Population Services International 1999-2000 Annual Report

Improving the Health of the People We Serve PSI’s social marketing makes a

CONTENTS

Report from the President 2 critical What Do We Do? 4 What Makes PSI Different? 6 Why It’s Important to Act Now 7 PSI’s Partners 8 difference Ensuring Program Continuity 9 Selected Success Stories Family Planning in India 10 HIV/AIDS Prevention in Romania 12 in the Malaria Prevention in Tanzania 14 AIDS Prevention in West Africa 16 Nutritional Supplements in Bolivia 18 Voluntary HIV Counseling and Testing in Zimbabwe 20 health of Prevention of Diarrheal Disease in Togo 22 Program Map 24 Additional Highlights 26 Our People 28 men, PSI Offices and Affiliates 30 Board of Directors 31 Senior Management 31 Country Representatives 31 women and Financial Report 32 How Can You Help? 33 children around the world. Veena Devi India

PSI has

Alina Ghimis Romania wonderful stories to tell...

Imagine your children living in the Abdullah Shaban Tanzania rural area of a developing country… with no medical insurance, no doctor or hospital, little cash, and no reliable means of transportation apart from their own two feet. Imagine they suffer from anemia and a poor diet, but work hard every day growing crops and preparing food without piped water Ibrahima Ouedraogo or labor-saving appliances. Their Cote d’Ivoire mother would like to postpone pregnancy until she has harvested her crops and paid back small loans.

This is precisely where more than a billion of our children live their lives. For the past 30 years, Population Services International (PSI) has been there, too. We are Petrona Sorioco grateful for being able to help Bolivia empower millions of low-income women and men worldwide to make better lives for themselves and their children. This report shares a few of their inspiring stories.

Daniel Gapare Zimbabwe

Afi Amegandjin Togo 2

REPORT FROM THE PRESIDENT Better Health in the Last Decade and the Year 2000

AS PSI ENTERS THE 21ST CENTURY, WE CAN look back with pride on all we have achieved over the last decade. Our network of nonprofit organizations—now operating in almost 50 developing countries and employ- ing nearly 2,000 people—has shown that social market- ing can efficiently deliver large quantities of health products to the poor and can inspire healthier behavior.

One example of this success has been the remarkable expansion of family planning and AIDS prevention in Africa. When PSI started its first African social market- ing project in Zaire, the use of condoms was uncom- mon. Today, lower income people in most of sub- Saharan Africa can space births and avoid HIV/AIDS if they choose—because a nearby PSI office is making products or services available at affordable cost. Last year alone, PSI prevented tens of thousands of cases of HIV/AIDS and provided enough contraceptives to protect over 13 million people from the consequences of unintended pregnancy.

PSI has expanded its programs to include insecticide- treated nets that help the poor avoid malaria, iodized products that prevent the deformities and IQ loss of iodine deficiency, oral rehydration salts that help children survive bouts of diarrheal diseases, water purification products to avert those diseases, and multivitamins that PSI 1999-2000 Annual Report 3

afford mothers healthy pregnancies and healthy babies. • We will not forsake the poor. Social marketing allows In Pakistan alone, PSI and Social Marketing Pakistan us to recover a meaningful portion of operational costs, have introduced family planning services and products in but we will resist raising prices beyond those levels low- thousands of Green Star clinics and pharmacies. income people can afford.

We have introduced life-saving health products to • We will continue to stimulate both supply of and many countries, like Cambodia, where the poor had demand for health products and services. To motivate never before had the chance to obtain these products or product demand without providing an easily attainable information about how to use them. We have revitalized product leaves a willing customer who cannot satisfy his and dramatically increased the reach of social marketing demand. And effective education and communications programs started by others in places like Rwanda, can not only increase product use but also improve Zimbabwe, Tanzania, Bolivia, and Nigeria. health in a variety of ways far beyond product use.

What are our challenges for the 21st century? • Finally, we will continue to ensure that our projects are sustainable by building institutional and local human We must increase the health impact of our programs by capacities. The enhanced capacity of our affiliates allows promoting positive behavior change, so that more people our contribution to be long-lasting—an essential feature will exercise their free choices for a healthier life. We of our work, because there is no quick fix to the health must increase product sales and the range of reproductive needs of most developing countries. and other health products and services we offer. All of this achievement has been and continues to be How will we achieve all this? made possible by our generous donors, the individuals, foundations, and governments who allow us to innovate • We will continue our bottom-line approach, focusing and distribute health care, family planning products and on the quantity and cost-efficiency of health impact. services at prices lower income families can afford. We We will continue to prize entrepreneurship and speed, thank you on their behalf, and thank you for the privi- because the poor desperately need these health oppor- lege of serving them. tunities now.

• We will continue to build local capacity. PSI creates jobs and helps the economies of the communities where we operate in profound ways, both directly through our activ- Richard A. Frank ities and indirectly through the health impact we have. President

• We will maintain our focus on people, including our dedicated international staff, who labor long and hard at nonprofit wages because they are committed to this cause. 4

groups (the young, the unmarried, What Do Social Marketing the rural, the poor) who may be reluctant to seek family planning or Social marketing is one of the other health services in clinical We Do? strongest tools we have for settings for a variety of personal, empowering low-income cultural and economic reasons. PSI’s service delivery model can be Where public health care facilities people to lead healthier lives. scaled up quickly, with just a few are scarce or overtaxed, and for- Social marketing harnesses dozen trained staffers, to reach and profit clinics and products are existing commercial and non- serve hundreds of thousands of beyond the reach of people earning profit channels to get people customers nationwide in a short barely $2 per day, PSI fills a critical the information they need, to time frame. gap. We do this by harnessing the make health products and size and strength of the existing services widely available at m Photo Below The success of these distribution retail distribution networks across low cost, and to motivate networks is supported by PSI’s Fishermen on the five continents. people to use them and Ayeyarwady River in engage in other healthful strong public education and promo- Myanmar reviewing tion campaigns. We use highly Private sector street vendors, behavior. PSI’s social market- reproductive health visible, popular, creative venues— information. PSI/ market stalls, pharmacies, and food ing creates well-informed billboard advertising, radio talk Myanmar has several shops have established efficient demand as well as widely strategies to reach accessible, affordable supply. shows and ads, television soap mobile, river-based distribution networks throughout operas, comic books, magazine arti- populations. the developing world. But these cles and newspaper ads, posters, logo merchandise like T-shirts and motivated by the sales revenues baseball caps, as well as sporting they generate. Our operations are events and rock concerts—all to therefore partly self-sustaining. raise public interest in safe, afford- PSI’s price structure minimizes able products to protect health and waste and maximizes the cost- plan families. PSI orchestrates the effectiveness of our operations. simultaneous promotion and deliv- Wherever possible, PSI distributes ery of products and services that are a variety of health and family plan- packaged specifically to appeal to ning products to maximize health local consumers. We train health impact at the lowest possible cost. professionals and peer educators, Once retailers find PSI products are and have developed strong youth- in high demand, they become outreach programs in many countries. enthusiastic partners in our interna- vendors have no incentive to stock tional network. PSI affiliates are staffed by contraceptives, oral rehydration approximately 1,800 developing- salts, vitamins, or other health Our widespread network of country nationals, who recruit local products—unless these life-saving neighborhood retail outlets is acces- retailers and wholesalers to build up technologies are priced at rates sible and user-friendly to many our far-reaching Photo Right l their customers can afford, yet with distribution net- enough profit margin to help the Each new project for works. In addi- insecticide-treated vendors stay in business. nets is geared toward tion to helping behavior change support the To reach the underserved poor, from the outset. In this thousands of drama, two PSI pro- PSI products and services are subsi- retailers who moters demonstrate dized with donor funds. Our prod- humorously the bene- stock our prod- ucts are sold at prices low-income fits of using nets and ucts, we use local retreating them with consumers can afford (rather than advertising and insecticide to prevent given away free) so that people will malaria. design firms; value and use them, and so that generate pro- many thousands of small retailers gramming for can be compensated in part and local radio, tele- PSI 1999-2000 Annual Report 5

vision, and billboard companies; We shield mil- PSI involves religious rent warehouse storage facilities; lions of people groups, such as these train student counselors; and trans- worldwide from monks in Cambodia, in AIDS prevention. fer skills and know-how to all who the ravages of work with us in advancing humani- HIV/AIDS. PSI tarian health goals. put condoms on the map in A typical PSI affiliate employs Africa, where about three dozen local profession- HIV rates als and spends less than $2 million exceed 25% of per year to procure, package, pro- the adult popula- mote and distribute its health care tion in some and family planning products under countries, and challenging or even hardship condi- where AIDS has tions. Despite the modest size and left millions of orphans. In less than private sector capacity of the resources of these local organiza- a decade, PSI affiliates have intro- countries where we operate. duced condoms throughout much PSI affiliates protect maternal n Photo Far Left of the continent, making them as and child health, address popu- commonly available as kitchen lation problems and HIV/AIDS, Teaching Burmese school children about matches. We also address the and build free enterprise and the importance of health needs of mothers and chil- economic infrastructure—all iodized salt also helps simultaneously and at very low communicate this dren (and families) by marketing information to mothers. oral rehydration salts, insecticide- cost. treated malaria nets, iodized salt, vitamins, water treatment products, and both pregnancy and HIV test kits. One of PSI’s biggest challenges is reaching people. One way PSI/ Because PSI’s work is carried out Benin does this is by by committed local staff, who rely sponsoring activities on central procurement and that are locally popular, such as this moped race. economies of scale to lower costs, PSI’s demographic and health impact is achieved at a low per tions, they are typically leading con- capita cost that few other health tributors to contraceptive use and programs can match—typically improved health in their countries. less than $5 per person served per year. At the same time, PSI also These PSI entrepreneurial opera- builds the human capital and the tions advance the public health agenda for low-income people The Let’s Talk cam- around the world. The collective paign is as visible to success of our affiliates has made the public as any other PSI the largest nonprofit distrib- mainstream advertis- ing in Kenya. As a utor of family planning products result, Trust is one of in the developing world today. the most recognized PSI packages, ships, and distributes brands in the country. more than half a billion condoms annually. We are a major distributor of oral contraceptives, injectable contraceptives, IUDs, female con- doms and emergency contracep- tion. PSI distributes 80% of all contraceptives available in Nigeria. 6

bility, improve- What ments in quality of care, and clients’ increased knowl- Makes PSI edge about health.

