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Ready When She Is, a CIFF-funded project creating a case for investing in on-demand contraception, sat with Gilda Sedgh, a Sexual and Reproductive Health Research Scientist, to explore the evidence – and where we go from here.


Gilda Sedgh: We started our research simply examining why women across low- and- middle-income countries who want to avoid getting pregnant choose to not use contraception. We have information on sexually active, never-married women in 31 low- and middle-income countries. We found that, on average, 49 percent of women in this group who wanted to avoid pregnancy and weren’t using a contraceptive method said that they were not using a method because they had sex infrequently. Infrequent or no sex was the most common reason for not using a method cited by never-married women in 17 out of 31 countries for which we have data.

We have data on married women from 52 countries and, maybe surprisingly, many married women also said they weren’t using contraception because they have sex infrequently. About one in three married women who wanted to avoid getting pregnant and weren’t using a method in Asia, Latin America and the Caribbean, and one in five in Africa, cited infrequent or no sex as a reason for not using contraception. In 12 out of these 52 countries, infrequent or no sex is the most commonly cited reason for nonuse among married women.

We also found that the prevalence of this reason has been increasing: compared with studies on women’s reasons for not using contraception from the 1980s, more women cite infrequent sex as their reason for non-use in the most recent evidence, which is from the past decade.


GS: Women define it for themselves. But we did do some analyses to see how many of the women who cited infrequent or no sex as their reason for non-use had sex recently. Among the married women who cited infrequent or no sex as a reason for non-use, about half (47 percent) reported being sexually active in the prior three months. In some countries, closer to 80 percent had sex in the three months before the survey. These women are probably at risk of having an unplanned pregnancy. All of the unmarried women in these analyses had had sex in the three months before the survey. The question is, how can we support them to make the choices best for their bodies and their lives?


GS: Of course, every woman is different. Some women might believe they have little or no risk of conceiving if they have sex infrequently, and some might be having infrequent sex in order to avoid an unplanned pregnancy. Others might feel that contraceptive methods available to them are too burdensome for the number of times they have sex.  No matter their situation, all women can benefit from access to contraceptive options and sexual health education from trust sources that align with their needs and preferences.

Unmarried women face additional challenges related to contraceptive use. Strong taboos against sexual activity outside of marriage make it harder for them to ask for contraceptive services. They are also more likely to require methods that they can use discreetly such as pericoital contraceptive methods, including condoms, which can be used at the time of sex in non-emergency situations.


GS: Counseling supports women who have infrequent sex to understand their risk of getting pregnant and plan for the families they desire. This education should be incorporated into their primary care services to more easily reach women who are not visiting family planning clinics.

Counseling should emphasize choice. Based on a woman’s preferences, we can support women to choose tools, like contraception, so they can take their health into their hands. For example, for some who rarely have sex, the contraceptive pills that we typically refer to as emergency contraception (contraception used in the first few days after unprotected intercourse) would help them prevent an unintended pregnancy if they do have sex. But many women who have infrequent sex do still have sex – that is, sex is not a rare event nor an “emergency.” A wide range of contraceptive choices – including on-demand options – are key.


GS: Woman-controlled, on-demand methods of contraception can be of value for women who have sex infrequently and want to prevent a pregnancy. But these methods might help other groups of women, too. Some women do not use contraception because they do not like the side effects of the methods available to them, and others do not use a method because their partners don’t want them to. If these women had access to a method free from undesirable the side effects typical of hormonal methods, and can be used discreetly, we could better support women to make the best choices for them.


GS: When it comes to contraceptive options today, our research shows that we’re missing the needs of a large segment of women and girls who have infrequent sex. When we invest in bringing woman-controlled, on-demand options closer to consumers, we’re support consumers to make the choices best for their lives. That’s what it means to be #ReadyWhenSheIs: to go where she needs us to go so she has the tools and support to be the driver of her own life.

