Collaborating to Build Stronger Health Systems

A conversation during the 2023 Concordia Annual Summit.

PSI President and CEO Karl Hofmann joined leading health organizations in conversation during the 2023 Concordia Annual Summit, a public-private sector forum to establish market-led solutions to today’s greatest challenges. Watch the video or read the transcript, below.

Alejandro Rincon, New York Correspondent, NTN24: Thank you so much for joining us this afternoon. First, I’m going to introduce everybody in our discussion. Shannon Thyme, she’s the Chief Legal Officer and President of the Moderna Charitable Foundation. Thank you so much, Shannon, for being with us. Also, Anil Soni, who is the CEO of the WHO Foundation, thank you so much for being with us. And then we also have the pleasure of the honorable Karl Hofmann, President and CEO of Population Services International, as well as Elizabeth Staudinger, who is part of the managing board of Siemens Healthcare…

Shannon, we can begin with you.

From your experience, what do you think are the best lessons that we have learned on equitable vaccine distribution and the role of Moderna in this process?

Shannon Thyme, Chief Legal Officer and President, Moderna Charitable Foundation: Thank you for the question and thank you for having us. For Moderna, we’re trying to have the greatest impact on human health that we can and that includes ensuring equitable access to vaccines. We saw four things that we think public-private partnerships need to come together to solve if we’re going to create the kind of sustainable health systems that lead to better outcomes.

The first is understanding our reliable procurement mechanism for low- and middle-income countries. Gavi COVAX did a nice job stepping in during an emergency, but how do we make that more robust, so you don’t need to lean in so quickly?

Second, is thinking about global supply chains. Asking countries not to create trade restrictions or export blocks, but to allow free movement of goods across the supply chain quite quickly so everybody can have access to important healthcare.

Third, is working together in the regulatory system. How do we get regulators to come together and understand how to move more quickly, how to build clinical trial capabilities and again, how to create a system that becomes self-sustaining for future pandemics? And, finally, data and data transparency. How do we make sure everybody, both regulators but also individuals, has the facts they need to make the right decisions?

AR: Now in that context, let me jump now to you Anil, because one of the main discussions that we have had throughout this crisis is collaboration and strengthening between the public and private sector. From your experience, is there any challenge that you would like to highlight? What actions can be taken to be more resilient in the future?

Anil Soni, CEO, WHO Foundation: One of the lessons coming out of the pandemic and the work of the World Health Organization (WHO) was around accurate information and the risk of misinformation. For any of you who’ve had a challenging moment in your health or if there was a new virus, you open the Internet, you go to Google and you ask yourself: How is this transmitted? What do I do to keep myself safe? What’s the appropriate treatment? In fact, information on the Internet is now one of the most important determinants of people’s healthcare.

So, during the pandemic, social media companies recognized that they had an important responsibility to make sure that accurate information around the pandemic was available to anyone around the world. The WHO worked with Google, Meta, and other social media companies so that hundreds of millions of people around the world had access to accurate information in multiple languages. That work is continuing because the pandemic’s emergency phase may be over, but there are a lot of health threats that we’re facing and there is a lot of misinformation online. So those very companies, Meta, and Google, are cooperating through the WHO, not necessarily with one another, but through the WHO on a health misinformation claims platform.

Essentially, their employees can go to The WHO and say – “we’re seeing online chatter that says this disease is spread in this way” – and the WHO can either confirm or deny, and that can then be promoted through online search. So that’s great, but it is reactive.

Part of where the WHO is trying to go, and this is going to require collaboration with the private sector, is getting proactive to actually say – how do we use tools like generative AI to make sure that the most accurate information and new evidence is getting out to healthcare providers and the general population as quickly as possible? That is going to absolutely require engagement with technology companies.

AR: You mentioned something which I think is great, and that is, how do we get out of the emergency mentality? Elizabeth, perhaps you can tell us about your experience at Siemens. What long-term actions do you think can be taken to build more resilient and equitable healthcare systems?

Elizabeth Staudinger, Member of the Siemens Healthineers Managing Board: When you look at health care, you can compare it a bit to the saying “it takes a village to raise a child.” That’s also a good way of looking at building a resilient healthcare system. You have to combine a lot of different elements to make sure that every component contributes and makes a difference.

For us, as a private sector company, there is of course certain products or solutions that we can bring to the equation. But that is only one of the pieces. And then we need to build on that and see, do we maybe need training? We need to make sure we upskill the healthcare workforce accordingly. We can also think about what other innovations we can bring to the table to make a difference, and connect the different players across the ecosystem.

AR: And then in that context, Karl, how do we strengthen these alliances between the public and private sectors on this same front?

