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Pathfinder Annual Report 2022 – Forging Pathways to Equity

Bangladesh Burundi Democratic Republic of the Congo Burkina Faso Egypt Côte d’Ivoire Ethiopia Uganda Tanzania Pakistan Nigeria Niger Jordan India Kenya

Explore Pathfinder’s 2022 Annual Report, which details important shifts and inspiring successes as we work to build lasting and trusted local partnerships to strengthen health systems and forge resilient pathways to sexual and reproductive health and rights for all.

Explore our digital 2022 Annual Report or view and download the PDF version.

Table of Contents

Letter from CEO & Presidents

For the first time, we are authoring a shared letter to you. We are two Presidents and one CEO. The three of us now lead Pathfinder. Under this new shared leadership model, we work closely with Pathfinder’s country directors and teams around the world.

Contraception

Increasing voluntary access to contraception remains foundational to Pathfinder’s work across all countries we serve. Widespread access to contraception allows people to have freedom in deciding how they lead their lives and contributes to gender equality, ensuring women and girls have agency over their choices.

Adolescents & Youth

Pathfinder recognizes that reaching people when they are young can help them to adopt healthy attitudes, values, and behaviors, practiced throughout their lifetimes

Comprehensive Abortion Care

Unsafe abortion remains a leading cause of pregnancy-related deaths, particularly in countries where legal barriers, stigma, and poorly resourced health systems prevent women from accessing safe abortion and postabortion care services.

Women-Led Climate Resilience

Climate change is creating life-altering impacts on every aspect of life, increasing health risks, hindering sexual and reproductive health and rights, increasing food and water insecurity, and worsening existing inequities—in every country where we work.

Integrated Programming

Our programs integrate contraceptive and other reproductive health services with services focused on HIV and AIDS; cervical cancer prevention; maternal, newborn, and child health; and gender-based violence.

Health Systems Strengthening

Pathfinder strengthens health systems to advance sexual and reproductive health and rights for all people. In fragile settings, this means preparing health systems and services to withstand acute shocks and long-term stressors, and responding during emergencies.

Pathfinder in the News

Over the past year, Pathfinder launched new programs and contributed to shifts in laws and policies in favor of improved health and rights. All of this was accomplished through myriad challenges including conflicts, natural disasters, and political instability.

Board Letter

Pathfinder’s work is critical to honoring the basic rights of women and girls, ensuring their health, and supporting them to live the lives they choose. They are also critical to our global future.

Financials

Revenue & expenses for the year ending June 30, 2022.

Letter from CEO and Presidents

Pathfinder’s Ma’an project reached communities through activities like this interactive theater performance. Today, Ma’an is developing green clinics, health clinics prepared for climate shocks. Photo: Medhat Saleh

DEAR PARTNERS, SUPPORTERS, AND FRIENDS,

For the first time, we are authoring a shared letter to you. We are two Presidents—one responsible for Pathfinder’s sub-Saharan Africa region, another for South Asia, the Middle East, and North Africa—and one CEO. The three of us now lead Pathfinder. Under this new shared leadership model, we work closely with Pathfinder’s country directors and teams around the world.

We are proud of the fact that we are no longer solely led from the US. This leadership shift is part of making Pathfinder a more equitable organization, one where decisions are made in the countries that run our programs, and offices in those countries are well resourced to make and act on those decisions. A globally equitable organization reflects the equity we seek to drive through Pathfinder’s work.

We all hold the conviction that the work we do at Pathfinder, every day, is for greater equity—be it gender equity, health equity, economic equity, social equity. We see sexual and reproductive health and rights as the foundation for a more equitable world.

Pathfinder offers people freedom to make pivotal decisions about whether and when to marry, have children, and how their lives unfold. Our work has never been more critical. Millions of women and young people we serve are on the frontlines of the greatest global challenges—climate change, pandemics, famines, conflicts, natural disasters, growing inequalities—putting their health, rights, and lives at stake.

