Tiyatien Health 2011 Annual Report

Tiyatien Health

- 2011 -

1 | 2011 Annual Report

Tiyatien Health aims to rebuild health - and hope - in the most remote corners of Liberia.

2011 Annual Report | 2

An aerial view of the Liberian coastOn the cover: Marcus, on a motorbike,

off to see patients in a rural villagePhoto Credits: Emily Schiller

The road to Zwedru from Monrovia, Liberia’s capitalPhoto credit: Maribel Zorrilla


Introduction Our Challenge Director’s MessageLiberia Our Model

Year in ReviewOur Programs Bridge Access Improve Clinics Tackle Poverty Change PolicyRefugee ResponseProfile: Alphonso MouwonSelected Press and Honors

Finance and Governance Financial ReviewOur Boards and Extended Family

Contact Information

Table of Contents

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Back Cover


Tiyatien Health’s youngest frontline health worker, Joel Klah, after a home visitPhoto Credit: Emily Schiller

The ProblemTraditional hospital-based services are failing to reach the world’s most remote villages. Nowhere is this crisis worse than in post-war Liberia, where more than 60% of the nation’s rural population lacks access to essential health care.

Our ApproachTiyatien Health is creating a new health workforce to bring care to remote villages. We train community members and former patients to serve as frontline health workers, delivering comprehensive home-based medical and social services to communities previously deemed unreachable.


Out of darkness, light can still shine. When my colleagues at Tiyatien Health (TH) and I were children growing up in Liberia, we never imagined that we would come face to face with violence. But our lives were changed forever when Charles Taylor launched a revolution that would become one of the world’s most brutal civil wars. Lasting nearly 15 years, the war claimed a quarter million lives, sent our families fleeing, and left our country in shambles.

When I returned to Liberia as a medical student in 2005, I heard stories of darkness from my patients. One boy suffering from depression told me how he had been drugged and forced to wield a gun at age 12. Men had tears in their eyes when they talked of carrying their pregnant wives on hammocks up to 17 hours by foot to reach the few clinics that remained standing. The war made our people vulnerable to disease, and left us with just 51 public doctors and too few resources to respond.

Ignited in response to an AIDS epidemic, TH has since transformed into a broader, organized effort to rebuild Liberia’s rural health system. By employing people from villages as well-trained health workers, we are providing care in remote communities lacking doctors. In this past year, TH has seen unprecedented growth. Our community-based clinical services have grown in scope and quality. We have expanded HIV, mental health, primary health and social services in over a dozen communities. And, community health workers, who founded our work, remain at the core of these efforts.

Others are beginning to recognize the transformative potential of our work -- not only for the rainforest communities we currently serve -- but also for the rest of rural Liberia. Based on early success, the Liberian Ministry of Health invited TH to pilot the HIV component of our model to improve care at 19 public clinics throughout Liberia. Our community-based mental health program treating victims of war has been recognized nationally as a rural center of excellence. But we think there is more that can be done.

Imagine a village-based workforce that would do everything your family doctor would do but in places your doctor would never go. In 2012, we are taking community-based care one step further, building a new class of highly skilled frontline health workers to redefine the way villages in Liberia – and perhaps around the world – access health care.

Ours is an unlikely story. It is story that would not be possible without you -- our supporters, our partners -- and the dedication, skill and contributions you bring to this effort. We look forward to working with you to bring light out of darkness.

Dear friends,

Rajesh Panjabi, MD, MPHCo-founder Executive Director 1


LIBERIA

Monrovia

Tiyatien HealthZwedru,

Grand Gedeh County

LIBERIA

For more than 140 years, Liberia suffered from toxic ethnic tensions and discriminatory politics until the country erupted in violence in the 1980s. The 14-year civil war killed an estimated 270,000 people and displaced hudreds of thousands more.

Since the war’s end in 2003, Liberians have pressed the nation to build back better, working to maintain peace while reconstructing their social, economic, and political systems.

Yet, due to the widespread destruction and looting of clinics and hospitals during the war, the nation’s health system has struggled to rebuild.

Today, in Liberia:

• There is only one doctor for every 74,205 people.• One out of two children will not receive a full set of vaccinations.• One out of every 12 women will die due to complications of childbirth.• Half of all Liberians in rural regions lack access to essential health services.

TH & Harvard publish groundbreaking national study

and develop rural treatment program on mental health.

Survivors of Liberia’s civil war found Tiyatien Health,

launching Liberia’s first rural HIV treatment program.

With support from UNHCR, TH expands comprehensive

HIV/AIDS care and treatment in Zwedru.

