Wall Street Journal (August 30, 2010)

Faced with Africa's devastation by HIV/AIDS, people are looking for scapegoats. Global pressure groups and now the World Health Organization are targeting "Big Pharma." The drug companies do make easy targets but that doesn't make them villains. The life-saving treatments they create remain Africa's best hope. The misguided battle against pharmaceutical companies' patent rights will only make Africa's health crisis worse.

Full Article at: http://online.wsj.com/article/SB10001424052748703578104575396931433315508.html

AIDS Patients Hurt by South African Strike

The Associated Press (August 26, 2010)

Doctors and activists say AIDS patients aren't getting treated because of a nationwide civil service strike in South Africa, the country with the most people infected with the virus that causes AIDS.

Full Article at: 

The HIV Shift

The Independent (August 25, 2010)

New studies in Uganda show that married or co-habiting couples today stand a higher risk of contracting HIV than single or young people. This marks an astonishing shift in the pandemic's infection patterns in the country.

Full Article at: http://www.independent.co.ug/index.php/features/features/42-features/3379-the-hiv-shift

South Africa Becomes a Victim of its ARV Treatment Success

IPS News (August 24, 2010)

South Africans are already on life long antiretorviral (ARV) Treatment and this number is supposed to triple in the next decade if the South African government keeps to its implementation plan. But the proepect of the government being able to meet its target is being threatened by a lack of funds.

Full Article at: http://www.ipsnews.net/africa/nota.asp?idnews=52572

South Sudan State Blames Spread of HIV/AiDS on Ignorance

Sudan Tribune (August 23, 2010)

A branch of southern Sudan's HIV/AIDS Commission says that ignorance and communication breakdown is hindering the efforts to reduce the prevalence of HIV/AIDS.

Full Article at: http://www.sudantribune.com/spip.php?article36048

First Lady of the United Republic of Tanzania, Salma Kikwete officially launched a four year project that will work to reduce maternal, newborn and child mortality in Mtwara and Tandahimba districts during the White Ribbon Day Celebrations held on March 15, at Mashujaa Grounds in Mtwara, southern Tanzania. (View an image slideshow of the launch)

The project, Putting African Mothers and Children First is a regional project running in Kenya, Tanzania and Southern Sudan and is funded by the European Union with co funding from AMREF in the Netherlands.

The launch ceremony also saw the signing of Memorandums of Understanding (MOUs) between AMREF and the Mtwara and Tandahimba District Councils in regards to the implementation of the project in the respective districts. The Mtwara MOU was by signed and handed over to the Mtwara District Executive Director Mr Mohamed Ngwalima and witnessed by Mtwara District Medical Officer Dr Margaret Mwakyusa, while the Tandahimba MOU was signed by the Tandahimba District Executive Director Abdalah Njovu and witnessed by District Medical Officer Dr Idd Msonde.

The project will work with the District administration, the District Medical Officer’s office and the Reproductive Child Health Units in Mtwara and Tandahimba in planning, budgeting, management and evaluation of maternal, newborn and child health activities.

AMREF in Tanzania’s Country Director Ms Blanche Pitt signed the MOUs on behalf of AMREF and was witnessed by AMREF Programme Manager Dr Ayoub Magimba.

The White Ribbon Day Celebrations were organised by the White Ribbon Alliance in Tanzania (WRA-TZ), a member of the international White Ribbon Alliance for Safe Motherhood that aims to become a grassroots movement for safe motherhood that inspires and saves women’s lives in Tanzania. The event brought together and show cased activities of likeminded organisations working in the area of maternal health in Tanzania including AMREF, CARE, PSI, Women’s Dignity and Jhpiego among others. The theme for this year’s White Ribbon Day Celebrations was Invest in Maternal and Newborn Health for Reduced Poverty and Enhanced Economic Growth.

During her speech at the White Ribbon Day Celebrations, the First Lady championed the need to invest in maternal and newborn child health through targeted budget lines in the national budget. The budget lines for quality service delivery proposed were deployment of skilled health workers to health facilities especially in remote regions, provision of essential medical equipment and supplies, infrastructure improvement for delivery, post natal and laboratory services, the establishment of neonatal units and tailor-made training for appropriate staff working in maternal and child health.

The newly launched AMREF project will work in line with the government’s Primary Health Sector Development Plan (PHSDP) towards improving the delivery of health services by empowering communities to actively participate in health service access and provision by building the capacity of community health workers to increase community awareness around essential health interventions (family planning, birth preparedness, early identification of complications, referrals, ante-natal/post-natal support and management of childhood illnesses) through health communication and education activities, advocacy, community mobilisation, mediation and lobbying. This will give a significant boost to the WRA-TZ led initiative in Mtwara and Tandahimba districts and on to a national level.

Tanzania loses about 8,000 women every year to maternal health complications, a significant loss within the country’s productive labour force. Over 88% of the total population of Mtwara rural district depend on agriculture; half of the agriculture labour force is made up of women.

AMREF’s ground breaking and award winning electronic learning (eLearning) project has launched in Uganda. The project which is designed to rapidly and cost effectively upgrade the skills of nurses and health workers across Uganda, was launched following a stakeholders meeting in Kampala.

“I am very pleased and indeed delighted to witness the beginning of the eLearning project in Uganda,” said the Minister of Health Honourable Stephen Malinga who presided over the launch. “As you are all aware, one of the biggest challenges in the health sector, not just in Uganda, but all over the world is the critical shortage of health workers. The focus of this project will be the nurse because they are the first point of contact for the communities seeking health services. They are the backbone of the health system and are placed to be the bridge that will close the gap that exists between communities and the peripheral end of the health system.”

