Earlier this week, the Trump Administration froze trillions of dollars of federal funding for health care, children’s education, and other vital programs. While an avalanche of public pressure and lawsuits forced the administration to reverse course, we must remain vigilant. The decision by the Trump Administration to jeopardize these services has already caused widespread confusion and fear. Combined with a global aid freeze, these directives are hitting historically marginalized communities the hardest, both at home and abroad. 

Over the last several days we’ve already seen destabilizing and negative effects in our communities. Public health agencies and community-based organizations, already chronically understaffed and underfunded, now face even greater uncertainty about their ability to continue to deliver essential services. Across the country, organizations led by and serving people of color and historically marginalized communities, are being hit the hardest. The combined impact of funding freezes, immigration crackdowns, and attacks on DEI is disrupting essential services and instilling fear that prevents already vulnerable populations from accessing critical programs and support. 

The services and agencies threatened by this federal funding freeze aren’t just numbers on a budget sheet; they ensure critical support for families, children, and seniors, especially in low-income and rural areas. The directive, made by memo rather than through legislative process, sets a dangerous precedent— one that bypasses the democratic principles and checks and balances, designed to ensure government accountability to the people. We are grateful to all of the advocates and organizers who mounted pressure through collective action to quickly roll back this initial attempt at cutting off federal funds to safety-net clinics, food banks, and public health departments, among others. 

Broad cuts, targeted efforts to roll back services to the most vulnerable, and generalized chaos in our federal policy and systems, are a threat to the health and wellbeing of everyone in the United States––and around the world. We stand ready to fight alongside our partners in the days and weeks ahead, and to continue to offer an alternative affirmative vision for our country, in which everyone can exercise their right to health.

The United States’ health system is plagued by a lack of affordability, unequal access, and underinvestment in primary care and prevention.  For nearly 80 million Americans, Medicaid is a critical solution—a source of access to care and financial protection that would otherwise leave people across the country extremely vulnerable.  

The mission of Partners In Health United States, or PIH-US, is to build strong, community-led public health systems that ensure everyone can exercise their right to health. Medicaid is critical to making this a reality by funding many of the community health programs that PIH-US supports. PIH-US also works with partners across the United States to advocate for coverage for the folks who need it most.  

With Congress and the new administration considering devastating cuts to Medicaid, we met with PIH-US team members Lucas Allen, advocacy lead of federal and state policy, Ali Bloomgarden, senior manager of advocacy engagement, and Khadija Gurnah, senior director of advocacy, to learn more about the program, its importance, and how to preserve this vital source of health care in our communities. Below, summarized, are their responses:  

What is Medicaid?

Medicaid is a public health insurance program that provides health coverage to about one in five people living in the U.S., including eligible low-income adults, working families, children, vulnerable seniors, and people with disabilities.  

It was established in 1965 as a federal-state partnership, meaning each state runs its own Medicaid program—sometimes with a unique name like MassHealth, SoonerCare, or Medi-Cal. However, the federal government holds the key to determining country-wide health care standards and funding.

How important is Medicaid to health in the U.S.?

Medicaid keeps people healthy at all stages of life.  

• 40% of all births in the U.S. are financed by Medicaid and that percentage is higher for Black (64%) and Hispanic (58%) women and birthing people.  
• Medicaid provides coverage to 2 in 5 children, and nearly 3 in 5 nursing facility residents.  
• It is also the largest payer of behavioral health services, encompassing mental health and substance use disorder treatments.  

Beyond the statistics, Medicaid allows families to seek the care they need without fearing overwhelming health care costs on top of already limited household budgets. It enables financial security and peace of mind.  

Compared to those without insurance, people with Medicaid are also more likely to feel empowered to access primary and preventive care services essential to reducing outbreaks and keeping broader communities healthy.  

How is Medicaid being threatened?

Key leaders in Congress are actively considering proposals that would slash Medicaid coverage. Republican majorities in the House and Senate are beginning work on major legislation that would provide tax cuts to disproportionately benefit the wealthiest folks in the country. The Treasury’s Office of Tax Analysis estimates that the top 0.1% of earners would get a tax cut of $314,000 under a full extension of the individual and estate tax provisions, with the total cost of those tax cuts amounting to $4.2 trillion between 2026 and 2035.

In order to pay for those tax cuts and cover that trillion-dollar gap, Congressional leaders are considering cuts to vital health programs, including Medicaid. While the specific proposals being considered vary, they would all reduce health funding and make clinical services less affordable, directly harming the millions of Americans who presently benefit--and often survive--due to these programs.

Who would be harmed if Medicaid was cut?

The answer is, likely, all of us. The impact of national cuts to Medicaid funding would be felt in our economy, our states’ budgets, and our communities. Medicaid is the largest source of federal funding to states and is critical for keeping hospitals and clinics afloat.

More specifically, 36.8 million children, 7.2 million seniors, 8.4 million adults with disabilities, and 13.9 million people with mental illness or substance use disorders receiving health insurance through Medicaid would be harmed. Depleting federal Medicaid funding would force state programs to restrict eligibility and reduce services, removing care from those who need it most.  

Community health worker (CHW) services might be among the first to be affected. At a time when CHWs are already struggling to sustain funding for their critical work, cutting Medicaid could threaten their hard-fought progress in advocating to be recognized and integrated into Medicaid programs.

Moreover, Medicaid cuts will particularly harm those who already face injustice and oppression. Entrenched racially discriminative systems have created barriers to wealth-building and job opportunities with employer-provided health insurance—driving people of color to disproportionately use Medicaid for their health coverage. Targeting Medicaid reinforces the idea that some lives matter less and that health is a privilege, beliefs that PIH has been fighting for decades.

In response to the concerning shifts we have seen, PIH recently joined almost 350 organizations in signing a letter led by our partners at Families USA, calling on Congress to protect Medicaid. The administration might be changing, but our work will not. We resolve to continue pushing for constructive improvements to Medicaid—such as the Community Health Worker Access Act—while opposing attempts to disinvest in the health of our communities.  

What can I do to help save Medicaid and protect the health of nearly 80 million Americans?

Tell your members of Congress to protect Medicaid and oppose policies that would cut this vital program as soon as possible before this legislation is completed. PIH-US has created a template to make reaching out easy.

Congress has considered defunding Medicaid before, and it’s always been the resolute voices and stories of advocates and community members that have protected it.  

Your voice—and the voices you bring along with you—will make the difference. Together, we demand health care for every single person. 

Aisara’s* year began like any other. As a busy mother of four, her days in early 2023 flew by in a whirlwind of caring for her young children, household tasks, and staying active in the local community. But by August, as the summer drew to a close, she began to feel unwell, more tired than usual.

At first, Aisara assumed her persistent cough and fatigue were symptoms of a common cold. But when she began losing weight and her cough worsened, the 41-year-old decided to visit a nearby clinic in her hometown to make sure it was nothing more serious. There, a sputum sample and chest X-ray confirmed an unspeakable fear: she had tuberculosis (TB)—the world’s deadliest infectious disease.  

Follow-up testing conducted in a TB center by the National TB Program, which receives technical assistance from Partners In Health Kazakhstan, revealed even more alarming news: Aisara had multidrug-resistant TB (MDR-TB), a particularly cruel and deadlier version of TB. Kazakhstan is one of the 30 high MDR-TB burden countries, with more than a quarter of newly diagnosed TB patients and nearly three-quarters of retreatment cases developing into this more resistant form.  

Since 2009, PIH has partnered with Kazakhstan’s Ministry of Health to tackle TB, including MDR-TB and the even more severe extensively drug-resistant tuberculosis (XDR-TB), providing care in prisons and for the general population. PIH currently helps to fight TB in all regions of the country, including the clinic where Aisara sought care.  

Due to the contagious nature of TB and the desire to start treatment as rapidly as possible, Aisara was hospitalized in one of the PIH-supported TB clinics, where doctors also provided education on her condition.  

“I didn’t understand how I could get tuberculosis, where I could get infected,” Aisara recalled. “There was a time when I cried and couldn’t accept my illness. The doctors explained everything—about the illness, treatment regimens, as well as the medications that I had to take.”

Initially hesitant about a lengthy treatment that would keep her away from her young family, Aisara was relieved when PIH Kazakhstan staff suggested a new, shorter, nine-month regimen—nearly half the standard 18 months—that had been successful among other MDR-TB patients. After discussing it with her family, she agreed to proceed and remained committed, never missing a dose of medication throughout her treatment.    

By February 2024, Aisara’s health had significantly improved, and she was discharged from the hospital, able to return home.

“Thanks to the people in white gowns, my condition improved. I was finally able to hug my children,” said Aisara. “I was happy.”

Alongside the medical care she received, Aisara credits other crucial factors for her recovery: financial assistance from the state, which enabled her to buy food and support her family while undergoing treatment, as well as psychological support, which helped her navigate one of the most challenging times in her life.  

“During treatment, I realized that in order to recover from any disease, you need the support of loved ones,” she said. “A positive attitude toward treatment and good, professional health workers who you can trust.”  

Today, Aisara is grateful for the care she received from her local TB doctors and the PIH Kazakhstan team which helped her achieve the progress she made in such a short time. She is healthy and home with her family, immersed, once more, in the busy rhythm of motherhood.

*Patient gave permission to use first name only 

For nearly 40 years, Partners In Health (PIH) has collaborated with the World Health Organization (WHO) to advance health outcomes across the 11 PIH sites where we work. From the organization’s critical support during disease outbreaks, such as the recent Marburg outbreak in Rwanda, to ongoing collaboration to address chronic conditions among children, the WHO’s partnership with PIH and national governments is indispensable.

To continue this work and advance the right to health, the United States must remain part of the WHO. As such, PIH opposes the Trump administration's announcement on January 20  to withdraw the U.S. from the WHO in the strongest terms possible.

Below, learn more about the WHO, what a U.S. withdrawal means for PIH and global health, the impact of the 90-day foreign aid pause, and more:

What is the World Health Organization (WHO)?

The WHO is a specialized agency of the United Nations and a cornerstone of global health, serving as a vital force in saving lives and advancing health equity worldwide. Established in 1948, the WHO has played a pivotal role in combating infectious diseases, coordinating responses to global health emergencies, and supporting underserved communities.

How is the WHO funded?

The WHO is funded by Member States, such as the U.S., who pay membership dues calculated relative to a country’s wealth and population; and voluntary contributions from Member States and other partners, such as philanthropic foundations and the private sector. The WHO operates on an annual budget of approximately $2.1 billion, with the U.S. historically providing about 15% of this funding.

What will the U.S. lose by exiting the WHO?

If the U.S. exits the WHO, this means:

• Losing a seat at the table in global decisions on which strains of flu and COVID should be used for annual vaccines
• Untimely access to invaluable global data about circulating viruses
• No involvement in discussions regarding plans to address emerging threats to public health

How will U.S. withdrawal from the WHO affect global health?

U.S. withdrawal from the WHO will have catastrophic consequences for global health, particularly for underserved and vulnerable communities. The withdrawal of U.S. financial and political support severely weakens the WHO’s capacity to respond to health crises, jeopardizes global vaccination and disease prevention programs, and disrupts critical partnerships needed for coordinated international responses.

How will U.S. withdrawal from the WHO impact countries where PIH works?

If the U.S. withdrawals from the WHO, potential impacts on PIH-supported countries include:

• Limiting invaluable resources for creating clinical protocols for diseases that impact patients globally, such as cholera, mpox, Marburg.
• Reducing the flow of critical information about disease outbreaks, transmission patterns, variants, treatment efficacy, and more to the Africa Centers for Disease Control and Prevention and ultimately, the rest of the world, including the U.S. This limits our collective ability to prepare for and stop the spread of new or emerging infectious diseases.
• Limiting resources for comprehensive, evidence-based approaches and tools for health system strengthening, such as increasing access to medical oxygen.
• Limiting research and development for essential medical countermeasures, such as diagnostics, therapeutics, and vaccines.

What is the foreign aid pause?

In addition to the U.S. withdrawal from the WHO, the Trump administration announced a concurrent 90-day pause in foreign aid. PIH strongly condemns the pause as a harmful decision with devastating implications for global health, international development, and the wellbeing of vulnerable people around the world.

How will the 90-day foreign aid pause impact PIH funding?

PIH is working to quickly understand the full scope of the impact the order will have on our work and partners. The abrupt suspension in funding disrupts essential supply chains, undermines health systems, and forces organizations like PIH to fill more gaps and shoulder the increased burden now placed on local health ministries already operating with limited resources. The ripple effects of this pause are far-reaching, threatening to destabilize decades of progress in global health and leaving critical initiatives underfunded and vulnerable. The Executive Order does not immediately place PIH in a state of financial instability; however, if extended, the long-term impact on PIH's operations is likely to be profound.   

PIH urges the Trump administration to reverse the U.S. withdrawal from the WHO and the 90-day halt to foreign aid. Failure to do so will have catastrophic consequences for global health.

Lerato Mpholo, a 24-year-old fuel attendant, was diagnosed with multidrug-resistant tuberculosis (MDR-TB), a condition that seemed to bring her life to a halt. She initially ignored the persistent flu-like symptoms that plagued her for weeks, no matter the medication she took. Eventually, the prolonged illness prompted her to seek help at a local health center. There, she was diagnosed with MDR-TB and referred to Partners In Health (PIH)-supported Botšabelo Hospital for specialized care.

“After being diagnosed with MDR-TB, it felt like the world no longer existed,” Mpholo shared, reflecting on the initial stages of her illness.

During the early stages of her treatment, Mpholo stayed at the halfway home for two weeks, where she and her treatment supporter received training on how to take MDR-TB medication. Although her physical health gradually improved, the illness’s toll on her mental health became evident. “I couldn’t cook, I lost a lot of weight, and everything seemed meaningless,” she recalled.

Despite significant advancements in tuberculosis (TB) medications, including shorter and less toxic treatments, the infectious disease remains incredibly taxing on a person’s overall well-being. In fact, an estimated 40%-70% of individuals treated for TB are also believed to have a mental health disorder, such as depression or anxiety.

“It’s our responsibility as doctors and nurses to screen every MDR-TB patient for depression and anxiety at every visit,” said Dr. Mikanda Kunda, medical doctor at PIH Lesotho. 

Between April 2023 and March 2024, PIH Lesotho screened more than 2,000 patients with MDR-TB for depression and anxiety across Botšabelo Hospital its seven Rural Health Initiative clinics.

Kunda emphasized that the severity of Mpholo’s condition, which was nearing extensively drug-resistant tuberculosis , took a significant toll on her mental health.

“Depression in MDR-TB patients often stems from the uncertainty of whether they will recover, especially since many are the main providers for their families. The stigma and social pressures only add to their struggles,” Kunda said.

Recognizing the impact that TB had on Mpholo, he referred her to PIH’s mental health team for counseling.

'I started smiling again'

For Mpholo, the turning point came when she was introduced to Problem Management Plus (PM+), a five-session program designed by the World Health Organization to treat depression, anxiety, and stress among individuals living in low- and middle- income countries. Since 2016, PM+ has been used across many countries where PIH works, including Rwanda, Peru, Mexico, and Malawi.

Matoka Mokhali, a counselor at PIH Lesotho, led Mpholo through the PM+ program and accompanied her as she began to regain control of her life.

“When I first met her, Lerato was deeply depressed, but her willingness to open up was a positive sign,” said Mokhali. Throughout five sessions, Mpholo learned practical skills to manage her emotions, including breathing exercises, problem-solving techniques, and reconnecting with activities she once enjoyed.

“The sessions helped me see that my life wasn’t over,” Mpholo shared.

To further support a full recovery, PIH Lesotho often involves family and friends in the healing process, creating a network of care that helps patients feel less isolated. “Having my loved ones involved gave me the strength to keep going,” Mpholo reflected.

During frequent check-ups, PIH staff closely monitored her progress with a screening tool, known as Patient Health Questionnaire-9, which assesses factors such as mood, social well-being, motivation, cognition, and resilience. As her mental health improved, so did her outlook on life.

“I started smiling again and thinking about the future,” she said.

Today, Mpholo encourages others facing similar challenges to seek support and remain hopeful. “If my story can make even one person feel less alone, then it’s worth sharing,” she said with a smile.

In partnership with the Ministry of Health, PIH Lesotho continues to make mental health care more accessible for people around the country; from the capital city to remote, mountainous villages.

Editor’s Note: This blog is part of our Need to Know series, which highlights interesting information on a single subject. If you’d like to check out previous posts, here are a couple of the most-read stories in the series: MUAC and malnutrition and social support.

Taking daily medication can be challenging, especially when there’s unpleasant side effects. However, completing care can be lifesaving for people, especially those with tuberculosis (TB)—the world’s deadliest infectious disease.

To support those with TB on their road to recovery, Partners In Health (PIH) Lesotho relies on treatment supporters. They’re key members of a larger, comprehensive care team who are committed to curing patients.

Below, learn more about treatment supporters, including who they are and what they do.

Who are treatment supporters?

Treatment supporters are non-clinical individuals who provide at-home support to patients living with TB. In many cases, a community health worker (CHW) is assigned to the treatment supporter role. If a patient lives too far from a CHW, someone else—oftentimes a trusted neighbor or friend—is identified by the patient.

At PIH Lesotho, there are four eligibility criteria for treatment supporters: 1) Ability to read and write in Sesotho; 2) Less than 60 years old; 3) Live within an hour walking distance of the patient; 4) No biological relation to the patient. A non-relative is important to help prevent any bias. For example, if a patient experiences nausea or vomiting, a loved one may be more inclined to allow them to skip a round of medication or meal, explains Leshoboro Marumo, PIH Lesotho’s multidrug-resistant tuberculosis (MDR-TB) community coordinator.

Once identified, how are they trained?

If an individual meets the criteria above, the next step is training. In Lesotho, treatment supporters participate in a mandatory five-day program at PIH-supported Botšabelo Hospital. More specifically, at the halfway home—a 14-bed facility where stable patients receive TB care.

During the training, Marumo teaches participants about the basics of TB; how to keep themselves, patients, and community safe; the importance of medication adherence; the positive outcomes of medication adherence; and more.

After completing training, treatment supporters immediately begin caring for their assigned patient.

What responsibilities do treatment supporters have?

Treatment supporters’ primary responsibility is to ensure patients consistently take their TB medication in the right dose, at the right time. To ensure the best care, they are assigned to only one patient at a time.

For months, a treatment supporter visits the patient twice daily at their home during the same time frames: 8 a.m. – 9 a.m. and 4 p.m. – 5 p.m. A strict medication schedule is important for many reasons, including more effectively targeting TB bacteria, maximizing the chance of curing TB, and reducing the risk of drug resistance.

That accompaniment continues for the full duration of a patient’s treatment—no matter how long it takes. If for any reason a treatment supporter can no longer fulfill their responsibilities, then a new person is identified, explains Marumo as he stresses the importance of medication routines.

Treatment supporters’ responsibilities extend beyond medication. They also help connect patients to social support resources, such as nutritious food; and accompany them to appointments at Botšabelo Hospital in Maseru, Lesotho’s capital. Between 2021 and 2024, PIH Lesotho worked with 483 treatment supporters to reach hundreds of patients with MDR-TB, ensuring they continued their medication and attended their scheduled follow-up visits.

Why are they important?

Like PIH’s nurses and doctors, treatment supporters are deeply committed to patients and curing TB. By providing compassionate care, treatment supporters help sick patients become well again.

On a recent home visit in Lesotho, a treatment supporter faced a challenge: the patient was missing. Dealing with marital issues and other personal challenges, the patient had disappeared. Recognizing the critical need for uninterrupted TB care, the treatment supporter was determined to find him. For two months, he made phone calls, house visits, and had countless conversations, in search of the patient. 

Finally, there was a breakthrough.

The treatment supporter “went all out to the extent that he found this patient’s brother. I was able to talk to the patient’s brother and he was the one who was able to take us to [the patient]. It was far, very far,” says Marumo, “If it wasn’t for [the treatment supporter], if he had no idea what is MDR-TB, would he have gone this far?”

The patient restarted treatment and is officially cured of TB. For Marumo, that example highlights the importance of educating and training treatment supporters about TB. Through ongoing dedication from treatment supporters and health care staff, TB care is improving for patients across Lesotho and around the world.

Partners In Health United States (PIH-US) and the Deloitte Health Equity Institute (DHEI) are excited to announce the release of a new resource: a co-authored framework for collaborative infrastructure.

At PIH-US, we know how essential collaboration is to advancing health equity in the United States; our work partnering with communities across the country has demonstrated this. During the COVID-19 emergency, many high-impact collaborations emerged to address immediate needs, but without resilient infrastructure, these efforts cannot be sustained to address the systemic drivers of health inequity that fueled the crisis. In 2022, PIH-US began work with DHEI to synthesize lessons from our work, as well as from other leaders in the field, and distill them into a framework that offers a guide to drive sustained collective action and meaningful change through strengthening collaborative infrastructure.

But what do we mean by collaborative infrastructure and why is it important?  Within the context of health equity, collaborative infrastructure refers to a network of partnerships—among community members, organizers, government, service providers, and more—all pooling resources, expertise, and influence. No single organization or institution can drive equitable health outcomes alone. Structured collaboration across a community enables diverse groups with shared aspirations to: 

• Align on community priorities and a common agenda 
• Share resources, knowledge, and skills across organizations
• Identify and steward funding opportunities more equitably
• Sustain collective action for the long-term 

At PIH-US we believe that strong collaborative infrastructure helps advance health equity because it leverages multi-sector partnerships and grassroots organizations to advance community-driven solutions and ensure that resources are distributed more equitably in the short-term, while working to disrupt deep-rooted power dynamics and systems that hold back justice and equity in the long term.

