In this episode of the Charity Charge Show, we sit down with Peter Navario, CEO of HealthRight International and professor of health economics at NYU. The conversation covers the current crisis in global health funding, innovative approaches to community-based healthcare delivery, and practical strategies for nonprofit resilience during uncertain times.
Overview
Key Topics Covered:
- The role of community health workers in bridging healthcare gaps
- How HealthRight’s evidence-based mental health programs translate from low-income countries to the United States
- The impact of foreign assistance cuts on global health organizations
- New funding mechanisms and direct investment platforms for nonprofit sustainability
- Why the dialogue between funders and implementers needs to change
Resources Mentioned:
- HealthRight International’s peer-led mental health intervention model
- WHO mental health tools and cognitive behavioral therapy principles
- Arnold Ventures grant for justice-involved communities
- Medicaid peer support reimbursement mechanisms
About the Guest
Peter Navario serves as CEO of HealthRight International, a global health nonprofit organization established in 1990 by Dr. Jonathan Mann, widely considered one of the fathers of the health and human rights movement. Navario also teaches health economics at New York University.
Under his leadership, HealthRight has focused on improving health outcomes for marginalized communities across more than 30 countries, with current operations concentrated in Kenya, Uganda, Ukraine, and the United States. The organization works across four programmatic areas: mental health, HIV/TB, reproductive and maternal health, and gender-based violence.
About HealthRight International
HealthRight International was founded in 1990 with a mission to improve health and well-being for marginalized communities worldwide. The organization employs local staff who are members of the communities they serve, avoiding the expat model common in international development work.
The organization’s approach centers on two core objectives: increasing access to health services for underserved populations and ensuring quality of care once access is achieved. Their interventions focus on the intersection between affected communities and primary care systems, building capacity at multiple levels rather than relying on single-point investments.
Full Interview
Grayson Harris: Hello everybody and welcome back to the Charity Charge Show. This is Grayson Harris. Today we are joined by Peter Navario. He is both the CEO of HealthRight International, which is really going to be our focus of conversation today. He is also a professor over at NYU, so he is busy. If you’re tuning into the video, you can see some of the work going on in the background. And I believe their classes start up next week, so we’re recording this at a good time here.
Peter Navario: Yeah, I teach health economics so you can see some of the explanations on the whiteboard.
Grayson Harris: Amazing. Well, if we could talk a little bit more about what HealthRight International is.
Peter Navario: So HealthRight International is a global health nonprofit organization. It was established in 1990 by Dr. Jonathan Mann, who’s very well known in the global health space, considered one of the fathers of the health and human rights movement. The work of HealthRight itself is focused on improving health outcomes, health and well-being, particularly for marginalized communities around the world. Over the course of HealthRight’s existence, we’ve worked in more than 30 countries.
Today we’re focused on four. We’re in Kenya, Uganda and East Africa. We have a large operation in Ukraine and we have programs here in the United States. We work across four programmatic portfolios. So one is mental health. The second is HIV/TB. The third is reproductive, maternal, adolescent child health. And the fourth is gender-based violence. Those are all obviously deeply interconnected issues. That’s very much by design.
When we design interventions, we’re really trying ideally to sort of address the multifaceted dimensions of public health problems. And often that means addressing things like gender-based violence and mental health in concert, together. So those are our four programmatic areas. And then I would say sort of our focus in terms of where we’re trying to really affect change, we’re really focused on two things in all of our projects.
One is increasing access to services in those four areas for marginalized communities. And the second piece of our work is addressing quality of care. Once marginalized communities are able to access health care services, we want to ensure that the quality of that care is good. So it’s both about overcoming barriers to access, but also once access has been achieved, ensuring that care is of good quality.
And really, so what that means for most of our work is that we’re really primarily working at the intersection of communities, affected communities, and the primary care system. So our interventions sort of nest right in between the two and are concerned, again, with issues around access and care quality.
Understanding the Healthcare Gap
Grayson Harris: What would you say is the biggest misunderstanding of this gap that you’re filling within the system? Because we talk about that all the time, that nonprofits fill gaps that the healthcare system or the government, that our public benefit system is not addressing. Could you explain a little bit more about where that gap maybe is coming from, and some misunderstandings around that?