For every 2000 people in Uganda, there is only 1 nurse and 1 doctor to almost every 200,000 patients, which is far below what is recommended by World Health Organisation (WHO) to ensure optimal care. For nurses, WHO recommends that there be 1 nurse for every 10 patients.

“Our nurse training institutions have been unable to train enough nurses to keep up with the country’s population growth rate and the increasing disease burden,” Said the honourable minister. “The Ministry of Health therefore greatly appreciates the introduction of this innovative eLearning approach to increase access for our nurses to quality, standardised training. ELearning has already been successfully used by our partner AMREF to rapidly and cost effectively up-scale nurses in Kenya (http://www.amref.org/info-centre/amref-courses--training-programmes/elearning-programme-/?keywords=nurses). By fast tracking the training of registered nurses, this eLearning project will greatly enhance the capacity of Uganda’s health system to provide care for the people of this country.” He reiterated.

The launch also saw the formation of a representative steering committee put together to guide the development and implementation of the project.

AMREF’s Country Director, Joshua Kyallo, expressed that the success of AMREF’s work is largely based on strategic partnerships. He requested the stakeholders to utilise their knowledge and expertise to ensure the feasibility and success of the implementation of the eLearning project in Uganda. “AMREF’s approach is to develop models that can be replicated across Africa. In this same spirit, the eLearning model, has been tried and tested in Kenya, and is now being replicated in Uganda. AMREF hopes to continue the replication throughout East Africa and beyond,” he added.

The launch, which took place at the Imperial Royale hotel in Kampala, drew participants and representatives from the ministry of health, ministry of education and sports, health training institutions, health facilities and other development partners. Other participants included representatives from the ministry of local government, professional health councils, the medical bureaus, the Uganda nurses and midwives union and council among others.

“The future lies in our innovative use of technology to improve the way our communities work, live, learn, communicate and, now, take charge of their own health,” said the minister. “The Ministry appreciates AMREF’s role in introducing this project and the Fresenius Foundation’s financial support through AMREF in Germany. Indeed it is only through working together in partnership and collaboration with other stakeholders like these that we will be able to get this country on the road to good health.”

AMREF, in a classic public-private partnership with the Nursing Council of Kenya (NCK), the African Medical and Research Foundation (AMREF), Accenture, the Kenya Medical Training Colleges, several private and faith-based nursing schools and the Ministry of Health Kenya pioneered a country-wide eLearning programme for upgrading nurses in Kenya. The programme commenced in September 2005 with a pilot of 4 schools and 145 students and aims to upgrade 22,000 Enrolled Community Health Nurses (KECHN) from ‘enrolled’ to ‘registered’ level within 5 years.

ELearning was the preferred mode due to its interactivity, cost effectiveness, ease of revision and ability to achieve the goal in less time and at a lower cost than the residential programme. It would also enable continued service provision, instant application of learning and improved quality of care.

For more information contact Steve Murigi, e mail steve.murigi@amref.org or Diana Mukami, email diana.mukami@amref.org.

Madam Ida Odinga calls on the media to highlight maternal health issues in Kenya ahead of International Women’s Day

Every day in Kenya, 21 women die during childbirth or pregnancy. It is a tragedy of enormous proportions, yet it receives very little public attention.

Madam Ida Odinga, patron of the White Ribbon Alliance for Safe Motherhood in Kenya (WRA-K), is challenging the media to highlight issues affecting the health of mothers in order for them to be addressed.

“Every single hour that we delay in taking action, a mother somewhere in Kenya is dying from complications related to pregnancy and child-birth. Yet maternal deaths can be prevented. You have a duty to actively bring the gravity of the matter to the awareness of the public and policy makers in order for it to be addressed,” she said.

Madam Odinga was speaking at a breakfast meeting at the Nairobi Sarova Stanley today, organised to bring to the media’s attention the unseen plight of thousands of mothers across the country. This is ahead of International Women’s Day to be marked on March 8, and which is set aside to celebrate the economic, political and social achievements of women.

“Women are at the heart of their families, communities and the country. Their health and survival has a huge impact on the economy and the environment, and on peace and stability. The death of a mother shatters her family and threatens the wellbeing of her family and her children. We all have a role to play to save their lives by advocating, among other things, increased funding for programmes to improve the health of mothers,” said Madam Odinga.

She pointed out that the solutions to improving maternal health already exist. “They include family planning, skilled attendance at birth and emergency obstetric care – things that some of us take for granted, yet they are inaccessible to the majority of Kenyan women.”

The White Ribbon Alliance for Safe Motherhood is an international coalition of organisations and individuals bound together by a common goal: to help ensure that safe pregnancy and childbirth are an attainable priority for all mothers and their newborns. With members in 118 countries, WRA advocates for changes to ensure every woman has access to quality health care before, during and after childbirth. 

While there has been progress in some health-related Millennium Development Goals (MDGs) set in 2001, the least progress has been made towards meeting MDG 5 – reducing the deaths of mother by three quarters by 2015. Maternal mortality in Kenya has remained unchanged over the years. And for every woman that dies in childbirth, 20 others suffer long-term illness and disabilities that are devastating to the woman and a serious economic drain on families and on society. 

“Maternal Mortality is the single greatest indicator of health systems that fail to meet the basic needs of the society’s poorest and most vulnerable women,” said Angela Nguku, WRA-K founder and National Coordinator.

