Driving Change: The Impact of Private Funds (Pathfinder International)

pathfinder international 2010 annual report

driving

change

the impact of private funds

The Power of Private Funds Supporting What Others Won’t

Bridging Gaps in Funding

Pioneering change and innovation

Maximizing the Impact

Private funds allow Pathfinder

Private funds assure the

Private funds sponsor innovative

Private funds support

to be truly comprehensive by

availability of Pathfinder’s

approaches, allowing Pathfinder

Pathfinder’s carefully chosen

advancing essential programs

services for the people who

to meet some of the developing

investments in people,

like safe abortion, youth-friendly

depend on them, despite

world’s most urgent sexual and

programs, and innovations

services, and advocacy on

ever-changing political

reproductive health needs.

that promise to have a long-

behalf of the underserved.

trends and funding priorities.

term, widespread impact.

Cover: tanzania Sala Lewis

b

Pathfinder International’s mission is to ensure that people everywhere have the right and opportunity to live a healthy reproductive life.

Guinea Sebati Karakurt

To our friends, partners, donors, and colleagues,

To have a profound impact, Pathfinder continually increases the efficacy of our services. To that end, we have intensified the rigorous monitoring

Family planning saved Georgette’s life. At 37, in a remote, war-torn

and evaluation of our programs. Private funds advance these efforts to

region of central Africa, she had been pregnant 20 times, losing seven of

ensure accountability in every facet of our work, while helping to provide

her babies to starvation when breastfeeding was continually cut short by

clients with the quality of care they deserve.

another pregnancy. Desperate for help, Georgette turned to a neighbor—

Private gifts advance our mission by sponsoring pioneering projects and

a Pathfinder-trained community health worker.

supporting the pivotal staff who make them possible. With your help,

Now Georgette has options. She has been empowered to select a con-

Pathfinder is combating some of the most pressing health challenges

traceptive method that is right for her and she knows she will not get

in the developing world. Last year, we made great strides to reduce

pregnant again. Georgette is a strong voice for her family and her com-

and manage postpartum hemorrhage, responsible for one-third of all

munity, telling everyone who will listen that family planning has changed

maternal deaths. Private gifts allowed us to expand our work from two

and improved her life.

to five countries. We are moving toward our goal of ensuring that no

Every day, Pathfinder International is focused on reaching individuals like

woman—no matter where she lives—will face death when giving life.

Georgette—women, men, and youth who are still in need of our services.

Pathfinder’s goals are more achievable today than ever before. Support

We will continue to focus on the underserved and the unserved until all

for our services and for those empowered by our care is mounting. A

people enjoy the right and opportunity to live a healthy reproductive life.

revolution is underway—a revolution to increase the quality and avail-

After all, it is our mission. Thanks to your continued support, we are that

ability of sexual and reproductive health care. With each private gift, we

much closer to achieving it.

can train more service providers, add and improve facilities, and build our

In India, our PRACHAR program to delay and space pregnancies

capacity to bridge the last mile—reaching more women, men, and youth.

has achieved great success. In the third, critical phase of the program,

Last year, more than 20 million visits and contacts were made to

Pathfinder is collaborating with the Government of Bihar to mobilize and

Pathfinder-supported facilities and community-based providers. Join

manage community-based outreach workers. In Tanzania, Pathfinder

us, and we can reach many more.

helped propel family planning into the national spotlight by advocating for reproductive health care with key government representatives and

Warm regards,

policy-makers. And in Ghana, where unsafe abortion is a leading cause of maternal mortality, Pathfinder advanced safe abortion and postabortion care, while striving to reduce the stigmas that often lead to clandestine procedures.

All of this was made possible by private funding.

Daniel E. Pellegrom President

Public gifts and grants, while vital, are often restrictive; they provide for some services but not others. Private funds preserve essential programs, like youth-friendly, safe abortion care. Private funds also bridge critical

P.S. To see how Pathfinder is driving change for those in need of our

gaps in funding to ensure the availability of our services for the people

services and learn how you can help, visit www.pathfinder.org

who depend on them. Without your support, the people we serve sometimes go without. With your support, they have options.

1

Private funds advance Pathfinder’s mission by supporting an entire spectrum of sexual and reproductive health services. With private support, Pathfinder improves access to safe abortion care, strengthens youth-friendly services, provides scholarships and training for women and girls, and advocates for women’s health and rights.