Peter Navario: Well, I think part of the gap is, particularly if you’re talking about low income countries, one of the sources of the gap is just a chronic lack of investment in health systems. You see that across low income, middle income countries, lower middle income countries. And that’s certainly the case in places where we work, particularly in low income areas in Kenya and Uganda. So health system underinvestment is a big challenge.
I think a lot of health systems have tried to address this gap by creating a new cadre of, well, in some places they’re considered health professionals, in some places they’re not, but community health workers. They’re really meant to act as that bridge between the community and the primary care system. And so a lot of our work is around helping to equip community health workers, but not just that.
I think investing and helping working with governments to invest in community health workers is critically important. But in many places, community health workers are not paid. So if somebody is a community health worker and they get a paying job, they often leave. And so you’ll find that there’s turnover with community health workers. And so that investment, if you’re only investing in the community health worker, you’re going to have to keep making that investment again and again and again.
And so our interventions are really focused on investing in the community health worker, but also investing in the communities themselves, understanding really what their experience of the healthcare system is, what are their barriers to access, what services are not there that they need, and then the primary care system. So it’s like this triangle. It’s community members, community structures. We work with community health workers. We work with community-based organizations, religious leaders, other types of community structures.
We’ve got a number of projects with unions, for example, transportation unions. We work a lot in the transportation sector. And so that’s a community structure and then the primary care system. And if your intervention is able to build the capacity at the community level and the primary care system at those three critical points, your projects have a much greater chance of success in our experience. And so we’re making investments in all three of those things.
I think people often, a lot of NGOs that we see sort of start and end with investments in community health workers. And I feel strongly, we feel strongly as HealthRight that it needs to go beyond that to be a sustainable investment. You can’t put all the pressure on overburdening community health workers, and that tends to happen where people are putting too much responsibility on community health workers. And so we’re trying to find creative ways to link them to other community structures and the primary care system in a way that spreads that responsibility around and hopefully is more sustainable and more effective.
The U.S. Healthcare Challenge
Grayson Harris: That’s really helpful. And then kind of my perspective as well, you mentioned the investment. And you mentioned that there’s a lot of domestic work that you are doing within the United States too, which has a large level of investment within the healthcare system, but there are still major gaps there. If you’re zooming in domestically within the United States, where would you kind of identify some of those challenges?
Peter Navario: So the services, it’s interesting, I have to say our programs, we have the four programmatic areas that I mentioned at the outset. Our programs in the United States are uniquely focused on mental health. We really saw a gap. We’ve spent about 20 years developing an approach to addressing common mental health disorders in low resource settings. And so a lot of our work started in the early 2000s in Uganda.
We subsequently brought it to Kenya and to Ukraine. So we’ve really developed an approach to, again, addressing common mental health disorders in low resource settings that don’t require trained mental health professionals because in many low income countries there are very, very few. And so if you’re waiting for trained mental health professionals to deliver mental health services, you’re going to be waiting a very, very long time.
So again, our approach is community based. Our interventions are peer-led and peer-facilitated. So again, we’re engaging the community members as facilitators, as peer leaders. We’re engaging community structures because we’re situating these mental health interventions typically outside of a clinical setting and often somewhere in the community. And then linking them to the primary care system so that there is supervision and oversight from the primary care system and there’s a referral network for folks who need advanced care.
We’re working with common mental health disorders and folks who have mild to moderate symptoms. Anybody with severe symptoms gets referred for specialty care. So we developed that model, as I said, over the past almost 20 years now, and we saw a massive gap in the United States just in terms of access. There’s a huge amount of need. There’s a ton of unmet need.
Particularly among adolescents and young adults, really big barriers to access, a lack of options and services. And even in a high income country like the United States, where we have lots of mental health professionals, the answer, given the burden of mental health issues in the country, the answer cannot be one-on-one therapy for everybody.
Grayson Harris: The scalability.
Peter Navario: It’s not scalable. It’s not feasible. It’s not affordable. And so we really felt like this model would translate well to the United States, again, for folks who have mild to moderate symptoms of common mental health disorders.
And so we brought the model here. We’ve just received our first grant from Arnold Ventures, which is a large foundation here in the United States to do some of this work with justice, criminal justice involved communities.
