of the Clinical Trials Unit at Socios En Salud. “Previously, it was thought that resistance only appeared due to treatment noncompliance, but today we know that someone can be directly infected with a resistant form.”  

In 2023, the World Health Organization (WHO) estimated 10 million new cases of TB, of which nearly 100,000 were pre-XDR. In Peru, that same year, 1,424 cases of MDR-TB were recorded. Among these, the pre-XDR fraction is smaller, but especially critical, requiring treatment of up to 18 months with potent drugs and constant monitoring.

To address this burden, the endTB project, a partnership between PIH, Médecins Sans Frontières, and Interactive Research and Development, and funded by Unitaid, has been working to develop less toxic and faster therapies against drug resistant forms of TB. As part of this partnership, the endTB-Q clinical trial was specifically designed to address pre-XDR TB.

The study recruited 324 participants from six countries, 6% of which were in Peru, to begin during the COVID-19 pandemic.  

“The experience was intense. Patients arrived in very serious condition, and we had to monitor them for two years in a context of fear and uncertainty,” Dr. Ruiz said. “When we started, the treatments were long, with injectables and hospitalizations. Today, we talk about shorter, all-oral regimens.”

Responding Amid a Pandemic

At the height of Espinosa’s illness, Socios En Salud found him at a local health clinic, reviewed his TB records, and invited him to participate in the endTB-Q study.  

“They told me they would support me with the medications, that they would bring them to my home, that I would no longer have to go to the health center or spend money on travel,” Espinosa shared. “Socios En Salud gave me transportation to appointments and support vouchers. The treatment lasted a year, but it was all pills, no injections."

The support, however, went beyond his immediate clinical needs. Amidst debt and the depression exacerbated by the disease, Espinosa received also psychological and social support. For Dr. Ruiz, this support makes a unique difference.  

“It's something that sets Socios En Salud apart: we apply the same comprehensive support approach in clinical trials as in our community programs,” Dr. Ruiz said.

Espinosa began to feel his body recovering. Unlike the treatment he had received early in his TB journey, he now took only four pills a day, had monthly checkups, and felt his recovery—improving and gaining weight each month.  

Groundbreaking Results

In November 2024, Socios En Salud’s Clinical Trials Unit traveled to Bali, Indonesia, for the Union World Conference on Lung Health, where preliminary results of the endTB-Q trial were presented. In July 2025, the full findings were published in The Lancet.

The study ultimately found that people who received an experimental six- to nine-month regimen of four key drugs—bedaquiline, delamanid, linezolid, and clofazimine—achieved a cure rate of 87%, and up to 93% in those who started with limited disease.

Compared to standard treatment of up to 18 months with injectables and severe adverse effects, this new regimen opens a shorter, safer, and more tolerable path for those facing the most resistant form of tuberculosis.

However, the study revealed that not all cases were straightforward. In people with very advanced tuberculosis, nine months weren't enough to prevent relapses. But Dr. Ruiz emphasized that, "it's key to vigorously support treatment, carefully manage side effects, and maintain people's trust."

For Espinosa, the endTB-Q trial allowed him to recover his life: the lost weight, his ability to work, his spirits, and his saxophone.  

In the living room of his home in Carabayllo, the saxophone remains untouched. Espinosa glances at it from time to time but hasn't yet picked it up to play. He doesn't need to touch it to know that, after his TB treatment, he will have recovered enough breath to try making music again. 

Being a teenager is already difficult enough. Add in a chronic illness and every day can present new challenges. During a life stage that is often characterized by both physical and psychological changes, adhering to a consistent treatment plan can seem futile.  

For adolescents living with HIV, the shift from pediatric to adult care can cause interruptions in their treatment, especially in vulnerable populations, due to a general lack of supportive, accessible health systems. Without consistent medication, HIV can develop into AIDS and a treatable condition could potentially become life-threatening.  

Now, imagine trying to explain the gravity of this diagnosis to a teenager. Without fully understanding how critical their treatment is, seeking medical attention for HIV can become a chore. In fact, the data—although limited for this age group in particular—shows that adolescents living with HIV have worse health outcomes than adults over the age of 25 across the HIV continuum of care.  

For Alexander*, a veterinary assistant in Peru, his symptoms caused a clinic to incorrectly diagnose him with dengue fever. Socios En Salud (SES), as Partners In Health (PIH) is known in Peru, happened to be hosting a sexually transmitted infection screening clinic around the same time, and Alexander wanted to attend. It was at this screening that his test came back positive for HIV.  

“I was in shock,” he remembers. “I couldn’t accept it. While they were explaining it to me, my mind wasn’t connecting with my body.”

In Peru, approximately 98,000 people live with HIV, nearly a third of whom are adolescents or young adults. Despite this large population, there aren’t many programs dedicated to their unique challenges.

To address this gap, SES partnered with Harvard Medical School (HMS) to launch an intervention called PASEO which provided accompaniment by community health workers (CHWs) to adolescents undergoing the transition to adult care. In Spanish, paseo means to stroll or walk, typically with friends. The name also serves as an acronym for peer accompaniment, support, and education.

“With the SES counselor, I could ask anything,” said Onexis*, a PASEO participant. “I valued the company, the understanding, and the guidance. When you start out, you have a lot of questions, and they were there when I needed them most.”

Following a pilot study, the National Institutes of Health (NIH) awarded a grant to Dr. Molly Franke, professor of global health and social medicine at HMS, in collaboration with SES, to fund a clinical trial that could help determine PASEO’s impact on viral load suppression as well as overall well-being.  

Studying the Critical Role of Accompaniment

PASEO enrolled and randomized 160 adolescents ages 14-23, either transitioning from pediatric HIV care to adult HIV care or receiving a new diagnosis, to one of two groups: a control group and an intervention group. The control group received the standard of care in Peru, as well as mental health screenings and referrals.  

The intervention group received PASEO’s model of accompaniment in addition to the standard of care. Each intervention participant was paired with a CHW for nine months, attended support groups and educational workshops, received mental health care screening and referrals, had monthly check-in visits, worked on personal development plans, and were accompanied to their clinic appointments. Surveys and chart reviews were completed by all participants at routine intervals throughout their 24-month participation in the study.

“We received a lot of information about [HIV], medications, and legal aspects, including what to do when looking for work,” said Isaac*, a PASEO participant. “We also received psychosocial support and integration activities. In addition, each of us had a [CHW] who accompanied us to the hospital or visited us at home.”

Following his diagnosis, Alexander was enrolled in the intervention group with people his age, like Isaac and Onexis.

“I always felt [SES] was by my side, as both an emotional and physical support,” Alexander said. “I received psychological counseling because I didn’t feel good about myself. During the walks and workshops, my anxiety began to decline, and I began to see it as just another aspect of life. Dealing with a condition like [HIV] isn't easy, even worse if you keep it a secret.”

The clinical trial was in its third year of five when HMS was notified that its funding from the NIH had been terminated, and this collaboration with SES would face a precarious future. Their immediate concern was for the study’s participants.  

“There was a great feeling of concern that both the team’s and the participants’ investment in and commitment to the study may have been in vain,” said Erika Gonzales, PASEO study coordinator. “We also felt disappointed that we would perhaps not be able to keep promises made to participants when they enrolled.”

An Unpredictable Fate

Immediately following news of the United States government’s funding cuts, Dan Nguyen, a medical student at Tufts University School of Medicine and current member of the Boston City PIH Engage chapter, arrived in Lima as a visiting student researcher for the PASEO project.

“I am still in awe of the staff’s resiliency and rapport despite the study's uncertain future,” he said. “They recognized that their patients were more than checkboxes, quantifiable viral loads, and CD4 counts [an indicator of immune system strength], making a meaningful and sustained impact on their livelihoods.”

During his time in Lima, Nguyen was able to see firsthand the impact that PASEO was already having on adolescents participating in the study, like Alexander, Onexis, and Isaac.

“Many... used to be fearful of seeking out care, coming to terms with their socially stigmatized diagnosis, or starting an unfamiliar treatment regimen,” he shared. “Today, they are confident, informed, and prideful young adults who recognize that HIV is not a death sentence, find comfort in support systems with similar diagnoses, and understand that being undetectable equals untransmissible. Their CD4 counts are at healthy levels, their viral loads are low, and they can lead healthy lives while living with HIV.”

Onexis felt similar about her first-hand experience.  

“It’s essential to feel supported,” she said. “Society sometimes pushes people away out of ignorance, but [SES] helps clear up these misconceptions. There are people who sink into loneliness, anxiety, or depression...but being able to help them see things differently is very important. Completing the treatment has given me more confidence.”

With two years left in the trial and already promising results, PIH, SES, and HMS have generously stepped in to support this project until June 2026. However, as funding still remains in limbo, the final year of the study is still in jeopardy.  

Beyond Teenagers in Peru

Cutting funding to research has massive implications on health advancements, particularly for vulnerable populations that are often left out of critical studies, like teenagers living with HIV in Peru.

“Without research, there is no public and global health. There are no recommendations for best practices or new ways to intervene to disrupt or improve the course of disease, both on an individual and population level,” Dr. Franke's research team shared. “Research is a long-game field that the general public many times doesn't realize affects their lives on a daily basis.”

Eliminating funding for PASEO’s research in particular removes a critical resource for their study participants and will ultimately hurt adolescents living with HIV globally. Even in the U.S., adolescents living with HIV have alarmingly low adherence rates.  

“If our research is permanently halted, we will be unable to continue accompanying participants,” Gonzales said. “The health system and participant data we have collected won’t be adequate to determine if the PASEO intervention could be scaled up and integrated into the Peruvian health system standard of care or beyond."

The PASEO program has the potential to inform HIV treatment for young adults around the world—bringing this large population tailored care that emphasizes humanity, accompaniment, and overall well-being.

*Last name omitted by participant request 

In Lesotho, where communities are far from clinics, multi-drug tuberculosis (MDR-TB) doesn’t just threaten health. It threatens livelihoods, families, and futures. That’s why Partners In Health (PIH) Lesotho is redefining care for those with tuberculosis, the world’s deadliest infectious disease.  

Across all PIH care delivery sites, accompaniment is a defining characteristic of our work. It means being there, together, for as long as it takes. In Lesotho, treatment supporters accompany patients to monthly clinic visits, record progress and symptoms, prepare meals, and more. These supporters are more than sympathetic neighbors or relatives; they are carefully selected, trained, and woven into PIH’s professional care network.

Once identified, treatment supporters undergo mandatory training at PIH-supported Botšabelo Hospital’s halfway home, a 14-bed facility where stable patients receive care. The training covers MDR-TB basics, the importance of strict medication adherence, infection control, nutrition, psychosocial care, and meticulous record-keeping. They learn how to recognize side effects and when to immediately alert the community health team at the hospital. Equipped with this knowledge, treatment supporters return as frontline caregivers, not just helpers.  

Below, are ten short stories of healing, strength, and skilled support from treatment supporters and patients.

Qacha Qabane, 50, once a farmer and now paralyzed from the waist down by MDR-TB, relies on his 24-year-old niece, Selloane Qabane. Trained at the halfway home, she learned to monitor medication timing, emotional shifts, and side effects. Each morning and evening, she administers medicine, records reactions, and ensures he stays connected to care. “Caring for him teaches me patience, hope, and the power of presence; every small act of support becomes a bridge and a reminder of our bond,” reflects Selloane.

________________________________________________________________________________

’Matumelo Seiso, 37, fearing she would die and leave her children without a mother, now receives  steadfast care from ’Mamolantoa Letlisa, 63. At the halfway home, Letlisa found her purpose in supporting patients: “I find purpose in seeing my support bring hope and strength to someone fighting MDR-TB. I find joy in being the shoulder my patient can lean on through the hardest days.”

________________________________________________________________________________

’Maseithati Kosi, 52, who contracted MDR-TB after caring for her late husband, is supported by ’Mapotlaki Teele, 64. At the halfway home, Teele learned the critical balance of medication oversight and nutritional support. With PIH providing food and transport, she ensures Kosi never skips a dose or misses a check-up. “Walking this journey with her has shown me that true care goes beyond medicine. It is about holding someone’s hand through every challenge and celebrating each small victory,” says Teele.

________________________________________________________________________________

Lekhotla Nkonyana, a 41-year-old mason, lost his ability to work after falling ill with MDR-TB. His treatment supporter, Mokoatsi Mabusela, 48, learned how to detect and report side effects, keeping treatment on track. Seeing Nkonyana tending livestock again, Mabusela says: “Knowing that my care helps him reclaim his life makes every challenge worthwhile. Being there for him is more than support; it is witnessing hope in action.”

________________________________________________________________________________

Ts’eliso Motsokonyane, 68, is battling MDR-TB. He once faced food shortages before receiving PIH’s social and medical support. His treatment supporter, ’Malumiso Sehlabo, 55, pairs care with precise vigilance, quickly reporting concerning symptoms and ensuring setbacks don’t derail treatment. “The smile of [Ts’eliso] when he started regaining his health [is] my greatest reward. My heart is full when I see a spark of hope return to his eyes,” reflects Sehlabo.

________________________________________________________________________________

Mots’elisi Malefane, 25, whose dream of earning a university degree was shattered by MDR-TB, is supported by ’Malerato Sejojo, 58. Through psychosocial training, Sejojo became both a healer and encourager. "Sometimes healing comes from words, reminding the patient that they are not alone," says Sejojo.

________________________________________________________________________________

Sarafina Makashane, 31, and her treatment supporter, Litlhare Matlole, navigate MDR-TB relapses together. Matlole’s training helps her detect symptoms early and offer steady support. Matlole explains: “What makes me proud is knowing that my small role can save someone’s life. I am fulfilled when my presence gives my patient the courage to keep fighting.”________________________________________________________________________________

For Kaizer Mahapa, 42, the constant care of Masingoaneng Kolosoa bridges the gap between home responsibilities and caregiving. Trained to log every symptom and report immediately, she reflects on her role: “Being a treatment supporter means turning fear into courage and sickness into recovery. For me, being a treatment supporter is about giving love, not just administering medicine.”

________________________________________________________________________________

Khamokha Khamokha, 56, an ex-miner who worked in a gold mine in South Africa for 29 years, learned in February 2023 that he had MDR-TB. Today, he makes a living through subsistence farming while navigating the challenges of treatment. Alongside him is his treatment supporter, ’Makhauhelo Mapulane, whose training helps her detect signs of relapse and provide both comfort and strength. “The bond I build with my patient gives me strength, as much as I give them strength. The bond I share with my patient is more than care; it is family,” says Mapulane.

