Annual Report 2022

Annual Report 2022

Driving transformation across the entire health ecosystem

CHAI was founded at the height of the AIDS crisis on the belief that no one, no matter where they lived, should die because they could not access HIV treatment.

We have since broadened our efforts to support many other government health priorities across Latin America, Southeast Asia, India, and Africa. Today we work on 20 programs across more than 35 countries.

But our approach, first developed in response to HIV/AIDS, remains at the heart of our work:

We drive change across the entire health ecosystem—from global price negotiations, to national health system planning, to last-mile delivery—to save millions of lives.

For the last 20 years, CHAI has reimagined what is possible to stop the biggest drivers of mortality and morbidity. Our 2022 Annual Report is an opportunity to pause and reflect on that impact—even as we continue to apply our approach to new and pressing health challenges.

20 Years of Impact

2002- 2003

CHAI’s first program: HIV/AIDS

First programs begin in Africa and the Caribbean, aimed at scaling up HIV/AIDS care and treatment in entire countries. 800,000 people are treated in these countries in five years as a result of this work, up from a total of 2,000 when the work began.

First programs begin in Africa and the Caribbean, aimed at scaling up HIV/AIDS care and treatment in entire countries. 800,000 people are treated in these countries in five years as a result of this work, up from a total of 2,000 when the work began.

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2003

HIV first-line agreement

CHAI negotiates lower prices for first-line HIV drugs by over 60 percent, enabling over 60 countries to access the new prices.

CHAI negotiates lower prices for first-line HIV drugs by over 60 percent, enabling over 60 countries to access the new prices.

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2003

ART program in South Africa

CHAI begins work with South Africa to scale up treatment, laying the foundation for the largest antiretroviral therapy (ART) program in the world.

CHAI begins work with South Africa to scale up treatment, laying the foundation for the largest antiretroviral therapy (ART) program in the world.

2004- 2005

Pediatric HIV treatment

CHAI leads global effort alongside Unitaid to scale up treatment for children with AIDS in 34 countries, from around 75,000 on treatment to over 900,000 today, lowering the price of medications from over US$600 to around US$60 per child, per year.

CHAI leads global effort alongside Unitaid to scale up treatment for children with AIDS in 34 countries, from around 75,000 on treatment to over 900,000 today, lowering the price of medications from over US$600 to around US$60 per child, per year.

2005- 2007

HIV second-line agreement

CHAI works with Unitaid to negotiate agreements to lower the price of second-line HIV/AIDS treatments by 75 percent and accelerate the roll out of these drugs to over 30 countries where patients were failing on first-line treatments.

CHAI works with Unitaid to negotiate agreements to lower the price of second-line HIV/AIDS treatments by 75 percent and accelerate the roll out of these drugs to over 30 countries where patients were failing on first-line treatments.

2007

Expansion into malaria

CHAI launches a malaria program, which grows rapidly to help government partners increase funding to combat malaria, improve access to quality diagnosis and treatment, and support evidence-based decision making to target resources and accelerate progress toward elimination.

CHAI launches a malaria program, which grows rapidly to help government partners increase funding to combat malaria, improve access to quality diagnosis and treatment, and support evidence-based decision making to target resources and accelerate progress toward elimination.

2009

Scale-up HIV care and treatment in South Africa

CHAI assists the government of South Africa with the largest scale-up of HIV care and treatment ever attempted, from 800,000 people in 2009 to approximately three million today. CHAI helps negotiate agreements to lower HIV and TB drug prices that save the South African government almost US$1 billion.

CHAI assists the government of South Africa with the largest scale-up of HIV care and treatment ever attempted, from 800,000 people in 2009 to approximately three million today. CHAI helps negotiate agreements to lower HIV and TB drug prices that save the South African government almost US$1 billion.

2010

Effective drugs to treat malaria

CHAI increases access to artemisinin-based combination therapies (ACTs). Over two years, we help get almost 300 million ACTs to patients in eight countries.

CHAI increases access to artemisinin-based combination therapies (ACTs). Over two years, we help get almost 300 million ACTs to patients in eight countries.

2011

Expansion into vaccines

CHAI begins work to lower costs and increase access to vaccines. Alongside the Bill & Melinda Gates Foundation, CHAI negotiates a landmark agreement to lower the price of the GSK rotavirus vaccine by 67 percent and the Biological E. Limited pentavalent vaccine by 50 percent, saving the global community over US$800 million and US$150 million respectively. The pentavalent vaccine averted an estimated 2.6 million deaths from 2011-2015.

