A proposal that would strip health insurance from at least 8.6 million people advanced out of the House Energy and Commerce Committee last week.

This policy is part of a larger bill that would slash over a trillion dollars in health and social services over the next 10 years to prolong tax cuts—which were passed in 2017 and set to expire Jan. 1, 2026— for the nation’s wealthiest. While most income groups would receive some form of tax relief, the benefits are heavily skewed toward the top 0.1% of earners, those making $3.5 million or more annually for a family of two, according to estimates from the Treasury’s Office of Tax Analysis.

Proposed health care cuts will amount to over $700 billion over the next decade, mostly from Medicaid, a program nearly 80 million people rely on, including low-income adults, working families, children, seniors and people with disabilities.

Additional red tape—including work requirements echoing a policy that was consistently blocked by courts—and other changes would leave millions without coverage.                             

It's simple: to finance tax breaks to billionaires and increased border militarization, health inequity would deepen in the United States.

How The Cuts Threaten Everyday Lives

The mission of Partners In Health is to ensure everyone can exercise their right to health. Partners In Health United States, or PIH-US, works alongside partners to build strong, community-led public health systems. Medicaid is critical to making this a reality by funding many of the community health programs that PIH-US supports.  

Medicaid allows low-income people to have access to health care and financial protection in a country where health is treated more like a commodity than a right. Reducing coverage and making clinical services unaffordable will exacerbate racial and economic disparities in health care access, reinforcing structural injustices that PIH-US and our partners have long fought against.  

If passed, the proposal would impose additional levels of bureaucracy to the Medicaid process—allowing for eligibility checks every six months instead of every year, in addition to levying work requirements nationwide. This would 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.

Instead, a recent study found an association between Medicaid work requirements and impacts on medical debt and health outcomes, including delays in critical care and lack of access to medications due to cost.

Work requirements could also lock people out of subsidized private plans. If a person cannot meet the reporting requirements and is removed from Medicaid, they are still technically eligible for the program even if they are not on it. This means they would only be able to purchase full-priced plans.

Attack on Reproductive Health and Immigrant Communities  

The consequences of the proposed Medicaid cuts would extend far beyond red tape and work requirements—they would also remove access to essential care from millions, particularly in the realm of reproductive and immigrant health.

The new plan would remove Medicaid funding for Planned Parenthood, which provides more than 2 million patients a year with essential, preventative reproductive health care, including birth control, cancer screenings, wellness exams, STI testing and treatment, and more.

This attack on reproductive care is compounded by policy changes that further target immigrant communities and transgender people. It includes numerous anti-immigrant policies, like states no longer being required to provide Medicaid while the status of people’s immigration is being considered, and slashes coverage to gender-affirming care. 

These proposals do not exist in a vacuum. The cruel and unacceptable cuts come as the Trump Administration proposes the first $1 trillion defense budget—a 13% increase. The administration also hopes to spend money on bolstering anti-immigrant policies, including investments in Immigrations and Customs Enforcement (ICE), detentions of migrants and border militarization.

Nearly half of all babies in United States come into the world with their care covered through Medicaid. The majority of nursing home care is through Medicaid. From a baby's first breath to an elder's last, Medicaid plays a critical role in the life of our communities.

This is not a matter of limited resources. Medicaid is not unaffordable or impossible to fund. Yet, the current bill moving through Congress will reallocate money from critical safety net programs to pay for more tax breaks for the wealthy and give billions of dollars to immigration enforcement agencies. PIH’s mission to protect the right of health for all is in vehement opposition to this vision.

Some members of the House are eyeing to pass the bill by Memorial Day, on May 26. We cannot afford more cuts to public health while the richest among us benefit.  

Other slashes to Medicaid have been proposed in the past, but public outcry helped stop them. Take action today to protect Medicaid—and push to make health care a right for all. 

Dr. Lorenzo Guglielmetti, co-principal investigator of the endTB clinical trials, has been named to the 2025 TIME100 Health list, which honors the most influential people driving innovation in global health and medicine. 

Each year, TIME100 recognizes individuals making a significant impact through their work. Guglielmetti’s inclusion underscores his leadership in the fight against tuberculosis (TB), the world’s deadliest infectious disease. 

“I am deeply honored to be part of this extraordinary group of individuals,” Guglielmetti said. “This recognition is not only for me but for the entire endTB team and the patients we work to help. It’s a call to action to continue advancing scientific research and to ensure that no one is left behind in the fight against TB.” 

His selection draws attention to the urgent need for innovation in global health, especially amid rising rates of drug-resistant disease and declining investment in public health. 

This recognition also acknowledges the groundbreaking work of the endTB project—a global partnership led by Médecins Sans Frontières, Partners In Health, Interactive Research and Development, and Harvard Medical School. Active in 18 countries, the project aims to provide shorter, less toxic, and more effective treatment for multidrug-resistant tuberculosis (MDR-TB)—a notoriously grueling form of the disease—through cutting-edge research and policy advocacy.  

Throughout his career, Guglielmetti has focused on developing treatment regimens that reduce side effects and treatment duration while expanding access for patients. He has authored more than 70 peer-reviewed articles on TB and mycobacterial infections. In 2025, Guglielmetti served as lead author of a landmark study in The New England Journal of Medicine that helped establish new oral drug regimens to treat rifampin-resistant TB. 

Research projects have taken Guglielmetti to countries heavily impacted by TB, including Georgia and regions of Central Asia. He currently holds positions at the National Reference Center for Mycobacteria and at Sorbonne University in Paris, where he continues to champion scientific collaboration and patient-centered care. 

Guglielmetti’s inclusion on the TIME100 list is not only a personal achievement but a testament to the global effort to eliminate TB. As the world confronts growing threats to public health, the recognition serves as a reminder of what can be achieved through collective action and scientific advancement. 

With continued support from global health leaders and organizations, the fight against TB will keep gaining momentum—pushing relentlessly toward a healthier and more equitable future for all. 

To learn more about Dr. Lorenzo Guglielmetti and his work, visit the endTB website, and read the full 2025 TIME100 Health list. 

Indigenous people in the United States face significant health disparities and barriers to care, rooted in a history of colonialism, racism, and discrimination. Compared to their white counterparts, American Indian and Alaskan Native (AIAN) people are more likely to report having fair or poor health, to have chronic conditions like asthma and diabetes, and to experience mental health challenges.  

However, barriers to treatment, such as broken promises and associated distrust and lack of health systems funding, make AIAN people far less likely to receive care.

The U.S. federal government is obligated to provide health care to AIAN people, based on the Constitution, treaties, Supreme Court cases, and various authorizing laws. The Indian Health Service (IHS) is an agency within the Department of Health and Human Services responsible for providing federal health services to 2.8 million AIAN people.  

There are many nongovernmental organizations throughout Indian Country who help provide care to AIAN people as well, such as COPE, PIH’s sister organization on the Navajo Nation, which works to provide accessible, quality health care to indigenous people within their community.  

Limited Budget, Limited Staff

The IHS funds multiple facilities and services, including IHS facilities run by the federal government, Tribal facilities operated by Tribes or Tribal organizations, and Urban Indian Organizations run by non-profit organizations. Collectively, these are known as “ITUs.”  

Unfortunately, ITUs are chronically underfunded and unable to meet the needs of their patient population. According to a Government Accountability Office report, the IHS faced a physician vacancy rate of 29% in 2018, which is estimated to have worsened over the years as increasing numbers of health professionals have left due to a lack of resources and career advancement opportunities.  

Addressing these workforce shortages—and the lack of funding that causes them—is critical to bolstering the health system and making care more accessible overall.

Each year, the IHS’s funding is determined by a budget that Congress allocates. When the budget runs out, services become more limited or disappear altogether, affecting what services ITUs can provide and the number of patients they can serve. In 2023, the average spending amount per person receiving care through IHS was just under half of that for Medicaid—$4,078, compared to $8,873—and less than a third of overall health care spending per person at $13,493. Under the current administration, crucial IHS—and overall health care—funding could decrease even further.  

This limited budget impacts how much funding can go to the IHS workforce, including to recruitment and training—the IHS receives no specific funding for physician residency training programs, unlike the nearly $900 million annual budget of the Veterans Health Administration. Through Medicare, Medicaid, and the Health Resources Services Administration (HRSA), taxpayers spend more than $20 billion each year to train physicians. As more than 50% of residents stay where they train, it’s critical to have this effective pathway available for recruitment and retention at IHS facilities.  

“It is a unique paradox that the Indian Health Service receives no congressional funding for graduate medical education (GME) yet has the highest rate of physician vacancies of any federal health organization,” Hannah Slattery, a Mi’kmaw descendant of Bear River First Nation in Nova Scotia, Canada and a member-at-large with the Association of Native American Medical Students (ANAMS), said. “For comparison, the Veterans Health Administration receives $874 million in congressional GME funding annually.”

Additionally, the IHS is the only large federal health system that doesn’t have a network of partnerships with academic medical centers. The eight residency and five fellowship programs that exist within IHS facilities are largely funded by the HRSA and private philanthropy.

By contrast, the Veterans Health Administration—which has benefited from 75 years of active partnership with teaching hospitals—supports tens of thousands of trainees in residency rotations. So, how can this gap be filled?  

The Power of the Purse

Through constituent advocacy, partnership with ANAMS, and support from the Schooner and Haas foundations, Partners In Health (PIH) supports a multi-agency approach to address workforce shortages across ITUs.  

To ensure that ITUs can recruit and retain the clinical workforce needed to care for AIAN populations in the U.S., PIH calls for:

• Increased funding for IHS to implement proven residency, rotation, and fellowship programs, from $0 to $30 million in FY2026
• Increase HRSA Teaching Health Center GME Program funding from $119 to $300 million per year
• Increased funding for the U.S. Department of Veterans Affairs’ pilot program for rotating residents with ITUs, which begins in 2025
• Enabling Medicare reimbursement for resident rotations at ITUs

In February and March, PIH advocacy staff supported ANAMS students as they met with their senators and representatives about these issues. Over 4 days at the Capitol, 37 young AIAN leaders from all over the country participated in 55 meetings with Congress.  

“I feel incredibly lucky to have taken part in the [Tribal health] Hill Day experience. We were able to draw attention to the workforce shortages for ITUs and discuss creative solutions, while highlighting the continued resiliency of our communities,” Anna Klunk, Red Lake Ojibwe and ANAMS member, said. “It allowed me to learn about the legislative process more in depth so I can continue to be an advocate for Indian Country in the future.”

By training ANAMS students, PIH strives to empower Indigenous medical students and build the capacity of the next generation of Tribal health leaders.

“A recent AAMC publication showed that in the 2024 medical school applicant cycle, AIAN matriculants decreased 22.1%, the most of any demographic group” Slattery shared. “This was a significant blow to the ANAMS and Indigenous students across the U.S., where we fight for cultural visibility on every rotation and in every clinic. The proposal for GME funding for the IHS comes at a historic moment, when the need for Native American physicians and physicians to serve Native America has never been greater.” 

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One afternoon, Dina Bustilles picked up a pencil and a blank sheet of paper. She began by drawing an apple. Then came a cow, a dog, a carrot. Thus, between lines and colors, she filled the pages of a small album for her youngest daughter, barely one year and seven months old.

The assignment was given during one of the CASITA sessions, an intervention of the Maternal, Child, and Adolescent Health (SAMIA) program of Socios En Salud, as Partners In Health is known in Peru. CASITA’s objective is to reduce the risk of developmental delays in children aged 6 to 24 months. Each mother or caregiver was asked to create a notebook with pictures to strengthen the bond with their children.

“I was going to print the images, but it's expensive. It was better for me to draw and color them well,”Bustilles says, flipping through the laminated pages.

When her daughter turned one, Bustilles noticed she wasn't speaking. She mentioned this during one of her checkups at the Bahía Blanca Health Center in Ventanilla, and they recommended she visit Sembrando Juntos School, one of the spaces where Socios En Salud has implemented its early childhood development intervention. This is how they identified that her little girl was at risk for social and language delays.

“She likes going. Me too, it's given me more experience [as a mother],” says Bustilles.

Although she doesn't speak yet, her daughter pauses at every page of the album. She stares in wonder, points to the figures, and smiles. In her own way, she communicates. And for her mother, who lives with the anxiety of this prolonged silence, seeing her react like this is a relief. A small step. A way to regain hope.

Growing up with CASITA

Six years ago, Bustilles left Huánuco to start a new life in Lima. Her husband, who works far away most of the time, told her he had bought a plot of land in Ciudad Pachacútec, in Ventanilla, a district north of Callao, and asked her to move there with him. Since then, she has lived with her two daughters on a hilltop, in a wooden house overlooking the sea.

Getting around from there isn't easy. To get to the market, she has to go down a dirt slope, walk to the road, and take a motorcycle taxi. She makes a similar journey, about half an hour long, every week to attend the CASITA project sessions with her younger daughter, while her 6-year-old daughter is cared for by a neighbor.

“It's hard being a mom,” she admits. “I make time to take her (to CASITA), but sometimes there's no car, no motorcycles …”

Caring for two girls alone is a demanding task. Her day begins at five in the morning and ends at dusk, amidst household chores. But on Wednesdays, at three in the afternoon, that effort finds a clear purpose: watching her youngest daughter play, laugh, paint, and build with blocks.

“I like it, it makes me much happier,” says Bustilles.

Since 2013, this SAMIA program intervention has successfully reversed the risk or developmental delay in 70% of participating children, especially in areas such as language, motor skills, and coordination. But the progress isn't limited to those who crawl or play.

For many mothers and caregivers, like Bustilles, the sessions also become a space for listening, trust, and support from community health workers, who are attentive to their care and visit them at home if they miss more than two sessions. There, they can share their concerns, discuss their difficulties, and feel supported.

“At first, when they just begin the sessions, many mothers don't play or sing with their babies, but later on, they warm up, share with each other, celebrate their children's achievements, and make the most of each session,” says Verónica Mondragón, a community health worker for the program.

“I believe that community support strengthens the relationship between mothers and their children because it gives them emotional security,” explains Heidi Damián, a CASITA project technician. “The trainings and individual support we offer allow caregivers to develop skills to effectively care for and educate their children. During each visit, we also identify cases that require additional support—emotional, social, or psychological—and activate the necessary networks. Because providing support is providing health.”

This is how mothers strengthen their bonds with their daughters and sons, learning to interpret their signals, respond with greater confidence, and celebrate each new gesture, word, or look as a step forward.

A motherhood that flourishes

Bustilles admits she's not a particularly affectionate mother. She believes it has to do with her own upbringing, in a home where her father didn't usually show affection. Even so, she strives every day to raise her children differently. She does this with small but consistent gestures: coloring in a notebook, walking with her daughter in tow, and showing up punctually for every CASITA session.

"I want them to be professionals in the future, to study. I want them to be better than me," she says.

Outside her house, a striking daffodil, a rue, and papaya leaves bloom. It's the only house in the area with plants. Bustilles patiently tends them. It's a small garden that not only beautifies the space but also reflects her desire to create, with what she has, a warm environment for her girls.

Like her plants, her motherhood grows silently. It's a form of care that isn't always visible, but it takes root. Because, as she herself has learned, growth also flourishes when there's someone there to support it.

Every day at Koidu Government Hospital (KGH), staff are working tirelessly to save lives and improve maternal health care. In the 14-minute documentary above, follow midwife Sister Patricia Efe Azikiwe as she accompanies expectant mother Sia Fengai, who is preparing to give birth at Partners In Health-supported KGH in Sierra Leone. From the maternal waiting home to the operating theater, witness the everyday care, choices, and challenges that shape this journey to motherhood. Learn more about Fengai, a first-time mom, and her experience in this photo essay.

*Editor's note: This blog is the fourth in a series addressing the global debt crisis. Read the first, second, and third.

In 2007, the government of Malawi invited Partners In Health to work in Neno, an impoverished, rugged district of 165,000 people characterized by its hills, maize and potato fields, and weak health care infrastructure. Most pressingly, local farmers, earning less than $1 per day, were suffering some of the worst rates of HIV on the continent. Roughly 1 in 7 adults in the district were infected.

Upon arriving, PIH staff helped construct health centers; hired and trained hundreds of people in the community as health workers; and built Neno District Hospital as the centerpiece of a revitalized health system. HIV survival rates in the district became the highest in the country, with 90 percent of patients alive one year after starting treatment.  

Since then, PIH Malawi, known locally as Abwenzi Pa Za Umoyo (APZU), has worked in partnership with the Malawian government to provide health care to thousands of people in the remote, southern Neno District. Before APZU arrived, Neno had one hospital with four inpatient beds, no functioning laboratory, and an unreliable water and electricity supply. Now, with the support of APZU, Neno has two hospitals, 13 health centers, and a large network of community health workers offering treatment for everything from HIV and malnutrition to mental health support and diseases such as hypertension, diabetes, and sickle cell anemia.

The World Bank currently classifies Malawi as one of the poorest countries in the world. It’s also one of the most vulnerable to the climate crisis, as approximately 80% of its economy depends on agriculture. In the 2022-2023 fiscal year, Malawi spent roughly a third of its budget on debt interest payments alone. Meanwhile, Malawians suffer from shortages of essential goods like food, fuel, and medicines, with over 70% of the population living below $2.50 a day.

As PIH takes a human rights-based approach to health financing, it’s impossible to ignore the implications of unfair global economic structures on health as a human right.  

A Need for Relief in Malawi

Malawi gained independence from the British in 1964, and in the 70s began to take on debt to finance social programs and infrastructure projects. Over the next decade, Malawi’s debt rapidly increased as interest rates rose and the prices of key exports, such as tobacco and tea, fell, pushing the country into an economic crisis. During the 80s and 90s, estimates from Debt Justice project that over $100 million of debt payments left Malawi each year, even as the country struggled to manage drought, food shortages, and hosting over one million refugees from Mozambique.

“The implications are enormous because they translate to the rising of prices, and it has led to issues around the standard of living,” Makhumbo R. Munthali, director of partnerships and grant acquisition for APZU, said.

In 2001, Malawi entered the Heavily Indebted Poor Countries (HIPC) Initiative, a program launched by the International Monetary Fund (IMF) and World Bank in 1996 to help developing countries with high levels of debt and poverty. When their program was completed in 2006, Malawi received nearly $3.1 billion of debt relief in the form of cancellation and rescheduling, reducing debt from over 100% of GDP to less than 20%.

However, to unlock that relief, Malawi had to implement IMF and World Bank structural adjustment policies to consolidate spending, which included ending agricultural subsidies and selling grain stocks. In 2002, the Malawian government sold the maize from its national food reserve to raise funds to help repay loans. Combined with a poor harvest that same year, this resulted in a serious food shortage, causing widespread hunger and starvation that impacted nearly 7 million of Malawi’s population of 11 million people, killing thousands.

“We see that social aspects, the concern and welfare of those that are vulnerable, are not taken into consideration when these agreements are being made,” Munthali said. “This becomes a serious concern for PIH as a social justice organization.”  

In the 2003-2004 fiscal year, as Malawi struggled to implement IMF programs to obtain debt relief, the government spent 23% of its budget on servicing debt, while spending 11.5% on health care and 12% on education.  

Even after receiving some debt cancellation, Malawi’s external public debt began to climb again. Climate shocks and the COVID-19 pandemic further plunged the economy into distress, and Malawi defaulted on its debt in 2022. With fiscal adjustments and Malawi reaching the maximum amount of lending it can obtain from the IMF, the country will remain economically unstable unless its external debts are restructured.  

However, of Malawi’s nearly $4 billion of public debt, $2.6 billion is owed to multilateral development banks like the IMF, which is not eligible for restructuring. One-third is eligible for restructuring, most of which is owed to banks and other private creditors. Negotiations are currently ongoing to obtain this relief, and Malawi is relying on creditors to take steep losses to close the gap.

Terms and Conditions

Currently, austerity measures implemented by the IMF in Malawi restrict the hiring of health care and education professionals. Despite their training and qualifications, and the tremendous need for more health workers, nurses, and teachers graduating from institutions within Malawi cannot currently be hired in the public sector due to wage bill constraints.  

These measures are forcing limited existing staff to bear the brunt of the workforce shortage, and the health and well-being of the people of Malawi also suffer as a result.  

“Our motivation when we are pushing for the removal of these austerity measures is centered on the patient,” Munthali said. “At the end of the day, where there is increased recruitment of health care workers, we also know that service delivery will be improved, we will have medicines in hospitals, and people in very hard-to-reach areas will be able to access services.”

