Reaching Women WheRe they aRe 2009/2010 Biennial Report

MissionVenture Strategies Innovations (VSI) is a nonprofit organization committed to improving women’s health in developing countries by creating access to effective and affordable technologies on a large scale.

VisionVSI’s vision is to make lasting improvements in the health of women in developing countries by creating access to life-saving and affordable health solutions for all.

ValuesEquity • Respect • Collaboration • Expediency • Accountability

Cover & inside Cover photo by kora image | ethiopia ©2011

I want to share Jacinta’s story with you. In rural Kenya, it’s a long road to the nearest health facility. It is even longer in the throes of childbirth. Jacinta felt her baby was coming soon. Having attended a prenatal care visit in a VSI project area of Maragua district, she understood the importance of getting to a health center to deliver. As a mother of two, Jacinta also knew the risks of childbirth. With the help of two community health workers, she began her arduous walk down the dusty clay road. Three tablets, stashed carefully in her bag, gave her peace of mind as she continued her journey. However, her labor proved too quick, and there on the side of a rural country road, she gave birth to her baby boy, Joseph. Looking back at her experience, Jacinta shared: “I have seen the goodness of misoprostol [tablets]. If you use it, there is no excessive bleeding. This time I didn’t bleed.”

Reaching women where they are is a principle that guides our work at VSI. Women are dying at alarming rates while proven solutions exist today. Our goal is to bring these solutions—like easy-to-use misoprostol tablets—directly to the places where pregnancy and childbirth are considered common killers. In 2009 and 2010, with your generous support, we made a tangible difference in the lives of thousands of women in Africa and Asia. Together we are reaching women like Jacinta wherever they may be—even the roadside.

VSI believes in a global imperative to act quickly. We choose programs that are both scientifically grounded and can be implemented at a large scale. We respect that people in developing countries possess the inherent capability to act on their health

needs. Our role is to support and equip them to do so. We believe that collaboration with those working on the ground is often the most effective way to have meaningful impact. We work closely with governments, other nonprofit organizations, and commercial businesses to bring solutions to women.

In these pages of our first biennial report, we share VSI’s values in action through three women:

Monaisha, a mother in Ulanga, Tanzania; Maria, a traditional birth attendant in Nacala, Mozambique; and Robey, a health extension worker in Kola Tembien, Ethiopia.

Women’s lives are important. Children, families and communities suffer when mothers die. Through your support, VSI brought a life-saving medicine to Monaisha, Maria, Robey and other women in 14 countries across Africa and Asia. We designed programs holistically: starting with women and working backwards to identify the channels to reach them. With this approach, we trained front-line health care providers, educated the public through women’s groups, community agents and media, and established a permanent supply of low-cost tablets in local markets. We also helped governments to integrate more effective solutions into their policies.

Thanks to the support of our contributors and partners, and guided by our shared values, we are making a difference. Thank you for giving through VSI. Together when we save mothers’ lives, we strengthen communities.

Melodie HoldenPresident/CEO and Founder

To our colleagues, friends, parTners and conTribuTors:

MonaishaMOTHER fROM ULANgA DISTRICT, TANzANIA

“Many mothers I know deliver [their babies] at home. If [a mother] encounters bleeding there will be no one to help her.”

Vsi b iennial reporT 2009/2010 5

“

on a huMid day in rural Tanzania, Monaisha sits on a bench with her sleeping baby, ramla, on her chest. The crowded prenatal clinic is abuzz with mothers waiting, cr ying babies on their laps. all three of Monaisha’s babies were born here—a rarity in Tanzania. after ramla was born, Monaisha swallowed three tablets of misoprostol, a generic medicine that pre-vents excessive bleeding af-ter childbir th, or postpar tum hemorrhage. This condition takes thousands of mothers’

lives in her country every year. after prenatal counsel-ing, Monaisha understood her risk and the impor tance of getting to the clinic to deliver, but points out that most of the women waiting with her at the clinic live in a neighboring village. Monaisha laments the distances women must trav-el when vehicles are scarce. When labor begins, women must walk and many will not make it to a clinic in time. she knows mothers who have de-livered on the roadside; not all have survived.

