Direct Relief has been ranked as the fifth largest charity in the United States and one of the most effective stewards of private donations, according to Forbes’ 2024 annual list of the 100 Top U.S. Charities, which ranks organizations by private donations.

“Direct Relief, No. 5 on this 26th edition of our list, is one of the most respected and older organizations in the disaster relief business,” Forbes stated.

Forbes awarded Direct Relief a perfect score of 100% for charitable commitment, reflecting the proportion of expenses allocated directly to its charitable mission, and 100% for fundraising efficiency, highlighting the organization’s minimal fundraising costs relative to private donations.

In fiscal year 2024, which ended on June 30, Direct Relief mobilized more than $2.4 billion in humanitarian aid, including $770 million in medical aid for victims of natural disasters, war, and civil conflicts in locations such as North Carolina, Maui, Ukraine, the Middle East, Haiti, and Sudan.

Direct Relief’s impact also included providing targeted financial support for projects such as funding mobile medical clinics, prosthetics clinics in Ukraine, and search and rescue teams in California.

Forbes highlighted Direct Relief’s leadership role in disaster response, noting that it “may pump more aid into disaster relief in the U.S. and abroad than any other charity on the new Forbes list.”

Top Ten Charities in the US – 2024

Leading Position Among California and International Charities

Among the 100 largest U.S. charities recognized by Forbes in 2024, Direct Relief stands out as the largest among the six headquartered in California, emphasizing its leadership in a state renowned for philanthropy.

Top California Charities by Size – 2024

Globally, Direct Relief is ranked as the second-largest charity in the “International Needs” category, underscoring its ability to address complex global challenges and deliver impactful humanitarian aid across diverse regions.

Top International Charities by Size – 2024

2024 Charity Ratings

Beyond its Forbes ranking, Charity Navigator, the nation’s leading nonprofit evaluator, awarded Direct Relief an overall 100% charity rating for 2024, marking its 14th consecutive Four-Star rating. This distinction underscores the organization’s commitment to excellence, accountability, and measurable impact.

Charity Navigator also recognized Direct Relief as one of the Best Humanitarian Relief Charities of 2024, highlighting its responses to Hurricane Helene, Hurricane Milton, and humanitarian crises in Sudan and Ukraine. These lists identify organizations that are “extraordinarily effective at what they do, giving you the chance to support a cause where you’ll have an impact.”

Direct Relief has also earned an A+ rating from CharityWatch, the highest grade awarded by the independent watchdog.

Humanitarian Impact in 2024

In 2024, Direct Relief advanced its global humanitarian mission with the following accomplishments:

• Delivering Lifesaving Medicines: Distributed over 380 million defined daily doses of medicine to more than 2,300 healthcare facilities across 90 countries and all 50 U.S. states.
• Hurricane Responses: Responded to Hurricanes Beryl, Helene, and Milton, providing financial support and essential medicines to over 90 healthcare providers across impacted states, including Florida, Georgia, North Carolina, South Carolina, Tennessee, Texas, and Virginia.
• Middle East Humanitarian Aid: Provided $299 million in medical aid to regions including Gaza, Egypt, Israel, Lebanon, Syria, and Yemen. This included nearly 150 tons of medical supplies, valued at more than $32 million, addressing critical health needs such as cancer treatment, diabetes care, cardiac conditions, and water purification.
• Support for Ukraine: Delivered $322 million in medical aid to Ukraine in 2024, bringing the total since 2022 to 2,600 tons, valued at $1.4 billion. Current initiatives focus on rehabilitation, mental health, mobile care, and energy resilience for healthcare facilities.

Policies on Donor Funds and Valuation of In-Kind Donations

Direct Relief ensures that no donor funds are used for fundraising expenses. Such costs—averaging just 2% of cash revenue—are covered entirely by earnings from a generous bequest, ensuring that 100% of donor contributions directly support humanitarian programs.

As an organization funded exclusively by private charitable contributions, Direct Relief does not accept government support. Its operational efficiency is bolstered through strategic partnerships with businesses and nonprofit organizations.

The majority of donations received and distributed by Direct Relief are in-kind contributions of medicine and medical supplies, valued at wholesale cost. These contributions form the largest share of the organization’s annual revenue.

Direct Relief’s long-standing support for locally run facilities providing essential health services to underserved communities has enabled it to expand its reach and strengthen fragile health systems globally, marking an unparalleled level of impact in its 76-year history.

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Direct Relief, which is funded entirely by private charitable contributions and does not accept government support, prioritizes operational efficiency through strategic partnerships with businesses and organizations. The vast majority of the donations it receives and distributes consist of in-kind donations of medicine and medical supplies. These contributions, valued at their wholesale cost, comprise the predominant share of the organization’s annual revenue.

Forbes awarded Direct Relief a score of 99% for charitable commitment (how much of a charity’s total expenses go directly to the charitable purpose) and 100% on fundraising efficiency (the percent of private donations remaining after deducting fundraising costs).

Forbes also ranked California-based Direct Relief as the largest of the six California charities included in its 2023 list.

Direct Relief, one of the world’s largest channels for humanitarian medical assistance to underserved communities and survivors of disasters, also ranks as the second largest charity in the “International Needs” category, according to Forbes.

Direct Relief in 2023

Doctors, midwives, community health workers, and other health professionals working in public-benefit health organizations around the world rely on Direct Relief to equip them with the medical resources they need to care for any patient, without regard to politics, religion, or ability to pay.

In its 2023 fiscal year, Direct Relief provided assistance in the form of essential medications, a broad range of medical supplies, and financial support in response to requests from healthcare providers and other local organizations across 88 countries and 55 US states and territories. The 2,900 tons of medical essentials provided by Direct Relief included 534 million defined daily doses of specifically requested medications, vaccines, insulin, and biologic therapies. The organization also provided $77 million in financial assistance through grants for a variety of emergency response and public-health related purposes.

In 2023, Direct Relief once again sustained and expanded existing programs while also responding to humanitarian emergencies globally. The organization’s continuing response to the war in Ukraine – now exceeding $1.5 billion in humanitarian assistance – remains the largest mobilization of medical resources in Direct Relief’s history.

Direct Relief’s longstanding approach of supporting locally run facilities providing essential health services to underserved communities has enabled the organization to distribute more medicine and supplies and strengthen fragile health systems in more places than ever before in its 75-year history. 

Since January 1, 2023, Direct Relief has:

• Donated insulin to 40,332 children with Type 1 diabetes in 32 countries.
• Provided more than 460,000 doses of lifesaving naloxone to health centers, free clinics, community organizations and harm reduction groups in the U.S.
• Delivered critical rare disease therapies to treat more than 600 patients in 17 countries.
• Launched projects to provide resilient energy solutions to 41 healthcare facilities in California, Florida, Louisiana, and North Carolina, projected to yield an estimated $4.3 million in cost savings annually.

2023 Charity Ratings

In addition to its top ranking from Forbes, Direct Relief earned a four-star rating from Charity Navigator, America’s largest independent charity evaluator.

This recognition marks Direct Relief’s 13th consecutive four-star rating and the first time it has been evaluated in Charity Navigator’s Impact & Results beacon, where its 100% rating contributed to an overall perfect score across the key nonprofit performance indicators Charity Navigator assesses.

Direct Relief also retains an A+ rating from Charity Watch, the highest score given by the independent charity watchdog.

Direct Relief, which receives no government funding and is supported entirely from charitable contributions, has a longstanding commitment to efficiency and frugality in all its organizational activities, including fundraising activities.

Direct Relief’s revenue includes both gifts of medications and other medical commodities and cash. Direct Relief believes it important to note that revenue associated with medical product contributions obviously may not be used for fundraising purposes, and that its modest fundraising expenses average about 2 percent of its total cash revenue. The organization pays all such fundraising expenses with earnings from a generous bequest, which means that zero percent of donated funds are used for the organization’s fundraising activities.

To learn more, please read the Direct Relief 2023 Impact Report.

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Forbes awarded Direct Relief a score of 100% for both charitable commitment (how much of a charity’s total expenses go directly to the charitable purpose) and 100% on fundraising efficiency (the percent of private donations remaining after deducting fundraising costs).

Top 5 Charities 2022 – Forbes

Top 5 California Charities 2022 – Forbes

Headquartered in California, Direct Relief is the largest of the five California charities included in the 2022 Forbes ranking.

Top 5 International Charities – Forbes

Direct Relief, one of the world’s largest channels for humanitarian medical assistance to underserved communities and victims of disasters, also ranks as the largest charity in the “International Needs” category, according to Forbes.

Direct Relief Activities – 2022

In its fiscal year 2022, Direct Relief provided more than $2 billion in medical aid and $58.2 million in financial assistance to healthcare providers and other local organizations in 98 countries and 52 US states and territories.

Ukraine was the largest recipient country of Direct Relief’s assistance in 2022, receiving 1,099 tons of medicine and medical supplies from Direct Relief, valued at $640 million, at the request of the Ukrainian Ministry of Health and other healthcare providers after Russia invaded the country in February. This includes extensive supplies for treating traumatic injuries and a broad range of medications ranging from cancer therapies, insulin, and antidotes for chemical attacks to those needed for chronic health conditions.

In addition, through the generosity of donors worldwide, Direct Relief provided $29.4 million in cash assistance for programs benefiting Ukrainians and Ukrainian refugees.

Direct Relief’s other recent activities include:

• Awarded $22.7 Million to 71 US healthcare and other nonprofit organizations through Direct Relief’s Fund for Health Equity
• Delivered 12.5 tons of emergency medical essentials to fight a cholera outbreak in Haiti, including IV fluids, oral rehydration salts, antibiotics and water purification tablets. Direct Relief also is actively responding to cholera outbreaks across the globe in Lebanon, Syria, and Malawi.
• Donated 273,312 doses of the lifesaving drug naloxone, which counteracts opioid overdoses, to public and private healthcare providers in 45 US states
• Distributed medicines to treat Type 1 and Type 2 diabetes to 536 healthcare facilities in 438 US cities in 2022
• Responded to Hurricanes Fiona and Ian with more than $4.5 million in medical aid to 127 healthcare providers throughout the US and Caribbean

2022 Charity Ratings

In addition to its top ranking from Forbes, Direct Relief earned a four-star rating for the 12th consecutive year from Charity Navigator, America’s largest independent charity evaluator.

Direct Relief received a 100% rating in Charity Navigator’s Accountability & Finance category, which “provides an assessment of a charity’s financial health (financial efficiency, sustainability, and trustworthiness) and its commitment to governance practices and policies,” Charity Navigator says.

Direct Relief also received an A+ rating from Charity Watch, the highest score given by the independent charity watchdog.

Direct Relief is supported only by private, charitable contributions, accepting no government funding. The vast majority of the value of donations received and aid distributed is in the form of medicine and medical supplies donated by their manufacturers (in-kind contributions). Direct Relief values donated medicine and supplies at wholesale value; see https://www.directrelief.org/about/finance/cash-and-in-kind-contributions/ for more information.

To learn more, please read the Direct Relief 2022 Impact Report.

