PSI NETWORK Angola Antigua and Barbuda Barbados Belize Benin Botswana Burundi Cambodia Cameroon Central African Republic China Costa Rica Côte D’Ivoire Democratic Republic of Congo Dominica Dominican Republic El Salvador Ethiopia Grenada Guatemala Guinea Haiti Honduras
H E A LT H Y L I V E S
India Jamaica
MEASURABLE
Kazakhstan
R E S U LT S
Kenya Kygyzstan Laos Lesotho Liberia Madagascar Malawi Mali Mexico Mozambique Myanmar Namibia
2012
PS I: I M PACT R E PO RT
Nepal Nicaragua Nigeria Pakistan Panama Papua New Guinea Paraguay Romania Russia Rwanda Senegal Somaliland South Africa South Sudan St. Kitts & Nevis St. Lucia St. Maarten St. Vincent and the Grenadines Suriname Swaziland Tajikistan Tanzania Thailand Togo Trinidad and Tobago Turkmemistan Uganda Uzbekistan Vietnam Zambia Zimbabwe
PSI addresses some of the most serious risks to the health of people living in the developing world: lack of access to family planning, HIV and AIDS, barriers to maternal health, malaria, diarrhea, pneumonia and malnutrition. As a global nonprofit organization, we work with a variety of donors, partners and stakeholders, including local governments and organizations in the countries where we work. Health products and services are promoted and distributed in ways that ensure wide acceptance, proper use and equitable access. In this fashion, PSI creates health solutions that are built to last. This report, distributed in December 2012, reflects on products distributed and services provided in 2011 and the impact they are expected to generate.
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Contents
Letter from the CEO....................................................................... 1 Measurable Results......................................................................... 2 Malaria................................................................................................ 6 HIV and AIDS................................................................................... 8 Family Planning...............................................................................10 Maternal Health..............................................................................12 Child Survival..................................................................................14 Tuberculosis....................................................................................16 PSI Health Impact: 2012 and Beyond......................................18 Definitions........................................................................................19 Endnotes..........................................................................................20 PSI Network....................................................................................21
Connect with PSI Website: psi.org Impact Magazine: psiimpact.com Blog: blog.psiimpact.com Twitter: PSIimpact Facebook: Population Services International YouTube: Healthy Behaviors
cover photo: Š Trevor Snapp
Letter from the CEO
PSI President & CEO Karl Hofmann visits Charlotte Kabirigi in Burundi, who uses PSI’s Mama Supanet to protect her family from malaria.
Š Benjamin Schilling
At PSI, we rigorously count each product we deliver and service we provide. We use technical models to translate the distribution of these products and services into estimates of real health impact: years of healthy life saved, years of protection provided against unintended pregnancy, episodes of disease prevented and deaths averted.
These metrics inform our work, define our impact and demonstrate our value. They also represent a core PSI belief: The implementation of cost-effective interventions, accompanied by robust communications and distribution efforts, improves access to, demand for and use of life-saving health products and services. PSI is dedicated to working with developing communities around the world to address the most pertinent and pressing diseases, helping people live healthy lives. —Karl Hofmann, President & CEO, PSI
H e a lt h y L i v e s , M e a s u r a b l e R e s u lt s | 1
MEASURABLE RESULTS
© Trevor Snapp
PSI relies on a set of efficient, timely and reliable metrics. These metrics enable us to report the impact of our interventions, track progress towards our strategic targets and estimate our contribution to global efforts to improve health. To measure reductions in disease and use of family planning interventions, PSI employs two metrics: the disability-adjusted life year (DALY) averted and couple years of protection (CYPs). These metrics take into account the full period over which a product or service will offer protection to a user: the effective life of the intervention. A long-lasting insecticide-treated mosquito net (LLIN), for example, has an effective life of at least three years.
2 | P S I : 20 1 1 I m pa c t R e p o r t
➔ When PSI averts one DALY, it means that we prevent the loss of one year of productive, healthy life. ➔ When PSI provides one CYP, it means that we provide one year of protection against unintended pregnancy.
1 DALY averted = 1 year of
healthy life saved
1 CYP = 1 year of protection against unintended pregnancy
PSI Distribution and Service Delivery Highlights: 2011 ➤
DELIVERED
1.3 billion+ condoms
➤
38 million+ cycles of oral contraceptive pills
11 million+
long-lasting insecticidetreated mosquito nets
doses of pre-packaged artemisinin-based combination therapies
PERFORMED
1.4 million+
110,000+
HIV counseling and testing sessions in 30 countries ➤
42.2 million+
voluntary medical male circumcisions in Mozambique, South Africa, Swaziland, Zambia and Zimbabwe
8,000+
voluntary surgical contraception operations in Pakistan
TREATED
Nearly 900,000
cases of pneumonia in Congo-Kinshasa, Madagascar, Malawi, Myanmar and Uganda
Nearly 19,000
cases of tuberculosis in Laos, Myanmar and Pakistan
Global Impact ➤
over the effective life of these and other interventions, psi is able to prevent
206,000+
4.7 million+
463,000+
13,600+
55.2 million+
3.9 million+
HIV infections
maternal deaths ➤
unintended pregnancies
malaria episodes
AVERT
22,170,000+ DALYS
malaria deaths
10,600+
child diarrhea deaths
diarrhea cases ➤
provide
19,000,000+ CYPs
H e a lt h y L i v e s , M e a s u r a b l e R e s u lt s | 3
MEASURABLE RESULTS: A LOOK BACK TO 2006 In 2007, PSI launched a five-year strategic plan. In that plan, we challenged ourselves to double our health impact in DALYs averted and substantially increase access to family planning interventions from 2006 through 2011. By the end of 2011, we not only accomplished this goal, we exceeded it. ➤
DALYS AVERTED
➤
CYPS PROVIDED
128%
57%
2011:
2011:
2006:
2006:
increase
increase
22,170,000+ 9,700,000+
19,000,000+ 12,100,000+
DELIVERING VALUE FOR MONEY: 2011 PSI provides necessary health products and services to those we serve in a cost-effective manner, creating real and measurable health impact with donor dollars. The World Bank considers interventions costing less than US $100 per DALY averted to be highly cost effective in the least developed countries.1 In 2011: The net cost to avert one DALY was
$29.70
For the price of two movie tickets, PSI can prevent the loss of one healthy year of life. For even less, PSI is able to provide a couple with a year of protection against unintended pregnancies.