Let’s start with Bangladesh. The communities where we work in Sylhet and Sunamganj were inundated by floods this past June, the worst in 122 years, leaving more than 4 million people at risk of hunger, and without safe drinking water and basic health care. This disaster preceded massive floods in Pakistan that left 6.4 million people in need of humanitarian assistance. During extreme flooding events, we’ve heard from women who say they can’t get contraception, causing unintended pregnancies to become a frequent reality—women in labor who have lost their babies because they couldn’t get to the hospital to deliver safely.

In Egypt, we are developing “green clinics,” ones that will have a lighter impact on the environment and will be able to withstand the effects that extreme heat has been having on communities there. For the past couple of years in Ethiopia, our Transform program served 57 million people through a devastating civil war that left more than 2 million people internally displaced.

This is the world we live in, and Pathfinder is positioned to respond. We have already been expanding our work to meet new demands and challenges. Our new women’s empowerment program in Egypt couples economic empowerment with reproductive health. Through a program in Pakistan with the United Nations High Commissioner on Refugees, we respond to gender-based violence affecting Afghan refugees. In Niger, we support women climate migrants to ensure accessible health services and economic opportunities.

We will continue along this path. We commit to acting decisively to adjust, adapt, and meet the needs of the people we serve—irrespective of in the circumstance.

Thank you for all of your support in building a more equitable world.

Yours,
Tabinda Sarosh, President, South Asia, Middle East, and North Africa
Biniam Gebre, President, Africa
Lois Quam, Chief Executive Officer

In October 2022, Dr. Tabinda Sarosh was selected as a “Heroine of Global Health,” one of 17 women across the globe who were recognized by Women in Global Health as global leaders working to transform our societies to be more gender equitable.

“Through Pathfinder, I am able to channel my experience as an activist, and transform it into concrete, evidence-based systems strengthening efforts. At the same time, I can continue my activism through policy and advocacy work. It’s a journey that holds a promise of sustainability and scale, and I am genuinely proud of the work I do.”
— Dr. Tabinda Sarosh, President South Asia, Middle East, and North Africa

Tejitu Shibabaw, 21, at a follow-up appointment in a maternity waiting room at the Dinakra Health Center, Amhara, Ethiopia. Photo: Genaye Eshetu

Contraception

130 million contraceptive methods were provided through Pathfinder- supported programs.

Amina Saley, 26, and the mother of four, holds a Sayana Press self-injectable contraceptive in Tibbo Béri, Niger. Photo: Tagaza Djibo

INCREASING CHOICE

INITIATIVE DE MOBILISATION POUR L’ACCES A LA CONTRACEPTION POUR TOUS (IMPACT 2)
NIGER | BILL & MELINDA GATES FOUNDATION

IMPACT 2 provided access to quality contraceptive services, including injectables and long-acting reversible contraception. In partnership with Niger’s Ministry of Public Health, UNFPA, public-sector partners, and civil society organizations, IMPACT 2 contributed to the scale-up of Sayana® Press (DMPA-SC) — a contraceptive that women can self-inject, as well as receive via community health workers. It is a highly desired option among women given that it is both effective and discreet. In the past year, IMPACT 2 provided 40,716 clients with long-acting contraceptives. Since the project’s start, a total of 652,931 clients have been reached.

One key to success? Reaching religious leaders. In its third year, IMPACT 2 worked with 46 religious leaders, who led awareness caravans about family planning in Islam. These leaders reached more than 100 villages and 15,227 people with their messages, including 8,075 women and 7,152 men.

REACHING THOSE IN NEED

SHUKHI JIBON
BANGLADESH | USAID

Shukhi Jibon advances innovative, scalable solutions for increasing access to and uptake of voluntary family planning where the need is greatest, including urban slums, communities with growing refugee populations, and regions devastated by climate change-induced floods and natural disasters.

Shukhi Jibon has reached more than 14.6 million couples and nearly 1 million adolescents across four geographic divisions with family planning information and services.

Selina Akhter Sheuli, from Telikhal, Bangladesh, was pregnant during last year’s extreme flooding. Photo: Pathfinder Bangladesh

AMPLIFYING CONTRACEPTION

AMPLIFY FAMILY PLANNING AND SEXUAL REPRODUCTIVE HEALTH (AMPLIFYPF)
BURKINA FASO, CÔTE D’ IVOIRE, NIGER, & TOGO | USAID

AmplifyPF mobilizes partners to expand access to, and use of, quality family planning services in the West Africa region. AmplifyPF has built relationships with ministries of health and health facilities across four countries and established 19 Integrated Learning Networks—local community networks that have mobilized resources for delivering high-impact reproductive health services to women and girls.