• PSI’s decision- Different? making is decen- Photo Right l tralized. PSI empowers its staff PSI/Laos adapted • PSI is run like a business. traditional forms of Unlike many traditional public in the field to make drama to launch the health programs, we use commer- program decisions, new condom brand Number One. cial marketing techniques. A visitor granting them an to a PSI project finds staff who are we do concrete programming on uncommon level of studying sales trends or meeting the ground, to help alleviate health authority and autonomy. PSI allows with advertising agencies to review problems directly. Nearly 90% of those closest to the action and local proofs of the latest ads. These pro- our annual budget is allocated to setting to make decisions that result fessionals use their private sector programs. PSI’s focus on implemen- in effective, adaptive in-country know-how to reach people in need tation means fewer children die programs. at the lowest per capita cost. from diarrhea or malaria, because they have • PSI people have wide-ranging access to experience. Many PSI personnel As part of PSI’s program in Burkina Faso, PSI ORS and have had previous experience in brings the AIDS pre- ITNs; more international development, and vention message to a couples can many staff come from the private joint humanitarian military exercise with avoid sector. Before joining PSI, they Togo. unwanted have marketed soft drinks, tooth- pregnancies, paste, and cosmetics. They have because they sold pharmaceutical products, learn about worked for advertising agencies, family plan- produced television shows, and ning and can worked as management consultants. afford the But all our staff members have one high-quality thing in common: they bring high • PSI involves private sector contraceptives that we help make energy, creativity, and a bold entre- partners. PSI uses the dynamism readily accessible; and fewer people preneurial approach to their work.

Photo Far Right l and resources of the private sector get HIV/AIDS or other sexually to achieve social goals. By giving transmitted diseases, because they A local theater group wholesalers, retailers and distribu- can understand our television and entertains the crowd in homemade wedding tors reasonable profit margins, PSI radio ads and buy our reliable, inex- costumes of cello- enlists the support of hundreds of pensive condoms. phane and latex during one of PSI/Russia’s thousands of private merchants. In youth events on safer Pakistan, for example, PSI/SMP • PSI’s management is results- sex. products are available at over oriented. Like any private sector 30,000 commercial outlets, while company, PSI manages by results over 11,000 private sector health and holds staff accountable for providers participate in PSI/SMP’s results. Sales of each of PSI’s 136 Green Star Network of health clin- brands are tracked monthly. Sales ics and pharmacies. trends are an important indicator of potential health impact. Staff mem- • PSI’s focus is highly practical. bers are also responsible for the PSI does not invest its efforts in achievement of other important pure research or international con- objectives, such as increasing sales ferences on public health. Instead, to at-risk groups, product accessi- PSI 1999-2000 Annual Report 7

• AIDS has killed over 16 million ceases to develop and function Why It’s people. Last year, 5.6 million people properly. became infected with HIV (2.3 mil- — Iodine deficiency is the most lion were women and 570,000 were common cause of preventable men- Important children under the age of 15). In tal impairment worldwide. For lack 1999, 2.6 million people died from of the equivalent of one tablespoon AIDS, and 33.6 million were living of iodine spread over an entire life- to Act Now with HIV/AIDS. Over 70 percent span, millions of people suffer goiter of HIV infections worldwide are the and reduced intelligence. Millions of young women, family result of heterosexual transmission. — Each year 250,000 to 500,000 breadwinners, and children die children become blind due to vita- needlessly every year from easily • More than one billion people are min A deficiency, and two-thirds of preventable causes. Simple, afford- disabled by micronutrient deficien- these children are likely to die as a able health products and services cies. Without iron, vitamin A, folic result of their disability. exist that could save their lives. acid, zinc, and iodine, the body — More than half the people on earth (two-thirds of Unfortunately, such those in the develop- The PSI safe water health products and ing world) suffer from program launch attracted a large services are not always anemia, which impairs crowd in Zambia. available, affordable, the cognitive develop- or understood by the ment of children, people who need causes productivity them: declines and school absences, and increas- • Over half a million es maternal morbidity women die each year and mortality. from pregnancy- related causes (approx- PSI programs imately one woman deliver affordable every minute of every health products, day), 99% of them in services, and informa- the developing world. tion that save lives Forty percent of the world’s women and give children a chance. PSI PSI/Laos delivers do not have access to reproductive programs do so at a low per capita messages to young cost that few other health care people about safer sex health care services; 120 to 150 mil- and abstinence. lion women want to limit or space delivery models can match. The their pregnancies, but do not have humanitarian, social and demo- the means. graphic impact of PSI’s programs is significant, especially in poor com- • Malaria has killed more people in munities. the tropics every year than any other infectious disease, while also These successes have a human impairing economic and social face: the truck driver who does development through its debilitat- not contract AIDS on the road ing effects on families and commu- and bring it home to his family; nities. It is the leading cause of the high school student who infant mortality in Africa. avoids pregnancy and can contin- ue her studies beyond the 10th • Diarrheal disease is the second grade; the young mother who leading cause of mortality in chil- can fully recover from her first dren under age five. An estimated pregnancy before the next one is 80 percent of all illness in the devel- upon her; the child who survives oping world is caused by lack of repeated waterborne infections, clean water and proper sanitation. thanks to oral rehydration salts. 8

PSI effectively harnesses the vast energy and extent of the commer- PSI’s cial sector to improve the health of low-income people. We capitalize Partners on the efficiency and profit motive of businesses worldwide. Top Photol Pharmaceutical companies donate PSI could not reach the millions of At a PSI event for the contraceptives to PSI’s programs to people that it does, nor operate at Commercial Market jump-start markets. Private sector Strategies project, the the national level in almost 50 U.S. Ambassador to clinics incorporate reproductive countries, without the many capable Uganda, Martin health services because PSI has Brennan, spoke on the partners we have around the world. importance of social shown them the operational benefits marketing. of doing so. PSI’s health products Donors are partners—and are available in hundreds of thou- investors—in PSI’s programs. sands of retail outlets around the Governments, international agen- world because commercial distribu- cies, private foundations, corpora- tion networks have enough motiva- tions and individuals all help to tion to sell these products. We also fund PSI’s operations. Private dona- use private sector advertising and tions play an essential role by pro- to PSI/India for contraceptive research agencies to develop state- viding seed capital for operations social marketing; the Government of-the-art public education and and funds that keep programs alive of Botswana provides more than 2 health product promotional cam- during gaps in government or multi- million condoms per year and over Photo Far Right l lateral agency funding. As full part- 40% of PSI/Botswana’s operating Walter North, USAID ners in PSI’s multinational network, funds; the Government of Kenya Mission Director in donors provide strategic and techni- Zambia, supporting has donated more than $400,000 in PSI’s campaign for cal guidance, while also holding PSI free air time to support malaria prevention. accountable for results. PSI/Europe PSI/Kenya’s AIDS prevention cam- attracts European funding for pro- paign. Numerous other govern- grams implemented by PSI affiliates ments have also contributed in the field, while providing techni- generously to PSI’s programs. cal assistance throughout the net- work. PSI collaborates with local Host governments understand NGOs wherever we operate. We that PSI provides critical health have partnered with PROSALUD, benefits to their countries. They the leading health NGO in Bolivia, routinely provide technical, finan- to manage social marketing opera- paigns. These campaigns win cial, legal, and regulatory support tions there. In Pakistan, PSI part- awards—but more importantly, they to PSI operations. The ners with Social Marketing Pakistan win the hearts and minds of the Government of India provides Ltd. to implement one of the millions of families who are encour- more than $1 million in subsidies largest health services social mar- keting programs in aged to live healthier lives. the world. Globally, Introducing Aphaw condoms into highly we partner with PSI wishes to thank and to visible, non-traditional dozens of other congratulate each of its partners retail outlets, which NGOs who bring for helping us better the lives of serve as private sector partners, has helped energy and talent to millions. destigmatize and our program efforts. normalize condom use in Myanmar. We also join with community-based organizations that have strong contacts and credibility with at-risk populations. PSI 1999-2000 Annual Report 9

plied. Formerly conscientious contra- The Russian rock band ceptive users risk becoming pregnant “NaNa” teamed with Ensuring PSI for the ‘New or disillusioned about the reliability Generation For Safer and value of family planning. Sex‘ campaign. Program PSI’s Partnership Fund protects the decades of value invested in existing distribution networks Continuity and reduces the risk that men and women will lack the supplies they PSI’s affiliates operate in an envi- The successful establishment of have come to trust and rely on. ronment of financial uncertainty. In these programs takes years of any year, at least 10% of these affili- effort, investment of substantial PSI/India focuses on ates face interim funding shortfalls. capital, and recruitment and giving women the PSI has had limited discretionary training of scores of professionals. information and products they need to funds to rescue such projects, Yet a six-month gap in funding can make an informed despite their enormous value. completely shut down an effective contraceptive choice. distribution network that took years In 1997, the PSI Partnership to build. During the funding gap, Fund was established with a founda- trained staff take other jobs or move tion grant of $1 million. Its purpose away. Distributors hoard inventory is to enable PSI to make emergency and raise prices because they are disbursements to affiliates whose unsure whether they will be resup- Having worked long and hard to n Photo Far Left build such trust, we naturally prefer The Society for Family to keep it. PSI hopes to attract more Health (SFH) reaches donor support for the Partnership thousands of sexually active youths with Fund to sustain deserving and innovative peer educa- successful programs facing interim tion programs such as this highly decorated funding gaps. AIDS club in South Africa.

funding is interrupted or delayed. PSI/Haiti delivers In the three years of the fund’s exis- health messages at a tence, 16 country programs have local carnival. been sustained or rescued through this emergency support, for a frac- tion of their replacement value. These countries are home to 1.5 billion people—a quarter of all humanity.

