test by PSI Population Services International

⁄

health impact 2

local solutions 4

equity 6

integration 8

scale 12

innovation 14

value for money 16

how PSI measures impact 17

psi worldwide 18

leadership 20

financials 21

10 12 8

—Karl Hofmann, President and CEO, PSI 2 | P S I P R O G R E S S R E P O R T 2011

SI is a leading global health organization with programs targeting malaria, childhood diarrhea, pneumonia, nutritional deficiencies, HIV, tuberculosis and reproductive health. PSI is also starting to develop programs related to non-communicable diseases such as cervical cancer, diabetes, obesity, genderbased violence and tobacco control. Working in partnership within the public and private sectors, PSI provides life-saving products, clinical services and behavior change communications that empower the world’s most vulnerable populations to lead healthier lives. PSI has a team of researchers who monitor and assess our activities on everything from service delivery to product distribution. In 2010, PSI’s programs directly prevented more than 186,000 HIV infections, more than 4.2 million unintended pregnancies, nearly 300,000 child deaths from malaria and diarrhea, and nearly 28 million malaria episodes.* * PSI Health Impact Report 2010.

“ PSI delivers measurable results; we are introspective and committed to finding the best strategy and models to do our job well and meet the needs of the people we serve.”

11 MILLION 1 BILLION+ 18 MILLION+ SAVED

38 MILLION+ HALF46,000 A MILLION+ 320,000 CASES YEARS OF LIFE THROUGH INTERVENTIONS IN FIVE HEALTH AREAS: CHILD SURVIVAL, HIV, MALARIA, REPRODUCTIVE HEALTH AND TUBERCULOSIS

DISTRIBUTED

MALE AND FEMALE CONDOMS

166,000+ INTRAUTERINE DEVICES INSERTED

DISTRIBUTED

NEARLY 28 MILLION MOSQUITO NETS 1.8 MILLION+

CLIENTS PROVIDED WITH HIV COUNSELING AND TESTING IN 26 COUNTRIES

AVERTED

4.2 MILLION+ UNINTENDED PREGNANCIES GLOBALLY TREATED

14 BILLION+

LITERS OF WATER TREATED IN 31 COUNTRIES TO PREVENT DIARRHEAL DISEASE

DISTRIBUTED...

PERFORMED...

TREATED...

n nearly 11 million doses of pre-packaged artemisinin-based

contraception in Pakistan n more than 75,000 male circumcisions in Mozambique, South Africa, Swaziland, Zambia and Zimbabwe

n more than 14,000 cases of TB through DOTS, Directly

n more than 38 million cycles of oral contraceptive pills

combination therapies for treatment of malaria n more than half a million doses of pre-packaged standard therapy for sexually transmitted infections

n more than 46,000 cases of voluntary surgical

n more than 320,000 cases of pneumonia in Ethiopia,

Malawi and Myanmar Observed Treatment Short Course, (WHO-recommended treatment) in Myanmar and Pakistan

P S I P R O G R E S S R E P O R T 20 1 1 | 3

PSI finds local solutions that have a global impact.

Our 9,000 local employees in the 67 countries dedicate their lives to improving the health of people in their communities. In 12 countries, PSI’s affiliate organizations are locally registered and almost entirely autonomous. PSI’s country platforms are increasingly self-reliant and draw strength from our global network. PSI provides malaria control support to national Ministries of Health in more than 30 countries worldwide.

nearly

11 MILLION

DOSES OF PRE-PACKAGED ARTEMISININBASED COMBINATION THERAPIES (ACTS) DISTRIBUTED GLOBALLY IN 2010 FOR TREATMENT OF MALARIA.

If the nets (in their packaging) were laid out side by side, the line would cover 18,939 miles. This is equivalent to 76% of the earth's circumference.

GLOBAL MALARIA EPISODES AVERTED

28,165,272 26,795,588 25,862,760

2010

2009 2008

nearly

28 MILLION

NUMBER OF BED NETS DISTRIBUTED BY PSI GLOBALLY IN 2010 TO PREVENT MALARIA. FREE DISTRIBUTION ACCOUNTED FOR AN ESTIMATED 95% OF THE BED NET DISTRIBUTION.

100 MILLIONTH

IN 2010, PSI DISTRIBUTED ITS 100 MILLIONTH MOSQUITO NET SINCE NET DISTRIBUTION BEGAN IN 1997. ➤ Scan here to learn how PSI's local solutions are resolving challenges in reproductive health, HIV and TB.

4 | P S I P R O G R E S S R E P O R T 2011

LOCAL SOLUTIONS TO LOCAL CHALLENGES

DONOR: The Global Fund to Fight AIDS, Tuberculosis and Malaria PARTNER: Government of South Sudan, Ministry of Health, BRAC, Catholic Diocese of Torit, International Rescue Committee, Malaria Consortium, Save the Children in South Sudan

rowing up in a rural area of Jonglei state in Sudan, far too often I witnessed malaria take the lives of innocent children in our community. Health facilities are few and far between in the some regions of South Sudan, leaving our communities vulnerable to this merciless, yet preventable killer. Political instability and insecurity in South Sudan led me to seek educational opportunities outside of my home country, but after completing my studies I came back to help fight malaria. In 2008, I was hired by PSI/South Sudan and commenced what has become a strong partnership. Today I’m proud to be the Program Manager of a successful malaria team. The impact of this department in the community is so great; it is fulfilling to be involved in this work. I’m motivated by the people we meet and the lives we save. During a recent mosquito net distribution, an elder in a small village not far from where I once lived expressed his gratitude for the nets we provided his people in 2009. He told me fewer children have died from malaria in his community since they began using the nets. As we celebrate our new nation and a bright future for our people, we will continue to work hard to reduce preventable deaths due to malaria and increase access to treatments for our communities living throughout South Sudan.