________________________________________________________________________________

Kaemane Makhetha, 22, an IT student, became a treatment supporter for his neighbor and friend, Sefonthoane Mohohla, 26. At the halfway home, he learned the intricacies of MDR-TB treatment: “I only knew about susceptible TB. I didn’t know there were so many types of pills, specific times, and the exact number of pills required.” Now, every morning before class, he ensures Mohohla takes his medication and that any issues are logged and reported. “Every dose I witness taken is a step closer to healing, and that gives me joy. Every moment I sit with him reminds me that healing starts with companionship,” explains Makhetha.

________________________________________________________________________________

Between 2021 and 2024, PIH Lesotho worked with 483 treatment supporters, enabling hundreds of patients to stay on track through their entire treatment journeys.

It's no secret that foreign aid and global health programming have weakened immensely under the current United States administration with severe funding cuts and widespread misinformation. In less than a year, these abrupt changes in global health funding have begun to dismantle years of work, by Partners In Health (PIH) and others, to make the world a healthier and safer place.  

Despite research detailing the risks and harms of pulling funding—like new estimates that 2.2 million people will die of tuberculosis (TB) in the next five years if funding cuts become permanent—the attacks on foreign aid persist.  

There are two programs in particular—which PIH has a long history with—that could lose billions of dollars of funding from the U.S. government this year. Not because the funding hasn’t been approved, or has otherwise been cut, but simply because the U.S. hasn’t sent the money that it promised to.  

For both the Global Fund to Fight AIDS, Tuberculosis, and Malaria, or the Global Fund, and the U.S. President's Emergency Plan for AIDS Relief, or PEPFAR, PIH Co-founder Dr. Paul Farmer played a pivotal role in their establishment. In 2001, the United Nations General Assembly endorsed the creation of a global fund to fight HIV and AIDS, drawing inspiration from Farmer’s advocacy and PIH’s work in Haiti. Similarly, in 2002, Farmer played a key role in providing the evidence that convinced President George W. Bush to announce PEPFAR.

Now, over 20 years later, even with bipartisan Congressional approval, the current administration is withholding over $4 billion in funding that these programs rely on to prevent disease outbreaks, strengthen health systems, and protect vulnerable communities, including those where PIH works.

Let’s take a closer look at each program:  

The U.S. President's Emergency Plan for AIDS Relief, or PEPFAR

PEPFAR is a long-standing, bipartisan global health program that has saved over 25 million lives. Over the summer, Congress successfully fought to save PEPFAR from any funding cuts in the president’s rescissions package. Despite this support across the aisle, the Office of Management and Budget’s (OMB’s) website revealed a troubling truth: they simply aren’t sending out the money that Congress has approved.  

As of the writing of this article, OMB has only distributed a little over $3 billion of the approved $6.045 billion to PEPFAR agencies. Withholding half of the funding is unprecedented, causing 30-50% cuts to PEPFAR-supported programs, and reducing access to lifesaving HIV treatment and prevention.  

Again, this funding hasn’t been revoked in any way by Congress or through rescissions. It is approved and authorized federal funding—taxpayer dollars—that is sitting in a bank as opposed to being used to save lives around the world.  

The Global Fund to Fight AIDS, Tuberculosis, and Malaria

The Global Fund, a global partnership that has saved 70 million lives since its inception in 2002, is also facing a severe funding gap. Historically, the U.S. has provided funding for up to one-third of the Global Fund’s activities.

The Global Fund receives its funding through pledges similar to a “match campaign” that a nonprofit organization may host—the U.S. will commit $1 for every $2 that other donors provide, helping to incentivize other governments, foundations, and companies to give.

Despite the U.S. Congress approving funds through binding appropriations law, as of now, the State Department has not released $1.25 billion of those fully approved U.S. contributions, causing the Global Fund to scale back grants they’ve already awarded. This lack of funding is cutting services by an average of 10% across more than 100 countries.  

With $2.5 billion of contributions in hand from the other Global Fund donors, the U.S. alone is folding on its commitment to the people around the world who rely on these services.  

The Real-World Impact

Let’s take Malawi for example. Malawi is one of the poorest countries in the world, where 70% of the population lives below the poverty line. Their health sector is drastically underfunded, with only about $16 allocated per person per year for health services. Unfortunately, over half of Malawi’s total health expenditures are donor funded, meaning disruptions—like the U.S. failing to live up to its commitments—can be detrimental to their entire system.  

The loss of PEPFAR and Global Fund contributions could equal a 26% cut in Malawi's total HIV budget. The lack of funding will also have a massive impact on HIV drugs, medical supplies, and diagnostic tools—the Global Fund provides funding for 99% of all of Malawi's HIV commodities—and on health workers—95% of HIV-related health workers in the country are funded by PEPFAR and the Global Fund. Together, these funds—that are being needlessly withheld—are essential to the care of patients with HIV and AIDS in Malawi.  

Abruptly pulling funding immediately makes matters worse for patients and communities. This is exacerbated by the country’s current debt crisis, whereby a third of Malawi’s national budget goes to debt servicing, leaving little remaining for urgent health investments. Without debt relief, Malawi will struggle to find resources to cover the gaps left by this funding.

Release the Funds

Withholding the lifesaving funds that the Global Fund and PEPFAR provide not only puts millions of lives at risk but also undermines Congress’s constitutional authority over federal spending and damages trust in U.S. global leadership. Until this funding is released, people around the world will continue to lose access to essential health programs.

The PIH community—including supporters like you—have helped secure congressional support for this funding for decades. Now, we must ensure it is shared and spent appropriately this year and in the future. To help, you can contact your Members of Congress and urge them to pressure the OMB and State Department to immediately release the full, congressionally approved funding for both PEPFAR and the Global Fund.  

Acefie Théodore began experiencing unusual symptoms.

The lifelong farmer had always been strong and hardworking. She grew crops, cared for animals, and raised her three children in Haiti’s rural town of Mathégouasse, located close to the border of the Dominican Republic.

“I would wake up before sunrise to prepare breakfast and go to the garden with my husband,” Théodore said. “We worked together. I was healthy, active, and independent. I was supporting my family.”

But in 2008, Théodore suddenly became extremely fatigued. Her appetite and weight declined dramatically and she had persistent, debilitating fevers.

Théodore was in critical condition when she arrived at the Partners In Health (PIH)-supported Notre Dame de la Nativité Hospital in Belladère. There, she discovered she was positive for HIV.

Suddenly, Théodore was not only dealing with an extreme physical toll, but also a deep emotional one.  

“When I was told I had HIV, I thought it was over,” she said. “I thought, ‘I will die soon.’ People in the neighborhood started to reject me, even some members of my own family turned their backs on me. They didn’t want to share meals with me anymore. They pointed fingers at me.”

It was profoundly painful for Théodore, who felt isolated, ashamed, and shrouded by stigmatization.

She began to regain hope, though, after she spoke to Oliver Antonio, a health care worker at Zanmi Lasante, as PIH is known in Haiti.

“One day, (Antonio) told me: ‘Illness doesn’t fall on trees, it falls on living human beings,’” Théodore said. “That sentence woke me up. I told myself that if God had kept me alive until now, it’s because He has a plan for me.”

Despite the long distance between Théodore’s home and the hospital—an approximately two-hour-long walk—she hardly missed a medical appointment in over 15 years, and always diligently took her medication.  

"I always went to the hospital, even when I didn't have money for transportation,” she said. “Sometimes I walked several kilometers. But I never stopped my treatment. I know that if I don't take my medicine, my life will end sooner."

Missed appointments and a race against time

As such, Dr. Stéphanie Laphague, head of the tuberculosis and HIV program at the Notre Dame de la Nativité Hospital in Belladère, grew concerned when Théodore didn’t come to the hospital as planned for two months.

In March of 2023, a community health worker found Théodore bedridden, and informed Laphague that her health had seriously deteriorated.

Laphague quickly mobilized a small team to travel to Théodore. The search party was composed of herself, a social worker, and a support worker.

Together, they made the trek to Mathégouasse. When they found Théodore, she was nearly unrecognizable.

Théodore was “extremely thin, lying down, and without energy,” Laphague said.

She had been unable to move or seek help and needed immediate medical attention, but the roads back were rough—and they did not have an ambulance.  

Instead, the team hauled Théodore onto a motorcycle, knowing it could be a matter of life or death.

She made it to the hospital, where she was diagnosed by clinicians with pulmonary tuberculosis (TB). Despite a TB cure existing for decades, it is still the deadliest infectious disease in the world. For people like Théodore, who have a weakened immune system from HIV, the chances of contracting the illness are even higher—and outcomes worse.

Théodore needed to stay at the hospital for weeks. However, with intensive medical care, psychological support, and nutritional support, she was finally released and able to start outpatient treatment.

“If Zanmi Lasante wasn't there, I wouldn't be alive,” Théodore said. “Zanmi Lasante is not just a hospital, it's hope. It's family. It's love. Thank you very much for everything you do for those who don't have money, for the unfortunate, for those who suffer.”

PIH also supported Théodore with financial assistance and emotional support during her TB treatment regimen and ongoing HIV care.

"I've been living with HIV for 17 years,” Théodore said. “I had tuberculosis, I almost died. But thanks to God and Zanmi Lasante, I'm still here. I tell everyone: don’t be ashamed, don’t be afraid. These illnesses aren’t a death sentence, they’re a call to take care of yourself.”

Laphague has been amazed by Théodore’s perseverance.  

“She's a strong, resilient woman,” Laphague said. “The work we do in the TB/HIV program isn't just about prescribing medication. It's a profound human commitment, a daily fight for human dignity."

That commitment is more important than ever before, especially with global health funds shrinking and disruptions to U.S. foreign aid disbursement. Access to HIV medication should not be more difficult over the next year, but beyond that horizon, the supply may fluctuate as the situation evolves and alternative sources of supply chain funding rise or fall, explained ZL Infectious Disease Division Director Alain Casseus.

"For me, every patient saved is a victory over stigma, over oblivion, over injustice,” said Laphague.

Every summer, Partners In Health (PIH) Engage’s Training Institute (TI) brings together hundreds of leaders from across the country for a weekend of education and community building. The weekend culminates with a day spent bringing the fight for health as a human right to our congresspeople on the Hill.  

Engage is a network of high schoolers, college students, and professionals across the U.S. that recruit, train, and equip dedicated teams of volunteer community organizers who mobilize their communities in the fight for health equity. This year, there are over 700 Engagers across 33 states—almost 300 of whom were at TI.  

Attending TI as a new Engager in the summer of 2024 truly changed my life. This event was my introduction to organizing and the first time in my life that I found myself in community with people who were so adamant in their belief that our collective actions could truly shape a fairer and more just world.

I’ll admit that I was nervous going into the weekend this year. As an intern who spent my summer helping to organize TI, I was scared that it might feel different or less magical than it had when I attended last year. But the energy, passion, and excitement that radiated from every single Engager in attendance filled me with so much hope, and reminded me exactly why this movement matters.

This year, our network leadership team kicked off TI by sharing reflections on the ‘north star’ that we identify as a driving force in our organizing work. For me, that activity made my north star very clear: the voices and experiences of patients and providers at PIH sites. Their stories remind us why we organize – not as advocates working in isolation, but as a network of accompagnateurs, walking alongside them in solidarity as we bear the moral responsibility to advocate for a world in which where you live doesn’t determine if you live.

Throughout the weekend, I was brought back to that north star constantly. We were so lucky to hear about PIH’s history and theory of change from Dr. Joia Mukherjee, PIH’s senior advisor to the CEO, clinical & academic strategy. We also had the incredible opportunity to hear from seasoned advocates, including David Bryden, PIH’s senior policy officer, Mackenzie Zendt, a former USAID staffer, and Dr. Melino Ndayizigye, the executive director of PIH Lesotho. These speakers helped us contextualize our work as organizers within the broader work that PIH does at every care delivery site across the world. They helped us understand that the broader goal is not for PIH to spearhead systemic change in every single country, but for the success of its revolutionary care models to inspire broader policy shifts and a deeper collective understanding of the role that each of us plays in repairing, and sustaining, the broken systems that exist today.

One of my favorite moments from that weekend was a panel on PIH’s work to combat tuberculosis in Sierra Leone, with Cate Oswald, PIH’s chief policy and program officer, and Dr. Marta Lado, PIH Sierra Leone’s medical director. Lado shared the story of the very first multidrug-resistant tuberculosis case tested for and treated in the country. At every step of that story, she seemed to be describing PIH providers resisting the typical narratives of “sustainability” and “cost-effectiveness” in order to ensure the absolute highest standard of care for that patient. Hearing that story gave me a new understanding of what it means to treat every patient as a member of your own family, something you can’t do halfway.

We also had so many incredibly goofy moments, which I hold so close to my heart. From Fynn Crooks, our advocacy senior community organizer, staging a lightsaber battle to symbolize our fight for equitable global health legislation to a very inspired dance break to Pitbull’s Timber (best song ever), these moments reminded me that joy and hope play such a crucial role in building our movement.

By the end of TI, it felt as if I had watched the unveiling of something extraordinary. The weekend wove political education, hands-on skill-building, and strategy into a shared experience that left the whole room buzzing with energy. More than anything, I felt the collective momentum of our network of hundreds of Engagers leaving TI centered in their own north stars and ready to step into the campaign year ahead.

That energy carried us into our Hill Day, where Engagers held over 170 meetings with their congressional offices. Engagers who were learning the basics of our campaign just days before spoke with clarity and confidence about protecting PEPFAR and the Global Fund, and advancing the Paul Farmer Memorial Resolution. In every meeting I attended, I felt the energy of the weekend fueling everyone’s voices.

As I said in some of my closing remarks to Engagers, I really think that the people holding the cards right now want us to believe that we don’t have the power, that we can’t change the system. So, the way we resist will have to be through hope and believing in one another, even if it may seem silly or feel a little delusional at times. But through the community that we have built together, I really feel that it’s the only logical conclusion.

That’s the role that TI and Engage play for us: they’re reminders that we are not alone. That we are part of something bigger: a movement that listens, stays, and fights together.

So as we left the weekend, I hope that our network carries that forward. I hope we remember the stories we’ve heard, the people we’ve met, and the promises we’ve made. And I hope we keep showing up together, refusing to turn away. 

On Friday, August 29, the White House declared it was going to cancel $4.9 billion in congressionally approved foreign aid by using a tactic called “pocket rescissions.” Through this action, the executive branch is overstepping Congress’ power of the purse in an attempt to control the United States government’s spending process.

To truly honor the democratic processes of this country, and the constitution on which it was founded, the Executive should not be able to use pocket rescissions to unilaterally and unlawfully withhold already approved funding.