PSI’s practical, cost-saving method of bridge funding and emergency support maximizes the ability of our nearly 50 affiliates to ensure the stabil- ity and high impact of their programs. Success Stories FAMILY PLANNING IN INDIA

eena Devi and her husband children born to a woman during Veena Devi and Vwere thrilled with the birth of her lifetime—is a relatively high their second child two years after 3.4. Research has found that higher the first. But when Veena became fertility rates correlate clearly with her husband pregnant again a few months later, higher rates of both maternal and enthusiasm flagged. “I was tired all infant mortality. Mothers and are elated that the time. I didn’t have enough milk. babies are both more likely to sur- The baby was sickly and not grow- vive when babies are born at least ing well. I was fired from my job two years apart. Many lives could be their three because I had to miss work often to saved if couples were able to space take the baby to the hospital.” their children, and mothers had the time to recover from pregnancy and children are Fortunately, Veena’s children to give each baby the attention it survived and so did she. For many needs. healthy. But Indian women, the prospects are not so good. For 1998, the World In many developing countries, Health Organization estimated too many and too frequent preg- their family is 125,000 Indian women died from nancies and resulting poor maternal maternal conditions and 7 of every and child health drag millions of now as large as 100 Indian babies failed to reach families further from the promise of their first birthday. India’s total fer- a better life. More than 30% of they want. tility rate—the average number of married women in some countries PSI 1999-2000 Annual Report 11 Through programs that span five continents, PSI provides many choices of low-cost, high-quality family planning products. say they would use family planning Total PSI CYPs The “couple-years of services if only they were available. protection” (CYP) 7,000,000 Almost half the pregnancies in provided by PSI pro- grams has grown from the world today are unplanned. 6,000,000 under 800,000 in 1988 to These children have less chance of 6.5 million in 1999. attending school and little chance of 5,000,000 breaking a seemingly endless cycle 4,000,000 of poverty. In India, just one-third of women can read and write in 3,000,000 rural areas, where 75% of its one billion people live. 2,000,000

1,000,000 Veena herself wanted something better. But she had heard questions 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 about the safety of family planning n Photo Far Left (KfW) and British Department for night to supplement the $35 that Veena discusses International Development she earns monthly from the factory. birth spacing with her (DFID), as well as several private “Every rupee counts,” she says, husband. foundations, PSI/India markets and “but the 5 rupees (12 cents) that I promotes a variety of low-cost spend on Pearl each month is the contraceptives, along with the best investment I could make in my information people need to protect children’s future. I’m proud that my

themselves from unwanted preg- girls are healthy and still attending PSI/India’s oral nancies and sexually transmitted school.” contraceptive Pearl. diseases, including HIV/AIDS. It uses the same outlets to market oral methods from her friends. They rehydration salts to protect children claimed that the local government from the often fatal effects of diar- service was “more concerned about rhea. Recently, PSI/India has been reducing numbers than caring for expanding its focus to India’s poor- our health.” Finally, Veena saw a est rural areas, which are more diffi- poster for PSI’s Pearl oral contra- cult to serve but are most in need. ceptive in her doctor’s office and Veena must work from home at asked what he thought. Having been visited by a PSI representative recently, he could recommend Pearl Making use of public transportation for confidently as a high-quality, inex- oral contraceptive pensive product. advertising.

Because of misconceptions about family planning in India, PSI’s pro- gram there presents information clearly and reassuringly. It collabo- rates with doctors, pharmacists, and other retailers, and stocks hundreds of thousands of outlets to improve contraceptive access and choice. With support from the German Kreditanstalt für Wiederaufbau Success Stories HIV/AIDS PREVENTION IN ROMANIA

exual relationships, sexual “Sinfections, condoms —almost everything about the subject of sex When the young model was really news to me. In this soci- ety, it has been hard to come by Alina Ghimis first got reliable information. Open talk of sexuality has been practically involved in PSI’s Romanian taboo.” Until just a decade ago, project, she said, “I hardly Romanians had been subject to strictly enforced policies encourag- ing births and prohibiting contra- understood a thing about ception. Even today, with these laws reversed, sex education is not cov- safer sex.” ered in the school curriculum, and PSI 1999-2000 Annual Report 13 PSI produces award-winning communications and dynamic “info-tainment” activities to reach young people most at risk. abortion rates remain high, reflect- set in an elevator and a photo focused condom promotion pro- ing common ignorance of birth booth, were chosen by the readers gram in the country. control. Today, as many as 20,000 of the Romanian TV guide as the Romanian people are infected with best Romanian commercials of PSI promotes better health by HIV. The country has the highest 1999. They went on to win several targeting high-risk groups, whether rate of syphilis in Europe and high prestigious international competi- youth in Romania or Haiti, truckers rates of other sexually transmitted tions in advertising and widespread in Bombay, or mothers in Pakistan. infections. For all these reasons, PSI recognition as model public service Numerous other PSI youth initiated its Romanian project, with announcements based on NGO- HIV/AIDS/STI prevention pro- the help of funding from the Dutch public-private collaboration. grams have also been established, in government’s MATRA program, UNICEF, and UNAIDS, and valu- Other creative techniques were PSI/Romania produced able contributions from the used to promote condoms as well. dynamic, MTV-style Romanian NGO ARAS, the The best-known Romanian rock advertising spots using Romanian government, and the band, “Holograf,” released a CD the catchy slogan ‘I do what I want–but I advertising agencies Bates and “141.” packaged with a Love Plus condom know what I’m doing.’ and an educational message from The slogan became a Given the lack of information the band’s leader. This was the best- popular phrase among youth, and the ads won available to the average Romanian, selling album in Romania that year. several awards. Alina says, “The first ad for the Other pop stars were recruited to Love Plus condom came as a shock. talk about their sexual experiences But it presented information very on Romanian television—about clearly, and in a way that made us what they had done right and laugh.” Dynamic ads in MTV style wrong—stressing the need for pro- talked about condoms and protec- tection. The PSI-sponsored Safer tion. They also offered a catchy slo- Sex Caravan traveled to high-risk gan: ‘I do what I want—but I know areas for youth, working with local what I’m doing.’ “These ads cap- media and NGOs to entertain and tured the attention of young people, educate young people through pop- and of older people, too. You began ular activities like beach games and to hear the slogan everywhere.” contests. One caravan reached young people from all over Albania, Russia, and dozens of other “Then I was amazed to find Romania at Black Sea vacation countries, as well as in PSI’s original myself selected for some of the new spots. U.S. model program for youth, Love Plus advertising spots. They Project ACTION. seemed daring to me at first, but I Today more than 70% of urban took on the acting assignment as a Romanian youth 15 to 24 years of About the approach used in challenge.” These humorous spots, age have seen or heard Love Plus Romania, Alina says, “It’s easier to communications. talk to your peers. They understand n Photo Left A recent national what you are going through and can The popular music survey found that give you the right piece of informa- group “Holograf,” who created a song condom use has tion or advice. After I got involved about safer sex, increased 43% with the PSI team, I read a lot of promotes Love Plus among unmarried their materials and talked with the condoms at special events in Romania. young women over volunteers. Now my friends and the past three years, neighbors actually ask me for a period during advice. It has been fun—but above which PSI/Romania all useful. My own sexual life would had the only have been very different without nationwide youth- everything I learned.” Success Stories MALARIA PREVENTION IN TANZANIA Only eight months old, Abdullah Shaban is already ill with malaria– a disease that kills one child every 30 seconds.

bdullah Shaban was born two Abdullah was extremely lucky—but mortality by as much as one-third Amonths premature, severely many other children are not. More in malaria-stricken regions. One- underweight, because his mother than 75,000 children under five die half million children could be saved Rose had malaria at the time. from malaria in Tanzania each year. every year by the use of these Millions of adults are also chroni- nets—at minimal cost. Not long after arriving in the cally debilitated by the disease. In world, Abdullah himself was bitten Africa alone, the roughly 300 million Abdullah had previously slept by a mosquito at night and began to malaria episodes suffered each year under a net in his parents’ bed, but show symptoms of malaria. Rose result in well over a million deaths. Rose had not treated the net with waited, worrying about the cost of Malaria’s economic costs are equally insecticide. Now, extremely grateful treatment and hoping he would pull staggering, with about 20% of that her baby lives—and finding out through. But after a rough and household expenditures and 40% of how much better prevention is than frightening week, she knew she had health facility expenditures in Africa cure—she has decided to treat the to get him to a hospital. Yet devoted to treating the disease. family’s net in the future. Today Abdullah’s first week of treatment there is a readily available, low-cost alone—at $15—took a quarter of his The World Health Organization PSI product, Ngao (“shield” in father’s monthly wage as a seller of has estimated that insecticide- Kiswahili), that enables her to do second-hand clothes. treated nets could reduce childhood this. Ngao is an insecticide tablet PSI 1999-2000 Annual Report 15 PSI’s promotion of mosquito nets and insecticide retreatment has helped reduce malaria-related illnesses, deaths, and economic hardship. packaged for home treatment of a A drama teaches single net. People who have used Tanzanians about the Ngao are pleased with the treat- Ngao home treatment kit. ment—it is quick, easy, inexpensive, and required only every few months. One Ngao treatment tablet costs just US$0.51, while PSI’s net retails for only US$3.20 to US$4.74, depending on size.

