Mercy Ships: Health Systems Strengthening in Sub-Saharan Africa

Mercy Ships: Health Systems Strengthening in Sub-Saharan Africa

a floating hospital delivering programs to transform a nation s surgical ecosystem "#$%()*+)+,-./0,./#-,1)2,3)/14)3(3("5)++)/13/)1$#",+"(",.3($,#"6".)7"#%)16"7"./*)1-1,3)/1+89(#/:-(3("6"*./%5"13/;/:#(/+*)3,.+()*<3(""#$%()#%*="#$%()*+4/#>+4)3((/+3 1,3)/1+3/;)..3("-,*+)1(",.3($,#"+%+3"5+ 4()."+"#7)1-3(")55"6),3"5"6)$,.1""6+/; 3(")#*/*:.,3)/1+8?./1-4)3(,(/+3/;+:#-)$,.*#/@"$3+< "#$%()*+*#/7)6"+"6:$,3)/1,.*#/-#,55)1- ;/#+:#-"/1+,16/3("#5"6)$,.*#/;"++)/1,.+8 In collaboration with local and international partners, Mercy Ships offers support to developing nations striving to make health care accessible for all. A1BCCD<"#$%()*+0"-,1;/$:+)1-*#/-#,56".)7"#%)1?;#)$,4)3("5*(,+)+/1$/:13#)"+#,1>"60%3("EF G:5,1H"7"./*5"13A16"I,5/1-3("*//#"+31,3)/1+ /;3("4/#.68 A13()+#"-)/1<"#$%()*+(,+*#/7)6"6+"#7)$"+)1"1"-,.<9("J,50),<J:)1",KL)++,:<J:)1",< )"##,M"/1"<M)0"#),<A7/#%N/,+3<J(,1,<9/-/<L"1)1<O"*:0.)$/;N/1-/</:3(?;#)$,,16,6,-,+$,#8 "#$%()*+(,+BP1,3)/1,./;;)$"+3(,3(".*+:**.%;:16+,167/.:13""#+8 Mercy Ships: Health Systems Strengthening in Sub-Saharan Africa 2

changing lives lasting impact )1$"BCQR<"#$%()*+ (,+*#/7)6"6+"#7)$"+,16 5,3"#),.+)16"7"./*)1-1,3)/1+7,.:"6,3/7"# $1.2 billion, )5*,$3)1-5/#"3(,1 2.5 million direct beneficiaries. I wish to thank all the volunteers on the ship who come from all over the world for their sacrifice and the comfort they have given " Ellen Johnson Sirleaf, President of Liberia Mercy Ships: Health Systems Strengthening in Sub-Saharan Africa 3