MAR ‘08

MAR ‘07 AUG ‘08

TH partners with Ministry of Health and Merlin to deliver Basic Package

of Health Services at 17 public clinics in southeastern Liberia.

MAR ‘10

Partnered with the Global Fund and the Ministry of Health, TH launches a national pilot of its HIV treatment model at 19 national health centers.

APR ‘10

Co-founder Dr. Raj Panjabi selected as PopTech Social Innovation

Fellow for TH’s pioneering community-based model of care.

SEPT ‘10

MIL

ESTO

NES


OUR MODELTiyatien Health is pioneering a community-led system to deliver comprehensive home-based medical care and social services to the rural poor. We have three major goals:

Connect rural communities to essential health servicesOur frontline health workers deliver care to patients in their homes, bringing life-saving treatment and prevention for diseases like HIV, tuberculosis, and mental illnesses to the places where rural Liberians live and work.

Overcome barriers to health careTo reduce stigma, malnutrition, and the costs of seeking care, frontline health workers organize patients and women into economic cooperatives, such as farms and sewing projects, while linking them to food and other forms of social support.

Partner with government to rebuild health systemsTiyatien Health trains government physicians and nurses to support and supervise frontline health workers, while providing policy planning, research, and health care delivery support.

1)

2)

3)

Ministry of Health invites TH to participate in writing 2011-2021 National Health

Policy and Plan.

OCT ‘10

TH partners with UNHCR in response to the Ivorian refugee

crisis, providing health and referral services in the refugee camps.

FEB ‘11Dr. Raj Panjabi selected as a

Rainer Arnhold fellow for TH’s scalable solution to the rural

health care access gap.

MAR ‘11

Dr. Raj Panjabi and Peter Luckow are selected as Echoing Green

fellows for TH’s leadership in the field of social entrepreneurship.

MAY ‘11

TH’s commitment to redefine how remote villages in Liberia access health care featured at the Clinton Global Initiative.

SEPT ‘11


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#16,912 home visits conducted

66 patients under FHW care

525 counseling sessions led

22 active FHWs

BRIDGE ACCESSIn response to Liberia’s massive health worker shortage, Tiyatien Health is building a novel network of paraprofessionals to deliver health care in rural communities. Since 2007, we have trained and employed community members and former patients to serve as frontline health workers (FHWs), bridging the gap between clinics and far-off villages. Supported by clinicians based in health centers, FHWs deliver therapy to patients in their homes, monitor for side effects, and offer much-needed psychosocial support. In 2011, Tiyatien Health’s 23 FHWs conducted nearly 17,000 home visits, providing significantly more care, supervision, and accompaniment than would ever be possible through conventional, hospital-based health systems. This year, Tiyatien Health designed a program for a more extensive training curriculum to enable new FHWs to provide comprehensive health services in even more remote communities.

Photo: Accompaniers leading a coping group


FHWs leading a coping group Photo Credit: Katie Kentoffio

#1,323 HIV clinical visits

335 patients receiving ARVs

130 new mental health patients in care

646 mental health clinical visits

211 new HIV patients in care

IMPROVE CLINICSWhile TH’s primary focus is on setting a new standard for village-based health delivery, our patients often require advanced levels of care at clinics or hospitals. TH has partnered with the Liberian Ministry of Health, Merlin, and Harvard Medical School to rebuild rural clinical services by providing direct medical and surgical care to mothers, children, and adults hospitalized at Tubman Hospital, serving a catchment population of 200,000 people. TH is also strengthening access to quality care for mothers and children suffering from HIV/AIDS, tuberculosis or mental illness, training over 90 nurses, physicians assistants and midwives to deliver testing and treatment in rural clinics. TH and its partners are committed to ensuring every patient gets the care they need from the village to the ward.

Entrance to Martha Tubman Memorial Hospital in ZwedruPhoto Credit: Emily Schiller


# OVERCOME BARRIERSMore than 85% of the Liberian population is unemployed, fueling a vicious cycle of poverty and illness. Redressing sickness therefore requires guaranteeing other social and economic rights in addition to medical care, such as housing, food, gender equality, and jobs. To break the chain of poverty and disease, Tiyatien Health provides food and transportation stipends to patients, conducts agricultural and small business trainings, and facilitates the region’s only community-based support groups for people living with HIV/AIDS and depression. Zwedru Women United for Change (ZWUC), a group designed and led by patients and frontline health workers, has brought dozens of women together to form a sewing cooperative and communal support groups to discuss and advance women’s rights.

