To some, PSI is an enigma. It claims to be "social" in nature, but employs private sector terminology to describe itself: phrases from the world of business and advertising like "bottom line," "focus groups" and "entrepreneurship." It calls itself nonprofit but charges for many of its products and services. It has "population" in its name but also works in health areas that have little to do with population. Is this the result of an identity crisis, a lack of strategic planning or something else?

Actually, PSI has a sure grasp of its identity and has very deliberately expanded the areas of its health impact. An amalgam of the worlds of commerce and charity, PSI borrows the best strategies from each and uses them to improve the health of the poor and vulnerable in a way that is tangible and measurable. It has turned its tool of social marketing, originally applied only to family planning, to other areas of health where social marketing could make a difference.

The confusion is nothing new. Though it has always been a nonprofit, PSI was founded in 1970 under the name "Population Services, Inc." to suggest a businesslike orientation. It was assumed by many that Population Services, Inc. was a for-profit company, so the "Inc." was changed to "International" in 1973.

And just as PSI has embraced the tools of the business world, the business world has embraced PSI and its social marketing approach. PSI was immortalized in 1985 by a Harvard Business School case study on its family planning social marketing project in Bangladesh. The case study has been studied by thousands of students and is still being used by business schools around the world.

At the 2002 World Economic Forum Bill Gates said, "Effective social marketing campaigns have been proven to generate five- to six-fold increases in condom sales and use in developing countries."

In 2005, PSI and its methods were praised in the Financial Times — for "remarkable successes" in social marketing, "one of the most innovative and effective approaches to delivery [of] subsidized goods, such as condoms, water treatment systems, anti-malaria bed nets." TheWall Street Journal called PSI "a nonprofit that market-loving, results-oriented, compassionate people would love," and reported that it "markets brands with Madison Avenue-style sizzle" and "tries, harder than many other nonprofits, to measure its effectiveness at improving health."

In the 21st century, the name "Population Services International" has become somewhat outdated in the sense that PSI's work is not limited to "population" or "services." However, the organization is even more "international" than when founded in 1973, when it operated one project in one country. In 2007, PSI works in more than 60 countries and not just in family planning (or "population") but also in HIV, malaria, water/child survival and reproductive health.

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PSI takes advantage of the commercial sector to get products and services to the people that need them. Here, a merchant in Afghanistan offers Clorin safe water solution.