POSITIONED FOR TOMORROW
                                                                                                                                            We are at a historic moment in time, when
                                                                                                                                            the investments we make today can end
                                                                                                                                            extreme poverty within our lifetime. Healthy
                                                                                                                                            girls and women are the surest investments
                                                                                                                                            to realize this future.

                                                                                                                                            PSI is investing in the health of girls and
                                                                                                                                            women by using proven business practices
                                                                                                                                            like marketing to tackle the greatest
                                                                                                                                            challenges that they face today and will face
                                                                                                                                            tomorrow. We’re bringing diverse global
                                                                                                                                            partners together to pilot game-changing
TABLE OF CONTENTS                              ABOUT PSI                                                CONNECT WITH PSI                    health interventions that deliver solutions
                                                                                                                                            where, when and how they are needed.
02     HEALTH IMPACT                           PSI is a global health organization dedicated to         WEBSITE
04     PSI: POSITIONED FOR TOMORROW            improving the health of people in the developing
                                                                                                                                            When girls and women are healthy, they go
                                               world by focusing on serious challenges like a lack of   IMPACT MAGAZINE
      04     ANTICIPATING HEALTH NEEDS OF                                                                            to school, join the work force, support their
             TOMORROW                          family planning, HIV and AIDS, barriers to maternal
                                                                                                                                            local economy and lift themselves and their
                                               health, non-communicable diseases and the greatest       BLOG
      06     CONNECTING GLOBAL PARTNERS                                                                                                     families out of poverty. We are acting today
                                               threats to children under five, including malaria,
      08     DEVELOPING GAME-CHANGING PILOTS                                                                                                to unleash the potential of millions of girls
                                               diarrhea, pneumonia and malnutrition. A hallmark         TWITTER
      10     DELIVERING INTEGRATED SOLUTIONS                                                            @PSIimpact                          and women tomorrow.
                                               of PSI is a commitment to the principle that health
                                               services and products are most effective when they       FACEBOOK
            GIRLS & WOMEN
                                                                                                        Population Services International
                                               are accompanied by robust communications and
14    PSI NETWORK                                                                                       YOUTUBE
                                               distribution efforts that help ensure wide acceptance
                                                                                                        Population Services International
15    FINANCIAL STATEMENT                      and proper use. In each of its platforms, PSI works                                                                                          PSI President & CEO Karl Hofmann meets 5-year-
                                               in partnership with local governments, ministries        EMAIL                                                                               old Jovitte Kezakimana, who lost three siblings
16    LEADERSHIP                                                                                                                                                      to malaria. Since her family started using a PSI
                                               of health and local organizations – creating health
                                                                                                                                                                                            mosquito net last year, she has been malaria-free
                                               solutions that are built to last.                                                                                                            and is excited about attending school regularly.
Cover Photo: ©Hank Badenhorst / ISTOCK
                                                                                                                                            ©Benjamin Schilling                                                                             01
This page: ©Jake Lyell
HEALTH IMPACT                                                                                                                                                                                      PSI ADDED 35.2 MILLION
                                                                                                                                                                                                   YEARS OF HEALTHY LIFE
SERVICES PROVIDED                                        PRODUCTS MARKETED & DISTRIBUTED                                                                                                           WITH THE PRODUCTS WE DISTRIBUTED AND
         627,000                                                                                                                                                                                   SERVICES WE PROVIDED IN 2012.
                                                                     24 million                                                            20,000

                                                         MDG 4&6
         long-acting, reversible contraceptives
MDG* 5

                                                                                                                                 MDG 6
         inserted (including implants and intrauterine               long-lasting insecticide-treated nets,                                courses of directly observed therapy,
         devices), empowering women and couples                      protecting families from malaria.                                     saving lives by treating tuberculosis.
         to plan for the families they desire.                                                                                                                                                     HOW DOES PSI                                           OUR IMPACT:
                                                                                                                                                                                                   CALCULATE YEARS OF
         186,000                                                     1.3 billion
                                                                                                                                                                                                   HEALTHY LIFE ADDED?                                    2007           16.9 million

                                                                                                                                 MDG 4&8
                                                         MDG 5&6

         voluntary adult medical male circumcisions                  male condoms, preventing transmission of HIV
                                                                                                                                           pre-packaged antibiotics, saving
         performed, preventing HIV and other                         and other STIs and empowering women and
                                                                                                                                           children’s lives by treating pneumonia.
                                                                                                                                                                                                                                                          2008           27.7 million
         sexually transmitted infections (STIs).                     couples to plan for the families they desire.                                                                                 PSI estimates the impact of its health interventions
                                                                                                                                                                                                   using the Disability-Adjusted Life Year (DALY), a
                                                                                                                                                                                                                                                          2009           29.9 million

         1.7 million
         voluntary testing and counseling sessions                   2.5 million                                                           15.4 million
                                                                                                                                                                                                   unit of measurement developed by the World Bank        2010           31.9 million

                                                                                                                                 MDG 4&8
                                                                                                                                                                                                   and the World Health Organization to estimate
                                                         MDG 4

         for HIV and other STIs conducted,                           diarrhea treatment kits, saving children’s                            courses of artemisinin–based
                                                                                                                                           combination therapy, saving                             years of life lost due to death and disability. We     201 1*         49.4 million
         reducing transmission rates and increasing                  lives by reducing the severity and

         access to treatment through referrals.                      duration of diarrheal disease.                                        children’s lives by treating malaria.                   track each product we deliver and service we
                                                                                                                                                                                                                                                          2012           35.2 million
                                                                                                                                                                                                   provide. We then use technical models to calculate
                                                                                                                                                                                                   the DALYs averted by our work.
                                                                                                                                                                                                                                                          *2011 was an exceptional year for long-lasting insecticide-treated net (LLIN) distribution. In 2011 alone, PSI distributed 42
IMPACT OF PSI INTERVENTIONS                                                                                                                                                                                                                                million LLINs, accounting for 56% of the total DALYs averted in 2011. In 2012, the LLIN distribution dropped to 24 million

                                                                                                                                                                                                   ONE DALY AVERTED =
                                                                                                                                                                                                                                                           LLINs, accounting for 31% of the total DALYs averted in 2012.