Sponsored by the British Department for International Development (DFID) and in col- laboration with Tanzania’s Ministry of Health and National Malaria Control Program, this PSI insecti- cide-treated net project is the largest project of its kind in Africa. A World Health Organization/Roll- Back Malaria case study found the project to be a model public-private come in more colors, shapes and partnership. PSI also runs 10 other sizes. Wherever possible, PSI aims insecticide-treated net programs— for just such a “halo effect” in the in Benin, Kenya, Rwanda, Namibia, sales of commercial products, to Zimbabwe, Zambia, Uganda, strengthen businesses and their Mozambique, and Malawi—and in markets. Bolivia as well. As of January 2000, more than 350,000 Ngao tablets had As in all PSI programs, one of the been sold in Tanzania. The project goals in Tanzania is to distribute will expand from the four successful products through the widest possi- pilot areas to a nationwide effort. ble array of private and public out- lets. In Tanzania, they include In addition to treatment tablets, government district health manage- all these PSI projects promote and ment teams, clinics, dispensaries, distribute mosquito nets them- mission hospitals, drug stores, gro- Total PSI Sales of Mosquito Nets and selves. In Tanzania, they are sold cery stores, kiosks, NGOs, and com- Insecticide Retreatments under the brand name Njozi Njema munity groups. In Rwanda and MOSQUITO NETS RETREATMENT (“Sweet Dreams”). But in the pro- Zimbabwe, as well as in Tanzania, ject’s early days, the decision was mobile video units travel around the 350,000 made to promote the treatment country, taping and replaying videos 300,000 tablet Ngao first. The point was to of local people who discuss the encourage people to treat the nets importance of regular net use. The 250,000 already in use and to increase com- goal is to increase the demand for mercial net sales. Recently, one net nets and treatment kits, while mak- 200,000 manufacturer reported that PSI’s ing these products readily available 150,000 Tanzania project increased the sales at very low cost. The target market of commercial nets overall, while segments are underserved rural pop- 100,000 bringing their prices down. New ulations, the poor, pregnant women, manufacturers have entered the and children under five—people just 50,000 market, and the nets available today like Abdullah and his mother. 1995 1996 1997 1998 1999 Success Stories AIDS PREVENTION IN WEST AFRICA

brahima Ouedraogo has been condoms. HIV infects 10% of Idriving a truck since the age of adults in some West African coun- 16. Today, at 21, he is a veteran tries, but the infection rate is often trucker. He has logged many thou- two or three times higher among On the road sands of miles up and down the truck drivers and sex workers. West West African coast—through Côte Africa has millions of mobile work- for long d’Ivoire, Ghana, and Togo—and ers of all kinds: some 3 million peo- into the Sahel through Burkina ple from Burkina Faso alone are Faso and Mali. Home is Bobo estimated to be working temporarily months at a Dioulasso, Burkina Faso. But his in Côte d’Ivoire. work—transporting goods, repair- ing his truck, and resting between Ibrahima is not married, but he time, trucker the legs of his journey—keeps him has a girlfriend at home and other far from friends and family for girlfriends along his routes. When Ibrahima has months at a time. asked whether he has heard about sexually transmitted diseases and Ibrahima is one of thousands of AIDS, he responds, “Of course! I several girl- long-haul truck drivers on the use condoms with my girlfriends, to highways of West Africa. Away avoid getting sick and unplanned friends along from home and families for long pregnancies as well.” Ibrahima uses periods, they often engage in high- Prudence, the brand PSI sells in risk behavior, with multiple sexual most of West Africa. Ibrahima his routes. partners, including commercial sex explains, “I am still young and I workers. And they don’t always use can’t support a family right now.” PSI 1999-2000 Annual Report 17 PSI prevents HIV from spreading among mobile populations through billboards, peer educators, and thousands of condom sales outlets en route.

PSI has taken on the challenge of Billboards have the reducing the risks West African highest visibility of all truckers face. Through the regional PSI’s communications materials for this West and Central Africa project target group. SFPS (Santé Familiale et Prévention du SIDA), PSI has established the PSAMAO initiative (Prévention du SIDA sur les Axes Migratoires de l’Afrique de l’Ouest), a transborder social marketing pro- gram that targets truckers, com- mercial sex workers, and other vulnerable mobile groups, such as seasonal workers and bus passen- gers. One large component of PSAMAO is educational: the innov- ative use of mass media, billboards, personal communications, and tries—Benin, Burkina Faso, Togo, HIV infection could be asympto- other channels informs these and Côte d’Ivoire. Cameroon is in matic rose from 57% to 68%. At groups about the risks of contract- the process of joining; and still the same time, truckers who report- ing HIV/AIDS and the need to other countries are expected to join ed sexual contact with someone protect themselves. Both truckers by 2003. other than a regular partner in the and commercial sex workers are previous year fell from 47% to trained to educate their peers. Bus A 1998 study found that 97% of 37%. PSAMAO activities have not hostesses are also trained as peer Ivorian truck drivers had seen a only increased the knowledge of educators and sales agents for con- PSAMAO billboard in their jour- truckers, they have also had a posi- doms. Condom distribution is an neys, 83% had seen the television tive impact on behavior. equally critical program compo- spot, and 71% had heard the radio nent, with sales points created at ads. Compared to a baseline study Truckers everywhere are at risk, so easily accessible sites, including rest in 1997, truckers reporting having PSI concentrates on them elsewhere stops, hotels, and gas stations. ever used a condom increased from too, such as in the major transport PSAMAO now spans four coun- 58% to 73%; and those aware that terminals of Mumbai and Delhi.

n Photo Left

Hostesses for the bus companies are trained to dispense HIV/AIDS messages to riders. Success Stories NUTRITIONAL SUPPLEMENTS IN BOLIVIA

t 62 years of age, Doña Petrona Concerned about her patients’ ASorioco de Hípamo is one of the most respected leaders in her 2,000-person community, a rural nutrition, nurse-midwife town in the eastern Bolivian low- lands. Petrona was born in inden- Petrona Sorioco de Hípamo tured servitude. Yet her parents encouraged her education. Aware of her community’s lack of health care, explains, “I feel responsible Petrona decided to take correspon- dence courses in nursing. For her for these women from the practicum, she traveled by horsecart every day to and from the nearest clinic a full 50 km away. In recogni- time they are born until they tion of her achievements, a hospital scholarship followed. Today give birth themselves.” Petrona is the only medically PSI 1999-2000 Annual Report 19 PSI has begun the first social marketing ever of multivitamins to women of reproductive age. trained person in Nuevo Horizonte. borns by more than 70%. Poor well as the appropriate use of As a nurse-midwife, she has also nourishment can affect both the vitamin supplements. VitalDía is delivered most of the community’s quality of a mother’s breast milk and sold through hundreds of clinics, children. “I feel responsible for her breast-feeding experience. pharmacies, and market and com- these women,” she says, “from the Nutritional deficiencies go on to munity vendors, like Petrona, who time they are born until they give contribute to Bolivia’s high child learned of the product herself birth themselves.” mortality rate—nearly one in ten through the project’s ads. Sales have children dies before age five. exceeded expectations—nearly 3 In this agrarian, cattle-ranching million tablets have been sold since area, where homes have no running For all these reasons—with the the project’s launch. A recent media water or telephones, and people use support of the Academy for survey suggests that 18% of low- horsecarts and motorcycles rather Educational Development and income urban women who have n Photo Left than cars, Petrona is often paid for heard the ads for VitalDía have pur- her services in chickens and rice. chased it. PSI and PROSALUD manage the entire production and distri- Recently, her regimen of prenatal Anemia is such a problem here, bution process, from care has come to include VitalDía Petrona says, “because women eat purchasing the raw materials, to packing vitamins—a product developed, poorly and have many children.” the tablets, to ensuring launched and distributed with the Only 12% of Bolivians consume the that the vitamins reach assistance of PSI. Like low-income recommended daily 2,200 calories the women who need them. populations everywhere, most peo- of a healthy diet, while 28% of chil- ple in Nuevo Horizonte have diets dren suffer from chronic malnutri- consisting largely of low-cost staple tion. “Most of us here cannot afford foods, with little of the animal fruits or vegetables, or meat every products, fruits, and vegetables that day, and even when we can, they are are rich in essential micronutrients. not always available.”