498 patients received transport grants

100 women in ZWUC

50 graduates of sewing classes

266 food stipends disbursed

75 patients in coping groups

Members of our women’s sewing cooperative at workPhoto Credit: Maribel Zorrilla


#8

CHANGE POLICYTo extend our impact beyond Zwedru, Tiyatien Health accompanies the Liberian government to develop stronger national health policies. By leveraging our relationship with Harvard University, we share our evidence-based research on a number of health policy planning committees in order to shape bolder national strategies, particularly in the realm of rural health delivery. This year, Tiyatien Health worked in partnership with the Liberian Ministry of Health and Social Welfare, the National AIDS Control Program, and the Global Fund to scale-up our model at 19 sites across the country. 95 frontline health workers were specially trained to accompany HIV patients through their illness. Our hope is that this national pilot will provide an advocacy base for use of well-trained, fairly-paid frontline health workers for complex health delivery, particularly in remote regions.

#20,000nation-wide home-based care visits

95 new FHWs trained

400 new patients enrolled

19 regional sites across 12 counties

Tiyatien Health trains frontline health workers in Monrovia as part of the national scale-up. Photo Credit: Kate Cummings


Theo Neewrayson, a Frontline Health Worker Leader teaches an Ivorian refugee how to install a mosquito net inside his home in the PTP refugee camp Photo Credit: Avi Kenny


REFUGEE RESPONSE #70,985 refugees in Grand Gedeh County

4,800 bednets distributed

400+ refugees trained in health education and promotion

6,031people served by community awareness sessions

1,000+ refugees attended health talks

Between December 2010 and May 2011, more than 180,000 refugees crossed into Grand Gedeh County, fleeing political violence in Cote d’Ivoire. Many of the Ivorians who arrived in Liberia had provided shelter and safety for our own staff when, fifteen years earlier, Liberians had sought safe haven in Cote d’Ivoire. Emboldened by this solidarity, Tiyatien Health mobilized our team to respond to the refugee crisis in the refugee camps and clinics. We deployed dozens of frontline health workers to provide community outreach in the camps, including mental health services, malaria prevention, hygiene promotion, and HIV treatment and prevention. Together with the United Nations High Commission on Refugees (UNHCR), we coordinated a fleet of three ambulances between the refugee camps, facilitating more than 1,000 emergency referrals to Martha Tubman Memorial Hospital.


UNHCR food distribution in Toe Town refugee camp Photo Credit: Katie Kentoffio

Refugee camps like this one can be found throughout Grand Gedeh CountyPhoto Credit: Dr. Raj Panjabi

PROFILE: ALPHONSO MOUWONAs a child, Alphonso Mouwon dreamt of becoming a doctor. From a young age, Alphonso contributed to the good health of his community, leading a health-oriented student group and taking it as his responsibility to take ill community members to the hospital. Today, Alphonso continues to care for his neighbors, now employed as Tiyatien Health’s Frontline Health Worker Supervisor.

Alphonso first met Tiyatien Health at Martha Tubman Memorial Hospital, where he was providing care to tuberculosis patients in the wake of the war. In 2007, Dr. Raj Panjabi encouraged Alphonso to join the Tiyatien Health team. Alphonso quickly became a leader within Tiyatien Health’s FHW program and he was soon promoted to the FHW Supervisor position, tasked with the management and quality improvement of the initiative.

When Alphonso explains the power of the FHW program, he says that FHWs are more than ordinary community health workers - they understand their patients’ problems to greater depths and accompany the patients consistently through their sickness. People trust their FHWs as family members and approach them first for assistance. Before, patients with HIV immediately thought that they were going to die. Today, FHWs show that they can continue living their lives with HIV and instill hope in their patients.

Alphonso believes that this work has empowered him to make real change in his community, “I love this frontline health work because... it makes me know people’s problems and how to solve the people’s problems... and not just die for nothing.”


Alphonso Mouwon showing the way to Tiyatien HealthPhoto Credit: Emily Schiller



“Where Tiyatien Health surpasses most NGOs is making sure that patients responding well to therapy enjoy rights beyond the right to health care - including the right to work and be a productive community member.”

