Partners In Health Co-founder Ophelia Dahl has been named to TIME’s annual list of 100 most influential people in the world, highlighting her leadership, advocacy, and impact in global health and beyond. 

Each year, the TIME100 list recognizes the impact, innovation, and achievement of the world’s most influential people. This year’s list will appear in the April 29 issue of TIME and today through its online edition. 

Examples of Dahl’s impact are numerous, and she has held many leadership roles throughout her life and career. Her commitment to social justice has been a throughline. 

“It’s an honor to be recognized alongside so many singular artists and leaders,” said Dahl. “I am proud and grateful to share our work at Partners In Health to deliver high quality health care to the poor—and, above all, to share it with the thousands of colleagues and friends at Partners In Health whose abiding commitment is a powerful antidote to despair.” 

Dahl’s work in global health began at 18 years old, when she went to Mirebalais, Haiti, to volunteer at a school for children with disabilities. There, she met Dr. Paul Farmer, who was working at a rural clinic in Cange. As she began to work with Farmer and Haitian health workers, responding to health disparities that she witnessed first-hand, she knew this was work she wanted to pursue. A lifelong passion for global health was born. 

In 1987, Dahl co-founded Partners In Health (PIH) with Farmer, Dr. Jim Yong Kim, Todd McCormack, and Tom White, deepening a shared vision to correct health inequities and redefine what’s possible in global health. Dahl and co-founders focused on providing health care that prioritized poor people’s needs and giving them access to the highest-quality treatments—not what was cheapest or easiest. 

In the decades since, Dahl has worked to make that vision a reality. She currently chairs PIH’s Board of Directors, after serving as the organization’s executive director for 16 years. Her vision and resolve helped lead PIH through tumultuous times, including the 2010 earthquake in Haiti, the Ebola outbreak in West Africa, and the COVID-19 pandemic.  

No stranger to leadership and its pressures, Dahl is also not afraid to roll up her sleeves and work behind the scenes, doing whatever it takes to push the work forward. She and Farmer ferried supplies, medicine, and equipment on trips from Boston to Haiti. She made home visits alongside health care professionals to listen to the needs of patients and their families. And using her connections and classic charm, she advocated for policy change and more financing for global health. Yet she credits much of her own success to the friends and colleagues who were there to teach, mentor, and support her. 

In addition to her roles at PIH, she is a trustee of Wellesley College, her alma mater, and a member of the Boards of Directors of the University of Global Health Equity, the Equal Justice Initiative, and the Clinton Health Access Initiative. She is also on the Board of Silkroad and the Advisory Board of the Center for Law, Brain & Behavior at Harvard Medical School and the Massachusetts General Hospital. 

Dahl’s inclusion in the TIME100 list is the latest accolade in addition to Harvard University’s Radcliffe Medal, Union Theological Seminary’s Union Medal, and, together with her PIH colleagues, the Hilton Humanitarian Prize.

To read more about Dahl, visit: https://www.pih.org/ophelia-dahl  

To read the full TIME100 list, visit: http://time.com/time100  
 

Neno is one of the most remote districts in Malawi. The district has only one paved road. Just over 3% of households have electricity.

Since 2007, Partners In Health (PIH) Malawi, known locally as Abwenzi Pa Za Umoyo (APZU), has worked in partnership with the Malawian government to provide health care to thousands of people in Neno. In December 2023, all that work was recognized: APZU received an award from two government agencies, the Non-Governmental Organizations Regulatory Authority (NGORA) and the Ministry of Gender. 

The award honored APZU for its contributions to the country’s health sector; it was presented at a gala dinner at the state house in Lilongwe, the country’s capital. The award, given for “significant investment in a hard-to-reach-area,” reaffirms APZU’s mission to create a preferential option for the poor in health care by accompanying the public sector and strengthening the provision of essential health services.  

Improving Infrastructure 

APZU began its work in Malawi in 2007 with the aim of strengthening health services in Neno, a rural district with a population of approximately 165,000 people. At first, APZU focused on providing comprehensive primary and secondary health care, but over the years, the organization expanded its work to support emergency response and sexual and gender-based violence (SGBV).  

Before APZU started its work in Malawi, Neno district had one hospital with four inpatient beds, no functioning laboratory, and an unreliable water and electricity supply. This rendered the hospital unable to treat patients with complicated medical conditions, who had to be referred to Mwanza District Hospital, 50 miles (80 kilometers) away.  

When APZU arrived, one of the key areas it invested in was infrastructure development. In partnership with the Ministry of Health, APZU constructed Neno District Hospital (2007-2009), Lisungwi Community Hospital (2008-2010), and Dambe Health Center (2016), making crucial health services available in the district.  

Despite constructing modern, well-equipped hospitals, the District Health Office observed that there was high staff turnover due to lack of housing in the area. To resolve this, APZU constructed over 30 staff houses to accommodate health workers. These homes are located near Neno District Hospital, Lisungwi Community Hospital, Dambe Health Center, and Chifunga Health Center. 

Through its Program on Social and Economic Rights (POSER), APZU has also constructed over 100 houses and renovated over 300 others for the most vulnerable people, such as patients with non-communicable disease (NCDs), the elderly, child-headed households, and those living with disabilities.  

APZU’s infrastructure work has extended beyond hospitals and homes. In 2010, APZU opened Malawi’s first-ever rural microbiology laboratory, making Neno District Hospital the first district hospital in the country to perform routine blood cultures and facilitating testing, treatment, and care. APZU also constructed “Dr. Keith Road,” from Lisungwi Community hospital to Neno District Hospital, to shorten travel time between the two facilities, which are about 42 miles (68 km) apart. 

A strong health system requires more than buildings and roads—resources like electricity are also essential. In response to frequent blackouts, which affect the operations of most hospitals in Malawi, APZU supported two of its hospitals and Dambe Health Center with backup high-capacity generators to ensure a 24/7 supply of electricity. It also supplied solar-powered refrigerators to all 14 health centers in Neno to help them store drugs in need of refrigeration. 

Providing Community-Level Care

PIH’s efforts to strengthen the health system in Neno go beyond infrastructure. In 2007, PIH Malawi started the community health worker (CHW) program. CHWs assist the government with screening and referring patients to nearby health facilities. CHWs also play a pivotal role in helping patients follow their treatment plans. 

CHWs, who are volunteers from the community, visit 20-40 households each month to monitor the health of every individual. This approach has improved the early detection and treatment of patients with various health conditions. For instance, in 2022, household visits by CHWs increased from 90% to 94%, and 14,850 referrals were made to health facilities. CHWs also accompanied over 1,500 pregnant women to their first antenatal clinic visit. 

On a typical day, and even during emergencies, the CHWs help APZU identify community members that need social support. Through POSER, CHWs work with the District Social Welfare Office to assess households before providing social support, such as cash transfers, food, and milk for infants.

APZU also provides free health screenings and education at the community level. Through APZU’s mobilization and outreach services, 51% of people screened at the community level have been referred to health facilities for further care. APZU has also conducted social dialogue sessions on sexual and gender-based violence (SGBV) in the communities, focusing on root causes, community empowerment, prevention, and reporting. APZU has supported the management of 487 SGBV cases as of November 2023. 

Additionally, to empower youth in Neno, APZU established adolescent clubs called SKILLZ BLA (Bwalo La Achinyamata), which have provided education and resources to 816 adolescents (10-14 years old) across the district, making sexual and reproductive health services accessible. Currently, APZU is establishing Mental Health Clubs in schools to equip youth with the necessary skills and knowledge to deal with common mental health conditions. 

The award highlights APZU’s past and ongoing work, which has been critical in strengthening Malawi’s health system and expanding access to care. It’s an honor that APZU Executive Director Basimenye Nhlema takes pride in.

“This award is not just for us as PIH Malawi team, but also [for] all our stakeholders who, because of the combined efforts, have made this possible,” she said. “It will always be a reminder for us to work even harder as we serve our beneficiaries. We will treasure this award as we strive to provide preferential option for the poor in health care in Neno and across the country.”  

April 1, 2024

Statement from Dr. Sheila Davis, CEO of Partners In Health, and Dr. Wesler Lambert, Executive Director of Zanmi Lasante, as PIH is known in Haiti.

For four decades we have been working in partnership with the Ministry of Public Health and Population in Haiti to ensure the most vulnerable people in the country have steady access to high-quality health care services—from prenatal check-ups to surgeries —free of charge. Until recently, we have proudly served some 3.3 million people through community to tertiary care each year. That was nowhere near enough, but at least the number was growing. Today, we face a new reality. The number of Haitians able to access health care has dramatically declined - not because the need has changed, but because the environment has changed. As a result our mission to advance health equity is becoming harder by the day. We urgently need the ability to safely transport staff, medications and supplies within and to Haiti.

In the past, we have lived through every imaginable challenge—from prolonged outbreaks of cholera to targeted violence at Zanmi Lasante supported facilities—and we’ve always found ways to keep the doors open, the health care high-quality. But in the past month, the University Hospital in Mirebalais, a national referral hospital, alongside the 16 other hospitals, health centers, and clinics we operate have been cut off. We cannot safely move medicines and supplies from our warehouses to the provinces where we work. Nor can we reach the dozens of containers we have at port. It is not from lack of trying – our teams have explored every possible avenue and gone to heroic lengths to move small quantities of supplies. Yet it is not enough. As a result of these challenges, we have begun rationing care, reducing the number of hours facilities are open and what services we provide. If nothing changes, within weeks our fuel reserves and some essential medications and supplies at University Hospital in Mirebalais will run out, and with it will go our ability to care for the child with dehydration, the adult with septic shock, the mother with a difficult labor, and more. If this happens, innocent patients will die. The risk is unprecedented.