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• Forbes ranks Direct Relief the fifth largest charity in the United States in 2021, and Charity Navigator rates the organization a “Perfect 100.”
• In response to devastating tornadoes in multiple U.S. states, Direct Relief has provided medications, wound care products, Tdap vaccines, and solar power generators. 
• Super Typhoon Rai has killed hundreds in the Philippines. Direct Relief is sending emergency supplies and funding.
• Many Americans live in “pharmacy deserts,” where access to pharmaceutical care and resources are scarce.

Top Stories

Direct Relief Ranked Fifth Largest Charity in the U.S., Rated “Perfect 100”

The situation: Forbes releases an annual list of the 100 largest U.S. charities, ranked by private donations. The independent evaluator Charity Navigator examined 160,000 nonprofits this year.

The response: Direct Relief, which received $1.9 billion in private donations in 2021, is fifth on the Forbes list. The organization is also one of 92 earning a “Perfect 100” from Charity Navigator for accountability and transparency.

The impact: “The acute new health challenges that Covid brought on for everyone made all the existing challenges that much worse—particularly for people and places most vulnerable and least fortunate,” said Thomas Tighe, Direct Relief President and CEO. “Direct Relief has and will continue to stretch every dollar to help in the most efficient, productive way possible.”

After Deadly Tornadoes Rip through South, Midwest, Direct Relief Launches Response Efforts

The situation: Tornadoes have ripped through parts of Kentucky, Arkansas, Illinois, Missouri, Mississippi, and Tennesee, and the death toll currently stands above 90.

The response:  Direct Relief is equipping on-the-ground groups with Tdap vaccines, solar generators, insulin, wound care products, baby formula, and more.

The impact: The supplies are designated to help shelter residents and power a donation distribution point.

The Death Toll of Super Typhoon Rai Continues to Rise. Direct Relief is Responding.

The situation: As the fifteenth and strongest storm to affect the Philippines this year, Super Typhoon Rai has killed at least 375 people and injured 500.

The response: Direct Relief is coordinating with agencies on the ground, including ASEAN’s AHA Centre and the Philippines Department of Health, to send emergency supplies and provide financial support. Direct Relief-funded emergency supplies are already staged at the AHA Centre’s disaster response depot.

The impact: The organization will continue to support on-the-ground agencies and groups caring for those affected by the storm.

Across the U.S., Many Live Without Access to a Pharmacy

The situation: Millions of people in the U.S. don’t have access to a pharmacy, meaning they can’t pick up prescriptions, meet face-to-face with a pharmacist, or access other health care services.

The response: Nonprofit charitable pharmacies are working to bridge the gap, sending people their medications, often for free. And despite the distance, they still manage to keep close tabs on patients.

The impact: For many patients, these pharmacies are their only reliable link to medication they can afford. But they’re not a substitute for in-person care, an expert says.

In Brief

The United States

• Over the past two weeks, Direct Relief has made 780 shipments to 516 partners in 45 states and territories, totaling $10.5 million in value and more than 17,425 pounds.
• During the same period, $1.2 million in grants was distributed.
• Direct Relief has begun receiving donations of Narcan, a nasally-administered form of naloxone that is frequently requested by health facilities and organizations, for groups fighting the opioid crisis.

Around the World

• In the past two weeks, Direct Relief has made 43 shipments to 34 partners in 22 countries, totaling $34.4 million in value and more than 91,480 pounds.
• A total of $100,000 was granted during the same period of time.

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Among the ten largest charities in the Forbes 2021 ranking, Direct Relief is the only one to receive a score of 100% for both charitable commitment (how much of a charity’s total expense go directly to the charitable purpose) and 100% on fundraising efficiency (the percent of private donations remaining after deducting fundraising costs).

Direct Relief is one of the world’s largest channels for humanitarian medical assistance to underserved communities and victims of disasters.

In Calendar Year 2021, Direct Relief has:

• Mobilized $1.9 billion worth of medicines, cancer therapies, vaccines, PPE, and other health-related supplies, all provided at no charge to thousands of healthcare providers across the globe.
• Supported local healthcare facilities, public health authorities, and logistical partners in 101 countries, including 55 U.S. states and U.S. territories.
• Launched the Fund for Health Equity with an initial $75 million in funding to improve access to health care in communities in which the effects of historic racism and socioeconomic disparities persist. Since then, Direct Relief has granted more than $10 million to 50 organizations advancing health equity across the U.S..
• Donated and distributed over 800 midwife birthing kits to facilitate 40,000 safe births across 10 countries; more than 9 million doses of insulin for children with Type 1 diabetes across 24 countries; and more than 687,000 doses of naloxone, a drug that reverses opioid overdoses, to organizations throughout the U.S.
• Nearly tripled its capacity to distribute cold chain medicine requiring refrigeration, including Covid-19 antibody treatments, insulin for children with Type 1 diabetes, and advanced chemotherapy medicine to treat pediatric cancer patients.
• Provided extensive, ongoing charitable support to over 2,000 community health centers and free & charitable clinics across the U.S. with donations of essential medications for patients without insurance or means to pay.
• Provided medicines to healthcare facilities in disaster zones, including to those affected by the earthquake in Haiti, hurricanes in Central America and the Gulf Coast, wildfires throughout the Western U.S. and Mediterranean, and ongoing refugee crises.
• Delivered 262.6 million Defined Daily Doses of medicine and 8.4 million pounds of medicine and supplies and supported 2,379 healthcare providers.

Among the 160,000 non-profits rated by Charity Navigator in 2021, Direct Relief is one of the 92 on the current “Perfect 100” list of charities earning scores of 100 in both the Financial and Accountability & Transparency categories.

“The acute new health challenges that Covid brought on for everyone made all the existing challenges that much worse—particularly for people and places most vulnerable and least fortunate,” said Thomas Tighe, Direct Relief President and CEO. “Direct Relief has and will continue to stretch every dollar to help in the most efficient, productive way possible.”

Direct Relief is supported only by private, charitable contributions, accepting no government funding. The vast majority of the value of donations received and aid distributed is in the form of medicine and medical supplies donated by their manufacturers (in-kind contributions). Direct Relief values donated medicine and supplies at wholesale value; see https://www.directrelief.org/about/finance/cash-and-in-kind-contributions/ for more information.

The complete list of Forbes’s ratings and its methodology for America’s Top Charities 2021 is available at https://www.forbes.com/lists/top-charities/?sh=72ca225f5f50.

To learn more, please read the Direct Relief 2021 Impact Report.

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Direct Relief’s overall revenue in its 2020 fiscal year included $1.82 billion in donated medicines and services (up 36% from last year) and $171 million in private cash contributions (up 81% from last year).

FORBES: AMERICA’S TOP CHARITIES 2020

As one of the world’s primary channels for humanitarian medical aid and the only global nonprofit recognized by the National Association of Boards of Pharmacy as an Accredited Drug Distributor, Direct Relief partners with and seeks in-kind contributions from businesses and organizations of goods and services. As such, in-kind donations, which the organization provides without charge to qualified health care organizations for patients in need, typically represent more than 90% percent of Direct Relief’s total annual revenue.

Contributions to Direct Relief during this period — a year that saw a deadly pandemic and a near-constant series of climate-driven disasters — coincided with an unprecedented spike in demand for the organization’s services. Direct Relief responded by providing more humanitarian assistance than ever before in its 72-year history to every U.S. state and 99 other countries worldwide.

Overall, the medical-material support provided by Direct Relief increased from the prior fiscal year to 5.2 million lbs. (up 73%) with a wholesale value of $1.4 billion (up 29%) and included 223 million Defined Daily Doses of requested medications (up 71%).

In the U.S. alone, Direct Relief’s stepped-up efforts in response to the concurrent crises of the largest-ever wildfires, the most active hurricanes in U.S. history, and the Covid-19 pandemic included 26 thousand deliveries of requested medications, supplies, and over 13 million units of PPE. These resources bolstered the efforts of more than 2,400 healthcare providers in medically underserved areas and to hospitals and public agencies dealing with surging caseloads across the U.S.

The outpouring of public generosity also enabled Direct Relief to disburse more than $43 million in cash grants to more than 500 nonprofit community health centers and free and charitable clinics in the U.S. The communities and patients served by these organizations include high percentages of persons from racial and ethnic minority groups who have experienced the highest rates of Covid infections, hospitalizations, and deaths since the pandemic began. The financial support helped bolster their shaken financial status, enhance safety measures for their frontline staff, and stand up community responses in their home communities.

In the Forbes 2020 ranking, Direct Relief received a score of 100% for charitable commitment (how much of a charity’s total expense went directly to the charitable purpose) and 100% on fundraising efficiency (the percent of private donations remaining after deducting fundraising costs).

Direct Relief accepts no government funding and is supported only by private, charitable contributions, and values donated medicine and supplies at wholesale prices (see https://www.directrelief.org/about/finance/).

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Direct Relief earned a four-star rating for 2018 from Charity Navigator, America’s largest independent charity evaluator, the eighth consecutive time that Direct Relief has earned this top distinction. Of the more than 8,000 charities rated by Charity Navigator, Direct Relief is one of only 66 to receive a perfect 100 score. These charities have earned perfect scores in Charity Navigator’s evaluation of Financial Health and Accountability & Transparency.

Charity Navigator also included Direct Relief in its 2018 lists of “10 of the Best Charities Everyone’s Heard Of,” the “10 Best Humanitarian Relief Organizations,” and “10 Highly Rated Charities Relying on Private Contributions.”

Others recognizing Direct Relief in 2018 include the Center for High Impact Philanthropy at University of Pennsylvania (2019 High Impact Giving Guide), Wallet Hub (2018’s Best Charities for Holiday Giving), Okta (2018 Oktane Award Finalist) and TheStreet (30 Charities That Won’t Waste Your Money).

According to Forbes, Direct Relief ranks as the seventh largest U.S. charity in 2018, scoring 100 percent in fundraising efficiency (percent of private donations remaining after fundraising expenses) and 99 percent for its charitable commitment (charitable services as a percent of total expenses).

A Year of Disaster and Response

The ratings came in a year defined by humanitarian crises and natural disasters of unprecedented scale, and Direct Relief has responded more expansively than ever before in its 70-year history—delivering $923 million in humanitarian assistance to locally-run healthcare providers in 101 countries, including $212 million in aid to communities in 50 U.S. states, Puerto Rico and the U.S. Virgin Islands.

Examples of Direct Relief’s work in 2018 include:

Disaster Response: Within the first two weeks after Hurricane Florence struck the Carolinas in September, leading to at least 47 deaths, Direct Relief had delivered more than 14,000 lbs. of medicine and medical supplies, including more than 300,000 defined daily doses of medicine, to local health centers and free clinics in the affected areas.

Over Thanksgiving week, Direct Relief staff rushed deliveries to California’s Butte County, where local shelters housing thousands of people displaced by the Camp Fire were hit by outbreaks of highly contagious norovirus. The team delivered prescription anti-nausea medications, anti-infectives, oral rehydration salts, and personal protective gear and disinfectants for clinical staff and clean-up teams.

Puerto Rico Post-Maria: Direct Relief was the first organization to bring medicine into Puerto Rico when the commercial supply chain completely broke down after Hurricane Maria made landfall in September 2017. More than a year later, Direct Relief has provided $70.2 million in medical aid, invested $12 million in initiatives to bolster health services and local infrastructure, and installed 791 kilowatts of solar energy and 2 megawatts of battery backup at 14 health centers and remote communities across the island.