In Bolivia, nutritional deficiencies Beyond providing important are common, with severe health micronutrients, PSI’s Bolivian pro- effects, especially for pregnant ject has helped PROSALUD devel- women and their infants. Iron defi- op its skills in product development The colorful pack ciency affects one Bolivian woman and social marketing, including the design of VitalDía was created in response to in three. Bolivia’s maternal mortali- USAID—PSI and the local NGO research, evaluation, and decision- the research finding ty rate is the highest in South PROSALUD have introduced a making needed to carry on a sus- that women consider America—and about half these daily multiple micronutrient sup- tainable project. fruit to be an essential contribution to health deaths result from anemia-related plement, VitalDía, containing many and beauty. hemorrhaging. Other maternal of the vitamins and minerals needed This pilot project in Bolivia has micronutrient deficiencies—of A, B, by women of reproductive age. been the first social marketing and D vitamins, folic acid and Together with basic educational of multivitamins in the world. zinc—are associated with increased programs on the importance of PSI is now undertaking micronutri- maternal and child mortality, mater- nutrition, VitalDía is targeted to ent social marketing projects in nal anemia, premature births, low low-income women, to improve Pakistan and Paraguay. Interest in birth weights, birth defects, nutri- their nutritional status before, dur- such programs runs high in many tional deficiencies in infants, and ing and following pregnancy. Ads countries, and the Bolivian project higher risks of infectious diseases on radio and TV, brochures, and is likely to be replicated widely. for both mother and child. Even in personal communications—as in developed countries, providing the Mothers Club that Petrona pregnant women with supplemental started herself—are all used to pro- folate has been shown to lower the vide information about better diets risk of neural tube defects in new- for mothers and their families, as Success Stories VOLUNTARY HIV COUNSELING AND TESTING IN ZIMBABWE Counseling HIV-positive people is hard, but Daniel’s generous nature helps.

he four Fs of happiness,” “TDaniel Gapare says, “are family, friends, football and food.” On weekends, a relaxed and good- humored Daniel can be found play- ing soccer with friends or enjoying easygoing times with the wife and three children he cherishes. A casu- al observer would never guess Daniel has one of the most stressful jobs in Chinhoyi, a midsize town about an hour from Zimbabwe’s capital, Harare. In a country with one of the highest rates of HIV prevalence in the world—an alarm- ing 25% of Zimbabwe’s sexually active adult population—Daniel works for the New Start HIV Voluntary Counseling and Testing program. The New Start program is implemented by the National AIDS Coordination Programme of the Ministry of Health with techni- cal assistance from PSI and funding from USAID.

“It was hard, at first, to look peo- ple in the eye when I had to tell them they were HIV positive,” he says. “I had nightmares about breaking the news. But the training in the New Start program has given me some deeply satisfying moments. Only one partner of a young married couple I counseled PSI 1999-2000 Annual Report 21 PSI’s recent New Start program uses innovative, cost-efficient voluntary counseling and testing to reduce the spread of HIV.

n Left Photo nity support groups. These services Nine New Start are advertised through broad pro- centers across motional campaigns which employ Zimbabwe provide high-quality VCT both mass media and creative, well- services. targeted interpersonal communica- tions techniques.

“I enjoy being a counselor,” Daniel emphasizes. “I really enjoy helping people. In the beginning, people were shy about discussing their fears of HIV. But even my neighbors and sometimes strangers now come by the house regularly for advice. Things are changing for New Start leverages available the better,” he says. Daniel repre- resources and proven techniques to Effective distribution sents above all the dedication and achieve results. It is integrated with and creative advertis- good will of those working in HIV ing have made existing health care services, in pub- prevention efforts, often under the Protector Plus lic and private clinics and hospitals. condoms a household most challenging circumstances. The integration offers great effi- name in Zimbabwe. was HIV-positive. It seemed the ciencies. Just as important, it couple was headed for a bitter sepa- reduces the stigma of HIV testing. ration. But as we talked the problem New Start targets at-risk popula- out, they realized they still loved tions: young couples, adolescents, each other and could take the first sex and transport workers, and step toward a future together by other mobile groups. The program agreeing to use condoms.” provides all the services needed to That couple represents only two achieve its goals: staff like Daniel of the thousands of people that are trained not only in state-of-the- Daniel and other trained counselors art, on-site HIV testing, but also in have worked with in the New Start counseling and referrals to commu- project, launched by PSI’s AIDSMark program in the spring of 1999, with technical assistance Interpersonal commu- from FHI (Family Health nication is key to the success of social International). New Start is marketing of PSI/ Zimbabwe’s new national voluntary Zimbabwe’s female condom, care. HIV counseling and testing (VCT) network. Research has found that counseling and testing contribute to reducing the spread of HIV. People who test negative are more likely to protect themselves in the future, while those who test posi- tive are more likely to protect oth- ers and to seek early medical attention for themselves. Daniel is one of nearly 80 counselors already trained by New Start in Zimbabwe’s nine new VCT sites. Success Stories PREVENTING DIARREAHL DISEASE IN TOGO As he was being weaned from breast milk, Benoit suffered exhausting bouts of diarrhea.

hifting among the goods she has Sspread out on the street to sell, Afi Amegandjin brushes the hot sand from her clothes again and watches her son Benoit tumble around her feet. Straightening her rows of pigs’ feet, pigs’ ears, elixirs and potions, Afi explains how she almost lost the now 18-month-old Benoit a year ago. She was weaning him from breast milk then, and the transition to solid food was not going well. He began to suffer seri- ous episodes of diarrhea. Afi knew Benoit’s illness resulted from conta- minated food and water. But her son’s transition to risky street food was an unfortunate necessity, as it is for most children in Togo’s capital of Lomé. The family lives in a multifamily compound, in a one- room house with a tin roof—a life this family of six sustains on about $3 per day. Every day Afi sits out- side her house on this central city dirt road with her merchandise, scraping together the money need- ed to feed her family.

When Benoit was ill a year ago, Afi relates, he simply grew weaker PSI 1999-2000 Annual Report 23 PSI’s promotion of oral rehydration salts makes them understandable and affordable for low-income mothers. and weaker. Finally, she grew frantic rheal illness by PSI/Togo’s commu- Total PSI ORS Sales by Region and took him to a local clinic for nity-based programs and health vol- AFRICA ASIA THE AMERICAS help. The clinic gave her Orasel oral unteers. 8,000,000 rehydration salts (ORS) to restore 7,000,000 Benoit’s electrolytes. This PSI- In nine other countries—Benin, promoted product, costing just 8 Burkina Faso, Cameroon, Côte 6,000,000 cents for a course of three treat- d’Ivoire, Guinea, Haiti, India, 5,000,000 ments, may have saved Benoit’s life. Malawi and Morocco—PSI sup- Each year, thousands of Togolese ports other successful ORS programs. 4,000,000 children under the age of five die Altogether these PSI programs have 3,000,000 from the dehydration of diarrheal sold more than 26 million packets 2,000,000 disease, the second greatest cause of of oral rehydration salts, saving the childhood deaths in the country lives of millions of children. 1,000,000 after malaria. One out of every 10 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 children dies before the age of five. A mere 37% of Togo’s rural popula- PSI sales of ORS have tion has access to safe water, and increased steadily over deaths from diarrhea are depress- the past five years, especially since their ingly common. In fact, these deaths introduction in West are the second greatest killer of Africa. children worldwide (after malaria), taking the lives each year of 1.8 mil- lion children under age five.

“Two days after taking Orasel,” Afi says, “my baby could eat again. Orasel was cheap, easy to use, and gave my baby his strength back quickly.” A young girl carries her free sample of Since 1997, PSI/Togo has sold Orasel from a PSI pro- motional event. Such more than three million packets of PSI efforts are needed Orasel oral rehydration salts to more than ever: more mothers like Afi throughout the children are dying from dehydration now than country. Working closely with 10 years ago. Togo’s Ministry of Health and the National Diarrheal Disease Prevention Program, the promo- tion and distribution of Orasel has made headway in filling a critical void in public health. With the help of UNICEF and USAID donations, PSI/Togo has made oral rehydration therapy convenient and affordable for even the poorest mothers. Orasel is widely distributed through Togo’s pharmacies, grocery stores, and peer education networks, as well as clinics and hospitals. Mothers are taught how to care for their infants in the all-too-likely event of a diar- 24 Program Map

PSI Countries Albania • • U. S. A Belize • • • Benin • • • • • Bolivia • • • • • • • • Botswana • Brazil • • Burkina Faso • • Burundi • Cambodia • • Cameroon • • • Central African Republic • CUBA DOMINICAN Costa Rica • REPUBLIC • HAITI Côte d’Ivoire • • • BELIZE • Cuba • • • • • • GUATEMALA • Democratic Republic of Congo (DRC) • • NICARAGUA Dominican Republic • EL SALVADOR • El Salvador • • COSTA RICA VENEZUELA Ethiopie • • • • • • • • • • • Eritrea • Georgia • Guatemala • Guinea • • • • Guinea Bissau • Haiti • • • • • India • • • Kenya • • BRAZIL Laos • • • Lesotho • BOLIVIA Madagascar • • • • • • • • • • • Malawi • • Morocco • PARAGUAY Mozambique • • • • • Myanmar • • Namibia • • Nicaragua • Nigeria • • • • • • Pakistan • • • • • • Paraguay • • Republic of Congo • Romania • Russia • Rwanda • • South Africa • • Tanzania • • • Togo • • • • Uganda • • • • USA • • Venezuela • • • • • • • Zambia • • • • • • Zimbabwe • • • • • 25

RUSSIA •

ROMANIA •

ALBANIA GEORGIA • • •

MOROCCO • PAKISTAN • • • • • •

INDIA • • • MYANMAR LAOS • • • ERITREA • BURKINA FASO GUINEA CAMBODIA BISSAU GUINEA • • NIGERIA • • • • • • • • • • • • • CENTRAL AFRICAN ETHIOPIA CÔTE D’IVOIRE REPUBLIC • • • • • • CAMEROON • TOGO • • • • • • • DEMOCRATIC UGANDA BENIN REPUBLIC REPUBLIC • • • • • • • • • OF OF KENYA CONGO CONGO (DRC) •• • • • • •

RWANDA TANZANIA PSI PROGRAMS BURUNDI • • •

MALAWI ZAMBIA Male Condoms • • • • • • • • MADAGASCAR Oral Contraceptives ZIMBABWE • • • • • • Female Condoms NAMIBIA • • MOZAMBIQUE Injectable Contraceptives • • BOTSWANA • • • • Inter-Uterine Devices Vaginal Foaming Tablets • Sexually Transmitted Disease Treatment Kits SOUTH AFRICA LESOTHO • • Emergency Contaception Oral Rehydration Salts Insecticide Treated Nets & Retreatments Lubricants Pregnancy Test Kits Home Water Chlorination Multivitamins HIV Test Kits Voluntary Counseling & Testing Iodized Salt 26

Additional Highlights

In the preceding stories about the people we serve, we noted many of our recent achievements. But we have seen other remark- able successes as well in the last two years. We mention just some of them briefly here.

