PSI ANNUAL
REPORT

2023

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Letter From
the CEO

The story of human health progress over the last century is amazing. The right policies, investments, partners, and political commitment have saved and improved the lives of hundreds of millions of people, perhaps even billions.

The COVID-19 pandemic slowed progress, we know, and in some cases sent lifespans into reverse. We are still recovering. And the challenges of health equity coupled with mega threats such as climate change have put our remaining health gaps on clear display.

We know that fresh thinking and new and deeper partnering is needed if we are to close gaps, recover our momentum, and continue to make progress toward health for all.

To transform health, we must do it together.

Together, we can tackle the root causes preventing people and their communities from achieving and maintaining good, quality, and affordable health. We can develop transformative solutions for people and communities, markets, and health systems. And we can forge the deep synergies needed to unleash solutions that last.

Together, we can make it easier for people to choose quality, affordable healthcare, wherever and whenever they need. At Population Services International (PSI), that starts by prioritizing strategic partnerships. The challenges that consumers face are not happening in isolation, they are interconnected. To respond, we must partner more deeply and collaborate more widely.

In 2023, the PSI global network laid the foundation for transforming health together by:

Leading locally and connecting globally to decentralize decision-making and shift power to consumers.

Building upon innovations like self-care and digital health to strengthen health systems to respond to crises more effectively.

Breaking binaries and fostering holistic, integrated solutions to the world’s greatest health challenges.

The world is sending us so many reasons to divide, but we achieve more when we work together.

Looking ahead, PSI will continue to work alongside consumers, governments, donors, and strategic partners to achieve Universal Health Coverage and make it easier for all people to lead healthier lives.

Karl Hofmann

Psi’s impact in 2023

In 2023, the PSI (Population Services International) Network captured its health impact in three ways, by measuring:

what we deliver
what we catalyze others to deliver, and
what we deliver through Viya Health, PSI’s sustainable social business model.

These three measures capture the millions of people reached with sexual and reproductive health and rights (SRHR), malaria, HIV/tuberculosis, and sanitation products and services.

As we work to transform health, an increasing share of the PSI Network’s impact is and will be achieved by catalyzing others to deliver products and services, sustainably, and at scale.

Together with other leading NGOs, we will mainstream catalytic impact as a central tenet of how programs are designed, delivered, and evaluated.

The numbers represent only one small piece of the impact that these interventions have on people’s lives and the barriers overcome to deliver them. Each person has their own story and intersectional identities advantage and disadvantage people unevenly. Much of the PSI Network’s programming seeks to reach those who are left behind.

people reached with healthcare products and services, for family planning, malaria, HIV, TB, and sanitation services.

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people reached through accelerated market growth and system change.

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people reached through our social business, Viya Health

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À propos de l'ISP

PSI is a network of locally-led, globally-connected organizations that are passionate about making it easier for people to lead healthier lives. Together with partners, we transform health by tackling the root causes preventing people and their communities from achieving and maintaining good, quality, and affordable health

where we work

Histoires from our network

At PSI we center the voices of people and communities, grow robust markets for health products and services, and support governments to build resilient health systems. Our integrated program design makes it easier to serve more people’s holistic needs for the long term.

People and Communities

We center the voices of people and communities to connect them with the information, products, and services to make it easier to lead healthier lives.

Benin – Malaria prevention helps children thrive

By Malia Skjefte, Technical Advisor, PSI; and Luc Bankole, Communications Advisor, Plus Project Benin

At the heart of Benin, near the Zogbodome Health Center, a young mother named Assohoto Mahuna Dame lives with her daughter, Naomie. Assohoto, a 24-year-old bread seller, was going about her daily routine when a community health worker approached her with crucial information about Perennial Malaria Chemoprevention (PMC) for children under two. This preventative treatment, administered alongside routine vaccinations and vitamin A supplementation, is a key measure in the fight against malaria.

Upon learning that Naomie had not yet received the necessary malaria prevention interventions, Assohoto took immediate action. She brought her daughter to the health center, ensuring that Naomie received her first round of PMC treatment, along with routine vaccinations. This seemingly simple act underscores the vital role community engagement plays in health awareness and malaria prevention, supporting mothers like Assohoto to make informed decisions for their children’s well-being.

