PSI IMPACT REPORT: 2012 In 2010, death and disability were estimated to cost the world’s population
2.5 BILLION years of healthy life (or DALYs).i
HOW IS PSI
RESPONDING? PSI distributes products and provides services that save lives and prevent disability across 69 countries, averting the loss of healthy life - averting DALYs.
We maximize our impact by targeting health areas which account for 21% of the disease burden in countries where we work.
MALAR IA & CH I LD S U R V I VA L
17,76 0 , 955 DALYs AVE RTE D
H IV/AI D S & TB
9, 419, 577 DALYs AVE RTE D
FAM I LY PLAN N I N G & MATE R NAL H EALT H
7, 9 95 , 307 DALYs AVE RTE D
WHAT IS A ➔
DALY?
D I S A B I L I T Y- A D J U S T E D L I F E Y E A R : 1 YEAR OF HEALTHY LIFE LOST
Years of life lost due to DEATH
PSI averted
+
Years lived with a DISABILITY
35,175,839 DALYs in 2012.
= DALYs
PSI IMPACT REPORT: 2012
DALYs AVERTED
CYPs Provided:
21,153,796
that’s one way PSI
measures its
health impact
Another way we measure our impact is through couple years of protection, or CYPs.
PSI uses these metrics to inform decisions by identifying communities in need and targeting high burden health areas. We also conduct robust research in order to better understand the places where we work and the people we serve.
WHAT IS A
CYP?
C O U PLE YEAR S O F PR OTE CTI O N1 1 YEAR OF PROTECTION AGAINST
UNINTENDED PREGNANCY
PSI IMPACT REPORT: 2012 PSI focuses on serious challenges like a lack of family planning, HIV and AIDS, barriers to maternal health, and the greatest threats to children under five, including malaria, diarrhea, pneumonia and malnutrition – helping people lead healthy lives.
HEALTH IMPACT
AEE SA EA
WCA
DALYS AVERTED BY
HEALTH AREA AND REGION
LAC
WCA
23% FA M I LY P L A N N I N G & M AT E R N A L H E A LT H
LAC
50% M A L A R I A & C H I L D S U R V I VA L
AEE
SA
27% H I V /A I D S & T B
EA EA
WCA West and Central Africa2
WCA
LAC AEE
SA
EA East Africa3 SA Southern Africa4
= 1 million
AEE Asia and Eastern Europe5
= 1 million
LAC Latin America and the Caribbean6
DALYs AVERTED:
35,175,839
AEE
LAC
WCA EA SA
CYPs PROVIDED:
21,153,796
MALARIA & CHILD SURVIVAL
PSI IMPACT REPORT: 2012
O R I G I N A L R E S E AR CH
N O N-AC TS
HEALTH IMPACT
+
3%
Other8
3%
Long-lasting insecticidetreated mosquito nets (LLINs)
32%
62%
D I S PAR ITY
1ST-L I N E T R E AT M E NT (AC TS)
Identifying barriers: In Myanmar, the likelihood that a child with diarrhea will receive correct treatment (such as oral rehydration solution) depends on access to information, treatment, money and transportation. When treated at home without any consultation, only one in four children will receive appropriate treatment.iii
Community Case Management works7: In Cameroon, PSI’s community case management interventions have increased the likelihood of children receiving appropriate treatment for malaria and diarrhea by a factor of nearly nine, while reducing disparities in access to care based on wealth.iv
TR EATM E NT
Analyzing markets: In the private sector, which dominates the antimalarial market in many sub-Saharan African countries, first-line malaria treatment (artemisinin-based combination therapy, or ACT) is less available and can be 5-24 times more expensive than less effective, non-ACTs.ii
Antibiotic treatment courses for pneumonia
Pre-packaged artemisinin-based combination therapy treatments (ACTs)
P R O D U CT H I G H LI G HT
In 2012, PSI distributed nearly
24 million long-lasting insecticidetreated mosquito nets. With an effective life span of about three years, these nets will avert nearly
DALYs AVERTED:
17,760,955 A M
A
Z
O R V E R I
11 MILLION YEARS That’s the age of the Amazon river!
N
11 MILLION DALYs.
= 1 million
H I V /A I D S & TB
PSI IMPACT REPORT: 2012
O R I G I N A L R E S E AR CH
Social marketing works: In Vietnam, PSI’s social marketing campaigns are increasing HIV testing services among key populations, including female sex workers, their male clients, and people who inject drugs.vii
I
n Nigeria, disproportionately high rates of HIV among men who have sex with men are due to high levels of unprotected sex, multiple sex partners, and low levels of HIV testing.v In response, PSI’s network member, Society for Family Health (SFH), is leading a USAID-funded combination prevention program — combating the epidemic through biomedical, behavioral and structural interventions.