Through Vsi’s program, the clinic provides women with the oppor tunity to protect them-selves from bleeding—wher-ever they deliver. in a country where over 90% of pregnant mothers receive prenatal care, distributing misoprostol tab-lets at the clinic to use later is a safe solution for expect-ant mothers. Knowing the tab-lets’ benefits firsthand, Monai-sha shared, “since misoprostol came into my community, we have not seen a mother die. it will be very impor tant to have in the health facility.”2

This means every 90 seconds around the globe another woman’s life is lost prematurely in pregnancy or child-birth. We can change this.

VSI focuses on women’s health care solutions that are simple, effective, practical and—given our focus on the poor—affordable. For instance, in our largest program, we are promoting access to an inexpensive generic

medication, misoprostol, because it can prevent and treat some of the leading causes of maternal death globally—postpartum hemorrhage (excessive bleeding after childbirth) and complications due to unsafe abortion.

In VSI’s model, women can get life-saving medicines and services no matter where they are—whether in a medical facility or close to home, urban or rural.

Each yEar, ovEr 340,000 womEn diE of causEs rElatEd to prEgnancyand childbirth; 99 pErcEnt arE in dEvEloping countriEs.1

[My] sincere graTiTude To you and your respecTiVe office for The dedicaTion and supporT you haVe giVen To our counTry on reducing MaTernal MorTaliTy.”

—shadya a. Karume, former first lady of zanzibar

1. hogan mC, Foreman kJ, naghavi m, et. al. “maternal mortality For 181 Countries, 1980-2008: a systematiC analysis oF progress towards millennium development goal 5.” Lancet 2010; 375 (9726): 1609-23.2. this proJeCt was done in Collaboration with the iFakara health institute in tanzania and the bixby Center at the university oF CaliFornia, berkeley.

counTries We serVed in 2009 and 2010: bangladesh • eThiopia • ghana • Kenya • Madagascar

VSI works collaboratively with the public and private sectors to reach the largest number of women in need. Central to our success is our ability to work with coalitions of government, medical organizations and community stakeholders,

galvanizing these essential players to take action that advances women’s health. Track the 2009 and 2010 timeline to read VSI’s achievement of the following milestones in each of these core programmatic

areas—product registration, policy, training and operations research.

MisoprosTol MilesTones

“i carried The drug in My bag WhereVer i WenT. When The labor sTarTed, i reMinded My husband, ‘reMeMber ThaT drug ThaT i broughT hoMe froM anTenaTal? if i deliVer, please giVe iT To Me.’ i didn’T reach The healTh faciliTy and i deliVered on The road. i sWalloWed The TableTs ThaT Were pacKed in My bag. i didn’T experience bleeding and dizziness afTer TaKing MisoprosTol liKe i had in My Three preVious deliVeries.”

—doris phiri, Kapiri Mposhi district, zambia

JAN.

NOV.

MAR.

SEP.

MAY JUL.

Jul. 29 – Kenya is the 12th country to register misoprostol for PPH and the second country globally for use in PAC.

Jan. 14 – Zambia launches antenatal care (ANC) distribution of misoprostol program in five districts.

feb. 9 – Somaliland registers misoprostol for PPH, the 9th country to do so with VSI support.

May 4 – With VSI support, Mozambique becomes the 10th country to register misoprostol for postpartum hemorrhage (PPH), and the world’s first to register for treatment in postabortion care (PAC).

May – 588 birth attendants trained to prevent PPH at home births with misoprostol in our Bangladesh operations research project.

Sep. – Training of 178 traditional birth attendants (TBAs) and 56 ANC providers across three districts in PPH prevention operations researchin Mozambique.

Dec. – Kenya pilot launches, introducing misoprostol for PPH prevention at ANC and by community midwives across two districts.

