Annual Report 2021
Recognizing our staff in 2021
At CHAI, our mission is to ensure everyone, no matter where they live or the circumstances of their birth, have access to quality, affordable healthcare. Our successes in delivering on that mission are driven by the talent, creativity, and efforts of the people who work for us.
We like to say that our staff is our greatest asset.
CHAI has always been deeply grounded in the countries where we work: 85 percent of employees are based in program countries and 68 percent are nationals in the countries they are based. This model of operation is central to our strategy: Our staff work closely with ministries of health to develop and implement lifesaving programs and provide on-the-ground support all the way from the national level to the last mile.
In 2021, as we entered our second year of the COVID-19 pandemic, our staff drove our work forward even as they dealt with challenges, illness, and loss in their personal lives. We are grateful for the tireless efforts of our colleagues.
Spotlight on 2021
New price of HIV/syphilis dual rapid test for public sector buyers in LMICs, through MedAccess, SD Biosensor, and CHAI partnership
Cancers that can be treated with access to new medications from expanded Cancer Access Partnership (CAP)
Price per patient for DRV/r, optimal generic second-line HIV treatment, through Unitaid and CHAI partnership with Hetero Labs LTD
At the end of 2020, over 84 million cases of COVID-19 and 1.9 million deaths were reported to the World Health Organization (WHO). Just over a year later, the numbers had jumped to 458 million cases and six million deaths. Almost every health system and health worker were strained to their limits.
The spread of new variants combined with inequitable access and use of tools to combat COVID-19, including vaccines and oxygen therapy, contributed significantly to the growth in both cases and deaths. CHAI has supported our partner countries to prevent, test, and treat COVID-19 since the beginning of the pandemic. In 2021, we continued that work.
Spotlight on Rwanda
Rwanda was among the first countries in sub-Saharan Africa to introduce COVID-19 vaccines. CHAI worked with the government and other stakeholders to build a national immunization plan to guide COVID vaccine rollout. We helped identify high-risk populations to receive the vaccine first, develop detailed implementation plans, and upgrade the skills of trainers at the national level who then trained other health workers at lower levels of care. As more vaccines were approved globally, CHAI supported the rapid scale-up of new products.
- Today, all health centers in Rwanda are equipped to vaccinate people against COVID-19.
- Rwanda was among the first countries globally to meet WHO COVID-19 vaccination targets, with 41 percent of the eligible population receiving two doses by the end of 2021.
- As of August 2022, over 95 percent of the population have received two doses and around 54 percent have received a booster dose.
Staff is our greatest asset
“A flexible workplace is supportive of my new life chapter as a first-time mother while leaving me with a sense of professional accomplishment.”
Program Manager, Oxygen, Cambodia
Nearly half the world’s population is at risk of malaria. While tremendous improvements have been made—malaria deaths have declined by 30 percent since 2010 due to target interventions like bed nets and indoor spraying of insecticides—the disease still kills over 400,000 people each year, with children under five representing most of those deaths.
CHAI is supporting over 20 governments across Africa, Latin America, the Caribbean, and Southeast Asia to strengthen surveillance systems and increase the quality and coverage of case management and vector control.
Spotlight on elimination
For the first time, in July 2021, the CHAI-supported region of Escuintla, Guatemala had zero cases of malaria. This area formerly experienced the highest number of cases in Central America. The milestone was built on work in previous years, including increasing public-private partnerships between the government and sugarcane production companies and developing stronger surveillance systems.
Similarly, Cambodia and Vietnam are both on pace for dramatic 70 percent drops in the number of cases, keeping them on track to eliminate drug-resistant plasmodium falciparum in the near term.
Staff is our greatest asset
“What I have enjoyed most at CHAI is the conscious decision and commitment to avoid parallel systems, while striving to help strengthen systems already in place.”
Dr. Rahel Belet Balkew
Country Director, Ethiopia
Maternal and Newborn Health
Nearly half of all children under five who die do so within their first 28 days of life. In many rural areas across countries CHAI serves, babies are not named until they are six weeks old. Until then, they are temporary visitors.
Simple and effective interventions can prevent unintended pregnancies, treat pregnancy and labor complications, and save the lives of newborns. The challenge in many of CHAI’s partner countries is to implement them in a reliable and timely way. Working with ministries of health around the world, CHAI has developed an integrated approach to address these challenges to serve women throughout their reproductive years, enabling them to safely avoid or plan pregnancies, have a healthy pregnancy and delivery, and ensure their newborns can thrive.
Spotlight on integrating services
Each year, more than 210,000 stillbirths or newborn deaths are caused by congenital syphilis, which can be prevented if the mother is tested and treated in time. But in many countries, while almost all women are tested for HIV during antenatal care, less than half are tested for syphilis. The WHO recommended rapid dual testing of HIV and syphilis for pregnant women during antenatal care in 2019, but few countries have adopted the test.
In November 2021, MedAccess, SD Biosensor, and CHAI partnered to bring to market an affordable, WHO-prequalified dual HIV/syphilis rapid diagnostic test. The test costs less than US$1 and is available to public sector purchasers in low- and middle-income countries. We are now supporting countries to accelerate syphilis screening among pregnant women to match levels of HIV testing.
- Through integrated HIV/syphilis testing, India increased syphilis screening among pregnant women nationwide from 30 percent to 67 percent.
- Nigeria and Ethiopia both committed to rolling out integrated HIV/syphilis testing nationally after successful pilot programs.
Staff is our greatest asset
“CHAI’s dedication to improving people’s lives and our entrepreneurial approach make our efforts feel purposeful, compelling, and enjoyable!”
Universal Health Coverage Analyst, Eswatini
A skilled health workforce is the backbone of every health system, yet the WHO estimates a shortage of 18 million health workers by 2030, mostly in low- and middle-income countries. COVID-19 has only made the situation worse, stretching doctors, nurses, midwives, and other health workers beyond their breaking point and causing many to leave their profession entirely. Beyond the pandemic, there is chronic underinvestment in education and training of health workers in some countries as well as budgetary constraints that lead to labor shortages.
CHAI is working with governments to identify their health workforce needs and develop sustainable systems to plan, train, and manage health workers to provide quality health services, and to do so in a way that builds domestic institutional capacity.
A case for investing in community health workers
Qualified, paid, and supported community health workers have enormous potential to improve health access and coverage by bringing services closer to home, and creating effective referral networks from communities to health facilities. For their potential to improve health and stimulate economies, community health workers have been found to have a return-on-investment of up to 10:1.
However, the community health worker landscape in many countries where CHAI works is fragmented and donor-driven. Many of these workers are unpaid or underpaid. CHAI drew on work we have done with governments in Zambia and Zimbabwe to strengthen national programs in order to develop a new organizational strategy to guide our support of governments’ national community health worker programs.
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Thank you to our many partners and donors for their tireless commitment to saving lives and ensuring that all people, no matter where they live, have access to quality, affordable health services.