Program areas at PATH
The programs & innovation division brings deep technical expertise and a robust, collaborative, and interdisciplinary approach to support Path country programs and partners in advancing health equity. We focus on generating analytical insights, translating them into advocacy and action, advancing inclusive and sustainable innovation, and strengthening workforce skills and resources that support integrated and resilient health systems. Our work covers digital transformation and data use, primary health care, diagnostics, product development, market shaping, epidemic preparedness and response, malaria and neglected tropical diseases, and more. (continued on schedule o)center of digital and data excellencepath uses digital technologies and data-led action to advance health equity. In 2022, Path's center of digital and data excellence catalyzed country-led digital health transformation in numerous ways. Work continued on the data use partnership, a project funded by the bill & melinda gates foundation through which Path supports the government of tanzania to improve its health information systems and use of data. With support from this project, the government published a refreshed digital health investment roadmap, an important step to ensure alignment of the country's digital systems. In addition, the project launched an improved human resources for health information system to better track credentials and allocate health workers across the country. The data use acceleration and learning project, also funded by the gates foundation, captured learnings from five countries - burkina faso, ethiopia, malawi, south africa, and tanzania - and developed a model for digital transformation for data use that builds on existing frameworks. The findings and recommendations were published in a report and a series of communications materials and were shared at events including the world health summit.digital square, a path-led initiative backed by a united states agency for international development (usaid) investment of up to $170 million through 2026, continued to bring donors and partners together to improve how the global community designs, uses, and pays for digital health tools and approaches with an emphasis on country-driven priorities. Highlights from 2022 included updating the digital square global goods guidebook, launching a new digital health technologies funding call (notice g), and releasing a new total cost of ownership tool. In 2022, digital square also announced the digital results improve vaccine equity and demand (drive demand) project, a two-year, $5 million partnership with the rockefeller foundation to deploy and expand the use of digital health tools in five countries.path, with us centers for disease control and prevention (cdc) funding, is leading overall health information system (his) support activities as part of the us president's emergency plan for aids relief (pepfar) technical assistance platform (tap), which partners with countries to build lasting digital health capacity. In 2022, the team began implementing the third year of the project, with a focus on national health data policies and governance, health information system standards, and health information system workforce strengthening. Through tap, Path worked to strengthen health systems for hiv and/or covid-19 in botswana, cote d'ivoire, democratic republic of the congo (drc), ethiopia, haiti, kenya, namibia, nigeria, rwanda, uganda, vietnam, and zambia.in 2022, Path launched the digital health ecosystem (dhe) project in partnership with medic and funded by the bayer foundation. This project supports sustainability and expansion of digital tools for health by helping local entrepreneurs more easily access financing, technical resources, and opportunities for scale. In 2022, dhe launched its first accelerator program and identified and funded four african digital health organizations to expand access to tools for community health. Path continued to participate in high-level global coalitions, including: transform health; the working group for recommendations for g20 leaders; the digital connected care coalition; the digital public goods alliance, of which Path became a member in may 2022; and the digital public goods charter campaign.diagnosticspath's diagnostics program aims to advance and increase access to high-quality and appropriate diagnostics that improve the health outcomes of people and communities in low-resource settings.in 2022, Path supported the advancement of affordable, reliable diagnostics, proteins, antibodies, and tools by aiding the development, commercialization, and procurement of new technologies; conducted performance evaluations and clinical studies to inform patient care; facilitated a g6pd (glucose-6-phosphate dehydrogenase) operational research community of practice; and published nine peer-reviewed articles. We continued to contribute to the availability of cost-effective and dependable diagnostic solutions in low-resource settings, ensuring that communities in need have access to tools for