Surgery is an indivisible, indispensable part of healthcare. The Lancet Commission on Global Surgery /#"*"/*."6)"6:"3/.,$>/;+,;"+:#-"#%3(,1;#/59L<5,.,#),,16GAS$/50)1"6. In 2010, 32.9% of global deaths resulted from conditions requiring surgery. H",3(+;#/5GAST?AH,169L4"#"U8DVW,166",3(+;#/55,.,#),,16/3("#3#/*)$,.6)+",+"+4"#"X8UW8?**#/I)5,3".%YBU5)..)/1+:#-)$,.$,+"+,#"*"#;/#5"6 -./0,..%",$(%",#8L:3</1.%+)I*"#$"13,#"6/1")1./4K,165)66."K)1$/5"$/:13#)"+. Five billion people around the world do not have access to safe, affordable and timely surgical and anesthesia care. A1./4K)1$/5",16./4"#K 5)66."K)1$/5"$/:13#)"+<,$$"++)+*,#3)$:.,#.%+*,#+"8 F)1"/;BD*"/*."$,11/3,$$"++0,+)$+:#-)$,.$,#"8?+, #"+:.3<5,1%",+).%3#",3,0."$/16)3)/1++:$(,+,**"16)$)3)+<("#1),<;#,$3:#"+</0+3#:$3"6.,0/#,16 $/1-"1)3,.,1/5,.)"+0"$/5"6",6.%8,1%/;3("+"$/:13#)"+,#";,$)1-,$/5*."I0:#6"1 /;)1;"$3)/:+<5,3"#1,.<1"/1,3,.,161/1K$/55:1)$,0." 6)+",+"+,16)1@:#)"+8:#-)$,.,16,1"+3("+),$,#",#"7)3,. 3/3("3#",35"13/;3("+"$/16)3)/1+,16,#";:16,5"13,.3/,1";;)$)"13< #"+*/1+)7"(",.3(+%+3"58Reduction of death and disability centers on access to affordable, timely and safe surgical and anesthesia care. 9/+,7".)7"+,16*#"7"136)+,0).)3)"+<,1,66)3)/1,.BVY5)..)/1+:#-"#)"+,#"#"Z:)#"6)16"7"./*)1- $/:13#)"+89/6,%[++:#-)$,.4/#>;/#$"4/:.61""63/6/:0.")1BU%",#+\X8X5)..)/15/#"+:#-"/1+<,1"+3("3)+3+,16/0+3"3#)$),1+,#"1""6"68 A17"+3)1-)1+:#-)$,.+"#7)$"+)+;)1,1$),..%#",+/1,0."<.);"K+,7)1-,16)3*#/5/3"+"$/1/5)$-#/43(89/ 5""3$:##"13,16-#/4)1-*/*:.,3)/16"5,16+<)17"+35"13)1#"+/:#$"+;/#+:#-)$,.,16,1"+3("+),$,#" )+$#)3)$,.8Without urgent investment in surgical scale-up, lost output will cost developing countries an estimated $12.3 trillion between 2015 and 2030. B 1 All data cited above is attributed to The Lancet Commission on Global Surgery (www.thelancet.com ) Mercy Ships: Health Systems Strengthening in Sub-Saharan Africa 4

few countries in Sub-Saharan Africa have functional healthcare systems M)5)3"6"6:$,3)/1,./**/#3:1)3)"+$/1+3#,)13("1:50"#,16+>)..."7"./;5"6)$,.*#/;"++)/1,.+8?$$/#6)1-3/3("]/#.6G",.3(^#-,1)2,3)/1_]G^`<4()."3("#")+,+(/#3,-"/;,..3%*"+/;*#/7)6"#+)1 6"7"./*)1-1,3)/1+<+*"$),.)+3+)1$.:6)1-/0+3"3#)$),1+</*(3(,.5/./-)+3+,166"13)+3+$/5*#)+"3("5/+3 $#)3)$,.-,*+8?$$/#6)1-3/,F,3)/1,.A1+3)3:3"+/;G",.3(+3:6% X <the 47 countries of Sub-Saharan Africa have an acute shortage of healthcare workers, the deficit amounting to 2.4 million doctors and nurses.9("#",#"34/6/$3/#+,16bb 1:#+)1-T5)64);"#%*"#+/11".*"#BD<DDD*/*:.,3)/1$/5*,#"64)3(BC6/$3/#+,16VC1:#+)1-T5)64);"#% *"#+/11".*"#BD<DDD;/#3("?5"#)$,+8A1a:#/*"<3("#",#"YX6/$3/#+,16QR1:#+)1-T5)64);"#% *"#+/11".*"#BD<DDD8 delivery of safe surgical care essential, accessible health service for all?$$"++3/+:#-)$,.$,#")+/1.%*,#3/;3(")++:"#"-,#6)1-1""6b+,;"<z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`8 U :#-)$,.$,#"<)1*,#3)$:.,#<$,10",++/$),3"64)3($/1+)6"#,0." #)+>/;$/5*.)$,3)/1+8A1+/5"*,#3+/;:0K,(,#,1?;#)$,<5/#3,.)3%;/#-"1"#,.,1"+3("+),$,10",+ ()-(,+/1")1BUD8 P )5*."<./4K#"+/:#$"3//.+,163#,)1)1-$,1(".*,66#"++3("+")++:"+3(#/:-(+>)..+ )5*#/7"5"13+,16"1(,1$"63",54/#>,5/1-+35"6)$,.*#/;"++)/1,.+8 A1XDDC<3("]/#.6G",.3(^#-,1)2,3)/1_]G^`.,:1$("63(")#X16J./0,.c,3)"13,;"3%N(,.."1-"<,;" :#-"#%,7"+M)7"+89()+)1)3),3)7"*#/6:$"63(":#-)$,.,;"3%N("$>.)+3_N`6"+)-1"63/)5*#/7",6("#"1$"3/0,+)$+,;"3%*#/$"++,163("#"0%)5*#/7"Z:,.)3%/;+:#-)$,.$,#"8 2 Shortage of healthcare workers in sub-saharan Africa: a nephrological perspective. Nov 2010. http://www.ncbi.nlm.nih.gov/pubmed/20979978 3 Meara, John G et al. (2015) Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. The Lancet. 4 WHO Safe Surgery Saves Lives. Initiative http://www.who.int/patientsafety/safesurgery/en/. Retrieved 4 May 2015. 5 WHO Safe Surgery Saves Lives. 10 facts on patient safety. Retrieved 4 May 2015 http://www.who.int/features/factfiles/patient_safety/patient_safety_facts/en/index6.html. 6 Ibid http://www.who.int/patientsafety/safesurgery/en/ Mercy Ships: Health Systems Strengthening in Sub-Saharan Africa 5