The net cost to provide one CYP was
These costs represent PSI’s commitment to providing real value for money.
$16.18
4 | P S I : 20 1 1 I m pa c t R e p o r t
MEASURABLE RESULTS: A LOOK AHEAD TO 2016 ➤
STRATEGIC TARGETS
As PSI continues to innovate and grow, we will maintain our focus on measurable health impact. Our 2012-2016 strategic plan focuses on specific targets relating to the scale of our impact, the value of our interventions and the relevance of our programs. ➤
Scale
25% 30%
2007-2011 sum of DALYs averted: 80 million GOAL: 2012-2016 sum of DALYs averted: 100 million 2007-2011 sum of CYPs provided: 80 million GOAL: 2012-2016 sum of CYPs provided: 104 million ➤
value
5% 15%
2011 net cost per DALY: $29.70 GOAL: 2016 net cost per DALY: $28.22 2011 net cost per CYP: $16.18 GOAL: 2016 net cost per CYP: $13.75 ➤
relevance
In 2011, PSI targeted 26% of the burden of disease in countries where we work.2 PSI’s health areas target burden attributed to malaria, HIV, sexually transmitted infections (STIs), maternal and perinatal conditions, diarrheal diseases, nutritional deficiencies, respiratory infections and tuberculosis.3 Global Burden of Disease in countries where PSI works
Disease burden targeted by PSI interventions
26.5%
diarrheal diseases, nutritional deficiencies and respiratory infections: 5.8%
(more than 1 billion DALYs lost)
maternal and perinatal conditions: 11.9% HIV & STIs: 6.0% malaria: 2.6% tuberculosis: 0.2% 2016 strategic priority
additional 16%
By 2016, we aim to increase our relevance by targeting an additional 16% of the burden of disease in countries where we work, ensuring that our interventions meet the most relevant needs of communities worldwide.
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STRATEGIC PRIORITIES
PSI is committed to reaching people with quality health products and services they need at prices they can afford. PSI operates in a larger market that includes the public sector and private sector. We aim to achieve and maintain healthy markets built on a combination of commercial products and services for the wealthiest, targeted subsidies for those less able to pay and free products and services for the poorest. We do not aim for the isolated short-term success of our own interventions. Instead, we look beyond our own outputs and focus on strengthening the overall markets that provide sustainable health care solutions. PSI contributes to and advocates for the greatest health impact in this total market approach. The total market approach focuses on increasing use of products and services by at-risk groups, improving equity and decreasing dependence on subsidies over time. New metrics will allow us to evaluate our performance from the context of the market that is delivering health care solutions: ➔ UNIVERSE OF NEED The number of products or services needed to reach universal coverage. ➔ MARKET VOLUME The number of products or services sold, distributed or provided in a given market. ➔ EQUITY The degree to which products or services are used or adopted across socio-economic strata. ➔ MARKET SUBSIDY The degree to which donors assume a share of the costs of products or services in order to provide these to consumers at a price they are willing to pay. ➔ Use The percent of at-risk populations using a product or service, or adopting a behavior.
H e a lt h y L i v e s , M e a s u r a b l e R e s u lt s | 5
Malaria Malaria affects approximately half of the world’s population. In 2010, the World Health Organization reported an estimated 216 million malaria cases and 655,000 malaria-related deaths, most of which were concentrated among African children.4 PSI’s malaria prevention and treatment interventions span 32 malaria-endemic countries, playing a key role in the realization of Millennium Development Goals 4.A and 6.C: Reduce the under 5 mortality rate by twothirds between 1990 and 2015 and have halted and begun to reverse the incidence of malaria and other major diseases by 2015. Below, we focus on the distribution of longlasting insecticide-treated mosquito nets for the prevention of malaria. For additional information about our malaria interventions, please see the Child Survival section of this report on page 14.
© Trevor Snapp
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IN 2011, PSI distributed...
