Spilling Chai: The Fight for Safe Abortion is Global

How does U.S. foreign policy impact women’s reproductive health and rights around the world? How does America import its domestic abortion politics by creating foreign policies that deny women access to safe abortion and a full-range of reproductive healthcare?

Those are the questions Anushay Hossain, host of podcast Spilling Chai, asks Dr. Milly Kaggwa, PSI’s Senior Clinical Advisor for Africa, Dr. Michele Bratcher Goodwin, Chancellor’s Professor at the University of California, Irvine, Founding Director of the Center for Biotechnology and Global Health Policy and PSI Board Member, and Jess Jacobs, Feminist artist, activist and philanthropist and Maverick Collective member.

Watch the podcast or read the transcript, below.

Hello. Welcome to Spilling Chai. I’m your host, Anushay Hossain, and if you follow my work, you’ve probably heard me described as a feminist policy analyst or heard me talking about my years, but on Capitol Hill here in Washington, D.C., lobbying on global health legislation.

But one of the main pieces of legislation and issues that I worked on during my time at the Feminist Majority Foundation was women’s reproductive health and rights, working for it, securing it, protecting and advocating on it. And of course, lobbying on it.

One of the key pieces policy pieces that we really worked on was a policy called the Mexico City Policy, which is more commonly known by feminists and advocates as the Global Gag Rule. Now this is a U.S. foreign policy, which means that it is not implemented in the U.S., but it is something that the U.S. implements overseas to any NGOs that receive any U.S. funding, whether it’s technical funding or financial assistance, they cannot use the word abortion in any of their work. They cannot advocate on the issue of abortion. They can’t even refer. You just refer a young woman who is at their facility on to go to another facility, which may even provide an abortion or abortion related services.

This is why it’s called a gag rule because it would be completely unconstitutional in the U.S. But of course, it is a stipulation. It is a policy that the U.S. implements abroad. It’s also become an extremely partisan U.S. policy, which means that, you know, Republicans usually implement it and Democrats usually repeal it. And it’s usually something that the president does of either party, the Republican Party or the Democratic Party. Whoever comes in, it’s usually one of their first orders of business is to repeal or reinstate this policy, which has deadly implications for women’s health and rights all over the world.

I’m so excited today because we have not one, not two, but three speakers from the really amazing organization Population Services International. And so I’m going to quickly read you the bios of our three esteemed guests today. I really do encourage you to look up their work and see all the amazing things they’ve done on behalf of women’s health and rights.

Our first guest is Dr. Michele Bratcher Goodwin. She’s a chancellor’s professor at the University of California, Irvine, and founding director of the Center for Biotechnology and Global Health Policy. She is an elected member of the American Law Institute, as well as an elected fellow of the American Bar Foundation and the Hastings Center, the organization’s central to the founding of bioethics. She is also the host of the On the Issues with Michele Goodwin podcast, which is, of course, from this magazine.

Next up, we have Jess Jacobs, who is a feminist artist, activist and philanthropist, a creative storyteller galvanizing the movement for equality through the fight for women’s reproductive rights. And she co-founded the woman led New York based production company Invisible Pictures. Jacobs has also regularly collaborated with nonprofit organizations such as Planned Parenthood and the National Women’s Law Center on special projects that advance women’s reproductive rights.

Last but certainly not least, our guest is Dr. Milly Nanyombi Kaggwa. She’s the senior clinical adviser for Africa at Population Services International, where she supports a service delivery portfolio that spans over 30 countries in maternal, newborn and child health, family planning and sexual and reproductive health programs. She is a medical doctor and public health professional with over 15 years experience, and she currently provides technical assistance throughout east and southern Africa.

These three incredible women are my guest today on stilling chai on the pain gap. And of course, there’s an entire chapter chapter two, in fact, on the Global Gag Rule in my book, The Pain Gap: How Sexism and Racism in Health Care Kill Women. I hope you enjoy today’s show.

AH: Jess Jacobs, I am going to start with you. Talk to me about how you got involved in this work, and why should Americans care about safe abortion around the world?

Jess Jacobs: That is an excellent question. First of all, for having me. I’m so glad to be here. I really got involved in this issue because of a personal experience. So I tell my abortion story regularly as a part of de-stigmatization efforts. I got pregnant when I was 19. I chose to have an abortion that was not a difficult decision for me, but what was difficult was the aftermath of that, which in which I felt very alone. I felt very isolated and I didn’t feel that there was really a space to talk about my experience. And I ended up a couple of years later, telling my mom finally that I’d had an abortion and she has consented to me sharing her story as well because she informed me that she also had an abortion, also as a teenager, and I had no idea because we didn’t talk about it growing up. And so this is this kind of big light bulb moment for me that there was something happening that we weren’t talking about that was harming people around the world. I mean, definitely here. I was living in New York City and at the time in college…my Planned Parenthood was around the corner for me. If I felt like that was…a heavy burden to carry…[imagine what was] happening all around the world. And so that was kind of really where I started.