2

“ When private donors give, they send a powerful message: we are all part of the global community. People—no matter where they live—should have the same rights. Pathfinder’s work is based on strengthening human rights, particularly as they relate to decisions individuals make about their reproductive health.” — Rema Nanda, PhD, Pathfinder Country Representative, India program focus areaS

2%

8%

Adolescent and Youth Sexual and Reproductive Health

21%

Maternal and Newborn Care

Safe Abortion and Postabortion Care

2% Advocacy / Policy

42% Contraception

25%

GHANA Nancy Ryan

HIV and AIDS

India Julia G. Kahrl

fy 2010

Youth and Adolescents

SAFE ABORTION SERVICES

UNWAVERING ADVOCACY

Pathfinder is a leader in providing reproductive health services for young people. Private funds have been critical to Pathfinder’s efforts to deliver these targeted interventions. For example, the David and Lucile Packard Foundation has provided essential funding for Pathfinder’s PRACHAR project to delay and space pregnancies among young couples in Bihar, India. Pathfinder’s community-based approach has yielded remarkable results: After two years of PRACHAR interventions, young married women in the project area were nearly four times as likely to use contraception as young married women who were not in the project area.

Nothing is more essential to a woman’s health, education, and economic participation than her ability to determine the timing and number of her pregnancies through contraception, or, when that fails, safe abortion. Yet, social stigma, high cost, and a lack of access to trained health professionals lead many women to seek clandestine—usually unsafe—procedures. Last year, with the support of multiple donors, Pathfinder provided safe abortion services in six countries—Ethiopia, Ghana, India, Mozambique, South Africa, and Viet Nam.

Throughout the developing world, the substantial need for family planning continues.

Despite dedicated staff and in-country partners, Pathfinder can reach only a fraction of those in need of care. In Tanzania, Pathfinder worked to advance contraceptive usage through a series of targeted advocacy interventions. With support from the Money Well Spent Fund of Tides Foundation, Pathfinder worked to develop new champions for family planning who have the potential to influence key policies. Pathfinder’s concerted efforts contributed significantly to the government’s recognition of the need for family planning; they have requested an allocation of approximately $9M for the procurement of contraceptives from the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Now in the third, critical stage of the project, Pathfinder has enlisted a valuable ally— the Government of Bihar—to help mobilize and manage community-based outreach workers. This cadre of trained workers delivers critical information to young married couples who are still forming attitudes and making critical reproductive health decisions that will have ramifications for the rest of their lives.

Watch CNN’s report on Pathfinder’s work with young couples in Bihar, India at www.pathfinder.org/CNN

In Ghana, where unsafe abortion is a leading cause of maternal mortality, Pathfinder trained midwives in public sector clinics and midwifery education programs to provide comprehensive safe abortion and postabortion care. To reduce dangerous stigma, Pathfinder conducted sensitization activities for influential community leaders and groups, trained outreach workers, and developed innovative radio discussions.

Broadcast to diverse audiences in greatest need, the interactive programming prompted callers to discuss abortion with doctors on-air. These Pathfinder-supported doctors are highly qualified to respond to community concerns, having trained local providers in safe abortion care.

3

The future appears just as promising.

Pathfinder’s collaboration with the Ministry of Health and Social Welfare influenced a proposed guiding plan for the next five years. The National Strategy for Growth and Reduction of Poverty now includes family planning as a national objective, expanding the capacity of district governments to mobilize more funds for family planning services.

every dollar

For Pathfinder, change begins in the community. By utilizing strengths that already reside within local institutions, Pathfinder programs are powerful and provide lasting benefits. Pathfinder leverages resources many times over to reach more clients with quality, cost-effective care.

$102.3 Million annual budget breakdown government/ 4% foreign multilateral

18% private Foundations 11%

+

Individuals 6%

+

Corporations 1%

fy 2010

= 18%

78%

united states government

“ A little funding can go a long way toward bringing about change in these women’s lives. With small private investments, we can break through.”

— Shabnam Shahnaz, MBBS, MPH, Pathfinder Country Representative, Bangladesh

Bangladesh Oliver Francis Bangladesh T. Cody Swift Tanzania Jaime-Alexis Fowler

Surmounting Barriers to Access Economic empowerment and sexual and reproductive health have long

Leveraging Resources to Maximize the Impact

gone hand in hand, and Pathfinder designs programs that promote both

In recent years, as key resources have been diverted to fight AIDS and

simultaneously. One such program focuses on empowering women,

other deadly diseases, family planning programs have been weakened.

while increasing access to reproductive health care for remote tribal

Yet, Pathfinder’s commitment has not. Pathfinder strategically seeks new

communities of Bangladesh.

opportunities to reach the more than 200 million women who currently

The Chittagong region of southeast Bangladesh is geographically iso-

lack access to contraceptives by building on the expertise and infrastruc-

lated. Community members maintain their own cultural traditions and

ture that has been created through HIV and AIDS health programs.