By Ashley Jackson, Former Deputy Project Director, Expanding Effective Contraceptive Options, and Léonce Dossou, Mass Media Communications, Sales, and Distribution Manager, L’Association Béninoise pour le Marketing Social et la Communication pour la Santé

Péniel, age 23, and Valérie, age 42, both use contraception – but only when they have sex.

“I am not living with my man at the moment, but he comes over from time to time,” Péniel shares.

Péniel didn’t feel like oral contraceptive pills and condoms were right for her. She worried she would forget her pills, or that her partner would use a condom incorrectly.

For Valérie too, sex happens intermittently. “When my husband comes back from his travels,” she explains. “Not every day.”

“I was hesitant about other methods,” Valérie adds. She wants her contraception to be discreet, easy to use, non-hormonal, and without side effects.

These women – like the 1.1 billion sexually active women globally who do not want to get pregnant – need options to prevent pregnancy on their own terms.

When a new on-demand, self-care contraceptive product first arrived in Benin, Péniel and Valérie were among the first in their community to line up for the Caya® diaphragm.


Consumers need a range of effective contraceptive options that meet their varied preferences, including the preference for on-demand contraception—especially among those who have infrequent sex.

Globally, the two most common reasons women give for not using contraception while in need are:

  1. Health concerns,” including health risks, fears of side effects, and unwanted menstrual changes.
  2. Infrequent sex.” Women who are unmarried and those who do not have children are more likely than others to say infrequent sex is why they do not use contraception.

Across a wide range of countries, studies have found an interest in on-demand options among women who have infrequent sex, many of whom desire convenience, ease of remembering, the ability to conceal use and the avoidance of continuous exposure to contraceptive hormones and/or side effects.

But for consumers who want contraception only at or around the time of sex, what on-demand options really exist?


The range of on-demand options on the market is limited. Only three options are widely available:

  • Withdrawal is one of the most common traditional methods of family planning. No product is needed. However, this approach is less effective than modern contraceptive methods.
  • Male and female condoms are the preferred modern methods for many. These non-hormonal barrier methods provide protection against HIV and other sexually transmitted infections in addition to contraception. But condoms do not satisfy the entire universe of consumers with a desire for on-demand contraception. Many consumers report they do not use condoms due to dislike of the physical sensation of use, social stigma, lack of male partner support, and other reasons.
  • Emergency contraceptive pills (ECPs) can be taken up to 5 days after sex. (The sooner they are taken, the more likely they are to be effective.) Unlike other modern methods, ECPs do not need to be accessed before sex—making this method particularly valuable when sex is unplanned. Yet some consumers, like Valérie, desire a non-hormonal option. In addition, regular use of ECPs is not yet authorized by national regulatory authorities.

Research shows that on-demand options have enormous potential to respond to consumer preferences. Yet of the USD $64 million spent globally on contraceptive technology development in 2018, just $3.7 million (5.7 percent) went to on-demand methods, according to the 2020 G-FINDER Report.

Three on-demand methods have the potential to become more widely available by 2025:

  • Pericoital oral contraception could address a need for women who want the option to use a contraceptive pill before or after sex, as needed. A review of 19 studies in 16 countries found substantial interest among women in a pericoital pill that could be taken repeatedly. Research by the World Health Organization supports the safety and efficacy of this use of LNG 1.5 mg pills, the same formulation of many current ECPs, multiple times within a menstrual cycle. Furthermore, recent (pre-published) research in Ghana and Kenya showed demand and high satisfaction with this method. Discussions are underway with regulatory bodies about the possibility of authorization of this method.
  • Vaginal contraceptive gels, such as spermicidal gels, can be self-inserted in the vagina before sex to stop fertilization. A new type of gel may enter more markets soon: Phexxi®, which prevents pregnancy by maintaining vaginal pH, received U.S. Food & Drug Administration (FDA) approval in 2020.
  • Diaphragms are a barrier method placed over the cervix during sex. Caya® departs from past diaphragms primarily because it comes in a single size, meaning it requires no fitting by a provider. With approvals by Stringent Regulatory Authorities and several dozen other countries, including three in sub-Saharan Africa (Benin, Niger, and Nigeria), Caya access may soon increase—including in countries that have never had widespread diaphragm access.