delivery of safe surgical care at its center 9/"+3,0.)+(3()+$#)3)$,.;/:16,3)/1;/#(",.3($,#"/1,-./0,.."7".< Mercy Ships delivers capacity-building healthcare education programs to reinforce sustainable care in Africa. 9("+"*#/-#,5+)6"13);%#"-)/1,.1""6+,164/#>$./+".%4)3(./$,.-/7"#15"13+3/"+3,0.)+()1)3),3)7"+3(,35,>",.,+3)1-6);;"#"1$"8 *"$);)$,..%<3("]G^:#-)$,.,;"3%N("$>.)+3,16M);"0/I9",59#,)1)1-*#/7)6")1+3#:$3)/1;/# *,#3)$)*,13+,3#"-)/1,.(/+*)3,.+,16,++)+3)1)5*."5"13,3)/1/;0"+3*#,$3)$"+,16:+"/;*:.+" /I)5"3"#+3/)5*#/7"3("Z:,.)3%/;+:#-)$,.$,#"*#/7)6"6,3#"+*"$3)7";,$).)3)"+8 delivering quality programming to countries with struggling healthcare systems d/#yr%",#+<"#$%()*+(,+0""1$/..,0/#,3)1-4)3(./$,.,16-./0,. *,#31"#+3/3#,1+;/#53("+:#-)$,."$/+%+3"5)13("6"7"./*)1-1,3)/1+ 3(#/:-(,1)13"-#,3"6*#/-#,56"+)-1/;3(#""*)..,#+e Mercy Ships: Health Systems Strengthening in Sub-Saharan Africa 6

