Partners In Health Annual Report
2021

Together we builda healthier world

CEO Sheila Davis. Photo by Jodi Hilton for PIH.

Dear Friends,

Reflecting on the past year, I am so deeply proud of our global teams, who have simultaneously fought COVID-19, delivered ongoing and lifesaving care, and responded to unexpected shifts in how we operate—always keeping our work centered on patients’ health and well-being.

Dr. Sheila Davis
CEO, Partners In Health

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CEO Sheila Davis. Photo by Jodi Hilton for PIH.
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Dear Friends,

Reflecting on the past year, I am so deeply proud of our global teams, who have simultaneously fought COVID-19, delivered ongoing and lifesaving care, and responded to unexpected shifts in how we operate—always keeping our work centered on patients’ health and well-being.

We have risen to these challenges with optimism and a plan. We are not emergency responders, but we respond to daily emergencies by leaning on strong health systems built over time—in some cases, decades—in partnership with local governments.

Our recent earthquake response in Haiti is one such example. Many of the first responders arriving in the southwest had been trained in emergency medicine at PIH’s University Hospital in Mirebalais, a teaching and referral hospital we built with government partners in response to the 2010 earthquake. These Haitian clinicians, who graduated from the first and only such emergency medicine residency in the country, worked tirelessly for weeks to save lives and provide support. Meanwhile, PIH colleagues from around the world reached out and offered support during this trying time. That’s solidarity. That’s family. That’s what I’ve come to call OnePIH.

Over the past year, we have explored how to best live our mission of ensuring health care is a human right. I am grateful to the global teams, coordination site staff, board members, and partners who worked collaboratively and dedicated countless hours to craft a strategic plan for PIH’s next 10 years. This foundational document lays out three pathways to action, which are highlighted in this year's Annual Report: build and strengthen health systems; advance the field of global health delivery; and center the needs and rights of the most vulnerable, specifically those of women, children, and adolescents.

In the following pages, you will see the many ways in which PIH teams innovated and adapted to an ever-changing COVID-19 pandemic, in turn inspiring our ongoing response across the United States. You will learn about our steadfast progress in training the next generations of global health practitioners. And you will read stories about how we have broken down barriers to care for some of our most vulnerable patients—mothers, infants, and youth.

Every day, I am heartened by the hard work and dedication of the PIH community around the world. Thank you for your unwavering commitment and support in service of our shared mission—in moments of crisis and celebration—as we work toward a more just and equitable world.

Thank you for accompanying us along this journey.

In solidarity,

Dr. Sheila Davis
Chief Executive Officer

More than three decades ago, Zanmi Lasante (Partners In Health in Haitian Creole) was formed to support the work that began in a small, rural community called Cange, in Haiti’s Central Plateau. From there, it expanded across the country, then on to Peru and Russia, across Africa, and on to Mexico and Navajo Nation.

Through it all, PIH has kept patient care at the center of its work and fought for health care as a human right—both within individual countries and the halls where global health policy is created.

In the timeline below, read how PIH has grown, innovated, and pushed the boundaries of global health to ensure that everyone has access to high-quality health care.

OUR HISTORYOUR HISTORYOUR HISTORYOUR HISTORYOUR HISTORYOUR HISTORY
1
Chapter 1

BuildingHealthSystems

IMPACT: GLOBALCOVID-19 RESPONSE

23,595

People given social support during COVID-19 isolation and quarantine

101,312

COVID-19 rapid diagnostic test kits provided to Ministry of Health partners

1,419,311

COVID-19 symptom screenings conducted by PIH-supported staff

212,578

COVID-19 tests made possible with PIH support

19,303

Individuals reached through contact tracing

3,746

Patients received inpatient care for COVID-19 at PIH-supported facilities

featured story

Compassionate Care for COVID-19

Diagnosed with epilepsy at 18, Félix Melgar had lived with medication for years, staving off the worst symptoms of his condition and regaining some amount of freedom and control.

Then, a COVID-19 diagnosis put all of that at risk.

But help wasn’t far away—it was available in his community, free of charge, from Socios En Salud, as PIH is known in Peru, where we’ve been working for 25 years alongside the Ministry of Health.

With generous support from USAID and the Global Fund, Socios En Salud mounted a comprehensive COVID-19 response through testing and contact tracing within communities, medical care and essential resources to patients, community health worker visits, and chatbot apps to connect patients virtually with care.

Socios En Salud put patients at the center of our COVID-19 response, which made all the difference for patients like Melgar. He received epilepsy medications, masks and hand sanitizer, and food and housing assistance. Community health workers regularly checked in with him—a gesture that meant a lot to Melgar and helped him make a full recovery.

Socios En Salud
25 Years
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Odilest Guerrier, a medical assistant, administers a COVID-19 vaccination at an inoculation site established by Healthcare Network of Southwest Florida in Immokalee. Photo by Scott McIntyre for PIH

Covid-19 Vaccine equity

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Osman Lopez from the Healthcare Network speaks with Maria Escutia at her home about the Covid-19 vaccination and offers masks, hand sanitizer and other helpful medical information in Immokalee, FL. Photo by Scott McIntyre for PIH

U.S. COVID-19 Response

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Nyiramucyo cares for her son Jean*, 15, who is staying in the pediatric oncology ward at Butaro District Hospital in Rwanda. Photo by Pacifique Mugemana / PIH
*Name changed for minor

Confronting Cancer

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Dr. Ekaterina Stepanova presents chest x-rays for a tuberculosis patient while discussing potential treatment regimens with clinicians in Russia. Photo by Elena Devyashina for PIH

Video Therapy For TB

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Story 1
Building Health Systems
COVID-19 Vaccine Equity

Since 2020, PIH has participated in the People’s Vaccine movement, a worldwide coalition of organizations campaigning to scale vaccine manufacturing. Our advocacy team has advised and spoken with officials across President Biden’s administration and the U.S. Congress; lobbied vaccine manufacturers; written for and been interviewed in national media; and participated in public forums, conferences, and demonstrations. Despite this political progress, the world will likely still face a shortage of COVID-19 vaccines through 2022. We will continue to lend our weight to this movement until universal access to COVID-19 vaccines is achieved.

Story 2
Building Health Systems
U.S. COVID-19 Response

When PIH launched its United States COVID-19 response in spring 2020 through the Massachusetts Community Tracing Collaborative (CTC), we called upon our experience fighting epidemics and strengthening public health systems around the world. Thanks to transformational gifts from supporters, we have since expanded our work alongside U.S. partners in 16 jurisdictions and tailored public health responses to the unique needs of communities through the U.S. Public Health Accompaniment Unit—now called PIH-US.

Together, we are accompanying and advising on: contact tracing and vaccine rollout, public health guidance, prevention and care protocols, and advocacy for policies leading to stronger public health systems.

Story 3
Building Health Systems
Confronting Cancer

Jean* was a healthy 14-year-old student who enjoyed going to school in rural Rwanda. Then one day, he came home with a mysterious lump on his neck. His mother, Nyiramucyo, took him to a local health center. He was given antibiotics, but the lump grew larger and caused breathing difficulties.

Eventually, Jean and his mother discovered Butaro District Hospital, supported by Inshuti Mu Buzima, as PIH is known in Rwanda. There he was diagnosed with Non-Hodgkin lymphoma—a cancer that starts in white blood cells, stayed in the pediatric oncology ward, and received free, comprehensive cancer treatment and long-term housing.

In 2020, 2,184 patients received dignified cancer care at Butaro District Hospital.

*Name changed for minor.

Story 4
Building Health Systems
Video Therapy for TB

In 2020, PIH revived our work in Russia as part of the Zero TB Initiative, a global alliance working to rapidly drive down rates of tuberculosis infection. In three cities in Vladimir Region, PIH and ANO Zdorovye.ru enrolled 160 patients in video-observed therapy, connecting them with health workers virtually to help them take their medications and follow treatment plans. The program has delivered care to the most at-risk, including patients who are HIV-positive, homeless, or recently released from prison.

2
Chapter 2

MedicalEducationand Training

IMPACT: GLOBALMEDICAL EDUCATION

153

Graduates across all specialties since 2012

134

Medical residences enrolled as of June 2021

96%

Of residency graduates have stayed to work in Haiti

49

New students enrolled in master's degree program in 2021

134

Graduates from master's degree program since 2018

featured story

Equity in Medical Education

Equity is essential to advancing the global health field—a lesson both taught and learned at the University of Global Health Equity (UGHE), which was founded by Partners In Health in Rwanda in 2014.

In the years since, that mission has been carried forward with each class’s graduation—a celebration that, last year, took place virtually due to COVID-19. In August 2020, 28 students graduated from UGHE’s Master’s in Global Health Delivery program—the fifth cohort to graduate from the university’s flagship degree program.

The students came from 12 countries and included a range of health professionals. All gained a foundation in health sciences, leadership and management skills, and first-hand experience understanding the social determinants of health in the rural context of Butaro, Rwanda, where UGHE is based. The graduates joined the ranks of more than 120 alumni of the master’s degree program.