For more information please go to www.whiteribbonalliance.org or contact Angela Nguku on Tel: + 254 20 699 3215

Students of AMREF’s Virtual Nursing School (AVNS) will hold a Health Action Day Camp at the Jam City slum in Athi River on Friday, February 12, 2010, starting at 9am.   The event, to be held at the grounds of the Amrita Children’s Centre in Athi River, is part of the training programme for nurses enrolled at the AVNS, and is geared towards equipping them with skills in community health care, a key component of in their professional practice. The primary purpose of the camp is to help individuals and the community to develop knowledge, skills and motivation to take charge of their own health. The day’s activities will include screening and treatment for diseases, family planning services, cervical cancer screening, immunisation for children under five years and expectant mothers, nutritional counselling, health education and environmental clean-up. Complex cases will be referred to hospital. This day would not be possible without the generous contribution and funding from The Nation Media Group whose staff will participate as volunteers for the medical camp. 

AMREF’s Virtual School has been training nurses through eLearning, a revolutionary method that uses computer and mobile technology to upgrade the skills of nurses while they are still working. Since its inception in March 2007, AVNS students have emerged the best countrywide in the two state registration and licensing examination that they sat for.

For more information, contact Angela Nguku on +254 722 365434 or 6993000

AMREF has received a 4.2 million Euro grant from the European Union (EU) to reduce maternal, newborn and child mortality in marginalised areas of Kenya, Southern Sudan and Tanzania, contributing to regional learning on MNCH while accelerating progress towards attaining the Millennium Development Goals (MDGs) in Africa. 25 % of the project budget will be co-funded by AMREF in the Netherlands who will also provide technical assistance on MNCH and monitoring and evaluation.

While global, regional and national policies to improve MNCH exist, and interventions to prevent maternal, neonatal and child deaths are available in Tanzania, Kenya, and Southern Sudan, MNCH indicators remain unacceptably poor.  Progress has been hindered by poor policy implementation and weak health systems, which do not engage with or respond to community needs. This results in poor access and utilisation of preventive and curative health services.

Tanzania has witnessed a significant reduction in child mortality rates over the past two decades, but maternal health statistics have yet to improve. Poor women are 7 times more likely to give birth at home than the rich, with little or no post-natal care. Huge discrepancies in utilisation of services between pregnancy and delivery prevail with 99% of women attending Antenatal Clinics (ANC) at least once, but only 46% of births are attended by skilled personnel.

Running in Mtwara and Tandahimba districts of Tanzania, the project Putting African Mothers, Newborns and Children First: Strengthening community capacity to improve maternal, newborn and child health, will work in line with the government’s Primary Health Sector Development Plan (PHSDP) towards improving the delivery of health services by empowering communities to actively participate in health service access and provision by building the capacity of community health workers to increase community awareness around essential health interventions (Reproductive and Child Health among others) through health communication and education activities, advocacy, community mobilisation, mediation and lobbying.

The inception of the project is based on needs identified by project partners and potential beneficiaries, and is designed to dovetail with Tanzania’s national health and poverty reduction strategies. Overall indicators in historically marginalised southern districts of Tanzania, such as Mtwara and Tandahimba are exceptionally poor with social services provision characterised by a shortage in health and education facilities and inadequate staffing.

The project’s specific objective will be to strengthen the capacity of communities, civil society organisations and local authorities to provide, improve access to, and demand quality MNCH services for marginalised communities. The expected results in line with local plans, national and international policies include:

• Communities, especially women and girls, who are empowered with the knowledge to promote health-seeking behaviour, demand and access MNCH services;
• Increased capacity of local health systems to manage and deliver inclusive and comprehensive community-responsive MNCH services;  
• Strengthened civil society organisation (CSO) capacity to participate in decision-making and influence MNCH policies and practices at local, national and international levels;
• Regional knowledge-base established on community based solutions to improving MNCH that will be used to inform policy making at national, regional and international levels.  

The project focuses on maternal, newborn and child health as linked public health issues, but strategies to address MNCH have wider benefits on the health system – a stronger referral system benefits others too, over and above mothers and children, by allowing access to health services in a timely fashion.  The project shall reach over 500,000 people in the target districts who will benefit from improved health and enhanced human resource capacity at the community and health facility level.

Day 2: International AIDS Conference in Vienna - Betty's Story

I would like to attend some of the sessions going on in the meeting rooms at the Messe Platz so that I can let the rest of the AMREF family know what the discussions are about, but there is so much to do at the exhibition stand, I am unable to tear myself away.

AMREF has a colourful stand, decorated with white and red kikoys (wraps). There are posters on the walls, in red and white and black, on various AMREF programmes on HIV – Maanisha in Kenya, Capacity Building in South Africa, Training at Headquarters, Home-Based Care in Ethiopia, PMTCT in Tanzania. A large screen plays AMREF movies – Chagua Maisha, Karibu Kwangu, PMTCT and Maternal Health, Into Africa, and Mapenzi Tamu. Three large banners draw passers-by to the stand. One says ‘Stand Up for African Mothers’ and explains what AMREF’s maternal health campaign is about. “That is what drew me to your stand – the fact that somebody is speaking out for African women and girls,” says a Ghanaian lady.  She buys three ‘Stand Up for African Mothers’ T-shirts.

The tables are covered with publications, including AMREF case studies, Annual Report, Short Course Training brochures, CDs with technical presentations, ART Hub and Flying Doctors Newsletters, Health Learning Materials books catalogue, and brochures focusing on several projects. The publications result in numerous inquiries: “We want to train physicians in Eastern Africa and we need to partner with an organisation that works in that area.” “We are flying a condom balloon to several African countries; we would like to link up with an organisation working in HIV in Africa.” “We have a mobile treatment project in Eastern Cape – how can we link up with your office in South Africa.” “I am a microbiologist. Can I get a job to train lab technicians in AMREF?” Contacts are established and referrals made. It’s a great networking opportunity.

