PIH Canada Celebrating 10 Years

Helping Patients Breathe

Partners In Health provides vital care for cancer, diabetes, heart disease, mental health conditions, and other non-communicable diseases (NCDs) to vulnerable communities, all while helping governments incorporate that care into strong public health systems and share lessons globally. Collectively, NCDs kill more people annually than all other causes combined. At a policy level, PIH care delivery sites have accompanied ministries of health to establish national commissions and working groups in Haiti, Liberia, Malawi, Rwanda, and Sierra Leone, and many of the recommendations that have been identified by national governments in countries PIH supports have been informed by PIH’s clinical care innovations across our sites. This includes the development of local care delivery models for severe, chronic NCDs such as type 1 diabetes and rheumatic and congenital heart disease that were scaled nationally in Rwanda, and the introduction of integrated chronic care and advanced chronic care clinics in Malawi. PIH is committed to supporting and advancing NCD care by meeting the extraordinary burden with proven methodologies in early detection, prevention, and treatment to strengthen entire health systems.

Addressing Child Malnutrition

With a focus on society’s most vulnerable communities, Partners In Health is determined to change the systemic injustices that prevent children from growing up healthy and strong. In many of the countries where we work, malnutrition is one of those injustices, threatening children’s survival, growth, and cognitive development. In Haiti, child malnutrition underscores the country’s high rate of child mortality: approximately one out of every ten children will die before reaching the age of five. To address this, Zanmi Lasante (as PIH is known in Haiti), with the support of PIH Canada, piloted and scaled up an approach to treatment that saves lives and helps children thrive. Using mobile malnutrition clinics, Zanmi Lasante brings screening, diagnosis, and treatment services to people in the communities where they live. This proactive approach leans heavily on community health workers (CHWs), who mobilize their communities to attend the clinics, ensure patient follow-up, and accompany severe cases to the hospital.

Comprehensive Emergency Response

Some disasters originate in nature, but their impacts are anything but natural. Over the past decade, PIH has responded to earthquakes and to epidemics, hurricanes and mudslides, floods, and fires. In all cases, the impacts have been hardest felt by those most affected by poverty and ill health. Lack of resources and infrastructure — itself a function of structural inequality — hampers response efforts and makes the communities we serve more vulnerable during emergencies. It’s why we have understood that crisis response must also have an eye on the long term while addressing urgent needs. Resources must be allocated and capacity built to ensure local health systems can respond to underlying conditions as readily as disasters, in order to properly provide care in any circumstance. And whether it be cholera or COVID-19, dignified care is far more than a specific clinical intervention; it also includes whatever social supports are required — food, shelter, transportation, clothing, supplies, and more — to ensure all people are able to live in dignity, during emergencies and whatever comes next.

Fighting Gender-Based Violence

The growth of PIH Canada over the past decade has shown that big impact can come from modest beginnings. A case in point is the expanded support for Haitian colleagues responding to violence against women and girls. In 2014, PIH Canada funding from institutional and individual donors enhanced Zanmi Lasante’s ability to treat and track cases of gender-based violence (GBV). Based on strong evidence of impact, the work expanded to six sites. In 2019, program learnings led to additional support from the Canadian government to again scale the program, introducing it to more rural and hard-to-reach areas. Today, Zanmi Lasante is providing comprehensive GBV medical care across 14 sites, all while bolstering the capacity of and coordination between other actors involved in the GBV response — including the judicial system, police, women’s rights organizations, and educational institutions. Since 2014, the project has cared for more than 3,500 survivors of violence — and other PIH sites are building on Haiti’s example.

Partnerships with Canadian Government

In Sierra Leone, Malawi, and Haiti, PIH Canada’s partnerships with Global Affairs Canada have helped to advance women’s rights and provide a pathway for expanded sexual and reproductive health services in communities PIH serves. In Sierra Leone and Malawi, our five-year partnership with Global Affairs Canada is strengthening clinical care for women and children and bolstering the capacity of health care providers to deliver high-quality, gender-sensitive, and youth-friendly services. Quality improvement programs focused on strengthening care throughout pregnancy, labour, and delivery have driven down the rates of maternal mortality and supported hundreds of women to safely deliver healthy babies. Services for adolescent girls are being strengthened by ensuring safe spaces to seek care and through expanded community-based and peer support activities. We are also grateful for Canadian government support of PIH’s work in times of crises, including during the Ebola epidemic in West Africa and during COVID-19.