UGHE Butaro Campus
Play video

Co-founder Dr. Paul Farmer (center) gave a lecture and spoke with clinicians at Hôpital Universitaire de Mirebalais while in Haiti following the August earthquake. Photo by Nadia Todres for PIH

Haiti Needs Us

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A man receives a COVID-19 test at St. Joseph’s Shelter in Gallup, N.M., on Navajo Nation. Photo by Robert Alsburg / COPE

Training Contact Tracers

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Dr. Lyazzat Zhanabayeva (left) continued to screen TB patients in Kazakhstan within modified wards in spite of COVID-19 risks. Photo by PIH

First Aid Education

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Amohelang Barenale’s 14-day-old daughter at a PIH-supported health center in Nkau, Lesotho. Photo by Karin Schermbrucker for PIH

Timely Training

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Story 1
Medical Education and Training
Haiti Needs Us

In collaboration with the Haitian Ministry of Health, Zanmi Lasante, PIH’s sister organization in Haiti, opened Hôpital Universitaire de Mirebalais in 2013, and the hospital has since become a hub of medical education and specialized care. The facility is home to seven residencies—family medicine, pediatrics, internal medicine, nurse anesthesia, surgery, emergency medicine, and OB/GYN—and fellowships in neurology, plastic surgery, and emergency sonography. Among graduates, 96% have remained to work in Haiti.

Dr. Mirrielle Bien-Aimé was among the first cohort to graduate from the four-year emergency residency program, the first and only of its kind in Haiti. Now, she is training the next generation of specialists and providing high-quality care at St. Boniface General Hospital. “Haiti needs us,” she says.

Story 2
Medical Education and Training
Training Contact Tracers

A comprehensive contact tracing workforce on Navajo Nation mitigated COVID-19 on the 17-million-acre nation, which once had the highest per capita infection rate in the United States.

Community Outreach & Patient Empowerment Program (COPE), PIH’s sister organization on Navajo Nation, in collaboration with the Navajo Incident Command and PIH, trained and supported over 500 health professionals in contact tracing and the unified technology platform that enabled contact tracing across health facilities.

Fern Spencer, a COPE contact tracer, was confident her personal experience of surviving COVID-19 would help those she called. Her instinct was right.

One person she called was experiencing mental health difficulties. When the conversation ended, Fern called back 30 minutes later. Then again, another 30 minutes later. And again, until she confirmed the individual reached the hospital for urgent care.

Story 3
Medical Education and Training
First Aid Education

Responding to COVID-19 requires more than masks, tests, oxygen, and vaccines. As patients cope with the loss of loved ones, unemployment, food and housing insecurity, and the virus, PIH staff know it is critical to integrate mental health care into the pandemic response. But that integration doesn’t happen overnight—it requires specialized education. In Kazakhstan, PIH provided training for 110 health workers in psychological first aid, as they cared for patients with tuberculosis in the cities of Almaty and Karaganda and delivered resources and relief. The training had one goal: to ensure that, in the midst of an isolating pandemic, no patient was truly alone.

Story 4
Medical Education and Training
Timely Training

In rural Lesotho, quality care for mothers and newborns is hard to come by, because health workers often lack the training and resources to fully support patients. Without the right equipment, even tasks like listening for a baby’s heartbeat become complicated and prone to medical error. To address this critical gap, PIH provided seven cardiotocography (CTG) machines to rural clinics. These machines electronically monitor babies’ heart rates during labor and help identify abnormalities. During the first CTG training, a midwife detected an alarming heart rate. Staff ushered the expectant mother into emergency care, and her baby was born safely through Cesarean section.

3
Chapter 3

Focus on Women,Adolescents,and Children

IMPACT: GLOBALMATERNAL HEALTH

11,200

Lifesaving C-sections

130,660

Prenatal Visits

55,400

Facility-Based Deliveries

featured story

Groundbreaking Maternal Care

On April 23, shovels struck soil on the grounds of Koidu Government Hospital—the only hospital in rural Kono District, Sierra Leone—and marked the start of construction of the Maternal Center of Excellence.

Sierra Leone is one of the most dangerous places in the world to give birth; women face a 1 in 20 lifetime risk of dying in pregnancy or childbirth, compared to a 1 in 3,800 chance in the United States.

The Maternal Center of Excellence—made possible thanks to the generous partnership, networks, and support of John and Sarah Green and Hank and Katherine Green—is poised to change that reality. The 166-bed center will expand the hospital’s maternity ward and special baby care unit and will equip clinicians with the essential resources and spaces they need to save lives.

Once open in 2023, the center is projected to increase facility-based deliveries by 121% and family planning visits by three times and drop the rate of stillbirths below 2% across Kono District. It will also provide a space for education and training Sierra Leone’s next generation of clinicians.