language, which has typically led to significant barriers to health care;

In Tanzania, Pathfinder linked clinic-based family planning services with

few local providers exist. Last year, Pathfinder launched a project to

a successful US government-supported home-based care program that

reach this underserved region with quality care, while increasing eco-

previously served only people living with HIV and AIDS, creating a refer-

nomic opportunities and advancing the skills of women.

ral system to ensure that clients had access to comprehensive care. By

Pathfinder is building the capacity of the community by training local

linking these services, Pathfinder was able to distribute 548,951 condoms

women as paramedics. After completing an 18-month course, these new professionals will provide a range of health care services including contraception, maternal and newborn health, general health, and nutrition services in local Pathfinder-supported clinics. Pathfinder is also recruiting

and 101,512 oral contraceptives, while providing antiretroviral medication and counseling to clients in their homes. This unique integration of programs brought services closer to the clients who need them, and provided them with the knowledge and tools to protect themselves

depot holders, female aides, and community-based health agents to help

against both unwanted pregnancy and HIV.

run the new facilities.

By mobilizing community resources in areas where there is a high level

By empowering local women as health care providers, Pathfinder can

of need, Pathfinder maximized the reach of family planning services.

foster real change for the entire region. Language will no longer be a barrier, and each new clinic will generate much-needed income for the teams that run it. Moreover, Pathfinder’s concerted efforts have the potential to reach 100,000 women, men, and children who have previously lacked access to services.

Through the integration of family planning and HIV and AIDS programs, Pathfinder served 90,212 new and returning users of family planning and trained 619 providers in Tanzania alone.

More than 10,259 women register with “Mayer Shasthya,” Pathfinder’s postpartum hemorrhage project (Bangladesh) as of June 2010

Pathfinder supports the Ministry of Women Affairs to provide and expand the use of the NASG to primary and secondary health facilities (Nigeria) 2010

Pathfinder’s training curriculum is gradually incorporated into state-level basic emergency obstetric care (India) 2009-2010

Pathfinder’s training is incorporated in the curriculum of 88 midwifery schools (Nigeria) 2009-2010

Pathfinder increases access to emergency blood supplies by mobilizing communities to donate and by establishing a blood bank (Nigeria) 2009-2010

Pathfinder’s comprehensive kit to reverse life-threatening shock is stored in emergency rooms and labor and delivery wards (India) 2009

India

Nigeria

Ban

PATHFINDER DEVELOPS A COMPREHENSIVE MODEL to build national government support, enable essential clinical interventions, and develop local government and community-wide knowledge and commitment to preventing and managing postpartum hemorrhage. 2007

$

John D. and Catherine T. MacArthur Foundation funds a project to address maternal mortality in India and Nigeria 2007

$

Pathfinder’s Board of Directors allocates private funds to expand Pathfinder’s postpartum hemorrhage work to Bangladesh and Peru 2009

6

$

John D. and Catherine T. MacArthur Foundation funds Pathfinder’s postpartum hemorrhage efforts in refugee camps in Tanzania 2009

$

Advancing change through innovation To save mothers’ lives, Pathfinder leverages

In 2007, Pathfinder developed a groundbreak-

services for refugee and displaced persons

every resource. Seven investments have ex-

ing clinical and community action model to

camps in Tanzania. In each country, Pathfinder

panded Pathfinder’s innovative approach to

combat postpartum hemorrhage. The model

works with community members to develop

preventing, identifying, and managing post-

pioneers inexpensive, innovative technolo-

locally appropriate solutions. By adapting key

partum hemorrhage from two to five countries.

gies—including a non-pneumatic, anti-shock

elements of the model, like transportation and

These investments have laid the groundwork for

garment—as part of a constellation of activities

blood loss measurement tools, to reflect cur-

global impact on maternal mortality.

to save mothers’ lives.

rent medical and cultural practices and available

In developing countries—where many births oc-

With the support of the John D. and Catherine

cur at home without a skilled birth attendant

T. MacArthur Foundation, Pathfinder first began

present—postpartum hemorrhage causes one-

implementing the Continuum of Care: Addressing

Pathfinder is committed to saving as many lives

third of all maternal deaths. The majority of

Postpartum Hemorrhage project in two coun-

as possible through replication of this innovative

these incidents could be avoided with prevention

tries, India and Nigeria. Only three short years

approach. With the recent completion of guide-

through active management of the third stage of

later, the project has expanded enormously.

lines and management protocols, a training cur-

labor, and earlier diagnosis and treatment.