PSI outreach works: Throughout Central America, the outreach efforts of PSI’s network member, Pan American Social Marketing Association (PASMO), are significantly increasing condom use and HIV testing among men who have sex with men.vi
HEALTH IMPACT
Directly Observed Treatment, Short-course (TB DOTS)
1% +
P R O D U CT H I G H LI G HT
In 2012, PSI distributed nearly 1.3 billion male condoms, enough to
avert more than
GET TESTED!
6%
Other9
6% Male and female condoms
7.5 million DALYs
7%
80%
due to HIV.
That’s enough to circle the earth
2X!
= 1 million
DALYs AVERTED:
9,419,577
HIV testing and counseling services Voluntary medical male circumcision
FA M I LY P L A N N I N G & M ATE R N A L H E A LTH
PSI IMPACT REPORT: 2012
O R I G I N A L R E S E AR CH
Reducing cost barriers: By providing vouchers directly to pregnant women in Pakistan, PSI increased the level at which the poorest women in Jhang province gave birth in a health facility by 50% during 2010.ix
Demand creation works: Through outreach and expansion of accessible service delivery channels, PSI increased the use of long-acting reversible contraceptive methods within the context of informed choice. A recent study found that nearly one quarter of all intrauterine devices (IUDs) inserted across 13 countries during 2009– 2010 went to new contraceptive users.viii
Intrauterine devices (IUDs) and implants
3%
Other family planning and maternal health interventions10
HEALTH IMPACT
21% Cycles of oral contraceptive pills
51% 15%
P R O D U CT H I G H LI G HT
Over the past 5 years, the proportion of PSI’s impact from IUDs and implants has grown from
9% to 21%
10% Male and female condoms Injectable contraceptives
’08 ’12
= 1 million = 1 million
CYPs PROVIDED:
21,153,796 DALYs AVERTED:
7,995,307
SOCIAL FRANCHISING WORKS : A F O C U S O N TH E S U N N E T W O R K 11
PSI IMPACT REPORT: 2012
P
SI operates 27 social franchises across 26 countries. The Sun Network, comprised of Sun Quality Health (SQH) and Sun Primary Health (SPH), is a network of private providers supported by PSI/Myanmar which provides health products and services in six health areas: HIV/AIDS & STIs, malaria, tuberculosis, reproductive health, pneumonia, and diarrhea. Evidence shows that this network is improving access to high-quality products and services in low-income communities, elevating the quality of provider care, improving health outcomes, and strengthening the private health sector.
M YA N MAR
In urban areas, 25% of all SQH TB patients are in the lowest wealth quintile, compared to 16% of TB patients in the national sample.x In 2012, the PSI Myanmar Sun Network contributed 23,900 TB treatments (16% of national TB treatments).
Clinics joining SQH increased family planning service provision by as much as 380%.xi
The SPH network is increasing the rate at which children receive optimal treatment for diarrhea using oral rehydration solution and zinc.xii
TH E R E S U LT
PSI averted 35.2 million DALYs in 2012 by working at scale across 69 countries.
The evidence we generate through measurement informs programmatic decisions that help PSI maximize impact. We will further reduce the burden of disease and support Millennium Development Goals 1, 4, 5, 6, 7 and 8 by working with our partners to expand proven, cost-effective interventions - helping people lead healthy lives. For more information, please visit us at
psi.org
Population Services International
@PSIimpact
blog.psiimpact.com
ANNEX
PSI IMPACT REPORT: 2012
ADDITIONAL RESOURCES PSI produces metrics for the full range of products and services in the countries where we work. Additional data can be downloaded from our website at http://psi.org/resources/disability-adjusted-life-years-dalys/impact-reports. Additional publications produced by or in collaboration with PSI staff can be downloaded from our publications catalogue at http://psi.org/resources/publications.
NOTE S 1. CYPs (Couple Years of Protection) are based on USAID conversion factors. 2. West and Central Africa includes: Benin, Central African Republic, Cameroon, the Democratic Republic of the Congo, Cote d’Ivoire, Guinea, Liberia, Mali, Nigeria, Senegal, and Togo. 3. East Africa includes: Angola, Burundi, Ethiopia, Kenya, Malawi, Mozambique, Rwanda, Somaliland, South Sudan, Tanzania, and Uganda. 4. Southern Africa includes: Botswana, Lesotho, Madagascar, Namibia, South Africa, Swaziland, Zambia, and Zimbabwe. 5. Asia and Eastern Europe includes: Cambodia, China, India, Kazakhstan, Kyrgyzstan, Laos, Myanmar, Nepal, Pakistan, Papua New Guinea, Romania, Russia, Tajikistan, Thailand, Turkmenistan, Uzbekistan, and Vietnam. 6. Latin America and the Caribbean includes: Antigua and Barbuda, Barbados, Belize, Costa Rica, Dominica, the Dominican Republic, El Salvador, Grenada, Guatemala, Haiti, Honduras, Jamaica, Mexico, Nicaragua, Panama, Paraguay, Saint Kitts and Nevis, Saint Lucia, Saint Maarten, Saint Vincent and the Grenadines, Suriname, and Trinidad and Tobago. 7. Community Case Management relies on trained community health workers to improve the quality of, access to, and demand for key child health interventions. 8. Interventions include: Diarrhea treatment kits, oral rehydration solution, water treatment tablets, and safe water solution, among others. 9. Interventions include: Antiretroviral treatment for HIV, treatment kits for sexually transmitted infections, clean needles and syringes, doses of naloxone, and basic care packages, among others. 10. Interventions include: Clean delivery kits, cervical cancer screening, voluntary surgical contraception, medication abortion combination packs, misoprostol tablets for post-partum hemorrhage and post-abortion care, manual vacuum aspiration services for post-abortion care, and multivitamin tablets, among others. 11. Social franchising uses commercial franchising strategies to respond to the health needs of communities. It builds on the existing private sector infrastructure and strengthens the capacity of private clinics, pharmacies, and community providers to deliver quality services.