an accurate and timely diagnosis.in response to the global covid-19 pandemic, we supported the development and validation of diagnostic tools, technologies, and solutions suitable for use in low- and middle-income countries (lmics). This included designing and producing 100 covid-19 benchmarking panels and facilitating independent evaluation of covid-19 diagnostics for the world health organization's (who) emergency use listing (eul); collaborating to develop a publicly available interactive dashboard that streamlined information on technical specifications, regulatory status, and supply of covid-19 tests, aiding procurement decisions; supporting national responses in multiple countries,including quantifying sars-cov-2 in wastewater and assessing cost-effectiveness; collaborating with multiple diagnostics developers to develop blinded panels to test molecular diagnostic assays and assess the best-in-class candidates via in-house studies to ensure unbiased performance evaluation; and, conducting feasibility studies in brazil to evaluate the effectiveness of contact tracing with serial self-testing and generating evidence and resources for implementation. We also launched the diagnostic image repository, offering over 35,000 open-source images of covid-19 rapid diagnostic tests to support development of artificial intelligence-based smart readers, and established partnerships to improve the operational aspects of who's eul processes.we conducted a clinical trial for assessing presumptive tuberculosis (tb) cases in a low hiv prevalence region (hanoi, vietnam) for the presence of a tb biomarker, lipoarabinomannan, in urine. This was the largest cohort of its type to date (n=780) and Path was able to assess the performance of two highly sensitive immunoassays on these samples. Urine samples were collected under full ethical approval and were made available for use by other diagnostic developers who aim to improve or develop new products.to enhance the security of local diagnostic supply chains in lmics, Path conducted a comprehensive landscape analysis to determine key market failures and identified market-shaping interventions needed to expand access to high-quality diagnostics. This included the development of an interactive dashboard that consolidated publicly available data on diagnostic companies with a manufacturing presence in africa, latin america, and southeast asia. The dashboard increased the visibility and awareness of these companies within each region while providing an overview of their product portfolios and quality systems.to increase access to g6pd testing, essential for treating plasmodium (p.) vivax malaria patients, we brokered a volume guarantee for the sd biosensor standard g6pd test, the sole quantitative point-of-care diagnostic for this type of malaria. This guarantee, provided by medaccess, supports sd biosensor in reducing the price of their point-of-care g6pd device and testing strips for lmics and more importantly ensures supply security of the test through commitments from the sole manufacturer.in collaboration with the uk national institute for biological standards and controls, Path worked to develop and release 29 high-quality and affordable monoclonal antibodies to support the development of pneumococcal vaccines that are low cost, serotype specific, and tailored for use by vaccine developers and researchers in lmics.
Africa region: Path's work in africa intersects virtually every Path global program, from advocacy and public policy to sexual and reproductive health. We have country offices in seven nations spanning central, eastern, southern, and western africa (drc, ethiopia, kenya, senegal, tanzania, uganda, and zambia) with project offices in seven more. Highlights from our offices include:(continued on schedule o)drcin 2022, Path worked closely with the ministry of health under the mashako plan to advance immunization coverage and combat epidemics, particularly polio. Developed by the moh, the primary aim of the mashako plan is to reduce the number of zero-dose children those who have not received any scheduled vaccines by 35 percent by the end of 2025 and to increase vaccine coverage through an initial phase of vaccination campaigns in haut katanga, haut lomami, ituri, kasai, kinshasa, kwilu, mongala, tanganyika, and tshuapa provinces. These nine provinces are most affected by the measles and polio epidemics and are home to half of all congolese zero-dose children. To date, the mashako plan has been gradually expanded between 2020 and 2022 to cover all of the country's provinces, generating a 50 percent increase in the number of vaccination sessions compared with 2018, resulting in full vaccination coverage rising from 35 percent to 50 percent between 2018 and 2020. In 2022, Path also supported the ministry of public health, hygiene, and prevention and the national universal health coverage council in the formal adoption and appropriation of the costed digital health investment roadmap, which aims to accelerate digital health transformation in the drc. The roadmap, supported by