This year, PIH-US supported community and public health partners with strategic planning, training and mentorship, moved millions in funding to community-led initiatives, and advocated for policies that lead to stronger, more just and responsive community health systems. Our collective efforts have strengthened public health infrastructure, empowered a more adaptable community health workforce, and moved us closer to community health systems that embrace equity for all.

Below, we recap some of PIH-US' accomplishments from 2023.

Supported public sector partners to engage community health workers.

PIH-US trained community health workers in Montgomery, Alabama as they canvassed neighborhoods and health events to conduct a community health needs assessment of approximately 1,000 community members. Responses to the survey, which was developed and analyzed by PIH-US, will give city officials a deeper understanding of community concerns and ensure future public health planning and strategies are designed to meet local needs.

PIH-US has joined forces with a regional health system to train and deploy community health workers throughout New Jersey.  The first two community health workers hired in Essex County through the launch of the project were placed at Newark’s Mary Eliza Mahoney Health Center, a federally qualified health center. Upon employment, these community health workers were enrolled into the state certification process and will serve as instrumental connectors in outreach and health education for patients of the clinic.

Provided the community-based workforce with on-going educational, mentorship, and professional development opportunities 

Over the past year, PIH-US has supported community health organizers in Chicago, Illinois to raise community awareness of critical services by facilitating connections and providing hands-on mentorship and 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. Since January 2023, PIH-US has hosted 11 learning sessions attended by organizations across communities and sectors, creating new networks of public health partners to meet the needs of Chicagoans.

PIH-US has been working alongside partners in Massachusetts to expand community-based mental health care through Problem Management Plus, or PM+, a psychological support intervention developed by the World Health Organization and adapted in different countries and contexts across Partners In Health’s sites. In September, PIH-US hosted a multi-day intensive training to equip staff members at five community-based organizations to identify, respond, and deliver PM+ to individuals facing mild to moderate mental distress and daily life challenges. The training prepared non-clinical staff to apply the PM+ intervention by immersing participants in hands-on learning through role play and dialogue. Since the training, participants have identified and enrolled new clients in PM+, providing on-going assistance to address their needs including stress management, behavior change, and social support services. PIH-US drew on lessons from our global teams’ work implementing such models in Malawi, Mexico, Peru, and Rwanda.

Helped partners to identify and pursue new sources of funding 

In Arizona, PIH-US partnered with the Tucson Indian Center to apply for and secure over $1.5 million in funding to enhance employment opportunities and career advancement for Pima County’s urban American Indian/Alaska Native community, an initiative that aims to disrupt the cycle of intergenerational poverty and improve health and overall well-being. With this investment, the Tucson Indian Center will partner with PIH-US, the Pima County Health Department, and Pima County Community & Workforce Development to co-develop the community’s first-ever Native-led database to accurately capture the assets and needs of the urban Indigenous population. Over the next three years this partnership will shift narratives, shape policy, and increase public funding allocations aligned with community priorities by building on traditional knowledge systems and transferring power and decision-making about data systems back to the urban Indigenous community.

Built awareness and support for the community health workforce 

In August, North Carolina became the first state to launch advanced levels of certification for community health workers. For nearly two years, the North Carolina Community Health Worker Association (NCCHWA) has worked to establish standardized core competencies and advanced training for community health workers, including specialized qualifications and a legacy track acknowledging the varied skills and lived experiences of seasoned community health workers. Along with partners in the state’s Community Health Worker Initiative, PIH-US provided technical assistance and support for developing a credentialing council, application processes, and requirements for the advanced and legacy tracks. Since the launch of the core competency training, over 950 community health workers have been certified and 11 have received advanced certifications to support career progression.

To prepare the Florida Community Health Worker Coalition for their first-ever Community Health Worker Advocacy Day, PIH-US hosted a series of trainings on legislative advocacy to ensure that attendees felt comfortable and confident sharing their stories and advocating for their communities to policymakers. In December, 15 community health workers and allies met with over 25 elected officials in Tallahassee to elevate the impact of this workforce on communities across the state.

From shaping policy at state and federal levels to championing the community health workforce, this year has been a testament to the power of collective action. Below, we reflect on advocacy gains from the year.

Community Health Workers and Allies Host Federal Briefing and Hill Day

PIH-US and the National Association of Community Health Workers coordinated a Congressional briefing on community health workers, bringing over 40 frontline workers and allies to Capitol Hill to advocate for long-term support for community health workers and promotoras. This event aimed to educate members of Congress and staff on the diversity and significance of the community health workforce, emphasizing their deep community connections and their fundamental role in promoting health equity. After the briefing, participants visited over 40 Congressional offices and connected with over 100 Congressional staffers, providing policymakers an opportunity to engage with this workforce and foster a deeper understanding of their critical work.

North Carolina Expands Medicaid, as Community Health Worker Advocacy Grows

In the spring, North Carolina’s General Assembly voted to pass Medicaid expansion, providing access to health coverage for over 600,000 North Carolinians. PIH-US supported Medicaid expansion as a member of the Care4Carolina coalition, which has been organizing for years to achieve this win for health equity. As more people become eligible for health services starting on December 1, 2023, community health workers will play a vital role in connecting these communities with health coverage, care, and social support. PIH-US also advocated alongside local grassroots coalitions and the North Carolina Community Health Worker Association (NCCHWA) for community health workers to be included in the NC state budget. This included co-hosting with NCCHWA North Carolina’s first Community Health Worker Advocacy Day in April, inviting over 80 community health advocates to travel to Raleigh, N.C., and attend over 50 meetings with legislative staffers to raise awareness. Although community health workers were ultimately excluded from the state’s final budget, our efforts in identifying champions and building an engaged coalition have established a strong foundation for future advocacy initiatives.

States Explore Medicaid Financing for Community Health Workers

After extensive statewide advocacy, including a letter from PIH-US supporting Medicaid coverage for community health worker and community health representative services and urging the state to prioritize community leadership, Arizona began paying community health workers for services delivered to Medicaid members in April. In Arizona and beyond, Medicaid offers an important avenue for sustainable funding for community health workers. With more and more states initiating policy changes to include this workforce and their services in Medicaid, PIH-US developed recommendations for state policymakers to follow to support community health workers through Medicaid financing and promote health equity.

Medicare Agency Introduces Payments for Community Health Worker Services

In August, The Centers for Medicare and Medicaid Services (CMS) proposed updated payments in the Medicare program, which provides health insurance to over 65 million Americans, primarily those 65 and over. For the first time, CMS will pay for new Medicare services that have been designed explicitly for community health workers. Effective nationwide January 1, 2024, this shift acknowledges the vital role community health workers play in health care. To influence this policy proposal, PIH-US collaborated with the National Association of Community Health Workers and over 100 community health workers, advocates, and allies to ensure community health worker voices were included in the policy process. This collective developed and disseminated accessible resources, from policy summaries to comment templates, which led to the submission of over 25 unique comment letters. Medicare funding for community health workers unlocks a new, sustained funding source that can support the workforce and improve the health of Medicare enrollees.

Congress Recognizes Community Health Workers Through Resolution

In September, Senator Bob Casey, Jr., and Representative Raul Ruiz, M.D., introduced a resolution to declare August 28 – September 1, 2023, as “National Community Health Worker Awareness Week.” This resolution was a significant acknowledgment of the essential contributions made by community health workers. It coincided with the inaugural National Community Health Worker Awareness Week organized by the National Community Health Worker Association, which saw over 80 organizations nationwide, including PIH-US, coming together to celebrate, unite, and raise awareness about the diverse roles of community health workers, their historical importance globally, and their impact on health and racial equity in the United States. 

PIH Engage Advocates for Community Health Worker Funding

PIH Engage, a grassroots organizing network of PIH supporters working to build a movement for the right to health, advocated to build policymaker support for community health workers in the U.S. In August, 160 PIH Engage leaders representing 80 local teams from across the U.S. came together in Washington, D.C., to develop their community organizing skills, learn about global health equity, and craft year-long legislative advocacy, peer-to-peer fundraising, and community building campaigns in support of PIH's mission. On "Hill Day," Engagers met with the offices of 100 Senators and Representatives to kick off a year of advocacy engagement for global and domestic health policy priorities, including legislation to provide funding for community health workers.

These wins signal a turning point for the community health workforce. In a year that continued to challenge the resilience of public health systems, we were reminded that community health workers are not just a necessity but a cornerstone of building robust, sustainable health ecosystems. We have ambitious goals for the new year as we continue to advocate for sustained support and recognition of the community health workforce, as well as greater investments in public health infrastructure—fundamental steps toward creating healthier, more resilient communities for all.

At Partners In Health, 2023 was a year of deepening our commitment to global health equity, from sustaining our care for millions of patients worldwide to advocating for policy change. 
 
From Haiti to Peru to Lesotho, we continued to accompany patients, clinicians, and communities, tirelessly working toward a world where no one dies of diseases that are treatable or because of where they were born. Our work reflects the vision of our late Co-founder Dr. Paul Farmer, whose legacy moves us to act in solidarity, not charity, and to do whatever it takes to make our patients well and help them thrive. 
 
Throughout the year, media coverage and events highlighted our work and our impact on global health. Here are some of our favorite moments: 
 
1. WBUR 90.9 FM: “‘We All Have to Do This Work’: Paul Farmer’s Greatest Legacy is the People He Left Behind” 
Paul’s admirable legacy unfolds not only in the groundbreaking work he accomplished but also in the people he inspired and empowered to carry on his mission. This piece, written a year after his passing, is a poignant reflection on how his enduring legacy lies in the individuals and communities he touched, united by a shared commitment to continuing the crucial work of advancing global health and social justice. Read the full story.  
 
2. NPR: “Ophelia Dahl on Her Radcliffe Prize and Lessons Learned from Paul Farmer and Her Youth” 
In May, PIH Co-founder Ophelia Dahl received Harvard’s esteemed Radcliffe Medal—a distinction she now shares with other iconic figures such as Ruth Bader Ginsburg, Madeleine Albright, and Toni Morrison. Dahl's steadfast commitment to health equity and social justice endures, more than three decades after she co-founded PIH alongside Paul Farmer, Jim Yong Kim, Tom White, and Todd McCormack. Reflecting on her journey, she emphasizes the importance of sustained effort, maintaining aspirational goals, and pushing the boundaries of what is achievable. Read the full story.  
 
3. ABC News: “Millions Could Soon Have Access to Lifesaving Tuberculosis Drug Following Online Uproar”  
PIH has been at the forefront of fighting multidrug-resistant tuberculosis (MDR-TB) for decades. This year is no different. In July, PIH joined bestselling author and board member John Green’s online campaign to protest Johnson & Johnson’s plan to extend the patent on bedaquiline, a lifesaving TB drug, until the end of 2027. The campaign was quickly followed up by a Johnson & Johnson announcement that it was working with the Global Drug Facility, a United Nations-based procurer of medications for public health systems around the world, to give it approval to purchase and supply generic versions of bedaquiline to low- and middle-income countries, where TB remains a potent killer, ultimately reducing the cost of care. “The availability of the generic drug could provide six million people with treatment over the next four years,” said Carole Mitnick, a professor of global health and social medicine at Harvard Medical School and a senior research associate at PIH. Read the full story. 
 
4. BBC Africa Daily: “How Can Sierra Leone Further Improve Care for Pregnant Mothers?” 
Sierra Leone has managed to reduce the number of women who die during and after childbirth by half in the last two years. But the maternal mortality figures are still some of the highest in the world, and the government has called it a “national emergency.” In the country’s eastern Kono District, PIH is helping build a new maternity center, in partnership with the local government and nonprofit Build Health International (BHI). The new 166-bed facility, called the Maternal Center of Excellence, is scheduled to open its doors by the end of 2024. Isata Dumbuya, PIH Sierra Leone’s director of reproductive, maternal, and adolescent health, spoke with the BBC about the project, along with BHI employees Bintu Missah and Hawa Baryoh. Listen to the full story.  
 
5. The Guardian: “The Door-to-Door Service That is Changing the Diagnosis for Malawians” 
PIH’s care delivery model goes beyond treating just one disease. It’s about strengthening health systems and providing integrated care to those who need it most. In Neno, Malawi, PIH is closing the gap between HIV treatment and treatment for non-communicable diseases (NCDs), such as hypertension, diabetes, and sickle cell anemia. Community health workers (CHWs) have been vital to Neno’s model of integrated chronic care, with 1,200 CHWs helping patients navigate the health system and access care. Read the full story.   
 
6. The Advocate: “The Cost of Inaction on PEPFAR, the AIDS Relief Program That's Saved Millions” 
In an op-ed, PIH CEO Dr. Sheila Davis and Chief Medical Officer Dr. Joia Mukherjee shared their views on the U.S. Congress’s failure to reauthorize critical AIDS legislation, the President’s Emergency Plan for AIDS Relief (PEPFAR). This inaction, they point out, is “jeopardizing millions of lives and stalling two decades of progress toward global health equity.” Starting with the HIV Equity Initiative in Haiti in the mid-1980s, PIH has played a significant role in the global response to the AIDS pandemic. PEPFAR funds have also helped strengthen the health system across five of the 11 countries where PIH works. PIH continues to call on U.S. leadership to take action and reauthorize PEPFAR. Read the full story.      
 
7. Remembering Our Beloved Paul  
In February, PIH hosted a virtual memorial event, marking one year since the passing of our Co-founder Dr. Paul Farmer and remembering his life, legacy, and the incredible impact he had on the world. Paul’s closest friends, family, partners, and the global PIH community were invited to share their reflections. Watch the event. 
 
8. Global Day of Action  
On Paul’s birthday on October 26, PIH organized a Global Day of Action to celebrate and honor his life and to use this time to recommit to our work and drive forward our collective vision for health equity. Learn more about the event.
 
9. Maternal Center of Excellence Instagram Live
In October, PIH Sierra Leone and our nonprofit construction partner Build Health International hosted our first Instagram Live tour of the Maternal Center of Excellence (MCOE). The MCOE, which broke ground in April 2021, will provide advanced maternal and child health care in Kono District and beyond and will serve as a hub for global innovation in maternal health.⁠ During the livestream, PIH shared the progress already made in access to maternal health care and the goals for the MCOE. Watch the IG Live.

10. Reddit AMA with John Green
In October, PIH clinicians and researchers with experience fighting tuberculosis (TB) globally were joined by TB advocate, bestselling author, and PIH board member John Green for a Reddit Ask Me Anything (AMA). During the live chat, the team answered an array of questions on TB, including how it’s transmitted, diagnosed, and treated and what we need to do to ensure more people have access to a cure. Read the AMA. 
 
11. Harvard Symposium
In November, PIH partnered with Harvard University and the Brigham and Women’s Hospital to host the Paul Farmer Symposium on Global Health Equity. Held on Harvard’s campus, where Paul was a student and later joined the faculty, the symposium featured experts, thought leaders, and Paul’s colleagues and friends discussing the importance of Haiti, the first free Black republic, in shaping the global health landscape as well as Paul’s own work. Watch the event.

Saio Kamara proudly holds a yellow, pocket-sized paper and with a smile tells those around her: “This is my TB certificate.”  

It’s more than just a piece of paper. It marks a major milestone: being cured of multidrug-resistant tuberculosis (MDR-TB). The document includes details, such as her diagnosis, treatment type, and, most importantly, her completion date: March 31, 2022. It’s a day she’ll never forget. 

 It’s when, after more than two years of intensive inpatient and outpatient care, the now 29-year-old widow was reunited with her son and two daughters. Many patients with TB around the world don’t get to experience that moment—or proper care, at all. But the situation is far different at Lakka Government Hospital in Sierra Leone, where the cure rate for MDR-TB is around 75%. Globally, the average is less than 60%.

“If I ever tell anyone I was a TB patient, they don’t believe me, because look at me now. I’m happy and strong,” says Kamara, who couldn’t stand by herself when she was admitted.

Meet Dr. Girum B. Tefera in the video above. For many years, he has treated patients with MDR-TB—from his home country of Ethiopia to now Sierra Leone. Since 2019, he has led MDR-TB care at PIH-supported Lakka Government Hospital. 

High-quality, patient-centered care 

TB is the deadliest infectious disease in the world despite it being treatable. The incidence of TB also reveals glaring health care inequalities, as more than 95% of deaths occur in developing countries, including ones where Partners In Health (PIH) works. And Sierra Leone has one of the highest burdens of the disease, which is why PIH is committed to improving care for patients there.

Since 2017, when PIH began supporting and renovating the facility, Lakka Government Hospital has led the way in MDR-TB care. It has had many firsts: the first MDR-TB treatment center in the country and, most recently, the first country in the world whose Ministry of Health accepts a shorter, six-month MDR-TB regimen for nationwide use.

The longer regimen, which Kamara completed, included more than 15 tablets per day for two years. Now, the regimen offered is between five to seven pills per day for six months.

While medication is a key part of care, support at Lakka Government Hospital extends beyond pills.  

When a patient is admitted to the hospital, one of the first people they meet is a social worker, such as Sarah Kamara, who speaks with them to better understand their needs.

“Most [patients] when they come in are destitute. Their family members or maybe neighbors just come and dump them. They just leave them here. So, 9 out of 10 [patients] need extra, extra social support,” says Kamara, who shares the same name with Saio Kamara, but is not related.  “Some have no clothes, bed sheets, toothpaste, gloves, or soap. Most of those things, PIH provides for them.”

Sarah Kamara and a psychosocial counselor go room-to-room every day to check on patients at the 140-bed hospital, of which only about 50 are currently functional following infrastructure renovations. They provide encouragement, basic counseling, and dispel misinformation.

Saio Kamara heard those stories, too, about the previously run-down hospital. Community members told her she wouldn’t survive if she went there.

“But when I came, the nurses, the doctors, and PIH took care of me,” she says. “[They] talked to me, advised me, and made me take my medicine.”

Even after being cured and discharged with a TB certificate, her uncle and loved ones were skeptical. So much so that they kicked her out of the house because of her cough. She immediately returned to the hospital to seek support. Yet again, PIH stepped in to help by providing a free, short-term apartment.  

That type of care isn’t a one-off situation. At Lakka Government Hospital, staff will do whatever it takes to make patients well. Sometimes social support includes money for school fees or food to bring home; it’s a personalized package. 

Addressing Challenges

But there are challenges too.  