15 14 13

12 11 10 9

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12 11 10 9

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12 11 10 9

Jul. 23 – With VSI support, Pakistan becomes the 11th country to register misoprostol for PPH.

May 10 – New York Times Mother’s Day op-ed on “A Birth Pill”: “There is an inexpensive medicine that could save a great many of these women’s lives—misoprostol.”

15 14 13

12 11 10 9

2009

Aug 20 – Supported by DANIDA, VSI completes training of 298 mid-level providers on misoprostol for PPH in Zanzibar. given demand, we train 427 more providers in 2010.

MalaWi • MozaMbique • nepal • nigeria • paKisTan • rWanda • Tanzania • uganda • zaMbia

in 2009 and 2010 Vsi faciliTaTed The iMporTaTion or donaTion of MORE THAN 2.4 MILLION TABLETS. When used, ThaT is enoughMisoprosTol TableTs To PROTECT 821,000 WOMEN in childbirTh.

fEB.

DEC.

APR.

OCT.

JUN.

AUg.

2010

Dec. 15 – With technical assistance from VSI, Nigeria becomes the first country in the world to endorse national guidelines for the use of misoprostol for PPH at the community level.

Sep. 30 – VSI project results met with commitment from Ministry of Health of Zambia. Permanent Secretary Dr. Mwaba: “It is a real way of reducing maternal mortality so that we can attain the Millennium Development Goals.”

Nov. 25 – The number ofrural health extension workers trained in misoprostol in Ethiopia reaches 1,274.

feb. 2 – Community-based PPH project results garner widespread enthusiasm at a dissemination meeting in Nigeria, resulting in a request for national guidelines on community-based distribution of misoprostol. “This tablet is saving the lives of our mothers, sisters and wives.” – Village Chief, Tsibiri

Mar. 1 – VSI unveils its website at www.vsinnovations.org

feb. 25 – VSI opens first country office in Addis Ababa, Ethiopia.

Jul. 29 – VSI and the Mozambican obstetricians and gynecologists association introduce misoprostol to address the high burden of unsafe abortion in Mozambique PAC pilot.

Aug. 4 – Zambia becomes the 4th

country to register misoprostol for PAC.

Jan. 18 – Malawi approves misoprostol for PPH and PAC, marking the 13th country to register the tablets with VSI support. This month also marks the 4th anniversary of the world’s first registration of misoprostol for PPH in Nigeria.

Jan. 28 – VSI’s safe motherhood project results met with support for scale-up by the Ethiopian federal Ministry of Health, prompting a large government order of tablets for its population’s needs.

Jun. 3 – Years of strategic advocacy lead to Ethiopia registering misoprostol for PPH, marking the 14th country to do so for this life-saving use. Also this month, VSI launches a PAC program in Rwanda with the generous support of the David and Lucile Packard foundation.

15 14 13

12 11 10 9

15 14 13

12 11 10 9

Oct 1 – In our Bangladesh research project, the number of pregnant women receiving clean delivery kits with misoprostol reaches 53,897, the most women ever reached in a study of its kind.

8 Vsi b iennial reporT 2009/2010

1 icon =

1,000 providers trained

17, 454 providers trained.Of those, 3,583 were providers working in facilities clos-est to communities. Additionally, 11,745 people, many of whom were community health volunteers, were made aware of the importance of misoprostol for these life-saving uses.

VSI has prioritized engaging the lowest tier of the health system to ensure that we reach women where they are with simple solutions to improve health.

In 2009 and 2010, VSI and its partners conducted 273

trainings on misoprostol for postpartum hemorrhage and/or postabortion care, directly training thousands of health care providers in valuable skills to improve women’s chances of surviving childbirth or an unsafe abortion.