The Collaborative Infrastructure Framework is a tool designed for organizations, health departments, leaders, and coalitions to think about with whom, how, and why they collaborate with others to advance health equity, either within a community or on a specific project. Whether part of a national organization, a small local nonprofit, or an individual leader, this framework aims to help users ask appropriate questions, make strategic decisions, and form partnerships that drive impact.

Inside you'll find:

• Four chapters designed to help groups think through the important elements and questions to ask when collaborating
• Interactive tools and exercises to help guide your work 
• Case studies that spotlight how others have built powerful collaborative networks—and the lessons they’ve learned along the way

Are you a community leader looking to make a bigger impact? A health department ready to deepen your partnerships? A coalition figuring out how to tackle complex challenges? The Collaborative Infrastructure Framework is for anyone passionate about creating healthier, more equitable communities. 

Download the Collaborative Infrastructure Framework to access helpful tools for action.

As we celebrate and reflect on Partners In Health’s (PIH) decade of work in West Africa, it’s clear that we’re closer to achieving health equity. Looking back at where we began to where we are now is a reminder of what’s possible with accompaniment and long-term partnership.

By working alongside local communities and the Sierra Leonean government, we’ve supported the country in cutting the maternal mortality rate by more than half. That was made possible through significant improvements to care for women and their families, including the following achievements between 2020-2023:

• 55% increase in women who gave birth at PIH-supported Koidu Government Hospital (KGH)
• 111% increase in women starting a new family planning method at PIH-supported Wellbody Clinic
• 219% increase in prenatal care visits at Wellbody Clinic 

In partnership with the Liberian government, we revitalized the health system in the most remote communities and the country at large. Together, we've strengthened primary care, notably by training and hiring community health workers (CHWs), who screen patients for various diseases, and refer—and often accompany—them to the hospital.

Between 2019-2023, CHWs in Liberia completed 171,693 home visits. Those visits and referrals include tuberculosis (TB) treatment, in which PIH has become a nationwide leader, and recently, pioneered artificial intelligence-based testing leading to a 92% treatment success rate in 2021. Other notable successes in TB care include the following between 2019-2023 in Liberia:

• 6,686 TB tests performed across PIH-supported facilities
• 3,682 patients started on TB treatment

Ten years ago, it was hard to imagine such progress in a region that—at the time—was struck by Ebola, a highly contagious and infectious disease with historically high death rates. Back then, an Ebola diagnosis was a death sentence. Thankfully, the epidemic was contained, and health systems are now stronger.

Launching an Ebola Response

In the summer of 2014, the governments of Liberia and Sierra Leone reached out to PIH for urgent support in responding to Ebola.  At the time, PIH leadership and clinicians had no experience treating the virus, nor did we work in West Africa. Despite that, late PIH Co-founder Dr. Paul Farmer knew PIH’s then decades-long experience in battling infectious diseases globally could help end the Ebola epidemic.

In October 2014, PIH’s work began in Liberia and Sierra Leone.

Anticipating many challenges, we were fueled by a simple belief: health care is a human right. We also knew that Ebola’s rapid spread and deep impact were symptoms of weak health systems shaped by decades of injustice: colonialism, the trans-Atlantic slave trade, and civil war, to name a few, in both countries.

“Across West Africa, weak health systems are a legacy of colonial rule, which, promises and propaganda aside, knew few successes in public health—and almost none in providing medical care for the natives,” Farmer wrote in Fevers, Feuds, and Diamonds: Ebola and the Ravages of History.

Such injustices allowed the Ebola outbreak to become the largest and deadliest in recorded history—with more than 28,000 people sickened and 11,000 deaths.

“We all realized that those deaths couldn’t be attributed to Ebola alone,” says Dr. Maxo Luma, PIH Liberia’s executive director. “And we refused to accept that as an organization.”

PIH began treating patients in collaboration with local ministries of health. In Liberia, the government directed PIH to Zwedru and Harper, two of the most underserved cities in the country. Harper, a remote coastal community in Maryland County, was lined with abandoned buildings, remnants of the war that ended a decade prior and home to J.J. Dossen Memorial Hospital. The aftermath of the war was also present in Port Loko and Kono Districts—where PIH was invited to provide care and support in Sierra Leone out of Ebola Treatment Units (ETUs) and existing health facilities.

As the death toll rose, international response remained slow and inadequate. Rightfully outraged by this, Farmer and other PIH leaders knew they needed to act fast.

First step: recruit staff.

“We had clinicians from Haiti who were there helping us. People in Mexico and Peru, who this wasn’t impacting them, but they were in solidarity to people who were suffering and knew that’s what we did best. Even if they couldn’t go, they were supporting behind the scenes to take care of other things,” says PIH CEO Dr. Sheila Davis, who served then as chief of Ebola response.

“It was never a question that we should go and that everyone would pick up the slack,” adds Davis, “as many staff were needed immediately to provide logistics, operational, and on-the-ground support.”

In the months ahead, PIH trained and deployed 200 volunteer clinicians from the United States and hired 2,000 community health workers (CHWs) and support staff across Liberia and Sierra Leone.

'They stopped ... but PIH continued'

Nurses, doctors, CHWs, and other staff were working across both countries, night and day, doing whatever it took to get patients well again. As Ebola ravaged through communities, killing hundreds of health care workers, those who survived remained committed to providing services.

In Liberia, PIH leaders and staff arrived in September to find the outbreak had mostly affected the capital of Monrovia and largely spared remote communities, such as those in Maryland County. While they worked with government partners to establish infectious disease prevention protocols, they also toured facilities, such as J.J. Dossen Hospital and nearby Pleebo Health Center, to assess where they could help provide care.

What they found was shocking: One general doctor was charged with leading J.J. Dossen’s administration and providing all specialized care.

PIH’s mandate gradually shifted from responding to a (now waning) outbreak, to supporting a health system that was in severe shortage of skilled staff.

Meanwhile in Sierra Leone, PIH-trained clinicians rotated in long shifts through ETUs in the capital of Freetown and more remote Port Loko and Kono districts. They focused on finding quicker ways to provide rapid rehydration to patients—key to treating a disease like Ebola—and moved from oral solutions to IVs. It was a risky move for caregivers, given transmission was through contact with contaminated fluids like blood, but it was lifesaving for many. All told, roughly  4,000 survivors left PIH-supported ETUs and returned home.

At Port Loko, each survivor who left the facility tied a ribbon made of local fabric to what became known as the “Survivor Tree.” The tree, now several meters tall, stands there, with remnants of fabric clinging to the highest branches. Many survivors still work for PIH Sierra Leone today, a decade later..

“When I initially went to the ETU, I was scared,” Mohamed Nao, an Ebola survivor turned PIH employee who’s known by colleagues as “Chairman,” reflects a decade after being discharged from an ETU. “When people started talking to us … giving us medication, taking care of our affairs and cleaning up ... Until that time I actually feel confidence that, ‘Yes, I am okay. I’m safe where I am.’”

Nao, 20, remained in the ETU’s male ward for 21 days. Then came October 5, 2014.

“Whenever I remember that day, I feel joy,” he says. “That was the day I survived.”

Less than two years later, the epidemic was officially declared over, and large, well-funded aid organizations quickly left the region.

“They stopped giving us support, but PIH continued,” says Nao.

Unfamiliar with PIH at the time, he distinctly remembers the ongoing assistance in the form of social support: bags of rice, monthly stipends, educational assistance, and more.  Since late 2014, Nao has worked as a social support and patient referral coordinator for PIH Sierra Leone, coordinating services from start to finish for survivors of Ebola and TB. On a regular basis, he communicates with PIH clinicians to discuss patients’ needs, visits schools to coordinate school supplies and fees, and visits patients in their homes.

Committed to long-term health system strengthening, PIH remains in West Africa. As other organizations left, PIH believed staying was the morally right decision, the best way to prevent future outbreaks, and the means to rebuilding the local health system.

Building Health Systems: A Holistic Approach

Over the past 10 years, PIH has worked with government partners to strengthen key elements known as the “five S’s”: staff, stuff, space, systems, and social support. With significant improvements in each area, health systems have become more reliable and resilient across West Africa.

“The value of accompaniment to our partners and patients means meeting them where they are in their journey and walking together from start to finish,” says Vicky Reed, PIH Sierra Leone’s executive director.

In Sierra Leone, PIH’s commitment to maternal health began from the moment we arrived, when we established one of the first maternal ETUs in Freetown. By safely isolating woman in labor from those with Ebola—who often experience the same symptoms—clinicians could provide appropriate care, while addressing common causes of maternal death, such as eclampsia. Across the country in rural Kono District, KGH was still standing when PIH arrived, despite the facility being in the epicenter of the civil war. However, it lacked electricity, running water, and other vital resources to deliver high-quality services. It was the only hospital in the region, but many patients avoided it because of its poor reputation. Today, KGH is adequately equipped to support expectant mothers—from pre- to post-natal care—and draws patients from around Sierra Leone and neighboring countries.

To date, thousands of babies have been safely delivered at KGH; and between 2020-2023, there was a 44% increase in lifesaving C-sections and a 51% increase in live births. Now, the facility is nationally recognized as a model hospital.

As we continue to advance women’s health, one of our most comprehensive projects is underway: the Maternal Center of Excellence (MCOE). As an expansion of KGH, the MCOE is a state-of-the-art teaching and referral hospital, which broke ground in April 2021. It will increase the availability of quality care for women and children and serve as an innovation hub for clinical training and research, creating a global platform of expertise that can deliver resources for improving women’s health worldwide.

In addition to improvements at KGH, PIH has achieved many other milestones in Sierra Leone over the past decade:

• opened the country’s first multidrug-resistant tuberculosis program at Lakka Government Hospital outside the capital;
• transformed Sierra Leone Psychiatric Teaching Hospital into a formally accredited facility, where clinicians provide dignified care and train future generations of mental health care providers;
• pioneered an electronic medical records system at Wellbody Clinic, while serving as a model of primary health care delivery, training, and innovation.

Always a Partnership

Simultaneously in Liberia, growth over the past decade is visible across the health care system—from basic primary care to lifesaving surgery. Since PIH’s arrival in the country, our strong integration and partnership with the Liberian government has enabled dramatic changes.

“Partners In Health went the extra mile in assisting our health sector,” says George A. Prowd, former superintendent of Maryland County, Liberia, noting PIH’s role in training and educating nurses and renovating existing infrastructure. “Sometimes if you try to reflect your mind far back as to the period before PIH and you start to wonder: ‘What if Partners in Health did not come? What would things have been like?’”

Together with government partners, PIH Liberia has made access to high-quality medical services in Maryland County a reality. At J.J. Dossen, we opened the first and only multidrug-resistant tuberculosis ward outside of Monrovia, the country’s capital. Committed to the next generation of health care workers, we’ve launched a family medicine residency for physicians at J.J. Dossen, and we’ve supported students enrolled in bachelor’s programs in nursing, midwifery, and public health at Tubman University, the only university in southeastern Liberia.

When Tubman University’s President, Dr. Olu Q. Menjay, arrived and toured the campus for the first time, he was discouraged by the poor infrastructure. Then, he entered a modern room. It was air-conditioned and lined with comfortable chairs, wooden desks, and new computers equipped with e-libraries.

“That room provided me hope at Tubman University. And that room was funded by Partners In Health,” says Menjay. The vibrancy of the University’s College of Health Sciences would not have been possible without the support of PIH, given the limited budget allocations from the Government of Liberia, he adds.

Guided by the firm belief that everyone deserves the best care possible, PIH will continue to work with partners and local communities to fight for health as a human right in West Africa, over the next decade—and beyond.

“As we look at pushing the envelope on health equity ... what are these other things that are happening that are going to cause transformation? That’s driven by leaders on the ground,” says Davis. “We have 19,000 people around the world and it’s very driven around what’s best for their communities. We’re there to support, but they’re driving it.”

On December 15, Cyclone Chido swept from the east coast of Africa to Malawi, bringing high-speed winds of 124 miles per hour and heavy rainfall equivalent to a Category 4 hurricane. The storm ravaged 14 districts across the country, affecting a population of approximately 34,740, leaving seven people dead, 16 injured, and many communities cut off from food, clean water, and health care.

Neno District, a remote region of Malawi, bore the brunt of the cyclone’s destruction. At least 253 homes were damaged, while extreme winds ripped away the roofs of schools, government buildings, and health facilities. The county’s Department of Disaster Management reported that critical roads leading to Matandani, Matope, Nsambe, and Dambe were destroyed, making access to health facilities in these locations extremely challenging. This has left many families stranded, unable to reach essential health services.

Partners In Health (PIH), known as Abwenzi Pa Za Umoyo (APZU) in Malawi, has worked alongside the country’s government since 2007 to provide health and social services to Neno’s community. Despite promising strides in the district’s health care offering over the past 17 years, infrastructure in the region is limited—the district has only one paved road, and just over 3% of households have access to electricity.  

Due to its underdeveloped infrastructure and geographic remoteness, Malawi is highly vulnerable to extreme weather events like cyclones, floods, and droughts. In recent years climate change has intensified the impact of such events, leading to catastrophic results.  

APZU staff are assessing the community's immediate needs and coordinating with local authorities to respond to the unfolding crisis. The team will assist with repairing damaged roads and will provide support to vulnerable households affected by the storm. APZU is also taking measures to prepare for a potential cholera outbreak.

Cyclone Chido exited Malawi on December 16, moving into neighboring Mozambique, but its aftermath continues to pose significant risks. Malawi’s Department of Climate Change and Meteorological Services (DCCMS) confirmed that the cyclone is no longer an active threat to the country, and they ceased search and rescue operations—but lingering extreme weather conditions could lead to flash floods and further destruction. As a precaution, the National Emergency Operation Centre remains operational, monitoring the situation and ready to respond as needed.  

The local government is currently completing an impact and needs assessment to determine the extent of the storm’s damage. Response teams across Malawi anticipate an urgent need for food and other items in the coming weeks, including blankets, sleeping mats, and tents.  

Meanwhile, PIH continues to support government stakeholders in mobilizing resources to address the evolving needs of the affected communities. Ensuring access to health care remains a priority. 

In May 2020, PIH-US was invited to Illinois to help support the Illinois Department of Public Health’s COVID-19 response. Throughout the pandemic, PIH-US convened community-based organizations, governmental public health leaders, local philanthropies, and health care providers from across the state to share resources, experience, and emerging best practices to strengthen and inform the COVID-19 response. Coming out of the crisis, PIH worked to sustain these alliances between community leaders and public health decision-makers through a range of convening spaces and programming.  We are grateful to have been a part of the exceptional community-based public health and health equity ecosystem in Chicagoland over the last several years. As we wrap up our current programming and formal partnerships in Chicago at the end of 2024, we want to celebrate some highlights from the last four years and express our gratitude for the many incredible partners we’ve had the privilege to accompany and work alongside. Below, we highlight our shared impact from the last several years.

(1) Bolstering the state’s pandemic response 

PIH-US supported the Illinois Department of Public Health to project contact tracing workforce needs. We also designed and scaled a state-wide care resource coordination program. Through this partnership, over 2,500 contact tracers, case investigators, care resource coordinators, and managers were hired to manage caseloads and support isolation and quarantine across the state. When vaccines became available, we helped the Cook County Health Department identify gaps in vaccine access and deploy mobile vaccination units to these areas. PIH-US also partnered with Malcom X Community College to develop a free, online training that prepared more than 3,000 community members to speak to their neighbors about vaccination. After the course, participants received ongoing support through an online learning community of vaccine ambassadors.

(2) Reducing barriers to vaccination

PIH-US convened and managed the Chicagoland Vaccine Partnership (CVP), a consortium of more than 160 community, government, and health care organizations that worked to coalesce community-led public health outreach and increase vaccine access in vulnerable communities. Through weekly town halls, grant distribution, skill-share trainings, and other events, community organizers were equipped with resources to build vaccine confidence and reduce barriers to access. As part of a consortium, PIH-US directed more than $3 million in grants to 100+ community-based organizations to design their own COVID-19 outreach and vaccine access solutions. One of these organizations, Public Equity, used grant funds to conduct door-to-door outreach and put on 23 events to educate and vaccinate. Events included quality of life fairs, where they reclaimed vacant lots to offer vaccination, nutrition advice, gym memberships, and free yoga classes, as well as “pop-up” events to encourage on-site and in-home vaccination

(3) Launching the Community Health Organizer Accelerator

PIH-US’s Community Health Organizer Accelerator trained community organizers to mobilize their communities in the fight for health equity. We partnered with community organizations to equip five community health organizers to raise community awareness of critical services by providing training in advocacy, organizing, public health skill-building, and resource navigation. When GAP Community Center, a community-based partner, struggled to identify legal and social services for the influx of migrants arriving in Chicago, PIH-US helped organize “Know Your Rights" informational sessions and facilitated connections to immigration lawyers. By connecting the Alliance of the Southeast, a coalition supporting neighborhoods in Southeast Chicago, to the Respiratory Health Association, PIH-US bolstered the Alliance’s efforts to hold a neglectful apartment management company accountable.

(4) Supporting the public health workforce

PIH-US convened and led the Chicagoland Learning Community, a network of community-based ambassadors strengthening health literacy, access, and outcomes across the region. The Learning Community hosted weekly knowledge-sharing, skill training, and community-building events and delivered customized trainings for cohorts across the region, including through a partnership with the Chicago Department of Public Health’s Healthy Chicago Equity Zone (HCEZ). The goal of HCEZ was to establish hyper-local partnerships to address and close Chicagoland's racial life expectancy gap. PIH-US provided mentorship and guidance to regional leads in the HCEZ, who offer administrative and project management support to community-based organizations.

Learn more about our work in Chicago.
 

The Community Health Worker Access Act is Introduced

PIH-US helped advance the Community Health Worker (CHW) Access Act, a bill that would increase access to CHW services for Medicare and Medicaid beneficiaries by improving reimbursement for the workforce through Medicare and supporting their integration into Medicaid.  PIH-US, CHW advocates, and PIH Engage—a grassroots advocacy network—have been partnering to advance this legislation throughout the year, meeting with over 90 members of Congress. In March, more than 80 CHWs, allies, and advocates from across the country gathered on Capitol Hill to meet with members of Congress and legislative staff about the CHW Access Act during the second annual CHW Hill Day. This year, Hill Day featured a congressional briefing, hosted jointly by PIH-US and the National Association of Community Health Workers, and a rally in a historic Senate hearing room.

North Carolina CHWs Use Annual Advocacy Day to Ask for Support

In May, the North Carolina Community Health Worker Association (NCCHWA) and its partners, including PIH-US, hosted the second annual NC CHW Advocacy Day to discuss community health workers’ impact on advancing the state's health priorities. More than 100 community health workers and allies from across North Carolina met with over 70 elected officials to ask them to sign on to HB1026, which would provide critical financial support enabling NCCHWA to mobilize, train, and certify CHWs. While HB1026 did not pass this session, the strong bipartisan support for this bill shows the increasing enthusiasm and momentum for CHW infrastructure in the state

Congress Supports CHWs Through Awareness Week Resolution  

In August, Senator Bob Casey, Jr. and Representative Raul Ruiz, M.D. introduced a resolution formally recognizing the week of August 26-30, 2024, as the second annual National CHW Awareness Week. The resolution (S.Res. 771 / H.Res. 1389), had 11 co-sponsors across the House and Senate, five more than last year. The national resolution was also accompanied by proclamations celebrating Awareness Week in several states, including North Carolina. Awareness Week, which was developed by NACHW, aims to encourage CHWs and allies across the United States to celebrate, commemorate, and collaborate with each other and to raise awareness of the diversity of the CHW profession, workforce, and movement. This year, organizations across the country hosted events, workshops, and outreach activities to increase awareness and engagement among communities and decision-makers.

Public Health for Community Power Building Coalition Launches

PIH-US joined the Public Health for Community Power Coalition as a founding member of its steering committee. Led by Human Impact Partners, the coalition unites public health and community power-building organizations to address systemic inequities through grassroots advocacy and policy campaigns.  

Massachusetts Takes Steps to Boost Public Health Systems

In November, Governor Maura Healey signed the SAPHE 2.0 bill into law, marking a major milestone for public health in Massachusetts. Championed by Senator Jo Comerford and Representative Hannah Kane, the bill establishes statewide public health standards, ensures credentialing for public health workers, secures funding for local health departments, and introduces a unified data system for all communities. PIH-US endorsed and actively advocated alongside the Massachusetts Public Health Association for the passage of this transformative legislation, which will strengthen public health infrastructure and support the public health workforce needed to address health issues.

Throughout the year, PIH-US partnered with state and national community health worker networks across the country to amplify their voices, foster collaboration, and support advocacy efforts through coalition building, policy development, and storytelling. It is crucial for health and government decision-makers to understand the incredible impact of community health workers on health outcomes, and to recognize the importance of this workforce. And the most effective advocates for this are community health workers themselves. These advocacy wins remind us that change is possible when those closest to the challenges are at the forefront of the solutions—ready, confident, and united in their mission. 

Every year comes with a different set of opportunities and challenges. As 2024 draws to a close, Partners In Health (PIH) is proud to have met this year’s highs and lows, standing in solidarity with marginalized people around the world. Through moments of turbulence, uncertainty, and despair, our global teams of clinicians, community health workers, researchers, and advocates worked tirelessly to remove roadblocks to health care and provide lifesaving support to those who need it most.  