Karl Hofmann, President and CEO, Population Services International: Thanks Alejandro. And first of all, let me say it is delightful to be next to two great private sector companies working in the healthcare space and the WHO represented here by Anil and the foundation, Moderna, a company that we’ve all come to know, and Siemens, a company we’ve known for decades. My own organization, PSI, is a global health nonprofit and we work in about 40 countries. But in the 50 years that we’ve been operating, the starting premise was really working with the private sector. Not the big international leading private sector companies, but local private sector players, because it is often the private sector that is delivering healthcare products and services to those who need it most because the public sector may be too weak to do so.

The private sector has been a part of our DNA from the very beginning. Over the years, we’ve come to understand that our work fundamentally has to be aligned with national healthcare policies in the 40 plus countries where we work. The Ministry of Health needs to be the steward of the health system, but we all know the health system is mixed. I’m not aware of any place, certainly no place that we work, where the healthcare provision is exclusively through the public sector or through the private sector. These sectors have to cooperate to make the whole system work effectively and equitably for everybody.

I think organizations like mine, which have this proclivity to work with the private sector, are trying to ensure that it is quality care and services that are being provided. So, I know there’s a quality piece to this, but there’s also a connecting-the-dots piece, a systems-thinking piece. We think about how to ensure that the regulators and the policymakers are looking at the private sector, and the way that it contributes to healthcare outcomes, in just about every geography we can think of, and ensure that it’s all aligned and delivering quality care for the people who need it. That’s the work we’re trying to do.

AR: I think it would be highly valuable for us to share any concrete experiences that highlight those stronger relationships between the public and private sector. If you can illustrate for us an example that you think is valuable, please jump in.

KH: We’ve had an experience over the last several years working on HIV self-testing technology. This is something that we could walk down the street to the nearest Walgreens or CVS and buy here in the US. You couldn’t buy it in many markets in the developing world, including those that were heavily impacted by HIV.

With the help of funding from UNITAID, we worked with private sector manufacturers, regulators, and policymakers to do what’s necessary to introduce self-testing as an HIV prevention strategy in 20-25 countries. Now, it’s expanded. Our intervention was really to pilot the idea, to create the regulatory framework, to introduce new providers, and then to exit and watch the market flourish, and it has. It’s absolutely flourished in our absence. So, it’s a great example of a development intervention that has turned into a sustainable market-led consumer-led intervention that is not going away anytime soon.

ST: I might just build on that. One of the things that we’re really excited about is what we’re doing through the Moderna Charitable Foundation. We’re working with social entrepreneurs like Vanessa Kerry at Seed Global, who is, to your point about healthcare being local and systems not being completely homogeneous, on the ground working in both clinical education and on the ground training of physicians in those countries.

Again, to go to the quality metrics, how do you improve the quality of healthcare in places where they may not have access to the same quality healthcare we do, while at the same time, working in the public-private space to make sure that you’ve got the manufacturing, you have the supply chain, and you have the delivery systems? But at the end of the day it’s on the ground where you have to make a difference.

ES: I would like to share a nice example from Kenya. We were looking at how to bring vaccines, medicine, but also blood testing to more remote locations where you may not have the right infrastructure in place. You don’t have the roads; you don’t have the broader facilities in place to serve these communities. We teamed up with a company that makes drones together with the local government and created a service where we use drones to actually shuttle both the medicines as well as the blood samples to the most remote areas and then back to the metro centers where you then can turn around the information. All of that was digitally connected, so you can also send the results of the tests directly back to the patients or the people in these remote areas. It’s a small example, but I believe a very fascinating one. How they can use technology to move beyond the barriers.

AR: Anil, any experience in particular that you’d like to share?

AS: What comes to mind, and this builds a bit on Karl’s example, before I joined the WHO Foundation, I was at a global pharmaceutical company. One of the things we tried to do was engage with consumer insights. And there’s a direct alignment. We were a company that wanted to sell products, but we wanted to sell products that were relevant. And by engaging with local stakeholders, you can design products that meet patient and consumer needs in a way that advances the company’s interest but also patient interest.

An example of that in South Africa was an initiative that’s still underway where we were combining HIV prevention and contraception. A single pill is doing both. The ability for young women to go to a pharmacy and purchase and take oral contraception was a way that they could be further protected with HIV prevention without the stigma associated with taking a pill to protect themselves from HIV.

AR: And finally, as we’re coming to a close to this very interesting conversation, what would you like to see in terms of the biggest challenges that should be addressed to strengthening these collaborations between public and private sectors?