EECO and Knowledge SUCCESS curated a collection of 20 Essential Resources for Contraceptive Product Introduction. The selected resources can support efforts by program planners and implementers to bring to market the new contraceptive products that consumers want, including on-demand options. 


“When he comes over and I’m ovulating, I use Caya to prevent pregnancy for now,” Péniel says.

In Benin and Niger, EECO project monitoring and user research have found that infrequent sex and a preference for on-demand contraception motivated many women like Péniel and Valérie to choose the Caya diaphragm.

Péniel and Valérie accessed the Caya diaphragm through USAID’s Expanding Effective Contraceptive Options (EECO) project, which leads pilot introductions of promising contraceptive methods. Through EECO, PSI’s network member in Benin, the Association Béninoise pour le Marketing Social et la Communication pour la Santé (ABMS), supports providers to offer Caya alongside a wide range of contraceptive options.

ABMS communicates with women and men about the possibility of pairing Caya with the fertility awareness-based Standard Days Method, which is available in the same clinics that offer Caya. On fertile days, some clients choose to use Caya rather than abstaining or using condoms.

To address unmet need among consumers who have infrequent sex and are dissatisfied with current contraception options, there’s more work to do. When pharmaceutical companies and donors invest in developing novel on-demand methods and when we collectively increase consumer access to available products, we put the power of choice into the hands of consumers like Péniel and Valérie.

“[Caya] is a very easy method to use,” Valérie explains. “It’s discreet… practical, and without side effects and hormones.”

Simply, it’s contraception on her terms.

For more information, please contact Abigail Winskell ([email protected]). 

Traditionally in international development, community-based and grassroots organizations are used solely as implementers: they’re given a small, specific scope of work that they’re asked to achieve, after a thorough due diligence process led by the “prime” awardee—typically a big INGO that serves as a pseudo-donor to the local partner.  

It’s time for local partners to lead  

When we shift power and co-create, co-implement and co-evaluate programming alongside local partners, we can advance people powered health solutions and get us all closer to Universal Health Coverage (UHC). 

Locally-led models for feminist funding can get us there. Maverick Collective by PSI and Fòs Feminista are collaborating on a new feminist fund – Maverick Portfolio.  

Fadekemi Akinfaderin, Chief Advocacy Officer, Fós Feminista  

Institutions with resources tend to hold the power and dictate how much funding is provided; to whom those resources go; and what priorities are resourced. Feminist funding aims to: 

  • Challenge this power by calling on institutions, especially those in the Global North, to question how this power is being used 
  • Call on us to provide increased and better-quality funding to activists, organizations and movements in ways that provide the greatest flexibilities on a long-term basis to bring about systematic change 
  • Center the leadership and experiences of those most affected by systematic oppression and aims to resource them to change the status quo.    

Common misconceptions about feminist funding include perceptions that grassroots organizations are not able to manage large and flexible funding that are not tied to prescribed project activities; that it is difficult to measure results and change with feminist funding; and that feminist funding has no due diligence processes, and it is greater risk. These misconceptions are false and center around the notion of power and control. We now have examples that have demonstrated otherwise.    

We recognize that many organizations, especially those led by excluded communities, do not have the luxury to engage in co-creation processes due to resourcing constraints. PSI and Fós Feminista are committed to eliminating this barrier by providing flexible funding to grassroots partners to not just engage, but take leadership in the entire process. Through this partnership we are demonstrating how we can shift power and work with partners horizontally in program co-creation, implementation and evaluation. 

To integrate feminist approaches into program implementation, we recognize the power we hold in our relationships with national partners; we commit to co-create the project and resulting scope of work for each partner; jointly own work products produced through this partnership and make it open source; and engage in a process of mutual learning, exchanges and capacity building, where every partner shares its strengths and capacities for the benefit of all.  We will also include as part of our theory of change and results framework systems to check on how we have been able to live into the partnership values we have set and not just the “outcomes” related to sexual and reproductive health and rights (SRHR).  