Private funds extended Pathfinder’s work to

riculum, and a training film, the initial investment

Peru and Bangladesh, and an additional grant

now has the potential to save mothers’ lives

from the John D. and Catherine T. MacArthur

worldwide.

A Delivery Bag, containing a flip booklet for low-literacy audiences, emergency medication, a blood loss measuring mat, and a safe delivery kit, is developed for use in home births (Bangladesh) 2009

Pathfinder advocates with Ministry of Health officials and key leaders in medical education and professional associations to promote the non-pneumatic, anti-shock garment (Peru) 2009-2010

ngladesh

Foundation allowed Pathfinder to adapt its

technologies, Pathfinder removes barriers to successful implementation.

To learn more about Pathfinder’s comprehensive approach to reducing maternal mortality, visit www.pathfinder.org/PPH

Pathfinder provides regional workshops on the nonpneumatic, anti-shock garment for emergency obstetric care providers (Peru) 2009-2010

Pathfinder trains the International Red Cross Society to prevent and manage postpartum hemorrhage in refugee settings (Tanzania) 2010

Pathfinder begins to collaborate with the Women’s Refugee Commission to improve maternal health care for crisis-affected populations (Tanzania) 2009

Peru

Tanzania

WORLDWIDE REPLICATION OF PATHFINDER’S MODEL IS NOW ACHIEVABLE. Governments and partner organizations can scale up interventions to combat postpartum hemorrhage using Pathfinder’s Global Training Curriculum, Tool Kit, and Training Film. These robust tools promote the expansion of Pathfinder’s comprehensive approach to saving mothers’ lives. 2010

UNFPA funds help build the capacity of 20 health facilities to receive Pathfinder training and the non-pneumatic, antishock garment in Nigeria 2009

$

World Bank supports Pathfinder’s efforts to prevent and manage postpartum hemorrhage in Bangladesh 2010

$

Cloverleaf Foundation funds a solar-powered blood transfusion service in Nigeria 2010

7

$

UNFPA funds a series of workshops on emergency obstetric care, incorporating the use of the non-pneumatic, anti-shock garment in Peru 2010

“ Pathfinder trusts me to implement our plans and ensure that donors’ funds are used properly. That is a great motivation in itself. I’m trusted to do a job because I understand my country. I’m able to provide the information and the intelligence within this environment.” — Jelilah Unia, CNM, RN, Pathfinder Program Manager, Papua New Guinea

With support from The William and Flora Hewlett Foundation, Pathfinder reinforced its capacity to deliver quality services by strengthening the monitoring and evaluation of programs. Staff from 15 countries adopted a more systematic approach to monitoring program performance. Program managers are better able to track the progress of their programs and make appropriate adjustments.

8

pathfinder staff by location

2%

11 staff

in Washington DC

10%

89 staff

at headquarters 750 staff

in the field

88% Nigeria Mark Tuschman Viet Nam Idriss Bigou-Gilles

Jelilah Unia leading community sensitization on non-scalpel vasectomy

papua new guinea Pathfinder Papua New Guinea

Stronger Data Collection = More Effective Programs Thanks to private funds, Pathfinder can serve more clients more effec-

A new reporting format that presents program-specific indicators has

tively. A new, systematic approach to monitoring and evaluation enables

also been implemented across all programs, enabling managers at all

program managers to determine the progress of their work throughout

levels to more easily track progress. These data are uploaded into a

the life of a program. By utilizing a sound plan, more efficient tools, and

new database developed by the Research and Metrics Unit to track key

a new database to collect data, managers can improve the quality of

indicators of Pathfinder’s focal areas. Pathfinder can use the essential

care and disseminate evidence of program results.

information drawn from the data to examine programs in each region and country. Additionally, Pathfinder can report on the overall progress

Pathfinder’s Research and Metrics unit led the implementation of this

of the organization and share these results with donors who helped

new approach in field offices around the world. Monitoring and Evalua-

achieve them.

tion staff from 15 countries gathered at regional training workshops to develop their skills and improve the quality of data collection efforts.

9

Peru Karl Grobl INDIA Karl Grobl

Esther Joni with her family in Tanzania. Meet Esther and see how integrated reproductive health care changed her life at www. pathfinder.org/Esther tanzania Sala Lewis

10

for the year ended June 30, 2010

Chief Financial Officer’s Report Statement of Activities

Pathfinder operates in some of the riskiest environments in the world—risky to women’s health and risky from a business per-

Revenues, gains, and other support

spective. We need superb internal controls to protect donor contributions against misallocation, waste, and fraud.