From Haiti to Rwanda to Mexico, we have remained steadfast in accompanying local governments, medical staff, patients, and communities, continuing the legacy of our late Co-founder Dr. Paul Farmer, who acted on the belief that health is a human right and that access to quality care should not be determined by income or geography.

For PIH, this year’s challenging times gave way to opportunities for change, growth, and strengthening our commitment to global health equity. In case you missed it, here are some of our favorite moments:  

1. TIME: Ophelia Dahl is on the 2024 TIME100 List

In April, PIH Co-founder Ophelia Dahl was named one of TIME Magazine’s 100 Most Influential People of 2024. In a piece written by esteemed author and PIH trustee John Green, Dahl is recognized for her more than three decades of work challenging health inequity around the world. Read the full story.

2. Devex: How Partners In Health has kept open its Haiti clinics amid crisis

Amid escalating violence and political instability, Zanmi Lasante (ZL), as PIH is known in Haiti, has been unwavering in its devotion to serving the country’s most vulnerable populations. In April, global news organization Devex spoke with Dr. Wesler Lambert, ZL’s interim executive director, about the 30 years of experience that help day-to-day clinical operations and care delivery persist, despite the challenges of transporting medical staff and supplies. Read the full story.

3. PBS News Hour: University connecting doctors to remote African communities

In April, PBS Newshour travelled to Rwanda to explore how the University of Global Health Equity (UGHE) is connecting people living in impoverished, remote communities to lifesaving care. Dr. Abebe Bekele, UGHE's deputy vice chancellor for academic affairs and research, discussed the programs and partnerships that help prepare medical professionals for treating underserved populations across Africa. Watch the video.  

4. Major advance in the fight against MDR-TB: three new short and effective treatments from recent clinical trials approved by the WHO

In August, the World Health Organization approved four new short and effective multidrug- or rifampicin-resistant tuberculosis treatment options, marking a significant breakthrough in TB care. The treatments, studied in a PIH-led endTB clinical trial, represent nearly a decade of scientific research and patient care across 18 countries. Read the full story.

5. AP News: Sierra Leone not long ago still chained mental health patients. A transformation is underway

With support from PIH, Sierra Leone’s mental health care system is undergoing a crucial transformation. In August, The Associated Press spoke with PIH’s Mental Health Program Co-director Dr. Giuseppe Raviola about the improved infrastructure, newly trained staff, specialized professionals, and expanded services that have turned a once stigmatized psychiatric facility into the highly regarded Sierra Leone Psychiatric Teaching Hospital. Read the full story.

6. NPR (Goats and Soda): Facing Haiti's gang violence, doctors stand by their patients

In a September article discussing disruptions to Haiti’s health care system, where many facilities have either been looted or closed due to the presence of armed gangs, NPR’s Goats and Soda spoke with ZL’s Director of Strategic Planning Dr. Joseph Reginald Fils-Aimé about ways the organization is adapting, offering mobile clinics and finding creative ways to transport patients in need of care to the few remaining hospitals. Read the full story.

7. The New York Times: Can John Green Make You Care About Tuberculosis?

In October, YouTube personality and longtime PIH supporter John Green spoke with The New York Times about the global fight against tuberculosis (TB) and his forthcoming nonfiction book, “Everything Is Tuberculosis.” Green uses his platform to raise awareness about the preventable and curable disease that still kills millions each year, engaging his dedicated Nerdfighteria community to advocate for affordable treatments and diagnostic tests. Read the full story.  

8. Timeline of Paul’s impact on TB Care  

In honor of Paul’s birthday in October, PIH developed a timeline tracking the PIH co-founder's contributions to improving TB treatment, research, and policy across the globe. Swipe through the illustration.  

9. Instagram Q&A: How PIH provides mental health support in Haiti and Mexico through uncertain times

For World Mental Health Day in October, PIH hosted an Instagram Story Q&A with mental health staff from Mexico and Haiti. Ana Ortega, mental health program coordinator, and Dr. Fatima Rodriguez, programs manager for Compañeros En Salud, as PIH is known in Mexico, joined Dr. Junior Brice, mental health program manager for ZL, to answer questions about sustaining mental health programming and self-care in challenging environments. Check out the recap.  

10. Instagram Live at the Maternal Center of Excellence (MCOE)  

Sierra Leone has one of the highest maternal mortality rates in the world, yet care is steadily improving at PIH-supported facilities, leading to significant decreases in maternal death. The MCOE provides advanced maternal and child health services that offer a promising solution to the devastation of maternal loss. Since breaking ground in 2021, PIH has made significant progress on the facility, and in December, hosted a live Instagram event, to talk about what this facility will mean to women and children living in Sierra Leone—and beyond. Watch the event.

This year, PIH-US supported community and public health partners to advocate for and advance community-centered policies, expand community health infrastructure, and train the community-based workforce. Below, we recap some of PIH-US's accomplishments from 2024.

Advanced Community-Centered Policies

In New Bedford, Massachusetts, PIH-US is working closely with the health department, public sector partners, and over 55 community-based organizations including local nonprofits and community development corporations to advance equity through a Health Equity Community of Practice (HECoP). By facilitating trainings, quarterly community convenings, and networking, this coalition is shaping policies that bolster community priorities. This year, the HECoP endorsed the "Cover All Kids" legislation to increase healthcare for every child in Massachusetts; supported initiatives to improve mental health awareness and training, while building partnerships to break the stigma around seeking help; and promoted civic engagement by improving language access for non-English speakers.

Expanded Community Health Infrastructure

PIH-US is working alongside Acenda Integrated Health and the New Jersey Department of Health to strengthen New Jersey’s community health worker (CHW) infrastructure and develop a statewide CHW Hub. The Hub focuses on training, deploying, and ensuring the sustainability of CHWs. As the lead agency of the Hub’s Engagement, Recruitment, and Retention Committee, PIH-US is leading efforts to engage and organize CHWs across New Jersey and ensure they have representation in the decision-making process. Most recently, PIH-US recruited 15 CHWs to help establish a working group for the first statewide CHW Association. PIH-US is also leading efforts to determine the current landscape of the CHW workforce in New Jersey. PIH-US launched a comprehensive employer survey to map out where CHWs are located in the state, the roles they serve, the benefits they receive, and the challenges they are facing. The survey currently has over 40 responses and provides a snapshot of New Jersey's CHW workforce.

Provided Continuous Education and Professional Development for the Community-Based Workforce

PIH-US has been working with the Arizona Community Health Workers Association (AzCHOW) to build support for the state’s community health workforce. In June, PIH-US delivered a plenary session to over 380 community health workers, community health representatives, promotoras, and allies in attendance at AzCHOW’s annual Roots Conference. The session equipped Arizona’s community health workforce with the tools to advocate for and amplify their roles in health systems. Following the in-person training, PIH-US and AzCHOW launched a webinar series to reinforce skills and connect Arizona’s community health workforce to additional training and resources.

PIH-US also delivered a plenary session to over 120 CHWs at the Florida CHW Coalition’s annual meeting. The session used lessons from the 2023 CHW Awareness Day and equipped CHW's with the tools and resources to educate local and state decision makers on the CHW workforce and the support they need. Participants also received continuing education credits for attending the training.

Documented Best Practices and Lessons Learned

For the last three years, PIH-US has supported the city of Montgomery, Alabama to integrate CHWs to tackle health disparities in underserved populations. Since 2021, CHWs in Montgomery have reached over 17,000 community members with health education and linkages to health resources, and partnered with over 300 local organizations to connect individuals to critical resources such as transportation, housing, and health services. In May, PIH-US published a project report for the CHW program which highlighted lessons learned, best practices, and recommendations for the future, including CHW models, hiring strategies, and sustainable funding pathways.

In August, PIH-US wrapped up three years of work with the North Carolina Department of Health and Human Services Office of Rural Health on the NC CHW Initiative. Working in close collaboration with the Office of Rural Health and other community partners, PIH-US helped build an infrastructure for CHWs in the state, including standing up the NC CHW Association, expanding CHW standardized and specialty training, launching a CHW pilot in federally qualified health centers, and evaluating the impact of past and present CHW programming across the state. PIH-US developed a CHW landscape report, as well as a comprehensive set of lessons learned that were informed by North Carolina’s CHW Initiative and designed to guide nationwide efforts to advance community-based health approaches. PIH-US continues to support North Carolina’s CHW Initiative alongside the NC CHW Association and partners with strategic planning and policy advocacy to ensure the long-term integration and success of CHWs across the state.

In November 2023, Partners In Health (PIH) announced Nadine Karema as the new executive director of Inshuti Mu Buzima (PIH’s local name in Rwanda). Nadine assumes this crucial role following Dr. Joel M. Mubiligi, now PIH’s chief innovation and growth planning officer in charge of setting a strategic organizational vision for growth across all 11 PIH sites and the University of Global Health Equity (UGHE) in Rwanda.    

Nadine brings a wealth of experience to her new role as executive director. Formerly the deputy executive director, she worked closely with Joel to provide comprehensive leadership for Rwanda's Inshuti Mu Buzima (IMB) mission and strategic plan.  

Since joining IMB in 2013, Nadine has held key positions, including health information systems (HIS) manager, HIS director, informatics director, and chief informatics officer, along with two mandates as chair of the procurement committee. Her career has mainly been focused on digital transformation, systems improvement, and promoting data-driven decision-making to improve the lives of patients and vulnerable communities served by PIH/IMB. She also has a growth mindset, fostering capacity building for strategic alignment within the many teams she oversees.  

In addition to her experience with IMB, Nadine provided technical assistance to the Rwanda Ministry of Health within the Digital Health Technical Work Group. She co-chairs the National e-Learning Committee for Rwanda’s health sector NGOs. Nadine has also contributed to UGHE's Executive Education program as a digital health expert and leadership instructor. She serves as a board member of UGHE.  

"Nadine’s commitment to serve the most vulnerable and demonstrated insight into how we can best serve them have positioned her as a thoughtful and trusted leader among IMB staff and a reliable collaborator among partners," Dr. Sheila Davis, chief executive officer of PIH, shared.  

IMB has been working in Rwanda since 2005, supporting the government's health system strengthening efforts. The organization is now helping with technical assistance and provision of high-quality healthcare in a catchment area of 47 health facilities serving over 1 million people across three districts.  

This announcement was originally published on IMB’s website: https://www.pih.rw/post/nadine-karema-appointed-as-the-next-executive-director-of-partners-in-health-rwanda 

It’s incredible what can happen in just a year.

This year, Partners In Health (PIH) staff faced incredible challenges: escalating violence in Haiti and instability in Mexico, the Marburg virus disease emerging in Rwanda, Sierra Leone declaring a national emergency due to substance abuse, and so many other daily struggles that occur in vulnerable communities around the world. However, PIH remained steadfast, accompanying patients and providing care no matter the circumstances.  

We saw breakthroughs in tuberculosis (TB) treatment, significant improvements in maternal health, activists building movements and shaping policy to improve health care, and countless other reasons to celebrate. See below the stories, videos, and social posts that you, our supporters, were most excited about this year.  

Becoming a PIH Insider

At PIH, we often use terminology that may be unfamiliar as we’ve developed our own lexicon over the years. A key term that describes the “why” and the “how” of PIH’s work is a concept from liberation theology called accompaniment. In simple terms, it means being there, together with our patients, for as long as it takes. This video helps articulate what that looks like in our work.

Another concept driving the work of PIH is social medicine, based on the idea that social forces affect our health and lead to health inequities. One of our favorite blogs of the year helps describe how this concept changes our approach to providing health care and why it matters.

If you want to delve even deeper into sources of inspiration—and entertainment—of PIH staff, we invite you to look at our summer What to Read, Watch, and Listen to list. Or watch “Bending the Arc," the critically acclaimed documentary about PIH’s origins. Speaking of PIH’s founding, Co-Founder Ophelia Dahl was named one of the world’s 100 most influential people in 2024 as part of the annual TIME100 list—a well-deserved recognition for her work as an advocate and leader in global health.  

The Deadliest Infectious Disease

Despite TB being considered a disease of the past for many people in wealthy Western countries, it is the deadliest infectious disease, killing someone every 20 seconds. So, why doesn’t it make headlines? We have a couple of ideas.

When talking about TB, we have to mention the incredible impact of our late Co-Founder Dr. Paul Farmer on the treatment of the disease. We made it easy for you to explore his work over three decades transforming care for patients with TB.  

Although Farmer passed away in 2022, his example remains a driving force in TB work around the world. TB experts and activists continue to advocate for equitable care, including better education about the disease and accessible treatment regimens.  

We are constantly working to carry on Paul’s legacy, through groundbreaking clinical trials and legislation that can revolutionize TB care globally. To make it simple, we joined in on this viral moment.

⁠Maternal Health in Sierra Leone

The PIH team in Sierra Leone, a country with one of the world’s highest maternal mortality rates, has been working diligently and thoughtfully to prevent maternal and child deaths. And it’s working.  

Isata Dumbuya, director of reproductive, maternal, neonatal, and child health, joined the BBC to speak about how maternal health care has improved and what we can look forward to with the future opening of the Maternal Center of Excellence (MCOE) in Kono District.

Sister Patricia Efe Azikiwe, a reproductive, maternal, newborn, child, and adolescent clinical program manager at PIH-supported Koidu Government Hospital, looks forward to seeing how the MCOE will help even more mothers and babies. She has become a key part of training and care delivery within the current facility’s maternal ward, supporting both clinical staff and expectant mothers. Both passionate and practical, she chose to share her story with us this year.

Care Continues in Haiti

As widespread violence and instability in Haiti continued to escalate throughout the year, we provided updates on how our work didn't stop for the patients who needed us most. Despite periods of uncertainty, care continued and Zanmi Lasante, as PIH is known in Haiti, remained a beacon of hope for patients. Even our mobile clinics, including those focused on treating and preventing malnutrition, found ways to navigate fuel shortages, violence, and unpredictable roadblocks to reach our patients at home–whether by rescheduling clinic visits or finding alternative routes.

During this challenging time, Zanmi Lasante found light in the darkness, harnessing the sun's power. In partnership with Build Health International, Zanmi Lasante installed an expanded solar power system at Hôpital Universitaire de Mirebalais to eliminate their reliance on the unstable national grid and fuel-powered generators. This new solar system will help ensure care can continue uninterrupted despite instability.  

Building a Better Future

Did you know you can support PIH and our work around the globe without pulling out your wallet? You can help prioritize TB care globally by signing the End TB Now Act, which has passed in the Senate, but still needs your voice to help it pass in the House of Representatives. And, while you’re in communication with your government officials, please tell them about the Community Health Worker Access Act as well.

We also compiled a list of nine resources to help global health advocates get involved. You can use these tools to get inspired to take action toward health equity in your community and around the world. 

This year, Partners In Health (PIH) continued to push for a more equitable world where every person’s right to quality health care is a reality. A modern canoe turned the tide in Liberia, giving families access to the hospital and school. Community health workers provided timely mental health care to patients.  Students celebrated the start of their education at Rwanda’s top-ranked University of Global Health Equity (UGHE).

Below, those moments and others are documented by PIH photographers across the 11 locations where we work. Throughout the story, staff members share reflections on the memorable moments they experienced alongside clinicians and patients, highlighting the impact of our shared efforts.

PIH Nurse Mampiti Mpiti leads a group exercise for expectant mothers at Manamaneng Health Center in Thaba-Tseka District, Lesotho. Photo by Justice Kalebe / PIH

Reflection from Justice Kalebe, photographer at PIH Lesotho:

“As a humanitarian photographer, understanding the mission and values of the organization is crucial for effectively conveying the stories behind the images I capture. When I visit the sites, I take the time to familiarize myself with the communities served by PIH clinics, adding depth to my photographs. During a visit to the Manamaneng Health Center, I met ‘Malisebo Sebilo (top photo) and her daughter, Ntsine, from Pholeng village, while they were collecting meals from the PIH-supported Lesotho Nutrition Initiative. ‘Malisebo has partial hearing impairment, and I worked to establish a rapport with her to capture authentic, engaging images in a dignified manner. Despite the snowy conditions, which made photography challenging, I seized the rare opportunity to focus on emotions, expressions, and interactions between mother and child through close-ups and detailed shots, providing a comprehensive view of their story. My time in Manamaneng was enjoyable, as I was able to connect with the subjects and create spontaneous moments that resulted in powerful images resonating with viewers and contributing to PIH’s mission. As a humanitarian photographer, I use my work as a monitoring and evaluation tool to document the impactful work PIH is doing. I find fulfillment in traveling to different sites, meeting clients, and capturing storytelling elements that effectively engage PIH's audience and partners, enriching my overall experience.”

In honor of International Women’s Day, staff from PIH Rwanda, known locally as Inshuti Mu Buzima (IMB), and the Kirehe District Hospital gathered to honor both organizations’ women with a celebration in Kirehe, Rwanda. Photo by Asher Habinshuti / PIH

Reflection from Asher Habinshuti, photographer at IMB: 

“I felt both honored and exhilarated to witness and document such an uplifting event. In Rwanda, the increase in women’s employment in recent years has been remarkable, with more women stepping into skilled sectors such as science, engineering, health care and manufacturing. This shift represents progress, not just for women, but for the entire society. Seeing men actively celebrating women on a day like Women’s Day is deeply meaningful. It’s more than just joy, it’s symbolic. Moments like these reflect the breaking of stereotypes and a communal acknowledgment of the vital roles women play in every aspect of life. As a photographer, capturing this moment felt like preserving a story of unity, respect, and shared appreciation. It’s a testament to how far we’ve come and a reminder of the work that remains in ensuring equality. The energy in the room, the laughter, and the confetti were more than just celebratory, they were proof of progress and hope for an even brighter future.”
 

Cherlie St. Fleur and her son, Henry Monay, outside of the conference room at Hôpital Universitaire de Mirebalais (HUM) in Haiti, during the Journey to 9 Plus (J-9) graduation ceremony. The J-9 program gives women and their newborns constant care and support throughout pregnancy and the baby’s first year. Photo by Mélissa Jeanty / PIH

Reflection from Mélissa Jeanty, multimedia specialist at Zanmi Lasante, as PIH is known in Haiti: 

“We were getting ready to head out to another Zanmi Lasante site when someone told us there was a J-9 graduation taking place at HUM. As we approached various mothers and asked if they’d be willing to share their stories with us, Cherlie happily volunteered. After a challenging delivery and surgery to remove her fibroids, she expressed immense gratitude to the J-9 team and was delighted at being able to have and hold her firstborn, Henry, whom she affectionately calls her "ti chouchou," or her "little boo." What makes this photo special to me is the joy: the joy of that day of celebration, her joy in becoming a mother, and the joy of connecting with people through their stories.”

Community members in Puluken, Liberia, gather to welcome PIH CEO Dr. Sheila Davis and to express their gratitude for the Puluken Town Canoe. PIH Liberia conceptualized and helped build the 15-seat motorized boat, which allows the community to cross the Hoffman River and access essential health services. Photo by Luther N. Mafalleh / PIH

Participants in the PIH Engage Training Institute met at the United States Capitol for Hill Day and held more than 100 meetings with legislative staff members. Photo by Jessey Dearing / PIH

Reflection from Jessey Dearing, video producer and editor: 

“It was a beautiful and warm August morning in front of the U.S. Capitol, where hundreds of PIH Engagers were meeting for Hill Day. Everyone was showing up, getting coffee and donuts to prep for their meetings with legislative staff members. There was really nice early morning light on the Capitol, but where everyone was standing was a bit shaded and not very interesting visually. Sam Kelts, manager of grassroots strategy, was standing in this slight dapple of light and her orange ‘Injustice has a cure’ PIH hat was bright enough to match the exposure of the Capitol building behind her. I took a few moments trying to get the right angle and focal length as she was moving around talking to people. I needed to be close enough to read the words, but also make it obvious that it was the Capitol in the background.”

Sahr Moses Jawara (left), mental health and psychosocial assistant supervisor, meets with Aiah Messah in Sierra Leone. Through a robust team of community health workers, homeless individuals living with mental illness are connected to psychosocial counseling, rehabilitation activities, and income-generating projects. Photo by Abubakarr Tappiah Sesay / PIH

Reflection from Abubakarr Tappiah Sesay, multimedia specialist at PIH Sierra Leone:

“Aiah Missah is a 44-year-old resident of Sedu/Seidu village, in the interior of Koidu City, a 29 km distance (1 hour, 5 min drive) to Koidu City. Like many mental health patients, Aiah was abandoned by his family members. His only caretaker was his grandma, who passed away in 2023. He’s cared for now by Isata, a resident of Sedu/Seidu Village.

In taking this photo, I sensed a brotherly bond between Jawara and Aiah. Their connection is like two orphan brothers in a strange land with no parents or guardians, wherein the situation forced one to look out for the sick one. Seeing the role Jawara played in Aiah’s life touched me! For a moment, I became paralyzed. Such moments give me reasons to keep on keeping on and remind me to always be ready to support others with my skills.

I feel fulfilled to be given the opportunity to be present and pause a wonderful moment of empathy, altruism, and [un]wavering concern being displayed in one shot. These types of moments and pictures are my sources of motivation in my work due to their authenticity.

The bumpy, narrow, and rocky roads, rough weather, bike breakdowns, and late home return are all worth it to capture and process such a rare humanity moment.”  