We’re in discussions with community colleges, high schools, and health systems around integrating our approach to mental health, this peer-led community-based approach to mental health in different settings. Again, with a particular focus on older adolescents and young adults where there’s really a gap. Typically at that age, folks don’t have a lot of disposable income. A lot of mental health care now is out of pocket and insurance doesn’t cover it.
Our approach is extremely affordable. We’re also working on, just started through this process to work on Medicaid approval. So our long term goal is to get our approach covered through the peer mechanism within Medicaid for reimbursement. So that’s our long term goal. But in the near term getting other sources of funding to support care for older adolescents and young adults who don’t currently have access to mental health services in the United States.
Why Peer-Led Mental Health Works
Grayson Harris: That’s incredible. The quick question that came to my mind around it is, obviously, I think you would advocate that it’s not a replacement, as you said, of that one-to-one, especially as more complex mental health challenges are being addressed. What about that peer and community approach is able to still achieve a lot of the same benefits that you get from those one-to-one settings, but at a larger scale? Why is it that this is working so well?
Peter Navario: It’s a really good question. So the first thing to say is that, just to be clear for the listeners, we have a really robust evidence base around the tools that we use. And several of the tools that we use are actually WHO tools. We’ve integrated some WHO tools alongside other tools, and we’ve created an integrated approach that is very plug and play. So depending on the community and the specific needs of the community, we can plug in different interventions into an overall model and folks work their way through this model.
We’ve seen significant symptom reduction within five weeks, typically across these interventions and we’ve published widely on them. Including in journals like The Lancet. So we feel, we’re doing this, we believe deeply in this because we also have the evidence to back it up. We’ve really seen it work.
And I think to your question, it works partially because particularly if you’re talking about older adolescents and young adults, they’re working with peers who we’ve trained. So we train the peers as peer facilitators. There’s an instant trust and level of comfort that people get to more quickly than they do with one-on-one therapy with somebody who at least starts out to be a stranger. You don’t know anything about them.
So you’re already starting, the peers come from your community, whatever that is, whether that’s a geographic community or an ethnic community or a social community. They’re coming from your community. So there’s that relatability, that level of comfort that comes with that.
The second thing that’s great about this is that all of the tools that we use, they themselves have an evidence base and they’re based on cognitive behavioral therapy, which obviously has a robust evidence base. And so they’re based on proven tools, all of the interventions that are either done as group work in a group setting, group facilitated, or we also have interventions that are self-guided, that are either audio books or books that you can work through, material that you can work through on your own, that just helps you think through how do you manage problems, how do you manage day-to-day stress, when something happens, how do you react to it.
And so it’s really straightforward kind of behavioral therapy principles that are imbued in all of these tools. And so I think for those reasons, it’s, and also the issue of accessibility. They’re very low cost. When we do this in low income countries, we provide them for free. We have grants that support the work, so it’s free, but we’re convinced that we can offer these things that are really affordable.
Initially we’re trying to get grants to do this work in the United States as well, so we would offer them with a partner, either through a community college or through a community partner for free. So I think the access issue, the affordability, and then the fact that it’s situated in a community structure closer to where the people are as opposed to in some sort of a clinical setting, which may also feel distant, uncomfortable, unfamiliar. I think for all of those reasons, these tools are appealing.
Facing the Funding Crisis
Grayson Harris: That makes total sense. The next question you started kind of getting to is why is this not available to everybody? And that really speaks to some of the overall challenges that your organization and broad NGOs that are serving both international and also underserved communities are facing right now. Can you talk a little bit more about what that looks like and especially some of the challenges over this last year that you have been facing?
Peter Navario: Well, so specifically in terms of our global work, all of our global work is supported by grants and those grants are provided by, we have a very diverse funding base. So it’s a mix of government providers like the US government. What was formerly USAID was not the State Department, European government development agencies, private philanthropies.
Multilateral organizations like the UN, we have grants from UNICEF, UNFPA, that sort of thing. We’re getting grants from a range of different types of providers. Of course, the US government in January of last year, it’s been about a year now, cut a great deal of foreign assistance, including for global health.
And we’ve been negatively affected by those cuts. We have had US government funding for quite some time. So it hit about 20 percent of our budget when those grants were cut, which was certainly challenging. Linked to that, and it gets a little bit less press, is that the Europeans have also been spending less on foreign assistance. They’ve been contributing less.