In its fourth year, AmplifyPF reached 481,951 clients, 150,295 of those who were new family planning users.

Adolescents & Youth

6.3 million people younger than 25 received contraception through Pathfinder-supported programs.

A family planning education session with Kyangoma Girls’ group members in Butambala, Uganda. Photo: Lovington Kambugu

FACILITATING DIALOGUES

UGANDA FAMILY PLANNING ACTIVITY
UGANDA | USAID

The USAID/Uganda Family Planning Activity (FPA) addresses underlying social, cultural, and structural barriers to family planning access, particularly among adolescents, youth, and first-time parents in 11 districts across Uganda. Through “Young Emanzi” dialogues, FPA held conversations on self- esteem, effective communication, body changes, pregnancy prevention, relationships, and even challenges of love with young people. These conversations reached adolescent boys and young men to promote positive gender norms, the development of gender-equitable and healthy relationships, economic productivity, and tips on how they can support the reproductive health of women and girls.

The project reached 167,885 young people under age 25 during its third year.

“I encourage adolescents and young people to take on family planning methods so that they don’t give birth to children by chance; birth is meant to be by choice.”
Joyce Nakato, FPA Youth Officer

Photo: Lovington Kambugu

YOUTH CHOICES, YOUTH VOICES

YOUTH VOICES FOR AGENCY AND ACCESS (YUVAA)
INDIA | BILL & MELINDA GATES FOUNDATION

The YUVAA project encouraged improved reproductive health and contraceptive use among young married couples and first-time parents. The project trained “Yuvaakaars,” young social entrepreneurs, as social change agents to counsel young couples on family planning and make referrals to local health facilities. Yuvaakaars also sell products, including hygiene products, small electrical appliances, and contraceptives, and can invest any profits they make as they choose. In the last year, Yuvaakaars reached 400,659 couples in 10 districts of Bihar and Maharashtra.

Digital integration is a key component to the YUVAA program. YUVAA’s m-Pari app supports counseling and conversations about contraceptive choices by service providers, health care workers, and peer promoters. More than 3,500 providers have downloaded the application

“If people have the will and the ability, they can do anything! And women aren’t less than any man. If you give me more incentives, I will do more!”
— Vaishali Chaugule, Yuvaakaar in Kohlapur, Maharashtra

Photo: Sarah Peck

DECREASING BIAS

BEYOND BIAS
BURKINA FASO, TANZANIA & PAKISTAN | USAID

Research shows that provider bias and judgmental behavior is a major barrier to young people’s of contraception, including newly married couples and first-time parents. Beyond Bias worked with providers over the past seven years to help them overcome their biases, contributing to empathetic, nonjudgmental, quality counseling and provision of a full range of contraceptives to young people. Through Beyond Bias, biased attitudes and beliefs among providers in all three countries decreased significantly, leading to more comprehensive counseling and better perceived treatment of young clients.

At Beyond Bias ‘summit’ events, providers come together and listen to personal stories shared by youth and other providers:

“It’s true that there may be gaps in training, but the problem really lies within. Today I came to understand that sometimes my services to youth can be changed by my own bias.”
Provider, Tanzania (After a Beyond Bias Summit)

An adolescent girl attending a Beyond Bias design workshop in Tanzania. Photo: Pathfinder Tanzania

Comprehensive Abortion Care

128,194 women reached with safe abortion and postabortion care through Pathfinder-supported programs, an 140% increase from the previous year.

A group in Niger plays Pathways to Change. Photo: Pathfinder Niger

SAFE ABORTION

SAUVER LA VIE (PSLV)
BURKINA FASO | NETHERLANDS MINISTRY OF FOREIGN AFFAIRS

PSLV supports Burkina Faso’s Ministry of Health to strengthen primary health care services, including family planning and safe abortion care. Over the past year, PSLV trained and supervised 498 health providers across 150 facilities on family planning, postabortion care, safe termination of pregnancy according to the law, values clarification and attitudes transformation related to abortion services, and gender-based violence response. Since the start of the project in October 2020, 752 providers have been trained, 104,647 clients have been reached, and 4,007 clients have received comprehensive abortion care.