As a way to push back against these restrictions, APZU began participating in the Universal Health Coverage Coalition in 2023 alongside sixty other organizations—including Oxfam, Last Mile Health, and Action Alliance—to organize advocacy efforts.  

“Just two years ago, various organizations in Malawi gathered under what is known as Universal Health Coverage Coalition to find ways on how we can support the government and other actors to push for the reduction or removal of these constraints that are really having serious implications on the health sector,” Munthali said. “This coalition decided to come up with a strategy that is going to help in terms of having an organized, systematic way to push for reforms.”

Over the next three years, two areas the coalition hopes to focus on are the inadequate health workforce and the lack of transparency from the Minister of Finance and the IMF. Other sectors, including the Minister of Health or Education, that are largely impacted by their decisions, are excluded from current discussions around the conditions of loans between the Minister of Finance and the IMF. Even the Parliament, as a legislature, is left out of this decision-making process.  

“Let there be open dialogue, transparency, inclusivity in these negotiations,” Munthali said.

The Fight for Fairness

The debt crisis is a large, complex, and interconnected issue directly impacting the well-being of people around the world—including APZU’s patients. As PIH teams globally continue to advocate for fair and equitable lending and payment practices, we hope you will join us in fighting this injustice.  

“While the wheels may take time to turn, we are hopeful that our voices will be heard,” Maria Chiwoni, APZU partnership officer, shared. 

Read Previous: Learn about how legislation in New York allows private creditors to take advantage of sovereign debt >

Four-year-old Pauline Baker enjoys playing on the porch of her new home — a blue and white structure with a corrugated roof — in Puluken, Liberia. After her diagnosis of multidrug-resistant tuberculosis (MDR-TB) in 2022, this home became crucial to Pauline’s survival.

In a country where TB impacts 308 per 100,000 people, and more than half the population lives below the poverty line, access to health care and safe housing remains out of reach for many.

For Pauline and her mother, Agatha, a single parent, these barriers made getting treatment and a successful recovery particularly challenging—but Partners In Health (PIH) Liberia and local community leaders in Maryland County stepped in to support the family.

The Role of Social Support in Recovery

Agatha and Pauline first crossed paths with Dr. Maxo Luma, executive director of PIH Liberia, one afternoon in March 2022. He and other members of PIH happened to be walking along the same sandy, tree-lined path to Puluken, across from the Hoffman River, to honor Dr. Paul Farmer, who’d passed away a few weeks earlier.

Agatha was carrying toddler Pauline, who was feeling unwell, on her back. Noticing Pauline’s coughing and rapid breathing, Luma approached Agatha. They spoke at the edge of the road, and he learned that Pauline also had an upset stomach, lacked appetite, and had enlarged lymph nodes. He provided Agatha with money for transport to nearby PIH-supported James Jenkins Dossen Memorial Hospital. The following day, a diagnosis was confirmed: Pauline had MDR-TB.

Agatha struggled to face the gravity of her young daughter’s diagnosis. “To talk true, I na know (Truth be told, I didn’t know) that sickness (tuberculosis), I was taking it to be malaria, ordinary cough and other small-small (minor) sicknesses that can come on the children,” she said.

At the time, she and Pauline were living with an uncle. While Agatha was grateful for the refuge his home provided, the living quarters often felt cramped, and she longed for a place to call their own. Following Pauline’s diagnosis, Agatha’s focus shifted not only to securing the treatment her daughter desperately needed but also to ensuring that their living environment would support a smooth, soothing convalescence.

Secure housing is a critical social determinant of health, particularly for those battling TB; overcrowded and unsanitary living conditions have been shown time and again to increase the risk of transmission and treatment failure. Aware of this imperative, Luma, who remained in touch with Agatha and Pauline and is a TB expert himself, made the critical decision to collaborate with Maryland County’s Health Team and the Puluken community to build a two-bedroom home where Pauline could safely recuperate.

“I was feeling happy and was praying for them to make it quick-quick (speedy) and finish the house,” said Agatha about hearing that PIH Liberia would provide her and Pauline with a new home.

This intervention was essential. Nine out of 10 residents in Maryland County live below the poverty line—and women and children with TB often delay treatment due to financial constraints, stigma, and limited mobility. With poverty exacerbating malnutrition and unsafe living conditions, interventions such as dignified housing are life-altering.

Tackling these factors head-on, PIH and its partners are working to break the cycle of poverty and disease. “Social medicine is not just about taking medicine because there are many social factors responsible for sickness,” said Dr. Seidoh Freeman, Maryland County Health Officer.

Community Collaboration and a New Chapter

Pauline’s new home marked a significant milestone for the Puluken community—standing as a symbol of hope and support for a mother and her child. During the ribbon-cutting ceremony, three years after their first meeting with Luma, Pauline and Agatha received the keys to their new home, and a jubilant crowd of neighbors gathered outside the freshly painted blue-and-white building.

“I was so happy that day, and now I am still happy because I got my own area (I have my own house),” Agatha said.

During the ceremony, two excited children ran onto the porch and picked up balloons nestled against the wall. "Batee o batee!" exclaimed Dr. Joia Mukherjee, chief medical officer at PIH. "Batee!" the crowd responded, their cheers growing louder as she repeated the local call-and-response phrase used at gatherings.

Mukherjee and Luma praised everyone involved in making the new home possible, and community leaders who were present also expressed their joy. “Since the house was completed, when strangers come, they ask me who the rich person is that owns this house,” said Puluken Town Chief Dweh T. Baker. “I tell them the owner is not even five years old.”

Adding to the speeches, Lancelot K. Wleh, chairperson of the Health Facility Development Committee in Harper, declared: “The community has requested that from today onwards, you are no longer Partners In Health. You are now Partners in Everything.”

As Mukherjee cut the yellow ribbon adorned with colorful balloons, the crowd surged forward, eager to step inside and celebrate Pauline and Agatha’s new chapter.

Today, Agatha and Pauline are happily settled in their new home, and the stable living quarters proved life-changing for Pauline, who no longer experiences MDR-TB symptoms.

“Pauline is fine,” said Agatha. “I na (I am not) seeing any sickness in her again, I thank God for it.”

On April 9th, a coalition of over 200 tuberculosis (TB) advocates, experts, and survivors gathered in front of the U.S. Capitol, donning matching “TB ISN’T OVER” lapel pins and representing nearly all 50 states. As the group prepared for the largest TB Hill Day to date, the atmosphere buzzed with conversations ranging from meeting logistics to swapping TB-themed friendship bracelets.

Organized by Partners In Health (PIH), We Are TB, the TB Roundtable, and TBFighters, this annual advocacy day brought the fight against TB—and its ongoing toll—directly to Congress. Participants were scheduled to attend 210 Congressional meetings—94 with Senate offices and 116 in the House—a sixfold increase from the 35 meetings held at last year’s event.

Critically, this year’s Hill Day saw a major surge in grassroots support thanks to PIH Trustee and bestselling author John Green, who has used his platform to spotlight TB as a solvable global health injustice. His call to action rallied members of his online community, Nerdfighteria—a subset of whom, in 2023, followed Green’s growing focus on TB and formed a grassroots network of activists known as the TBFighters.

Despite being completely preventable, treatable, and curable, TB remains the leading infectious disease killer worldwide.  

The U.S. government has historically been one of the largest single funders of TB care and prevention worldwide, providing 42% of all international health funding. With its vast federal budget and global influence, Congress has the power to allocate funds that could significantly curb the spread of TB around the world.  

“I'm often thinking about how systems have failed people over and over again. This is a fight we can win, and we've just decided that it's not worth winning,” said Kate O'Brien, a TB survivor and advocate from New Jersey who works with We Are TB. “I 500% believe that we can eradicate this disease. I truly, truly believe we can eliminate this disease. All it needs is resources. And I think that our job is to point that out constantly.”

Jessica Dirks has been a Nerdfighter for well over ten years and a TBFighter since the beginning in July 2023. Within TBFighters, she is a community organizer and the lead social media manager. Dirks played a key role in coordinating the group’s presence at TB Hill Day.

“Like most TBFighters, I learned about TB through John Green’s fascination with the issue,” Dirks shared. “When Vincent Lin brought the idea of supporting an existing TB Hill Day to TBFighters, we thought a few people might be interested. As usual, the community blew our expectations out of the water with over one hundred TBFighters traveling to D.C., most on their own dime.”

Throughout the day, TBFighters—often accompanied by PIH staff, TB survivors, or TB experts—met with their congressional representatives to call for urgent, increased federal investment in TB prevention and care.  

The requests included:

• Restoring USAID staff and increasing funding for global health TB programs
  • Support $1 billion in Fiscal Year 2026 for global bilateral TB efforts.
  • Require additional and more frequent reporting that demonstrates appropriated funds are being spent as intended.
• Supporting a contribution of $2 billion to the Global Fund to Fight AIDS, TB and Malaria
  • This would help mobilize up to $4 billion from other donors during this replenishment year.
• Protecting CDC’s Division of TB Elimination
  • Support $225 million in FY 2026 for the CDC’s Division of TB Elimination.
  • Support $21 million in FY 2026 for the CDC’s Division of Global TB.
• Sustaining at least $7.29 billion for the National Institute of Allergy and Infectious Diseases (NIAID)
  • Protect the structure of NIAID and its support for TB research.

While these million- and billion-dollar requests may seem large, they are modest within the context of the federal budget. In 2024, the U.S. budget totaled nearly $7 trillion—yet only around $400 million was spent globally on TB research. To put it into perspective: Americans spend roughly seven times more on pet food annually than is spent globally on TB.  

With global investments of $20 billion dedicated to TB annually, we could reduce mortality by 90%.

“TB has been curable and preventable for 80 years,” said Dr. Carole Mitnick, professor of global health and social medicine at Harvard Medical School and PIH researcher. “It’s really a matter of how we choose to allocate resources that results in TB’s persistence.”

Following Hill Day, participants began contacting congressional offices to encourage lawmakers to sign on to “Dear Colleague Letters”—memos circulated by members of Congress to build support for specific funding requests.  In 2024, the TB Hill Day letters earned signatures from 26 Senators and 131 Representatives. This type of collective citizen advocacy has helped increase bilateral TB funding from $94 million in FY 2006 to $406 million in FY 2024.  

“I've been coming to this Hill Day with We Are TB since 2016, and it's been incredible. Every year, I leave feeling so recharged,” O’Brien shared. “But this year, having the involvement of the TBFighters, of Partners In Health, of John Green, and just this huge grassroots movement around TB... It's just been so incredible. I have, in my deepest heart, wished for a moment like this.”

Feedback from the hundreds of meetings held during Hill Day was overwhelmingly positive. Participants reported feeling hopeful, listened to, and part of a united push for justice throughout the event. Several noted the kindness of the Congressional staffers and the overall accessibility of the process.  

“The takeaway I heard from so many people is: ‘this wasn’t as hard as I thought,’” Dirks said. “It seems so scary to schedule a meeting and talk with someone at a time when anything vaguely political feels so combative, but the people we met with—mostly aides—were just people.”

Amid rising threats to foreign aid funding, the day served as a powerful reminder of what’s possible when communities organize and raise their voices.  

“In this dark moment, an event like this Hill Day gives me hope,” Mitnick shared. “Seeing the generosity of people coming from every single state in the union to be here, to exercise their rights as constituents, and to demand that they be heard by their members of Congress, and to do it with respect and with compassion.”

As the work continues, participants view this year’s Hill Day as one part of a larger movement for global health equity, especially when it comes to TB.  

“I’m deeply grateful to be partnering with groups who have been in this fight for so long because now is the time to build a foundation for these efforts. We can all do more together,” Dirks expressed. “There is still so much work to do, but I do think we can end TB, and we’re in this for the long haul.” 

Bintu Jalloh’s blood pressure spiked as she was ushered into Koidu Government Hospital’s (KGH) maternity ward by Community Health Officer Lamina Mansaray. Jalloh, who was 32 weeks pregnant with twins at the time, expected to stay in the ward only a few days—like she had earlier in her pregnancy. But this time was different.

Her blood pressure steadily worsened, eventually becoming uncontrollable. Just a day after being admitted to KGH, Jalloh required an emergency C-section, and though both babies were initially healthy, one tragically died two weeks later.

Jalloh’s blood pressure continued to be unstable following the birth, so clinicians advised her to remain in the maternity ward to recover. Her newborn, meanwhile, fought to stay alive in the nearby special care baby unit (SCBU)—a facility similar to a neonatal intensive care unit.

“It was really tough,” says Jalloh of those weeks. “But due to Lamina and his word of courage, I was able to be okay at the maternity ward.”
 
After staying at KGH for nearly 60 days, Jalloh's baby was discharged in February—a month after Jalloh was discharged. During this lengthy recuperation, Jalloh received ongoing encouragement and counseling from Mansaray and other members of the hospital’s newly established bereavement support program. This compassionate care from Mansaray—who Jalloh now sees as “family”—helped her process her loss and find strength to keep going.

Navigating Loss Together

The bereavement support program was initiated in February 2024 by midwife Sister Patricia Efe Azikiwe, who recognized the need to support mothers and families better after they experienced a devastating loss. However, while the program is new, Azikiwe’s experience supporting others through loss spans decades. As a child, she suffered a tragedy of her own when her stepsister died during labor.  

“My sister’s death was what made me to go into midwifery. I vowed that I would do everything possible to save a woman from dying,” says Azikiwe, KGH’s reproductive, maternal, newborn, child, and adolescent clinic program manager. “I’ve slept in this office on several occasions if we have a critical case. If the patient [dies], I know I have done everything humanly possible [to save her].”

Through the bereavement support program, Azikiwe, Mansaray, and staff across departments have created a safe and empathetic environment to help patients and families navigate grief and trauma. They offer mental health counseling, physical and emotional coping strategies, and practical guidance for mothers who have lost a baby, for spouses and families grieving a loved one, and for mothers whose babies were born severely deprived of oxygen. 

Since its inception, the bereavement support program has provided comprehensive counseling to 45 people.

“They work hard for pregnant women, they encourage us all, [and] make sure we are safe and our babies are safe,” says Jalloh, who received individual counseling throughout her time at KGH. “When you are in critical condition, they tell you what is going on and do the best they can.”

As the program evolves, the team is working to recruit more staff and offer specialized training on grief counseling; they endeavor to reach as many mothers and families as possible who are coping with an unexpected loss. They also look forward to the Maternal Center of Excellence (MCOE), which will open in January 2026. The brand-new facility, located on the existing KGH campus, will address several challenges within the maternity ward, including lack of space.  

Currently, mothers with healthy babies and those who have lost a newborn must receive postpartum care in the same room—a setup that can have a severe emotional impact. The MCOE will provide separate spaces for mothers and families with and without babies. It will also have space for a significant other or relative to accompany a patient during labor.  

Beyond Sierra Leone, Partners In Health (PIH) provides comprehensive women’s and maternal health care in nine countries while promoting gender equity and striving to end preventable deaths during pregnancy and childbirth. The bereavement program is one part of PIH’s mission to provide a preferential option for the poor in health care and goal to deliver holistic, high-quality care that every woman deserves regardless of where she lives. Jalloh and her baby continue to do well at home, with Jalloh still feeling the impact of the bereavement program months later.  

“My baby is alive [and] strong. Words are not enough to express how grateful [I am] for the care [Lamina] provided to us,” says Jalloh, who recently visited KGH to show Mansaray her happy and healthy baby.

Sia Fengai stopped eating when the smell of fish—and other once-favorite foods—became unbearable. Nausea and persistent stomach pain led her to leave Freetown to visit her family in rural Sierra Leone, some 450 miles from the capital city, in search of care and support.  

At a local health clinic in Njaiama Nimikoro, after two visits, she learned she wasn’t sick. Rather, she was pregnant with her first child. Moreover, due to her petite frame and height—less than five feet—her pregnancy was classified as high-risk. The clinic immediately referred her to Partners In Health (PIH), known for having the only facilities in the region equipped—with the “five S’s”—to manage complex maternal health cases.

On October 1, 2024, Sia was admitted to the maternal waiting home at PIH-supported Wellbody Clinic, a primary care facility in Kono District. There, women with high-risk pregnancies are closely monitored around the clock by maternal health staff in the weeks leading up to delivery at nearby Koidu Government Hospital (KGH), a PIH-supported secondary care center.  

In the photo story below, follow 26-year-old Sia’s journey: receiving care in the maternity ward at KGH, to undergoing a C-section, and welcoming a healthy baby girl into the world.

*Editor's note: This blog is the third in a series addressing the global debt crisis. Read the first and second.

At Partners In Health (PIH), providing a preferential option for the poor in healthcare means working to support the equal dignity of all people everywhere, which requires understanding the social and power dynamics that produce poor health. For PIH Co-Founder Dr. Paul Farmer, respecting, protecting, and fulfilling the right to health required “a searching analysis of the systemic drivers of deprivations of dignity," from colonialism to unfair economic ordering.

Excessive burdens of sovereign debt, or the money countries borrow from a variety of sources, is a crippling factor that prevents many low- and middle-income countries from investing in public services, like health care, education, and infrastructure.  

Nearly 50 developing countries with around 3.3 billion people currently spend more on interest payments alone than on either education or health, according to a report by United Nations Trade and Development.

While the Global North touts an annual aid budget of $2 trillion to support the Global South, they annually extract around $5 trillion from those same countries, meaning there's an estimated $3 trillion of net financial flows from the Global South to Global North each year, and debt is a huge part of this. This large imbalance means that poorer countries are developing richer countries rather than the other way around.

“[Sovereign debt] is perhaps the most important component right now given the context of the larger global debt crisis, but it's only one element of public spending,” said Joel Curtain, PIH senior director of advocacy. “Other elements take the form of unjust financial arrangements that facilitate exorbitant interest payments on debts, tax evasion, illicit money transfers, and unjust trade rules designed to benefit Global North countries that enable them access to artificially cheapened labor and resources in the Global South.”

As PIH takes a holistic approach to addressing barriers to comprehensive health financing, the Advocacy Team is moving to ease this unjust and lopsided burden of debt.

Welcome to New York

New York State’s legal system is a big part of the sovereign debt problem. The state's current legislation allows abuse by holdout creditors—creditors who refuse to participate in restructuring deals in the hopes of obtaining a better deal than other creditors. At their worst, these creditors purchase the debt at cheap rates and sue for full collection, plus interest. Funds that use this holdout tactic are called vulture funds. One such vulture fund is responsible for creating a legal precedent that helps enable this behavior in New York.  

In 1996, Elliott Associates, a United States-based hedge fund, bought approximately $20 million of Peruvian debt for $11 million and immediately sued Peru in New York courts for full collection of the debt, plus interest. In 1998, the Southern District of New York U.S. District Court issued a judgement in favor of Peru, ruling that the conduct violated a specific part of New York law called the Champerty Doctrine, which states that one cannot buy claims, like debt, for the purpose of suing on them.  

Shortly after the initial court case, the company appealed the decision, and in 1999, received a ruling in their favor.

“The courts effectively decided that because it couldn’t be proven that the sole intent of purchasing the debt was to sue, these types of lawsuits can be allowed so long as the primary purpose is to collect payment—even if there was never an expectation that full payment could be provided,” explained Chloe Dahleen, PIH’s advocacy specialist.

Elliott also successfully obtained a court order that would ensure Peru would have to first pay them and the other vulture funds that had sued for full collection, before paying its other bondholders who agreed to participate in a debt restructuring deal. This tactic has since been used repeatedly to extract profit from poor countries.  

Vulture funds then spent several years lobbying in New York to officially change the Champerty Doctrine, and in 2004, the New York Legislature adopted a loophole that allowed any purchase of debt over $500,000 to be excluded from the purview of the law—a loophole that still exists today.

The IMF estimates that in some cases, claims by vulture funds constitute as much as 12 to 13% of a country’s GDP. In 2015, the World Bank estimated that nearly one-third of countries that were eligible for debt relief and other poverty alleviation programs were the targets of nearly 26 vulture funds.  

Now, you may be asking why vulture funds are targeting these countries that are already burdened by debt and suffering from poverty. Well, unfortunately, it works. Vulture funds have averaged recovery rates of about 3 to 20 times their investment, equivalent to returns of 300%-2000%. They also routinely get 20% better terms than official and multilateral creditors during restructuring deals.  

It’s all completely legal, and is also a key reason low- and middle-income countries have less money to invest in public services, like health care, for their people.

