Examining Maternal Health Trends in Uganda


By, Elizabeth Tenney, Public Health Intern at PMI

With the United Nations Sustainable Development Summit this past weekend, I thought maternal health would be a great focal point for this post. It’s one of the targets under Sustainable Development Goal 3, which aims to “ensure healthy lives and promote well-being for all at all ages.”(1)

Poor maternal care is a leading global development challenge, especially in Africa. This deficit accounts for about half of the world’s maternal deaths. There has been very little progress towards reducing maternal mortality, and most of these deaths are due to a lack of prenatal care coverage and skilled attendance at delivery.(2)

Determinants of maternal health services utilization in Uganda takes a close look at the predictors of utilization for maternal health services (MHS).(3) In other words, it investigates the factors that affect new and expectant mothers’ decisions to seek healthcare.

Andersen’s behavioral model of health service was used to examine these various factors. It states, “A family’s use of health services depends upon its (1) predisposition to use services, (2) ability to secure services, and (3) need for services.”(4)

The authors conclude that use of maternal health services in Uganda varies widely by demographic characteristics and socioeconomic status. Women with higher levels of education, in urban areas, and with a higher income were most likely to use the desirable maternal health services package. This package is characterized by four visits before the birth, assistance of skilled personnel during delivery, and a post-natal check-up within two days of delivery.

While I was not surprised that women from the higher end of the socioeconomic spectrum were most likely to use MHS, I was shocked to find that 90% of the women in the study fell into the category of the undesirable maternal health services package. In this category, women had no visits before delivery, did not have a skilled attendant during delivery, and did not receive a post-natal check up afterwards.

I found the cultural explanations very interesting, especially because they can vary from region to region. Regarding cultural values and norms, “Ugandan women adhere to very traditional birthing practices and believe that pregnancy is a test of endurance and maternal death is merely a sad but normal event.”(5) In some districts of Uganda, pregnancy and childbirth are areas where women command power and status. They can harness this power in order to gain status within their households and communities. In other areas of the country, women feel they have the most power during the birthing process and it gives them a sense of control that they may not have in other aspects of their lives. The article explains “in some Ugandan societies, women are considered to be strong and independent if they can handle the birthing process by themselves,”(6) which makes them less likely to use MHS.

Other determinants that could affect women’s decisions were found through a study from a rural district in Eastern Uganda.(7) It found eight independent factors that contribute to the likelihood of women to deliver in a health facility. Some of these include being of high socio-economic status, previous difficult delivery, having less than four children, access to transportation, and being able to make an autonomous decision to seek care.

In summary, the women who need the most attention are in the lower-income categories, have no education, and live in rural areas. Ugandan culture also poses a challenge to maternal health indicators. So, one should consider “the nature and scope of the population groups that are most affected”(8) before implementing an intervention.

These findings exemplify the inverse care law, where those who need the most care are the least likely to receive it. Generally speaking, countries that have made great progress in the area of maternal health have progressed in a similar manner. “Coverage has increased first among the urban rich, followed by the rural rich and the urban poor, with access among the rural poor the last to be achieved.”(9)

Palmetto Medical Initiative recognized the need for maternal health services in rural Masindi, Uganda and, in October of 2012, the Masindi-Kitara Medical Center opened the doors to its maternity center. The center provides new and expectant mothers with a labor and delivery room, recovery ward, and operating theaters.

  1. (Neal, 2015, p.1)
  2. (Rutaremwa, 2015)
  3. ibid
  4. (Kehrer, 1972, p.125)
  5. (Rutaremwa, 2015, p.6)
  6. (Rutaremwa, 2015, p.6)
  7. (Rutaremwa, 2015)
  8. (Rutaremwa, 2015, p.7)
  9. (Neal, 2015, p.2)

Works Cited:

Kehrer, B. (1972). A Behavioral Model of Families’ Use of Health Services/Paying the Doctor . Journal Of Human Resources , 7 (1), 125.

Neal. (2015, June 16). Universal health care and equity: evidence of maternal health based on an analysis of demographic and household survey data. International Journal for Equity in Health.