42.2 million+
long-lasting insecticide-treated mosquito nets (LLINs)
Impact ➤
over the effective life of this intervention, PSI is able to...
prevent nearly
prevent
avert
malaria episodes
malaria-related deaths
DALYs
55.3 million 372% increase over 2006
6 | P S I : 20 1 1 I m pa c t R e p o r t
414,000+
432% increase over 2006
13 million+ 430% increase over 2006
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PSI protects communities from malaria:
In collaboration with our partners, PSI distributed more than 42.2 million LLINs around the world. This included approximately half of all LLINs delivered in Africa in 2011, a region which accounts for 78 percent of all malaria cases and 91 percent of all malaria deaths.5 K enya
•
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PROGRAM HIGHLIGHT
WIDE-SCALE NET DISTRIBUTION IN KENYA n = Countries across which PSI distributed more than 42.2 million LLINs in 2011.
More than 70 percent of Kenyans are at risk of malaria. This preventable disease is responsible for the loss of 170 million working days each year and 13 percent of all deaths among children under five (34,000 deaths).6 Kenya is a recognized success story in supporting ownership of LLINs through integrated routine and mass distribution. Pregnant women and children under the age of one receive LLINs at no cost through routine distribution at antenatal care and child welfare clinics.
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PSI’s goal:
PSI will continue to play a key role in the global effort to achieve MDGs 4.A and 6.C by working towards universal coverage for malaria prevention. We will continue to distribute LLINs to at-risk communities around the world and sustain the gains made in LLIN coverage.
Populations in rural malaria endemic and epidemic areas can access subsidized socially marketed LLINs through PSI/Kenya with the support of community-based organizations. A universal mass net distribution exercise conducted in 2011 ensured one net for every two members of a household in malaria endemic and epidemic areas. As a major partner of the Kenyan Division of Malaria Control, PSI/Kenya delivered more than 5.1 million LLINs through both routine and mass distribution in 2011 alone, averting more than 8.2 million episodes of malaria and more than 35,000 deaths.
For more information about PSI’s malaria interventions, click here. featured peer-reviewed publication: Determinants of insecticide-treated net ownership and utilization among pregnant women in Nigeria. A. Ankomah, S. B. Adebayo, E. D. Arogundade, J. Anyanti, E. Nwokolo, O. Ladip, and M. M. Meremikwu. BMC Public Health, 12:105 (2012)
H e a lt h y L i v e s , M e a s u r a b l e R e s u lt s | 7
HIV and AIDS Despite the drop in HIV incidence worldwide, an estimated 34 million people are living with HIV globally. Southern and Eastern African regions still face generalized epidemics, accounting for 70 percent of the global HIV burden. In most parts of the world, HIV disproportionally affects key populations, including women, female sex workers, men who have sex with men and people who inject drugs. While AIDS-related mortality has declined due to increased access to antiretroviral therapy (ART), there were 1.8 million AIDS-related deaths and 2.7 million new HIV infections in 2010 alone.7 PSI implements behavioral, biomedical and structural HIV interventions in 55 countries in Africa, Asia, Eastern Europe, and Latin America and the Caribbean. Leading interventions include behavioral risk reduction, male and female condoms, basic care package, HIV counseling and testing and voluntary medical male circumcision (VMMC). PSI applies the latest evidence to maximize cost effectiveness and efficiencies while applying the most up-to-date scientific advances to program design and implementation.
© Gareth Bentley
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IN 2011, PSI DISTRIBUTED…
1.3 billion+ condoms
17 million+
basic care packages (typically comprised of condoms, long-lasting insecticidetreated mosquito nets for malaria and safe water treatment) +
+
AND PERFORMED…
nearly 800,000
1.4 million+
nearly 36,000
111,000+
clean needles and syringes targeting people who inject drugs
8
➤
antiretroviral fixed dose combination tablets and
HIV counseling and testing services
voluntary medical male circumcisions
nearly 550,000 Impact ➤
treatment kits for sexually transmitted infections
over the effective life of these interventions, PSI is able to...
avert
prevent
DALYs
new HIV infections
4.1 million+ 43% increase over 2006 8 | P S I : 20 1 1 I m pa c t R e p o r t
200,000+ 53% increase over 2006
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PSI prevents HIV:
In 2011, PSI conducted more than 111,000 voluntary medical male circumcisions (VMMCs) across five high-priority countries in Southern Africa, preventing the transmission of more than 25,000 cases of HIV and averting more than 138,000 DALYs. S o u thern africa
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PROGRAM HIGHLIGHT
SCALING UP VOLUNTARY MEDICAL MALE CIRCUMCISION IN PRIORITY AFRICAN COUNTRIES
n=C ountries where PSI provided voluntary medical male circumcision services in 2011. n=A dditional countries where PSI provided services or distributed products for HIV prevention and care in 2011.
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PSI’s goal:
PSI will increase access to VMMC services in additional priority countries in Africa to reduce the apread of HIV. In 2012 alone, PSI expanded to provide VMMC in Kenya and Lesotho and will expand further to Namibia and Malawi in 2013.