The Plus Project, spearheaded by PSI and funded by Unitaid, is instrumental in promoting and scaling up PMC in Benin, Cameroon, Côte d’Ivoire, and Mozambique. This initiative is pivotal in reducing the burden of malaria and anemia among children in malaria-endemic regions of sub-Saharan Africa.

However, challenges persist. Vaccination rates tend to drop as children grow older, and many women in Benin face difficulties in tracking follow-up appointments or deciphering the handwriting in child health cards. The often significant distances between health centers and communities further complicate efforts to ensure children receive timely follow-up care.

In October 2023, the project team conducted visits to various health facilities across Benin to enhance awareness of PMC through community engagement. Utilizing mobile video units (MVUs) as a dynamic platform, the team delivered interactive presentations on the benefits of PMC, its dosing schedule, and broader malaria prevention strategies. These sessions also served as a critical opportunity to understand and address the barriers that community members encounter in preventing malaria.

The impact of these efforts is evident. Over 2,200 people participated in the MVU sessions, reflecting the community’s engagement and enthusiasm for the project in Zogbodome. Since its inception in 2022, the Plus Project has supported the Ministry of Health in Benin in distributing more than 104,000 doses of sulfadoxine-pyrimethamine (SP), the drug used for PMC.

Through the Plus Project and similar initiatives, we are making strides toward a world where every child can access their fundamental right to health. Together, we can continue to champion child health and well-being, ensuring a future where every child not only survives but thrives.

Cambodia – It takes two: Engaging men in family planning

By Michelle Priya Sahai, Monitoring, Evaluation, Learning and Communications Fellow, PSI Cambodia

“Learning about contraception helps eliminate misunderstandings [about contraception] between men and women,” said Chhorn Srieng, a resident of Cambodia’s Battambang Province. “And it encourages us to discuss both the traditional and modern methods of family planning.”

Because most modern family planning methods are primarily designed for women to use and reproductive health programs typically engage women, the responsibility of family planning too often falls to women alone.

With the USAID-funded Promoting Healthy Behaviors (PHB) project in Cambodia, we are bringing men into the conversation. In collaboration with the Royal Government of Cambodia, PSI and partner 17-Triggers used social and behavior change (SBC) techniques, including human-centered design, to understand the needs of rural couples and co-develop the following programs:

Heart Protector – Also known as the “Men’s Session,” Heart Protector is named after men’s traditional roles as protectors of their families. It includes engaging, participatory activities and materials through which groups of men learn and discuss, many for the first time, about modern methods of family planning and how to discuss the topic with their partners or wives. Through the sessions, men are encouraged to consult with trained health providers, have informed, open discussions with their partners about contraception, and support their partner to use family planning.

Loving Relationship – The Loving Relationship program works with couples to help them communicate openly about family planning. Alongside an interpersonal communication agent, partners talk about fears and misconceptions of modern methods, see real contraception product samples, and play games to have fun and build trust as well as ease the discomfort many couples feel talking about taboo topics, such as family planning.

These programs were crafted to increase the uptake of modern family planning methods, promote joint decision-making among couples, and equip Cambodian men with the knowledge and tools to make informed choices about family planning. This initiative is strengthened through partnerships with community-based organizations such as Partners in Compassion, Khemara, and Action for Health Development (AHEAD).

The impact has been substantial. Community events hosted through these programs have reached over 120,000 individuals, including 76,642 men. A post-assessment revealed that 60 percent of participants, most of whom were men, had meaningful conversations with their partners about family planning.

By involving men in family planning decisions, we are helping to build stronger, healthier families. Addressing the contextual barriers to modern family planning for Khmer men and their partners has supported couples in Cambodia to take control of their health and make informed decisions about their families’ futures. This initiative serves as a model for how couples worldwide can choose whether, when, and how they build their families.

Markets

We grow robust markets for health products and services to ensure people can access the resources they need when and where is best for their health, lives, and futures.

Shaping the Global Market
for Self-Care

By Dr. Karin Hatzold, Global Director HIV, Tuberculosis and Viral Hepatitis

Eight years ago, the concept of HIV self-testing (HIVST) was still emerging, with global guidelines absent and only a few countries, such as the United States, the United Kingdom, and France, having policies that allowed for it. In low- and middle-income countries, where the burden of HIV is high, there was a significant gap in diagnosis, compounded by the lack of evidence and guidance for HIV self-testing.