You aren’t alone if you’re unsure what a pocket rescission is. This method hasn’t been used by a president since 1983—and never in this way—so it’s not surprising that many voters aren’t aware of what it entails.  

So, what are pocket rescissions?  

Under the current rules of the Impoundment Control Act (ICA), federal funds may be withheld from obligation for up to 45 days through a process called rescissions. Once a rescissions package has been shared with Congress, they have the opportunity to act by voting for, against, or not voting at all on the proposed cuts. If Congress fails to act, the President must make the funds available to be spent.  

We saw this play out in July when Congress voted on—and passed—the Trump administration’s $9 billion rescissions package that made significant cuts to foreign aid and public broadcasting.

Separately, a “pocket rescission” can only occur when funds are set to expire. The standard rescissions procedure allows Congress to have the final say. With pocket rescissions, this is different. Instead, the president waits until late in the fiscal year to propose a funding cut. Then, when the fiscal year ends on September 30, the expiring funding lapses and cannot be paid out—regardless of Congressional action.

This system puts Congress in a bind because even if they were to vote down the president’s proposal the next day, the president is still able to pause the funds for 45 days.

According to the Center for American Progress, to “deliberately freeze significant portions of budget authority until it lapses this way is illegal and a violation of the president’s constitutional duty to carry out the law.”

The Government Accountability Office has also explained that pocket rescissions are against the law, despite protests from Russell Vought, director of the Office of Management and Budget. If the ICA allowed the president to use a loophole to withhold funds without Congress’s consent, it would give the executive limitless impoundment power and allow them to dictate spending without Congressional input. 

What is happening now?

The Trump administration has announced it will revoke nearly $5 billion in congressionally approved spending by utilizing this unlawful strategy. His proposal includes the termination of $3.2 billion in development assistance, $521 million in contributions to international organizations—including the Pan American Health Organization, the Americas branch of the World Health Organization—$393 million for peacekeeping activities, and $445 million in separately budgeted peacekeeping aid. This funding had been frozen earlier this year and remained unspent, even against a court injunction.

Of note, Republican Senate Appropriations Chair Susan Collins responded to this action with a statement that, “any effort to rescind appropriated funds without congressional approval is a clear violation of the law.”

Politicians, scholars, and advocates fear that should the executive succeed in this pocket rescission, it will set a precedent that would codify this maneuver to make it easier for future use. If we allow pocket rescissions to cut foreign aid funding now, any spending—including health care in the U.S., education, and defense—could be at risk in the future.

What can I do?

The Trump administration has been withholding funds for lifesaving programs since January. Right now, Congress has a great deal of power to prevent these pocket rescissions from terminating this funding completely. The Office of Budget Management is relying on the current language in the ICA to support the legality of pocket rescissions. Congress can amend this phrasing, however, and effectively block future attempts at this maneuver.  

You can contact your elected officials to share your frustration with pocket rescissions, remind them of the power they have to change it, and why you care that global health funding—that Congress has already approved—is properly spent.  

Dr. Sterman Toussaint has been appointed Partners In Health’s (PIH) chief medical officer, where he will further catalyze our care delivery around the world.

Toussaint joined PIH in 2011 as the attending surgeon for the family medicine residency program at Zanmi Lasante, PIH’s sister organization in Haiti. Over the next decade, he held several leadership positions before moving to West Africa in 2021, where he most recently served as PIH Liberia’s director of clinical services.

Building on that experience, Toussaint has now taken on PIH’s top medical leadership post. On July 1, he succeeded Dr. Joia Mukherjee as chief medical officer, who served in this role for 25 years and recently transitioned into the newly created position of senior advisor to the CEO, clinical and academic strategy.  

"It is the honor of my life to pass this blessing of a job to someone for whom I have so much love and respect as I do for brother Sterman," says Mukherjee. "If you don’t know him, you will love him!"

We spoke with Toussaint about his career, social medicine, and more. Below are four lessons in leadership from his time with PIH Liberia—and how he plans to carry those insights into his new, global role.

1. Prioritize teamwork and collaboration. 

When thinking about his most memorable moments with PIH Liberia, Toussaint recalls many, each with a common thread: teamwork. Of note, Toussaint highlights the success story of Dennis Toe, a 7-year-old boy treated at PIH-supported J.J. Dossen Memorial Hospital after being transferred from Pleebo Health Center in November 2022.  

A motorbike struck Toe, leaving him partially paralyzed as blood pooled in his skull, compressing his brain. PIH clinicians across departments came together to diagnose his injuries—without the availability of advanced imaging, at the time—and provide comprehensive treatment.  

After 21 days of around-the-clock care, Toe could finally move again. Toussaint attributes this success to teamwork. Though there wasn’t a neurosurgeon on staff,  the health care system had been thoughtfully revitalized over the last decade—by PIH Liberia, in collaboration with the Liberian government—to respond to people’s needs, including acute trauma cases like Toe’s. Because of this, “we managed to keep Dennis alive without any disability,” Toussaint says. “That’s what teamwork can achieve. We work together, for each other, to support each other.”

That teamwork wasn’t always seamless. In fact, Toussaint notes his biggest challenge in Liberia was navigating team dynamics across departments and specialties. However, he believes they managed to achieve that togetherness by better supporting underappreciated roles and reinforcing cohesiveness.  

It’s not about a single specialty, rather “it’s about one team standing in solidarity to support the voiceless, the underserved, and the marginalized,” says Toussaint.

2. Be patient and listen.

As a longtime educator, Toussaint has taught hundreds of medical residents—and learned just as much, or even more, from them. By his own admission, he was once impatient; his students taught him to take the time to listen. He carried those skills into his leadership style and work in Liberia, and plans to bring them to his cross-site role.  

“I’m starting this new role with a very, very small mouth and very, very big ears,” says Toussaint. “Listen to understand [and] to provide feedback to people, to help them to become better. Everyone comes to the table with some knowledge. How can we build on [that] knowledge to make people better?”

3. Understand PIH’s mission, values, and social medicine.

In 2010, Toussaint declined a job offer from PIH. He assumed PIH’s work might create dependency among people living in poverty—something he did not want to contribute to. Now, he laughs at that thought realizing it was a major misunderstanding. Poverty isn’t ever an individual’s fault; it’s injustice.

“Why is someone going to the field as a farmer working from 6 a.m. to 6 p.m. and that person is still poor? Something is wrong,” says Toussaint. “PIH helped me to understand that people are poor because of what happened in the past and because of current global policies that keep people in poverty.”

In Liberia, he felt he finally gained a full understanding of PIH’s work. Toussaint recognized that others—across all levels of the organization—didn’t, so he spearheaded a social medicine training initiative to help staff better understand the work. Social medicine is an approach based on the idea that social forces—such as language, housing, and income level—affect our health and lead to health inequities. This concept is core to PIH’s work around the world and global health at-large; however, it's often not part of medical school curricula.

By bringing this training to Liberia, Toussaint says more staff began to understand why PIH does things the way we do, how to advocate for patients, and why the work is based on solidarity, rather than charity alone.

4. Build solutions beyond health care.

At PIH we believe that all human lives have the same value, and that every human being has the inalienable right to be healthy and to fulfill their potential. To achieve this, we must do more than deliver health care; we also create jobs and other opportunities that help people get back on their feet and become self-sufficient.

When Toussaint first met Jowel Mahdee, she was struggling with an undiagnosed illness, unemployed, and wandering the streets without clothes. PIH staff identified her and provided much-needed support: a high-quality medical assessment, a schizophrenia diagnosis, medication, psychosocial support, family therapy, and vocational skills training. Through the training program, Mahdee learned how to tailor clothes. Leveraging strong community relationships, PIH identified a shop willing to hire Mahdee as an apprentice. She’s now also a mentor for others enrolled in the program.

“Jowel, who used to be naked, is now the one putting clothes on people. That’s amazing,” says Toussaint. “We have to continue to do this work. We have to continue to push.”

Fourteen years after joining PIH, Toussaint remains deeply committed to the mission.

“This is where I should be fighting against injustice, making sure that people receive the care they deserve in dignity,” he says. “This is something that I would like to do all my life, and I won’t get tired doing [it].”

Dequia Rainey’s patient, Joyce*, could barely eat.

She had severe dental problems and was unable to chew, meaning her food had to be blended or ingested as a liquid.

Rainey, a community health worker in North Carolina, feared Joyce was suffering from malnutrition, even as food surrounded her in nearby supermarkets and restaurants.

“There's only so much that you can blend—and I was able to obtain a juicer for her—but it's still not enough of the nutrients that she needed,” said Rainey.

But the cost of dental surgery was too expensive for Joyce to afford.

Rainey attempted to find ways to help her get the medical care that she so desperately needed. She discovered a grant that might be able to help, but it would only cover the cost of surgery on a single tooth—only a small portion of the treatment Joyce needed.

Rainey explored Medicaid and Medicare as options, but Joyce was 60 years old—and didn't qualify for either health insurance program.

Then, in 2023, lawmakers voted to expand Medicaid in North Carolina to include 138% of the federal poverty level and adults aged 19-64. Finally, Joyce received health care coverage and got the dental surgery she required.

After years of drinking her food as smoothies, Joyce could chew solid food again. Rainey watched, relieved, as she gained weight back.

When Rainey saw lawmakers working to make the largest cuts to Medicaid in U.S. history, she thought of Joyce—and how much of a difference it made in her life.

The new law imposes burdensome work requirements and other red tape on people who get their health insurance through Medicaid expansion, like Joyce. The Congressional Budget Office estimates that over 5 million people will lose their health care from this provision alone, many of whom are still eligible for Medicaid but unable to keep up with the bureaucratic hurdles to keep their coverage.

Rainey, other community health workers, and patients who use Medicaid are preparing for how this could impact the landscape of health care in the U.S. 

“You’re going to increase costs because people are not going to have access to the proper care that they need,” Rainey said. “It's going to cause so many barriers, so many limitations. And you're going to find an increasing influx of mental health disorders, chronic health diseases, you're going to see more impact of STDs. It's going to be a surge.” 

Preparing for additional red tape

In 2004, Maria Sutter was 28 years old and living in New York City. She had gone to college, received her degree, and jumped into her career at an architecture firm.

One day, as she was finishing a bike ride, someone hit her with their car.

Sutter survived, but sustained a severe spinal cord injury.

She moved back to Ohio and began navigating the Medicaid system for the first time in her life. It was a “whirlwind” to handle it after her accident, and Sutter couldn’t believe how confusing it was.

“I definitely did not understand what was going on,” said Sutter. “And, in fact, we made a mistake with the paperwork, and it didn't go through the first time.”

Even though Sutter has now been on Medicaid for more than 20 years, recertifying every year is still “terrifying,” and constantly leaves her with a barrage of questions cycling through her mind.

“Like, did I fill it out correctly? Did I fill something in wrong? Will somebody contact me if it's wrong?” she said. “And then I just kind of watch. Did it go through? Is it still pending? If it's still pending, is it my fault? Am I going to lose something? It's very nerve-racking.”

The recent changes in reporting requirements—switched from once a year to every six months starting in late 2026—only compound that fear.

“It's not a way people should have to live, and the idea that you'll then have to recertify every six months... There's no breaking it for you,” Sutter said. “You'll recertify and then you'll be ready to recertify again.”

Sutter isn’t sure if she will be part of the group that will have to file more frequently or not yet.

“The new requirements are still very unclear to me, which is part of the reason for my concern,” she said. “The best I can do is try to stay informed, vigilantly check my email and traditional mail, and hope I don’t miss information."

There are also new “engagement requirements” that mandate able-bodied Medicaid recipients to work, volunteer, or go to school for 80 hours a month, with exemptions for several groups, including people who are pregnant or recently incarcerated.  

However, most people enrolled in Medicaid are already employed. When Arkansas implemented a similar policy, 18,000 people lost coverage in less than a year, primarily from confusion over the reporting requirements. There has been no evidence to show that work requirements increase rates of employment.  

“It's purposely designing a system where you're set up to fail and that they want you to fail because then you won't be on the system anymore,” Sutter said. “Or they want you to feel so insecure about it that you throw up your hands and say, ‘I won't do this. This is too hard.’”

Community health workers and nurses at the Cherry Hill Free Clinic in Cherry Hill, New Jersey, share Sutter’s fears. The clinic, who PIH-US has collaborated with for the last two years to promote the essential job of community health workers, provides free health care. The majority of patients are uninsured, though the clinic also serves critically underinsured patients, including those who only have insurance for emergency room visits, but not primary care or those with very limited employer insurance.

While the clinic does not have any patients with Medicaid, staff are expecting a large influx of patients who lose Medicaid coverage due to the new requirements, said Nurse Director Katherine Nguyen.

At the same time, the Cherry Hill Free Clinic lost a federal grant in the spring, which was used to employ community health workers and a nurse. Federal grant funding was temporarily restored at the clinic, but it officially ended in July, said Nguyen.

"We're in this conundrum right now where people are losing access to health care through the Medicaid cuts, but then all the safety net organizations like us are also getting cut off at the knees,” Nguyen said. “We're basically being asked to do more with less.”

Pushing back against stigma

Destiny Murdock, a CHW in Maryland, was a Medicaid recipient herself many decades ago. Murdock is a survivor of domestic violence and stalking, which left her caring for three children as a single mother while constantly relocating and, eventually, changing her name and social security number.

During that time in her life, Murdock was able to access mental health services through Medicaid.

“I really don't know what condition my life would have been in, considering all that I went through, the trauma, (without it). Medicaid—it's about helping people get through their difficult seasons of health concerns. And then when they're better, they can do better.”

Rainey, too, temporarily needed Medicaid. She was poor, working, and pregnant. When she was finally able to get on Medicaid during her second trimester, she discovered she had severe medical complications from her pregnancy.

“I was dying and didn't know I was dying,” Rainey said. “If it hadn't been for having the right insurance—having any type of insurance—my child and myself would have died.”

“That would have been my story,” she said.  

Amid the historical nationwide cuts to this program, both community health workers and past and present Medicaid recipients want to push back on the stigma surrounding it.

Sutter, who said Medicaid is what allows her to be as independent as possible, implored people to realize that one in four people will live with a disability throughout their lives.

“When that happens, you will need support. Someone in your family may have to compromise how they live or what they do—and then need help themself to help you. And so that is a lot of what Medicaid does. It provides a health benefit to people so that they can then provide support to others if and when the time comes.”

Those who use Medicaid and community health workers who see its positive impact want people to understand how beneficial it is for society.

“We have a duty to help our people that are suffering regardless of race, creed, color or sex or gender,” said Rainey. “It's a human concern. We are a society that is built to help one another, and to have these cuts performed will impede the impact of these populations that they were elected to serve.”

