Keene-born InSHAPE expands nationwide, but faces sustainability struggles in 20th year

Worker-owned home-care cooperatives are emerging as an alternative to the for-profit agencies that dominate America's direct-care sector. In these cooperatives, professional caregivers earn an average of $2 more per hour than the industry standard, share in business decision-making, and stay on the job at nearly double the rate of workers at traditional agencies. Patients also stay with co-op agencies twice as long, suggesting higher satisfaction and quality of care.

mDoc's Garden in a Box initiative distributes biodegradable seed kits to pregnant women identified through nutritional screening as having critical dietary gaps. The women are enrolled through a structured coaching and referral system in primary healthcare facilities and community outreach points, and receive ongoing support via a digital health platform. More than 300 women have been referred to the initiative and 96% collected a seed box.

Missouri's Transformation of Rural Community Health (ToRCH) pilot program is reimagining how rural hospitals serve communities by addressing social determinants of health. The program uses Medicaid waivers and a digital platform called Unite Us to coordinate referrals between hospitals and community organizations for non-medical needs like home repairs, utility assistance, and food security. In its first 18 months, the program generated nearly 3,000 referrals. The closed-loop referral system allows hospitals to track whether patients actually receive help, something that was impossible before.

The Mamacare Foundation has trained over 860 traditional birth attendants (TBAs) in hygiene, safe delivery practices, danger-sign recognition, and timely referral systems over the past decade to improve maternal care in the region. The program pairs each TBA with a supervising midwife, creating a collaborative bridge between traditional and modern maternal care. The training has increased referrals from TBAs to clinics by 40%, and district hospitals report fewer emergency cases arriving in critical condition since the Foundation has formed.

Led by a local doctor and supported by Pfizer's Accord initiative and other partners, Rwanda launched a one-month training fellowship to train local doctors with specialized rheumatology skills. Since its implementation in February 2024, more than 1,800 patients have received rheumatological care, many for the first time in their lives.

South Africa's implementation of 6MMD (six multi-month dispensing) allows stable HIV patients to collect their antiretroviral medications only twice a year instead of monthly. The program aims to reduce clinic congestion and improve patient retention and consistent medication use.

The Abiye Project registered over 20,000 pregnant women using a community-based model to ensure they receive proper healthcare. The program connected women with trained health rangers who served as liaisons with traditional birth attendants (TBAs). When TBAs’ resistance stalled the program, the government introduced financial incentives, paying them for each patient referral, leading to more hospital births and a reduced child and maternal mortality rate.

The Olympia Bupe Clinic's walk-in model for treating opioid addiction allows patients to receive medication-assisted treatment with buprenorphine on their first visit without barriers or extensive wait times. This low-barrier approach eliminates the hurdles people often face when seeking treatment. The Clinic also hires staff with lived experience with addiction to build trust and community with patients.

Doulas are becoming a more widely used resource among pregnant people, particularly Black women who historically face racial inequities during pregnancy and childbirth. Groups like The Doula Network and the Southern Birth Justice Network are working to expand doula services by training and connecting pregnant women with certified doulas. Doula care is more holistic and studies show that women using doulas have about a 65% reduction in their odds of developing postpartum depression or anxiety when a doula is present during labor and delivery.

Dental offices like Asian Health Services are starting to incorporate mental health care in their dental services. By observing changes in oral health, building trust with patients to talk about their mental health and having them fill out questionnaires about how they’ve been feeling, dentists are able to identify patients that may be struggling and then help connect them with therapy and treatment. Asian Health Services screens 300 to 400 patients per year, about 7% of which are then referred to counseling.