PSLV reached 5,039,644 people with messages about sexual and reproductive health over the past year, through community and advocacy activities. This included games like Pathways to Change, conversations with local elected officials, journalists, and community champions, as well as radio broadcasts

SAFE MOTHERHOOD THROUGH POSTABORTION CARE

PAMOJA
TANZANIA | ANONYMOUS

In Tanzania, where abortion is only permitted to save a woman’s life, it is estimated that unsafe abortions are responsible for up to a quarter of maternal deaths. The harmful and often lethal effects of unsafe abortion on women and girls can be significantly mitigated through comprehensive postabortion care—a pillar of safe motherhood services. Pathfinder’s Pamoja project worked with the Tanzanian government to improve comprehensive postabortion care accessibility and quality, with a goal of reducing the number of women dying from unsafe abortions.

From January 2020 to July 2022, Pamoja supported 66,674 women to receive comprehensive postabortion care.

Women-Led Climate Resilience

By 2030, Pathfinder aims to reach 10 millions women and girls with integrated health, equity, and climate programs

Siwema Ramadhani fetches water every morning from Lake Tanganyika. In the rainy season, she has to walk through knee-deep water to get to the lake. Photo: Roshni Lodhia

GREEN CLINICS

MA’AN
EGYPT | MERCK SHARP & DOHME CORP (MERCK FOR MOTHERS PROGRAM)

Pathfinder’s Ma’an project has supported local service providers to respond to the family planning and reproductive health needs of young married women and first-time parents. Pathfinder is now incorporating a climate-resilience approach into Ma’an, including green health clinics that will be better prepared for climate shocks, and environmentally friendly solutions like solar panels, efficient water utilization, waste disposals, and recycling. Educating communities and contributing to women’s agency and ability to influence climate adaptation and related health issues is also a part of this work.

Flash floods in Bangladesh impacted more than 7 million people in nine northeastern districts in 2022. Photo: Pathfinder Bangladesh

WOMEN AND GIRLS ON THE FRONT LINES OF THE CLIMATE CRISIS

ADVANCING THE LEADERSHIP OF WOMEN AND GIRLS TOWARDS BETTER HEALTH AND CLIMATE CHANGE RESILIENCE
PAKISTAN & BANGLADESH | TAKEDA PHARMACEUTICAL COMPANY LIMITED GLOBAL CSR PROGRAM

Pathfinder is building the resilience of communities in Bangladesh and Pakistan to climate shocks and emergencies through women-led preparation, response, and recovery. Our integrated approach strengthens health systems to ensure women and their communities can access essential services when disasters strike and supports improved nutrition and water, sanitation, and hygiene. The program positions women and girls as change agents in increasing access to equitable health services and building community resilience to climate shocks—ultimately helping women forge their own paths to a healthier future.

Integrated Programming

Pathfinder’s integrated programming averted 8,665 maternal deaths and saved $503 million in direct health care costs.

Maria Simao Wate, Mozambique. “I’m 22 years old. I felt sick – I went to the hospital, and am now getting treatment. My life is changed. The ARV pills are working on me.” Photo: Ricardo Franco

ADDRESSING VIOLENCE AGAINST WOMEN AND GIRLS

EMPOWERING YOUTH TO LEAD HEALTHY SEXUAL AND REPRODUCTIVE LIVES IN KINSHASA
DEMOCRATIC REPUBLIC OF THE CONGO (DRC) | THE DAVID & LUCILE PACKARD FOUNDATION

In DRC, 64 percent of 15- to 19-year-old women and girls report having been forced into nonconsensual sex. Pathfinder integrates sexual and gender-based violence services at Kinshasa’s “youth corners,” which offer a suite of youth-friendly services, including contraceptive services, diagnosis and treatment of sexual transmitted infections, and postabortion care. The program focuses on access to these services among marginalized and disabled youth through an approach that includes training people with disabilities as peer educators. Since 2021, the program has reached more than 57,000 young people.

