2019 Annual Report




CARE 2 COMMUNITIES
2019 ANNUAL REPORT

LETTER FROM THE EXECUTIVE DIRECTOR

Dear friends,

As I look back on 2019, I am struck by what an extraordinary year we had at C2C.

It was full of new milestones and achievements few could have imagined a couple of years ago. In just over two years, we have doubled our clinic network and more than doubled our patient reach. In 2019, we were able to grow our clinic revenue by 29% while maintaining our 80% cost-recovery ratio. We also had the honor to be recognized on global stages such as the Concordia Conference in New York City and Duke University’s Innovation in Healthcare Alliance.

We are proud to have achieved all of these advances despite what was a very challenging year in Haiti. As most of you may know, waves of civil unrest struck the country throughout 2019. Our team struggled through frequent road closures, violent protests, as well as numerous fuel supply and power interruptions. It was extremely difficult at times and yet our incredibly dedicated staff persevered, keeping our clinics open and serving patients who often had no other options for the care they desperately needed. I cannot thank them enough for their hard work and dedication.

I also cannot thank you all enough. Without you, none of our accomplishments and commitment to deliver high-quality healthcare to the people of Haiti would have been possible. Thank you, again, from all of us.

Finally, as I look to the coming year, I am excited by our plans to build on the momentum we built-in 2019. Unfortunately, it is clear that 2020 will also be a very challenging year.  The underlying political drivers of the unrest we saw last year are still in place in Haiti, as well as the current pandemic, COVID-19, which brings unknowns for all of us. One thing we know is that the challenges of addressing COVID-19 in Haiti will be extreme, but the likelihood of more political unrest cannot keep us from our mission. There is still so much to be work to be done for the communities that have almost no access to healthcare, and certainly no access to quality primary care.

Your support is making an absolutely critical difference in the lives of tens of thousands of Haitians every day. It enables us to significantly expand C2C’s impact and to stay the course in very difficult conditions. You are the main force driving our impact and momentum. On behalf of all of the families and communities we serve, thank you.

Onward to many more achievements in 2020!

Scott Schroeder




OUR VISION:

We envision accessible, affordable,
high-quality healthcare for every family
in Haiti – today and in the future.



OUR MISSION:

We work to create a model for sustainable, community-based healthcare in Haiti that transforms the status quo, meets the needs of poor and low-income people, and empowers families to lead healthier lives.


WHAT WE DO

In severely disadvantaged countries like Haiti, the major causes of death and disability are treatable, preventable illnesses but access to care is inconsistent, substandard or non-existent. Worldwide, primary care interventions have become one of the most cost-effective means to address health problems before they become catastrophic and expensive health events, saving money for poor families, improving health outcomes and raising national well-being all in one. At C2C, we are committed to addressing primary care gaps to achieve maximum health benefit for the people of Haiti.

In partnership with the government of Haiti, we provide a unique combination of health delivery model components to make primary care accessible by rehabilitating the government’s community clinic network. This innovative model reduces the cost to the consumer and increases the quality of care higher than baseline government quality rankings. Notably, C2C’s model transforms the clinic into a viable social business.

We provide a combination of technical and management support, centralized operations, and rigorous benchmarking and evaluation to ensure that clinics are transformed into centers of excellence. The key features of the C2C clinic model include 6 main components: Public-Private Partnership, Electronic Medical Records, Local Supply Chain, Sustainability, One-Stop-Shop, and Locally Hired & Trained Staff.


WHERE WE WORK

We operate a clinic network in the North and Northeast Departments of Haiti, where we currently have 7 operational clinic sites serving a catchment area of over 250,000 people.

C2C’s patients are among the most disadvantaged families living in the underdeveloped northern and northeastern regions of Haiti. C2C’s community clinics serve over 10% of the population. The clinics are located in the North Department, concentrated around the Cap Haitien area (communities include: Acul du Nord, Camp Coq, Cité Chauvel, Sinek, Bayeux, Savanette), and most recently, our first clinic in the Northeast Department, Roche Plate.

C2C’s average patient lives on $2-$4 USD per day and receives household income through economic activities like resale vending, small-scale agriculture, and family remittances from abroad. We serve approximately 45% children, 35% women, and 20% men. The women face multiple barriers to safe pregnancy and delivery and children are at risk for malnutrition and disease.














WHY HAITI?

Haiti, born of slavery and revolution, has struggled with centuries of crippling debt, exploitation, corruption, and waves of natural disasters, ranking it the Western Hemisphere’s poorest nation.  It remains one of the poorest countries on the planet despite close proximity to the richest one.  Based on the World Bank’s 2018 ranking of countries by GDP per capita, Haiti sits in the bottom 10% of all 200+ countries ranked at just $870 per person, below Mali and Benin and just above Liberia.  Haiti’s infant and maternal mortality rates remain stubbornly high, life expectancy is the lowest in Latin America and the Caribbean, and roughly 40% of the population lacks access to essential health and nutrition services.