PIH Advocacy’s Legislative Campaign

Over half of all sovereign debt bonds, or a total of approximately $870 billion, are governed by New York state laws. The PIH Advocacy Team has been involved in supporting the push for legislation to help countries that are suffering due to unjust—and immoral—debt payments.  

PIH helped convene experts, legislators, and advocates to push for the strongest possible legislative proposals in New York State that would curtail vulture funds’ attempts to extract profit through sovereign debt restructuring. These efforts are generating global attention to the problem of debt restructuring, and comparable legislation has been introduced in the United Kingdom parliament.  

Eliminating legal loopholes for vulture funds will reduce expensive legal battles, eliminate unfair payouts, and help streamline the restructuring process, freeing up millions of dollars for indebted countries. By convening experts and advocate groups, and participating in coalitions with other global organizations, PIH hopes to turn the tide for countries crippled by the debt crisis—including the ones where our patients live and receive care.  

In June 2024, one of the bills PIH had been advocating for passed the New York Senate. Most recently, on June 4th, 2025, it passed in the New York Senate again. 

“This was the first time since 2011 that any legislative body in a high-income country passed legislation to address the growing sovereign debt crisis in any meaningful way,” Dahleen said. “This was not just a groundbreaking moment for us at PIH and for New York, but a groundbreaking moment for the world.”

Impact on PIH Patients

The PIH Advocacy Team knows that what happens in New York’s legal system has a direct impact on our staff around the world and the patients we serve. Nearly every country where PIH works is suffering from a lack of public funding for health care, in large part due to their astronomical debt payments.

Currently, in the countries where PIH works:

• Sierra Leone and Haiti spend over twice as much public money on servicing debt than on funding health care.
• Health investment is approximately 6% of Peru’s GDP, while external public debt amounts to 17%, including 13% owed to private creditors.
• In Lesotho, Haiti, and Mexico, annual debt payments outstrip health budgets.  
• Debt payments are more than four times the health budget in Malawi and around one and a half times in Liberia.

In Sierra Leone, the 2024 national budget notes that “debt service payments account for an average of 25 percent of domestic revenues, thereby reducing the resources available for spending on Government priority programmes.”

“[Sierra Leone’s] 2024 budget reduced their health spending from about 12% to 7%,” Curtain said. “And they noted that this was due to large debt service payments in their budget. We know that health budgets are dwindling as a consequence, but for them to say it explicitly makes it very clear that it has to be imperative for us to stop this behavior and increase health spending as a result.”

Read Next: Learn more about how global debt affects Malawi's ability to fund its public health care system >

Pregnancy and childbirth customs vary from community to community, culture to culture. In the United States, we often imagine pregnant people being well prepared for labor and delivery—having a go-bag ready, the car seat secured, and a supportive partner ready to take them to the hospital. These expecting families are likely arriving in the family car, or in an ambulance in emergency situations.  

In the countries where Partners In Health (PIH) works—where maternal mortality rates are some of the worst in the world—preparing for routine pregnancy visits can look vastly different. In Sierra Leone, a traditional birth attendant may accompany a pregnant woman until she needs to head to a maternal waiting home or a clinic to deliver. In Lesotho, women may arrive for prenatal appointments via canoe. In Liberia, a hired motorbike driver may be responsible for carrying a pregnant woman safely to her doctor.  

We partnered with PIH photographers around the world to help document how women arrive at our facilities in six different countries. Take a look:  

In Liberia, Aletha Walker and her fiancé travel to Pleebo Health Center for prenatal appointments via motorbike. Photo by Ansumana O. Sesay / PIH.

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In Mexico, Maritza Alejandra Zavaleta Ramirez is met at the doors of Casa Materna by Service Manager Ameyalli Juárez, when arriving for a consultation. Photo by Francisco Terán / PIH.

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In Malawi, Prisca Changwala, nine months pregnant, walked over six kilometers—nearly four miles—to Dambe Health Center in Neno to access maternal care. Photo by Joseph Mizere / PIH.

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In Rwanda, Manirangena Josiane arrives at Kirehe District Hospital to give birth, hand-in-hand with her brother, Niyobuhungiro Janvier, who has accompanied her on the journey. Photo by Asher Habinshuti / PIH.

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In Malawi, Esther Mughogho, a nursing officer from PIH-supported Neno District Hospital, visits Agness George and her husband, Daniel George, at home to give their newborn son, Daniel George Junior, a check-up. When their son was born, the couple traveled over eight kilometers—around five miles—on foot from their home to seek maternal health services. Photo by Joseph Mizere / PIH.

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In Lesotho, Makarabo Mohafa embarks on a four-hour walk from her home village to Nkau Health Center where she's receiving prenatal care. Photo by Justice Kalebe / PIH.

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In Sierra Leone, Deborah Messie Sondufu, PIH nurse midwife, sits with Sia Fengai at the maternal waiting home at Wellbody Clinic as they wait for an ambulance to transfer Sia to Koidu Government Hospital. Due to a high-risk pregnancy, Sia traveled over 400 miles to stay at the home for five weeks and is being transferred for a C-section. Photo by Chiara Herold / PIH.

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In Lesotho, Nobelane Ntlanyane walks from her village to Nkau Health Center with her daughter, Amahle Ntlanyane, secured to her back to access health services. Photo by Justice Kalebe / PIH. 

At 36 weeks pregnant, Ntsoane Mofao faced a daunting decision. Her village, situated in a remote area of Lesotho, was miles away from the nearest health facility. The paths were treacherous, especially for someone in their third trimester. Determined to ensure a safe delivery, she chose to stay at a maternal waiting home.

"I came here because I wanted to be safe," Mofao recalls of her time at the Partners In Health (PIH) Lesotho-supported facility. "The roads to Nohana Health Center are hard to travel, and I didn’t want to risk going into labor at home with no medical help."

Maternal waiting homes are residential facilities with access to qualified medical professionals. They provide a place for women from hard-to-reach areas to await their delivery, ensuring timely access to skilled midwives. This approach has been instrumental in reducing maternal and child mortality, particularly in regions with challenging terrains.

"Some women go into labor on the way to the facility because the journey is hard," notes Thandy Ketsia Tsoke, a PIH nurse-midwife at Nohana Health Center. "Others miss their check-ups because rivers are in flood." Despite these obstacles, she emphasized, "the facility strives to provide quality health care."
 
Like Mofao, many pregnant women in Lesotho live hours away from health facilities, often relying on untrained traditional birth attendants at home, where obstetric emergencies can quickly become fatal. To address this, PIH established maternal waiting homes at seven remote health centers in 2009, providing safe spaces for expectant mothers under medical supervision. In October, PIH Lesotho and the country’s government opened a 32-bed maternal waiting home at Lebakeng Health Center; and another home is currently under construction at Bobete Health Center.

Life at the Waiting Home: A Sanctuary for Mothers

During her stay at a maternal waiting home, Mofao received comprehensive care including regular prenatal check-ups. Beyond medical attention, the waiting home offered educational sessions on childbirth, postnatal care, and immunizations.

"I learned so much during my stay," she reflects. "Before, I didn’t fully understand why vaccines were so important, but now I know they protect my baby from diseases like measles and polio. I don’t want my child to suffer from preventable illnesses."

Ntsoane gave birth to a healthy baby girl, Nkeletseng Mohlakoana, at Nohana Health Center. She stayed at the facility for two days post-delivery, during which both mother and child were closely monitored.

"They checked my baby's weight and made sure she was feeding well," Ntsoane shares. "They also monitored my blood pressure and other vital signs to ensure I was recovering well after childbirth."

Embracing Immunization: Protecting the Future

With baby Nkeletseng in her arms, Mofao is resolute about following the recommended immunization schedule. Her time at the waiting home instilled a deep understanding of the benefits of vaccines.

"From what I learned here, if a child is not vaccinated, they can easily get sick," she asserts. "I’ve seen children suffer from measles because their parents didn’t take them for immunization. I will never let that happen to my baby."

Childhood immunizations are pivotal in protecting children and those around them from various diseases, including polio, tetanus, and diphtheria, which can have devastating effects.

"Immunizing children contributes to community immunity, making it harder for diseases to spread and protecting those who cannot be vaccinated," explains Tsoke. "This collective protection is essential in preventing outbreaks and ensuring the health of future generations."

In 2023, PIH supported the administration of 664,645 childhood vaccinations, such as hepatitis B and measles vaccines, across seven countries: Haiti, Lesotho, Liberia, Malawi, Peru, Rwanda, and Sierra Leone.

A Mother's Message: Advocating for Maternal Waiting Homes, Immunization

For Mofao and baby Nkeletseng, the journey of safe motherhood and immunization is just beginning. Their story highlights the profound impact of maternal waiting homes and the critical importance of childhood vaccinations.

"I am grateful for everything I learned here," Ntsoane says with a smile. "Because of this place, I had a safe delivery, and now my baby will grow up healthy. I encourage other pregnant women to come to the waiting home if they live far from the clinic. It can save your life and your baby’s life."

Her commitment to Nkeletseng's immunization schedule is unwavering. "My baby is my priority, and I will make sure she gets all her vaccines,” she says.

Note: The following was originally published in Spanish on Socios En Salud’s blog.

Sometimes, when she accompanies a person affected by tuberculosis (TB), Marlene Osorio can tell when someone has taken their medication and when they’ve missed a dose or two. It's not intuition, but memory. Almost ten years ago, she had the disease and, at one point, hid one of the many pills she had to take every day.  

“Every person with tuberculosis experiences something I've also experienced,” said Osorio. She still remembers how, after recovering, she felt a tireless curiosity to better understand what she had been through. “As a person with tuberculosis, a lot of things happen to you, and that's when you need other people,” she said.  

She decided to join the Organization of People Affected by Tuberculosis—or Organización de Afectados por la Tuberculosis (OAT) in Spanish—to provide support to people with TB in Peru who, like her, were seeking help from someone who had experienced the disease firsthand, faced difficulties accessing health services, and overcame the many challenges of their care.  

This experience encouraged her to join an intervention in 2023 that was aimed at developing a pilot program for peer counseling for patients with TB. Implemented by Socios En Salud, as Partners In Health is known in Peru, in coordination with the country’s Ministry of Health and the National Multisectoral Health Coordinator, this initiative is part of the 2022-2025 TB-HIV Country Project.

As a first step, Osorio completed the TB peer counseling course, the Curso de Consejería de Pares TB, offered through the pilot program to strengthen her skills. Since October 2024, she and her classmates have been providing counseling sessions in health facilities in northern Lima.

Peer counseling is a support strategy in which trained individuals—known as peer counselors—who have recovered from TB or are in the final stages of treatment to provide emotional support and guidance to others affected by the disease. Their role is crucial in TB prevention and TB care, as it helps improve treatment adherence and increases the likelihood of current patients successfully recovering.  

“In my time, apart from my family, I lacked even one person who would listen to me. My case was terrible, as my treatment for multidrug-resistant tuberculosis (MDR-TB) lasted almost two years,” said Jessica Palacios, who was cured of TB 15 years ago and is now part of an OAT in the Villa María del Triunfo district, southeast of Lima.  

Like Osorio, Palacios was one of the 34 people invited to participate in the course’s pilot. With a decade of experience as a peer counselor, she says the training has provided her with valuable tools.  

“The teaching we've received follows guidelines, methodology, and dynamics,” she said. “Helping others is what has motivated me. I give a little of my time to the patients, I listen to them, we talk, we gather information, we exchange experiences.”  

Empower to Transform

TB remains a public health problem in Peru. Despite effective treatments, their success is hampered by inconsistent follow-up and the vulnerability of those affected. In 2020, 4.6% of TB patients discontinued treatment, and in 2019, the attrition rate for MDR-TB cases reached 18.5%.  

For this reason, Peru's Ministry of Health incorporated peer counseling into its technical strategies as part of the guidelines for TB prevention and control. This program promotes health with a focus on human rights, equity, and cultural sensitivity.  

“It highlights the importance of accompaniment, education, and psychosocial support to strengthen treatment adherence and TB prevention,” said Diana Yupanqui, training specialist for the Country Project.  

“When we present ourselves as people who has been through the same thing, people are more willing to listen to us—unlike when they receive instructions from medical personnel,” explained Sofía Canchari, a peer counselor who had TB 15 years ago and is taking the TB peer counseling course this year.  

Both times the course was offered—the first in 2023 and the current session in 2025—a call for applications was held for OATs associated with the TB-HIV Country Project. Selection criteria included OAT membership, at least six months of participation, and personal experience with TB. In the second course, applicants also underwent qualitative interviews to assess their knowledge of TB and their responses to simulated TB cases in different settings.

"So far, the course has allowed me to better understand the disease, the recovery process, and the adverse effects of medications—all things we must clearly explain to patients," said Canchari, who is completing this training with 23 classmates from Metropolitan Lima and regions such as Chimbote, Iquitos, and Trujillo.  

Yupanqui highlighted the course's educational approach saying, "It integrates reflection and practice as pillars of the training process." Structured in three units, the program covers essential topics such as community TB care, the background of the disease, and peer counseling. This final section includes two in-person workshops designed to simulate counseling sessions, enhancing communication skills and socio-emotional management.  

“Each teacher is unique in their approach to teaching. There are many new aspects, such as terminology and medications, many of which I never took myself,” said Alberto Amaya, another peer counselor who overcame MDR-TB 18 years ago and is currently also teaching the course. “I have experience supporting people with TB, but with this training I'll be able to do it even better,” he added.

Empower with Knowledge

Osorio knows that her work goes beyond sharing information. She seeks to connect with each person affected by TB she visits in districts such as Puente Piedra, Independencia, and Comas, conveying confidence and clarity in her messages. To achieve this, she combines theoretical knowledge with real-world application, adapting to the needs of each patient.  

“I explain to patients that they should take care of themselves and protect others. I always give them an example: 'Have you seen Goku [the character from the cartoon Dragon Ball]? When you hit him, he gets stronger. That's how bacteria are. If you don't take the pills, they'll become resistant and the medication won't work anymore,'” she said.  

Osorio and Palacios know that the first 30 days of treatment are critical to preventing dropout, especially for the people with substance use disorders whom they support. Each case presents a complex challenge, often made harder by the task of helping them confront TB’s stigma through education.

“Before, we didn't know our rights,” Palacios said. “Now, health centers are more empathetic. In addition to supporting TB patients, we hold talks at markets, churches, and soup kitchens to discuss stigma and discrimination.”  

Peer counseling is also empowering. “Thanks to the training, I've changed a lot. I used to be very shy; I struggled with public speaking. Now I don't care if people know I had TB—what matters most is that the community learns how to prevent the disease. And I tell patients: “Don't be discouraged, this disease can be cured.”  

By strengthening the skills of those who have experienced TB firsthand, Partners In Health transforms personal experiences into tools for change. With each new cohort of counselors, the support network grows, demonstrating that recovery is a path no one should walk alone. 

At Partners In Health (PIH), we believe women’s rights are human rights. And that an investment in women and girls is an investment for all—from communities to families.  

In the countries where we work, women have historically had some of the worst health outcomes. Fortunately, we’ve seen significant improvements, including a drastic decrease in maternal mortality in Sierra Leone after being among the highest in the world. Through a commitment to long-term accompaniment, PIH will continue to empower women and promote gender equity through health.

Below, learn about four ways PIH supports women’s health in Sierra Leone:

1. Partnering with traditional birth attendants

Traditional birth attendants are respected community members who offer support to women for all things pregnancy and childbirth related. They gain their skills through informal learning, including knowledge sharing with elders in the community. Many countries, including Sierra Leone, have laws that ban or restrict expectant mothers from relying on traditional birth attendants due to the dangers that women face during childbirth without supervision from a trained clinician.  

To bridge the gap between tradition and a formal health care setting, PIH Sierra Leone employs traditional birth attendants.  

Over the years, PIH has invested in thoughtful community engagement, outreach, and training to recognize the important role of traditional birth attendants. Since that investment, there’s been an increase in women willing to seek care at health facilities.  

“When PIH came in, it stopped us from conducting home births and gave us the responsibility of referring all pregnant women to the hospital,” says Hawa Sawa, a traditional birth attendant. “We were trained on how to talk to patients and counsel them.”

Between July 2023 through June 2024, PIH Sierra Leone worked with 191 traditional birth attendants who made over 25,000 visits. 

2. Empowering adolescents to discuss sexual and reproductive health  

Adolescents have the right to safe and effective sexual and reproductive health services. Unfortunately, access to those services can be hindered by misinformation, societal beliefs, and lack of knowledge.  

“We live in a place where girls still don’t understand the menstrual cycle and sometimes, they don’t come to school when they are on their period,” says Umu, a peer educator in rural Kono District.

To address these barriers, PIH Sierra Leone established 10 programs at schools in Kono District to train peer educators about sexual and reproductive health. During a five-day training, peer leaders learn about menstruation, teenage pregnancy, sexually transmitted diseases, early marriage, and more. The youth leaders then spread the knowledge to their peers, reaching more than 100 students every year through small group discussions, school-wide assemblies, and educational games.

“When a student comes to me with a problem, I first calm them down and thank them for coming to me with their problem. I encourage them and make sure they know that it’s all going to get better,” says Umu, who also accompanies girls to PIH-supported facilities.

3. Supporting survivors of sexual and gender-based violence

Addressing sexual and gender-based violence and supporting survivors is essential to improving health care for women and girls. In Sierra Leone, PIH partners with the nonprofit Rainbo Initiative to provide survivors with free clinical, legal, and psychosocial support.  

Survivors receive counseling and preliminary exams at Kono Rainbo Center, then they’re referred to PIH-supported Koidu Government Hospital (KGH) in Kono District.  

“As soon as the referrals come in, we attend to them. We don’t delay justice here,” says Dr. Emaudu Aribior Deen, KGH’s medical superintendent.  

As part of these efforts, PIH has invested in increased training for KGH clinicians to stay informed about gender-sensitive care, reporting methods, and more—to provide high quality, dignified care to survivors.  

Between April 2023 and March 2024, the Kono Rainbo Center provided sexual and gender-based violence services to 216 survivors—most of whom were referred to KGH.

4. Developing a brand-new facility by women, for women

Alongside the Ministry of Health, PIH partnered with Build Health International to build the Maternal Center of Excellence (MCOE), which will open in January 2026. The brand-new facility is a 120-bed center built by women (67% of the construction crew is female) for women.  

With dedicated spaces such as a cutting-edge neonatal intensive care unit, labor and delivery suites, surgical units, and adolescent-friendly services, the MCOE is designed to meet the diverse needs of women and children while advancing global efforts to improve maternal health.

When I signed up to join the Partners In Health (PIH) team for Tuberculosis (TB) Hill Day, I was excited: it would be my first visit to Washington, D.C. Raised by European parents, I’ve spent time wandering the grounds of grand castles—some still in use—throughout my life. But something about D.C. always felt mythical and out-of-reach by comparison.  

So, when our minivan pulled up outside the Capitol building at 7:30 AM on April 9, I was in awe. Seeing it looming over a garden of tulips against a bright blue sky made it appear even grander than images I’d seen. I must have whispered “wow” at least 17 times as I hopped out and made my way to the Capitol steps to join the growing crowd I’d be advocating alongside for the day.  

TB Hill Day takes place annually, and this year it was organized in partnership between PIH Advocacy, We Are TB, the TB Roundtable, and TB Fighters—an incredible collaboration of activists, survivors, and health care advocates.  

I hadn’t slept much the night before, feeling anxious and excited for our day of meetings with legislators and staff to advocate for critical TB resources. As the van pulled away, my thoughts began to spiral. What if someone completely shut us down? What if I got lost in the maze of underground tunnels connecting Congressional office buildings? What if I forgot everything I knew about TB at the exact moment it mattered most?

Luckily, we came prepared. The organizers and my PIH colleagues, along with PIH trustee and author John Green, shared their experiences, passed out matching lapel pins so we could spot each other in the halls, and armed us with talking points to underscore the urgent need for TB funding.

The longer I stood among that determined crowd, the more my nerves faded. Excitement took over. I wasn’t alone. Over 200 of us were ready to take on Congress in 210 meetings—94 with Senate offices and 116 in the House—representing 49 states. A massive jump from last year’s 35 meetings.  

At a time when it’s easy to feel powerless in the political process, it felt pretty stinking cool to be part of this movement.  

We soon walked away from the crowd at the Capitol’s grand steps and into one of the House office buildings. My first impression once inside was how accessible it seemed. As long as you made it through security—the metal detectors and bag scans—you could walk right in. No one asked me who I was or why I was there. For a building filled with such consequential people and remarkable history, I was surprised by its lack of exclusivity.