HIV AND TUBERCULOSIS (TB)

REINFORCEMENT OF ADHERENCE & RETENTION OF PATIENTS IN ART AND SCREENING FOR TB (RARE)
MOZAMBIQUE | THE GLOBAL FUND TO FIGHT AIDS, TUBERCULOSIS AND MALARIA (THROUGH THE CENTER FOR COLLABORATION IN HEALTH)

Pathfinder’s RARE project reached those who are HIV-positive or have TB at home to increase the likelihood that they will use and stay on their medications. Pathfinder also conducted community dialogues to educate communities about HIV and TB, particularly treatment and stigma and discrimination. This work was conducted in Gaza, Manica, and Sofala provinces, where Pathfinder already works to advance sexual and reproductive health and rights.

By the end of the project, 85,713 (63%) of patients who had been lost to follow-up were reintegrated into antiretroviral therapy.

SAFE PARENTING

UZAZI SALAMA
KENYA | THE GLOBAL FUND TO FIGHT AIDS, TUBERCULOSIS AND MALARIA (THROUGH THE CENTER FOR COLLABORATION IN HEALTH)

Pathfinder’s Uzazi Salama, or “Safe Parenting” in Kiswahili, increases access to and use of quality, high-impact reproductive, maternal, newborn, child, and adolescent health services in Homabay County. The project conducts community dialogues, door-to-door conversations, engages community champions and advocates, supports community health workers, and integrates digital technology for reporting on project reach.

Uzazi Salama seeks to reach 200,000 community members in Homabay, including 50,000 women of reproductive age and 40,000 children under age 5, over the next two years.

Health Systems Strengthening

Bizuayehu Esubalew, 26, midwife, with Asayech Belay, 18, at a maternity ward in Kidamaja Health Center, Ethiopia. Photo: Genaye Eshetu

EMERGENCY RESPONSE AND HEALTH SYSTEM RESILIENCE

TRANSFORM: PRIMARY HEALTH CARE
ETHIOPIA | USAID

Over the past five years, Pathfinder’s USAID Transform: Primary Health Care program strengthened Ethiopia’s health system, reaching 57 million people with health information and services and helping people access health care and other essential services during a conflict in the north of the country and the COVID-19 pandemic. Transform provided more than 15,000 different humanitarian supplies to sites for internally displaced persons and health facilities and worked continuously to improve the management, performance, and sustainability of quality services delivered through the primary health care system. A strengthened health system will be more likely to withstand future emergencies and shocks.

Transform supported mobile health and nutrition teams to reach 327,475 women and children with family planning and maternal and child health services at sites for internally displaced people.

HOLISTIC HEALTH SYSTEM READINESS IN HUMANTIAN SETTINGS

HEALTHNET TPO
BURUNDI | EUROPEAN UNION

Healthnet TPO, across three of Burundi’s provinces, mitigates the impacts of humanitarian emergencies on local communities by focusing on the continuity and quality of essential health services. Additional health worker trainings and community education sessions have focused on pressing health issues facing local communities, like COVID-19, cholera, and mental health. Working on the nuts and bolts of the health system, the program has improved ambulatory services, sustainability of medical equipment and supplies, referral systems, and monitoring and support to community health workers and other providers.

Healthnet TPO has trained 2,493 community health workers over the past year to manage childhood illnesses, with a specific focus on malaria, and 474 community health workers on the provision of Sayana® Press.

PATHFINDER IN THE NEWS

Shitaye Kebede, 43, gets her contraceptive implants at Dinkara Health Center in Amhara, Ethiopia. Photo: Genaye Eshetu

Over the past year, Pathfinder launched new programs and contributed to shifts in laws and policies in favor of improved health and rights. All of this was accomplished through myriad challenges including conflicts, natural disasters, and political instability.

In Egypt, Pathfinder launched the Women’s Economic and Social Empowerment Program, which will provide 200,000 women in seven Egyptian governorates with employment and leadership opportunities and access to digital financial services. Survivors of violence will be supported with health, legal, and psychological services.