Finally, we are very intrigued and excited about working through Maverick Portfolio on “engaging men and boys” for delivering SRHR interventions.  This is the funding theme the pilot countries have selected, with local input, to focus on, and we see this as a unique opportunity to reflect, dream and co-create a feminist model to engaging men and boys. Most of the national partners are feminist organizations who have strong analysis that will be brought together in the design of this new initiative ensuring that we continue to center women, girls, and gender diverse people, while working with men and boys to transform harmful social norms around masculinities. 


Natalie Fellows, Senior Manager for Impact, Experiential Philanthropy, PSI DC 

We know that local partners, and their deep ties to the community, as well as their experiences and expertise, bring so much to the table, especially in terms of strategy, setting priorities and determining metrics for success. We want to work with incredible local organizations and grassroots movements as true partners – this means mutual accountability, transparency, respect and decision making. 

We are doing this through Maverick Portfolio, a new giving program from Maverick Collective by PSI implemented in partnership with Fòs Feminista. 

The Portfolio started with a question: how is traditional philanthropy and international development actually standing in the way of achieving the most impact possible? With this question, we launched a co-design process—with seed funding from our existing members—to create a philanthropic fund that eliminates these barriers and puts impact front-and-center. The resulting model shifts power from the donors to the doers, the people in the countries where our programs operate, who are closest to the impact. We hypothesized that by moving decision making power to those closest to the work; providing flexible funding to allow for adaptive programing; engaging with local partners who bring their full value to the table; and co-creating solutions, we can create more impact, at-scale for the communities we aim to serve.  

But we know we can’t catalyze systemic change alone. Our partnership with Fòs Feminista and local actors is fundamental to us accomplishing long-term change; this partnership will be our guidepost to make sure we’re walking the walk and not just talking the talk.    


Metsehate Ayenekulu, Adolescent Sexual and Reproductive Health Director, PSI Ethiopia 

The Maverick Portfolio model is all about centering consumers and ensuring local priorities and solutions are uplifted. We know that local partners often have some of the deepest connections to the communities we are aiming to serve, and by working with them it can help further support the goal of consumer powered healthcare.  

Through Maverick Portfolio’s development, we’ve thought a lot about the due diligence process, reporting requirements, credit due and donor access. We see these as elements of a partnership in need of change. Why should INGOs get to see all the financial, operational and programmatic details of a local partner during the due diligence process, when they themselves are sharing no information? How can we co-create reporting requirements that fit both organizations’ needs? And how do we ensure that local partners have access to donors as well, and are also given proper credit for the success of initiatives they contribute to and lead? These are all things we’re working to shift through Maverick Portfolio.  

We can see that, on an operational level, PSI is shifting in a similar way – looking at its subaward processes to simplify and streamline for our partners, and making a concerted effort to continue shifting power to local-led entities. We hope that this pilot will deepen the evidence base for how INGOs can shift power dynamics on resource allocation and decision-making processes; how we define success and on how we thoughtfully and effectively engage local partners.  

Visit Fòs Feminista and Maverick Portfolio to learn more.  

By Faustina Fynn-Nyame​​, Executive Director, Africa, Children’s Investment Fund Foundation  

The year was 1995, the location, Beijing, China.   

Back then, many of us did not quite comprehend how the deliberations and commitments made at the United Nations Fourth World Conference on Women would impact the future of the girl-child and women across the globe.  

Adopted by 189 countries, the Beijing Declaration and Platform for Action presented a significant turning point for the global agenda for gender equality, identifying 12 strategic areas and actions aimed at removing all the obstacles to women’s active participation in all spheres of public and private life through a full and equal share in economic, social, cultural and political decision-making.  

26 years after these commitments were made, there has been significant progress, but we are still a long way from removing all obstacles to gender equality and the advancement and empowerment of women and girls.  

A 2020 analytical review of achievements and challenges in the 12 areas of the Beijing Platform for Action conducted by UN Women for the East and Southern Africa Region cited persistent gender gaps in education and training, negative cultural and entrenched patriarchal social norms, dwindling political will to adopt sustained campaigns for the transformation of these negative social norms, and inadequate resources to implement them as some of the present-day obstacles to delivering on these commitments.  