Rutaremwa. (2015, June 16). Determinants of maternal health services utilization in Uganda. BMC Health Services Research.

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PMI Roots: How Needtobreathe Moved a Passionate Community in Stillwater, Oklahoma to get Involved

Needtobreathe and PMI in Stillwater, OK

By, Steve Carpenter and Joe Ogle – PMI Donors, Volunteers and all-around Rock Stars

How did you first hear about PMI?

Steve: I had the opportunity to work with the guys from Needtobreathe on a fundraiser concert where PMI was one of the beneficiaries, here in Stillwater, OK. That is where I first met Dr. Ed O’Bryan, who shared the PMI vision before the show with the concert supporters and invited me to go to Africa.

Joe: I first heard about PMI through the Needtobreathe fundraiser concert here in Stillwater in October, 2013, as well. Steve had worked to bring the band to town and there were three different organizations that benefited from the event, including PMI. Dr. Ed O’Bryan and some of the PMI staff attended the concert and had an information tent. It was there that I began the conversation that quickly turned into volunteering for a trip in Uganda (December 2014). Through meetings and conversations with other friends and colleagues, seven people from Stillwater ended up going on that trip.

What drew the Stillwater community together to support the vision and mission of PMI?

Steve: I believe the common thread of our involvement falls right in line with what our friends at PMI are doing. They have answered a call in their lives to be part of something extraordinary by giving through their time and talents and having faith that they are part of a much larger plan.

Joe: For me personally, it was an opportunity to be part of a mission that focuses on meeting the medical needs of people. As I began having conversations with others in our community, I found that there are many others in Stillwater that have the same longing. To be able to meet the immediate health needs of a person is a very fulfilling encounter. Deep down, all of us want to be able to “make a difference.” This is the kind of work in which we can see an immediate result of being able to use the talents and skills God has given us.

Our community is quick to volunteer and be engaged in missions work (e.g. Joplin, MO, after a devastating tornado; Haiti after the earthquake in 2010; Working with orphanages along the US / Mexican border), so it was absolutely no surprise to see the immediate support of the work PMI is doing in Central America and East Africa.

You all are big fans of Needtobreathe, can you talk about how their support for PMI has played a role in raising awareness about healthcare around the world?

Steve: Needtobreathe is committed to growing awareness and support for PMI. They have created a unique partnership and present all kinds of opportunities for PMI. They have been on PMI trips. As my involvement has grown, it is amazing how many people on a medical trip or at the Needtobreathe Charity Golf Classic mention that they first heard about PMI at a NTB show.

Joe: The obvious answer is that so many people are exposed to PMI through Needtobreathe and their music. On our trip to Uganda in December, 2014, there were at least 10 people on our team that had heard about PMI initially through some sort of Needtobreathe connection. From me seeing them at a fundraiser event, to my new friend Erin that noticed a part of her Needtobreathe concert ticket payment went to support PMI, the guys in the band are taking a leadership role in getting the message out to a receptive public regarding the needs that exist and the opportunities to impact those needs through PMI. I can tell you that they don’t just pay “lip service” to supporting the work that PMI is doing. They’ve been there on trips, rolled up their sleeves, counted pills, carried people too sick to walk, distributed reading glasses, built seating systems for toddlers too weak to sit up on their own, played with kids, and prayed with families.

Professionally, the band has played at sold-out venues to tens of thousands of people. They just wrapped up a world-wide tour including Australia and the UK. That said, one of the most beautiful pictures I have ever seen is that of Seth Bolt playing his guitar to an audience of one…to soothe the soul of a frightened child. For that week in Africa, they were there as volunteers and were donating their time and talents, just like the rest of our group.

There was a private Needtobreathe concert offered during the 2015 Golf Classic. The show ended up being in Stillwater, tell us more about how the event went.