Commitment to Medical Education

A rural family medicine residency and nurse training partnership with Tubman University in Liberia. A one-of-a-kind university in Rwanda, with equity at its core. A multi-country mental health team committed to decentralized care delivery and shared learning. Whatever the location, medical education for health professionals is central to PIH’s mission. Take University Hospital of Mirebalais (HUM) in central Haiti, built in partnership with the Haitian government following the 2010 earthquake that decimated an estimated 60 percent of Haiti’s health infrastructure. The vision for a tertiary-level teaching hospital capable of training the next generation of Haitian health professionals has become a reality, with residency programs across nine medical specialties, a number of which PIH Canada has been proud to support. Residencies include pediatrics, internal medicine, obstetrics/gynecology, surgery, and the first emergency medicine program in Haiti’s history. Not only is HUM providing care never before available in Haiti’s public sector, but following the August 2021 earthquake in the country’s south, it was Haitian clinicians — many of whom were trained in residency programs at HUM — who led the response.

Social Support, Always

When PIH started working in Sierra Leone during the 2014-15 Ebola epidemic, one of the first jobs was to train and hire Ebola survivors as community health workers. The strategy recognized the importance of a regular income for so many people who were living in poverty, and the need to reduce stigma, support local economies and build community trust. It was also a form of social support programming that focused on treating the whole patient and meeting the needs of a community, not just a particular medical condition. PIH often provides basic necessities and resources including food, housing, transportation, and even financial support for patients and their families. In Peru, COVID-19 has had compounded challenges faced by the poorest and most marginalized families, for whom food and housing security are common concerns. PIH’s sister organization, Socios En Salud, expanded its services to provide food vouchers and socioeconomic support. In Haiti, Zanmi Lasante offers travel vouchers for patients undergoing chemotherapy. Many PIH care delivery sites also employ social workers who make assessments for patients in need of additional supports, easing the often bumpy road between sickness and a return to health.

Service and Equity at UGHE

Aspiring physicians in medical school at PIH’s groundbreaking University of Global Health Equity (UGHE) in northern Rwanda spend much of their first year listening to and learning from community health workers. Upending traditional medical education in favour of a comprehensive focus on health equity is at the core of everything UGHE does, so it makes sense to leverage the expertise of the cadre of health workers who are closest to patients’ lives. In this way, UGHE, founded in 2014, is pioneering a new model of training leaders who will emerge ready to develop health care services and systems that connect neglected communities with essential and life-saving care. Students, the majority of whom are women, come from across Africa and the globe. To attract the best candidates irrespective of ability to pay, tuition for the six-year, dual degree Bachelor of Medicine, Bachelor of Surgery program is free — but in exchange, students sign an Umusanzu Agreement, a commitment to serve the most vulnerable for six to nine years after graduation. Based on the values students learn at UGHE, we have little doubt it will be a lifelong practice. See www.ughe.org for more.

Essential Workers? Hello, CHWs

For three decades, PIH-supported community health workers (CHWs) have addressed the root causes of suffering in the poorest and most remote places by directly serving the communities where they live. From accompanying HIV and TB patients to health promotion, home visits, and everyday acts of solidarity, the simple act of showing up and being of service – otherwise known as ‘accompaniment’ – has had transformative impacts on patient outcomes. PIH is active in global advocacy to ensure CHWs are compensated, trained, mentored, and supervised, as fits their role as the eyes and ears of a health system. Over the years, as ministries of health are moving toward polyvalent models in which CHWs focus on a range of health issues rather than specific diseases, PIH sites including Malawi and Liberia have adopted a “household model” of CHW programming, a transition that PIH Canada has actively supported. In Malawi, for example, a CHW is assigned to each of the more than 32,000 households across the catchment area where we work, carrying out epidemiological surveillance, treatment, and care services that are at the heart of Neno district’s public health system. See story on Page 20.

Centering Needs of Women and Girls

In all countries where PIH works, women and girls have fewer opportunities than their male counterparts to live safely, freely, and in good health. PIH strives to address this inequity by consistently expanding access to women’s health services, including by introducing and scaling up family planning services, high-quality prenatal and obstetric care, and cervical cancer screening and treatment. In Haiti, PIH was among the first NGOs to embrace the HPV vaccine for girls. In Rwanda, PIH supported a successful national HPV vaccination program. It also remains a core part of our mission to radically reduce maternal mortality. In April 2021, groundbreaking began on a state-of-the-art teaching and training center: the Maternal Centre of Excellence in Kono District, Sierra Leone. Based at Koidu Government Hospital, the center will provide high-quality labour, delivery, and maternal health services and serve as an example of what is possible in a country with one of the highest rates of maternal mortality in the world.

The Way Forward

As we consider the next 10 years, we know PIH Canada needs to grow in order to increase our impact. It won’t always be a linear path, but it will be grounded in equity and PIH values of commitment, partnership, humility, integrity, and accountability. As shown in our 2021 annual report, when PIH Canada staff came together to think about how we can accelerate our work and expand our impact, here’s some of what came out: