Partners In Health (PIH)

Our mission is to provide a preferential option for the poor in health care. By establishing long-term relationships with sister organizations based in settings of poverty, Partners In Health strives to achieve two overarching goals: to bring the benefits of modern medical science to those most in need of them and to serve as an antidote to despair. We draw on the resources of the world's leading medical and academic institutions and on the lived experience of the world's poorest and sickest communities. At its root, our mission is both medical and moral. It is based on solidarity, rather than charity alone. When our patients are ill and have no access to care, our team of health professi...
Jul 10, 2014

Maternal Mortality Reduction - July 2014 Update

Photo by Merida Carmona / Partners In Health
Photo by Merida Carmona / Partners In Health

Thank you for your generous support of Partners In Health!  We're thrilled to share the following excerpt, recently published on our website, announcing the Ministry of Health's transformative national initiative to ensure access to high-quality care for women and children in Lesotho, in which Partners In Health/Lesotho will play a major role. 

Improving outcomes by working in the community

Lesotho is struggling to address some of the most pressing health challenges in the world. In recent years, the country has lost ground on important measures of health. Between 2000 and 2010, maternal mortality nearly tripled, from 419 to 1,155 per 100,000 live births. In the same period, the child mortality rate climbed from 110 to 119 per 100,000 live births.  Meanwhile, nearly one in four people in the country has HIV—the prevalence of the virus has held steady at 23.6 percent since 2004. This HIV crisis has helped fuel a nationwide tuberculosis epidemic—Lesotho is one of few sub-Saharan countries where TB incidence has climbed by more than 10 percent over the past two decades.

In 2006, the government of Lesotho invited PIH to help tackle some of these challenges, beginning by supporting the Ministry of Health in a handful of rural health centers. Following the PIH approach, the goal was to design and implement a comprehensive program that addressed the social determinants of illness, such as poverty, hunger, and poor work conditions, that prioritized equity, and expanded access to care for vulnerable patients in a small number of districts. PIH/L’s initial strategy focused on bringing the health system to the people who needed it by improving services at hard-to-reach mountain clinics. Village health workers (VHWs) were vital in this strategy, forging trusting relationships between patients and clinicians and overcoming cultural and economic barriers that impeded access to care.

As the years went on, PIH/L’s ambitions expanded. In 2009, in the village of Bobete, the organization piloted its Maternal Mortality Reduction Program (MMRP)—a truly integrated approach to maternal care that weaves comprehensive accompaniment and active case finding with antenatal care, HIV testing and counseling, family planning, and an array of other clinical services. Identifying patients as early as possible allows PIH/L to help prevent pregnancy-related complications, mother-to-child transmission of HIV, and other problems that claim the lives of mothers every day in Lesotho.

A cornerstone of the program is maternal waiting homes. Many pregnant women walk hours on treacherous mountain paths, sometimes in the snow, to reach clinics. Doing so while in labor could spell disaster—or keep women from trying to reach a facility at all. Maternal waiting homes provide a comfortable space for soon-to-be moms so that when labor begins, they are only a few feet from trained medical staff and a well-stocked health facility.  

“We improved infrastructure, we treated patients with dignity, we addressed transportation challenges and we made sure expectant mothers were accompanied to the clinics before their due date,” PIH/L Director Dr. Hind Satti said. “Focusing on these issues and properly training staff made a significant difference. Addressing maternal mortality is a gate for us to address all aspects of women’s health—empowering women, which impacts their children’s and families’ health.”

The program was a major success. The year before the program launched, only 46 women delivered at Bobete Health Center. The year after, more than 215 women delivered at the facility. PIH/L expanded the program to seven different health centers, and each health center saw noticeable jumps in the number of facility-based deliveries. The program also yielded significant improvements in the number of women being tested for HIV, child vaccination rates, TB detection efforts, and family planning.

PIH/L’s approach and successes caught the attention of the country’s leaders.

The question: How did PIH/L achieve substantial, sustainable progress toward key health indicators in some of the most rugged parts of Lesotho, while the rest of the country was losing ground on the same measures? Could Lesotho adopt the PIH/L model at a national level?

A new level of accompaniment

In late 2013, PIH/L and the Ministry of Health began collaborating on a plan to scale up the maternal mortality program so that all health clinics would be able to deliver a comparable level of care to what PIH/L had been delivering for years. While PIH/L will be intimately involved in training staff and providing technical assistance, the health centers will remain under the purview of the Ministry of Health. The national reform will occur in three phases over five years.

The first phase, happening now, focuses on bolstering infrastructure, improving the supply chain, designing monitoring and evaluation systems, training staff, and building a system to support a cadre of VHWs who will be vital to earning the trust of communities. The first phase focuses on four districts.

The second phase will bring the reform to the country’s six remaining districts, rigorously document outcomes from phase one, and disseminate those findings so the program can be modified as needed.

The third phase, expected to occur in 2018, will focus on evaluating and analyzing the impact of the program. Thorough documentation may prove invaluable for other poor countries struggling with maternal and child mortality.

“This program will show that it is possible to deliver better services for patients and better outcomes at a lower cost when you work with, and work in, the communities,” Satti said.

In the first few months of the reform, nearly 2,000 VHWs have been trained, and a new national VHW policy has been approved. The team has conducted more than 50 baseline assessments and trained dozens of nurses.