Steve: The buzz created by the first fundraiser show here in 2013 made it real easy to collectively raise the $25,000 donation to the auction from our community…..everybody was pumped to host the guys again. The show was phenomenal. They played an acoustic set and totally captivated the small crowd of supporters, plus gave us the opportunity to continue to raise awareness for PMI. Needtobreathe arrived in Stillwater after 4 straight days of shows in Albuquerque, Dallas, Las Vegas and Tucson. They played our show on the 5th night, something they rarely, if ever, do. To me, this was a prime example of their commitment to PMI and the sacrifices they make for something they love.

Joe: I was a little worried, to be honest, that the concert was going to be a little bit of a let-down. Let me explain: The first Needtobreathe fundraiser in 2013 was just an awesome event. It was outside, the weather was perfect, the performance by the band was incredible, more money than was expected was raised, our friend (Stillwater native) Matt Holliday made a presentation….it really was one of those events where you could tell there was something “bigger” involved. So, in my mind, I thought there was no way the 2015 PMI benefit concert could measure up.

I was wrong. The show was every bit as memorable, but in a totally different way. We had new friends from as far away as Illinois; Houston, TX; Auburn, AL; Baton Rouge, LA; and College Station, TX, come for the show. We were able to find and book a perfect theater to serve as our venue on the campus of Oklahoma State University. There were so many people that were able to lend their talents to making the show literally a “once-in-a-lifetime” experience. From stage design, to lighting, to sound expertise, to photographs from PMI trips to decorate the lobby, to a facility to host a reception….everything came together in a way that none of us expected. Once again, I was convinced that this event was a “Divine Appointment” for all of us that were in the room that night.

As a result, at least two additional groups are currently in plans for future PMI trips to both Nicaragua and Uganda.

Thank you to Steve, Joe and the entire Stillwater community for your continued support. We are blown away by your passion and drive to pursue a greater good and go out into the world to make a difference. We are forever grateful for what you are doing to get others involved, fundraise and especially for the time you sacrifice to go on trips and serve others.

Changing the Focus: USAID Highlights the Importance of Sustainability

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Ambassador Alfonso E. Lenhardt, the Acting Administrator of USAID, speaks to the Faith Works luncheon.

By, Michael O’Neal, PMI’s Director of International Projects

On September 22, PMI was graciously included in the Faith Works luncheon in Washington D.C. Ambassador Alfonso E. Lenhardt, USAID Acting Administrator, hosted the event. The purpose of the event was to bring together a diverse cross-section of religious leaders, representatives of faith-based/faith-inspired organizations and government officials to recognize and further our common work in advancing peace, prosperity and development around the world.

The world is on the threshold of shifting the strategy and approach to international development as the Millennium Development Goals (MDG’s) come to an end and the Sustainable Development Goals are adopted (SDG’s). In the last 25 years, we have seen great gains made in lifting some the worlds least advantaged out of poverty. For example, a child born today is two times as likely to survive into adolescence as in 1990. International development efforts have had a tremendous impact on breaking the cycle of poverty for many of our brothers and sisters around the world. However, it is not enough. Faith communities, development organizations and governments have noticed for many years the salience of partnerships with the stakeholders in communities where we serve. Additionally, the development community has unanimously spoken out to say that we must go beyond relief and invest in long-term sustainable solutions to many of the world’s problems. The very title of the new development goals, Sustainable Development Goals, which intend to carry the efforts of eradicating poverty through 2030, is encouraging! Sustainability is at the center of our efforts for long-term change and transformation.

It was an incredibly encouraging day to be surrounded by the best minds in the field. With an opportunity to hear Pastor Rick Warren, Ambassador Lenhardt, Gayle Smith, Ambassador Saperstiein, and others expressed the importance of working WITH the developing world to create innovative and lasting solutions to poverty. PMI is thankful for the opportunity to serve alongside our partners and friends both domestically and internationally, to see lasting change! We look forward to investing our minds, resources and time into sustainable healthcare solutions for our friends in Uganda and Nicaragua for years to come

Additional Photos from the Event:

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Jars of Clay, affiliated with Blood Water Mission, performs at the luncheon.