CHAI begins work to lower costs and increase access to vaccines. Alongside the Bill & Melinda Gates Foundation, CHAI negotiates a landmark agreement to lower the price of the GSK rotavirus vaccine by 67 percent and the Biological E. Limited pentavalent vaccine by 50 percent, saving the global community over US$800 million and US$150 million respectively. The pentavalent vaccine averted an esti...

2011

MATCH study launch

CHAI, with support from the Bill & Melinda Gates Foundation, conducts the Multi-Country Analysis of Treatment Costs for HIV/AIDS (MATCH) with the governments of Ethiopia, Malawi, Rwanda, South Africa, and Zambia, using evidence to inform debate on affordability and sustainability of universal access to treatment. As a result, an additional 443,000 patients are eligible for treatment.

CHAI, with support from the Bill & Melinda Gates Foundation, conducts the Multi-Country Analysis of Treatment Costs for HIV/AIDS (MATCH) with the governments of Ethiopia, Malawi, Rwanda, South Africa, and Zambia, using evidence to inform debate on affordability and sustainability of universal access to treatment. As a result, an additional 443,000 patients are eligible for treatment.

2011

Expansion into human resources for health

CHAI helps the government of Rwanda establish a world-class health system through educating doctors, nurses, and health managers. CHAI eventually expands this work to other countries including Liberia, Malawi, and Zambia.

CHAI helps the government of Rwanda establish a world-class health system through educating doctors, nurses, and health managers. CHAI eventually expands this work to other countries including Liberia, Malawi, and Zambia.

2012

Human resources for health in Zambia

CHAI begins working with the Zambian government to educate large groups of community health assistants who are then deployed to villages across the country to bring high-quality healthcare to people with limited access.

CHAI begins working with the Zambian government to educate large groups of community health assistants who are then deployed to villages across the country to bring high-quality healthcare to people with limited access.

2012

Long-acting reversible contraception

CHAI and partners, including the Bill & Melinda Gates Foundation, the United Kingdom’s Department for International Development, United States Agency for International Development, NORAD, Children’s Investment Fund Foundation, and the Swedish International Development Cooperation Agency, negotiate an agreement to lower the price of Bayer and Merck’s long-acting reversible contraceptives from US$18 to US$8.50 per implant and accelerate roll-out of the products to save the lives of women.

CHAI and partners, including the Bill & Melinda Gates Foundation, the United Kingdom’s Department for International Development, United States Agency for International Development, NORAD, Children’s Investment Fund Foundation, and the Swedish International Development Cooperation Agency, negotiate an agreement to lower the price of Bayer and Merck’s long-acting reversible contraceptives from U...

2013

Improving severe malaria testing and treatment

CHAI works to lower the cost and increase the availability of injectable artesunate, a malaria medicine that can dramatically decrease malaria mortality, particularly in children. CHAI also worked with global manufacturers and importers in Tanzania’s private sector to reduce the price of malaria Rapid Diagnostic Tests (RDTs) by 50 to 70 percent.

CHAI works to lower the cost and increase the availability of injectable artesunate, a malaria medicine that can dramatically decrease malaria mortality, particularly in children. CHAI also worked with global manufacturers and importers in Tanzania’s private sector to reduce the price of malaria Rapid Diagnostic Tests (RDTs) by 50 to 70 percent.

2013

Treating childhood diarrhea

CHAI begins work to reduce mortality from diarrhea for children under five, scaling up access to lifesaving zinc/ORS treatment in India, Kenya, Nigeria, and Uganda. CHAI supports governments to lower the cost of zinc/ORS products, resulting in wholesale prices dropping by approximately 60 percent.

CHAI begins work to reduce mortality from diarrhea for children under five, scaling up access to lifesaving zinc/ORS treatment in India, Kenya, Nigeria, and Uganda. CHAI supports governments to lower the cost of zinc/ORS products, resulting in wholesale prices dropping by approximately 60 percent.

2014

Ebola response in Liberia

CHAI, with the support of the Norwegian Government, helps lead case management and health worker training in response to the Ebola crisis in Liberia, serving as a critical link between the international emergency response and the Liberian government.

CHAI, with the support of the Norwegian Government, helps lead case management and health worker training in response to the Ebola crisis in Liberia, serving as a critical link between the international emergency response and the Liberian government.