Opioid Epidemic: Direct Relief last year began shipping the life-saving drug naloxone, which can revive people who have overdosed on opioid medications, to health partners around the country. Through November 30, 2018, Direct Relief has shipped 173,460 doses of naloxone to healthcare providers in 45 states, Washington, DC, and Puerto Rico as part of a four-year commitment from Pfizer to supply up to 1 million total doses.

Humanitarian Crises: While responding to fast-onset disasters, Direct Relief continued aiding local healthcare providers in parts of the world enduring “slow-burn” humanitarian disasters—from Syria, Yemen and the Democratic Republic of Congo to Bangladesh.

In Bangladesh, where over 700,000 Rohingya have sought refuge from mass violence in Myanmar, Direct Relief is working with its longstanding partner HOPE Foundation in Cox’s Bazar to establish a field hospital for women and children, and provided durable medical tents, diagnostic and testing supplies, medical protective gear, oral rehydration salts, prenatal vitamins and personal hygiene items.

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The growing support from donors came in a year when Direct Relief extended help to more people in need than ever before in its 69-year history, furnishing essential medications, vaccines, instruments and supplies through 13,554 deliveries to all 50 U.S. states and 86 countries. Direct Relief is supported only by private, charitable contributions, and accepts no government funding.

In the Forbes ranking, Direct Relief earned a perfect score of 100 percent in fundraising efficiency (percent of private donations remaining after fundraising expenses) and a 99 percent rating for its charitable commitment (charitable services as a percent of total expenses).

Direct Relief has also earned a place on the Perfect 100 list published by Charity Navigator, one of only 65 charities to achieve 100 percent scores out of the nearly 8,000 organizations rated by the charity watchdog for accountability, transparency and financial health.

From July 2016 through June 2017, Direct Relief’s activities included the following:

• Provided $129 million in lifesaving medicines and other medical aid to more than 1,300 health centers and clinics throughout the United States, helping patients face challenges including chronic diabetes and opioid addiction.
• Responded to Hurricane Matthew in Haiti and prepositioned emergency medical supplies along the Gulf Coast of the U.S. and the Caribbean in advance of the devastating 2017 hurricane season.
• Supported doctors in Syria with urgently needed medical items, including a chemical weapons antidote, after a deadly series of attacks on Syrian medical facilities.
• Bolstered Yemeni hospitals with medications and supplies to combat a rapidly expanding outbreak of cholera.Since 2009, Direct Relief has provided more than $4.4 billion in lifesaving medicines and medical resources to help low-income people in 115 countries and all 50 U.S. states. The only organization to obtain VAWD accreditation to distribute pharmaceuticals in all 50 U.S. states, Direct Relief operates the country’s largest charitable medicines program.

The full list of Forbes’s ratings and methodology for The 100 Largest U.S. Charities of 2017 is available here.

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Direct Relief earned a perfect score of 100 percent in fundraising efficiency (percent of private donations remaining after fundraising expenses) and a 99 percent rating for its charitable commitment (charitable services as a percent of total expenses).

The Forbes ranking is the most recent of several accolades received in 2016 by the humanitarian medical aid group:

• CNBC last month named Direct Relief #1 on its list of “Top 10 Charities Changing the World in 2016.”
• Of the more than 8,000 charities rated by independent evaluator Charity Navigator, Direct Relief was one of only 49 to achieve a perfect score of 100 under Charity Navigator’s new rating system, CN 2.1. To be named to the Perfect 100 list, Direct Relief achieved perfect scores in Charity Navigator’s two main ratings categories, Financial Health and Accountability & Transparency.
• Charity Navigator last month named Direct Relief its highest ranked charity in the Humanitarian Relief Supplies category.

Supported only by private, charitable contributions, Direct Relief this year (FY2016) extended more help to more people in need than ever before in its 68-year history, furnishing $760 million in essential medications, vaccines, instruments and supplies through 11,146 deliveries to all 50 states and 81 countries.

Over the past 12 months, Direct Relief’s activities have included the following:

• In response to Hurricane Matthew, Direct Relief delivered $10 million in medicines and medical supplies to Haiti – nearly 20 tons, including more than half a million daily doses of medication. Direct Relief also shipped more than $1.3 million worth of supplies to storm-affected communities in the U.S.
• When a 7.8 magnitude earthquake on April 16 caused devastation in Ecuador, Direct Relief chartered a 767 cargo aircraft that delivered 47 tons of medicines and supplies worth $2.1 million – the largest single shipment of emergency medical assistance sent in response.
• Direct Relief this year has provided more than $4 million in critically-needed medical items to support health services for refugees of Syria’s civil war.
• In Liberia and Sierra Leone, where maternal mortality has gone up since the Ebola crisis, Direct Relief provided prenatal vitamins to more than 100,000 expectant or recent mothers.

Since 2000, Direct Relief has provided more than $2.2 billion in medical resources to support health services for low-income people in 88 developing countries and all 50 U.S. states.

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Meeting that need is at the heart of Direct Relief’s mission, and the California-based nonprofit is the first and only humanitarian aid organization to be FDA-registered as a wholesale drug distributor and is licensed to distribute prescription drugs into all 50 states. The organization also distributes to 70 countries around the world.

To keep up with global demand and more rigorous oversight on prescription drugs, the organization broke ground Thursday on what will be the largest distribution hub for humanitarian medical aid in the United States.

Several decades ago, all that was required to ship medical aid was a warehouse and a humanitarian mission. Today, stringent regulations govern what can be sent where and to whom.  Extensive tracking in all stages of the supply chain — down to the number of units — is essential.

“The noblest of missions is no longer sufficient in and of itself to qualify to provide humanitarian medical aid in the 21st century,” said Judy Partch, Direct Relief’s director of administration and compliance.

Whether drugs are shipped with a commercial or a humanitarian purpose in mind, the same laws, regulations and licensing agreements apply.

Direct Relief must maintain over 70 distinct licenses in the proper locations, make sure the products are stored correctly and aren’t diverted into the black market, as well as monitor the myriad of local and national laws that apply.

In recent years, the bar has been raised even higher.

To address counterfeit and unsafe drugs entering the marketplace, lawmakers approved the Drug Supply Chain Security Act in 2013, which outlined a system that would trace pharmaceutical products through the supply chain. This law preempted existing state laws and a national standard was put into place for wholesale distribution of drugs.

Direct Relief’s new medical distribution center and headquarters will meet those heightened federal requirements for security and storage of prescription medications. The new facility, expected to open in 2018, will also increase efficiencies for Direct Relief’s expanding humanitarian activities that serve people throughout the United States, and globally.

Now the ninth-largest U.S. charity, according to Forbes, Direct Relief runs the largest charitable medicines program in the United States and is among the largest providers of humanitarian medical aid in the world, both to meet ongoing needs and in response to emergencies.

“More than ever before in its 68-year history, Direct Relief is being called upon to assist people who are vulnerable – who endure poverty or crisis situations, and who often confront both,” said Thomas Tighe, Direct Relief President and CEO. “This is a pivotal moment in Direct Relief’s history and essential to its future.”

By incorporating state-of-the-art distribution technology, it will also transform how the organization mobilizes medical aid and dramatically increase the efficiency of its services.

To complete and endow the new facility, Direct Relief today announced a $40 million fundraising campaign, for which it already has secured $25 million in private gifts and pledges from corporate partners such as FedEx, foundations such as the Zegar Family Foundation, and members of the community.

“FedEx is honored to support the lifesaving work of Direct Relief as part of our FedEx Cares initiative,” said Patrick Fitzgerald, senior vice president, Integrated Marketing and Communications at FedEx. “The new headquarters and medical distribution warehouse will help Direct Relief do what it does best – provide immediate relief to men, women and children who need it most.”

Investment in this global supply chain will allow these medicines and equipment to reach every corner of the world, places where Direct Relief is uniquely suited to go.

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Only 51 of the more than 8,000 charities rated annually by Charity Navigator received an overall score of 100.

As America’s largest and most widely used independent evaluator of charities, Charity Navigator works to guide donors toward more intelligent giving.

“We applaud these charities for exceeding industry standards and outperforming other organizations performing similar work,” said Sandra Miniutti, VP of Marketing at Charity Navigator.”

The ninth-largest U.S. charity, according to Forbes Magazine, Direct Relief conducts the most expansive charitable medicines program in the United States and is among the largest private providers globally of humanitarian medical material aid to people in need due to poverty or emergency situations.

To be named to the Perfect 100 list, Direct Relief achieved perfect scores in Charity Navigator’s two main ratings categories, Financial Health and Accountability & Transparency.

Direct Relief is also rated No. 1 on Charity Navigator’s “10 of the Best Charities Everyone’s Heard Of” list.

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In addition to ranking the top American charities by size, the magazine evaluates the financial efficiency of each nonprofit. Direct Relief received a perfect score of 100 percent in fundraising efficiency.

Top Ten U.S. Charities

Direct Relief’s Forbes ranking is based on its revenue of $892 million in the fiscal year that ended June 30, 2015, nearly twice the $455 million received by the nonprofit in the year prior. The vast majority of Direct Relief’s revenue came in the form of donated medications and medical supplies, which the organization provides, at no charge, to support humanitarian health efforts throughout the United States and internationally.

Direct Relief is being called upon more than ever before to assist people who are vulnerable – from poverty or emergency situations, and often both,” said Thomas Tighe, Direct Relief President and CEO. “The Forbes ranking reflects an expansion in private support – mainly in the form of donated essential medications – which are critically needed by people stuck in the huge gaps that remain in both the U.S. and around the world.”

Direct Relief’s cash revenue of $27 million came from private contributors, whose financial support enabled the organization to deliver of 1,837 tons, or 278 million defined daily doses, of requested medications and supplies to health centers and clinics in all 50 U.S. states and more than 70 countries worldwide, including in response to the Ebola crisis that occurred in West Africa and the earthquakes in Nepal.

Top Charity Ratings

Forbes joins other independent charity evaluators in giving Direct Relief high marks for its efficiency. This includes Charity Navigator, the country’s largest independent evaluator of charities, which assigns Direct Relief an overall score of 99.4/100 and the No. 1 spot on its list of the “Ten Best Charities Everyone’s Heard Of.”

The Ten Best Charities in The U.S. – Charity Navigator

Charity Navigator, the largest independent evaluator of U.S. charities, ranks the 10 top charities from the more than 8,000 organizations it reviews each year. Charitable givers should feel confident that these national institutions put their donations to good use. – Charity Navigator.

The post Forbes Ranks Direct Relief Among Nation’s Ten Top Charities appeared first on Direct Relief.

He continued to lose motor abilities and some of his facial features began to develop atypically, prompting his parents to consult a physician. After seeing about half a dozen doctors and specialists, Arian and his family received a confirmed diagnosis of MPS II, also known as Hunter syndrome.

At the time of his diagnosis in early 2006, there were no treatment options available in the world for MPS II.

“It was beyond our comprehension that there was no medicine that could help our only child,” wrote Arian’s father Sib in a letter. “Our world collapsed around us and we felt as if we had lost everything that mattered to us.”