AS: Well, especially given the topic of the panel, Brazilian healthcare systems, what I focus on in terms of urgency is the intersection of climate change and health, and the need for us to be much more engaged in thinking about building resilient healthcare systems relative to the risks of climate change. These are no longer years or decades in the future.

I was floored by the degree of the floods in Libya last week. There are people who are no longer alive right now because of climate change. People are dying of climate change all the time, and we don’t necessarily call it that. We have a lot of other specific causes of mortality or morbidity, but we need to reframe it because in Libya, it was the creation of storms that have never existed before putting pressure on infrastructure that had never been designed for that pressure, which led to the dams collapsing and entire towns and communities being wiped out. How do we anticipate that?

At this point, as much effort is going into mitigation. We can look and understand the degree to which communities are not prepared for what’s happening with climate change in terms of infrastructure. The number one infrastructure investment, it is not a silver bullet, it is not a medicine. It is healthcare workers. We absolutely need to invest in the healthcare workforce, but we can also stay ahead of disease patterns. We know dengue is going to explode. We know that’s happening. And if you can look ahead to what the health risks are, there are incredible solutions. There’s a couple of vaccines being developed for dengue. Of course, there’s also a naturally occurring bacteria that can prevent the mosquitoes from transmitting dengue to humans. We have to invest in those technologies now because the pace of the effects of climate change and human health are going through the roof.

ST: One of the things that we’re super focused on is how do you continue to drive a community? No one company, no one entity, is going to have the right answer. I think you see so often all the companies and governments go in with the right intention but they’re all solving the first step in the problem instead of coming together in a different way to convene and say – let’s split up the problem and segment it – so we actually get more of the problem tackled together as a community trying to build healthcare systems.  

That’s something we’re focused on with our technology, just democratizing it through our mRNA access program. We’re working with researchers in academia and governments around the world on the emerging diseases that today do not have vaccines. I would love to see more people come together, to challenge us to do this as a community. I think we’re at a moment in time where we can make a tremendous difference if we do.

KH: Anil used the word from his time at a pharmaceutical company. And of course, I’m sitting between two representatives of big private sector companies. They tend to think about consumers. And I want to say, this nonprofit that I am proud to be associated with, we think about consumers, too. Consumer insight is the recognition that you have to start every intervention, no matter what you’re aiming for, by listening to the people you’re trying to serve. Treating them as consumers with agency, with choice, even though they may not have resources, they have the ability to make a choice. You want to treat them with the dignity that that represents. You’re treating them as the fundamental building block of health systems as opposed to the subject of health systems. The fundamental agent of a health system is the consumer, the individual. That’s the sort of transformational idea that we try and hold on to in designing our programs. And I think it’s a thread that unites everybody here, too.

ES: To wrap things up, I believe there is a lot of opportunity teaming up across the different players and working with the local communities. And one thing which is very important to me as I think about it is: how do we make things stick? Are we doing things in a way that’s sustainable? That they stand on their own feet. Because that is the foundation for something to take a hold, take roots and really make a difference. Not only in the first month or the first year, but for the years to come.

AR: As you have all seen, now more than ever, strengthening collaborations and participation between the public and private sector is more essential than ever. It’s been our hope and our pleasure that from our experiences we help guide those who are interested this topic, to create better, more resilient healthcare systems around the world.

Thank you everybody. It’s been a pleasure.

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In this video, Dominic Montagu, Professor Emeritus at the University of California, San Francisco, and CEO of Metrics for Management outlines the three levels of data from private healthcare providers in low- and middle-income countries that need to be sequentially integrated into a country’s health information system to assure that governments can manage the overall health system more effectively.

Join us in this illuminating session as we explore the evolution of the STAR self-testing project, sharing insights, challenges, and successes that have emerged over the years. By examining the lessons learned and considering the implications for future healthcare strategies, we hope to foster a deeper understanding of the transformative potential of self-testing in improving healthcare accessibility and patient-centric services.   

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In this session, PSI and PSH will share lessons for optimizing access to comprehensive, culturally sensitive HIV and sexual and reproductive health services. Topics will include enhancing the accuracy and reliability of sex worker population data, improving HIV case finding among men who have sex with men (MSM) through reverse index case testing, and scaling differentiated service delivery models. The session will also cover integrating mental health and substance abuse in key populations (KP) programming and lessons in public sector strengthening.  

Additionally, the session will showcase solutions that MSMs have co-designed, highlighting how this collaboration has improved the consumer care experience. It will demonstrate the critical role of KP communities in establishing strong and sustainable HIV responses, including amplifying KP voices, strengthening community-led demand, and establishing safe spaces at national and subnational levels for KP communities to shape and lead the HIV response.

