Get inspired by five cutting-edge programs in global health.
(And sign up to receive this quarterly report by email.)
Health implementer: Responsible for delivering health outcomes
Investor: Invests private capital to fund project at the outset
Outcome Payer: Pays back investor when intended outcomes are achieved
In today’s changing donor environment, PSI is looking to stay ahead of the curve by offering innovative and sustainable solutions to financing development. Impact investments have the potential to deliver both social impact and a financial return. With this in mind, PSI is collaborating with Zurich Insurance Group, USAID’s Global Health Bureau, and USAID’s Development Credit Authority (DCA), to explore the potential to launch a model for the development impact bond (DIB) of the future.
To make a DIB work, implementers, outcome funders/donors and investors must understand the value of the mechanism to each of them. In a forward-thinking venture, the team has developed a framework to screen PSI’s portfolio of interventions to determine which ones are best suited for DIBs. A risk-reward model has also been created to price payments against targets in a DIB. With this as a foundation, PSI is finalizing an intervention and geography for implementation, and aims to solidify commitments from donors and investors, and structure incentives and payouts to launch a DIB.
The aim of the mechanism is to align incentives for all parties. With this tool, investors expect to meet their responsible investment goals while diversifying their asset allocation, implementers get up-front capital for implementation of a flexible approach designed to deliver outcomes, and outcome funders/donors transfer their risk by only paying when the expected health outcomes are achieved.
In addition, attracting private sector capital into the development space will create a business-enabling environment with private sector rigor and intelligence channeled into the non-profit arena. The benefits will allow implementers to maintain their focus on delivering impact that reduces poverty, enables social and gender equity and improves access to essential health services.
Collaborators: USAID’s Global Health Bureau | USAID’s Development Credit Authority (DCA) | Zurich Insurance Group
Delve Deeper: Center for Global Development’s DIB Working Group
Photo Credit: Background: Sebastiano Rossi | Inset: Gurmeet Sepal
Zimbabwe is among the countries most affected by HIV in the world. The Zimbabwean Government has identified voluntary medical male circumcision (VMMC) as one of its pillars in the HIV response.
Modeling shows that 212,000 HIV infections could be averted by 2025 if VMMC would be scaled up to reach 1.3 million men by 2017. PSI has been supporting the Ministry of Health and Child Care in Zimbabwe since 2009 to reach its ambitious goal. A total of nearly 520,000 male circumcisions have been conducted since the inception of the program through PSI’s support. Although notable advances have been made in scaling up VMMC, there is urgent need to further accelerate the pace towards the national target of 1.3 million VMMCs.
Male circumcision devices have the potential to accelerate VMMC roll-out by making the procedure easier, quicker, and more widely accessible. One promising device for VMMC is PrePex. PSI supported the MOHCC in pioneering PrePex and conducted several pilot implementation studies demonstrating its safety and acceptability. After WHO prequalification of the device, PrePex has been integrated within the national VMMC program.
Since April 2014, a total of over 12,500 PrePex male circumcisions have been conducted in Zimbabwe, contributing currently to about 20% of all VMMCs per month, but PrePex VMMC services are expanding rapidly. PSI expects that by 2017, PrePex will contribute to 40-50% of all VMMCs conducted in the country through roll-out at primary health care facility level.
Zimbabwe has one of the highest HIV prevalences in the world. 15% of adults were estimated to be living with HIV in 2014. Circumcising 1.3 million men in Zimbabwe could reduce HIV prevalence to 4.4% by 2025 against a projected HIV prevalence of 7.3% in the absence of VMMC scale up. Perceived barriers to VMMC include fear of surgery and loss of wages. The PrePex device addresses those barriers by making the procedure quicker, safer, and more cost effective. The simple device allows primary care nurses to provide the procedure at primary health care centers, making scale-up efficient and less costly.