usaid and digital square at Path and adopted following a roundtable discussion that included more than 90 participants from the drc government, donor organizations, and the private sector will help to plot a course for standardizing the drc's different digital platforms, training thousands of health workers, and computerizing thousands of health centers by 2024.ethiopiain april 2022, usaid-funded surveillance for malaria elimination (s4me) project was launched in ethiopia to strengthen the capacity of national and subnational malaria elimination efforts. Path partners with addis continental institute of public health in the implementation of the s4me project. The s4me team established three cluster offices in harar, debreberhan, and shashemene, operating within the health bureaus to bring support closer to end users, foster collaboration with regional health bureaus and zonal health departments, and ensure the sustainability of the project. To assess the implementation status of the national malaria elimination program (nmep), Path conducted a baseline survey across 57 supported woredas (districts) in seven regional states. Survey findings of strengths and gaps in the nmep were used in designing targeted and tailored support for malaria surveillance and elimination efforts. After usaid received a request for support from the moh and the global fund country coordinating mechanism, under the s4me project, Path also managed the hiring process for two consultants, both international and local, to provide expertise that will strengthen ethiopia's application for funding from the global fund. Path continued running the malaria control and elimination partnership in africa (macepa) program in ethiopia. In 2022, the macepa team customized the public health emergency management district health information system-2 (dhis2) to monitor weekly and immediately reportable diseases (enhancing the capacity for disease surveillance), and created user accounts for 40,000 health facilities. In partnership with the ethiopian public health institute, the project introduced a digital solution using the dhis2 tracker system to capture travelers' vaccination status, facilitating the recording of administered vaccines and adverse reactions. Moreover, the macepa team played a key role in malaria risk stratification for targeted interventions and resource allocation. Collaborating with the university of California san francisco, the federal ministry of health (fmoh), the armauer hansen research institute, and the amhara public health institute, the project conducted studies to understand malaria transmission dynamics in high-risk populations.path also supported the gates foundation's hpv cost of delivery study project. In 2022, Path conducted a comprehensive hpv vaccine cost of delivery study in ethiopia, providing insights into the operational and contextual factors, and the overall costs, of the hpv vaccination program among 14-year-old girls. Recommendations were made to improve program efficiency and expand vaccination to multi-age cohorts, targeting girls aged 9 to 14 years. Under usaid's targeted and tailored covid-19 mass vaccination project, Path worked with the ethiopian government to mitigate the covid-19 pandemic by providing support in coordination and planning, capacity building, service delivery, demand generation, and monitoring and evaluation of vaccination campaigns. The project played an active role in facilitating the integration of covid-19 vaccination into the routine immunization program and provided capacity building, supportive supervision, and data management support to six regions. The project team actively contributed to the development of guidelines for covid-19 vaccination integration into the existing routine immunization system with the aim to increase uptake and improve access to the covid-19 vaccine. Path also worked with the gates foundation's covid-19 vaccine hesitancy project in ethiopia to address covid-19 vaccine hesitancy through data-driven, tailored, culturally sensitive, and inclusive communication interventions in addis ababa and bahir dar city administrations. Path continued working as part of gavi's targeted country assistance (tca) project to support the fmoh and the afar and somali regions in achieving increased and equitable immunization coverage with a focus on identifying, mapping, and reaching zero-dose children, under-immunized children, and missed communities. The project team developed a plan to sustain health facilities while preparing to exit from the four supported woredas in the afar and somali regions. Path's ethiopia senior management team visited facilities in the afar and somali regions to assess the impact of the gavi tca project in the face of prolonged conflict in northern ethiopia. We also provided technical support on leadership, management, and good governance to the national and regional expanded program on immunization teams under gavi's covid-19 vaccine delivery support leadership management coordination project. Path continued implementing usaid's brueh tesfa demonstrating