*Pseudonym used to protect the patient’s identity

It’s 1 a.m. and the power snuffs out at the remote Neno District Hospital in Malawi.

Vital operations grind to a halt. Oxygen production slows. Baby warmers, which regulate the temperature of premature or critically ill infants, will soon grow cold.

Calls are made, and hospital staff race in ambulances to the home of an electricity technician for help.

They know the length of time it takes to get the power back on can be the difference between life or death.

Both the Neno District Hospital and the Lisungwi Community Hospital are equipped with robust backup generators, installed to combat the frequent and random power outages in Malawi caused by persistent load shedding and an unstable grid.  

After decades of colonial rule, Malawi gained independence from Britain in 1964 and began to take on debt to finance social programs and infrastructure projects. However, climbing out of sovereign debt can be incredibly difficult.

In the 2022-2023 fiscal year, Malawi—classified as one of the poorest countries in the world by the World Bank—spent roughly a third of its budget on debt interest payments—leaving key public services underfunded and over 70% of the Malawian population living below $2.50 a day. Despite these challenges, the country is working to expand essential infrastructure. In May, Malawi received a grant from the World Bank to expand its energy generation and storage capacity. Still, demand outweighs the load bearing capacity, resulting in frequent outages.

In a period of 53 days, staff at Abwenzi Pa Za Umoyo (APZU), as Partners In Health (PIH) is known in Malawi, counted more than 30 power outages—sometimes multiple times a day.

Still, the process of switching from grid power to generator power requires the help of a specially trained technician. The technician must run between the hospital and the building where the generator is located. It takes about 10 minutes for the technician to perform the switch—but that’s only if everything goes according to plan.

If it happens in the middle of the night, hospital staff must call the home of a sleeping technician, wake them, and have them get in a vehicle back to the hospital so the switch can be made.

“The blackouts would come at 1:00 AM and then that means looking for a driver to go and pick a staff member up,” said APZU Infrastructure Manager John Munthali. “The moment they get home, then electricity is back.”

Previously, staff tried to schedule an electricity technician at all hours—but even with the combined effort of PIH and Malawi’s Ministry of Health, or MOH, the workforce was spread thin.

And it weighed heavily on staff members, who felt a deep sense of responsibility for ensuring patients’ safety.

“Patients don’t wait for any minute,” said Munthali. “There’d be someone on an oxygen concentrator, babies on life-supporting equipment, blood samples in the laboratory, somebody undergoing a (surgery). There is a whole lot of life and death risk associated, and to put in someone’s hands—it was unfair to both those who would lose life to it and those that were being entrusted with such.”  

To combat the temperamental nature of this vital technology, APZU and MOH staff worked to obtain automatic transfer switches, or ATSes, which are specialized pieces of equipment that allow the power to switch automatically between grid and generator power without the need for a technician.

Unfortunately, those switches often broke after a week or two of use, unable to handle the extreme load shedding.

“We used to have a lot of power surges that were beyond what the other automatic transfer switches could contain,” said Munthali.

For over a year, APZU staff worked alongside the MOH to procure two robust, durable ATSes with the support of PIH’s Non-Negotiables Phase 1 grant, funded through an anonymous PIH donor.

APZU and MOH staff held consultations to determine which technology would be most tailored to the hospitals’ needs, with a specific focus on long-term use that could adapt to changing technology over the next 10 to 20 years. After months of conversations and quotations, the team finalized its ATS plan.

Installation boosts oxygen production, decreases environmental impact

After more than a year of design consultations and sourcing parts, APZU and MOH staff obtained all the necessary components—with the ATSes coming all the way from South Africa, and the installation materials sourced locally in Malawi.

Despite the cost and difficulty sourcing the technology, PIH and MOH staff established ATSes in both hospitals in May and June of 2025, meaning no more middle of the night wake up calls to transfer the power, or lost oxygen production, or interrupted surgeries.  

What was once an anxiety-inducing plunge into darkness has changed to a six second blink, as the grid power automatically shifts to generator power.

“It’s quite a relief,” Munthali said, smiling.

The quick shift also means the hospital can produce more oxygen for storage, a vital part of patient care, said APZU Biomedical Engineer Kingsley Gwesere. Countless conditions, including tuberculosis, asthma, heart failure, COVID-19, and pneumonia, require patients to rely on a steady supply of lifesaving oxygen.

This seamless transition between grid and generator power means the hospital can continue producing oxygen without interruption. That additional oxygen could save a patient in need, said APZU Electrical Engineer Chisomo Jeputala.  

It also means a reduction in diesel usage. The switch can sense when the grid power comes back on, meaning it can quickly switch away from the diesel generator power. This fast switch will eliminate the use of an estimated 409 liters of diesel annually, reducing approximately 1.1 tons of carbon dioxide released into the atmosphere.

PIH believes that people deserve the highest quality of medical care, starting with those who need it most. Even when facing problems that seem overwhelming, PIH and our partners are committed to navigating them in a thorough, thoughtful, and patient-centered way.

All the health care services we receive today are the result of efforts—over several decades—by researchers determined to make the world healthier. This research has been a major factor in human life expectancy rates jumping from around 40 years in the early 19th century to 72 years in 2020.  

At Partners In Health (PIH), research is a critical component of the mission. When health providers around the world believed multidrug-resistant tuberculosis (MDR-TB) wasn’t worth the hassle of trying to treat in resource-limited settings like Peru, PIH Co-founder Dr. Paul Farmer set out to prove that it was.  

The qualitative research conducted by Dr. Farmer and his colleagues at PIH paved the way for advanced TB care in Peru and, eventually, future clinical trials that would inform MDR-TB treatment worldwide. Even the World Health Organization has used results from research conducted by PIH through the endTB project to update its global TB treatment guidelines.  

The Importance of Research in Medicine

Some of the greatest advancements made through research include vaccines, insulin, anesthesia, and treatments for infectious diseases. From laboratory studies to clinical trials and epidemiological investigations, scientists around the world use different methods of research to advance disease treatment, enhance diagnostics, and improve our overall understanding of diseases.  

“Research is the key to advancing health on the individual, community, national, and global level,” said Cora Cunningham, PIH Engage member, Harvard T.H. Chan School of Public Health student, and research assistant with the Lantagne Group at Tufts University. “Whether about drinking water quality, disease dynamics, health systems, or the patient experience, research in public and global health is what allows us to access, receive, or deliver quality and patient-centered health care.”

Without research, there would be no breakthroughs, no clinical advancements, and no new cures. Despite its importance to humankind, biomedical research—particularly research funded through the National Institutes of Health (NIH)—has been targeted by the current U.S. administration. Years of progress have been disrupted through frozen funding, intentional roadblocks to financing, and overly complicated new procedures.

Funding the Cure

With the NIH being the world’s largest public funder of biomedical research, suspending payments will stifle progress in disease prevention, diagnostics, treatment, and patient outcomes. A lack of funding opportunities restricts research that otherwise would have helped Americans live healthier lives—and will make it challenging for the U.S. to maintain its position as a leader in health care innovation.

Cunningham was a part of research focused on evaluating water, sanitation, and hygiene (WASH) programs to reduce the burden of infectious disease in humanitarian settings. In early February, her group’s work was placed on a stop-work order, and upon the dismantling of USAID, all of the funding for this project disappeared.

“Receiving the email from my Principal Investigator that she had lost 100% of her funding was shattering,” Cunningham said. “I was devastated for her, her family, my colleagues, and even more so for the millions of people who benefit from this type of operational research, and for the more than 150 million people around the world still in need of humanitarian aid.”

For millions, these funding cuts meant immediate interruptions to their care or treatment. Unlike other projects that receive government funding, the rapid stop work orders in biomedical research can skew results, force projects to start over, and leave patients neglected—sometimes in the middle of a clinical trial or treatment. By halting medical research, the current administration is throwing away millions of dollars with no regard for patient safety.  

Carole Mitnick, PIH’s director of research for the endTB project, co-principal investigator of the endTB trial, and professor of global health and social medicine at Harvard Medical School, was part of a project researching post-TB lung disease in Peru. This project would be a follow-up to one—which had significant taxpayer investment—that followed a cohort of TB patients and carefully categorized aspects of their disease to see if there were any trends in developing post-TB lung disease.  

“With just one single follow-up visit that would have been funded through a grant, we could have completed a whole universe of information that would tell us who is at risk for developing post-TB lung disease, what the characteristics are, and how we can screen people and possibly apply interventions at the beginning of TB treatment,” Mitnick said. “This has not only big picture consequences for patients, but also is just a waste of the investment already made. To start this work over will take two or three times as long and cost two or three times as much.”

Concerns Across the Aisle

Disruption to NIH spending has received significant bipartisan pushback. In the early days of his presidency, the Trump administration paused specific communications by NIH, preventing them from posting notices of grant review meetings, which are how grants are evaluated and funds are allocated. Without these meetings, the grantmaking process was ostensibly shut down.  

Over two months later, meetings were resumed, but NIH funding still wasn’t fully stable. On May 1, the NIH announced that American researchers were prohibited from issuing subcontracts to partners at institutions outside of the U.S. According to STAT, this decision is forcing approximately 1,800 health research projects to decide between their international collaborators and their funding.  

“There is not a single innovation in treatment, in diagnosis, in prevention, and even in supportive mechanisms in priority populations—in both TB and HIV—that has not relied on, at least in part, research in South Africa,” Mitnick said. “We’ve just completely cut ourselves off to say: you can still do research, you just can’t do it there.”

In early August, the Government Accountability Office, a Congressional watchdog, concluded that by abruptly canceling NIH grants, the Trump administration illegally withheld funding that had already been approved by Congress. While their findings aren’t enforceable, they have caused tension as the Legislative Branch pushes back on the administration’s attempts to override Congress’ power of the purse.  

Long-Term Consequences  

It is likely that we may not see the impacts of stalled or suspended research for years—but there is no doubt that their consequences will reverberate for generations. Patients who were part of clinical trials will face health risks due to the abrupt end to their treatment and support. Advancements made on cures and treatments for various diseases will be squandered. Jobs will be lost, and public health will suffer.  

“It’s hard to estimate, but our best guess is that if you stop research for a year, you’re going to have a three-year recovery time. Even if funding was reinstated tomorrow, you’ve got to find the staff, get approvals, and rebuild trust with the organization and patients,” Mitnick said. “If there aren’t intentional efforts made to not only restart but also compensate for everything that’s been lost, the impact on human lives is going to be really severe.” 

At Partners In Health (PIH), accompaniment means walking with someone in the hard, scary, confusing, and stressful moments—for as long as it takes—no matter how difficult or uncomfortable it may be.

This can mean caring for someone with multidrug-resistant tuberculosis, building a maternal health wing of a hospital, or ensuring medical supplies get to the right place at the right time to prevent lapses in care.

It also means accompanying people in some of the hardest stages of their lives, including caregiving and end-of-life planning.

August is National Grief Awareness Month and National Make a Will Month. Wills ensure you can protect the people and causes you care for most beyond your lifetime. In the United States, just 4 out of every 10 people have a will or living trust.

Many supporters of PIH are already pushing against this inertia, creating plans for their legacies and reclaiming their agency. In recent years, PIH’s Gift Planning team has connected with 616 people seeking accompaniment through the Legacy Planning process.

Most of them are what we like to call “Rebel Caregivers.” Based on the 12 Jungian archetypes, most PIHers are caregivers at heart, with an irresistible urge to protect the vulnerable, support others, and ease suffering. But they are also rebels—people who are never comfortable with the status quo and who speak truth to power, even when it means being the lonely voice in the room. Rebel Caregivers don’t go along with mainstream thinking and do not like to compromise on core values.

Whether you have already planned your will, are still figuring out how to start, acting as a caregiver, or undergoing a period of grief, contending with death—both your own and your loved ones’—can feel incredibly overwhelming, scary, and even anxiety-inducing.

You don’t have to do it alone, though.

Supporters of PIH have offered end-of-life-care to their loved ones, experienced grief, and have sought out resources to come to terms with mortality and reclaim their own agency and legacy.

Out of gratitude for the beautiful conversations and experiences our Gift Planning team, coordination site staff, clinicians, and staff around the world have shared with our Rebel Caregiver community, we are pleased to recommend books, podcasts, and movies that can bring healing to the universal experiences of caregiving, end-of-life planning, and grief.  

From the patients PIH serves to our children, parents, spouses, and community members we support, may these resources help nourish you to allow you to continue your heartfelt care.

Congress started this summer in the hot seat, under pressure from the Trump administration to pass both the “One Big Beautiful Bill Act” and a $9 billion rescissions package, which sought to claw back funding previously allocated by Congress. Many of you joined our efforts asking Congress to vote no on this legislation—trying to save Medicaid, foreign aid, and uphold Congress’s power of the purse.  

Over the past several months, there were tens of thousands of calls and emails conducted through Partners In Health’s (PIH’s) tools. You all helped us remind Congress of what we stood to lose if the One Big Beautiful Bill slashed Medicaid and foreign aid was gutted through the rescissions package.  

Unfortunately, within weeks of each other, both pieces were passed by a slim margin in Congress, causing tension on Capitol Hill and leaving many with unanswered questions.  

Ransacking Foreign Aid

The rescissions package—part of spending cuts made by the Department of Government Efficiency (DOGE)—will take away $9 billion in already approved federal funding for foreign aid and public broadcasting. The suspension of these programs is directly opposed to the interests of the United States. Treating infectious diseases, responding to emergencies, and supporting research helped position the U.S. as a leader in global health and development, while also creating jobs locally. Simultaneously, the gutting of public broadcasting could leave many people—particularly in rural communities—with less access to information about natural disasters, or other local health concerns and resources.

The news of rescissions’ approval was devastating. Unfortunately, many partners of PIH in the fight for global justice were not spared: USAID, UNICEF, water, sanitation, and hygiene initiatives, and many other health programs will now lose critical, lifesaving funding.  

After the package initially passed the House, several Senate Republicans pushed back on some of the reductions. Thanks to discontent among the party and ongoing constituent pressure, they demanded the removal of $400 million in proposed cuts to the President’s Emergency Plan for AIDS Relief (PEPFAR)—a bipartisan program that has provided lifesaving care for two decades.

While $400 million may not seem like much in the face of the $9 billion package, it’s a lifeline for tens of millions of people who rely on PEPFAR’s services. Last year alone, PEPFAR provided testing services for nearly 84 million and helped 20.6 million people access lifesaving antiretroviral treatment. Your calls, emails, and advocacy helped remind Congress of the massive impact of PEPFAR’s programs.  