I was paired with Jen Furin, TB doctor and educator, and Rosie Poling, PIH’s health policy officer. I quickly learned that Rosie is not only a brilliant advocate, but one who comes stocked with fruit snacks for anyone needing an energy boost amid the repetitive nature of our meetings. She also navigates the Senate and House buildings like a seasoned pro. My fear of getting lost dissipated—especially once I discovered the buildings are equipped with cafeterias, barber shops, and gift shops. I could survive here for a while if needed.

One of our early meetings was with the office of a representative from Ohio. It was the first of several conversations with folks I don't necessarily see eye-to-eye with politically. Sitting at the large, round table in a cramped staff room, I found myself feeling defensive. But that quickly changed. The staffer was kind, asked thoughtful questions, took notes, and requested follow-up materials. Jen, a constituent of their Ohio district, shared knowledge of the issues on the ground in her hometown, and we were joined by two TB fighters, also from Ohio, who reinforced her message.

I can be painfully optimistic—sometimes naïve—about people’s intentions. But I left that meeting feeling hopeful. There’s certainly an element of political courtesy during Hill Day. But this first meeting was an essential reminder that members of Congress, and their staffers, are human just like us. Many genuinely want to do right by their constituents—or, at the very least, be seen as responsive during re-election season.

Several offices remembered PIH from past TB Hill Days, and most folks were generally aware of TB and its destructive nature. Still, a common theme emerged: uncertainty. Every office I met with expressed concern over rapidly shifting policy and health budgets, both domestically and globally. Our asks—modest, considering the scope of the overall federal budget—were met with interest but tempered by a wait-and-see stance considering funding cuts, lawsuits, and budget resolutions.

Even so, the staffers we met with were incredibly respectful and receptive. I began picking up on their specific “catch phrases”—polite expressions like “I hear you,” “I see where you’re coming from,” or “I understand.” I couldn’t always tell how sincere they were, but I was fascinated by how Rosie and Jen tailored our messaging to each of them. They knew what would ultimately make that office care. Like, for instance, that Alaska has the highest TB rates in the U.S., or that Kansas is currently facing an outbreak that could easily spread to neighboring Nebraska.

Later, our trio of “women who do things,” as Jen dubbed us, trekked from one side of the Capitol to the other. When we arrived at the Senate buildings, a long line wrapped around the block. Even with Rosie’s insider knowledge about a sneaky side entrance, we waited nearly an hour—quite a contrast from our morning entry.  

Seeing the sheer number of people assembled, waiting, empowered to speak with their senators, was encouraging. It reinforced what I’d come to believe throughout the day: anyone can participate in this democratic process. For something I’d built up as intimidating, the day turned out to be a remarkable learning experience—and dare I say, fun. I am truly grateful to the Advocacy Team, and to the TB experts, doctors, survivors, and activists who generously shared their expertise. Without their support, I wouldn’t have learned half as much.  

Like the beautiful castle grounds I’ve loved exploring all my life, the Capitol buildings—and the people they hold—are very much within reach. The day reminded me that members of Congress are people who have been chosen as our leaders, people who are meant to represent our values. We can talk to one another, learn from one another, and, in partnership, we have the power to make history. If we keep showing up—together, on the same day, in the same place—like we did on April 9th, I believe I’ll see the elimination of TB in my lifetime. 

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*Editor's note: This blog is the second in a series addressing the global debt crisis. Read the first here.

In today's world, money and power are tightly intertwined. Many low- and middle-income countries around the globe lack the monetary resources they need to build robust education, health care, and infrastructure systems, harming their ability to determine the direction of their development.  

But why is it that so many countries have limited resources? And why are national governments turning to Partners In Health (PIH) for support in building and reinforcing public health care systems?

The answers are complicated. The Global South’s need for foreign aid—which is currently under attack by the Trump administration—is a larger, systemic issue that is steeped in centuries of inequality and the history of colonialism. Colonial systems of exploitation and extraction continue to enrich the Global North while keeping the Global South artificially poor. At PIH, we call this systemic injustice—the biased, manmade structures, rules, and regulations that inflict deep harm on countries and their people. While restoring foreign aid is incredibly important to alleviating the immediate harms caused by its removal, it's also important to address the chronic issues that produce enormous unnecessary suffering in the first place.  

This is why, in addition to delivering health care on the ground, PIH is engaging in advocacy to alleviate issues of systemic injustice. This is a story of one of these issues: global debt.

It's a topic that PIH’s late Co-Founder Dr. Paul Farmer didn’t shy away from.  

“Claims that we live in an era of limited resources fail to mention that these resources happen to be less limited now than ever before in human history,” Dr. Farmer wrote in Pathologies of Power. “Arguing that it is too expensive to treat multidrug-resistant tuberculosis sounds nothing short of ludicrous when this world contains individuals worth more than $100 billion.”

As Dr. Farmer points out, the resources needed to facilitate sustainable health care delivery for everyone aren't in short supply—they just aren't directed where they're needed. Outflows from poor countries, like enormous debt payments, prevent funding from being used to address basic needs like health and education.

Carrying on his legacy, the PIH Advocacy team, informed by the devastating impact the debt crisis is having in PIH-supported countries and beyond, are ramping up efforts to champion legislation and policy change—both within the United States and globally—to address predatory lending practices that keep dozens of countries locked in an endless cycle of debt and prevent them from investing in health care and other public services.  

Chloe Dahleen, PIH advocacy specialist, and Joel Curtain, PIH senior director of advocacy, help break down the current situation, the evolution of global debt, and what needs to happen to rebalance a dysfunctional global health financing system.

The Debt Crisis, Explained

Governments around the world get into debt by borrowing money from sources such as investors and pension funds, international organizations, and banks or asset managers to help fund expenses that exceed their revenue. These expenses include public services that rely on government funding, such as education and health care.  

“While this debt, called sovereign debt, can be beneficial to fund things that are vital to a country’s development—such as schools, hospitals, and disaster relief programs— it can also cause significant harm to countries when structural factors impede their ability to pay it back,” Dahleen shared.

In many of the world’s developing countries, public debt and rising interest rates have become a massive burden, threatening many of the programs they were intended to build up.

Compared to 2011, governments are now allocating twice as many resources toward paying public debt, leaving less money for sustainable development as they are forced to prioritize debt spending over public spending. The International Monetary Fund (IMF) has estimated that over 70 countries are either currently in or near debt distress. In 2023, approximately 60% of critically indebted countries cut their public spending by an average of 2.4% of their GDP.  

Global debt levels have recently exploded:

• Public debt levels have more than doubled since 2008, with global public debt reaching a record $97 trillion in 2023.
• 2024 is the costliest debt service year this century, estimated to top $400 billion,  
• And in 2024, countries will have to pay almost 10 percent more in debt service than in 2022, when payments reached $365 billion.

According to UN Trade and Development:

• Developing countries’ net interest payments on public debt reached $847 billion in 2023, a 26% increase compared to 2021.
• On top of that, developing regions borrow at significantly higher rates, with interest payments 2 to 4 times higher than those of the United States, and 6 to 12 times higher than Germany.
• And 48 developing countries, with a total of around 3.3 billion people, spend more on interest payments alone than on either education or health.

Often, countries will end up paying their original loan many times over through principal and interest payments.

These crushing debt conditions also make it impossible for countries to invest in climate adaptation and mitigation. The same countries that are overburdened by debt are often the ones hardest hit by the climate crisis. Many citizens of developing countries are impoverished, living in precarious housing environments, and may rely on farming for survival. When floods, cyclones, earthquakes, hurricanes, and other natural disasters destroy the existing infrastructure and many people’s livelihoods, a country’s relief efforts are often funded by loans—which will eventually have to be paid back, plus interest. It’s a double burden.

The Evolution of Global Debt

So how did low- and middle-income countries get here in the first place?  

Colonial powers have always seen the Global South as critical to Northern economic growth and capital accumulation. Colonialism served this goal through the theft and extraction of resources and labor—through untold forms of violence. So, the primary objective of anti-colonial movements was not just to realize formal independence but to break this colonial arrangement.

In the 1940s to ‘60s, as many countries won independence through anti-colonial struggle, many did just that by pursuing economic sovereignty. Southern governments embarked on reforms to address the root causes of underdevelopment, including investing in public services like health care and education, resulting in dramatic reductions in poverty and an increase in per capita income.

However, as they were losing access to cheap labor and resources from the Global South, Northern powers intervened, and by the 1980s, the colonial economic arrangement was reestablished. This was done first through coups and then through leveraging power as creditors to reverse progressive domestic reforms in Global South countries.

Extraction of cheap labor and resources from the Global South to the Global North left former colonies with no choice but to borrow money to pay for essential services. By the 1970s and ‘80s, most of the former colonies owed sovereign debt to multilateral development banks, like the World Bank or the IMF, which were set up and controlled by the Global North. The multilateral development banks give loans to developing countries at fairly low interest rates. However, these loans come with restrictions and conditions known as structural adjustment—a deadly mix of privatization (selling off public assets), austerity (cuts to social spending), and trade liberalization (eliminating subsidies to protect domestic industries, and cutting protections on labor and the environment). These policies enabled the continued appropriation of resources by the Global North.

When some countries failed to pay back their loans—largely due to factors outside of their control, like adverse global economic conditions—they received lower credit ratings and became less attractive to official creditors, like other countries. These punishing practices led countries to seek out other creditors, such as in the private sector.

While there is more flexibility with these loans, private creditors impose higher interest rates, justifying them due to countries’ lower credit ratings. Additionally, the more countries borrow from larger and more diverse creditor groups, the more complex things get in the event of a default.

“There are no international rules or regulations that require orderly loan restructuring when countries cannot pay their debts,” Curtain said. “There is no bankruptcy court for sovereign nations.”

Private creditors, who make up an increasing proportion of lenders to developing countries, don’t have to comply with restructuring deals. This impasse sometimes leads countries back to where they started; the World Bank or the IMF end up providing additional loans, which should be supporting needed social services like health care and education, but are instead being drained to pay back private creditors. In essence, global taxpayers foot the bill for predatory private lending practices.

The Private Creditor Problem

In recent years, private creditors’ involvement in sovereign debt has increased dramatically, which becomes problematic when profit margins take precedence over financing obligations. For example, since 2022, private lenders received nearly $141 billion more in repayments from public borrowers in developing countries than they issued in new financing —the first time since 2015 this reversal has occurred.  

This means that countries in the Global South had to spend more money servicing their existing debt than private creditors made available to them in the form of new lending, obfuscating the stated aims of providing needed capital to assist with development. Low- and middle-income economies owed 61% of their external public debt to private creditors at the end of 2021—a 15% increase from 2010. These payments siphon off revenue that could—and should—go toward a country’s sustainable development, including health care.  

The gap between the people making these financial decisions and those who must live with the consequences of those decisions is extreme, and unjust.

To close the financing gap, a report from Debt Relief for Green and Inclusive Recovery estimated that over $800 billion of debt needs to be restructured across all creditor classes. In order for countries to meet their financing needs for climate mitigation and sustainable development goals, the report estimates that public and private creditors will have to accept less than what was due on particular loan payments—between $317 billion to $520 billion in debt relief, at minimum.  

That is a far cry from today’s reality.  

“Instead of granting debt relief, certain private creditors are suing poor countries—usually in courts based out of New York or London—when they reach such a dire financing situation that they default or need to restructure their debt,” Dahleen said. “As a profit-making strategy, these creditors will refuse to agree to a restructuring deal and then sue the country for the full payment, plus interest. The human cost of this strategy, as countries undergo the resulting economic turmoil and people suffer from lack of access to essential goods, is immense.”

These creditors are called vulture funds: hedge funds that purchase sovereign debt when countries are nearing distress and their bonds are devalued. They then file lawsuits to claim repayment plus the interest, refusing to work with the countries and their other creditors to reach a restructuring agreement. These predatory practices enable them to profit from countries in debt distress.

Since the mid-2000s, about 50% of sovereign defaults end up in litigation, with most of the cases occurring in New York and London, as those are the primary jurisdictions private bonds are issued in. Over half of these bonds are governed by New York State laws.

Read Next: Learn more about how legislation in New York allows private creditors to take advantage of sovereign debt >

On February 4, a small crowd gathered in front of the newly constructed non-communicable diseases (NCD) clinic at Koidu Government Hospital (KGH). Two small tents and several rows of white chairs were arranged to seat the speakers and attendees. The audience — a mix of hopeful community members, patients, and clinicians — had waited years for the clinic’s expansion, fueled by an increasing demand for care.

The crowd had assembled to celebrate a historic milestone for Sierra Leone: the launch of a dedicated NCD clinic for severe conditions under the PEN-Plus strategy. PEN-Plus is designed to improve access to care for patients living with serious NCDs at first-level hospitals in rural settings. NCDs are chronic illnesses that usually develop over a long period of time and are caused by a mix of genetic, biological, environmental, and lifestyle-related factors. PEN-Plus equips mid-level health care workers, such as nurses and health officers, with the specialized training to treat conditions including type 1 diabetes, rheumatic heart disease, and sickle cell disease.

A plaque on the clinic’s entrance proudly highlights the collaboration between the Ministry of Health (MOH), NCDI Poverty Network, and Partners In Health (PIH). At the ribbon-cutting event, patients spoke candidly about their journeys of diagnosis, long-term treatment, and renewed hope. Officials from MOH and other partners expressed pride in this achievement and reaffirmed that this clinic was just the beginning.

Not Just a Western Problem

Health systems in low-resource countries like Sierra Leone are grappling with a double burden of disease. While they continue to battle infectious diseases like HIV and tuberculosis (TB), access to NCD care remains severely limited. According to the World Health Organization (WHO), more than one-third of deaths in sub-Saharan Africa are caused by NCDs, with a worrying increase among people under the age of 70. In 2019, NCDs accounted for 34% of all deaths in Sierra Leone.

These conditions — which require lifelong care and consistent medication — place an immense financial burden on patients and families already navigating poverty and limited social safety nets. In many countries, NCD care is either inaccessible or unaffordable for rural and marginalized populations, leading to unnecessary disability and premature death.

“I want people to understand that NCDs are not just a Western problem. They are a growing issue in Sub-Saharan Africa. We're seeing an increasing number of complex cases and disabilities mainly driven by limited access to care,” says Dr. Eleyias Tebeje, internal medicine doctor at KGH and the NCD PEN-Plus lead.

The Dignity of Privacy

KGH began offering NCD services in 2018, and quickly became a referral point for patients not only across Sierra Leone but also from neighboring Guinea and Liberia. Yet the demand soon outpaced available resources.

“The patient-to-clinician ratio was high, and the space was small. There was no privacy, making it impossible to deliver diagnoses confidentially,” recalls Tebeje.

The long wait times and the pressure on clinicians to see large volumes of patients led to treatment dropouts and high rates of loss to follow-up.  This challenge was a stark reminder of how inadequate infrastructure can undermine even the best clinical efforts.

That challenge gave rise to the vision for a larger, purpose-built NCD clinic.

Today, the new NCD clinic includes three consultation rooms, an observation room for stabilizing critically ill patients, a vital signs and screening room, and an ultrasound room. A new pharmacy nearby exclusively serves patients from the NCD clinic, reducing congestion and wait times elsewhere in the hospital. For community health officer Amadu Gbandeh, this new facility brings a sense of security. 

"The presence of this structure shows the project's commitment to sustainability,” remarks Gbandeh. “It assures us that the NCD clinic will be here for years to come.”

Modern Tools and Systems

Equipped with the tools to manage the most common NCD cases, the clinic offers testing for type 1 diabetes, sickle cell screening, and echocardiograms for patients with congenital and rheumatic heart disease. Moreover, the site has implemented an electronic medical record (EMR) system – a crucial step in improving continuity of care, quality control, and data-driven decision-making.

“The system ensures that we can easily retrieve information and data whenever we need it,” explains Tebeje. “Unlike the previous paper-based system, EMR allows us to implement our protocols and establish indicators to help track and assess our progress.”
 

Building Expertise

For many clinicians working in the NCD clinic, this facility holds a much deeper meaning. "I greatly understand what patients go through. When I began working at KGH in 2021, I was diagnosed with diabetes, and I spent a difficult year managing the condition,” shares Gbandeh. For patients with type 1 diabetes, the initial challenge of managing multiple daily injections can be overwhelming without proper guidance and support. Having providers with lived experience can be powerful in building trust.

The clinic is also a center of professional development. Through mentorship from the NCDI Poverty Network's technical and research team, clinicians are strengthening their capacity in diagnostics and care delivery.

"I came to KGH straight from school with no experience, and all the training and knowledge I have came from the project," says Gbandeh. 
With regular, hands-on training, community health officers and nurses now perform basic scans and read and interpret X-rays, a crucial step in decentralized care. The team is actively expanding this model beyond the hospital by training clinical staff at primary health units (PHUs) across Kono District.

"We are training mid- and low-level clinicians at PHUs," explains Abubakkar Samura, the PEN-Plus project specialist. "Our goal is to transform this site into a training hub for handling PEN-Plus conditions.”

Shaping Healthier Futures

One of the most effective ways to prevent NCDs is through education. Each morning, outside the NCD clinic, a nurse leads a 30-minute health talk for patients awaiting registration. Seated on benches, patients listen as the nurse uses bright visuals to explain the principles of a healthy diet and the risks of behaviors such as smoking, excessive alcohol use, and physical inactivity.

This space allows for open dialogue. Patients ask questions and raise concerns, and the nurse responds thoughtfully, ensuring everyone understands.

"For many of these patients, it's the first time they’re learning about these conditions," comments nurse Lilian Kumba Phillie. "So we emphasize the importance of regular check-ups and stress that while these conditions aren’t curable, management is possible." 
 

Fynn Crooks first heard about Partners In Health (PIH) in 2014 when a college roommate started a chapter of PIH Engage—a grassroots network of community organizers—at their school and began hosting events to support global health in their home in Asheville, North Carolina. Fast forward a decade, and Crooks found their way back to PIH, this time as a member of the Advocacy team.

We chatted with Crooks, who is currently leading Engagers around the country from their home in Vermont, as part of our series Working In Global Health, which spotlights PIH staff who have dedicated their careers to making a global impact. During our conversation, we talked about how they were first connected to PIH, how their involvement has evolved over the years, and the similarities between participating in a choir and the global health movement.

When did you join PIH?

I originally joined PIH in early 2020 as a part of the Community Tracing Collaborative (CTC) because I read a piece in the New York Times one night at about 3 A.M.—while I was helplessly doomscrolling about Covid—which struck a chord. The article talked about the collaboration between PIH and the Massachusetts State Government to respond to the virus in the U.S. The name Partners In Health rang a bell, but also the evidence-based community contact tracing approach to the outbreak really landed for me.  

I felt alone and adrift in my anxiety, and this organization seemed to be building a life raft. I wanted on.  

Joining PIH at that time meant that I had access to sound information about what was happening, it meant that I could learn from people who had responded to other outbreaks, and it gave me a way to access community—both my community of colleagues and also the community we were helping—these were all instant balms and served to give me direction at an otherwise terrifying time.  

A few months into my time at the CTC, I met a colleague who had gone to Sierra Leone in 2014 to respond to the Ebola outbreak there, and I realized why I had originally recognized the name PIH. I was actually briefly on a PIH Engage Team in 2014! It’s a long story, but one of my roommates was an MPH candidate at the time, and she and another friend started a chapter right as Ebola was hitting Sierra Leone. We held a few meetings at our house, I did some tabling with them at student events, and we sent fundraising letters to friends and family to combat the outbreak—where my future colleague was working on the ground! Like I said, long story, but that Engage team looked very different than the way more organized version I’ve come full circle to join in 2024.

What is your role with PIH now?

I found my way back to PIH as a member of the Advocacy team. My technical title is Senior Community Organizer for Advocacy at PIH Engage. That’s a lot of words to say that I get to work with Sam Kelts and Queeny Jose to lead our grassroots Engage network, which has grown to more than 80 teams spread out across the U.S. Most teams are affiliated with colleges and universities, but some are also based in major U.S. cities like Boston, Philadelphia, New York, and Cleveland.  

All of those teams represent a lot of constituent voices, and my job is to help chart the course for government advocacy.  

What are some important aspects of your work with the Engage network?

We teach Engage members how to reach out to their members of Congress in support of legislation that builds the right to health—like the Paul Farmer Memorial Resolution, the Community Healthcare Worker Access Act, or the End Tuberculosis Now Act—all of which have been recent focuses of our advocacy campaign. We also teach Engagers about the Appropriations process, which is proving to be extra relevant right now during federal funding cuts.  