For more information about PSI’s HIV interventions, visit the Combination Prevention issue of PSI’s Impact Magazine, here. featured peer-reviewed publicationS: Multiple partnerships and risk for HIV among the Garifuna minority population in Belize. J. Buszin, B. Nieto-Andrade, J. Rivas, K. Longfield. Health, 4:8 (2012)
Conclusive research shows that male circumcision reduces men's risk of acquiring HIV via vaginal sex by up to 60 percent.9. 10, 11 However, Southern and parts of Eastern Africa, regions accounting for almost three quarters of new HIV infections worldwide,12 the proportion of men who are circumcised remains llow at an estimated 20 percent.13 PSI is engaged in global efforts to increase the proportion of men aged 15-49 who are circumcised in 14 priority countries in Southern and Eastern Africa to 80 percent. To meet this target, set by the Joint United Nations Programme on HIV/AIDS (UNAIDS), 20 million adult VMMCs need to be performed. If successful, this effort would prevent 3.4 million new HIV infections by 2025, saving more than US $16.5 billion in HIV treatment costs.14, 15 PSI is a leader in ensuring VMMC services are integrated into a comprehensive package of services. Clients who access VMMC services are offered HIV counseling and testing and screening for sexually transmitted infections. Clients receive information about remaining abstinent during the healing period and practicing safer sex after healing, including correct and consistent condom use and avoiding multiple and concurrent sexual partners.
Acceptability of early infant male circumcision as an HIV prevention intervention in Zimbabwe: A qualitative perspective. W. Mavhu, K. Hatzold, S.M. Laver, J. Sherman, B. R. Tengende et al. PLoS ONE, 7:2 e32475 (2012)
H e a lt h y L i v e s , M e a s u r a b l e R e s u lt s | 9
More than 220 million women in the developing world have an unmet need for family planning. 16 Increased access to family planning helps women prevent unintended and high-risk pregnancies, decreases maternal mortality, contributes to the overall health of women and their children and reduces the need for abortion.
Family Planning
PSI contributes to the global effort to improve the lives of women and their families. In 2011, PSI expanded access to a range of contraceptive methods, informed choice, client safety and quality assurance in 57 countries across Africa, Asia, Eastern Europe and Latin America and the Caribbean. We are committed to offering affordable, comprehensive and high-quality family planning services through various channels, including social franchise clinic networks, pharmacies, community-based distributors, drug shops and mobile services outreach.
© Jake Lyell
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in 2011, PSI distributed...
Short-acting contraceptive methods:
1.3 billion+
male and female condoms
nearly 8 million
injectable contraceptives
nearly 3.8 million
Long-acting reversible contraceptive methods:
Permanent contraceptive method:
cycles of oral contraceptive pills
nearly 174,000
8,400+
45,000+
835,000+
38.2 million+
CycleBeads
®
contraceptive implants
voluntary surgical sterilizations
intrauterine devices (IUDs)
emergency contraceptive pills
Impact ➤
over the effective life of these interventions, psi is able to…
provide
prevent
avert nearly
couple-years of protection
pregnancies
DALYs
19 million+ 57% increase over 2006 1 0 | P S I : 20 1 1 I m pa c t R e p o r t
4.7 million+ 55% increase over 2006
2.9 million 56% increase over 2006
➤
PSI addresses unmet need for family planning:
In 2011, PSI offered four or more modern contraceptive methods, including at least one long-acting reversible contraceptive method, to women in 21 countries, representing 37 percent of countries in which we work.
M ali
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PROGRAM HIGHLIGHT
REACHING WOMEN IN NEED OF FAMILY PLANNING during CLINIC IMMUNIZATION DAYS IN MALI In Mali, where one out of every 28 women dies of pregnancy-related causes,17 only 6 percent of women use a modern contraceptive method.18 Moreover, four out of five new mothers have an unmet need for family planning, resulting in considerable negative health outcomes.19
n = Countries where PSI provided 4 or more modern methods of contraception in 2011. n = Countries where PSI provided 3 or fewer modern methods of contraception in 2011.
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PSI’s goal:
By 2016, PSI will offer four or more modern contraceptive methods, including at least one long-acting reversible contraceptive method, to women in 42 countries. This corresponds to 75 percent of countries in which we work.
featured peer-reviewed publications: Physicians in private practice: Reasons for being a social franchise member. D. Huntington, G. Mundy, N. Mo Hom, Q. Li, T. Aung. Health Research Policy and Systems, 10:25 (2012)
PSI/Mali expanded access to contraceptive products and services by launching an intervention to reach post-partum women at routine immunization services. While women wait to have their children immunized, midwives provide counseling on the benefits of family planning and the availability of a range of modern contraceptives, while also dispelling myths and misconceptions about contraceptive methods. On the same day, women interested in obtaining a method can choose from short-acting and long-acting reversible contraceptive methods, including an intrauterine device (IUD) or contraceptive implant, avoiding the obstacle of having to return to the health center later. Through this intervention, PSI/Mali is increasing capacity within the public health care system and expanding the outreach model to rural areas. In 2011, PSI/Mali offered six modern contraceptive methods (two of which were long-acting reversible methods) to Malian women. PSI/Mali provided more than 400,000 couple-years of protection and averted more than 93,400 DALYs through the distribution of approximately 12.4 million male and 14,000 female condoms, 450,000 injectable contraceptives, 1.5 million combined oral contraceptive pills, 2,000 CycleBeads®, 22,000 contraceptive implants and 6,000 IUDs. For more information, click here to read the full case study about this program.