Construction workers build the North Ward of the Maternal Center of Excellence (MCOE), a state-of-the-art facility for maternal and child health in Kono District, Sierra Leone. At the MCOE, 67% of construction workers are women. Photo by Chiara Herold / PIH 

At Compañeros En Salud, as PIH is known in Mexico, Dr. Azucena Espinoza meets with patient Britzel Danaeth Perez Roblero and his mother, Rita Roblero Galvez, at Hospital Básico Comunitario Ángel Albino Corzo in Jaltenango. Photo by Francisco Teran / PIH 

Nurse Hilda Mbalati treats patients with cervical cancer at Neno District Hospital in Malawi. Photo by Joseph Mizere / PIH

Reflection from Joseph Mizere, photographer at Abwenzi Pa Za Umoyo (APZU), as PIH is known in Malawi:

"Hilda Mbalati is a dedicated nurse who has spent much of her life advocating for women’s reproductive health and cervical cancer awareness. Her passion for educating women and promoting health has made a significant impact in her community. Known for her constant smile, she is a beloved figure at Neno District Hospital, where both patients and staff recognize her warmth and dedication.  For me, being able to capture people like Hilda in photos is a deeply personal experience. It's more than just taking a picture, it’s about preserving the essence of their kindness, strength, and commitment to making a difference. Hilda’s smile and dedication are reminders of how powerful the work of individuals can be in shaping lives and communities. I'm grateful to have the opportunity to share their stories through my lens, because it's these moments that truly inspire me.”

UGHE's third cohort of Bachelor of Medicine, Bachelor of Surgery students celebrate after receiving their white coats during a ceremony in Butaro, Rwanda. Photo by Asher Habinshuti / PIH

Patrick Francis, a 19-year-old ASPIRE project participant trained in tailoring, uses his sewing skills to make a living and serve his community in Malawi. The ASPIRE project equips teenagers living with HIV with education and skills to enable healthy decision making and economic mobility. Photo by Madock Masina / PIH

Nina Sandra Natasha Ngowi, UGHE Master of Science in Global Health Delivery alumna, during the graduation ceremony with her daughter, Isheja Vania Rubagumya. Photo by Asher Habinshuti / PIH

Reflection from Asher Habinshuti, photographer at IMB:

“Graduation is a milestone that represents years of hard work, sacrifice, and dedication—not only for the graduates themselves but also for the families who stand by them throughout the journey. When I saw the child sitting close to her mother, who was proudly wearing her cap and gown, I felt a wave of emotion and a deep sense of pride in capturing such a meaningful moment. This image speaks to more than just individual success; it’s a powerful reminder that accomplishments are often shared. It’s about the support systems that make the journey possible and the inspiration we pass on to those who follow in our footsteps.”

Over 90 people, including patients and their families, joined Socios En Salud, as PIH is known in Peru, in the closing activities for a mental health program for individuals living with schizophrenia. Photo by Diego Diaz / PIH

Janki Moneni, 61, receives treatment for multidrug-resistant tuberculosis at Botšabelo Hospital in Maseru, Lesotho. Photo by Justice Kalebe / PIH

The birthplace of the Civil Rights Movement, Montgomery is no stranger to the fight for justice and equality. The city’s long history of transforming challenges into opportunities for positive change is a testament to the community’s desire for and commitment to progress.  

Montgomery’s approximate 200,600 population is 60.6% Black/African American and 52.9% female with 21.2% of residents living at or below the poverty line. Almost 40% of people living in Montgomery classify as obese, and more than 14% of residents have experienced significant food insecurity. Challenging the city’s public health landscape further, in 2021, amid high rates of heart disease, cancer, and diabetes, nearly 10% of the population lacked health insurance.  

City leadership’s newly proposed Envision Montgomery 2040 plan, geared toward sustainable development and enhancing quality of life in the community, marks a symbolic step forward in tackling ongoing challenges of lingering inequality in access to health care, employment, education, housing, transportation, and food. Anchored by a restored focus on the future, Montgomery is poised for a new chapter.

A Community Health Needs Assessment (CHNA) supported by Partners In Health United States (PIH-US), in partnership with the city of Montgomery and the Alabama Department of Public Health (ADPH), is guiding comprehensive reforms in Montgomery, aimed at addressing the city’s high social vulnerability and improving community wellness. Identifying critical gaps in vital resources and prioritizing interventions that target the root causes of health inequity, the assessment offers evidence-based recommendations for systemic changes that respond to the community's specific needs and create a healthier environment.

Public Health and Safety Challenges

In the wake of the COVID-19 pandemic, Montgomery secured a grant from the CDC and ADPH to redress health disparities impacting the city’s underserved populations. This grant, awarded in 2021, uniquely supported local community health workers (CHWs), whose close understanding of residents’ needs plays a key role in addressing social vulnerabilities and strengthening community resilience.  

A welcome addition to a city with very few public health offerings, PIH-US provided education guiding the city in its integration of CHWs for the first time. As community members, CHWs bridged the gap between Montgomery’s health care providers and the communities they serve and were on the frontlines of the city’s coronavirus response.

“I think initially the priority for the city was to identify health issues and health disparities and fix it,” recalled Kelbrey Porter, grants director for the city of Montgomery. “So, the route we've been taking as far as grants have been concerned, up until this point, is to apply for everything we qualify for, and in that process, we found that we qualify, but we're not competitive and we're missing a lot of data that is required.”

Recognizing the value of their proximity and expertise, PIH-US staff consulted CHWs in developing the assessment, ensuring the appropriateness of survey language and subject matter. Staff also mentored and trained CHWs responsible for administering the survey, walking them through the process of interviewing participants and recording their responses into a database.  

The assessment consisted of 27 questions that explored respondents’ demographic information, their perspectives on community health, and their actions and beliefs around the COVID-19 vaccine. Between January and May 2023, eight CHWs used the survey to collect data from over 1,000 residents across 17 zip codes through community canvassing and city-supported health events. Data from the assessment, closely tracked and analyzed by PIH-US staff, helped identify residents’ health behaviors, challenges, and strengths and offered a detailed look into local issues threatening public health and safety.  

According to the assessment’s findings, people living in Montgomery are most concerned by violent crime, substance abuse, mental health, and lack of community support.  

Survey participants also expressed significant dissatisfaction with their ability to access safe drinking water, fruits and vegetables, grocery stores, public transportation, adult education, and health insurance—all social determinants of health.  

Gun Crime, Violence Top of Mind

One year after the assessment was completed, in April 2024, PIH-US conducted six focus group discussions and three key informant interviews, delving deeper into survey findings. At separate events held at the Loveless and Regency Park Community Centers, 30 study participants shared thoughts on the issues shaping their neighborhoods’ health and their experiences contending with gaps in government services and facilities.  

At Regency Park, community members voiced deep concerns about public safety, particularly gun crime and youth involvement in violence, highlighting socioeconomic factors like limited opportunities as key drivers.  

“We think that a lot of times it's the crime that's the issue, but it's really opportunity, it's education, it's economics,” one focus group participant explained.  

According to residents, young people living in the city often find themselves both perpetrators and victims of violence, a troubling cycle that stems from barriers to meaningful opportunities for education, employment, social networks, and other resources that help people live longer and healthier lives.  

“When I first started working with young people,” a city employee shared, “they used to have a term ‘youth at risk.’ All youth are at risk now.”

Loveless Center discussions, capturing the perspectives of community leaders and health care providers, echoed similar sentiments, emphasizing strained relationships with law enforcement, a lack of community togetherness, and feelings of isolation as underlying causes for violent behavior. Respondents stressed the need for mentorship programs that integrate social, cultural, and career development activities. They were confident that professional therapy services in schools could not only address emotional problems but also serve as a preventive measure against crime. Other key suggestions included increasing economic opportunities, educational resources, and programs designed to address the underlying social drivers of violence, as well as improving neighborhood infrastructure with video surveillance and better street lighting.  

Gaps in Mental Health Care

City health care providers are troubled by the increasing severity of mental health issues since the pandemic. Difficulties accessing care, coupled with pervasive stigmas and a lack of awareness about mental health and available services, undermine efforts to improve community wellness. For providers who are under-resourced and understaffed, bridging gaps in knowledge and combatting misinformation are only the tip of the iceberg.  

"It's heartbreaking to think that we're having to [discharge clients from social service programs] even when we're providing referrals, even when we're putting them in the car and taking them to a service provider,” a community member shared in a focus group discussion. “If that service provider is over capacity and says, ‘I'm sorry, there's nothing we can do,’ we're having to exit people from a program that is meant to save lives.”

Montgomery residents, law enforcement, and health care workers are keen on implementing initiatives that better prepare them for responding to mental health crises within the community, advocating for broader access to mental health services and more funding toward mental health programming, facilities, and staff.

A Need for Better Transportation, Nutrition, and Recreation  

Another barrier to addressing health issues in the city is transportation, repeatedly named as a root cause of inequity. The obstacles created by lack of transportation commonly derail efforts to tackle Montgomery’s health disparities, which has resulted in unanimous support for improvements to public transportation, ensuring health care and outreach efforts for particularly vulnerable populations are not in vain.  

The reallocation of funding to improve Montgomery’s transportation infrastructure, however, will only be as successful as the quality of local facilities made available.  

Residents participating in the assessment noted a host of chronic conditions that would benefit from better recreational facilities and nutritional support, including asthma, diabetes, hypertension, heart disease, and obesity. In discussions, they agreed the lack of affordable resources geared toward improving physical health such as diverse food options, safer biking and walking trails, and community gyms and health clinics played a fundamental role in Montgomery’s poor health.  

“If you're trying to get people that aren't doing any of this now, they may not know what they might enjoy... sometimes you have to just get them into something that would draw them to an event, and then have [activities] available,” a community member shared during a focus group.

Creating a Stronger Sense of Community

At the center of Montgomery’s struggle to better connect residents to local resources is a sheer desire to cultivate community. Nearly every discussion attributed negative health and social conditions, at least partially, to an absent feeling of belonging and togetherness within families, neighborhoods, and the city.

Montgomery’s leaders and residents alike share a vision for community development through neighborhood-based facilities that serve as hubs for health information and programming, including regular testing and preventative interventions. These community centers would offer support for youth, caretakers, and those at risk of social isolation, providing recreational spaces to convene with friends and family, particularly during emergencies.

In addition to funding for community centers, residents hope to see the city revitalize public infrastructure and improve collaboration across community organizations and government agencies to better promote available resources without duplicating services.

“I think for us we got a better understanding of what health equity is,” Porter explained. “We're addressing different health disparities in areas that may appear to be the same on the outside or by demographic, but within their community there are differences, and they've been able to highlight those and advise us on where we can make changes.”  

Thanks to PIH-US's support of the assessment and focus groups, health equity in Montgomery is becoming more tangible. PIH-US staff developed an infographic CHWs could distribute and discuss with residents that gives a snapshot of their community’s health landscape and outlines the effort to create a healthier environment.  

Results from the assessment will also be used to design a Community Health Improvement Plan, focused on the most actionable recommendations. PIH-US will continue partnering with the city, inviting contributions from community members to help determine the most effective and inclusive path to equitable access to health resources and services.  

“Now the city is looking at considering Community Health Workers as a position for the city based on the work that we did here and the information and data we can support that we received from the team,” Porter shared.  

Working closely with PIH-US staff, the city plans to facilitate a Health and Human Services Committee that will manage the planning and implementation of health initiatives. The committee will bring together community leaders and local health care providers to collaborate on responses to Montgomery’s health needs and establish goals that have widespread impact. 

PIH-US staff and city officials together plan to seek, apply for, and manage grants that address concerns made evident by the assessment’s findings. The city is committed to expanding efforts to reduce Montgomery’s social vulnerability, relying heavily on data provided by PIH-US to inform strategies and help secure funding for improved health and wellness in the community.   

Thérèse,* a resident of Haiti’s Artibonite region, is living with a renewed sense of hope and strength due to her involvement in a program called the “Mothers Club,” dedicated to women living with HIV and their children.  

The group, supported by Zanmi Lasante (ZL), as Partners In Health is known in Haiti, offers a lifeline to those facing challenges of the disease, providing long-term medical care, social support, and other essential resources.  

Reflecting on the moment she first learned of her HIV diagnosis, Thérèse vividly recalls the shock and confusion she felt. "I didn't know how I caught the virus," she said.  

It was a difficult time, but with ZL’s unwavering support, Thérèse was able to regain control of her life. "I feel good," she shared, expressing deep gratitude for the ongoing care she receives.

As the largest provider of HIV care in Haiti’s Central Plateau and lower Artibonite regions, ZL’s approach follows the patient-centered accompaniment model, focusing on prevention, screening, treatment, and support through solidarity. The organization offers free HIV and tuberculosis (TB) screening tests, distributes vital medications, and provides support that goes beyond medical care. ZL’s efforts have led to a reduction in mother-to-child transmission of HIV and improved survival rates for those living with HIV and TB in Haiti.

Thérèse’s daughter, Tatiana,* who was born with HIV, also benefits from the program. Under ZL’s care, Tatiana is living a normal life, growing up without the limitations often imposed by the disease, including stigma and discrimination that can lead to social isolation.  

Thérèse is especially grateful for the community health workers and social workers whose support is also a source of motivation for her. "When I'm discouraged, they come to my house. They help me continue my treatment, "she said.  

For Thérèse and Tatiana, support from ZL is key to building their future. With the organization’s help, they look ahead with hope, living each day with dignity.  

*Names were changed to preserve patients’ identities. 

Haiti is once again grappling with deepening political instability and a surge in gang violence, threatening the lives and livelihoods of its citizens and the ability to provide quality health care.

On November 11, Haiti’s Transitional Presidential Council—created to reestablish democratic order in the country—ousted interim Prime Minister Garry Conille after six months, claiming he failed to restore security and democratic rule, and replaced him with Alix Didier Fils-Aimé, an entrepreneur and former senate candidate.  

This political instability has challenged law enforcement. While security forces from Kenya are on the ground, they have limited resources and manpower and have not been able to stem the violence.  

The gangs dissolved their coalition, breaking the truce between factions. The situation has resulted in increasing violence in the capital of Port-au-Prince and elsewhere, including Petite Rivière de l'Artibonite where Zanmi Lasante (ZL), as Partners In Health is known in Haiti, operates.

Roads from the capital to the Central Plateau are again blocked, disrupting the transport of supplies to clinics and hospitals.  

Gangs opened fire and hit multiple planes coming in and out of the Port-au-Prince airport, which is now closed. No date is set for its reopening. The Federal Aviation Administration has banned all flights from the United States to Haiti for the next 30 days, and some airlines have suspended operations to Haiti for the next three months.

Now, for the second time this year, Haiti’s busiest international airport is shut down, derailing critical humanitarian aid coming into the country.

“Despite these challenging situations and risky environment, the team remains committed as never before while being prudent,” says Dr. Wesler Lambert, Zanmi Lasante’s interim executive director. “We will continue to create hope and do what we know best, which is providing health care to the best of our capacity.”  

Zanmi Lasante remains strong and continues to operate facilities and provide critical care and resources to those who need it most, even under the threat of attack and supply chain disruptions. Staff mental health and wellness teams continue to be an essential resource for caregivers, who are dealing with traumatic experiences while providing essential care.

For more than 40 years, Zanmi Lasante has been a cornerstone of health care delivery in Haiti and remains a critical lifeline today for the most vulnerable Haitians.

In November 2019, Sania* was diagnosed with intestinal cancer during a routine screening with her local doctor in Kazakhstan. What began as any other regular day, quickly became filled with fear.  

“When I left the [State Cancer Center in Almaty City], I literally got lost,” Sania remembered. “I couldn’t even find a bus stop and was wandering down the street aimlessly. I sat down and started to cry.”

As the sole caregiver for her severely disabled son, she worried about being able to care for him while also completing her own treatment. All in all, Sania had to undergo seven surgeries and attend numerous clinic visits for chemotherapy.  

Before her last surgery in 2023, her son passed away. The grief nearly crushed her.  

Fortunately, a psychologist at the oncology clinic recognized her struggle and referred her to Partners In Health’s (PIH’s) mental health program.

“I was depressed and didn’t even have the strength to live,” Sania said. “The psychologist at the clinic literally led me by the hand to the PIH mental health team.”

PIH launched the mental health program in Kazakhstan in January 2020 to provide free, comprehensive mental health care to patients, particularly those with difficult diagnoses such as tuberculosis or cancer. The program was established with the support of the Many Voices Collaborative in Community-Based Mental Health Care, a cross-site initiative that began in 2018 to support the development of mental health services across the countries where PIH works.

During her first visit, Sania spent two hours with the psychologist—discussing the mental health program, asking each other questions, and talking. She remembers feeling relieved after that first appointment and decided she would visit again. Despite interruptions from her cancer treatment, Sania continued to participate in therapy with PIH regularly.

“I felt much better after each visit,” Sania shared. “The PIH mental health staff are very attentive and listen to people carefully. I regained interest in my life, and it wasn’t just me who noticed. Everyone around me noticed that I had perked up.”  

The mental health program taught Sania a variety of techniques to help manage her emotions. From breathing techniques to journaling, she found ways to work through challenging memories and recurring negative thoughts. She still uses these techniques daily when she feels overwhelmed.  

“Before my last surgery, my blood pressure jumped to 210 and the doctors wanted to postpone the operation,” Sania said. “I asked the doctors to give me some time and I began to meditate and gradually calmed myself down. When the doctors measured my blood pressure again, they were surprised my blood pressure had dropped to 140 and they took me to the operating room.”  

Before her experience with the mental health program, Sania viewed therapy as “just another chatter” and didn’t believe it would help her in any way. Now, she believes words, like medicine, can heal.

Sania’s health has improved significantly. Since May, she has officially been cancer-free, and her blood pressure has returned to normal.  

“Looking back, I understand that I have come a long way, accomplished the impossible,” Sania said. “I would advise others who receive similar diagnoses not to lose heart. Go where you will be helped. There are people who will help you.”

*Patient gave permission to use first name only 

On September 27, Rwanda's Ministry of Health reported the country’s first outbreak of Marburg virus disease (MVD), a contagious viral infection that affects multiple organ systems and can lead to death. Rwanda has confirmed 66 cases and 15 deaths as of November 8th, making this the third largest known outbreak of MVD. 

As of November 8, the Rwandan Ministry of Health declared the outbreak under control, and the last remaining patients receiving treatment recovered. The Rwandan government led a comprehensive and notably effective response, and outbreak activities are now focused on research and disease surveillance.  

The World Health Organization (WHO) and other partner organizations are supporting the Rwandan government in their response by deploying experts and providing critical supplies needed for the outbreak response. A coordinated initiative to run critical vaccine and therapeutic clinical trials has reached over 1,600 frontline health care providers and high-risk individuals, such as mine workers.  

Inshuti Mu Buzima (IMB), as Partner’s In Health is known in Rwanda, and the University of Global Health Equity (UGHE) are closely aligned with the Rwandan government and have also supported the coordinated response. IMB is providing support and technical expertise, specifically in mental health and psychosocial support and helping ensure routine health care services remain available. UGHE provided technical expertise to the effort to identify the first documented patient and confirm the transmission source. 

Due to Rwanda’s highly effective response, no new deaths have been reported in more than four weeks. 

Considered a neglected tropical disease, progress toward the elimination of MVD has historically been slow. Limited MVD‐specific funding, research, and drug and vaccine development heightened the importance of public awareness and community involvement in reducing viral transmission. 

Infectious disease specialist Dr. Marta Lado, PIH’s director of clinical programs and health policy in Sierra Leone, and IMB’s MVD response clinical lead Dr. Erick Baganizi, head of the division for clinical programs at IMB, agree that broader and more detailed clinical data is required to better understand the disease. 

As candidate vaccines and therapeutics emerge, Lado and Baganizi focus on prevention methods and improved patient care. Below are six things they think you should know about MVD: 

1. MVD is not a new disease.

Since its initial detection in 1967, simultaneously in Germany and Serbia, cases and outbreaks have been sporadic. Often found in remote regions, the disease has previously been reported in Angola, the Democratic Republic of Congo, Ghana, Guinea, Kenya, South Africa, and Uganda, with the most recent outbreaks occurring in Equatorial Guinea and Tanzania between February and June 2023.

2. MVD is a contagious viral infection.

MVD spreads through direct contact with the blood, organs, or bodily fluids of infected humans or animals, and with surfaces, objects, and materials contaminated with the virus. 

The disease is introduced to human populations through infected bats and primates, usually after prolonged exposure to mines or caves inhabited by wildlife. In fact, the first outbreaks in Frankfurt and Marburg, Germany, and in Belgrade, Serbia, were associated with laboratory work using green monkeys imported from Uganda. The current outbreak in Rwanda is linked to transmission from a fruit bat. 

Once MVD is transmitted from animals to humans, it can spread to other people through contact with contaminated bodily fluids from those who are infected. 

People infected with MVD can infect others as soon as they are symptomatic, and they remain infectious as long as the virus is present in their blood. 

3. Symptoms can develop quickly as the illness advances.

The time between exposure to MVD and the appearance of symptoms varies from two to 21 days. Once symptoms appear, the disease can progress rapidly. 

In the first stage of MVD, symptoms can seem malaria-like and occur abruptly with high fever, headaches, fatigue, feelings of weakness, and localized pain in joints and muscles. Gastrointestinal symptoms, such as diarrhea, abdominal pain, nausea, and vomiting can also occur in this stage of the disease; but amid the current and most recent outbreaks, they have not been commonly observed. 