Funders: PEPFAR through USAID | DFID | Bill and Melinda Gates Foundation
Photo Credit: Miguel Samper
In partnership with Novo Nordisk and the World Diabetes Foundation (WDF), the Pan American Social Marketing Organization (PASMO), a PSI network member, has been working to improve prevention, detection, and management of gestational diabetes mellitus (GDM) in Nicaragua. The team has taken an integrated approach to diagnosing and managing GDM and maternity-induced hypertension by encouraging expectant mothers to undergo screening for diabetes and hypertension as a way to safeguard their own health and the health of their baby.
The program pairs women with a PASMO-trained nutritionist to track and improve a patient’s dietary habits and outlines an individualized plan for participation in a pregnancy-safe exercise regimen. Motivational SMS messages help keep these patients encouraged and engaged in their new diets and healthy activities. A case manager also improves coordination between the various providers delivering care to pregnant women, offering a more holistic approach prior to delivery and continued follow-up post-partum.
Adult prevalence of diabetes in Nicaragua is 12.4%, the second highest in South and Central America. Additionally, 15% of the pregnant women screened by PASMO have GDM, which can lead to pregnancy and birth complications, as well as increase type 2 diabetes risk later in life for both the mother and child. The rise of non-communicable diseases and the global obesity epidemic means that the threat of GDM is increasing globally, which is why finding and scaling solutions like these are more important than ever.
Funders: Novo Nordisk | World Diabetes Foundation
Delve Deeper: Healthy Mothers & Babies Through Screening and Management of Gestational Diabetes Mellitus in Nicaragua – PSIImpact.com
Photo Credit: Beth Murphy
We’ve heard of women in the developing world getting vital maternity information through SMS messages, but in Rajasthan and Alwar, India, pregnant women are being enrolled by their health care providers in a text-based loyalty program that incentivizes antenatal care. PSI, philanthropic partner Martha Darling and social enterprise Triggerise have launched the TIKO Companion, a low-tech mobile service that follows women through their pregnancy, sending reminders about antenatal services personalized to each woman. When she uses the voucher she was sent through her device to attend her regular appointment, pick up her pre-natal vitamins or engage in other interventions prescribed by her provider, she’s rewarded with tangible benefits at particular retailers in her community.
The rewards, in the form of a virtual currency called a TIKO, can be redeemed in local markets for goods and services ranging from groceries to cell phone credits to hair salon appointments. Once her baby is born she can upgrade to the next Companion focused on post-natal care for her and the first years of life for her baby’s health. Along with incentivizing women to receive health services, TIKO rewards are boosting the local economy, connecting the health system, providers, and local shops to a broader integrated eco-system.
The WHO recommends pregnant women receive four antenatal visits during their pregnancy, but in Alwar, India only 49% attend at least three visits. All over the world, women want to provide for their families but often have to juggle all their duties and might miss receiving essential health services when necessary. By incentivizing healthy behavior, the Companion functionally rewards women with the things they and their families need. This application is being considered for rollout throughout the programs of PSI’s network members.
Growing a business means having access to effective tools to provide services, monitor work, and plan for the future. Much like PSI’s 32 other social franchise networks in 30 countries, PS Kenya’s Tunza franchise model has provided business and marketing support to more than 323 health providers and clinics since 2009. By becoming a member in the Tunza network, health care clinic owners receive free training for their staff, as well as services and products to sell.
Most have seen increased growth in the quality of health offered and financial income of their clinic. But to truly stand up a business, it must become self-sustaining. So, a new social franchise model has been developed to continue helping clinics deliver high quality service and grow their businesses, but also hold Tunza responsible for helping to increase revenue.
Through the new model, members pay Tunza 15% of incremental income generated with the help of the benefits provided. Participating members will receive a larger bundle of services, which can include digital measurement and evaluation systems, training, business planning, and access to loans. Additionally, with funding from UK Department of International Development (DFID), Tunza franchisees can finance an electronic clinic management system and options to lower energy costs such as solar panels and energy-efficient lamps, windows and roofs.