AH: Tell me about your work in the film industry and about The Global HER Project that you made.

JJ: Absolutely. I think that will connect you to sort of why Americans should care. Tthis was a project that I collaborated with Mary John Frank, who’s a fabulous director and choreographer. And then Erica Rose produced alongside me. We created a short musical PSA type piece, which is all about the Global Gag Rule.

And this project was put together because when Trump came into office he signed an executive order for the Global Gag Rule. At that point I was 24. I hadn’t ever heard of the Global Gag Rule because Obama had been in office for the majority of my life. And so myself and also Mary, John, Frank and Erica, we all were like, What is this policy? What does this mean? And it really, I think, spoke to the U.S.’s hegemonic approach to our role in the world with such deep colonialist ties. It’s so harmful. And the way in which Trump had expanded the Global Gag Rule also was one of these kind of ways in which I saw how abortion access really as a precursor to so many other harmful and impactful things that the U.S. has the capacity to do because of our role in the world and because of how we’ve established ourselves in a lot of cases.

When COVID came around, we saw how much care had been reduced because of the Global Gag Rule. It was evident that abortion access is actually kind of a marker for where a as a world and as a country we are in terms of providing healthcare to our most marginalized…it really impacts everybody.

AH: It really impacts everybody, I love that you said that because I think a lot of people don’t understand how intertwined women’s health and women’s rights are globally and how such a big donor and powerful rich nation like the U.S. can implement and affect the health and rights of women and girls around the world…Which brings me to you, Dr. Kaggwa.

I feel like we’ve all had experience on the policy level. I mean, I live in D.C., so this is an issue I’ve worked on on Capitol Hill and advocates and activists here and policymakers and allies. You know, we have so much stress and anxiety over the ping pong-ing of this policy. And of course, there’s a lot of movement to permanently repeal the Global Gag Rule. Talk to me, though, about what you see on the ground. If I were somebody on the ground, it almost be better to not take U.S. funding, but obviously people don’t have that choice.

Dr. Milly Nanyombi Kaggwa: Thank you for having me and this discussion, and you’re definitely right. Having the Global Gag Rule sometimes and not having it other times is definitely a big problem for programs that are implementing safe abortion programs worldwide in Africa, where I work as well.… we could have been used to implement programs for women and children, instead of moving money to be able to comply to the Global Gag Rule, to be able to work within the partnerships that all of a sudden became really small. Because look, organizations could not necessarily implement their normal health programs, HIV malaria programs, if they were also having…programs. And that means that the funding that they had was really reduced to and they had to make a decision whether they will be able to continue this work or whether they would have to pull out of that work.

So at PSI, we decided that really we needed to be responsible…it made sense to try and despite the difficulties and had those continue to the work…because women still need contraceptive services…so to see how it really does affect the space where you will find health providers that used to have programs that were giving out with HIV services, integrated services, sexual reproductive health services, they can’t do that anymore. They have to make a choice if they want to be able to receive funding. They are reduced… We’ve seen lots of teenage pregnancies. We’ve seen lots of women being impacted by unwanted pregnancies that they still seek unsafe abortion…I think that’s something that so many people don’t understand in Africa, in Asia, in America that when you make abortion difficult to access, it’s not that women aren’t going to have it. They’re just not going to get a safe legal one. You know, they’re going to have dangerous back-alley abortions, which you know, exist around the world. And I hate that term. But with what’s happening in America now, maybe we will lose our right to abortion again… too.

AH: What do you want people in the states to understand about the impact of U.S. policy? And why? Why should Americans care?

MK: Yeah, I think that’s a very good question that you ask; why should this matter to an average American citizen? I think Americans have been very well educated about their laws. They know the impact that will come out of the Supreme Court’s ruling. That’s not necessarily the case in some of the lower income countries, like where I come from. Women don’t necessarily know what the law is about. Service providers don’t even know what the law is, and these are countries where these restrictions impact abortion access… In the U.S., this conversation is coming at a time where I think it is possible to put the conversation really even out of the U.S. context to a global audience so that you can open up the discussion for countries outside the U.S.

The U.S. is the leader. The U.S. is one of the biggest funders of global health. If they make changes…in the U.S….we’ll see the impact on the laws that are existing already in Africa, in Asia, in South America. Yes, we have seen some tremendous movement toward lifting restrictions in some countries. We’ve seen for countries in the recent past that have lifted abortion restrictions. But how about the rest of the world, which is still dependent on U.S. funding for their sexual reproductive health programs, contraceptive programs, malaria programs, HIV programs?