What is MPS II/Hunter syndrome?

MPS II is an inherited rare disease and is estimated to affect 1 in 100,000 to 1 in 150,000 males, according to the MPS Society. A disease or disorder is defined as rare when it affects fewer than 1 in 2,000 people in Europe and fewer than 200,000 in the United States.

One of the mucopolysaccharide diseases, people with MPS II are missing an enzyme that helps break down specific types of sugar molecules in the body. The incomplete breakdown causes progressive damage to many parts of the body.

The damage over time leads to joint stiffness, coarse features of the face, and affects mental function, among other symptoms. There is no cure for MPS diseases, but there are ways of managing and treating the problems they cause.

Elaprase: An Out-of-Reach Solution

Shortly after Arian’s diagnosis, Elaprase – a drug manufactured by specialty bio-pharmaceutical company, Shire – was approved as a treatment for MPS II in some countries. Elaprase is designed to replace the enzyme that is missing or defective in patients with Hunter syndrome.

Among other measures, it has been shown to improve walking capacity in patients five years and older. To receive Elaprase, you go to a treatment center every week to receive it intravenously.

However, the treatment was not available in India. Furthermore, the high cost of the medicine limited their family’s ability to afford the treatment. In fact, Forbes included Elaprase on their 2010 “World’s Most Expensive Drugs” list at around $375,000 per year.

“We felt so helpless watching Arian’s condition deteriorate compounded by the fact that there is treatment available that we couldn’t afford,” wrote Sib.

Their family began to speak up, spreading the word about Arian’s condition to Indian policy makers and starting a #SaveArian campaign to help raise money that garnered support from many on Twitter.

Global Charitable Access Program Provides Hope

About two years ago, Shire and Direct Relief partnered to launch the Shire Global Charitable Access Program to improve access to Enzyme Replacement Therapy (ERT) for those living with Lysosomal Storage Diseases (LSDs) – like MPS II – in countries where Shire’s products are not commercially available.

Through the program, Shire and Direct Relief are providing allocated Enzyme Replacement Therapy free-of-charge to patients that qualify. Physicians apply on behalf of their patients and their applications are then reviewed by an independent Medical Expert Committee.

Arian was accepted to the program last summer.

His father wrote that after receiving the news that Arian had been approved, “it took us several minutes of silence to really comprehend what we had heard and then we cried tears of joy.”

Observing Rare Disease Day

Having just turned 13 years old, Arian has much to celebrate this week as people like him will be recognized worldwide on February 28, Rare Disease Day.

The goal of Rare Disease Day is to raise awareness among the general public and decision makers and advocate for advancement in national plans and policies for rare diseases. Access to treatment for those with rare or special conditions can be a big challenge, even in developed parts of the world.

In 2010, an advocacy organization formed in New Delhi called the Lysosomal Storage Disorders Support Society (LSDSS). The Chowdhury’s became members and have since been advocating for Arian and other children across India suffering from LSDs. On Rare Disease Day, they will continue to speak out on behalf of other families who share their struggle.

“Our struggle isn’t just a struggle for one family. It is that of many. The hope we now have for our son should be the hope of these families for their children, too,” wrote Sid.

The post Arian’s Story: A Reason to Advocate on Rare Disease Day appeared first on Direct Relief.

The Affordable Care Act (ACA) is a sea change in the U.S. healthcare system. In the context of that change, the critical role of nonprofit safety-net healthcare providers warrants particular attention. Providing care to more than 24 million people, these health centers and clinics are on the front lines of treating those who are most in need, without insurance, and living in poverty. This report, as in past reports, aims to provide a current overview of these providers. In this edition we have also added a snapshot of their perspectives on the ACA.

Interviews were conducted over the past year with an array of providers—large and small facilities, free clinics and Federally Qualified Health Centers, providers in rural and urban environments, in states that have expanded Medicaid and states that have opted out. The goal was to understand the pending impact of one of the most sweeping laws our nation has seen on the providers that are, in many ways, most important to reaching disadvantaged communities. Perhaps, not surprisingly, there is a wide range of views and feelings among safety net health providers.   I anticipate that we will be seeing a large increase in the number of folks who will come to see us, which presents us with challenges.” — Dan Ahearn, CEO, Community Health Alliance, Reno, NV
As the report details, the perspectives of these providers on the implications and outcomes of the ACA have much to do with where they exist, what type of facility they are, and what sort of population they serve. The environments range dramatically – from states that have moved forward with Medicaid expansion compared with states that have not, some of which already have significantly greater disease burdens and risks than others. Facilities range widely from larger and more established health centers with staff that have extensive experience assisting with insurance enrollment, as compared to smaller, volunteer run free clinics with minimally comparable background. Still, though their environments may differ, their purpose does not: ensuring that everyone, regardless of their ability to pay or their personal background, have access to safe, high-quality healthcare.

Direct Relief is the sole nonprofit licensed to distribute prescription medicines in all 50 states and runs the largest U.S. charitable medicines program through a network of more than 1,200 of these providers in all 50 states. A unique perspective is afforded from our close, daily interaction to understand these providers’ circumstances, needs, interests, and concerns and, in turn, mobilize and deliver charitable resources efficiently.

Through the course of Direct Relief’s daily work, safety net providers continuously demonstrate that the most informed and thoughtful views are not always delivered in the loudest voice or even heard at all over the din of vigorous debate. These leaders’ voices, experienced and reflective of the breadth of circumstances that exist on the frontlines of the healthcare safety net, describe the strong influence of place and the differences in circumstances that exist. For the millions of people that depend on America’s nonprofit healthcare safety net, we hope these voices will be heard much more in the years to come.

1. At the highest level, all providers, regardless of location, size, or facility type, underscored that for the foreseeable future the need for charitable health care will remain. The need for charitable care is perhaps most obvious in the states that Have chosen not to expand Medicaid, which will under any immediate scenario continue to have higher levels of people who are uninsured than in the expansion states. Beyond this very obvious need there will continue to be gaps in coverage for immigrants (undocumented and otherwise) and those who will otherwise fall through the cracks.
2. As safety net providers have long known, having insurance is not the same as having access to a high quality health care provider. Great unease exists throughout the safety net about demand for services among the newly insured dramatically outpaces the supply of health facilities and health professionals.
3. Geography matters – one cannot talk about the Affordable Care Act without taking about differences of place. Vast unevenness exists in the law’s application, most obviously again in the split between Medicaid expansion and non-expansion states. But that geographic unevenness is amplified by unevenness in the functionality of the new insurance exchanges (federal and state), in the public health and economic conditions of different areas of the country, and even in
   the differential risk of natural disasters in places where the law’s outcomes are as yet unknown.
4. Safety net providers consistently pointed out that we are only at the very beginning stages of the momentous changes yet to come. Change of this scale cannot happen overnight. The shifting landscape of insurance coverage and health providers that treat low income patients is creating a more complex safety net; the provision of charitable care must rise to meet the challenge of that additional complexity. As people receive coverage they in some cases had never had before in their lives, it is a new experience for them and will take time to adjust. While the ACA is a national law, the practice of US health care, particularly for the most vulnerable parts of our population, is changing on a community by community basis.

Safety Net Voices & the Affordable Care Act

An interview with Nicole Lamoureux, Executive Director, National Association of Free and Charitable Clinics

Can you provide some background into your association and free clinics?

NICOLE LAMOUREUX: The National Association of Free and Charitable Clinics is the only national organization that is organized and developed to work with free clinics in the communities they serve. Our mission is to broaden access to affordable health care for the medically underserved by increasing public awareness, promoting volunteerism, and supporting and advocating for the nation’s Free and Charitable Clinics as we work together to build a healthy America, one
patient at a time. Many people do not realize that there are approximately 1,200 free or charitable clinics throughout the nation, who, since the 1960s, have been filling in the gap for those who fall through the cracks in our current healthcare
system.

Our clinics believe in giving a hand up, not a hand out. We activate at the grass roots level, not at the government level. What sets us apart from our other counterparts in the safety net arena is that we receive little to no state or federal funding and we are not considered Federally Qualified Health Centers. Our clinics rely very heavily on the generosity of individual donors, foundations, and grants as funding sources, and we utilize a staff and volunteer model to provide health care
to those in our communities who need it the most.

As the legislation has begun to roll out, how do you see the initial impact affecting free clinics?

NICOLE LAMOUREUX: The first thing that I stress when I’m speaking to people is one of the most common misconceptions about how the United States will look after the full implementation of the ACA is that there will no longer be a need for free or charitable clinics any longer.

The Affordable Care Act was never designed to be a universal healthcare option, a public option – an option where every single person in America was given an insurance card. Rather, it was to lower the barriers of health affordability for many
people in the country. We know that this is not a public option, so that means that everyone is not going to have access. So as we’re looking at where the ACA is going to go in the future, free clinics are dealing with a couple of different issues when it comes to our patients.

There are clinics who are located in states who have not expanded the Medicaid program. There are about 26 of those states across the country. Those states may or may not decide to have a model that is a different way to expand Medicaid than the one that was outlined in the bill. But currently in the states where there is no expansion of Medicaid, the patients will not have access to any of the subsidies or any of the programs that those living in expansion states do.

As we’re looking at patients across the country, first and foremost, there is important education going on. If you think about it, having health insurance is confusing for those of us who have had health insurance our entire lives, never knowing what form to fill out, or whether your doctor is in-network or not in-network, if you are self-insured or your employer offers your healthcare plans. This is confusing for people who have had health insurance, imagine being someone who has never had health insurance before and you have no idea how to fill out what forms are needed for you or where you can go to the doctor. And then, even more so, imagine if you are a person who is eligible for the health insurance plans, but you have a job that doesn’t allow you to go to the doctor between 9:00 and 5:00. One of the things that Free and Charitable Clinics can offer as part of the safety net is sometimes our hours are different. They are the non-traditional hours that allow people to go to the clinics to get the care that they need and continue to be working.

Is there a difference for free clinics in the states that will expand?

NICOLE LAMOUREUX: Clinics in states that are not expanding their Medicaid programs are definitely going to continue working in the same way that they have in the last couple of years, with an eye towards the future and what other clinics are doing in other locations. The reality of not expanding Medicaid means that you have a very similar patient base to what you have today, as opposed to those states that have expanded their Medicaid programs and their patient demographics may look a little different moving forward.

However, I think what you are finding more clinics doing is looking at how to best serve the needs of their community. And what we are finding is we can look  at clinics who have decided that it is the best interest of their community and their patient base to transition into a Federally Qualified Health Center role, where they will still serve the uninsured, but be able to take some funding from the federal government. Then we look at some of our clinics who have decided to take more of a charitable clinic role where, at this point in time, they are asking patients for a $5 payment towards their services, instead of free.

We also then have clinics in states, regardless of whether Medicaid is expanding, who have said, “You know what? We need to be a hybrid clinic. We need to have an entire free clinic side of things, but we also need to start accepting some Medicaid patients as well.” Then I think you’re also looking at clinics who have said, “For right now, where we are in our communities and what we’re doing, we’re just going to remain free clinics.” That’s probably one of the most beautiful things about Free and Charitable Clinics is that we truly can be community built and grassroots built. We’re finding that clinics are looking at how to best serve their community and does the business model need to change, and how does that impact the mission of my organization all at one time? It’s a real growth and opportunity time for us, along with a challenge.