Our motto has been and will always be that we “do whatever it takes.” We are pursuing every possible shipping option—via land, air, and sea, from the Dominican Republic, other parts of Haiti, and Miami. Doctors and nurses continue to work heroic hours, many sleeping at hospitals and not seeing their families for a month at a time. But the violence—and those who allow the violence to continue—has cut off our necessary lifelines. At a time when our patients need us more than ever: many other hospitals have closed, pharmacies have been attacked, and millions face acute hunger. We are trapped, unable to provide people with the care that is their right. We are a Haitian organization, made up of Haitians, working in Haiti, for Haiti. And we are here to stay. But our patients, and we, need help in a way we never have before. 

As the violence and instability in Haiti worsens, the health system is being crushed. Hospitals around the country have been attacked and looted, health care workers have been forced to flee or hide for their safety, and basic drugs and supplies can’t reach facilities, much less the patients who need them.

At Zanmi Lasante, PIH's sister organization in Haiti, our teams are doing everything they can to continue providing care to those who need it most. This is an extraordinary feat as they face serious shortages of fuel, supplies, and critical medicines, due to rising costs and transportation challenges such as roadblocks.

“You have to live it to understand it,” said Dr. Ralph B. Charles, Zanmi Lasante’s regional director for the Lower-Artibonite district. “There’s this constant fear. Every day there’s a new obstacle, so you have to be ready to devise a new strategy. It’s an ongoing battle.”

A roadblock, which can include a pricey toll or the threat of violence, can create a cascade of problems: blocking food deliveries for our nutrition programs, preventing supplies and medicine from reaching our clinics, intimidating patients from freely and safely accessing health care, and restricting fuel to power our hospitals.

The consequences can be life-threatening—our clinical team at Hôpital Universitaire de Mirebalais (HUM) currently only has enough IV fluids to continue providing care for two days.

“There’s a saying in French, ‘à chaque jour suffit sa peine.’ It’s basically saying, ‘deal with everything one day at a time.’ That’s the only way we can do it,” Dr. Charles said. “If you keep thinking about the big picture of the situation all the time, it’s so overwhelming that your head might explode. You just have to focus on what you can deal with.”

So, one day at a time, Zanmi Lasante’s teams continue providing care. While many facilities around the country have closed their doors, ours have stayed open. But patients still fear traveling for care, weighing access to treatment against the threat of violence—a calculation no patient should have to make.

“It was already hard to access care and now it’s ten times harder. There are a lot of patients that don’t make it to the hospital or that make it too late,” Dr. Charles said. “Those that do make it, they do it at the risk of their own lives. I had a story of a pregnant patient who was going to the hospital to deliver and got shot in the leg at a barricade on the road. When she got here, we stabilized her, and she delivered immediately, even before we took care of the bullet wound.”

For the patients who are able to access care, limited resources—and the resulting surge in prices—are another obstacle they must face.

“Care that used to be provided for free has been limited because of the supplies we can’t get,” said Dr. Charles. “If a patient goes to a pharmacy for medication, and the pharmacy actually has the medication there, it’s going to cost the patient about five or six times what it used to, and sometimes way more depending on what they need.”

Dr. Charles, who earned his master's degree in Global Health Delivery at Harvard University and returned to Haiti in late 2022, has made an incredible commitment to his work and his colleagues at Zanmi Lasante, choosing to work alongside them, on the ground in the Lower-Artibonite district.

“I love the work I’m doing, and I can’t stand it to not be done well,” Dr. Charles shared. “And I think it motivates the staff because your staff sees that you are making sacrifices in your position, that you don’t have to. They feel more appreciated and supported.”

Being there for his team has also helped him understand how this crisis is directly impacting Zanmi Lasante facilities and has allowed him to strategize based on first-hand experience. For example, he was able to secure fuel for a month, because he noticed multiple tankers passing on a road that was supposed to be blocked. With the road clear, he was able to go out almost immediately and collect fuel, giving him peace of mind and time to plan for the next month’s supply.

The road was closed again the next day.

However, choosing to work alongside his Zanmi Lasante colleagues in Haiti has not been easy for him—or his family.

“The worst part is my daughter. Because she’s six, she doesn’t really get it,” he said. “Lately she’s been calling me and asking me when I'm gonna come back to visit because I usually travel every 45 days to be with her for a week or two, and how come I haven’t told her when I’m gonna come home yet because it's been more than 45 days since my last trip. This is when reality sinks in and makes me want to cry. And she doesn’t understand, she can’t understand.”

As the crisis in Haiti continues to escalate, Dr. Charles and the Zanmi Lansante team are doing everything they can to continue caring for our patients, accompanying them, standing by them in solidarity, and keeping them safe. Patients across Haiti are going to extraordinary lengths to reach our facilities—and we will be there for them, whatever it takes. 

In March, more than 80 community health workers, allies, and advocates from across the country gathered on Capitol Hill to meet with members of Congress and legislative staff during the second annual Community Health Worker Hill Day. 

In addition to over 80 meetings with legislative offices, the Hill Day featured a Congressional briefing and rally in a historic Senate hearing room. Congressional briefings serve as a platform to educate members of Congress and their staff on a specific issue. This briefing, hosted jointly by PIH-US and National Association of Community Health Workers (NACHW), allowed Congressional staff to engage directly with community health workers and gain insights into the workforce's diverse nature. 

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

In January, Partners In Health organized the first-ever Americas Regional Workshop. Hosted in Lima, Peru, the convening brought together PIH colleagues from Haiti, Mexico, Navajo Nation, Peru, and the United States to deepen relationships across PIH sites and consolidate learnings on government accompaniment. 

Around the globe, PIH works shoulder-to-shoulder with government partners across levels of influence to shape policy and advance systems change. With a diverse range of expertise and experience in government partnership, policy, advocacy, and community engagement, participants shared approaches and best practices for collaborating with governments at their respective sites. 

Discussions focused on site-level strategies for government accompaniment and creating a framework to guide this type of collaboration across PIH. Participants also met with Peru’s Ministry of Health to learn about their partnership with Socios En Salud (as PIH is known in Peru) and visited SES labs, pharmacies, health centers and project sites. 

The Americas Regional Workshop is a testament to the importance of cross-site learning and collaboration. By coming together, sharing experiences, and collectively refining strategies, participants not only strengthened their respective site capacities, but laid the foundation for deeper collaboration in the future.

Each year, tuberculosis (TB) kills about 1.3 million people worldwide—that’s more deaths than HIV/AIDS and malaria combined. TB is the world’s deadliest infectious disease (though briefly eclipsed by COVID-19), killing someone every 20 seconds. 
 
But, despite its massive fatality rate, TB rarely makes headlines. 
 
In fact, many people in wealthy Western countries have no idea what TB is. Alternately, it’s considered a disease of the past, belonging in a history textbook. 
 
But the disease that ravaged Europe and North America centuries ago remains a deadly, day-to-day threat in much of the world. And even though a cure exists, the disease continues to kill at unparalleled rates. 
 
So why is TB still the world’s deadliest infectious disease? And why is it so little-known in the West? 

What is tuberculosis? 

To understand the gap in TB awareness, it’s crucial to consider how the airborne killer operates—and where in the world it’s most commonly found. 
 
Tuberculosis is an airborne disease that spreads when infected people cough, talk, or even just exhale deeply. The disease typically attacks the lungs, but can affect almost any part of the body. Symptoms can be mild at first and resemble those of other conditions, like the common cold, making TB difficult to detect. If untreated, it can be fatal. 

TB has treatments and even a cure. But the path to a full recovery is long and arduous. Unlike diseases such as malaria, which can be treated within days, TB requires at least four months of treatment, and can take even longer to treat depending on severity and drug sensitivities. The standard regimen includes five drugs, which must be taken together each day. These drugs come with an array of side effects, such as nausea, skin rashes, and jaundice. 
 
Although only a small percentage of people infected with TB end up experiencing the effects of the disease, its airborne nature, common symptoms, and long, arduous treatment regimen make it especially lethal in the places where it is most prevalent: impoverished countries with weak health systems.

‘A Neglected Disease’

Lesotho, a landlocked nation of around 2.1 million in southern Africa, has the highest TB incidence in the world—661 cases per 100,000 people, compared to 2.5 cases per 100,000 people in the U.S. 
 
This data reflects global trends. Worldwide, more than 95% of TB deaths occur in low- and middle-income countries. In fact, TB is often called a “disease of poverty.” 
 
Dr. Afom Andom has studied TB for years, first as a graduate student, then as a technical advisor for Lesotho’s national health reform and now, as chief medical officer of PIH Lesotho. He has devoted much of his career to understanding why TB remains such a glaring issue in global health—and what can be done. 
 
“TB is a neglected disease. It has been killing for centuries,” he says. “It’s been very persistent in countries with low socioeconomic conditions.”  
 
The reasons for that persistence are many, but perhaps the most salient—and the most surprising—has to do with food. 
 
“When you’re chronically malnourished, it affects your immune system,” says Dr. KJ Seung, senior technical advisor at Partners In Health and co-lead of endTB. “That makes you more likely to get infected if you’re exposed and less likely to control the disease if you’ve been infected.” 

TB drugs are also notoriously nauseating and taking them on an empty stomach can result in patients abandoning their treatment altogether. 
 
Malnutrition isn’t the only reason why TB is typically linked to poverty. There are also issues like overcrowding, a lack of ventilation, a lack of transportation or time off work to reach clinics or hospitals, and so on.  
 
To tackle TB at all—from testing to treatment to care—a strong health system is a must. Even prevention requires a level of infrastructure that has made TB difficult to curb. Simple measures that help prevent other diseases, like handing out bed-nets or condoms, aren’t going to work. 
 
“TB is airborne,” says Seung. “You’re going to get it, you’re going to get exposed, and when you get exposed, you need a really well-functioning health system to get diagnosed and treated—and that just doesn’t exist.”

