Maverick Collective’s Rena Greifinger on gender equity and changing the status quo

This piece originally ran on alliancemagazine.org.

A women’s funding initiative is about more than funding causes which others won’t. It’s about a different way of seeing women in philanthropy. Rena Greifinger, managing director of Maverick Collective, and director for Philanthropy at Population Services International talks to Charles Keidan about advancing gender equity and challenging the status quo.
Changing the way philanthropy’s done

Charles Keidan: What is the Maverick Collective and how is it connected to Population Services International (PSI)?

Rena Greifinger: It was co-founded 10 years ago by PSI with Melinda French Gates and HRH Crown Princess of Norway. The idea was to create a space for women to go ‘beyond the chequebook’ and engage deeply in the work that they were funding. The vision was to become informed champions for sexual and reproductive health and rights for women and girls, to use capital in a bold and flexible way to advance the space and also change the way philanthropy is done. PSI is a global health nonprofit working in about 40 countries. Our aim is that everybody has access to safe and equitable healthcare with a strong focus on reproductive health and rights. We’ve been working in most of these countries for decades. We are very much locally-led so about 95 per cent of our workforce is local to the countries and regions where we work. PSI was seen as a really strong organisation to incubate the Maverick community, and that’s because it has always gone where others won’t.

Does going where others won’t refer to the causes you work on or the approaches that your philanthropists take?

It’s both. The Mavericks are bound by a passion for advancing gender equity through investing in women’s health. We are taking on issues that are often being ignored or under-resourced, like cervical cancer which is an entirely preventable and treatable cancer. In the Global North, very few women are dying from it, but in Africa, for instance, it’s one of the leading causes of cancer deaths for women. Investment could eliminate the disease yet almost no one funds it.

Presumably, Melinda Gates realised that her foundation, despite its size, couldn’t do this alone and needed to work with a larger group of committed philanthropists?

Big traditional funders whether bilateral, government or a large foundation, like the Gates Foundation, are typically constrained in the way they can spend money and are less able to take on risk. Our view is that private philanthropy can invest in the most creative ideas and de-risk the investment for others by proven concept. It’s a venture-like mindset.

Could you give an example of Maverick members that have done that?

One of my favourite examples is a funder named Stasia Obremskey. She was a Wall Street banker who was passionate about family planning and reproductive access. She was one of our founding members, and she invested in a project in Mozambique to build the market for self-inject contraception, rather than women having to go to a clinic every three months. At the time a lot of funders didn’t want to fund it because the government wasn’t yet on board and there was a lot of scepticism that women could safely inject at home. With Stasia’s support, we did a three-year pilot study to test the viability of the idea. We were able to demonstrate demand, that it was safe and effective, and that women of course can be trusted to do this. We were also able to equip community health workers to support women in communities, which reduces the burden on the traditional healthcare system. We spent the next two years doing deep advocacy with the government, and today, Mozambique has changed its national policy to make the self-inject contraceptive available in pharmacies. Stasia herself went to Mozambique and was deep in the project work, that’s part of the Maverick experience. She’s since changed her career to working in venture capital for reproductive technologies.

That is a sophisticated intervention for an individual donor. Was that possible because of support and training you offer to members of your community?

Bringing donors along on a learning journey is really what makes Maverick different in the ecosystem of donor networks. Donors get a deep hands-on learning by doing, getting proximate to the communities and to the frontline leaders and PSI staff and partners. The first thing we do is develop really authentic and trusting relationships between the donors and the people delivering the work. They spend a lot of time getting to know one another, sharing their experiences, their passions, their interests, developing a mutual respect for the value they each bring to the relationship because a Maverick member, yes, she is bringing significant funding, but the expertise and experience of the people who are delivering the work is equally valued. We are actively building a generation of philanthropists to bring their A-game – authentic, accountable, and activated – which means that donors are their true selves, willing to listen and learn in the same way that our teams are. We build a mindset in our donors that they should be as accountable to their grantees as grantees are to them. That’s about being in it for the long run, being flexible and adapting when things fail, understanding that failure is an important part of changing very complex systems, which is what we’re trying to do. So, we have a whole learning framework with different touch points throughout the year and we also do very specific training when they go into a country. We talk about ethics and cultural practices, to make sure that they are coming in as a learner, partner and listener and trying to break down the inherent power dynamic between them and those on the ground.

Given the sensitive nature of the work you do, some of it must be challenging the status quo both at home and abroad. How do you respond when that happens?

