BOARD OF DIRECTORS Dignitas International Michael Schull, Clinician-Scientist and Associate Professor, Department of Medicine, University of Toronto (Chair) David Fleck, President and CEO Macquarie Capital Markets Canada Lloyd Barbara, Vice Chairman Burgundy Asset Management Ltd. Willa Black, Vice President Corporate Affairs, Cisco Canada Roman Dubczak, Managing Director Head of Cash Equities CIBC World Markets Inc. Mario Garcia, Director New Haven Health Department Gwen Harvey, President BridgeWater Family Wealth Services Pamela Hughes, Senior Partner Blake, Cassels & Graydon LLP Dorothy nyaKaunda Kamanga, Deputy Registrar High Court Elske Kofman Jacquie Labatt, President CanAIDia International
Douglas Lawson, Senior Vice President and Chief Financial Officer North American Fur Auctions Elisa Nuyten James Orbinski, Professor of Medicine and Political Science, Chair of Global Health, Dalla Lana School of Public Health, University of Toronto (ex officio) Nada Ristich, Director, Corporate Donations, BMO Financial Group Ross Upshur, Professor, Department of Family and Community Medicine University of Toronto; Canada Research Chair in Primary Care Research Seodi White, National Coordinator Women and the Law in Southern Africa Research and Education Trust (WLSA Malawi) Merrick Zwarenstein, Senior Scientist Institute for Clinical Evaluative Sciences Sunnybrook Health Sciences Centre University of Toronto
Dignitas USA Michael Young, President, Quadrant Capital (Chair)
Dignitas International 2 Adelaide Street West, Suite 200 Toronto, ON M5H 1L6 Dignitas USA 8333 Douglas Avenue, Suite 1350 Dallas, TX 75225-5860 +1.416.260.3100 | 1.866.576.3100 dignitasinternational.org Canadian Charitable Registration # 86033 3426 RR0001 Registered US 501(c) (3) EIN 26-0387288
Roland Augustine, Co-Founder Luhring Augustine Gallery Ric Clark, President Brookfield Properties Corporation Carol Devine Writer and Researcher – HIV/AIDS, Policy, Gender and Access to Medicines Mario Garcia, Director New Haven Health Department Marguerite Steed Hoffman Pamela Hughes, Senior Partner Blake, Cassels & Graydon LLP Ciara Hunt, CBC Royal Commentator Former Editor-in-Chief, HELLO! Canada James Orbinski, Professor of Medicine and Political Science, Chair of Global Health, Dalla Lana School of Public Health, University of Toronto Robert Raich, President and Chief Investment Officer, Abacus and Associates Tom Stephenson, Managing Partner Look Entertainment Monica Winsor
FACES OF CHANGE
CHANGING THE FACE OF GLOBAL HEALTH ONE INNOVATION AT A TIME
CAMPAIGN LEADERSHIP Co-Chairs Michael Young Roman Dubczak Vice-Chairs Marguerite Steed Hoffman Jacquie Labatt Campaign Cabinet Roland Augustine Lloyd Barbara Willa Black Ric Clark David Fleck Gwen Harvey Pamela Hughes Ciara Hunt Nada Ristich Tom Stephenson Monica Winsor Ambassadors Margaret Atwood Jim Creeggan Jill Denham Barbara and Patrick Keenan Elske and Jim Kofman Sonia and Arthur Labatt Elisa Nuyten Michael Ondaatje Miranda Richardson Alan Rickman Deedie and Rusty Rose David Young
Left to right: Michael Schull, Chair, Dignitas International Michael Young, Chair, Dignitas USA James Fraser, Co-Founder, President and CEO, Dignitas International James Orbinski, Co-Founder, Dignitas International
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veryone has the right to health and dignity. At Dignitas, we are determined to improve the lives of millions currently denied this right.