ENGAGING THOSE CLOSEST TO WOMEN IN NEED

seVeral years ago the inter-national health community had largely given up on women like Maria, a traditional birth atten-dant. she lives in the coastal town of nacala, Mozambique where she volunteers her wisdom and skills to laboring mothers. she has caught countless babies born at home and often for only a ration of rice and the respect her skill commands in the vil-lage. she learned her craft from women before her, not from a formal nursing school. in the 1980s, ngos and government programs invested in special training of traditional birth at-tendants, but rates of maternal death simply did not drop as

was envisioned. birth attendants like Maria were deemed ineffec- tive—even harmful. and yet, even the most highly skilled doc-tor is incapable of saving a moth-er’s life without the right tools and medicines.

Vsi and the Mozambican obste-tricians and gynecologists associ-ation trained 178 traditional birth attendants like Maria to identify complications in pregnancy and childbirth and, for the first time in Mozambique, provided them with misoprostol tablets to address the bleeding that robbed children of their mothers in Maria’s com- munity for years. Maria believes in misoprostol. she has seen the tablets work and literally sings

their praises. she even stashed three tablets away to have on hand for her daughter’s delivery of her grandson, dario.

in Mozambique there are approximately 40 national ob-stetricians/gynecologists for 12.3 million women and girls. The scarcity of highly skilled providers is staggering and the challenge of reaching the thousands of moth-ers in a given year requiring care is daunting, unless you consider women like Maria. she is where doctors are not. she is sewn into the brightly colored fabric of her port town. When supported, equipped and linked to a strong referral network, women like Maria are saving lives.3

“My own belief and the belief of the Ministry of health is that traditional birth attendants are part of the coMMunity. we believe in coMMunity engageMent, coMMunity eMpowerMent and coMMunity participation. we need to engage theM.”

—dr. gebre ab barnabas, former head, tigray regional health bureau, ethiopia.

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3. this proJeCt was done in Collaboration with assoCiação moçambiCana de obstetras e gineCologistas, the bixby Center at the university oF CaliFornia, berkeley, and population serviCes international.

MariaTRADITIONAL BIRTH ATTENDANT fROM NACALA, MOzAMBIQUE

“We are so thankful. Before we had the tablets, our mothers would die. Now, we can stop the bleeding before it is too late.”

Our leadership combines backgrounds in clinical medicine, demography, program design and management, epidemiology, monitoring and evaluation, finance and public policy.

Vsi leadership

Melodie HoldenPresident/CEO and Founder

Ndola PrataDirector, Medical and Programs

Alexander KramerVice President, Finance and Accounting

Shannon Bledsoe Vice President, Operations

BOARD Of DIRECTORS

Robert (Nap) A. HosangChairman, VSI Board of Directors;Program Head, Interdisciplinary MPH Program,University of California, Berkeley School of Public Health

Martha M. Campbell President and Founder, Venture Strategies for Health and Development; Lecturer, University of California, Berkeley

Melodie HoldenPresident/CEO and Founder, VSI

April McMahonTreasurer, VSI Board of Directors;Enrolled Agent; Accounting and tax preparation business owner

Dominic MontaguAssistant Professor of Epidemiology and Biostatistics, University of California, San Francisco;Lead for the Health Systems Initiative, UCSF Global Health Group

“SPOTLIgHT: DR. NDOLA PRATA

Dr. Prata had spent the first part of her career in her native Angola, where death during childbirth is so routine that, ‘when a mother goes into delivery, she explains to her children that she’s going on a journey and that she might not come back. I’ve seen women die of postpartum hemorrhaging in front of me, and I still have nightmares, to be honest. You just watch them die.’ When she heard misoprostol could combat PPH, she had only one question: ‘How can I bring this to the women who deliver at home, to the real world?’

—The Globe and Mail, June 25, 2010, “When health and moral values collide” (Canada)

in My long career deliVering babies, There is no sadder MoMenT Than When a MoTher dies as a resulT of childbirTh. i ThanK The Many Willing parTners and conTribuTors Who supporT Vsi’s WorK. a liTTle can go a long Way and We haVe a unique opporTuniTy To MaKe a difference WiTh a siMple soluTion. no child deserVes To lose Their MoTher, so leT’s Keep WorKing TogeTher To MaKe ThaT a realiTy.”