This is where the power of working through PSI comes in, because PSI has been in this work for more than 50 years. We have very deep roots in community as well as partnerships with government all the way down to district level. When we bring Maverick donors to countries, sometimes we have meetings with the Ministry of Health. It’s always extremely welcome because this is an investment of flexible, catalytic capital in the country but through an organisation that is trusted and credible. Of course, there are anti-choice movements in the countries where we work but PSI only delivers safe abortion in countries where it’s legal, but we are working as hard as we can to deliver as much access as we can. We partner with organisations who are sometimes working against what a more restrictive government is doing, and that’s a way that we can support activist movements even in a place where we are also working with government.

I can also imagine conversations among Maverick members about where to put their efforts, particularly when many of them will be US philanthropists seeing challenges at home as well.

It’s a central issue for members, particularly since the Dobbs Decision in the US Supreme Court. What’s really powerful about the power of the collective is that these women have a very intimate and trusted network where they can bring conversation and investment opportunities to one another that are really advancing this space to overcome some of the hurdles being put in our way. For instance, in the last year, we had one member come to the collective who’s doing political advocacy work in North Carolina on getting women-progressive candidates into office to protect abortion rights there. She brought the Maverick Collective together with these women candidates to hear about what’s happening on the ground and then got members to invest or support them in other ways. Another woman in the collective co-produced a documentary film about Plan C, the self-medicated, self-managed abortion pill, that premiered at the Sundance Film Festival. She helped to get about five other Maverick members to back the film and to go to the Sundance festival to talk about the importance of keeping self-managed abortion legal. Another Maverick invested in a company that developed an app which talks women in Venezuela through self-managed abortions at home because in Venezuela abortion is completely illegal.

How do you see the community growing and changing over the next 10 years?

So far, we’ve mobilised a hundred million dollars through direct investments from Maverick members and what we’ve been able to catalyse or unlock from bigger, traditional foundation funders. There are a lot of really exciting things on the horizon over the next 10 years. One is we have always attracted younger, newer donors to this space. Many of our members are brand new to this scale of philanthropy and we have a specific programme for next-gen donors, Maverick Next, so we are not just talking to the same small group of progressive women donors who already fund gender equity and sexual and reproductive health and rights. We are bringing in new donors and new dollars. The second thing I’m excited about is that we are now starting to fund outside the 40 countries PSI works in. For instance, in 2021 when the Taliban took over in Afghanistan, the Mavericks got on calls with women activists on the ground to learn about what was happening and were able to help raise more than 12 million dollars, in a collaborative effort led by Vital Voices Global Partnership, in a matter of weeks to evacuate women and women leaders from Afghanistan. Again, in Venezuela, when we learned that contraception is almost completely impossible to access for women, many Maverick members did a similar thing. Within a matter of weeks about a quarter million dollars went to grassroots organisations in Venezuela helping women access contraception. We’ve now got an entire Maverick programme called Maverick Portfolio, which is a feminist-designed fund that is funding both PSI and grassroots feminist organisations in three African countries to work on systemic barriers to sexual and reproductive health and rights, with a focus on healthy masculinities and transforming the role of men and boys. Where we were very focused on women and girls, we’ve now got a more expansive view of gender equality and investing in men and boys and masculinity. We’re never going to see the long-term change we want without men and boys changing and that masculine culture hurts everybody. When you see men unable to share emotionally, you have loneliness and mental health crises and the underpinning issue is masculinity. That’s not being addressed at all and it’s a very difficult issue to get funding for.

The other area where you’re making your presence felt is by challenging norms about philanthropy
itself. What does your work mean in terms of the role of women in philanthropy?

The patriarchy is embedded in philanthropy as much as every other system so women have often been left out of leadership in philanthropy. A few years ago, the stock image of a philanthropist was an older white man – Rockefeller, Vanderbilt and then Bill Gates and Warren Buffett. It’s only in the last few years that women have been seen as philanthropists who are taken seriously and it’s only a few. Women are telling us: ‘When I’m sitting in that foundation board room, I’m not being looked to or taken as seriously as my brother or my father. I am still left out of the real decision-making.’ That’s one side of gender inequity – typical masculine culture is affecting women in philanthropy. But there’s a young woman who just joined Maverick. She comes from a multi-generational wealthy family with a foundation. The men do the investing in the business and the women have this nice thing called philanthropy. She is a young woman who wants to build a career, and joining a philanthropic network, starting to get involved in her foundation is at odds with that. That’s a really interesting nuance in how philanthropy is gendered that we need to unpack, particularly for younger generations because if she and others like her decide to resist getting involved in philanthropy because it is seen as ‘women’s work’, then we are going to miss out on this incredible opportunity that we have experienced at Maverick to start them early. We need to re-evaluate what it means to be a woman philanthropist. We’re still at the early stages, and that’s what I’m excited to see accelerate over the next decade.

