Partners in Health (PIH)

In Haiti, PIH, known locally as Zanmi Lasante (ZL), serves a direct catchment area of 1.2 million people in primary care alone and nearly 3.9 million with secondary and tertiary care. Since its founding in 1987, ZL has built and run, in partnership with the Haitian Government, a network of 17 hospitals and health centers, including Hopital Universitaire de Mirebalais (HUM). All of ZL's facilities today represent an indispensable lifeline for millions of patients in the Central Plateau region. ZL's staff of more than 6,500, mostly Haitian nationals, includes more than 2,300 community health workers, who work tirelessly to provide hope, health services, and social support to local communities. HUM is the largest, internationally accredited, public teaching hospital in Haiti, and offers an unparalleled scope of medical services and training opportunities in rural Haiti. The 205,000-square-foot, 350-bed health facility operates in conjunction with the Haitian Ministry of Public Health and Population (MSPP). HUM is filling a significant gap, both locally and nationally, for people who previously had very limited access to quality health care. HUM offers advanced care across clinic specialty and subspecialty areas including a full-service emergency department, critical care units, psychiatry, oncology, urology, dermatology, nephrology, general and orthopedic surgery, medical evacuation capacity, on-site oxygen production, and more. HUM brings innovation and services previously unavailable to Haiti's public system: digital imaging, an open-source electronic medical records system, telemedicine capacity, and high-tech classrooms for training the next generation of Haitian medical professionals. The Mirebalais Reference Laboratory for Diagnostics and Research on the campus of HUM is further setting a new standard for laboratory excellence in Haiti. Centrally located at HUM and providing a wide range of diagnostics for all PIH/ZL facilities, this 12,000 square foot reference lab is the premier reference center for HUM, as well as for an extensive network of other PIH/ZL-supported public health centers and hospitals across the country. HUM received international accreditation as a teaching institution in 2019 and is home to six residency programs. Through residency and training programs in Mirebalais and in Saint Marc, PIH/ZL is providing high quality training to increase the pipeline of trained clinicians working in Haiti. PIH's clinical residency programs at University Hospital in Mirebalais (HUM) and Saint-Marc are increasing the number of medical specialists across the country, including emergency medicine (the first residency of its kind in Haiti), family medicine, internal medicine, pediatrics, surgery, obstetrics/gynecology, and nurse anesthesiology. Since 2012, Zanmi Lasante's medical education program has trained 194 Haitian clinicians across 10 different specialties. 80% of graduates stay to work in Haiti and more than half (52%) of graduates are women; in 2022-2023 there are 143 clinicians currently in training, with 54.5% women. Together, these highly trained professionals are bolstering Haiti's health system, one new graduate at a time.

Since 2005, PIH in Rwanda, known locally as Inshuti Mu Buzima (IMB), has partnered with the Rwandan Ministry of Health and Rwanda Biomedical Centre (RBC) to strengthen the public health system in several previously underserved rural districts. IMB supported the construction or rehabilitation of district hospitals at Rwinkwavu, Kirehe, and Butaro, and the organization continues to partner with the Ministry of Health to support care at all three facilities and the 45 affiliated health centers that provide primary care to a combined population of over 850,000. IMB, in partnership with the Government of Rwanda, supports over 300 clinical staff, 1,000 non-clinical staff, and 6,000 community health workers. IMB's centerpiece facility is the Butaro District Hospital, located in the Burera District. Inaugurated in 2011, the156-beds hilltop facility brings modern medical care to a district that did not previously have a functioning hospital. IMB is currently leading an innovative program to deliver comprehensive, integrated care for major chronic non-communicable diseases (NCDs) such as diabetes, hypertension, cancer, asthma, heart failure, and mental illness. IMB has also been heavily involved in the creation of the adjoining Butaro Cancer Center of Excellence (BCCOE), which opened its doors in July 2012. BCCOE offers patients comprehensive cancer care, a service that was rarely available for poor sectors of the population in Rwanda and elsewhere in East Africa. As of 2019, BCCOE sees about 1,700 new patients each year with patients travelling from numerous East African countries. The hospital is staffed by 11 Rwandan general practitioners, 13 interns, 5 Rwandan internists, 2 pediatricians, one general surgeon, as well as 117 Rwandan nurses who have received specialized training in oncology care from rotating nurses from Dana-Farber Cancer Institute. All care is provided in remote partnership with oncologists, pathologists and surgeons based at Dana-Farber and other institutions in the United States and Europe.

For 25 years, PIH in Peru, known locally as Socios En Salud (SES), has been deeply embedded in the communities it serves and has strong ties to the health system at all levels. SES supports public health services at the first level of care and at the national level, and supports the Ministry of Health on issues such as tuberculosis, HIV, mental health, maternal and child health, among others. Over 500 staff support the team's work in 90 health centers and 13 hospitals. SES's programs serve 284,000 people's primary health needs, and the national TB work reaches 31.8 million people. SES currently serves at the Ministry of Health's lead partner in COVID response and as the Global Fund Principal Recipient for HIV/TB from 2022-2025. At Mexico Health Center in Peru, COVID-19 has impacted the ability to provide patient care and timely HIV case detection. Many providers were moved to work from home to prevent severe COVID-19 infections, resulting in only 23% of expected HIV cases being detected. SES implemented a quality improvement (QI) project to increase HIV case detection by establishing a virtual telephone exchange and technical assistance for the use of GeneXpert (rapid real-time PCR test) for screening. This allowed health center staff to work remotely. After a four-month intervention period, over 100% of all expected HIV cases were detected, achieving a nearly 108% case detection rate. SES has also complemented and informed efforts to improve the treatment of HIV, TB, MDR-TB (Multi-Drug Resistant TB), and XDR-TB (Extensively Drug Resistant TB), by completing several research projects in this field. In 2010, a study in Lima, Peru showed people living with HIV and accompanied by a CHW had better outcomes at 12 months, including higher viral suppression. From 2007-2014, the US National Institutes of Health (NIH) granted PIH a $5.7M research award to study the epidemiology and transmission dynamics of MDR-/XDR-TB, a study involving over 124 health centers, 4,000 patients, 20,000 contacts and hundreds of staff in Peru, making this study among the world's largest research studies on tuberculosis. During 2013-2016, the NIH awarded PIH $1.1M to conduct a phase two pharmacodynamics study of high-dose levofloxacin in MDR-TB treatment. Most recently, the NIH awarded PIH $342,635 for a study measuring TB metabolic factors.

In addition to the programs listed, PIH has programs in Rwanda, Sierra Leone, Lesotho, Malawi, Liberia, Kazakhstan, Mexico, and Navajo Nation. Major expenditures in other programs include those for endTB, research, electronic medical records, monitoring and evaluation, and mental health.