—nap hosang, chairman, Vsi

“

RobeyHEATH ExTENSION WORKER fROM KOLA TEMBIEN, ETHIOPIA

“It brings me joy to be able to treat at-risk mothers and cure them. The women are happy to get this service from me. They used to take traditional remedies all the time and have many complications.”

Vsi b iennial reporT 2009/2010 13

aT age nineTeen, robey began helping WoMen. Where she lives, it is tough to be a woman, and pregnancy and childbirth often are fatal. for the last seven years robey has dedi-cated herself to serving women in Kola Tembien, ethiopia. she is a health extension worker and brings essential services to those who otherwise would have to travel for miles to receive care.

she bridges a critical gap from the village to the health system in a vast, rural country. from rudimentary health posts embedded in the community or through outreach at their homes, robey reaches women where they are. she is among tens of thousands of young women with at least a 10th grade

education and some additional training that the government has placed on the front lines to provide basic maternal and child health services.

robey is also among a group of 40 intrepid health extension workers we trained to pioneer bringing life-saving postabor-tion and early medication abortion services to women with a high risk of unintended pregnancy and harmful termi-nation practices. With a smile on her face and strength in her eyes, she recounts the story of a young woman she helped. The woman had arrived in robey’s care weak and bleeding badly after attempting to end her pregnancy with a toxic local plant. Miles from the nearest

emergency health facility, robey had the woman swallow three misoprostol tablets which ultim- ately saved her young life. The story is the same for other women experiencing miscar-riage, a botched abortion or a clear conviction that they cannot absorb another mouth to feed or end their education with an unintended pregnancy. This innovative program inte-grates a simple treatment with prevention: family planning and counseling—all within reach of women’s homes.

in the villages where they live and work, women like robey are the first vital link to better health, and are now equipped with a new tool to combat ma-ternal death and disability.4

COLLABORATIVE GLOBAL SOLUTIONS

VSI collaborates with Ministries of Health and a variety of organizations across disciplines to improve women’s health. The list below includes VSI’s partners with whom we conducted research and implemented programs during 2009 and 2010. These collaborations not only save lives, but strengthen communities, an accomplishment shared by VSI and our local partners.

aMua (Kenya)

associaTion of gynaecologisTs and obsTeTricians of Tanzania

associaTion for MoThers and neWborns (paKisTan)

associação MoçaMbicana de obsTeTras e ginecologisTas (MozaMbique)

associaTion of obsTeTricians and gynaecologisTs of uganda

bixby cenTer for popula-Tion, healTh and susTain-abiliTy aT The uniVersiTy of california, berKeley

byTrade Tanzania lTd

collège Malgache des gynécologues obsTéTriciens (Madagascar)

crs-nepal coMpany

danida

The daVid and lucile pacKard foundaTion

dKT, eThiopia

engenderhealTh, bangladesh

eThiopian MidWiVes associaTion

gerMan agro acTion

ghana healTh serVices

icddr,b

ifaKara healTh insTiTuTe

Kenya obsTeTrical and gynaecological socieTy

MadaWa pharMaceuTicals, lTd (Kenya)

Marie sTopes Kenya

Marie sTopes Madagascar

MidWifery associaTion of paKisTan

naTional coMMiTTee for MaTernal and neonaTal healTh (paKisTan)

naTional priMary healTh care deVelopMenT agency of nigeria

nepal ferTiliTy care cenTer

obsTeTrical and gynaecological socieTy of bangladesh

organizaTion for healTh educaTion research serVices (Kenya)

pace (uganda)

populaTion and reproducTiVe healTh parTnership (nigeria)

populaTion serVices inTernaTional

priVaTe nurse MidWiVes associaTion of Tanzania

reproducTiVe healThserVices (Kenya)

Tanzania MidWiVesassociaTion

Tigray regional healTh bureau

uganda priVaTe MidWiVes associaTion

uniVersiTy of california, san francisco

4. this proJeCt was done in Collaboration with the tigray regional health bureau and the bixby Center at the university oF CaliFornia, berkeley.

