African Medical and Research Foundation (AMREF)

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African Medical and Research Foundation (AMREF)
Opposite Wilson Airport, Langata Road
P.O. Box 27691-00506
Nairobi, Kenya

Tel: +254 020 699 3000
Fax: + 254 020 609518

Email: info@amrefhq.org
Website: http://www.amref.org

Director General
Dr. Michael Smalley
Tel: + 254 020 699 3318
Email: michaels@amrefhq.org

Deputy Director General
Dr. Florence Muli Musiime
Tel: + 254 020 699 3307
Email: florencem@amrefhq.org

Description

AMREF, founded in 1957 in Kenya by three reconstructive surgeons concerned with the inaccessibility of rural Africans to surgical care, is headquartered in Nairobi, Kenya where it is registered as a company, limited by guarantee and as an international non-governmental organization (NGO). AMREF also has national offices in Europe and North America each of which is registered as a nonprofit organization according to the regulations of the countries in which they are based. Each has its own Board of Directors.

AMREF’s aims to ensure that every African can enjoy the right to good health, by helping to create vibrant networks of informed and empowered communities and healthcare providers working together in strong health systems. This mission sits upon four pillars: to be a leader in the NGO community, developing and documenting best practices and training programs; to bridge gaps between communities, health systems and governments; to be a leading force on advocacy for health system reforms in Africa; and, to improve the lives of disadvantaged people in Africa through better health

AMREF’s main activities are geared towards catalysing an evidence-based movement aimed at reducing the gap between communities and the rest of the health system. This is based on the recognition that currently, a gap that separates marginalized and vulnerable communities from the rest of the health system exists. This gap prevents the integration of these communities into the system and exacerbates disparities in healthcare, weakening health promotion and disease prevention.

To help overcome these disparities and close the gap, AMREF emphasises community empowerment and engagement in the health system and aims at creating a revitalized culture in the African healthcare arena so that communities become an integral partner in a vibrant healthcare system, and where especially the poor and marginalized can achieve their full health potential, as is their right.

In order to achieve its objectives, AMREF has set up a strategy which it pursues through three interdependent program themes; Partnerships with Communities for Better Health, Building Capacity for Strengthened Communities and Health System Responsiveness, and Health Systems Research for Policy and Practice. Within this current strategy, AMREF aims to actively facilitate the engagement of communities in their healthcare, from planning through to implementation and evaluation of prevention activities and service delivery.

Track Record

In its fifty years of developing, testing, evaluating and promoting the adoption of best practice models that are appropriate, relevant and affordable, AMREF has recorded scores of achievements. Through its different programs, AMREF has increased capacity building at all levels and has influenced policy-makers to make changes to policy and practice based on evidence-based best practices. In this regard, AMREF´s notable best practice programs include:

  • The Personal Hygiene and Sanitation Education (PHASE) Project was introduced in Kenyan primary schools, and in 2004 the Government of Kenya adopted PHASE for nationwide scale up. It is also being replicated in Uganda, Zambia and South Africa.
  • The Tanzanian Ministry of Health adopted AMREF’s training curriculum for Community Integrated Management of Childhood Illnesses (CIMCI) at a time when the Government was beginning to make IMCI operational as the overriding national strategy for child healthcare.
  • AMREF’s component of the Home Based Management of Fever Programme in Uganda has influenced national policy makers to consider community drug distributors as essential partners in preventing malaria-related morbidity and therefore needing official recognition and motivation to become more involved.
  • The Comprehensive Nursing Training Programme in Uganda has been adopted as a national policy and curriculum for the training of nurses in Uganda.
  • The “Jijenge” Project in Tanzania that piloted male involvement in reproductive health through a rights-based approach is being replicated as a model by UNFPA in Tanzania.
  • The “Angaza” Project in Tanzania has established a model for the rapid scale up of HIV testing and counselling; the Government has now adopted the “Angaza” model to scale up HIV testing and counselling nationally.
  • The “Umkhanyakude” Project links traditional healers with health professionals in the formal health sector of South Africa to better manage HIV/AIDS, TB and other infectious diseases.
  • An E-learning project has been used to retrain 22,000 nurses in Kenya.
  • The regional AMREF laboratory programme has played a major role in developing national laboratory policy in Tanzania, Kenya and Uganda. It has achieved standardisation of laboratory procedures with the East African Ministries of Health through the regional External Quality Assessment Scheme.
  • AMREF was one of the first to help prove the impact of insecticide-treated nets at community level, has played an important role in monitoring drug efficacy and has been influential in the strengthening of effective diagnostic services throughout eastern Africa.

Other than pioneering programs in different areas, AMREF has proved to be a trusted participant in developing health systems policies and plans. Notably, it contributed to the development of the National Health Sector Strategic Plan 2005-2010 in Kenya through its membership in various Ministry of Health (MOH) committees including the overall policy making body in MOH, the Joint Intersectoral Coordination Committee (JICC). Within this, AMREF lobbied for and contributed successfully to the inclusion of the community as part of the health system—the community is now recognized as Level I and there is significant focus on this level and its interface with level II (dispensaries) and III (health centres) in the new strategy.

Similarly, the organization reinforced scholarship by commencing a three year Diploma in Clinical Medicine and Public Health for Clinical Officers at the National Health Training Institute, Maridi, South Sudan in 1998. Today 91 clinical officers who now make up 45 percent of all clinical officers working directly with communities in Southern Sudan are a product of the institute. Currently, the school has a population of 107 students with students drawn from all regions of Southern Sudan. As a result, AMREF was asked by the new Government of Southern Sudan to prepare a Human Resource (HR) assessment for the health sector. The report has influenced both government and donor policy and the World Bank has used single source procurement through the Government of Southern Sudan to contract AMREF to develop a framework for HR development for health across southern Sudan.