The Empathy Gap

Seung, who is based in Boston, has worked on TB across continents as co-lead of endTB, a clinical trial spanning seven countries that found safer, shorter treatments for multidrug-resistant tuberculosis. Through the years, he has seen stark differences in awareness levels of the world’s top infectious disease. In short, it depends on who you talk to. 
 
“TB is really part of the culture of Africa, Latin America or Asia. People have more strong feelings about it compared to in the U.S. or Europe, because it just doesn’t exist here,” he says. “You don’t know somebody who has TB, or you might have to go back generations in your family. That same cultural cache just doesn’t exist.” 
 
That “cultural cache” is reflected in health care systems, too, and how they respond to TB. 
 
TB is so common in many countries that it’s part of primary care. In Western countries like the U.S., it’s instead treated as a rare disease; Americans with TB would have to see a specialist. 
 
Less than 1% of Americans have TB. It’s not widely known, and most Americans don’t have to think about the disease on a regular basis, if at all, or know people who have had it.  
 
These differences might seem more surface-level if they didn’t underscore a darker reality. 
 
“If people are not interested in a problem, in the West, then it just makes all the effort to eliminate the disease globally very difficult,” says Seung.  
 
For years, TB has struggled to get global attention, resources, and funding, despite ambitious targets like the UN’s goal to end TB by 2030.  
 
“There is a huge disparity between the rich and the poor and that makes the disease persistent,” says Andom. “All the technologies, all the potent drugs, all the potent reagents are in high-income countries.” 
 
Disparities between rich and poor emerge not only on the global level, but also within the countries most burdened by TB. 

In Peru, those most at-risk for TB are from vulnerable populations, including transgender people, migrants, prisoners, and people living in the Amazon rainforest. 
 
“The only way to go to communities [in the Peruvian jungle] is by the river, and it’s difficult to transport all the [TB] equipment to the communities,” says Dr. Marco Tovar, director of health services at Socios En Salud, as Partners In Health is known in Peru. 
 
In marginalized communities, TB is far from the only killer. There’s dual epidemics of TB and COVID-19, or TB and HIV; drug-resistant forms of the disease, like MDR-TB or XDR-TB, and then there’s poverty, making actions as simple as getting to a clinic or eating a healthy meal an insurmountable challenge.

Changing the Narrative 

With all the challenges and complexities of TB, it might be easy to think of the disease as inevitable, as some natural state of affairs. That’s a narrative that Dr. Maxo Luma is fighting against. 
 
“1.3 million die every year of a disease that is totally curable,” he says. “That’s not normal.” 
 
TB is not inevitable. When health systems are strengthened, it is preventable, treatable, and even curable. 
 
Luma has seen this first-hand in Liberia, where he is the executive director of PIH’s country program. 
 
Before PIH began its work in the West African nation of around 5 million, the only health center for MDR-TB was in Monrovia, the capital. For those living in the rural southeast of Liberia in Maryland county, traveling there could take up to 4 days and, during the rainy season and flooding of roads, could take weeks, if it was possible at all. 
 
Since it began working in Liberia in 2014, PIH has treated thousands of patients with all forms of TB including hundreds with MDR-TB. In 2017, PIH opened the first-ever decentralized regional hub for MDR-TB care in the southeastern part of the country, at J.J. Dossen Memorial Hospital, in partnership with the Liberian government.  

Similar progress has emerged in Lesotho. 
 
PIH began its work in the southern African nation in 2006; the following year, it opened Botšabelo Hospital, one of the first MDR-TB treatment hospitals in Africa and the only one in Lesotho. The hospital has since become a model for MDR-TB care across the continent. 

PIH’s TB work in Lesotho and elsewhere has tackled another key element in preventing the disease: testing. 
 
While treatment is often put in the spotlight, an effective TB response starts before a patient is sick. To get treatment and recover from TB, people first have to know that they have it. Globally, around 30% of TB cases are never diagnosed or treated. In Lesotho, that percentage is much higher, around 63%. 
 
Most TB diagnoses in Lesotho happen at district hospitals, due to a lack of diagnostics at the health center level. Health centers typically transport samples to hospitals on scheduled days, resulting in delays between when patients are tested and when they are diagnosed. 
 
Starting in 2020, PIH began working with Lesotho’s Ministry of Health to make diagnostics available at the health center level in seven rural, hard-to-reach health facilities, as part of the Rural Health Initiative.   
 
Now, at PIH-supported health centers, patients can get test results within 1-2 hours and return home with a diagnosis and treatment plan, thanks to GeneXpert machines and digital x-ray equipment. 
 
Progress has been made on a global level, too. With the endTB trial, PIH and partners found safer, shorter drug regimens for MDR-TB patients. PIH recently joined clinicians and TB activists to call on pharmaceutical companies to drop patents and prices to make TB care more accessible. 
 
But there is still much more work to be done—both in raising awareness and in making essential funding and resources available where they are most needed. 
 
For Luma and many other experts, the fight is not just medical—it’s moral. 
 
“It doesn’t have to be in our backyard to make it our problem. We are a global village,” he says. “I think more people need to be aware so we can change the narrative around TB…It is time for all of us to finally unite around ending this disease.” 

In Haiti, the number of children suffering from severe acute malnutrition has drastically increased during this time of widespread violence and political and economic instability, as food prices have skyrocketed and resources have become even more limited. According to UNICEF, the number of children experiencing malnutrition increased by 30% in 2023 compared to the previous year, with nearly 115,600 children affected compared to 87,500 in 2022.

Did you know:

• In Haiti, 1 in 4 children suffer from chronic malnutrition;

• Malnutrition is the leading cause of death for children under 5;  

• Around 11,000 children under the age of 5 suffer from acute malnutrition in two of the primary areas Zanmi Lasante delivers care: the Central Plateau and Artibonite regions;

• Even acute malnutrition can prohibit children from properly developing physically and cognitively.

At Zanmi Lasante, as Partners In Health is known in Haiti, the nutrition team provides screening, treatment, and education to respond to this crisis. The program serves patients, typically infants, children from 6 months to 5 years old, and pregnant or breastfeeding women, through clinic visits and through mobile clinics conducted in the surrounding communities.  

The mobile clinics are critical to the program because they allow our teams to reach remote communities and identify malnourished children earlier, so treatment can be delivered before health problems turn fatal. However, amid the current national instability, it has become exceedingly challenging for our teams to travel with mobile clinics, as they face fuel shortages, violence, and unpredictable roadblocks that restrict the team’s movement.

Despite this, our nutrition team has persisted, finding ways to reach our patients at home–whether by rescheduling clinic visits or finding alternative routes. Their dedication has provided lifesaving care for families all over Haiti.  

Jolène, a mother of five, felt powerless when her youngest son, three-year-old Raphaël, fell extremely ill last August. He couldn’t stop vomiting, his belly was swelling, he was covered in rashes, and he was deteriorating as he rapidly lost weight. When Jolène brought him to the Zanmi Lasante team for help, he was immediately hospitalized: Raphaël was suffering from severe malnutrition.

“I was very affected by his illness. I had no hope at all. I thought I had lost him,” recalls Jolène.

Raphaël’s condition was severe and required him to remain hospitalized for three months until he regained his strength. Today, he continues outpatient treatment with the Zanmi Lasante team monitoring his progress and supporting his nutrition, and his mom is committed to never missing an appointment.  

Zanmi Lasante’s nutrition program provides children with a lifesaving treatment called Nourimanba, a high-calorie, high-protein paste made from locally grown peanuts and mixed with essential vitamins and minerals. This ready-to-use therapeutic food, produced by Zanmi Lasante in partnership with local farmers, helps children gain weight and grow quickly over several weeks of care. Raphaël is just one of the thousands of children who have been saved by this food. Last year alone, 6,190 children were admitted and treated for malnutrition through Zanmi Lasante’s network of hospitals and clinics.

Haiti’s population continues to be vulnerable to malnutrition, facing food insecurity, poor infrastructure–particularly in terms of water and sanitation–and, currently, political and economic instability. Around 4.35 million Haitians are grappling with severe food insecurity. However, the Zanmi Lasante team remains steadfast, determined to record zero deaths of children under 5 years old due to malnutrition.  

Raphaël is one child among many to have his life saved by the incredible people at Zanmi Lasante with the support of our generous, global Partners In Health community. During this critical time in Haiti, Zanmi Lasante is sustaining their operations and providing care to those who need it most, bravely showing up for our patients every day.  

Compañeros En Salud, as Partners In Health is known in Mexico, has nearly 100 community health workers on staff; 98% are women.

This is just one of the many ways that women are vital to PIH’s work in the Sierra Madre region of Chiapas, where we have worked since 2011 providing free health care and social support in partnership with the Ministry of Health. 

From treating patients to training clinicians to setting agendas, women have been essential to fulfilling Compañeros En Salud’s mission from day one—as doctors, midwives, executive leadership, janitors, and more.

As we celebrate International Women’s Day, we uplift the stories of women at Compañeros En Salud and honor their contributions to our work.

Udis Sánchez, health assistant 

As a health assistant, Udis Sánchez has faced many challenges over the years—as part of the first-ever nursing team at a rural clinic, as an infection control worker in the COVID-19 response, and as a nursing student. 

On top of all those challenges was the pressure she often felt as a woman.

“In the communities where we work, many people tell you that because you are a woman, you cannot achieve things,” she says. “You cannot study or work…you always have to be at home.”

It was a message she’d heard growing up in Laguna del Cofre, a rural community in the Sierra Madre mountains, where women in traditional households are often discouraged from pursuing their education or career.

Despite this pressure, Sánchez refused to be deterred. Last year, she graduated with her nursing degree—one of her proudest, most hard-won achievements.

“It doesn’t matter if you come from a highland community, because at the end of the day, we [women] decide,” she says. “We don’t have to be afraid.”