We know that compassion alone is not enough. To overcome the numerous challenges preventing access to health care — including crisis-level shortages of health workers and clinics overcrowded with critically ill patients — we need intelligent and informed responses. Through partnership, invention and innovation, Dignitas is strengthening health systems in the developing world. We’re working with health workers, researchers, policymakers, and communities to make health care more accessible, efficient, and effective. We have spent the last 7 years investing in our program and research capacity, which has demonstrated life-saving and replicable results. Since founding Dignitas in 2004, we’ve dramatically increased access to HIV and TB treatment and prevention services. Our programs have literally saved tens of thousands of lives in Malawi, and we’ve created and tested innovative solutions that are sustainable and applicable throughout the developing world. We’re now at a tipping point in our evolution. The results of our research and experience have already improved global health policy and practice. Over the next three years, Dignitas will continue to deliver frontline medical care and training, conduct high-impact research, as well as build capacity for advocacy and policy engagement so that our research evidence and innovations are shared beyond Malawi to impact the lives of millions in the developing world. We invite you to join us in this next phase of development by participating in our $25M Faces of Change Campaign. Together, we’ll make a real difference in the lives of families and communities around the world.
AN INVESTMENT IN DIGNITAS IS AN INVESTMENT IN SOLUTIONS FOR GLOBAL HEALTH.
HOW WE WORK: Frontline Medical Care to save lives Health Systems Strengthening by training health workers and managers Operations Research and Innovation to build new evidence and replicable models of care Advocacy and Policy Engagement to improve global health policy and practice
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BARRIERS TO DIGNITY Why can’t millions of people access treatment? • Shortage of trained health workers • Inefficient health systems • Policy and practice based on untested theory and outdated evidence • Lack of financial resources and political will
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• Inequality and discrimination toward vulnerable groups • Distance to health care for rural populations • Cultural constraints
n investment in Dignitas is an investment in solutions for global health.
Dignitas provides frontline medical care and training, conducts highimpact research, develops innovative models of care, and advocates for changes in health policy to improve lives and transform communities in the developing world. Approximately 15 million people die needlessly each year due to infectious diseases1. Nearly a third of these deaths are caused diseases that are either treatable or preventable — including HIV/AIDS, TB, and malaria2. Almost all occur in developing countries. In the past decade, billions of dollars have been invested into health care in the developing world and there is evidence of positive results. The returns, however, have not been enough to prevent the health gap from widening. Dignitas seeks to close this gap through innovative problem solving. Our work starts with the right questions: “What is the problem?” and “Where are the opportunities for change?” At Dignitas, we bring an intelligent approach to a compassionate response. Not only do we treat patients and train health workers to save lives directly, we also work to improve the lives of millions currently denied their right to health. We do so by identifying and analyzing the gaps and bottlenecks afflicting patient care and health systems, sharing evidence and developing practical solutions, and actively engaging policymakers and practitioners for change.
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World Health Organization (who.int)
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The Global Fund to Fight AIDS, Tuberculosis and Malaria (theglobalfund.org)
CAMPAIGN PILLARS THE CAMPAIGN WILL ENABLE DIGNITAS TO:
1. STRENGTHEN HEALTH CARE, RESEARCH AND DEVELOPMENT .................... $12M
Your support allows us to continue to research, design, implement, and share solutions for global health.
2. EXPAND COMMUNITY-LEVEL ACCESS TO HIV/AIDS SERVICES ................................................ $7M 3. DEVELOP STREAMLINED TOOLS AND TRAINING (STAT TM)................ $3M 4. INNOVATE IN TB AND LABORATORY SERVICES ................................................ $1M 5. INNOVATE IN HEALTH INFORMATICS ............................... $1M 6. BUILD ADVOCACY AND POLICY ENGAGEMENT CAPACITY ................................................$1M
TOTAL ........................................... $25M
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STRENGTHEN HEALTH CARE, RESEARCH & DEVELOPMENT
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s a medical researcher and physician, Dr. Adrienne Chan was key to establishing Dignitas’s long-term program, research and development site in Zomba District, Malawi. It is here in Zomba that close to 20,000 adult and pediatric patients have been treated for HIV, over 60,000 mother-baby pairs have received prevention of motherto-child transmission prophylaxis, and more than 500 health workers have been trained to date. It is also here that Dignitas has developed innovations such as a model for community access to HIV/AIDS services, an HIV-TB clinic, and a health worker clinic. Zomba has also been the site for over 40 research projects aimed at directly improving health care delivery. Faced with barriers such as human resource shortages, inadequate patient records, and poor transportation, we’ve worked with Malawian health care providers to improve systems and implement processes that save lives. By monitoring our impact, conducting research studies, and sharing
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our experiences with the global health community, we’re providing information that will help others around the world make similar gains. “We don’t pat ourselves on the back because we’ve done something charitable,” says Adrienne. “We’re constantly analyzing whether we’re meeting our goals, and looking at what is working and what isn’t.”