Once you have the Global Gag Rule moving the goalposts, it’s hard to make lasting impact on unsafe abortion. And it’s hard to make lasting changes that affect women positively. And it’s really a sexual reproductive health issue, a public health issue and a human rights issue that we’re talking about here.

Why should this matter to an average American citizen? I think Americans have been very well educated about their laws. They know the impact that will come out of the Supreme Court’s ruling. That’s not necessarily the case in some of the lower income countries.

Dr. Milly Nanyombi Kaggwa, PSI’s Senior Clinical Advisor for Africa

AH: Oh, perfect. I’m getting my blood is boiling. And you know, we are saying women, but a lot of times these are very young girls we’re talking about. I mean, I grew up in Bangladesh. I have seen it a lot of times. These people, we’re talking about our kids, their 13 year old girls, they’re, you know, 12 year old girls, often impregnated through sexual violence. I mean, it’s…all connected. Which brings me to you, Dr. Goodwin.

It’s incredible to me…how American domestic abortion politics spills out into the international arena. From a legal perspective, how is America able to implement a policy that would literally be unconstitutional in America? There’s a reason we’re calling it the Global Gag Rule. It is called, by the way, to my audience, the Mexico City policy. Obviously, I speak about this in my in my intro, but how is America able to do this? Please help us with your brilliant legal minds.

The first question that you ask is how in the world is it that the United States could determine policy in other places? Are we removed from the fact that the United States is a country that sits in and on indigenous lands?

Dr. Michele Bratcher Goodwin, Chancellor’s Professor at the University of California, Irvine, Founding Director of the Center for Biotechnology and Global Health Policy and PSI Board Member

Dr. Michele Bratcher Goodwin: Well, first, I want to thank you for having me with you and with these really impressive guests, I’m really pleased and honored to be in all of your company. And, you know, I think it’s important that we think about not just the Mexico City policy, the Global Gag Rule. Talk about a mouthful! But also the Helms amendment as well and who these people are who have been behind these types of actions.

The first question that you ask is how in the world is it that the United States could determine policy in other places? Are we removed from the fact that the United States is a country that sits in and on indigenous lands? Right, I mean, it’s something that we just take for granted and we move from. Let’s pay attention to the fact that as part of the capital that made the United States what it is, that it was a country that bought into by law, by policy, by culture, through judicial sanction, slavery, right, the kidnap, the trafficking of children, of women, of men, the sexual subordination of that baked into the soil. Not for a sort of a one day experiment, not for a week long experiment, but something that lasted centuries and a Supreme Court that upheld laws doing that.

So that is just to sort of set the frame for like how in the world could that be? I mean, we’re already talking about, you know, a space from which there has been slavery, colonialism, Jim Crow, the sanctioning of the most horrific things that we have ever seen eugenics, right? I mean, we could go on, but I need to get to Mexico City and the Helms amendment. But what? But when you start from that space, then it’s perhaps not within reach. And especially when you think about American slavery itself as being something that was rooted in the sexual subordination of a whole group of people denying them bodily autonomy, privacy, liberty, reproductive freedom. When you start from that type of position, naledi and then you go into a position naledi that is eugenics that says we can even further deny you the opportunity to ever reproduce. It really doesn’t matter which way we’re controlling it. It is all about control.

And for the United States Supreme Court in 1927 to uphold Virginia’s eugenics law that was then taken by the Third Reich and implemented in Germany… In 1973, right after the United States Supreme Court banned laws that would criminalize abortion, Jesse Helms then pushed through Congress the Helms amendment, which would deny U.S. funds from being used with regard to abortion. And then that would serve as a platform later on for the Mexico City policy.

I want to just point out that at the time, even Richard Nixon was in opposition of the Helms amendment. Most people in the Senate were. But we must also understand the connective tissue behind the person who first proposed this completely understanding what he was doing. A person who was a self-professed sexist. He was homophobic, did not want funding for HIV and AIDS research; He was a person who was self-described in his racial animosity. It was from this space that we see the denying of women abroad and girls abroad the opportunity to be able to determine their own reproductive destinies. And I think that that’s important as we think about in the United States what all of this is rooted in, because we’ve also failed to see the interconnected threads of white supremacy as being connected with the denial of reproductive health care. And for people who think that that’s a stretch there, there are articles that have been written. It has been shown that the people who have been terrorizing people at abortion clinics were some of the people who showed up on January 6th to try to take down our Capitol and to interrupt the U.S. election process. So I’ll stop there. There’s so much more that I could say…but let me just say this: at the time in which the Helms amendment was put to the Senate and Jesse Helms coerced his colleagues into the passage of that amendment, literally holding up U.S. funds abroad until he could get his way. And then he refused to even sign on to his own amendment because he did not support U.S. funds going abroad… All to say that when we look at how this could happen, it comes from a space that has never been empathetic, gentle or kind, or understanding or caring about the integrity, dignity, independence and privacy of women of color. I am very rarely left speechless.