And so it’s really been a compounding problem. There are lots of NGOs that are closing their doors actually globally. And so it’s a pretty tough time in global health and development. Nevertheless, the need persists for these services.
The governments where, you can always make an argument that the governments, I mentioned earlier, governments, the health systems that we work in, Kenya, Uganda have suffered from chronic underinvestment over the years. And you can certainly make the argument that governments should be investing more in healthcare. But you can’t expect them to turn on a dime like this.
I think Kenya has made moves to increase their investment in healthcare. Kenya has more resources than a country like Uganda though and there are a number of countries in Africa that are going to really struggle to make up the money that supports these critical services. And lots of people, it’s already been documented, have been dying and falling ill unnecessarily, unfortunately. So it’s really a bit of a global health crisis at the moment.
Crisis obviously first and foremost for the communities on the ground who are benefiting from the services that were supported by this money, but also for the NGOs themselves who are again, closing their doors due to a lack of funding.
Strategies for Nonprofit Resilience
Grayson Harris: And well, that brings me to my next question. How has it been navigating it? Because you are not shutting your doors. And what’s gone into that? Because I’m sure it’s been a challenge, you have to be scrappy over this past year.
Peter Navario: We’ve had to be scrappy for sure. We’ve had layoffs. We’ve had to really, we’ve had to go without in some instances with certain roles, find ways to creatively work around it. We’re fortunate to be in a position that we were able to pivot.
And the other thing that enabled us to do this has been that even before all of these cuts to foreign assistance happened, we were already working on a few new strategic initiatives within the organization that were aimed to diversify our revenue sources, move us into new places.
So the US Mental Health Program is a perfect example of that. That was launched at the beginning of quarter three last year. And so, but we were working on that. We’ve been working on that program for more than a year and a half now. So those wheels were already in motion and growing out of decades of work abroad. And so that investment, I think we’re really optimistic about our US mental health program. There’s been a lot of interest.
And then the other thing that we’ve been working on is a new funding platform that will allow folks to invest directly in our programs. And so that’s, I can’t say too much about it yet, but we’re getting ready to launch it by the end of Q1 this year. And we’re really excited about that. I think there’s been very…
Grayson Harris: Geared towards individual donors is what you’re speaking to?
Peter Navario: Individual donors, anybody really. So it’s in a way a riff on a collaborative fund. I think it’s innovative also and quite unique in a number of ways. And so I look forward to being able to talk about it more. We just have it. It’s not quite ready to go live yet, but we will be soon. And I’m also working on a publication around this.
But so we’re trying to create new mechanisms for people who care about this work to be able to support it directly. Could be individuals, it could be family foundations, it can be family offices. And so we’re trying to connect with people directly and connect people directly to the programs that we’re implementing, again, across the four portfolio areas that I mentioned earlier.
The very first mechanism that we’re going to be seeking funding for is around reducing preventable maternal mortality. We’re also going to do one on mental health in the US. Those are going to be the first two platforms that we launch around direct investment. So we’re excited about that. So, I mean, let’s see if they take off.
I think there’s a real need in the health space for creative thinking. I’ve been, obviously this is my job. I’ve been following the dialogue around foreign assistance and how to deal with the cuts to foreign assistance. And frankly, I’ve been a little disappointed in the thought pieces you read. They’re largely just recycled old ideas that have been around for almost 30 years.
And I think there needs to be a dialogue around actually how do we connect people who have solutions that really can have an impact on the ground with capital. That’s the trick. And the traditional way of doing that has been for these large organizations, private philanthropies, government donors, multilaterals, to make grants.
It’s slow, it’s very constraining, it does not provide NGOs with enough capital to actually invest, succeed over the long term, sustain themselves over the long term. So the current financing regime, the way it’s worked for the past 60 plus years, is really, it’s time to have a dialogue about how to do global health financing, development financing, foreign assistance better.
And with our direct investment platform, that’s one of the things that we’re trying to do. With this platform, I think we’re addressing some of the major problems that we see in global health and development, the way it’s financed. It’s still very top down. It’s too short term. All of these problems. You’re talking about capacity building and health system strengthening, and you can’t do that in two or three years with a small grant.