Gayle Smith, Special Assistant to the President and Senior Director for Development and Democracy, speaks at the luncheon.

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Ambassador David Saperstein speaks at the Faith Works luncheon.


Pastor Rick Warren, of the PEACE plan and Association of Related Churches, addresses the luncheon.

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International Youth Day


By, Lynda Krisowaty, A Peace Corps Volunteer Leading MKMC’s public health education program

On August 12th, 17 members of MKMC’s youth group and 5 students from Kamurasi Primary School, a fellow Peace Corps volunteer’s site, came together to celebrate International Youth Day. Observed each P1010446year, and endorsed by the United Nations, International Youth Day helps highlight issues pertinent to youth around the globe.

This year’s theme emphasized the importance of youth civic engagement. To demonstrate their concern for the community’s wellbeing, youth learned about environmental health concerns such as the harmful effects of not disposing of trash properly and the burning of plastics. In Uganda, environmental health is not emphasized or routinely taught, so the disposal of trash and burning of plastics often leads to the creation of breeding grounds for various germs and disease carrying vectors such as typhoid and mosquitoes which carry malaria, contaminated water supplies and crops, in addition to health problems such as cancer, birth defects, and respiratory tract infections. Youth then learned how to reduce their consumption of plastic as well as creative ways to reuse plastic bottles and bags.

P1010468 Following the learning activity, youth collected trash on the road from MKMC to Kijura Market. Along the way, they put their teaching skills to good use and educated over 50 community members about environmental health issues. The community was genuinely interested in learning ways they can assist in improving their environment, and youth group members are excited at the prospect of organizing other environmental health activities.



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Thoughts from the PMI Team on The Global Goals 

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Today, the United Nations is meeting in New York. Over the course of the weekend, they will be discussing some very important topics, including The Global Goals. The Global Goals, which are formally known as the Sustainable Development Goals, will be replacing the expiring Millennium Development Goals. Team members here at PMI have shared their thoughts on The Global Goals. And, last night, our Co-Founder, Dr. Ed O’Bryan gave a speech before the ONE campaign on The Global Goals. Excerpts of his speech are included below.

PMI’s Director of Operations, Tyler McCoy:

Global Goal #9 (Industry, Innovation and Infrastructure): What we have found working in the developing world are intelligent and talented individuals who are incredibly innovative in their solutions. It is really quite simple to spend money and resources to correct a problem, but if you are able to solve problems in the absence of all that then you are able to do really big things. And that is something that we would love to see more and more of around the world–smart and innovative people, in our case, changing the scope of healthcare.

PMI’s Special Projects Coordinator, Claire Kendall:

Global Goal #4 (Quality Education): Every country needs leaders with evolved sets of ethical values to step up and make objective and informed decisions to improve the status quo without fear. This is how sustainable efforts even begin to gain admittance into developing countries. But how will we make changes if no one has empowered us to think deeply about our own human existence, if no one has challenged us to live for something outside of ourselves, or given us access to the minds of others who were great before us?

PMI’s Central America Director, TJ McCloud:

Global Goal #8 (Decent Work and Economic Growth): While we are a medical NGO, and the obvious answer is #3 (Health & Well-Being), I find myself most excited about # 8 (Decent Work & Economic Growth), that is; building a sustainable market for healthcare that not only gets people the care they need for accessible prices, but also creates jobs and opportunities in areas that desperately need the employment growth our clinics represent. The great thing about so many of these SDG goals is that they are interconnected and complementary. Better economic growth can create opportunities for better health, gender and income equality, peace and justice, public infrastructure… and each of those, in turn, can generate more economic growth!

PMI’s Co-Founder, Dr. Ed O’Bryan: 

What kind of impact are we having when people are struggling so desperately that they are willing to get a disease as severe as HIV just to have their basic needs met?

That’s why the “17 Goals Global Goals for Sustainable Development” are so important. They’re comprehensive. They don’t leave people with partially unmet needs. They restore dignity, they foster opportunity, and they foster hope. These are all things that we are blessed with in abundance. FullSizeRender

As a founder of PMI, I have seen firsthand what a small group of dedicated individuals can accomplish.