                  203,000                                                                                                                                   237,000                                ONE YEAR OF HEALTHY
                                                         MDG 4,6&7

                                                                                                                                 MDG 4&7
                                                                                16.6 billion

                                                                                                                                                            Deaths due to malaria,
                  HIV infections
                                                                                Litres of water treated                                                     diarrhea & pneumonia
                                                                                                                                                                                                   LIFE ADDED.                                            To stay at the forefront of our field, we have                     (2) The Lives Saved Tool provides us access to
                  prevented                                                                                                                                                                                                                                                                                                  estimates of deaths averted by a range of products
                                                                                                                                                                                                                                                          aligned the way we estimate DALYs averted with
                                                                                                                                                                                                                                                          two external tools widely used by the global health                and services for children under the age of five.

                  14,000                                                        5.2 million                                                                                                                                                               community: (1) The 2010 Global Burden of Disease                   These estimates are based on the most current,

                                                          MDG 5

                                                                                Unintended                                                                                                                                                                Study and (2) the Lives Saved Tool.                                peer reviewed data available.
                  Maternal deaths
                                                                                pregnancies prevented
                  prevented                                                                                                                                                                                                                               (1) The 2010 Global Burden of Disease Study
                                                                                                                                                                                                                                                          introduced more accurate methods for
                                                                                                                                                                                                                                                          calculating a DALY.
                                                                                                                                                          *MDG = Millennium Development Goal
                                                                                        For more information on our health impact, go to to read the 2012 Impact Report.
ANTICIPATING HEALTH NEEDS                                                                                                                                                          GROWING BURDEN OF                                           DECADES OF GLOBAL                                        Availability of ACTs increased from 27% to 63%:

                                                                                                                                                                                                                                                                                                                     27%                       63 %
                                                                                                                                                                                   NON-COMMUNICABLE                                            MALARIA CONTROL
OF TOMORROW.                                                                                                                                                                       DISEASE                                                     EFFORTS UNDER
                                                                                                                                                                                                                                                                                                        Availability of oAMT decreased from 51% to 36%:
The growing burden of non-communicable and treatable diseases threaten decades of progress in                                                                                      Between 1990 and 2010, there was a 61% growth in the
                                                                                                                                                                                                                                                                                                                            36%       51%
global health. We follow evidence and build solutions to address these tough challenges, ensuring that                                                                             burden of cervical cancer in Zambia. In response, Society
investments are best aligned with need.                                                                                                                                                                                                        Emerging resistance to the most effective
                                                                                                                                                                                   for Family Health, PSI’s network member in Zambia,
                                                                                                                                                                                                                                               antimalarial drug (artemisinin) in Southeast Asia is a
                                                                                                                                                                                   is training public sector clinicians to conduct cervical                                                             Most impressive, the market share of ACTs
                                                                                                                                                                                                                                               serious threat to global efforts to eliminate malaria.
                                                                                                                                                                                   cancer screening alongside family planning services.                                                                 relative to oAMT in priority outlets increased
                                                                                                                                                                                                                                                                                                        from 3% to 73% over this period:
                                                                                                                                                                                                      1,362                                    One of the key drivers of resistance has been the
                                                                                                                                                                                                                                                                                                           3%                                         73%
                                                                                                                                                                                                      women in the Copperbelt province         widespread availability and use of partial courses

                                                                                                                                                                                                      were screened for cervical cancer        of oral artemisinin monotherapy (oAMT) in the

                                                                                                                                                                                                      last year, representing                  informal private sector, instead of artemisinin-based
                                                                                                                                                                                                                                                                                                        What does this mean? A sustained price subsidy
                                                                                                                                                                                                                                               combination therapy (ACT). This has been a serious
                                                                                                                                                                                                                                                                                                        combined with an oAMT importation ban and
                                                                                                                                                                                                      28%                                      problem in Myanmar, in particular.
                                                                                                                                                                                                                                                                                                        intensive communication campaigns can bring
                                                                                                                                                                                                      of all family planning clients served
                                                                                                                                                                                                                                                                                                        about rapid changes in antimalarial markets where
                                                                                                                                                                                                      in clinics that offer the screening.     In response, PSI/Myanmar implemented an
                                                                                                                                                                                                                                                                                                        an urgent intervention is justified.
                                                                                                                                                                                                                                               emergency country-wide program focused on
                                                                                                                                                                                   Of these, 75 women received cryotherapy treatment
                                                                                                                                                                                                                                               addressing access and pricing in the private             Donors: UK Department of International
                                                                                                                                                                                   for abnormal cells on the cervix, and eight were
                                                                                                                                                                                                                                               sector by flooding the market with heavily               Development, Bill & Melinda Gates Foundation,
                                                                                                                                                                                   referred for loop electro surgical excision procedure
                                                                                                                                                                                                                                               subsidized ACTs. The program was supported               and Good Ventures
                                                                                                                                                                                   at the University Teaching Hospital.
“GLOBAL BURDEN OF DISEASE [DATA FROM] 2010 SHOWS THE REMARKABLE                                                                                                                                                                                by intensive communication campaigns, and the
                                                                                                                                                                                                                                               Ministry of Health’s efforts to prevent further
HEALTH ACHIEVEMENTS OF THE PAST TWO DECADES, AS WELL AS THE                                                                                                                            Olga Akakulubelwa is one of the women who
                                                                                                                                                                                                                                               importation of oAMT.
                                                                                                                                                                                       were referred to the Lusaka University Teaching
CONTINUING, AND EMERGING, CHALLENGES THAT REQUIRE ACTION.”                                                                                                                             Hospital. When she was told her results, Olga
                                                                                                                                                                                       broke down. “I’m crying because I’m happy the           After just nine months, significant changes in
Jim Yong Kim, President of the World Bank1
                                                                                                                                                                                       problem has been found and will be addressed.           the availability of ACTs were observed in more

                                                                                                                                                                                       I don’t know what would have happened to me             than 3,500 outlets surveyed, particularly among
                                                                                                                                                                                       had I not heard about the service,” she said.           pharmacies, retail stores and itinerant drug vendors
                                                                                                                                                                                       Today, Olga is a self-appointed ambassador for          that historically provided the bulk of oAMTs.
                                                                                                                                                                                       early cervical cancer screening.