Gabriela Gamboa, janitor

Gabriela Gamboa spends her day washing bedsheets, disinfecting tools, and cleaning the rooms of Casa Materna, a birthing center supported by Compañeros En Salud. Her daily tasks may seem small, but are essential to keeping the center open and ready to serve the hundreds of women who give birth there every year. 

It’s not just Casa Materna’s mission—providing dignified care for mothers in Chiapas—that inspires Gamboa in her work. It’s also the financial independence that the work affords her, enabling her to support herself, and the sense of community. 

“What inspires me in a woman is that she knows how to get ahead on her own, that she can raise a family on her own,” says Gamboa. “In general, I admire all women who fight.”

In her spare time, Gamboa has found another inspiration: leading a dance group for women and children in the community. Once too shy to dance in public, she now helps her students learn how to dance and, most importantly, to move, have fun, and express themselves.

“In the field where I work, being a woman is a unique experience that makes me feel proud,” she says. “I am very happy to be part of a team that is so committed to the health of others.”

Saira Morales, community nurse

Saira Morales began working with Compañeros En Salud during unprecedented times: in the throes of the COVID-19 pandemic. The experience challenged the young nurse, personally and professionally. Day to day, she had to contend with shutdowns, resource shortages, sick patients and staff, and constantly evolving guidelines.

Amid the chaos, Morales saw an opportunity: a chance to make her mark professionally.

“I am proud of myself in my performance as a nurse, in all that I have learned here and in my years of experience,” she says. 

For Morales, being a woman in nursing “is taking care of others, offering dignified treatment to patients…and at the same time making my potential and capacity as a nurse known.”

Nursing—considered a caring profession and with a workforce of over 70% women—has garnered more attention in recent years, as more nurses seek to take on leadership roles and make their mark on health care systems that have historically undervalued them.

As Morales continued her work with Compañeros En Salud, eventually transferring to a community clinic in Laguna del Cofre, she drew inspiration not only from the work, but from her colleagues—many of them, women.

“All the women around me inspire me,” she says. “Women are fighters. We are strong…If we want something in life, we can achieve it."

Sandra Martínez, office assistant

Sandra Martínez still remembers her first boss, Dr. Jafret Arrieta, when she began her work at Compañeros En Salud.

“I saw that she was very intelligent and capable,” Martínez recalls. “She is very hardworking, very active…an excellent person.”

To this day, Martínez strives to infuse those same values into her own work as an office assistant. She has now worked with Compañeros En Salud for 12 years.

And it’s not her only role. It comes on top of her other full-time job: being a mother.

“I feel very proud of myself, for having my children, for having raised them with love and education,” she says. “I am happy to have the job I have, which allows me to support us.” 

Balancing work and motherhood is no small feat. But Martínez is thankful for the sense of community—and home—she’s found at Compañeros En Salud.

“It is having many responsibilities, working a lot, but at the same time enjoying it, because I am with the people I love,” she says.

Though daunting for some, she wouldn’t trade her lifestyle for anything.

“Above all, [I am proud] to be a woman,” she says.

Since March 3, Partners In Health (PIH) and our sister organization in Haiti, Zanmi Lasante (ZL), have faced severe challenges brought on by escalating insecurity in Haiti. Roadblocks have hindered the transportation of vital supplies, including medications. The price of fuel has skyrocketed. Violence remains a constant threat.

Despite these added complications, with a four-decade history of providing high-quality health care for Haitians, ZL continues to deliver care to the patients who rely on their services. ZL’s persistence during this time of conflict highlights the resilience, innovative thinking, and sometimes heroic efforts of staff and the effectiveness of long-term accompaniment. 

Our topmost priority remains the safety and well-being of our dedicated staff and the communities we serve. So far, all of our patients and staff are safe; we are working to support mental health, food, and housing needs; we are actively exploring ways to overcome logistical challenges; and ZL is continuing to provide care, as it has during the last two and a half years of unprecedented instability.

Staff and partners work tirelessly, embodying our shared commitment to the principle that health is a human right and continuing our mission to provide quality care to those who need it most. In this critical period, we urge everyone involved to take all appropriate measures to help stabilize the country, so Haitians can access health care and other fundamental rights. We thank all those who stand in solidarity with Haiti.

Today, Senator Bob Casey (D-Pa.) introduced the Community Health Worker Access Act, a new bill proposing crucial investments in the community health workforce to improve health care access in the United States. 

The Community Health Worker Access Act aims to enhance access to health services for Medicare and Medicaid enrollees by improving reimbursement for services provided by community health workers under Medicare and facilitating their integration into Medicaid.  

Including community health worker services within Medicare and Medicaid would improve the health of people enrolled in these programs and keep our communities healthy, as demonstrated by community health workers’ years of impact on health care in the U.S. and worldwide. This bill will also help strengthen the community health workforce by providing more sustained sources of funding within the health care system.  

The Community Health Worker Access Act is supported by over 270 community health worker networks and public health organizations, including Partners In Health. Partners In Health is adapting lessons learned from our experience around the world to bolster equity-centered public health systems in the U.S. by investing in community health workers. 

Below, we explain why this legislation is important and how you can take action.  
 

Remind me, what is Medicare and Medicaid? 

Medicare is a nationwide health insurance program for people 65 or older and some people under 65 with certain disabilities or conditions. Medicaid is a public health insurance program that provides coverage for more than 1 in 5 Americans, including eligible adults with low incomes, children, pregnant women, elderly adults, and people with disabilities. Together, these programs provide health coverage for millions of people and are influential sources of public funding for health services.  

How will the Community Health Worker Access Act enhance these programs? 

The Community Health Worker Access Act would improve payment eligibility for community health workers, promotoras de salud (a Spanish term used to describe community health workers), and community health representatives (a title for community health workers in tribal communities) who provide services to individuals receiving insurance through Medicare and Medicaid while expanding access to community-based services for enrollees in these major health programs.  

This bill would provide coverage for two new categories of community health worker services in Medicare:  

• Services to prevent illness, reduce physical or mental disability, and restore an individual to the best possible functional level 
• Services to address social needs through education and referrals to health care and community-based organizations.  

Currently, community health worker services are an optional benefit in Medicaid that at least 29 states have begun to offer. This bill would require the U.S. Centers for Medicare and Medicaid Services to provide guidance to states to support expanded access to community health worker services. It would also unlock additional federal resources for states to expand these services through Medicaid. 

Why is this legislation important? 

Decades of evidence has shown that community health workers are effective at improving health outcomes by providing services tailored to a community’s needs, in a way that is relevant to them. In the U.S., community health workers serve as essential connectors between communities and medical services and have been key to improving chronic disease control and mental health, promoting healthy behaviors, and reducing hospitalizations. They are particularly effective in rural and underserved areas where access to medical care is less accessible.   

Despite growing recognition of community health workers’ critical role and impact in the U.S., the workforce has struggled with inadequate and unstable funding. Congress has passed significant temporary investments on a bipartisan basis, but there is a need for sustained funding to support community health workers and to better integrate their unique strengths into health care systems. 

Covering community health worker services in Medicare and Medicaid will promote health equity by improving care coordination, culturally responsive care, and connections to services. 

How did PIH contribute to this legislation? 

PIH and our partners at the National Association of Community Health Workers (NACHW) were invited to offer feedback on the draft bill, and we worked with Senator Casey’s team and partners to ensure the final bill reflected the needs identified by community health workers. Our policy paper on sustained Medicaid funding for community health workers helped inform our recommendations.  

PIH Engage, a grassroots organizing network of PIH supporters working to build a movement for the right to health, has advocated to build policymaker support for the Community Health Worker Access Act. In August, 160 PIH Engage leaders representing 80 local teams from across the U.S. came together in Washington, D.C., and met with the offices of 100 U.S. senators and representatives to kick off a year of advocacy engagement for global and domestic health policy priorities, including the Community Health Worker Access Act. 

PIH and NACHW wrote and circulated a sign-on letter, which was signed by over 200 national, state, and local organizations asking Congress to move the Community Health Worker Access Act forward. A sign-on letter is an advocacy tool where several organizations sign a letter to demonstrate their shared support for a policy. Because PIH-US works alongside so many community partners, we were able to show broad support for this legislation.  

What can people do to support this? 

Help us make the Community Health Worker Access Act a reality. Contact your Congress members today and ask them to cosponsor the bill. 

Seabata Moeletsi, a mine worker living in southern Lesotho, was diagnosed with multidrug-resistant tuberculosis (MDR-TB) in 2008. Shortly after, he enrolled in Partners In Health (PIH) Lesotho’s MDR-TB program.

Preparing for the worst, Moeletsi asked staff at PIH Lesotho to care for his two youngest children, in the event of his death. After all, he was all they had. His wife had passed years ago due to tuberculosis, leaving behind four kids. Soon after his request for support, he passed away due to complications from MDR-TB.

Keeping their promise, PIH Lesotho’s community health team stepped in to support the family. They enrolled the two youngest children in a new PIH program for orphans and vulnerable children (OVC).

Long-term, comprehensive support 

After losing both parents, Mankopane Moeletsi, 6, and her brother Tšoloane Moeletsi, 8, were depressed. Such types of trauma, known as adverse childhood experiences, can impact a child’s health well into their adult years.

Through the OVC program, Mankopane and her brother received mental health support, including therapy sessions. Other support included school fees and supplies, food, clothes, and medical care. For years, they lived in PIH Lesotho’s orphanage, a home dedicated to the OVC program, with three other children, and a foster mother.

During this time, the eldest son was working in South Africa as a citrus fruit harvester, while the second had just turned 18 years old, making him a legal adult.

"My second brother endured the most hardships and pain in life; when we lost our father, he had just turned 18. According to me, he was still very young and in need of some form of support,” Mankopane explains. “It breaks my heart. He stayed at home to fend for himself and made a living by looking after people's livestock with occasional direction from our late mother’s aunt."