Across Kenya, Ethiopia, Nigeria, and Burkina Faso, nearly half of the adolescent girls are married before 18, two-thirds do not attain secondary education, one quarter have a child by 18, and young working women continue to earn less than men. These outcomes are worsened by a resistance to include comprehensive sexuality education in school curricula, denying both boys and girls the information and skills to safely manage their sexuality to avoid early sex debut and unwanted pregnancies.  

This is happening against a backdrop of inadequate investment in the health sector, with many countries heavily relying on foreign assistance and donor grants further limiting quality and equitable access to (reproductive) health and related social services.  

We will continue to fail women and girls if we fail to eliminate these obstacles and barriers.  

The Children’s Investment Fund Foundation (CIFF) is committed to transforming the life of the African girl. Informed by CIFF’s Africa Strategy, our aim is to ensure that girls achieve their aspirations and rights. Our work is not done until African girls have the health, economic opportunity, and the agency to contribute to a thriving and self-determined Africa.  

This complex challenge calls for bold, catalytic, transformative, and locally driven sustainable solutions, with an explicit equity focus that leaves no girl behind. This will involve tailoring interventions to reach and improve outcomes for girls in marginalized communities and doing things differently. Business as usual will not suffice, but rather a radical change in how we view the problem and its solutions.   

Our promise to the African girl is to build her capabilities by addressing norms and barriers to staying in school and learning, and building life skills and agency, to prepare her for the future by supporting secondary education and vocational pathways, universal access to sexual reproductive health (SRH), and economic empowerment by addressing gender gaps in key sectors.  

For this to happen, we have made a commitment to put the adolescent girl at the center of our design process starting with her needs and aspirations, and address this holistically to maximize impact. We realize that we can only do this sustainably by working through local organizations and leaders, building capacity, strengthening networks and empowering the voices of our partners while leveraging existing platforms, partnering with government to scale our investments, and putting sustainability at the front and center of our strategic approach.   

To deliver on this promise and commitment calls for transformational opportunities to scale what we and our partners know works, testing new models where evidence is lacking, and providing catalytic funding to transform large scale programs and initiatives.   

26 years on, the African Girl still needs all our support to become the woman of her dreams. To live in a world where she can actively participate in all spheres of public and private life through a full and equal share in economic, social, cultural, and political decision-making. And to live in the world we promised her in September of 1995 in Beijing.  

Only when girls, including those most-at-risk, have equal rights, opportunities and agency to achieve their full potential can we have resilient, prosperous and just societies.’’ 

By Mariela Rodriguez, Senior Learning and Communications Advisor, MOMENTUM Private Healthcare Delivery/ PSI, Gustave Camara, Director of Information and Communications, PSI Mali, May Namukwaya, Health Services Coordinator, PSI Uganda, Fosca Tumushabe, Advocacy and Communications Officer, PSI Uganda 

MOMENTUM Private Healthcare Delivery funded USAID, supports private sector engagement in the delivery of vital healthcare, strengthens how public and private healthcare actors work together, and ensures healthcare information and services are respectful, high-quality and people-centered. Through this work, the program aims to accelerate reductions in maternal, newborn, and child mortality and morbidity in countries around the world. 

In many communities around the world, midwives are often the frontline of community-level sexual and reproductive healthcare (SRH). In Mali and Uganda, MOMENTUM partners with networks of private midwives to help them increase community access to and availability of quality SRH services.  

We spoke to three midwives working in Mali and Uganda to learn more about how they strengthen local health systems. 


MOMENTUM in Mali works with private sector midwives like Setan and Fatoumata to strengthen their capacity to provide and maintain quality of care in the delivery of SRH services. MOMENTUM also seeks to increase access to family planning services in Mali by increasing availability of SRH products and health education.  