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Our presence in Malawi combined with our team of internationally renowned researchers and medical personnel makes us a powerful voice in the global health policy arena.” — DR. ADRIENNE CHAN
But Dignitas doesn’t just work with health workers on the ground. We are also in regular talks with policymakers from the local to the international levels. We highlight areas where resources and policy changes are desperately needed. Our presence in Malawi combined with our team of internationally renowned researchers and medical personnel makes us a
powerful voice in the global health policy arena.
capacity to reach more communities and respond to new health care challenges.
The campaign will enable Dignitas to continue to invest in the medical care, training, and operations research that are integral to delivering quality health care services, developing innovative models of care, and improving health policy and practice. We will also seed the growth of a new long-term research and development site, building our
2010 – 2013 INVESTMENTS WILL ENABLE DIGNITAS TO: • Strengthen our capacity to deliver frontline medical care, including 470,000+ patient consultations. • Provide ongoing training and mentorship to 500+ health workers and health system managers. • Conduct real-time monitoring and evaluation to improve health care delivery. • Forge new partnerships with international research and policy networks and implement 30+ collaborative, long-term, and multi-country research initiatives. • Develop innovative health care delivery models for HIV/AIDS, TB, malaria and other priority diseases.
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C A M PA I G N P I L L A R
EXPAND COMMUNITY-LEVEL ACCESS TO HIV/AIDS SERVICES
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n the last five years, Dignitas brought HIV/AIDS treatment, which was once only available in private health clinics, to 25 public community health centres across Zomba District in Malawi. Gabriel Mateyu, a Malawian Clinical Officer, led Dignitas’s efforts to decentralize HIV/AIDS services to local health centres and has seen remarkable transformations in his patients. “When we first started, our patients were much sicker, because many of them were starting antiretroviral treatment too late as they couldn’t afford the cost of transport to the hospital. The hospital was just too far,” he says. “Now, because our patients can get care close to their homes, they are healthy again and are able to work and provide for their families.” Thanks to a matching grant from the U.S. Agency for International Development (USAID), we’re bringing our community-based model to five additional districts in Malawi. That means barriers such as distance and transportation costs will no longer
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prevent access to HIV/AIDS services for more than 3.1 million people — a quarter of Malawi’s total population. By building the capacity of local health centres to treat HIV/AIDS, Dignitas strengthens the entire health system. For example, we provide training and logistics support so that local clinics are able to collect, store and transport blood samples for testing. Our model will bring diagnostics for other health priorities, such as malaria and nutritional deficiencies, into the community. We are also strengthening referral and patient tracking systems between health centres and hospitals to ensure better patient care and follow-up.
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By building the capacity of local health centres to treat HIV/AIDS, Dignitas strengthens the entire health system.” — GABRIEL MATEYU
“We’re so happy when we see the Ministry of Health taking on these services,” says Gabriel. “It ensures what we’re doing is sustainable.”
To influence health policy leaders to bring HIV/AIDS care and other health services closer to the people who need them, Dignitas is integrating operations research on cost-effectiveness and sustainability in conjunction with expansion efforts. We will share this research and other practical guidelines for use throughout the developing world.