Since 2008, PMI and its small staff in the US and abroad, have built four sustainable medical centers in Uganda and Nicaragua that have treated over 125,000 patients and saved countless lives.

The majority of our work has been in relation to healthcare, but good health truly spans the spectrum of the sustainable development goals.

For example, goal #3 – we live in a world where no child has to die from diseases we know how to cure and where proper healthcare is a lifelong right for all of us.

There is a lot of press and focus on HIV, but do you know that diarrhea kills almost twice as many people annually?

Also, simple flu and pneumonia, easily treatable diseases, kill over twice as many people a year as HIV.

Here in the States, we can go see the doctor, get some antibiotics, and we are all good…but in fact 80% of the world doesn’t have this luxury. The Global Goals for Sustainable Development will help to:

  • Ensure the belief that all are created equal and all will have equal access to appropriate healthcare;
  • Establish community change possible at the intersection of quality and accessibility;
  • Change cultural attitudes towards health and the impact it is making in the world: This is one of the most important things we have seen in Uganda, Nicaragua, and beyond to have individuals take ownership of their health.

Good health promotes other Global Goals for Sustainable Development.

For example, number 8 – good jobs and economic growth. PMI’s model to empower local doctors, medical professionals and administrative staff to run clinics and address the immediate needs. MKMC is a great example of long term sustainability and how the staff there grew so quickly; up to 75 staff in one hospital within just a few years. That’s jobs, development, and opportunity.

Along with healthcare, economic development, and education comes the eradication of prejudices which leads us to Global Goals number 10 – We live in a world where prejudices and extremes of inequality are defeated – inside our countries and between different countries.

Equal access to healthcare, education, and opportunity leads to understanding our differences and severing the seemingly ever-increasing gap between the 1% and the 99%.

Should we feel comfortable living in a society where the physician density is 1 doctor for every 1,000 people, while in some parts of the world, especially in Africa, the rate is close to 1 for every 200,000? That would be equivalent to me being the only doctor in ALL of Charleston.

Should we feel comfortable living in a world where babies die at a rate 10 times of babies here?

“Dignity” is a core value at PMI, as well as ONE, and goal #10 will restore that dignity.

And the final Global Goal I will mention tonight is #17 – We must live in a world where all countries and we, their people, work together in partnerships of all kinds, to make these Global Goals a reality for everyone.

Partnerships are key and the sky is the limit when we work together. No one can do this alone! But it all starts with a decision.

On September 25th, 2015 193 world leaders will commit to 17 Global Goals to achieve extraordinary things in the next 15 years. End extreme poverty. Fight inequality and injustice. Fix climate change. The Global Goals for Sustainable Development could get these things done. In all countries, for all people.

This is not a decision we take lightly. I am here tonight to prove to you that no matter how unprepared, how under-educated, or how you may feel of limited you- you are not. You have already made the decision to support those in need, and in partnership with wonderful organizations like ONE, you are proving that you’re willing to do what it takes to make a difference. Thank you!

Sustainable Development Goals and What That Means for International Development


By, Aaron Stroud-Romero, PMI’s East Africa Director

You may have been hearing a lot about “The Global Goals” but are confused as to what that exactly means for the future of international development. Our East Africa Director explores the goals in more detail. Stay tuned this week for more thoughts on these goals by the rest of our team here at PMI, as well as highlights from a speech on these goals that our Co-Founder, Dr. Ed O’Bryan, is delivering in Charleston this evening.

There has been a ton of chatter in the last couple of weeks around the Sustainable Development Goals (SDGs), also known as The Global Goals. These are the proposed targets that will be officially adopted at the United Nations Sustainable Development Summit this weekend. A big part of the discussion is actually around how to create buzz around these new development goals (see this story from NPR), which are replacing the Millennium Development Goals (MDGs) that ran from 2000 – 2015.