A recent Alliance contributor identified some serious issues of gender representation on foundation boards, and one proposal is to have gender quotas to make sure that women are equally represented at the decision-making levels. What’s your view of that?

My sense is that gender quotas do serve a role in getting women into leadership positions, whether it’s philanthropy, politics, business. It would serve us better if philanthropy had time-limited quotas on gender and leadership. But it’s not going to solve the problem of patriarchy on its own. We still have a deeply patriarchal, masculine culture within philanthropy that needs to be disrupted. Quotas would be one small piece of solving that puzzle.

And the work of Maverick will be another small piece?

Small but mighty is what I like to say. The late Anita Roddick who was a very early mentor of mine once said: ‘If you think something small can’t have an impact, try sleeping in bed with a mosquito.’ I always come back to that line when I think about Maverick and the contribution that we are making to the impact of philanthropy on women and girls.

ACCELERATING UPTAKE OF HEALTH INSURANCE

Governments in LMICs that have opted for a pathway toward UHC involving health insurance are implementing various measures to increase health insurance coverage. However, these efforts do not automatically translate into high uptake of health insurance or, among those enrolled, into increased utilization of services, as several barriers may still prevent individuals from enrolling or from utilizing the available services provided under insurance schemes. How can governments navigate the complexities of health insurance to accelerate uptake in LMICs?

Explore our resources

04

Building Resilient, Consumer-Powered Health Systems

PSI’s Health Systems Accelerator is built on 50+ years of experience collecting and elevating consumer and health system insights, scaling innovations and partnering with government and private sector actors to shape stronger, more integrated health systems that work for consumers. Learn more here.

CAN DIGITAL LOCATOR TOOLS IMPROVE ACCESS TO HIGH-QUALITY HEALTH SERVICES AND PRODUCTS IN LOW-RESOURCE SETTINGS?

In the absence of a trusted and dedicated Primary Healthcare (PHC) provider, individuals often spend valuable time and resources navigating through a multitude of health facilities, visiting various providers in search of the right place to address their health concerns. Challenges navigating the health system can result in delays in assessment, diagnosis, and treatment, potentially leading to poor quality of care and adverse health outcomes. One promising solution is the digital locator, which can enable healthcare consumers to promptly find high quality, affordable health products and services when they need them. What are current applications of digital locator tools?  How can they be improved? What are the challenges faced in utilizing these tools?

Explore our resources

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Better data for stronger health systems

In the ever-evolving health landscape, a robust health management information system (HMIS) stands as a cornerstone of a strong health system. It not only guides decision-making and resource allocation but also shapes the well-being of individuals and communities. However, despite technological advancements that have revolutionized data collection, analytics, and visualization, health systems in low- and middle-income countries (LMICs) continue to grapple with a fundamental challenge: fragmented data and limited effective data use for decision-making. What are some promising solutions?

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.

03

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.

02

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. 

01

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. 

HOW COULD PRIVATE SECTOR PHARMACIES AND DRUG SHOPS ADVANCE PROGRESS TOWARDS UNIVERSAL HEALTH COVERAGE?

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?

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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.

Safiya Ahmed, from Oromia region of Ethiopia, is seen immersed in transformative technical training on floor solutions and SATO pan installation

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.

OUR COMMITMENTS

WHISTLEBLOWER AND ANTI-RETALIATION

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.

OUR COMMITMENTS

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.

OUR COMMITMENTS

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.

OUR COMMITMENTS

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.

OUR COMMITMENTS

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.

OUR COMMITMENTS

UNITED NATIONS GLOBAL COMPACT

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.

OUR COMMITMENTS

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.

OUR COMMITMENTS

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.

OUR COMMITMENTS

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.

OUR FOCUS

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.

OUR COMMITMENTS

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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01 #PeoplePowered

02 Breaking Taboos

03 Moving Care Closer to Consumers

04 Innovating on Investments

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