                                                                                                                                                                                   Donor: Dutch Ministry of Foreign Affairs
 04                                                                                       Kim: Data for better health—and to help end poverty. The Lancet 380 (Number 9859):2055                                                                                                                                                                            05
                                                                                                                                                             ©Chris James White
CONNECTING GLOBAL                                                                                                                                                                     A PUBLIC–PRIVATE                                    1,628                                                        However, more than a third of rural families in Bihar,
                                                                                                                                                                                                                                                                                                       India, have no toilet facilities, even though they
                                                                                                                                                                                      SECTOR SOLUTION                                     Women like Nakiranda Sabirah delivered safely in

                                                                                                                                                                                                                                                                                                       want one. Why?
                                                                                                                                                                                                                                          PACE franchise clinics in less than nine months.

                                                                                                                                                                                      50 X                                                                                                                • Affordable, quality toilets are unavailable.
                                                                                                                                                                                      A woman in Uganda is 50 times more likely to die       Nakiranda had never been to an antenatal clinic.
                                                                                                                                                                                                                                                                                                          • The supply chain is fragmented; it is difficult for
PSI connects government donors, corporations, foundations and philanthropists to improve the health of
                                                                                                                                                                                      giving birth than women in the developed world.        While she was pregnant with her fourth child,
                                                                                                                                                                                                                                                                                                           families to find the needed materials.
people in resource poor settings in the developing world. These partnerships fuel sustainable approaches
                                                                                                                                                                                                                                             Mr. Kirira, a MUM outreach worker, encouraged
                                                                                                                                                                                                                                                                                                          • Households do not have the required cash on hand.
and business models that can tackle the unmet needs of girls, women and families.                                                                                                     The MSD (aka Merck & Co.) for Ugandan Mothers
                                                                                                                                                                                                                                             her to go to a health clinic. “The doctor checked
                                                                                                                                                                                                                                                                                                          • Entrepreneurs do not have access to financing to
                                                                                                                                                                                      (MUM) partnership was created to reduce this high
                                                                                                                                                                                                                                             my pregnancy and realized my baby was not
                                                                                                                                                                                                                                                                                                           invest in selling toilets.
                                                                                                                                                                                      maternal mortality. Working in collaboration with
                                                                                                                                                                                                                                             fine,” says Nakiranda. The providers advised
                                                                                                                                                                                      the US government’s “Saving Mothers, Giving Life”
                                                                                                                                                                                                                                             Nakiranda to come regularly for checkups until
                                                                                                                                                                                                                                                                                                       PSI partnered with Water for People India, Monitor
                                                                                                                                                                                      initiative, the MUM partnership will:
                                                                                                                                                                                                                                             the baby’s birth via caesarian section. “If it had
                                                                                                                                                                                                                                                                                                       Group and PATH to launch a sustainable, market-
                                                                                                                                                                                                                                             not been for Mr. Kirira’s advice, my child and I
“WE WANT TO BE SUCCESSFUL AND SUSTAINABLE WHILE INCREASING                                                                                                                               • Increase availability of and demand for
                                                                                                                                                                                                                                             might have died,” says Nakiranda.
                                                                                                                                                                                                                                                                                                       based solution in Bihar to make investment in
                                                                                                                                                                                                                                                                                                       toilets attractive to families and the private sector.
OUR POSITIVE IMPACT ON SOCIETY. . . . THIS IS NOT CORPORATE                                                                                                                               quality maternal health information, products
                                                                                                                                                                                                                                                                                                       Key components of the project include:
                                                                                                                                                                                          and services in private sector clinics and
SOCIAL RESPONSIBILITY ANYMORE; THIS IS TAKING CO-OWNERSHIP                                                                                                                                pharmacies.
                                                                                                                                                                                                                                          Donor: Merck for Mothers

TO CONTRIBUTE TO ISSUES OF HEALTH AND SANITATION, OF FOOD                                                                                                                                                                                                                                                 • Mapping the existing sanitation market

SECURITY, OF EQUITABLE GROWTH.”                                                                                                                                                          • Expand PACE’s ProFam franchise network         A SUSTAINABLE,                                                  • Developing business models that coordinate
                                                                                                                                                                                                                                                                                                           supply and demand
                                                                                                                                                                                          by training 522 providers in basic emergency    MARKET–BASED                                                    • Designing an affordable toilet that families
Paul Polman, CEO for Unilever 1                                                                                                                                                           obstetric care.
                                                                                                                                                                                                                                          SOLUTION                                                         aspire to own
                                                                                                                                                                                                                                                                                                          • Increasing access to financing for both
                                                                                                                                                                                         • Develop a community health insurance
                                                                                                                                                                                          program to serve 3,500 members.                 2.5 BILLION                                                      households and entrepreneurs

                                                                                                                                                                                                                                          people lack access to                                           • Exploring business opportunities for fecal

                                                                                                                                                                                                                                          adequate sanitation.                                             waste management
                                                                                                                          In 2012, Unilever Foundation and PSI taught                 The MUM partnership is led by PSI, PACE
                                                                                                                                                                                                                                                                                                          • Creating demand for sanitation
                                                                                                                          200,000 CHILDREN                                            (member of the PSI network), the Association of
                                                                                                                                                                                                                                          > 1 BILLION
                                                                                                                          IN 400 SCHOOLS
                                                                                                                                                                                      Obstetricians and Gynecologists of Uganda, Save
                                                                                                                                                                                                                                                                                                       The project will provide a sustainable, market-
                                                                                                                                                                                      for Health Uganda, and Transaid.                    people are forced to
                                                                                                                          across three countries how to correctly                                                                                                                                      based solution to sanitation for families in Bihar.
                                                                                                                                                                                                                                          defecate in the open.
                                                                                                                          and consistently wash hands with soap.
                                                                                                                                                                                                                                                                                                       Donor: Bill & Melinda Gates Foundation
                                                                                                                                                                                                                                          A toilet not only provides privacy, particularly for girls
                                                                                                                                                                                                                                          and women, it prevents the spread of diarrhea and
                                                                                                                                                                                                                                          other diseases, which kill 1.8 million children each year.
  06                                                                                      Quote as appeared in Trends Talk: A Vision for Sustainable Living. Impact Magazine 12: 20                                                                                                                                          2012 PROGRESS REPORT                 07
                                                                                                                                                              ©Benjamin Schilling
DEVELOPING                                                                                                                                                                             A MULTI–SECTOR,
                                                                                                                                                                                       INTEGRATED SOLUTION
                                                                                                                                                                                                                                                Massa, a 31-year-old single mother of six,
                                                                                                                                                                                                                                                was one of these women. “I am not ready
                                                                                                                                                                                                                                                                                                              2. Protect women and
                                                                                                                                                                                                                                                                                                                 babies at childbirth