2010 – 2013 INVESTMENTS WILL ENABLE DIGNITAS TO: • Train 1,500+ health workers to provide HIV/ AIDS services within an integrated primary care setting. • Provide HIV testing to 200,000+ people. • Provide Prevention of Mother-to-Child Transmission services to 110,000+ pregnant women. • Treat an additional 40,000+ people with life-saving HIV treatment. • Decentralize HIV/AIDS-related services to 70 community health centres, reaching a population of more than 3.1 million people.
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C A M PA I G N P I L L A R
DEVELOP STREAMLINED TOOLS AND TRAINING (STAT™)
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s a physician and scientist at Sunnybrook Health Sciences Centre, Dr. Michael Schull is working with Canadian and African partners in the Knowledge Translation Unit at the University of Cape Town Lung Institute to develop a toolkit known as Streamlined Tools and Training (STAT™). This toolkit helps health workers in remote health centers recognize and treat common conditions like HIV/AIDS, tuberculosis, malaria, and pneumonia. Having recently spent a year in Malawi himself, Schull knows that the most important faces of change are the “incredibly dedicated health workers struggling day in and day out to cope with a huge burden of patients and very few resources.” STAT uses evidence-based decision making processes that start with a patient’s symptoms and then guides health workers through a series of questions that lead to appropriate treatment and referral decisions. Moreover, the on-site and practical training approach used with the toolkit has proven to improve learning and reduce training costs
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compared to other training models currently used in Africa. STAT helps health workers identify diseases and infections that are too often missed or misdiagnosed, especially in rural areas where many health workers are overworked and undertrained.
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STAT is a tool that guides health workers to make better, more evidence-based decisions.” — DR. MICHAEL SCHULL
“Rural health workers often start the day with a line of 120 patients waiting to be seen. There are babies crying and it’s 38°C. It’s natural that the health workers make quick, but sometimes wrong, decisions,” says Schull. In these situations, STAT is a tool that guides health workers to make better, more evidence-based decisions. “For example, if a patient comes in with a fever and cough, the health worker might, by habit, assume it is pneumonia. But STAT reminds the health worker to ask about the duration
of cough, and if it is more than three weeks, to consider tuberculosis. They are also prompted to think about malaria given that the patient has a fever,” explains Schull.
communities and countries beyond Southern Africa.
The campaign will allow Dignitas to expand STAT for completely integrated primary care and extend training for health workers at the community level in Malawi. In addition, we will work with our partners to adapt STAT models for
2010 – 2013 INVESTMENTS WILL ENABLE DIGNITAS TO: • Strengthen partnerships with the Knowledge Translation Unit at the University of Cape Town Lung Institute. • Implement research to evaluate and refine Streamlined Tools and Training (STAT) models. • Expand STAT for completely integrated primary care (encompassing chronic and non-communicable diseases) and extend training for health workers at the community level in Malawi. • Adapt STAT for use in other resource-limited regions beyond Southern Africa.
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INNOVATE IN TB AND LABORATORY SERVICES
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IV/AIDS cannot be addressed effectively without also preventing and treating tuberculosis (TB). Although preventable and curable, TB remains one of the world’s biggest killers and the leading cause of illness and death for people living with HIV/AIDS1. Approximately 75 percent of TB cases occur in patients whose immune systems are already compromised because of HIV/AIDS2. To effectively treat co-infected patients, Dignitas established an HIV-TB clinic in Zomba, Malawi, which has resulted in a significant increase in the uptake of life-saving HIV treatment. “If patients with TB were referred to the HIV clinic and had to come back another day, many of them wouldn’t make it, in part because of the transport costs of getting to the hospital,” says Edson Mwinjiwa, who manages Dignitas’s main referral clinic, which follows close to 20,000 patients. When co-infected patients don’t have rapid access to the drugs that slow down the replication of HIV, their immune systems weaken and they become increasingly vulnerable to death from TB.
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Dignitas will now focus on extending the integration of HIV/AIDS and TB services to the community level across the 6 districts of South-East Malawi. The efficiencies gained through HIVTB service integration will save time, money and, most importantly, lives.