➤ Check out more stories and photos about people like Peter Matiop at psi.org.

P S I P R O G R E S S R E P O R T 20 1 1 | 5

PSI focuses on the needs of the child

through integrated pneumonia, diarrhea and malaria programs. In 2010, nearly 9 million children under five years of age died of causes related to these diseases. PSI supports national Ministries of Health to implement integrated child survival programs and enable the scale up of proven, evidence-based interventions that are appropriately packaged and marketed in the local context. To reach families in remote areas, PSI trains community health workers to diagnose and treat common childhood illnesses, or to refer to local clinics when necessary. PSI's focus on integration produces measurable results and ensures a positive impact on the health of children and families.

NEW PSI PROGRAM SHOWS COMMUNITY HEALTH WORKER IMPACT

INTEGRATED TREATMENT OF CHILDHOOD DISEASES

In the Cameroonian districts where PSI launched the Canadianfunded Impact program, 61% of symptomatic children were treated for diarrhea – 90% of them were treated by community health workers. In the districts without the program, just 7% of symptomatic children received treatment for diarrhea – most of them from a public facility.

PSI has growing experience working with community health workers to improve access to health care in rural communities. PSI is involved in integrated case management (ICM) by providing treatment for diarrhea, pneumonia and malaria. In Mali, Cameroon, DRC and Malawi, community health workers provide diagnosis and treatment and then make a referral when they are unable to provide care at the community level. In Uganda, community health workers refer caregivers to a local facility where a child can receive care.

ANTIBIOTICS FOR TREATMENT OF PNEUMONIA IN CHILDREN DISTRIBUTED IN 2010 - DOUBLE THE DISTRIBUTION IN 2009.

8 | P S I P R O G R E S S R E P O R T 2011

PSI distributed 1.5 million diarrhea treatment kits globally in 2010. A diarrhea treatment kit contains two sachets of oral rehydration salts to prevent of dehydration and zinc tablets to reduce the severity of the diarrhea episode.

Cameroon

Malaria

Democratic Republic of the Congo

Diarrheal Disease

Pneumonia

Mali

Malawi

Uganda

➤ PSI also provides integrated family planning and maternal health services to women. Scan here to learn more about PSI’s integrated approaches in reproductive health and other health areas.

COMMUNITY HEALTH WORKERS, VILLAGE HEROES

arlier this year when Sandra Konjons developed a fever, her mother sought care from Desire Andono, a community health worker (CHW) in rural Cameroon. Desire treated Sandra with an artemisinin combination therapy (ACT), the top-line treatment for malaria. Her mother sought care for Sandra two more times for diarrhea, and Desire promptly provided oral rehydration salts (ORS) and zinc. ORS prevent dehydration, which is the main cause of death when a child has diarrhea, and zinc tablets reduce the severity of the diarrheal episode. Now, Sandra is a vibrant and healthy three year old. Only two years ago, children in this area who developed fever or diarrhea had very little chance of accessing any effective treatment. Today they can seek help from a cadre of approximately 1,749 Cameroonian CHWs trained under PSI’s Community Case Management Impact Program, funded by Canadian International Development Agency. The CHWs represent the first line of defense against major childhood killers such as malaria and diarrhea by increasing access to life-saving interventions in the poorest and most remote communities where quality health services are virtually non-existent. The CCM Impact program is also supporting hundreds of CHWs in DRC, Malawi and Mali. These community health workers are selected from the communities they serve and trained to provide a clinical diagnosis of malaria, pneumonia and diarrhea, and to treat appropriately or refer severe cases to a health facility. By providing this service in the community, treatment is provided before diseases progress to a life threatening stage. In December 2012, the program will be evaluated for the impact on all-cause child mortality. Until then, Desire and his colleagues will continue their work as village heroes, reaching the most underserved and preventing child deaths in their community. DONOR: Canadian International Development Agency (CIDA) PARTNER: Association Camerounaise pour le Marketing Social (ACMS), PSI’s affiliate in Cameroon ➤ Check out more stories and photos at psi.org.

IN THE CAMEROONIAN DISTRICTS WHERE PSI LAUNCHED THE CANADIAN-FUNDED IMPACT PROGRAM, 57%% OF SYMPTOMATIC CHILDREN WERE TREATED FOR MALARIA – 82% OF THEM WERE TREATED BY COMMUNITY HEALTH WORKERS. IN THE DISTRICTS WITHOUT THE PROGRAM, JUST 24% OF SYMPTOMATIC CHILDREN RECEIVED TREATMENT FOR DIARRHEA – MOST OF THEM FROM A PUBLIC FACILITY.

PSI believes in equity for every woman, man and child.