Dedicated providers of long-acting reversible contraception: New approach in Zambia. J. Neukom, J. Chilambwe, J. Mkandawire, R. Kamoto Mbewe, D. Hubacher. Elsevier, 83:5 (2011)
H e a lt h y L i v e s , M e a s u r a b l e R e s u lt s | 1 1
Maternal Health an estimated 208 million women become PREGNANT EACH YEAR IN THE DEVELOPING WORLD. In 2010, approximately 287,000 women died from pregnancy-related causes, 99% of whom were in the developing world.20 Severe bleeding (post-partum hemorrhage) and unsafe abortion account for nearly 37 percent of all such deaths worldwide.21 Furthermore, every year, 5 million women suffer disability from an unsafe abortion.22 PSI provides essential healthcare products and services throughout a woman’s life — including contraception, safe-birthing kits, medication abortion packs, and misoprostol for postpartum hemorrhage and post-abortion care — empowering women to make informed and safe decisions about their health.
© Gareth Bentley
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in 2011, PSI distributed...
64,000+
2.6 million+
clean delivery kits
4.2 million+
iron folic acid tablets
336,000+
multivitamin tablets Fe
medication abortion combination packs (comprised of 1 tablet of mifepristone and 4 tablets of misoprostol)
580,000+
misoprostol tablets for post-partum hemorrhage and post-abortion care
1,200+
manual vacuum aspirations for post-abortion care
Impact ➤
over the effective life of these interventions, psi is able to...
prevent
13,600+ maternal deaths*
averts nearly
55,000 DALYs
*This impact takes into account distribution and provision of family planning interventions. 1 2 | P S I : 20 1 1 I m pa c t R e p o r t
➤
PSI increases access to high-quality, life-saving products and services:
In 2011, PSI supported maternal health interventions in 20 countries, targeting the reduction of maternal mortality due to severe bleeding, infection and unsafe abortion.
SOMALILAND
➤
PROGRAM HIGHLIGHT
PSI/Somaliland is empowering women and providers to practice life-saving behaviors.
n
= Regions which accounted for 99% of all maternal deaths in 2010 (284,000 maternal deaths).23, 24
n=C ountries in which PSI supported maternal health interventions to reduce maternal mortality due to severe bleeding, infection and unsafe abortion in 2011.
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PSI’s goal:
PSI will continue to contribute to the global effort to reach the fifth United Nations Millennium Development Goal of reducing the maternal mortality ratio by 75 percent between 1990 and 2015.25
For more information about PSI's maternal health programming, please visit our website, here.
Somali women are among the most vulnerable populations in the world with an estimated maternal mortality ratio of 1,044 maternal deaths per every 100,000 live births.26 In Somaliland, given the lack of proper cool chain facilities, misoprostol is ideal for the prevention and treatment of post-partum hemorrhage (PPH), one of the leading causes of maternal deaths. PSI/Somaliland, in close collaboration with the Ministry of Health, is implementing a country-specific, branded communication strategy for misoprostol and postpartum hemorrhage. Key messages are delivered through media and interpersonal communication sessions. PSI also trains providers on the safe use of misoprostol for PPH prevention and treatment. In addition, misoprostol is provided to health facilities with delivery services at subsidized prices to create universal access. Since 2010, PSI has expanded this program to include 54 health facilities. From April 2010 to October 2012, 322 health providers have been trained in partnership with local health institutions and 9,500 women have received misoprostol for the prevention or treatment of PPH.
Featured peer-reviewed publication: Changes in the proportion of facility-based deliveries and related maternal health services among the poor in rural Jhang, Pakistan: Results from a demand-side financing intervention. S. Agha. International Journal for Equity in Health, 10:57 (2011)
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CHILD SURVIVAL In 2010, 7.6 million children under five years of age died of causes that are largely preventable and treatable. Most of these deaths could be addressed with simple, cost-effective interventions for the prevention and treatment of pneumonia (responsible for 14 percent of all child deaths), diarrhea (responsible for 10 percent of all child deaths), malaria (responsible for 7 percent of all child deaths), and malnutrition (which is the underlying cause of one-third of all child deaths).27 Through integrated case management (ICM) of malaria, pneumonia and diarrhea, PSI ensures that each child is correctly assessed and receives effective treatment or referral in any service delivery setting. ICM is service delivery – trained and motivated providers effectively diagnosing and treating the most prevalent health issues of children under five.
© Ollivier Girard
➤
In 2011, psi distributed...
1.3 million+
diarrhea treatment kits
nearly 5 million
oral rehydration solutions
280,000+
nearly 70 million water treatment tablets
nearly 62 million
PUR water purification powder sachets
zinc treatments ➔ for the prevention and treatment of diarrhea
11.4 million+
pre-packaged artemisininbased combination therapy treatments
2.1 million+
nearly 900,000 antibiotic doses
➔ for the treatment of pneumonia
rapid diagnostic kits for the early detection of malaria
2.5 million+
➔ for the detection and treatment of malaria
➔ for the treatment of malnutrition
packets of micronutrient powders
Impact ➤
over the effective life of these interventions, psi is able to...
prevent
3.9 million+ episodes of diarrhea
1 4 | P S I : 20 1 1 I m pa c t R e p o r t
prevent
57,000+
malaria-, diarrhea- and pneumonia-related deaths
avert
1.8 million+ DALYs
➤
PSI protects children:
In 2011, PSI operated ICM programming in 18 countries, 17 of which are located in Africa and Southeast Asia, regions which account for more than 70 percent of all child deaths.28 D emocratic rep u blic of the congo
➤
PROGRAM HIGHLIGHT
Integrated COMMUNITY CASE MANAGEMENT IN THE DEMOCRATIC REPUBLIC OF THE CONGO With a child mortality rate of 158 deaths per every 1,000 live births,31 the Democratic Republic of the Congo (DRC) is among six countries which account for more than 50 percent of all deaths among children under five.32
n
= Regions which account for more than 70 percent of all child deaths.29, 30
n = Countries in which PSI operated integrated case management programming in 2011.