What to Expect

Immediately, it’s hard to say how devastating these funding suspensions will be. As clinics close, medicine becomes inaccessible, communities lose clean water, and food insecurity rises, people around the world will suffer at the hands of U.S. lawmakers. Among other health concerns, malnutrition, infectious diseases, and drug resistance will thrive in this new reality caused by abrupt program cancellations. PIH is already assessing how our global network can help fill these gaps in care caused by $8 billion in lost funding.

Unfortunately, the White House has said it is already planning to send more rescissions packages to Congress to continue to cut funding for programs they deem wasteful. While Congress isn’t sure exactly what these cuts will look like, they have spoken up for their constituents and for more transparency in what will be revoked. By communicating with your members of Congress and holding them accountable, you've helped make meaningful change already.  

While there is uncertainty in the future of foreign aid and overall government spending, PIH won’t stop fighting injustice. We hope you’ll continue to join us. 

Support PIH

Help us continue to advance health care as a human right.

Give Now

The screaming ambulance sirens and newly erected white tents were eerily familiar to Katie Bollbach. She sat in her Brooklyn apartment, listening as emergency vehicles whirred past every few minutes.

Those sights and sounds transported her back to Sierra Leone, over five years prior, during the Ebola epidemic.  

The resemblance gnawed at her.  

Bollbach joined the Partners In Health (PIH) Ebola Response Team in Sierra Leone beginning in early 2015, eventually becoming chief policy and program officer. There, she witnessed an “acute on chronic” crisis hit its health care structures: the Ebola emergency strained an already under-resourced and underfunded system.

Years later in New York City, Bollbach was working as a consultant at a nonprofit. As she listened to the sirens and watched the white tents flap in the breeze day after day, Bollbach realized the COVID-19 pandemic had stark similarities.

The United States’ health system fails to protect the right to health for all, resulting in gaping health inequities felt most acutely by low-income people, people of color, and rural communities. Public health systems were already under-supported in the United States before the COVID-19 pandemic, creating another “acute on chronic” crisis as the infectious disease spread.

Bollbach knew it was time for her to come back to PIH.

She took a leave of absence from her job in 2020 to “pitch in at PIH for a few months” as director of the newly established U.S. Public Health Accompaniment Unit.  

Five years later, Bollbach still hasn’t left.

She now leads PIH-US, the most recently established country site—and knows she has a unique task at hand.

PIH’s commitment is to offer a preferential option to the poor, starting with those who need it most. While the U.S. spends trillions of dollars a year on health care, health outcomes are vastly dependent on where someone lives, how much money they have, and whether they belong to a marginalized group—from race to gender to sexuality to immigration status.

There can be a 20-year life expectancy gap in the U.S., depending on where you live, your race, and how much money you make.

Even after vaccines began to rollout and the COVID-19 infection rate began to shrink, Bollbach knew there was a place for PIH in the U.S.—and that the U.S. had a lot to learn from Sierra Leone, Haiti, and Rwanda.

While other countries have less money to spend on health care than the U.S., there is an understanding that people have the right to health. PIH-US envisions a future where structures of oppression no longer determine the quality or length of a person’s life.

“We could offer not just a COVID emergency response effort, but a longer-term, moral imagining of a different future where health is actually a human right in the U.S. and not just a commodity for sale or a privilege for the few,” Bollbach said.

As the U.S. faces slashes to Medicaid, threatening people’s lives to prolong tax cuts to the nation’s wealthiest, Bollbach knows the work of PIH-US is essential.

"This is a really challenging moment for our country and the world,” Bollbach said. “I think we're starting from such an insufficient baseline in terms of our system's ability to take care of those who need care the most. And we're seeing so much of that come under direct attack and assault right now in terms of the recent devastating cuts to Medicaid, the claw back of public health funding, the attacks on immigrants and basic care and services for other marginalized communities.”

"Those Partners In Health People”

Years before, in 2005, a bus whirred down roads and over hills during the 30-hour ride from Lusaka, Zambia to Dar es Salaam, Tanzania. A then-20-year-old Bollbach sat transfixed, reading.  

Between worrying about the “terrifyingly fast” driving and stopping at gas stations for cold sodas, delicious greasy meat pies, and roasted corn, Bollbach devoured Tracy Kidder’s book Mountains Beyond Mountains, learning about PIH and co-founder Dr. Paul Farmer.

Bollbach was at a crossroads, debating what the next stage of her life would be. She spent her summer living in Zambia, where she worked with refugees. One of her friends on the trip, Jonny Dorsey, told her she had to learn about Farmer—and gave her the book.

After reading it, Bollbach knew she needed to talk to “those Partners In Health people.” She was stunned by the organization’s ability to see the full humanity of every person and address immediate suffering, but also have the courage to call out broader systems and past harms holding oppressive conditions in place.

“It was just remarkable in terms of the ability of one team or organization to take all of that on,” Bollbach said.

The “mischievousness” and humor of PIH also captivated her and she felt drawn in by what she calls the PIH “pathological optimist gene.”

Her summer in Zambia turned into a year away from school, where she paused her degree at Stanford University to continuing working with refugees, but she never forgot PIH.

When she returned to the United States, she partnered with the nonprofit to do advocacy and organizing work, laying the foundation for what would later become PIH Engage.

And about a year later, Bollbach had the opportunity to travel to Rwanda for a year with PIH. Again, she put her degree on hold and flew to Africa. There, she helped establish income-generating programs, which aimed to create income streams for residents—and became even more certain this was the kind of work she wanted to do throughout her life.

“It was an incredibly influential and inspiring time that really changed the way I looked at the world and who I wanted to be and how I wanted to contribute to working on some of these issues,” Bollbach said.

She earned a degree in International Relations, became the founding program director with Global Health Corps, and advocated against gender-based violence in South Africa as a policy coordinator for the Sonke Gender Justice Network, creating a coalition of thousands who demanded a national plan for gender-based violence.

She went back to school, earning a Master in Public Health from John Hopkins University. She then started another degree, this time a Master in Public Administration from Harvard University’s Kennedy School.

Then Ebola hit.

“I got a call from an old friend saying, ‘Hey, PIH is putting a response team together. Could you maybe pitch in, or would you come work with us? I said, ‘Sure, I can pitch in for a few months.’”

It was supposed to last six months. Bollbach stayed for three years.

“You’ll see a pattern here,” she said, smiling.

Bollbach has an irresistible urge to help others, even when it means putting her plans on hold. In true PIH fashion, she stays—accompanying people, organizations, and communities for as long as it takes.

Over and over again, Bollbach has worked to establish new programs and systems, whether in Rwanda or Sierra Leone or the United States. It shouldn’t have been a surprise, then, when Bollbach picked up her phone in her Brooklyn apartment, and asked how she could help.

The Pendulum Swing

PIH supported pandemic response in some of the hardest-hit areas in the country through contact tracing, connecting patients and families to vital resources like food and housing, and accessing lifesaving vaccines.

18 months later, PIH announced it was here to stay in the United States, officially becoming PIH-US.  

Since then, PIH-US has partnered with public health and community leaders to lay the groundwork for resilient community health systems across the country.

Today, PIH has made an open-ended commitment to work in six different states—Alabama, Arizona, Florida, Massachusetts, New Jersey, and North Carolina—and walk alongside those partners and communities for as long as they invite PIH into in their journey to health, equity, and wellness.

Beyond partnering with local governments and offering technical assistance and support, PIH-US has a strong advocacy arm. The nonprofit uses grassroots organizing, legislative advocacy, and coalition building to advance policies that lead to stronger, more just and more responsive community health systems.

Members of PIH-US frequently meet with government officials to share lessons, stories, and results from their work around the country, with a focus on expanding fair and equitable access to care, funding public health services-including community health workers, and advocating for stronger social support systems.

The fit was natural—Bollbach had already built nonprofits from the ground up to make tangible change. She marched in the streets of South Africa for policies to fight gender-based violence and strategized in Sierra Leone on pivoting from emergency Ebola care to long-term health system improvements.

It hasn’t always been easy, though, especially when so many public health programs have lost funding in the U.S.

“It's not like we're just on a steady onward march to progress all the time,” Bollbach said. “We've been through these sort of pendulum swings before and found a way to keep work moving and justice moving forward.”

She strives to keep her focus on the long-term vision, while also never minimizing immediate harms.

“As Paul would say, doing hard things with friends is so often what keeps us going and gives the most meaning in work and in life, often,” Bollbach said.

One of those friends is Dorsey, the person who gave Bollbach Mountains Beyond Mountains in Zambia. After hours spent talking and eating sugar cane, the two forged a lifelong friendship. Dorsey—now a PIH Board of Trustees member—says Bollbach is so humble, people sometimes miss how remarkable she is.

“She never needs to be the center of attention, the one getting an award, the loudest in the room—but she’s often the one we should all be listening to most closely,” Dorsey said. “She’s often done more, read more, and connected with others more than anyone knows—and refracted all that through her powerful mind and seasoned optimism. She’s a star and we’re all lucky she’s a leader in the PIH family.”

When Dorsey handed Bollbach the book, he did not know countless sushi nights were in their future, that Bollbach’s mother would officiate Dorsey’s wedding, that Dorsey would one day watch Bollbach read to his daughter, or that she would one day lead PIH-US.

“She’s got all the strengths she had then—moral clarity, a sharp sense of community and connection, hilarious sense of humor, the willingness to leap first—and other skills she's honed over time that make her the powerful executive she is today.”

Bollbach said she grateful to get to do this work alongside incredible people, and envisions a future where people can exercise their right to health in the U.S.

“Some people say never meet your heroes,” Bollbach said.  “I'm so grateful I've gotten to meet many of those heroes and now get to work with them every day.”

Some patients with highly drug-resistant tuberculosis (TB) could benefit from a shorter treatment regimen with fewer drugs while others may warrant more aggressive therapy, according to the findings of a new study known as endTB-Q.

This study was part of the larger endTB project. A partnership between Partners In Health (PIH), Médecins Sans Frontières, and Interactive Research and Development, and funded by Unitaid—endTB utilized clinical trials of new drugs in shorter treatment regimens to dramatically improve the treatment of drug-resistant TB around the world. The endTB-Q trial was conducted in 17 countries, including three countries where PIH works: Kazakhstan, Lesotho, and Peru.  

The endTB project has been critical in sharing new research and innovations in TB treatment. In 2024, the World Health Organization (WHO) recommended three new regimens for multidrug- or rifampicin-resistant tuberculosis (MDR/RR-TB), which were studied in the endTB clinical trial.

Despite being completely preventable and curable, TB is the world’s deadliest infectious disease. While TB occurs everywhere, many of the cases and deaths—around 80%—occur in low- and middle-income countries. These disparities highlight the importance of research that makes treatment more accessible.  

“We must continue to support and expand such clinical trials as endTB and endTB-Q,” said Amanzhan Abubakirov, endTB co-investigator with PIH Kazakhstan. “It is precisely these scientific initiatives that bring us closer to the global goal—a world without deaths from tuberculosis. Every new study is a step toward shorter, safer, and more effective treatment that changes the lives of millions of people.”

endTB-Q, specifically, is the first-ever clinical trial to focus exclusively on people with pre-extensively drug-resistant tuberculosis (pre-XDR-TB), a form of the disease that is more challenging to cure than multidrug-resistant TB but not yet as difficult as extensively drug-resistant TB.  

“The endTB-Q trial is a testament to our mission of bringing modern science to the most vulnerable communities,” said Dr. Leonid Lecca, executive director for Socios En Salud, as PIH is known in Peru. “For PIH, it reflects our commitment to health equity, through which we continue to demonstrate that it is possible to conduct high-quality clinical research in resource-limited settings—investing all our effort and knowledge to always keep the patient and their family at the center.”

The findings highlight the importance of selecting therapy to account for patient-to-patient differences—such as lung damage—and giving everyone with pre-XDR-TB a treatment regimen that is the most likely to be effective and limits toxicity for them, the researchers noted.

The aim of the endTB-Q trial was to test whether a shorter, more tolerable treatment would be effective in patients with pre-XDR-TB. The trial’s investigators compared an experimental regimen that used a combination of four drugs—bedaquiline, delamanid, clofazimine, and linezolid—for six or nine months to a regimen based on the standard of care recommended by the World Health Organization (WHO), which included four to six drugs taken for 18 to 24 months.

“Traditional treatment for drug-resistant TB has been long, toxic, and often ineffective. The results of the endTB-Q trial helped to change the mindset of TB specialists by demonstrating that patients with pre-XDR-TB could complete treatment in just six to nine months, experience fewer side effects, and achieve better outcomes,” said Assel Stambekova, TB program manager for PIH Kazakhstan. “The trial also emphasized the importance of patient-centered care—showing that a comprehensive approach to follow-up, side effect management, and psychosocial support is just as critical as the medications themselves."

The results of the trial showed that the shorter regimen could be a promising alternative for many patients with pre-XDR-TB. The study found that the shorter regimen was 87% effective while the longer therapy was 89% effective. The research was designed to measure “non-inferiority,” a technical term that describes when an experimental treatment is good enough to replace an existing standard of care. In this study, the shorter regimen did not meet that standard across the full study population.  

The study found differences in the way patients responded to the shorter regimen. Those with more advanced lung damage did not fare as well as those with less advanced disease. For the first group, the shorter regimen—even when delivered for nine months—was not as beneficial as the longer regimen. This could mean treatment needs to be longer in that group or treatment needs to be reinforced with more drugs, the researchers said.

“This shorter regimen is not a surefire cure for everyone,” said Carole Mitnick, professor of global health and social medicine at Harvard Medical School, PIH’s director of research for the endTB project, and co-principal investigator of the endTB trial. “The big takeaway is that we might need a more tailored approach to treatment of this kind of resistant TB.”

The recent guidance from the WHO, which came out after the endTB-Q trial was underway, recommends six-month regimens irrespective of disease severity. The researchers shared that, given the findings of this study and similar results from other studies, the guidelines should be updated to include consideration of stratified approaches to care based on resistance pattern and extent of disease.

“We are most proud of having contributed to generating evidence that can help change global treatment guidelines for drug-resistant tuberculosis—and of having done so from Peru, with a committed and highly trained local team—but it is important for our colleagues to know that endTB-Q does not end with the publication of its results,” Dr. Lecca said. “The true impact of this trial depends on our ability to advocate for the implementation of these new treatments in national and international health policies.” 

Global health is finally getting the attention it deserves—but not for the right reasons. The interdisciplinary field and its impact—on everyone, everywhere—has become more visible in recent months due to foreign aid cuts enacted by the U.S. government.