What are some of the opportunities or challenges the ACA presents  free  clinics?

NICOLE LAMOUREUX: Well, I think definitely the opportunity that we see, and that we are hoping by telling the story of our clinics across the country and the amazing work that they do on a daily basis, we’re hoping to highlight how critical we are to the nation’s safety net. We are an essential piece to the safety net and that’s an opportunity, to tell the story of who’s left behind when it comes to the Affordable Care Act, the stories of the patients that are not going to receive coverage.

Some of the challenges that we are addressing are not just for our clinics, but also for our patients: Whether or not people understand what the Affordable Care Act is, if someone gets an insurance card in their pocket, will there be a flooded healthcare system? Will there be a doctor to accept their health insurance? What about the hours of operation, as I talked about before? What about citizenship? Affordability of these programs that are there, especially in those states that did not expand their Medicaid programs? Transportation, how people are going to get to and from the doctor? Sometimes it’s great to have an insurance card in your pocket, but if you don’t have the $20.00 to go round trip to your doctor that becomes a challenge for you to get that health care.

Will charitable healthcare remain a relevant model?

NICOLE LAMOUREUX: Again, one of the most common misconceptions about how the U.S. will look after the full implementation of the ACA, is that there will no longer be a need for our clinics to continue to provide charity care as a member of the safety net. People are surprised to hear that according to the Congressional Budget Office – there may be as many as 29 million people, including documented, undocumented, and those who are eligible for Medicaid, but reside in states that are not going  to expand this program, who are still without access to health insurance. So we feel at the national level in the upcoming months and years, doctors and hospitals, navigators, states, and our clinics, as well as other members of the safety net, will be addressing the needs of the underserved with respect to affordability and accessibility of primary, specialty, dental care, and medication access. There will continue to be a need for charity care in the United States after the full implementation of the Affordable Care Act.

The following provides an overview of demographic information from 2013 for the almost 22 million people treated annually at the nation’s Federally Qualified Health Centers (FQHCs).

• 21.7 million total patients served
• 7.6 million patients (34.9%) lacked health insurance
• Of individuals for whom income level was known, the vast majority (71.9%) were living at 100% or below of the Federal Poverty Level (FPL) – in 2013, that amounted to $11,490 for an individual and $23,550 for a family of four.

The following charts show demographic information on patients at FQHCs in 2013, and what has changed compared to previous years.

For the last five years the percent of individuals with incomes at or below 100% of the FPL seeking care at FQHCs has hardly varied (71.4-71.9%).

While the percentage remained fairly stable, this is actually an aggregate increase from 10.1 million to 11.7 million individuals.

From 2012 to 2013 not only did the uninsured percentage of patients seen at FQHCs decrease, but the aggregate number did as well, from 7.59 million to 7.57 million.* 2013 also saw an increase in patients using Medicaid, a continuation of the change seen in 2010 when Medicaid patients first exceeded uninsured patients. * The only other insurance category that decreased in both percentage and number was Other Public Insurance (non- Medicaid or Medicare).

Those aged 60-74 years were the fastest growing group as a proportion of the whole. This is a continued age increase from 2010 when the fastest growing group was those aged 50-64 years.

By gender, the five most common ages of patients seen at FQHCS were:

• Males 0-9 yrs (2,142,889)
• Females 20-29 yrs (2,128,691)
• Females 0-9 yrs (2,057,539)
• Females 30-39 yrs (1,887,387)
• Females 10-19 yrs (1,775,540)

Safety-net health facilities, such as the Federally Qualified Health Centers, play a critical role in providing care for at least 1 in 13 Americans. As part of a health network caring for under- and uninsured working class poor that do not otherwise have access to health care it is important that not only do the services exist, but that they are of the highest standards. Indeed, a 2011 study conducted by Randall Stafford, MD, PhD of Stanford University found that despite treating significantly more “medically and socially complex patients” than those seen by private providers, community health centers actually provide “better care than do private practices.”

There’s a significant portion of our population that probably has not ever been insured in their adult life.” — Rhonda Stuart, Enabling Services Manager, Northern Health Centers, Lakewood, WI In 2011 the Health Resources and Services Administration changed the way in which diagnoses at Federally Qualified Health Centers were tracked to include all diagnoses at a visit, regardless of primacy. Previously only the primary diagnosis was used to estimate percent of patients with a condition or for tracking number of visits. The change, however, took into account that primary diagnosis alone likely underestimates the morbidity and burden of certain conditions for the patients and for the health centers. This hypothesis is carried out when comparing the data on total visits by diagnosis from 2011, for which the data showed 12.3% of visits were related to hypertension, diabetes, heart disease and asthma, and 2013, for which the new calculation gives 22.8% for the same four conditions.

The new data collection parameters already show a greater number of patients than previously estimated for all tracked diagnoses, giving a more accurate portrayal of the burden on FQHCs for service provision. Particularly with chronic conditions, which account for a large percentage of total services provided, there is an even greater stress placed on clinics due to these conditions requiring services over a longer period of time. It is thus up to FQHCs to provide high quality care to a growing population of patients with increasing needs.

From 2010-2013 FQHCs saw the percentage of adults aged 18 and older with a hypertension diagnosis increase by 11.0%. In fact, hypertension as a primary or related diagnosis accounted for more visits in 2013 than any other condition, a total of 9,472,375. While the rate of FQHC patients with hypertension is increasing, the patient population at these safety-net facilities tend to actually have a lower rate than for the state population.

States colored in blue have a lower rate of diagnosed hypertension at FQHCs than the rate for that respective state. States in red scale have a greater rate of diagnosed hypertension at FQHCs.

Despite the increasing burden of hypertension, FQHCs have shown to provide the utmost in quality of care for patients. Stafford’s study identified blood pressure screening as one of six measures that FQHCs and FQHC Look-Alikes performed better on than private primary care practices. As well, almost all state FQHC populations have met the United States’ Healthy People 2020  Target of 61.2% of adults with a hypertension diagnosis considered controlled. Fifteen states have not yet met the Target, but even the state with the lowest percentage of controlled hypertension, Arkansas, is only 5.3 percentage points away, with five years remaining.

Healthy People 2020 lists controlled hypertension as a Leading Health Indicator. The Target is  61.2% of adults with a hypertension diagnosis considered controlled. Thirty-five states have met the Target within the FQHC population.

A condition that has a similar weight on safety net resources is diabetes. Of note is that diabetes is over represented amongst FQHC patients compared to the rest of the US population. The rate of diagnosed diabetes among adults aged 18 and older is higher in the FQHC population in all but one state. As many FQHCs continue to see an increase in the proportion of patients with

controlled diabetes, they are also thus faced with a greater demand for services and medication. No state has yet met the Healthy People 2020 Target of 83.9% of adults with a diabetes diagnosis considered controlled. The over burden of diabetes exemplifies the need for support and resources to enable safety-net facilities to provide and expand quality care for all their patients.

These quality of care measures for chronic diseases are important as if these intermediate outcomes are improved, then later poor health outcomes will be far less likely. Direct Relief USA works with more than 1,200 clinic partners across the country, more than half of which are Federally Qualified Health Centers like the ones studied. The report from Stanford and the collected FQHC data confirm that the patients Direct Relief’s clinic partners serve can access quality care from what many acknowledge is an already- strained network caring for a disproportionate share of socially vulnerable and chronically ill patients.

States colored in blue have a lower rate of physician diagnosed diabetes at FQHCs than the rate for that respective state. States in red scale have a greater rate of diagnosed diabetes at FQHCs.

Healthy People 2020 lists controlled diabetes (Hb A1c <9%) as a Leading Health Indicator. The Target is 83.9% of adults with a diabetes diagnosis considered controlled. No state has yet met the Target within the FQHC population.

The preeminent issue for understanding the impact of the ACA upon uninsured people across the country remains the status of their state relative to the Medicaid expansion portion of the law. According to a study published in Health Affairs1 along with related studies published by RAND and the Kaiser Family Foundation, there are likely an estimated 8 million individuals living  in the 25 states which are not expanding Medicaid who would be newly insured this year had their states opted in to the Medicaid expansion provisions of the ACA. Almost all of these individuals will remain uninsured, given that their incomes will likely remain too low to qualify for the health insurance exchange subsidies, yet not low enough to fall within prior Medicaid qualifications. Subsidy amounts were set at a minimum of 138 percent of the Federal Poverty Level (FPL) for a family of three, under the assumption that Medicaid expansion would take care of coverage for those households and individuals between 100 percent and 138 percent of FPL.

Among those nearly 8 million uninsured individuals exist hundreds of thousands of cases of depression, diabetes, and other chronic illnesses which will likely require some form of charitable mechanism to address. The most incisive study to date on the possible impact of the uneven Medicaid expansion landscape on the health of people without insurance was published by JAMA in April 20144. According to the authors’ interpretation of health data collected from a national pool of roughly 19,000 persons living under the 138% FPL threshold, chronic conditions such as hypertension, cancer, stroke, and respiratory diseases were significantly more prevalent among those living in non-expansion states. In other words, poor residents of non-expansion states will not only be unlikely to receive additional assistance from the ACA with improved access to healthcare payments, but are also already in poorer health than their counterparts in Medicaid expansion states. Granted, health insurance in itself does not guarantee access to quality healthcare. Yet the best evidence available indicates that where you live in the future may play an even greater role in the health outcomes than it has so far.

Local, just as much as national, landscapes of care are shaped by the conditions of place. Cities like Las Vegas, NV and New Orleans, LA face very similar challenges in the post-ACA world. The populations of these cities are of similar population size and income distributions. Both have dealt with significant challenges over the past several years: Las Vegas through the crisis in the housing market and the pressures of economic recession, New Orleans with the aftershocks of Hurricane Katrina and their own recessionary trends since 2008. Mapping the census blocks of each city according to the ACA’s new Medicaid eligibility levels (138% FPL) in relation to the locations of safety net facilities reveals high densities of proximate neighborhoods with high likelihood of significant numbers of newly insured people. Yet, of course, these landscapes mean very different things in 2014 based upon differences in approach at the state level to the ACA. In Las Vegas, given that Nevada is participating in the Medicaid expansion, census blocks with median income levels of 138% FPL and below will be likely to put pressure on the safety net through increases in new Medicaid patients. In New Orleans, however, given Louisiana’s opposition to the Medicaid expansion, this very same landscape is one which indicates persistent uninsured levels and sizeable ongoing gaps in the ability to pay for healthcare services. In each case, safety net institutions face significant pressures, but the nature of those pressures differs markedly depending on where they occur and how their states have chosen to approach the implementation of the ACA.

Community Health & Medicaid Expansion

Community health centers are experiencing in 2014 an overall increase nationwide in people seeking care at their facilities, but a decrease in people who are uninsured. This finding accords with a number of other recent indicators showing that the ACA does appear to be reducing uninsured rates nationally. However, Direct Relief’s poll also shows that the impact of the ACA is highly variable based upon geography.

