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2021 Annual Report

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CARE 2 COMMUNITIES 2021 ANNUAL REPORT 1 C2C_AR2021_FINAL indd 1 6 21 22 6 40 AM

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Our Vision Our Mission Accessible affordable highquality healthcare for every family in Haiti today and in perpetuity We work to create a model for sustainable community based healthcare in Haiti that empowers people to lead healthier lives 2 C2C_AR2021_FINAL indd 2 6 21 22 6 40 AM

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From Cap Haitien Haiti 2021 Leadership Letter Dear Friends of C2C What does the future of healthcare in Haiti look like if we build it together It s a question I ask myself often As C2C s Managing Director I am proud to live here in Cap Haitien Haiti s second largest city on the northern coast of the country These have been challenging years as we have navigated the COVID 19 pandemic as well as profound economic and social instability in our country We are not solving healthcare deficits with a patchwork effort we are driven to transform systemic problems And while I worry about Haiti s future I am mostly filled with optimism for what we can become if we work together At C2C for more than a decade we have taken the long view We are not solving healthcare deficits with a patchwork effort we are driven to transform systemic problems We work hand in hand with the government of Haiti to build a strong and resilient network of community based health centers so that poor and low income people can access the care they need when and where they need it This means that the Haitian government is not only our partner in name they have skin in the game Together we are proving that a community clinic can be a vibrant and sustainable social business it can be a place where parents and children come to get well when they are sick but also a place where they can come to prevent illness before it happens A resource to empower people to live healthier lives In 2021 we welcomed several new Haitian leaders to our management team we launched exciting new programs that are tackling the demand side challenges of healthcare we converted 3 of our clinics to solar energy and we began to transition our clinic network to a customized electronic medical record system technology that will give us access to health data in a new and transformative way I am proud of our dedicated staff I am humbled by the strength and resilience of our patients and I am grateful for the generosity of our incredible donors who share our vision for the future of healthcare in Haiti Your charitable contributions are making this work possible but even more so your donations are leveraged by 3x because of our public private partnership which is building a sustainable and replicable model for care across every community in Haiti We cannot do this without you Thank you for being a part of the C2C community Please don t hesitate to reach out to me with questions or feedback I welcome the opportunity to share more about our team and our work here in Haiti In gratitude Racha Yehia Managing Director Cap Haitien Haiti racha care2communities org 3 C2C_AR2021_FINAL indd 3 6 21 22 6 40 AM

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What We Do Delivering high quality sustainable primary care to the people of Haiti In severely impoverished countries like Haiti the major causes of death and disability are treatable preventable illnesses Access to care is inconsistent and unreliable and the government s healthcare system is both desperately underfunded and fragmented According to research by the World Health Organization only 23 of Haiti s population and just 5 of the rural population have access to high quality primary care Cap Haitien Through a public private partnership with the government of Haiti C2C s healthcare delivery model rehabilitates public sector community clinics so that people have access to affordable high quality primary care close to home This innovative operating model reduces the cost of care for patients dramatically improves quality and is measurably improving health outcomes for families C2C s clinic model is a onestop shop community health center where patients can consult a physician and access well resourced laboratory services and a fully stocked on site pharmacy Community Health Workers CHWs augment clinicbased care by reaching patients at home and at school with follow up care health screenings and education In 2021 C2C s 7 community clinic sites served a catchment area of 250 000 people Port au Prince 4 C2C_AR2021_FINAL indd 4 6 21 22 6 40 AM

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Staff Spotlight Dr Weedjney Destouches Dr Weedjney Destouches was born and raised in Port au Prince He is a general practitioner specializing in public health and project management He joined the C2C team in June 2021 as Director of Operations Leading a team of Clinic Managers and operational specialists Dr Detouches ensures that C2C s network of clinics is running smoothly for the tens of thousands of patients who seek our care each year Dr Destouches knows that high quality efficient operations are essential for a best in class healthcare experience Dieula Augustin Dieula Augustin joined C2C as Program Manager in August 2021 with more than ten years of experience in governmental and non governmental organizations managing a variety of programs such as HIV tuberculosis TB nutrition pediatric health reproductive health maternal health and family planning Currently she supervises all of C2C s specialty clinical programs and community health interventions Ms Augustin s career has been devoted to lifting up families and communities through access to healthcare Tania Hiliare Tania Hiliare earned a degree in nursing from Notre Dame de la Sagesse nursing school at Justinien University Hospital in 2012 Afterward she worked for several years at Sacr Coeur Hospital CRUDEM Foundation one of the biggest hospitals in Cap Haitien She joined C2C in May 2021 as a Clinic Manager overseeing the operations of our Camp Coq l Acul du Nord and Bayeux clinics Ms Hiliare is motivated to break down the social environmental and financial barriers that prevent people from seeking care so that whole families can have healthier futures Lindsey Joseph Lindsey Joseph studied planning economics and statistics at CTPEA Centre de Techniques de Planification et d conomie Appliqu e a Portau Prince university where public administration professionals are trained under the Ministry of Planning and External Cooperation She joined C2C s team in April 2021 as Monitoring Evaluation Officer taking the lead in managing all program and operational data Lindsey believes in data driven solutions to healthcare challenges and she helps to use data analysis and evaluation to strengthen C2C s services delivery 5 C2C_AR2021_FINAL indd 5 6 21 22 6 40 AM