Some of the questions are pretty technical. Others are country-specific. I refer these to Melusi Ndhlalambi, or Dr Ojakaa, or Dr Ilako, or Dr Temu, or Dr Akatch, who are all attending the conference, and taking turns to help out at the stand.

The Kikoys and T-shirts draw a lot of attention. People buy them for themselves, their wives, and their mothers. A lady from Croatia asks to be shown how to carry a baby with a Kikoy. A young Malawian man gets a T-shirt and Kikoy for his girlfriend, who is not very happy that he is away that week.

Across the aisle from us is the International Planned Parenthood Federation stand. A huge sign on their wall says: “Crimimalise Hate, not HIV.” At one point, the traffic to our stand trickles down, but the IPPF stand has a steady flow of visitors. Their give-away red lanyards and blue bottles of lubricant are quite popular. Hmmm, I think to myself, maybe AMREF should …

And then again, maybe not - We have a great deal on our plate already. I answer questions about Uganda, Southern Sudan, Ethiopia; about training midwives, water and sanitation, and integrated HIV and AIDS interventions; about working with governments, with CBOs, with youth and with hospitals. I speak about the impact our projects have had; how they have been scaled up nationally, and across borders; our work with nomadic communities, our maternal health campaign. Many of those who stop by already know about AMREF. There are partners from Johnson and Johnson, FHI and the Global Health Council; there are delegates representing the ministries of health in South Africa, Ethiopia and the Netherlands; there is a former student of the DCH (Diploma in Community Health) course from Southern Sudan, and another from Kenya. A retired doctor from the UK narrates how he flew with Dr Michael Wood in the late ‘70s. All have words of praise for AMREF.

At one point, a long queue snakes its way past our stand, obscuring human traffic. Someone is giving out free T-shirts. A lady on the queue cannot understand why we will not give her a T-shirt. “They are being given for free round the corner, and you are selling yours for five euro?” A few minutes later, three people who were on the queue for the free T-shirts ask to buy the AMREF shirts. “I will wear this one, and give out the free one to my friend,” one of them says, a young lady who is working with a community-based organisation in Limpopo. “So now, tell me about your organisation.” She leaves with a bunch of publications, and the contacts of AMREF’s office in Pretoria.

By noon, I have run hundreds of metres in that little space in the exhibition stand and spoken my mouth dry. It’s exhausting work, but exciting, and fulfilling. All for better health for Africa.

Leaders and activists demand increased funding to ensure universal HIV treatment

The 18th International AIDS Conference opened in Vienna with a strong message to governments and donors to meet their funding obligations for treatment, care and support of people living with HIV and to ensure universal treatment.
Delegates from more than 185 countries are meeting at the magnificent Reid Messe Wien in the Austrian City from July 18-24, taking part in a wide range of activities including plenary sessions, workshops and satellite discussions, cultural activities in the colourful Global village, technical poster presentations and hundreds of exhibition stands where organisations and institutions are showcasing their work in HIV.

The opening session of the conference was a lively mix of beautiful music by the Vienna Orchestra, passionate official speeches, and noisy demonstrations for more HIV funding and recognition of human rights for marginalised groups. ‘No Retreat, Fund AIDS’, declared one huge banner that found its way to the main stage in between speakers. ‘Broken Promises Kill’, read dozens of posters held up by delegates in the massive hall. ‘Sex work is work!’ shouted a group of sex workers under scarlet umbrellas.

In his address UN Secretary-General Ban ki Moon noted that, although there has been significant progress in global HIV interventions, with a decline in new infections and more people on antiretroviral therapy (ART), there is a big threat to these advancements because some governments are cutting back on funding. “Recent gains must not be reversed,” he said, emphasising the importance of all governments to ensure that there was enough funding to maintain the momentum.

Ki Moon noted that increased funding for HIV interventions had been proven to be directly related to maternal health. One of the Millennium Development Goals (MDGs), he pointed out, was to reduce maternal deaths, but this could not be achieved if mothers kept dying from HIV because they could not access treatment or accessed it too late.

The theme of the conference is ‘Rights Here, Right Now’, which the UN Secretary General said was a call to the world to recognise and honour the human rights of people living with HIV, and especially those most marginalised and stigmatised, by ensuring that they have access to the prevention, treatment, care and support that they need to survive.

Conference Chair Julio Montaner expressed profound disappointment with the recent G8 and G20 meetings for their failure to take full responsibility meeting the pledge to provide universal treatment for HIV, and for being silent on a roadmap to meet the Millennium Development Goals (MDGs). Said Montaner: “These countries could afford to pump millions of dollars into averting the financial crisis last year, but they choose to ignore a global health crisis such as this. Without universal access to treatment for HIV, we will not meet the MDGS by 2015. They must act, and they must act now.”

Montaner emphasised the direct co-relation between treatment and prevention. “ART is not just about treatment. It is also an integral part of prevention. There is evidence to show that there is a 90 per cent reduction of HIV transmission when an infected person is treated. Prevention is treatment; they are one thing, and they are the way forward.”

AMREF Director General Dr Teguest Guerma warns that the shortage of funding will have a profound negative effect in sub-Saharan Africa. “Because the G8 and other donors are not honouring their commitment to ensure universal access to HIV treatment, people are going to die. Without enough treatment, we will go back to the 1990s, when people in the North were getting treatment and those in the South were not.”

Treatment, said Dr Guerma, is an integral part of prevention. If we want to stop new infections, we must treat those who are infected. But there aren’t enough drugs; only 3 million people in Africa are currently on ART. This number is less than 40 per cent of those who need the antiretroviral. She added: “We would like to stop infection of newborns in a few years’ time, but this will not be possible if there is no treatment for pregnant women. I hope that some of the US$5 billion approved for maternal health by the G8 will go into prevention of mother to child transmission of HIV.”