Patients with MDR-TB stay at Lakka Government Hospital for a month, at minimum, and often much longer. While staff try to keep patients engaged and mentally healthy, many struggle with depression and other mental health conditions. And there aren’t yet any daily recreational activities, TV, or other forms of entertainment to keep patients occupied. Knowing all this, staff are focused on stabilizing patients and helping them reach a point in their care when they are no longer contagious, allowing them to re-enter their communities and visit the hospital as outpatients through the rest of their treatment regimen.

Perhaps the most pressing challenge is the lack of an ambulance. There’s one, but it’s only allowed to transport patients to another facility for tests not available at the hospital such as X-rays, CT scans, or ultrasounds. An ambulance—dedicated to transfers—is needed to bring patients who need specialized care to other facilities.

Advancing the model of care 

Despite these challenges, care is improving. There are now three MDR-TB treatment centers in the country, including one at PIH-supported Koidu Government Hospital in Kono District and another in Makeni, which is supported by Médecins Sans Frontières. The goal is to create additional MDR-TB facilities to expand and decentralize access to care for the country’s 8 million residents. For that to become a reality, more specialized staff—among other things—are needed.

PIH staff currently work with the Ministry of Health staff at the facility level by providing on-the-job training and intensive workshops on MDR-TB care. Additionally, at the national level, the team provides technical assistance to partners in Sierra Leone’s National TB Program by helping to develop protocols for care and update guidelines.  

In partnership with the government, PIH is paving the way for more people like Saio Kamara to recover. Since 2017, more than 900 patients with MDR-TB have received free services at Lakka Government Hospital.  

“When you come here,” says Sarah Kamara, “we want to see you leave here healthy.”

Below is a press release issued on November 15, 2023, reporting results of the endTB clinical trial, which was conducted by a team of researchers including Partners In Health.  

Clinical trial results presented for the first time today at the Union World Conference on Lung Health revealed evidence to support the use of four new, improved regimens to treat multi-drug resistant tuberculosis or rifampicin-resistant tuberculosis (MDR/RR-TB). The team—led by Médecins Sans Frontières (MSF), Partners In Health (PIH), and Interactive Research and Development (IRD) and funded by Unitaid—formed the endTB consortium and began this Phase III randomized controlled trial in 2017. 

MDR/RR-TB is a disease caused by a TB bacterium that is resistant to rifampicin, one of the most powerful first-line antibiotics, plus/minus resistance to isoniazid. Roughly half a million people fall sick with MDR/RR-TB each year, and many die from it. Though a range of MDR-TB regimens are now in use around the world, many people are still treated with conventional treatments that are long (up to 24 months), ineffective (only 59% treatment success in 2018), and often cause terrible side effects, including acute psychosis and permanent deafness. Patients on these regimens must ingest up to 14,000 pills over the full course of treatment, and some have to endure months of painful, daily injections.

New Regimens, Reduced Treatment Time

The trial found three new drug regimens that can deliver similar efficacy and safety to conventional treatments while reducing treatment time by up to two-thirds. The endTB regimens represent important alternatives for short MDR-TB treatment and complement the use of another highly effective, shorter MDR-TB regimen, called BPaLM, which is not suitable for certain populations. If recommended by the World Health Organization, these new patient-centered treatment regimens would empower clinicians to offer shortened MDR-TB treatment regardless of age, pregnancy, and comorbidities that are common among people with MDR-TB. 

In addition, the trial supports the use of a fourth regimen as an alternative for people who cannot tolerate bedaquiline or linezolid; at least one of these two drugs is in every current World Health Organization-recommended regimen for MDR-TB. 

The endTB trial enrolled a diverse group of 754 patients from seven countries (Georgia, India, Kazakhstan, Lesotho, Pakistan, Peru, and South Africa). This included historically excluded populations like adolescents and those with comorbidities like substance-use disorders, and retained participants who became pregnant during the trial. The trial evaluated five nine-month treatment regimens, and randomization was outcome-adapted, meaning more patients were assigned to regimens that were producing better outcomes. 

A Breakthrough, But Cost Remains a Barrier

“We stand on the cusp of a significant breakthrough in the battle against MDR, a disease that disproportionately affects impoverished populations around the globe. Our results offer hope to those in dire need and underscore the urgency of continued research and innovation—and accountability of private companies that receive public funds—to address diseases that too often strike the most vulnerable among us. But the cost of some drugs remains a barrier. One example is delamanid which is still priced at 12-40 times higher than it should be according to an independently estimated cost to produce the drug,” said Carole Mitnick, ScD, Partners In Health Director of Research for the endTB project, Co-Principal Investigator of the study, and Professor of Global Health and Social Medicine at Harvard Medical School. 

“For far too long, MDR-TB has loomed as a formidable threat with limited, poorly tolerated treatment options, but today, we unveil evidence for multiple innovative all-oral, shortened regimens that will allow patient-centered, individualized treatment of MDR-TB. This marks a pivotal moment in the fight against a disease that has plagued vulnerable populations worldwide. What makes these results even more remarkable is the diversity, and resulting generalizability, of this Phase III randomized controlled trial,” said Lorenzo Guglielmetti, MD, Médecins Sans Frontières Director for the endTB project and Co-Principal Investigator of the study. 

“These results provide new hope for all those awaiting treatment for the most dangerous and difficult to treat forms of tuberculosis worldwide,” said Dr Philippe Duneton, Executive Director of Unitaid. “We have the gold-standard research. The drugs are already available where they are needed. If recommended, this high-quality evidence could quickly translate into better treatment options suitable for all people with drug-resistant tuberculosis.”

The endTB clinical trial evaluated five experimental regimens for MDR/RR-TB against the standard of care in two distinct analysis populations. endTB regimens 1, 2, 3, demonstrated non-inferiority to the control in both primary analysis populations, establishing their success in treating RR-TB. Regimens 1, 2, and 3 achieved favorable outcomes in 89.0%, 90.4%, and 85.2% of participants, respectively. Regimen 5 also showed a strong treatment response at 85.6% and was non-inferior to the control's 80.7% in one of the primary analysis populations. While consistent results in both populations are needed to formally establish non-inferiority, regimen 5 holds promise as an alternative for patients unable to receive other recommended treatments.

True access to these new treatment options depends on removing all barriers to timely and high-quality care. These trial results could address a major barrier to care for many people and the endTB consortium will continue to advocate to improve access and affordability to quality TB care.

To read more about the clinical trial results, please visit endTB.org. 

Before becoming ill, Kaizer Mahapa, 44, worked as a street vendor in Maseru, Lesotho, selling jewelry, snacks, and fruits at two roadside stalls; one uptown in Maseru and another in his own yard.

Mahapa, who grew up in rural Lesotho, was diagnosed with HIV in 2019. Two years later, he contracted tuberculosis.  He’d never attended school, instead cared for the family’s animals. Mahapa was living with his daughter when he fell ill.

Mahapa commenced antiretroviral therapy (ART) in 2019. But his battle with tuberculosis began after multiple hospital visits for symptoms that were initially misdiagnosed as a normal cold. He coughed up blood clots just before being admitted to the hospital again in 2021. The following year, he received a diagnosis of drug-resistant TB. Mahapa began treatment for his tuberculosis, but his health deteriorated further. Hospitalized yet again, he was treated for heart failure and anemia, in addition to the other conditions.

Despite his treatment, Mahapa developed severe, permanent lung damage and respiratory failure due to the TB, and he now requires supplemental oxygen to maintain normal blood circulation levels.

Mahapa was ultimately cured of TB, but it became clear he would need supplemental oxygen for the rest of his life. So, PIH staff rallied to help; they would do everything necessary to support their patient’s recovery.

In Lesotho, there typically is no treatment available for those with chronic lung disease requiring supplemental oxygen. These patients are usually sent home without oxygen, with the expectation that they will not survive for long. PIH had already planned to help Mahapa with supplemental oxygen by giving him an oxygen concentrator. However, this requires electricity, which Mahapa did not have at home. So, the PIH infrastructure team conducted a home assessment while Mahapa was still in the hospital, so they would be able to provide electricity when he returned to the house.

The home assessment found multiple problems. In addition to the lack of electricity, there was no water supply, no proper ceiling and several broken windows.  “Mahapa’s home was not fit for someone in his condition,” said Koali Lerotholi, the operations and infrastructure manager at PIH. When it rained, the roof leaked, he said, and mold was developing. So, the PIH team got the house repainted and fitted with ceilings, and fixed the broken windows.

Mahapa's illness took a significant toll on his business. He was forced to shut down both of his stalls, and his daughter had to discontinue her education during her final year of high school. He remains worried about his future, his daughter’s future, and their financial situation. “I used to be able to provide for my family, my daughter was almost done with high school. I have big dreams too, but now I feel like a burden to my family because everyone wants to take care of me instead of focusing on their lives,” Mahapa said. 

He can no longer provide for his family, but he remains hopeful that he will eventually be able to breathe independently for extended periods. At present, he can go without oxygen for a maximum of one hour. His sister has taken on the role of the sole breadwinner, but her income is limited as she works in a factory.

“Government assistance to patients ought to mirror the way Mahapa was handled,” said Dr. Chase Yarbrough, one of Mahapa’s doctors. “He underwent and continues to endure a protracted struggle. His path is lengthy, even though he has been cured of tuberculosis.”

Mahapa agreed that every TB patient who needs oxygen and other assistance should receive it. “At least, with the help of oxygen,” he said. “I can experience improved breathing.”

Philistin Gloria’s parents were worried. Their 2-year-old child, the third of four, was refusing to eat, despite her thin frame, and her breathing had become labored. So Gloria’s father, a driver, and mother, a street vendor in Estere, a village in the Artibonite region, rushed to the hospital with their little girl early last year. Gloria was quickly diagnosed with severe acute malnutrition, as well as tuberculosis and edema. At the time, the child weighed a few ounces over 15 pounds. According to the World Health Organization, the average weight for a 24-month-old girl is 26.5 pounds.

In Haiti, food insecurity has only grown worse in recent years, as violence, gang warfare, and social and political unrest have escalated. With 44% of the population facing major food consumption gaps,the worsening food crisis has left the country with the heaviest burden of hunger and malnutrition in the Western Hemisphere.

Young children are particularly vulnerable. A recent Demographic and Health Survey reported that 22% of Haitian children under 5 were stunted; 4% suffered from moderate to severe wasting; and 10% were underweight. Approximately 1 of every 10 children will die before reaching 5 years old, a trend largely driven by hunger and malnutrition. Even when acute malnutrition is not fatal, the survey notes, it is a major source of human suffering. Partners In Health (PIH) seeks to curb this deadly trend.

A collaboration between PIH Canada and Zanmi Lasante (ZL), as PIH is known in Haiti, deploys mobile food clinics staffed with medical professionals and community health workers (CHWs) to sites in the Artibonite region, seeking to identify malnourished children earlier, so treatment can be delivered before health problems turn fatal. The program focuses on communities with the highest burden of malnutrition in the areas Zanmi Lasante serves, Hinche and St. Marc, and is slowly making progress, not only by decreasing malnutrition but also by eroding some of the entrenched gender stereotypes that undergird child hunger.

For instance, in the year before the mobile clinics were launched, 18 children died of malnutrition at Hôpital Saint-Nicolas in St. Marc. When the mobile clinics began the following year, the fatality rate dropped by 56%, with eight deaths. From April 2022 through March 2023, however, not a single child died of malnutrition in St. Marc.

In addition, a recent report documenting the program’s gains over the past 26 months shows:

• More than 2,250 children were cured of malnutrition;
• Patients visited mobile clinics for malnutrition treatment more than 14,700 times;
• Children were screened over 18,800 times to assess their nutritional status, both in mobile clinics and brick-and-mortar buildings.

Finding Children Under 'Abandonnement'

Katia Bien-Aime, senior nurse and coordinator of Zanmi Lasante's nutrition program, said that years ago, her team noticed a high rate of children who had been seen at the nutrition clinic, but never came back. 

“Many were categorized as 'abandonnement,' or lost-to-follow-up at the institutional level,” she said. “We weren’t seeing a lot of kids getting better. We wanted to fix that.”

The mobile clinics allowed providers to get closer to patients, delivering food assistance and other basic medical care to their villages and homes. “It worked,” Bien-Aime said. “We were able to get to the really sick kids faster, earlier, and the lost-to-follow-up rate dropped dramatically.” Indeed, within a year of the mobile clinics being operational, the lost-to-follow-up rate declined by 59%, according to program reports.

In the mobile clinic van, there are nurses and lab technicians who help with HIV and other testing; drivers who navigate often difficult terrain, and CHWs, who know the families in the area and help mobilize parents to secure care for their kids. Sometimes, CHWs go door-to-door as part of their work, or they travel through communities with a megaphone urging people toward the medical vans.

The focus is on nutrition, Bien-Aime said, but often, acute hunger makes children susceptible to other illnesses. So, the mobile units also provide tools to clean water and improve sanitation and hygiene, as well as offering vaccinations for children and education and care for HIV and other opportunistic infections.

“It is possible to fight against this scourge that is malnutrition in the communes of Hinche and Saint Marc,” said Dr. Alain Gelin, a Zanmi Lasante project manager. “The mobile clinics are particularly effective at preventing severe forms of malnutrition. … As the clinics ramped up, fewer children required inpatient care, as their malnutrition was being detected earlier.”

Gender Bias Remains

Over time, Bien-Aime said she and her colleagues observed how gender considerations play out in the ways children are fed. For instance, she said: “There’s a myth that little boys eat more than little girls.” Many people believe that boys will be stronger, more robust, and bigger than girls, and therefore need more time breastfeeding and more food in general.

“If there are twins, you will see it really clearly,” she added. “The boy twin will be bigger than the girl;  resources are divided in that way.”

These biases can be dangerous on many levels. Clinicians categorize hunger by severity, ranging from moderate to severe and, finally, severe with medical complications. Through gender analyses conducted by the PIH and Zanmi Lasante teams, it appears that girls are disproportionately affected by hunger in all but its most acute form and generally treated as outpatients. This means that more boys, who suffer from the most extreme and dangerous forms of malnutrition, most often require inpatient care. In the last year, that has meant more boys died. The hypothesis is that all of these long-held beliefs about boys being more robust affect the timing of when parents bring children in for treatment. They think boys are stronger, so they delay seeking health care for their sons. The results: at all of the sites tracked, there were five total deaths, one was female, and four were male.

Another way gender impacts malnutrition relates to the demands of feeding families, which largely fall on women. 

“Feeding children and meal preparation put demands on women’s time,” Bien-Aime said. “But if she is busy, or must go to the market, or work on the harvest, food doesn’t get made and feeding is delayed.”

So is medical care. Often the reason a child is lost-to-follow-up is because the mother didn’t have time to bring the child in. “It’s mainly women who bring the kids in [to the clinic],” Bien-Aime said. “Mothers, grandmothers, sisters and, rarely, a dad, brings them in.”

Addressing Gender Stereotypes and Malnutrition

Training on gender is central for care providers—even the mobile clinic drivers—supporting families with malnutrition, Bien-Aime said. The messaging is integrated into education sessions and treatment delivery, for instance, telling mothers that, “Each kid is unique, and there should not be a difference in how food is distributed in the household," she said. "We focus on how parents can be engaged; talk about how dads can be involved in feeding, health, and recovery. Treatment is given based on weight, and follow-up care is based on recovery.”

For 27-month-old Tinonm Carlens from Rivage, the mobile clinics were key. Raised in a single-parent family, Carlens’s mother, Saint Jean Milove, a shopkeeper, played the roles of both mother and father in caring for her child. Carlens was growing thinner and his health was deteriorating, but his mother found it quite difficult to walk to the hospital and back. But the team from the mobile clinic diagnosed the child with severe acute malnutrition with medical complications earlier this year. He had a cough, fever, brittle hair, and weighed 15.8 pounds. He was admitted to the Hospital St. Therese in Hinche’s nutritional stabilization unit for treatment.

After 22 days, he was sent home, while continuing treatment at the mobile clinics. After six follow-up appointments, the child had stabilized with a weight of just over 23 pounds.

Navigating Enormous Challenges

These days, it’s become more difficult to navigate the mobile clinics into communities, with gangs blocking roadways and violence preventing access to towns. The security disruptions were particularly challenging around St. Marc, where getting out of the city center is often difficult and dangerous with gangs controlling the area.

Still, for the most part, the nutrition teams have been able to provide care to people where they live, whether that means rescheduling clinic visits or finding an alternative route.

“The mobile clinic team delivered services in the face of enormous challenges, from gas shortages and vehicle issues to gang activity, kidnappings and the personal mental toll,” Gelin said. “These results are a testament to their commitment and resolve.”

When Linda Depoyou, a 27-year-old mother of three, gave birth to her fourth child in July, he weighed only .6 kilograms, or 1.3 pounds. So, Depoyou and her newborn, Godsent Yeoh, were immediately transferred to the neonatal intensive care unit (NICU) at Partners In Health-supported James Jenkins (J.J.) Dossen Memorial Hospital in Maryland County.

Depoyou, who lives in neighboring River Gee County, suffered from malnutrition, with very little milk to feed the baby. She was enrolled in PIH’s social support program and fed hot daily meals throughout her nearly three months of stay at J.J. Dossen Hospital.  

Alongside other mothers with newborns in the NICU, Depoyou was introduced to the kangaroo mother care (KMC) approach. KMC is a well-known practice that clinicians around the world use to decrease the deaths of premature newborns, especially in countries like Liberia where incubators and reliable electricity are hard to come by.  The practice involves the mother holding her baby to her bare chest to ensure direct, skin-to-skin contact.

Garmai Forkpah, PIH’s senior clinical mentor, says the NICU received 12 preterm babies from July to August 2023, and they all have been introduced to the KMC approach.

 “In Liberia, it’s very unlikely for premature babies, especially like Linda’s, to survive without intensive care as the one given to baby Godsent,” Garmai said.

PIH began providing community-based KMC at J.J. Dossen Hospital and the communities it serves in Maryland in August 2018, with nurses providing care and follow-up directly in new mothers' homes. Infants at the hospital are eligible for KMC if they have a birth weight of less than 1.8 kilograms (about 4 pounds).

A study on Liberia’s Profile of Preterm and Low Birth Weight Prevention and Care shows that 22,000 babies are born prematurely each year and 1,100 children under five die due to direct preterm complications in Liberia.