BENIN grams through political turmoil, thanks PSI/Benin produces the popular to generous donors. Record sales were newsletter for young people Amour & achieved in 1999 for condoms and oral Vie. In Africa, AIDS is spreading fastest and injectable contraceptives. Oral among those 15 to 19 years old. This PSI rehydration salts were also launched newsletter presents engaging comic last year. Contraceptive sales (in cou- ple-years of protection) and condom The Amour & Vie sales per capita were among the high- comic strip, one of est in the world for any social marketing PSI/Benin’s many inno- program. vative approaches for reaching youth. PAKISTAN Pakistan is another country in need, with high fertility rates, high female illit- eracy and insufficient national health care services. In Pakistan, PSI and its PSI/Paraguay’s Arte y Parte radio show is run by and for adolescents, bringing safer sex messages to this target group.

traception won the Paraguayan equiva- lent of an Oscar for best documentary. Its Pantera condom radio spot was strip treatments of down-to-earth judged “Best Jingle” in the country for issues and a Q&A section on reproduc- 1999 and awarded honorable mention tive health and staying healthy. With 20 for the five-country region known as the times the circulation of one national Southern Cone. Sales of the recently newspaper, this newsletter is grabbed launched Pantera are growing swiftly. up as fast as it is passed out, and even PSI’s program has persuaded the enjoys a flourishing trade in photocopies. Minister of Health to lend his support for our program activities. HAITI PSI/Haiti, operating in the poorest GUINEA country of the hemisphere, has won yet Over the last two years, PSI/OSFAM in another prize. For its contribution to Guinea has broken sales records for all family planning, it was granted the UN four of its products, increasing condom Population Fund’s first Emmanuel Ade Affordable, quality reproductive health care is sales by 50%, and doubling or nearly Award. PSI managed to sustain its pro- now available to low-income Pakistanis doubling previous sales records for oral through the Green Star Network of clinics. rehydration salts and injectable and oral contraceptives. The percentage of This non-traditional Guineans using modern contraceptive partner SMP have developed the Green sales outlet is a good methods has more than quadrupled example of how PSI Star Network of clinics. This network is over the last seven years. distributes health prod- one of the largest franchised health ucts in Haiti’s poorest care networks in the world, with over neighborhoods. 11,000 health providers in 40 cities. The Green Star Network provides contra- ceptive choices, information, and coun- seling to millions of low-income Pakistani women each year.

PARAGUAY In Paraguay, PSI/PROMESA has won distinguished prizes for its radio spots and its youth education program Arte y PSI/OSFAM dramatically expands the contra- Parte. Its youth-targeted video on con- ceptive choices for Guinean women. PSI 1999-2000 Annual Report 27

UNITED STATES UGANDA Interpersonal educa- PSI’s U.S. programs have grown from As part of the Commercial Market tion is a key part of the one field office to three, to implement a Strategies (CMS) project, PSI in Uganda Nigerian behavior diverse array of projects, including gave a colorful launch to PSI’s new change communication youth sexual risk reduction, promotion condom brand, Protector. The parade strategy. of family planning services, and marking this event stopped traffic. A increasing awareness of and access to convoy of motorcycles, with their young emergency contraception (EC). The drivers clad in dapper Protector T-shirts, Portland, Oregon, office is conducting presented fancy maneuvers for the research among women just above the appreciative audience of 100,000. poverty line as the first phase of a five- A police escort and booming music year, statewide effort to improve their provided accompaniment to the educa- access to family planning services. An tional messages and free samples. NIGERIA EC project to train medical providers PSI’s affiliate in Nigeria, the Society for and educate low-income women on EC Family Health, has a nationwide HIV/AIDS will decrease the problem of unwanted prevention program. Teams of highly pregnacies. Finally, PSI is replicating its trained field educators use interperson- groundbreaking Project ACTION model al communication to help increase in the Central California Coast region, knowledge, awareness, and risk per- where Latino teens will be a special tar- ception among a variety of at-risk get group. The model, which uses mass groups. The Nigeria program changes media campaigns and improved contra- behaviors through the systematic use of ceptive access to help young people information gained through rigorous protect themselves from disease and program research and evaluation. unintended pregnancies, has been suc- cessfully implemented in Portland, ALBANIA Seattle, and San Jose. Project ACTION PSI/Albania and its local affiliate, has produced significant increases in ASMA, launched two blimps, flying condom use by sexually active youth in them over downtown Tirana during all three locations. The colorful launch of Protector condoms World AIDS Day and Valentine’s Day. On World AIDS Day, PSI also sponsored The USAID-funded program in Uganda concerts in Moscow and Bucharest. has just piloted a pre-packaged kit for treating sexually transmitted diseases. PSI’s blimp put condom The name of the kit, Clear Seven, signals use on front pages and to the user that the infection will clear in the national news in after seven days of treatment. Clear Albania. Seven allows urethritis sufferers to seek treatment in outlets like drug shops, which they find easily accessible and U.S. programs get input directly from teenagers free of the stigma associated with STD for teen pregnancy prevention campaigns. clinics. The kit includes antibiotics, con- doms to prevent re-infection, and refer- ral cards to encourage the user’s partner to seek treatment. Results from RUSSIA the six-month pilot are encouraging: 84% PSI/Russia’s Saratov affiliate is testing of Clear a novel approach to reaching youth Seven users with messages about sexual health: were cured, organizing some of the “extreme” and 93% of ZAMBIA sports events popular with young trend- Clear Seven In Zambia, PSI developed a new home setters, such as rollerblading, skate- users com- water chlorination program that helped boarding, and snowboarding. PSI uses plied with halt the spread of a cholera epidemic. these events to draw large crowds of treatment. youth and talk to them about the risks Clear Seven users were also far more Zambian children from they face in their sexual lives and how likely to use a condom during treatment cholera-affected areas to protect themselves. In Saratov and (36% versus 18% in the control group), participated in the launch of Clorin, PSI’s elsewhere in Russia, PSI is also reach- and 22% of these people used a condom safe water product. ing out to IV drug users, explaining how for the first time. These rates are partic- they can protect themselves and others ularly important, given the high STD/HIV from HIV and STDs. IV drug users prevalence rates and low condom use account for 90% of new HIV cases in rates in Uganda. Plans are underway to the country. expand the Clear Seven project in 2000. 28

woman with HIV, who regrettably died from the disease. But the knowledge St. Our Hilaire gained in working for PSI has helped him remain HIV-negative. St. Hilaire began as a driver for PSI, and People after several well-earned promotions, now directs distribution and sales of PSI products throughout his region. PSI‘s people make our organization unique. What brings these extraordi- CAROL SQUIRE nary people to PSI? Most often, it is the Carol Squire claims that she took her realization that their business skills first “real” job with PSI, at the advanced age of 37. However, she pre- Tropical Medicine. At PSI, she has been can make a real difference in the viously managed several of her own the driving force behind the success of world. successful businesses—in professional a Tanzanian program to market these and management training, market treatment kits. With a charismatic per- PSI staff do their work in some of the research, and sustainable and integrat- sonality and old-fashioned hard work, ed development. She found it tough to she has enlisted a remarkable array of most difficult places on the planet, yet private and public stakeholders in they are known for their joie de vivre. Tanzania’s national fight against malaria. Whether setting up a 20-foot inflatable condom, traversing the bumpy back roads of a developing country, or creat- OSWALD KASSA Oswald Kassa spends much of his time ing a TV soap opera about HIV/AIDS, as “a crazy guy in public.” As a condom PSI staff bring a spirit to their work that promoter/educator, Oswald can often comes from being part of an important, be found surrounded by crowds at the public market, lecturing and demon- dynamic enterprise. strating condoms. Prior to this work, Oswald sold cigarettes in “dark, dingy We invite you to meet just a few of places” like bars—and he still works in the 2,000 people who make PSI the such places, as he points out, “but with PSI I know I’m helping people, rather leading social marketing organization than hurting them.” He is also paying in the world. Of these 2,000 people, 97% are nationals of the countries in which leave her own business, where she they work. managed the work of nearly 200 employees. “Yet I felt I could have more impact with an international organiza- tion.” As PSI’s country representative in ST. HILAIRE LAFORET India, Carol’s responsibilities include St. Hilaire Laforet has been an excep- “hiring the best and encouraging them tional contributor to PSI/Haiti for over to express their talents fully,” and build- five years. He has experienced real ing strong relationships with donors to tragedy in his life, but his PSI work create critical new programs, such as helped him avoid a great deal more. one that expands contraceptive method Three years ago, St. Hilaire married a choice. “People need real rather than the school fees for most of his siblings hypothetical choices in life. PSI is in the and taking care of his aging parents— business of making these choices avail- and this year he will be able to wed. able for everyone.” In 1999, Oswald and his colleagues established 7,000 sales outlets in Benin—a country just the size of JANE MILLER Tennessee. Research shows that con- One of the first British twins born in dom use depends in part on ready Moscow, Jane Miller was hailed by the accessibility, so Oswald sells to a multi- British press as one of the “Red Star tude of outlets—including open-air Twins.” A specialist in medical para- snack stands, barber shops, and the sitology, Jane followed up her doctoral many roving general goods traders who research by developing a novel “dip-it- are an essential part of Benin’s market yourself” insecticide treatment kit for system. antimalarial nets, under the auspices of the London School of Hygiene and PSI 1999-2000 Annual Report 29