Our journey to impact

PSI led the Unitaid-funded HIV Self-Testing Africa (STAR) Initiative to evaluate the feasibility, acceptability, and scalability of HIVST in resource-limited settings and address market barriers to self-testing rollout. From the beginning, the STAR Initiative aimed to generate crucial information about delivering self-testing products effectively, ethically, and efficiently. Through different distribution models — including facility-based, community-based, private sector, community pharmacy, workplace, and virtual models using both oral-fluid and blood-based kits — the project investigated for cost, client preferences, linkage to care and prevention, and the impact of HIVST in increasing access to services faster. STAR generated critical evidence demonstrating that HIV self-testing is not only safe and acceptable but also cost-effective for reaching high-risk populations with limited access to conventional HIV testing.

Evidence from STAR informed the pre-qualification process of six self-testing kits by the World Health Organization and was instrumental in informing normative guidance and influencing national policies and regulatory frameworks. STAR also informed demand and supply needs for HIVST, enticing manufacturers to invest in new product development and market entry, increasing the availability of diverse products and choice while simultaneously generating competition. Today, over 108 countries have reported HIV self-testing policies, with many scaling up to complement and, in some cases, partially replace conventional testing services. This progress became even more critical as countries worked to maintain HIV services amid the disruptions caused by the COVID-19 pandemic.

Expanding the horizons of self-testing

Leveraging our expertise in HIV self-testing implementation, PSI expanded its efforts to explore how self-testing for Hepatitis C and COVID-19 can enhance testing uptake and coverage. This research focused on identifying specific areas and populations where self-testing can make the most significant impact. STAR developed targeted strategies to expand access to self-testing, ensuring individuals have convenient, timely options for testing, and are effectively linked to care, treatment, and prevention services through differentiated test-and-treat approaches.

By pioneering the expansion of self-testing beyond HIV, PSI is helping to decentralize health services, bringing care closer to those who need it most. By enabling individuals to take control of their health, PSI’s approach also strengthens health systems, enabling them to continue providing essential services even in the face of challenges and crises. This model builds more resilient and adaptable health systems worldwide.

Ethiopia – A market-based approach to scale sanitation

By Dr. Dorothy Balaba, Country Representative, PSI Ethiopia

Traditional efforts to eliminate open defecation have often relied on the distribution of free or heavily subsidized sanitation products. While these methods have provided immediate relief, they often lack sustainability. To foster lasting change, a more durable solution is required: that’s where market-based sanitation comes in.

In Ethiopia, the PSI-led USAID Transform WASH (T/WASH) project, in collaboration with consortium partners SNV and IRC WASH, is using this market-driven approach. The project aims to build robust markets for underutilized sanitation products, enhancing household access to affordable, high-quality sanitation solutions. By integrating market forces, supporting business growth, creating demand at the household level, and providing clear pathways for purchasing WASH products, T/WASH is driving considerable progress in Ethiopia’s sanitation sector.

In partnership with Ethiopia’s Ministry of Health, Ministry of Water and Energy, and Ministry of Labor and Skills, T/WASH has achieved promising results:

158,000+ households have invested in upgraded sanitation solutions, with rapid expansion expected as the initiative scales and market growth accelerate.
500+ small businesses have been trained, including community masons and construction-related enterprises, equipping them with the technical skills for sanitation product installation, as well as the operational capacities, marketing, and sales skills necessary to run successful, growing businesses.

Nationwide scaling

The project has supported the Ethiopian government in scaling this market-based approach across the country. Furthermore, T/WASH has collaborated with the One WASH National Program and various government ministries to examine and influence policies that encourage increased household uptake of basic WASH services. These efforts include advocating for targeted sanitation subsidies, tax reductions to boost affordability, and improved access to loan capital for businesses seeking expansion and households needing assistance to upgrade their facilities.