More than 200 million women worldwide have an unmet need for family planning. Today, PSI's reproductive health programs are improving lives of families in 36 developing countries worldwide. We remain focused on providing quality health care regardless of a woman's income level or location. In many countries, PSI coordinates mobile outreach services and clinic event days to expand access to comprehensive contraceptive choices, maternal health products and services and sexually transmitted prevention and treatment, while creating strong links to other health areas.

PSI PROVIDED

YEARS OF PROTECTION PER COUPLE IN 2010. NEARLY HALF OF THIS HEALTH IMPACT WAS GENERATED IN PAKISTAN, NIGERIA AND INDIA.

GLOBAL MATERNAL DEATHS AVERTED

21,776 19,568 18,263 17,315

2010

CYCLES OF ORAL CONTRACEPTIVE PILLS IN 2010 A 27% INCREASE FROM 2009 - TO HELP WOMEN AND COUPLES BETTER PLAN FOR THEIR FAMILIES.

HIGH INCOME

2009 2008 2007

PSI DISTRIBUTED

TOTAL MARKET APPROACH

PSI DISTRIBUTED

INTRAUTERINE DEVICES TO HELP WOMEN SPACE THEIR BIRTHS AND STAY HEALTHY.

MIDDLE INCOME

LOW INCOME

PSI uses a total market approach (TMA) to achieve a marketplace where all segments of society are reached according to their ability to pay: the resource-poor through free distribution, those somewhat better off through subsidized products, and those with greater ability to pay through commercially-distributed products. The metrics by which we measure the total market approach are impact, equity and sustainability.

➤ Scan here to learn more about PSI’s commitment to equity. 6 | P S I P R O G R E S S R E P O R T 2011

ngrid Alvarado, 44, has a warm smile and a caring nature. It is no surprise that she is a mother of seven children. Today, Ingrid is happy and healthy, and so are her kids, but she has experienced her share of struggles. Ingrid and her family live in a poor neighborhood in Guatemala City. Her husband is a day laborer and brings home a small income. Ingrid stays home to care for their children. Ingrid knew about family planning early on and searched for the right method. She first struggled to find access to an affordable option; then she experienced painful side effects from hormonal methods and eventually discontinued family planning. And her family grew…as their resources thinned. After her last child was born, she saw a flyer for a public health clinic day hosted by PASMO, PSI’s affiliate in Latin America, and decided to attend. Though private clinics, such as those in PASMO’s network Red Segura, provided these services for women of a lower or middle income status, Ingrid could not afford to pay even a little and sought out the free services at the public health clinic. There, a PASMO health worker educated her about family planning and her options. Ingrid chose to get an IUD, which is non-hormonal and prevents pregnancy up to 12 years. Ingrid is happy to recount that she has not been pregnant since she received the IUD. She cares deeply for her children and is proud that she is able to share information and insight on family planning with them. Ingrid has advised her three married children to use contraception. Today one of Ingrid’s daughters uses the IUD and her daughter-in-law uses a hormonal implant. DONOR: Women’s Health Project PARTNERS: Pan American Social Marketing Organization (PASMO) ➤ Check out more stories and photos at psi.org.

REACHING EVERY WOMAN P S I P R O G R E S S R E P O R T 20 1 1 | 7

PSI works at scale on a global level to meet the needs of those we serve. We are a leader in implementing innovative and evidence-based HIV prevention interventions. Our HIV programs engage all sectors in the response, developing innovative campaigns to create informed demand for HIV products and services and employing efficient approaches to deliver quality services to hundreds of thousands of people.

HIV HEALTH IMPACT IN 2010

PSI PROVIDED

+ .

MALE AND FEMALE CONDOMS DISTRIBUTED

CLIENTS WITH HIV COUNSELING AND TESTING IN 26 COUNTRIES

PSI PREVENTED

MALE CIRCUMCISION CLIENTS*

HIV INFECTIONS THROUGH A RANGE OF HIGH-QUALITY PRODUCTS AND SERVICES, AND TARGETED BEHAVIOR CHANGE COMMUNICATIONS.

1 2 | P S I P R O G R E S S R E P O R T 2011

20,129 2,154 216

2010

2009

75,207

* Clients were from Zimbabwe, Zambia, Swaziland, South Africa, Mozambique.

2008 2007

â&#x17E;¤ Scan here to learn more about how PSI works at scale in other health areas to reduce the burden of disease in the countries where we work.