Among those nurses is Justinah Kuotso at the Mohalinyane Health Center, one of the first health centers to undergo the reform. It was Kuotso who accompanied Masechaba Molefsame when she arrived at the clinic in late April. After a week and a half in the maternal waiting home, Molefsame went into labor. Staff worked together seamlessly to deliver a healthy baby girl—the first child delivered under the national reform.

In Lesotho, it is tradition not to name a baby until after the umbilical cord has fallen off. In the days after the delivery, staff at the health center affectionately dubbed the newborn “Reform Baby.” In the following weeks, several more babies, including a set of twins, were safely delivered at clinics throughout the four districts where the reform began.

In Lesotho, the challenges are still immense, and resources still limited. But with a generation of “Reform Babies” on the way, Lesotho has reason to hope for a bright and healthy future.

Jun 30, 2014

Childhood Malnutrition in Haiti - June 2014 Update

(Above) Cange, Haiti, A child suffering from malnutrition at the pediatric inpatient unit in Cange is fed  nourimanba by his mother.   Credit: Rebecca Rollins/PIH

 

While visiting patients in a rural village, a Partners In Health (PIH) community health worker spotted 14-month-old Lovena. Little Lovena had diarrhea, she was weak, and she had no appetite. With the encouragement of the health worker, her parents brought her to a PIH hospital. Her diagnosis was malnutrition.

This story is all too common. Malnutrition is a terrible disease that afflicts children in Haiti and around the world. It is a disease that stems from extreme poverty, but it is treatable and preventable. Thanks to your generous support, we are able to provide that treatment free of charge to children like Lovena. 

Lovena’s parents, who were very poor and lived about a two-hour walk from the hospital, didn’t understand the source of her sickness. It was severe acute malnutrition, caused by a shortage of the nutritious food toddlers require to grow up healthy. To help her recover quickly, we immediately provided Lovena with a ready-to-use locally produced therapeutic peanut butter packed with micronutrients, which we call Nourimanba.

She returned many times to the hospital to ensure she was healthy and growing. Recently, a doctor saw her for a simple cold and reported that she is now a healthy, active toddler. Without the treatment for malnutrition that Partners In Health provided, a simple cold could have easily killed her.

The prevalence of malnutrition in children around the world is unacceptable. It accounts for nearly half of all the deaths of children under 5 years old, which makes up a staggering 3 million deaths each year—or more than 8,000 every day.
These numbers are proof that we must do more to fight this needless suffering. Malnutrition is a sickness of poverty, and the children who are most affected often live in the most rural areas—far from health services and sources of steady
employment.

When I visit clinics in rural Haiti, up to half of the children I see are malnourished, placing them at much greater risk for other illnesses and even death. The effects, even if the child survives, can be long-term. Prolonged malnourishment can lead to cognitive and physical delays in development that make children less productive for the rest of their lives. These
setbacks make them less able to care for their own children, passing on the joint injustices of malnutrition and poverty.

With your help, Partners In Health has been fighting this disease in Haiti and in other countries we work to support. We’ve made great progress in the areas we serve, by using this simple innovation: therapeutic peanut butter packed with
micronutrients that we produce locally, to treat malnutrition effectively in clinics and in children’s homes. And we don’t stop at clinical care. In Haiti, we work with farmers to provide them with seeds and training to grow the peanuts for the Nourimanba peanut butter. Then, Partners In Health employs people to make the paste—a mixture of five
ingredients: peanuts, milk powder, vegetable oil, sugar, and vitamins. The product doesn’t require refrigeration and resists spoiling—making it the perfect treatment for children to take home with them to continue their recovery.

To save more lives, Partners In Health is scaling up production of Nourimanba in the same area our clinics serve in Haiti. Local production creates jobs, which helps the economy and prevents malnutrition.

Despite tremendous progress, we have more work to do. Partners In Health has committed to eliminating deaths of children under 5 years old from malnutrition in the areas we serve. This challenge will require reaching more of the most vulnerable families. It will require training more community health workers to identify children at risk, help
parents prevent malnutrition, and provide follow-up care in children’s homes. And it will require producing and distributing more therapeutic Nourimanba.  We hope that you continue to stand alongside us as we do whatever it takes to tackle this preventable illness. 

Thank you again for your support, 

Dr. Joia Mukherjee
Chief Medical Officer
Partners In Health

Jun 12, 2014

Support children in Malawi - June 2011 Update

With your support, PIH/Malawi—Abwenzi Pa Za Umoyo (APZU) can provide the necessary resources for children like Annie and Mary to attend school, where they develop the skills that can ultimately lift them out of poverty.  Thank you for your generosity and for making this work possible. 

Annie and Mary, classmates in Form 2 at Chifunga Day School Secondary School, in Lower Neno, are both recipients of POSER school support. They are from farming families whose livelihood comes from maize and groundnuts and have 5 and 6 other siblings. They are both only able to be in secondary school because of POSER’s involvement in their lives. As Annie says, “In my family there are [currently] three children in secondary school, so it would be very hard for my parents to pay school fees for me.” Mary notes that it is helpful not only to have fees the paid, but also to receive materials. 

They both aspire to become nurses at university after completing secondary school in Chifunga, where Biology and Physical Sciences are favorite subjects. Mary explains that “I work hard at school … so that I can assist patients.” 

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