Depoyou says that she “felt very bad” and was worried when her baby was born so small and at such a low weight. The baby ended up spending three months in the NICU, before Depoyou could bring him home to Glaro Freetown, where they live with her fiancé, Romeo Yeoh.

“I am very happy that my wife and baby are going home with me today,” said Yeoh, who works as a cocoa farmer in River Gee County, earning the equivalent of about $384 annually. “I want to say thank you to all the hospital people (nurses, doctors, and other healthcare workers) for taking care of my family.”

Dr. Mulbah G. Smith is an intern pediatrician who has been providing care for Linda and other preterm babies at J.J. Dossen Hospital. It’s Dr. Smith’s first experience providing care for a premature baby between the weight of 0.6kg to 1.50kg.

“I feel even more excited that I have helped to save a child’s life. It was not easy but with God and the help of the team (doctors and nurses), we’re happy that Linda will be leaving with her baby today,” Dr. Smith said.

According to the World Health Organization, it is estimated that 15% to 20% of all births worldwide are low birth weight, representing more than 20 million births a year. Currently, prematurity is the leading cause of death among children under five around the world and a leading cause of disability and ill health later in life. Sub-Saharan Africa and South Asia account for over 60 percent of preterm births worldwide, according to a 2022 Global Nutrition Report.

Low birth weight continues to be a significant public health problem globally and is associated with a range of both short- and long-term consequences.

PIH’s social support programming treats the whole patient, not just the disease or medical condition. Social support comes in many forms, it primarily involves the provision of food, housing, transportation, education, and job security to patients, families, and communities.

In close partnership with the government, PIH continues to transform Maryland, an area with the lowest number of healthcare providers in the country into a vibrant health system with top-notch care for the region and neighboring Ivory Coast.

Ruth Vázquez once had to attend births by the light of a cell phone.  
 
Now, the Masisea resident can use the facility lights 24/7, thanks to solar panels installed by Socios En Salud, as Partners In Health is known in Peru, and the Ministry of Health. 
 
The solar panels are among more than 230 installed by Socios En Salud over the past year, equipping health centers with the electricity needed to power medical equipment and facilities even in the most rural areas.  
 
The solar panels, installed in partnership with the United States Agency for International Development (USAID), come as part of Socios En Salud’s larger efforts to strengthen Peru’s health system. 
 
Socios En Salud has worked in Peru since 1994, when it responded to a deadly outbreak of multidrug-resistant tuberculosis, saving hundreds of lives and inspiring the World Health Organization to update its treatment guidelines. In the decades since, Socios En Salud has expanded its work, in partnership with the Ministry of Health, to provide medical care and social support for thousands of people in Lima and beyond. 
 
Much of that work has focused on communities historically and systemically marginalized. 
 
Peru is home to more than 2 million people of indigenous descent. As COVID-19 surged in 2020, these communities were left behind, with health centers lacking staff, medication, and safety measures—if there were health centers at all. 
 
Stable electricity is essential to patient care, enabling health workers to run medical devices like heart monitors, quickly heat water to disinfect surgical tools, and refrigerate medications and vaccines. At Partners In Health, utilities like electricity and running water are known as the “stuff” that make up strong health systems. 
 
Electricity has been one of the major challenges for health centers in Masisea and Iparia, rural communities in the Amazon rainforest, reachable only by boat. More than 12,000 people live in these communities, representing 87 indigenous groups, such as the Asháninka and the Shipibo-Konibo. The poverty rate is as high as 14% in the region, which has also been impacted by drug trafficking and guerilla warfare. 
 
At these health centers, generators were rundown and access to electricity was irregular, rendering key medical equipment and tools inoperable and putting patients and staff at risk. Staff constantly had to transport large quantities of fuel for generators, which was costly and far from a guarantee of electricity. 
 
The unreliable electricity was especially dangerous for patients on oxygen. Most oxygen concentrators use around the same amount of electricity as a refrigerator. Mothers and newborns were also put at risk, without adequate lighting during births or a way to power medical equipment such as the ultrasound machine at Masisea Health Center–the only one in the entire region. 
 
“We have attended births with cell phone flashlights when there’s been an emergency at night,” says Vázquez.  
 
To respond to this urgent need for electricity, Socios En Salud installed 44 solar panels at Masisea Health Center and 48 at Iparia Health Center in June and July 2022, in partnership with USAID. Socios En Salud installed a total of 232 solar panels and 130 oxygen wall outlets last year throughout Peru. 
 
Solar panels are a form of renewable energy, crucial in the midst of unprecedented climate change. More than 80% of the world’s energy comes from fossil fuels, which emit greenhouse gasses that contribute to global warming. Renewable energy such as solar is also more cost-effective in the long run. 
 
To generate electricity, solar panels convert sunlight—plentiful in the Ucayali region of the Amazon rainforest—into electrical energy. The panels installed by Socios En Salud store this energy in a battery, ensuring electricity is available even on cloudy days. As part of its efforts to strengthen health systems sustainably and for the long term, Socios En Salud trained clinic staff on how to maintain the solar panels and their batteries. 
 
Ever since the panels were installed, they’ve been powering the health centers in more ways than one. 
 
“Now, patient demand is more regular,” says Mónica Córdoba Macuy, an obstetrician at Masisea Health Center. “Before it was not much.” 
 
The stable, 24/7 electricity supplied by the solar panels has directly impacted care for at least 1,200 patients in Masisea. 
 
“Now that they’ve put in solar panels for 24-hour lighting, that helped us a lot,” says Vázquez. “It’s the first time in my life since I was born that I’ve seen lights 24 hours a day.” 

Every year, tuberculosis (TB) claims more than 1.6 million lives worldwide. In the Americas, Peru has approximately 13% of the cases, with the highest number of TB cases after Brazil and the highest number of multidrug-resistant tuberculosis (MDR-TB) cases.  

For more than 25 years, Socios En Salud, as Partners In Health is known in Peru, has partnered with the Peruvian government to respond to TB, including efforts to strengthen detection, treatment, prevention, and research. This work has included curing diseases once thought incurable: In the 1990s, Socios En Salud cured 75 MDR-TB patients, which inspired the World Health Organization (WHO) to revise its protocols and recommendations for the treatment of the disease in impoverished settings.  

Since then, Socios En Salud has expanded its efforts to detect and treat TB cases throughout Peru. Tools such as the TB Backpack, which enables detection of the disease within minutes, or the TB Mobile, a truck with state-of-the-art X-ray equipment, have made it possible for thousands of people to access care. Last year, for example, the TB Mobile screened more than 28,000 people. 

These achievements have established Socios En Salud as a leader in TB care, making it critical to regional and global conversations about the disease. Most recently, Socios En Salud attended the United Nations’ High-Level Meeting on TB, where a series of political declarations were approved that included key actions and investments needed to save millions of lives.  

Dr. Leonid Lecca, executive director of Socios En Salud, participated in this meeting, which was held in New York on September 22. An expert in TB care, Lecca is also a focal point of the Parliamentary TB Front for the Americas and a member of the TB Social Observatory of the Americas.  

We sat down with Lecca to learn more about the latest developments in TB care and what’s next: 

In 2018, the United Nations held its first-ever High-Level Meeting on TB, where a political declaration was signed that would serve as a guide for the fight against TB at the global level. What were the key commitments of this declaration and to what extent did the Peruvian government adopt them or not? 

More than 100 delegations from different countries participated in the meeting, and 15 heads of state spoke, one of whom was the president of Peru, the only one from the Americas region to speak out. All countries committed to achieving the Sustainable Development Goals and the WHO’s End TB strategy, and indicators were drawn up regarding the target for the number of people to be diagnosed or treated for TB. There were also components linked to equity in human rights, vulnerable populations, and an accountability framework for countries.  

In practice, very few of the initial commitments were fulfilled. Of all the goals for diagnosis, treatment, and prevention, the only one that was met was the target of 6 million people with HIV accessing TB preventive treatment within four years—the number achieved was 10 million. In terms of people receiving TB treatment in four years, the target was more than 40 million, but only 26 million received treatment. Among children, 3.5 million should have received treatment, but the number reached was 1.9 million. In the case of MDR-TB, the gap was even more tragic: 1.5 million people should have received treatment, but only 650,000 did.  

Like many other countries, Peru has failed to meet the targets. The WHO asked countries to be accountable, but very few did so, including Peru. We have no data on how we have progressed. The only thing we have are the global TB reports, where data from Peru appears. [We know that] diagnostic coverage has fallen because of COVID-19. Before the pandemic, there was a 20% gap and now it is 40%. Unfortunately, we have not reached the desired outcomes. 

What role have Latin American countries played in the fight against tuberculosis, especially in relation to this new political declaration on TB?   

We [civil society leaders] have been working for the new political declaration since last year from various sectors. Socios En Salud, through me, had the opportunity to join the global civil society group, where we have been pushing for a new political declaration with better goals and accountability mechanisms. However, it has been difficult, politically speaking, to come up with a better statement. Not all of the most vulnerable groups have been considered and there has been a lot of resistance to putting indicators in place.  

The Latin American bloc is together. This year, WHO held a TB meeting in Brazil, and next year the Stop TB Partnership meeting will also be held in Brazil. We hope to continue to push [for progress on] some regional issues linked to vulnerable populations, such as people in prisons, indigenous populations, and migrants, who are increasingly affected by TB.  

Innovation, research, and development in TB were key points at this year’s High-Level Meeting. How has Socios En Salud contributed to this goal in the past year?   

Socios En Salud is playing an important role in the region and in the world when it comes to the implementation of technology, diagnostic solutions, and new treatments to address TB. In the Americas region, we were the first organization to implement a new diagnostic algorithm using mobile radiology and artificial intelligence for automated reading, followed by a molecular test. This is being replicated by several countries in the region with our advice, such as Colombia and the Dominican Republic, as well as by organizations that have asked us for support and have visited us to learn about our approach. 

In terms of treatment, we recently held a meeting of endTB researchers, which is an initiative for shortened oral treatments of nine months for MDR-TB. The initiative has had very good results, which will be presented in November at the World TB Conference. We are in the early stages of talking with the Peruvian authorities so that these results can be shared and can help health systems make better decisions in the treatment of MDR-TB patients in the country; 40% of all the patients who were treated with these different regimens are Peruvian, so we have local evidence that will help the world to improve treatment regimens. 

In May, the WHO declared the end of the COVID-19 global health emergency. However, the impact it had on the fight against TB is irreversible. What are the lessons learned and how must we include TB in pandemic preparedness and responses moving forward?   

Health systems were not prepared. The science was not ready. However, all this has shown us that, with financial resources, you can move fast in finding new vaccines and diagnostics. That is a lesson for TB, which has not had a new vaccine for many decades and needs one.  

Unfortunately, the pandemic was not used to search for and treat TB cases. COVID-19 was an airborne respiratory infection with a more rapid course, but still similar to TB. During the first wave, we found that COVID-19 was affecting the same communities in North Lima and East Lima where we always found TB cases. 

That is why our rapid response teams, in addition to providing COVID-19 tests in the communities, asked for a sputum sample from people with respiratory symptoms to rule out TB through a molecular test: the GeneXpert. Through this test we found many TB cases in the community. Some also had COVID-19.  

This information was shared with the Peruvian Ministry of Health, and finally, several months later, a directive was issued to do joint searches for COVID-19 and TB. The finding was that Peru has regressed in all indicators: the gap in TB detection went from 20% before the pandemic to 40%. The WHO estimates that in Peru there are 44,000 cases each year and only 26,000 are being found. 

The problem of climate change has intensified and the forecasts for the coming years are not encouraging. To what extent does this increase the risk of infectious diseases such as TB?   

Actually, there are no studies that directly link the effect of global warming with the development of TB. What we have seen are indirect effects: If global warming affects crops, through landslides or droughts, this can indirectly affect people's nutrition, which could complicate their immune systems and make them more susceptible to infections such as TB. We are trying to assess the impact of climate [on TB], but we have not yet found a direct relationship. 

During the UN General Assembly meeting, there were satellite discussions on climate change and how it affects people's health, for example how mosquito-borne diseases due to temperature change will continue to produce outbreaks in the poorest communities [as is the case with dengue fever in Peru]. So, better surveillance systems are being discussed to monitor infections, outbreaks, and resurgences. 

Over the past decades, we’ve made remarkable progress in the fight against tuberculosis and MDR-TB, globally and in Peru. But there is still a lot of work to be done. Where are we currently in the fight against tuberculosis? 

The challenge right now in Peru is to rapidly implement the latest recommendations that are in the WHO’s TB prevention and control guidelines. For a long time, we raised the concern that there were no innovations. But in the last four years, the WHO has rapidly updated its diagnostic, treatment, and prevention guidelines, and many of these updates still have not been included in Peru's national TB protocols. 

We need to move quickly to include the lessons and new technologies that the WHO now allows us to use, such as better diagnostics, shortened oral treatment regimens, shortened oral preventive therapies, and a number of other innovations that are slowly being implemented in Peru, but whose work we need to accelerate. 

How has Socios En Salud contributed to the fight against TB in Peru, both historically and in recent years? 

We have had the opportunity to help on many issues related to diagnosis, treatment, and prevention, but also related to social determinants, stigma, human rights, discrimination, and gender. For us, our TB work is a key opportunity to continue working with the Peruvian Ministry of Health to help them make the best decisions and ultimately reduce the suffering of individuals and families affected by this terrible disease. 

To improve TB screening, we continue to help implement new diagnostic algorithms, including mobile radiology, artificial intelligence, and molecular testing, not only in Peru but also at other PIH sites such as Lesotho and Malawi.  

In terms of treatment, we are working to share the results of the endTB project, so that these lessons can be applied by other countries. The challenge is to implement the shortened preventive therapy. We are already doing it in North Lima and in our own medical center in East Lima, but there is still a need for greater expansion at a national level and in other countries in the region. 

Looking ahead, as we continue our work to diagnose and treat TB in Peru, what are your priorities as executive director of Socios En Salud? What's next for our TB work?   

We are now in discussions with Peru’s National TB Program so that many of the WHO updates can be included. We had already made progress in some areas, such as the active search for TB, but where there have been delays is in the implementation of shortened oral treatments, which we are discussing to see how we can help. The same issue has happened with preventive treatment. Our goal is to continue strengthening the health system at all levels, so that people can have access to timely, dignified, and quality treatment. 

We are approaching disease control under two main pillars. One is to do everything we can to strengthen the health system through our 5S model, so that regular health services can admit people and give them timely, quality care. 

But we also have another very important pillar, because we recognize that probably the poorest and most vulnerable people have not even reached a health service. We have to go and look for them in the communities themselves and bring them closer to a diagnosis, to a medical evaluation, and then, obviously, link them to the formal health system, so that they can continue with their treatment or whatever they need. That is what our seven health programs are focused on, and we hope to continue scaling up these initiatives and working for the benefit of the communities. 

Care doesn’t end when a patient is discharged from a Partners In Health (PIH) facility. In many ways, it marks the beginning. The beginning of a new routine, new responsibilities, and a new type of care. 

Such is the case for Nthabiseng Mokone, a 27-year-old patient with multidrug-resistant tuberculosis (MDR-TB). After spending six months in inpatient care, Mokone recently reunited with her loved ones.    

Below, follow through photos as Mokone travels from a PIH-supported halfway facility to her home.  

A new era of patient care has begun at Butaro Hospital.

After nearly two years of construction and renovation, Butaro Hospital has completed its expansion project, positioning it to offer improved care and services to the over 33,000 patients who seek treatment there each year.

“This milestone is a demonstration of our joint commitment to providing quality health care services to the people of Rwanda,” says Dr. Joel M. Mubiligi, executive director of Partners In Health in Rwanda and interim vice chancellor of the University of Global Health Equity. “We are honored to be part of this transformative project.”

The ambitious, multi-year expansion project, which Partners In Health began in December 2021 in partnership with the government, has increased the hospital’s capacity from 150 to 237 beds, doubled the number of surgeries able to be performed, and added a four-story wing, including a radiology suite, an emergency unit, and two admission oncology wards.

In addition to improving patient care, the expansion has further established Butaro Hospital as a leading medical and scientific institution in the region and has helped it secure teaching hospital accreditation—a milestone that enables the hospital to serve as a fertile training ground for students from the nearby University of Global Health Equity, which PIH founded in 2015 in partnership with the Rwandan Ministry of Health.

Known locally as Inshuti Mu Buzima, Partners In Health has worked in Rwanda since 2005, strengthening the health system in partnership with the Ministry of Health. Butaro Hospital was built in 2011 through that partnership, along with architectural partner MASS Design.

In the years since, the hospital has expanded its programs and services, working with communities across Burera and providing lifesaving care in a rural district that once had no hospital.

As programs and services have expanded, so too has demand. In 2012, just a year after opening, the hospital served 561 new patients in its oncology ward. By 2019, that number had surged to 1,770, reflecting an increased demand and fueling the need for growth.

Before the expansion, the oncology ward was at 120% capacity and the pediatric ward was at 130% capacity. Crucial services were also unavailable, including a CT scan—needed by more than 75% of cancer patients. As a result, cancer patients had to be transferred to other centers for imaging, costing precious time and money and putting their health at increased risk. The hospital also had no intensive care unit, no oxygen plant, and only one operating room for all types of surgery.

Now, with the expansion complete, patients can access these services and more, including a newly-renovated cafeteria where free meals will be provided to patients and their families, as part of PIH’s social support program.

The newly-expanded, teaching-accredited hospital is set to improve patient care for years to come.

“We are grateful to our hardworking team, our generous donors for their unwavering support, and the Ministry of Health for their leadership in making this expansion a reality,” says Mubiligi. “Together, we will continue to build a brighter and healthier future for all Rwandans.”

Following Friday’s precedent-setting announcement that in low- and middle-income countries Johnson & Johnson will not enforce patents on bedaquiline, a key drug in the fight against multidrug-resistant tuberculosis (MDR-TB), Partners In Health CEO Dr. Sheila Davis shares this statement. 

For decades, progress in the fight against MDR-TB has been too slow. Too many people have become sick. Too many people have not had access to modern medicine. And too many people have died. 

Only weeks ago, countless people of conscience escalated decade-long pressure on Johnson & Johnson to increase access to bedaquiline. These activists built upon a movement of TB survivors, governments, health care providers, and others. 

On Friday, their appeals were answered. Johnson & Johnson’s announcement is a heartening example of solidarity, and one that will make a real difference in the lives of the half-million people who newly fall sick with MDR-TB each year. 