As it advances, MVD can become more severe, leading to multi-organ dysfunction. In days, renal and liver failure can develop, as well as respiratory distress, seizures, loss of consciousness, anemia, hepatitis, hemorrhaging, blood vessel damage, and delirium. 

4. MVD can be fatal.

The average MVD case fatality rate is around 50%, ranging from 24% to 88% in past outbreaks. Through supportive care facilitated by a robust health care system, most of Rwanda’s infected patients survived, putting the case mortality rate for this outbreak at around 23%, among the lowest ever recorded for the disease. 

Some patients only experience fever symptoms that resolve on their own, without treatment. Others, however, arrive at care facilities already suffering from organ failure, difficulty breathing, and central nervous system disruptions, making their cases more difficult to manage and lowering their chances of recovery. 

Moreover, the time needed to accurately diagnose MVD can put patients and health care workers at a lethal disadvantage. Symptoms of the disease, similar to other infectious diseases commonly found in areas where MVD is detected, are often mistaken for typhoid fever, food poisoning, and malaria, as was the case in Rwanda for the earliest cases. 

In fatal cases, death is usually preceded by severe blood loss and shock, occurring most often between eight to nine days after symptoms start.

5. Survival depends on effective supportive care.

While other medical conditions can further complicate the disease, even people who are considered healthy can have poor outcomes. 

There are currently no fully approved vaccines or antiviral treatments for MVD. 

The most effective approach to managing the disease, proven to increase chances of survival, is the delivery of intensive supportive care, which includes rehydration, antibiotics to prevent complications and super infections from bacteria, blood transfusions, medical oxygen therapy, and other treatments for specific symptoms. 

Access to supportive care played a critical role in lowering the MVD case fatality rate in Rwanda.  

6. Health care workers are especially vulnerable to MVD.

Clinicians, laboratory workers, and other people caring for individuals sick with the disease face an increased risk of infection. Because of difficulties clinically distinguishing MVD from other diseases, health care workers not yet aware of the need for isolation protocols and proper protective equipment are vulnerable to prolonged and potentially deadly virus exposure. 

Despite a swift and effective response to the MVD outbreak, over 80% of Rwanda’s confirmed cases were among health care workers, emphasizing the need for enhanced protection for frontline workers, surveillance and contact tracing, and additional resources for infection prevention and control practices within health facilities. 

Basimenye Nhlema was announced as the executive director of Abwenzi Pa Za Umoyo (APZU), as Partners In Health (PIH) is known in Malawi, in November 2023.

Originally from Karonga, a district in the northern region of Malawi that borders Tanzania, Nhlema is one of 18 children from three mothers in her family, and the first woman to have received a university education. She started her career as a project manager for a theatre company, having studied drama and public administration in college. After a few years, she transitioned to working with nongovernmental organizations, focusing on community health in her home country.  

This introduction to public health sparked a passion to make meaningful change that has guided Nhlema’s career. In 2017, she relocated to Neno District to join the APZU team as Director of Community Health and has been a leader among her colleagues since then.

We spoke with Nhlema about her time at APZU, the challenges she anticipates as she looks to the future, and her guiding principles as a leader. Below, edited and condensed, are her responses:

Tell us about your journey with APZU since you began in 2017.  

I joined PIH in January of 2017 as APZU’s Director of Community Health. I joined at a time when the community health worker program was transitioning from a program supporting only HIV and tuberculosis (TB) patients, to a comprehensive program involving household assignments. During my four years as Community Health Director, I was also responsible for the Program on Social and Economic Rights (POSER) as well as the Community Engagement Program.

In January 2021, I transitioned to the role of Chief Operating Officer, heading up our operations and administrative functions. In November 2023, I became the Executive Director.  

How did you feel when you learned you were selected as the executive director?

My family and friends were happier about the news than I was. Personally, I would say this was the most difficult period of my professional life because I had so many fears and questions going on in my mind, and genuinely wondered whether I had made the right decision. I feared I wasn’t going to be good enough for the position and that I would fail in my duties and end up undermining the great milestones that my predecessor and the organization had achieved. Not having a medical background made me feel even more vulnerable and fearful of the task that was before me.

But, I can say after a year, that the yoke is lighter. The task generally remains daunting every single day, but I have learned that I don’t need to know or have answers to everything. All I need is to continue leveraging my strengths, strengths that gave the organization confidence to appoint me in this position. And most importantly, I have also learned that it’s okay to ask for help and rely on the strengths and support of my team.  

How have you grown personally and professionally at APZU?

As someone who does not have a clinical or medical background, working with PIH has helped me gain a deeper understanding of the Malawian health system and the factors that affect health, health care delivery, and health outcomes in the country.  

When I was joining PIH, I had a superficial understanding of health and what is involved in health care provision, but with time, I have come to learn the depth to which forces such as economic policies, economic systems, political systems, social norms, as well as development agendas directly influence health in a country or specific context.

What is one of your most memorable moments as executive director thus far?

One moment was the day I welcomed 9-year-old Promise and 49-year-old Vitalina home on their way back from Tanzania, where we had sent them to access heart surgery services after they could not find help in Malawi. This day is deeply ingrained in my spirit because we, as an organization, demonstrated through tangible action what we mean by pragmatic solidarity and what we mean by providing a preferential option for the poor in health care. I was happy beyond words to see restored hope on their faces and those of their family members.      

What are some of the challenges that you and APZU may face as you look ahead?

While there are noteworthy milestones that we have achieved, there are several significant challenges in health care delivery as we look to the future including resource constraints, burdens of disease, and climate change. The lack of resources in the country poses a huge risk to universal health care and the provision of quality care for people in Malawi.  

However, demand for health services is growing rapidly in Malawi. Our country continues to struggle with a high burden of infectious diseases, such as TB, HIV/AIDS, and malaria, while at the same time facing rising noncommunicable diseases like diabetes, hypertension, and cancers.

Malawi has also been experiencing a rise in events like floods, cyclones, and droughts caused by climate change. We have seen these exacerbating problems such as poverty, malnutrition, increasing spread of diseases such as cholera, and even the resurfacing of diseases that were once controlled.  

As you face these challenges as a leader, what are some of your guiding principles?

I have three major rules that I live by. The first is to practice kindness. Life is tough as it is, and I don’t need to add any acts of unkindness. I treat others with compassion and empathy, as I know everyone is fighting their own battles. Second, I practice gratitude. I remind myself to be content with what I have because someone, somewhere is praying for what I have. Last is to embrace curiosity. I seek to learn and understand the world around me. I stay open-minded, explore new perspectives, and am not afraid of mistakes because they are necessary for growth and success.

What inspires you to continue your work with PIH?  

When I first started with APZU, I had given myself two years. Living and working in the ‘village’ was not meant to be a long-term plan, but when I started working, I fell in love with the organization, its values, philosophy, mission, vision, work environment, and people. I can’t believe that I will soon be celebrating eight years in Neno with APZU.

There are many things, but at the very core is our philosophy that all life matters and that we do whatever it takes to take care of each life. This is the driving force of our progressive and relentless problem-solving spirit, particularly when it comes to finding solutions for the most vulnerable groups.

We are bold and daring in our overall approach to work and health care. We do not allow problems or circumstances to limit our imagination of what is possible. We believe that if there is a solution, we will find it, implement it, document it, and even share it with others so they can learn from what we have demonstrated as doable. I find this utterly beautiful and reassuring, especially in a world that is systematically structured to oppress the vulnerable and poor.  

The medical landscape in rural Liberia has undergone a remarkable transformation in recent years as doctors have shifted their approach to patient care. This shift is particularly evident at Partners In Health (PIH)-supported James Jenkins (J.J.) Dossen Memorial Hospital, where health care professionals increasingly focus on patient-centered care. This means treating the whole person, not just their disease, by providing holistic treatment and addressing the underlying factors contributing to illnesses.

Dr. Robert Sieh Jr., a medical resident at J.J. Dossen Memorial Hospital, says he has experienced a profound perspective change and gained a deeper understanding of the psychological and social forces—such as culture, housing, and income level—that may contribute to a person’s illness. These forces, known as “social determinants of health,” are a key part of social medicine, an approach that guides PIH’s work across 11 locations.

Sieh is enrolled in the Family Medicine Residency Program, a partnership between the Liberian College of Physicians and Surgeons and PIH Liberia. Originally launched in July 2017, the program was officially handed over to PIH Liberia earlier this year and relocated to Maryland County.

The primary goal of the residency is to equip physicians with the necessary knowledge and skills to effectively address health care needs in Liberia. Based at J.J. Dossen Memorial Hospital, the program prepares doctors to work in remote, underserved regions, such as Maryland County—some 250 miles from Monrovia, the country’s capital. Through a hands-on approach, participants learn how to care for individuals of all ages, from infants to older adults.

“We are training the residents not only to provide care to the patients but to communicate and treat them with respect, empathy, and dignity,” says Dr. Paul Gueilledana, PIH Liberia’s family medicine residency lead.

Patients are noticing the compassionate care, too. “The doctors can talk to the people [politely],” says Tebanyene Huskin, a 45-year-old mother who received care at J.J. Dossen Memorial Hospital, speaking in Liberian Kreyol translated into English.

Continued success, empowerment

Since the program’s inception, 19 specialists have graduated and continued working in various regions across Liberia. The current cohort has five resident doctors: Flomo Cole, Mitchell Risk-Dragba, Robert Sieh Jr., Kangar O. Diggs, and Beyan Gweama. They rotate in core clinical areas such as pediatrics, obstetrics and gynecology (OBGYN), surgery, and internal medicine. All residents work in the inpatient ward at J.J. Dossen Memorial Hospital and serve as primary doctors during pediatric and OBGYN rotations at PIH-supported Pleebo Health Center, the largest primary health center in Maryland County.

The comprehensive, three-year course follows the curriculum of the West African College of Physicians, which is an association of medical specialists that promote professional training of physicians in West Africa to improve standards of practice and specialty training. In addition, PIH Liberia cultivates partnerships with international universities and accredited teaching hospitals to strengthen their workforce and develop the next generation of health care professionals.

On the night of October 3, 2024, the small town of Pont-Sondé was the scene of one of the deadliest massacres Haiti has seen in recent history. An armed gang, arriving by canoe to catch unsuspecting residents by surprise, opened gunfire and set fire to homes and vehicles, causing widespread panic and despair. The attack claimed the lives of at least 115 people, including women and children, and forced thousands to flee the community.  

Faced with this tragedy and a growing number of forcibly displaced people, the Saint-Nicolas Hospital in Saint-Marc, supported by Partners In Health’s sister organization in Haiti, Zanmi Lasante (ZL), immediately provided lifesaving care to those affected. In the first 24 hours following the attack, the hospital admitted 23 victims who suffered gunshot wounds: five died upon arrival and another succumbed during a surgical procedure. 

Despite challenges posed by an overwhelming influx of victims with severe injuries and a critical lack of resources, medical teams acted quickly, treating 42 patients, five of whom required emergency surgery.  

"We received a large number of patients suffering from serious gunshot injuries, most of whom arrived in critical condition,” said Dr. Ernsot Jean Marc, head of the emergency department. “We had to reorganize resources, mobilize our staff, and coordinate efforts to welcome these victims."  

Medical Director Dr. Alexis Frantz applauded ZL for supplying medical equipment and strengthening the hospital's emergency response teams. "We were able to mobilize three surgeons, two orthopedists, and 10 residents in family medicine, as well as receive help from doctors from other health centers in the city," he explained.  

Local solidarity also played a vital role in effectively managing the crisis. Community members supported both staff and patients, providing water, food, and supplies.  

“The camaraderie between the hospital teams and the help of the people of Saint-Marc allowed us to hold on in these uncertain times,” Jean Marc said.  

On October 4, Prime Minister Gary Conille traveled to the hospital to thank the medical teams for their exemplary response. He recognized ZL’s far-reaching efforts, highlighting their continued commitment to improving health care in Haiti, even in crisis situations.  

Zanmi Lasante is currently supporting the operation of a mobile clinic in Antoinette Dessalines to provide care for survivors located outside of the Saint-Marc region. Organized by Saint-Nicolas Hospital with the support of UNICEF, the clinic offers prenatal, general, and pediatric consultations to those who fled from the attack on Pont-Sondé. This initiative aims to provide essential care to pregnant women, children, and others affected by the crisis, meeting the most urgent needs of the displaced population. 

Three decades ago, Partners In Health’s Co-founder Dr. Paul Farmer and global colleagues embarked on a journey to combat multidrug-resistant tuberculosis (MDR-TB) in low-resource settings, such as the rural Central Plateau in Haiti and densely populated neighborhoods surrounding Lima, Peru. 

Farmer championed a model of community-based TB treatments that kept patient concerns at the center of care, forever transforming global health delivery, research, and policies. This approach addressed the underlying factors that contribute to disease spread, ensured marginalized populations received the medical support they deserved, and laid the foundation for sustainable solutions that have improved TB outcomes worldwide.  

Although Farmer passed away in February 2022, his legacy remains strong. The work he started decades ago continues to bear fruit and inspires innovations that have revolutionized TB care. His example inspired new generations of TB experts to follow in his footsteps, at PIH and beyond.  

The timeline below highlights Farmer’s pivotal role in the fight to end TB, driven by a vision for equitable health care that lives on today. 

1989: Reimagining TB treatment in Haiti

Farmer and colleagues at Zanmi Lasante established community-based tuberculosis treatment in Haiti by ensuring patients received medications, food packages to improve nutrition, and a community health worker, who provided emotional support and resources along patients’ care journey. 

1991: Community-based care increases cure rates

Farmer conducted and reported the results of a first clinical trial in which a group of Haitian patients living with TB received community-based care and social support in rural areas. Compared to a group that received only free care, those receiving the full support package had substantially better treatment outcomes: no deaths and a 100% cure rate. The study revealed the benefits of accompaniment and helped establish PIH’s signature approach for managing complex diseases in impoverished settings. 

1996: MDR-TB fight moves to Peru

Following visits to Peru, PIH Co-founder Dr. Jim Yong Kim helped uncover an MDR-TB outbreak among patients living on the outskirts of Lima. He, Farmer, and other Harvard colleagues found common cause with Peruvian clinicians and researchers and formed Socios En Salud, as PIH is known locally, to fight the disease. 

1998: New model improves MDR-TB patient outcomes

Farmer and Kim introduced the idea of DOTS-Plus (Directly Observed Therapy, Short-Course) to expand the WHO recommendation for treatment of TB beyond first-line therapies—and beyond just watching people take their medication—to include other drug regimens coupled with supportive care for MDR-TB patients. After successfully piloting a small community-based treatment program for patients living with MDR-TB in Lima, Peru, they argued that such programs could not only achieve excellent treatment outcomes but could be cost-effective if such interventions reduced disease and disability and prevented ongoing spread of MDR-TB.  

PIH proved this model of MDR-TB care in Haiti and Peru and then expanded it to Russia—and beyond. 

2001: Global Fund to Fight AIDS, TB and Malaria is born

Farmer and PIH’s work in Haiti inspires pressure from the global access community, and he and others sign statements of support for global funding to treat infectious diseases. The United Nations General Assembly endorses the creation of a global fund to fight HIV/AIDS in June 2001, which holds its first meeting in January 2002. Since that time, the Global Fund to Fight AIDS, Tuberculosis and Malaria has provided 76% of all international financing for TB, investing $9.9 billion in TB programs and an additional $1.9 billion in TB/HIV programs.  

2002: A worldwide initiative for AIDS and TB relief 

Farmer is one of four doctors invited to the White House by Dr. Anthony Fauci, then the director of the National Institute of Allergy and Infectious Diseases, and presents PIH’s outcomes data from treating AIDS in rural Haiti with community health workers. PIH’s work is a key part of the evidence that convinces President George W. Bush to announce at the 2003 State of the Union address the President’s Emergency Plan for AIDS Relief, which has provided antiretroviral treatment for 20.5 million people and TB preventive therapy for 13.4 million people on ART. This was especially important funding in the fight against TB, given the disease was the most frequent infection among people living with HIV globally. 

2003: Evidence of success in MDR-TB treatment

A study published in the New England Journal of Medicine about the DOTS-Plus program in Peru demonstrated that 83% of properly treated and supported MDR-TB patients could experience good treatment outcomes; this countered the prior narrative that it was not possible (or worthwhile) to treat MDR-TB in poor settings. This study ignited WHO support for the uptake of DOTS-Plus and the adoption of global policies to directly address drug-resistant TB. The paper has been cited in medical literature over 500 times.  

This same year, Farmer testified on Capitol Hill before the United States Senate Committee on Foreign Relations stressing the urgency of a growing health care crisis in Haiti. Increased TB deaths were due in part to U.S. policy affecting the country and the total amount of aid being reduced by two-thirds since 1995. 

2005: Transforming WHO's TB care guidelines

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 Kim summarized PIH’s influence on international MDR-TB policy in a 2005 article, in which they were optimistic about the future of global health and challenged everyone to be more ambitious: “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.”

2010: TB tied to global poverty

Through a publication in The Lancet, Farmer and fellow activists with Treatment Action Group, an independent and community-based research and policy think tank fighting to end HIV, TB, and hepatitis C virus, called for “a bold new vision at the Stop TB Partnership,” a UN organization established in 2001 to eliminate TB.   

“Tuberculosis control and elimination need to be more closely aligned with the general economic development of afflicted communities. The natural history of tuberculosis clearly shows that to achieve tuberculosis elimination there needs to be some degree of poverty alleviation,” Farmer and authors wrote.  

2013: Grassroots advocates fundraise for TB

Farmer helps launch the PIH Engage grassroots volunteer network, with hundreds of individuals fundraising in their communities for PIH’s TB work and advocating for billions of dollars in U.S. government funding of multilateral and bilateral TB programs, such as the Global Fund.  

With his encouragement and guidance, this network contributes annually to growing the global funding pie, through thousands of calls, letters, and meetings with congressional offices. As a result of continued advocacy, U.S. bilateral TB funding grew from less than $100 million in 2006 to $233 million in 2013. 

2015: Launching the endTB project

PIH, Médecins Sans Frontières, and Interactive Research and Development launched the endTB project, which aimed to find shorter, less toxic, and more effective treatments for MDR-TB through access to new drugs (delamanid and bedaquiline), clinical trials, and advocacy at national and global levels.   

Farmer’s influence was intentionally woven into every aspect of endTB: through the accompaniment of national TB programs as they introduced new drugs into care regimens, advocating for lower drug prices, ensuring patients benefitted from advancements in research and quality care, and supporting patients beyond medical treatment to address other needs, such as food, housing, and financial assistance.

2019: Congressional support for equity-driven TB solutions

Farmer and the PIH Advocacy team are tapped by congressional leaders to integrate equity-focused TB elimination strategies into annual U.S. funding of TB programs. He and his PIH colleagues also provide technical advice to Congress on the TB reauthorization strategy bill, the End TB Now Act.  

February 21, 2022  

Farmer passed away in Rwanda, but the work he inspired continued.

2023: New MDR-TB regimens revealed

In November, endTB clinical trial results were presented for the first time at the Union World Conference on Lung Health with evidence to support the use of three new, improved regimens to treat forms of TB that are resistant to rifampin, the most important drug in standard TB treatment.

2024: WHO approves three, new MDR-TB regimens

In August, the WHO approved new, safe, and effective tuberculosis treatment options, including three new shorter regimens for multidrug- or rifampin-resistant tuberculosis, which were studied in the PIH-led endTB clinical trial.   

The resulting recommendations, which for the first time offer novel, shortened regimens universally to children, adolescents, pregnant and breastfeeding women, represent the culmination of nearly a decade of scientific research and patient care across 18 countries.   

Public health has a long history: from inoculation practices in early India, to aqueduct sanitation systems in ancient Rome, to the sprawling public hospital systems we think of today. Since its early days, the field of public health has evolved alongside the governments that help establish public health policies.

In the modern world, global governments influence health care by setting goals and standards, enforcing laws, contributing resources, providing services, building infrastructure, and involving the public in decision-making processes regarding health care. This influence is part of the reason Partners In Health (PIH) works so closely with local governments to help improve health systems and expand health programs globally.

Despite governments globally contributing to global health policies and dictating local health care services, some of the largest influences in health care around the world lie in one country. The U.S. government is the world's largest donor to global health, providing $12.3 billion in funding for global health in 2024. However, while the U.S. may lead in the overall dollar amount, the country’s relative contributions to global health are some of the lowest when considering overall national income—meaning that the U.S. has the capacity, and the responsibility, to increase its global health spending. Many different U.S. government departments and agencies, congressional committees, and funding streams are involved in shaping global health policy.

U.S. Government Shaping Global Health Policy and Programming

Take tuberculosis (TB) for example. The executive branch takes the lead on programming and budgeting. The White House sets the agenda by appointing agency leaders, and by suggesting budget amounts to Congress with the combined President’s Budget Request each spring, which is released with the annual State of the Union address. Through the State Department, the bilateral country-to-country funding of the President’s Emergency Plan for AIDS Relief and the U.S. contribution to the multilateral Global Fund to Fight AIDS, Tuberculosis, and Malaria (the Global Fund) support a significant proportion of global HIV-TB and TB programs. Through the U.S. Agency for International Development (USAID), the U.S. government funds global TB efforts, as well as malaria, maternal and child health, vaccines, nutrition, and other specific disease areas. The Centers for Disease Control and Prevention (CDC) has a global TB program, and the National Institutes of Health (NIH) is the world’s largest single funder of TB research.  