GAME-CHANGING PILOTS                                                                                                                                                                   In partnership with the Education Development
                                                                                                                                                                                                                                                to be a grandmother,” said Massa. “I want
                                                                                                                                                                                                                                                my daughter to complete high school
                                                                                                                                                                                                                                                and college before she starts to have her
                                                                                                                                                                                                                                                                                                    Nearly 600,000 women and 1 million newborns die

Solutions to some of the greatest health problems for girls and women exist, but delivering them in                                                                                    Center, PSI/Liberia launched a pilot within                                                                  every year from complications during childbirth. In
                                                                                                                                                                                       USAID’s Advancing Youth Program to promote               own children.” Massa and her 16-year-old
sustainable, cost-effective ways poses a barrier. PSI and partners on the ground have developed new                                                                                                                                                                                                 Uganda, PSI is arming community health workers
                                                                                                                                                                                       sexual and reproductive health among out-of-             daughter chose a contraceptive implant.
projects that change the way health is delivered and will make it easier for generations of girls, women                                                                                                                                                                                            with improved Safe Delivery Kits that can be used

and families to be healthier.                                                                                                                                                          school youth ages 13-35.                                                                                     at home or in a clinic. The kit contains:
                                                                                                                                                                                                                                             Donor: US Agency for International Development
                                                                                                                                                                                       The pilot is a week-long curriculum, culminating
                                                                                                                                                                                       in a one-day, community-wide celebration with
                                                                                                                                                                                       on-site HIV counseling and testing and family
                                                                                                                                                                                                                                             PILOTS THAT INTEGRATE
                                                                                                                                                                                                                                             LIFE-SAVING SOLUTIONS                                     SOAP          RAZOR         STERILE      GLOVES
                                                                                                                                                                                       planning services.                                                                                                                           CLOTH

                                                                                                                                                                                                                                                                                                    along with two additions – chlorhexidine (prevents

                                                                                                                                                                                                      1,350                                                1. Prevent cervical cancer
                                                                                                                                                                                                                                                                                                    newborn infections) and misoprostol (prevents life-
                                                                                                                                                                                                                                                                                                    threatening bleeding).
                                                                                                                                                                                                      out-of-school youth were reached by
                                                                                                                                                                                                      the program in the first six months.                                                          Supported by friend and philanthropist Sara Ojjeh.
                                                                                                                                                                                                                                             India bears one-fifth of the global burden of
                                                                                                                                                                                                                                             cervical cancer – about 74,000 deaths every
                                                                                                                                                                                                      72%                                    year. PSI will integrate cervical cancer screening
                                                                                                                                                                                                      received HIV counseling                and preventative treatment into India's existing                        3. Break the cycle
                                                                                                                                                                                                      and testing.                                                                                                      of violence
                                                                                                                                                                                                                                             network of private clinics to save millions of lives

“FOCUSED INVESTMENTS IN ‘GAME-CHANGING’ INNOVATIONS CAN                                                                                                                                                                                      from this easily preventable disease.

DRAMATICALLY IMPROVE HEALTH FOR THE POOREST BY INCREASING                                                                                                                                             1,481                                  Supported by friend and philanthropist Kathy Vizas.    One in three women is physically or sexually

THEIR ACCESS TO LIFE-SAVING INTERVENTIONS AND CARE,                                                                                                                                                   women received a hormonal
                                                                                                                                                                                                      contraceptive method.
                                                                                                                                                                                                                                                                                                    abused in her lifetime. In India and Trinidad and
                                                                                                                                                                                                                                                                                                    Tobago, PSI is addressing gender-based violence
PARTICULARLY AT THE COMMUNITY LEVEL.”                                                                                                                                                                                                                                                               through the provision of essential health services
                                                                                                                                                                                                                                                                                                    for survivors and transforming negative gender
Dr. Ariel Pablos-Mendez, Assistant Administrator for Global Health at the US Agency for International Development1
                                                                                                                                                                                                                                                                                                    norms within communities.

                                                                                                                                                                                                                                                                                                    Supported by Indrani’s Light Foundation.

 08                                                                                                 Quote as appeared in Trends Talk: Dr. Ariel Pablos-Mendez. Impact Magazine 12: 9                                                                                                                                                                     09
                                                                                                                                                                   ©Ollivier Girard
DELIVERING INTEGRATED                                                                                                                                                                INTEGRATED CARE                                          Between April and September 2013, the distributors
                                                                                                                                                                                                                                              provided:                                                 When couples like Lovemore and Fungai visit one of
                                                                                                                                                                                     FOR THE MAJOR                                                             95,605
                                                                                                                                                                                                                                                                                                        PSI’s 15 New Start clinics, they receive more than just

                                                                                                                                                                                     KILLERS OF CHILDREN                                                       children with antibiotic
                                                                                                                                                                                                                                                                                                        HIV counseling and testing. PSI provides integrated
                                                                                                                                                                                                                                                                                                        HIV prevention and treatment as well as sexual and
                                                                                                                                                                                                                                                               treatment for pneumonia.
The people we serve seek solutions for all their health needs – not just one. PSI provides integrated                                                                                South Sudan has one of the highest childhood                                                                       reproductive health and family planning services in

solutions to address the complex needs of the hardest-to-reach girls, women and families when, where                                                                                 mortality rates.                                                          120,636                                  a one–stop shop to protect Zimbabweans from their

and how they are needed.                                                                                                                                                                                                                                       children with oral rehydration           greatest health challenges.