Respondents in states which are not expanding the Medicaid program overwhelmingly reported that their uninsured rates have actually been increasing, whereas the opposite was true in states which have undertaken Medicaid expansion. Respondents from states that have adopted expanded Medicaid eligibility authorized under the Affordable Care Act also indicated that they hold a substantially more favorable view of the law’s impact than those in non-expansion states.

These findings come from a poll of nearly 100 community health centers conducted by Direct Relief in August 2014 at the annual conference of the National Association of Community Health Centers. Survey respondents collectively serve more than 1.5 million people and operate clinical sites in 27 U.S. states.

• Affordable Care Act  (ACA) – requires health insurance for most citizens and legal residents of the U.S., and provides for the creation of state-based American Health Benefit Exchanges through which individuals can purchase coverage, with premium and cost sharing credits available to individuals/families with income between 133-400% of the Federal Poverty Level. The ACA creates separate Exchanges through which small businesses can purchase coverage. . Requires employers to pay penalties for employees who receive tax credits for health insurance through an Exchange, with exceptions for small employers. Impose new regulations on health plans in the Exchanges and in the individual and small group markets. Expands Medicaid to 133% of the Federal Poverty Level.
• Community Clinic – a nonprofit provider agency that treats anyone regardless of ability to pay, but generally charges patients on a sliding fee scale. Federally Qualified Health Center (FQHC) – public and private nonprofit healthcare providers located in medically underserved areas that treat anyone regardless of ability to pay, and meet certain federal criteria under the Health Center Consolidation Act (Section 330 of the Public Health Service Act). There are 1,202 FQHCs operating over 8,000 sites in 2013 that treated 21.7 million people across the United States, of whom 7.6 million lacked health insurance.
• Direct Relief Partner – a community clinic, Federally Qualified Health Center, or free or charitable clinic that was vetted and approved to be part of the Direct Relief Partner
• Direct Relief Partner Network – the network of more than 1,200 community clinics, Federally Qualified Health Centers, and free or charitable clinics that Direct Relief currently supports with donations of free medicine and medical supplies.Network.
• Federal Poverty Level (FPL) – the set minimum amount of gross income that a family needs for food, clothing, transportation, shelter, and other necessities as determined by the Department of Health and Human Services. FPL varies according to family size. The number is adjusted for inflation and reported annually in the form of poverty guidelines.
• Free Clinic – a nonprofit, usually volunteer-based provider facility that treats anyone regardless of ability to pay, typically free of charge or with a nominal donation for services. An estimated 1,200 free clinic operate across the United States.
• Look-Alike – an organization that meets the eligibility requirements of Section 330 of the Public Health Service Act, but does not receive federal grant funding. Look-Alikes receive many of the same benefits as FQHCs, including enhanced Medicare and Medicaid reimbursement, and eligibility to purchase prescription and non-prescription medications at a reduced rate. There were 100 Look-Alikes in 2013 that treated 1.0 million people across the United States, of Whom 329,000 lacked health insurance.
• Medicaid – a U.S. government program—financed by federal, state, and local funds—that provides health coverage for lower-income people, families and children, the elderly, and people with disabilities.
• Safety Net – the network of nonprofit provider agencies that deliver health services to vulnerable populations experiencing financial, cultural, linguistic, geographic, or other obstacles to accessing adequate health care. The nation’s healthcare safety net includes more than 10,000 clinical sites providing comprehensive, culturally-competent health services to more than 24 million people regardless of their ability to pay.

HEALTH RESOURCES AND SERVICES ADMINISTRATION – Uniform Data System: The information presented here applies to those entities from which the U.S. Department of Health and Human Services’ Health Resources and Services Administration (HRSA) collects data through the Uniform Data System (UDS). These are grantees of the following HRSA primary care programs: Community Health Centers, Health Care for the Homeless, and Public Housing Primary Care providers. Grantees can be found in all 50 states, the District of Columbia, and U.S. territories. The reported data should not be
extrapolated to any other population as it is representative only of those individuals who utilize services of FQHC grantees. Please note that rates of diagnoses, insurance levels, demographics, etc. are descriptive measurements to provide context and are not intended for the sake of population-level analysis or comparison with institutions that are not nonprofit safety-net health centers and clinics. For example, a particular health center might show that a high percentage of its patient population consists of homeless individuals. This does not necessarily mean that the area in which it operates has an exceptionally high rate of homelessness. Rather, the health center may have specific programs and outreach aimed at bringing health care to homeless individuals. Such a program therefore would skew the facility’s patient population numbers not only away from the norm of its service area, but also from levels seen at FQHCs without such programs. Likewise, disease diagnosis rates recorded at these institutions should not be mistaken for disease prevalence rates among the area’s general population. It should also be noted, however, that all FQHCs are located by law in areas that are deemed by the federal government to be medically underserved.

COMMUNITY HEALTH INSTITUTE AND EXPO FLASH POLL: During the 2014 Community Health Institute and Expo hosted by the National Association of Community Health Centers, Direct Relief surveyed attendees regarding their perceptions related to health centers, their patient population, and the Affordable Care Act. The survey was a total of six questions and each respondent represented an individual from a health center. Fifty-six responses were garnered from this population from August 23-24, 2014.

VOICES OF THE SAFETY NET: Interviews took place with nonprofit safety-net clinic and health center staff, as well as national associations from August 2013 – March 2014. Quotes from the following interviews are included in this report:

• Dan Ahearn, CEO, Community Health Alliance, Reno, NV
• Jane Calhoun, VP Medical Affairs & Clinical Director, Delta Health Alliance, Stonesville, MS Shane Chen, Chief Operations Officer, Asian American Health Coalition Clinic, Houston, TX Pam Cross-Cupit,
• Executive Director, Health Alliance for the Uninsured, Oklahoma City, OK Alieta Eck, Founder, Zarepath Health Center, Somerset, NJ
• Richard Gibbs, President and Co-Founder, San Francisco Free Clinic, San Francisco, CA Sean Granahan, President/General Counsel, The Floating Hospital, Long Island City, NY Jim Harris, CEO, Health
• Access Incorporated, Clarksburg, WV
• Beth Houghton, Executive Director, St. Petersburg Free Clinic, St. Petersburg, FL
• Florence Jameson, Founder and CEO, Volunteers in Medicine of Southern Nevada, Las Vegas, NV Judy Jones, Executive Director, Bethel Free Health Clinic Inc., Biloxi, MS
• Rhonda Stuart, Enabling Services Manager, Northern Health Centers, Lakewood, WI
• Ana Taras, Chief of Strategic Initiatives, William F. Ryan Community Health Center, New York, NY Tom Tocher, Chief Clinical Officer, Community Health Center of Snohomish County, Everett, WA Barb
• Tylenda, Executive Director, Health Care Network, Racine, WI
• Shondra Williams, CEO, Jefferson Community Health Care Centers, Marrero, LA
• Nicole Lamoureux, Executive Director National Association of Free and Charitable Clinics, Alexandria, VA

Since 1948, Direct Relief has provided humanitarian assistance to improve the health and quality of life of people affected by poverty and disasters throughout the world by providing essential material resources—medicine, medical supplies, and basic equipment. Direct Relief is the nation’s leading nonprofit provider of donated medicines to community clinics, free clinics, and community health centers for low-income patients without health insurance. It operates the largest charitable medicines program of its kind, and is the only nonprofit that is certified by the National Association of Boards of Pharmacy to distribute prescription medicine in all 50 states. Since 2004, Direct Relief has delivered more than $440 million (wholesale) in medical resources to more than 1,200 nonprofit clinic and health centers.

Direct Relief is recognized for its fiscal strength, accountability and efficiency, and consistently achieves top rankings from Forbes, Charity Navigator (including “Top Charity” and “4-Stars”), the Better Business Bureau, and Consumers Digest. In 2011, Forbes rated Direct Relief “100% efficient” and “[Among the] 20 most efficient large U.S. charities.”

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The survey respondents collectively serve more than 1.5 million patients from 27 U.S. states.  Respondents from states that adopted expanded Medicaid eligibility authorized under the Affordable Care Act indicated a more favorable view of the law’s impact than those in non-expansion states.

Direct Relief CEO Thomas Tighe was the keynote speaker at the annual meeting, noting the fundamental though often unheralded leadership role that health centers play within their respective communities and more broadly throughout the health system and for the entire country.

“Health centers are hiding in plain sight as the solution to many of the vexing problems that exist elsewhere in healthcare system, and you have never lost sight that the whole point is to help people achieve better health,” said Tighe to the audience of health center leaders. “Thank you for rejecting the false choice among access, affordability, or quality decades ago, and proving beyond question that all three can and must be done together.”

Direct Relief works with a network of more than 1,200 health centers and community clinics in all 50 states and received NACHC’s 2014 “Power of Partnership” award for its various efforts to mobilize private resources to support the nonprofit safety net facilities nationwide, including $450 million in charitable medications and medical supplies and over $10 million in financial assistance over the past decade.

In presenting the 2014 Power of Partnership Award, Malvise A. Scott, Senior VP for Partnership and Resource Development, NACHC, cited Direct Relief’s extensive efforts to help Community Health Centers serve their current patient-base of 23 million people – both on an ongoing basis and during emergencies such as Hurricane Sandy. Immediately after the storm hit the East Coast, Direct Relief joined with NACHC to establish a special fund to support patients receiving care at health centers in affected communities.

“It makes us proud that Direct Relief has dedicated the full force of its programs in the United States to ongoing support of community health centers and other safety net providers,” said Scott.

The only U.S. nonprofit to obtain Verified Accredited Wholesale Distributor© (VAWD) certification by the National Association of Boards of Pharmacy, Direct Relief is among the largest medical suppliers to safety-net facilities throughout the U.S. and the world. A winner of the CECP Directors’ Award, the Peter F. Drucker Award for Nonprofit Innovation and the 2013 Esri President’s Award for GIS Mapping, Direct Relief maintains a four-star rating from Charity Navigator, and a 100% fundraising efficiency rating from Forbes magazine. For more information, visit www.DirectRelief.org .

About National Association of Community Health Centers

Founded in 1970, the National Association of Community Health Centers (NACHC) is a non-profit organization whose mission is to enhance and expand access to quality, community-responsive health care for America’s medically underserved and uninsured. NACHC represents the nation’s network of over 1,200 Federally Qualified Health Centers (FQHCs), which serve 23 million people through over 9,000 sites located in all of the 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and Guam. For more information, please visit www.nachc.org

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As America’s largest and most utilized independent evaluator of charities that exists anywhere, Charity Navigator works to guide donors toward more intelligent giving.

In addition to maintaining Charity Navigator’s 4-star accreditation, Direct Relief was rated #1 on the rating organization’s “10 of the Best Charities Everyone’s Heard Of” list.

Direct Relief consistently receives numerous awards and recognitions from some of the nation’s top independent evaluators of humanitarian relief organizations. Direct Relief was recognized last year by Forbes as “100% efficient,” and “[among the] 20 most efficient large U.S. charities.”

Direct Relief has received The Independent Charities Seal of Excellence, has been included in CharityWatch’s Top-Rated charities, and has also been recognized by the Better Business Bureau, Chronicle of Philanthropy, and Worth Magazine, among others.

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The event brought together leading technologists, entrepreneurs, and members of the disaster response community to showcase tools capable of making tangible impacts in the lives of survivors of large-scale emergencies.