The House and Senate of Congress are also responsible for allocating funding to TB programs through the annual discretionary appropriations process. For example, the State, Foreign Operations, and Related Programs appropriations subcommittee allocates funding to the TB programs under USAID and the Global Fund. Equally important are the House Foreign Affairs Committee and the Senate Foreign Relations Committee, which have jurisdiction over the policy guidelines and goals for global TB programs—for example, the End TB Now Act. All members of Congress have an opportunity to weigh in on the appropriations process, including how much funding is allocated to TB programs. Funding for domestic TB work, including through the CDC and NIH, is allocated by another appropriations subcommittee, and governed by separate authorizing committees. It's worth noting, however, that mental health, surgery, and non-communicable diseases like cancer and diabetes receive little or no funding, and PIH is continually working to change this. 

While the U.S. government may hold the purse strings to help advance health policy, PIH recognizes that partnering with local governments to implement health programs is vital to their sustainability and success.  

PIH and Government Accompaniment

Since the beginning, PIH leaders knew that real advancement toward a universal right to health would only be possible through strong partnerships. Our goal is not to expand across the globe, but to partner with governments and organizations who invite us to work together. PIH's collaboration with national governments, local districts, organizations in the private and public sectors, and civil societies helps drive all our health system strengthening work, everywhere.

“What makes PIH unique is that we provide clinical care and provide evidence to the Ministry [of Health] of our impact through a system strengthening model,” Danielle Sharp, director of policy and partnerships for PIH Lesotho, said. “And through that accompaniment model, [we] are then able to transform the health system.”

PIH’s approach to accompaniment includes working side-by-side with our friends and colleagues at all levels, whether they are community-based, state health authorities, or global health advocates, to deliver the highest quality care. We call on those in power, from local legislators to world leaders, to advance equitable health care.  

“Health care is a human right and a public good that is best designed and delivered at scale through government,” Ashley Damewood, director of policy and partnerships for PIH Liberia, said.

Through accompaniment, PIH teams around the world aim to influence legislation, funding, and programmatic decisions to support the movement for global health equity.

Advocating for Public Health Advancements

In both the U.S. and globally, PIH works to improve health equity and address disparities by improving public policy. Through coalition and grassroots advocacy, PIH has successfully co-authored and spurred the introduction of important new legislation—such as the Community Health Worker Access Act—and opened new financing at the state and federal levels.

“We work daily to grow a foundation of strong bipartisan and bicameral congressional and agency support for critical global and domestic health programs, regardless of who may be in elected or appointed roles at a given time,” Vincent Lin, associate director of health policy and advocacy, said.

Thinking again of TB, the PIH advocacy team worked with Congressional leadership to integrate lessons from PIH's care delivery work across sites and lay out an ambitious strategy for ending TB in the End TB Now Act.  

As a result of this dedicated advocacy focused on global health funding, the U.S. has continually increased funding for global health programs. PIH’s grassroots network of volunteer organizers, known as PIH Engage, has contributed to this national movement through more than 1,500 meetings, calls, and letters to elected policymakers over the last year. PIH supporters far and wide have taken action from all 50 states and Washington D.C., with more than 40,000 calls made and letters written to Congress on important health access topics from addressing Tribal health disparities to TB spending.

The Public’s Role in Influencing Global Health

Each year, executive and congressional staff seek input from the public. By design, congress is responsive to the desires of their constituents. For example, congressional staff will meet face-to-face with constituents, take phone calls, read emails and handwritten letters, and hold town halls to better understand the interests of the communities they serve. 

Aside from engaging with their representatives, another way constituents have power to influence the public health priorities of our government is through voting. During an election year, the phrase “healthy voter turnout” takes on a new meaning when we view voting as a public health priority. According to the Health & Democracy Index, communities with higher voter turnout rates have better health outcomes. Voters also have the power to influence policy decisions that impact health care, both locally and globally.  

After about eight months as interim executive director, Vicky Reed was appointed Partners In Health (PIH) Sierra Leone’s new executive director in August.

A dedicated nurse and leader, Reed grew up in Freetown and moved to the United States when she was 15, during the beginning of Sierra Leone’s 11-year civil war. While in the U.S., she earned degrees in international business and Spanish, then spent seven years in banking.  

Inspired by her mother and grandmother, Reed made a career change and enrolled in nursing school. After several visits to Sierra Leone —including for the funeral of her beloved grandmother, a respected nurse—Reed was drawn to move home. A PIHer since 2019, Reed was first hired as PIH Sierra Leone’s director of nursing. In that role, she mentored nurses, developed protocols to improve care, and participated in the Global Nurse Executive Fellowship. In December 2023, she transitioned into the interim executive director role.

We spoke with Reed about her background, new position, and the road ahead. Below, edited and condensed, are her responses: 

Describe the moment you learned you were selected as executive director. How did you feel?

It depends on which time. After the leadership transition in December, it was overwhelming because this is not something I aspire to; I just came here to do my job. The fact that I was considered for the role is a huge honor and privilege. I think the second time around when the position was confirmed in August, I felt some sort of validation because I didn't expect the news. Being appointed into the permanent position made me feel that I am doing something right.

How have your life and professional experiences uniquely positioned you to successfully lead PIH Sierra Leone?

Growing up, my dad always taught us that when you work hard, you'll be recognized for your hard work. Don’t point out the things that you're doing. You work hard because that's what you're supposed to do, and then anything else that happens afterwards, you deserve it. In terms of my career, this is just how I've always been. I've never been one to be in the forefront and have always preferred to be in the background.

My career as a nurse really prepared me for this role. Nurses are always thrown into the fire and the unexpected. You try to juggle different things with competing priorities. When I started my career in nursing, I worked in the medical surgical unit where you had to take care of five or six patients, or even sometimes seven or eight. Even if you were short-staffed,  you had to provide the best possible care. 

What are some of the challenges in health care delivery that you, and PIH Sierra Leone, face as you look ahead?

Most people can’t afford health care, and we don't have a free health care system in Sierra Leone. In collaboration with the government, we at PIH are trying to fill the gap and address many health care needs. We are focusing on providing care and meeting the needs of the most vulnerable patients.

Many PIHers in Sierra Leone know you; however, many others haven’t had the pleasure of meeting you. With that in mind, what is something that most people don’t know about you that you’d like to share?

Most people know I have three kids: two daughters and a son. Maybe one thing they don't know is that my oldest daughter is in her last year of high school, so she'll start college soon. And when I look back at it, I can't believe that I almost have kids in college!

Do your kids want to follow your path?

I did not push any of my kids into health care. However, my oldest daughter, 17, wants to become a neonatal nurse. And my youngest daughter, 12, wants to be a midwife. I don't know where she got that from either because that's not something we even talk about in the U.S. When they came to Sierra Leone in 2022, they shadowed Dr. Naphtal while he was feeding babies in the special care baby unit. They wanted to pursue health care even before they got that exposure.

Reflecting on your time at PIH, what is your most memorable moment and why?

There are so many memorable moments. There's one patient who had issues with gastrointestinal (GI) bleeding and was often in the emergency department. We once sent him to Freetown to undergo a procedure at a private hospital. Then, a few months later we were planning a computer training session for some of the nurse mentors, and it turned out that the patient was one of the instructors.

The fact that he was teaching our nurses was a full circle moment because this is somebody who we can't view as just a patient. Patients are people who have lives outside of the hospital. And the impact that we had on him to where he's still able to go out, make a living, and now teach PIH staff, is special.

You’ve previously discussed the tremendous impact that your grandmother, a nurse, had on your life and career. Who else inspires you and why?

My dad inspires me because he has always been a very humble person, displays humility, and respects people regardless of their stature in life. He was a professor, deputy minister of foreign affairs, and minister of tourism. He knows the value of hard work and always instilled that in me.

When I think about things, I don't get worked up or worried about different positions or what I believe I deserve because I feel like whatever you deserve is going to come back to you. The way he approaches things and handles different situations in life is inspiring. 

Which PIHer is a mentor or go-to person for you and why?

Right now, Patrick Ulysse because he is supportive and pushes me to come out of my shell; however, all staff inspire me in some way. There’s a woman who has worked at PIH’s guest house since 2014, the year PIH began working in Sierra Leone. She really willed herself and joined PIH’s adult literacy program. While I was at the office last week, she was using a laptop and sending emails. This is huge because this is someone with no formal education who couldn’t read or write. She’s self-motivated, puts herself out there, and always wants to learn. She’s somebody I really look up to. 

What do you want people who aren't familiar with PIH (both nationally and globally) to know about PIH Sierra Leone and the country’s history?

Sierra Leone has had a very tough history with the decade-long civil war, Ebola, mudslides, and Covid—all of which have impacted our health system. At one point, Sierra Leone had the worst maternal mortality rate in the world. The numbers are much better now, but there are still challenges.

We have very poor health outcomes nationwide in many different indicators. But at PIH, we are not just going to focus on one thing, rather we are going to address everything in terms of the 5 S’s model.  It's not an easy feat, but we've made that commitment to stay and improve the health care system. Personally, I want people to understand that this is very challenging, but if we continue to get support from people, this is something feasible for us to do.

What has been the biggest change in pivoting from director of nursing to executive director?

As director of nursing, I was focused on clinical work. As executive director, I have responsibilities beyond that. Since I started this role, I've been trying to better understand finance and operations because those are not my strong suits. However, those areas are very important for the organization because if we strengthen financial and operational systems, then we can improve our clinical work. Expanding beyond the clinical side has been one of the biggest changes for me and has allowed me to more deeply understand what’s going on within PIH.

Is there anything you’d like to share that I didn’t ask you about?

This has been an interesting time in my life and for the organization. It has been a challenging year with many transitions, but I think this is the start of something better. I'm looking forward to steering the organization to make sure that we are a site that others can learn from and gain insights, just like we are doing with other PIH sites now. I want PIH Sierra Leone to become a model for the rest of the organization.

Maternal mortality remains a daunting challenge in Lesotho, with a rate of 566 deaths per 100,000 live births, surpassing the Southern African regional average of 545 per 100,000, according to the World Health Organization. This alarming statistic has driven Partners In Health (PIH) Lesotho to take decisive action, particularly in remote areas where access to prenatal care and safe delivery services is limited.

In a significant stride toward reducing maternal and neonatal deaths, PIH Lesotho built and opened a new maternal waiting home. The facility is designed to provide expectant mothers with a dignified environment as they approach their delivery dates.

The former maternal waiting home, which sits adjacent to the new one at Lebakeng Health Center, recently became overcrowded. This forced many women to endure risky home deliveries or undertake arduous journeys while in labor. To address space constraints, the new building is larger and has 32 beds, a significant increase from the original 8-bed home.

In collaboration with the government, PIH Lesotho officially opened the facility in June during a ceremony led by Prime Minister of Lesotho Ntsokoane Matekane. He lauded the initiative, noting the challenges many expectant mothers face, such as long distances to health care facilities, poor road conditions, and the adverse effects of climate change on health services. These factors often prevent safe deliveries, leading to unnecessary deaths. Matekane emphasized that the new facility would allow mothers to stay at the clinic both before and after childbirth, providing a healthy and supportive environment that significantly improves health outcomes.

More Than a Building

Since 2009, PIH Lesotho has included maternal waiting homes at its seven mountain clinics, located in some of the most remote, underserved regions of the country. The facilities are part of a comprehensive effort to increase facility-based deliveries and reduce mortality.

In addition to a safe space, “we provide social support, including food, linen, and baby clothes, ensuring the mothers are comfortable while waiting at the clinic,” says Dr. Melino Ndayizigiye, executive director of PIH Lesotho.

Health care workers at the homes conduct regular check-ups, offer nutritional guidance, and provide emotional support, ensuring that women are well-prepared for childbirth. Each of those efforts align with PIH’s belief that five key elements are needed to strengthen health systems: staff, stuff, space, systems, and social support.

About 100 miles north of Lebakeng Health Center, another maternal waiting home is under construction at Bobete Health Center. For years, the clinic has struggled with limited space. To maximize space, staff removed all bed frames and placed mattresses directly on the floor. This adjustment, while not a perfect solution, created room for more mattresses, accommodating the increase of pregnant women admitted to the home.

There are “...only four bedrooms available in the existing maternal waiting home. One room is allocated to new mothers, leaving three rooms to accommodate an influx of 25 to 38 women each month,” says Palesa Khomonngoe-Moea, Bobete Health Center’s nurse-in-charge.

Looking ahead, she believes the facility will have a transformative impact, particularly for women who often walk for hours to reach the clinic. Once complete, the new building will also have 32 beds.

The construction of maternal waiting homes is more than an infrastructure project; it is a symbol of hope for the future of maternal health in Lesotho. 

Between January 2021 and August 2024, a total of 11,691 women received care across PIH Lesotho’s maternal waiting homes. 

Through continued efforts, in partnership with the government, the journey to motherhood is becoming safer, and the goal to achieving a healthier future for Lesotho’s mothers and children is gradually becoming a reality.

In the United States, September kicks off Hispanic Heritage Month, a national observance celebrating the histories, cultures, and contributions of Hispanic, Latin American, and Afro-Latino communities, running from September 15 to October 15. 

Although the annual celebration is confined to these dates, PIH-US acknowledges that elevating the voices, stories, and histories of these communities is crucial year-round. Today, and every day, we honor the work of Hispanic, Latin American, and Afro-Latino individuals in shaping a future where everyone can thrive. 

Below, we highlight the incredible contributions and achievements of some of our community partners in Florida, Massachusetts, and North Carolina.

In the 1950s, federal policies like the Indian Relocation Act coerced Native communities off reservations with unfulfilled promises of housing, education, and jobs in nearby cities. While the act touted opportunities, it led to the dissolution of federal support for reservations, leaving urban Native Americans to face high poverty rates, job discrimination, and limited opportunities.

For the more than 70% of American Indians and Alaska Natives (AI/AN) living in urban areas, these harmful policies continue to exacerbate inequities. Despite enduring significant challenges, Native communities seldom have a say in or control over the policy decisions affecting their lives, or the data that drives these decisions.

To address this gap, Native communities in Pima County, Arizona, are stepping up to reclaim ownership of their data and reshape the policies that affect them.

Last year, Partners In Health United States (PIH-US) and the Tucson Indian Center (TIC), which offers health and other essential support services to urban Indigenous residents of Pima County, co-launched the Pima County Indigenous Health Equity Coalition to oversee the development of a Native-led and owned data ecosystem. Traditional research and data collection methods often exploit Native communities, leading to inaccurate data that results in underfunding, limited access to services, and increasing health and poverty issues for Native populations, both on and off reservations. 

While TIC already collects data on their programs, they don't currently have a unified system to fully understand and track the breadth of community strengths and needs. This new coalition will create an ecosystem that captures the urban Indigenous community's assets and needs, while also developing a shared language and vision to guide collaboration on database design, data protection, and analysis, connecting the community's platform, processes, and people. By building on traditional knowledge systems and transferring power and decision-making about data systems back to the urban Indigenous community, TIC and PIH-US aim to help shape policies and increase public funding allocations aligned with the needs of the Indigenous community. 

“In current data sets, there is often a disconnect between definitions and meanings of words. How [Indigenous] communities define health might be different than the general population,” said Dylan Baysa, Social Services Director at the Tucson Indian Center. “The data ecosystem will enable us to develop shared language and bridge the gap. We are creating something that is not only for the Native community but informed by them.” 

More accurate insights will help Dylan and his team improve access to primary care, behavioral health, and social support services for off-reservation Indigenous community members in Tucson. The data from the ecosystem will also be used to inform long-term collaboration with local government partners, including the Pima County Health Department (PCHD).

Since 2020, PIH-US has collaborated with PCHD and TIC to improve health outcomes by enhancing community engagement and creating programs that center equity and are data-driven. With PIH-US support, PCHD established an Office of Policy, Resiliency and Equity and hired a dedicated Tribal Liaison. Similarly, PIH-US is supporting TIC to establish an advisory council, which brings together diverse stakeholders to guide the creation of the data ecosystem and ensure the principles of Indigenous data sovereignty are upheld.

And this is just the beginning. 

“The health department already collects data on Native Americans, but there are gaps between the data they are collecting and what might be needed to inform policy,” explains Dylan. “By bridging the gap between the community and the health department, we’ll be able to collectively align with community priorities and use this information to develop legislation and policy.”

Intentional redistribution of power and inclusion of the community narrative are necessary to meaningfully affect change. Cross-sector collaborations like those in Pima County can yield improvements in health outcomes that no single organization or institution would have been able to achieve on its own. By centering community members’ lived experience, agreeing on shared priorities, and pooling resources, knowledge, and skills, organizations can build a collaborative infrastructure that tackles both immediate and long-term inequalities in the region.

“Having community members be a part of the community advisory council and giving them a seat at the table with the health department, I am hopeful we will build trust and start to repair some of this historical trauma,” explains Dylan. “I think [this work] is a huge step toward the future.”

Cardiovascular diseases (CVDs) are among the leading causes of death in the world, taking an estimated 17.9 million lives each year, with one-third of deaths occurring in people under the age of 70. These diseases, including coronary artery disease, rheumatic heart disease, pulmonary embolism, heart valve disease, and more, encompass a range of conditions that affect the heart's structure and ability to function.  

In sub-Saharan Africa, the prevalence of risk factors for CVD is high, and access to specialized care is limited. With a staggering ratio of just one cardiothoracic surgeon for every 14.3 million people, options for managing heart conditions in countries like Malawi are few.  

Two Worlds Collide  

Promise Douglas, a 9-year-old from Nyaiyaye Village in Malawi’s Neno District, and Vitalina Chaona, a 49-year-old from Gochi 2 Village in the Ntcheu District, had lost hope after years of struggling with severe heart diseases.  

Douglas, suffering a congenital heart defect, and Chaona, battling rheumatic heart disease, received inadequate treatment for their conditions until Abwenzi Pa Za Umoyo (APZU), as Partners In Health (PIH) is known in Malawi, stepped in. 

For Chaona, a shortness of breath and discomfort in her chest coupled with a general feeling of weakness prompted a visit to the PIH-supported Neno District Hospital in September 2021. There, she was examined by Medson Boti, a clinician specializing in chronic care for severe noncommunicable diseases. After thoroughly assessing Chaona, Boti diagnosed her with rheumatic heart disease, a condition that begins with a bacterial infection and leads to complications that affect heart valves. 

Chaona recalled, “When I was first informed that I had been diagnosed with this heart condition, I was initially worried; but I was relieved that at least I could be put on pain relief medication, refilled every month from Neno District Hospital. PIH Malawi also supported me with transportation during my monthly visits to the facility.” 

“We immediately started treating the symptoms on Vitalina,” Boti said, “then consulted a cardiologist who conducted a further assessment on her and concluded that she could benefit from surgery.” 

Around the same time and within the same country, another patient experienced frightening symptoms as well. Diagnosed with Tetralogy of Fallout at Lisungwi Community Hospital in February 2022 and again at Queen Elizabeth Central Hospital in January 2023, Douglas experienced difficulties breathing and eating, blue-tinged skin, fainting, an inability to exercise, and heart palpitations. Doctors concluded he had a rare condition caused by a combination of birth defects that change the way blood flows through the heart. 

“We facilitated further assessments with cardiologists and a recommendation was made for him to undergo surgery,” Boti said. “Cardiac surgeons from Tanzania who were in Malawi visiting at the time made similar recommendations, and he was immediately put on list of those waiting to go for surgery.”  

Seeking Treatment Abroad 

Both Chaona and Douglas were treated with medications to manage their symptoms. However, due to limitations in cardiac care available in Malawi, the two required further treatment outside the country.   

Boti explained: “Currently, we are unable to conduct open heart surgery in Malawi. We only have medications that improve the symptoms of heart diseases. Patients with heart conditions are sent outside the country for surgery.”  

APZU identified Jakaya Kikwete Cardiac Institute in Tanzania as the most suitable facility for the lifesaving surgical procedures both patients needed, and a carefully planned trip was arranged.   

Accompanied by Nurse Dester Nakotwa for support, the hopeful pair set off for Tanzania by way of Chileka International Airport in Blantyre in November 2023.  

Uncertain of the procedure's outcome and desperate for relief from the ongoing pain her condition inflicted, Chaona nervously anticipated her surgery. 

“When I was informed about the surgery in Tanzania, I was excited but scared at the same time,” she said. “I was reluctant as I was not sure of the outcome of the procedure; however, I needed to be free from the pain I had been feeling for over three years. When we arrived, I was scared after some assessments, but I was assured that I was going to get better after the treatment.”  

The patients stayed at the health facility for about a week before their procedures, as doctors conducted tests in preparation and to ensure readiness. Afterward, they remained in the hospital’s intensive care unit for an additional two weeks before returning to Malawi. Each surgery lasted an estimated six to eight hours, and both were successful.   

Recovery and Ongoing Support 

Five months after surgery, APZU continued monitoring Chaona and Douglas, who showed significant progress. Boti, who is keeping a watchful eye throughout their recovery, is hopeful that the two will live normal lives.  

“Overall, there has been great improvement on the condition of the patients following the treatment in Tanzania,” Boti reported. “For Promise, there is a lot that is expected of him as a child, and we are hoping that he will be able to grow healthy and reach his maximum potential.”  

“On the other hand,” he continued, “I have personally examined Vitalina since her return from Tanzania and I can see some great improvements. She is now able to walk [and] breathe properly as compared to the period before surgery. I believe she will be able to resume some household chores as a woman in her home.”  