The Global Goals will set the agenda for international development for the next 15 years, by helping to direct action and build coalitions. The MDGs brought a whole new focus to the discussion of development. They took a concept that all of us in the development field are familiar with, creating and measuring progress towards goals on a project level, and applied it to the macro level. While we haveGoal 3 also been measuring poverty, health, and education outcomes for a long time, the MDGs galvanized the development world around meeting a set goal. Although not every MDG was reached (look for another post in the next month on the success of the MDGs), there was incredible progress made on all.

There are 17 SDGs, and while the goals themselves are pretty generic, there are a number of targets under each goal, which make the path to achieving the goal clearer. For example goal number three is “Ensure healthy lives and promote well-being for all at all ages”, but most of the targets under this goal are more concrete:

Target 3.1
By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births
Target 3.2
By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births

To put these in peGoal - 3rspective the World Bank estimates that around half of the countries, which report in their database have maternal mortality ratio’s above 70 per 100,000. Here in Uganda the rate is 360. That is a major reduction from 740 back in 1995, but is still a long ways from 70. Neonatal and under-5 mortality rates are also a long way from reaching these targets. More than 40% of countries report rates above target 3.2. Uganda will need to more than half its current rate of 54.6 under-5 deaths. One positive area is that the neonatal mortality rate has dropped by 42% in just the last 15 years. If that pace continues Uganda will have more than achieved this target.

There is a long road ahead and a lot of work to be done, but if we can continue to make the kind of progress that has been made in the last 15 years, I know that 2030 will be a much healthier, happier, and prosperous world for us all.

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PMI Roots: An Interview with Bill Rose


Bill Rose was our first Project Director in Nicaragua. We are so grateful to him and his wife Ally for their passion, time and commitment to PMI and the people of Nicaragua. Read more below on how they got involved and they impact they were able to make.

How did you first hear about PMI?

I first heard about PMI when I was in Grad School at Eastern University studying International Development. Michael O’Neal was in my cohort and I got to learn all the ins and outs of what PMI does and wants to do in developing nations. Michael and I had a lot in common and quickly built a friendship on our common world views and previous time in the for-profit world. At this time, PMI was just getting started in Uganda and it was great to hear stories from Michael on the excitement and challenges of implementing the PMI model in the Ugandan context. Before we graduated I remember mentioning to him that if PMI ever expands to Latin America please let me know as I would love to be a part of this type of non-profit organization in the region of the world that is so close to my heart. About 3 months after that conversation I got a very exciting call from Michael letting me know that, sure enough, PMI had plans to implement its sustainable model in Nicaragua. It didn’t take much time for me to change up my life and the next thing we knew our bags were packed and we were moving to Nicaragua!

What was it like to get the Nicaragua project up and running?

Hitting the ground running in Nicaragua and setting things in motion for PMI Central America was by far one of the most exhilarating, stimulating, challenging and interesting ventures that I had been a part of. The absolute best thing about all of this was the joy, hope and excitement that we brought to the country and the local community of El Viejo and in turn the joy that gave us! The Nicaraguan people’s hearts were wide open and they received us like family. I truly believe that the success of any project depends on the solid relationships and trust built with the local communities. We understood that well and we never went  IMG_1248into any situation thinking we knew better than the locals. We learned from them and then were able to support them in the specific ways that enhanced who they already were rather than trying to force systems or ideas that would not fit in the cultural context. With every step of the process we utilized the local workforce and created so many opportunities for Nicaraguans to use their skills, talents and education to contribute to the design, construction and establishment of the first PMI medical facility in Nicaragua. I absolutely loved seeing locals get excited about the work they do and helping them understand the long-term/forever impact that their hard work was going to have in the country and local communities. To me there is nothing better than empowering local communities to not only create generational change but to have them truly enjoy the work they are doing along the way. And we really had a lot of fun- a lot- working with and walking alongside the Nicaraguan people. The joy was so reciprocal!

What is it that drew you to PMI’s model?