Among the experts in attendance, Direct Relief U.S. Program Director Damon Taugher took part in discussions on strengthening emergency response capacity domestically.

“Technology is rapidly redefining the way emergency response occurs, with new tools, new information, all at much faster rates,” Taugher said. “Our goal is to leverage these tools to help people most in need be more prepared and recover more quickly.”

Direct Relief employs a range of technologies to assist its disaster relief work, including data analysis and visualization tools from technology companies Palantir and Esri as well as SAP software to help ensure medical aid is delivered efficiently, among other innovations.

The White House Innovation for Disaster Response and Recovery Initiative was launched by the Obama administration following Hurricane Sandy as part of an effort to find the most effective ways technology can empower survivors, first responders, and local, state, tribal, territorial, and Federal government with critical information and resources.

Earlier this year, Direct Relief joined the National Voluntary Organizations Active in Disaster (VOAD) as the first Associate Member. The organization is also the only U.S. nonprofit to obtain Verified Accredited Wholesale Distributor (VAWD)© certification by the National Association of Boards of Pharmacy, which enables Direct Relief to send pharmaceutical aid anywhere in the U.S. when an emergency occurs.

Direct Relief supports a network of more than 1,100 nonprofit clinics and health centers serving the most vulnerable populations in all 50 states. It has top charity ratings, including four-star and “top-notch” rating from Charity Navigator, and a 100% fundraising efficiency rating from Forbes magazine.

Direct Relief was the winner of the 2011 Peter F. Drucker Award for Nonprofit Innovation as well as the 2013 President’s Award from technology company Esri for its use of technology in improving the health and lives of people in need.

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Harrison was reunited with one of the best-known previous “Bachelor” stars, Andrew Firestone, at the fundraiser, which was also attended  by Jane Lynch (“Glee”), Susan Sullivan (“Castle”, “Falcon Crest”), Joanna Kerns (“Growing Pains”), actor/director Emilio Estevez, and “Girls” and “Chicago Fire” regular Shiri Appleby, star of the upcoming Lifetime series, “Un-Real.”

Appleby’s fiancé, Jon Shook and his business partner Vinny Detolo, of L.A.’sAnimal restaurant, were the celebrity chefs for the night.

Direct Relief, rated “Four Star” by Charity Navigator and “100% Efficient” by Forbes magazine, provides medicine and medical equipment to people in the U.S. and around the world who otherwise would not have access to it because of poverty, civil unrest or natural disaster.

Auction items at the Hollywood-themed fundraiser included: a “Sideways” 10th anniversary reunion dinner with cast and crew of the iconic film, a week at a cottage at the Cotswolds, with a private visit and tea at Highclere Castle where “Downton Abbey” is filmed, a private dinner with the cast of “Modern Family” and a trip to New York with front row seats for the “Project Runway” finale.

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Since 2007, the nonprofit organization has pioneered the use of GIS in informing, mobilizing, targeting, and delivering humanitarian medical assistance to areas and people in need. Direct Relief has integrated GIS and spatial analysis into a broad range of essential roles, including the identification of health condition patterns and medical needs, complex logistical management and project evaluation, and transparent public reporting regarding financial and medical material assistance.

“GIS tools have revolutionized our ability to assist people in need and to show precisely what every charitable dollar of assistance is used for at each and every health facility we support around the world,” says Andrew Schroeder, director of research and analysis at Direct Relief. “So many people recognize that enormous needs exist in the world, and they want to know that their contribution will make a difference. These tools are incredibly powerful in enabling Direct Relief to demonstrate that to every donor.”

Recent projects reflect the breadth of geospatial technology throughout the organization. Following the tornadoes in Moore, Oklahoma, Direct Relief used GIS to monitor the real-time movement of sensitive aid materials. In another effort, it partnered with the United Nations Population Fund and the Fistula Foundation to create the world’s first map of the distribution of surgical services for obstetric fistula. It is also working to spatially enable the public health laboratory system in Ethiopia.

“I was inspired by their work following the 2010 earthquakes in Haiti, where they used geospatial technology to track and distribute aid,” said Esri president Jack Dangermond. “They constantly find new ways of applying geography to improve people’s lives and proactively identify vulnerable populations. They are incredibly deserving of this recognition and are an example any organization should be proud to follow.”

Direct Relief is a global humanitarian medical aid organization with partnerships in all 50 US states and more than 70 countries. It works to identify high-quality local health care providers in areas with highly socially vulnerable populations to connect them with the best health care resources available. Direct Relief was recently rated one of the 20 most efficient large US charities by Forbes and received the prestigious Peter F. Drucker Award for Nonprofit Innovation in 2011.

Editor’s note: The Global Fistula Map was migrated to the Global Fistula Hub in 2020 to better understand the landscape, known need, and availability of fistula repair services around the world.

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The need for their services is great. Named one of America’s Most Miserable Cities for the last several years, Stockton is a community where 20 percent of adults report not having eaten for an entire day and 26 percent have admitted to cutting the size of their children’s meal because there was not enough money to buy more food, according to a recent survey.

Since opening doors in 1955, St. Mary’s has expanded to not only offer three meals a day, seven days a week, but to also provide medical services at no cost to individuals and families that are in need. They are the only clinic in the city that offers free medical services including consultation, lab work and medication (if they have it in stock).

St. Mary’s sustains a Dental Clinic, Social Services and Homeless Court, and the Dr. Virgil Gianellli Medical Clinic. Currently, the clinics operate with only a few paid staff, relying on about 40 volunteer professionals to support the organization. Because St. Mary’s runs solely off these volunteers and donations, aid organizations such as Direct Relief are invaluable to the sustainability and growth of the organization.

“The doctors are very grateful that we have such an organization like [Direct Relief] for helping the safety net clinics,” said Mary Ann Soria, director of health services. “I don’t think we can continue doing this without all of your help.”

She said many of the patients have chronic illness such as diabetes, hypertension and asthma that need daily, uninterrupted treatment. With medications from Direct Relief, Soria said the clinic can make sure the patient goes home with medication in hand.

Additionally, personal care supplies from Direct Relief help support the Clothing and Hygiene Center which allows people access to hot showers, hygiene products, and clothing. More than 80,000 women and children utilized the center in 2011. The center also offers men’s haircuts and clothing exchanges several days a week.

Since July 2012 – shortly after Stockton filed for bankruptcy – Direct Relief has distributed six shipments of medical supplies to St. Mary’s, valued at more than $300,000.

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Santa Barbara, CA (March 8, 2012): Direct Relief USA, the country’s only non-profit provider of free medicines to clinics and health centers in all 50 states, today announced that Abbott, Johnson & Johnson Patient Assistance Foundation, Inc., and Novartis Patient Assistance Foundation, Inc. have joined a new model of charitable donations of medications for people without health insurance.

Nonprofit Direct Relief USA, which provides medical donations to a network of more than 1,000 nonprofit community clinics and health centers nationwide, announced that the three organizations are participating in a five-state pilot program to donate medicines on a replenishment basis to uninsured, low-income patients. This model is based on a successful pilot conducted in recent years with Abbott.

The expanded pilot initiative announced today will provide needed medications to patients at ten nonprofit clinics and health centers that collectively serve 268,476 patients in medically underserved areas. Nationwide, it is estimated that more than 20 million patients receive primary health care services at community-based nonprofit facilities, which include Federally Qualified Health Centers and free clinics.
“This replenishment model brings new efficiencies to charitable efforts to help patients at clinics and health centers get the medications they need on an ongoing basis,” said Damon Taugher, Director of Direct Relief USA.

“We are pleased that nonprofit safety-net clinics, their uninsured patients, and companies’ charitable resources can each leverage Direct Relief’s unique status as the only nonprofit licensed to distribute medications in all 50 states, the robust information and distribution systems, and extensive network that we have built for this purpose,” said Taugher.

Direct Relief USA provided more than $54 million (valued at wholesale acquisition cost) worth of medicine to its network of clinics and health centers in 2011. Direct Relief was awarded the 2011 Peter F. Drucker Award for Nonprofit Innovation for its aggressive adaptation of commercial technology for humanitarian purposes.

Direct Relief’s program focuses on high concentrations of uninsured patients in America’s nonprofit safety net clinics and health centers and complements existing traditional patient assistance programs (PAPs) through which individual companies provide free or discounted prescription medicine to low-income, uninsured patients.
The benefits of the new approach of the Replenishment Program increases efficiencies through a scalable platform, through which multiple companies participate in a program designed to enhance patient care through a streamlined process. The program aims to:

• Improve the way patients receive medications at clinics and health centers;
• Streamline the clinics’ administrative processes spent on PAP enrollment and dispensing;
• Maximize efficiencies in providing donated medicines to patients;
• Provide a scalable platform for a national program accessible to additional pharmaceutical companies and recipient clinics.

For participating nonprofit clinics and health centers, which must demonstrate rigorous internal controls for drug dispensing and recordkeeping, the program provides a single point of access to multiple pharmaceutical companies’ drugs. This eliminates the need to manage numerous programs and submit duplicative applications for individual medications, which enables redirection of scarce clinical resources from administrative tasks for improved patient care.

Abbott, Johnson & Johnson Patient Assistance Foundation, Inc., and Novartis Patient Assistance Foundation, Inc. will provide prescription drugs that will assist healthcare providers in the treatment of patients with cardiovascular disease, hypertension, hypothyroidism, neurological disease, mental health disease, HIV/AIDS, infection and other conditions. Recipient clinics will be better equipped to care for their patients by offering them much-needed continuity of care.

“Direct Relief’s Replenishment Program streamlines our ability to provide high-quality care to the patients we serve,” said Sharon Ng, Pharmacy Director of Venice Family Clinic in Venice, California. “With a significant reduction in paperwork and with fewer packages to receive, unpack and update into our inventory, we are able to spend more time with our patients and less time on the administrative component of traditional patient assistance programs. The timesavings provided to us through the Replenishment Program helps keep costs low and patient care the main focus.”

The Replenishment Program will support ten clinics in California, Washington, Texas, Michigan, and Florida.

About Direct Relief International

Direct Relief is California’s largest medical relief organization, active in all 50 states and over 70 countries. It works with more than 1,000 health clinics across the U.S. to assist in emergencies and an ongoing basis, providing them with free medications for people in need. The organization has been among the world’s largest medical suppliers in Haiti after the 2010 earthquake, has top charity ratings, including four-star and “top-notch” rating from Charity Navigator, and a 100% fundraising efficiency rating from Forbes magazine. For more information, please visit www.DirectRelief.org.

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Over the past two years, Direct Relief has provided over 1,000 tons of life-saving medications and medical supplies valued at over $70 million wholesale and continues to provide its medical distribution program serving 115 hospitals and clinics across Haiti.

“The expansion of vaccine storage is just one among many parts of healthcare infrastructure that are essential and require continued attention and support,” said Brett Williams, Director of International Programs for Direct Relief.  “The two-year marker provides a moment to look back, but it’s also a sharp reminder that for all the progress that has been made and efforts expended, severe needs exist and much more remains to be done.”