PIH has been researching MDR-TB, advocating on behalf of those suffering from MDR-TB, and providing MDR-TB care for people in low- and middle-income countries since 1996. Two of our co-founders, Dr. Paul Farmer and Dr. Jim Kim, were at the vanguard of fighting for and introducing care for people with MDR-TB in low-income countries. Subsequently, through direct collaborations between PIH and ministries of health, hundreds of thousands with MDR-TB have been treated in the places we work. But it has never been enough. Friday’s news means that we, like so many around the world, will be able to widen and strengthen our efforts, getting ever closer to bringing people affected by TB the care they deserve and ending this terrible disease. 

We have a lot of work ahead of us in the fight for global health equity, and specifically in addressing the cruel inequities of TB. Hundreds of thousands of people with MDR-TB are left undiagnosed and untreated each year. Recent progress has also been made on the cost of one diagnostic tool, Cepheid’s Xpert MTB/RIF cartridge. But enormous gaps will remain as long as commercial producers of health tools are permitted to unilaterally set prices and conditions for how those tools are obtained. As PIH Trustee John Green recently said at the United Nations High-Level Meeting on TB, “The patients are where the tools are not, and the tools are where the patients are not.” 

Let’s keep pushing to bring high-quality care to all who need it. 

The Executive Leadership of Zanmi Lasante and Hôpital Universitaire de Mirebalais (HUM) strongly condemn the shocking attack perpetrated by a gang at HUM, at roughly 2:30 a.m. today. This brutal attack violated the moral agreement that hospitals are places of neutrality, leaving medical staff and patients deeply traumatized.

"We strongly condemn this attack as a breach of the principle of medical neutrality protected by International Humanitarian Law," says Marc Julmisse, ZL's interim executive director. "Despite this targeted attack on HUM, Zanmi Lasante staff remain committed to providing lifesaving care for the people of Haiti, and we ask that you stand in solidarity with them."

HUM is a symbol of quality health care and a place of healing for the Haitian community. It is where lives are saved, where pain is soothed, and where everyone, regardless of their circumstances, finds help in time of need. Hospitals are neutral places, refuges where everyone can find safety and care, regardless of their origins or affiliations. This attack on HUM violates the essential principles of hospital neutrality, and it has left a deep scar on hospital staff and patients alike.

Of the more than 350 patients present at the time of the attack, many were in intensive care, in critical condition. The hospital's neonatal intensive care unit— housing fragile, helpless newborns in incubators—was also targeted by gunfire, damaging several of the incubators and endangering these already vulnerable babies.

Although no deaths or injuries occurred, this attack underlines the urgent need for local authorities, law enforcement agencies, and the international community to take firm action to ensure that hospitals remain sanctuaries of care. Acts of violence against health care facilities not only disrupt the vital provision of medical care, but also cause lasting trauma to those who seek and provide care.

Zanmi Lasante and HUM remain committed to our mission of providing quality care to patients in Haiti, whatever the difficulties we face. We remain determined to continue our work, to restore the neutrality of health care facilities, and to support our community in these difficult times.

We stand in solidarity with our courageous and dedicated staff, our patients and their families, and all those affected by this attack. Together, stronger than ever, we are committed to healing, compassion, and hope.

Less than a decade ago, most expectant mothers in Lesotho didn’t have the option to give birth at a health center. Instead, they delivered at home—often without the help of health care workers.  

Today, more facilities are better equipped, providing mothers with dignified space for labor and delivery. That’s largely due to the country’s National Health Reform. A recent research article, published in PLOS Global Public Health, highlights the impact of the initiative on maternal and child health. 

Key Findings

Launched in 2014, the National Health Reform is a set of interventions designed to increase access to high-quality, affordable health services. It was developed and carried out by the country’s Ministry of Health in partnership with Partners In Health (PIH) Lesotho. The reform was piloted at all health facilities across four rural districts: Berea, Leribe, Butha-Buthe and Mohale’s Hoek. These regions include 40% of the population or about 815,520 people.

One of the interventions included assessing and improving the 5 S’s—staff, stuff, space, systems, and social support—to align with the disease burden in the regions. This includes ensuring proper staffing, an adequate number of beds, and appropriate medications, among other necessary items. 

Another important intervention was decentralizing health care management. Previously, management was top-down from the central ministry to the district hospitals and health centers. The intervention aimed to empower districts by creating district health management teams to oversee and manage all health services in the districts. Lastly, community involvement was encouraged. Village health workers were hired and trained to accompany pregnant women. 

In the recent article, researchers assessed metrics from pre-Health Reform in 2013 to during the Health Reform in 2017. They found that the number of health centers adequately equipped to provide facility-based deliveries increased from 3% to 95%. “Adequately equipped” means there is the required equipment for deliveries, 24-hour midwife staffing, a maternal waiting home, proper heating during cold weather, food for mothers and babies, and more. This was associated with an increase in facility-based deliveries from 2% to 33% per quarter at health centers. Other findings included an increase in antenatal and postnatal care visits and an increase in children getting fully immunized before their first birthday.

“We have seen tremendous progress,” says Melino Ndayizigiye, PIH Lesotho’s executive director. “Think about how many lives we would have lost if we didn’t invest in the health reform.”

Next, the team will continue to work toward universal health care.

“And to do that, we’ll continue to use the reform model to align the disease burden with inputs. It can be human resources, supplies, space, systems. Basically, an investment in the 5 S’s model will drive us towards achieving universal health care.”

Ambulances, stretchers, and bandages are essentials in an emergency response. At Partners In Health, they’re also known as “stuff”—one of five elements, which we call the 5 S’s, that make up a strong health system.

The 5 S’s were developed through our 30+ years of partnering with governments to strengthen public health systems and move the world closer to free, universal health care for everyone, everywhere. 

As we’ve partnered with health systems and communities for the long-term, we’ve learned a few things about global health delivery and developed our own lexicon, made up of phrases both original and borrowed, along the way. These words describe the “why” and “how” of our work and what powers us every day, from the rolling hillsides of Cange, Haiti, to the bustling streets of Lima, Peru.

Here are some of the key words and phrases that drive our work:

1. Accompaniment

Being there, together, for as long as it takes 

From Haiti to Rwanda, we care for our patients, who we often call “our bosses,” for as long as it takes, accompanying them not just during their treatment plan, but on the path to wellness. Much of this accompaniment, a concept from liberation theology, is carried out by our 10,000 community health workers worldwide—local residents hired and trained to provide basic health services and to help patients navigate the health system.

2. Pragmatic solidarity

The idea that compassion, or “suffering with,” is not enough—it must be linked to practical efforts to stop the suffering, with actions and solutions led by those most affected

Pragmatic solidarity is a social justice approach that combines immediate, practical action, such as providing medical care, with responding to the root societal causes of suffering and injustice. Importantly, these actions and solutions are led by those most affected. Solidarity alone won’t heal communities. Medical expertise is also insufficient on its own. Caring for patients means treating the medical aspects of the disease along with the structural violence that caused it. Guided by this concept, PIH provides not only medical care, but also social support such as food, housing, and transportation.

3. Health care is a human right

The belief that all people, everywhere, deserve to be healthy

The right to health is core to PIH’s mission and underscores all aspects of our work, from clinical care to social support to advocacy efforts. All people, regardless of race, gender, social class, nationality, or other markers, deserve unconditional access to free, comprehensive health care.

4. Preferential option for the poor

The idea that we must put the needs of the most vulnerable first

This phrase, which has its roots in liberation theology, has been part of PIH’s work since our earliest days. In a global health context, it means making sure those who live in impoverished countries have access to the highest standard of care possible—the same standard of care available in wealthy countries and that we would want for ourselves and our families.

5. The 5 S’s

Staff, stuff, space, systems, and social support—the essential building blocks of a strong health system

At PIH, we view strong health systems as having five key ingredients: staff, stuff, space, systems, and social support. We call these elements the 5 S’s. To provide the highest standard of care, health systems must have well-trained, qualified staff; tools and resources to deliver care; safe, dignified spaces with capacity to serve patients; effective systems for patient care, leadership, and governance, and social support that is essential to care, such as food, housing, and transportation.

Partners In Health (PIH) welcomes the news that Danaher Corporation will lower the price of its high-quality tuberculosis test cartridge, the Xpert MTB/RIF Ultra, by 20 percent and urges the Washington, DC-based conglomerate to do more.

Tuberculosis ranks as the world’s deadliest infectious disease. In 2021, 1.6 million people—equivalent to the population of Trinidad and Tobago—died of it and 10.6 million people—equivalent to the population of Greece—fell ill. Over 80 percent of deaths occurred in low- and middle-income countries.

“In rural, extremely poor settings, people with tuberculosis fight valiantly every day to survive,” says Lindsay Palazuelos, PIH Senior Director of Policy & Government Accompaniment. “This price reduction will help us give more patients the care they deserve.”

PIH has relied on Xpert tests since 2012 and currently uses them daily in Haiti, Peru, Malawi, Rwanda, Lesotho, Liberia, Sierra Leone, and Kazakhstan. In most of these places, there is a chronic shortage of cartridges because of their high cost.

Carole Mitnick, PIH TB Specialist and Professor of Global Health and Social Medicine at Harvard Medical School, was heartened to hear of the move to expand access to high-quality care, but pointed out questions unanswered in press releases. These include: 

• Danaher says it will sell the cartridges “at cost.” How can this be publicly verified and will they partner to work toward lower costs?
• When will other Danaher test cartridges, including the XDR cartridge, be available at more affordable prices?

“It’s truly exciting to imagine more patients getting prompt diagnosis,” says Mitnick. “We’ve got much more to do and important questions that need urgent answers, but I’m deeply thankful for everyone—activists, clinicians, scientists, everyone—who acts in solidarity with those suffering from a disease too often ignored.” 

From 2010 to 2020, substance use increased by 26% across Mexico—but access to treatment has lagged. In rural areas like Jaltenango, a city in the mountainous Sierra Madre region of Chiapas, where Partners In Health works, heavy substance use has been evident, with alcohol being the most common, followed by marijuana, cocaine, and methamphetamines. But treatment for people who use drugs has historically been few and far between.

Substance use generally doesn’t happen overnight or come out of nowhere. It is complex and often linked to people’s trauma, mental health conditions, and the environments where they live. In most cases, it takes much more than abstinence alone to achieve rehabilitation—there are many social, psychological, and economic factors that influence a person's recovery.

Since October 2022, Compañeros En Salud, as Partners In Health is known in Mexico, has run a mental health project called "Me cuido y nos cuidamos” (Spanish for “I take care of myself and we take care of each other"). Offered by the mental health team, the project is led by clinical psychologist Azul Marín and mental health community health worker Ervin Morales.

"Me cuido y nos cuidamos” works with men who are staying at one of the treatment facilities for substance use recovery in Jaltenango and with high school students at the nearby Centro de Estudios Científicos y Técnicos (CECyT). It has two goals: to create a safe space for men to reflect on their substance use and to unpack their understanding of masculinity.

The program was inspired by the success of Compañeros En Salud’s pilot of “Women’s Circles” in 2022, which promotes community, knowledge sharing, and wellness for women in the Sierra Madre region.

Twice a month, Marín and Morales gather reflection circles for men to discuss their feelings and experiences with substance use and their relationship with masculinity. As facilitators, Marín and Morales hope to help the participants process their experiences, identify their emotions, and learn tools for emotional regulation.

“We have had men who started using substances from the time they were 12 years old…and we believe it has a lot to do with cultural influence on what it means to be a man,” says Marín. “It is very much related that to be a real man, there has to be substance use involved.”

Globally, about 270 million people used psychoactive drugs in the past year and about 35 million are affected by drug dependence, according to the World Health Organization. Men are more likely than women to use almost all types of illicit drugs. In Mexico, 71% of people have used alcohol at least once in their lives and 8.6% have used marijuana.

There is no one reason why people use drugs, but substance use can often be related to mental health problems such as depression, anxiety, and poor anger management. Instead of prioritizing treatment for people who use drugs’ mental and physical health, governments have historically moved to criminalize drug use and imprison people, adding to the trauma that marginalized people, families, and communities already experience. But in recent years, more policies and programs have emerged that aim to address substance use as a public health issue.

“Me cuido y nos cuidamos” is one of those programs.

"There are a lot of men who don't take care of their mental health, because no one has taught them how, and because of the social dynamics in which they operate,” says Morales. “There is pressure to be a man who has to put up with everything.”

Support groups like the reflection circles offer spaces for community and accountability—crucial in helping people on their recovery journeys, wherever they are in the process. The recovery model of care emphasizes that treatment is not medicine alone and that human rights are granted to all.

By building a more compassionate, emotionally aware, and conscious masculinity, the young men in the treatment facility have been able to form healthier relationships with themselves and others, as they continue on the path to recovery.

So far, 35 men have participated in the group.

"I questioned a lot where drugs have taken me, and I learned about what I was doing wrong,” says Osmin, one of the group members. “But what I learned most is that for as many things as I am or what I go through, I'm always going to be a person. I'm going to be me, and we all deserve to be respected."

The project has not only had an impact on the men in the group, but also on those who facilitate it.

"Every day we are with them, they teach us a new lesson,” says Morales. “They are very strong and courageous people, and all this also helps to put a name to many processes that even I lived through."

"Me cuido y nos cuidamos” will maintain its activities, continue to reach out to men seeking recovery from addiction, and work to prevent substance use among adolescents, offering support and a safe space for men to recover.

The GeneXpert is a machine that tests clinical samples to quickly identify infectious diseases, such as tuberculosis (TB). As TB remains the world’s deadliest infectious disease, treatment and support rely first and foremost on diagnosis. This machine has become critical to patient care at eight Partners In Health (PIH) care delivery sites, as it allows clinicians to receive complete and accurate diagnoses quickly, ultimately helping treat patients effectively and stop the spread of disease.  

To learn more about GeneXpert, we spoke to Megan Striplin, laboratory services program manager for PIH; Nadeige Hilaire, laboratory coordinator for Zanmi Lasante, as PIH is known in Haiti; and Mokenyakenya Matoko, laboratory lead for PIH Lesotho. Below, edited and condensed, are their responses to questions about the technology, why the machine is vital to patients, and the challenges we face in the global diagnosis and treatment of TB: 

What is the GeneXpert? 

The GeneXpert is a closed-system polymerase chain reaction (PCR) machine that allows you to perform automated, cartridge-based PCR–the gold standard for many diagnostic lab tests. With GeneXpert, a PCR test can be performed within hours, by inserting a disease-specific cartridge into the machine that will detect and amplify specific sequences of genetic material (DNA or RNA), confirming the absence or presence of that disease of interest from the sample. Traditional PCR testing requires a molecular biology lab with skilled technicians and a highly controlled environment. Utilizing the GeneXpert machine allows you to bypass those needs and provides a more “point-of-care" test.  

Each cartridge is used for a single PCR test for a specific oncology marker or infectious disease, such as COVID-19, HIV, and more. The cartridges are single-use, self-contained, and consist of all necessary reagents for PCR testing.   

If we want to make an analogy using a pre-prepared meal, the GeneXpert cartridge is the TV dinner and the GeneXpert machine is the microwave–the ONLY machine that can heat it. The beauty of the cartridge, or TV dinner, is that all ingredients are included, pre-measured, and prepared–you do not need a cutting board or chef knife, and it does not require a trip to the market for the individual ingredients. The level of technical “culinary” skill level is minimized, and finish time is significantly shortened. 

How long has PIH been using GeneXpert technology? 

For over a decade. PIH Lesotho first started using the GeneXpert around 2012 for TB testing. They were the first facility in the country to have a GeneXpert machine. 

How many PIH care delivery sites are using the GeneXpert machines? 

We currently have GeneXpert machines at eight PIH-supported facilities–in Haiti, Peru, Lesotho, Malawi, Rwanda, Liberia, Sierra Leone, and Kazakhstan.  

How many tests are we running a year through GeneXpert machines? What are we primarily testing for? 

We run thousands of tests per year using the GeneXpert. In Haiti, we’re running about 8,500 tests per year, and in Lesotho, around 5,000-6,000 tests per year—to give a couple of examples. We test primarily for TB, but also HIV viral load, HIV early infant diagnosis, and Hepatitis B viral load. 

Why are these machines important to our work, for both PIH clinicians and patients? 

From a clinical perspective, GeneXpert provides useful information such as HIV and Hepatitis B viral load and confirmation of the presence of infectious disease. For TB specifically, the GeneXpert cartridge provides drug susceptibility testing which informs what treatment will and won’t be effective, which also helps classify if a patient has drug-sensitive TB or multidrug-resistant TB (MDR-TB).  

These machines also do not require highly skilled lab staff, and cartridges can be stored at room temperature, which is huge for our care delivery sites. And once you have one machine, you can perform a variety of different tests, so long as you can afford the cartridges. 

For our patients, the turnaround time to receive results is drastically reduced to hours, enabling patients to receive their results within the same visit–allowing for timely treatment and preventing the spread of disease. 

What would happen if we didn’t have the GeneXpert machines? 

Mainly, we miss out on the opportunity for quick diagnosis and treatment for TB patients. Overall, our diagnostic capacity would be significantly crippled, in particular for TB, where the alternatives are smear microscopy (which is not very accurate) and/or sending out sputum samples to the reference laboratory for culture, which can take a month, or longer, to receive the results.  

Without the GeneXpert machine, a process that only takes hours at PIH-supported laboratories would take weeks or months at national reference TB labs. 

What impact would it have on our care delivery sites if cartridge prices were lowered? 

A major challenge we face with these machines is cost, including the recurring cost of the cartridges and the machines themselves. If the price per cartridge was lowered, we could increase access significantly. We’re currently limited on the number of tests we can perform simply due to budget. 

Henry Domingo Vilca used to be “cold and distant,” not expressing his feelings or connecting with his children emotionally. Now, the sight of his daughter running toward him, shouting “Papa!,” often brings him to tears.

“She is my everything,” he says. “She is my world.”

He didn’t experience moments like that growing up.

“My father was quite firm and had a traditional upbringing,” Vilca says. “He didn’t hug me or tell me how he felt. He even hit me.”

In Peru, machismo still runs deep. This set of ideals and beliefs associates masculinity with traits like dominance and aggression and has fueled decades of violence against women and girls, including femicide, and promoted traditional gender roles. At the same time, machismo has also pressured men to suppress their emotions, masking their struggles with mental health and discouraging them from seeking help.