MUYAPEKWA KALIMA ing, she recalls, she found the “operat- “Pekwa” Kalima, 22, has spent nearly ing theater” long deserted, with broken four years as peer educator for the window panes and lizards scooting Society of Family Health (SFH)/Zambia. around. It required all her effort to con- She is widely admired for her enthusi- vince the accompanying senior medical asm and compassion. “It’s great to consultant not to abandon the post. Her teach young people about positive liv- team pasted cardboard on the win- ing—both safe motherhood and pro- dows, scrubbed the room, and set up tecting themselves against sexually the equipment from the base station. The next day they performed 30 tubal ligations. From then on, there was no turning back. Rehana’s clinical experi- FLORENCE ZAKE ence and leadership have been invalu- Originally from Uganda, Florence Zake able in helping lay the foundation for fled with her family in 1972, on the eve of Pakistan’s PSI/SMP Green Star Idi Amin’s reign of terror. She became a Network of clinics and pharmacies. U.S. citizen and, after working with other U.S.-based international NGOs, came to PSI in 1997. Her earlier experience was DAW SWE ZIN HTAIK in integrated rural development, includ- When PSI/Myanmar’s Project Officer ing local NGO capacity-building, strate- for Media walks down the street, peo- gic planning, and project design and ple stare. Daw “Grace” Swe Zin Htaik is evaluation. Those eight years, five of one of Myanmar’s most famous them based in sub-Saharan Africa, actresses, featured in over 200 films. proved ideal preparation for the work Though she no longer acts, Grace still Florence has done with PSI, first as pro- transmitted diseases. Pekwa caught has the elegance and confidence of a gram manager for West and Central people’s attention during the star. Her technical know-how helped Africa, and then as Africa regional man- International Conference on HIV/AIDS her produce Myanmar’s first television ager for the USAID-sponsored in Africa (at Lusaka) last year, after she Commercial Market Strategies (CMS) appeared on a TV youth program. project. Currently, Florence is deputy “I was thrilled to receive e-mails from director for PSI’s USAID-sponsored all over Africa after that.” worldwide AIDS prevention project (AIDSMark).

DR. REHANA AHMED After graduating from Karachi’s Dow SCOTT BILLY Medical College, Dr. Rehana Ahmed Scott Billy started at PSI as PSI/ traveled to England with her husband Washington program manager for for his career. Returning to Karachi Eastern Europe, moved to Albania to some years later, she took charge of a start PSI’s program there, and now is family planning clinic. Here she added PSI/ Washington program manager for outreach work, establishing camps for Asia, covering Cambodia, India, Laos, surgical contraception in rural areas. and Myanmar. “We benefit tremendous- Her first such camp, in the Tharparkhar ly from participating in a global social Desert, could be reached only by an marketing network. There are many arduous eight-hour drive. On first arriv- more similarities than differences. I might be the only person in the world who knows how much Albania and Laos drama about AIDS, PSI’s “Happy have in common.” It is not the travel that Travelers.” Her star power helped get brings satisfaction, Scott says, but see- Happy Travelers on the air. “I’m glad to ing condom use double in Albania and contribute my network of contacts in watching it grow in Laos. the film industry. This is the first time AIDS has been really discussed on tele- vision here.” Happy Travelers is a 10- part series that integrates AIDS prevention and education messages into a gripping story about a Burmese family affected by the disease. The series will reach people in Myanmar with vital information on AIDS. 30

PSI Offices and Affiliates

Albania Democratic Republic of Congo (DRC) Morocco Rwanda Albania Social Marketing Association Building Shell PSI/Morocco PSI/Rwanda KP 2430 No. 12 Blvd. 30 Juin 33, Rue Oued Ouargha, 1st floor #3 B.P. 3040 Tirana, Albania (coin 30 juin & Wangata) Residence ZIM, Agdal Immeuble BDR Rabat, Morocco Phone: + 355-4234376 Kinshasa 1, DR Congo 1er Etage Phone & Fax: + 243-12-20544 Phone: + 212-7671989 Fax: + 355-4234378 Boulevard de la Revolution E-mail: [email protected] E-mail: [email protected] Fax: + 212-7671984 E-mail: [email protected] Kigali, Rwanda Benin Eritrea Phone: + 250-72896 PSI/Benin Eritrean Social Marketing Group Mozambique Fax: + 250-77813 PSI/Mozambique B.P. 08-0876 Zone 1 Subzone 01 E-mail: [email protected] Cotonou, Benin Nakura Street, House No. 14 Av. Patrice Lumumba, No. 204 Phone: + 229-30-77-00 Asmara, Eritrea C.P. 4059 South Africa Maputo, Mozambique Fax: + 229-30-77-03 Phone: + 29-1-12-62-40 Society for Family Health Phone: + 258-1-430-307 E-mail: [email protected] Fax: + 29-1-12-73-50 41 Frost Ave E-mail: [email protected] Fax: + 258-1-430636 Bolivia E-mail: [email protected] Building 7 PSI/Bolivia Guatemala Auckland Park 2006 Myanmar Johannesburg, South Africa Calle 11 No. 824 PASMO PSI/Myanmar Zona de obrajes 13 calle 3-40, Zona 10 36 Golden Hill Avenue Phone: + 27-21-448-7303 esq. Av. 14 de Septiembre Edificio Atlantis, 6to Nivel, Oficina 606 Bahan Township Fax: + 27-21-448-8075 Casilla de Correo No. 9502 Guatemala City, Guatemala Yangon, Myanmar E-mail: [email protected] La Paz, Bolivia Phone: + 502-366-1557 Phone & Fax: + 95-1-514473 Phone: + 591-2-783-253 Fax: + 502-366-1567 E-mail: [email protected] Tanzania Fax: + 591-2-784-561 E-mail: [email protected] PSI/Tanzania Namibia TEXCO Building, 4th Floor E-mail: [email protected] Guinea Social Marketing Association Pamba Road Botswana OSFAM Kenya House, Office 302 P. O. Box 33500 PSI/Botswana B.P. 4111, Arret Sogetrag Robert Mugabe Avenue Private Bag 00465 Cite Ministerielle – Donka P.O. Box 22870 Dar es Salaam, Tanzania Gaborone, Botswana Conakry, Guinea Windhoek, Namibia Phone: + 255-51-117372 Phone & Fax: + 267-305-265 Phone: + 224-41-32-15 Phone: + 264-61-244-936 Fax: + 255-51-135389 E-mail: [email protected] Fax: + 224-41-24-55 Fax: + 264-61-244-937 E-mail: [email protected] E-mail: [email protected] E-mail: [email protected] Burkina Faso Togo PROMACO Guinea Bissau Nicaragua PSI/Togo c/o Dimecosa 03 B.P. 7109, Ouagadougou 03 PSI Immeuble Auba, 1ieme Etage BD Burkina Faso Rua Severino Gomes de Pina Del Semaforo de la Optica Matamoros 2-1/2 cuadras abajo BP 13804 Phone: + 226-36-40-04 Nos. 74e 74A Lóme, Togo Fax: + 226-36-50-54 Bissea - Guinea Bissau Cx. Postal #275 Managua, Nicaragua Phone: +505-277-0855 West Africa E-mail: [email protected] Phone: + 245-211940 E-mail: [email protected] Fax: + 245-202321 Phone: + 228-22-2755 Burkina Faso E-mail: [email protected] Nigeria Fax: + 228-22-4624 PSI/Burkina Faso The Society for Family Health E-mail: [email protected] Cite SOCOGIB Dassagho Haiti Awaye House (Suite 6), 2nd Floor Villa No 15 Rue 28/49 PSI/Haiti Lagos/Badagry Road, Orile Iganmu Uganda 01 B.P. 636, Ouagadougou 01 B.P. 1169 Lagos, Nigeria CMS Uganda Project Burkina Faso Port-au-Prince, Haiti Phone: + 234-1-585-0546/5850539 Plot 46 Windsor Crescent, Kololo Phone: + 226-36-45-47 Phone: + 509-245-6285 Fax: + 234-1-774-2745 PO Box 3495 Fax: + 226-36-45-51 Fax: + 509-245-9979 E-mail: [email protected] Nakasero, Kampala E-mail: [email protected] E-mail: [email protected] Pakistan Uganda Burundi India Social Marketing Pakistan (SMP) Phone: + 256-41-230080 PSI/Burundi PSI/India D-29, Block 2 Fax: + 256-41-258678 Prudence Center C-445. Chittaranjan Park KDA Scheme #5 E-mail: [email protected] Ex-Cultural American New Delhi 110 019, India Clifton CH. Rwagasore, B.P. 1474 Phone: + 91-11-648-7589 Karachi, Pakistan 7500 USA Bujumbura, Burundi Fax: + 91-11-646-7419 Office: + 92-21-583-8841 PSI/USA Phone: + 257-2-29466 E-mail: [email protected] Fax: + 92-21-586-7891 1120 Nineteenth Street, NW, Suite 600 Fax: + 257-2-29467 E-mail: [email protected] Washington, DC 20036 USA E-mail: [email protected] Kenya Phone: 202-785-0072 PSI/Kenya Paraguay Fax: 202-785-0120 Cambodia P.O. Box 22591 PSI/Paraguay PROMESA PSI/Cambodia Nairobi, Kenya Capitán La Fuente 789 esq. Brasilia E-mail: [email protected] No. 47, Street 302 Phone: + 254-2-446318 Asuncion, Paraguay Phone: (595-21) 22-17-14/22-17-15 Venezuela Sangkat Boeung Keng Kang 1 Fax: + 254-2-440899 Prosalud Khan Chamcar Mon Fax: (595-21) 21-01-66 E-mail: [email protected] E-mail: [email protected] Torre Findo Común Phnom Penh, The Kingdom of Cambodia Phone: + 855-23-3-60122 PDR Laos Regional West Africa Project Av. Andres Bello Fax: + 855-23-3-62518 PSI/Laos SFPS Esq. Callejón Don Fidel de E-mail: [email protected] PO Box 8723 22 B.P. 1356 al Urb. Sarria Vientiane, Laos PDR Abidjan 22, Cote d’Ivoire Piso 13, ofc. 13-B Cameroon Phone: 856-21-312-519 Phone: + 225-22-47-10-18/47-10-22 La Candelaira PSI/PMSC Fax: + 856-21-315-334 Fax: + 225-22-47-17-28 Caracas, Venezuela B.P. 14025 E-mail: [email protected] E-mail: [email protected] Phone: +582-574-0549 Yaounde, Cameroon Phone & Fax: + 237-209-224 Madagascar Republic of Congo Fax: +582-576-5010 E-mail: [email protected] CMS Madagascar Project Association de Santé Familale E-mail: [email protected] Immeuble - FIARO (Information same as DRC above) Zambia Central African Republic Rue Jules RANAIVO Romania PSI/RCA ESCALIER-D, 2eme Etage PSI/Romania PSI/Zambia B.P. 127 BP 7748 Calea dorobantilor, 184 bis 39 Central Street Bangui, Central African Republic Antanananrivo 101 Sector 1, Bucharest 71282 Jesmodine, Lusaka Rue Africare Madagascar Romania Phone: + 260-1-292443 Phone: + 236-616795 Phone: + 261-20-22-629-84 Phone: + 401-230-7225 Fax: + 260-1-292463 Fax: + 236-619188 Fax: + 261-20-22-361-89 Fax: + 401–230-7233 E-mail: [email protected] E-mail: [email protected] E-mail: [email protected] E-mail: [email protected] Zimbabwe Côte d’Ivoire Malawi Russia PSI/Zimbabwe PSI/ECODEV PSI/Malawi PSI/Russia (Cocody 2 Plateau, lot 561 AE Tranche) P.O. Box 529 1st Yamskogo Polya Street, Blvd. 28 #4 Rocklands Road 15 B.P. 95 Abidjan 15 16 Leslie Road First Entrance , 4th floor Hatfield, Harare Côte d’Ivoire Blantyre, Malawi Moscow, 125124, Russia Zimbabwe Phone: + 225-22-41-60-57 Phone: + 265-674-139 Phone: + 7-095-257-4196 Phone: + 263-4-572347 Fax: + 225-22-41-9414 Fax: + 265-674-138 Fax: + 7-095-257-3377 Fax: + 263-4-572-856 E-mail: [email protected] E-mail: [email protected] E-mail: [email protected] E-mail: [email protected] PSI 1999-2000 Annual Report 31