y name is Honesty Mweene. I was born in Magwama village in Lusaka Province of Zambia, and I’m a psychosocial counselor by profession. In 2009, I joined the voluntary medical male circumcision (VMMC) program of the Society for Family Health (SFH), PSI’s affiliate in Zambia as a VMMC counselor. I was inspired to join the program after working with commercial sex workers and truck drivers along the border with Zimbabwe, and seeing the many social problems related to HIV/AIDS. I also underwent circumcision at our SFH center and it was a life-changing experience. When I began promoting VMMC within the non-circumcising community where I live in Southern Province, it was difficult to convince men to come for the procedure. Many had misconceptions and were afraid of the pain. The community had little knowledge of VMMC, and some actually wondered if the process could cure them of HIV. But things are changing. Today most men I meet have heard about VMMC from their friends or from SFH community health promoters and this has made my work much easier. When offering counseling before or after the circumcision, we listen carefully to the clients’ concerns so that we can provide the right kind of support and guidance. Most men are motivated to adopt safer sexual practices after the procedure, but we want them to continue with those behaviors long-term. In my time with SFH, I have proudly provided comprehensive education and behavioral counseling to more than 1,000 clients. Since the program launched in 2007, with support from the Bill & Melinda Gates Foundation and USAID, more than 100,000 clients have accessed services, ranging from group education, voluntary HIV testing to post-procedure behavioral counselling. I believe male circumcision can contribute greatly to the fight against HIV and AIDS in my country. DONORS: U.S. Agency for International Development and the Bill & Melinda Gates Foundation PARTNERS: Marie Stopes International, Jhpiego and Population Council, Zambian Ministry of Health ➤ Check out more stories and videos at psi.org.

HIV CASES AVERTED FROM MALE CIRCUMCISION REGIONALLY 2007-2009

CHANGING BEHAVIOR, PREVENTING HIV

PSI addresses the link between tuberculosis and HIV. Tuberculosis

(TB) is a preventable disease, but it remains one of the leading causes of death among women of reproductive age and people living with HIV. PSI’s uses a public-private sector approach to deliver TB services to vulnerable populations in Asia and Africa. We integrate routine TB screening for clients who access our network of voluntary HIV counseling and testing (CT) centers. In 2010, PSI’s TB-DOTS programs saved more than 52,000 years of life.

PSI’S TB PROGRAMS:

PSI’S APPROACH TO TB PROGRAMMING •

• India • Kazakhstan • Kyrgyzstan • Laos • Myanmar • Pakistan • Swaziland • South Africa • Tajikistan • Vietnam • Zambia • Zimbabwe

Retool, Rethink and Recharge

with a Journalism Fellowship at Stanford

The John S. Knight Journalism Fellowships offers a year of study, research and creativity — in the company of other accomplished journalists at one of the top academic institutions in the world. A year to pursue your inspirations and develop something of benefit to yourself and the profession. What could be better? We give outstanding journalists the chance to broaden and deepen their understanding of a changing industry while working on journalism issues in the real world. Our goal? To improve the quality of news and information reaching the public through the news media: print, broadcast and cyberspace. JOHN S. KNIGHT FELLOWSHIPS

Building 120, Room 422 Stanford, CA 94305-2050 email: info@kf.stanford.edu http://knight.stanford.edu

C ome help us transform journalism — and yourself, and your career, too.

John S. Knight Fellowships

STANFORD UNIVERSIT Y

ZIMBABWE PSI/Zimbabwe’s HIV testing and counseling SOUTH AFRICA centers have identified PSI’s New Start 24,000 patients franchise tested more suspected of TB since than 7,000 people for screening began in HIV from July 20062005. Of these, 10,000 2009, and 37% tested received TB diagnostic positive. New Start services and 4,000 MYANMAR AND uses mobile units to were started on TB PAKISTAN provide voluntary HIV treatment. Ninety-one Initiated treatment for counseling and testing percent of HIV-positive 14,000+ cases of TB to clients at TB wards at clients were screened through DOTS, Directly two partner hospitals. for TB from February Observed Treatment The program offers to October 2010, and Short Course, HIV testing to patients 55% were successfully (WHO-recommended with suspected and referred to a national treatment guideline). confirmed cases of TB. TB center. 1 0 | P S I P R O G R E S S R E P O R T 2011

PUBLIC-PRIVATE MIX PSI recruits and trains private and public sector healthcare providers in TB symptomatic screening, diagnosis, treatment and referrals. Providers are connected through branded social franchises and unbranded networks that benefit from a common promotional and quality improvement system, implemented by PSI and in collaboration with local authorities and partners. KAZAKHSTAN, KRYGYZSTAN TAJIKISTAN PSI has integrated TB messaging into its HIV prevention programs that reach most at-risk populations. Activities range from peer education and case management to support guides who escort clients to and from HIV and TB services. The program will reach 71,000 individuals between 2009 and 2014.

SERVICES INTEGRATION PSI integrates routine TB screening for clients who access its network of voluntary HIV counseling and testing (CT) centers. HIV CT counselors use a simple questionnaire to identify TB suspects and to refer them for diagnosis and treatment. PSI also offers HIV CT at TB diagnostic treatment sites.

DEMAND CREATION PSI utilizes interpersonal and mass communications and community outreach campaigns to promote TB services, increase care-seeking behaviors and reduce stigma around TB and treatment. ADHERENCE CHAMPIONS PSI trains providers and treatment adherence champions (from within the community and among family members of patients) to followup with and support patients throughout their treatment program. These champions also can identify and refer others who might be at risk for TB.