When Vilca’s son was born, he followed traditional gender roles, acting as the breadwinner while his wife managed the home and caregiving responsibilities. He also didn’t show affection or take much interest in his son’s feelings.

But when his daughter Cayetana was born, all that began to change.

For one, the girl had a hemangioma, a vascular tumor that is usually benign, on her back. Fortunately, the condition went away on its own. But it worried Vilca. He made sure to take her to the local clinic in Carabayllo for her 12-month check-up.

At the clinic, staff evaluated her psychomotor development and found that she was showing signs of risk for developmental delays in her social, language, and motor skills, prompting them to connect Vilca and his family with Socios En Salud, as Partners In Health is known in Peru.

Fathers As Caregivers

Socios En Salud has worked in Peru since 1994, when it responded to a deadly outbreak of multidrug-resistant tuberculosis in Carabayllo. In the years since, Socios En Salud has expanded its work to provide medical care and social support for thousands of people nationwide.

One of those programs is CASITA, a three-month intervention for caregivers and children ranging from 6 months to 2 years old. Based in Carabayllo, the program identifies children at risk of developmental delays and enrolls them and their caregivers in free sessions to learn social-emotional, motor, language, and cognitive skills through play. Since 2013, CASITA has enrolled more than 3,648 children and screened more than 6,795, with 85% showing improvement during its pilot period.

Early detection of developmental delays is critical in helping children access the care and support they need to become healthy, independent adults. This is especially true in Carabayllo, where daily challenges include poverty, malnutrition, and domestic violence and where only 34% of children under 3 are up-to-date on their growth and development checks.

Vilca began CASITA in February, attending weekly classes with Cayetana and 10 other caregivers and their children. The sessions were taught by a community health worker, one of nearly 100 local residents hired and trained by Socios En Salud to provide basic health care at the community level.

Over the next three months, Vilca and other caregivers sang songs, read books, and built pyramids of toys with their children. With each session, Cayetana began to show signs of growth, including taking her first steps, improving her foot-eye coordination, and memorizing and pronouncing words. And she wasn’t the only one learning new skills.

“Socios En Salud was there at a key moment for our family,” says Vilca. “It has really helped my daughter and me as her father.”

Learning To Play

Vilca was the only father in the group—a fact that, at first, made him self-conscious.

In traditional Peruvian households, the mother is responsible for caregiving, raising the children, and taking care of the house, while the father is the breadwinner, bringing in income. Throughout history, caregiving has been a role assigned to women, attributed to “maternal instinct” instead of viewed as a learned behavior. This stereotype has harmed women, creating a widely-documented gender gap in caregiving, has led to the devaluation of caring professions such as nursing, and has also reinforced the myth that men are less capable of caregiving.

In reality, caring has no gender.

As the weeks went by, Vilca grew his own confidence as a caregiver. He learned how to show affection and respond to Cayetana’s emotional needs.

Those changes went beyond the classroom.

“I see that she’s happy when she’s with me and that makes me feel like the best dad,” he says. “Now I suddenly have the desire to spend time with her, as well as with my son. I really enjoy going out to play and have time with them outside of [CASITA] sessions.”

He used to barely acknowledge his children when he came home from work each night, exhausted and depleted. But since CASITA, his evening routine has changed.

“I love holding my children when I arrive [at my house] and hugging them,” he says. “I won’t deny that it was strange at first.”

He and Cayetana have now completed the CASITA program. But he keeps in touch with Socios En Salud staff and the other caregivers.

“I am grateful to Socios En Salud for our lives,” he says. “Some may think that SES only helped my daughter, but they also cared about our family and counseled me on my relationship with my partner. It has strengthened everyone’s bond and left us with great lessons on how to face challenges in the future.”

The greatest lesson, for Vilca, is feeling more connected with his children.

“They have completely changed me,” he says. “My greatest wish is to see [them] achieve their dreams...I want them to know that I will always be there to listen, guide, and support [them].”

Health promotoras, health educators, community ambassadors––though known by many different names, community health workers are frontline public health workers who leverage their unique understanding of local language and culture to connect communities to health care and social support.   

Our experiences have shown that a robust community health workforce is crucial for achieving better health equity, empowering communities, and building a stronger public health system. Across the globe, community health workers play a vital role in reducing health burdens while significantly improving the health and lives of people in their communities. In the U.S., community health workers serve as essential connectors between communities and medical services by accompanying individuals on their health care journey, advocating for their community’s health needs, and matching individuals to essential social support, all of which are integral activities to ensure the right to health for everyone. 

Communities of color and people living in low-income and rural areas face countless challenges such as documentation status, access to transportation, and translation support that make not only accessing, but navigating the health system difficult. Community health workers are crucial to mitigating these barriers by supporting their own communities in identifying culturally relevant resources, navigating complex health and social service systems, and advocating for the design of more accessible health services. A robust community health workforce is vital for achieving better health equity, empowering communities, and building a stronger public health system. 

Here are some ways PIH-US partners with community health workers across the country: 

Chicago, Illinois 

Four Community Health Organizers from local community-based organizations in Chicago are enhancing their capacity to address public health needs by attending PIH-US-led trainings in advocacy, organizing, public health skill-building, and resource navigation. Each organizer has identified projects within their organization that they would like to introduce–from creating wraparound services for a growing immigrant community and advocacy campaigns for Medicaid expansion, to improving staff wellness services–to mobilize their neighbors in the fight for environmental justice and health equity. 

Immokalee, Florida 

PIH-US and our partners at HealthCare Network hired and trained community health workers in Immokalee to go door-to-door to connect community members to health and social services. In doing so, they help the primarily migrant community overcome barriers to health care like travel times, costs, and stigma. Throughout 2022, 15 community health workers completed over 8,600 engagements with community members including conducting COVID-19 mobile testing, facilitating transportation to vaccine events, and serving as resource navigators. When Hurricane Ian hit parts of southeastern Florida, community health workers launched vaccination outreach events for TDaP (tetanus, diphtheria, and pertussis) and influenza in hard-hit neighborhoods.  

New Bedford, Massachusetts  

In Massachusetts, PIH-US partnered with the New Bedford Health Department to train promotoras from New Bedford’s Community Economic Development Center, an advocacy organization that supports a large Central American immigrant population, to conduct surveys and outreach for the local community health needs assessment. They gathered over 800 surveys from historically excluded communities detailing their health needs, challenges, and concerns about the system. By providing the health department and local health system with a deeper understanding of community concerns, the surveys collected by this workforce will ensure future public health planning and strategies are designed to meet local needs. 

North Carolina 

PIH-US is working with the North Carolina Community Health Worker Association, North Carolina Department of Health and Human Services, and others to develop both a formal training and certification process, as well as a community, public health, and clinical integration model which are designed to provide career development and employment opportunities for community health workers across the state. To further uplift community health worker voices, PIH-US partnered with North Carolina Community Health Worker Association to host a series of trainings on legislative advocacy to ensure that community health workers participating in a state-wide Advocacy Day felt comfortable and confident sharing their stories and championing their communities to policymakers. In April, community health worker advocates met with over 50 elected officials to elevate the impact of the community-based workforce on communities across the state and urge legislators to support plans to sustainably integrate community health workers into North Carolina’s public health infrastructure. 

Now more than ever, it is critical that decision-makers recognize community health workers as an essential frontline workforce whose knowledge and skills are indispensable. PIH-US is working closely with the National Association of Community Health Workers to promote recognition and funding for this workforce nationwide. We believe that investing in community health workers is imperative to the fight for health and racial justice in America. 

Cholera is often thought of as a 19th-century disease that spread around the world through travel and trade. But in low- and middle-income countries, especially in the wake of natural disasters, cholera continues to kill tens of thousands of people—even though a simple, effective treatment exists.

A similar narrative emerges with other diseases. Health conditions that have known treatments and cures continue to claim millions of lives worldwide, disproportionately in the Global South. This inequity is due to the enduring injustices of poverty and colonialism that have led to weak health systems and a lack of access to testing, treatment, and care.

These issues bring to light the urgent need for global health equity, a mission that has been the cornerstone of Partners In Health’s efforts around the world for more than 30 years—from our work fighting HIV/AIDS and multidrug-resistant tuberculosis in the 1990s to our response to Ebola, COVID-19, and several other health conditions, including non-communicable diseases.

From Haiti to Lesotho, our work is driven by a simple yet radical idea: health care is a human right, and it should be free and accessible for all people, everywhere. 19th-century diseases should not be a death sentence, anywhere, in the 21st century.

Below are five diseases that are fully treatable but continue to devastate much of the world:

1. Tuberculosis

A cure has existed for tuberculosis for decades. But millions of people continue to be infected and die of the disease, despite diagnosis and treatment being available in wealthy countries. The WHO estimates that 1.6 million people died of TB and 10.6 million fell ill in 2021. Over 80% of these cases and deaths occur in low- and middle-income countries.

2. HIV/AIDS

While no cure exists for HIV/AIDS, the disease is treatable and it is fully possible for people to live long, healthy lives with access to the proper medication and care. Over the past decade, massive strides have been made in widening access to antiretroviral therapy, with 76% of all people living with HIV accessing treatment. Still, 630,000 people died of HIV-related causes and 1.3 million acquired the disease in 2022, highlighting the need for continued efforts to improve access to treatment and care.

3. Malaria

Malaria is curable and can be prevented through measures like mosquito nets, medication, and vaccination. But despite the existence of a cure, 619,000 people died of malaria and 247 million became infected in 2021 due to lack of access to care. And the disease has a disproportionate impact: 96% of deaths and 95% of cases happen in the WHO African Region, with children under 5 accounting for 80% of all malaria deaths in the region.

4. COVID-19

Vaccines and treatments have been developed for COVID-19, the virus that has led to nearly 7 million deaths worldwide since its emergence. Despite the world’s fastest-ever vaccine development—with the first vaccines produced in less than 12 months, without compromising safety—vaccines remained unavailable for most of the global population, as wealthy nations bought up the world’s supply. In 2022, 1.3 million people died of COVID-19—a total that is likely much higher, given that many deaths were not officially reported. Only 23% of people in low-income countries had at least one vaccine dose by November 2022, compared to 80% of people in high-income countries.

5. Cholera

Cholera, which can cause death within 24 hours, is easily treatable: less than 1% of patients die when they’re rehydrated quickly, through oral rehydration solution, a mixture of water, salt, and sugar. But each year, anywhere from 21,000 to 143,000 people die of cholera, due to lack of access to treatment. The disease is especially deadly in countries with weak health systems in the wake of flooding, earthquakes, and other natural disasters, including in Haiti and Malawi.

In March, a woman was killed every three days in Peru. Since January, the country has seen at least 51 cases of femicide.

Gender-based violence is just one of the daily realities that women and girls face in Peru. They must also make their way, personally and professionally, in a society that is still sexist and patriarchal in many respects. More than 50% of Peruvians believe that women should put their role as mothers and wives first, ahead of their own dreams, according to Peru’s National Institute of Statistics and Informatics.

And then, for women who live in impoverished areas, there are challenges such as a lack of clean drinking water, a lack of sewage services, and overcrowding. In Lima alone, according to the National Superintendence of Sanitation Services, more than 635,000 people do not have access to clean drinking water, which can cause health issues such as parasitosis and chronic diarrhea.

Delia Lunasco has seen these problems first-hand.

In her role as a community health worker with Socios En Salud, as Partners In Health is known in Peru, she is not only dedicated to promoting health care and accompanying patients in their recovery—she has also become an advocate for women’s empowerment in her community.

A commitment to community

Socios En Salud has worked in Peru for more than 25 years, providing medical care and social support to thousands of patients in Lima and beyond. To provide this care, Socios En Salud enlists the help of 90 community health workers—local residents trained to provide basic health services in their communities, such as delivering medications and checking on patients at home.

Over 90% of these community health workers are women.

Lunasco, 54, has been a community health worker with Socios En Salud for more than a decade. But her commitment to the health of her community, El Progreso of Carabayllo district, began more than 20 years ago.

In Lima, the vast majority of settlements are on the slopes of hills on the outskirts of the city, where more than half of residents do not have title deeds or access to basic utilities, such as electricity, drinking water, or sewage, according to the NGO Techo Peru. Thousands of people live in the settlements, many of them migrants and refugees, and make a living by working informal jobs such as street vending.

It was in El Progreso that Lunasco became a leader of the neighborhood committee, and her passion for community health was born.

"In the hills, there is always filth and diseases that especially affect the children," she says.

Lunasco would have liked to become a nurse. But as a mother of six children, with limited financial resources, she was forced to set that dream aside.

It’s a reality all too common for women in El Progreso.

A survey by the Institute of Peruvian Studies estimates that, in 82% of Peruvian households, women do most of the housework, spending twice as many hours per week as men on tasks such as cooking, washing, or cleaning. The burden of unpaid domestic labor often means that women have less time and energy for education, work, or other pursuits.

Still, Lunasco was determined to find a way to strengthen her community and address the health issues she saw day-to-day.

In 2013, she learned about a new opportunity: community health worker with Socios En Salud. Not having higher education was not an obstacle—all residents were welcome to apply. Through a one-week orientation and recurring training, she could learn how to provide basic health care and prevention and eventually be dispatched to homes and clinics to care for patients.

Lunasco was thrilled at the news. Her husband was not.

After joining Socios En Salud, she started leaving her home in the mornings and afternoons to attend trainings and visit patients. One day, her husband, a bus driver, suggested that she should work for him instead as an assistant.

To this day, Lunasco remembers her answer vividly: "And me, what am I going to do sitting around? I'm not going to produce anything. Instead, by leaving [home] I'm helping [other people], because there are patients who can't get up and we have to go find them."

It took time, but her husband eventually began to support her. In a few weeks, her training was complete, marking the start of a decade-long career.

Facing challenges

Over the years, Lunasco has cared for dozens of patients, helping them access testing, treatment, and care for tuberculosis and other health conditions. She has accompanied them to appointments, visited them at home, and helped them navigate the local health system. She has also delivered a crucial message to the women in her community.

"I tell all of them that we are unique, that they should go forward and not be stuck at home,” she says. “We are women leaders—empowered."

In June, Lunasco was recognized by Socios En Salud during its annual Community Health Worker Day, for her tireless work in the tuberculosis program and her years of service to the community.

For her, this recognition is a reflection of her commitment to the health of the most vulnerable people, as well as the value of community health workers—a role that is often overlooked, misunderstood, or unknown to people, even within health care.

Throughout her career, Lunasco has witnessed how some health centers downplay the importance of community health workers, even though they often have the strongest bonds and most frequent contact with patients. She also believes that machismo is still a problem in the health sector, making women’s empowerment and education ever more crucial.

Along the way, Lunasco has helped dozens of young women find work in health care, from becoming health promoters at the health center in El Progreso to community health workers with Socios En Salud.

"We want to rise and move forward," she says.

Tuberculosis (TB) is preventable and treatable. Despite this, 1.6 million people died from the infectious disease in 2021—a majority of whom live in low- and middle-income countries. 

In an effort to reduce deaths and find safer, shorter treatments, Partners In Health (PIH), in collaboration with Médecins Sans Frontières and Interactive Research & Development, launched the endTB project in 2016. A key part of the Unitaid-funded partnership is research, including the endTB clinical trial that concluded in Lesotho and 6 other countries in late June. A second trial, endTB-Q, will be completed in 2024.  

We spoke to three researchers involved with the endTB clinical trial in Lesotho: Dr. Llang Maama, Ministry of Health TB and leprosy manager; Dr. Kunda Kwabisha Mikanda, drug resistant-TB senior medical officer and site principal investigator; and Carole Mitnick, co-principal investigator of the endTB trial and professor of global health and social medicine at Harvard Medical School.  

Below, edited and condensed, are their responses to questions exploring the challenges of this clinical trial, preliminary results, and what this means for global TB care: 

What challenges did you face before the endTB trial began in Lesotho, in treating patients with multidrug-resistant tuberculosis (MDR-TB)? 

Kunda: Before we started the endTB trial, patients were receiving treatment that involved taking daily pills and injectables for 24 months. Many patients stopped their treatment along the way because it was too long with too many pills—about 14,600 throughout treatment. In addition, there were lots of irreversible side effects like psychosis, renal failure, and permanent deafness. It was a big challenge and we didn’t have another treatment option at the time.    

Can you give a big picture overview of the endTB clinical trial? What did you examine and who was enrolled? 

Mitnick: The endTB clinical trial was set up to examine five experimental regimens for treatment of a type of TB caused by bacteria resistant to the most important first-line drug, rifampin. 

Participants were randomized to six different arms: five experimental and one standard of care or “control.” All the experimental arms included nine months of treatment using all-oral regimens. The control arm was 24 months and could contain an injectable agent, according to World Health Organization guidance at the time. We used a fancy system for randomization called Bayesian response-adaptive randomization. Most trials pre-define the number of people in each arm, and that number is often identical across arms. In endTB,  we used the information coming out of the trial as the trial was running to randomize more people to the arms that were performing better. We did this because it allowed us to efficiently  test a whole bunch of regimens at the same time.  

There were 754 participants from seven countries, including three where PIH works, enrolled in the trial. Participants were pretty young. The median age was 32 years old. About 20% of the people enrolled have comorbidities, such as HIV and diabetes. We also included people with substance use disorders or mental illness. We wanted our trial population to be similar to the population in the world that gets drug-resistant TB, so that the results would be relevant. 

Why is this trial unique? 

Mitnick: There are a few reasons. First, this was the first time Bayesian response-adaptive randomization was used in a TB trial. It has been used in cancer trials in high-income countries, but never for TB.  

Second, it was a trial carried out by three major service-based non-governmental organizations, who don’t normally get involved in trials: PIH, Médecins Sans Frontières, and Interactive Research & Development. All three of these organizations thought this was important because nobody else was going to do it. The pharmaceutical companies that developed two of the newer drugs used in the regimens did not finish the job; they got their drugs approved by the U.S. Food and Drug Administration and other regulatory authorities and stopped short of really understanding how best to use the drugs. 

Lastly, because PIH led the project, it had a strong influence on the design of the trial and used an accompaniment model to support study participants to complete their treatment and trial participation.  

Acknowledging that the team is still sorting through the data (which will be publicly available later this year), what is the biggest takeaway so far? 