operational rhythm of Mercy Ships?**#/I)5,3".%P3/BX5/13(+*#)/#3/,+()*[+,##)7,.<, "#$%()*+3",53#,7".+3/,(/+3$/:13#%3/0:).6 #".,3)/1+()*+,16-,3("#)1;/#5,3)/1#"-,#6)1-3(" 1""6+/;3("(",.3($,#"+%+3"58 9%*)$,..%<"#$%()*+,##)7"+)1,*/#3$)3%)1?:-:+3 ",$(%",#4("#"4"+"#7";/#,BDK5/13(*"#)/68?1?67,1$"9",5<4()$(+*"16+;/:#3/;)7"5/13(+)1 3("(/+3$/:13#%*#)/#3/3("+()*[+,##)7,.<"+3,0.)+("+ 3("6/$>+)6",#",,163("/;;K+()*$.)1)$+:3).)2"6 6:#)1-3(";)".6+"#7)$"8 "#$%()*+4/#>+)1*,#31"#+()*4)3((/+3-/7"#15"13+<./$,.5"6)$,.*#/7)6"#+<,16./$,.,16 )13"#1,3)/1,.FJ^+3/*#/7)6"6)#"$35"6)$,.+"#7)$"+<5"6)$,.$,*,$)3%0:).6)1-,16)1;#,+3#:$3:#" $,*,$)3%0:).6)1-8 H:#)1-",$(BDK5/13(;)".6+"#7)$"" Mercy Ships provides an average of 2,000 free surgeries for adult and child patients; treats more than 18,000 at land-based dental and eye clinics; and provides holistic healthcare education to approximately 500 local healthcare professionals and 800 community leaders.,>)1-3()+)5*,$3*/++)0.",#"/:#$#"45"50"#+4(/#,)+"3(")#/41;)1,1$),.+:**/#389()+ )13"#1,3)/1,.$/55:1)3%/;:*3/B<VDD7/.:13""#+,11:,..%$,1#"*#"+"135/#"3(,1VD1,3)/1+8 c#/@"$3"7,.:,3)/1)+$/5*."3"64)3()1bxkxv5/13(+,;3"#+()*6"*,#3:#"8?3",5+*"16+34/4"">+/1./$,3)/1#"7)"4)1-,16+$/#)1-3("-/,.+,16/:3$/5"+/;",$(*#/@"$38d)1,.#"*/#3+)1$.:6",6"3,)."6 /7"#7)"43(,3()-(.)-(3+*#/*/+"67"#+:+,$3:,.+;/#6)#"$3+"#7)$"+,16;)1,1$),.6,3,8 Mercy Ships: Health Systems Strengthening in Sub-Saharan Africa 7

innovative approach with state-of-the-art delivery 9("*#)5,#%0"1";)3/;:+)1-,(/+*)3,.+()*7"#+:+,.,16K0,+"6;,$).)3%)+$/13#/./;"17)#/15"138E1.)>",.,16K0,+"6$.)1)$/#(/+*)3,.<,+()*)+1/3 $/1+3#,)1"60%.,$>/;,6"Z:,3")1;#,+3#:$3:#"+:$(,+"."$3#)$)3%/#4,3"#8The state-of-the-art hospital aboard the Africa Mercy can be delivered to areas of great need to fulfill the mission regardless of local infrastructure constraints such as power failures or unsanitary water, making it a sustainable delivery platform in the developing world.?66)3)/1,..%<"#$%()*+ 0#)1-+4/#.6K$.,++"Z:)*5"13)1$.:6)1-,$$"++3/$/5*:3"#+<.,0/#,3/#)"+,166),-1/+3)$3//.+8As a result, Mercy Ships is able to offer first-world quality care to the poorest of the poor. 9("+()*K0,+"6(/+*)3,.5/6"./;"#$%()*+,.+/*#/7)6"+,1"I$".."137"1:";/#3#,)1)1-*#/@"$3+8 E3).)2)1-,5/0)."*.,3;/#5<3("/#-,1)2,3)/1)+,0."3/0#)1-$,*,$)3%K0:).6)1-/**/#3:1)3)"+3/?;#)$,8 9()+5/6".*#/7)6"+*#/;"++)/1,.+4)3(,./$,./*3)/13/*,#3)$)*,3")1,()-(KZ:,.)3%"6:$,3)/1*#/-#,58 d:#3("#5/#"<3("*#/i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e3("./$,.(",.3($,#"6".)7"#%+%+3"55:+3$/13)1:"3/*#/7)6"+"#7)$"+ #"-,#6."++/;3("+()*[+*#"+"1$"8 Mercy Ships: Health Systems Strengthening in Sub-Saharan Africa 8