Usually, Engagers hold congressional meetings to ask for funding for PEPFAR, the Global Fund (GFATM), and USAID programs. Those asks have proven especially difficult but incredibly timely and necessary this year. Part of my job is to craft the best messaging possible so that Engagers head into meetings feeling educated and able to, in turn, educate their elected officials.  

How have PIH's advocacy efforts responded to this year’s unique circumstances?

This year, it has proven difficult and has taken an incredible team effort to keep up with the news cycle, but that’s also where I’ve seen the most direct impact from our advocacy efforts. In one evening alone, during an emergency call-a-thon with Engagers, we made nearly 300 calls to members of Congress.  

Engagers have also built relationships with offices and their staffers, who they can call on when global health hits the news cycle, which is constant right now.  

Just this past week, I’ve gotten several emails from Engagers who sent news articles about global health spending, TB programming that’s being cut, and the negative impact that the current administration’s policies are having globally and in their own communities. One of our Boston City Engagers had his research funding cut; he sent a blistering email to his reps, and he got an immediate email back saying that they were listening. I see this back and forth in my job all the time—I get cc’d on every email that every Engager sends to a DC staff member to request a meeting or follow-up—and I see the relationships being built. And while it takes a great effort to move the needle, I can at least see that new staffers who previously didn’t know the acronym PEPFAR wasn’t a soda brand sure know what it stands for now, and their own constituents are concerned about it.  

How has PIH been important to you personally?

Finding PIH has been a little like finding my choir. I mean that both literally and figuratively. I spend a lot of time when I’m not at work singing with a really big community choir here in Brattleboro. That’s something I’ve always done—sung in choirs, though it always takes time to find the right one. Once, a friend of mine mentioned that singing is the only socially acceptable time that everyone can talk loudly all at once; if it were done anywhere else, it’d just be noise or disruptive.  

But in a choir, we can all be heard, and it becomes music. It’s also sort of wild what a choir can do together. One singer can only hold a note for so long—but a choir could go on holding one note forever just by breathing at different times. I think that’s remarkably relevant to this moment and to what we’re trying to do at PIH.  

We all have to breathe. We can’t sustainably hold on to this fight unless we do so together. If we all pick different times to breathe, we can keep fighting as long as it takes.  

Coming to PIH and to Engage has meant that I’m surrounded by a chorus of voices all fighting (singing?) for the right to health, and since there are so, so many voices in this choir, I know we’ll be heard, and I know we can hold this note for as long as it takes. That’s what gives me hope right now. 

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The new U.S. Administration has carried out an unprecedented attack on foreign aid during its first 100 days, destabilizing decades of progress in global health and undermining access to care around the world—including in many of the places where Partners In Health (PIH) works.  

This situation is dire for countless people around the world and raises a number of challenging and important questions for the movement for global health equity, such as:  

• What can be done immediately to minimize the unnecessary and significant harm these attacks are causing?
• What modifications to the aid infrastructure might help reduce harm in the near future?
• What meaningful structural transformations, beyond aid, are needed to address the roots of global health inequity?      

At PIH, our focus is on forging a world where everyone has the right to health. To fully realize this vision, we must aspire beyond the reinstatement of U.S. aid, which by itself has never been enough to guarantee health as a human right. While getting U.S. aid funding back out the door is essential to reduce the unnecessary suffering caused by its reckless and poorly planned removal, the current system of aid is insufficient to halt the unnecessary suffering inflicted by centuries of colonialism and the current unequal economic world order.

Reducing Harm Immediately

The rapid, uncoordinated, and unstable withdrawal of U.S. foreign aid has caused immense destabilization worldwide. Consequently, experts project unconscionable harm, predicting 200,000 cases of paralytic polio a year, 310,000 deaths from tuberculosis in the next year, and up to 166,000 additional annual deaths from malaria—all of which aid funding could help prevent. Each of these statistics is made up of individual patients who are losing access to essential medicines and treatment, facing preventable suffering and death due to forces far beyond their control.

PIH continues to work alongside partners and supporters to reduce this cruel and unnecessary harm. The PIH advocacy team has magnified constituent voices by supporting calls, emails, and meetings with more than 500 congressional offices—including every U.S. senator—asking for a reinstatement of foreign aid cuts.

Meanwhile, ongoing lawsuits are challenging the legality of the administration’s actions. Removing congressionally directed funding by executive decree violates the very premise of separation of powers enshrined in the U.S. Constitution, bypassing bipartisan support for global health funding.

While this pushback is critical towards reducing some of the unprecedented damage occurring around the world, PIH Co-Founder Ophelia Dahl would describe the attacks on foreign aid as an “acute-on-chronic" problem. The acute situation—the rapid removal of aid that has limited access to care for patients around the world—must be addressed. But we cannot ignore the underlying chronic issues: that the current aid infrastructure forces dependency on foreign funding and obscures the larger systems at play that produce a need for aid in the first place.  

Rethinking Foreign Aid

It’s important to note that aid has been essential to a dramatic reduction in global illness and death over the past several decades, with programs like PEPFAR and the Global Fund to Fight AIDS, Tuberculosis, and Malaria achieving remarkable advances in treatment, delivered to the poorest and sickest people in the world. Yet much of the world’s aid still doesn’t contribute towards strengthening public health systems, which are critical to establishing lasting, reliable care infrastructure for patients.

As Dr. Paul Farmer, PIH’s late co-founder, put it: “The aspiration to improve the lives of those living in extreme poverty through better public health, public education, and public works by definition requires public-sector capacity.”  

Health care initiatives can’t be brought to scale without a strong public sector to support them. This is why PIH’s accompaniment model focuses on providing long-term support to governments, seeking to align external funding with national health plans and priorities. Ultimately, PIH’s goal is to become irrelevant in this equation, leaving local governments with the economic sovereignty they need to support and strengthen their own public health sectors. Overreliance on aid is both a product of poor countries’ lack of autonomy and an obstacle that continues to prevent them from obtaining it.  

PIH’s accompaniment model inspired the Paul Farmer Memorial Resolution, a bicameral resolution introduced in the U.S. Congress in 2022 to support a bold global health strategy for the U.S. government—offering us a roadmap for how to respond to today’s crisis. The resolution calls for a massive increase in bilateral financing from the U.S. government to poor countries and presses for that money to be used wisely to support crucial public health sector strengthening. But the resolution also takes a look at the deeper systems that perpetuate much of the preventable suffering in today’s world.  

Structural Transformation

Ultimately, even a 10-fold increase in dedicated health foreign aid wouldn’t be enough to close the current Universal Health Care financing gap, which is estimated at over $400 billion. This is due to the enormous outflow of resources from Global South countries to the Global North.

Countries in the Global North—like the U.S., Canada, and almost all European countries—often tout the generosity of their aid. And it's worth noting that in 2022, global official development assistance for health was $36 billion, much of which is providing critical health system inputs. But this narrative of generosity obscures the broader reality.  

If you look at all financial flows—including exports, imports, interest payments, debt servicing, illicit financial flows, remittances, and more—the numbers show a different story: the Global South’s net transfer of wealth to the Global North is at least $3 trillion every year. This reality flips the development narrative on its head. Poor countries are actually financing richer countries to the tune of $3 trillion a year, not the other way around. These outflows are colonial in origin and include excessive interest payments on debt, trade mis-invoicing, tax evasion and avoidance, and patent licensing fees.

Illicit financial flows are unrecorded outflows extracted via the international trade system. Corporations may report false prices on their trade invoices to siphon money out of Global South countries, directing it into tax havens and secrecy jurisdictions. Many countries lose five to 10 times as much as their annual health budgets to these illicit financial flows.

Additionally, exorbitant debt payments also take priority over—and come at the expense of—addressing basic human rights and needs, including health care. Many countries are locked into vicious cycles of debt and interest payments. Currently, over 45 countries now spend more on interest alone than they do on health care.  

And then there’s the World Trade Organization's (WTO’s) Trade-Related Aspects of Intellectual Property Rights (TRIPS), which sets minimum standards around intellectual property, including essential medicines, through the WTO. Developed and directed by high income countries, TRIPS advantages private interests over public access, and costs developing countries $60 billion per year in extra patent licensing fees.

These outflows are examples of the man-made, structural violence that must be eliminated if poor countries are to achieve the fiscal space necessary to finance robust public services like quality health care. To get to the root of global health inequity, PIH advocates for structural financing solutions beyond aid. The Paul Farmer Memorial resolution calls for financial reparations for colonial harms, the advancement of the United Nations Framework Convention on International Tax Cooperation to address illicit financial flows and other unfair tax practices, and the cancellation of unjust debt burdens.  

With decades of experience partnering with governments to strengthen health systems and partnering with civil society to build a movement for global health equity, PIH is standing up to lead a reimagined, more equitable approach to international health financing.

Read Next: Learn more about global sovereign debt and its unjust burden on the Global South >

Advocacy at PIH

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For decades, Partners In Health (PIH) has been guided by the principle that health care should be a human right for all—an unfortunately radical belief even today. PIH staff, colleagues, Engagers, and supporters have become advocates for people around the world as they fought for accessible, equitable health care, particularly in settings of poverty.  

We reached out to some of those advocates for content recommendations for the PIH community to learn more about the intersection of health and social justice. Without further ado, here are a few of their suggestions:  

On March 12, Partners In Health United States (PIH-US) and the National Association of Community Health Workers (NACHW) convened over 100 community health workers (CHWs) and allies from across the country for the 3rd annual CHW Capitol Hill Visit. The event, featuring Hill meetings with legislators, a CHW rally, and Congressional briefing, helped bring critical awareness to the community health worker profession and workforce. 

“Community Health Workers are everyday people who are doing incredible things in the lives of individuals and families.” says Denise Octavia Smith, CHW and Executive Director of NACHW. “The commitment of CHWs to help people get and stay healthy comes from our own personal experiences of having poor health or barriers to living our best lives. We are trusted professionals who live, play, and pray in the same communities where we serve.” 

Despite their growing recognition, CHWs face persistent challenges with inadequate and unstable funding. The 2025 Capitol Hill Visits helped bring these issues to Congress, calling on lawmakers to secure long-term sustainability for the CHW workforce. The Hill Day focused on three urgent calls to action (1) protect Medicaid from cuts, (2) support the Community Health Worker Access Act, which would improve access to CHW services through Medicaid and Medicare, and (3) support the National CHW Awareness Week Resolution, to recognize the vital role CHWs play in advancing community health. 

“As Congress considers the future of vital health services, it’s more important than ever to raise our voices and advocate for the protection and expansion of CHW programs,” says Katie Bollbach, Executive Director of PIH-US. “It's essential we ensure that CHWs continue to have the resources to provide care and support to the communities that need them most." 

Below, we share a selection of photos from the day.

Audrianna Marzette (left), PIH-US Project Lead, Montgomery, and Bakari Thompson (right), a CHW in Alabama, meet with Caleb Alford (center) a legislative correspondent for Senator Tommy Tuberville of Alabama.

Omar Clay (right), a CHW with the Newark Department of Health Community & Wellness speaks with Mia Furtado (left), a legislative correspondent for Senator Cory Booker of New Jersey.

Pictured left to right, counterclockwise: Joana Goncalves, a CHW with the New Bedford Health Department, Isaac Nelson, Joanne Calista, both with the Center for Health Impact, Yoann Sophie Jean-Felix, Director of Education & Workforce Development at Massachusetts Association of Community Health Workers, Cynthia Orofo, CEO at Culture Care Collective, and Emily Iskandar, PIH-US Project Lead, New Bedford, meet with the office of Senator Edward J. Markey of Massachusetts.

Participants cheer on speakers making remarks outside of the Capitol Building as part of the CHW rally.

When Richard Ellie visited his brother at Koidu Government Hospital (KGH) in 2012, he found him in distressing conditions. Throughout the facility, mosquitoes and a pungent odor filled the halls. Recovering from appendix surgery, 12-year-old David Ellie spent several days in a room without electricity, bedding, or running water.  

It’s an experience the brothers would never forget—one that shaped Richard’s career path.

“I was angry about the fact that the hospital was not decent. There were not enough staff. It was not clean,” Richard reflects. “I was inspired to go do something ... and give back to the community.”

KGH had long struggled due to its location in Kono District, a diamond-rich region heavily impacted by the country’s decade-long civil war. Rebel forces exploited the area’s resources to fund their war, leaving the hospital severely under-resourced, with shortages of medical staff, supplies, and equipment.  

Two years later, in 2014, the region faced new hardship during an Ebola epidemic. It was then that Partners In Health (PIH) responded to Sierra Leone’s Ministry of Health’s invitation to support the fight against Ebola. KGH was still standing, but like many facilities across the country, it lacked critical investment and resources, as the Ellie brothers had witnessed firsthand.  

PIH has remained ever since, working in close partnership with Sierra Leone’s government and local communities to strengthen the health system and transform care at KGH.

Pursuing Public Health, PIH

The Ellie family has lived in rural Kono District for generations. Some relatives leave to study elsewhere, says Richard, but they always return to Kono.  

Richard was one such family member. In 2018, he moved some 100 miles away from home to attend university. While there, he pursued various jobs—from commercial motor biking to cake decorating—to earn money to pay for school. Seeking work that aligned with his strengths and interests, he began teaching himself graphic design on his phone. Small business owners soon began hiring him to create marketing materials, helping him fund his education. He graduated with a bachelor’s degree in public health from Njala University in 2023.  

Even after graduating, he continued honing his design skills while searching for jobs—always with the goal of moving back home. As fate would have it, he came across an advertisement for a full-time role as a graphic designer for PIH Sierra Leone. He applied, was hired, and returned home in October for his new job, where he now develops informative materials for patients at KGH, among other tasks.

Before long, he returned to the facility where his brother had been treated all those years ago—this time as a PIH staff member.  

“The first day I went to KGH, I was really inspired,” says Richard. “I was really happy and I was smiling based on the impact I’ve seen PIH have in the hospital, the emergency ward ... Kono, and Sierra Leone at large.”

He reflected on how, at the time of David’s procedure, the hospital did not have a dedicated surgery ward, and patients often stayed for days due to limited staff and resources.  

“To God be the glory, I was able to survive,” says David, now a professional event decorator who recently worked on the design for PIH Sierra Leone’s 10-year anniversary celebration dinner and also revisited KGH. “You can see the improved facilities. Undergoing surgery is no longer a threat like before,” he adds.

Today, patients who undergo the same procedure that David did in 2012 are typically discharged from KGH in less than 24 hours. There’s also a surgery ward, where 5,755 general surgeries for injuries, tumor removals, and other operations were performed from 2018-2024. This does not include C-sections, which totaled an additional 7,360 surgeries during that period.

These improvements have been made possible through long-term investment and collaboration. That includes hiring locally to provide culturally relevant care and stable job opportunities. In Sierra Leone, PIH employs more than 900 staff members, 94% of whom are Sierra Leonean nationals. The headcount will soon increase as PIH prepares to train the next generation of Sierra Leonean maternal health experts—doctors, nurses, and midwives—to serve women and children at the Maternal Center of Excellence (MCOE). The brand-new facility, currently under construction on the existing KGH campus, is set to open in January 2026.

MCOE: ‘We really need this’

During Richard’s onboarding to PIH, he went on a guided tour of the MCOE construction site. Walking around the facility, he learned how every detail was carefully developed to set a new standard for health care excellence—from its innovative design and infection control measures to dignified, patient-centered spaces.

“It is amazing this is happening. Are we really getting this? We really need this because so many lives would be saved here,” Richard thought to himself as he was flooded with emotions during the tour. “It was a mixture of being happy and being sad. I was sad for those that did not have the opportunity to get access to it. They lost a lot of things along the way. And happy for those that will have access to it when we finally open it.”

Excited about the future of health care in their hometown, Richard and David acknowledge the remarkable improvements made in the last decade.

Their mother is impressed, too. She recently called Richard—who was out of town for work—seeking advice about pain and fluid in her ear. He confidently referred her to KGH. During her visit, staff diagnosed the infection, thoroughly cleaned her ear, and gave her free medication. On a follow-up call with Richard, she noted how friendly the staff were to her and others—a stark difference from their experience during David’s surgery when resources were critically scarce.

“Since PIH came in, health care has become accessible and is improving every day,” says Richard. “Kono that used to be one of the places with the [worst] health care is becoming one of the hubs for good health in Sierra Leone.”

Last week, the Trump Administration terminated more than $12 billion in public health funding authorized and appropriated by Congress through the Centers for Disease Control (CDC) and Substance Abuse and Mental Health Services Administration (SAMHSA), a move that threatens to erode essential public health infrastructure and undercut critical efforts to address health inequities. 

This funding was allocated in response to COVID-19, supporting COVID-specific efforts like testing, vaccination, and education. But these grants also helped strengthen essential infrastructure for tackling infectious diseases, substance abuse, mental health, and health inequities, and marked a long-overdue investment in chronically underfunded public health systems. COVID-19 was an acute-on-chronic crisis that exposed the fragility of our core public health infrastructure. By investing in core public health functions, these grants aimed to build more resilient public health systems that are prepared to respond to future health threats. 

Now, that progress is at risk. Cutting these funds will devastate critical work being done to address the gaps prevalent in public health systems across the country. Community health workers (CHWs),who are frontline public health workers with trusting relationships in the community, are particularly impacted. Investments in CHW programs under the CDC’s Community Health Workers for COVID Response and Resilient Communities, dispersed more than $340 million across 67 organizations to support the hiring, training, and deployment of CHWs nationwide. The abrupt termination of these funds is resulting in mass layoffs and leaving many communities without access to essential services. 

While the full impact of these cuts may take months or even years to fully understand, many communities, including those where PIH-US works, are feeling the disruption and harm right now. In Arizona, the Pima County Health Department lost $1.9 million, impacting health disparity and vaccine equity programs and cutting at least 25 jobs. North Carolina faces $100 million in cuts and over 80 job losses, impacting immunization efforts, disease monitoring, behavioral health, and more statewide. And in New Jersey, $350 million in cuts will threaten disease tracking, addiction treatment, mental health services, and public health infrastructure. 

Although many of these funds were originally set to expire in the coming months, last week's clawback accelerates this funding cliff, leaving many projects unfinished. This premature termination highlights a deeper, ongoing failure to establish sustainable, long-term funding for community health worker initiatives and public health more broadly. These funding cuts undermine health departments’ efforts to implement sustainability measures, leaving them without the necessary staff to plan for transitions away from federal dollars and setting back critical, ongoing programs that cannot simply be paused and resumed. Without consistent investment, our public health infrastructure remains fragile and unprepared to effectively respond to both current challenges and future health crises. 

While we’re encouraged to see states and advocacy groups fighting back through litigation, lawsuits alone won’t be enough. To protect our public health infrastructure, we must continue to apply relentless public pressure and ensure these cuts remain a national outrage—not a forgotten headline. We cannot afford more cuts to public health. 

April 3, 2025

The below is a statement from PIH CEO Dr. Sheila Davis:

Armed gangs stormed into Mirebalais, Haiti, on Monday, March 31 and attacked and set fire to buildings throughout the towns before security forces arrived. While Hôpital Universitaire de Mirebalais (HUM) has not been attacked at this time, the ongoing violence continues to put our patients and staff at risk. The safety and well-being of staff and patients of Zanmi Lasante (ZL), PIH’s sister organization in Haiti, is our highest priority and we continue to work closely with local authorities to take every precaution possible.  
  
These brutal attacks endanger not only our staff and patients, but also the stability of an already fragile health system in Haiti. HUM is a lifeline for hundreds of thousands of Haitians, providing critical medical care, including emergency services, maternal care, infectious disease treatment, and surgical interventions. If Mirebalais falls, the consequences will be catastrophic: Haiti’s health infrastructure risks total collapse, leaving countless individuals without lifesaving care.  
  
We are closely monitoring the evolving situation and working with ZL leadership, local authorities, and partners on next steps.   
  
We ask that you stand in solidarity with Mirebalais and the ZL team. 

Community Outreach and Patient Empowerment (COPE) is an Indigenous-led sister organization to Partners In Health (PIH), working across Navajo Nation and based in Gallup, New Mexico. Navajo Nation is the largest Indigenous sovereign nation in the United States, occupying portions of northeastern Arizona, northwestern New Mexico, and southeastern Utah.  