“We give the women a warm welcome and provide correct information, especially about reproductive health. [Our work] is about helping women give birth and also to promote health and reduce maternal and infant mortality rates.” –Setan Gassama, Midwife at Cabinet Medical Momo

“It’s about going into the community with advance strategies, often during gatherings; hosting educational talks, and doing home visits…As a midwife, I’m helping to reduce maternal, child and infant mortality and morbidity so that no woman dies in childbirth and so that giving birth brings joy, not sadness.” –Fatoumata Berete, Midwife at Keneyaton Clinic


Miriam Nabatanzi Bwete is a midwife at the Biva Maternity and Health Clinic outside of Kampala, Uganda with over 20 years of experience. Miriam is part of the Uganda Private Midwives Association (UPMA) and receives training and support from MPHD. Through MOMENTUM, Miriam and other colleagues from UPMA were trained in person-centered postpartum family planning service delivery, using the Counseling for Choice approach. 

“At Biva Maternity and Health Clinic, I take on all roles such as welcoming the clients and setting the right ambiance for them. As SRH is a sensitive topic, I guide clients towards total opening up by actively listening and provoking of details.”

“I also provide relevant information about applicable [contraceptive] methods and the benefits of one over the other, administer the client’s choice method, and even do follow up to ensure that the client is well and happy.”         

“People centered care helps me to understand client’s [contraceptive] method of choice, how best the method can be delivered, and the support to be offered.”

By offering person-centered care, Miriam is helping to ensure clients are heard and supported. Strengthening providers’ capacity to deliver quality, person-centered care can promote the localization and sustainability of approaches that lead to positive health outcomes.

Midwives are an essential component of localized SRH care. Engaging with private-sector health providers, like midwives Setan, Fatoumata, and Miriam, helps foster sustainable, person-centered health systems.  

In many ways, the establishment of PSI’s Social Business Unit (SBU) goes back to our origins.

PSI began selling mail-order condoms to support sexual reproductive health and rights (SRHR) programming in low-middle income countries. We used business and marketing discipline and behavior change communications to promote healthier lives.

Like a traditional commercial business, a social business seeks to earn income through the sale of products and services. However, it also aims to achieve health and social impact for people in vulnerable situations, thereby creating a double bottom line.

Learn more here.

Section 4/4

Digitally Signposting to Quality Primary Health Care

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Better data for stronger health systems

Explore our resources

View our short interviews

In this video, Wycliffe Waweru – Head of Digital Health & Monitoring at Population Services International – outlines three barriers to the use of data for decision-making in health in low- and middle-income countries. For each barrier, Wycliffe proposes some concrete solutions that can help overcome it.

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.   

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 Population Solutions for Health 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 the program.  

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.


Scaling Digital Solutions for Disease Surveillance

Strong surveillance systems are essential to detect and respond to infectious disease outbreaks. Since 2019, PSI has worked alongside the Ministries of Health in Cambodia, Laos, Myanmar, and Vietnam to strengthen disease surveillance systems and response. Learn more here.


Misinformation and Vaccine Hesitancy

As COVID-19 spread globally, so did misinformation about countering the pandemic. In response, PSI partnered with Meta to inspire 160 million people to choose COVID-19 preventative behaviors and promote vaccine uptake. Watch the video to learn how. 


The Frontline of Epidemic Preparedness and Response 

Early warning of possible outbreaks, and swift containment actions, are key to preventing epidemics: disease surveillance, investigation and response need to be embedded within the communities. Public Health Emergency Operations Centers (PHEOCs) are designed to monitor public health events, define policies, standards and operating procedures, and build capacity for disease surveillance and response. Learn more here. 

integrating pharmacies and drug shops into the health system



Private sector pharmacies and drug shops play an important role in improving access to essential health services and products for millions of people living in low- and middle-income countries (LMICs), where healthcare resources are often limited. However, the way in which these outlets are, or are not, integrated into health systems holds significant importance. Do they serve as facilitators of affordable, high-quality care? Or have they become sources of substandard health services and products?

Read the blog here
Read the technical brief here

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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.


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02 Breaking Taboos

03 Moving Care Closer to Consumers

04 Innovating on Investments

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