AIDS Conference Co-chair Brigitte Schmied said shorting of funding forced health service providers to make agonising decisions of who lived and who didn’t because they could not meet the needs of all those who required treatment. “We must not let that happen,” she said, adding: “AIDS is not just about science. It is also about social justice. We must ensure that the human rights of people living with HIV and those who are most vulnerable yet marginalised to infection are met.”

The conference chairs urged delegates to sign the Vienna Declaration, a scientific statement seeking to improve community health and safety by calling for “the incorporation of scientific evidence into illicit drug policies.”

The statement declares that stigma towards people who use illicit drugs reinforces the political popularity of criminalising drug users and undermines HIV prevention and other health promotion efforts. “The criminalisation of illicit drug users is fuelling the HIV epidemic and has resulted in overwhelmingly negative health and social consequences. We are inviting scientists, health practitioners and the public to endorse this document in order to bring these issues to the attention of governments and international agencies, and to illustrate that drug policy reform is a matter of urgent international significance.”

Dr Guerma acknowledges that the stigma and discrimination are a major issue in Africa, particularly with regard to men who have sex with men and intravenous drug users, as these practices are both taboo and illegal. “To date 95 per cent of HIV infections in Africa are transmitted through sex, but they are increasingly being transmitted through intravenous drug use. Drugs like heroin used to be inhaled, but now they are being injected. Africa has also become a passage for drugs to and from Europe and North America. AMREF has experience in working with communities - be they of interest or practice - particularly those who are vulnerable and marginalised, and we are actively exploring ways of working with these groups because we realise that they are an increasingly important constituency in health interventions in Africa.”

In talks after the tour, Dr Guerma emphasised that it was important for AMREF and the WHO to continue exploring linkages and potential areas of collaboration.

“AMREF and WHO have a key role to play to ensure that every African can enjoy the right to good health,” she said. “AMREF recognises that health service delivery is in the hands of governments. As the first African public health NGO, our role is to work in communities to create knowledge and demand for health services, and to form a vital bridge between communities, health facilities and the policy level.”

Dr Jack, who has only been the Kenya Representative for two months, indicated that AMREF was the first NGO he was visiting in his official capacity in the country.

“First, AMREF is a credible organisation, not just with the WHO but amongst all organisations promoting access to health services for communities,” he said. ”You serve as an essential link between policy and access at the community level. Your role is very essential.”

“On a more personal level,” he added, “AMREF for me is a continuation of a link. Dr Guerma was my colleague in Botswana and the late Dr Chris Wood, the AMREF pioneer, was my professor in Community Health. I actually visited AMREF in 1974 and the growth that I have witnessed today is remarkable.”

The two organisations discussed areas of further collaboration, including research and publishing to influence the global health agenda, increasing use of AMREF’s renowned capacity for the training of health workers, and showcasing AMREF successes at WHO regional and global meetings.

Dr Jack was accompanied by Dr Joyce Onsongo, the Disease Prevention and Control Officer, Dr Christine Kisia, the Health Promotion Officer and Dr Joyce Nato, the National Officer in charge of Prevention and Control of Non-communicable Disease, Mental Health and Tobacco Control.

Dr Florence Muli-Musiime, Deputy Director General; Dr Peter Ngatia, Director of Capacity Building; Dr Jane Carter, Director of Clinical and Diagnostics Programme, Dr Festus Ilako, Deputy Country Director – AMREF in Kenya; and Bob Kioko, Director of Communications, represented AMREF.

African governments made a commitment to honour the 2001 Abuja Declaration of allocating 15 per cent of national budgets towards health spending. In an eight point draft declaration on maternal and child health, African leaders meeting at the 15th Ordinary Session of the African Union in Kampala committed to strengthening health systems - particularly primary health care, training community health workers and waiving user fees for pregnant mothers and children under 5.

The actions also called on the Global Fund for HIV/AIDS, malaria and TB to create a new fund for maternal, newborn and child health and the AU to establish a special task force on maternal and child health. Member countries also committed to launching the AU led Campaign on Accelerated Reduction of Maternal Mortality in Africa (CARMMA).

Following the G8 Muskoka Initiative to invest $5 billion USD in maternal and child health in developing countries, African governments have now also addressed this critical health issue.

“It’s time to move from declarations to real action. Now that African leaders have also prioritised maternal and child health throughout this summit, we urge them and the international development community to ensure adequate resources are made available and targeted to the mothers and children in Africa who need them most,” says AMREF in Uganda’s Country Director Joshua Kyallo.

With a commitment to many of AMREF’s key recommendations to leaders at the Summit, AMREF remains optimistic that the actions proposed today will translate into reduced child and maternal deaths across Africa and bring African countries closer to achieving Millennium Development Goals 4, 5 and 6.

“We know that access to basic health services will go a long way in saving the lives of mothers and newborns. We are pleased with the outcome of the Summit but remind leaders that it is critical that they deliver on these promises in a timely and transparent manner,” says AMREF’s Director General Teguest Guerma.

The biggest threat to the lives of teenage girls and young women in Africa is pregnancy and childbirth. According to WHO, a woman living in sub-Saharan African faces a 1 in 16 lifetime risk of dying due to pregnancy, and for every woman who dies, another 20 suffer from illness and devastating birth-related injuries.

Founded in 1957, AMREF is the world’s leading African health development organisation. With headquarters, history and feet on the ground in Africa, AMREF ensures good health for the most marginalised people in Africa. With their active involvement, AMREF develops and implements innovative solutions to critical health challenges facing the continent.