As its guiding mission, COPE believes that the power to overturn long-standing, historical health inequalities lies inherently in Indigenous communities themselves. In recognition and appreciation of that power, COPE works with local health care teams and communities on Navajo Nation to develop programs that address structural barriers and bridge gaps in the health care system.  

COPE started collaborating with Navajo Nation partners in 2010, and its bold approach and relationship-building have enabled the organization to respond to community-identified priorities with high-impact programs that address food access and nutrition security, reducing the burden of chronic diseases, improving patient-centered cancer care, and strengthening community access to health care through community health workers and other frontline health workers.    

One of COPE’s core areas of focus is to increase access to healthy and traditional foods across the Navajo Nation. To address this need among Navajo communities, COPE takes a holistic approach by partnering with families, growers, store owners, and health workers to achieve the following goals:

• Increase access to, and consumption of, healthy and locally grown foods  
• Provide culturally relevant nutrition education and outreach to Navajo families  
• Strengthen economic growth by promoting the local sales of healthy foods on Navajo Nation
• Enhance collaboration among clinic-based and community-based health teams to better support Navajo families at all stages of life
• Build a rigorous evidence base to catalyze policy and system change

One way COPE is hoping to achieve these goals is by supporting community-based demonstration gardens.

Over the past year, COPE has collaborated with local partners, including the Indian Health Service, community food and nutrition leaders, and Navajo Nation Chapter houses to develop demonstration gardens across the Eastern region of Navajo Nation. The goal of these gardens is to provide hands-on, garden-based health and nutrition education for community members.  

At eight different locations, COPE helped prepare and plant garden beds alongside community members and partners. All beds included a mixture of vegetables, herbs, and flowering plants that encourage pollinators. Many also included regional varieties of corn and squash that are traditional to Navajo and other Indigenous Nations in the Southwest.  

The gardens now provide engaging outdoor learning spaces where health educators and community leaders are able to highlight Navajo food and nutrition teachings. They also help promote healthy lifestyles through physical activity, community building, and stress reduction. As the herbs and vegetables ripen, community members have been encouraged to harvest and use the fruits of their labor—pun intended.  

This initiative has been particularly unique in its vision of working collaboratively across eight sites and continually seeking feedback from the community and partners. These community gardens have the potential to nourish families in the surrounding area for many years to come, but only with community ownership and buy-in. By developing the gardens through a community-based, collaborative model, this program promotes sustainable access to locally grown, nutritious, and traditional produce for Navajo families. 

At Partners In Health (PIH), we aspire to eliminate tuberculosis (TB)—for everyone, everywhere. With the right approach and care, we know that achieving this ambitious goal is possible. After all, we’ve already seen tremendous progress from our work over more than three decades—beginning with reimagining TB care and treatment in 1989 to the approval of safer, shorter medication routines in 2024.

But, there’s still more work to do in eliminating the world’s deadliest infectious disease.

Below, learn more about how PIH is reenvisioning the search, treat, and prevent approach and how it’s part of our comprehensive plan to alleviate suffering from TB for all. 

What is the search, treat, and prevent approach?

The search, treat, and prevent approach is a three-part method to address TB. While much of the framework was laid in the 1990s, the approach was formalized decades later. It’s used by governments, public health organizations, and others in countries around the world.

Why is PIH reenvisioning the approach?

In practice, the current search, treat, and prevent approach tends to 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.” Rooted in historic examples of successes in driving down rates of TB, we believe universal access search, treat, and prevent can more successfully move the world towards eliminating TB.

What is PIH's universal access search, treat, and prevent approach?

The universal access search, treat, and prevent approach involves:

• Search: This means actively searching for and properly identifying TB in communities, many of which are remote and hard to reach. In Lesotho and other countries, PIH TB screeners do meticulous contact tracing to identify individuals who have been in close contact with TB.  At PIH, we welcome the use of innovative tools to search and test for TB, such as artificial intelligence-enabled X-rays to reach more people with TB screenings; and work tirelessly to expand access to where the tools are most needed.

   

• Treat: This involves medication, food, counseling, and other resources that are necessary to make people with TB well again. Treatment includes a comprehensive care team—including nurses, doctors, and treatment supporters—who have the skills and knowledge to treat many forms of tuberculosis, including multidrug-resistant TB and extensively drug-resistant TB. This step also includes screening and caring for post-TB lung disease and linking critically ill patients to facilities such as PIH-supported Botšabelo Hospital in Maseru, Lesotho’s capital. In 2024, PIH-supported facilities conducted over 36,600 TB tests and 3,200 people with TB completed a full course of treatment.

  

• Prevent: By stopping the spread of TB, we can prevent future cases of the curable disease. Prevention includes strengthening contact tracing and preventative therapy for those exposed to or at high risk of TB before they develop active disease, such as people in close contact with a person with TB, people living with HIV, people in crowded settings like prisons, health care workers, and others.  

Why is PIH's universal access search, treat, and prevent approach important?

The universal access search, treat, and prevent approach is an important part of stopping unnecessary deaths from tuberculosis around the world. Roughly every 20 seconds, someone dies from TB. Most of those deaths are in low- and middle-income countries, such as ones where PIH works; however, TB is everywhere, including the United States.  

In many cases, people don’t know they’ve been infected, which can make it even harder to track. TB can remain inactive for weeks—or even years—and then become active, often when a person’s immune system is weak.  This causes them to become sick, explains PIH Lesotho’s Executive Director Dr. Melino Ndayizigiye.

“I myself, I didn’t know that I was infected until I was accepted for a post graduate training program at Harvard and I was asked to get tested as a requirement for international students,” says Ndayizigiye. “I was lucky to have access to the test for latent TB infection and I was diagnosed before the TB became active and made me sick. I took [preventative] treatment for three months and I got completely healed. Many people with latent TB infection around the world don’t have access to such tests. They end up developing active TB and die if not treated.”

How is the approach being carried out in PIH-supported countries?

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. Beyond Lesotho, PIH provides TB care and works with governments to improve access and quality in eight other countries: Haiti, Kazakhstan, Liberia, Malawi, Mexico, Peru, Rwanda, and Sierra Leone. By bringing TB care directly to vulnerable people and communities and utilizing our expertise in the search, treat, and prevent approach, we can eliminate TB for everyone, everywhere.

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Note: The following was originally published in Spanish on Socios En Salud’s blog.

In December 2023, Kioshi Vásquez, a 19-year-old living in Lima, Peru, was at work when he started coughing. It didn't feel like an ordinary cough, and after noticing traces of blood, he immediately went to the emergency department of Daniel Alcides Carrión National Hospital, located in Callao, a port city 12 kilometers from Lima.

"They told me it wasn't serious, so they gave me an injection to prevent the hemorrhage and bleeding," he recalled.  

Despite these assurances, doctors recommended an additional test that same day to rule out tuberculosis (TB). The tests came back negative—every time. Yet, the cough persisted. And so did the blood.  

"I was very scared because I didn't know what was wrong with me," he admitted. "I didn't tell anyone at work because I thought I might get fired."  

Vásquez had nowhere to turn. He had been living alone after a fallout with his family. The independence he'd once embraced now felt overwhelming. Determined to find answers, Vásquez decided to get an X-ray at the same facility. A few days before Christmas, he received the diagnosis: he had TB.

"At that point, I said, what do I do now? I live alone, I don't know what to do," he said.  

Further testing revealed that Vásquez had multidrug-resistant TB (MDR-TB), one of the most difficult forms of the disease to treat.  

Peru—one of the countries with the highest TB burden in Latin America—detects around 1,500 cases of MDR-TB each year, according to the Ministry of Health (MINSA, in Spanish). However, detection and treatment rates remain low worldwide. The Pan American Health Organization reports that of the 400,000 who developed MDR-TB in 2023, only 44% received a diagnosis and access to treatment.  

“Fortunately, Vásquez’s persistence led to a diagnosis—but that was just the beginning,” Betsabé Roman, TB Program project coordinator at Socios En Salud (SES), as Partners In Health is known in Peru, said.  

Treating MDR-TB involves a grueling regimen that can last up to two years, involving two to three injections daily along with countless pills.  

"It was very difficult, really, very difficult," he said.

The Accompaniment That Made the Difference  

Since he lived in Carabayllo, a district north of Lima, Vásquez was referred to the Raúl Porras Barrenechea Health Center for treatment. Its proximity made access easier, but conflicting commitments prevented him from attending his first treatment appointment.  

"I actually didn't go until the nurse in charge called me and told me I had to go, no matter what, or my illness could get worse," Vásquez admitted. "I won't deny that there were times I didn't go because I had to go every day, and I had to work and didn't have the time. But deep down, I knew I had to recover and not just give up."  

That was when SES reached out.  

Roman explained that since 2022, SES has been implementing its TB Elimination strategy in key areas such as Carabayllo and Metropolitan Lima. The initiative is built on three fundamental pillars: screening, treatment, and prevention.

To detect TB cases early, the SES team conducts active screening in vulnerable communities using portable X-ray machines and molecular tests. But their work doesn't stop with diagnosis. The strategy also ensures that patients receive the support needed to complete treatment.

This approach is carried out in close coordination with Peru’s MINSA health centers, such as the Raúl Porras Barrenechea Center where Vásquez was receiving care. In 2024 alone, SES’s TB Elimination strategy led to the detection of 81 cases of latent TB, 29 cases of susceptible TB, and three cases of MDR-TB in Carabayllo.  

"We intervened [in Vásquez’s treatment] when the nurse informed us about his case," said Hilda Valdivia, a nursing technician from SES on the project.

For Vásquez, this support from SES was instrumental. As he coped with the shock of his diagnosis and the debilitating side effects of treatment, which left him exhausted and sometimes reluctant to continue, the SES team began visiting him at home.  

"This way, we monitored his treatment, learned how he was feeling, identified his needs, and assessed what kind of support we could offer him. We also went to the health facility to help coordinate his care, whether it was testing or medical consultations," Valdivia explained.  

The support not only ensured that Vásquez continued treatment but also addressed social difficulties that could jeopardize his recovery. He received food supplies, clinical evaluations, and ongoing psychological support.  

Over time, the fear and uncertainty that had marked the beginning of his treatment began to dissipate. He still had a long road ahead, but he was no longer alone.  

The Strength to Move Forward  

Looking back, Vásquez acknowledges that his illness taught him an important lesson.  

“[Tuberculosis] made me really rethink who I am and how I am with others," he said.  

Like many people affected by TB, Vásquez initially feared sharing his diagnosis with those around him: his family, coworkers, even the owner of the room he was renting. But the experience ultimately reinforced the value of empathy and the need to combat stigma.

After a month and a half of daily injections, Peru’s National Retreatment Evaluation Committee—a MINSA body responsible for evaluating complex TB and MDR-TB cases—determined that Vásquez could transition to a shortened, all-oral regimen, easing his recovery process.

In 2025, Vásquez tested negative for TB and was discharged.  

Now 20 years old, this young man looks to the future with a different perspective. Surviving MDR-TB was not only about regaining his health but also about discovering his own resilience. His story is a testament to the challenges TB poses—and to the power of timely diagnosis, proper treatment, and unwavering support.

"I've had a lot of losses,” he said. “It's been very difficult for me to control the situations, but in the long run, or in the short run, it's possible. My advice is to hang in there and keep going."

Hear directly from Vásquez about his journey: https://youtu.be/CRn6kgmNHmU?si=JRWPhNOqzGUIjFNW 

In early 2023, Saya* wasn’t concerned when she came down with a cold. She knew how to care for herself and waited patiently for her self-administered treatment to bring relief. When, despite her best efforts, she wasn’t getting any better, she visited the clinic in her district of Kazakhstan. In the second week of March, her lab tests revealed that she had tuberculosis (TB).  

TB is the world’s deadliest infectious disease, despite being completely treatable. When bacteria from the TB infection spreads, it steadily affects different organs in the body, usually starting with the lungs. Globally, around 30% of TB cases are never diagnosed or treated.

For patients who do receive a diagnosis, TB can be confusing at least, and often terrifying. But Saya wasn’t afraid.  

“I did not experience much fear or stress, since I knew first-hand about the disease,” said Saya. “My mother and brother had already had tuberculosis in the past. When I was admitted to the hospital, I was already mentally ready that I would be away from home and my family for a long time.”

Saya was directed to receive treatment through a Partners In Health (PIH)-supported program under the care of the same physician her brother and mother had been treated by, Dr. Amanzhan Abubakirov, PIH Kazakhstan endTB co-investigator. Despite her general fear of doctors, his familiarity helped improve her comfort and confidence.  

At the clinic, Dr. Abubakirov introduced Saya to the endTB project—a partnership between PIH, Médecins Sans Frontières, and Interactive Research and Development, funded by Unitaid—which utilizes clinical trials of new drugs and shorter treatment regimens to dramatically improve the treatment of multidrug-resistant tuberculosis (MDR-TB). Kazakhstan is one of 17 countries participating in the project, along with two other countries where PIH works: Peru and Lesotho.  

For Saya, participating in the endTB project is almost a family tradition.  

“My mother was treated in 2017 as part of the endTB observational study, and my brother in 2018 as part of the endTB clinical trial,” she shared. “They both were able to successfully overcome the disease.”

Saya, however, was going to participate in the endTB-Q clinical trial, a trial specifically for people with pre-extensively drug-resistant tuberculosis (pre-XDR-TB), a very hard-to-treat form of TB.

The endTB-Q clinical trial enrolled 323 patients across six countries, including India, Kazakhstan, Pakistan, Peru, Lesotho, and Vietnam. Of them, 21 were enrolled in Kazakhstan, including Saya.

To participate in endTB-Q, Saya was given instructions on her requirements: taking her medications on time and as instructed for nine months, coming for regular checkups, and reporting any side effects she experienced. She was also provided with food and transportation vouchers to help ease the burden of this extensive treatment regimen.  

“I am grateful to all employees who took part in the project and provided me with medical care and support,” she said. “I had various examinations and information support was always provided: if I had any questions, I always received a detailed and reasonable answer."

Fortunately, throughout Saya’s 9-month course of treatment, she did not experience any significant or severe side effects and is delighted to now be back in good health.  

Her advice for others who receive a TB diagnosis? Don’t “worry or be stressed, but trust professionals and accept help from people who are trying to help you. No matter how hard it is, don’t worry and then everything will be fine.”

*Patient gave permission to use first name only 

Partners In Health (PIH) is pleased to announce that the Maternal Center of Excellence (MCOE) will open in January 2026, following the completion of construction in October 2025.

The brand-new facility, which sits on the existing Koidu Government Hospital campus, will increase the current 48-bed maternal ward and special care baby unit to a 120-bed center that includes a cutting-edge neonatal intensive care unit (NICU).  

Sierra Leone previously had one of the highest maternal mortality rates in the world—an injustice that the Ministry of Health (MOH) and PIH are working tirelessly to address. Recognizing the urgency of the need, the MCOE will open in a phased approach to ensure both quality and efficiency.  

In October 2025, construction will conclude with an inauguration event and a ribbon-cutting ceremony at the facility. In the months that follow, intensive staff training and final preparations will take place to ensure the seamless delivery of new clinical services. By January 2026, the hospital will begin welcoming its first patients, starting with inpatient care and gradually expanding services and capacity. This phased approach will allow time to refine protocols, enhance training, and optimize patient care in the early days of the unrivaled facility. Further details about the inauguration event, including the specific date, will be announced in April 2025.

Alongside the MOH, PIH has partnered with Build Health International to lead the hospital’s construction. Since breaking ground in April 2021, significant progress has been made in both infrastructure and operational planning. Every detail has been carefully developed to set a new standard for health care excellence—from its innovative design and infection control measures to dignified, patient-centered spaces, this facility embodies a commitment to equity and quality. Moreover, the landscaped courtyards and kitchen area for mothers will provide patients and their families with a place of rest and comfort, reinforcing the MCOE’s commitment to holistic, compassionate care.  

PIH is deeply committed to ensuring that the MCOE serves as a model of excellence in every aspect – from the building design and corresponding patient flow to the construction materials used and equipment procured.

Beyond transforming maternal care in Sierra Leone, the MCOE will serve as a global model of innovation, proving that maternal deaths are preventable with the right investment and commitment. In addition to providing advanced clinical services, the MCOE will train the next generation of Sierra Leonean maternal health experts—doctors, nurses, and midwives—equipping them with the skills and supplies to provide outstanding care in a well-resourced environment. With dedicated spaces such as a NICU, labor and delivery suites, surgical units, and adolescent-friendly services, the MCOE is designed to meet the diverse needs of women and children while advancing global efforts to improve maternal health.

This facility stands as a testament to the inherent value of every human life and the belief that making motherhood safer is not just a health initiative—it is a human rights imperative. As we prepare to open the doors, we are not just unveiling a hospital—we are ushering in a future where no woman dies giving life.

Lakka Government Hospital in Freetown has been at the forefront of Sierra Leone’s fight against tuberculosis (TB) and especially multi-drug-resistant tuberculosis (MDR-TB). Through the partnership between the Ministry of Health (MOH) and Partners In Health (PIH), Lakka transformed from an under resourced hospital to one which TB/HIV Program Manager Dr. Girum Tefera envisions as “a center of excellence and an infectious disease treatment hub.” The hospital has revolutionized TB care in a low-resource setting by showing that comprehensive treatment not only involves administering the right medicine. It also includes creating dignified spaces, ensuring access to essential equipment, addressing patients’ psychosocial needs, and offering social support—what we refer to as the “five S’s” of strong health systems.

Since 2017, over 1,100 patients have been enrolled in the MDR-TB treatment program with a treatment success rate above the global average.

Sanctuaries for Care  

At Lakka, sparkling blue and white buildings stand tall, newly painted and spaced apart. Nurses and doctors move between them, while a few patients, wearing masks, sit under the mango tree at the center of the hospital. Landscaping is in progress and the once bare ground now has accessible pathways connecting the campus and freshly planted flowers and greenery. This process of renovating and rebuilding has created a sense of renewal. Lakka is entering a new phase of infrastructure improvements that prioritize safety and health, placing the patients at the center of design.

“What once resembled a deserted village is now a vibrant, welcoming space,” remarks Momoh Moiwo, the psychosocial rehabilitation technician at Lakka.

These changes include a handful of new spaces: two consultation rooms, a procedure room, nursing station, and staff bathroom. Nearby, there’s a spacious and well-ventilated waiting area for patients, along with a patient bathroom; and a renovated pharmacy and storage area.

“Most of these drugs are sensitive to heat and ultraviolet rays, so they need to be stored in a temperature-regulated environment,” says Tefera. The laundry room is also newly renovated, and the hospital introduced six coughing booths, allowing patients to safely produce sputum samples for TB testing. “Patients feel like they are in a proper hospital setting. Some of them don’t want to leave,” jokes Dr. Ronnie Harding, the medical superintendent at Lakka.

The Backbone of Patient Support

The treatment for MDR-TB has evolved dramatically over the years. What once required patients to take up to 20 pills and injections every day for up to eight months, often causing severe side effects such as deafness and kidney issues has now been reduced to seven tablets for six months for most patients. Those changes began in 2023 under the new World Health Organization (WHO)-recommended BPaLM regimen, of which Sierra Leone was the first country in the world whose MOH accepted the shorter treatment for nationwide use.

“This change has not only improved patient compliance but also reduced the burden on both patients and clinicians,” explains Tefera.

In addition, the availability of diagnostic technologies like GeneXpert machines reduced the turnaround time for TB diagnoses from weeks to 90 minutes. The high-tech machines are highly sensitive and user-friendly requiring only basic orientation for lab technicians. They not only diagnose TB in patients but also detect whether the bacteria are resistant to first line treatments, helping to identify potential cases of MDR-TB early.

To secure 24/7 access to electricity to power these and other critical machines, PIH provides fuel for Lakka’s generators. This is vital for patients that are oxygen dependent. As a long-term solution, the MOH has selected Lakka as one of 11 hospitals in Sierra Leone to benefit from a solar project. This initiative will reduce fuel consumption, while providing staff with more safety. “This place is very dark at night, and the solar power will allow for the installation of light poles,” adds Harding. Once the solar infrastructure is up and running, PIH can redirect resources spent on generator fuel into other critical areas of care.  

In addition to energy improvements, PIH has addressed plumbing and water supply issues by drilling a borehole, a type of well that ensures a continuous supply of clean water and reduces the risk of hospital-acquired infections.