➤ Scan here to learn more about PSI’s commitment to implementing cost-effective programs.

alitha Gopal runs a rental shop in the Bagalur slum of Bangalore, India, where thousands of migrant construction workers from various Indian states live in tiny low-roofed dwellings with hardly any ventilation. This slum has been identified by the Revised National Tuberculosis Control Programme (RNTCP) as having one of the highest concentrations of tuberculosis (TB) cases in the city. In November 2009, the Project Connect team, a USAID-funded project led by PSI/India, met Lalitha as they searched for a volunteer from Bagalur to help TB patients who could not get to the health center for DOTS treatment. DOTS (directly observed treatment, shortcourse) is the WHO-approved treatment for TB. Lalitha became an energetic volunteer and was trained by PSI and the RNTCP to administer DOTS in her community. Saving lives and helping those in need motivated her to become a volunteer, Lalitha says. Belonging to a Tamil family who migrated to Bangalore, Lalitha identifies with the plight of the migrant workers who had limited access to treatment. ”When forced to make a choice between taking rest and a starving family, many patients chose the latter, throwing themselves to peril by opting to work,” she says. Lalitha has so far successfully administered DOTS to 10 people and motivated many community members with symptoms to get tested for TB. She received the award for the best DOTS provider in Greater Bangalore Municipal Corporation in March 2011 for her exceptional contributions. People like Lalitha have crucial role to play in India’s fight against TB and HIV as the government faces challenges in reaching the hard to reach. DONORS: U.S. Agency for International Development PARTNERS: Indian Ministry of Health

Lalitha Gopal, a community volunteer for the national TB program at Bagalur slum in Bangalore, India.

TREATMENT ADHERENCE CHAMPION P S I P R O G R E S S R E P O R T 20 1 1 | 1 1

(SOCIAL) FRANCHISING FOR HEALTH

PSI’S SOCIAL FRANCHISING NETWORKS PROVIDE

PEOPLE WITH HIGH QUALITY ESSENTIAL HEALTH CARE SERVICES.

ranchising has reached millions around the world by identifying a consumer need and filling it over and over again with standardized products or services. Social franchising does the same thing, but with the goal of improving quality of life, rather than generating profit. With more than 15 years of experience and social franchises in 22 countries, PSI is the world’s largest social franchiser of health care to resourcepoor communities. PSI has successfully adopted the model to offer high-quality health care products and services, in both the private and the public sector, to lowincome people around the world. PSI developed and tested models to deliver quality services in a range of health areas including family planning; prevention and treatment of postpartum hemorrhage; HIV counseling and testing; male circumcision; diarrheal disease management; and diagnosis and treatment of malaria, pneumonia and tuberculosis. Through this innovative and cost-effective approach, PSI aims to provide an integrated package of highquality and affordable health services through one delivery point.

PSI HAS MORE THAN 10,000 FRANCHISE SITES IN 22 COUNTRIES.

IN MYANMAR, PSI’S SUN QUALITY HEALTH NETWORK CURR ENTLY CONTRIBUTES APPROXIMATELY 11% OF THE NATIONAL TB CASES REGISTERED AND BEING TREATED.

•

Green Star – Pakistan ProFam – Benin, Cameroon, Mali POMEFA (“POur une MEilleure FAmille”) – Togo

Saadhan – India

Sun Quality Health Network – Cambodia, Nepal, Laos, Myanmar

Retool, Rethink and Recharge

with a Journalism Fellowship at Stanford

Building 120, Room 422 Stanford, CA 94305-2050 email: info@kf.stanford.edu http://knight.stanford.edu

C ome help us transform journalism — and yourself, and your career, too.

John S. Knight Fellowships

ed Segura – R El Salvador, Guatemala, Nicaragua

STANFORD UNIVERSIT Y

Happy Mothers Network – Nigeria Réseau Confiance – Democratic Republic of Congo NewStart – Zambia, Zimbabwe

ProFam – Uganda Tunza Family Health Network – Kenya Familia – Tanzania

Top Réseau – Madagascar

Sisterhood Network – South Africa

PSI is a part of a global community of practice in social franchising. P S I P R O G R E S S R E P O R T 20 1 1 | 17