PIH has worked in Lesotho since 2006, when it was invited by the government to support its response to the HIV epidemic. In the years since, PIH’s programs have expanded, ranging from non-communicable diseases to child health, providing lifesaving care to thousands of people in the southern African nation. In 2007, PIH launched the country’s first treatment, care, and support program for patients with MDR-TB, the drug-resistant form of the common, infectious disease that Mankopane’s father had.

With the support of PIH Lesotho, Mankopane Moeletsi completed elementary school, middle school, and high school.  

“If PIH had not been in my life, I would not have gone to school at all,” she says.

Upon graduation, she enrolled in a business and community development program at a vocational school, where she studied environmental science, culinary arts, travel and tourism, and woodworking. Most interested in culinary arts, Mankopane Moeletsi decided to start a small business in her hometown, baking and selling pastries such as cupcakes and fat cakes, a type of deep-fried doughnut. She ran her business for a year before she made her way back to PIH.

“My business seemed quite promising at first and I made some money. But things changed when individuals started taking fat cakes and muffins on credit, and occasionally they didn't buy them at all, so we ended up eating them. My business gradually began to collapse,” she says.

When she thought everything was falling apart, PIH Lesotho stepped in again.

PIH Lesotho’s community health director contacted Mankopane and other members of the OVC program and urged them to apply for vacant positions.  

“What motivated me to apply was the fact that I knew more than anybody else about the benefits of PIH and the prospect of more OVCs like myself receiving support inspired me to apply,” she states.

Full circle moment

In July, Mankopane Moeletsi began working at PIH Lesotho as an OVC assistant. In her role, she assists children in the program by gathering and distributing food, clothes, and other essential items. She also supports them with navigating medical care and school.

“Working within this program is very close to my heart because I can now make a difference in other OVC’s lives,” she says. “It’s literally what I wake up for and my greatest wish is for them to lead successful lives.”

Her 10+ years-long connection with PIH, especially in recent months, has inspired her to take her education even further: pursuing a career in health care.

“I enjoy being of service to others and making a noticeable difference in their lives,” she says. “Now that I am part of Partners In Health Lesotho, and I have closely seen the work, I want to continue assisting those in need by studying nursing.”

Since 2009, the OVC program in Lesotho has supported 91 children. All orphans are children of patients who died from HIV or TB, two diseases of which Lesotho faces some of the highest rates in the world. Similar OVC programs exist across other countries where PIH works, including Haiti, Malawi, and Rwanda. 

Global health leader Dr. Howard Hiatt passed away at age 98 on March 2. Well-known and respected in the public health field, Dr. Hiatt played pivotal roles in his decades-long involvement with Partners In Health (PIH).  

PIH CEO Dr. Sheila Davis shared a message: “From his early work identifying messenger RNA to his deanship at the Harvard School of Public Health—and numerous other leadership roles—Dr. Howard Hiatt made a transformational impact on global health. He was the beloved mentor of two of PIH’s co-founders, Dr. Paul Farmer and Dr. Jim Yong Kim, and was an early PIH supporter and member of our Board. With the late Dr. Farmer and Dr. Kim, Dr. Hiatt co-founded and led the Division of Global Health Equity at Brigham and Women’s Hospital, where he established a groundbreaking residency program in internal medicine, public health, and global health equity that has since given rise to other equity-based training models. Beyond his extraordinary scholarship and advocacy, Dr. Hiatt was known for his exceptional kindness, commitment to service, and unstinting investment in the next generation of global health leaders—his legacy will live on through the many lives he improved and those he inspired to work in pragmatic solidarity with some of the world’s most impoverished communities.” 

A mentor to PIH co-founders Drs. Paul Farmer and Jim Yong Kim, Dr. Hiatt dedicated his life’s work to advancing global health equity. When Paul Farmer and Jim began curing dozens of patients in Peru with drug-resistant tuberculosis (TB), some were skeptical of this work and hesitated to fund it. However, Dr. Hiatt believed in both the work and Paul and Jim as people. Dr. Hiatt, through his diplomacy and keen strategic insight, helped them change global policy surrounding TB. Through his connections, he also helped secure tens of millions of dollars in donations.

“You can’t be exposed to Paul Farmer or Jim Kim and not think that this is the thing you should do,” Dr. Hiatt told The Boston Globe. “I was seduced by those two guys, and that became my next career.”


And in 2001, the trio formalized their legacy. They co-created the Division of Global Health Equity at Brigham and Women’s Hospital, dedicated to serving vulnerable populations and teaching how heath care can better serve people. In 2004, a novel residency program followed: the Doris and Howard Hiatt Residency in Global Health Equity and Internal Medicine.  Graduates of this residency have strengthened health services in rural Malawi; built a graduate medical education program in Haiti; developed treatment protocols for Ebola treatment units; and more. Many continue to work at PIH sites around the world.

Another example of Dr. Hiatt’s impact is his support of the founding of PIH’s sister organization on Navajo Nation: Community Outreach and Patient Empowerment, Inc. (COPE). He was committed to not only addressing health disparities globally, but also strongly felt the injustice of these historical inequities in our own back yard. In 2007, Dr. Hiatt and his colleague, Dr. Phyllis Jen, began conversations to build a collaboration with partners on Navajo Nation. COPE was launched in partnership with the community, local leaders, Navajo Nation programs, and the Indian Health Service to promote health equity and strengthen the well-being of Indigenous communities. COPE is honored to continue the humble approach to accompaniment Dr. Hiatt always modeled, recognizing that the solutions to overcome health disparities lie inherently in Indigenous communities themselves. 

Beyond PIH, Dr. Hiatt wore many hats. Personally, he was a husband, father, grandfather, and great-grandfather. Professionally, he was an accomplished molecular biologist, professor at Harvard Medical School, dean of the now Harvard T.H. Chan School of Public Health, senior physician at Brigham and Women’s Hospital, and more.

Black History Month has been observed in the United States since 1976. Although the annual celebration is confined to the month of February, PIH-US recognizes that amplifying Black voices, stories, and history is essential year-round. Today, and every day, we celebrate the efforts of Black individuals in creating a future where everyone can thrive.

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

Artificial intelligence, 3D bioprinting, and wearables are just a few of the tech innovations that have disrupted health care in recent years.

But, despite these strides, many of these technologies have yet to become widely available in low- and middle-income countries, due to centuries of global injustice. As a result, technology’s potential to improve health outcomes worldwide remains largely untapped, according to the World Health Organization.

As part of its mission to make the highest standard of health care free and accessible to all patients, everywhere, Partners In Health is using advanced technology and innovations in the 11 countries where it works. From employing mobile applications to digitizing health records, PIH is modeling how affordable, scalable technology can aid global health, expanding access to care and paving the way for a healthier, more connected future.

Here are five ways technology has strengthened PIH’s work:

1. Using AI to screen for disease

In Lesotho and other countries, PIH is using artificial intelligence to accelerate tuberculosis screenings, quickening the path to early detection, treatment, and care. The AI-powered technology, which is used in 6 of 10 districts nationwide, scans chest x-rays and quickly detects the probability of TB, as well as conditions like heart failure and cancer. With the help of AI, PIH has completed more than 700 screenings each month, tripling the number of TB cases detected at our clinics.

2. An ultrasound, on a cellphone

Ultrasounds are crucial to care, helping clinicians monitor pregnancy, evaluate trauma, and quickly diagnose life-threatening conditions. But traditional ultrasound machines are large, costly, and confined to hospital units—often requiring patients in low-income countries to make long, expensive journeys to access care. Handheld ultrasounds were developed about a decade ago as an alternative; these portable devices connect to a phone and stream real-time sonographic images, allowing care to be delivered outside of the hospital. PIH uses handheld ultrasounds in several communities, including the Sierra Madre region of Chiapas, Mexico, enabling clinicians to make informed decisions quickly and expediting patients’ access to care.

3. Care via chatbot

As COVID-19 emerged in 2020, leading to millions of infections and deaths, routine care was disrupted worldwide, with staff and facilities diverted to pandemic response and communities urged to stay home. As a result, countless patients were forced to cancel or delay their scheduled appointments. To address this issue, PIH turned to telehealth. In Peru, PIH developed seven chatbots to connect patients with care across clinical areas, from mental health to chronic disease management. These chatbots enabled PIH to conduct screenings virtually and connect patients with care, such as virtual therapy sessions or medications delivered to their door.

4. Digitizing health records 

In communities like Kono District, Sierra Leone, patient records were once handwritten in notebooks, prone to getting lost, damaged, or misinterpreted. Now, those records are entered into a system called OpenMRS, an open-source electronic medical records platform founded by PIH and the Regenstrief Institute in 2004. PIH now uses the system in 10 countries where we work. OpenMRS tracks everything that happens when a patient is in the hospital, from appointments to prescriptions, saving clinicians time and freeing up valuable storage space. OpenMRS has been so effective that it has since been implemented in over 40 countries and, in some cases, scaled to support all health facilities in their national health systems. 

5. There’s an app for that

Medical records, whether paper or digital, are typically stored in health facilities. But community health workers and other staff outside the hospital have to manage patient data, too. To streamline data collection and management at the community level, PIH has turned to mobile apps. In Rwanda, health center nurses use the mUzima app to conduct cancer screening for women and to securely track and store patient data. In several countries, including Malawi and Mexico, community health workers use CommCare to log appointments, referrals, and other key information. Both apps work offline, making them usable in areas with spotty or nonexistent internet, and sync to OpenMRS, centralizing patient data and optimizing care. 

Globally, 94% of maternal deaths occur in low- and middle-income countries.

A woman in Sierra Leone, for example, has a 1 in 52 lifetime risk of dying in pregnancy or childbirth, compared to a 1 in 3,800 lifetime risk in the United States.

Such health disparities cannot be explained by medicine alone.

That’s according to social medicine, an approach that has its roots in Latin America and focuses on how social forces and disparities affect health outcomes.