Direct Relief’s expanded humanitarian health efforts since the 2010 quake followed more than 40 years of ongoing support in Haiti. The organization received over $6.7 million in contributions following the earthquake from more than 25,000 people and extensive support in the form of in-kind goods and services valued at over $70 million, including transportation from FedEx and specifically- requested medications, vaccine, and medical supplies from over 130 healthcare companies.

Consistent with the organization’s longstanding practice, all Direct Relief medical contributions have been approved by the Ministry of Health in Haiti for importation.  The organization also developed and has published online the precise location of each medical donation in a highly-detailed interactive map to ensure transparency and prevent duplication of effort.

The organization established an online ordering system for medical commodities and a nationwide distribution system now used by over 115 health facilities, which proved essential in mobilizing, allocating, and rapidly distributing medical supplies in response to the cholera outbreak that has claimed 7,000 lives since its onset in October of last year.

Approximately two-thirds of the funds raised have been spent to mount an expansive post-quake emergency medical-supply program, a cash-grant program for local Haitian community groups, and essential funding for both prosthetics and rehabilitative services in-country to meet the increased demand caused by the catastrophic event.  With all remaining funds committed to long-term recovery, Direct Relief intends to remain in Haiti for as long as necessary.

Over these past two years, more than 25,000 donors gave to Direct Relief to help the people of Haiti.   Recently ranked by Forbes magazine as one of the twenty most efficient large charities in the United States, Direct Relief  honors that commitment by ensuring 100% of those donations are used exclusively to help people in Haiti  whose lives remain threatened by sickness, disease, and injury.  For more information, please visit www.DirectRelief.org.

Haiti Fact Sheet:

Below is more information about the work that Direct Relief has engaged in with its partners in Haiti:

• Getting the right medicines in the right hands:  An effective and efficient distribution system built on four decades of work in Haiti has been aided by Direct Relief’s new online ordering system. Using a state-of-the-art, commercial grade IT backbone, Direct Relief created the only charitable online ordering platform for Haitian healthcare providers to efficiently order and receive medications and supplies at no cost to them.

• Ensuring access to long-term rehabilitation services: Direct Relief granted $700,000 to Healing Hands for Haiti International— the only Haitian physical-rehabilitation organization providing services before the earthquake—to ensure rehabilitative services for people who were injured in the earthquake. After Healing Hands’ clinic was destroyed in the earthquake, Direct Relief’s grant allowed Healing Hands to open a new facility where ongoing care has been provided to 863 adults and 424 children who were injured and needed long-term treatment after the earthquake. An additional 99 patients who suffered spinal cord injuries have also received care and rehabilitation from Healing Hands.

• Supporting Local Organizations:  International aid groups received over $2 billion in donations for Haiti yet many smaller local groups still struggle to access funding. That’s why Direct Relief established a Community Grant Fund to provide over $630,000 to local, Haitian-run organizations responding to the needs of their communities. More than 500,000 people have benefitted from the work of these grassroots local groups who have, among other things, provided more than 1,000 children with schooling, cared for 500 orphans (many of whom with special needs), and trained community health workers to work in areas that previously lacked access to health care.

• Fighting Cholera: Cholera had been absent in Haiti for over 50 years when, late last year, an outbreak occurred – just as many aid agencies were winding down emergency earthquake operations. Tragically, cholera claimed 7,000 lives and continues as a threat but, fortunately, Direct Relief never left Haiti and has provided enough medical supplies and equipment to treat 100,000 people and prevent further loss of life.  Cholera, and the response to it, exemplifies both the challenges and progress in Haiti.

• Helping Women and Babies:  Haiti has the highest prevalence of maternal mortality, infant mortality, and HIV infection in the Western Hemisphere. Pregnancy and its complications have become the leading cause of death and disability among mothers, and 86 out of 1,000 babies die during their first year. These interventions include expanding access to safe deliveries by training and equipping traditional birth attendants and midwives, addressing complications in birth with emergency obstetric care, and enrolling mothers into the Prevention of Maternal-to-Child Transmission of HIV program. By targeting eight health centers strategically located in eight of the ten departments (or states) in Haiti, Direct Relief will reach a population of 563,000, including approximately 60,000 pregnant women.

• Unprecedented Corporate Support:

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“We are intensely focused on doing more, better, for people who need help in these challenging economic times,” said Direct Relief President and CEO Thomas Tighe. “We are so deeply thankful for this gift and for every act of generosity, which has particular poignancy and is deeply humbling in these still-challenging economic times.”

Direct Relief receives no government funds, devotes 100% of contributions to its programs, and relies entirely on support from private parties to finance its humanitarian health programs in the United States and throughout the world. Fundraising and management expenses are paid by a bequest from a longtime donor.

Recently named by Forbes magazine as one of the 20 most efficient large charities in the U.S., Direct Relief, as do many charities, typically receives one-third or more of its annual revenue in December in year-end charitable contributions.

The Direct Relief USA program, which supports care for patients at more than 1,000 nonprofit community health centers and free clinics nationwide, has expanded rapidly since becoming the only nonprofit licensed to distribute prescription medications in all 50 states three years ago and has provided over $53 million in free medications and supplies in 2011 that the organization receives via donations from nearly 100 healthcare companies.

Internationally, Direct Relief’s humanitarian health programs support midwives and other health workers and facilities in over 50 developing countries with essential medications and supplies to improve maternal and child health, diagnosis and treat patients, and care for people in emergencies.

The organization recently won the prestigious 2011 Peter F. Drucker Institute Award for Nonprofit Innovation for its use of technology in the Direct Relief USA program and for bringing efficiencies to humanitarian health efforts worldwide.

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Forbes’s 13th annual rating of the 200 top American charities calculates three major efficiency ratios for each nonprofit: charitable commitment, fundraising efficiency, and donor dependency.  Direct Relief received a perfect score of 100 percent in fundraising efficiency for ninth time in the past 10 years and a 99% score for charitable commitment.

Forbes noted that the organizations included in the top 200 list represent less than 2/100th of 1 percent of the more than one million tax-exempt organizations in the U.S.

The rating of Direct Relief is based on its 2011 fiscal year, during which the organization responded to emergencies both in the United States and around the world, expanded its support within the United States for uninsured, low-income patients to receive free medications, and worked to improve maternal and child health in developing countries.

Direct Relief is the only nonprofit in the United States to be licensed to distribute prescription medications in all 50 states, and it works with over 1,000 nonprofit clinics and community health centers to furnish free medications to low-income, uninsured patients.

The organization was recently awarded the 2011 Peter F. Drucker Award for Nonprofit Innovation for networking disparate nonprofit health facilities together, enabling much more efficient distribution of medications and supplies for persons in chronic need as well as in emergencies, such as the tornado in Joplin, Missouri six months ago to which Direct Relief responded immediately with needed vaccine, medications, and emergency supplies.

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Here’s what Direct Relief has done to help so far:

• FedEx overnighted emergency aid to North Carolina and Arkansas for people living in temporary shelters;
• Text alerted our 168 clinic partners in the six affected statesto let them know our $36 million in inventory stands ready to help;
• Delivered more than $756,000 in medical material to 39 health facilities in Arkansas, Alabama, Georgia, Mississippi, Missouri, and Tennessee this past week as part of our safety net support program;
• Coordinated efforts with national contacts, including the National Association of Community Health Centers, National Association of Free Clinics, Federal Emergency Management Agency (FEMA), and Rx Response;
• Offered aid through the Primary Care Associations in Georgia, Mississippi, and Alabama, as well as the Community Health Centers of Arkansas.

Thanks to donors like Zynga, FedEx, and others, Direct Relief can leverage every $1 given into about $25 in medical aid. Direct Relief is 100% privately funded, so we rely on donations from individuals to do our work.

Direct Relief has top charity rankings, including four-star and “top-notch” rating from Charity Navigator, and a 100% fundraising efficiency rating from Forbes magazine.

Direct Relief is the only nonprofit organization licensed to distribute prescription medications in all 50 states and maintains an ongoing support program with more than 1,000 nonprofit clinics and health centers across the country, including 168 facilities in the six states affected by recent tornadoes.

Direct Relief thanks Zynga and its gamers for their support.

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This new rating continues a nine-year period during which Direct Relief has earned a fundraising efficiency score of 99 percent or better, with the organization receiving a perfect score of 100 percent for eight of those years. Direct Relief is among just 20 groups on this year’s list rated as 100 percent efficient in fundraising, and is one of only two of the 20 based in California.

Forbes’ annual rating of 200 top American charities calculates three major efficiency ratios for each nonprofit: charitable commitment, fundraising efficiency, and donor dependency.

Direct Relief received a score of 99 percent in the charitable commitment category, which measures “how much of total expense went directly to the charitable purpose.” Only 15 groups scored 99 percent or higher in this category.

“We are pleased that Forbes’s survey has again found Direct Relief to be in the top tier for efficiency and commitment among all U.S. nonprofits,” said Thomas Tighe, Direct Relief President and CEO. “Using each dollar as productively as possible is always important, but it’s even more so during these tough economic times when more people need help and there’s less money available.”

The rating of Direct Relief is based on its 2010 fiscal year during which the organization’s assistance programs doubled as it expanded its nationwide charitable medicines program for uninsured patients in the United States and managed an unprecedented emergency effort in response to the Haiti earthquake.

• Chronicle of Philanthropy: Rated Direct Relief as California’s largest international charity based on private support;
• The NonProfit Times: Named Direct Relief as one their NPT 2010 Top 100 charities in the country;
• Membership in the Better Business Bureau’s Wise Giving Alliance.

Direct Relief was featured in November in the Forbes online column “Good Works”, which covers entrepreneurs and other topics: http://blogs.forbes.com/helencoster/2010/11/11/a-matchmaker-for-excess-drugs-and-the-patients-who-need-them/.

The full list of Forbes’s ratings and methodology for The 200 Largest U.S. Charities is available at: https://www.forbes.com/lists/2010/14/charity-10_rank.html

2010 U.S. and International Programs Accomplishments:

• Efficiency: Direct Relief spent less than one percent of its total expenses on fundraising and less than two percent overall on non-programmatic expenses.
• Emergency Response and Preparedness: Direct Relief has been the largest nonprofit provider of medical material aid to Haiti since the January earthquake and in response to the cholera outbreak, with over $54 million year to date and also continues to respond to the floods in Pakistan, the tsunami and volcano eruption in Indonesia and the floods in Vietnam, among other global emergencies. Direct Relief was honored by the US Department of Health and Human Services for developing a standardized medical kit for citizen-volunteers of Medical Reserve Corps members in the U.S.
• International Medical Programs: Direct Relief has provided surgical materials to enable 4,000 obstetric fistula surgical repairs in seven countries, managed the world’s largest nonprofit HIV test-kit distribution program (2.4 million kits provided), and provided medicines and supplies to care for millions of patient treatments in 60 countries abroad, with an emphasis on programs focused on maternal and child health, HIV/AIDS, and local health system strengthening.
• USA Programs: Direct Relief USA is the only nonprofit program licensed to provide prescription medications in all 50 U.S. states and is the largest nonprofit provider of free prescription medications to low-income, uninsured patients in the country.  In 2010, the program has provided medications to fill 10 million prescriptions to patients at community-based nonprofit clinics and health centers in all 50 states.

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