“We would like to say thank you on behalf of the Ugandan government. Thank you for an exemplary job in treating these patients,” said Honourable Dr Stephen Mallinga.

The team, led by AMREF’s Head of Surgical Outreach, Dr John Wachira will work with the doctors and nurses at Kampala’s Mulago National Hospital. Mulago received an overwhelming number of patients after last week’s explosions that resulted in 76 deaths and at least 40 critically injured.

The team will provide expertise in neurosurgery, orthopaedics, anaesthesiology, intensive care and psychology as they work with a matching team from Mulago Hospital.

Honourable Mallinga further added that the partnership between AMREF and the Ministry of Health is a good model for East Africa as neighbouring countries of the East African community can indeed support each other to manage disasters of this kind.

At a joint press conference by the Ministry of Health and AMREF at the Mulago Hospital, AMREF in Uganda’s Country Director Joshua Kyallo explained that many of the experts have extensive experience in similar emergencies.

“AMREF learned a lot from the 1998 attacks on the American Embassy in Nairobi and many of the experts here were part of AMREF’s emergency response,” he said.

The team of ten is the second group AMREF has dispatched to support the Ministry of Health’s response to the Kampala explosions. On July 15, AMREF sent a team of four medical staff to assist at the hospital and assess the materials and personnel needed.

AMREF has since sent two shipments of medical supplies and equipment.

Over the next week, the AMREF team will operate on 10 – 15 patients, providing critical and reconstructive care. Along with treating physical wounds, this team also includes a psychologist and counsellor to help patients deal with emotional trauma.

“Even after the patients leave the hospital, go home and their wounds heal, the emotional wounds and scars still remain. The people who lost loved ones and saw people die need our support,” says Dr Wachira.

Clinical care and emergency response has been at the heart of AMREF’s work since AMREF was founded 53 years ago. Each year, the AMREF Specialist Outreach Programme trains over 1,000 doctors and 3,000 nurses while carrying out almost 17,000 consultations in more than 100 remote hospitals in seven African countries. In times of emergency, AMREF mobilises doctors, nurses and paramedics to support these missions.

As long term partners, AMREF and Uganda’s Ministry of Health have worked closely together on strengthening health systems and bridging the gap between communities and formal health systems in Uganda.

The ten medical experts dispatched to the Mulago National Hospital are:

Dr Jane Carter – an internist and haematologist, she is the Director of the Clinical and Diagnostics Programme. She is currently in Uganda to guide and coordinate the AMREF-Ministry of Health emergency response. Dr Carter was pivotal to the AMREF response during the 1998 bombing in Nairobi.

Dr John Wachira - consultant surgeon and urologist. Dr Wachira has been the Head of AMREF’s Surgical Outreach Programme in eastern Africa for 20 years and comes with a wealth of experience working with and teaching other surgeons in some of the most remote areas of the eastern Africa region. He has been involved in several disasters and managed crises in the region including the 1998 Nairobi bomb blast, the Molo oil tanker explosion in Kenya, and the outcomes of the Rwanda genocide and DRC crisis.

Dr Meshack Onguti - a maxillofacial surgeon and former Director of the Kenyatta National Hospital, Kenya’s largest referral hospital. He played a key role in helping the victims of the U.S. Embassy bombings in Nairobi in 1998.

Dr Patrick Akuku - a neurosurgeon, who was also part of the first team that came to support the Mulago Hospital on July 16, 2010.

Dr Hezron Odondi Opele - an anaesthesiologist with a sub speciality in paediatric anaesthesiology

Lucy Kimemia – a Kenya registered Intensive Care Nurse with 6 years experience in ICU and 9 years experience as a community health nurse.  She is also a forensic nurse examiner.  She is currently working at Kenyatta National Hospital.

Bolivia Olasya - a Kenya registered Critical Care Nurse with experience in both critical care and high dependency nursing.  She has worked for the International Organization for Migration at a refugee camp clinic. 

Caroline Magiri – a Kenya registered Theatre Nurse with 6 years of experience. She was involved with the 2007 Kenya election crisis and participates in the AMREF Specialist Outreach Programme. She is currently working for the Ministry of Health in Nairobi Province.

Richard Mwangi – a Kenya registered Theatre Nurse with more than 10 years of experience, and a trained phlebotomist. He is currently employed at Nairobi Hospital.

Jael Alaro - a Kenya registered community health nurse and qualified psychologist. She was a major player for 4 years in the medical assistance programme for survivors of the 1998 bombings in Nairobi, and was also involved with the victims of the post-election violence in Kenya in 2007.

Kepha Maranga - a qualified psychology counsellor and trainer with more than 10 years
experience who participates in the AMREF Specialist Outreach Programme. He has worked in trauma counselling and is a member of the Kenya Association of Professional Counsellors. 

The Situation

The biggest threat to the lives of teenage girls and young women in the developing world is pregnancy and childbirth.

According to the World Health Organisation, a woman living in sub-Saharan Africa faces a lifetime risk of dying due to pregnancy of 1 in 16 (compared with 1 in 30,000 in Western Europe). And for every woman who dies, another 20 suffer from illness and disability, like obstetric fistula, which without surgery to repair it leaves its victims incontinent social outcasts. This is the greatest health inequality in the world. More than 250,000 (of the 536,000) deaths among women and girls every year as a result of complications during pregnancy and childbirth are among African women. Sadly, Africa also contributes 60 per cent of the 9 million children under-five who die globally every year.

In most African countries the maternal and child death rates are actually getting worse, and it is unlikely that Millennium Development Goals 4 and 5 (reducing child and maternal deaths by 75 per cent by 2015 respectively) will be achieved without urgent action.