Since 1987, PIH has worked hand-in-hand with governments and local partners worldwide to deliver high-quality, patient-centered care in some of the most rural and hard-to-reach settings. This work is rooted in long-term commitments, trust, shared goals, and local leadership.

Still, when we use the term "global health", what exactly do we mean? Below, learn more about the field, PIH’s role, and why global health is at risk. 

What is global health?

Broadly speaking, global health is “an area for study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide,” as defined in a widely cited 2009 Lancet report. However, there are growing critiques of this definition, and experts across the field offer differing interpretations.  

The field also includes “advocacy, research, [and] activism toward the reduction of disparities and protection against global threats,” explains Dr. Sterman Toussaint, PIH Liberia’s director of clinical services. At PIH, advocacy has always played a role in our work, from advocating for access to treatment for patients living with HIV/AIDs in the 1980s to recently mobilizing more than 16,000 calls and letters to Congress urging the protection of foreign aid.

There’s no denying that global health is complex—shaped by historical injustices that have led to systems designed to make it challenging for people to receive health care and for governments and societies to provide it, notes PIH Chief Medical Officer Dr. Joia Mukherjee in a webinar about her textbook, “An Introduction to Global Health Delivery: Practice, Equity, Human Rights.” The 14-chapter book explores the history of the global health movement, the systems necessary to deliver high-quality health care, and the critical role of advocacy. 

This essential work is carried out by varied organizations, including multilateral organizations, such as the World Health Organization; bilateral organizations, such as the now dismantled USAID; and non-governmental organizations, such as PIH.

In a unique approach, PIH combines a broad social justice mission with a rigorous clinical and academic model for action. Our work is driven by a moral call to health equity and backed by evidence-based care delivery and research.

Unlike others in the field, we address the root causes of disease by tackling social determinants of health and forming deep partnerships to support long-term, holistic care. Grounded in solidarity, we expose and challenge the systemic injustices that drive poverty and sickness. 

PIH's role in global health

For nearly four decades, PIH has responded to the moral imperative to provide high-quality care globally to those who need it most. We currently collaborate with national governments in 10 countries around the world to fight social injustice, together. We strive to ease suffering by providing a comprehensive model of care that includes access to food, transportation, housing, and other key components of healing.  

“I want people to understand that global health isn’t charity—it’s about fairness and systems change. It’s about training health workers, equipping clinics, addressing social determinants, and building sustainable systems that work for the most vulnerable. And the solutions often come from within communities themselves—they just need support and recognition,” says Dr. George Dalitso Limwado, PIH Malawi’s senior medical officer.

While the work looks different across each PIH care delivery site—adapting to local context and culture—our mission remains the same.  

“Global health matters because health challenges don’t respect borders—whether it’s infectious diseases, drug resistance, or the effects of climate change. But more importantly, it reflects our shared humanity. Investing in global health is investing in justice, stability, and economic development for all. We’ve seen firsthand in places like rural Malawi how global solidarity can translate into real, life-saving care,” says Limwado.

The future of global health

Global health is currently under threat.  

Funding continues to be slashed for lifesaving global health programs, initiatives, and clinics in countries around the world, including ones where PIH works. The U.S. government’s foreign aid cuts and freezes have already had a devastating impact on health systems. For example, in six districts across Lesotho, U.S.-funded HIV and tuberculosis programs have been dismantled, clinics are closing, and health workers are being laid off. 

“Global advocacy and activism should intensify to force the powerful to stop the cycle of impoverishment in low- and middle-income countries,” says Toussaint.  

PIH was founded on the premise that health is a human right, not a privilege. We believe that national governments hold the primary obligation to respect, protect, and fulfill that right, while communities must be empowered to fully participate in its realization. Perhaps most importantly, we believe that the international community also holds a responsibility—as duty bearers of the right to health—to work in solidarity with governments and communities to make health equity a global reality.

As the U.S. government continues to attack funding for lifesaving patient care, we remain where we are needed most. We will continue fighting for global health—for everyone, everywhere, as long as it takes.

Last week, Congress pushed through the biggest cuts to Medicaid in history.

These changes will strip health coverage from nearly 10 million people, cut essential mental and behavioral health services, close rural hospitals, and leave seniors, children, people with disabilities, and low-income communities without care. This legislation also gives $150 billion to the immigration enforcement agencies that are separating families and devastating our communities across the country with raids and mass deportations. If you’re feeling overwhelmed, heartbroken, or angry—you’re not alone. 

While we didn't stop the bill from passing, your efforts mattered. 

Congressional leaders advanced this bill quickly because they knew how unpopular these cuts were. And while the outcome is devastating, our collective efforts were powerful. Time and time again, you showed up to defend the right to health, and it made a difference. Because of our persistent advocacy, we helped prevent even more harmful provisions from becoming law.

Most importantly, we showed those in power that we are paying attention. We must keep amplifying the voices of those impacted the most. Alongside our partners, PIH-US will continue to organize to ensure a future where everyone, everywhere, can exercise their right to health.  

In recent months, we’ve heard deeply disturbing reports from communities across the country where Immigration and Customs Enforcement (ICE) raids are disrupting essential health services and threatening the well-being of entire communities. 

In Massachusetts, community health workers are struggling to reach patients, many of whom are too afraid to respond to outreach or attend scheduled visits. In Florida, anxiety, trauma, and stress-related illness are spiking as families brace for what’s next. And in New Jersey, food distribution centers reported a 50% drop in attendance in the week following a major ICE operation. These aren’t isolated incidents—they’re part of a broader strategy of criminalizing immigration and sowing fear. These actions threaten public health, forcing people to live in fear of detention and deportation and making it harder for them to access care, education, housing, and other vital services. The result is a deepening of existing health and social inequities. 

Unfortunately, things could soon get worse. The Senate is debating legislation that would pour an additional $150 billion into the same immigration enforcement agencies responsible for these raids and deportations—agencies that are devastating communities and separating families across the country. To fund this massive expansion of immigration enforcement—and to help pay for tax cuts for the wealthy—the bill proposes deep cuts to Medicaid, a program millions of families rely on for essential health services.  

Anti-immigrant policies strip funding from the very services—health care, education, housing—that communities depend on. As partners in the fight for health equity and human rights, we need to apply public pressure now more than ever.

In a matter of months, a nurse, in collaboration with other health care workers at Partners In Health (PIH)-supported Rwinkwavu District Hospital in Rwanda, increased the percentage of child patients screened for malnutrition from 52 percent to 96 percent.

During the same time—in another part of the continent—a nurse at the Neno District Hospital in Malawi implemented a project that more than tripled the amount of monthly cervical cancer screenings performed on women.

And thousands of miles away in Haiti, the percentage of nurse aids at the Hôpital Universitaire de Mirebalais who could confidently perform breast cancer self-examinations climbed from 20 percent to nearly 90 percent.

When nurses are empowered to be leaders in their clinics and communities, lives change.

Launched in 2017, the PIH Global Nurse Executive Fellowship (GNEF) facilitates the development of culturally humble and confident nursing and midwifery leaders. Participants address current and emerging health issues and work to transform health systems while growing their executive presence alongside their communication, financial management, and team-building skills.

Nurses and midwives are often the first people patients interact with in hospitals. They are acutely attuned to the challenges of patient care delivery—and are key in implementing the solutions. This fellowship aims to empower these health care professionals to tackle problems and invest in them as leaders.

Self, others, and systems

Fourteen nurses and midwives across the OnePIH network joined the fourth cohort of the fellowship. The nine-month program includes mentorship, training, coaching, and professional development. There are also three weeklong intensive sessions, each focused on a different area of leadership: self, others, and systems.

The “leading self” piece involves creating a personal nursing vision, building executive presence and communication skills, and creating a capstone project proposal—like determining how to increase the number of children screened for malnutrition or nurses who can perform breast cancer self-examinations. This year, fellows gathered in Kigali, Rwanda’s capital city, for a 10-day intensive on this part of the fellowship.

In the second phase, participants focus on leading others. Fellows learn about financial management, supply chains, and budgeting. Patient safety, improved service delivery, evidence-based care, team building, and mentoring are also central themes of the curriculum. In this phase, the capstone project implementation begins.

The final phase is the “leading systems” section. It focuses on applying knowledge and understanding the role of professional advocacy, grant writing, and financial management. Fellows also refine their personal visions, develop abstracts and posters, and analyze and deliver their capstone projects.

"The GNEF represents a one-of-a-kind opportunity for rising nurse leaders in clinical sites across the OnePIH network to identify their own unique leadership styles and enhance their executive leadership skills while simultaneously showcasing their abilities to design, implement, and evaluate significant quality improvement initiatives within their work environments,” said Katie Buhikire, GNEF program manager.  

The fellows, who are from 8 different country sites around the world, grew their leadership skills and made tangible changes in their communities—from testing all pregnant women for asymptomatic bacteriuria infections, which can cause premature labor, to digitizing vaccine stock management in Lesotho, which increased the number of children under the age of 5 who received immunizations.

“The fellowship is a transformative journey beyond professional development—it serves as a platform for building leadership, driving innovation, and making a tangible impact in health systems,” said Patricia Efe Azikiwe, one of the Cohort 4 fellows. “I want people to understand that this fellowship is not just about acquiring new knowledge, but about applying that knowledge to real-world challenges. It equips fellows with the tools necessary to lead change, inspire others, and enhance the quality of care in their communities.”

Azikiwe’s GNEF capstone project revolved around implementing the World Health Organization’s Safe Childbirth Checklist at the Koidu Government Hospital in Sierra Leone. In Sierra Leone, 1 in 74 women face a lifetime risk of dying in childbirth. In comparison, the rate is approximately 1 in 4,000 in the United States and 1 in 60,000 in Norway. The scale of this injustice is almost hard to imagine.

While continued investment and ambitious policies have driven down the rate by over 70 percent in two decades—a faster decline than any other county in the world, in almost any 20-year-period in modern history—there is still significant work to be done.  

“My thought process began with a simple yet powerful question: How can we ensure every woman receives essential, evidence-based care during childbirth and psychosocial support, every time?” Azikiwe said.

After implementing the checklist through the GNEF program, birth asphyxia rates dropped from 37 percent to 15 percent and postpartum hemorrhage from 32 percent to 20 percent. Patricia also added a depression screening to the checklist, leading to the identification of mental health cases in 3 percent of patients.

Another fellow, Jules Cesar Munyabugingo, implemented an audit for maternal and neonatal near-miss cases, or MNNs, at the Kirehe District Hospital in Rwanda. These are instances where a mother or baby nearly dies from a serious complication but ultimately survives. After implementation, the surgical site infection rate decreased from 2.6 to 1.2 percent the birth asphyxia rate dropped from 1 to 0.6 percent, and there was only one case of uterine rupture in the last two months.

“As a GNEF graduate, I feel both rewarded and empowered, furthermore, knowing that all the efforts I invested have paid off,” Munyabugingo said. “The exposure and learning I gained throughout the program have significantly strengthened my confidence to lead with purpose and by example. I now feel more equipped and capable to lead myself, leading the systems, and leading others.”

And Mphatso Sayenda, whose project centered around increasing the testing of pregnant women for asymptomatic bacteriuria infections, said she is encouraged to know the Lisungwi Community Hospital in Malawi will continue to implement this practice even after the conclusion of her project.

With their new skills, fellowship graduates have gone on to become leaders at Partners In Health, including Vicky Reed, a Cohort 2 member who is now the executive director of PIH-Sierra Leone.

Cohort 4 was also the first time the program expanded to include four Spanish-speaking fellows from Mexico and Peru. The curricula were translated and administered in Spanish and the fellows were paired with Spanish-speaking coaches. PIH also provided translators for mixed-language settings.  

“As Program Manager of this innovative fellowship, it has been a privilege to guide Cohort 4 throughout their leadership journey, and we are looking forward to building upon the experiences of this group to continue improving delivery of the program to the next round of distinguished fellows,” Buhikire said. 

The medical world is filled with jargon, long words, and complicated definitions. And acronyms—trying to make it all less confusing. That’s true at Partners In Health (PIH) too, but our hope is to make things clear, for supporters and patients alike.

When we talk about tuberculosis (TB), many of those words arise. Simply put, TB is a common infectious disease. However, there are other related terms we often use that are important to know and understand.

In the alphabetized list below, learn about 14 TB terms, and how they show up in PIH’s everyday work:

1. Active TB

What It Means: If a person has active TB, this means the bacteria is “awake”—unlike with a TB infection (explained below)—and likely causing lung damage, possibly transmitting to and making other people sick, and needing treatment urgently.  

In Our Work: In 2024, there were 3,200 people with active TB who successfully completed treatment across PIH care delivery sites.

2. Chest X-ray

What It Means: A chest X-ray is an imaging test used to view the lungs, heart, and other structures. It helps diagnose TB in people with or without symptoms; and monitor progress. 

In Our Work: Modern X-ray machines are available across most PIH care delivery sites. Recently, Socios En Salud—as PIH is known in Peru—received 28 X-ray machines equipped with artificial intelligence for the detection of abnormal chest films. 

3. Co-infection

What It Means: A person with TB may also be diagnosed with another infectious condition, such as HIV.

In Our Work: Nearly 75% of patients treated at PIH-supported Botšabelo Hospital in Lesotho are co-infected with TB and HIV.  

4. Directly Observed Therapy Plus (DOTS-Plus)

What It Means: It’s an evidence-based strategy where a trained person—either a health care worker or treatment supporter— supports a patient through complex treatment and delivers care in the home or another location convenient for the patient.  

In Our Work: In 1998, PIH Co-founders Drs. Paul Farmer and Jim Yong Kim introduced the idea of DOTS-Plus to expand the World Health Organization recommendation for treatment of TB. Beyond the WHO’s limited scope of first-line treatment and watching people take their medications (known as DOT or directly observed therapy), PIH included additional drug regimens necessary to cure drug-resistant TB coupled with supportive care. PIH proved this model in Haiti and Peru and then expanded it to Russia—and beyond.

5. endTB

What It Means: The endTB project—a partnership among PIH, Médecins Sans Frontières, and Interactive Research and Development, funded by Unitaid—utilizes clinical trials of new drugs and shorter treatment regimens to dramatically improve the treatment of multidrug-resistant tuberculosis.

In Our Work: In 2024, the World Health Organization approved new, safe, and effective TB treatments which were studied in a PIH-led endTB clinical trial. The resulting recommendations represent the culmination of nearly a decade of scientific research and patient care across 18 countries.

6. Extensively drug-resistant tuberculosis (XDR-TB)

What It Means: It’s a form of TB caused by bacteria resistant to at least four common medications.