It’s essentially a marriage of medicine and social sciences, and it’s core to Partners In Health’s work around the world, from training hundreds of local residents to provide care in their communities to connecting patients with food, housing, and other essentials. 

But, despite its staying power, this concept is lesser-known outside of global health. Even then, it isn’t typically part of medical school curriculums, let alone taught to non-clinical audiences.

So, if you’re lost on what social medicine means, or need a refresher, here are a few facts to get you up to speed:

What Is Social Medicine?

Social medicine has had many definitions over the years. But the approach, in a nutshell, is based on the idea that social forces affect our health and lead to health inequities. Social medicine, as Dr. Michelle Morse, PIH board member and former deputy chief medical officer, once put it, seeks to understand the root causes of these inequities and to take action to change them.

In other words, the biomedical approaches typically taught in a med school classroom, such as reviewing a patient’s medical history in order to help treat a specific illness, are important, but not always sufficient in understanding health inequities. Social forces must also be taken into account. These social forces—such as language, culture, housing, immigration status, and income level—are often called “social determinants of health” and provide crucial insight into a patient’s health needs.

For example, maternal mortality rates are high in the rural, coffee-growing Sierra Madre region of Chiapas, Mexico. But the causes run deeper than a patient’s medical history. There are only 4 ambulances in the communities where PIH works. Reaching the nearest hospital can take hours of traveling via dirt roads prone to flooding during the rainy season. And Chiapas has a history of obstetric violence—clinicians ignoring or even abusing women in labor—leading to distrust of the health system and fewer women seeking facility-based deliveries.

Why does social medicine matter?

Social medicine is crucial to achieving health equity and combating inequities in health care, which have been documented to worsen health outcomes. Also, by widening the focus from an individual patient to health systems and social forces, social medicine reduces the risk of patients being blamed for their health problems and helps clinicians more effectively link them to care and essential resources suited to their needs. Further, the approach encourages health staff to get out of the clinic and into the community, building relationships and expanding awareness of and access to care.

What are some ways that social medicine guides PIH’s work?

In all 11 countries where PIH works, community health workers are a “first line of the practice of social medicine,” as Morse puts it. These workers are locals, hired from the communities where they work and trained to provide basic health services, such as delivering medications to patients at home, accompanying them to the clinic, and spreading the word about public health efforts such as vaccination campaigns.

Such efforts are especially crucial in communities where social factors like language, geography, or distrust of the health system might deter patients from seeking care on their own or even knowing about their care options. In Chiapas, for example, maternal health workers proactively go into communities to find pregnant women and encourage them to come to Casa Materna, a PIH-supported birthing center providing dignified care, with the goal of reducing maternal mortality.

With her left hand on an expectant mother’s belly, Sister Patricia Efe Azikiwe raises her right hand, wiggles her fingers, and explains how to examine the patient’s abdomen. With the fingertips, not the palm, she emphasizes. And don’t press down. Instead, gently move the hand in a circular motion.  

For years, Azikiwe, a reproductive, maternal, newborn, child, and adolescent clinical program manager at the Partners In Health-supported Koidu Government Hospital (KGH), has guided the next generation of clinicians in eastern Sierra Leone. She uses a direct, practical approach, is passionate about her work, and has become a key part of training and care delivery within the facility’s maternal ward.  

“No mother should die in pregnancy, at birth, or after delivery. And how we ensure that is by mentoring,” she says. “That will help us to reduce maternal deaths.” 

Indeed, fewer mothers are dying. In 2020, the lifetime risk of women dying in pregnancy or childbirth in Sierra Leone improved from 1 in 20 to 1 in 52. For context, the same rate is 1 in 3,800 in the United States. Sierra Leone’s is still one of the highest maternal mortality rates in the world, yet care is steadily improving at KGH, where there was an 8% decrease in maternal deaths from 2020 to 2022.  

Azikiwe and her colleagues hope to see that rate steadily improve over time through their hard work and dedication.

New approach, one goal: “save patients”

PIH Sierra Leone began supporting KGH in 2016 during the Ebola epidemic. Back then, the hospital was structurally in rough shape, care was expensive, and resources were sparse. There was no water or reliable electricity. If a patient needed surgery, their family member would need to supply the fuel to power the generator for the operation.   

Today, the hospital is a renovated and welcoming space, where most services are free and significantly more comprehensive.  

The expansive facility has surgical suites, maternal and child health and internal medicine departments, and the only emergency ward outside of Freetown, the capital. The maternity unit has many components, including an outpatient area for prenatal appointments, labor and delivery, its own surgical suite, recovery and post-operating rooms, family planning, and an adolescent and youth-friendly services section with a separate entrance to maintain patient privacy. A pharmacy and a blood bank are also housed in the ward. The latter is especially important, as it has made it possible to safely screen and store blood, meaning postpartum hemorrhage is no longer a death sentence for women. That is largely because PIH staff regularly speak with patients’ family members and have conducted community outreach about the importance of blood donation, as it was not historically an accepted practice. 

These renewed services and resources are critical. And patients have noted the difference; the facility saw a 36% increase in women choosing to give birth there from 2020 to 2022. From January to July alone, there were 2,537 women who gave birth at KGH. 

Among those women, 880 had lifesaving C-sections. In 2022, approximately 37% of births at KGH were C-sections. The percentage is high because KGH is a key referral facility for pregnancy complications, which often lead to a C-section. 

“Saving someone’s life is something I’m so, so passionate about,” says Azikiwe. “This is a referral [hospital]. And as soon as a patient comes here, let us do what we are known for and save patients.”

“Good news room”  

Attached to the maternity unit is the special care baby unit (SCBU), which was established about two years ago and is similar in capacity to a neonatal intensive care unit. Infants born outside the facility—at home or a district clinic—are cared for in one section, and those born in the hospital are housed in another section, all to prevent infection. In a short time, there has been high demand, including a 27% increase in monthly neonatal admissions between 2021 and 2022. From January to July of 2023, there were about 85 admissions a month, far surpassing the unit’s planned 20-person capacity. 

Designed for pre-term babies or those born with an infection, jaundice, and other conditions which require specialized care, the SCBU is highly valued among patients. 

“The care is good, especially for us that gave birth to pre-term babies,” says Regina Foday, a 33-year-old patient with a two-week-old baby. “Before now, people [thought] if you give birth to a preterm baby, they’ll not make it. But because of this facility, when you give birth to pre-term babies, the nurses and doctors here, they are really, really trying to see that baby survive.” 

The unit is touted as the “good news room” by staff because of newborns’ high survival rate, about 96%. Before the SCBU opened, admitted newborns’ mortality rate at KGH was 14%. Now, it's 4%. Still, staff acknowledge there’s much room for improvement. There’s no space for mattresses for a nursing mother’s overnight stays, limited medications for discharge, and a growing influx of mothers who gave birth at facilities beyond KGH and are referred there for specialized care. 

To address these challenges and continue making progress in saving women and children’s lives, PIH Sierra Leone launched an innovative solution: the Maternal Center of Excellence (MCOE).  

Future of maternal health care

Located on a plot of land adjacent to the hospital, the 166-bed MCOE will provide high-quality care to women and families who need it most, build local health care workforce capacity for sustained impact, and create a blueprint for scaling proven interventions in women’s health across Sierra Leone—and around the world. 

PIH Sierra Leone broke ground on the facility in April 2021 and the infrastructure team, led by partner Build Health International, has spent careful months since then leveling and compacting the site, pouring concrete, preparing electrical and plumbing, and building the walls of two main buildings within the massive complex. The south ward and birthing center are on track to be completed and patient services offered by the end of 2024. Two additional buildings will rise within the compound, with the facility at full capacity by the end of 2026. 

The hospital’s clinical staff have also had the opportunity to receive specialty training, with scholarships awarded to eight PIH Sierra Leone nurses participating in a two-year course studying perioperative care, critical care, and anesthesia in Ghana. Upon their return, they will be vital resources at the MCOE, sharing their new skills and training with other colleagues. As an accredited teaching hospital, KGH will serve as a destination for clinicians seeking medical specialization as they rotate through new residency programs and help increase staffing at the hospital and the new MCOE. 

Meanwhile, Azikiwe continues to arrive every morning in KGH’s maternity ward, ready to mentor the nurses and midwives who currently provide lifesaving care to mothers and newborns. Because she knows this work is an essential step toward a world in which no woman dies while giving birth to a new life. 

“We usually say that the joy of every midwife is at the end of labor. You hear the cry of the baby and the voice of the mother,” says Azikiwe. 

It’s been a packed year.  

Headlines highlighted escalating violence in Haiti, cholera spikes in Malawi, and damage from climate-related weather extremes across the globe. But there was good news too: medical education programs launched, major policy breakthroughs on drug pricing and tuberculosis treatment, and reduced rates of maternal mortality. Through it all, Partners In Health persevered, providing top-notch health care to people who need it most.  

PIH reaches far beyond a narrow view of medical care to encompass mental and social health as well as physical well-being. Watch this video to better understand the heart of our work, then see below the stories, other videos, and social posts we were most excited about in 2023. It’s an unscientific tally, but reflects our unwavering mission: a commitment to health care as a human right and true justice for all.  

Social Support, Mental Health Care 

We are beginning to make inroads stopping gender-based violence in countries with entrenched patriarchal cultures.  In Haiti, for example, when a 17-year-old woman was gang-raped near her home, Zanmi Lasante, as PIH is known locally, sent a support team, including a psychologist and social worker, to help the survivor and her family begin to process the trauma and offer practical assistance. These mental health professionals are part of a program that seeks to help survivors through direct care and counseling, while also advocating for systemic change, like educating judges and police on gender-based violence. 