WHAT WE ACCOMPLISHED


NEW PROGRAM HIGHLIGHT: MEDICAL RESIDENCY

We are proud to have the Haitian government as an ally in our mission to provide high-quality, sustainable medical care in Haiti. As part of our Public-Private Partnership (PPP), the Ministry of Health provides social service residents as part of the medical staff working in our clinics. This is a major contribution to our mission and the advancement of our formal partnership. 

Social service residents are recent medical school graduates who are looking to complete their medical residency for one year. We are excited to have them as part of the C2C team and to be able to contribute to the education of the future doctors of Haiti at the same time. We launched our service residency program by welcoming our first class of residents at the beginning of 2019.

After launching this program, we took the opportunity to improve our teaching methods. Since C2C has more than doubled in size in the last two years, we realized that we needed to structure a formal training protocol to train and guide the residents year by year.

We also wanted to ensure that they followed our protocols in terms of medical care and provided the same exceptional patient experience throughout our network of clinics.

We made it our priority to begin to formalize our coaching methods by creating an educational component to the residency program, standardizing our diagnostic protocols, and training the residents on this protocol.

To lead the program, we promoted one of our most trusted doctors, Dr. Wilnick Richard, as Senior Doctor to be in charge of training and supervising the social service residents, as well as ensuring that we continue to offer high-quality medical care and positive patient experience.

The program was a great way to enhance our medical services for our patients, all while contributing to the education for the future doctors of Haiti. We are excited to see what is in store for us next year as we hope to be welcoming our second class in the later part of 2020.


Dr. Richard training a social service resident during a patient consultation at our Savanette clinic


NEW CLINIC OPENING

We made it our priority to begin to formalize our coaching methods by creating an educational component to the residency program, standardizing our diagnostic protocols, and training the residents on this protocol.



PATIENT
SPOTLIGHT

I brought my three-year-old son Kendly to the Savanette clinic because he was experiencing abdominal pain and vomiting. I bring Kendly to C2C whenever he isn’t feeling well because ever since our first visit, I have been happy with the quality of service. I have since brought him three times since the clinic opened last May and the staff always treats us well and provides good care. I appreciate that C2C’s medications are priced lower than at other clinics. I live in a very rural area, but the Savanette clinic is easily accessible to us and I do not have to pay transportation fees to get here. I regularly recommend the clinic to all of my neighbors when they are sick.” — Kendly François


SUSTAINABILITY

In 2019, program spending increased by 10% while clinic revenue increased by 34% in just one year. We also expanded our footprint by adding a new clinic to our clinic network in the North Department, as well as a newly formed partnership with the Northeast Department’s Ministry of Health.

COST RECOVERY

C2C tracks each clinic’s distinct earned revenue over the clinic’s distinct expenses to yield a cost recovery ratio. This year we made great progress improving cost recovery ratios across our network and have achieved an 80% average despite a large variation in size, staff and location (rural vs. urban). While our focus is to deliver essential health services while improving cost-recovery through patient fees, we believe that long-term sustainability is predicated on localizing the business though local clinical staff and local supply chains. Here’s how cost recovery has improved in the last three years:

79% *

ACROSS ALL
C2C CLINICS
* Distinct clinic variable costs vs. distinct clinic revenue

CLINIC COMPARISON

Our clinics have reached at least 73% and as high as 87% cost recovery with still only moderate volume.


FINANCIALS

EXPENSES

Programs

General & Administrative

Fundraising

$924,965

$92,901

$179,058


Total Expenses

$1,196,924

REVENUE

Foundations & Corporations

Individuals

Earned Income

$1,223,233

$419,142

$240,583


Total Revenue

$1,882,958

Clinic Revenue, 2017 – 2019


BOARD OF DIRECTORS

From left to right: Rick Dwyer, Claire Dillavou Jarashow, Peter Urbanczyk (Emeritus Director), Sally Ourieff, Allison Howard-Berry (Chair), Elizabeth Sheehan (President), Kelly Dougherty, Carmel Shields, Scott Schroeder (Executive Director), Robin Reed, Glenn Paredes, Constance Eagan, and Kim Wilson. Not pictured: Marie Marthe Saint Cyr, Richard Sugarman

ANNUAL BOARD
RETREAT UPDATE

C2C’s Board gathered in September for a weekend retreat to discuss the overall trajectory of the organization and goals for the next few years. The retreat kicked off with a discussion on C2C’s updated Theory of Change, how we define quality of care, and our EMR system. The Board also discussed C2C’s three year plan, emphasizing the expansion of maternal health services, hiring more staff on the ground in Haiti, and further strengthening our partnership with the Ministry of Health, as well as expanding our clinic network while focusing on C2C’s quality of care.



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