In Our Work: PIH clinicians across most care delivery sites have experience treating XDR-TB, the most rare and difficult-to-treat form of the disease. In Kazakhstan, Peru, and Lesotho, PIH led a clinical trial specifically for people with pre-XDR-TB, an early form of the disease; and cured patients, including a mother-daughter duo whom you can read more about in this blog.

7. GeneXpert

What It Means: It’s a machine that tests clinical samples to quickly identify infectious diseases, such as TB.

In Our Work: PIH-supported Botšabelo Hospital first started using the GeneXpert around 2012 and was the first facility in Lesotho to have the machine. PIH now has GeneXpert machines across seven additional hospitals and clinics in Haiti, Peru, Malawi, Rwanda, Liberia, Sierra Leone, and Kazakhstan.

8. Multidrug-resistant tuberculosis (MDR-TB) 

What It Means: It’s a form of tuberculosis caused by bacteria resistant to at least two common medications.

In Our Work: In partnership with the government, PIH Sierra Leone opened the country’s first MDR-TB treatment center at Lakka Government Hospital in 2017. Since then, over 1,100 patients have been enrolled in the program.

9. Prophylaxis

What It Means: It refers to measures—such as antibiotics or routine wellness visits—used to prevent diseases before they occur.

In Our Work: In many of the communities where PIH works, families often live in overcrowded houses which makes it easier for TB to spread. If someone has TB and the rest of the family tests negative, PIH staff may still recommend they take daily preventative medication, known as TB prophylaxis, for one to three months depending on their medical history.

10. Sputum

What It Means: It’s a thick mucus that can accumulate in the airways in people with respiratory disease. Testing it helps identify and diagnose TB.

In Our Work: Community health workers collect sputum samples during home visits. A person coughs deeply, coughs the sputum into a container, then the sample is tested in a laboratory.

11. TB infection

What It Means: It’s when TB bacteria are present in the body, but inactive. The person has no symptoms and cannot spread the disease to others. A person can be infected for weeks—or even years—before the bacteria becomes active. Treatment of TB infection virtually guarantees that TB disease will not occur and will not be spread to others.

In Our Work: To detect TB infections early, Socios En Salud—as PIH is known in Peru—and other care delivery sites conduct active screening in vulnerable communities using portable X-ray machines and molecular tests. 

12. Treatment success rate

What It Means: It is the percentage of patients who finish their entire TB treatment with a positive outcome and are clinically better.  
 
In Our Work: Between 2019-2023, community health workers in Liberia completed 171,693 home visits. Those visits and referrals include TB treatment, in which PIH has become a nationwide leader, and have also pioneered artificial intelligence-based testing leading to a 92% treatment success rate in 2021.

13. Treatment supporter

What It Means: Treatment supporters are non-clinical individuals—oftentimes a person with TB’s neighbor or friend—who provide at-home support with medication routines, appointments, and more.  

In Our Work: Between 2021 and 2024, PIH Lesotho worked with 483 treatment supporters to reach hundreds of patients with MDR-TB

14. Universal search, treat, and prevent

What It Means: It’s a three-part approach designed to eliminate TB. Standard approaches focus more heavily on one pillar—typically “treat”—and often cannot reach the full population. At PIH, we are reenvisioning the approach to simultaneously carry out each pillar for a wider group of people—what we refer to as “universal access search, treat, and prevent.”

In Our Work: In Lesotho, PIH is launching the universal access search, treat, and prevent approach in a full district. We believe it is our moral imperative to end TB and through this approach we can detect and treat thousands more people with TB.

Editor’s note: This is an actively evolving situation with limited transparency, so some information may shift.

The Trump administration’s attack on foreign aid began on his first day in office in January 2025. Through executive actions, he initiated a 90-day review of foreign aid, accompanied by a “stop-work order” that froze payments and services for work that was already underway in countries and clinics around the world. Following this initial disruption, the dissolution of the United States Agency for International Development (USAID) caused even more services to shutter—leaving people in the lurch as their jobs, their health, and their livelihood were all being threatened.

Consequences of Cutting Foreign Aid

Now, several months into Trump's second presidency, billions of dollars for lifesaving foreign assistance have been stripped away. It is hard to quantify the impact these cuts have had on the well-being of people who relied on these services, but it's clear that critical supplies, jobs, and lives have been lost.  

“If we look at an example from PIH, tuberculosis (TB) case detection rates in Lesotho have declined as patients are unable to receive a diagnosis at local clinics even if diagnostics are available, due to the thousands of health care workers who were laid off through project terminations,” said Vincent Lin, PIH associate director of health policy & advocacy. “Referral hospitals are seeing fewer patients and TB is spreading.”

And these are still the early consequences—these cuts will reverberate for generations to come.

If the current situation continues:  

• At the patient and family level: We fear increased morbidity and mortality from undiagnosed or delayed-diagnosis illnesses. We are also concerned about the long-term impacts to families, communities, and individual patients, like the unmitigated spread of infectious diseases and limited access to health care services.
• At the microbial level: Resistance develops rapidly to the antiviral and antibiotic tools that we do have, which can increase when patients don’t have access to the medication they need to complete their treatment.
• At the system level: Clinicians, who are specialized in delivering health care, have been laid off and may leave the field entirely, or are bearing the burden of trying to provide care to patients with limited resources and limited staff.  

“There's great uncertainty around several key variables that determine how the landscape will appear a year from now,” Lin said. “Lawsuits around terminations and impoundment, agency reorganization, congressional action on rescissions—these are all likely to be resolved within the next year and are each critical to what global health funding will look like in the future.”

Changing the Future of Aid Through Rescissions

On June 3, the White House sent Congress a rescissions package that would cut $8.3 billion in foreign aid funding. Rescission packages happen when the President requests that Congress cancel previously allocated—but unspent—funds. The current package includes devastating cuts to global health programs, including the President's Emergency Plan for AIDS Relief (PEPFAR) and the United Nations Children's Fund (UNICEF).  

PEPFAR, which PIH co-founder Dr. Paul Farmer advocated for at the White House using evidence from his work in Haiti, has helped avert the deaths of over 25 million people by providing critical HIV treatment and prevention around the world. Currently, the State Department estimates that 20.6 million people are receiving U.S.-funded antiretroviral therapy.  

Without these programs, some of the world’s most vulnerable will lose access to essential health services. Maternal mortality rates will rise, more children will suffer from malnutrition, and more people will die from treatable, preventable illnesses like TB. In their justifications, the Administration wrote that these cuts “would not reduce treatment,” which simply isn’t true.  

For one proposed cut, the Administration writes, “this proposal would not reduce treatment but would eliminate programs that are antithetical to American interests and worsen the lives of women and children, like ‘family planning’ and ‘reproductive health’...” Each year, an estimated 287,000 women—primarily in low- and middle-income countries—die from complications during pregnancy and childbirth. An estimated one-third of maternal deaths could be averted each year if women had access to and used effective contraception. Regardless of rhetoric, the truth is that essential health treatment would be yanked back as a result of these rescissions.

Unfortunately, rescission bills only need a simple majority in the House and Senate to become law, which makes it much easier for these funding cuts to become permanent. If Congress were to codify this rescissions package, the health consequences would be devastating, and it would set a dangerous precedent for future funding cuts.

While PIH recognizes that current aid structures have their flaws, removing funding completely—without any resources to support critical programming—is not the solution.  

“We must aspire beyond the reinstatement of U.S. aid, which by itself will never be enough to realize health as a human right,” said Joel Curtain, director of advocacy at PIH. “While getting U.S. aid funding back out the door is essential in delivering health system inputs to reduce the acute and unnecessary suffering caused by its reckless removal, broader transformations are required to halt the ongoing unnecessary suffering inflicted by centuries of colonialism, neocolonialism, and ecological breakdown.”

The People’s Power

Despite its lifesaving track record and overall bipartisan support, aid for health programming is being targeted by the current administration.  

Currently, by using only around 1% of the federal budget, U.S. foreign assistance saves around 9,000 lives on an average day. There is also large public support for global health foreign aid: around eight-in-ten Americans believe the U.S. should provide medicine and medical supplies, as well as food and clothing, to people in low- and middle-income countries, according to the Pew Research Center.  

At PIH, we’ve seen an overwhelming number of our supporters and partners speaking up against the removal of foreign aid.  

“We've mobilized more than 16,000 calls and letters to Congress from 96% of House districts and 100% of Senate offices, as well as hundreds of volunteers via multiple rounds of global health advocacy on Capitol Hill, including an unprecedented TB Hill Day,” Curtain shared. “In spite of the enormous challenges posed to global health at this moment, this advocacy is having a clear impact; we are seeing record numbers of Congressional offices calling for increased funding support for these programs.”

Use Your Voice

With the rescissions package currently in the hands of Congress, constituent voices are extremely important in influencing its passage into law.  

“Congress—under Article I of the Constitution—holds the power of the purse, as well as oversight authorities for foreign aid,” Lin said. “Local voters have a major role to play in influencing the positions of their members of Congress.”

Jennifer Furin and Carole Mitnick’s path to becoming tuberculosis (TB) experts began at Partners In Health (PIH) in the ‘90s. What started with research tasks and photocopying led to hands-on work like collecting sputum in baby food jars. These early days at PIH were pivotal in shaping their professional lives.  

Now, three decades later, Furin is a renowned infectious disease clinician and medical anthropologist, and Mitnick is one of the leading TB clinical trialists in the world, as well as a professor of global health and social medicine at Harvard Medical School, where she also conducts clinical research.

Throughout their careers, Furin and Mitnick have shared roles as colleagues, co-authors, caregivers, friends, and advocates for TB care. In this Q&A, they reflect on their remarkable journeys and PIH’s evolution from a fledgling organization to a leader in global health. Read on to learn more about these two incredible women and their lasting impact:  

Let’s start off by discussing how you both first got connected to PIH.  

Furin: I’d just finished my PhD in medical anthropology at UCLA and was starting my first year at Harvard Medical School. My thesis advisor’s wife said, “You should call these guys Jim Kim and Paul Farmer because they’re also anthropologists and doctors.” So, I did—and I started volunteering with PIH.  

They were writing Women, Poverty, and AIDS at the time, and they needed a student who could go to the library, find all their papers, and photocopy them.  

Mitnick: One thing you have to know about Jen is that she is incredibly quick at literature searches and parsing information, so I'm sure Paul was completely blown away by what you were producing.

Furin: I could find anything. I don’t know if Paul was impressed, but when I first sat down with him at the PIH house—that served both as an office and home to some staff—in Boston, I was dropping off some articles, and he said he had something for me to look at. He asked if I could get it back to him tomorrow. I said sure—keep in mind that I was a first-year medical student, so I was also trying to do the things that first-year medical students do, like learn anatomy—and he handed me a 300-page book.  

I thought he was just going to give me an article to summarize, but I still did it, and I think that was the start of him thinking: “Alright, this one will say yes to anything, but she’ll actually finish it quickly.”

I hung around a lot more than a work-study student usually does, and people were very open and receptive to having me there and to teaching me.

Mitnick: I was in a doctoral program at the Harvard School of Public Health. The experience was different than I had expected, and I had trouble finding my way.

But I didn’t want to leave without a degree, so I petitioned to get a master's degree and chose to do my thesis on TB among the non-U.S. born in Massachusetts, building on work I was doing as a volunteer in the Department of Public Health.

Then I met Meche [Becerra], who was in my doctoral program, as I was debating taking a leave of absence. She said: “You have to meet Paul Farmer; he’s really interested in TB.” After she introduced us, he advised me on my thesis.  

For the coming year (1996-1997), PIH was planning to focus on TB at the Institute for Health and Social Justice, which Paul had founded with his MacArthur Genius Grant, and they were looking for a fellow to run the activities. I applied, got a one-year fellowship, and never left.

I found Jen there.

Did you two work together?

Furin: It was an interesting time at PIH because our work was primarily focused on Haiti and Boston. But Jim and Paul both knew Father Jack Roussin, who died of drug-resistant TB in Carabayllo, Peru. When he died, there were major discussions around PIH starting work in Peru.  

I was just the photocopier, but I learned that if you keep your hands busy and listen, you can be around really cool people and hear interesting discussions. Ultimately, the decision was made to start a drug-resistant TB project in Peru.  

As a student, I was involved in helping to shape the program, like when they needed things such as drugs taken to Peru and samples brought back. I remember going around with Sonya Shin and community health workers to collect sputum in baby food jars—literal baby food jars—and bringing them back to Boston in my backpack.  

I also remember a lot of moral discussions, too. I just learned so much. To be able to hear these discussions and share them with other students like Carole... Our hearts were together in so many ways.

Mitnick: We would have these weekly staff meetings in the kitchen at PIH, and we would be around the table listening to these intense conversations about decision-making and how to use the budget.  

Furin: Paul, Jim, and Ophelia [Dahl] had this way of helping you connect whatever activity you had to a higher social justice principle. I remember one of my jobs was to make the indexes for the Institute for Health and Social Justice books. Paul sat me down and said, “You know, Jenny, indexes are not just a listing of topics, right? You can use an index to help make connections that people may not see. Like under U.S. government policy, you can list where it is in the book, but you can also write: ‘see injustice,’ ‘see structural violence.’”  

Mitnick: That was something Paul was truly gifted at, and it was not just lip service. It was totally genuine—there were ways for all of us, whatever our strengths or passions, to orient ourselves toward social justice and solidarity. I was able to play to one of my strengths in Peru by setting up the first data collection structure for the first patients treated for multidrug-resistant TB (MDR-TB).  

I want to discuss where both of you are in your careers now. How has your work evolved over the years?

Mitnick: I found my way back to grad school, really, because of PIH and people like Paul and Jen and my peer mentors. I had access to more research funding, and I could teach more and be involved in expanding the movement for global health equity.  

We started thinking about clinical trials, and Jen, Meche, Salmaan [Keshavjee], and I went to London to meet with the people who were kind of the grandparents of clinical trials for TB to learn and try to develop protocols.  

And that became my area of work for the last 15 years with PIH. It’s always been oriented toward improving access to care and quality of care, as well as building the accompaniment model into our research. We’ve also tried to use the results of our research to promote better access to drugs and diagnostics for the populations we serve.

Furin: I worked on MDR-TB, but it was a hard fight—and we were fighting, at the time, for a treatment regimen that was miserable for patients. I told Jim that I needed a break from it, and that’s when he sent me to Lesotho, where PIH had started an HIV project. I was excited because I always wanted to do HIV work, but I was only in the country for about 6 months when one of the worst outbreaks of highly drug-resistant TB started happening right by us in South Africa.