pathways to scale for nurturing care through engagement, leadership, and systems strengthening project, working to integrate ethiopia's early childhood development policy framework into maternal and child health programs and promoting multisectoral collaboration.ghanain 2022, Path worked in collaboration with the ghana health service (ghs) to expand the onsite chlorine generation project to three additional regions with 40 aqua research stream chlorine generators installed in 24 health care facilities. We also supported refresher training for over 200 health workers in infection prevention and control practices as part of this project.with funding from the uk foreign, commonwealth, and development office, Path supported the introduction of the ellavi uterine balloon tamponade (ubt) into the postpartum hemorrhage management and safe motherhood protocols in ghana. Path collaborated with the manufacturer sinapi biomedical in south africa to identify a local distributer and registered the ellavi ubt in ghana. We also shared a policy brief with the ghs policy, planning, monitoring, and evaluation division for country scale-up and inclusion of the device in the essential commodities for maternal health and subsequent addition in the essential medicines list and national health insurance medicines list.path developed training manuals for infection control and management and social behavior change materials to support implementation of the maternal infectious diseases control project at antenatal care services in bono east region.with funding support from the children's investment fund foundation and in collaboration with kybele inc. and africa health supplies through implementation of the mebci 2.0 project, Path equipped four regional hospitals' neonatal intensive care units with newborn equipment. We also supported trainings on the correct use and maintenance of equipment per manufacturer standards for more than 250 clinical engineers, doctors, and nurses who offer neonatal services from all four facilities.
Essential medicines: Path's essential medicines division develops and delivers lifesaving vaccines and drugs for women, children, and communities around the globe. (continued on schedule o)center for vaccine innovation and accesspath's center for vaccine innovation and access aligns expertise across every stage of vaccine research, development, and introduction to make vaccines available to more communities, particularly in lmics. Our portfolio includes more than two dozen vaccine products in development or already in use, with an emphasis on the leading infectious causes of child death and disease worldwide.in 2022, Path continued to support the global covid-19 response by providing expertise to the covid-19 vaccines global access (covax) facility, supporting vaccine supply chain networks, providing technical assistance and training to vaccine manufacturers, strengthening country delivery readiness, and training pharmacists in ghana as vaccinators. We also coordinated grants to research groups conducting trials of covid-19 vaccines at fractional doses in low-resource settings. We supported the mrna vaccine technology hub in south africa and provided coordination and technical assistance for a consortium developing an egg-based covid-19 vaccine for production in brazil, thailand, vietnam, and other lmics. Additionally, we supported studies in australia, brazil, indonesia, mongolia, and pakistan. In ongoing efforts to facilitate local vaccine production, Path supported lmic vaccine manufacturers to ready locally made vaccines for the global market, thereby increasing available interventions and potentially making vaccines more accessible for lmics. We provided technical assistance to several manufacturers preparing for who prequalification submission or inspection; supported manufacturers in clinical trial design and regulatory filings; began mapping the current vaccine manufacturing capacity in africa; and supported clinical assay development and technology transfers, among other activities. Path continued to provide technical support to polio vaccine manufacturers and advance research on new inactivated polio vaccine and oral polio vaccine candidates. In 2022, Path disseminated collaborative study results on universal reagents for sabin inactivated polio vaccines. Throughout the year, Path and our partners expanded coverage of japanese encephalitis (je) vaccination and developed and disseminated evidence to support je vaccine decision-making. Path continued studies on the cost of illness for je and its long-term consequences in bangladesh, laos, and vietnam. Path worked closely with the government of bangladesh and local partners to inform the country's je vaccination decision-making and submitted an application for je vaccine introduction to gavi, the vaccine alliance, in september 2022. Introduction of je vaccine in bangladesh is anticipated in 2025.also in 2022, we completed a pivotal phase 3 study of a polyvalent meningococcal meningitis conjugate vaccine (mmcv). This vaccine, developed by serum institute of