                                                                                                                                                                                                                  1 IN 10                                      salts and zinc for diarrhea.
                                                                                                                                                                                                                                                                                                        New Start clinics provide the following services:
                                                                                                                                                                                                                  children dies before
                                                                                                                                                                                                                  the age of five.
                                                                                                                                                                                                                                                               children with artemisinin-                  • HIV counseling and testing
                                                                                                                                                                                                                                                               combination therapies for malaria.          • Counseling and referral for voluntary adult
                                                                                                                                                                                                          ALMOST 1/2                                                                                        medical male circumcision to prevent HIV
                                                                                                                                                                                                          of these deaths can be              Donors: UK Agency for International Development and
                                                                                                                                                                                                                                                                                                           • Screening and treatment for sexually transmitted
                                                                                                                                                                                                          attributed to malaria, diarrhea     the Global Fund to Fight AIDS, Tuberculosis and Malaria
                                                                                                                                                                                                          and pneumonia together.
                                                                                                                                                                                                                                                                                                           • Tuberculosis screening and treatment

                                                                                                                                                                                     PSI and partners – International Rescue                  COMPREHENSIVE CARE                                           • Point–of–care CD4 cell count and other HIV–

                                                                                                                                                                                     Committee, Save the Children, Malaria
                                                                                                                                                                                                                                              FOR THE GREATEST                                              related laboratory services
                                                                                                                                                                                                                                                                                                           • Antiretroviral therapy
                                                                                                                                                                                     Consortium, BRAC, and Catholic Diocese of
                                                                                                                                                                                                                                              HEALTH CHALLENGES                                            • Female and male condoms
“ONE ARGUMENT FOR INTEGRATION IS THAT YOU CAN HAVE THE ONE-                                                                                                                          Torit – are working with the government of South
                                                                                                                                                                                                                                                                                                           • Family planning services with a wide range of
                                                                                                                                                                                     Sudan to improve the health of children.
STOP SHOP SITUATION WHERE ONE, TWO, THREE TRAINED PROVIDERS                                                                                                                                                                                      Lovemore met Fungai a year ago. “We had
                                                                                                                                                                                                                                                                                                            options, including intrauterine contraceptive

CAN DELIVER SERVICES AT THE SAME TIME. WHEN YOU LOOK AT THE                                                                                                                          This partnership has equipped 7,862 community-              so much in common – both in our thirties,
                                                                                                                                                                                                                                                                                                            devices, implants and emergency contraception
                                                                                                                                                                                                                                                                                                           • Cervical cancer screening and cryotherapy
COMPONENTS OF AN INTEGRATED SYSTEM, IT IS VERY EASY TO SELL. IT                                                                                                                      based distributors in remote areas with the skills and      divorced with a child,” says Fungai. Recently,
                                                                                                                                                                                                                                                                                                           • Services for survivors of sexual abuse
                                                                                                                                                                                     drugs to diagnose and treat malaria, diarrhea and           Fungai saw a TV ad for PSI’s New Start HIV
MAKES SENSE FOR GOVERNMENTS TO BUILD AND PUT THIS TOGETHER.”                                                                                                                         pneumonia. They also learned to screen for acute            clinics, which showed a couple who tested for
                                                                                                                                                                                     malnutrition and refer severe cases of diseases to                                                                 Donors: UK Agency for International Development
Professor Babatunde Ostotimehin, Executive Director for UNFPA1                                                                                                                                                                                   HIV before getting married. With her wedding
                                                                                                                                                                                     health facilities.                                                                                                 and US Agency for International Development
                                                                                                                                                                                                                                                 to Lovemore fast approaching, Fungai thought
                                                                                                                                                                                                                                                 it was a good idea. “Lovemore and I are
                                                                                                                                                                                                                                                 starting a new life together,” she says. “We
                                                                                                                                                                                                                                                 should know each other’s HIV status, especially
                                                                                                                                                                                                                                                 since we’ve been married before.”

  10                                                                                    Quote as appeared in 7 Questions with Professor Babatunde Osotimehin. Impact Magazine 7: 5                                                                                                                                                                                11
                                                                                                                                                                      ©Eric Gauss
THE RESULT:                                                                                                                                                                 LAVERNE

HEALTHY, EMPOWERED                                                                                                                                                          “Those of us who live with HIV know each other and build informal networks,” says Laverne,                         “This question haunts me daily: How will

                                                                                                                                                                            a peer outreach worker in Belize. Laverne conducts home visits with people living with HIV and                     my daughter’s life be if I get HIV?” says
                                                                                                                                                                            AIDS. She talks about the importance of adherence to antiretroviral therapy, consistent condom                     Oanh, the wife of an HIV-positive injecting
                                                                                                                                                                            use, and proper nutrition, and provides referrals to a combination of preventative and care                        drug user and mother of a 10-year-old. When
PSI’s programs empower generations of girls and women to take control of                                                                                                    services. “When people notice that their friends stop their medication or stop going to the clinic,                Oanh’s husband first wanted to buy a new,
their health and the future of their families, communities and countries.                                                                                                   they ask us to go see them.” In just a year, Laverne and her colleagues increased by 300% the                      more expensive needle and syringe (N/S),
                                                                                                                                                                            number of people living with HIV and AIDS that PASMO (PSI’s local network member) reaches.                         she did not allow it. Later, PSI informed her
                                                                                                                                                                                                                                                                                               that the N/S reduces HIV and Hepatitis C
                                                                                                                                                                            Donor: US Agency for International Development
                                                                                                                                                                                                                                                                                               risk. Oanh and her husband tested negative

“ONCE WOMEN AND GIRLS                                                                                                                                                                                                                                                                          for Hepatitis C the very next day. “If the N/S

EXPERIENCE A MIND-SHIFT – THE                                                                                                                                                          WHITNEY
                                                                                                                                                                                                                                                                                               was available three years ago, my husband
                                                                                                                                                                                                                                                                                               might not have even gotten HIV,” she said.
KNOWLEDGE THAT THEY HAVE                                                                                                                                                               Liberia                                                                                                 Thinking of her daughter’s future, Oanh

POWER OVER WHEN THEY HAVE                                                   ARACELY
                                                                                                                                                                                                                                                                                               told her husband: “You should use the new
                                                                                                                                                                                                                                                                                               generation N/S. Better late than never.”
CHILDREN OR THAT THEY CAN                                                   El Salvador
                                                                                                                                                                                       “I use family planning,” said 18-year-old
                                                                                                                                                                                       Whitney, a veteran radio host and youth                                                                 Donor: Merck
TAKE ACTION TO INCREASE THEIR                                                                                                                                                          advocate. Whitney educated young girls
                                                                            “I know how hard it is to be a single mother. That’s why I can relate to
CHILD’S CHANCE OF SURVIVAL –                                                them,” says Aracely, who conducts combination prevention outreach
                                                                                                                                                                                       while she was a host on PSI/Liberia’s youth-