Angola

HIV, MAL, DD

●▲▼

Burundi

HIV, MAL, DD

●▲▼

Ethiopia

HIV, DD

Kenya

HIV, MAL, DD, RH

●▲▼n

Burkina Faso HIV, RH

Malawi

HIV, MAL, DD, RH

●▲▼n

Cameroon

Mozambique HIV, MAL, DD, RH

●▲▼n

Rwanda

●▲▼n

Central African Republic HIV, MAL

HIV, MAL, DD, RH

●▼

Somaliland DD, RH Sudan

▼n

HIV, MAL, DD

●▲▼

Benin

HIV, MAL, DD, RH HIV, MAL, DD, RH

Cote d’Ivoire HIV, MAL, DD DR Congo

HIV, MAL, DD, RH HIV, DD, RH

Belize

HIV, RH

●n

Cambodia

HIV, MAL, DD, RH

●n

Caribbean

HIV, RH

●n

China

HIV, RI

●▲▼n

Costa Rica

HIV, RH

●n

India

HIV, DD, RH, RI

Dominican Republic

Kazakhstan

HIV, RI

●▲

HIV, DD, RH

Kyrgyzstan

HIV, RI

●n

Laos

HIV, MAL, RH, RI

●n

Myanmar

HIV, MAL, DD, RH, RI ● ▲ ▼ n ◆

Nepal

HIV, MAL, DD, RH

●▲▼n

●▲▼

El Salvador HIV, RH

●▲▼n

Guatemala HIV, RH

●▼n

HIV, RH

●n

Pakistan

RH, RI HIV, MAL, DD

●◆ ●▲n◆

HIV, MAL, DD, RH

●▲▼n

Uganda

HIV, MAL, DD, RH

●▲▼n

Liberia

HIV, DD

Mali

HIV, MAL, DD, RH

●▲▼n

Mexico

HIV, RH

●n

Nigeria

HIV, MAL, DD, RH

●▲▼n

Nicaragua

HIV, RH

●n

Papua New Guinea

Togo

HIV, MAL, RH

Panama

HIV, RH

●n

Romania

HIV

Paraguay

HIV, RH

●n

Russia

HIV, RI

●◆

Tajikistan

HIV, RI

●◆

Thailand

HIV

●▲n

Honduras

●◆

Tanzania

●▼

HIV, MAL, DD, RH

●◆ ●▼n◆

Guinea

●▼n

Haiti

●▲▼n

Turkmenistan HIV, RI Botswana Lesotho

HIV HIV

Madagascar HIV, MAL, DD , RH, RI Namibia

HIV, DD , RI

South Africa HIV

1 8 | P S I P R O G R E S S R E P O R T 2011

Swaziland

HIV

Zambia

HIV, MAL, DD, RH

Zimbabwe

HIV, MAL, DD, RH, RI

●

Uzbekistan

HIV, RI

●

Vietnam

HIV, DD, RI

●▲▼n◆ ●▼◆ ● ● ●▲▼n ●▲▼n◆

●▲▼n n◆ ●▲n ●

● ●◆ ●◆ ●▼◆

RUSSIA ●◆ PSI / EUROPE KAZAKHSTAN ●◆

ROMANIA ●

UZBEKISTAN KYRGYZSTAN ●◆ ●◆ TURKMENISTAN TAJIKISTAN ●◆ ●◆

PSI / WASHINGTON

PAKISTAN ■◆ MEXICO ●■

DOMINICAN REPUBLIC BELIZE ●■▼ ●■ HAITI HONDURAS ●▲▼■ GUATEMALA ●■ ●■ NICARAGUA EL SALVADOR ●■ ●■ PANAMA COSTA RICA ● ■ ●■

CHINA ●◆ NEPAL ●▲■◆

INDIA ●▼■◆ MALI ●▲▼■

CARIBBEAN ●■

SUDAN BURKINA FASO ●▲▼ ●■ SOMALILAND NIGERIA ▼■ GHANA ● ▲ ▼ ■ CENTRAL AFRICAN ETHIOPIA ●▲▼■◆ REPUBLIC ●▼ LIBERIA ●▲▼■◆ ●▼ UGANDA CAMEROON ●▲▼■ ●▲▼■ COTE D’IVOIRE DEMOCRATIC ●▲▼ REPUBLIC OF CONGO KENYA ●▲▼■ ●▲▼■ RWANDA TOGO ●▲▼■ ●▲■ BURUNDI TANZANIA BENIN MALAWI ●▲▼■ ●▲▼ ●▲▼■ ●▲▼■◆ GUINEA ●▼■

ANGOLA ● ▲ ▼ ZAMBIA ●▲▼■

SOUTH AFRICA ●

● HIV = HIV n CS = Child Survival ▲ 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

PAPAU NEW GUINEA ●▲▼

MOZAMBIQUE ●▲▼■

ZIMBABWE NAMIBIA ●▲▼■◆ ●▼◆ BOTSWANA ●

PARAGUAY ●■

MYANMAR ● ▲ ▼ ■ ◆LAOS ●▲■◆ THAILAND VIETNAM ● ●▼◆ CAMBODIA ●▲▼■

MADAGASCAR ●▲▼■◆

SWAZILAND ● LESOTHO ●

P S I P R O G R E S S R E P O R T 20 1 1 | 1 9

PSI SPENT

ON AVERAGE, PSI SPENT

ON AVERAGE, PSI SPENT $32.06 TO SAVE A YEAR OF LIFE IN 2009. THE WORLD BANK STATES THAT INTERVENTIONS COSTING $50 OR LESS PER DALY AVERTED IN LOWINCOME SETTINGS ARE HIGHLY COST-EFFECTIVE.

PSI'S NET COST PER YEAR OF LIFE SAVED BY HEALTH AREA per malaria DALY

IN 2009, IT COST PSI...

$0.01 $18.73 $44.68 $0.13 $54.77 $0.53 $57.35

to treat 10 liters of water

per HIV & TB DALY

To protect a couple for a one-year period using contraceptives in 2009.

to distribute a male condom

per reproductive health DALY

per child survival DALY

to distribute a cycle of oral contraceptives

$0.58 $2.37 $25.01 $100.95

to treat a case of pneumonia

PSI'S NET COST PER YEAR OF LIFE SAVED 2005-2009 PSI is consistently cost-effective with its interventions.

$29.96 ❘

2005

DALY

$30.60

$32.09

$26.25

$27.70

❘

2006

2007

2008

2009

PSI measures its health impact with the DALY (disability-adjusted life year). One DALY equals one year of life lost due to illness or death. In the context of PSI, we avert DALYs, meaning that we work to prevent the loss of one year of healthy, productive life. Cost effectiveness of PSI’s interventions can be estimated by combining cost data and DALYs averted.