india pvt. Ltd., builds on the success of menafrivac, a groundbreaking vaccine against serogroup a meningococcal meningitis that was developed through an earlier Path partnership. The polyvalent vaccine targets serogroups a, c, w, x, and y. As the first vaccine to target serogroup x, the vaccine has the potential to eliminate meningococcal meningitis epidemics from africa's "meningitis belt" region. We continued to contribute technical and strategic expertise to the global defeating meningitis by 2030 initiative and supported the rollout of defeating meningitis by 2030: a global road map. Path also served as a coordinator between who, gavi, and global partners to identify pathways to accelerate mmcv introduction once the vaccine is made available. Path accelerated the development and introduction of a wide variety of malaria vaccine candidates and approaches. We continued to work with who; the ministries of health in ghana, kenya, and malawi; and other partners to introduce the world's first malaria vaccine, known as rts,s, in selected areas of those countries. In july 2022, who prequalified the rts,s malaria vaccine, having recommended it for broader use in 2021 to curb p. falciparum malaria in children living in moderate-to-high malaria transmission areas. In november 2022, malawi became the first of the three countries to expand vaccination into the so-called "comparator" areas of the pilot program. We continued to advance research into whether reducing the dose level of rts,s and delaying the administration of doses has the potential to stretch limited vaccine supplies. We also continued to research use of the vaccine alongside seasonal malaria chemoprevention to avert malaria in highly seasonal settings.the defeat diarrheal disease initiative continued its role as a digital hub for information on preventing and treating childhood diarrheal disease, the second-leading cause of death among children in lmics. A major focus of 2022 was the need to continue to strengthen routine immunization coverage during covid-19 recovery, using rotavirus vaccine as an example of the challenges and opportunities.to reduce the burden of rotavirus, a major cause of severe diarrhea, Path continued clinical development of an injectable nonreplicating rotavirus vaccine candidate through a phase iii efficacy study at three clinical sites in africa. Path also continued a phase ii study with this candidate in south africa to examine immune responses to different combinations of oral and injected rotavirus vaccines. In addition, Path continued a case-control study in india to evaluate the effectiveness of serum institute of india pvt. Ltd.'s licensed rotavirus vaccine, rotasiil. Path continued to support research related to vaccine candidates that may provide protection against shigella, one of the leading bacterial causes of diarrheal illness, for which there is no licensed vaccine. We conducted preclinical research on the novel, orally administered, inactivated whole cell shigella truncated mutant vaccine candidate. We also initiated a clinical trial to test two experimental challenge strains of shigella to inform the future development of shigella vaccines. Finally, we completed a series of studies to better understand the public health value of potential shigella vaccines and help inform decisions by international agencies, funders, vaccine developers, and national policymakers.we also hosted the 2022 vaccines against shigella and enterotoxigenic escherichia coli conference in Washington, dc. This three-day international meeting brought together 270 attendees from 29 countries to share research related to the development of vaccines against neglected diarrheal pathogens.path continued to advance preclinical development of a vaccine against group b streptococcus, a leading cause of bacterial sepsis and meningitis in young infants worldwide, and against pneumococcal disease, a top cause of deadly childhood pneumonia. We supported inventprise as it works to develop multivalent conjugate vaccines for both diseases that will be affordable for lmics. We also initiated work on a project to evaluate two different measles and rubella microarray patches. Clinical study preparations were underway throughout 2022. As part of the typhoid vaccine acceleration consortium, Path worked to advance typhoid conjugate vaccine (tcv) introduction in gavi-eligible countries. We provided support to the government of nepal to introduce tcv in april 2022 and to make the transition to have tcv in routine immunization; we continued to support the government of malawi to plan for tcv introduction; and Path worked with national decision-makers to advance applications for tcv introduction. The government of bangladesh, with Path support, submitted an application in september 2022. Burkina faso had a near-final application in 2022. In additional countries, we initiated discussions to support decision-making. We continued to share new data and serve as a hub for typhoid information, raising awareness on typhoid disease and prevention through an integrated approach that includes vaccines. To prevent cervical cancer, Path continued to coordinate a consortium of nine independent research institutions to collate, analyze, and disseminate evidence on single-dose human papillomavirus (hpv) vaccination to who and other stakeholders. Based on this evidence, in 2022, who endorsed a single-dose hpv vaccination schedule to help alleviate countries' financial, logistical, or other barriers to hpv vaccine introduction. Path also sponsored a phase iii study of a licensed hpv vaccine in ghana and bangladesh to generate evidence in lmics and on extended dosing schedules. We also published an hpv vaccine product choice calculator for assessing and comparing costs of hpv vaccination programs.