As Michael Negash, Deputy Chief of Party of T/WASH, aptly noted,

“Plutôt que de s'appuyer sur des modèles d'aide traditionnels qui distribuent souvent des produits d'assainissement gratuits ou fortement subventionnés, l'assainissement basé sur le marché crée des solutions durables et abordables, en intégrant les forces du marché et en soutenant les entreprises pour qu'elles se développent”.”

Health
Systems

We support governments to build resilient health systems that can efficiently respond to changing population needs and adapt to new environmental contexts.

Somalia - How holistic care makes health systems stronger

By Zamzam Arale Hassan, Research, Learning & Documentation Specialist, Eden Issak, Senior M&E Specialist, Abdiwahit Jama, Senior community Health Specialist, PSI SOM

In Somalia, the Marwo Caafimaad Program has emerged as a promising initiative, transforming community health while also strengthening the country’s health systems. Over the past year, this initiative has equipped female health workers with the training, resources, and ongoing support to deliver essential healthcare services directly to the homes of those in need. This holistic approach ensures that healthcare is not only accessible and affordable but also deeply attuned to the specific needs of each community.

The program’s impact is vividly illustrated through the story of Hidaya, a female health worker in the heart of Hamar Bile Village, Warta Nabada district of Mogadishu. Hidaya’s unwavering commitment to her community and the Marwo Caafimaad Program’s support have led to transformative outcomes, particularly in the case of Ali Dahir, a 10-year-old boy suffering from a severe skin disease on his scalp.

During one of her routine visits, Hidaya encountered Ali, whose condition had left him in daily pain and discomfort. With her keen observational skills, empathy, and the training provided by the program, Hidaya took immediate action. She referred Ali to a health facility for comprehensive treatment, diligently cleaned his wounds with antiseptic, and ensured he adhered to a prescribed regimen of antibiotics and painkillers.
Hidaya’s care extended beyond medical intervention; she became a pillar of support for Ali and his family. Understanding the importance of holistic care, she went the extra mile by purchasing anti-dandruff shampoo to maintain Ali’s hygiene and closely monitored his recovery process. Her dedication not only alleviated Ali’s suffering but also brought relief to his family, who were spared the burden of travel and hospital expenses.
Ali’s father noted,

“My child experienced daily pain and discomfort. Now, thanks to Allah and the efforts of Hidaya, my child has fully recovered and is healthy. The Marwo Caafimaad program and Hidaya have alleviated this burden.”

This story underscores the Marwo Caafimaad Program’s role in strengthening health systems in several critical ways. By building the capacity of female health workers like Hidaya, the program enhances the overall quality and effectiveness of healthcare delivery. The decentralized model of bringing healthcare services directly to communities—particularly in remote and underserved areas—addresses significant gaps in access and equity, ensuring that even the most vulnerable populations receive the care they need.

Moreover, by reducing financial barriers and providing care within the community, the program prevents families from facing catastrophic health expenditures, thereby contributing to the sustainability of the healthcare system. The strong referral system, as demonstrated by Ali’s case, ensures that patients receive appropriate levels of care, optimizing healthcare resources and improving patient outcomes.

India – Superwomen of Indore changing lives one tap at a time

By Ankita Gambhir, Assistant Manager of Communications, and Suma Pathy, Chief of Party, Samagra, PSI

Hemlata’s son has liver damage – and she wants private sector care.

The catch: it is pricey and Hemlata needs guidance on where to get government-funded subsidies for private health services.

Through the USAID-funded project Samagra, PSI and Haqdarshak are building out digital health platforms to make it easier for people like Hemlata to access the tools and resources to get the care they need. In partnership with Haqdarshak, who offers a digital platform originally built to help rural populations navigate government support programs, we tailored the platform to fit the unique needs of marginalized urban populations – which are typically more diverse, have less permanent housing, and sometimes have less reliable social and family networks than their rural counterparts.

Living in Indore City, India, Hemlata met Seema, who is a “Haqdarshika” – a community-level entrepreneur for Haqdarshak. PSI and Haqdarshak identified and trained local women like Seema to act as digital facilitators for government services. The Haqdarshikas are deeply rooted in their communities; they are the superwomen connecting people to relevant government support systems and supporting them to not just access but navigate their journey to care.

Seema worked with Hemlata and her son to access an Ayushman Bharat ID, needed to access government funding for private care, and choose a health insurance that they were eligible for. After navigating this process together, Hemlata’s son received treatment for liver damage at a private hospital, free of cost.