According to Neno District's noncommunicable disease (NCD) coordinator, Haules Zaniku, heart conditions are relatively common in the region, where facilities register at least three to five new patients every month. Frequently reported heart conditions include: cardiomyopathy, hypertension, and rheumatic and congenital heart diseases, normally caused by rheumatic fever, alcohol use, HIV, and other infections.   

Zaniku applauded PIH for its role in facilitating high-quality care for patients with complex health conditions, saying: “The efforts of PIH in ensuring that patients have access to treatment outside Malawi is of very great importance, as we don`t have more advanced facilities that are able to perform heart surgeries including advanced laboratory services currently in Malawi.”   

Expanding Cardiac Care 

In 2018, PIH, in partnership with Malawi’s Ministry of Health, opened PEN-Plus clinics at Neno District Hospital and Lisungwi Community Hospital. These clinics provide decentralized care for severe NCDs through the integration of health services.  

Both facilities address heart-related conditions through outpatient care, offering medication to help manage symptoms. People requiring surgery rely on government assistance and partner sponsorships to access treatment centers outside of the country.  

The two facilities also treat type 1 and type 2 diabetes, asthma, sickle cell, stroke, deep vein thrombosis, and occupational lung diseases, among other conditions.  

The success of the PEN-Plus clinics led to their expansion to Karonga and Salima Districts in December 2023, giving local health care providers the capacity to manage and treat both simple and complex NCDs at primary and secondary health care levels. 

As of April 2024, there were 595 patients enrolled in Neno’s PEN-Plus clinic receiving advanced NCD care. Among them, 86 were seen through home visits due to physical challenges associated with their illnesses. There are four patients on the waiting list for cardiovascular surgeries abroad.  

A new chapter of hope is being written in Thomonde, where Zanmi Lasante (ZL), as Partners In Health is known in Haiti, opened its first oxygen plant in collaboration with the Ministry of Public Health and Population (MSPP) in August.  

Bringing new infrastructure and innovation to the Central Plateau and lower Artibonite regions, the Thomonde Oxygen Production Center marks a significant step towards improving health care delivery in Haiti, providing a reliable and sustainable supply of medical oxygen to communities with limited access to critical resources.  

Hospitals and clinics across Haiti have experienced dire shortages of medical oxygen, preventing them from administering lifesaving medical treatment. Fuel scarcity, blocked roads, supply chain issues, and broken oxygen generators have all made the availability of oxygen when and where it is most needed significantly more challenging. 

ZL health care facilities in Central Plateau and the lower Artibonite previously relied on the costly purchase and transport of about 850 oxygen cylinders per month. Too often, however, patients with severe respiratory conditions and other critical illnesses endured long waits for oxygen supplies, and at times, faced shortages and delays that put their chances of survival in jeopardy.  

With the capacity to produce up to 100 cylinders of oxygen per day, the Thomonde Oxygen Production Center puts an end to troubling uncertainties. Local oxygen production eliminates the dependence on external oxygen supplies and will significantly improve emergency response, the quality of neonatal care, the ability to treat chronic and acute conditions, and reduce mortality rates. 

The center also reduces the costs and logistical hurdles associated with importing oxygen from distant locations, allowing ZL to reallocate resources to other critical areas. 

Operating 24 hours per day, the facility offers new employment opportunities to the community, staffed by three rotating teams of plant operators and technicians who perform daily procedures, including maintenance and repairs.  

Reporting to Plant Manager Jean Marie Aneus, staff are trained by PIH in partnership with Build Health International to maintain oxygen infrastructure, complete future upgrades, and ensure long-term function. 

Roosevelt Jean, the Thomonde Health Center administrator, was integral to the success of the project, actively participating in the planning and development stages. Community involvement, while also promoting a sense of ownership and sustainability, is vital to assure the oxygen plant addresses regional needs. 

"This center will play a crucial role in providing oxygen first to the Thomonde Health Center and the health institutions in the Central Plateau, thus strengthening our ability to save lives and improve the health of the communities we serve," said Dr. Wesler Lambert, executive director of ZL, at an inaugural event for the facility.  

Dr. Wolve Irvens Charles, an MSPP representative, added: “This new oxygen plant clearly demonstrates the sincerity and transparency of the collaboration between the MSPP and Zanmi Lasante. In keeping with the principle of partnership, let us make sure that together this new oxygen production center will contribute to a high proportion of oxygen production that can meet not only the needs of the department’s regions, but other regions of the country too.”  

ZL plans to establish other oxygen production centers at key sites, increasing its ability to provide essential health services and making its network fully autonomous in terms of oxygen supply. A long-term investment in improved infrastructure and quality of life, the oxygen infrastructure is certain to help people living in Haiti breathe easier. 

Partners In Health (PIH) was founded in 1987 on the principle that health care should be a human right for all—a somewhat radical belief, even today. Increasingly over time, PIH staff, colleagues, and supporters became advocates for people around the world as they fought for accessible, equitable health care, particularly in settings of poverty.  

Advocacy within PIH has evolved over the years. From our beloved late Co-Founder Dr. Paul Farmer writing books and facilitating congressional briefings and hearings to share his personal beliefs and professional experiences, to now: a robust, dedicated Advocacy team with a strong network of grassroots supporters.  

To build sustainable health systems, PIH is advocating every day, both behind the scenes and by the bedside, to advance global health equity.

To learn more about this part of PIH’s work, we spoke with Joel Curtain, PIH Director of Advocacy; Vincent Lin, PIH Associate Director, Health Policy & Advocacy; and, Carole Mitnick, PIH Senior Research Associate and Harvard Medical School Professor, Global Health & Social Medicine. Below, edited and condensed, are their responses:

What does Advocacy mean at PIH?

Lin: Advocacy is an umbrella term that we use as an organization to talk about a lot of different work we do. PIH builds the evidence base for changing policy and uses that evidence coupled with our technical expertise to advocate with intergovernmental decision-makers in policy-setting organizations—like the World Health Organization (WHO).

We also integrate what we’re learning from our work around the world in co-writing legislation with U.S.-based policymakers, and dedicated grassroots and coalition-based legislative advocacy. With our grassroots PIH Engage network, we’ve trained thousands of volunteers in federal legislative and appropriations advocacy, generating hundreds of meetings and thousands of contacts with Congress.

In broad coalitions, we advocate alongside community health workers (CHWs) for CHW funding in the U.S. at the state and federal levels, with Tribal leaders and providers for sustained financing to address Tribal health disparities, and with TB survivors to increase tuberculosis (TB) funding. We work to accompany and empower the communities most directly affected by injustice. We also mobilize a broad base of supporters in advocacy campaigns through calls to action like our latest push for passage of the End TB Now Act of 2023, where over 12,000 letters have been sent by constituents to their members of Congress.

We’ve also seen the power of coalitions of activists over decades who have won increases in funding and reductions in the prices of necessary medications and diagnostic tools.

Curtain: Eliciting structural change is core to PIH’s history and mission. We’ve all been inspired by how PIH’s care delivery work can create new political possibilities. This is why Bending the Arc is such a compelling film. However, there are many, many steps between care delivery and meaningful policy change, which require building and leveraging power meticulously and tenaciously. This is what our team is tasked with. So, to us, advocacy is a deliberate process of developing and executing strategies to build and leverage power to change specific policies and conditions that improve people's lives. All advocacy is based on power relations.

“[Advocacy] involves developing and executing strategies to build and leverage power to change specific policies and conditions that improve people's lives.”

Mitnick: I think accompaniment is key to the PIH approach to advocacy. We advocate for what the population we serve needs, generating more resources or changing policy for the diseases of importance to those communities. And then it goes all the way up the chain to bring the needs of the patients we serve into the halls of power.  

Lin: It’s pretty amazing to have seen Dr. Paul Farmer constantly working to span multiple arenas—from huts in Cange to the White House, from local clinics to the WHO in Geneva, and from the medical classroom in Rwanda to the halls of Congress. Now, as an organization, we’re scaling such efforts in tandem with partners at Brigham and Women’s Hospital (BWH) and Harvard Medical School (HMS) and colleagues around the world.

Mitnick: And we take our advocacy to ministries of health in the countries where we work and to entities that define what’s permissible or supported in global health projects. Locally, in countries and regions where PIH works, the teams are now organizing formal efforts to keep governments accountable. To me, that’s another form of PIH’s advocacy.

How has advocacy at PIH evolved?

Mitnick: When I started at PIH in 1996, there was deliberately no advocacy strategy, as the focus was on direct service and bringing the best-known standard of care to the most marginalized. But through involvement in certain initiatives—for example, the treatment of HIV in Haiti—we realized that without a parallel advocacy effort to change the policies and the underlying assumptions that led to those policies, we weren't going to be able to effectively deliver care.

“We realized that without a parallel advocacy effort to change the policies and change the underlying assumptions that led to those policies, we weren't going to be able to effectively deliver care.”

Lin: Historically, PIH programs on the ground have served as an example of what’s possible. Back in the early 2000s, Dr. Paul Farmer was one of four physicians brought to the White House to inform the Bush administration on the treatment of HIV/AIDS. Paul described what PIH had achieved in impoverished, rural settings, and PIH’s work demonstrated what could be later scaled through PEPFAR.  

Paul always talked about growing the pie for global health equity funding overall. We've taken that mandate from him and applied it to our grassroots and coalition-based advocacy work. One thing that is unique today versus 20 years ago is that we have experts on training advocates, writing legislation, and federal and state budget cycles on our staff. We're trying to mobilize thousands of people, supporters and volunteers, to collectively and effectively improve public sector decision-making in an evidence-based manner.  

Curtain: That it is evidence-based is so important. PIH has developed this work to be very specific, targeted, rigorous, and robust—intervening in specific processes along the way, knowing when to intervene, with whom to intervene, knowing local pressure, and doing so with an enormous grassroots constituency is something that makes PIH different from other global health organizations.

Are there other aspects that set PIH’s advocacy efforts apart from similar organizations?

Lin: Our volunteers are pretty unique. PIH has attracted many people to the cause by operating from a framework of social justice: “Injustice has a cure.” We’re trying to give folks who already care about these issues a way to be active and effective in advocacy through formal training and organizing work.  

“We’re trying to give folks who already care about these issues a way to be active and effective in the advocacy space through formal training and organizing work.”

Mitnick: PIH’s approach to advocacy is unique in that it is informed by theory and rigorous evidence, both on the clinical care side and from a social justice foundation. Coming from the perspective that there actually are plenty of resources in the world if they are reallocated intentionally, in conjunction with a delivery model that prioritizes marginalized populations and uses advocacy to support them, using the research that comes from partnerships with BWH and with HMS as well as other partners... PIH does all that and advocacy is a core pillar of the whole model.

How does Advocacy help grow the health and social justice movement?

Mitnick: Our advocacy work helps bring people along who were very invested in the mission of PIH, but who weren’t going to go to medical school or public health school. They weren’t ever going to work in this space, but the advocacy work and having the opportunity to change things fundamentally also created a way for people to get involved with PIH.  

It’s been so important for us to form alliances with affected populations and other organizations to work toward some of these changes, including reductions in the price of necessary treatment and diagnostic equipment, like the GeneXpert TB diagnostic test.  

Can you give an example of how PIH advocacy has changed over the last 30 years?

Mitnick: I think our work in TB is such an incredible example because it goes all the way back to the beginning of PIH, in Haiti in the late 1980s, and the very first “randomized controlled trial” that PIH conducted studying the delivery of TB treatment. Unsurprisingly, it showed that, in an impoverished population in rural Haiti, TB treatment delivered with treatment support led to much better outcomes than TB treatment without support.

It was the first thing that was intentionally done by PIH to show the rest of the world and say, ‘Hey, this is something that needs to be adjusted.’ We didn’t define this as “advocacy” at the time, but, in retrospect, it clearly was. It used an example from PIH’s work as a model for how quality care could be delivered in impoverished settings.

In ‘98 and ‘99 we started to present results from our experiences treating TB to the WHO to try to revise treatment guidelines. Our efforts evolved from just doing the work, to doing it and trying to persuade global policymakers to think about how to reach those in need. This year, evidence from our endTB clinical trial has now informed treatment recommendations from the WHO.

Now we're on the other side of that guideline process—where there's still a lot of work to do to scale up these innovations—but we have a much more robust evidence base than we ever had before.

Lin: In August 2024, we led 130 congressional meetings between constituents and their elected officials on global and domestic TB legislation and funding. This year, a record 131 members of the House signed on in support of increasing global bilateral TB funding by 250%. That's a result of many volunteers—not just our supporters, but TB survivors and policy experts—going to Capitol Hill to specifically talk about TB.

It's been tremendous to see people picking up the phone and calling congressional offices and saying to the interns and staff there on a daily basis, ‘I want to see TB funding grow.’ I think that it’s cool to see growth in the movement over the last five years, and how many more people know about and care about TB, and are willing to put their time and energy into advocating for it.

And this has paid off: On September 19th, the U.S. Senate passed the End TB Now Act. PIH supporters alone are responsible for 12,000 messages to Congress in support of the bill, a massive effort that we are so grateful for. However, we still need your help to get it through the House of Representatives. 

New, safe, and effective tuberculosis treatment options were recently approved by the World Health Organization (WHO). These treatments—which were studied in the Partners In Health (PIH)-led endTB clinical trial—and the resulting recommendations represent the culmination of nearly a decade of scientific research and patient care across 18 countries.

The new treatments will benefit people with some of the most difficult to treat forms of the infectious disease, including multidrug-resistant tuberculosis (MDR-TB) and rifampicin-resistant tuberculosis (RR-TB). Combined with prompt diagnosis, these regimens can improve the lives of countless patients.

For more insight about this major advancement in tuberculosis care, we spoke with Carole Mitnick, PIH’s director of research for the endTB project, co-principal investigator of the endTB trial, and professor of global health and social medicine at Harvard Medical. Below, edited and condensed, are her responses:

How would you summarize the recent news announced by WHO to a non-clinician who is not familiar with tuberculosis, but is eager to learn more? 

For the first time ever, virtually everyone with MDR/RR-TB—no matter their age, whether they’re pregnant, whether they have HIV—can get a novel, all-oral, shorter and effective treatment. These new guidelines overcome three major barriers to universal care: 1) With the old standard—a long, toxic, expensive regimen that involved shots every day for six months or longer—health systems could only deliver this complex regimen to a handful of people with MDR/RR-TB each year; 2) the first, shorter, novel regimens had been recommended only for subsets of patients (e.g., adults who weren’t pregnant); 3) because of prior work done by PIH and partners also through the endTB project, there is much more familiarity and comfort among doctors and patients with the drugs in the newly recommended shorter regimens than there was with the first. For all these reasons, the new recommendations should help shorter, effective treatment reach many more people. 

Why does this news matter?

Without treatment, MDR/RR-TB transmits in homes and communities and kills people often after a long, debilitating illness. It frequently strikes young adults in the prime of their lives. The number of new cases each year has stubbornly held at roughly half a million. Without these new treatments, we had no hope of ending this scourge.

The endTB project is a collaboration among PIH, Médecins Sans Frontières, and Interactive Research and Development, and funded by Unitaid. What, specifically, was PIH’s role in this work?

PIH led the grant from Unitaid and the endTB project. In all parts of the project, PIH instilled social justice principles, which drives our everyday work. Specifically, PIH enacted these principles through: accompaniment of participants in the endTB clinical trial (and the other studies); provision of social, nutritional, and other forms of support to trial participants; use of modern methods for diagnosis and comprehensive care for side effects; and linkages to other services as needed for other illnesses or economic or social challenges. Essentially, PIH brought the five S’s (staff, stuff, space, systems, and social support) to a clinical trial! PIH led the implementation of the endTB trial in Kazakhstan, Lesotho, and Peru, where the organization has a longstanding presence and critical history of collaboration with each country’s ministry of health.

The new WHO-approved TB drug regimens included children, adolescents, pregnant and breastfeeding women. Why is that important?

These groups are usually excluded from clinical trials to “protect them,” so we don’t know if treatments work the same in them or cause harm. But the reality is that they get MDR/RR-TB and other illnesses that need treatment, so providers are reluctant to use innovations. In the case of MDR-TB/RR-TB, this means they continue to receive older, more toxic regimens that contain many more pills and sometimes injections. Ironically, for pregnant people, many of the drugs used in the old regimens are not known to be safe during pregnancy. So, it’s a terrible situation and vicious cycle.

The endTB regimens used only drugs that are recommended for use in any age group and during pregnancy. Adolescents could join the trial (with permission from a parent or guardian) and people who became pregnant could stay in the study if they chose to. This contributed to the evidence base for the safety of the drugs in pregnancy.

Why is this news especially important for patients with MDR-TB in countries where PIH works, such as Lesotho and Peru, with some of the highest burdens of the disease in the world?

Peru was one of the last countries in the world still using older, injectable-containing, longer regimens. The fact that nearly 40% of endTB participants were enrolled in Peru allowed the Ministry of Health to immediately act upon seeing the results and change practice in October 2023. Even before the WHO recommendation was released, a couple hundred MDR/RR-TB patients in Peru had started an endTB regimen.  

Lesotho and Kazakhstan, while quicker to eliminate the injectable agent, had not yet fully adopted shorter, all-oral alternatives. Their participation in the endTB project broadly, and the endTB trial specifically, gave health leaders and providers comfort with the emerging endTB regimens.  

Lesotho has a very high rate of HIV infection, which makes people more vulnerable to transmitted MDR/RR-TB. So, interrupting transmission of MDR/RR-TB sooner and more fully with these shortened, effective regimens is key to protecting this vulnerable group from getting sick.  

Kazakhstan has one of the highest burdens of MDR/RR-TB in the world. Shorter, effective regimens could allow them to deliver more care in outpatient settings (rather than the norm of hospitalizing them) and, again, contributing to reduced transmission. 

How do we hope this news will impact global TB care and financing?

Two of the recommended endTB regimens are the cheapest to purchase on the market. They can be delivered for roughly $300 per treatment course. Using shorter regimens poses less of a burden on health systems and shortens the time people are suffering with the inevitable side effects.

Freed up money used to pay for the other treatments and the additional health services required can be repurposed toward rapid diagnostics. The high price of diagnostic tests limits their use, which, in turn, leaves many people undiagnosed and without treatment. Buying more diagnostics and treating more people will ultimately drive down the burden of disease.  Plus, people can go back to work, school, or to taking care of their families sooner. 

What are the next steps?

There’s still a lot of work to do to ensure that adequate resources are available to deliver these treatments successfully. The five S’s are more important than ever to ensuring that people can receive a timely diagnosis and complete treatment. PIH is fully invested in initiatives that increase access to even more proven innovation, like the 1/4/6x24 campaign, which draws its inspiration from PIH’s late Co-Founder Dr. Paul Farmer’s commitment to medical science and health as a human right, and PIH Co-Founder Dr. Jim Yong Kim’s aspirational 3x5 initiative for scaling up access to HIV care in low-income countries.

PIH’s involvement in advocacy efforts to squash efforts to create “patent thickets” or “evergreen patents” means that critical drugs, like bedaquiline, are much cheaper than they would otherwise be. And the Time for $5 campaign, in which PIH is a partner, has also yielded a key win in a 20% reduction in the price of the key diagnostic tool to establish the presence of RR-TB. Our work isn’t done there as the price is still not set at a level equivalent to cost plus a reasonable profit, which is $5 as estimated by our friends at MSF.  And many other tests made by the same manufacturer at the same cost, which are key to improving health in the places we work, are still priced much too high. We are also working to increase funding for TB in the U.S. budget.

What else should the world know about tuberculosis and the work PIH is doing to treat patients with this deadly but curable infectious disease? 

Exactly that: TB newly affects 10 million people each year and close to 1.5 million die. But TB is curable and preventable. PIH is at the forefront of bringing all the available tools (the 5 S’s) to bear on this scourge to stop stupid deaths in the places we work. Through efforts like endTB, PIH is also pioneering research to improve the available tools. And, PIH doesn’t stop there, it makes sure that these new tools are taken up by countries and providers who see a lot of TB.  PIH works tirelessly to increase the pot of resources available to those facing this disease. 

Editor's Note: This blog was originally published on November 2, 2022 and was updated with new resources and information on May 28, 2024.

At Partners In Health (PIH), it is our moral imperative to expose social injustice and to work toward correcting those systemic forces that create inequalities. Strategic partnerships and actions targeted at those who have direct control to change systems are essential to our global impact.

Below are resources to help you learn about and advocate for health care for all.

Take Action

1. Connect over shared values.

Share a story over coffee with a friend about why health equity and social justice matter to you. Pass along an inspiring book or film with a personalized note of why it made you think of the recipient. Build a relationship with those who engage with your social media posts about your favorite causes. 

2. Contact your representatives and voice support for important causes.

One first step could be encouraging your US representative and senators to co-sponsor global health-related legislation, such as the End TB Now Act. State and local governments have a significant role to play in local health systems, so consider contacting them about health inequities in your community.

3. Write a letter to the editor of your local newspaper.

This guide details the importance of such letters and gives tips on how to write one. Elected officials and government agencies routinely clip and circulate such letters around their offices as proof of what matters to constituents. If you reference an elected official, it's likely that your published letter will end up on their desk!

4. Open browser tabs and support your favorite cause.

Tab for a Cause is a free, secure browser extension that allows you to raise money for PIH and other causes with every tab you open.