Although Lakka lacks the capacity to conduct CT scans, there’s an X-ray machine available.  Alpha Badara, a medical officer at Lakka, highlights that the hospital is ahead of many other local health facilities in terms of resources. He adds, “In most institutions I’ve worked in, the availability of medications and lab results are always a challenge. It's never an issue here and that stands out.” 

Beyond the Basics  

The approach to care at Lakka places a strong emphasis on the overall well-being of patients. When they first arrive, Social Worker Sarah Kamara and Psychosocial Rehabilitation Technician Momoh Moiwo conduct thorough assessments to identify any psychosocial needs, such as mental health counseling, and determine the best approach to support each patient. “Sarah and Momoh’s roles are critical. It’s not just about financial support but also the emotional and spiritual aspect,” explains Alice Karim, a nurse at Lakka. The team also arranges recreational activities, such as board games, to reinforce that Lakka is a place of healing.

“If we want to watch a movie or play football, they organize everything and that makes us feel better,” says Abdul Davis, a patient at Lakka.

The mental health teams at PIH-supported facilities don’t work in silos. The social workers work closely with a clinical psychologist from the Sierra Leone Psychiatric Teaching Hospital, who visits monthly for group counseling and mentorship.

Additionally, all patients with MDR-TB receive three meals per day while at Lakka. A nutritious diet is a key part of TB treatment, which is why PIH Sierra Leone has long advocated to prioritize nutritional support as an essential component of TB care rather than an additional element. Through strategic collaboration and accompanying the MOH, this policy shift was successful in 2024 and has allowed for streamlined funding that includes nutritional support for patients, institutionalizing more equitable health services. 

A Unified Approach

The more than decade-long partnership between Sierra Leone’s MOH and PIH has been instrumental in addressing this neglected disease, leading to holistic strategies that specifically address TB’s links to poverty in Sierra Leone. As Harding shares, “While we don’t always have everything we need to fully run the hospital, the ministry will always play its part, and we are grateful to PIH for filling in the gaps.” Tefera highlights the strength of this collaboration, saying “we work as one entity” and this relationship drives the commitment to continuously improve the quality of care at Lakka.    

Partners In Health (PIH) has been treating tuberculosis (TB)—the world’s deadliest infectious disease—in impoverished countries since the 90s before many in the United States thought it necessary, or even possible. This important work has served a critical role in proving to policymakers the importance of comprehensive, patient-centered TB treatment.

From inspiration to implementation, PIH has helped shape policy and treatment guidelines that are aimed at eliminating TB worldwide. We compiled a list of some of our biggest wins in TB advocacy below:

2000

Creation of WHO’s Green Light Committee

The Green Light Committee was an early initiative aimed at ensuring patients with drug-resistant forms of TB receive appropriate treatment that will help prevent further drug resistance. PIH helped establish this committee in 2000, alongside other partners like Médecins Sans Frontières and Interactive Research and Development, within the World Health Organization (WHO) to help make treatment for multidrug-resistant TB (MDR-TB) more accessible to patients around the world.

2001  

Establishment of the Global Fund

In June 2001, the UN General Assembly endorsed the creation of a global fund to fight HIV/AIDS, drawing inspiration from PIH Co-founder Dr. Paul Farmer’s advocacy and PIH’s work in Haiti. Since then, the Global Fund has provided 76% of all TB international financing and has saved the lives of over 65 million patients with HIV, TB, and malaria.

2002

Shaping the President’s Emergency Plan for AIDS Relief

In 2002, Farmer was one of four doctors invited to the White House by Dr. Anthony Fauci to present PIH’s outcomes from treating AIDS in rural Haiti, demonstrating that high quality HIV care could be delivered in resource-poor settings. PIH’s work is a key part of evidence that convinced President George W. Bush to announce the President’s Emergency Plan for AIDS Relief (PEPFAR)—a uniquely bi-partisan initiative—which has provided antiretroviral therapy (ART) for 20.5 million people and TB preventive therapy for 13.4 million people on ART. PEPFAR has saved over 25 million lives since its launch in 2003.

2005, 2008, and 2011

PIH Influences WHO MDR-TB Protocols

PIH’s model of care for MDR-TB—and accompanying studies—informed WHO’s 2005, 2008, and 2011 guidelines on the programmatic management of MDR-TB. Farmer and fellow PIH Co-founder Dr. Jim Yong Kim summarized PIH’s influence on international MDR-TB policy in 2005: “The world is now poised to move beyond minimalism and think about the full range of tools and interventions that will be necessary to meet the most pressing global health challenges.”

2013  

PIH Engage Begins Bringing Awareness to TB Funding

Farmer helped launch the PIH Engage grassroots volunteer network, with hundreds of individuals advocating for U.S. government funding for TB programs, such as the Global Fund. This network contributes annually through thousands of calls, letters, and meetings with congressional offices.

2019  

PIH Supports Writing the End TB Now Act

In 2019, Farmer, PIH staff, and Harvard University colleagues began supporting efforts to codify comprehensive TB elimination strategies into federal law. The End TB Now Act—a bill requiring all U.S. government-funded TB programs to deliver the highest standard of TB care—is a reflection of their efforts and determination. In September 2024, the act passed the U.S. Senate following thousands of PIH community members writing their Congressional representatives and holding constituent meetings in support.  

2023  

Price of GeneXpert Lowered

PIH has worked for years to advocate for increased access to drugs and testing in the fight against TB. In 2023, PIH joined clinicians and TB activists—such as John Green, PIH board member and bestselling author—to collectively urge Danaher Corporation to lower the price of its test cartridges used in GeneXpert machines, which can rapidly detect TB. Because of this coordinated global activism, Danaher Corporation lowered the price of GeneXpert cartridges by 20%.

Bedaquiline Becomes More Accessible Worldwide

PIH and partners also called on Johnson & Johnson to increase access to bedaquiline, a key drug in the fight against MDR-TB. In response, Johnson & Johnson agreed not to enforce patents on bedaquiline in any low- or middle-income countries, lowering costs by allowing generic versions to be manufactured. In February 2025, prices had dropped over 50%.  

2024  

WHO Updates Treatment Protocols Based on endTB Results

The endTB project—a partnership between PIH, Médecins Sans Frontières, and Interactive Research and Development and funded by Unitaid— dramatically improved treatment of MDR-TB through clinical trials of new drugs and shorter treatment regimens. In August 2024, the WHO recommended the use of three new MDR-TB treatment regimens studied in the endTB clinical trial, a pivotal decision as countries often determine treatment protocols based on WHO recommendations.  

The oxygen plant in Lesotho whirs with activity, air thick with the tang of compressed gas. Francis Sambani moves through the Partners In Health (PIH)-supported facility with precision, reading pressure gauges on the oxygen manifold while the rhythmic chug of compressors punctuates the quiet.

The machinery Sambani attends is vital. Just a two-minute walk away at Botšabelo Hospital, patients battling tuberculosis and pneumonia depend on the medical oxygen it generates for their treatment and recovery.

Until recently, PIH bioengineers like Sambani needed to rely on external contractors—often from a manufacturer based in South Africa—to diagnose and repair any mechanical issues that occurred at plants. It was a dependency that sometimes led to costly delays, directly impacting patient care.

But a shift is underway: a training for PIH’s in-house biomedical engineers, developed and led by Build Health International (BHI) in collaboration with PIH, is equipping staff with the skills to maintain and repair machinery independently. Last November, a five-day intensive course at Koidu Government Hospital (KGH) in Sierra Leone marked a major step, immersing ten PIH trainees in specialized plant operations and maintenance. 

Hands-On Learning in Sierra Leone

PIH-supported hospitals, including the one where Sambani works, often serve as depots, creating oxygen through pressure swing adsorption (PSA). During this process, air is drawn in from the atmosphere, filtered, and separated to extract 90%+ pure oxygen before it is distributed in portable cylinders to facilities nationwide. With 60% of the world lacking access to safe, affordable medical oxygen, this steady supply and distribution is crucial for patient care.

Sambani reflects on how, before the recent PSA training, even minor fixes, such as replacing a compressor belt, required outside intervention. “We would see them come and see what they did,” he said of the external contractors, leading him to think, “Okay, maybe we just haven’t been trained on this. It’s not that hard. It’s not rocket science. And even if it is rocket science, it’s made by a man—still you can learn it.”

That mindset took hold. The Cencora Foundation-sponsored training brought together plant leads from Lesotho, Liberia, Rwanda, Malawi, and Sierra Leone. Unlike typical seminars, however, this training—designed by BHI’s global medical oxygen team with input from PIH—took place inside a working PSA plant, where spare equipment was repurposed for practical learning.

“A lot of times, people get a conference room in a hotel with flipcharts and training slides,” said William Haggerty, senior technical lead at PIH, who co-designed the course. “We need to move away from that model and be very hands on. We want people working with the equipment, spending time in the PSA plant, turning wrenches.”

Participants tackled real-world scenarios over a week, troubleshooting oxygen supply issues that frequently arise across PIH-supported sites. “We took everything apart and put it back together,” Sambani said. “We were able to create problems and learn about other parts and what they do—maybe the air compressor, maybe the oxygen compressor. It was really fun just being in that classroom and learning.”

The training was equally transformative for biomedical engineer Grace Bwanali from Malawi. “Before, whenever there was a problem with the plant, we were not able to do proper troubleshooting due to a knowledge gap,” she said, “leading to very long PSA plant downtime. But now, we can do that on our own—identify the problem and resolve it.”

The training occurred just minutes from the Maternal Center of Excellence, a state-of-the-art facility under construction at KGH. Trainees toured the site, and Sambani was struck by the foresight that went into its design. “It’s beautiful inside. Everything is so thought through,” he said. “The technology, the standard—everything. They even made sure that the walls look nice.

“Whoever was involved in that process wasn’t just thinking about today. They were thinking 10 years down the line: What will still work? How much capacity do we need? Let’s not just do something for now. I would really love to work there. It’s so inspiring. This is what we should be doing.”

Strengthening Oxygen Systems for the Future

Beyond mechanical repairs, PIH biomedical engineers must also ensure the stability of overall hospital infrastructure. This involves collaborating with worldwide procurement and logistics colleagues to ensure spare parts arrive on time, make it through customs, and are properly stored, as well as upskilling in related specialties such as electrical systems.

“I’m not an electrician by profession, but I know a little because my work sits in the middle of different fields,” Sambani said, describing his need to pivot between various elements of oxygen plant machinery. “I have to know a bit of this, a bit of that. Even the sound of a compressor tells you when something is off. You learn to listen.”

A colossal amount is at stake when it comes to well-functioning oxygen infrastructure, as Bwanali put plainly: “With undisturbed production, we ensure that oxygen is administered to all patients, reducing deaths.”

With such training, biomedical engineers like Sambani and Bwanali are better equipped to ensure lifesaving oxygen reaches patients who need it most. And they aren’t working in isolation—graduates of the Sierra Leone training program stay tightly connected through a WhatsApp group, exchanging knowledge and advice in real-time from their facilities across Africa.

Highly trained engineers mean more reliable oxygen supplies, fewer disruptions in care, and ultimately, more lives saved. Sambani will continue to work with precision amid his plant’s machinery in Lesotho, keeping it running 24 hours a day—and with the expertise and dedication of people like him and Bwanali, the oxygen will keep flowing.

Note: This letter was originally published on February 4, 2025, in French and English on Zanmi Lasante’s website.

Starting on January 20 and continuing for weeks afterwards, the new U.S. administration began issuing executive orders that directly impact Partners In Health’s (PIH’s) work and the communities we serve. Most of these orders are ambiguous, deeply harmful, and unprecedented, breeding widespread panic and confusion.

Funding freezes implemented by the U.S. government are straining already fragile public health infrastructure and overburdening essential care delivery programs, including at PIH sites around the world, impacting our staff, patients, and work. This interruption destabilizes decades of progress in global health, amplifies the risk of preventable deaths, and weakens emergency preparedness.

Zanmi Lasante, PIH's sister organization in Haiti, is painfully aware of how these funding gaps will limit access to care for thousands of local patients. Below is a letter from Wesler Lambert, Zanmi Lasante’s interim executive director, acknowledging how a reduction in funding could reverse years of progress in clinical care:

Dear supporters,

I’ve spent part of the month of January visiting our facilities in the Central Plateau and Lower Artibonite regions. These visits are a core part of my work—allowing me to assess our progress, identify areas for improvement, and engage directly with the staff and patients who make our mission a reality. From our maternal health, malnutrition, and emergency care programs to HIV, tuberculosis, and cancer care, I saw firsthand the impact of our interventions and the challenges we must continue to address.

Patients who once faced certain death are now thriving—receiving lifesaving treatment, supported by dedicated community health workers, and regaining the hope they once lost. These successes are the result of decades of commitment, fueled by the unwavering support of partners like the U.S. Centers for Disease Control and Prevention (CDC) and the President’s Emergency Plan for AIDS Relief (PEPFAR). But today, this progress stands on fragile ground.

Zanmi Lasante is the leading healthcare provider in Haiti after the Ministry of Public Health and Population. Since launching one of the world’s first programs to provide antiretroviral therapy (ART) in a resource-limited setting in 1998, we have defied expectations and demonstrated that treating HIV in poor countries is not only possible but essential. Today, our 12 HIV care sites serve as a lifeline for thousands, driving progress toward the UNAIDS 95-95-95 targets. In Plateau Central, we have already surpassed two of these milestones—ensuring that nearly all people living with HIV know their status and that every diagnosed patient receives treatment. Across both regions, we continue to strengthen viral suppression rates, prevent mother-to-child transmission, and expand access to pre-exposure prophylaxis for at-risk populations.

None of this would be possible without the longstanding support of PEPFAR, the Global Fund, and other key partners. These investments have allowed us to integrate clinical care with vital social support, ensuring that patients not only receive medication but also food assistance, housing support, school fees, and transportation stipends. The backbone of our success is our network of community health workers—accompagnateurs—who provide in-home support, reinforce adherence to treatment, and extend care to even the most remote communities.

Beyond HIV care, these investments have strengthened our entire health system, reinforcing services across maternal health, nutrition, pediatrics, and non-communicable diseases. Our integrated approach ensures that every program benefits from the infrastructure, training, and human resources built through decades of HIV investments. A reduction in funding would not only impact HIV treatment but would ripple across all of our services, limiting access to care for thousands of patients who rely on our hospitals and clinics for survival.

Yet, at a time when we should be redoubling our efforts, we are instead facing the devastating possibility of losing critical funding. The potential rollback of PEPFAR support is not just a bureaucratic decision; it is a direct threat to the lives of thousands of Haitians. It risks undoing two decades of progress, jeopardizing the ability of patients to access treatment, and setting back global efforts to control HIV. Moreover, it threatens to overwhelm an already fragile health system, exacerbating the impact of Haiti’s ongoing crises—including insecurity, economic instability, and the emigration of trained healthcare workers.

Let me be clear: This is not just a Haitian issue. This is a global health and human rights concern. Haiti has been a proving ground for what is possible in global HIV care, influencing policies and inspiring similar initiatives worldwide. The lessons learned here have shaped international strategies, informed global policy, and demonstrated that universal HIV treatment is both feasible and necessary. To abandon this progress now would be an injustice not only to the people of Haiti but to all those who have fought to make lifesaving HIV care a reality.

I call upon U.S. policymakers to recognize the weight of this moment and to make the right decision. Cutting funding for HIV programs in Haiti would be catastrophic—not just for the individuals directly affected but for the global fight against this epidemic. We have come too far to turn back now. The world has a moral obligation to protect the gains we have made and to ensure that access to lifesaving care is not determined by geography or economic status.

At Zanmi Lasante, we are committed to our mission. We will continue to advocate, innovate, and push forward, no matter the challenges. But we cannot do this alone. Now, more than ever, we need the international community to stand with us. We need our supporters to raise their voices. And we need decision-makers to reaffirm their commitment to health as a fundamental human right.

We will not turn back. With the right support, we will continue saving lives.

Wesler Lambert MD, MPH

Zanmi Lasante Interim Executive Director 

Note: The following was originally published in Spanish on Socios En Salud’s blog.

In early February, a ceremony was held with Peru’s Ministry of Health (MINSA, by its Spanish acronym) to deliver modern equipment with radiology, artificial intelligence (AI), and molecular biology capabilities that will help facilitate the early detection of tuberculosis (TB) in the Peruvian population and strengthen health services overall. This new equipment has been delivered to health facilities at the first level of care.

The acquisition of this equipment is in response to an objective set by the Directorate of Tuberculosis Prevention and Control within MINSA to reduce exposure to tuberculosis to 95 or less new cases per 100,000 inhabitants by 2026. The procurement of this new equipment, financed by the Global Fund, happened within the framework of Peru’s TB-HIV Country Project 2022 - 2025, was coordinated by MINSA and the National Multisectoral Health Coordinator, and is being executed by Socios En Salud, as Partners In Health is known in Peru.

“The work that the implementing body [of the TB HIV Country Project], which is Socios En Salud in partnership with MINSA, has been carrying out is a joint technical-scientific effort based on evidence, which allows us to ensure that each step we take will be a step that represents results in the fight against tuberculosis,” said Dr. Eric Peña Sánchez, vice minister of health.

What impact will this new equipment have in the fight against TB?

The new supplies include 28 X-ray machines equipped with AI for the detection of abnormal chest films; 33 TRUELAB molecular biology devices for rapid and reliable confirmation of tuberculosis infection; and 60 glycosylated hemoglobin analyzers, 60 electrocardiographs, and 3 spirometers for patient monitoring and diagnosis of the long-term effects of tuberculosis treatment.

Dr. Leonid Lecca, executive director of Socios En Salud, highlighted that this acquisition will contribute, first of all, to continuing to actively search for tuberculosis cases using portable X-rays and artificial intelligence.

“The next important step has to do with improving monitoring and treatment. Now, we have changed to shortened oral treatments, of shorter duration, for people with multidrug-resistant TB, and equipment is being purchased to carry out pharmacovigilance, to see the adverse events and safety of the medication,” said Lecca.  

In that sense, this equipment translates into greater technology reaching patients with TB early in their care, so they can benefit from early diagnosis and receive effective treatment quickly. Earlier detection of TB will also help prevent its further spread within the population.

Where will the equipment be distributed?

The equipment has been distributed to health facilities in areas with a high incidence of TB, strategically selected according to their level of complexity to ensure efficient and accessible care for the population.

Throughout Lima and other regions of the country, patients will see this equipment incorporated into their care. Health establishments of the Armed Forces, the National Police of Peru, and the National Penitentiary Institute have also received equipment, ensuring that coverage is comprehensive and reaches key sectors of the health system.

In rural Sierra Leone, Partners In Health (PIH)—in collaboration with the country’s Ministry of Health—recently opened a cutting-edge microbiology lab. Its impact was immediately felt by staff and patients alike: quicker diagnoses, improved treatment, and early interventions to stop disease outbreaks within the hospital—all while contributing to the global fight against antimicrobial resistance (AMR).

According to the World Health Organization, AMR is one of the biggest threats to global health and neglecting it could undo a century of medical advancements. The AMR process occurs when microorganisms such as bacteria, viruses, and fungi evolve, making medications used to treat the infections they cause ineffective. Due to their clinically resistant abilities, these microorganisms are often termed “superbugs”.

In 2019, global estimates showed that AMR directly caused 1.27 million deaths and contributed to the loss of 4.95 million lives. Moreover, Sub-Saharan Africa is disproportionately affected due to limited resources and infrastructure, which has resulted in fragmented health systems, limited data, and weak laboratory systems for surveillance and containment.

PIH Sierra Leone is committed to preventing AMR by reducing infections that could contribute to the misuse of antibiotics, improving access to accurate diagnoses and proper treatment, while also driving innovation and data use. These commitments led to the major renovation of the laboratory, which officially opened on December 16 at PIH-supported Koidu Government Hospital (KGH).

Informed decision-making, shorter wait times 

A well-equipped and functioning laboratory “acts as an eye for the doctor,” says Saffiatou Darboe, a clinical microbiologist and diagnostics lead at KGH. She explains, “With the right information from the labs, clinicians can prescribe the right antibiotics, dosage, and duration.” This eliminates the reliance on empirical treatment, which involves the prescription of medication based solely on a clinician’s experience and a patient’s reaction to a course of antibiotics. Instead, with the correct equipment, clinicians can gain a clear picture of the underlying bacteria causing an illness.  

“Clinicians can now make informed decisions,” Darboe adds.  

At KGH, when doctors suspect a condition, they’re now able to use the lab to confirm the diagnosis and receive recommendations for effective antibiotics. This process is supported by a specific test—called “biogram”—that identifies which antibiotics are most and least effective in treating infections in a specific region.

