A Global Relief Organization Keeps the Spigot Open for Community Healthcare Providers Closer to Home

Based in Hawaii, Healthy Mothers Healthy Babies receives support through Direct Relief’s Fund for Health Equity.

Direct Relief’s name encapsulates its mission in clear, unflashy language, which matches its approach. The organization aims to provide assistance, including medicines and healthcare resources, to communities around the world — whether they’re experiencing a natural disaster or a global conflict.

In the U.S., Direct Relief seeks to boost healthcare access in underserved communities through its Fund for Health Equity. As the name suggests, the fund is a vehicle for nonprofit grantmaking — or, in this case, regranting money from several big-name backers, including two major pharma companies and MacKenzie Scott. It recently announced its latest round: $7 million to 38 organizations around the country. Grantees include community health centers, clinics, educational institutions and other community organizations “fighting the inequities that further health disparities.”

The idea for the Fund for Health Equity originally came from the AbbVie Foundation, according to Byron Scott, chief operating officer of Direct Relief and co-chair of the Fund for Health Equity. “AbbVie was the anchor organization,” Scott said. “They came to us and asked if we would create a fund for health equity, although it wasn’t called that yet; in 2020, they gave $10 million over five years. MacKenzie Scott gave us $50 million, Eli Lilly and Company provided $5 million in 2021, and then others joined, too, so we had $75 million. That’s how it started.” AbbVie and Eli Lilly and Company are both longtime Direct Relief partners and donate medicines and other supplies that Direct Relief distributes to organizations around the globe.

Since its launch in 2021, the Fund for Health Equity has provided more than $50 million to 161 organizations across the U.S. Many grantees are community-based health centers that punch far above their weight. According to Direct Relief, “These facilities provide comprehensive, culturally competent health services to more than 30 million U.S. residents. Nearly 70% of patients have incomes below the federal poverty level, and roughly 23% lack health insurance.”

Sofi Bergkvist, the president of the Center for Care Innovations, emphasized the key role these centers play in promoting health equity when IP interviewed her earlier this year: “Community health centers serve 1 in 11 Americans — more than 30 million people — and that is increasing. They are the largest providers of primary care in the country.”

But despite their critical role, community health centers tend to operate on shoestring budgets, thanks to inadequate government funding. Many safety net health centers rely on philanthropy to cover funding gaps — a situation that is likely to persist as long as the U.S., which spends more on healthcare than virtually any other country in the world, leaves so many behind. Many community and regional foundations support community health centers to tackle health disparities. MacKenzie Scott has also recognized the important role community health centers play, directly backing many of them in her tsunami of giving over the last several years, in addition to her support through Direct Relief.

Funding work to address upstream determinants of health — including economic inequality and structural racism — has been popular among major health-focused funders in recent years. The Fund for Health Equity’s approach is more conventional in that it offers direct support to service providers, but since community health centers also respond to the structural inequities that prevent patients from accessing healthcare, backing them complements more typically “upstream” health funding.

Bringing care to families in Hawaii

The Hawaiian Islands may be a paradise and a playground for tourists from the mainland, but life isn’t always easy for the people who live there. A recent report from the Hawai'i Appleseed Center for Law and Economic Justice found that wages remain low, even though Hawaii has the highest cost of living in America. This is due, at least in part, to the state’s dependence on tourism, which concentrates employment in primarily low-wage leisure and hospitality jobs. The report cites a survey that found that “54% of Hawai’i residents spend all of their income on necessities, leaving them with little savings for unexpected costs, such as emergency room bills or vehicle repairs.” 

Healthy Mothers Healthy Babies Coalition of Hawaii (HMHB), which has received funding from Direct Relief since 2021, sees poverty’s impact on Hawaii residents every day. The organization provides clinical care, mental healthcare and other services, along with necessities like cribs, diapers and food. Its 13-person staff, along with volunteers, works out of offices on the Big Island and Maui, as well as three mobile vans that visit remote areas of the islands and homeless shelters and encampments. 