THEY START TO FEEL EMPOWERED                                                with female sex workers to prevent the transmission of HIV. “Most
                                                                                                                                                                                       centered weekly radio show, “Let’s talk about
                                                                                                                                                                                       sex.” Designed by youth, the show addresses                           DR. AYE AYE MU
IN OTHER AREAS OF LIFE AND ARE                                              women who are sex workers are single mothers, and do it so that they
                                                                                                                                                                                       youth-related health issues. As part of the                           Myanmar
                                                                            can support their children,” she adds. Aracely provides pre- and post-
BETTER ABLE TO LIFT THEMSELVES,                                             test HIV and sexually transmitted infection counseling for women in her
                                                                                                                                                                                       program, Whitney also distributed condoms
                                                                                                                                                                                                                                                             “My family has sought medical advice from Dr. Aye Aye Mu for over 10 years now,”
THEIR FAMILIES AND THEIR                                                    community. She also provides referrals to complementary or structural
                                                                                                                                                                                       to female sex workers, some of whom are
                                                                                                                                                                                       her age. Just last year, the show aired 176 live                      says Ma Ei Shwe, a 36-year-old mother of three. “Her clinic is open at convenient
COMMUNITIES OUT OF POVERTY.”                                                services, such as violence prevention, treatment for alcohol and drug
                                                                            abuse, and family planning services. Last year, the program reached
                                                                                                                                                                                       episodes and the program distributed more                             times, her medical products are affordable, and she always explains the options
                                                                                                                                                                                       than 840,000 condoms.                                                 available in a confidential and safe environment.” Dr. Aye Aye Mu is one of 1,500
Melinda Gates, co-chair of the Bill & Melinda Gates Foundation1             3,369 sex workers in El Salvador.
                                                                                                                                                                                                                                                             doctors who belong to PSI/Myanmar’s Sun Quality Health franchise. Annually,
                                                                                                                                                                                       Donors: United Nations Population
                                                                            Donor: US Agency for International Development                                                                                                                                   they treat more than 16% of TB cases nationwide, provide more than 1.5 million
                                                                                                                                                                                       Fund & the Global Fund to Fight AIDS,
                                                                                                                                                                                                                                                             reproductive health consultations, and treat approximately 60,000 cases of malaria
                                                                                                                                                                                       Tuberculosis and Malaria
                                                                                                                                                                                                                                                             and 100,000 children for pneumonia.

  12                                                                                       1                                                                                                                                                                                                                                                      13
                                                                                               Quote as appeared in 7 Questions with Melinda Gates. Impact Magazine 13: 4
THE PSI NETWORK                                                                                            DR. KRISHNA JAFA
                                                                                                                                                                     FINANCIAL STATEMENT                                                                                                                      VALUE FOR MONEY
                                                                                                           Dr. Krishna Jafa started her PSI career in India

                                                                                                           and Afghanistan. She then joined the US Centers           2012 REVENUE BY DONOR
                 HQ                                     Programs                                           for Disease Control & Prevention’s Epidemic
                  +                                         +
                                                                                                           Intelligence Service, after which she returned
                                                                Greater                                                                                                                Other                                                  41%
                                                                 on the
                                                                                                           to work for PSI in Zimbabwe. Today, she is Vice
                                                                                                           President of PSI’s Sexual & Reproductive Health &
                                                                                                                                                                     14%                                                                      U.S.
                                                 Systems                                                                                                             Foundations &
                                                                Ground         Stronger health of                                                                                                                                             Government
                                                                              the people we serve          Tuberculosis department.                                                                                                                                                                           With every $16.36 you invested in PSI in 2012,

PSI’s local partners lead health programming for the network in 69 countries around the world. These                                                                      15%                                                                                                                                 you added a year of healthy life.

strong, on-the-ground programs, with a lasting presence and deep local roots, are the backbone of the
                                                                                                           Dr. Jafa leads a team of more than 20 staff across             International
                                                                                                           three continents, supporting PSI network members                                                                                     Non-U.S.
PSI network. Together, we have added more than 245 million years of healthy life in the last 10 years.
                                                                                                           and partners with technical expertise, capacity                                                                                      Governments
                                                                                                           building, project management, and technical
                                                                                                                                                                                                                                                                                                              Australian Government Overseas Aid Program
GLOBAL SERVICES VALUE                                                                                      representation. Dr. Jafa is passionate about
                                                                                                           connecting local, regional and global technical           EXPENSES BY YEAR (IN MILLIONS)                                                                                                           Bill & Melinda Gates Foundation
                                                                                                                                                                                                                                                                                                              Canadian International Development Agency
                                                                                                           resources to improve quality of care for clients today
                                   2002                                               2012                 while strengthening local capacity for tomorrow.
                                                                                                                                                                         Program                Management & General                     Fundraising
                                                                                                                                                                                                                                                                                                              Centers for Disease Control & Prevention
                                   7.5 cents / dollar                                 6.5 cents / dollar                                                                               $502.2                                                                            $35.2                                ExxonMobil Foundation

                                                                                                                                                                     2012                                                                                                         $0.3                        Global Fund to Fight AIDS, Tuberculosis & Malaria
                                                                                                                                                                                                                                                                                                              KfW Entwicklungsbank
                                                                                                                                          “The PSI network                             $637.2                                                                                              $35.3
For every dollar invested in PSI, 93.5 cents goes to programs
that directly reach the people we serve. The rest – 6.5 cents –             93.5                                                          has invested in me         2011                                                                                                                          $0.4       Ministry of Health of Cambodia
                                                                                                                                                                                                                                                                                                              Ministry of Health of Malawi
                                                                           CENTS                                                          for over a decade,”
connects the network, providing members access to the following:                                                                                                                       $550.0                                                                                    $36.1
                                                                                                                                          says Dr. Jafa.
                                                                                                                                                                     2010                                                                                                                $0.3
                                                                                                                                                                                                                                                                                                              National AIDS Control Organisation of India
                                                                                                                                                                                                                                                                                                              Netherlands Government Ministry of Foreign Affairs
                                                                                                                                          “I’m thankful for
                                                                                                                                          the opportunity                                                                                                                                                     Three Diseases Fund
       • Knowledge and expertise of more than 8,900 employees worldwide.
                                                                                                                                          to work with a                                                                                                                                                      United Kingdom Department
       • Best practices and lessons learned help maximize efficiency.
       • Technical experts who help network members design and implement cost–effective
                                                                                                                                          diverse and highly         REVENUE BY YEAR                                                                                                                          for International Development
                                                                                                                                          skilled group of                                                                                                                                                    United Nations Children’s Fund
        programs, and provide technical oversight and quality control.                                                                    colleagues; to             2012               $546,449,232                                                                                                          United Nation’s Population Fund
       • Growth and transition within the network for high–performing, local staff.                                                       use marketing
                                                                                                                                                                                                                                                                                                              United States Agency for International Development
       • Strong financial and compliance oversight.                                                            techniques to make being healthy easier and           2011               $682,802,373
                                                                                                                                                                                                                                                                                                              United States Department of Defense
       • Vital support in proposal development, management, training, marketing, external                      more fun; and, to lead an outstanding team

        relations, procurement, contracts, research, metrics, and program management.
                                                                                                               committed to the health of our clients.”              2010               $585,021,282                                                                                                          World Health Organization