2014

Introducing new products to treat childhood diarrhea

CHAI helps introduce more than 15 new high-quality, affordable zinc and ORS products, including co-packaged products, into local markets in CHAI partner countries. The increased market competition leads to wholesale prices being reduced by 40 to 75 percent.

CHAI helps introduce more than 15 new high-quality, affordable zinc and ORS products, including co-packaged products, into local markets in CHAI partner countries. The increased market competition leads to wholesale prices being reduced by 40 to 75 percent.

A neonate in an incubator sleeps while receiving supplemental oxygen.

2015

Expansion into new programs

CHAI introduces new programs in hepatitis, pneumonia, and cancer.

CHAI introduces new programs in hepatitis, pneumonia, and cancer.

A neonate in an incubator sleeps while receiving supplemental oxygen.

2015- 2016

Reducing mother and infant deaths in Nigeria

CHAI introduces a comprehensive community-based approach to save mothers and newborns in Northern Nigeria through improved outreach, treatment, and training of health workers, resulting in a sustained 37 percent reduction in maternal deaths, a 43 percent reduction in newborn deaths, and a 15 percent reduction in stillbirths within 12 months.

CHAI introduces a comprehensive community-based approach to save mothers and newborns in Northern Nigeria through improved outreach, treatment, and training of health workers, resulting in a sustained 37 percent reduction in maternal deaths, a 43 percent reduction in newborn deaths, and a 15 percent reduction in stillbirths within 12 months.

2016

Lowering the cost of hepatitis C treatment

CHAI helps reduce the cost of hepatitis C treatment in seven countries by 71 to 95 percent, from US$2,618 per patient to between US$133 and US$789 per patient treated.

CHAI helps reduce the cost of hepatitis C treatment in seven countries by 71 to 95 percent, from US$2,618 per patient to between US$133 and US$789 per patient treated.

2016

Ethiopia develops first-of-its-kind medical oxygen roadmap in Africa

While many countries later followed suite, CHAI's support to implement this in the years before the COVID-19 pandemic significantly contributed to Ethiopia's preparedness and access to oxygen to treat COVID-19 patients during the early days of the pandemic.

While many countries later followed suite, CHAI's support to implement this in the years before the COVID-19 pandemic significantly contributed to Ethiopia's preparedness and access to oxygen to treat COVID-19 patients during the early days of the pandemic.

2017

Increasing access to cancer medications

CHAI announces an agreement with the American Cancer Society, Pfizer Inc., and Cipla Inc. to expand access to 16 essential cancer treatment medications, including chemotherapies, in Ethiopia, Kenya, Nigeria, Rwanda, Tanzania, and Uganda, where 44 percent of cancer cases in sub-Saharan Africa occur.

CHAI announces an agreement with the American Cancer Society, Pfizer Inc., and Cipla Inc. to expand access to 16 essential cancer treatment medications, including chemotherapies, in Ethiopia, Kenya, Nigeria, Rwanda, Tanzania, and Uganda, where 44 percent of cancer cases in sub-Saharan Africa occur.

2017

Affordable single-pill HIV regimen with DTG

CHAI and partners, including UNAIDS, the Bill & Melinda Gates Foundation, Unitaid, the United Kingdom’s Department for International Development, PEPFAR, USAID, and the Global Fund to Fight AIDS, Tuberculosis and Malaria, announce a groundbreaking agreement with Aurobindo and Viatris to accelerate the availability of the first affordable, generic, single-pill HIV treatment containing DTG, a best-in-class HIV medication, to public sector purchasers in low- and middle-income countries at around US$75 per person, per year.

CHAI and partners, including UNAIDS, the Bill & Melinda Gates Foundation, Unitaid, the United Kingdom’s Department for International Development, PEPFAR, USAID, and the Global Fund to Fight AIDS, Tuberculosis and Malaria, announce a groundbreaking agreement with Aurobindo and Viatris to accelerate the availability of the first affordable, generic, single-pill HIV treatment containing DTG, a be...

2018

Breakthrough pricing agreement for latest diagnostic technology

CHAI and partners, including United Kingdom’s Department for International Development (DFID), Unitaid, MedAccess (backed by the UK government), the United States President’s Emergency Plan for AIDS Relief (PEPFAR), the African Society for Laboratory Medicine (ASLM), and the government of Zambia, reach a breakthrough pricing agreement with Hologic to significantly lower the cost of state-of-the art diagnostic testing for HIV, hepatitis, and cervical cancer in low-and middle-income countries at a price of US$12 per patient sample.