- Dr. Paul FarmerCo-founder, Partners in Health

HONORS

SELECTED PRESS AND PUBLICATIONS

Clinton Global Initiative, Featured CommitmentEchoing Green, 2011-12 FellowshipPopTech, Class of 2010 Social Innovation FellowsRainer Arnholds Fellows Program, 2011 Fellowship

Harvard College Global Health Review, Global Mental Health, Post-War Liberia, and the Urgent Need for Better Primary Care Systems (Spring ’10)Huffington Post, In The Shadow’s of Liberia’s Civil War, Rajesh Panjabi and Leymah Gbowee (May ‘11)Need To Know on PBS, After Conflict in Ivory Coast, Native Liberians Return to Help Refugees Overcome Crisis (May ‘11)PRI’S The World, Ivorian Refugees Affecting Liberian Health Care (May ‘11)Scientific American’s Lives, New Answers for Global Health, Inspiring Lives: Rajesh Panjabi (Fall ‘10)XVIII International AIDS Conference, Effect of Community Health Worker Supplementation to ART Delivery on HIV Patient Survival and Retention in Resource-Poor, Post-Conflict Liberia (Summer ’10)

Dr. Raj Panjabi with President Clinton and our featured commitment at the 2011 Clinton Global Initiative Annual MeetingPhoto Credit: Clinton Global Initiative


FINANCIAL REVIEWFinancial Statement

Leveraging partnerships to maximize U.S. donations

Individual contributions from the United States, especially unrestricted donations, allow Tiyatien Health to implement bold programs and drive innovation, such as paying community health workers and transporting patients out of the country for advanced care. To maximize the potential of these individual gifts, we have built partnerships with the Minstry of Health and other institutions to cover our core operational and support costs, allowing for private, unrestricted donations to go directly to the patients in most need.

Strengthening systems for transparency and planning

Financial transparency and accountability is a top priority for Tiyatien Health. To that end, we graduated this year from an Excel-based system to professional Quickbooks accounting software, and added additional staff in Liberia and the United States to focus on financial tracking and planning.


Diversifying our funding base

At our inception in 2007, Tiyatien Health was fueled by wedding donations from our co-founders. This initial catalytic gift laid the foundation for our work, which grew exponentially this year with major grant support from The Global Fund and the Liberian Ministry of Health’s Pool Fund. These new grants enabled us to grow our work in clinics and communities through Grand Gedeh County, in addition to strengthening our Liberian management team. In the coming year, we hope to sustain these substantial grants while investing heavily in growing our United States donor base, which will strengthen our ability to innovate and expand our services to the most remote corners of Liberia.

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SUPPORT AND REVENUEIndividual Contributions $125,744Direct Liberia Grants* $350,214 Total Support and Revenue $475,958

EXPENSESProgram Services US Contribution $75,347 Direct Liberia Grants* $350,214 Total Program Services $425,561Supporting services Management and General $7,507 Fundraising $7,230 Total Expenses $440,298

June 30, 2011

Statement of Activities FY2011 Revenue

FY2011 Expenses

* Direct Liberia Grants include monies overseen by Tiyatien Health that were arranged to be sent directly to our Liberian sister organization, including major grants from the Liberian Ministry of Health’s Pool Fund and The Global Fund to Fight AIDS, Tuberculosis, and Malaria. These figures are prepared from unaudited statements.

26%

74%

IndividualContributions

Direct Liberia Grants

80%Programs - Direct

Liberia Grants

17%

Programs - US Contribution

2%Management2%Fundraising


An initial meeting of Tiyatien Health to identify the needs of the communityPhoto Credit: Dr. Pat Lee On the back cover: Benjamin Grant, Kah Kadi, and Stevie Davis walking toward Dougee refugee campPhoto Credit: Michael Jaung


OUR BOARDSBoard of Directors

Lynn Black, MD, MPHEdward Cardoza, MA.MinJoia Mukherjee, MD, MPHAmisha Raja, PsyDLeslie Vensel, MD

Advisory Board

Lisa Cooper, MD, MPHPeter Ehrenkranz, MD, MPHPaul Farmer, MD, PhDRobert Lawrence, MDNancee Oku Bright, DPhil

OUR EXTENDED FAMILYAshoka ChangemakersBrigham and Women’s HospitalDirect Relief InternationalEchoing GreenThe Global FundGlobal Health CorpsGlobal Neighborhood FundGlobeMed at University of MichiganThe Greenbaum FoundationHavard Medical SchoolKansas Wesleyan UniversityKeller Family FundThe Lester FundLiberian Ministry of Health & Social Welfare

Massachusetts General HospitalPartners In HealthPopTechRainer Arnhold Fellows ProgramSegal Family FoundationStill HarborUNHCR


A: 666 Dorchester Ave, Boston, MA 02127P: +1-617-297-7482M: [email protected]: www.tiyatienhealth.orgT: @tiyatienhealth

Tiyatien Health is a 501(c)(3) nonprofit corporation and a Connecticut public charity.

Tiyatien Health 2011 Annual Report

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