Advocacy and public policypath's advocacy and public policy team works in the united states, in countries in africa (such as the drc, kenya, south africa, and uganda), and at the global level with multilateral agencies. We partner with policymakers to help them understand issues and motivate them to commit funding, craft policies, and sponsor initiatives to strengthen global health. As a 501(3)c organization, Path does not influence the outcomes of elections and does not employ any registered lobbyists. Path provides behind-the-scenes support to advocacy partners in the places where we work to help strengthen their capacity to engage with local decision-makers to improve health in their communities. We facilitate peer-to-peer learnings among these partners to exchange best practices and lessons learned about the practice of advocacy, and we help elevate local voices in global conversations around health. In 2022, Path led efforts to ensure support among our partner policymakers to maintain and strengthen pivotal work in global health research and development, maternal and child health, immunization, phc, and pandemic preparedness and response. Successes included protecting key us government funding for Path's priority health areas and helping decision-makers shape the global response and recovery effort for the covid-19 pandemic.asia, middle east, and europe regionpath's leadership in the asia, middle east, and europe (amee) region leverages our global expertise across multiple health disciplines to champion equity in access to care, introduce new technologies and approaches, and partner across sectors to provide human-centered care and support. Path coordinates our work in this region from offices in eight countries, including offices in china, india, ukraine, and vietnam, that serve as regional hubs for technical and scientific innovation and program delivery. Highlights include:in 2022, Path continued forging local partnerships to advance innovative, agile health systems in bangladesh, indonesia, laos, and nepal and exploring collaborations in new geographies in the middle east.path prepared and responded to emerging health threats in the region by providing technical support, enhancing laboratory capacity, strengthening respiratory care response, improving the covid-19 surveillance system, and leveraging our network of partners to support the pandemic response and teaching in eastern europe and south asia regions. In addition to the covid-19 emergency, we committed to eliminate mother-to-child transmission of viral hepatitis b and implement factory-based pandemic preparedness programs in southeast asia. Thanks to our continuous work in improving lives with science and technology, Path was able to strengthen the development of covid-19, polio, hpv, yellow fever, and measles, mumps, and rubella vaccines in china; develop high-impact public health programs such as rice fortification, diagnostic & surveillance, and digital health in india; and support medication-assisted treatment for tb, hiv, and hepatitis c patients in ukraine. Throughout the year, amee programs focused on increasing primary health system services, capacity, and resilience using community-based approaches that bring awareness, availability, and accessibility of health services to the most vulnerable communities. For instance, in india, we launched a climate change strategy that focuses on generating evidence, building partnerships, and advocating to support climate-resilient health systems in the country.path in the amee region introduced its work at the highest political levels during the commonwealth heads of government meeting in kigali, supported india in its g20 health track meetings, and began preparing to participate in the 28th meeting of the conference of parties at the un climate change conference in the united arab emirates to highlight the need for urgent action in climate change and health.path continued our close collaboration with who, unicef, gavi, and the global fund on large-scale efforts to control and eliminate debilitating diseases such as malaria and hiv; to improve access to lifesaving vaccines for cervical cancer, diarrheal disease, and pneumococcal disease in low-income countries; and to strengthen vaccine manufacturing capacity and the cold chain as part of our ongoing efforts to bring health and well-being to all.