CHAI and partners, including United Kingdom’s Department for International Development (DFID), Unitaid, MedAccess (backed by the UK government), the United States President’s Emergency Plan for AIDS Relief (PEPFAR), the African Society for Laboratory Medicine (ASLM), and the government of Zambia, reach a breakthrough pricing agreement with Hologic to significantly lower the cost of state-of-the ar...

2018

Lowering costs for lifesaving oxygen diagnostics

CHAI helps negotiate a 58 percent reduction, on average, for the price of handheld pulse oximeters — simple, life-saving tools that can help quickly diagnose severe pneumonia.

CHAI helps negotiate a 58 percent reduction, on average, for the price of handheld pulse oximeters — simple, life-saving tools that can help quickly diagnose severe pneumonia.

2019

Improving access to quality cancer treatment

CHAI forms Allied Against Cancer with the American Cancer Society, the National Comprehensive Cancer Network (NCCN), and IBM. NCCN adapts cancer-treatment guidelines for use in African hospitals and IBM develops an online tool to help African oncologists use the guidelines more efficiently.

CHAI forms Allied Against Cancer with the American Cancer Society, the National Comprehensive Cancer Network (NCCN), and IBM. NCCN adapts cancer-treatment guidelines for use in African hospitals and IBM develops an online tool to help African oncologists use the guidelines more efficiently.

2019

Expansion into cervical cancer

CHAI begins work to scale up safe, effective, and affordable cervical cancer screening and treatment of pre-cancerous legions across partner countries.

CHAI begins work to scale up safe, effective, and affordable cervical cancer screening and treatment of pre-cancerous legions across partner countries.

2020

Responding to the COVID-19 pandemic

CHAI helps countries secure affordable supplies to safely and effectively treat patients with COVID-19, including personal protective equipment, biomedical devices for oxygen therapy, and diagnostics. This includes a global partnership with Unitaid, Viatris, and Macleods to make available 120 million affordable, rapid diagnostic tests for low- and middle-income countries.

CHAI helps countries secure affordable supplies to safely and effectively treat patients with COVID-19, including personal protective equipment, biomedical devices for oxygen therapy, and diagnostics. This includes a global partnership with Unitaid, Viatris, and Macleods to make available 120 million affordable, rapid diagnostic tests for low- and middle-income countries.

2020

Price agreement drastically lowers cost for yearly pediatric HIV treatment

CHAI and Unitaid announce a groundbreaking agreement with two pharmaceutical companies, Viatris and Macleods, to reduce by 75 percent the cost of HIV treatment for children in low- and middle-income countries. The partnership resulted in the fastest ever U.S. regulatory approval for a generic pediatric HIV drug.

CHAI and Unitaid announce a groundbreaking agreement with two pharmaceutical companies, Viatris and Macleods, to reduce by 75 percent the cost of HIV treatment for children in low- and middle-income countries. The partnership resulted in the fastest ever U.S. regulatory approval for a generic pediatric HIV drug.

2021

Partnership makes dual rapid test for syphilis and HIV available for under US$1 in over 100 countries

CHAI, MedAccess, and SD Biosensor introduce new price for point-of-care rapid diagnostic test that enables simultaneous diagnosis of syphilis and HIV in under 20 minutes from a single finger-prick sample.

CHAI, MedAccess, and SD Biosensor introduce new price for point-of-care rapid diagnostic test that enables simultaneous diagnosis of syphilis and HIV in under 20 minutes from a single finger-prick sample.

2021

Unprecedented cooperation with global oxygen suppliers increases access and paves the way to address COVID-19

Agreement brokered by Unitaid and CHAI under the COVID-19 Oxygen Emergency Taskforce sees two of the world’s largest medical oxygen suppliers, Air Liquide and Linde, each collaborate with these ACT-Accelerator partners on increased access to oxygen.

Agreement brokered by Unitaid and CHAI under the COVID-19 Oxygen Emergency Taskforce sees two of the world’s largest medical oxygen suppliers, Air Liquide and Linde, each collaborate with these ACT-Accelerator partners on increased access to oxygen.

A woman in a wheelchair plays a game. Missing Billion report launched in October.

2021

CHAI partners with 10 country governments to increase access to assistive technology

Supporting global stakeholders under the UK Aid-funded AT2030 program, CHAI completed market analyses on wheelchairs, hearing aids, prosthetics, eyeglasses, and personal digital devices to understand interventions to support access and investment opportunities.