In Democratic Republic of the Congo (DRC),Pathfinder paved the way to improve women’s and girls’ access to contraception through targeted advocacy. Pathfinder achieved buy-in through influencer and advocacy sessions, and ultimately achieved the issuance of formal authorization from the government of DRC for the pilot introduction of family planning services in pharmacies and drugstores including initiation and self- injection of Sayana® Press.

In Burkina Faso, a political coup resulted in a security crisis. Pathfinder’s PREPARE project trained staff and community engagement officers in fire safety systems, crisis and critical incident management, and personal security and humanitarian access. Despite the ongoing political instability, including the shutdown of 70 of the targeted 160 health care facilities PREPARE supports, the project reached 73,906 children with measles vaccines, trained 77 providers on supporting survivors of gender-based violence, and engaged 800 community leaders on building community resilience to various shocks.

DIGTIAL INNOVATIONS

Across our programs, Pathfinder is integrating digital technologies to increase communication with clients, provide trainings to health care workers, increase data exchange between organizations, provide mentorship opportunities, and map need through geographic information. In Bangladesh, for example, Pathfinder’s Shukhi Jibon project is supporting public-sector family planning service providers through a mentorship app that helps facilitate clinical mentoring, captures data, and promotes data-driven decision making.

FROM THE BOARD

Joyce Nakato is a Youth Officer with the USAID Uganda Family Planning Activity. Says Joyce, “we need to continuously lobby and work with policymakers on the benefits of supporting health workers with the basic necessities they need to do their work.” Photo: Lovington Kambugu

DEAR PATHFINDER COMMUNITY,

This past year was my first as Pathfinder’s Board Chair. It’s been an honor to serve an organization that works on issues so close to my own heart.

I was born in Uganda after my father was exiled from South Africa for speaking out against apartheid. I spent the first 16 years of my life as a refugee in countries where Pathfinder works today—first Uganda, and then Kenya and Tanzania. During those years, I was surrounded by the women and girls in my family, as well as those who lived alongside us. Their strength and resilience impressed me beyond what words can describe. They were constantly pulling together scant resources to meet the basic needs of their families—putting their children and communities ahead of themselves. They were the fabric holding us together.

I realized, even at a young age, there were many rights and privileges afforded to me just because of my gender—an education, freedom to move around independently without fear of sexual assault and harassment, and a life free from the burdens of unintended pregnancies. I watched girls become pregnant when they were teenagers—even some just children. Not only were their health and lives at risk, but their dreams of a career were also robbed from them.

Pathfinder’s work is critical to honoring the basic rights of women and girls, ensuring their health, and supporting them to live the lives they choose. They are also critical to our global future. Our societies are confronting some of the greatest challenges of our time— protracted conflicts, the impacts of climate change, worsening and deepening inequalities. We’ve never needed the strength, smarts, and resilience of women and girls more. The future starts with reproductive health.

During my first year as Board Chair, Pathfinder has been on a transformative journey. The organization has quickly moved from the headquarters-field model that has dominated the international development industry since its infancy to a model based in equity and inclusion. We have a Global Leadership Council where decisions are no longer solely made by an executive team based in the US but are made by leaders from the countries we serve. We have two new Presidents, one who oversees countries in South Asia, North Africa, and the Middle East, and another who leads for sub-Saharan Africa. We are shifting resources and decision-making powers to countries outside of the US.

Our Board has also been on a journey. We’ve become a more diverse Board over the past couple of years—professionally, geographically, and culturally—and more than 50 percent of our members are women. The Pathfinder Board now better reflects the organization it remains accountable to.

These operational shifts make Pathfinder stronger and more ready to confront today’s pressing challenges. We know that an organization fueled by the knowledge and insights of our teams around the world, and individuals with diverse skills, experiences, and ideas, will allow us to do our work in any situation.

I am proud to be a part of this journey, and grateful to be able to support the lives of so many women and girls around the world.

Thank you for walking this path with us.

Yours,
Collin Mothupi
Board Chair, President

FINANCIALS

Seema Kumari, a Yuvaakaar with the YUVAA project. Photo: Sarah Peck

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