5. Volunteer in your community.

Consider social justice-minded organizations or grassroots groups such as PIH Engage, which recruits and trains volunteer community organizers on how to take meaningful action in the global right to health movement. There are more than 700 PIH Engage members across 85 communities. Join an existing PIH Engage team or apply to start your own.

Stay Informed

6. Watch How To Survive a Plague.

It is a documentary about the early years of the HIV/AIDS pandemic. The film serves as a reminder that the road to systemic change usually involves struggle, but that—ultimately—the results can be life-affirming.

7. Read Why David Sometimes Wins: Leadership, Organization, and Strategy in the California Farm Worker Movement by Marshall Ganz.

The book details the story of the United Farm Workers and how “rethinking relations of power can lead to structural change determined by the exploited, rather than the exploiters.”

Possibly most notable for future advocates, Ganz highlights three elements that lead to organizers’ success: motivation of the movement’s leaders, their diversity of approach, and their creative decision-making.

8. Read An Introduction to Global Health Delivery: Practice, Equity, Human Rights (Second Edition) by Dr. Joia Mukherjee, PIH’s chief medical officer.

Dr. Mukherjee’s book is a valuable resource to become a more informed advocate for global health equity. And John Green, a bestselling author, vlogger, and PIH supporter, found it key to his own education as an advocate.

9. Enroll in online courses to further your education about a favorite cause.

PIH Engage’s Crash Course, updated in 2024, not only provides an overview of the history and current state of global health inequities, but also demonstrates how committed individuals can work together to address those inequities. To access PIH Engage's Crash Course, register as a new member for free, then login.

Examples of Successful Advocacy

Since PIH's inception in 1987, social justice work—which requires understanding the harm done to communities and working to remediate that harm—has played a key role in our clinical care.

Together with partners around the globe, PIH advocates for policies and practices that lead to stronger, more just health care systems in impoverished communities. From advocating for access to treatment for patients living with HIV/AIDS in the 1980s to more recently pushing for equitable access to COVID-19 vaccines, advocacy helps drive change to save lives. It takes many different forms: grassroots organizing, congressional calls and emails, fundraising events, educating the public, and more.

Partners In Health (PIH)-supported Botšabelo Hospital looked vastly different when Paul Soko began working there in 2010. The roads throughout the campus were gravel with minimal landscaping. And the warehouse and retaining wall weren’t built yet.
 
Upon being hired as a clerk of works assistant, Soko immediately began envisioning ways to make the buildings and grounds more attractive, healthier, and easier to access. For nearly 15 years, he dedicated his career to achieving that.
 
Today, it’s difficult to point out a structure on campus that Soko wasn’t involved with in some way.
 
He oversaw the team who built the warehouse, a massive building that stores food and other lifesaving necessities for patients with tuberculosis. He helped construct the hospital’s oxygen plant and dug a trench to bring piped oxygen to bedsides. He designed and laid hundreds of pavers, causing less dirt and debris in the air and making the road more accessible for wheelchairs and vehicles. He planted flowers and trees to make the atmosphere more welcoming. The list goes on.

 “In my opinion, the surroundings can heal a sick person,” says Soko, PIH Lesotho’s infrastructure and maintenance coordinator.

At PIH, we believe the surroundings—or “space”—are one of the five essential elements for strong health systems. By renovating existing facilities and building others from the ground up, PIH creates spaces to meet clinicans’ needs and provide a healing environment for sick patients across the 11 sites where we work.
 
Since 2010, Soko has played a key role in improving Botšabelo Hospital as well as PIH Lesotho’s seven Rural Health Initiative (RI) sites located in the most remote areas of the mountainous country.  He supervised maintenance staff at all RI sites and addressed any needs, such as roof repairs and electrical issues.
 
“Whenever they have a problem, they call me,” says Soko. “I’m happy all the staff understand the importance of saving lives. If people at RI sites are happy, it’s going to be easy for them to do their job well.”

Always Helping

Mary Lesesa, PIH Lesotho nurse-in-charge and program manager, first met Soko while working at Nohana, an RI site, in 2010. Soko would stay at the hard-to-reach clinic for days at a time to address maintenance problems.  

“He’s very helpful and very ready to assist, even if something is beyond his scope,” says Lesesa.

Back then, Soko would often express his ideas to Lesesa. She says he’d always eventually make them a reality. Reflecting on their long time working together, Lesesa is most impressed by one of his recent projects outside of the intensive care unit (ICU) building, which opened at Botšabelo Hospital in 2023.

“He designed the picnicking area, the flowers, the trees,” says Lesesa. “It was wonderful because I wanted those trees, but I didn’t say anything to him. He just volunteered. The place is very nice.”

Soko's Next Chapter

Soko’s last day at PIH Lesotho was on August 30. He’s transitioning into retirement due to the country’s law regarding mandatory retirement age.

“It's so unfortunate I have to leave, but at the same time I'm so interested [in] helping our fellow countrymen and to improve their lives as well. I am interested in farming and I want to help those people as much as I can,” says Soko.

He plans to dedicate his time to supporting his son and two brothers with their farming business. They aim to plant 120,000 apple and peach trees. While those are growing, they’ll plant cabbage and other vegetables.

A seemingly lofty goal for four people, Soko notes his objective is to expand their operation and ultimately create jobs in Lesotho, where there is a 16.4% unemployment rate.

“You don’t have to keep people suffering,” he emphasizes as he reflects on PIH patients and more broadly, the people of Lesotho. 

Sarafina Makashane, 30, has always been driven by her dual passions: fashion design and software development. Instead of choosing one career path, she persistently pursues both, determined to make her mark in the seemingly disparate fields.

In 2023, Makashane began establishing herself in the fashion industry in South Africa. Her designs were gaining recognition, and she was excited about her future. Simultaneously, she was enrolled in a software development course.  

Then, her journey took an unexpected turn when she began experiencing what she thought was simply a sore throat. Believing it was a minor illness and hoping to alleviate the discomfort, she purchased over-the-counter cough syrup and flu medication.

A Sudden Health Crisis

Within a few days, Makashane's symptoms escalated to severe breathing difficulties and relentless vomiting. Alarmed by her rapid decline, she sought medical attention at a health center in South Africa. There, she received the devastating diagnosis: multidrug-resistant tuberculosis (MDR-TB). She was immediately put on treatment; however, her condition continued to worsen.

As her health declined, Makashane made the difficult decision to return home to her family in Lesotho. She knew she needed their support as she faced the biggest challenge of her life. While in South Africa, she was referred to Partners In Health (PIH)-supported Botšabelo Hospital, which is Lesotho’s only facility equipped to handle severe cases of MDR-TB.  

“Getting MDR-TB is life-threatening. I didn't think I'd still be alive considering how difficult it was,” Makashane recalls. “My life was horrible. I couldn't even walk. I watched my entire life flash before me.”

Upon admission to Botšabelo Hospital, Makashane was placed on an 18-month treatment plan involving a combination of drugs. The side effects were harsh, with severe nausea, fatigue, and pain becoming part of her daily life. Tuberculosis (TB)—known to attack the lungs—caused a blockage in Makashane’s left lung, which required complex surgery. The procedure was necessary to save her life but added to her distress, leaving her with chronic pain and constant worry.

Being in the hospital meant missing exams for her software development course, delaying her progress, and causing significant setbacks in her studies. Although frustrated, Makashane remained determined to continue her education as soon as her health allowed.

After three months at Botšabelo Hospital and two weeks in a PIH-supported MDR-TB halfway house, the time finally came for Makashane to head home.

Road to Recovery

Although well enough to leave the hospital, Makashane continues to recover. Every day, she follows a strict schedule to regain her strength and restore her health. Part of this routine includes walking to the nearby shopping mall; a simple, but significant activity. These walks are not just about exercise; they are also a source of fashion inspiration. As she strolls past store windows filled with the latest trends, her passion for design is reignited, motivating her to continue pursuing her dreams.

Since becoming ill, Makashane’s love for both software development and fashion design never waned. She is continuing with her online software development course, which is self-paced, allowing her to balance her studies with her ongoing treatment.

 “After I've fully recovered, I plan to completely embark on a journey to fortify my fashion designing skills,” she says with a hopeful smile.

Treatment Supporter Litlhare Matlole, who received training at the halfway house, visits Makashane at least twice daily to ensure she is taking her medication. Matlole also provides much-needed companionship and emotional support, helping Makashane navigate the long and often lonely road to full recovery.

With the right care and treatment, TB is curable.  

“Awareness, early diagnosis, and adherence to treatment are crucial. Sarafina's journey is a reminder of the importance of these elements and the incredible strength it takes to endure such a battle,” says Dr. Ninza Sheyo, PIH Lesotho’s intensive care unit specialist and a key member of Makashane’s care team.

TB typically affects adults in their most productive years, according to the World Health Organization; however, people of all ages are at risk. Lesotho, with a population of around 2 million, has one of the highest TB incidences globally, with an estimated 661 cases per 100,000 people. Despite being treatable and preventable, TB remains a leading cause of death in low- and middle-income countries, with more than 1.3 million people dying in 2022 alone.

PIH Lesotho plays a critical role in combating TB, providing not only medical care but also social support to patients. This support includes food for patients undergoing taxing treatment regimens, temporary housing at the MDR-TB halfway house for those who cannot travel to the hospital daily, and stipends for transportation. The goal is to treat the whole patient, not just their condition.  

“Every day I feel a bit stronger,” Makashane says. “I'm grateful for the support I've received from PIH and the chance to chase my dreams again. MDR-TB tried to take my life, but it won't take my spirit.”

Malawi, one of the most impoverished countries in the world, has among the highest HIV infection rates and is home to a growing population of adolescents who are HIV-positive and facing challenges that go beyond physical health.  

Burdened by poverty, social stigma, and lack of education, young people in the region living with the virus are often isolated from their community, less likely to take medications as prescribed, and discouraged from accessing vocational opportunities.

Recognizing that health is deeply intertwined with social and economic factors, Partners In Health (PIH) prioritizes the development of programs that go beyond modern medical care and address patients’ needs, including access to food, transportation, housing, and regular employment.  

For Abwenzi Pa Za Umoyo (APZU), as PIH is known in Malawi, social support—meaning care that goes beyond clinical—plays a crucial role in building a stronger public health system. Grappling with significant health care challenges, like the HIV epidemic, has required an emphasis on community engagement and capacity building.  

Building Economic Independence

In December 2022, APZU launched the ASPIRE project, a program aimed at equipping teenagers living with HIV with education and skills that would enable healthy decision making and economic mobility.  

Supported by the Malawi Ministries of Health, Labor, Youth Development, Gender, Community Development, Social Welfare, Agriculture, and Education, ASPIRE implements a redesigned Teen Club curriculum in the Neno District’s 14 health facilities that ensures the support patients are provided extends beyond quality medical provision to include mental wellness support, vocational opportunities, and networking activities.

Through ASPIRE, teenagers in Neno ranging from ages 17 to 19 are trained in skills that include brick laying, tailoring, plumbing, and mechanics. Along with vocational education provided through Teen Clubs, program participants receive funding to start their own businesses in the areas they are trained.  

According to Jimmy Harare, APZU’s associate director of community health, the goal of the ASPIRE project is to achieve long-term improvements in health and socioeconomic conditions for teens living with HIV in Malawi’s Neno District.  

“For us to attain this,” he explained, “we’re looking into two thematic areas. The first one is to ensure we are improving access to quality HIV treatment services through the decentralized services we provide in Neno. The second thing is also ensuring that we are creating a socioeconomic opportunity for the adolescents that are living with HIV, so that at the end, they should be self-reliant and improve their economic pathway.”  

Breaking the Cycle of Poverty

Nineteen-year-old Patrick Francis from the Tsoka Village in Neno is among several teens who have benefitted from the project. In 2023, Patrick was trained in tailoring. After completing his training, APZU provided him with business start-up capital, a sewing machine, 50 meters of cloth, measuring tapes, needles, scissors, and thread among other items to help kick-start his entrepreneurial journey.  

Today, Francis is bringing convenience and craftsmanship closer to home, operating his business in the village, where residents previously travelled long distances for tailoring services. He currently earns around $40 each month through his business and is able to support his grandmother. This level of income is out of the ordinary for most people living in Malawi, where over half of the population still lives below the poverty line – earning less than $1 per day.

“Through the tailoring skills I attained with support from Abwenzi Pa Za Umoyo,” he said, “I am able to earn a living and look after my granny. This season I have managed to buy 15 bags of maize, which I want to sell. My aim is to buy a motorcycle to ease my mobility to and from Mwanza, where I buy material for my tailoring.”  

Once acquired, Francis plans to use his motorcycle to also operate a kabaza (bicycle) business, offering people in his community a flexible and affordable means of transportation to areas where vehicles cannot reach due to the terrain. He has also been able to purchase other items for his home and business including solar panels, pigeons to address the problem of food scarcity, and a public address system that community members can rent for weddings and other events, providing Francis with another avenue for income.  

Expanding the Program

The ASPIRE project will allow APZU to expand programming and continue implementing a range of initiatives focused on education and career guidance to empower teens living with HIV in Malawi, improving their physical health and helping them secure the basic conditions needed to realize their potential. These efforts, which will now have a greater impact due to increased funding, include the facilitation of internships, job shadowing, volunteer opportunities, as well as a local youth forum providing life skills training.  

Moreover, the project will incorporate guidance on sexual and reproductive health and rights—with a special emphasis on sexual and gender-based violence, which is prevalent in the region and disproportionally affects girls and young women.  

Focusing on the whole person and not just their illness, ASPIRE aims to address the community’s immediate health care needs and lay the foundation for a brighter future. The project seeks to reach a 90% retention rate for teenagers in care by 2025.  

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

The community care model of Socios En Salud (SES), as Partners In Health (PIH) is known in Peru, seeks to strengthen the health system through activities that bring timely, equitable, and quality medical care to the most vulnerable communities. Thanks to strong community partnerships, the program brings people closer to health facilities and accompanies them during their treatment.

The Many Voices project, part of SES’s Mental Health Program and PIH's global mental health programming, exemplifies this model. Through community strategies aimed at the support and rehabilitation of people living with schizophrenia, 99% of program participants achieved greater adherence to treatment.

Schizophrenia, which affects approximately 1 in 300 people worldwide, is characterized by significant behavioral changes and impairments in perception, including delusions, hallucinations, disorganized thoughts and behaviors, or agitation. Around the world, people with schizophrenia often face social stigma that impacts their relationships with others; discrimination which can limit access to health care, education, housing, and employment, as well as human rights violations due to the symptoms of their condition.  

There are effective treatment options including medication, education, family interventions, and psychosocial rehabilitation. Unfortunately, for many people in low- and middle-income countries, this treatment is not always accessible or available. More than two out of three people experiencing psychosis, which can be caused by schizophrenia, do not receive specialist mental health care.  

The treatment and care that SES provides through Many Voices is vital in giving people with schizophrenia a sense of community and empowerment.  

In 2019, Many Voices began its interventions with the Carabayllo Community Mental Health Center. Following its success, the community care model was expanded to other similar establishments to strengthen activities carried out by Peru’s Ministry of Health.

“Currently, there are 307 people living with schizophrenia who are being served [by the project’s community health workers], of which 306 are adhering to treatment,” said Milagros Tapia, SES’s Many Voices project coordinator.  

Consistent, Comprehensive Support

Treatment adherence for patients with schizophrenia is measured by monitoring medication intake and appointment attendance, including psychiatric, psychological, or occupational therapy sessions. Before beginning the Many Voices project, SES staff provide each patient with a baseline test at their local community mental health center, as explained by Tapia. After the evaluation, Many Voices assigns previously trained community health workers (CHWs) to follow up with each patient to assess progress against that baseline.  

“[CHWs] check if they are taking their medications, or if they stopped taking them for some reason,” Tapia said. This information is recorded in the patient’s file, where other challenges, if any, are also recorded.  

Each CHW conducts home visits twice a week for between 10 to 15 people living with schizophrenia and their caregivers. To monitor their adherence, the CHW will verify that the patients are taking their medications by asking them to show their prescription and either pills or injectables, and if necessary, asking them to take the medication right then.

Caregivers can also help verify that patients are taking their medication as directed. In severe cases, a caregiver or responsible family member can be responsible for providing the medication to the patient. In mild cases, patients can administer their own medication, but always under the supervision of the caregiver or responsible family member.

During their visits, the CHWs also provide mental health education as needed and link patients or their caregivers to a health facility if they are experiencing additional health conditions.

SES’s CHWs also provide support to the families of people with schizophrenia. They help families navigate obtaining their National Identity Document, which can otherwise be a challenge for patients with several mental health conditions, or help complete their registration to the Comprehensive Health System, which helps provide public health insurance coverage.  

“We do not work alone, but hand-in-hand with Socios En Salud’s Social Protection Program,” Tapia highlighted.

Care That Builds Community

Alberto Gamarra, 43, is one of the people in the Many Voices project living with schizophrenia. His mother, Milka Asís, affirms that the community support model has been important so that her son can be social and connect with his peers.

Despite Gamarra’s friendly nature, the deep-seated stigma and discrimination against people with schizophrenia did not allow him to establish friendships with other people. But Asís assured SES that his encounters with more people like him through Many Voices has reawakened his desire to build community and have friends.

Dionila Jiménez found a similar reaction from her mother, 64-year-old Agustina Dionila, who also benefits from the Many Voices project.  

For her, accompaniment “has been necessary and indispensable. Now that [my mother] has been following her treatment, she has met people and has been able to function more,” Jiménez said.

“This project has been good, and it is good, and I hope it continues,” said Julio Gamarra, who takes care of his mother, a Many Voices project participant. “The activities keep her active, going to her group to socialize through workshops, therapy, and taking her medication." 

The increasing spread of an infectious disease is making headlines again.  

Mpox (previously called monkeypox), a viral disease known for rashes and lesions on the skin, has led to more than 15,600 cases and 537 deaths in the Democratic Republic of Congo alone in 2024. Additional cases were reported in 12 other African countries, including Rwanda and Liberia—where Partners In Health (PIH) works. This is the first time a case was reported in Rwanda.
 
On August 14, the World Health Organization declared a global health emergency due to the rise in mpox cases and new virus strain. A previous mpox outbreak in 2022, which was also declared a global health emergency, led to nearly 100,000 cases and 208 deaths across 116 countries.  

Most patients recover on their own, after two to four weeks; but the drastic increase in cases is sounding alarms worldwide and spurring calls for global vaccination. Treatments and vaccines can control an mpox outbreak; however, they remain widely unavailable across Africa. 

Here are seven things to know about the disease:

1. What are the signs and symptoms of mpox?

Symptoms usually include a fever, severe headache, muscle aches, back pain, low energy, swollen lymph nodes, and skin rashes or lesions. The rash usually begins within one to three days of the fever.

The lesions may be flat or slightly raised and filled with clear or yellowish fluid. Eventually, the lesions dry, scab, and fall off. Rashes tend to occur on the face, palms of the hands, and soles of the feet, but may also be found on the mouth, genitals, and eyes.

Symptoms usually last two to four weeks.

2. How is mpox transmitted?

Human-to-human transmission can occur through contact with the skin lesions of an infected person, mucus or saliva, or contaminated objects. It typically requires skin-to-skin contact.

Animal-to-human transmission occurs through direct contact with the blood, body fluids, skin lesions, or mucous membranes of infected animals. The animals that host this virus are often rodents or primates.

3. Is mpox a new disease?

Mpox is not a new disease. The virus has been considered endemic in 12 countries on the African continent for decades. But it has also previously occurred in the United States—the first outbreak in the U.S. was reported in 2003, spreading from prairie dogs to humans and affecting six states.

The current outbreak is causing concern due to its fast spread and new virus strain. But mpox is not nearly as contagious or as deadly as COVID-19. Unlike the coronavirus, mpox typically requires close physical contact with someone who is infected.

4. Is mpox fatal? 

It can be fatal. In most cases, symptoms often resolve within a few weeks on their own, without treatment.

In some people, the virus can lead to medical complications. These complications—such as pneumonia or infections in the brain or eyes—can be fatal.

Newborns, children, and immuno-compromised people are most at risk for severe symptoms.

5. Is there a cure?

The U.S. has two vaccines approved for use, as prevention measures, and recently announced plans to donate 50,000 doses to the Democratic Republic of Congo, a country with a population of nearly 100 million people as of 2022. More vaccines and treatment are needed to effectively control the spread.

6. Who is most at risk of catching mpox?

During the 2022 mpox outbreak, men who have sex with men comprised the vast majority of new cases. However, susceptibility to the disease is not limited to people who are sexually active or to men who have sex with men.

Anyone can catch mpox. The current outbreak has mostly impacted children under 15 in the Democratic Republic of Congo.

It is vital to fight not only the spread of the virus, but also the spread of misinformation and stigma, which only further endangers marginalized groups, including LGBTQ+ people and Black people.

7. How can I stay safe?

The World Health Organization recommends that men who have sex with men consider limiting their number of sexual partners to lower their risk of infection and reduce transmission.

The WHO also recommends avoiding skin-to-skin contact whenever possible, washing your hands regularly with soap or using hand sanitizer, and washing clothes, sheets, towels, and other items or surfaces that have been potentially exposed.

If you think you have symptoms, please isolate at home until you can be evaluated by a doctor.

Mpox testing is now widely available in the United States. If you have been in direct contact with someone infected, or have been at an event or location with a known mpox outbreak, please be on the lookout for symptoms, and consider getting vaccinated for mpox immediately.

For more information, visit the World Health Organization.