Mitnick: Our very preliminary analysis of some patients shows 84% favorable outcomes across the board. In comparison, the standard of care when we started the trial was around 60%. That's a massive improvement. We don't know how that will shake out among the arms. It’s really encouraging that overall the results are good. I think some of the other takeaways are that there is a space for organizations like PIH and its service partners, its social justice- oriented, human rights-oriented peer organizations to be involved in clinical research.  

We relearned that accompaniment is really helpful for people with complex diseases or social conditions to help them through care. And COVID-19 amplified all of this because the trial was running during the pandemic, which reinforced the importance of nimbleness in doing both service work and research. 

What does the conclusion of the study mean locally in Lesotho, where the TB incidence is the highest in the world? 

Maama: This is a very exciting experience. I remember in the beginning we were doubtful whether we were a suitable country to implement the trial, considering our limitations especially in monitoring patients. Capacity was built here. We are happy to be part of the evidence.  

Kunda: The conclusion of the trial will be tremendous to the country in terms of policy changes and guidelines implementation to improve lives in Basotho. When the results are published, they'll help the government and stakeholders to adopt better treatment regimens which are shorter with less side effects. 

Do you think these results will have an impact on global TB care? And if so, how? 

Maama: I think the impact has already been felt because we started with injectables, but because of the ongoing trials we have transitioned to all oral regimens. And that has really reduced that burden on patients who were losing their hearing to treatment, and becoming incapacitated in terms of their work, and their inability to sustain their families. So yes, the impact of this is visible now that we have improved the regimens and compliance. Even our treatment outcomes have improved because of the endTB evidence. 

What happens next for enrolled patients? How will they continue care and treatment? 

Mitnick: All of the participants in the trial have completed their TB treatment. Thankfully, TB can be cured. It does not require continuous treatment in the same way HIV does. Unfortunately, people who get TB once are at higher risk for getting TB a second time than somebody who has never had TB. And there's increasing awareness that people who have TB are also at risk of chronic lung damage, cardiac disease, and other complications. You can think of this as “long TB” like long COVID. In other efforts, PIH is working to follow people who have completed treatment and make sure they get the care they need for any of these long-term effects.  

We will also be sharing the results with the study participants. Oftentimes, the results only get shared at professional society meetings, conferences, or in peer-reviewed publications; the people who volunteered their time and gave us their trust to be in this trial don't hear the results. We're looking for ways to reach this population and engage with them in a meaningful way when the results become available. 

University Hospital of Mirebalais (HUM) in Haiti recorded 40 cases of extreme fever over the weekend, with 11 confirmed cases of dengue fever so far, according to Dr. Christophe Millien, HUM’s chief medical officer. Dengue fever is a mosquito-borne viral disease occurring in tropical and subtropical areas. Symptoms can include high fever, rash, and muscle and joint pain. In severe cases there is serious internal bleeding and shock, which can be life threatening. Preventing mosquito bites is the best way to avoid getting dengue fever. Treatment includes providing patients with hydration and pain relievers. Severe cases require hospital care.

Millien has started working closely with his team to prepare an action plan for community intervention. “Considering there is currently an epidemic of dengue fever in the Dominican Republic, it has probably already spread throughout our territory,” he says. The viral disease has already spread through many rural areas of the Dominican Republic, which shares a border with Haiti. Communities in the Dominican province of Elias Pina, which neighbors Mirebalais, are at greatest risk.  

“We are planning to go into the communities in Mirebalais and raise awareness through the radio and television stations,” explains Millien. The team will also distribute mosquito nets to help with prevention.

“We are currently monitoring all cases of fever at HUM and have set out rapid tests to be able to diagnose the symptoms very quickly,” he says. “I have also started training the staff at HUM on the proper ways to tackle this.”

It’s been over four years since multiple cases of dengue fever were recorded throughout most of Haiti, while 3,500 cases were identified in the Dominican Republic at the time. The difference may also indicate a difference in the two countries’ abilities to systematically screen for the disease.

HUM is a 205,000 square-foot, 330-bed teaching hospital, which opened its doors in March 2013, in partnership with the Haitian Ministry of Health (MSPP) and filled a void for people with limited access to quality health care. HUM receives over 1,250 outpatient visits per day and serves a population of 1.3 million people. Ten years since its opening, with a highly skilled staff of medical practitioners like Millien and his team, HUM remains committed to bringing the benefits of modern medical science to those who need it most and to serve as an antidote to despair.

Tuberculosis (TB) is a common, and in many cases fatal, infectious disease that attacks the lungs, and can affect other parts of the body. The incidence of TB, like many infectious diseases, reveals glaring health care inequities where more than 95% of deaths occur in developing countries.  

Partners In Health (PIH) has been battling this injustice for more than three decades by treating and preventing the spread of TB while working with partners to dramatically improve treatment of multidrug-resistant tuberculosis (MDR-TB) in some of the most vulnerable communities in the world. 

Although the World Health Organization has labeled TB as the deadliest infectious disease in the world—outpacing HIV—there are still many who aren’t aware of the disease and its ongoing global impact. 

Here are 5 misconceptions we often hear regarding TB:  

1. TB is a disease of the past. 

In reality, the prevalence of TB has been rising. Globally, the incidence rate of TB is 134 per 100,000 people, which, after two decades of trending downward by about 2% per year, amounts to an increase of 3.6% from 2020 to 2021. This increase can be partially attributed to disruptions caused by the COVID-19 pandemic as people isolated together and spread the deadly bacteria while there was limited access to health services to detect, prevent, and treat the disease. Even the United States saw a growing number of cases in 2022 with 8,300 reported, compared to 7,874 cases reported in 2021.  

2. TB doesn't kill many people anymore. 

Along with the increase in prevalence, there has also been an increase in the number of deaths from TB, reversing many years of slow decline. In 2021, 10.6 million people fell ill with TB and 1.6 million people died. Despite being both treatable and preventable, TB is a leading infectious killer, above HIV/AIDS. 

3. MDR-TB is incurable. 

There are drugs available that can treat and cure MDR-TB, a more severe form of the disease. Over two decades, PIH has treated more than 10,500 people for drug-resistant TB in Peru and has a 77% cure rate for MDR-TB thanks to new medications. 

Unfortunately, as only 10% of people with drug-resistant TB receive treatment that cures them, MDR-TB is still a public health crisis. The primary form of transmission for MDR-TB is through contact with someone who has drug-resistant TB, regardless of any previous infection with the disease, making treatment even more critical to stop the cycle of infection.  

Since 2016, PIH has worked with partners on the endTB project to dramatically improve the treatment of MDR-TB through access to medications, clinical trials of new drugs, and shorter treatment regimens. 

4. TB care is prohibitively expensive. 

TB has a global impact that warrants large investments. One plan to address TB estimates funding needs around $15-32 billion per year to prevent, diagnose, treat, and conduct research for TB until 2030. However, the amount spent globally on TB is absurdly low. With only $5 billion going to combat TB annually, just half of what Americans alone spend annually on celebrating Halloween, we aren’t close to fulfilling the financing needs. The world needs much greater international cooperation and investment in resources to end this curable disease.  

According to a recent analysis, if governments meet the WHO 2030 End TB goals, as many as 23.8 million lives could be saved and $13.1 trillion in economic losses averted. Additionally, it’s estimated that every dollar invested in TB research and response will yield $40 in economic benefits alone through 2050–not to mention the lives saved. 

There are also ways pharmaceutical companies can make TB care less expensive and more accessible. For example, patents on lifesaving medication contribute to increased drug costs and restrict access to care for many of the populations where resources are already limited. At PIH, we are urging further steps to ensure critical TB drugs, including bedaquiline, are available to all.  

5. Treating TB and MDR-TB is too complex to be achieved in settings of poverty. 

Since the 1980s, PIH has been working in impoverished communities with significant TB burdens to advance treatment and improve the health of patients. PIH takes a community-based approach to TB care, including recruiting community health workers who provide in-home care and support, partnering on clinical trials to improve the treatment of MDR-TB, and deploying mobile clinics to bring screening, education, and treatment directly to vulnerable populations.  

This approach is changing local, national, and global systems of care and providing a model for fighting the disease. Three of our original MDR-TB pilot projects have successfully been handed over to ministries of health, where they can be scaled up nationally and leaders can provide training and technical assistance to neighboring countries. 

In late July, Partners in Health opened a new maternal health center in one of the deadliest places to give birth in Chiapas, Mexico. The center, called Casa Materna, will provide dignified care for mothers and newborns in the rural community of Siltepec, serving a population of up to 32,000 people.

The new center follows the model of PIH’s first Casa Materna in Jaltenango, bringing maternal health care, including support for pregnancy, childbirth, and postpartum, within reach. Just months ago, new and expectant mothers in Siltepec had to take long, risky, and costly trips to other cities to access such care or give birth at home with assistance from a traditional midwife.

"The [new] Casa Materna provides a safe space for quality care for mothers and their babies," says Estefanía Monterrosas, clinical supervisor at the Casa Materna in Jaltenango. "We come to strengthen the health system in Siltepec, to understand its work, and to complement it with our skills and knowledge."

The first Casa Materna was opened in 2016 in Jaltenango, a central city in the rural Sierra Madre region of Chiapas. Partners In Health, known locally as Compañeros En Salud, established the maternal health center in collaboration with the Mexican Ministry of Health and the community hospital, Hospital Básico Comunitario Ángel Albino Corzo. Last year, the center provided care for 1,490 women and supported the delivery of 292 babies.

Compañeros En Salud has worked in Chiapas since 2011, providing health care at 10 rural clinics and at the community hospital and Casa Materna in Jaltenango—work that has now expanded to Siltepec.

Respectful Childbirth

Siltepec is one of the deadliest cities for mothers to give birth in Chiapas, with one of the state’s highest maternal mortality rates. Also troubling are the rates of medical abuse and mistreatment that mothers routinely experience from clinical staff. Across Mexico, more than 33% of women who have given birth reported having suffered some type of mistreatment at the time of delivery. This mistreatment, including shouting, insults, humiliation, and non-consensual procedures, is known as obstetric violence and can have lasting effects on women’s physical, emotional, and mental health.

These issues make Casa Materna’s model of “respectful childbirth,” first practiced at the center in Jaltenango and now at the new center in Siltepec, critical.

"We want to rethink and rebuild the way births are attended in Chiapas, so that women recognize that their body is theirs and that they can have control over the care they receive," says Monterrosas.

The respectful childbirth model centers the needs of patients by recognizing their autonomy and empowering them to make decisions at the time of delivery. These decisions include birthing positions, whether or not to use medications, preferences about set up within the labor room, and the people who are present. 

It is also led by midwives and nurses—not doctors. The United Nations found that models of care that include midwives help prevent two-thirds of maternal and neonatal deaths. At the Casa Materna in Jaltenango, midwives regularly facilitate consultations, labor, and delivery.

 "The role of nursing is also something fundamental, since we have the first contact with the patients, and we build relationships of trust with them, making them feel safe," says Julieta Gonzalez, head nurse at the Siltepec Health Center.

The Casa Materna de Siltepec will have a labor room, a delivery room, and a multipurpose area, among other spaces. This design will allow patients to have privacy during consultations and childbirth, helping them feel protected and avoiding putting them in vulnerable situations.

”Our ultimate goal at Casa Materna is to provide a safe space and quality care for dignified births, through collaborative work and respect for pregnant women,” says Monterrosas.

For centuries, cholera killed millions of people. The diarrheal disease could cause dehydration, shock, and death within 24 hours. Since the 1970s, it has been treatable by a simple therapy: oral rehydration solution, a mixture of water, salt, and sugar.  

That medical advance has saved millions of lives. 

Cholera remains an urgent issue in low- and middle-income countries, especially in the wake of disasters such as flooding and earthquakes. But its simple, low-cost treatment offers proof of global health’s progress. 

Over the past 50 years, the world has seen advances in science and medicine, public health, and advocacy that have helped millions worldwide access care, reaching patients once neglected and diseases once untreated.  

Global health inequities persist, and the movement for free, universal health care remains as urgent now as ever. But in a world rife with injustice, it is important to also look to moments of progress—moments that invite us to reject despair and cynicism and show that, with concerted effort, resources, and support, historic change is possible. 

1. AIDS-related deaths have declined more than 60% since the peak in 2004. 

Massive strides have been made in the fight against HIV/AIDS. At the peak of the epidemic in 2004, some 2 million people died of AIDS. In the years since, as access to treatment and care improved, deaths have declined dramatically. Additionally, progress has been made in finding a cure, with the virus cured in mice using gene-editing technology. Still, millions worldwide live with HIV and access to treatment and care remains an urgent issue. 

2. Child mortality has fallen by nearly 60% over the past 30 years. 

Over the past half-century, millions of children’s lives have been saved due to improved access to vaccinations, nutrition, and other forms of medical care. In 1990, 1 in 11 children under 5 died. By 2021, that rate was 1 in 26, more than halved. Despite this progress, child mortality continues to take a devastating toll. In 2021, roughly 13,800 children under 5 died each day, showing how much progress has still to be made.   

3. Smallpox has been eradicated and polio, nearly eradicated 

Global health advocacy and scientific and medical advances have led to the end of once-deadly diseases. Smallpox, a disease that killed 300 million people in the 1900s alone, was declared eradicated in 1980, thanks to vaccination campaigns that enlisted the help of thousands of health workers worldwide. Global health initiatives have also led to a 99% drop in cases of polio, a disease that can lead to lifelong paralysis, since 1988. 

4. World’s first Ebola vaccine approved 

In 2019, European health regulators approved an Ebola vaccine, opening the door for the vaccine to be widely deployed as opposed to limited to experimental programs. The 2014 outbreak in West Africa, which Partners In Health responded to in partnership with ministries of health, killed more than 11,000 people. More recent outbreaks in the Democratic Republic of Congo have killed more than 2,000. 

5. COVID-19 vaccine developed in record-time 

Vaccines to fight the COVID-19 pandemic were the fastest vaccines ever created in history. Normally, vaccine research and development can take as long as 10-15 years. COVID-19 vaccines were developed in less than 12 months, without compromising safety—the vaccines were built on decades of existing research and the testing process did not skip any steps. Despite this breakthrough, vaccine inequity has persisted. Only 24% of people in low-income countries have received at least one dose. 

6. World’s first malaria vaccine approved 

After 100 years of research and clinical trials, the world’s first-ever malaria vaccine was approved by the World Health Organization in October 2021—a historic moment that marked a turning point in the fight against the deadly disease, which kills about 500,000 people each year. Questions remain about cost and access to the vaccine, but its approval has the potential to change the course of global health.

Herlinda Basilio, now a midwife, still remembers the first birth she witnessed.

"I'm the oldest of three sisters," says Basilio, who now works with Partners In Health, known in Mexico as Compañeros En Salud. "When I was about 7 years old, my youngest sister was born, and I wanted to see it. I wanted to watch the birth happen."

Because of her young age, Basilio was not able to see the entire birthing process. But she was able to see the care provided by her grandmother, before and after the birth. She remembers something else about that day, too: her grandmother waited for the placenta to come out and then buried it next to a fig tree.

It was a tradition linked to her Purépecha heritage. The Purépecha are one of 68 indigenous groups in Mexico. Most live in the northwestern Michoacán region, where Basilio grew up. Her parents were artisans, making bells and wicker mats that they sold at local markets. The family wore traditional clothes, and Basilio and her sisters grew up speaking Purépecha at home—not Spanish.

Over 7.3 million Mexicans speak indigenous languages, representing 6% of the country's population. More than half of this population lives in indigenous regions. However, most of these municipalities are impoverished, making access to education far from a guarantee, especially for girls.

Basilio knew from a young age that she wanted to go to school. Witnessing the birth of her sister and her grandmother’s caregiving inspired her to set her sights on a career in health care.

Breaking Barriers

She first started nursing school at Patzcuaro, an hour from her home.

It was a tough transition.

"My native language is Purépecha. So at first, I got tired of speaking Spanish all day," she recalls. "It was also difficult because my classmates would see my family, [including] my mom [and] how she was dressed in traditional skirts, and they would ask me why she was dressed like that."

The microaggressions went beyond the classroom.

"Once I did rotations in a private hospital. I felt like they treated me differently,” she says. “They asked me what I was doing there, if I was indigenous. They wouldn't let me see patients.”

Basilio was far from alone in her experience.

Mexico’s National Institute of Statistics and Geography found in 2020 that 24% of the indigenous population in Mexico had experienced at least some type of discrimination, because of their speech, clothes, or religious beliefs. Those patterns extend to the health care field as well, where health workers of indigenous descent routinely experience discrimination, offensive comments, and mistreatment.

As Basilio continued to study nursing, coming to terms with the discrimination, she had another revelation. Nursing wasn’t what she truly wanted to do. She wanted to deliver babies. Halfway through her studies, she learned about a school called Mujeres Aliadas and met with the director. The meeting inspired her to change her educational path and study professional midwifery.

She still vividly remembers the first time she was present at a birth as a midwifery student. It was a dream she had long had: to be able to accompany someone during such an important moment. She, along with her classmates, prepared the space to tend to the woman who would give birth that day. They massaged her belly and prepared a tub with water and herbs.

"My more experienced colleagues were the ones in charge of attending the birth, but I was accompanying them and I was surprised,” she says. “[I realized] this is what I like. I discovered that this was my place."

‘This is my dream’

Now, Basilio is a midwife with Compañeros En Salud, as Partners In Health is known in Mexico. Her work at Casa Materna, a maternal health center in Jaltenango, is far from her home in Michoacán. But her cultural and medical knowledge guide her work every day.

"For me, midwifery means something very beautiful, because it's accompanying women during this process," she says. "It's being able to give her the freedom to choose in which position she wants to give birth, who she wants to accompany her...and every woman's story is different."

She is completing her year of social service, mandatory for all students in Mexico, with Compañeros En Salud. She then plans to return to her hometown, San Andrés Tziróndaro, to support the women in her community.

Each year, Compañeros En Salud accepts 10 first-year clinicians—including doctors, nurses, and midwives—as part of its pasante program. The program aims to strengthen health systems by providing training and mentorship to young clinicians across Mexico who come to live and work in Chiapas for one year.

At Casa Materna, Basilio spends her days meeting with mothers to discuss pregnancy and birthing, preparing labor and delivery rooms to meet their needs, and learning from the professional and traditional midwives on staff. And she does what she loves most of all: she delivers babies.

"I feel proud to be a midwife,” she says. “This is my dream. And I want to accompany each of the women I have the opportunity to care for."