Before the microbiology lab opened, transporting blood cultures to the nearest lab was a complicated and time-consuming process. “We would prepare the samples, request a vehicle, and then wait for approval. It would take two hours to reach Makeni, and sometimes we had to send them to Freetown, which is nearly six hours away,” says Yusuf Othman Sheriff, lab manager at PIH Sierra Leone.  

Today, the new lab serves as a central hub for the hospital, providing test results for all departments within a standard turnaround time that ranges from 24 to 72 hours.

Aligning with international standards

The new lab has cutting-edge technology and advanced tools to enable quicker detection of microorganisms, even in patients undergoing antibiotic treatment. These advancements also improve laboratory efficiency by minimizing hands-on time and providing faster reporting. 

“The equipment we have here is unlike what you’ll find in other parts of Sierra Leone. If you visit labs in other cities, it’s clear that this lab is far ahead, ” Sheriff notes.

However, even with new technologies, Darboe believes it’s important to incorporate traditional methods. “I tell my students that while speed is good, microbiologists need to maintain certain manual skills which are essential when automation isn’t an option,” says Darboe, who oversees the training of lab staff and interns at KGH and gives an annual lecture on newer microbiology diagnostic technologies at the London School of Hygiene and Tropical Medicine.

Setting up a lab like this requires careful consideration of the context.  Darboe highlights that across Africa, many labs remain inactive, with equipment unused because it was donated or purchased without considering key factors. “Assess the region’s needs, choose equipment whose maintenance is possible, ensure there is reliable electricity, and that necessary reagents can be sourced," she emphasizes.  

After successfully establishing a lab in a low-resource region, the team is now setting even bigger goals. They are working toward achieving an international accreditation that outlines the requirements for quality and competence in medical laboratories. A key part of this process involves investing in quality management systems, capacity building, and providing leadership and soft skills training such as communication and teamwork for scientists.

The new microbiology lab is already making a tangible difference in patient care. As Darboe shared, “Just recently, we suspected an outbreak at the special care baby unit (SCBU) from some data coming from the lab. They had previously suspected it and sent samples to Makeni. But we have a lab now, so we can just process the samples.” This means the SCBU can get real-time data, and clinicians are able to intervene early enough to stop the transmission and create control measures.  

In the remote villages of Lesotho, where families often live in close quarters and health care access is limited, tuberculosis (TB) remains a persistent threat. Partners In Health (PIH) Lesotho is at the forefront of efforts to curb the spread of this deadly infectious disease through meticulous contact tracing, a strategy that is particularly vital in overcrowded households.

A Family's Struggle with Tuberculosis

In a small village nestled in the southern highlands of Lesotho, a modest one-room house is home to nine family members. Among them is 73-year-old Thobei Tlake, who has been battling TB for several months. Thobei shares this confined space with his wife, 78-year-old 'Mankopane Monyane, who has been his primary caregiver throughout his illness, and their seven grandchildren, who range in age from 6 to 13 years old.

The close quarters and the presence of a person with TB create a high-risk environment for everyone in the household. When ‘Maposholi Posholi, a dedicated TB screener with PIH Lesotho, arrived at the family’s home, she was acutely aware of the risks posed by such tight living conditions.

"TB spreads easily in environments where people are in constant close contact, especially in overcrowded spaces," Posholi explained as she prepared to conduct the necessary screenings to see if the infection had spread to other members of the household. "It’s crucial that we identify and treat TB as early as possible to protect these children and prevent further transmission."

The Crucial Role of Contact Tracing

TB contact tracing is a meticulous process that involves identifying and screening all individuals who have been in close contact with TB. In this case, Posholi’s task was particularly urgent. With seven children living in a single room with their ill grandfather, the risk of transmission was alarmingly high.

The dangers of such living arrangements are manyfold. TB is an airborne disease, spreading through tiny droplets released into the air when an infected person coughs, sneezes, or even speaks. In a cramped space, these droplets can linger in the air, significantly increasing the likelihood of transmission. For the children, whose immune systems are still developing, and their elderly grandmother, the risk was even greater.

"These children are our future, and we must do everything we can to protect them from this disease," Posholi said, her voice steady but filled with concern. She began the contact tracing process, carefully observing each child for signs of TB; and asking if any of them were experiencing persistent coughing, weight loss, night sweats, and fatigue. The process also included measuring the height and weight of each child to monitor their growth and overall health.

To ensure a thorough assessment, Posholi collected samples of sputum—a thick mucus made in the lungs and airways—from each grandchild and their grandmother. This sample collection is a vital step in TB diagnosis, as it allows for the detection of TB bacteria in the lab.  

"Early detection is key," Posholi emphasized. "In many cases, TB can go undetected until it’s too late, especially in children. By conducting these tests, we can catch the disease early and begin treatment immediately."

Fortunately, in a week’s time, all the sputum tests came back negative, providing the family with some relief. However, given the close living conditions and the imminent risk of TB infection, Posholi took further precautions. 

Mitigating the Risk: TB Prophylaxis

To mitigate the imminent risk of TB infection that the children and their grandmother were facing, Posholi recommended that they all take daily preventative medication, known as  TB prophylaxis, for three months. The treatment helps to stop TB from developing in individuals who have been exposed to the bacteria but are not yet symptomatic, people with weakened immune systems, and others. This measure was essential in protecting the family from the potential onset of TB, particularly in such a vulnerable environment.

"Prophylaxis is a critical step in preventing the disease from taking hold," Posholi noted. "By taking this preventive measure, we can reduce the likelihood of the children and their grandmother developing active TB, ensuring that they remain healthy."

Overcrowding: A Breeding Ground for Tuberculosis

The visit to Thobei Tlake’s family home highlights a broader issue that is prevalent in many parts of Lesotho: overcrowding. In rural areas, it’s common for large families to live in small, single-room houses, with little ventilation and no space for isolation. These conditions create a perfect storm for the spread of TB, turning homes into breeding grounds for the disease.

"Overcrowded living conditions are one of the biggest challenges we face in the fight against TB," Posholi noted. "When multiple people share a single room, there’s no way to avoid exposure if someone has TB. This is why contact tracing and early intervention are so critical."

In households like this one, where space is limited, the lack of isolation can turn a single case of TB into a household outbreak. This is particularly dangerous in Lesotho, where TB rates are already among the highest in the world, and the HIV epidemic has only exacerbated the situation by increasing individuals' susceptibility to TB.

Partners In Health Lesotho: A Lifesaving Mission

The work of PIH Lesotho goes beyond just treating TB; it involves educating communities through door-to-door outreach, supporting patients, and implementing preventive measures that can stop the spread of the disease. Contact tracing is a cornerstone of this effort, allowing health care workers to identify potential cases early and intervene before the disease can take hold.

"Every visit and every test is a step toward a TB-free Lesotho," Posholi reflected as she prepared to leave the family’s home. "It’s a long journey, but with each household we visit, we’re making progress."

As PIH continues its work across Lesotho, the importance of TB contact tracing remains clear. In a country where the disease has touched thousands of lives, these efforts are not just about treating illness; they’re about safeguarding the future. Through diligent screening, timely intervention, and unwavering commitment, PIH Lesotho is bringing hope to families like Thobei’s, ensuring that they can look forward to a healthier, TB-free tomorrow.

Since the invention of the world’s first successful vaccine—against smallpox—in England over two centuries ago, the public health tool has prevented hundreds of millions of deaths—from HPV and polio to measles and COVID-19. As vaccine misinformation spreads and threatens public health, we must remember the facts: vaccines are rigorously researched and tested, they’re safe and effective, and they protect against more than 20 diseases.
 
Simply put, vaccines save lives.
 
At Partners In Health (PIH), immunization is one of the many ways we bring the benefits of modern medicine to those most in need.
 
Here are 4 ways vaccines save lives across countries where PIH works:

1. Vaccines protect children.

More than 13,000 children worldwide die every day from preventable or treatable conditions—many of which can be addressed with vaccines. At PIH, we work together with local governments and health clinics to protect children in vulnerable communities who often face an increased risk of infectious disease.  

In 2023, PIH supported the administration of 664,645 childhood vaccinations, such as hepatitis B and measles vaccines, across seven countries: Haiti, Lesotho, Liberia, Malawi, Peru, Rwanda, and Sierra Leone.

2. Vaccines curb disease outbreaks after natural disasters.

Hurricanes, floods, and mudslides can have severe health impacts on communities. Such disasters can damage water sanitation infrastructure and contaminate water, leading to outbreaks of cholera, a bacterial disease. Fortunately, cholera is preventable and treatable.

In Haiti, PIH conducted a cholera vaccination campaign after the 2010 earthquake that protected 50,000 people against the deadly disease. The campaign’s success motivated the World Health Organization (WHO) to establish a global stockpile of oral cholera vaccines and to change protocols that expanded patient access.

Later, in 2017, when severe flooding and mudslides threatened a cholera outbreak in Sierra Leone, this global stockpile became a lifesaving resource. PIH staff led a vaccination campaign in partnership with Sierra Leones's Ministry of Health, providing the necessary two doses of the cholera vaccine to 500,000 people.

3. Vaccines strengthen global health systems.

During the COVID-19 pandemic, PIH advocated for an increased global supply of vaccines and their equitable distribution to low- and middle-income countries, such as Haiti, Lesotho, and Malawi.

In the United States, PIH accompanied local health departments and community partners to establish vaccine rollout plans centered on equity and access; and created a vaccine toolkit with practical resources for achieving vaccine equity.

4. Vaccines prevent serious illness and death.

Recently, the first-ever vaccine for malaria, a mosquito-borne infectious disease, was approved by the WHO. In 2024, Sierra Leone became the third country to roll out the vaccine nationwide at PIH-supported Wellbody Clinic and other health facilities. At Wellbody Clinic, all babies who are at least six months old can receive a malaria vaccine during their regular appointments. This marks a significant step towards saving countless lives and reducing the burden of malaria on families, communities, and the health care system. In 2023, there were 597,000 malaria deaths around the world, a majority of which were among children under 5 in Africa.

If we don’t vaccinate the most poor and vulnerable communities, everyone will continue to be at risk. At PIH, we’re committed to enhancing vaccine access and strive to make health care a human right for all people, starting with those who need it most.

Tuberculosis (TB) is often thought of as an illness of the past, despite the fact that it’s the world’s deadliest infectious disease today—claiming a life roughly every 20 seconds. 

Countries around the world grapple with its devastation as a lack of resources places proven TB care and prevention out of reach of people who need them most. Even the United States—which spends more on health care per person than almost every other wealthy country—is currently experiencing one of its largest recorded outbreaks of TB, centered in Kansas.  

“While outbreaks are alarming, it's actually a good thing that we are finding them,” Lindsay Palazuelos, PIH senior director of policy and program replication, said. “It's good when we have the public health infrastructure to find outbreaks, and reminds us that we need to keep strong public health workforces and institutions so that we can drive down rates of TB in the U.S. as well.”

TB has always been a disease that hurts the impoverished the most. When you're chronically malnourished or have other illnesses like HIV that impact your immune system, are unable to access health care, or are living in a densely populated area, you can be more susceptible to TB and experience poorer outcomes.

“Although tuberculosis is inextricably tied to poverty and inequality, experience shows that modest interventions have effected dramatic changes in outcome,” late PIH Co-founder Dr. Paul Farmer wrote in “Infections and Inequalities.” “Pragmatic solidarity means increased funding for tuberculosis control and treatment. It means making therapy available in a systematic and committed way.”

Many folks in the U.S. may not have heard of, or worried about, TB in their lifetimes. However, in the countries where PIH works, TB is all too well known. People may not have heard all the scientific details, but they understand TB’s impact because they’ve seen friends, neighbors, and loved ones who have fallen sick or died from the disease.

TB is, however, completely preventable and curable. So, why are over 1.2 million people dying of this disease every year? Let’s learn more about the disease, how it spreads, and how we can be a part of the movement to end TB.

The Deadliest Infectious Disease

TB is an infectious disease, passed from person to person. It spreads through the air when people who are already sick cough, sneeze, talk, or spit—which can result in infection. It's necessary, but not sufficient, to develop into TB disease. Moreover, diabetes, a weakened immune system, and malnutrition can increase someone’s risk of contracting TB disease.

“Being a contagious disease transmitted by air, anyone can get tuberculosis, even after years of being exposed to the bacteria,” Dr. Leonid Lecca, executive director of Socios En Salud, as PIH is known in Peru, said. "There are conditions of the person—age, immune system, presence of diseases—socioeconomic conditions—overcrowding, poverty—and conditions of health services—limited access—that make certain populations more vulnerable to TB.”

When bacteria from the TB infection spreads, it steadily affects different organs in the body, usually starting with the lungs. Common symptoms include a prolonged cough, chest pain, weakness, fatigue, and fever. However, these symptoms may be mild for many months, or some patients may not experience any outward indication of the infection at all, making it easy to spread TB without knowing you have it.  

Some people may even have TB infection, be asymptomatic, and potentially days or years later, experience active TB disease. In both cases, however, treatment is available. With TB infection, patients can take preventative therapy to avoid ever getting the active disease—and avoid transmitting it to others. If TB disease develops, there are proven treatment methods that can cure patients, and also help them avoid spreading the disease.

People who develop active disease often experience progressive destruction of the lungs, which, over time, can cause death due to respiratory failure—when people can’t get enough oxygen or eliminate enough CO2—or due to shock or suffocation secondary to blood loss. Even before death, the experience of coughing up blood can be extremely distressing.  

Preventing the Spread of TB

Globally, around 30% of TB cases are never diagnosed or treated. However, when people with TB do access treatment, it is highly successful, curing upwards of 80% of those who receive it. And while treatment is often seen as the most important tool, an effective TB response usually starts before a patient is sick.  

The best way to prevent TB is to redress the inequalities that increase a person’s risk in the first place—working to ensure people have adequate food, preventing overcrowding, and ensuring adequate ventilation and medical care in settings like dormitories, factories, mines, prisons, and jails where TB can spread rapidly.

“We've known what successful interventions for TB look like from experiences in the U.S. and elsewhere since the mid-20th century, including sustained support for public health services, improved living conditions and nutrition, and policies that facilitate universal access to compassionate, respectful health care," Carole Mitnick, PIH senior research associate and Harvard Medical School professor of global health & social medicine, said.

Seeking medical attention, getting tested for TB if you are experiencing any symptoms—particularly if you are at an increased risk or have come in contact with someone infected by TB—and prompt treatment, whether for active TB disease or through TB Preventative Therapy, can help stop the disease from spreading and improve your chance of recovery.

“Early detection and timely and correct treatment are useful tools that reduce TB transmission in the community,” said Lecca.

Treatment is one of the strongest forms of prevention, not only saving lives but also interrupting the transmission of disease. Someone who is cured of TB can’t spread it to those around them.

Treating TB takes time and diligence, even in the early stages of the disease, making treatment support important to success. Normally, when you think of bacterial diseases that require treatment—strep throat, ear or sinus infections—you get a course of one single antibiotic from your care provider, and everything clears up relatively quickly, generally within days or a week. For TB, however, a cocktail of multiple antibiotics must be taken over four to six months.  

Additionally, TB bacteria have been shown to mutate and become resistant to drugs, resulting in the deadlier and more difficult-to-treat multidrug-resistant TB (MDR-TB) or extensively drug-resistant tuberculosis (XDR-TB). PIH was instrumental in showing that these forms of TB are treatable and in finding better, safer, and shorter combinations of drugs to do so.  

“With new innovations in TB care led by PIH, the options and prognosis for people suffering from this form of TB are vastly improved,” said Mitnick. “Nearly all people with simpler forms of MDR-TB can be treated in 9 months or less. The treatment is much shorter, compared to 18-24 months, and more effective than the treatments used in the very recent past.”

The Burden of Disease

While TB occurs everywhere, 80% of cases and deaths are in low- and middle-income countries. Though improved treatments and tools, such as PCR testing with GeneXpert, can make a difference today, they are out of reach of many in countries where TB is most prevalent due to continued high prices, intellectual property models that favor originators and investors, cash-strapped governments forced to pay debts rather than support investment in health care, and low global prioritization of TB. Until these conditions change or improve, TB will continue to be a public health threat, causing grief and suffering where treatment and survival are possible.  

Recent executive orders to halt foreign aid programs will exacerbate these challenges. The U.S. government is the largest bilateral TB donor, investing more than $4.7 billion to combat TB globally since 2000 through USAID. The interruption of this support endangers lives from Kansas to Kazakhstan and could set progress back by years.

Millions of people should not be dying of a preventable and curable disease. For years, TB has struggled to get global attention, resources, and funding despite ambitious targets like the UN’s goal to end TB by 2030. While we see progress being made at PIH sites around the world and through global partnerships like the endTB clinical trials, there is still much more work to be done.  

“Since we know how to search for, treat, and prevent TB, the failure to do so is particularly outrageous," said Mitnick. "The 70 cases diagnosed in recent months in Kansas, among the nearly 11 million occurring globally in the last year, could have been averted."

To learn more about TB and PIH's work, check out:

• How Dr. Paul Farmer Revolutionized Tuberculosis Care
• TB Is the Deadliest Infectious Disease. So Why Haven’t You Heard of It?
• Video: Dr. Girum Treating TB at Lakka Government Hospital
• Pursuing Dreams: Tuberculosis Patient Remains Hopeful, Chases Career Goals
• 5 Common Misconceptions About Tuberculosis
• Major advance in the fight against MDR-TB: four new short and effective treatments from recent clinical trials approved by the WHO

Partners In Health (PIH) strongly opposes President Trump’s executive order to reinstate the Mexico City Policy, or “Global Gag Rule” as it became known by critics due to its silencing effect on discussions addressing abortion services as a critical component of reproductive care.

The policy demands that foreign nongovernmental organizations cease using funds from the U.S. government to “perform or actively promote abortion as a method of family planning.” Those caught breaking this order will see their funding from the U.S. slashed.

In 2017, President Trump significantly expanded the scope of the Global Gag Rule to apply to all U.S. health aid issued to countries worldwide. During former President Joseph Biden’s first month in office, he rescinded the policy as part of a series of executive orders aimed at increasing access to health care globally. On January 24, the Trump Administration reinstated the expanded policy.  

The Global Gag Rule has a dangerous impact on the fundamental rights and health of women, girls, and pregnant people, and it disproportionally affects those who are already systemically marginalized. It also undermines clinicians’ duty to provide comprehensive care to their patients. Since the second Reagan administration first implemented the policy in 1985, when the Global Gag Rule was put in place, women have faced a decrease in contraceptive and outreach services, and there has been instrumental damage to health system integration and referral networks, along with an overall erosion in advocacy for reproductive justice worldwide.  

The reinstatement of this harmful policy will continue to have a negative ripple effect across entire health systems, such as:

• Reducing essential training and equipment for clinicians to provide safe abortion care, even when it is needed to save a woman’s life
• Fueling a reluctance by clinicians to provide critical care following unsafe abortions, which are the third leading cause of maternal mortality worldwide according to the World Health Organization
• Decreasing the provision and use of contraception among women
• Increasing unintended pregnancy, abortion rates, maternal and child mortality rates, and HIV rates

The order to reinstate the Global Gag Rule comes shortly after the U.S. State Department’s recent directive to immediately stop work on the majority of existing foreign aid programs in response to an executive order that paused any new aid for 90 days.  

The Trump administration’s stop-work order on all foreign assistance will have a detrimental impact on family planning services. For the last nine years, Congress has consistently designated $607.5 million in foreign aid for family planning annually, providing an estimated 47.6 million women and girls with modern contraceptive care in 2025.

According to the Guttmacher Institute, on average, 130,390 women get contraceptive care each day under U.S.-funded programs. Over the course of the full 90-day freeze on foreign aid, around 11.7 million women and girls will be denied this essential care.

What does this mean for recipients of these services? Based on global trends, if 11.7 million women and girls are denied access to contraceptive care in 2025, 4.2 million will experience unintended pregnancies, and 8,340 will die from complications during pregnancy and childbirth.

Under international law, all people have a human right to make their own choices about whether and when to have children. The Global Gag Rule and stop-work order undermine the collective efforts to protect the sexual and reproductive health and rights of people around the world.  

Lifesaving abortion services, and information regarding such services, cannot be separated from a person’s reproductive health needs. PIH believes that to protect the sexual and reproductive health and rights of people around the world, the Global Gag Rule needs to be permanently repealed.