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58 292 Total Patient Visits Our patients come to C2C s 7 communitybased clinic sites from across the north and northeastern regions of Haiti C2C clinics serve a catchment area of over 250 000 people 2 854 Prenatal Visits In 2021 C2C clinics provided perinatal services for pregnant women at 3 of our 7 clinic sites thanks to our partnership with the IZUMI Foundation Pregnancy outcomes for Haitian women are among the worst in the world with 1 in 80 women dying from conditions related to pregnancy and childbirth C2C s full service maternal care program is vital to the health and wellness of mothers and babies We will expand this important service to additional clinic sites in 2022 and beyond 74 Cost Recovery Our commitment to operational sustainability differentiates C2C from healthcare organizations that operate solely on philanthropy funding Our public private partnership with the government of Haiti shares the costs of delivering essential care to patients and our below market rate user fees build a stronger health system for the long term 6 C2C_AR2021_FINAL indd 6 6 21 22 6 41 AM

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113 C2C Staff Members C2C is a Haitian organization with our head office based in the city of Cap Haitien in the northern region of the country C2C s head office serves as a centralized hub to support communitybased clinic sites through central supply chain management staff training financial and technology management and comprehensive quality assurance support Haitian physicians health workers and managers lead our care practice and are driving innovation in their own public health system 14 881 Patients Reached Through Community Health Workers Community Health Workers are the arms of the clinic reaching out into the community They complement clinic based services with vital programming and education services For economically vulnerable families the demands of everyday life present challenges Our job is to break down the barriers to care and to welcome more people into the care system C2C s Community Health Workers perform a variety of functions from home based follow up visits to hypertension clinics to group education classes to school based vaccination campaigns 16 980 Vaccines Administered In Haiti only 40 of children are fully vaccinated C2C provides comprehensive vaccination programming by offering the service at every curative pediatric visit and by deploying Community Health Workers where people live and work Educating parents about the importance of vaccines is a crucial part of our work to support family health 7 C2C_AR2021_FINAL indd 7 6 21 22 6 41 AM

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Sexual Reproductive Health Education for Adolescent Girls In 2021 C2C successfully piloted a firstof its kind sexual and reproductive health education after school program for adolescent girls ages 13 18 Young girls face unique risks in Haiti due to the lack of health education and inadequate knowledge about sexual development 10 of Haitian girls aged 15 19 have been pregnant Without knowledge about their bodies and their rights girls cannot have control over their reproductive lives One study from 2014 surveyed 200 adolescents in the Port au Prince area and found that the mean age of sexual initiation was 13 for boys and 14 5 for girls 53 of the boys reported not using a condom during their last sexual encounter Through peer cohort based education about anatomy contraception gender based violence sexually transmitted infections and consent C2C is supporting and empowering young girls toward a healthier future Our intervention was designed with input from parents teachers community leaders and clergy members C2C s sexual and reproductive health curriculum was strongly supported by the community and by parents who have seen the negative consequences that the lack of sexual education has on the young women in their lives Many wanted to educate their children on these subjects but didn t know how or did not have the knowledge themselves C2C worked with a Haitian American psychologist to build the course curriculum covering a range of sexual health and development topics human development gender roles risk taking relationships pregnancy HIV and STIs consent myths and misconceptions and family planning 10 of Haitian girls aged 15 19 have been pregnant 81 of Haitian girls have never received any education about sexual health 217 girls enrolled in the first year s pilot cohort each attended one education session per week for 20 weeks Prior to joining the program 81 of girls had never received any education about sexual health Through comprehensive pre post test data collection we were able to measure the efficacy of the program and to determine if the education provided over six months provided the enrolled girls with new knowledge attitudes and practices The pilot evaluation showed that amongst other indicators the curriculum increased girls understanding of condom use and STI prevention by 32 We are grateful for the support of three key partners the Conservation Food and Health Foundation Together Women Rise and the Lalor Foundation who have made this important program possible and will help us to enroll another 500 adolescents in 2022 8 C2C_AR2021_FINAL indd 8 6 21 22 6 41 AM

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Vaccinations in the Community Expanding access to pediatric vaccinations has always been a key priority for C2C The childhood vaccination rate in Haiti remains stubbornly low at just 40 C2C has long provided vaccinations at our clinic sites but reaching children and families with the vaccination services they need requires new and novel approaches In 2021 we launched a program to bring our vaccination program into the community to reach people where they are and to break down the barriers to preventive and curative care seeking Our Community Health Workers followup with parents whose children haven t yet received a full course of childhood vaccinations They visit households schools and churches to make vaccines more accessible and to ensure that parents are empowered with information about how vaccines keep their children safe In 2021 C2C administered 16 980 vaccinations Using Electronic Medical Records to Enhance Patient Care C2C s customized open source electronic medical records EMR system provides an accurate snapshot of the true impact of our services on population health and is an essential tool for accurate case management reporting efficient supply chain management and quality patient care Quick access to patient records lab results and medications dispensed facilitates patient centered care allowing clinicians to make better data driven decisions The EMR allows us to more easily track patients between visits improving care continuity and reducing loss to follow up This is especially critical in Haiti where healthcare providers have difficulty finding patients in paper records due to inconsistent name spellings and lack of ID cards With our EMR we can access a patient file within seconds whether their most recent visit was two days ago or two years ago In Haiti where all public health facilities function with paper based record keeping and reporting our EMR is improving all aspects of service delivery 9 C2C_AR2021_FINAL indd 9 6 21 22 6 41 AM