Brenda Mijahuanca looks out the window of her apartment in Lima, Peru. Photo by Diego Diaz Catire / PIH

Mental health care and social support are central elements of our work. A free therapy program is helping trans women in Peru, where stigma, discrimination, and violence against people who identify as transgender are prevalent and prevent patients from accessing care. In Sierra Leone, PIH launched the first mental health hotline staffed  24/7 by psychosocial counselors and a community health officer manager. When callers dial in to the helpline, they receive a range of advice and resources, from basic mental health tips and straight talk about myths and stigma, to connections for follow-up medical care. 

Advances in Tuberculosis and Other Treatable Disease 

Our collaborative efforts yielded important advances in treating tuberculosis, a fully preventable and curable disease that still kills more than one million people a year, mostly in low- and middle-income countries.  PIH researchers were part of a team that presented results from a landmark clinical trial this year. Their findings pushed the field forward, with evidence to support the use of four new, improved regimens to treat multidrug-resistant tuberculosis. PIH patients in Lesotho participated in the trials as part of the endTB project.  

There remain a number of other, curable diseases —think malaria and cholera — that kill many thousands of people each year. PIH aims to correct this deep injustice. 

Emergency Care

Although PIH is not an emergency response organization, when emergencies happen, we act to provide treatment and relief. When Cyclone Freddy hit southern Malawi in March, the storm was reported to be the longest-lasting tropical cyclone ever recorded in the southern hemisphere, leaving hundreds dead, thousands injured, and hundreds of thousands of people displaced.  

Abwenzi Pa Za Umoyo, as PIH is known locally, immediately moved in to offer medical treatment and psychological care. The storm arrived at night, causing intense flooding and devastation to the region, as shown in this video detailing Cyclone Freddy’s aftermath.  

Emergencies don’t always come in the form of natural disasters or disease outbreaks. When patients don’t have enough medical oxygen, it’s literally a matter of life or death. That’s why we spent much of this year working to improve the infrastructure and hospital systems at our sites to give patients greater access to oxygen.  As one doctor said, “One of the worst things in the world is listening to a patient gasping for breath.”

Empowering Patients and Communities 

Energy self-sufficiency leads to better patient care. In Haiti, for example, with gang violence and social instability this year, obtaining adequate fuel for the generators at Zanmi Lasante’s Hôpital Universitaire de Mirebalais became far more challenging. As a result, the hospital encountered power losses on several occasions. Our investment in solar power at hospitals in Haiti and Peru means we can provide patients and clinicians a stable and reliable energy source, essential for medical care and treatment.  

Rose Mukabatabazi tends to crops in a greenhouse opened by Partners In Health in Kirehe, Rwanda. Photo by Asher Habinshuti / PIH

In a novel program, we are also supporting greenhouses in rural Rwanda to combat food insecurity and create sustainable sources of income for impoverished families. Farmers enrolled in this program include those with chronic illnesses and those with young children suffering from malnutrition. 

For more information about global health inequities in the countries where PIH works, visit this widely shared post on Instagram. One example: Sierra Leone, a country of eight million people, only has three psychiatrists.

Accompaniment  

For PIH, “accompaniment” means that we remain beside patients from the start of their health care journeys and remain alongside them as long as it takes—even if that means a lifetime. When Linda Depoyou, a 27-year-old mother of three in Liberia, gave birth to a little boy this summer, he weighed only 0.6 kilograms, or 1.3 pounds. But after three months of care, social support, and medical treatment at the neonatal intensive care unit at Partners In Health-supported J.J. Dossen Memorial Hospital in Harper, Depoyou and her new baby were able to return home and restart their lives together.  

Sometimes, PIH patients becomes such an integral part of the culture, they stay and become health workers, like Jean Claude "Gatoto" Rutayisi, who lives with HIV and is now a community health worker supervisor in eastern Rwanda. 

Advocacy and Good News in Global Health 

We advocate for community health workers (CHWs) around the world, including in the United States, where PIH-US and other national organizations spoke to lawmakers in Washington D.C. this year about the critical role of CHWs and what policies might support the expansion of this frontline public health workforce.  

Despite the harsh realities around the world, we’ve seen progress in global health, from declines in AIDS-related deaths to decreased child mortality. We believe that sometimes, it’s good to post good news; it shows that change is, indeed, possible.  

Partners In Health staff and partners expanded a state-of-the-art hospital in Rwanda. Clinicians cured patients living with tuberculosis. Technicians helped deliver lifesaving oxygen to more patients across the globe.  

The year 2023 saw its share of challenges—from a record-breaking cyclone that devastated communities in Malawi, to increasing gang violence in Haiti. But it also saw moments of triumph. 

In this collection of images, chosen from more than 12,000 taken over the course of the year, PIH photographers and contributors stood beside our dedicated staff as they broadened the scope of medical services and deepened engagement with communities. Through these brief snapshots in time, we celebrate the triumphs and bear witness to the challenges of the past year.  

Settea Benard receives a blanket and food package on April 1.  Abwenzi Pa Za Umoyo, as Partners In Health is known in Malawi, visited the Mitondo camp in Chikwawa District in response to Cyclone Freddy. The team offered clinical services as well as food packages for residents of the camp, all who were displaced by the cyclone. Each food package consisted of a bag of maize flour, beans, soya pieces, cooking oil, salt, and sugar and will last the average family 2.5 weeks. 
Photo by Caitlin Kleiboer / PIH

 
Oxygen cylinders are transferred off an oxygen truck and into boats to be delivered to Tebellong Hospital in Qacha’s Nek, Lesotho. 
Photo by Zack DeClerck / PIH 

Juan Hurtado, medical staff at the San José de Chincha Hospital, does routine maintenance and inspection work on the medical oxygen systems of the oxygen plant. 
Photo by William Castro Rodriguez for PIH  

A reflection from William Castro Rodriguez, one of several freelancers working with Socios En Salud (SES), as PIH is known in Peru: 

"Working together with the SES team means a genuine and human commitment. Being a creative producer has allowed us to accompany them and be close to their great work in communities. Seeing the joy of people whose health has been positively impacted has special meaning for us."

Members of Partners In Health’s Engage Training Institute spent Monday, August 14 at the U.S. Capitol for Hill Day, where they held 100 meetings with legislative staff members to talk about community health bills they would like introduced in Congress. Photo by Melissa Lyttle for PIH 

An aerial view of the campus of Partners In Health-supported Koidu Government Hospital in Kono District, Sierra Leone. Photo by Abubakarr Tappiah Sesay / PIH 

Prince is accompanied by his father, John, as the 4-year-old receives care at the cholera treatment unit at Lisungwi Hospital in Lower Neno, Malawi. Photo by Zack DeClerck / PIH 

Patricia Efe Azikiwe, the reproductive, maternal, newborn, child, and adolescent health clinical program manager at Koidu Government Hospital in Sierra Leone, mentors student nurses and midwives. Photo by Caitlin Kleiboer / PIH

A reflection from Caitlin Kleiboer, associate director of multimedia: 

"Reflecting on my time with our care delivery site staff this year, the short day spent with Sister Patricia Efe Azikiwe at Koidu Government Hospital in Sierra Leone stands out in my memory. As I followed her through the hospital, I was struck by the profound impact of her passion and dedication. She is one of the hardest working people I have ever met. 

In this moment, I was in a room packed with over a dozen student nurses and student midwives, all clamoring for a spot to see her work, practicing the maneuver she was teaching in the air along with her. To be honest, she is the kind of teacher that in my student days I would have called ‘tough.’ But her rules are basic and fair, and she doesn’t mince words. Don’t be late. Don’t have your phone out. Pay attention. Learn the skills. She is also the kind of teacher that I would have looked back on as one of the most impactful of my life.  From that day with her, I feel very sure that something someone learned will save a life of a woman or baby. That toughness, those rules, that dedication is truly lifesaving, and I feel lucky to have been able to witness it."

Inshuti Mu Buzima, as PIH is known in Rwanda, saw a need for children with disabilities to have access to adaptive chairs for their occupational therapy in Kirehe. Because these chairs can be prohibitively expensive, our Pediatric Development Clinic staff found ways to make three types of assistive devices—corner seats, specially designed chairs, and standing frames—out of affordable materials like cardboard and recycled paper. Photo by Asher Habinshuti / PIH
 

Construction workers build cinder block walls at the Maternal Center of Excellence in Kono, Sierra Leone. When completed, the center will provide advanced maternal and child health services in Kono District and beyond. Photo by Caitlin Kleiboer / PIH 

Wellington Dennis, a communications intern with PIH Liberia, stops on the beach as the tide rises while on the way to Putuken, a small community where PIH provides mobile care and support. It is separated from Harper, home to J.J. Dossen Hospital, by a small river and is only accessible by boat. Photo by Caitlin Kleiboer / PIH

Ruth Lazo (center), who received clinical services from PIH, sleeps outside at the Somo Camp with Piriran Seza (right) and their 4-month-old daughter after being displaced from their home by Cyclone Freddy. Somo does not have tents and bug nets are removed during heavier rains to preserve their effectiveness. Photo by Zack DeClerck / PIH 

Reflection from Zack DeClerck, global multimedia manager:  

"Despite our primary focus not being disaster response, PIH swiftly stepped in when Cyclone Freddy ravaged southern Malawi. Over half a million people were displaced, and countless crops were destroyed. Though the worst-hit areas were outside Neno, PIH extended its support to places like Somo Camp in Chikwawa District, where residents share heartbreaking stories about fleeing their homes with their children in the dead of night.  
 
When we met Ruth, Piriran, and their 4-month-old daughter Alufa, they were absolutely exhausted. We all fought tears as they detailed the impossible choices they faced navigating life after being displaced. Two weeks post-cyclone, the camp lacked tents, faced food shortages, and there were no insights on when adequate shelter might become available. PIH responded where other agencies fell short, deploying additional staff for medical care, mental health support, and food packages. 
 
The lack of international media coverage infuriated me; in many parts of southern Malawi, PIH stood alone in the support it provided. This crisis underscored the profound impact of climate change on impoverished communities, intimately connected to our mission of delivering quality healthcare. 
 