➤
PSI’s goal:
PSI is part of a global effort to reach Millennium Development Goal 4.A – reduction of the mortality rate among children under five by two-thirds between 1990 and 2015. To contribute to this goal, PSI will expand the scale and scope of our ICM programming at a national scale, reaching more children in more countries.
featured peer-reviewed publicationS: Narrowing the treatment gap with equitable access: Mid-term outcomes of a community case management program in Cameroon. M. Littrell, L.V. Moukam, R. Libite, J.C. Youmba, and G. Baugh. Health Policy Plan, (2012) Evaluation of a social marketing intervention promoting oral rehydration salts in Burundi. S. Kassegne, M.B. Kays, and J. Nzohabonayo. BMC Public Health, 11:155 (2011)
In the DRC, PSI and its local affiliate Association de Familial Santé (PSI/AFS), with funding from the Canadian International Development Agency, are implementing an integrated, scalable, community-based initiative delivering free treatment for malaria, pneumonia and diarrhea in communities where deaths among children under five are most common. During phase one of the program, PSI/AFS trained 796 community health workers and 396 health promotion agents in integrated community case management of childhood illness, serving a population of 636,000 people. In 2011 alone, PSI distributed approximately 125,000 treatments of co-formulated artemisinin-based combination therapy for malaria, 51,000 treatments of oral rehydration salts and zinc for diarrhea, 143,000 treatments of approved antibiotics for pneumonia, 3.2 million PUR water purification powder sachets and 7.6 million water treatment tablets. These efforts prevented more than 1,100 deaths and averted more than 36,000 DALYs in the DRC. For more information, click here to read a story in PSI’s Impact Magazine about integrated community case management.
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TUBERCULOSIS In 2010, 1.4 million people died from tuberculosis (TB). More than 95 percent of these deaths occurred in low- and middle-income countries, where TB is among the top three causes of death for women of reproductive age. TB also accounts for one-quarter of all deaths due to HIV.33 Yet, TB is both preventable and curable. In 14 countries, PSI prevents deaths from TB using innovative approaches to identify people with active TB infection and provide access to treatment services. Additionally, because HIV infection increases the risk of active TB disease, PSI has integrated TB interventions into many of PSI’s long-standing HIV interventions, particularly HIV counseling and testing.
© Piers Benatar
Impact Directly observed treatment, short course (TB DOTS), is an internationally recommended intervention that is highly effective in curing TB, preventing the emergence of drug-resistant TB and preventing new infections. ➤
IN 2011, PSI OPERATED TB DOTS PROGRAMS IN THREE COUNTRIES TO...
avert
58,000+ DALYs
1 6 | P S I : 20 1 1 I m pa c t R e p o r t
successfully treat nearly
19,000 cases of TB
prevent nearly
2,000 deaths
➤
PSI detects and treats TB:
Today, 22 countries account for more than 80 percent of the world’s TB cases.34 PSI currently operates TB activities, such as TB DOTS, TB screening or TB diagnosis, in seven of those high-burden countries. M yanmar
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PROGRAM HIGHLIGHT
INTEGRATED TB/HIV SERVICES AT PSI’S CLINICAL SOCIAL FRANCHISE NETWORK IN MYANMAR In Myanmar, approximately 20,000 people died of tuberculosis in 2010, and 250,000 were living with the disease.36 According to recent surveys, a significant portion of TB cases remain undetected.37
n=H igh-burden country where PSI operates but has no TB activities. n = High-burden country with PSI TB activities. n = Additional countries with PSI TB activities.
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PSI’s goal:
In partnership with global and local partners, including the World Health Organization’s Stop TB department, PSI makes a measurable contribution toward achieving the sixth Millennium Development goal of halting and reversing the incidence of TB by 2015.35
In 2004, PSI/Myanmar added TB treatment to services provided through its Sun Quality Health (SQH) social franchise. SQH is a network of private physicians providing a range of high-quality health services. Within this network, PSI provides training, patient education materials, service promotion, and access to health products, supervision and monitoring. In 2010, 12 percent of nationally registered TB cases were successfully treated through the SQH network. TB/HIV co-infection is an additional challenge for SQH providers in Myanmar where the HIV prevalence among individuals newly diagnosed with TB is 10 percent38 and the prevalence of active TB among HIV-positive patients is estimated to be more than 30 percent.39 To address this dual burden, PSI works with SQH providers to integrate TB and HIV services. SQH providers conduct HIV counseling and testing for their TB patients and offer symptomatic TB screening and diagnostic services for people living with HIV. As a result of this integration of TB/HIV activities and innovative social franchising, PSI averted more than 50,000 DALYs, successfully treated more than 14,000 cases of TB and prevented 1,600 deaths in 2011. To learn more about PSI's efforts in Myanmar, read the full case
For additional information about PSI’s TB programming, visit our publications catalogue here.
study about the program here.