Social franchises are critical to improving private sector health care quality, equity, impact and cost-effectiveness for underserved populations, while also creating economic opportunities for health care professionals and their communities. As providers have found great value in the services offered by PSI’s social franchises, PSI has tested whether they are now willing to pay a small fee to receive the services, products and trainings. This new approach makes supporting these clinics financially sustainable as the availability of aid dollars continues to shrink.
4,334,884 unintended pregnancies prevented. (MDG 5*)
10,530 maternal deaths prevented. (MDG 5)
478,545 deaths due to malaria, diarrhea & pneumonia prevented. (MDG 4 & 7)
260,517 HIV infections prevented. (MDG 6)
811,165 long-acting, reversible contraceptives inserted (including implants and intrauterine devices), empowering women and couples to plan for the families they desire. (MDG 5)
353,924 voluntary adult medical male circumcisions performed, preventing HIV and other sexually transmitted infections (STIs). (MDG 6)
2,137,790 voluntary testing and counseling sessions for HIV and other STIs conducted, reducing transmission rates and increasing access to treatment through referrals. (MDG 6)
38,841,985 long-lasting insecticide-treated nets, protecting families from malaria. (MDG 4 & 6)
1,143,414,790 male and female condoms, preventing transmission of HIV and other STIs and empowering women and couples to plan for the families they desire. (MDG 5 & 6)
2,846,858 diarrhea treatment kits, saving children’s lives by reducing the severity and duration of diarrheal disease. (MDG 4)
24,218 courses of directly observed therapy, saving lives by treating tuberculosis. (MDG 6)
841,682 pre-packaged antibiotics, saving lives by treating pneumonia. (MDG 4 & 8)
17,845,632 courses of artemisinin–based combination therapy, saving lives by treating malaria. (MDG 4 & 8)
13 billion liters of water treated with water treatment products. (MDG 4, 6 & 7)
*MDG = Millennium Development Goal
View PSI’s 2013 Health Impact.
PSI estimates the impact of its health interventions using the Disability-Adjusted Life Year (DALY), a unit of measurement developed by the World Bank and the World Health Organization to estimate years of life lost due to death and disability. We track each product we deliver and service we provide. We then use mathematical models to calculate the DALYs averted by our work.
OUR IMPACT: Years of Healthy Life Added
At PSI, we believe that extreme poverty can be eradicated in our lifetime only by breaking the traditional development model. Together with our partners, we develop and test breakthrough concepts that actually have the potential to go to scale and make it easier for people in the developing world to lead healthier lives.
ONLY PSI HAS
A global network structure of more than 65 member organizations.
A 43-year track record of developing cutting-edge health solutions.
The ability to take proven health interventions to scale.
ONLY TOGETHER WITH OUR PARTNERS CAN WE
Invent effective health solutions.
Test concepts and bring investments to the right ideas.
Free 1.2 billion from poverty within our lifetime.
2014 REVENUE BY DONOR
EXPENSES BY YEAR (IN MILLIONS)
REVENUE BY YEAR
AstraZeneca United Kingdom
Bill & Melinda Gates Foundation
Civil Society Fund
Global Fund to Fight AIDS, Tuberculosis and Malaria
Government of India
Government of the Netherlands
Government of South Africa
Merck & Co., Inc.
Swedish International Development Cooperation Agency
United Kingdom Department for International Development
United Nations Children’s Fund
United Nations Office for Project Services
United Nations Population Fund
United States Agency for International Development
United States Centers for Disease Control and Prevention
United States Department of Defense
World Health Organization
* Donors listed contributed a minimum of U.S. $1 million in 2014.
The figures on this page are excerpted from statements and schedules issued by PSI’s external auditors. Copies of audited statements are available upon request from PSI in Washington, DC. Please email [email protected].
Get PSI Pulse delivered straight to your inbox every quarter so you can stay current on our innovative programs in global health.