Haqdarshikas like Seema work across Indore city, India aiming to bridge the digital divide and bring crucial government support programs directly to people’s doorsteps, especially for women. Samagra’s Haqdarshak initiative in Indore City supported over 226,000 individuals, unlocking access to 315,000 government-funded health grants. As designed, 70 percent of these individuals were women. By making information and services accessible, Samagra is igniting a sense of independence and agency in marginalized communities. Through partnerships with local governments and healthcare institutions, Samagra lays the foundation for a sustainable future.

Program Spotlight MOMENTUM

Private Healthcare Delivery

Health challenges are complex and intersectional, and to find solutions, we can’t operate in silos. MOMENTUM’s impact highlights how integrated program design makes it easier to serve more people’s holistic needs in the long term.

By Mariela Rodriguez, Senior Learning and Communications Advisor, MPHD et Salamatou Mamane Sani Issa, Manager of Communications and Knowledge Management, MPHD Niger

In low- and middle-income countries, the private sector plays a crucial role in healthcare, providing over 40 percent of health services. Recognizing this, the USAID-funded MOMENTUM Private Healthcare Delivery (MPHD) project uses integrated program design to strengthen every level of the private sector.

MOMENTUM creates and sustains the health markets and systems necessary for individuals and communities to access high-quality, person-centered reproductive, maternal, and child health services. By engaging people and communities, markets, and health systems, MOMENTUM ensures the sustainability and quality of private sector healthcare to serve people’s holistic health needs.

People and Communities – Partnering with the private sector to deliver person-centered care in Niger

Aichatou Sidi’s visit to the Aida clinic in Zinder, Niger, during an open day exemplifies the impact of MOMENTUM’s initiatives. She received a free prenatal consultation, an experience that left her both surprised and pleased.

“I was consulted free of charge, even though it’s a private clinic,” Aichatou shared. “I’m delighted because I was welcomed and treated well by the staff.”

These open days, organized by private sector facilities partnering with MOMENTUM in Niger, are designed to help underserved communities access quality care and become familiar with the reproductive, maternal, and child health services available. In 2023, MOMENTUM Niger facilitated over 100 such events, significantly enhancing awareness and access to family planning and reproductive health services.

At the core of MOMENTUM’s work is the promotion of person-centered care, a pioneering effort to integrate this approach across reproductive, maternal, and child health services in the private sector. MOMENTUM has developed a comprehensive training program for private sector providers, offering user-friendly tools and strategies to promote holistic, person-centered care. This training focuses on adolescent and youth-responsive care, gender-transformative care, respectful maternity and childcare, client-centered family planning counseling, and empathetic communication. By equipping providers with these tools, MOMENTUM ensures that care is tailored to the values, preferences, and needs of individuals, thus strengthening the capacity for person-centered care in the private sector.

Markets – Expanding access to contraceptives in Nigeria and Mali

Access to contraceptives, particularly hormonal IUDs, a type of birth control that’s placed in the uterus and uses hormones to give long-term birth control, remains limited in many low- and middle-income countries. This is primarily due to the prohibitive cost of hormonal IUDs as well as the specialized provider training required to insert them. MOMENTUM is addressing this challenge by training and certifying private healthcare providers to deliver hormonal IUDs (brand name: Avibela) in Nigeria, equipping over 250 providers across 11 states. From April to December 2023, over 1,000 hormonal IUD units were sold through the private sector, illustrating the growing capacity of local providers to offer this essential contraceptive method affordably.

In Mali, MOMENTUM collaborates with national partner JIGI to ensure the availability of high-quality, socially marketed contraceptives in the private sector. MOMENTUM’s support has significantly improved the supply chain for contraceptives, leading to the sale of over 353,000 oral contraceptive packs, 410,000 injectables, 2,800 implants, 1,600 IUDs, and 1.6 million condoms between 2022 and 2023. These efforts are strengthening markets for affordable contraceptive products, ensuring sustainable access for individuals in need.

Health Systems – Enhancing data-based decision-making for health in Uganda

In Uganda ongoing challenges related to limited government oversight and resource constraints have hindered the effectiveness of healthcare delivery. Recognizing the need for improved collaboration and data-driven decision-making, MOMENTUM has taken significant strides to bridge these gaps.