Grayson Harris: To align incentives and that long-term sustainability.
Peter Navario: So we’re looking to really change that and hopefully we can.
Message to Nonprofit Leaders
Grayson Harris: Thank you for sharing that. I guess what would be your message to the other nonprofits within this space, other leaders within this space that are listening?
Peter Navario: I think I will say I’m glad you asked the question because I think when you look at the dialogue around global health financing, the voice that’s missing in the space is the implementer’s voice, the NGO leader, the community based organization leader. You hear from the philanthropists all the time. You hear from the government leaders all the time. And I say this as someone who’s formerly out of a think tank, or you hear from think tanks about how we should do this better, but you rarely hear from the implementer.
What is their perspective on how global health financing should work optimally? And so what I would say to NGO leaders out there is they’re in a difficult position because it’s hard to be critical of the way global health is financed because you have to be a little bit critical, hopefully constructively critical, of the folks who are funding your work.
But there’s really been a lack of dialogue over the years between the funders and the implementers. It’s been a one-way street. It’s funders who have by and large dictated how this works. And I think the consequence of that has been NGOs who do not have the financial resilience to withstand a shock like the one that we saw this year. And that’s why you’re seeing just thousands of NGOs shutting their doors. International NGOs, local NGOs, they just don’t have the ability to withstand the shock and it’s partially because of the way the space is financed.
And so there needs to be a much better dialogue between funders and implementers to make the process more efficient, more effective, always with a view to the end beneficiary, who are the communities and the health systems that we’re all working to strengthen and improve.
So I would encourage them to find… The first thing I would say is we’ve just decided to try. We don’t know if it’s going to work, but we’re going to try to solve this on our own. To some degree, I mean, this is not the only way we’re going to mobilize revenues, but hopefully it’s another avenue for mobilizing revenues.
So I think you can think creatively. You don’t have to sit around and wait for the folks in the space to sort of solve the problem. And I would also encourage them where they can to reach out to funders and have that dialogue. And I would say to funders in the space that they really need to reach out and have a dialogue with implementers. There’s not enough dialogue on how to improve, how grants are designed and structured.
Everybody, you know, donors talk about scaling and impact and sustainability, but nobody wants to pay for it. I’ve been doing this for a long time. Nobody’s paying for scaling for the most part. You just don’t see scaling grants. Everybody says they want a scalable solution, but they don’t want to pay to scale it. So we have an issue.
Kudos to somebody like MacKenzie Scott, who is… And not everybody has to follow her model, but I think her model is great. She’s basically saying, listen, organizations like HealthRight have been doing this for 36 years now. We know what we’re doing. We have a proven track record. We have deep relationships in communities and on the ground.
As an organization, we don’t employ expats. Our staff are members of the communities that we’re partnering with. We are deeply connected to both the problems that these communities face as well as with the solutions that they need to overcome those challenges. And so that, just giving organizations the cash to be able to creatively solve it is a wonderful thing.
Not everybody has to do that, but it’s a great, at least she’s thinking a little bit differently. And that’s great to see. And I hope there’s more of that. It’s needed.
Grayson Harris: I love it. Peter, thank you for coming on. I really appreciate the conversation that we had today and I would love to have you back at some point in the future as well.
Peter Navario: Yeah, thanks for having me. Appreciate it.
Key Takeaways for Nonprofit Leaders
Build financial resilience before you need it. HealthRight’s ability to weather the funding cuts came partly from strategic initiatives already in motion before the crisis hit. Diversifying revenue streams and exploring new service areas takes time. Start now.
Invest in the whole system, not just one component. The “triangle” approach of investing in community health workers, community structures, and primary care systems together creates more sustainable outcomes than single-point investments.
Evidence matters for scaling. HealthRight’s peer-led mental health model gained credibility through rigorous research and publication in journals like The Lancet. Building an evidence base opens doors for replication and new funding sources.
Challenge the status quo constructively. The current global health financing system has significant structural problems. NGO leaders should advocate for change while developing innovative alternatives like direct investment platforms.
Think about unit economics and sustainability. One-on-one therapy cannot scale to meet demand. HealthRight’s community-based approach offers a more cost-effective model that can reach more people. Nonprofits should consider similar approaches to scale impact without proportionally scaling costs.