As an organization that believes passionately in bringing the benefits of modern medical science to those most in need of them, PIH is cautiously optimistic after hearing today that Johnson & Johnson plans to work with the Global Drug Facility, a United Nations-based procurer of medications for public health systems around the world, to open the doors to generic medication for tuberculosis. A few hours ago the Stop TB Partnership, an organization which runs the Global Drug Facility, posted a blog saying J&J had given the Facility approval to purchase and supply generic versions of bedaquiline, a key drug in treating tuberculosis, to “the majority of low-and middle-income countries.” If J&J lives up to the spirit of this agreement, bedaquiline will lower prices of TB treatment, make treatment more accessible to people, and save lives. 

Many partners and friends have recognized the need for increased access to bedaquiline—TB kills some 1.6 million people each year, making it the most deadly infectious disease in the world—and have pushed for urgent action, including author and PIH trustee John Green and the Nerdfighteria community. At PIH, we will build on the work we’ve done as TB activists and clinicians—publicly and privately calling on J&J to increase access to bedaquiline, running two global clinical trials to make sure bedaquiline is prescribed in the most optimal way, and more.

While optimistic, we will not be ready to celebrate until J&J takes steps to ensure access. First, J&J needs to formalize its commitment to equitable access to bedaquiline by making the details of the Stop TB deal public, including specifics about eligible countries, quantities, and indefinite duration. Second, we must maintain solidarity with people suffering from TB. Despite a positive step today, the same cruel pharmaceutical system remains. Companies can still get patents for fake “innovations,” can still privatize publicly funded research and development, and can still put profits over patients. Whatever comes of the promised deal, PIH will keep working to address these systemic inequities and advance long-term solutions in the fight against TB.

It is late June, and farmers in Kirehe, a rural district in eastern Rwanda, are harvesting, cleaning, and packaging yellow and red peppers for transportation to the market. This achievement didn’t come easily: it is the result of a greenhouse, where carefully-planned conditions have helped the vegetables develop their ideal color, shape, and size.

This greenhouse, established in 2020 by Inshuti Mu Buzima, as Partners In Health is locally known, is specifically aimed at addressing food insecurity and creating sustainable sources of income for impoverished families. Farmers enrolled in the program include those with chronic illnesses and those with young children suffering from malnutrition.

One of the farmers at the greenhouse is Anthonia Nyiransengiyaremye, 61, a single woman who found herself caring for her malnourished grandchildren after her daughter was diagnosed with HIV and moved out.

“When my daughter found out that she was sick, the news took a toll on her mental health,” said Nyiransangiyaramye. “She moved far from the neighborhood to start a new life, leaving me with two babies, aged 9 months and 3 years old.”

Nyiransengiyaremye struggled to provide for the babies for several months. Then, she visited the local health center for a workshop on nutrition and learned of a new resource: a farming collective called the Twitezimbere self-help group, supported by Inshuti Mu Buzima. (Twitezimbere translates to "self-empowerment" in English.)

The group provided her and other members, selected based on financial and health needs, with stable access to food and cash to support their households. Inshuti Mu Buzima supports 148 similar groups with 1,744 members and 5 cooperatives with over 733 members in Burera, Kayonza, and Kirehe districts in Rwanda. Members of these groups are involved in agriculture, livestock rearing, crafts such as basket-weaving, and financial savings, among other activities.  

Nyiransengiyaremye and other members were given livestock and received training sessions on various topics, including modern farming techniques. They expressed a desire to focus more on agriculture. In late 2020, Inshuti Mu Buzima constructed a greenhouse for the group, provided seeds, organic manure, and pest control, and even hired an agronomist to mentor the farmers. 

“This greenhouse is a great resource,” said Nyiransengiyaremye. “The crops we cultivate in this greenhouse grow well and the harvest is sold well on the market.”

Climate Resilience

Producing crops and growing families’ income aren’t the only outcomes of the greenhouse. It’s also a way to build resilience to climate change.

This modern farming initiative in a rural community exemplifies how Inshuti Mu Buzima, through its Program on Social and Economic Rights (POSER), strives to break the cycle of poverty and illness by building farmers' resilience to climate change. Located in the eastern province, the hottest part of Rwanda, Kirehe has experienced changing weather patterns over the past several years that have disrupted the traditional agricultural seasons. Small subsistence farmers like Nyiransengiyaremye, who depend solely on natural conditions for crop cultivation, have been particularly affected. 

Rwanda's agricultural seasons are typically divided into two main cultivation seasons: the first season runs from September to January and the second season from February to June. During the dry season between June and September, the scorching heat and dry soil mean that farming is only possible with irrigation—a labor-intensive task that involves fetching water from streams downhill and carrying it up the mountain to the fields. However, many members of the Twitezimbere group lack the strength and money required for this method.

Even during the cultivable seasons, a single climate shock such as heavy rains can devastate entire crops, jeopardizing the livelihoods of farmers and their families. In May, for example, heavy rainfall caused floods and mudslides that resulted in the loss of 130 lives, as well as destruction of houses and crops in different parts of Rwanda.

Jeanne D’Arc Murekatete, Inshuti Mu Buzima's livelihood manager, explains that as farmers achieve economic stability through agriculture, they can access essential needs.

“Our farmers pay health insurance on time,” said Murekatete. “Even when they are sick, they can afford the cost of treatment and medication because they have savings from the fruits of their labor.” 

She also highlights that bringing farmers together regularly plays a key role in building a sense of community and supporting their mental health, especially for those who struggle with depression. 

Projects like the greenhouse and farming groups also serve as a financial safety net for communities, enabling farmers to generate income from their harvests and use the funds for essential services such as education, quality housing, health care, and food.

“We used to provide direct support like food packages, “said Murekatete. “But now we don’t have to, because they pay for it using the money they make.”

As the members of Twitezimbere wind down a busy day of harvesting, they have successfully harvested 603 pounds of peppers which will be sold at nearby markets and in bigger cities like Kigali.  

“We are thinking of planting peppers again because it is a good cash crop,” said Nyiransengiyaremye.

In the past 50 years, global health has seen medical and scientific breakthroughs, from the eradication of smallpox to dramatic declines in AIDS-related deaths to the approval of the first-ever malaria vaccine.

But glaring inequities persist—realities that are as alarming as they are steeped in history, namely centuries of colonialism and war that left countries in the Global South impoverished and millions worldwide without access to health care.

In many communities where PIH works, the nearest clinic is several hours away, only accessible by dirt roads. Doctors must prescribe medications that aren’t available in their community or even countrywide. Mothers must give birth by candlelight when the power goes out.

For more than 30 years, PIH has been on the forefront of a global movement to fight these inequities—training thousands of local doctors and nurses, funneling resources to government-run hospitals and clinics, enlisting community members to provide basic health services, and advocating for policy change at the local, national, and global levels.

Despite the immense progress of the past decades, PIH’s fight for global health equity remains as crucial now as ever.

Below are six facts that highlight the startling extent of global health inequity:

1. Sierra Leone—a country of 8 million people—has only 3 psychiatrists.

Sierra Leone, a West African nation that has endured colonialism, the trans-Atlantic slave trade, and civil war, has only 3 psychiatrists for its population of over 8 million. The country also has only one hospital dedicated to mental health care: PIH-supported Sierra Leone Psychiatric Teaching Hospital.

2. 1 in 6 adults in Mexico live with diabetes.

Diabetes is one of the leading causes of death in Mexico. PIH, known locally as Compañeros En Salud, is enlisting the help of community health workers to respond to diabetes and other noncommunicable diseases in the rural, mountainous Sierra Madre of Chiapas. Community health workers are local residents hired and trained to provide medications, emotional support, accompaniment to appointments, and other health services.

3. Before 2011, cancer care was virtually nonexistent in Rwanda.

Just a little over a decade ago, cancer care was nearly nonexistent in Rwanda, leaving patients with nowhere to go for care and treatment, including chemotherapy. In 2011, PIH broke ground on Butaro District Hospital in partnership with the Ministry of Health and, the following year, opened Butaro Cancer Center of Excellence. These programs have since enrolled more than 14,000 patients and provided care for over 20 types of cancer.

4. 1 in 4 people in the world have tuberculosis.

Tuberculosis is the world’s deadliest infectious disease, despite treatment being available in wealthy countries. As part of the endTB project, PIH has continued its decades-long TB work by helping patients access shorter, less toxic treatment regimens through observation studies and clinical trials. The project works in 17 countries where the multidrug-resistant form of the disease is prevalent, including Peru, Lesotho, and Kazakhstan.

5. 50% of people around the world lack access to essential health care.

At least half of the world’s population lacks access to basic health services, such as immunization and family planning. PIH’s medical care and social support are crucial to helping patients access the care they need, from community health workers knocking on doors to mobile clinics visiting rural communities. Also critical is PIH’s partnership with governments to strengthen public health systems and advocacy at the local, national, and global levels.

6. 94% of maternal deaths occur in low- and lower middle-income countries.

The vast majority of maternal deaths happen in the Global South. In Sierra Leone, for example, a woman has a 1 in 20 lifetime risk of dying in pregnancy or childbirth. These inequities make maternal health vital to PIH’s work around the world, from lifesaving c-sections to facility-based deliveries to dignified childbirth with traditional midwives.

Partners In Health (PIH) announced that the organization’s University of Global Health Equity (UGHE) in Rwanda was ranked 8th in the Sub-Saharan Africa University Rankings by Times Higher Education.

This inaugural ranking included 117 universities from across sub-Saharan Africa, with a final ranking of 88 institutions. Times Higher Education developed these rankings to evaluate universities' impact in addressing the most pressing challenges faced in the region. The methodology assessed five key pillars: resources and finance, access and fairness, teaching skills, student engagement, and Africa impact. Universities and students collected the data directly through surveys, and bibliometric data was provided by Elsevier.

UGHE earned second place in the “Africa Impact” metric, which measured African research citations, African research co-authorship, policy, lawmaker outreach, and education. This ranking underscores UGHE's significant contributions to research on the African continent.

Times Higher Education’s recognition of UGHE as a Top 10 Sub-Saharan Africa University is a testament to the leadership, faculty, staff, and students at UGHE and their unwavering commitment to providing high-quality education and research, as well as improving health outcomes and social systems. 

"This is a testimony of the extraordinary vision of our founder, Dr. Paul Farmer, the unwavering commitment to excellence of our staff, and the unique environment Rwanda offers as a country,” said Dr. Joel M. Mubiligi, UGHE vice chancellor and executive director of Partners In Health Rwanda.

PIH launched UGHE in 2015 with the support of the Cummings Foundation, the Bill & Melinda Gates Foundation, and the Government of Rwanda. The campus operates alongside PIH-supported Butaro District Hospital, the first district-level teaching hospital in the country.

UGHE and the hospital are accelerating collective efforts to increase the number of health care workers in Rwanda and around the world. At the current pace of growth, it will take three decades for the global health workforce to expand enough to meet people’s basic health needs, according to the World Health Organization.

This month, Partners In Health United States (PIH-US) released a policy paper providing recommendations to state policy makers on how to establish more sustainable funding for community health workers.  

Community health workers form the backbone of PIH’s work across the globe, and are central to our vision for equity-centered public health systems in the U.S. While this crucial workforce has too often been underfunded and under supported, many states have begun to integrate community health workers into their Medicaid programs. As a public health insurance program administered by states, Medicaid covers many Americans, including low-income individuals and vulnerable populations. While community health worker services can be beneficial to everyone, community health workers are particularly effective in supporting populations more likely to be covered by Medicaid. State policymakers are increasingly recognizing the crucial role community health workers play in promoting health equity and have started integrating this workforce into Medicaid programs by utilizing existing policies to fund their services. 

Our new policy paper examines best practices from states and recommends five key principles that every state can follow to fund community health workers through Medicaid and promote health equity. This tool provides key reference information for PIH-US and our partners and can be used for advocacy. The recommendations in this paper were informed by our work with community health workers around the world and in the U.S., as well as by national partners and experts. We aim for this tool to actively contribute to supporting sustained investments in community health workers by recognizing their value, preserving what makes them unique and effective, and promoting community health worker leadership in policy-making processes. 

By following these recommendations, state policy makers can more effectively support community health workers and leverage their expertise to promote health equity and improve health outcomes in their communities. 

Download the policy paper

On April 19, over 80 community health workers from 24 counties across North Carolina descended on the state’s capital, Raleigh, for an Advocacy Day to educate representatives about their profession and make their voices heard throughout the halls of power. After arriving a bit nervous, Monique Onema, a certified peer support specialist and community health worker from Cabarrus County, felt encouraged after she was able to help her representative reframe his perception of community health workers.  

“[My elected official] was telling me how he was helping a gentlemen get housing and get into treatment, and I explained to him that’s exactly what we do too. I said, ‘See, you’re a community health worker too,’” explained Monique. 

For advocates like Monique, this trip to the capital came at a time of uncertainty. As the federal government discontinues funding supporting state-led public health programs launched in response to COVID-19, Monique and her colleagues fear that the key social supports they’ve been demanding for decades – services like housing support, healthy foods, and public transportation - are once again at risk.  

Over the last three years, North Carolina has invested roughly $75 million dollars of pandemic funding into training, certifying, and employing nearly 800 community health workers to support the COVID-19 response in the most rural and underserved areas of the state. This investment helped community-based organizations and local health systems develop outreach and social support programs for thousands of people affected by the pandemic. Without additional investments, there is no clear path to ensure this critical work continues. Community health workers are key trusted messengers, system navigators, and health equity champions. That’s why PIH-US and our partners are mobilizing community health workers as we encourage decision-makers to champion policies and initiatives that prioritize this essential workforce.  

Since PIH-US' initial engagement in North Carolina in May 2020, we have supported a growing network of public health implementers and community-based organizations like Monique’s to elevate community health worker voices at the state and federal levels. As a strategic thought partner and advisor to North Carolina’s Department of Health and Human Services (NCDHHS), the North Carolina Community Health Worker Association (NCCHWA), and additional partners within the NC Community Health Worker Initiative, PIH-US works to strengthen the statewide infrastructure for community health workers including training, certification, employment, and systems integration, while also developing sustainable financing mechanisms to assure the long-term success of this workforce.   

Organizations like NCCHWA, which co-hosted the Advocacy Day with PIH-US in April, are elevating the impact of this workforce on communities across the state and urging legislators to support plans to sustainably integrate community health workers into North Carolina’s public health infrastructure.  

“Community health workers were spotlighted during COVID-19, but we’ve been here for decades. We are the bridge between underserved communities and health systems, ensuring that families across North Carolina have the resources needed to not just survive, but to thrive,” says Honey Estrada, NCCHWA’s president and a proud community health worker. “The work we do is valuable and needs to be respected as such.” 

This drive to raise awareness is what led to such a strong turnout for the Advocacy Day in Raleigh, where community health workers were able to meet with over 50 elected officials. In addition to meeting with state legislators, community health workers had the opportunity to connect with peers from across the state and share their experiences.  As Josymar Garcia, a member of the U.S. Army reserve and a community health worker from Kinston, North Carolina, put it, "We're the frontline workers. We’re the ones going into people’s homes and going into the migrant camps. We’ve got to stick together.” 

To prepare community health workers like Josymar and Monique for the Advocacy Day, PIH-US and NCCHWA hosted a series of trainings on legislative advocacy to ensure that attendees felt comfortable and confident sharing their stories and advocating for their communities to policymakers. After meeting with his local representatives, Josymar told us, “Coming from a Hispanic background, it’s not very often we’re able to spread our voices. Being able to advocate for the people that we serve, both Hispanics and other ethnicities, made us feel really good. It was awesome to be able to speak to them in person.”  

NCCHWA is hoping that advocacy efforts like Josymar’s lead to concrete policy change at the state level. “We’re in conversations with decision-makers about the state budget and how community health workers fit into the fabric of North Carolina’s public health system. We’re hoping to continue working with our partners at NCDHHS and the General Assembly to craft a sustainable and integrated role for community health workers to continue supporting communities across North Carolina,” said Honey.  

Looking forward, PIH-US is supporting community partners to build out these advocacy efforts and implement health equity initiatives across North Carolina. As for Monique, she plans to continue to share her experience to inspire action.   

“Advocacy is a hugely important part of the work that we do,” she said. “We are the voice for others when they can’t have a voice themselves – and I am so proud to be a part of it.” 

Content warning: this story contains mention of child sexual abuse and violence against transgender women

When Alexia*, 26, first arrived in Lima she was disappointed. She didn't like the cooler weather, and the thought even crossed her mind to return to Pucallpa, a city in the Peruvian jungle where she had lived before.

"What I missed most was making money,” she says. “The cold didn't let me work."

During her first winter in Lima, she had to wear two jackets to endure the cold as she stood on the streets, waiting for clients.

More than 62% of transgender women in Peru are engaged in sex work, due to a lack of employment opportunities, according to Peru’s Ombudsman’s Office.

Alexia is one of them.

She was forced into sex work at the age of 11, when she was still living in her native Iquitos. There, her days were split between a family at home that did not accept her and a shelter for children and adolescents from which she had to escape for safety reasons.

"I practically grew up alone," she says.

She arrived in Pucallpa at 15 years old. That’s when Alexia, assigned male at birth, started taking hormonal contraceptives, as a gender-affirming method due to lack of access to hormone therapy, to begin her transition.

Unexpected Diagnoses

In Lima, 86% of transgender women have faced discrimination, and more than half experienced domestic violence. That violence and discrimination is not only reflected in the limited employment opportunities or family rejection that transgender women face, but also in their limited access to health care, often due to their lack of identity documents that match their gender. Many are unaware of health conditions that they are living with, including sexually transmitted infections (STIs).

That’s one of the urgent issues that Socios En Salud, as Partners In Health is known in Peru, is responding to through JunTrans, a community-based intervention that seeks to improve access to health care for transgender women in Lima.

Free screenings are critical to that mission. JunTrans screened more than 400 transgender women for STIs, tuberculosis and mental health disorders between July 2022 and March 2023 by running mobile clinics and visiting homes for transgender women in Lima.

Alexia was among the women who accessed free screening in December 2022, previously unable to access any health services due to her lack of identity documents. The results were not what she expected: she tested positive for HIV and tuberculosis.

She describes the whirlwind of feelings that swept over her as like a bucket of cold water.

"I didn't feel like working,” she recalls. “I was disgusted by men—angry."