AH: Your answer was an education for me; you just took us to church. God, Jesse Helms, man. Even in his death still affecting the health and rights of women and girls around the world…

There is a lot of momentum to just repeal the Global Gag Rule permanently. What are the chances of that from a legal perspective?

MG: Well, there are always the possibilities that we can, in fact, climb on to that moral arc of justice and do the right thing. I think if there are any lessons that we have in law from, let’s say, Plessy v. Ferguson, which instituted Second Class Citizen literally into law post emancipation. And then we see the lift of that took almost a hundred years, but we see the lift of that through Brown v. Board of Education in the 1960s, we saw the 1964 Civil Rights Act enacted, sadly after the deaths and harms that were experienced by American black people who fought so hard for our Constitution to have real meaning beyond paper, but to really live up to its promise of equality for all. And then we saw the 1965 Voting Rights Act and the reason why I mention that and I mentioned the Supreme Court and I also mentioned Congress that it is absolutely possible for Congress to do the right thing.

It is absolutely possible that a Supreme Court can do the right thing, striking down unjust laws, upholding just laws.

But we are at a time in which it is a very fractured system of democracy. Right now, there are international organizations that have declared that the U.S. is a democracy that is in decline. But there are people who are in Congress that are fighting for the codification of Roe and who are also fighting for the permanent repeal of the Helms amendment. And so there is a momentum now, perhaps a momentum that we have not seen in recent decades, but that is afoot now to make sure that we codify and protect reproductive health rights and justice domestically and abroad.

It’s really important that you’re doing this show, and I think it’s really important that we connect the threads of reproductive health, liberty and freedom to democracy. The two go hand in hand.

AH: I want to ask everybody because despite the doom and gloom, I’m actually very hopeful. I really am. I feel like the pandemic has just exposed how important it is to invest in women’s health and to listen to women ways. What is giving you hope right now?

There is a movement toward what I call abortion joy that I really love and which we connect with each other based on the experiences that we’ve had. That’s something that…is giving me a lot of hope in the face of some of the scary stuff that’s happening.

– Jess Jacobs, Feminist artist, activist and philanthropist and Maverick Collective member

JJ: I love this question. I think that we’re really seeing a galvanization toward abortion storytelling, toward sharing our experiences, toward the honoring of community and of building up community. And I think that really the thing that’s going to bring us forward. One in three women in the world have had an abortion. One in four women in the United States have had an abortion. There is not the statistics for folks who do not identify as women, but there are even more than that for folks who can get pregnant and don’t identify as women. This is a large community and we all can support each other.

There is a movement toward what I call abortion joy that I really love and which we connect with each other based on the experiences that we’ve had. And I think that’s something that…is giving me a lot of hope in the face of some of the scary stuff that’s happening.

AH: I love that you said that and that you brought up the point on storytelling because it’s something I talk about in my book because I’m kind of obsessed now with what women don’t talk about and the stories that we keep to ourselves. But there is so much power when we start sharing our stories, you just realize, oh, I’m not the only one.

MK: Previously in the 50s, 60s, 70s, 80s, there was no abortion medication available for women. They needed to go to a health provider who was like the gateway to services. But now we’re seeing even the abortion pill, the availability of a medication abortion pill that can be accessed that the World Health Organization says is safe for women to use in their first trimester. You do not need to have a medical personnel help you to administer it. I think that gives me hope. Lots of women now have at least some safe option, and they don’t have to go through the very, very, very risky decisions that were made by our parents, by those who came before us.

AH: Yes, hopefully we will not see the return of the coat hanger and yes, for mifepristone, which, by the way, Feminist Majority was so involved in those early, early clinical trials for it.

MG: It’s giving me hope is that we’re having conversations like the one we’re having today, and it gives me hope that we’re connecting the dots and that people are beginning to see and news media are beginning to report just the interconnected tissues between these kinds of issues.

I really do think that as people are paying attention to matters of democracy and are seeing the fracturing of democracy and the very places where there is the denial of reproductive access, that these two things go hand in hand. And I think that is a really important point. It’s a sophisticated point that was missed by many people decades ago. I think that many people who are people of color and who are vulnerable saw it. But I think that today it is far more revealing for everyone, and that actually gives me hope because we begin to center democracy and then we begin to center.

Well, what are the needs of all people and how do we make this a better society? And in making this a better society, then we’re going to be talking about abortion, which is really important. But we’ll be talking about maternal mortality and morbidity, and we’ll be talking about access to contraception and we’ll be talking about access to sex education and more. And really understanding that reproductive rights is a is a is a wheel that has many different spokes and prongs and that we need all of that together in order to really fulfill the promise of what reproductive freedom and liberty really happens to be. And I think we’re at that time where we can have those conversations.