1 4 | P S I P R O G R E S S R E P O R T 2011

to treat a case of sexually transmitted infection

per client for voluntary HIV counseling and testing services

to treat one client with top-line TB treatment (DOTS)

➤ Scan here to learn more about PSI’s commitment to implementing cost-effective programs.

PSI

estimates its health impact using the disability-adjusted life year (DALY), a metric developed by the World Bank and the World Health Organization to estimate disease burden. One DALY equals one year of healthy life lost due to illness or death. PSI estimates its health impact in terms of DALYs averted. For every DALY averted by PSI, one year of healthy life would have been lost without PSI's intervention. Another way to think of it is in terms of life years saved. PSI uses a series of statistical models to estimate its health impact. These “DALY models” take into acocunt a wide range of factors, from country-specific disease prevalence to the effectiveness of health products at preventing or treating disease. Disease prevalence changes from year to year, so PSI updates its models annually to take into account the latest data on the global burden of disease as well as the latest research data on the efficacy of interventions. These updates enable PSI to report more accurate health impact estimates. More importantly, they help PSI to refine its strategy, ensuring that programs are targeted, economical and effective.

HEALTH AREA

PRODUCT & SERVICE

Years of Lives Saved in 2010

● HIV* & Tuberculosis

4,029,258 (38% in Southern Africa)

● Reproductive health

3,439,402 (42% in West & Central Africa)Child Survival

● Malaria

8,288,681 (70% in East Africa)

● Child survival (i.e. pneumonia diarrheal disease & nutritional deficiencies) TOTAL

➊ Long-lasting HIV & TB

➋ ➌ Pre-packaged

24%

411,314 (47% in East Africa) Malaria

49%

16,168,656

*HIV data includes DALYs averted by behavior change communication.

315,211

283,386

people living with HIV

244,431

➑ Safe water solution ➒ HIV counseling & testing ➓ Adult male circumcision

186,444

175,891

105,626

4,553,344 (41% in malaria control) 7,656,590 (76% in malaria control)

● Southern Africa

2,624,104 (58% in HIV & TB)

TOTAL

(distributed)

➐ Basic care package for

● East Africa

77,379 (92% in reproductive health, HIV & BCC) 1,257,240 (68% in reproductive health)

484,433

Years of Lives Saved in 2010

● Asia & Eastern Europe

➍ Oral contraceptives ➎ Injectable contraceptives ➏ Intrauterine devices

1,383,150

22%

REGION

● Latin America & the Caribbean

malaria treatment

6,757,437 42% 5,332,380 33%

Reproductive Health

● West & Central Africa

insecticidal nets

Male condoms

TOTAL

15,268,389 94%

Asia & Eastern Europe LAC

16,168,656

Southern Africa East Africa West & Central Africa

P S I P R O G R E S S R E P O R T 20 1 1 | 1 5

Asia & Eastern Europe

KARL HOFMANN President and Chief Executive Officer

KATE ROBERTS Vice President, Corporate Marketing & Communications

PETER CLANCY Executive Vice President, Programs and Chief Operating Officer

BRIAN SMITH Vice President and Regional Director, Asia & Eastern Europe

STEVEN CHAPMAN Senior Vice President and Chief Technical Officer SALLY COWAL Senior Vice President and Chief Liaison Officer KIM SCHWARTZ Chief Financial Officer DESMOND CHAVASSE Vice President, Malaria Control & Child Survival CHASTAIN FITZGERALD Vice President, New Business & Advocacy DAVID REENE Senior Vice President, Strategy

MOUSSA ABBO Regional Director, West & Central Africa DOUG CALL Regional Director, Southern Africa ELIZABETH CRAWFORD Controller SHANNON ENGLAND Director, New Business Development STEVEN HONEYMAN Director, Learning & Performance KRISHNA JAFA Director, Sexual, Reproductive Health & TB MARUSYA LAZO Director, Global Internal Audit Group

20 | P S I P R O G R E S S R E P O R T 2011

KIM LONGFIELD Director, Research & Metrics CHARITY NGARURO Director, Procurement JAMES POLCARO Chief Information Office and Director, Facilities GRACE ROACHE Director, People CELINA SCHOCKEN Director, International Organizations LISA SIMUTAMI Regional Director, East Africa CAROL SMITH Director, Contracts MARSHALL STOWELL Director, Corporate Marketing & Communications DAVID WALKER Director, Social Marketing BARRY WHITTLE Regional Director, Latin America & the Caribbean

FRANK LOY Chair of the Board Former Undersecretary of State Washington, DC

DR. SHIMA GYOH Professor of Surgery, Benue State University Benue, Nigeria

DR. REHANA AHMED Reproductive Health Specialist UN Millennium Project for East & Southern Africa Nairobi, Kenya

GAIL MCGREEVY HARMON, ESQUIRE Attorney Harmon, Curran, Spielberg & Eisenberg, LLP Washington, DC

DAVID BLOOM Professor and Chair, Department of Global Health & Population Director, Program on Global Demography & Aging Harvard University Boston, MA BARBARA PIERCE BUSH President and Co-Founder Global Health Corps New York, NY SARAH G. EPSTEIN Population Consultant Washington, DC FRANS ENGERING Former Netherlands Ambassador The Hague