Supporting global stakeholders under the UK Aid-funded AT2030 program, CHAI completed market analyses on wheelchairs, hearing aids, prosthetics, eyeglasses, and personal digital devices to understand interventions to support access and investment opportunities.

A woman in a wheelchair plays a game. Missing Billion report launched in October.

2022

CHAI partners with governments to screen over one million women for cervical cancer

More than 80 percent of women received appropriate treatment across the program's 10 countries, with half of the countries exceeding 90 percent treatment coverage among women who screened positive for pre-cancerous legions.

More than 80 percent of women received appropriate treatment across the program's 10 countries, with half of the countries exceeding 90 percent treatment coverage among women who screened positive for pre-cancerous legions.

Highlights from 2022

Testing for COVID-19

Over 1M women in 10 countries screened for cervical cancer

85% of women received appropriate treatment across the program, with half of partner countries exceeding 90% coverage among women who screened positive for pre-cancerous lesions.

Through the Unitaid-funded Cervical Cancer Project, CHAI partnered with governments to roll out an affordable, effective package of tools and accompanying delivery models that put countries on track to reach the screening and treatment coverage targets laid out in WHO’s ambitious Cervical Cancer Elimination Strategy. In 2022, we capitalized on the groundwork laid in previous years to accelerate screening and improve linkage to treatment.

Testing for COVID-19

Stories of Impact

“We can build trust and bring substantial positive change through evidence-led solutions, a genuine desire to address an issue, and transparent stakeholder engagement.”

Abhishek Tupe

Country Support Manager, Global Essential Medicines

Testing for COVID-19

New agreement secures historic US$1 price for HIV self-test

Pricing enabled a two-year pilot in Nigeria that drove a 400% increase in HIV self-test kits distributed to adolescents, significantly expanding testing among teens.

Self-testing is a proven approach to expand access to testing, especially among underserved groups, such as young people, men, and those at high risk of infection. However, early self-tests could cost up to five times more than conventional rapid tests used in hospitals and clinics. In 2022, CHAI worked with MedAccess to negotiate a volume guarantee agreement with Wondfo Biotech Company, setting the ceiling price of their test at US$1—a 50 percent decrease over the leading HIV self-test.

Testing for COVID-19

Stories of Impact

“I look forward to the day when malaria elimination has been accomplished in [Latin America], and we can consider our jobs done. In the meantime, I feel very privileged to work for CHAI and the Ministry of Health towards reaching this historic goal.”

Christina Bradley

Senior Operations Manager, Global Malaria, Panama

Nurse performing a finger prick test on a patient

More than 20 countries upgrade medical oxygen infrastructure and equipment

48 health facilities in over 20 countries have made upgrades to their power supply, piping network, oxygen plants, and bulk liquid oxygen tanks to better deliver oxygen to patients who need it.

Translating pandemic response into sustainable, quality services that save lives requires building up the underlying systems necessary to provide reliable care. This includes keeping oxygen equipment up and running for its full lifespan and providing health workers the right tools, processes, and practices to avert the more than a million deaths per year driven by lack of access to medical oxygen. In 2022, working with Unitaid, ELMA, and The Bill & Melinda Gates Foundation, CHAI leveraged recent investments in oxygen as part of the COVID-19 response into longer-term health systems strengthening.

Nurse performing a finger prick test on a patient

Stories of Impact

“The CHAI way is to listen to what the government is asking for on behalf of its people, and to organize ourselves, our teams, and our funders to deliver on that request.”

Attila Yaman

Associate Director, Strategy and Investment

Testing for COVID-19

“Networks of Care” dramatically reduces mother and newborn deaths with focus on 48 hours around delivery

In four countries, Ethiopia, Nigeria, Uganda, and Zambia, these changes happened in record time–within one to two years of program start.

CHAI partnered with governments to implement an integrated approach to maternal and newborn health, known as Networks of Care in many regions, especially poor, rural communities where the odds of survival for pregnant women and newborns can be dismal. The approach identifies pregnancy and delivery complications early, applies simple interventions to prevent those complications from becoming life-threatening, and rapidly refers cases to the appropriate level for treatment. In 2022, our program in Northern Province, Zambia—which has some of the highest maternal and newborn deaths in the country—transitioned to the provincial government. Over the course of two years, the program reduced maternal mortality by 41 percent, newborn mortality by 45 percent, and perinatal mortality by 43 percent.

Testing for COVID-19

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.

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2022 Annual Report

The theme for this year is 20 Years of Impact, highlighting the successes and hard work of the people who work at CHAI.

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