Board of Directors Senior Management Country Representatives

Timothy R. L. Black C.B.E., M.D., Richard A. Frank Albania M.R.C.P., M.P.H. President Kastitys Kaleda Benin Chief Executive Steve Lutterbeck Marie Stopes International Alex K. Brown Bolivia London, England Executive Vice President, CFO Chris Brady Botswana Ivor Williams (Project Manager) Rita I. Bass Peter Clancy Burkina Faso PROMACO CEO Senior Vice President, Moussa Abbo MEDIBANC, Inc. Director of AIDSMark Burkina Faso Denver, Colorado Josiane Yaguibou (Consultant) Burundi Michele R. Cato Immaculee Nsengiyumva (Consultant) Robert L. Ciszewski Vice President Cambodia Social Marketing Consultant Regional Director John Deidrick Sanger, California Cameroon West and Central Africa Dana Ward Central African Republic Sarah G. Epstein Dana S. Hovig Tim Betoni Population Consultant Vice President Central America Washington, D.C. Daun Fest (Regional Representative) Regional Director Côte d’Ivoire Asia, Americas, Eastern Europe Jeff Barnes (Senior Country Representative) Richard A. Frank Cuba/Dominican Republic Pamela Faura President William Warshauer Population Services International Democratic Republic of Congo (DRC) Regional Director John Loftin Washington, D.C. East and Southern Africa Eastern Europe Michael Holscher (Regional Representative) Eritrea Gail McGreevy Harmon Michelle P. Armoni Attorney Rob Maroni Director, Human Resources and Harmon Curran, Spielberg & Eisenberg, LLP Guinea Administration William Stringfellow Washington, D.C. Guinea Bissau TBD Karla Bonner Haiti William C. Harrop Imran Zafar Retired U.S. Foreign Service Director Procurement and Logistics India Washington, D.C. Carol Squire Kenya Phillip D. Harvey Carlos Cuellar John Berman (Senior Country Representative) CMS Deputy Project Director Laos President Barry Whittle DKT International Madagascar Washington, D.C. Clayton Davis David McAfee Technical Services Director Malawi David Walker (Senior Country Representative) Sallie Craig Huber, M.S.P.H. Morocco Project Director Dan R. Marvin Mohammed Ktiri Management Sciences for Health Inc. Controller Mozambique Boston, Massachusetts Jill Shumann Myanmar Patricia L. McGrath Steve Honeyman Gilbert Omenn, M.D. Director of Development Namibia Executive Vice President for Medical Affairs Irene Guevara (Consultant) University of Michigan Nicaragua Pilar Sebastian Ann Arbor, Michigan Dominique Meekers Research Director Nigeria Tim McLellan Malcolm Potts, M.D. Pakistan Bixby Professor, School of Public Health Kate M. Roberts John Hetherington Director of Public Affairs Paraguay University of CA, Berkeley David Olson San Mateo, California USA Marlaine Tocatlian Janet Livingston (Director U.S. Programs) Contracts Director West & Central Africa Mechai Viravaidya Jacqueline Devine, Chairman (Family Health AIDS project—PSI Chief of Party) Population and Community Development Republic of Congo Association of Bangkok John Loftin Bangkok, Thailand Romania John Beleutz Russia Cynthia Robinson Rwanda Brian Smith Stephen W Bosworth resigned September South Africa 1997 to assume Rob Eiger (Senior Country Representative) U.S. ambassadorship to Korea. Tanzania Brad Lucas (Senior Country Representative) Frank Loy resigned November 1998 Togo Auguste Kpognon to become Under Secretary of State for Uganda Global Affairs. Elizabeth Gardiner (Social Marketing Director) Venezuela Alan Lambert (Consultant) Zambia Nils Gade Zimbabwe Andrew Boner (Senior Country Representative) 32

Financial Report

Population Services International Statement of Activities For the years ended December 31, 1999 and 1998

1999 Total 1998 Total Public support, other revenue, and gains: Grants and fees from U.S. government 40,941,576 31,670,391 Grants and fees from other governments 28,768,419 23,034,795 Grants and fees from international organizations 2,675,563 2,540,567 Other grants and contributions 10,249,223 2,864,103

Total public support 82,634,779 60,109,856

Investment and other income 266,717 297,468

Total revenue and gains 82,901,496 60,407,324

Expenses: Program services 67,796,648 53,254,942 Management and general 7,935,252 6,875,385

Total expenses 75,731,900 60,130,327

Changes in net assets 7,169,597 276,997

Net assets, beginning of year 9,017,148 8,740,151

Net assets, end of year 16,186,745* 9,017,148

* Note: More than half of PSI’s 1999 net assets are restricted for program activities in future years under the terms of existing contracts and grant agreements. Of the remainder, approximately $5 million is used as working capital, and the balance to launch new initiatives or sustain ongoing programs facing funding gaps.

The figures above have been excerpted from statements and schedules issued by PSI’s outside auditors. Copies of our audited statements are available upon request, from PSI in Washington, DC. How Can You Help?

PSI is a tax-exempt, nonprofit organization with the bottom-line orientation of a business. For about $5 per person served per year, PSI affiliates give millions of low-income families around the world the means to space births, avoid unintended or unhealthy pregnancies and invest more in the health and education of their children. We help young people avoid the tragedy of AIDS. We provide the information, products and services that people need to safeguard their health, the first step to pulling themselves out of poverty and joining the global economy.

The health care needs of poor communities worldwide are urgent. PSI has the entrepreneur- ial ability to set up projects quickly, often using private bridge funding and its own limited reserves to jump-start initiatives that later attract support from governments, UN agencies and other sources. When this institutional support lags or falters, PSI remains committed to meeting the ongoing health care needs of communities at risk: our PSI Partnership Fund provides interim funding, sometimes for years, until new grants or contracts can again ensure high levels of health impact in these valuable programs. The generous support of individual, foundation, and corporate donors enables PSI to meet this objective.

PSI welcomes and encourages tax deductible gifts of cash, securities and other assets, as well as planned gifts and bequests. Please contact our Development Director for assistance and details.

Credits: All images in this report are taken from PSI country programs. Cover photo by Piers Benatar, PSI/Pakistan Population Services International 1120 19th Street, NW Suite 600 Washington, DC 20036 Phone: 202.785.0072 Fax: 202.785-0120 E-mail: [email protected] http://www.psi.org

PSI Europe Douglas House, 1st floor 16-18 Douglas Street London SW1P 4PB United Kingdom Phone: 44-171-834-4433 E-mail: [email protected]