                                                                                                                                                                                                                                                                                                          *   Donors listed contributed a minimum of U.S. $1 million in 2012

                                                                                                                                                                     The figures on this page are excerpted from statements and schedules issued by PSI’s external auditors.
  14                                                                                                                                        © Laetitia Lemoine/PSI                                                                                                                                                                                                             15
                                                                                                                                                                     Copies of audited statements are available upon request from PSI in Washington, DC. Please email
LEADERSHIP                                                                                                                                EXECUTIVE LEADERSHIP
                                                                                                                                          KARL HOFMANN                                                                  JUDI HEICHELHEIM                         MARUSYA LAZO
                                                                                                                                          President & Chief Executive Officer         KRISHNA JAFA                      Senior Regional Director                 Director, Global Internal Audit
                                                                                                                                                                                      Vice President                    Latin America & the Caribbean
                                                                                                                                          PETER CLANCY                                Sexual & Reproductive Health                                               KIM LONGFIELD
                                                                                                                                          Executive Vice President & Chief            & TB                              MICHAEL CHOMMIE                          Director
COUNTRY LEADERSHIP                                                                                                                        Operating Officer                                                             Director                                 Research & Metrics
                                                                                                                                                                                      DOUG CALL                         PSI/Europe & Strategic
                                                                                                                                          KIM SCHWARTZ                                Vice President                    Partnerships Unit                        DANIEL MESSER
JAN AKKO ELEVELD           NICOLAS BETSI                ANTHONY OKOTH                SHAZINA MASUD        ALISON MALMQVIST                Senior Vice President & Chief Financial     Southern Africa                                                            Chief Information Officer
Angola                     Côte d’Ivoire                PS Kenya                     Nepal                Senegal                         Officer                                                                       ALAMELU DEIVANAYAGAM
                                                                                                                                                                                      LISA SIMUTAMI                     Acting Director                          CAROL SMITH
                                                                                                                                          BRIAN SMITH                                 Vice President                    People Department                        Senior Director, Procurement,
                                                                                                                                          Senior Vice President & Chief Strategy      East Africa                                                                Grants & Contracts
Bangladesh                 Côte d’Ivoire (AIMAS)        Kyrgyzstan, Kazakhstan and   Nicaragua            Somaliland                      & Resources Officer                                                           COLLEEN GREGERSON
                                                        Tajikistan                                                                                                                    MOUSSA ABBO                       Director                                 MARSHALL STOWELL
GUADALUPE HUITRON          ERIC SEASTEDT                                             LEGER FOYET          SCOTT BILLY                     KATE ROBERTS                                Senior Regional Director          New Business Development                 Director, External Relations and
Belize                     Dominican Republic           ROBERT GRAY                  Niger                South Africa (SFH)              Senior Vice President                       West & Central Africa                                                      Communications
                                                        Laos                                                                              Corporate Partnerships & Philanthropy                                         STEVEN HONEYMAN
MEGAN WILSON               NESTOR ANKIBA                                             BRIGHT EKWEREMADU    GUY ROGERS                                                                  MARCIE COOK                       Director                                 DAVID WALKER
Benin                      Democratic Republic of the   PIERRE-LOUP LESAGE           Nigeria              South Africa                    DESMOND CHAVASSE                            Senior Regional Director          Learning & Performance                   Director, Social Marketing
                                                                                                                                          Senior Vice President                       Asia and Eastern Europe
                           Congo                        Lesotho
                                                                                                                                          Malaria Control and Child Survival
CORNELIUS GAETSALOE                                                                  CHRISTOPHER CONRAD   NANA FRIMPONG
(ACTING)                   NURIA CANIZALEZ              REID MOORSMITH               Pakistan             South Sudan
Botswana                   El Salvador                  Liberia
                                                                                     SARATIEL KARICA      PAMELA FAURA
Burkina Faso
                           STACIANN LEUSCHNER
                                                        CHARLES SZYMANSKI
                                                                                     Panama               Swaziland                       BOARD OF DIRECTORS
                                                                                     SALVATORE GABRIELE   DR. SUSAN MUKASA
                                                                                                                                          FRANK LOY
ELIZABETH BROGAARD-        PILAR SEBASTIAN              SARAH GIBSON                 GANCI                Tanzania                                                                  BARBARA BUSH                        PUNAM KELLER, PH.D.                      BILL SANDERS
                                                                                                                                          Chair of Board, Former Undersecretary
ALLEN                      Guatemala                    Malawi                       Papua New Guinea                                                                               President & Co-Founder              Professor of Marketing                   President & Partner
                                                                                                                                          of State for Global Affairs
Burundi                                                                                                   ANDREW BONER                                                              Global Health Corps                 Tuck School of Business at Dartmouth     400 Capital Management LLC
                                                                                                                                          U.S. Department of State
                           SALIFOU COMPAORE             RODIO DIALLO                 SONIA MARCHEWKA      Thailand                                                                  New York, NY                        Hanover, NH                              New York, NY & Washington, DC
                                                                                                                                          Washington, DC
YASMIN MADAN               Guinea                       Mali                         Paraguay
                                                                                                                                                                                    FRANS ENGERING                      SALMA MAZRUI-WATT                        GOVERNOR TOMMY THOMPSON
Cambodia                                                                                                  KUASSI KONTEVI                  REHANA AHMED, M.D.
                                                                                                                                                                                    Former Netherlands Ambassador       Chief Executive Officer                  CEO
                           MARTIN FINNEGAN              RICARDO ROMAN                LUIZA ROTARU         Togo                            Reproductive Health Specialist
                                                                                                                                                                                    Netherlands Ministry of             Kibeni Ltd                               Thompson Family Holdings
AUGUSTE KPOGNON            Haiti                        Mexico                       Romania                                              Nairobi, Kenya
                                                                                                                                                                                    Foreign Affairs                     Nairobi, Kenya                           Madison, WI
Cameroon &                                                                                                ZACCH AKINYEMI                                                            The Hague, The Netherlands
                                                                                                                                          J. BRIAN ATWOOD, PH.D.
Central African Republic   JULIO ZUNIGA                 IULIAN CIRCO                 GALINA KARMANOVA     Uganda                                                                                                        GILBERT OMENN, M.D.                      REBECCA VAN DYCK
                                                                                                                                          Professor & Chair of Global Policy
                           Honduras                     Mozambique                   Russia                                                                                         KATHRYN A. FORBES, CPA              Professor of Internal Medicine, Human    Head of Consumer Marketing
MARINA HILAIRE-                                                                                           JOSSELYN NEUKOM                                                           Vice President Administration and   Genetics & Public Health                 Facebook
                                                                                                                                          Humphrey H. School of Public
BARTLETT                   PRITPAL MARJARA              BARRY WHITTLE                CAITLIN UNITES       Vietnam                                                                   Chief Financial Officer,            University of Michigan                   Menlo Park, CA
                                                                                                                                          Affairs at University of Minnesota
                                                                                                                                                                                    Electric Applications Inc.          Ann Arbor, MI
Caribbean                  India                        Myanmar                      Rwanda                                               Minneapolis, MN
                                                                                                                                                                                    Phoenix, AZ
                                                                                                          DR. NAMWINGA CHINTU
                                                                                                                                                                                                                        MALCOLM POTTS, M.D.
MARCELA CUBERO             CHRIS JONES                  LAVINIA SHIKONGO             MANASSEH GIHANA      Zambia                          DAVID BLOOM, PH.D.
                                                                                                                                                                                    SHIMA GYOH, M.D.                    Director of Bixby Center for
Costa Rica                 Kenya                        Namibia                      WANDERA                                              Professor, Department of
                                                                                                                                                                                    Chairman, Nigerian Medical &        Population, Health & Sustainability
                                                                                                                                          Global Health & Population
                                                                                     Rwanda (SFH)         LOUISA NORMAN                                                             Dental Council                      School of Public Health, University of
                                                                                                                                          Harvard School of Public Health
                                                                                                          Zimbabwe                                                                  Nkar, Benue State, Nigeria          California, Berkeley
                                                                                                                                          Boston, MA
                                                                                                                                                                                                                        Berkeley, CA