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will be reduced through economies of scale,” says Edson. “The new innovations have the potential to help health workers recognize and diagnose hidden TB in millions more people.”
The new innovations have the potential to diagnose hidden TB in millions more people.” — EDSON MWINJIWA
2010 – 2013 INVESTMENTS WILL ENABLE DIGNITAS TO: To combat TB, Dignitas will also support community-led public education for early detection, which has proven essential for improving patient outcomes. In addition, we’ll test and evaluate new TB diagnostic technology, which has the potential to revolutionize TB care by shortening the time required for diagnosis so that patients can be started on treatment sooner. “Even though these laboratory technologies are currently expensive, we believe that if we’re able to prove the effectiveness of these new technologies, more developing countries will adopt them and their cost
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UNAIDS (unaids.org)
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World Health Organization (who.int)
• Establish a fully integrated HIV-TB clinic to improve treatment of complex cases and to serve as a centre of excellence for TB diagnostics, treatment, and infection control. • Integrate TB services into Dignitas’s community-based model in order to facilitate timely screening and treatment in health centres. • Support community-led public education efforts across 6 districts for early TB detection to save lives and ease the burden on the health system. • Evaluate emerging point-of-care TB diagnostic technologies for the developing world.
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INNOVATE IN HEALTH INFORMATICS
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asy-to-understand and accessible information on treatment protocols and patient medical histories is key to the successful treatment of chronic diseases, including HIV/AIDS and TB. This has prompted Dignitas to invest in health informatics, a new frontier that uses information technology to guide clinical decision making and build health-related data and knowledge. In this vein, Dignitas is piloting touch screen technology for electronic medical records, which is proving to save time and reduce errors in data entry. With the campaign, we’ll further develop the functionality of our electronic medical records and bring the technology to more health centres across Malawi. The campaign will also enable Dignitas to develop communications systems so that health workers in remote areas can consult with doctors at referral hospitals via phone, text messages and the web. Finally, we’ll translate our training tools into software applications so that remote health workers can get instant access to images and advice
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that guide them through diagnosis and treatment.
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Health informatics also reduces the burden on health staff by involving community members in the treatment process.” — ?????????
In addition to helping health workers make better decisions and freeing up their time so they can see more patients, these technological innovations will also provide more accurate and advanced data to help identify epidemic trends as well as the causes of treatment successes and failures. Health informatics also reduces the burden on health staff by involving community members in the treatment process. Gertrude Mnthambala is an “expert patient” who provides counseling and administrative support to new patients. She helps collect and store patient information and personally follows up with patients who have missed appointments. This matters because patients who don’t refill their prescriptions on time put themselves at risk of developing drug resistance, which makes their
AIDS more difficult to treat. Gertrude is a great example of how health informatics can mobilize lay personnel to strengthen the health system through improved patient care. “I like my job very much, especially because I can help other parents,” says the HIV-positive mother of two. “It’s easy for them to talk to me because I’m a role model, they know I went through the same problems they have. They trust me because I was seriously ill too, and now I’m strong again.”
2010 – 2013 INVESTMENTS WILL ENABLE DIGNITAS TO: • Develop locally adapted software solutions to improve management of health information and aid health workers in the assessment and provision of quality patient care. • Enhance touch-screen electronic medical records database. • Implement monitoring and evaluation to improve systems for better patient care and health worker efficiency and effectiveness. • Incorporate mobile or wireless technologies to improve the quality and timeliness of patient care and to support remote diagnosis and treatment.