Bigger Than A Building:
The Maternal Center of Excellence in Sierra Leone
Play video

Kay Manmito, the maternal waiting home at Hôpital Universitaire de 32 Mirebalais in Haiti. Photo courtesy of Tranquillin Ricardo for PIH

A Mother’s Journey

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Miguel, 9, has been hard of hearing his whole life and recently received hearing aids, thanks to support from PIH in Mexico. Photo by Paola Rodriguez / PIH

Newfound Freedom

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A mother carries her baby in Neno District, Malawi. Photo by Karin Schermbrucker for PIH

Never Left Behind

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From left to right: Daniel Maweu, Nursing Center of Excellence lead; Annie Weah, community midwife; Garmai Forkpah, obstetric nurse mentor. Photo by Jason Amoo / PIH

New Ward Meets Demand

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Story 1
Focus on Women, Adolescents, and Children
A Mother’s Journey

In Haiti, the Journey to 9 Plus (J-9) program at Hôpital Universitaire de Mirebalais (HUM) recruits expectant mothers, many of whom have high-risk pregnancies, to ensure they and their newborns receive constant care and support throughout pregnancy and the first year of life for the newborn.

In January 2021, 400 newborns graduated from the J-9 program, which supports mothers and their babies with four key services: group prenatal and pediatric care, psychosocial services, home visits, and hospital-based services.

More than 800 women have enrolled since the program began in 2019 and nearly all have had facility-based deliveries, compared to 36% nationwide.

Story 2
Focus on Women, Adolescents, and Children
Newfound Freedom

When Carmela Sánchez gave birth to her son, Miguel*, it was not apparent that he was deaf. A visit to the doctor after his first birthday confirmed Sánchez’s suspicions and eventually led her to Compañeros En Salud, as PIH is known in Mexico.

Compañeros En Salud has provided health care, timely referrals to specialized care, and social support to thousands of families in rural Chiapas for the past decade.

With Compañeros En Salud’s support, Miguel was referred to an advanced hospital for care, where he had molds taken of his inner ear. A few weeks later, he went home with hearing aids—and a new sense of freedom.

*Name changed for minor

Story 3
Focus on Women, Adolescents, and Children
Never Left Behind

When a girl experienced sexual and gender-based violence in Neno, Malawi, there used to be little support for her. If she became pregnant, she could have been forced to drop out of school or get married.

Since 2019, PIH has addressed these challenges through No Woman or Girl Left Behind—a project that aims to improve sexual and reproductive health services and strengthen the health system to support survivors. In January 2020, PIH established a team of health and social services staff to identify and investigate such cases of sexual and gender-based violence. The team has developed reporting structures, hosted workshops, and investigated 95 cases as of July 2021.

Story 4
Focus on Women, Adolescents, and Children
New Ward Meets Demand

At Pleebo Health Center in Liberia, clinicians went from seeing two dozen patients daily to hundreds in just a few years. In February 2020, Partners In Health Liberia opened a new ward to help meet this increased demand and better support maternal and child health care in Maryland County.

Financials

Revenues by source

  • Governments and Multilateral Organizations (48%)
  • Individuals and Family Foundations (41%)
  • Foundations and Corporations (7%)
  • Gifts in Kind and Contributed Services (3%)
  • Other Income (1%)
Revenues$313 million

Revenue

In fiscal year 2021, PIH received $313.2 million in revenue, a 44% increase over fiscal year 2020, which was primarily driven by COVID-19 response efforts in the United States. Fiscal year 2021 revenue was comprised of $150.8 million from governments and multilateral organizations (48% of total revenue), $127.4 million from individuals and family foundations (41% of total revenue), and $21.8 million from foundations and corporations (7% of total revenue). In addition, PIH received $8.6 million in donated goods and services and $4.6 million in other income (4% of total revenue).

Expenses by program

  • U.S. Programs (32%)
  • Haiti (20%)
  • Development and Administration (7%)
  • Multi-Site Clinical and Program Support (7%)
  • Peru (6%)
  • Rwanda (6%)
  • Sierra Leone (5%)
  • Liberia (3%)
  • University of Global Health Equity (3%)
  • Malawi (3%)
  • Lesotho (3%)
  • EndTB (3%)
  • Navajo Nation (COPE) (1%)
  • Mexico (1%)
Expenses$283 million

Expenses

PIH expenses increased from $174.6 million in fiscal year 2020 to $282.6 million in fiscal year 2021. Nearly all of this $108.0 million increase was related to growth in program services and driven by COVID-19 response efforts in the United States. In fiscal year 2021, 93% of funds were for direct program costs and 7% went to fundraising and administration.

Surplus (deficit)

PIH ended fiscal year 2021 with a $30.6 million operating surplus.

Allocation of expenses

  • Program Services (93%)
  • General and Administration (4%)
  • Development (3%)
Expenses$283 million

Governance

Partners In Health is a 501(c)(3) nonprofit corporation and a Massachusetts public charity. The programmatic work of PIH is guided by our Leadership Council, overseen by the Board of Directors, and supported by the Officers and leaders in our cross-site management team.

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