  16                                                                                                                     © Bouba Diarra                                                                                                                                                             17
PSI NETWORK                                                                                                                                  RUSSIA

                                                                        PSI / EUROPE

                                                                                                                                                   UZBEKISTA N
                                                                                                                                                      ●◆            KYRGYZSTAN
                                                                                                                                                 ●◆              TA JIKISTAN
                                    PSI / WASHINGTON                                                                                                                 ●◆

                                                                                                                                                           PAKISTAN              NEPAL
                                                                                                                                                           ▼■◆■                  ●▲ ■
                    BELIZE                    CARIBBEAN
                    ●■■              HAIT I                                                                                                                                         BANGLADESH
   MEXICO                                       ●■■                                                                                                                                    ■ ▼■
                                    ●■▲■▼                                                                                                                                 INDIA
    ●■                                                                                                                                                                                 MYANMA R     LAOS
                                                                                   MALI                                                                                 ●▼■◆■ ■                   ● ■ ◆▼ ■
                                                                                  ●▲▼■          NIGER
                      HONDURAS            DOMINICAN REPUBLIC
                                               ●■ ■               SENEGAL                         ■                                                                                          THAILAND  VIETNAM
                         ●■        JAMAIC A                        ●▼■            BURKINA                                                                                                        ●
                                    ●■ ■                                                                                                                                                              ●▼◆■ ■
          ●■           NICARAGUA                                                   FASO                                                                                                                            PHILIPPINES
                          ●■■                                         GUINEA        ●■        NIGERI A             SOUTH                                                                       CAMBODIA
                                                                      ●▲▼■                  ●■▲▼■◆■    CENTRA L    SUDAN           SOMALILAND                                                  ●▲▼■◆                    ●
                           PANAMA                                                                      AFRICA N ● ▲ ▼ ◆ ■              ■▼■
   EL SA LVADOR COSTA RICA   ●■                                                                       REPUBLIC                ETHIOPIA
     ●■■■          ●■                                                                                    ● ■                    ● ▼
                                                       SURINAME        LIBERIA             CAMEROON
                                                         ●■■           ●▼■                ●▲▼■◆■                      UGAND A
                                                                      CÔTE D’IVOIRE                    DEMOCR AT IC           KENYA
                                                                           ●▼                            REPUBLIC          ●▲▼■■■
                                                                                                         OF CONG O
                                                                                                        ●▲▼■◆                             RWANDA
                                                                             TO GO                                   UNITED REPUBLIC      ●▲▼■                                                                                      PAPAU
                                                                            ●■▲■                                       OF TA NZANIA                                                                                               NEW GUINEA
                                                                                     BENIN                  BURUNDI      ●▲▼■          MALAWI                                                                                     ●▲▼■ ◆
                                                                                    ●▲▼■                     ●▲■                     ●▲▼■◆
                                                                                                           ●▲▼■ ■■

                                                                                                                  ZIMBABWE               MADAGASCAR
                                                                                                   NAMIBI A       ●▲▼■◆                  ●▲▼■◆■ ■
                                                                                                   ● ▲▼ ■
                                                  PARAGU AY                                                              MOZAMBIQUE
                                                     ●■                                                    BOTSW ANA
                                                                                                              ●■          ●▲▼■ ■

                                                                                                        SOUTH AFRICA    LESOTH O
                                                                                                            ●■           ●■■

                                                                               ➤ HEALTH AREA KEY
                                                                               ● HIV = HIV                                         ▼ DD = Diarrheal Disease                                       ◆ RI       = Respiratory Illness
                                                                                                                                          Includes Safe Water,                                                 Includes TB and Pneumonia
                                                                               ■ CS     = Child Survival
                                                                                                                                          Oral Rehydration and Hygiene
                                                                                          Includes Nutrition                                                                                      ■ NCD = Noncommunicable Disease
                                                                                          and Neonatal Care                        ■ RH = Reproductive Health                                             Includes Cardiovascular
                                                                               ▲ MAL = Malaria                                            Includes Maternal Health                                        Disease, Cancers, Diabetes,
                                                                                                                                          and Family Planning                                             and Chronic Obstructive
                                                                                                                                                                                                          Pulmonary Disease
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