AH: I think so too. Amen and hallelujah, ladies, I could speak to you all day. This is my favorite topic. I mean, not the Global Gag Rule, but like women’s health and women fighting. All right. Thank you so much for your time.

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For example, in Mali, access to formal health services remains challenging, with four in ten people living several miles from the nearest health center, all without reliable transportation or access. In 2009, the Ministry of Health adopted a community health strategy to reach this population. The U.S. President’s Malaria Initiative (PMI) Impact Malaria project, funded by USAID and led by PSI, supports the Ministry with CHW training and supervision to localize health services.  

In 2022, 328 thousand malaria cases were recorded by CHWs); 6.5 thousand severe malaria cases were referred to health centers, according to the national health information system. 

During that time, the PMI Impact Malaria project (IM) designed and supported two rounds of supportive supervision of 123 CHWs in their workplaces in the IM-supported regions of Kayes and Koulikoro. This included developing and digitizing a standardized supervision checklist; and developing a methodology for selecting which CHWs to visit. Once a long list of CHW sites had been determined as accessible to supervisors for a day trip (including security reasons), the supervisors telephoned the CHWs to check when they would be available to receive a visit [as being a CHW is not a full-time job, and certain times of the year they are busy with agricultural work (planting, harvesting) or supporting  health campaigns like mosquito net distribution].  

Supervisors directly observed how CHWs performed malaria rapid diagnostic tests (RDTs) and administered artemisinin-based combination therapy (ACT). They recorded CHW performance using the digitized checklist, interviewed community members, reviewed records, and provided on-the-spot coaching. They also interviewed the CHWs and tried to resolve challenges they expressed, including with resupply of commodities or equipment immediately or soon afterwards.  

Beyond the observed interactions with patients, supervisors heard from community members that they were pleased that CHWs were able to provide essential malaria services in the community. And the data shows the impact. 

In IM-supported areas of Mali, 36% of CHWs in the first round were competent in performing the RDT, which rose to 53% in the second. 24% of CHWs in the first round compared to 38% in the second were competent in the treatment of fever cases and pre-referral counseling. Between both rounds, availability of ACT increased from 80 percent to 90 percent. 

Supportive supervision with interviews and observations at sites improved the basic competencies of CHWs between the first and second rounds, and additional rounds will help to understand the longer-term programmatic benefits.

Taking a market-based approach to scale sanitation in Ethiopia

By: Dr. Dorothy Balaba, Country Representative, PSI Ethiopia  

In Ethiopia, PSI leads the implementation of USAID Transform WASH (T/WASH) activity with consortium partners, SNV and IRC WASH. Contrary to traditional models that rely on distribution of free or heavily subsidized sanitation products, T/WASH utilizes a market-based sanitation approach. This approach creates sustainable and affordable solutions, by integrating market forces and supporting businesses to grow, while creating demand at the household level. 

During the last six years, T/WASH has worked alongside the private sector and government (Ethiopia’s Ministry of Health, Ministry of Water and Energy, and Ministry of Labor and Skills), among other stakeholders, to increase household access to affordable, quality sanitation products and services. For example, more than 158 thousand households have invested in upgraded sanitation solutions with rapid expansion to come as the initiative scales and market growth accelerates. 

T/WASH has successfully trained more than 500 small businesses, including community masons and other construction-related enterprises, with technical know-how in sanitation product installation, operational capacities, and marketing and sales skills needed to run successful, growing businesses. The Ethiopian government is now scaling the approach to all districts through various national, regional, and local institutions with requisite expertise. T/WASH has also worked the One WASH National Program, Ministry of Health, Ministry of Water and Energy, and Ministry of Labor and Skills to examine policies that influence increased household uptake of basic WASH services, such as targeted sanitation subsidies, tax reduction to increase affordability, and increased access to loan capital for business seeking to expand and households needing help to improve their facilities. 

To share the journey to market-based sanitation, representatives of the Ethiopian Ministry of Health and the USAID Transform WASH team took to the stage at the UN Water Conference in 2023.

“Rather than relying on traditional aid models that often distribute free or heavily subsidized sanitation products, market-based sanitation creates sustainable and affordable solutions, integrating market forces and supporting businesses to grow.”  

— Michael Negash, Deputy Chief Party of T/WASH 

Promoting self-managed care like Self-testing and Self-Sampling

By: Dr Karin Hatzold, Associate Director HIV/TB/Hepatitis

Building upon the success and insights gained from our work with HIV self-testing (HIVST), PSI is actively applying this approach to better integrate self-care, more broadly, in the health system beginning with Hepatitis C and COVID-19. Self-testing has emerged as a powerful tool to increase access to integrated, differentiated, and decentralized health services, accelerating prevention, care, and treatment for various diseases, while also increasing health system resilience against COVID-19.