In the case of Ethiopia, the National Health Sector Policy and its associated Health Sector Development Program (HSDP) are the blue prints on which health service delivery and development are based and AMREF, in partnership with the MOH, identified performance gaps and designed strategies and programs to assist the government to achieve its objectives. For example, the HSDP has a community component called the Health Extension Package (HEP) that is intended to take preventive and promotive services as close to communities as possible. The government has been able to implement this in settled communities, but the design has proved unsuitable for nomadic pastoralist communities. AMREF has been asked to carry out an operations research intervention that will produce a workable model for the HEP in pastoralist communities. The model is likely to lead to policy change on the nature of health posts and personnel in nomadic areas.

In Tanzania AMREF worked with the MOH and many civil society partners to develop and test a community driven program for HIV counselling and testing. The program is called Angaza (Swahili for “to shed light on”). AMREF and its partners have demonstrated the value of the Angaza approach, which is now being scaled up as the national model for counselling and testing in Tanzania. The success of this approach and its marketing has resulted in the word “Angaza” now being widely understood and used in Tanzania as the word for HIV counselling and testing.

In South Africa, AMREF works to strengthen the links between communities and district health services based on the needs identified by both the district health systems and communities. For example, its TB initiative in the Eastern Cape Province was a response to a request from local health services to find new ways to strengthen the management of TB services at the peripheral end of the health system. AMREF worked with the DOH (at local, district and national levels) and local communities and included both community mobilization and health systems strengthening (capacity building of service providers and improvement in information systems). This initiative was guided by the national plans to prioritize TB management and control at national, district and local levels and has resulted in a model that strengthens TB services at the periphery. AMREF South Africa is increasingly recognized for its work in this area and is working on an initiative to integrate TB/VCT (Voluntary Counselling and Testing) services.

AMREF recognizes the importance of working with partners at different levels to ensure that its contribution towards Better Health in Africa is attained. To this end, it engages in open discussions with other stakeholders to share knowledge and experiences related to health development issues in Africa. These stakeholders include local communities, governments, NGOs, FBOs and CBOs, the Development Community and the Private Sector.

AMREF’s programs and activities depend on traditional funding mechanisms, fundraising and grants from multilateral and bilateral donors (for example: EU, USAID, DCI, CIDA, DfID, MFS), UN organizations (e.g. UNFPA, UNAIDS), Foundations (for example: Elton John Foundation, Rockefeller Foundation, Hewlett Foundation, Starr Foundation, Allan and Nesta Ferguson Charitable Trust, Big Lottery Foundation, Comic Relief and Band Aid) and local and international corporations (for example: GlaxoSmithKline, Pfizer, Wellcome, Barclays Bank, Safaricom). The Foundation also receives core support from the governments of Canada and Sweden. In addition AMREF has a fund-raising network of 12 European and North American National Offices as well as the Flying Doctors’ Society in Kenya that spearheads fundraising in those countries.

In recognition of its unique and significant contribution towards reducing poverty through improving the health of disadvantaged people, AMREF has been the recipient of two honorary awards: the US$1 million Conrad Hilton Humanitarian Award in 1999, and US$1 million Gates Award for Global Health in 2005.

Challenges

Despite AMREF´s robust and responsive strategy, strong resolve and political will to achieve its goals, it faces the challenge of finding the means to continue strengthening its health development activities and its development and growth as an organization.

Over the many years it has been working in health development, AMREF has increasingly realized that vertical programming for health service delivery, especially over the past 10 years, has come up short and requires refocusing. Regardless of increased expenditure on health by governments and donors, and successes in prevention and treatment of common diseases, the African health crisis progresses relentlessly, creating many challenges and dilemmas for policy makers and the managers of health systems.

In principle, help is available for many of Africa’s health problems but existing health systems—organizations, institutions and resources, including people, devoted to promoting, restoring, maintaining and improving health—fail to reach large proportions of the population, especially the poor. The factors responsible for the poor functioning of health systems include poor utilization of available resources, acute shortages of health professionals and increasing equity gaps. Moreover, poor and vulnerable communities are not connected in any way to—are unable to interact with, and are thus increasingly disengaged from—the primary level of health services delivery. This disconnection, combined with the low capacity of the peripheral health system, represents a great barrier to improving the health status of the poor in Africa.

At the same time, AMREF recognises that building a human and institutional infrastructure for good health is not a “quick fix” but a long-term challenge. Achieving the UN millennium development goals by 2015 will require sustained social investments in human resources. Actions need to be undertaken by governments, educational institutions, and international agencies, including private foundations and international, regional and national NGOs. African leadership and ownership are essential, but international responsibility is also important to navigate an increasingly global world. Localising the MDGs would be a step in the right direction. Longer-term financing as opposed to short-term project support will be vital to facilitate this search for solutions.

Opportunities

The Foundation will bring its 50 years of experience to bear on strengthening health systems—and helping to close the gap between communities and the rest of the health system. Opportunities for AMREF’s programming lie in its ability to generate and use information, capacity building and advocacy for the promotion of best practices affecting gap issues. AMREF’s actions over the next ten years will begin to chart a path for the longer-term realignment of social investments for building people and institutions for better health, and will focus on building that sorely needed African leadership.

As a recognized partner in the healthcare arena, AMREF is well positioned to act as a facilitator and broker in linking communities to their health systems. This emergent role is essential in the fight against poverty and underdevelopment.

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