There are a lot of non-profits out there and a lot of them doing great things. However, there is something special about PMI which separates them from the rest and that is PMI’s sustainable long-term business model and focus on Social Entrepreneurship. There is a lot research out there on International Development showing that social entrepreneurship is one of the best methods to providing positive long-term generational change in developing nations and, to me, PMI is doing this better than most. PMI provides a platform that allows locals to use their strengths, insight and education to be agents of change for their local communities. By providing oversight, training, and transformational leadership in each region of operation, PMI equips locals with the extra pieces they need to get to take their communities to the next level of development. When applying this model to the healthcare systems in developing countries, nobody is making more of a tangible, long-lasting impact on the well-being of people living in developing nations than PMI. PMI is without a doubt educating, healing, and empowering!

Anything else you’d like to add?

I absolutely loved being a part of the PMI team and I am so excited to stay connected to see PMI’s sustainable business model expand throughout the world.


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Construction Galore!

By, Aaron Stroud-Romero, PMI’s East Africa Director

If you have been keeping up with PMI at all, one thing you must be aware of is the number of construction projects going on. In Uganda we are in the midst of building an addition to our flagship clinic in Masindi, as well as constructing our second clinic (Bulima Kitara Medical Center). The addition at Masindi Kitara Medical Center (MKMC) includes a Diagnostic and Imaging Center, which will include a digital ultrasound and x-ray machine. It will also include an Education and Research Center, which will host many medical journals, as well as a computer lab for our staff to continue their medical education. The facility will also include a dedicated public health space where we will be able to expand our public health programming and teach the community more around preventative health care.

The additions at MKMC are supported through a grant with USAID’s American Schools and Hospitals Abroad (ASHA) program, while the clinic in Bulima is made possible through the generous donations of individuals and church partners. Later this month we will share more about how we are able to use donations to focus on new projects through our sustainability model, but for now we just wanted to share the amazing progress we are seeing here on the ground.

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PMI Roots: Achieving Sustainability Through Social Enterprise


By, Michael O’Neal, PMI’s Director of International Projects

This week, during #Summit15, some of the nation’s leading thought leaders and entrepreneurs are meeting in Denver to discuss how social enterprise leads to sustainable impacts. Our very own Michael O’Neal takes a look at how PMI achieved sustainability and pursued the question, what if?

Long-term sustainability is the process of ensuring that immediate needs are met without compromising the ability of future generations to meet their own needs. Recognizing the need to build on a foundation of financial and operational sustainability as opposed to adding to the cycle of dependency has been primary objective of PMI from day one.

As I write this, and think back to the first seven months of providing health services to the community of Masindi, Uganda I am overwhelmed with pride for PMI’s first international team. All along the way we were told that we had a pipe dream, but not a model that could actually work. And to be honest, we had our doubts as well. However, we were committed to giving it a chance, because what if?

What if, we could implement a financial model that was based on covering operational cost by generating revenues from user fees? What if we believed what the local community was telling us, and that they would invest in quality healthcare for themselves, their families, and their employees? What if we could identify a local staff team that would revolutionize the standard of healthcare in rural Uganda? What if we could provide all of this, in a way that would allow it to continue for generations to come?

We had to try because the “what if” was too significant not to try, so try we did. The response was overwhelming, just seven months into opening MKMC we saw patient volume grow from 260 patients in January 2011 to 1011 patients in July 2011. As the community became more confident in our staff to deliver quality, affordable healthcare our financial model started to prove itself as well.

In July, just seven months after opening the doors, MKMC was operating at 92.2% operational sustainability! We were thrilled to pass the 90% sustainability threshold so quickly, but more than that, it gave us a glimpse into what could be. The what if, was becoming a reality right before our eyes. We had seen our staff create an atmosphere that produced results of lives being changed through quality healthcare. We had seen their commitment to the implementation of an efficient and effective financial model based on cost sharing with the community, and it had proven that it could work.

So, the foundation was laid for MKMC to continue serving the Masindi community for generations to come! I am proud to say the hard work of those first few months continues to yield sustainable results. To date, PMI Uganda has provided health services to 130,000 people and has been operating at over 100% operational sustainability for the last few years.

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