Call to African Leaders   

AMREF has been working for 53 years with communities to empower them to know more about their health and be able to demand better services from health facilities and providers. AMREF will continue to work to improve the linkages between communities and health facilities by increasing access to health information and providing communities with better knowledge of their health and health needs.

Recently, G8 leaders made a fresh commitment to invest US$5 billion to reduce maternal and child deaths in developing countries. African leaders should meet their commitment made 11 years ago through the Abuja Declaration (2001). African governments agreed to set aside 15 per cent of national budgets to go towards health spending.

For more information please contact:

Joshua Kyallo
Country Director - AMREF in Uganda
Email: joshua.kyallo@amref.org

Bob Kioko
Director of Communications
Email: bob.kioko@amref.org

Steve Murigi
Communications Officer - AMREF in Uganda
Email: steve.murigi@amref.org 

AMREF is asking for a removal of all barriers to universal access to treatment of HIV, including shortage of funds for treatment and complicated drug combinations, if the momentum gained in interventions to reduce infection in sub-Saharan Africa is to be maintained.

AMREF Director General Dr Teguest Guerma, who is leading a team from AMREF at the 2010 International AIDS Conference that opened today in Vienna, Austria, says there are many people whose hopes of living a full life have been raised by the availability of antiretroviral therapy, and we must not let them down.

 “Let us make sure they get the treatment. The cost of drugs is high - it must be reduced. Anti-retroviral therapy is a life-long treatment; if it is cheaper, it can be made available for everyone who is infected.  In addition, we need innovative insurance schemes to make treatment affordable. We also need to have a simpler standardised drug, instead of the cocktail that is currently being taken. It has been done with TB, and there is no reason why it cannot be done with HIV.”

The global health crisis has affected funding for AMREF’s activities, acknowledged Dr Guerma, but the organisation is considering new ways of raising money, including from individuals and Corporates in Africa, with whom AMREF has not engaged much so far. This will ensure that the organisation is able to continue its work with the most vulnerable communities, including supporting treatment and care for people living with HIV in these communities.

This is important, she said, because AMREF works in places where nobody else goes – like Turkana District in northern Kenya, South Omo in Ethiopia, and Tali in Southern Sudan. “AMREF is special because we work with the most isolated and poorest people, from urban slums to nomadic communities. We build the organisational capacity of grassroots civil society organisations, such as faith-based and community-based organisations, ensuring that the work they do is effective by giving them technical skills in financial management, monitoring and evaluation, and accountability.”

AMREF’s HIV prevention, treatment and care interventions integrate maternal health, as well as reproductive health services and education for young people, said Dr Guerma. AMREF’s rallying call at the conference is ‘Stand Up for African Mothers; Rights Here, Right Now’, which incorporates AMREF’s campaign to improve the health of African mothers over the next five years and the theme of this year’s International AIDS Conference, ‘Rights Here, Right Now’.

“Africa has made minimal progress towards attaining the Millennium Development Goals to reduce maternal and child deaths. We must ensure that we put enough resources into improving the health of women and girls. I hope that a substantial amount of the US$ 5 billion pledged by the G8 in Muskoka for maternal health will be used in an integrated approach that includes prevention and treatment of HIV, comprising prevention of mother to child transmission, education, care and support.

Dr Guerma emphasised the importance of incorporating treatment as part of comprehensive prevention programmes. Prevention and treatment are two sides of the same coin. We need a comprehensive prevention package that includes treatment, as this has been proven to have a huge impact on reduction of new infections,” said Dr Guerma.

HIV prevalence in Kenya, for example, has fallen to 6 per cent in 2008, down from 10 per cent in the 1990s because of a combination of behaviour change and treatment, which have greatly reduced HIV transmission. But she lamented the fact that not everyone who needs the life-saving ARVs is using them, mostly because they are not available. She said that less than 40 per cent of those who need the drugs can get them from existing programmes.

Stigma and discrimination are an important barrier to accessing treatment and care too, Dr Guerma observed. “Many people fear the reaction of society to infection, so they do not test to find out their status. This means that they do not get access to treatment, even when they need it. We have made a lot of progress in reducing stigma and discrimination, but we still have a long way to go. We must find ways to eliminate this barrier, and all the others that stand in the way of universal treatment. We must keep the hope alive.”

AMREF is presenting nine technical posters at the conference. The team includes staff from Tanzania, South Africa, Kenya and AMREF Headquarters in Nairobi. In addition, AMREF has set up an exhibition at the conference, which continues to attract a steady flow of visitors on the first day of the conference, many of whom were keen to learn about the organisation’s work and to pursue areas of potential partnership.

The simultaneous blasts have so far resulted in 80 reported deaths, at least 40 people in critical condition at the country’s Mulago National Hospital and an unknown number in other hospitals in the Ugandan capital, Kampala.

AMREF has been approached by the Uganda Government because of its experience and key role in the response to the 1998 bombing of the US Embassy in Kenya; because of the current role in providing outreach services to health facilities in Uganda; and because of AMREF’s commitment to community support in the region. The members of the team going to Uganda formed part of AMREF’s core response team in 1998.  The AMREF team, which will be stationed at the Mulago National Hospital, will offer support to treating victims at this and other hospitals; as well as providing an assessment for the government to inform ongoing emergency response efforts and future trauma management.

In addition, AMREF’s Outreach Programme is providing emergency medical supplies worth US$30,000 to the Ugandan Government through support from AMREF in the Netherlands. Further support has so far been received from:

• AMREF in Italy
• Direct Relief International (DRI) amounting to US$30,000 to procure emergency supplies
• Johnson & Johnson, who have donated medical supplies

AMREF is also working with other potential donors to provide further support, especially in building capacity for future preparedness.