2009 and 2010operating expenses

$9.6 million

90.8 %PROgRAM

SERVICES

8.1 %gENERAL AND

ADMINISTRATIVE

1.1 %DEVELOPMENT AND

fUNDRAISINg

deliVering on our proMisefinancial report for fiscal years 2009 and 2010

During 2009 and 2010, VSI delivered safe motherhood programs valued at $8.7 million dollars to beneficiaries in 14 countries. During the two years, an average of 91 cents of every dollar spent was deployed in support of our programs, enabling us to serve more women in more places.

In this period, we released $9.9 million in previ-ously committed funds to deliver on our promise to our contributors and the women we serve. By the end of 2010, we were on solid financial footing, and responsible for more than $3.1 million in net assets.

Independent financial audit results for 2009 and 2010 demonstrate the financial discipline we have consistently applied to support our fiscal,

program and donor commitments. Internal con-trols in the United States, as well as in the field, ensure money is spent as intended. To manage growth, we are upgrading our accounting system to provide expanded reporting capacity.

Contributions to VSI are precious. It is incum-bent upon us to be responsible stewards of donor funds, ensure these funds are well spent, and ef-ficiently reach the women who stand to benefit the most from this generosity. We thank our con-tributors and partners who enable us to go the distance in pursuit of our shared mission.

Alexander KramerVice President, Finance and Accounting

“an independenT audiT of Vsi by Vasquez & coMpany, llp aTTesTs To The unqualified sTrengTh and inTegriTy of Vsi’s financial conTrol and reporTing sysTeMs. Managing parTner gilberT Vasquez adds, “accounTing records are in good order Which proVides a solid foundaTion for groWTh.”

OPERATINg SUPPORT AND REVENUE SOURCESgrants and contractsContributions in kindOther investment incomeNet assets released from restriction

Total operating support and revenue

PROgRAM AND OPERATINg ExPENSES

Program servicesgeneral and administrativeDevelopment and fundraising

Total operating expenses

Net assets, beginning of year 2009Net assets, end of year 2010

TOTAL$2,329,253

$50, 837$188,725

$9,991,260

$12,560,075

$8,701,347$776,086$102,906

$9,580,339

$10, 156,521$3,155,396

Complete financial statements are available by request. find VSI on www.guidestar.com.

WalK The lasT Mile WiTh us. TogeTher We can achieVe More.CONNECT www.youtube.com/user/vsinnovations

www.facebook.com/vsinnovations

www.linkedin.com/company/venture-strategies-innovations

WATCH Monaisha’s interview and meet others in her community at www.vsinnovations.org/monaisha Share it with three friends and spread the word of empowering women to help women, wherever they live.

gIVE through VSI at www.vsinnovations.org/donate-now. Support getting simple, innovative products into the hands of women who need them most.

conTacT inforMaTion

VSI Southern California (HQ)2401 east Katella avenue, suite 400anaheim, california 92806 usaTel +1 714 221 2040fax +1 714 221 2047

VSI Ethiopiap.o. box 80925axum buildingKirkos sub city 01/19addis ababa, ethiopiaTel +251 910 303 930

www.vsinnovations.org

VSI Northern California 2115 Milvia street, suite 4aberkeley, california 94704 usaTel +1 510 665 1880fax +1 510 665 1881

VSI Tanzaniaplot 168 old bagamoyo roadMikochenidar es salaam, TanzaniaTel +255 756 482 254

PhotograPhy: kora image (Cover, 2, 7,12 ) ©2011; videoCam ProdUCtioNS (6, 15) ©2011; Sameer kermalli (10) ©2011, vSi Staff: aliCe Cartwright (7) ©2010, amy groSSmaN (9) ©2011, martiNe holStoN (7,11) ©2009, ShiriNe mohagheghPoUr (6) ©2009, emma NeSPer (4,6,7) ©2010-2011, Natalie williamS (6) ©2010.

VSI is a tax-exempt 501(c)(3) nonprofit organization incorporated in the State of California.