Grants and contracts

Donors’ money is precious. We owe donors and our program

Contributions

beneficiaries our utmost energies to ensure these funds are

Contribution in-kind

well spent. Strong internal controls assure that prized donor funds deliver improvement to women’s lives.

In the past year, we stayed true to this goal and continued to maximize the impact of every resource, including our dedi-

Other

$91,653,1 5 7 3,898,930 3,516,647 222,437

TOTAL

99,291, 1 71

cated staff. For example, we expanded cross-training oppor-

Expenses

tunities: Our Ethiopian controller prepared our Burundi project

Program services

for its annual audit; our South African controller trained the

Management and general

newly hired controller in Angola; and our controller in Viet Nam

Fundraising

conducted an internal audit in Papua New Guinea. Finally, we created an internship program for the field finance managers

TOTAL

at the headquarters, both to integrate our worldwide programs and retain our best people.

Operating deficit

In FY 2010, Pathfinder International delivered sexual and reproductive health services valued at $102.3 million dollars.

Non-operating gains

We ended the year in strong financial condition, having added

Change in net assets for the year

$1.5 million to unrestricted net assets. A deficit in temporarily

Net assets beginning of year

restricted net assets arose when we delivered services funded

Net assets at end of year

by our very successful Make a Difference campaign. The deficit

90,077,014 10,621,041 1,600,723 102,298,778 (3,007,607) 1,597,053 (1,410,554) 35,253,696 33,843,142

is evidence of fulfilled promise: campaign funds have been put The information presented here is drawn from Pathfinder International’s financial statements, audited by Mayer Hoffman McCann PC. They are available from our headquarters office upon request.

to use around the world.

Thomas Downing Chief Financial Officer

total expenses

2%

fundraising *

AFRICA

88%

NEAR EAST

16% asia & the pacific 13% 1%

program services

latin america

10%

total expenses by region

management & general *Pathfinder receives Charity Navigator’s highest rating for organizational efficiency.

11

70%

India Karl Grobl

12

Too often, what prevents extremely poor families—the clients we are trying to reach—from using family planning services is the distance to health facilities and the cost to reach them. Pathfinder strengthens services at formal health facilities, but also bridges what we call ‘the last mile’ to ensure services at the community level.

Private funds allow us to bridge that gap.

The Last Mile

— Mustafa Kudrati, MPA, Pathfinder Country Representative, Tanzania

To hear more from Mustafa Kudrati and other voices from the field, visit www.pathfinder.org/Voices

board of directors as of May 2010 Founders

Board of Directors

Emeritus Directors

Clarence J. Gamble, MD 1894 –1966

Andrew A. Arkutu, MB, FRCOG Claudine Bacher Richard L. Berkowitz, MD Cornelia L. Cook Patricia J. Cooper Andrew L. Frey Walter J. Gamble, MD Susan M. George, MD Jane L. Havemeyer Anne Hale Johnson Benjamin R. Kahrl Edward M. Kaplan Rajen A. Kilachand Elisabeth L. Lyon Florence W. Manguyu, MD Deborah Prothrow-Stith, MD Valerie C. Spencer Kathryn Ketcham Strong Ronda E. Stryker John F. Swift Alfred W. Tate Ralph S. Tate June L. Tatelman Roslyn M. Watson

Sharon W. Allison J. Bayard Boyle, Jr. James R. Epstein Sarah G. Epstein Henry W. Foster, Jr., MD Mary B. Hewlett Denise E. Holmes, JD, MPH Julia G. Kahrl, PhD Susan C. Kirk Kathryn H. Lansing Mary D. Lindsay Nafis Sadik, MD Prakash Shah Normand F. Smith, III, Esq. Joseph C. Wheeler

Sarah B. Gamble 1898–1984 President

Daniel E. Pellegrom Officers

Susan S. Swift, DPA

[In Memoriam]

Chair of the Board Cynthia A. Fields Acting Chair Manuel Urbina, MD, MPH Secretary

printing Kirkwood Printing design Hecht Design

James M. Schwartz Treasurer

DEDICATED TO SUSAN S. SWIFT July 8, 1946 - March 15, 2010 Susan’s passion for Pathfinder’s work emerged from her desire to ensure every person who wanted access to family planning, could have it—particularly in the developing world. We honor her life and her efforts on behalf of women and men around the world.

13

“ I think the beauty of Pathfinder’s approach is that we work with communities to design sustainable interventions. They will continue the work long after we leave.”

— Ton van der Velden, MD, MPH, Pathfinder Country Representative, Viet Nam

XX%

9 Galen Street, Suite 217 Watertown, MA 02472 USA T 617.924.7200 F 617.924.3833 www.pathfinder.org

Cert no. XXX-XXX-XXX

14