With limited resources, our colleagues in Malawi gave me so much hope through the grace in which they delivered care. PIH’s response to Cyclone Freddy embodied solidarity, accompaniment, and a refusal to accept injustice. The Malawian government specifically came to PIH for assistance with their response and that’s a testament to the power of partnership and the long-term commitment of our mission."

Communications staff with Companeros En Salud, as PIH is known in Mexico, Marina Luria (left) and Diana Bernal (right) paint a mural on the wall in JaltenangoJaltenango. The mural, which translates to “Health for all,” was completed as part of the Global Day of Action in October to honor what would have been Co-founder Dr. Paul Farmer’s 64th birthday. Photo by Francisco Terán / PIH 

Reflection from Francisco Terán, media designer:  

"For me, photography is a powerful tool to share stories, convey emotions, immortalize moments, and invite reflection. Here I captured a moment as the Comms team works on a colorful mural to celebrate Global Day of Action.

From Jaltenango, Chiapas, it has been an honor to be part of Paul Farmer's legacy on this special day, feeling like a very precious, emotional, and important moment to continue sharing his vision and mission, as well as the impact he has had on thousands of people. It is very valuable to be part of something so great, of a legacy and a work that will continue to grow year after year and that will continue to be shared with generations to come."

Clinicians with Zanmi Lasante, as PIH is known in Haiti, review a patient's chart at Hopital Universitaire de Mirebalais on March 24. Photo by Nadia Todres for PIH 
 

Makatleho Monyake and her 4-month-old baby prepare to ride home on horseback with a food package following an appointment at Bobete Health Center in Lesotho. Photo by Zack DeClerck / PIH

Ekram Hussien Ahmed, a graduate from the Gender, Sexual and Reproductive Health track at the University of Global Health Equity, attends her graduation ceremony in Kigali, Rwanda, in August. Photo by Serrah Galos for UGHE 

Miguel Apolinario does not remember ever having worked under such extreme temperatures as those in Loreto, a region located in northeastern Peru, in the heart of the Amazon.

"I checked my cellphone and the temperature was 36 °C [96 °F]," he recalls. 

Apolinario, a nurse technician, had come to the region on a distinct mission: to find people at-risk for tuberculosis and offer free screenings. 

Tuberculosis (TB) is the world’s deadliest infectious disease, disproportionately affecting people in low- and middle-income countries, where treatment and care are routinely inaccessible. Early detection is critical in responding to tuberculosis, which can go undetected for years. But finding these cases is challenging, especially in communities like Loreto.

Located in the Amazon rainforest, Loreto is home to 1 million people, including 32 Indigenous groups in 1,200 communities. It’s one of the largest regions of Peru, bordering three countries: Ecuador, Colombia, and Brazil. It’s also one of the hottest, with temperatures routinely in the 90s (Fahrenheit). Filled with forests, swamps, and rivers, Loreto is isolated. Its capital, Iquitos, is not accessible by land—the only way to visit it is by plane or boat. 

These conditions, along with systemic injustice, have made formal health care mostly inaccessible in Loreto. As a result, the region has been among the hardest-hit by diseases like TB. While TB cases in Peru have largely been diagnosed in Lima and Callao, which together report 56% of cases nationwide, Loreto's incidence rate is 164 cases per 100,000 people—higher than the incidence rate in both major cities.

To address this unmet need, Socios En Salud, as Partners In Health is known in Peru, has been expanding its TB work to include remote regions like Loreto. That work stems from its decades of experience responding to TB in partnership with the Ministry of Health and local communities, ever since its founding in 1996.

As the latest chapter in innovative TB work that has ranged from mobile clinics to portable x-ray screening that fits in a backpack, Socios En Salud launched a 10-day active search campaign in Loreto. The campaign had an ambitious goal: screen hundreds of people across 18 communities.

An Unmet Need

In mid-November, Apolinario and colleagues Alexander Gutiérrez, a radiologist, and Juan Herrera, a lab technician, traveled by boat across the Amazon river basin.

In the boat, the health workers brought ultra-portable, AI-powered digital radiography equipment, enabling them to screen and evaluate patients within minutes. 

They didn’t know how receptive the communities would be. But their presence was expected—weeks ago, Socios En Salud had sent former TB patients to the communities to promote the screenings and register patients.

Each day began at 7:30 a.m., when the medical vessel docked in a community. The team provided dozens of free screenings using the radiography equipment. If a patient had an abnormal result, the team would request a sputum sample for the GeneXpert molecular test, providing a rapid TB diagnosis within two hours.

Over the course of 10 days, the team screened a total of 369 people. For those who tested positive, the plan was to provide them with economic assistance to travel to the nearest health center where TB care was available.

"These are people who in some cases had not set foot in a health center for years,” says Apolinario. “Most of them had never had a TB screening in their lives." 

Peru’s last national census in 2017 revealed that 61% of Indigenous communities lacked any health facility. Only 1 of the 18 communities Apolinario visited, Colonia Oran, had a health post.

The lack of health care only adds to the challenges for communities in Loreto, where as many as 36% of people live in poverty.

"The department of Loreto, just like all regions of the Peruvian jungle, are affected by health and environmental problems, which lead to poverty and malnutrition, in addition to limited access of the population to health facilities due to distance and resources," says Milagros Mendoza, project coordinator of Socios En Salud’s TB Program. 

Because of the lack of formal health services, people in the communities often resort to natural medicine and traditional healing practices. 

"They told me that, in the old days, there were people with TB who refused medications and treated themselves with the sap from bananas and trees," he says.

As Socios En Salud and others work to expand health care access in the region, the times are changing. But despite the technological advances in TB care, challenges remain in getting that care to patients who need it. 

Even during their 10-day intervention, Apolinario and his team faced hurdles.

"Sometimes there were no community health workers,” he recalls. “So Alexander, the radiologist, and I  would have to get off the boat, use the light from our cellphones to see the road, and look for people, especially the elderly, who were waiting for their [test] results at home, and we delivered it to them directly.”

Still, the team persisted, connecting hundreds with screening and care, including, for those diagnosed, accompaniment by a community health worker and free transportation to a clinic. 

The intervention in Loreto marked a step forward for TB care in the region.

"There were people asking when we were coming back, because they wanted to bring more family members,” he says. “They were very grateful.”

Carlos Vázquez is originally from Pequeñez, Chiapas. At 67 years old, he continues to work on his farm, where he grows coffee, corn, and beans a few meters from his home. He has planted and harvested these foods with love and dedication throughout his life. 

In 2000, when he was in his 40s, he began to experience a wave of unusual symptoms and didn’t know if his life as a farmer could continue.

"It started with a headache that I put up with at first, but then it became more constant...soon, more aches and pains came along," he recalls. In the following weeks, he began to have frequent urination during the day and night, and he was drastically losing weight. 

At that time, there were not many doctors near his home, so he traveled to a private practice a few hours away. There, he learned that his glucose level was 500 mg/dl, compared to the 99 mg/dl that would be healthy for a man his age. He received a diagnosis: diabetes.

The doctor prescribed medication, but it cost approximately $2,500 MXN ($145 USD) per month—unaffordable for Vázquez, who had a family of five to support. His earnings from his crops were not enough to consistently pay for his treatment, so he took his medications irregularly.

In 2005, his condition worsened. "I became very weak,” he recalls. “My family took me to the hospital. We didn't know what was going to happen. We thought that I was nearing the end." 

Vázquez was hospitalized for 20 days and fortunately managed to recover, but this is not the case for many other people. 

In Mexico, 1 in 6 adults live with diabetes. The country has the second highest prevalence of diabetes in Latin America, with 18.3% of the population suffering from the disease. It’s one of the leading causes of death, with 140,729 deaths recorded in 2021. 

Care and treatment for chronic diseases like diabetes involves not only medication but also education about the disease and its effects, lifestyle changes, social support, and systems that facilitate recovery by allowing the patient to continue treatment properly. 

After over a decade of barely managing his symptoms with costly, private doctors, Vázquez was introduced to Compañeros En Salud, as Partners In Health is known in Mexico, in 2014 when a first-year doctor began working in the community clinic in Salvador Urbina, near his home. He began attending the free consultations offered there, a much more affordable and accessible option to help control his diabetes. Since then, he has been receiving medication and follow-up treatment from the acompañantes program. 

The acompañantes, or community health workers, are residents from the communities where Compañeros En Salud works, who receive training, supervision, and mentoring in chronic diseases, respiratory illnesses, and pregnancy care. The program, which has been running for 10 years and currently has 75 community health workers, has accompanied patients at every turn, from the home to the hospital. Acompañantes care for patients, counsel them, and help them follow their treatment plans, which can involve several medications.

Vázquez is one of those patients. 

Every two weeks, he receives a visit from Irma Gálvez, one of Salvador Urbina's acompañantes, who checks his glucose and blood pressure levels, encourages him to continue with his treatment, restocks his medications, and provides emotional support. 

"I don't know where I would be if Irma didn't come to visit me. I probably would have already lost control [of my glucose level] again and died," he says. "She comes when I feel bad. She advises me on my diet...I feel happy."

Similar community health interventions have been shown to result in significant improvements in the health of chronically ill patients. Acompañantes have conducted more than 22,121 home visits to patients with diabetes since the program began. Currently, they support 1,620 patients with non-communicable diseases; 63% of patients supported by acompañantes were able to bring their diabetes under control, with blood sugar levels in normal ranges, and 72% of those with high blood pressure kept their levels under control. 

That care has made a difference for patients like Vázquez, who now, thanks to the support of acompañantes, is able to resume his daily farm work. 

"I know that I have a condition and that it is not going to go away," he says. "But I have also been able to go on with my life. I am going to see my children and grandchildren. I am grateful that the acompañantes come to visit me, because they have really helped me get better."

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.