Here’s how we got there.

Seven years ago, the landscape of HIV self-testing lacked global guidelines, and only the U.S., the UK and France had policies in place that allowed for HIV self-testing. High disease burdened countries in low-and-middle-income-countries (LMICs) lacked evidence and guidance for HIVST despite major gaps in HIV diagnosis.

However, through the groundbreaking research from the Unitaid-funded HIV Self-Testing Africa (STAR) initiative led by PSI, we demonstrated that HIVST is not only safe and acceptable but also cost-effective for reaching populations at high risk with limited access to conventional HIV testing. This research played a pivotal role in informing the normative guidelines of the World Health Organization (WHO) and shaping policies at the country level. As a result, more than 108 countries globally now have reported HIVST policies, with an increasing number of countries implementing and scaling up HIVST to complement and  partially replace conventional testing services. This became especially significant as nations tried to sustain HIV services amidst the disruptions caused by the COVID-19 pandemic.

By leveraging our expertise, PSI is conducting research to identify specific areas and populations where the adoption of Hepatitis C and COVID-19 self-testing could significantly enhance testing uptake and coverage. This research serves as the foundation for developing targeted strategies and interventions to expand access to self-testing, ensure that individuals have convenient and timely options for testing for these diseases, and are linked to care, treatment and prevention services through differentiated test and treat approaches.

Using peer coaches to counter HIV stigma in South Africa

By: Shawn Malone, Project Director, HIV/AIDS Gates Project in South Africa, PSI Global

In South Africa, where the HIV response has lagged in reaching men, PSI’s Coach Mpilo model has transformed the role of an HIV counselor or case manager into that of a coach and mentor who provides empathetic guidance and support based on his own experience of living with HIV. Coaches are men who are not just stable on treatment but also living proudly and openly with HIV. Situated within the community and collaborating closely with clinic staff, they identify and connect with men struggling with barriers to treatment and support them in overcoming those barriers, whether that means navigating the clinic or disclosing their HIV status to their loved ones.

PSI and Matchboxology first piloted the model in 2020 with implementing partners BroadReach Healthcare and Right to Care as well as the Department of Health in three districts of South Africa. Since then, the model has been rolled out by eight implementing partners in South Africa, employing more than 300 coaches and reaching tens of thousands of men living with HIV. To date, the model has linked 98 percent of clients to care and retained 94 percent of them, in sharp contrast to the estimated 70 percent of men with HIV in South Africa who are currently on treatment.

Given the success of the program, South Africa’s Department of Health and the United States President’s Emergency Plan for AIDS Relief (PEPFAR) have each embraced the Coach Mpilo model in their health strategy and are embedding it in their strategies and programs. 

“The men we spoke to [while I was traveling to South Africa for a PrEP project with Maverick Collective by PSI] were not only decidedly open to the idea of taking a daily pill…many were willing to spread the word and encourage friends to get on PrEP too. We were able to uncover and support this new way forward because we had flexible funding to focus on truly understanding the community and the root barriers to PrEP adoption. This is the philanthropic funding model we need to effectively fight the HIV epidemic, and it’s beneficial for all sorts of social challenges.”

– Anu Khosla, Member, Maverick Collective by PSI

simplifying consumers’ journey to care in Vietnam

By: Hoa Nguyen, Country Director, PSI Vietnam

In late 2022, with funding from the Patrick J. McGovern Foundation, PSI and Babylon partnered to pilot AIOI in Vietnam. By combining Babylon’s AI symptom checker with PSI’s health provider locator tool, this digital health solution analyzes symptoms, recommends the appropriate level of care, and points them to health providers in their local area. The main goal is to support people in low-income communities to make informed decisions about their health and efficiently navigate the healthcare system, while reducing the burden on the healthcare workforce. The free 24/7 service saves people time and subsequent loss of income from taking time off work and from having to pay unnecessary out-of-pocket expenses. Under our global partnership with Meta, PSI launched a digital campaign to put this innovative product in the hands of people in Vietnam. By the end of June 2023 (in the nine months since product launch), 210 thousand people accessed the AIOI platform; 2.4 thousand people created personal accounts on the AIOI website, 4.8 thousand triages to Symptom Checker and linked 2.2 thousand people to health facilities.   

