Health and disease management in 2023

By 2035, 43 percent of India’s population—more than 675 million people—will live in cities. This rapid urbanization brings with it many challenges, from strained health systems to environmental degradation.

In the face of these challenges, PATH is spearheading urban primary health care (PHC) initiatives across the states of Jharkhand, Madhya Pradesh, Maharashtra, Manipur, and Odisha, including:

• Creating a network of 3,800 Urban Health and Wellness Centres and 278 polyclinics with the aim of enhancing access to care in urban slums and slum-like settlements.
• Training 100 health and urban department officials in joint planning, implementation, and bolstering of urban governance and health systems resilience.
• Using behavioral science approaches to understand the enablers of and barriers to access to care across different urban populations, and developing a community mobilization strategy that spans self-governance, localized planning, and community engagement.
• Harnessing cutting-edge technologies like Geographic Information System mapping, and championing integrated models of care for mental health and tuberculosis.
• Closing gaps in current supply chains by analyzing existing shortcomings and developing a roadmap for ensuring the availability of drugs and diagnostics.
• Supporting adoption of a One Health approach by bringing together key stakeholders from human and animal health at state and city levels.
• Promoting climate health resilience among urban communities and workplaces.

Through these efforts, and a shared commitment to excellence and collaboration, we’re not only supporting the future of urban health in India—we’re redefining it.

This work advanced the Improving lives with science and technology (P2) and Increasing health system capacity and resilience (P3) strategic priorities.

Integrated, person-centered care is central to strong PHC. This approach means putting people and communities—not diseases—at the center of health systems and designing services that meet their unique needs. In the Democratic Republic of the Congo, Ethiopia, Ghana, India, Indonesia, Kenya, Mozambique, Senegal, Ukraine, Vietnam, and Zambia, PATH supports local partners working to increase access to high-quality health services through integrated, person-centered approaches.

In Mozambique, PATH assisted the Maternal and Mental Health Departments at the Ministry of Health in testing the country’s first-ever protocol for screening and managing postpartum depression within routine postnatal care. Instituted in eight health facilities, the pilot showed the effectiveness of integrating mental health screening for new mothers: more than 70 percent of symptomatic cases of postpartum depression referred by nurses were confirmed by mental health technicians.

In Vietnam, PATH supported the development and scale-up of sustainable social enterprise PHC clinics that offer key populations a suite of integrated services, including HIV testing, pre-exposure prophylaxis (PrEP), antiretroviral treatment, and services for tuberculosis, viral hepatitis, sexually transmitted infections, noncommunicable diseases, mental health counseling, addiction management, and transgender health care through fixed, mobile, and telemedicine-based services adapted to the needs of clients in each locality.

In Kenya, our support to the Ministry of Health in developing and rolling out integrated PHC and community health worker policies transformed the way in which services are being offered. And in Uganda, we supported adolescent-led design of integrated family planning and HIV prevention (PrEP) services with the Ministry of Health.

This work advanced the Increasing health system capacity and resilience (P3) strategic priority.

Economic insecurity is a risk factor for HIV transmission. While biomedical HIV prevention interventions are key, truly effective HIV prevention programs must simultaneously address economic and social factors as well. That’s why since 2016, PATH has been working with county governments and partners in western Kenya to enhance access to HIV and preventive health services that integrate economic empowerment activities. The goal? To build individual and household resiliency and improve HIV and broader health outcomes for adolescent girls and young women (AGYW) and orphans and vulnerable children (OVC).

Programs for OVC provide parents and other caregivers with emergency cash transfers and business start-up support, and the Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS) program connects AGYW to entrepreneurship and professional training. In 2023, PATH’s DREAMS and OVC programming reached more than 106,000 youth and 28,064 OVC households.

The Chak a Chaka program, which was completed in 2023, took the DREAMS initiative a step further. The program employed an integrated approach to support 1,225 DREAMS-graduated young women in Kenya to form and register savings groups and build access to enterpreneurship opportunities and finances to address the structural economic barriers that contribute to increased HIV vulnerability. This integrated approach included economic empowerment activities to build financial capability as well as complementary, gender-sensitive health, professional, and community networking and education interventions.

The results were far-reaching: across 49 savings groups, young women were able to grow their businesses and use savings for everything from funding their own health insurance to paying school fees, and reported positive changes in household decision-making power with their partners and knowledge about HIV prevention.

This work advanced the Increasing health system capacity and resilience (P3) strategic priority.

While tuberculosis (TB) is curable, the diagnosis can create challenges and stress—especially for children, who may not fully understand the disease, the tests and exams required, or the multi-month course of treatment. Comprehensive, integrated support for children and their families can help. That’s why PATH’s Support TB Control Efforts in Ukraine project, funded by the US Agency for International Development (USAID), launched Ukraine’s first-ever multidisciplinary resource rooms for children and adolescents on TB treatment.

Children play with toys, games, and books in the safe and fun environment of a resource room while they receive care from a multidisciplinary team comprising a pediatric TB specialist physician, psychologist, and social worker who provide health education, child development counseling, and social and psychological support to them and their families.

“The presence of a space where children receive a friendly attitude, psychological support, the opportunity to play and learn something new, gives them the opportunity to take bright memories of childhood into the future. This approach makes it possible for children to overcome fear, stigma, and everyday life challenges in order to successfully complete TB treatment,” shared PATH’s Natalia Zaika, Senior Program Officer.

In the first six months of use, the resource rooms have already been a success, with parents reporting that the services are appreciated and useful. To date, 109 children and adolescents and 31 parents have used the available services, and 12 children have successfully completed TB treatment. The integrated approach of the multidisciplinary teams, combined with the introduction of modern TB diagnostics, adherence support tools, and treatment methods, has enabled a people-centered approach at the PHC level that supports families with TB on all fronts.

This work advanced the Increasing health system capacity and resilience (P3) strategic priority.

The conflict in northern Ethiopia (2020–2022) resulted in mass casualties and displacement, while also devastating the PHC system. Conflict, loss of loved ones, displacement, and trauma are associated with poor maternal mental health (MMH) and developmental delays in children. However, too often, PHC reconstruction does not include MMH and early childhood development (ECD) support. Through 2022 and into early 2023, PATH partnered with the Amhara Regional Health Bureau and six woredas affected by the conflict to integrate MMH and ECD into rebuilding efforts at 18 health centers and 81 health posts.

Health facility–level providers were trained to set up play areas in waiting rooms, monitor child development, screen for maternal depression, and counsel caregivers on psychosocial well-being and ECD topics like responsive care and early learning. Health extension workers were trained to conduct mother-baby support groups for pregnant women and mothers of young children, which aimed to improve MMH and parenting practices in nutrition, responsive caregiving, and early learning.

In total, more than 700 health care providers were trained, and more than 100,000 under-5 children were developmentally monitored—of whom 1,310 had suspected developmental delays. All health centers and 31 health posts established play areas. In addition, 16,222 women were screened for maternal depression, of whom 218 were confirmed to have mild depression and subsequently linked to support groups. Participation in mother-baby support groups was associated with reduced mild depressive symptoms: from 44 percent of women at the start to only 4 percent at the end. Participants’ knowledge of how to support their children’s development and nutrition also increased, with average scores rising from 31 percent to 61 percent.

This work advanced the Preparing for and responding to emerging health threats (P1) and Increasing health system capacity and resilience (P3) strategic priorities.

2023 PATH annual report
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