The U.S. has a serious infant and maternal health problem, and Hawaii does, too, in addition to unique challenges of its own. “We have huge disparities when it comes to caring for pregnant and birthing people,” said Sunny Chen, executive director of Healthy Mothers Healthy Babies. “Access to care is very limited. We don't have many specialists, and then we have special challenges geographically because we're spread across islands.” 

Although it’s been providing services to Hawaiian families for more than 30 years, Healthy Mothers Healthy Babies only began offering clinical care during the pandemic. “We always knew we wanted to add a clinical arm, we just didn’t know what it was going to look like,” Chen said. “During COVID, we added the mobile clinics. We have three cute mobile clinics, they are refurbished vans, so now, we provide full spectrum care: pregnancy care, prenatal care, postpartum care, and then kind of everything in between, from contraceptives to early abortions to STI screening for reproductive health.”

HMHB starts by treating mothers and babies, and often ends up treating everyone else in the family as well. “When we were doing COVID vaccines, we’d give them to the entire family,” Chen said. “Or often, we visit a mother and they are caring for an elderly person, or a person with a disability who is bed-bound or homebound, so we provide care for them, too. When our nurse practitioner goes out to shelters, she’ll do back-to-school physicals and sports physicals for kids — services our families traditionally have trouble accessing.” 

Along with dollars from the Fund for Health Equity, Direct Relief also provides Healthy Mothers Healthy Babies with free medication, including vaccines and long-acting contraceptives and equipment, like refrigerators for vaccines. During the Maui wildfires last August, Healthy Mothers Healthy Babies jumped in to help. It set up a 24-hour hotline and sent a mobile van staffed with a nurse, midwife, mental health provider and other health workers. The organization also distributed breast pumps, formula, diapers and other supplies, according to The 19th.

Chen said that when the fires began, she reached out to Direct Relief. “They were the first people we called when we had the wildfires,” she said. “With their help, we were able to deploy so much aid out there,” she said. “They sent a team and brought medical kits and other emergency supplies.”

“Kind of like our Oprah”

The Fund for Health Equity is just a few years old, but Direct Relief has been around for a while. It grew out of a project created by William Zimdin, who immigrated to the U.S. from Estonia. Beginning in 1945, Zimdin sent packets of medicine, food and clothing to those he knew in war-ravaged Eastern Europe. He created the William Zimdin Foundation in 1948; after his death, a business associate carried on and expanded its work. The organization was renamed several times — it was called the Direct Relief Foundation, then Direct Relief International, and finally Direct Relief — as it expanded its reach to medically underserved communities around the globe. In 1962, Direct Relief was licensed as a wholesale pharmacy so it could secure and distribute prescription medicines abroad. 

Until recently, Direct Relief primarily partnered with pharmaceutical and medical supply companies that donate in-kind pharmaceutical drugs or medical supplies, which Direct Relief distributes. The organization continues that work today, but in recent years, it has begun to receive more cash donations as well.

“That has allowed us to help organizations with some of their other needs,” Byron Scott said. “They may have a program where they're trying to make improvements in, let's say, high blood pressure, and to do so takes either manpower resources or technology — you know — hard dollars, and they're on tight budgets. So we've been able to help some of our partner organizations fulfill some of their needs or projects separate from the Fund for Health Equity.”

Direct Relief keeps a low profile given its size. A Forbes report last year ranked it as the fifth-largest charity in the U.S., and it’s also the largest charitable medicine program in the country. Thanks to a bequest the organization received in 2007, along with several subsequent legacy gifts, Direct Relief does not use any of the donated funds it receives on fundraising activities.

Today, many of the crises Direct Relief responds to globally are extreme weather events triggered by a changing climate, as well as new conflicts flaring up in places like Ukraine and Gaza. Last week, for example, it delivered medical aid to 37 U.S. states and territories and 13 countries, including Kenya and Tanzania, which recently experienced flooding and a devastating cyclone.

With its Fund for Health Equity, though, Direct Relief is moving resources closer to home to patch some of the many holes in the American healthcare system.

“I joke that Direct Relief is kind of like our Oprah,” said HMHB’s Sunny Chen. “They provide so many resources, both financially and through medical supplies; it would be very, very difficult for us to do this health equity work without them, because we're seeing the people who fall through the cracks. We couldn't do this work without their help.”