I guessed I had unfinished business with TB. I stayed in Lesotho with PIH for the next 3 years, and we changed our country strategy there to include an MDR-TB treatment program—the first one ever in the country.  

In 2010, for personal reasons, I left PIH officially. But one never really leaves PIH, and I maintained my connections and collaborations with colleagues there as I moved over to Médecins Sans Frontières to continue working on MDR-TB. Only in leaving did I realize how much clinical experience and expertise I had gained over the years.  

It was a good lesson that sometimes you have to step away from the organization you grew up in to realize your potential—but that potential can still be used for our shared goals and shared mission.  

I’ve now been working in the field of drug-resistant TB for 30 years.  

Mitnick: It’s painful to have people like Jen and others we grew up with leave because we’re all so close. But, I’ve come to realize how good it really is for the movement. With all the organizations Jen has worked for and consulted with, where she has taught, all these people have now been exposed to PIH’s model and standards.  

Furin: I can’t imagine doing anything else. A lot of it is the people. It’s that sense of community that started when I was with PIH. We have a rich fabric of connection, and there’s a joy in doing this work.  

Mitnick: The patients and colleagues I’ve met over the years in Boston, at PIH care delivery sites, and elsewhere compel me to keep trying to find ways to use my voice, my skills, my institutional affiliation, and my other privileges—no matter how uncomfortable I am—to counter the deadly notion that some lives matter more than others.

Mental health care remains at the margins of global health delivery: nine in ten people worldwide receive no care for treatable mental health conditions. Partners In Health (PIH) works to expand mental health care from institutional treatment to community systems, meeting people where they live to help address this need.  

PIH’s Cross-Site Mental Health Program seeks to improve the lives of patients and communities by expanding the continuum of mental health and psychosocial support services across all 11 PIH care delivery sites globally.  

Learn more about these services by getting to know six of PIH’s Mental Health Program leaders around the world:

Junior Brice, MD, MPH – Zanmi Lasante Mental Health Director

When Dr. Brice was working in the HIV program at Zanmi Lasante (ZL), PIH's sister organization in Haiti, he collaborated with psychologists to provide clinical evaluations to patients. There, he was amazed by their approach to understanding how psychosocial factors impact overall health. Seeing the importance of integrating mental health work into patient care helped guide his work for ZL's Mental Health Program.

“I want to help transform how mental health is understood, valued, and integrated into everyday life in Haiti, break the stigma surrounding mental illness, and make mental health care accessible, community-based, and culturally relevant,” Dr. Brice shared.

At ZL, he has helped ensure mental health services are a key component of primary health care and brought the program directly into communities by training general clinicians and community health workers to provide consistent support and reduce stigma.

“[ZL] has an integrated model in treating mental illness together with the social and economic problems that typically propel it,” he said. "It is a model respectful of local culture and addresses mental health as both a medical and a social issue. The level of care provided by PIH—integrated, consistent, and community-based—simply doesn’t exist elsewhere at that scale in rural Haiti.”

Dr. Brice is proud to work for a program that is so deeply rooted in the communities it serves. He believes it makes treatment more humane, consistent, and trustworthy.  

“In Haiti, where mental health is stigmatized and neglected, every single person who receives care and finds hope is a victory,” Brice said. “The PIH and ZL approach to mental health shows that when people are treated as a whole and when communities are involved in the treatment process, we can achieve sustainable results and build an equitable health system.”

⎯

Carmen Contreras, MSc - Socios En Salud Mental Health Program Director

After over two decades of working on various research and initiatives for Socios En Salud (SES), as PIH is known in Peru, Contreras took on leading the mental health team eight years ago. She developed mental health intervention strategies with guidance from other mental health leaders within PIH and from the implementation of various initiatives across other PIH sites.  

“We have a superb Mental Health Cross-Site team, with whom we strengthen each other,” Contreras said. “We've learned that, together, we are stronger than apart. Our meetings, sometimes remote and sometimes in person, have allowed us to learn new interventions and continue growing as a team.”

For Contreras, community has a significant impact on PIH’s approach to mental health care—both between colleagues and with the patients they serve.  

“Community work makes a difference,” she said. “Through community support, we help people with mental health problems approach health centers with greater confidence, enabling communities to connect with services, and in return, both are strengthened: the community feels more heard, and mental health services become more humane and accessible.”

Contreras finds her purpose in seeing these transformations. Seeing the changes, hearing patients’ stories, and feeling their trust reminds her why she remains committed to this work.  

“Every word of gratitude we receive—whether from a health professional at a Community Mental Health Center or a representative from the Ministry of Health—is a sign that we're on the right path,” Contreras said.

⎯

Chenjezo Gonani, BSc, MMSc – PIH Sierra Leone Mental Health Program Manager

When Gonani was growing up, he saw his best friend experience a mental health crisis that was followed by extreme stigma and abuse. This childhood memory stuck with him as he was practicing as a general clinician in rural districts of Malawi and noticed families in need of mental health care that was inaccessible to them. He now works to make sure no one has to suffer due to a lack of resources.  

“PIH's approach to mental health is very unique because we build functional mental health care delivery systems along the continuum of care, ensuring that there are services to treat and rehabilitate people in severe mental distress, as well as those who are experiencing mild to moderate distress,” Gonani explained.  

This approach has helped transform mental health care for people in Sierra Leone, where Gonani works.

“Before PIH's involvement, access to mental health care was almost nonexistent in the country,” he said. “For example, the few patients that were at Kissy Home—the oldest psychiatric hospital in sub-Saharan Africa and now, with the support of PIH, transformed into Sierra Leone Psychiatry Teaching Hospital—were left in chains because of a lack of mental health medication and providers to effectively provide care, and no services were available in the outskirts of the country.”  

The changes Gonani has seen from PIH’s bold, innovative, and compassionate approach has brought him great joy and hope. PIH Sierra Leone helped establish the first specialized child and adolescent mental health unit, the first psychiatry residency program in the country, the first national toll-free mental health helpline, and the first specialized drug treatment and rehabilitation services.

“I am motivated by seeing the impact of our initiatives that have given hope to so many people who, for years, have been struggling with mental illness and are now getting back to their normal selves and functioning well in the community,” Gonani said.

⎯

Helen Tedros Haile, MD – PIH Liberia Mental Health Program Manager

As a psychiatrist, Dr. Haile often notices the immense gap that exists in accessing mental health care, especially in rural and underserved communities. When she joined PIH Liberia, she turned her passion into action through care delivery, support, and community-based interventions.  

“PIH’s approach is rooted in the belief that mental health care is a human right and should be integrated into the broader health system,” Dr. Haile shared. “It’s not just about medication or diagnosis, it’s about dignity, equity, and long-term recovery.”

Haile shared that many mental health services in Liberia area concentrated in urban areas, but still with very few trained professionals and little community outreach. She is grateful for the care PIH Liberia provides communities that are often neglected by health systems.  

“Without PIH, access would be extremely limited in southeast Liberia,” she said. “Patients in rural settings would face long travel distances, high costs, and significant stigma. They would likely not receive the same quality, continuity, or compassionate care that PIH provides, including the follow-ups, family engagement, psychosocial support, and skill-building opportunities we offer.”

Haile has been amazed to witness how PIH Libera’s work has transformed lives and communities.  

“My favorite part of my work is watching people recover and reclaim their lives. Every life we touch, every patient we accompany toward healing, reinforces the value of this work,” she said. “Knowing that we are changing the narrative around mental health in Liberia keeps me going.”

⎯

Augustin Mulindabigwi, MPH – Inshuti Mu Buzima Mental Health Program Director

Mulindabigwi saw a need in local communities that were affected by mental illness. He witnessed how, when left untreated, symptoms could impact every aspect of life. After studying clinical psychology, he joined Inshuti Mu Buzima (IMB), as PIH is known in Rwanda, in 2022 to lead their mental health program.  

“I believe one of the most impactful aspects of our work is our commitment to system strengthening,” he said. “We do not just provide services—we invest in training, infrastructure, data systems, and advocacy to ensure mental health is sustainably integrated into the broader health system, specifically into chronic care service delivery.”

This work has been life-changing for many of IMB’s patients and people all around Rwanda.

“IMB’s involvement in mental health care has significantly supported the government’s efforts to decentralize and integrate mental health care into primary health care settings,” Mulindabigwi said. “Our work has brought services closer to communities, trained local providers, and integrated mental health into primary care—making care more available, holistic, and person-centered.”

The human-centric approach is very important to Mulindabigwi. He strives to build trust and foster healing, even beyond clinic walls.

“Our approach values the treatment of people more than their diseases and focuses on addressing social determinants of health,” he shared. “Mental health work can be tough, but witnessing resilience in the face of adversity is incredibly powerful and humbling.”

⎯

Ana Cecilia Ortega, MSc – Compañeros En Salud Mental Health Coordinator

During her undergraduate psychology studies, Ortega felt frustrated by the mostly clinical and individualistic focus, and longed to integrate community and social support into her work. When she joined Compañeros En Salud (CES), as PIH is known in Mexico, there was only one dedicated staff member in the mental health program. Now, the program has grown to 13 members, consisting of psychologists, a psychiatrist, and most importantly to Ortega: community mental health workers.  

“Nowhere else in Mexico, that I know of, will you find a model like this of employed and consistently supervised and supported Community Mental Health Workers,” she said. “We are constantly co-creating projects with the Community Mental Health Workers and asking for feedback from community members every time we facilitate a new intervention.”

The Community Mental Health Workers are vital to bringing mental health care directly to the communities who need them most.  

“Without the services CES provides, people would have to travel for four to six hours at least to reach the closest psychologist or physiatrist,” Ortega said. “At CES, Community Mental Health Workers, teleconsultations, and group interventions help people receive individual mental health care within their communities.”

Ortega finds inspiration in this specialized, community-focused approach.  

“The Community Mental Health Workers have been my greatest mentors throughout these years,” she said. “Seeing their incredible work that they tailor to the needs of their communities, how they organize as a team, and being able to support and accompany their struggles and achievements.” 

Editor’s Note: This blog was originally published in Spanish on Socios En Salud’s blog.

In most health centers, the first person a patient sees isn't a doctor. Usually, it's a nurse or midwife. They monitor children's development, detect preventable diseases, and are pillars of key programming for areas such as mental health, HIV, tuberculosis, and sexual and reproductive health.

Although their role is essential, it’s rarely recognized that—in addition to providing care—these professionals lead teams, drive change, and address critical situations with leadership, empathy, and decision-making skills. Their impact goes beyond the clinical sphere: they are role models for their colleagues and communities.

Therefore, during Nurses Week between May 6 and 12, Socios En Salud (SES), as Partners In Health (PIH) is known in Peru, wanted to highlight the work of nurses and midwives as leaders in community health and underscore the need to strengthen their leadership, mentoring, and decision-making skills to address health system challenges.

Training Health Leaders at the Community Level

"Leadership is something we practice every day, but we're not always aware of it," said Rosa Yataco, head of monitoring and evaluation in the SES Program Management Directorate.

For this reason, Socios En Salud implemented a six-month Leadership Skills Training Program specifically for nurses and midwives, which saw participation from 70% of these health professionals at SES.

Leadership in community health allows us to respond to vulnerable populations in areas with limited access to health services. In Peru, nurses and midwives lead in both clinical care and social support. Programs like this one seek to promote transformational leadership with technical and community impact resources starting at the primary care level.

“Many of our colleagues are afraid to take on new opportunities, sometimes because they don't know how to start. That's why we decided to create a program that would help them recognize their leadership and prepare them to make decisions in their workplace,” Yataco said.

Yataco led the training program, which consisted of six modules focused on topics such as the fundamentals of leadership in community health, self-leadership and personal management, communication and teamwork, decision-making and problem-solving, ethics and empowerment in leadership, and applied leadership in the community.

For Yataco, ongoing training is key. “A leader isn't trained overnight; they gain experience and must share it with others, as a mentor, as a peer,” she pointed out.

Leadership in Action: Experiences From the Field

Danna Obregón, midwife and coordinator of the Salud Materno Infantil y Adolescentes, or Maternal, Child, and Adolescent Health program, found that the leadership course allowed her to identify something she had already been doing: leading a team of community health workers.

“I was the one with the professional training, but they were the ones who supported people in their daily lives,” Obregón said. “So, my role as a leader was also to provide them with tools and recognize them as agents of change.”

Obregón emphasizes that nurses and obstetricians are already natural leaders: “We are the ones who work directly with the community, who promote health and prevent disease. But that requires preparation and leadership to deal with the unexpected that always appears in the community.”

Jenny Orihuela, a midwife and clinical studies monitor at the Unidad de Ensayos Clínicos (UNEC), or Clinical Trials Unit, adds that leadership is also practiced in technical settings.

“[The training] has allowed me to improve active listening, teamwork, and build trust. And that is essential, because in community health, if people don't trust you, you can't help them,” Orihuela shared.

For Orihuela, leadership should not only be applied to work, but also to social transformation: “If I could implement change, it would be through education. If the population is better educated about health, they can take better care of themselves and go to health centers in a timely manner.”

Breaking Stereotypes: Midwives in Invisible Communities

Carla Rodríguez, midwife and coordinator of the HIV and STI program, says that thanks to her role, she has been able to break stereotypes about her profession.  

“We tend to associate midwives with childbirth care or the health of women of childbearing age. But today I work with trans women, a population that has historically been excluded from the system,” Rodríguez said.

Through her work, Rodríguez not only provides care but also builds bridges of trust.  

“Leading in this context also means raising awareness through the way you speak, how you look at people, and how you address them,” she shared. “It's a constant challenge because many of them have suffered family and social rejection.”

Her greatest wish: equal opportunities. “Not only in access to health care, but in rights. That's what can truly change the well-being of these communities.”

Outside of providing community-based care, in rural areas, where doctors are often unavailable, nurses alone also lead care in health centers. Edith Soncco, a nurse at UNEC, emphasizes the importance of teamwork and clear communication to achieve change.  

“Nurses don't just provide care: they organize, direct, and address whatever arises,” she said. “That's why it's essential for us to empower them and strengthen their skills.”

The impact of nurses goes beyond their clinical role. By managing programs for infectious diseases, nutrition, or mental health, for example, they are often the only health representatives in underserved communities.

A Future with More Opportunities

The staff at SES can all agree on one thing: leadership is learned, trained, and strengthened through experience and ongoing education.

At Socios En Salud, Nurses Week helps to serve as an opportunity to make visible what is often invisible: the powerful and decisive leadership of nurses and midwives in the health care system.

For Rosa Yataco, awareness and education are just the first steps: “We need more professionals to take the plunge, train, and recognize themselves as leaders. Because in the community, their role is not only clinical. It's transformative.”