Fear, anger, and other complex feelings are common with such diagnoses, according to Carla Rodríguez, coordinator of JunTrans. It’s why the program goes to great lengths to connect patients not only with care for their physical health conditions, but also mental health care and social support, such as food and safe housing.

"We can want many things [for them], but we cannot pressure the person," she says.

After her diagnoses, Alexia was immediately connected with psychotherapy delivered by mental health specialists from the JunTrans team. Over time, as she processed her feelings over several sessions, she came to terms with her conditions, realizing how many people lived full, beautiful lives while managing their conditions.

"I'm not the only person in this world who has it," she recalls thinking. "So why should I be crying or getting depressed?”

She then agreed to start treatment, which included antiretroviral treatment for HIV and oral medication for TB. She was also assigned a community health worker for support and accompaniment.

‘A beautiful stage in my life’

Alexia considers herself a romantic girl. She likes ballads that talk about love, and in her room in downtown Lima, heart-shaped stuffed animals are everywhere.

She says that the room she previously rented, located inside the same house where she now lives, was bigger and had the perfect amount of space for all the dolls and stuffed animals she wanted. When she changed rooms, she had to get rid of many of those things. 

"It hurt me to sell a lot of things," she confesses.

She’d had to leave the first room as fast as possible, fleeing to Huánuco as a wave of violence against transgender women swept through downtown Lima in February. Girls she knew, including others supported by JunTrans, were murdered by an organized crime group that charged quotas to trans women for working on the streets.

The violence not only put Alexia’s life in immediate danger, but also affected her health, as she was forced to leave her supply of medications behind.  

Alexia has since returned to the house and is now in stable health, following her antiretroviral treatment to the letter and resuming her treatment for tuberculosis.

In the meantime, the JunTrans team is helping her to obtain her ID card, which she has never had before. She already has big plans for the future, once her identity documents are in order.

"God willing, I'm going to another country.... Italy or Paris [France]," she says.

Having access to health care, and a path to get her ID card, has allowed her to dream again. Now, Alexia is at peace with herself, confident that her health will open new doors. 

"I'm in a beautiful stage of my life," she says.

If you or a loved one are experiencing a mental health crisis, help is available. In Peru, call 113 (option 5). In the United States, call 988 for the Suicide & Crisis Lifeline.

*The patient's name has been changed for safety reasons

In the midst of political and economic insecurity and widespread violence, why is Zanmi Lasante (ZL), as PIH is known in Haiti, focusing on expanding and improving its solar power system? The answer is clear: The collaboration between ZL and Build Health International (BHI)— to replace and improve the solar panels atop Hôpital Universitaire de Mirebalais (HUM) —is key to energy self-sufficiency at the site, allowing for a stable, reliable source of electricity.  

The project will lead to increased functional independence, so the medical team can think less about non-negotiables (electricity, water, adequate facility space, etc) and more about providing patients with top-notch care. 

HUM already has a robust solar energy system, with 1800 rooftop panels delivering power. The new system more than doubles the solar production capacity and does not rely on the national grid. 

We spoke with members of the solar project team, including ZL Program Manager, Léonardo Virgo Charles; PIH Associate Director of Facilities, Forrest Shroyer; and HUM Facility Manager Dieudonne Fanfan to find out more about the plans. Here, edited and condensed, are their answers.   

What’s the main rationale for this project? 

Recognizing the vulnerabilities caused by HUM’s dependence on fuel-powered generators, the new solar system serves as a promising solution. Haiti’s current insecurity means that roads are often blocked, so accessing fuel is sometimes impossible. Other times, fuel might not be available at all or it is outrageously expensive on the black market. By harnessing solar energy, HUM will significantly reduce its reliance on fuel and the associated challenges of obtaining and maintaining a steady supply. 

How will the new system improve energy delivery? 

The project will more than double the current solar production capacity, from 509 kWp (kiloWatt-peak) to 1,316 kWp, and reduce a projected 2,298 tons of CO2 from hospital emissions annually. This will reduce reliance on HUM’s generator, leading to an estimated annual savings of $820,000 per year from solar alone, which can then be redirected to serve patients. Additionally, savings from the installation of high efficiency lighting and other improvements is estimated to add another $80,000 in annual savings. 

During the last year of instability, how often has HUM lost power to the point that it impacted hospital operations?  

During the past year, the escalating gang violence and instability in the region have posed challenges in obtaining an adequate fuel supply to power the hospital's generators, not to mention the fact that the power on the national grid is unstable, causing HUM to rely exclusively on diesel-powered generators.  

Consequently, the hospital encountered power loss due to these circumstances approximately four to five times in November and December of 2022. Most of these outages were relatively short, lasting between one to two hours. However, there was one particular instance where the hospital endured an extended outage lasting nearly seven hours. All hospitals and services were interrupted. At that point, everyone at the hospital was mobilizing to find fuel and smaller generators to support critical services. 

These power outages have had a significant impact on the hospital's ability to provide uninterrupted care to patients. Critical medical equipment, such as life-support machines and refrigeration units for medication storage, rely heavily on a stable power supply. 

How will the new solar project help doctors, medical providers, and patients at HUM?  

The new solar project reduces the number of hours necessary to run the generators from 24 hours per day to 4 or 5 hours per day. The main points here are accessing a more reliable power system and huge savings on fuel.

From a medical standpoint, the solar system will provide consistent and high-quality power supply to support biomedical equipment and critical HVAC systems. Biomedical equipment, including lifesaving devices and diagnostic tools, requires a stable power source to operate effectively. By eliminating power disruptions, the solar system enhances the ability of doctors and medical providers to diagnose, treat, and monitor patients, thereby improving the overall quality of care. 

Moreover, the solar system's reliable power supply directly benefits patients. It ensures uninterrupted access to lifesaving essentials such as oxygen supply and other critical medical needs. This is particularly important for patients with severe health conditions who depend on life-support equipment or require constant medical attention. 

How many workers were hired for this project, and what percentage of them were Haitian? 

For this project, BHI has a dedicated workforce consisting of approximately 50 individuals per day, spread across the electrical and masonry crews. It is worth noting that an overwhelming majority, around 98%, of the workforce are Haitian nationals. 

What else is important to know about this project and why it aligns with PIH’s mission? 

Building solar capacity at HUM and across our sites deeply aligns with PIH’s mission because: 

--It ensures that lifesaving services continue despite fuel shortages around the country; solar capacity will ensure that critical services requiring electricity can continue even when other surrounding facilities and in Port-au-Prince can’t function; 

- Mindful that the climate crisis greatly impacts global health, we are working to reduce our carbon footprint;  

- Investments now lead to cost-savings. For example, our site at Belladere has been fully solarized since February 2023 and the need to transport fuel has been significantly reduced (fuel consumption reduced by 70%); enabling us to save money for fuel and put it towards patient services such as women’s health, nutrition, or oncology, among others. 

With this additional solar power and upgrades to the system, how will you manage storage?  

The new system includes 12 large Tesla battery cabinets which will be used for energy storage.  

As mentioned above, HUM relies exclusively on diesel-powered generators and has been disconnected from the grid for at least 8 years. Therefore, no power will be collected from the grid. 

When will the new solar power system be complete? 

Currently, we are actively engaged with BHI in the installation of the new solar system. The new system will likely be ready for use in the coming months.  

About half of Partners In Health’s (PIH) clinical workforce are nurses and midwives, mirroring global trends.

Midwives, in particular, are vital to women’s health. The care they provide helps women with the spiritual, psychological, and physical experiences of childbirth and motherhood. 

In Sierra Leone, PIH is honored to work with 14 midwives that support mothers from preterm care to postpartum care at PIH-supported Wellbody Clinic and Koidu Government Hospital (KGH) in Kono District. These midwives, in partnership with PIH, work to reduce maternal mortality across the country. 

Meet midwives Aminata Kamara and Harolda Onike, who share more about their work below.

Aminata Kamara

Aminata loves being part of a mother’s journey. A special bond is created between mothers and midwives, she says, that spans from the early weeks of pregnancy to postpartum care.  

And for her, the most joyful moment is “when you hear the baby cry, affirming that you have delivered a healthy baby and a healthy mother.”

Aminata has come a long way. The 34-year-old former nurse was once afraid of delivering babies.

With mentorship from colleagues and hands-on experience at KGH, she has since faced that fear. She has delivered more than 200  babies since 2019, when she began working as a midwife.

In the future, Aminata hopes that midwife training becomes widely available across Sierra Leone and that there is at least one midwife for every pregnant woman. Right now, she cares for about five or six women in labor at the same time. Across the country, she’s one of fewer than 500 midwives. Another part of her job is to investigate maternal deaths to determine the cause. Simultaneously, she finds ways to support grieving families.

It’s a challenging job, but also rewarding—especially when babies are delivered safely. Building relationships is a key part of the work. In fact, Aminata often runs into former patients while shopping at the local market. 

“They approach you with so much gratitude, saying ‘oh sister, you are the one who delivered my baby and they are so big and healthy now,’” says Aminata, noting that sometimes the women give her food to show appreciation. “Moments like these are priceless and affirm how special the support of midwives truly are.”

Harolda Onike

Since she was a child, Harolda Onike has admired her grandmother’s work as a midwife. It inspired her to pursue midwifery, too, and ultimately find her “spiritual calling.” 

“The most beautiful thing is bringing a life into this world,” says Harolda, a midwife in KGH’s maternity ward. “It gives me so much passion to safely deliver a baby into the world without complications."

On a typical day, Harolda supports the delivery of ten babies during her 12-hour shift—from 8 a.m. to 8 p.m. The deliveries are usually a mix of natural births and scheduled and emergency C-sections.  

Recently, she supported a lifesaving delivery. A first-time mother was referred to KGH by a smaller clinic. Upon arrival, she was diagnosed with obstructive labor pains and was making minimal progress. At one point, the baby wasn’t breathing; the mother was given an IV, among other types of care. Within an hour of arriving at KGH, staff began an emergency C-section and the mother delivered the baby—but it still wasn’t breathing. With the support of the special care baby unit staff, Harolda and her colleagues resuscitated the baby. Both mother and baby are now happy and healthy.  

Stories like this—and seeing Sierra Leone’s progress in maternal health care—are what gives Harolda hope. In particular, she looks to the Maternal Center of Excellence, which broke ground in April 2021 and will provide advanced maternal and child health services in Kono District and beyond. 

“With that structure, people all over the country will be able to access free and quality health care,” she says.

Eight years into her career, she remains passionate about this work and supporting midwives. On a daily basis, she mentors junior colleagues, providing the same support she received early on. 

To current and future midwives, she says, “Keep the fire burning…although there are challenges, this is the most beautiful and fulfilling work.”

The United States has the highest maternal mortality rate of any high-income country, and this crisis is only worsening. Maternal deaths have increased by 40 percent over the last few years, Black women are three times more likely to die from a pregnancy-related cause than white women, and maternal mortality rates are nearly two times higher in rural areas than urban areas.  

More than 80 percent of these deaths are preventable. The structural racism and social and economic inequities that lead to poor maternal health outcomes in this country are preventable, too. 

Last month, the Black Maternal Health Momnibus Act, an ambitious legislative package that aims to solve the U.S. maternal health crisis, was re-introduced to Congress. More than 200 organizations, including Partners In Health, have endorsed this bill which calls for historic investments critical to addressing racial inequities in health outcomes, advancing maternal health equity, and building robust, community-led health systems. 

Below, we outline the provisions of the package and how you can take action. 

What is the Black Maternal Health Momnibus Act?  

The Black Maternal Health Momnibus Act is a comprehensive legislative package to solve the U.S. maternal health crisis and end racial and ethnic disparities in maternal health outcomes. Called the “Momnibus” for short, this package includes 13 evidence-based bills to address different drivers of the maternal health crisis, including bias in the health care system, investments in social determinants of health, and growing and diversifying the health workforce.  

The Momnibus package was introduced by the Black Maternal Health Caucus, a group of Congressional members working to establish Black maternal health as a national priority. Overall, the Momnibus includes more than $1 billion to help address systemic inequities that lead to worse health outcomes, particularly for communities that have high rates of maternal mortality and large maternal health disparities between racial and ethnic groups. 

What does the Black Maternal Health Momnibus Act include? 

“Omnibus” is a term for a legislative package consisting of multiple smaller bills. The historic Black Maternal Health Momnibus Act includes thirteen individual bills that will: 

• Make critical investments in social determinants of health that influence maternal health outcomes, like housing, transportation, and nutrition.  

• Extend the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) eligibility in the postpartum and breastfeeding periods.  

• Provide funding to community-based organizations that are working to improve maternal health outcomes and promote equity.  

• Increase funding for programs to improve maternal health care for veterans.  

• Grow and diversify the perinatal workforce to ensure that every mom in America receives maternal health care and support from people they trust.  

• Improve data collection processes and quality measures to better understand the causes of the maternal health crisis in the U.S. and inform solutions to address it.  

• Support moms with maternal mental health conditions and substance use disorders.  

• Improve maternal health care and support for incarcerated moms.  

• Invest in digital tools to improve maternal health outcomes in underserved areas.  

• Promote innovative payment models to incentivize high-quality maternity care and non-clinical support during and after pregnancy.  

• Invest in federal programs to address maternal and infant health risks during public health emergencies.  

• Invest in community-based initiatives to reduce levels of and exposure to climate change-related risks for moms and babies.  

• Promote maternal vaccinations to protect the health of moms and babies. 

How will the funding be disbursed? 

The funds are allocated across different programs to meet specific needs in maternal health. For instance, $100 million would go to community-based organizations, tribal organizations, Native Hawaiian organizations, or nonprofits that work with multiple community-based partners. The money can be used to hire and train staff, develop culturally and linguistically appropriate resource centers or materials specific to communities, create demonstration projects that address social determinants of health, and host community-led consultations. These funds will also give communities the ability to develop tailored plans  and build out culturally competent trainings. Funding will also be used to increase and diversify the nursing workforce in maternal and perinatal care, grow the doula workforce, and increase the maternal mental health and substance use disorder workforce. In addition, money will be allocated for grants that would allow educational institutions to train midwives, physician assistants, and others in maternal health.  

What progress has been made thus far? 

An earlier iteration of the Momnibus was first introduced in Congress in 2020. In 2021, Congress passed the Protecting Moms Who Served Act, making this bill the first piece of the Momnibus package to be signed into law. 

The reintroduction of the Momnibus is unlikely to garner enough support to pass in its entirety due to the current political climate, but Congressional champions are working to advance components of the package one bill at a time. This means that PIH can both advocate for the ambitious and visionary package as a whole, and pragmatically push for individual bills within the package at the same time. 

What can people do to support this? 

All moms deserve care and dignity in their health care, regardless of race or circumstances. Congress must work together to pass the entire Momnibus. 

Use this action tool to contact your members of Congress and tell them to support investments in maternal health. 

The phones keep ringing.

Some people call seeking assistance for their anxiety or depression. Others call for help with time-sensitive emergencies, such as domestic violence or suicidal thoughts. Regardless of the reason, they all call for the same purpose: to receive free, confidential support.

Until recently, that wasn’t an option. Mental health resources were scarce and not integrated with other services.

In November, Partners In Health (PIH) Sierra Leone, in collaboration with the Ministry of Health and Sanitation, launched the country’s first toll-free, mental health helpline. Since its inception, more than 430 people have called. 

The helpline is staffed 24/7 by psychosocial counselors and a community health officer manager in Kono District, a rural eastern region of the country. When a person calls the line for themselves or a loved one, they receive a range of advice and resources. This includes basic mental health tips, addressing mental health myths and stigma, and linkage to follow-up medical care. 

Such a helpline was much needed in Sierra Leone. With a population of more than 8 million people and only three psychiatrists in the country, mental health services have historically been nearly nonexistent and until recently, largely centralized in the capital, Freetown. For many Sierra Leoneans, transportation and lack of access are barriers to receiving life-saving mental health care. 

The mental health helpline and other initiatives—such as PIH-supported Sierra Leone Psychiatric Teaching Hospital—are working to change that.

A Historic Need

When asked what inspired the launch of the helpline, Chenjezo Grant Gonani, PIH Sierra Leone’s mental health program manager, shared that it’s important to consider how much suffering the country has gone through.

“Sierra Leone has been a country faced with a lot of devastation,” says Gonani, citing the country’s 11-year civil war from 1991-2002, the 2014 Ebola outbreak, the 2017 mudslides, and the COVID-19 pandemic. “Yet, despite all of these unfortunate events, access to mental health treatment and psychosocial services are still extremely limited, and 90% of people are still not able to get the support they need.” 

The helpline seeks to fill that gap. 

Originally launched during the COVID-19 pandemic in 2020, the line was designed for people quarantined at home or in isolation units. It was very successful  in offering immediate psychosocial support and linking people to care. So, the team brainstormed ways to expand the line beyond COVID-related scenarios. 

Before transitioning the line, the team did thorough research to set it up for success. Other organizations had developed similar lines, but they were short-lived. After a year of research, planning, and mobilizing resources, the line transitioned to a general mental health resource. 

During the first month, 250 people called. 

“Of course, we have had our challenges with the helpline,” states David Mafinda, a psychosocial counselor. “For example, during Christmas time we had a little boy call the helpline and ask us for a bike. Another asked us for money. While we are many things, I had to explain that we are, unfortunately, not Santa Claus,” he says with a smile.

Lessons Learned

Today, the phones continue to ring, and people are calling in hours away from Kono, the pilot area. They’re calling from Makeni, Kenema, Falaba, and Freetown, likely because family and friends shared the number. To respond to this growing need, the helpline team is actively documenting where calls are coming from to offer location-specific referrals and, eventually, to fully expand helpline services with dedicated staff for those regions. Their immediate priority is to expand to Kailahun District, where many referrals are coming from.  

It's a team effort. The mental health team is collaborating with PIH’s electronic medical records team to keep track of patient calls and the IT department to manage missed or dropped calls. The local mental health team also partners with PIH’s cross-site mental health team for technical advice and support.

As demand for services grows, more staff is needed. When the helpline started, there were originally four counselors. Now, there are seven. Judith Conteh, who has been on PIH’s mental health team since 2019, is one those counselors. 

“The weapon that I used to serve my country during the 2014-2016 Ebola crisis was my psychosocial skills,” Conteh reflects. “Over the years, I have maintained my strong passion for this line of work. Watching people cope with their challenges is so rewarding and is what keeps me going.”