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BUILD ADVOCACY AND POLICY ENGAGEMENT CAPACITY
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he key to improving health policy and practice lies in evidence-based policy engagement and grassroots advocacy. To change the state of global health, Dignitas must engage in both. Carol Devine advocates for patient rights at the community and international levels. In Malawi, Dignitas supports women, youth, health workers, and other vulnerable patient groups. For example, Dignitas’ work on Malawi’s national HIV legislation focused on protecting women and girls from violence or economic repercussions related to their HIV status. Dignitas also led the development of a network of police, lawyers and health workers in Zomba to rapidly respond to rape cases. This network’s success has led authorities to replicate it in other districts of Malawi. With more than a decade of experience advocating for people in countries such as Rwanda and East Timor, Devine knows that Dignitas’s impact on global health isn’t limited to the specific geographic location in which we work: “Through advocacy
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and policy engagement, we leverage our experience and expertise to strengthen weak health systems in communities well beyond Malawi.”
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We cannot be silent when we have evidence that can improve the lives of millions.” — CAROL DEVINE
The campaign will enable Dignitas to publish research and disseminate solutions that address the barriers to health care access in the developing world. As Devine says, “You can’t just treat people, you also have to address the barriers that prevent people from getting treatment.” By building a team of top policy analysts and advocacy specialists, Dignitas will aggressively seek to influence academic and policy debates at national and international levels. With the specific aim to increase the adoption of innovations, Dignitas will encourage evidence-based decision making for improved patient care.
millions,” Devine explains. The campaign will also ensure that Dignitas is able to continue building grassroots support for global health through public education initiatives, using both traditional and social media. By rallying communities, Dignitas will continue to pressure G20 countries to honour their global health funding commitments.
Dignitas will advocate on behalf of the millions currently denied their right to health and whose voices can no longer remain ignored.
2010 – 2013 INVESTMENTS WILL ENABLE DIGNITAS TO: • Inform academic and policy debates by sharing peer-reviewed research at national and international forums. • Engage policymakers and practitioners to adopt improved health policies and health care practices. • Generate grassroots support for global health through public education and communications initiatives, using traditional and social media. • Engage in targeted initiatives to pressure governments to honour global health funding commitments.
“We cannot be silent when we have evidence that can improve the lives of
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D
IGNITAS WAS FOUNDED to save lives and reduce suffering on a grand scale.
Dignitas exists because millions of people in the developing world are dying due to lack of access to medicines, or due to insufficient numbers of health workers available to care for the sick. They are dying because the world believes the challenges are too big and the solutions too costly. We believe differently.
AN INVITATION WE INVITE YOU to join our community as we undertake the most ambitious fundraising campaign in our history. We know that healthy people build vibrant, thriving communities. Children who are strong can learn, play, and dream. Healthy parents and grandparents can channel their energies into their farms, schools, and businesses. Families that have hope make plans for their future.
TOGETHER, WE’RE CHANGING THE FACE OF GLOBAL HEALTH, ONE INNOVATION AT A TIME.
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Whether a multi-year pledge or a one-time donation, your contribution will not only help us provide millions of people access to health care, it will help us build the foundation on which they can build their lives and dreams. We invite you to join our community and become a Face of Change
We believe that by employing new ways of thinking, by applying intelligence and innovation, we can leapfrog over these challenges, and have a significant impact on the lives of millions. By providing frontline medical care and training, conducting highimpact research, developing innovative models of care, and vigorously engaging policymakers, Dignitas is demonstrating that the right investments can have an exponential and longterm impact. Underlying our success is the active participation of many faces of change: doctors, nurses, health workers, community members, researchers, advocates, policymakers, donors, and volunteers – we all play a vital role. In order to achieve our goals, we must continue to build our community.
MEDICAL CARE + PARTNERSHIP + RESEARCH + INNOVATION POLICY CHANGE = GLOBAL IMPACT
WHAT $
25M WILL
ACCOMPLISH • 2,000+ health workers trained •
HIV/AIDS-related health services decentralized to 70 sites for
3.1 million people
• 200,000+ people tested for HIV • 40,000+ people started on lifesaving HIV treatment
• 30+ research projects completed and disseminated
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Innovative and evidence-based health models adopted by regional governments
• Advocacy and Policy Engagement activities influencing global health policy and practice
Most importantly, the campaign will advance practical solutions that will improve health care delivery and benefit the lives of millions of people in Malawi and beyond.
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