scaling up for greater impact 9/,66#"++3("-#/4)1-1""6;/#,;;/#6,0.",16+,;"+:#-)$,. $,#")16"7"./*)1-1,3)/1+<"#$%()*+)+"I*,16)1-)3+ ;.""38The newest vessel, slated to enter service in late 2018, will carry on a long and proud history of serving the poorest of the poor around the world. Together with the Africa Mercy, the new ship will increase lives transformed and medical professionals trained by more than 2 ½ times current levels. A34)..;",3:#""I*,16"6,16;."I)0.")13"-#,3"6"6:$,3)/1,.,163#,)1)1- $,*,0).)3)"+<,../4)1- :+3/6%1,5)$,..%0,.,1$",$:3")55"6),3"1""6+,16 3("+3#"1-3("1)1-/;"I)+3)1-./$,.#"+/:#$"+8 A3)+/:#-/,.3(,36"7"./*)1-1,3)/1++"#7"60%"#$%()*+4).. "I*"#)"1$"$/1+)+3"13<4/#.6K$.,++ 5"6)$,.$,#"3/-"3("#4)3(,1)1$#",+"6,16"1(,1$"6"5*(,+)+/1$,*,$)3%0:).6)1-8 New Ship Rendering expansion of services; increase in operational funds ])3(3(",66)3)/1/;,1"4+()*<,1)1$#",+")1/*"#,3)/1,. ;:16)1-)+1""6"68"#$%()*+$:##"13.%#"$")7"+,**#/I)5,3".% fyd)1$/13#)0:3)/1+,16-#,13+",$(%",#89("+"-);3+$/5" 3(#/:-(/:#BP1,3)/1,./;;)$"+4/#.64)6"8O/:16)1-/:3/:# /*"#,3)/1,.0:6-"3/;fUY<QRD<PRV_XDBU`,#"-);3+K)1K>)16< 6"*:3)2"6+3,;;;:16#,)+)1-,16$/13#)0:3"6+"#7)$"+8 By 2018, in order to support both ships, we must grow from $30M to $40M in donor contributions annually world-wide. Mercy Ships: Health Systems Strengthening in Sub-Saharan Africa 9

A1XDBU<3("E/;;)$"$/13#)0:3"6,**#/I)5,3".%fBU8Q)1;:16)1-3/+:**/#3"#$%()*+89/5""3/:# -#/4)1-*#/-#,55,3)$,16/*"#,3)/1,.1""6+<4"*#/@"$33(";/../4)1-E#"7"1:"#"Z:)#"5"13+;/#3(" 1"I33(#""%",#+e Our history of mission success and sound financial management, as well as our continuous, effective and experienced leadership, provides a framework for long-term organizational continuity and sustainability. A1,66)3)/1<3/,+3#/1-()+3/#%/;+:**/#3 ;/#/:#5)++)/13(#/:-()16)7)6:,.6/1/#+< 4",#"$/55)33"63/"1+:#)1-3(,3/:# 4/#>$/13)1:"+4)3(,1/1K-/)1-+3#,3"-)$ ";;/#3/;6)7"#+);)"6;:166"7"./*5"13 )1$.:6)1-e gai*,16)1-/:#$/#*/#,3"t;/:16,3)/1 #".,3)/1+()*+ gh"7"./*)1->"%*,#31"#+()*+4)3( -/7"#15"13,.)1+3)3:3)/1+ ga1.,#-)1-/:#"16/45"13 gc#/5/3)1-*.,11"6-)7)1- /**/#3:1)3)"+ gm"7"#,-)1-;:16+3(#/:-(5,3$()1-,16 $(,.."1-"$,5*,)-1+ committed to transparency Mercy Ships: Health Systems Strengthening in Sub-Saharan Africa 10