Babylon’s AI symptom checker and PSI’s health provider locator tool captures real-time, quality data that supports health systems to plan, monitor and respond to consumer and provider needs. But for this data to be effective and useable, it needs to be available across the health system. Fast Healthcare Interoperability Resources (FHIR) standard provides a common, open standard that enables this data exchange.
PSI’s first consumer-facing implementation of FHIR was launched in September 2022 as part of the Babylon Symptom Checker project in Vietnam, enabling rapid alignment between PSI and Babylon’s FHIR-enabled client records systems. PSI already has several other consumer health FHIR implementations under active development in 2023, including PSI’s collaboration with the Kenya MOH to launch a FHIR-enabled WhatsApp national health line for COVID-19 health information. PSI will also look to adopt and scale health workforce-facing FHIR-enabled tools, such as OpenSRP2, which will be piloted in an SRH-HIV prevention project in eSwatini in partnership with Ona by the end of 2023.

— Martin Dale, Director, Digital Health and Monitoring, PSI

Engaging the private sector for disease surveillance in Myanmar

By: Dr. Zayar Kyaw, Head of Health Security & Innovation, PSI Myanmar

Under a three-year investment from the Indo-Pacific Center for Health Security under Australia’s Department for Foreign Affairs and Trade (DFAT), PSI is enhancing disease outbreak surveillance and public health emergency preparedness and response capacities in Myanmar, Cambodia, Laos, and Vietnam. When PSI conducted a review of existing disease surveillance systems in Myanmar, it identified several gaps: although the Ministry of Health had systems in place for HIV, tuberculosis, malaria and other communicable diseases, they were fragmented, with different reporting formats and reliance on paper-based reporting. In addition, private sector case surveillance data were not routinely captured, yet private clinics and pharmacies are the dominant health service delivery channel in the country. This hindered effective disease prevention and control efforts.

Building on our extensive private sector malaria surveillance work under the BMGF-funded GEMS project in the Greater Mekong Subregion, PSI implemented a case-based disease notification system using social media channels to overcome the limitations of paper-based and custom-built mobile reporting tools. These chatbots, accessible through popular social media platforms like Facebook Messenger and Viber, proved to be user-friendly and required minimal training, maintenance, and troubleshooting. The system was implemented in more than 550 clinics of the Sun Quality Health social franchise network as well as nearly 470 pharmacies. The captured information flows to a DHIS2 database used for real-time monitoring and analysis, enabling rapid detection of potential outbreaks. Local health authorities receive instant automated SMS notifications, enabling them to promptly perform case investigation and outbreak response.

In 2022, private clinics reported 1,440 malaria cases through the social media chatbots, while community mobilizers working with 475 private providers and community-based malaria volunteers reported more than 5,500 cases, leading to the detection of two local malaria outbreaks. Local health authorities were instantly notified, allowing them to take action to contain these surges in malaria transmission. During the same time, pharmacies referred 1,630 presumptive tuberculosis cases for confirmatory testing – a third of which were diagnosed as tuberculosis and enrolled into treatment programs.

Training health workers in Angola

By: Anya Fedorova, Country Representative, PSI Angola  

The shortage of skilled health workers is widely acknowledged as a significant barrier to achieving Universal Health Coverage. To address this challenge, PSI supported ministries of health to develop a digital ecosystem that brings together stewardship, learning, and performance management (SLPM). The ecosystem enhances training, data-driven decision-making, and the efficiency of healthcare delivery.

Here’s what it looks like in practice.

In July 2020, PSI Angola, alongside the Angolan digital innovation company Appy People, launched Kassai, an eLearning platform that targets public sector health workers in Angola. Through funding from USAID and the President’s Malaria Initiatve (PMI), Kassai features 16 courses in malaria, family planning, and maternal and child health – with plans to expand learning topic areas through funding from ExxonMobil Foundation and private sector companies. A partnership with UNITEL, the largest telecommunication provider in Angola, provides all public health providers in Angola free internet access to use Kassai.

Kassai’s analytics system to follow learners’ success rate and to adjust the course content to learners’ performance and needs. Kassai analytics are integrated with DHIS2 – the Health Management Information System (HMIS) of Angolan MOH, to be able to link learners’ knowledge and performance with the health outcomes in the health facilities.  The analytics track learners’ performance by course and gives visibility by health provider, health facility, municipality, and province. Each course has pre-and post-evaluation tests to track progress of learning, too.

By the end of 2022, there were 6,600 unique users on the Kassai platform and 31,000 course enrollments. PSI Angola’s partnership with UNITEL, the largest telecommunication provider in Angola, allows for free internet access to learn on the Kassai for all public health providers in Angola. Building on its success for malaria training, Kassai now also provides courses in family planning, COVID-19, and maternal and child health. This reduces training silos and provides cross-cutting benefits beyond a single disease.

Implementing the SLPM digital ecosystem brings numerous benefits to health systems. It allows for more strategic and efficient workforce training and performance management, enabling ministries of health to track changes in health workers’ knowledge, quality of care, service utilization, and health outcomes in real time. The ecosystem also supports better stewardship of mixed health systems by facilitating engagement with the private sector, aligning training programs and standards of care, and integrating private sector data into national HMIS. Furthermore, it enables the integration of community health workers into the broader health system, maximizing their impact and contribution to improving health outcomes and strengthening primary healthcare.