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PSI Health Impact: 2012 and Beyond
© Benjamin Schilling
By expanding access to interventions which target high-burden health areas, PSI ensures that our programs are relevant to the communities in which we work and contribute to the realization of the 2015 Millennium Development Goals. Over the next five years, we aim to avert the loss of 100 million years of healthy life, provide 104 million years of protection against unintended pregnancy, and improve our business model to strengthen health markets and deliver even more cost-effective interventions. Our strategic priorities place the needs of the communities in which we work at the center of our efforts. These priorities are focused on expanding access to cost-effective, life-saving interventions that increase choice and reduce disease burden. Connect with PSI Website: psi.org Impact Magazine: psiimpact.com Blog: blog.psiimpact.com Twitter: PSIimpact Facebook: Population Services International YouTube: Healthy Behaviors
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PSI’s continuing focus on the most relevant health issues facing resource-poor communities ensures that our health interventions generate meaningful impact – millions of healthy lives worldwide. If you would like to learn more about PSI, please visit www.psi.org.
Definitions Burden of Disease: A measure representing the proportion of DALYs lost due to one or more diseases among a specific population. PSI currently relies on estimates of DALYs lost for 2004 – the latest, reliable estimates available – from the 2009 revisions to the World Health Organization (WHO) Global Burden of Disease estimates. When new estimates of DALYs lost are released for 2010, PSI will incorporate them into our metrics. Cost per DALY / Cost per CYP: The estimated net cost to PSI to avert one DALY or provide one CYP. Couple Year of Protection (CYP): The estimated protection from unwanted pregnancy offered to a couple by contraceptives distributed by PSI or through referrals to partners. CYPs are calculated according to conversion factors from the United States Agency for International Development that indicate the time of effective protection per unit for each contraceptive method. Disability-Adjusted Life Year (DALY): A key metric in WHO Global Burden of Disease estimates, widely used to capture disease burden. One DALY is a year of life lost due to poor health or premature death.
DALYs Averted: The metric PSI uses to measure health impact. When PSI averts one DALY, it means that PSI has prevented the loss of one year of productive, healthy life – a year of life that, without PSI’s intervention, would have been lost to illness or death. Endemic: Describes a disease that appears frequently within a specific geographic area. Maternal Death: The death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.40 Maternal Mortality Ratio (MMR): Number of maternal deaths during a given time period per 100,000 live births during the same time period. Metric: A unit used to measure PSI’s impact or track PSI’s progress. Unsafe abortion: A procedure for terminating an unintended pregnancy carried out either by persons lacking the necessary skills or in an environment that does not conform to minimal medical standards, or both.41
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Endnotes 1. Laxminarayan R., Chow J.,
11. Gray, R.H., Kigozi, G., Serwadda,
20. World Health Organization, UNICEF,
31. UNICEF Humanitarian Action for
Shahid-Salles SA. Intervention
D., et al. Male circumcision for HIV
UNFPA, and World Bank. Trends in
Children. 2011. West and Central
cost-effectiveness: Overview of
prevention in men in Rakai, Uganda:
maternal mortality: 1990 to 2010;
Africa: Democratic Republic of the
main messages. In: Jamison DT.,
A randomized trial. The Lancet. 2007;
WHO, UNICEF, UNFPA and World
Congo.
Breman JG., Measham AR., et al.,
369:657-66.
Bank estimates. 2012.
editors. Disease Control Priorities in Developing Countries. 2nd edition. Washington DC: World Bank. 2006. Chapter 2. 2. Based on: World Health Organization. 2008. Global burden of disease: 2004 update. 3. PSI is considered to be working
12. Joint United Nations Programme on HIV/AIDS (UNAIDS). World AIDS
maternal mortality. Obstetrics &
day report, 2011.
gynecology. Reviews in Obstetrics &
13. Wilcken, Andrea, Thomas Keil, and Bruce Dick. Traditional male Africa: A systematic review of
guidance for health systems. 2nd
prevalence and complications.
edition. 2012.
country only after interventions
Organization. 2010. 88:907-914.
reported. 4. World Health Organization Media Centre. Malaria. Fact sheet n. 94. Posted April, 2012. 5. The Kaiser Family Foundation. 2011. The global malaria epidemic. U.S. Global Health Policy Fact Sheet. 6. USAID Kenya. Malaria. Last updated April, 2011. 7. Joint United Nations Programme on HIV/AIDS (UNAIDS). World AIDS day report, 2011. 8. Condoms are also distributed for contraceptive purposes. 9. Auvert, B., Taljaard, D., Lagarde, et al. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: The ANRS 1265 Trial. PLoS Medicine. 2005; 2(11):1112-1122. 10. Bailey, R., Moses, S., Parker, C.B., et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: A randomized controlled trial. The Lancet. 2007; 369:643-56.
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22. World Health Organization. Safe abortion: Technical and policy
Bulletin of the World Health
health area are implemented and
Gynecology. 2008; 1(2): 77-81.
circumcision in eastern and southern
within a health area in a specific targeting disease burden within that
21. Nawal, N M. An Introduction to
14. Public Health Round-Up. Bulletin of
23. World Health Organization, UNICEF, UNFPA, and World Bank. Trends in maternal mortality: 1990 to 2010;
the World Health Organization. 2012;
WHO, UNICEF, UNFPA and World
90(1):1-74.
Bank estimates. 2012.