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Fiscal Year 2021 Statement of Activities Individual Contributions Earned Revenue Income Individual Contributions 28 374 244 Foundation Grants 41 545 163 Earned Revenue 31 414 116 INCOME Total Revenue 1 333 523 Foundation Grants Programs Expense 88 Programs 1 137 036 Administration 6 81 747 Fundraising 5 70 069 EXPENSE Total Expense 1 288 852 Admin Fundraising We are grateful for the sustained philanthropic support of so many donors foundations and partners Our partnerships with charitable foundations have fueled our growth and impact in 2021 and we offer special thanks and recognition to 10 C2C_AR2021_FINAL indd 10 6 21 22 6 41 AM

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Thank you We are also deeply grateful for the generous support of Jack Connors Jr Richard Dwyer Constance Eagan David and Mona Eliassen Taliaferro William and Lynda Glavin The Kuih Beri Fund of the Marin Community Foundation The Lalor Foundation Milton Millman John P Mullman and Sandy Logan Mullman Kristin Mumford The Robert and Kate Niehaus Foundation Ned and Nicole Sahin Elizabeth Sheehan Gerald and Maureen Sheehan Jack Shields Eric Silverman Jack Tarver Foundation Dune Thorne Melissa Abernathy Jeffrey Annis Mary Elizabeth Bacon Sharon Bauer Mark Jane Berry Robina Bhargav Judith Bihary Daniel Blake Marcia Boehlke Kevin Borgella Cassandra Borgella Jo Ann Brooks Christine Candio Timothy Chapman Lorraine W Check Joanie Ciardelli Charles Martha Clapp Walter Brenda Conlin Philip Cook C2C_AR2021_FINAL indd 11 Joan Deppe Michael Diamond Moira Donoghue Steve Dowd Joan Eagan Mary Ellen Eagan Karen Edwards Emerging Markets Trade Association Laurie Emrich Roxanne Eugene Trenton Foster MA James Gallerani Samuel Gillett Thomas Janet Gorman Paula Graham Dwyer Michael Mary Guilfoile Marietje Halbertsma Leilani Haywood Henry Schein Cares Foundation Stephen Mary Beth Hines Allison Howard Berry Weston Susan Howland Donald Hunsicker Syed Ibrahim Claire Dillavou Jarashow Pedro Jimenez Elizabeth Johansen Nancy Joseph Karen Ketterer Paul Gaynor Katharine King Cynthia Knapp Leanne LaBelle Joseph LeMay Yrleyjander Salmito Lopes Charles Lower Michelle Martin Sarah Matousek Camilla McCaslin Brian McGuire Elizabeth Tangusso Paula Medina Nancy Meyer Roger Margot Milliken Juanita Miranda Robert Mondello Paul Mary Alice Moynahan Mary Flynn Myers Roger Nuss Eileen O Brien Glennon O Grady Sally Ourieff Eleanor Pages Glenn Paredes Khare Parth Maureen Partyka Elizabeth Pattullo Kenneth Perkins Andrea Pliakas Barbara Raho Robin Reed Tedd Ella Saunders John Kristen Sheehan Nicholas Marie Spellman Karin Stanley Lockman Sheldon Lockman Richard Sugarman William Mary Supple Tevin Thompson Lisette Tiller Melody Tortosa John Hagan Jens Touborg Maria Tramontozzi Michael Tuohey Robert Wally Mark and Lisa Walsh Kathleen Walton C2C Board of Directors As of May 31 2022 Allison Howard Berry Chair Christine Candio LFACHE Richard Dwyer Constance Eagan Elizabeth Louis PhD Claire Jarashow PhD MPH Na k Ledan Sarah Matousek PhD MPH Glenn Paredes Robin Reed MD MBA Jocelyn Sargent Carmel Shields Victor Silva Richard Sugarman JD MBA Kim Wilson MD MPH C2C Leadership Racha Yehia Managing Director Dr Wilnick Richard Chief Medical Officer Dr Weedjney Destouches Director of Operations 11 6 21 22 6 41 AM

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How to Support C2C Your generous donation to Care 2 Communities is fully tax deductible You can send a check to Care 2 Communities 24 School Street 2nd Floor Boston MA 02108 You can also donate online at www care2communities org Or via QR code here Care 2 Communities C2C www care2communities org 54 Street 27 A Cap Haitien Haiti 24 School Street 2nd Fl Boston MA 02108 USA C2C_AR2021_FINAL indd 12 6 21 22 6 41 AM