PSI does not tolerate retaliation or adverse employment action of any kind against anyone who in good faith reports a suspected violation or misconduct under this policy, provides information to an external investigator, a law enforcement official or agency, or assists in the investigation of a suspected violation, even if a subsequent investigation determines that no violation occurred, provided the employee report is made in good faith and with reasonable belief in its accuracy.


Global Code of Business Conduct And Ethics

PSI’s code sets out our basic expectations for conduct that is legal, honest, fair, transparent, ethical, honorable, and respectful. It is designed to guide the conduct of all PSI employees—regardless of location, function, or position—on ethical issues they face during the normal course of business. We also expect that our vendors, suppliers, and contractors will work ethically and honestly.


The Future of Work

With overarching commitments to flexibility in our work, and greater wellbeing for our employees, we want to ensure PSI is positioned for success with a global and holistic view of talent. Under our new “work from (almost) anywhere,” or “WFAA” philosophy, we are making the necessary investments to be an employer of record in more than half of U.S. states, and consider the U.S. as one single labor market for salary purposes. Globally, we recognize the need to compete for talent everywhere; we maintain a talent center in Nairobi and a mini-hub in Abidjan. PSI also already works with our Dutch-based European partner, PSI Europe, and we’re creating a virtual talent center in the UK.


Meaningful Youth Engagement

PSI is firmly committed to the meaningful engagement of young people in our work. As signatories of the Global Consensus Statement on Meaningful Adolescent & Youth Engagement, PSI affirms that young people have a fundamental right to actively and meaningfully engage in all matters that affect their lives. PSI’s commitments aim to serve and partner with diverse young people from 10-24 years, and we have prioritized ethics and integrity in our approach. Read more about our commitments to the three core principles of respect, justice and Do No Harm in the Commitment to Ethics in Youth-Powered Design. And read more about how we are bringing our words to action in our ICPD+25 commitment, Elevating Youth Voices, Building Youth Skills for Health Design.


Zero Tolerance for Modern-Day Slavery and Human Trafficking

PSI works to ensure that its operations and supply chains are free from slavery and human trafficking. Read more about this commitment in our policy statement, endorsed by the PSI Board of Directors.



Since 2017, PSI has been a signatory to the United Nations Global Compact, a commitment to align strategies and operations with universal principles of human rights, labor, environment and anti-corruption. Read about PSI’s commitment to the UN Global Compact here.


Environmental Sustainability

The health of PSI’s consumers is inextricably linked to the health of our planet. That’s why we’ve joined the Climate Accountability in Development as part of our commitment to reducing our greenhouse gas emissions by 30 percent by 2030. Read about our commitment to environmental sustainability.


Affirmative Action and Equal Employment Opportunity

PSI does not discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, protected veteran status or any other classification protected by applicable federal, state or local law. Read our full affirmative action and equal employment opportunity policy here.


Zero Tolerance for Discrimination and Harassment

PSI is committed to establishing and maintaining a work environment that fosters harmonious, productive working relationships and encourages mutual respect among team members. Read our policy against discrimination and harassment here.

PSI is committed to serving all health consumers with respect, and strives for the highest standards of ethical behavior. PSI is dedicated to complying with the letter and spirit of all laws, regulations and contractual obligations to which it is subject, and to ensuring that all funds with which it is entrusted are used to achieve maximum impact on its programs. PSI provides exceptionally strong financial, operational and program management systems to ensure rigorous internal controls are in place to prevent and detect fraud, waste and abuse and ensure compliance with the highest standards. Essential to this commitment is protecting the safety and well-being of our program consumers, including the most vulnerable, such as women and children. PSI maintains zero tolerance for child abuse, sexual abuse, or exploitative acts or threats by our employees, consultants, volunteers or anyone associated with the delivery of our programs and services, and takes seriously all complaints of misconduct brought to our attention.


Diversity and Inclusion

PSI affirms its commitment to diversity and believes that when people feel respected and included they can be more honest, collaborative and successful. We believe that everyone deserves respect and equal treatment regardless of gender, race, ethnicity, age, disability, sexual orientation, gender identity, cultural background or religious beliefs. Read our commitment to diversity and inclusion here. Plus, we’ve signed the CREED Pledge for Racial and Ethnic Equity. Learn more.


Gender Equality

PSI affirms gender equality is a universal human right and the achievement of it is essential to PSI’s mission. Read about our commitment to gender equality here.


01 #PeoplePowered

02 Breaking Taboos

03 Moving Care Closer to Consumers

04 Innovating on Investments

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