This enlightening session promises to provide updates from WHO guidelines and share insights on the journey toward viral hepatitis elimination. It will also showcase outcomes from the STAR hepatitis C self-testing research and discuss how these findings could potentially inform hepatitis B antigen self-testing and the use of multiplex test kits in the context of triple elimination. Join us in this crucial discussion as we work together to fast-track the global journey toward a hepatitis-free world by 2030. 

In this two-part session, the Bill & Melinda Gates Foundation, PSI, and PSH will share lessons and best practices from rigorous research and hands-on implementation experience in Zimbabwe. The session will cover important topics like client-centered, community-led demand creation, differentiated service delivery, sustainable financing, and digital solutions. The sessions will also cover lessons in program management. These insights are applicable beyond Zimbabwe and can be used to scale up HIV prevention efforts in the region.


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The Consumer as CEO

For over 50 years, PSI’s social businesses have worked globally to generate demand, design health solutions with our consumers, and work with local partners to bring quality and affordable healthcare products and services to the market. Now consolidating under VIYA, PSI’s first sexual health and wellness brand and social business, our portfolio represents the evolution from traditionally donorfunded projects towards a stronger focus on sustainability for health impact over the long term. Across 26 countries, the VIYA model takes a locally rooted, globally connected approach. We have local staff, partners and providers with a deep understanding of the markets we work in. In 2022, we partnered with over 47,000 pharmacies and 10,000 providers to reach 11 million consumers with products and services, delivering 137 million products. VIYA delivers lasting health impact across the reproductive health continuum, from menstruation to menopause. Consumer insights drive our work from start to finish. Their voices, from product exploration to design, launch, and sales, ensure that products not only meet consumers’ needs but exceed their expectations. The consumer is our CEO. 

In 2019, our human-centered design work in East Africa explored ways that our work could support and accompany young women as they navigate the various choices required for a healthy, enjoyable sexual and reproductive life. Harnessing insights from consumers, VIYA is revolutionizing women’s health by addressing the confusion, stigma, and unreliability surrounding sexual wellness. Across five markets – Guatemala, Kenya, South Africa, Uganda and Pakistan – VIYA utilizes technology to provide women with convenient, discreet, and enjoyable tools for making informed choices about their bodies. The platform offers a wealth of high-quality sexual wellness information, covering topics from periods to pleasure in an accessible and relatable manner. Additionally, VIYA fosters a supportive community where users can share experiences and receive guidance from counselors. In 2023, VIYA will begin offering a diverse range of sexual wellness products and connect users with trusted healthcare providers, ensuring comprehensive care tailored to individual needs.  

Digitalizing contraceptive counseling to reach rural women and girls in Ethiopia

By: Fana Abay, Marketing and Communications Director, PSI Ethiopia 

In rural Ethiopia, women and girls often face significant barriers in accessing healthcare facilities, which can be located hours away. Moreover, there is a prevailing stigma surrounding the use of contraception, with concerns about potential infertility or the perception of promiscuity. To address these challenges, the Smart Start initiative has emerged, linking financial well-being with family planning through clear and relatable messaging that addresses the immediate needs of young couples—planning for the lives and families they envision. Smart Start takes a community-based approach, utilizing a network of dedicated Navigators who engage with women in their localities. These Navigators provide counseling and refer interested clients to Health Extension Workers or healthcare providers within Marie Stopes International-operated clinics for comprehensive contraceptive counseling and services.  

In a significant development, PSI Ethiopia has digitized the proven counseling messaging of Smart Start, expanding its reach to more adolescent girls, young women, and couples. This approach aligns with the priorities set by the Ethiopian Ministry of Health (MOH) and is made possible through funding from Global Affairs Canada. The interactive and engaging digital messaging has revolutionized counseling services, enabling clients to make informed and confident decisions regarding both their finances and contraceptive choices. 

Clients who received counseling with the digital Smart Start tool reported a higher understanding of their options and were more likely to choose contraception (74 percent) compared to those counseled with the manual version of Smart Start (64 percent). Navigators also found the digital tool more effective in connecting with clients, leading to higher ratings for the quality of their counseling. 

By December 2023, PSI Ethiopia, working in close collaboration with the MOH, aims to reach over 50 thousand new clients by leveraging the digital counseling tool offered by Smart Start. This innovative approach allows for greater accessibility and effectiveness in providing sexual and reproductive health services, contributing to improved reproductive health outcomes for women and couples across the country. 

Building community health worker capacity to deliver malaria care

By: Christopher Lourenço, Deputy Director, Malaria, PSI Global 

Community health workers (CHWs) are critical lifelines in their communities. Ensuring they have the training, support, and equipment they need is essential to keep their communities safe from malaria, especially in the hardest to reach contexts. 

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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