WILLIAM C. HARROP Former U.S. Ambassador Washington, DC JUDITH RICHARDS HOPE, ESQUIRE Attorney President and CEO, Hope & Company, P.C. Washington, DC ASHLEY JUDD Actor, Author & Activist Franklin, TN PUNAM KELLER Charles Henry Jones Third Century Professor of Management Tuck School of Business at Dartmouth Hanover, NH

DR. GILBERT S. OMENN Professor of Internal Medicine, Human Genetics and Public Health Director of the Center for Computational Medicine & Biology University of Michigan Ann Arbor, MI DR. MALCOLM POTTS Professor and Bixby Chair in Population and Family Planning University of California at Berkeley Berkeley, California

NANA FRIMPONG Angola LARA SMITH Belize LEGER FOYET Benin RICHARD HARRISON Botswana MARIE-LOUISE BALENG Burundi YASMIN MADAN Cambodia

NESTOR ANKIBA Democratic Republic of Congo STACIANN LEUSCHNER Ethiopia MEG GALAS El Salvador SALIFOU COMPAORÉ Guinea PILAR SEBASTIÁN Guatemala ALISON MALMQVIST Haiti

AUGUSTE KPOGNON Cameroon & the Central African Republic

JULIO ZÚNIGA Honduras

JULIA ROBERTS Caribbean

DANA WARD India

LEILA KOUSHENOVA Central Asia

CHRIS JONES Kenya

ANDREW MILLER China

ROB GRAY Laos

MARCELA CUBERO Costa Rica

DENNIS WALTO Lesotho

LALAH RAMBELOSON Cote d'Ivoire

AXEL ADDY Liberia

ERIC SEASTEDT Dominican Republic

CHUCK SZYMANSKI Madagascar

RICKI ORFORD Malawi

DRAGOS GAVRILESCU Romania

RODIO DIALLO Mali

GALINA KARMANOVA Russia

PAMELA FAURA Mexico

ZACCHAEUS AKINYEMI Rwanda

IULIAN CIRCO Mozambique

SHAZINA MASUD Somililand

JOHN HETHERINGTON Myanmar

JULIE STEIGER Sudan

LAVINIA SHIKONGO Namibia

SCOTT BILLY South Africa

ANDREW BONER Nepal

BABAZILE DLAMINI Swaziland

NORBERT DE ANDA Nicaragua

DANIEL CRAPPER Tanzania

BRIGHT EKWEREMADU Nigeria

CARMEN CHAN Thailand

CHRIS CONRAD Pakistan

KUASSI KONTEVI Togo

ETHEL GORDON Panama

SUSAN MUKASA Uganda

CYNDE ROBINSON Papua New Guinea

JOSSELYN NEUKOM Vietnam

SONIA MARCHEWKA Paraguay

MANNASSEH PHIRI Zambia LOUISA NORMAN Zimbabwe

ANGOLA LIBERIA BELIZE MADAGASCAR BENIN MALAWI BOTSWANA MALIto “ I t is thanks BURKINA FASO MEXICO the dedicated, BURUNDI MOZAMBIQUE CAMBODIA energetic,MYANMAR CAMEROON & THE NAMIBIA tireless CENTRAL AFRICAN NEPAL REPUBLIC leaders inNICARAGUA CARIBBEAN NIGERIA the field and at CENTRAL ASIA PAKISTAN CHINAheadquarters PANAMA COSTA RICA PSI PAPUA NEW that COTE D’IVOIRE GUINEA thrives and DOMINICAN PARAGUAY REPUBLIC has grownROMANIA DEMOCRATIC RUSSIA overOFthe last REPUBLIC RWANDA 40 years.”SOMILILAND CONGO ETHIOPIA SUDAN EL SALVADOR SOUTH AFRICA Loy, GUINEA —Frank SWAZILAND GUATEMALA TANZANIA Chairman of the Board HAITI THAILAND HONDURAS TOGO INDIA UGANDA KENYA VIETNAM LAOS ZAMBIA

2010 REVENUE BY DONOR TYPE Other Foundations & Corporations

12%

EXPENSES BY YEAR

REVENUE BY YEAR

$700,000

$585,492,231 $524,174,258 $415,055,231

U.S. Government

30%

2010 $600,000

International Organizations Foundations & Corporations Other

Note: International Organizations includes the Global Fund to Fight AIDS to Fight AIDS, Tuberculosis and Malaria. The Global Fund is a major donor of PSI.

$400,000

n Management & General n Program

$300,000

n Fundraising

$200,000

$100,000

$2008

19%

Non-U.S. Government

2009

Non-U.S. Government

33%

2008

$500,000

2010

International Organizations

30% 19% 33% 12% 6%

USD (Millions)

U.S. Government

2009

The 2008 and 2009 figures above have been executed from statements and schedules issued by PSI's external auditors. Copies of our audited statements are available upon request from PSI in Washington, D.C.

PSI is a leading global health organization with programs targeting malaria, child survival, HIV, reproductive health and non-communicable disease. Working in partnership within the public and private sectors, and harnessing the power of the markets, PSI provides life-saving products, clinical services and behavior change communications that empower the world's most vulnerable populations to lead healthier lives.

Note: All 2010 financial data are provisional.