15. Curran et al. Voluntary medical male
24. Regions include: Northern Africa,
32. World Health Organization. Maternal, newborn, child and adolescent health. Child health epidemiology. 33. World Health Organization Media Center. Tuberculosis. Fact Sheet n. 104. Posted October, 2012. 34. World Health Organization Media Center. Tuberculosis. Fact Sheet n. 104. Posted October, 2012. 35. World Health Organization. Tuberculosis. The Stop TB stategy: Vision, goal, objectives and targets. 2010. 36. World Health Organization Tuberculosis profile: Myanmar.
circumcision: Strategies for meeting
Sub-Saharan Africa, Eastern Asia,
the human resource needs of scale-
Southern Asia, Southeast Asia,
up in Southern and Eastern Africa.
Western Asia, Caucasus and
PLoS Medicine.2011; 8(11).
Central Asia, Latin America and the
Health, Government of Myanmar.
Caribbean, and Oceana.
Report on national TB prevalence
16. Gingh, S., and Jacqueline E. D. Adding it up: Costs and benefits of
25. More information about MDG 5
contraceptive services; Estimates
can be found on the United Nations
for 2012. Guttmacher Institute and
website, here.
United Nations Population Fund. 2012. 17. World Health Organization, UNICEF, UNFPA, and World Bank. Trends in maternal mortality: 1990 to 2010; WHO, UNICEF, UNFPA and World Bank estimates. 2012. 18. Salif S., et al. Mali: DHS, 2006 - Final Report (French). CPS/MS/DNSI/ MEIC Bamako, Mali and Macro International Inc.. Calverton, Maryland, USA. 2007. 19. Population Services International. ProFam Urban Outreach:Â Â A high impact model for family planning. Washington, DC. 2012.
26. Somalia: Monitoring the situation of children and women. Multiple
Generated August, 2012. 37. Ministry of Health, Department of
survey: 2009-2010, Myanmar. 38. National AIDS Programme. Global AIDS response progress report: Myanmar. Submitted March, 2012. 39. Nationwide scale-up plan for TB/HIV
Indicator Cluster Survey. UNICEF.
collaborative activities in Myanmar,
2006.
2012-2015. A Draft.
27. World Health Organization. Children:
40. World Health Organization, UNICEF,
Reducing mortality. Fact Sheet n.
UNFPA, and World Bank. Trends in
178. Posted June, 2012.
maternal mortality: 1990 to 2010;
28. World Health Organization. Children: Reducing mortality. Fact Sheet n. 178. Posted June, 2012. 29. World Health Organization. Children: Reducing mortality. Fact Sheet n. 178. Posted June, 2012. 30. Regions include: Africa and Southeast Asia
WHO, UNICEF, UNFPA and World Bank estimates. 2012. 41. The prevention and management of unsafe abortion. Report of a Technical Working Group. Geneva. World Health Organization. 1992.
PSI Network
RUSSIA ● PSI / EUROPE KAZAKHSTAN ●◆ ROMANIA ●
UZBEKISTAN ●◆ TURKMENISTAN ●◆
PSI / WASHINGTON
MEXICO ●■
GUATEMALA ●■
PAKISTAN ■■◆
BELIZE ●■
HAITI ●■▲■
CARIBBEAN ●■
DOMINICAN REPUBLIC HONDURAS ●■▼ ●■ JAMAICA ●■ NICARAGUA ●■■
EL SALVADOR COSTA RICA ●■ ●■
KYRGYZSTAN ●◆
TAJIKISTAN ●◆
PANAMA ●■ SURINAME ●■
GUINEA ●▲▼■ LIBERIA ●▼■
PARAGUAY ●■
MYANMAR ●▲▼■◆■
LAOS ●■◆
THAILAND ●
NIGERIA ●■▲▼■◆■
BENIN ●▲▼■
VIETNAM ●▼◆■ CAMBODIA ●▲▼■◆
SOUTH SUDAN ●▲▼◆
SOMALILAND ■▼■ ETHIOPIA ●▼ UGANDA ●▲▼■ DEMOCRATIC KENYA REPUBLIC ●▲▼■■ OF CONGO RWANDA ●▲▼■◆ ●■▲▼■ UNITED REPUBLIC OF TANZANIA BURUNDI ●▲▼■ MALAWI ●▲■ ●▲▼■◆ ANGOLA ●▲▼ ZAMBIA ●▲▼■■
CAMEROON ●▲▼■◆■
CÔTE D’IVOIRE ●▼ TOGO ●■▲■
NEPAL ●▲▼■ INDIA ●▼■◆■
MALI ●▲▼■
SENEGAL ●▼■
CHINA ●◆
CENTRAL AFRICAN REPUBLIC ●■
ZIMBABWE NAMIBIA ●▲▼■◆ ●▼◆ MOZAMBIQUE BOTSWANA ●▲▼■ ●
SOUTH AFRICA ●
PAPAU NEW GUINEA ●▲▼■
MADAGASCAR ●▲▼■◆■
SWAZILAND ● LESOTHO ●
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health area key
● HIV = HIV n CS = Child Survival Includes Nutrition and Neonatal Care ▲ MAL = Malaria ▼ DD = Diarrheal Disease Includes Safe Water, Oral Rehydration and Hygiene ■ RH = Reproductive Health Includes Maternal Health and Family Planning ◆ RI = Respiratory Illness Includes TB and Pneumonia ■ NCD = Noncommunicable Disease Includes Cardiovascular Disease, Cancers, Diabetes and Chronic Obstructive Pulmonary Disease
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