Working in partnership with Uganda’s Ministry of Health, the MOMENTUM project is focused on enhancing the exchange of data between public and private digital health platforms. This initiative is not only fostering greater collaboration between sectors but also is empowering healthcare providers with the information they need to make informed decisions.

“With support from USAID’s Momentum Private Healthcare Delivery,” says Dennis Chemonges of PSI Uganda, “we are aiding the government in transforming these fragmented systems into a cohesive framework. By integrating public and private sector data, we are generating the evidence necessary to support everyday decision-making for health service providers.”

This effort underscores the importance of collaboration in overcoming healthcare challenges in Uganda, ensuring that both public and private sectors can work together to deliver quality health services to all.

Integrated Program Design – Supporting women’s health choices in Ghana

“Prior to adopting the Counseling for Choice (C4C) approach, I really did not know I was overloading my clients with information,” said Theresa, a midwife trained by MPHD “This time around, when the clients come, we give them the exact information they need and they leave here satisfied.”

We know supporting women’s health choices is important, but when it comes to contraceptive counseling, the question is how. Recognizing the gap in how contraceptive information was being delivered, MOMENTUM designed C4C as an evidence-based counseling method that equips clients to make informed decisions about their contraceptive options, focusing on what matters most to them.

MOMENTUM’s efforts have not only transformed individual practices but are also influencing national health systems. In partnership with Total Family Health Ghana and Ghana Health Services, MOMENTUM successfully integrated the C4C approach into Ghana’s National Family Planning Protocol. This inclusion allows the C4C method to be implemented across the country, reaching a broad spectrum of health providers and ensuring that person-centered care is accessible to all.

By prioritizing informed choice and respecting clients’ voices, C4C is changing the landscape of family planning counseling in mixed health systems, where individuals depend on both public and private sectors for their healthcare needs. MOMENTUM and its partners are making significant strides in ensuring that everyone receives the respectful, effective, and personalized care they deserve.

To transform health, we can’t work in silos. MOMENTUM’s impact in strengthening the private sector to meet people’s holistic health needs is powered by partnerships at every level of local health systems and the global health community. Together, we can leverage integrated program design to tackle barriers to health and achieve Universal Health Coverage.

A WAY FORWARD

Looking ahead to 2024 – A new strategic direction

In 2024, we will introduce a new strategic vision – Transforming Health Together. This strategy is designed to create transformative solutions for people, communities, markets, and health systems, recognizing the deep synergies between these elements as the key to lasting impact.

Broadening our focus and leaning on partnerships

Over the past five decades, we have consistently pushed boundaries, challenged taboos and crafted innovative solutions to some of the world's most complex health challenges. In coming years, we will continue to look beyond healthcare and tackle a wider range of issues that influence health and well-being – from the effects of climate change to urbanization, and limited livelihood opportunities. We will lean on new and existing partnerships to reach people in new, impactful ways.

Building on digital transformation

We aim to unlock the potential of emerging digital technologies by working with global and in-country partnerships to adapt, test and build an evidence base on the use of these innovations to power health outcomes. In addition, we will work closely with governments and relevant partners to support scaling and sustainability of proven digital innovations in a manner that adopts common standards and reduces fragmentation – ultimately supporting stronger health systems.

Sustaining impact through Viya Health

PSI remains committed to delivering impact at scale through donor-supported programming, but increasingly this impact is also being delivered by our social business, Viya Health. This year, Viya Health became a wholly owned, independently incorporated business, granting it greater autonomy to differentiate its offerings, finance expansion, and continue delivering sustainable results.

Leveraging our Global Network

Although PSI has long championed locally-led development, this approach has gained momentum as the capacity of donor recipient countries has strengthened. National governments, USAID, and other leading donors are prioritizing partnerships that align with national plans and strengthen local organizations. We will continue to evolve our locally-rooted, globally-connected network to maximize flexibility and agility, improve accountability and shift power closer to our consumers.

2023 Financial
Summary

PSI is proud of the growth we experienced over the past year. The financial support we receive helps us address growing health challenges thought the wold. Visit PSI’s consolidated financial statement