REFERENCES i. Institute for Health Metrics and Evaluation. The global burden of disease: Generating evidence, guiding policy. Seattle, WA: IHME, 2013. ii. O’Connell, Katherine A. et al. 2011. “Got ACTs? Availability, price, market share and provider knowledge of anti-malarial medicines in public and private sector outlets in six malaria-endemic countries.” Malaria Journal 10:326. Available at http://www.malariajournal.com/content/10/1/326/ iii. Aung, Tin, Willi McFarland, Hnin Su Su Khin, and Dominic Montagu. 2012. “Incidence of pediatric diarrhea and public-private preferences for treatment in rural Myanmar: A randomized cluster survey.” Journal of Tropical Pediatrics 59(1):10-6. Available at http://www.ncbi.nlm.nih.gov/pubmed/22874876 iv. Littrell, Megan, Laure Vartan Moukam, Roger Libite, Jean Christian Youmba, and Gunther Baugh. 2011. “Narrowing the treatment gap with equitable access: Mid-term outcomes of a community case management program in Cameroon.” Health Policy and Planning. Available at http://www.ncbi.nlm.nih. gov/pubmed/23144228 v. Vu, Lung et al. 2013. “High HIV prevalence among men who have sex with men in Nigeria: Implications for combination prevention.” Journal of Acquired Immune Deficiency Syndrome. 63(2): 221-7 http://www.ncbi.nlm.nih.gov/pubmed/23406978 vi. Vu, Lung, Benjamin Nieto-Andrade, Rebecca Firestone, Jose Enrique Martinez, and Krishna Jafa. 2012. “Effectiveness of interpersonal communications (IPC) on reducing HIV risk among men who have sex with men (MSM) in 5 countries in Central America: Guatemala, El Salvador, Honduras, Nicaragua, and Panama.” International AIDS Conference 2012 poster presentation. Available upon request vii. Mundy, Gary, Josselyn Neukon, Dinh Truong Linh Chi, and Do Huu Thuy. 2012. “VCT uptake among most at risk populations in Vietnam: The contribution of social marketing to an HIV prevention program.” International AIDS Conference 2012 poster presentation. Available upon request viii. Blumenthal, Paul D., Nirali M. Shah, Kriti Jain, Aleen Saunders, Corina Clemente, Brad Lucas, Krishna Jafa, and Maxine Eber. 2012. “Revitalizing long-acting reversible contraceptives in settings with high unmet need: A multicountry experience matching demand creation and service delivery.” Contraception. 87(2): 170-175. Available at http://www.contraceptionjournal.org/article/S0010-7824(12)00891-8/abstract ix. Agha, Sohail. 2011. “In Jhang, Pakistan, providing vouchers directly to pregnant women has proven effective at increasing childbirth in health facilities among poor women in rural settings.” International Journal for Equity in Health. 10:57. Available at http://www.equityhealthj.com/content/10/1/57 x. Montagu, Dominic, May Sudhinaraset, Thandar Lwin, Ikushi Onozaki, Zaw Win, and Tin Aung. 2013. “Equity and the Sun Quality Health private provider social franchise: Comparative analysis of patient survey data and a nationally representative TB prevalence survey.” International Journal for Equity in Health. Available at http://www.equityhealthj.com/content/12/1/5 xi. Huntington, Dale, Gary Mundy, Nang M. Hom, Qingfeng Li, and Tin Aung. 2011. “Physicians in private practice: Reasons for being a social franchise member.” Health Research Policy and Systems 10:25. Available at http://www.health-policy-systems.com/content/10/1/25 xii. Montagu, Dominic, Kim Longfield, Christina Briegleb, and Tin Aung. 2013. Private sector healthcare in Myanmar: Evidence from the 'Sun' social franchise. PSI & UCSF. Available at http://psi.org/resources/research-metrics/publications/child-survival/private-sector-healthcare-myanmar-evidence-su Smith, Graham, Amy Ratcliffe, Lek Ngamkitpaiboon, Hongmei Yang, Meghan Reidy and Kim Longfield. 2013. “PSI Impact Report: 2012.” Population Services International.