Joshua Kyallo, the AMREF in Uganda Country Director, is serving on the Uganda Ministry of Health’s Emergency Panel, which is coordinating immediate service needs. The panel, which includes other non-governmental organisations, is helping to build the capacity of both the Ministry and the NGOs to respond to this and other emergencies in the future.

Currently, AMREF’s Clinical Outreach services are on standby in case more support is required. AMREF which was instrumental in establishing emergency structures and medium- to long-term trauma management services following the 1998 bomb blast in Nairobi, will be bringing its experience and expertise to support the development of similar structures in Uganda that address both physical and psychosocial needs.

  ‘If fistula was a condition affecting men, would it have taken us this long to do something about it?”   Dr Eunice Kiereini, chairperson, Flying Doctors’ Society of Africa

Sarah Omwenga could easily have passed for a surgeon as she confidently took to the podium at the International Society of Obstetric Fistula Surgeons’ (ISOF) Conference in Nairobi this week. When she began to speak, her strong voice cutting across the room, the participants from across Africa, Asia, Europe and America fell silent, their undivided attention on the young Kenyan woman.

For the next 12 minutes, Sarah spoke of her ordeal with fistula, a condition caused by prolonged labour that leaves a woman unable to control the flow of urine, and sometimes stool as well. Young mothers whose bodies are not sufficiently formed to handle the rigours of childbirth, and women who cannot access qualified maternal health care, are particularly vulnerable to fistula, and to the disgrace, dejection and isolation that come with the demeaning condition.

Sarah became pregnant as a teenager after she was raped. 

“I was in labour at home for 20 hours and then I was taken to the local dispensary, where I spent another 18 hours in labour. When the child finally came, it was dead,” she told the hushed room.

Three days after delivery, she realised she could not control her urine. “I stayed in hospital for two months, hoping for a cure, but I was told that my condition required a doctor from abroad.” With no money to pay for an operation, she went home to hide away from the world.

 “My nights were full of tears. I felt trapped, lonely and dejected.”  For 12 years, she suffered from the pain and discomfort of genital sores and the ever-present, humiliating stench of her own urine. The shame and the dejection finally drove her into depression and in 2007; she was admitted to the Moi Referral Hospital’s psychiatric ward. It was here that a doctor told her that fistula could be treated at the hospital. Sarah was thrilled.

“After the surgery I regained my life and my dignity. I survived physical and emotional trauma to become a living testimony of how our health system has failed. I now speak on behalf of shattered families and children devastated by the deaths of their mothers,” she said.

Sarah’s story reflected the struggle of more than two million women across the world who live with fistula. Today, she is an ambassador for the United Nations Population Fund (UNFPA), adding her voice to a global campaign to eliminate fistula in the world and restore the dignity of women who suffer in silence from a condition that could be prevented and cured.

The three-day Fistula Surgeons’ Conference, hosted by the African Medical and Research Foundation (AMREF), aims at sharing knowledge in the prevention and treatment of a condition that mostly affects developing countries and particularly Africa.

From Kenya to Pakistan, the story is the same: more women are developing fistulas because health care systems across the developing world are poorly funded, inaccessible and too expensive for most rural women. Thousands of lives are being shattered by the poor attention mothers receive at the hands of untrained birth attendants and in poorly equipped rural health facilities.

According to Conference Chair, who is also AMREF’s Outreach VVF surgeon, Dr Weston Khisa Wakasiaka, 90 per cent all fistulas occur in Africa.

“Fistula in Africa is linked to the status of the health care system, malnutrition, poverty and ignorance. Women must be empowered with knowledge and resources to take decisions that enhance their health,” said Dr Wakasiaka.

Statistics presented at the conference indicated that rural women were most affected by fistulas, with tough terrain and cultural factors making them particularly vulnerable. In Ethiopia, for example, women are sometimes forced to walk for up to three days to access health facilities. “Even when they can take public transport, some find it difficult to use public vehicles because of urine leakage,” observed Amare Desta, a public health officer at Yirgalem Hamlin Fistula Centre in Ethiopia.

The situation is compounded by cultural factors, added Desta, because men often deny their wives permission to attend ante-natal clinics during the farming season, preferring them working on the land. At least 9,000 Ethiopian women develop fistulas every year. Desta believes that public awareness campaigns must be intensified to educate health workers and the public on how to identify and prevent them.

“Although many men and women of reproductive age have heard about obstetric fistula, they are not aware of the risk factors. Besides, most women living with the condition are poor and reside in remote areas where they cannot access health care,” Dr Julius Onesmo from Tanzania observed.

Studies conducted by AMREF in Kenya’s Kibwezi District showed a high level of awareness about the importance of seeking maternal health services, but women were prevented from accessing them by the long distances to health facilities.

“Women are not opposed to delivering in health facilities. Most of them cannot access the facilities and even when they can, they are unable to afford the medical charges,” observed Dr Johnson Musomi of AMREF’s Clinical Outreach programme.

Jane Makona, a district public health nurse who has worked in Western Kenya, fears that complications like fistula will continue causing misery to women in rural parts of Africa.

Working in the interior parts of Western Kenya for the last 20 years, Makona has seen the population grow without a corresponding increase in health facilities. She has also seen the rural population getting poorer.

“The women rely on traditional birth attendants because they can pay them using maize or chicken. The tragedy is that most of these attendants are not trained to detect or prevent complications like fistula,” she noted.

Dr Anne Wamae, head of Child and Adolescent Health at the Kenyan Ministry of Health, said that even in situations where the children survive after prolonged and poorly managed labour, they often end up with brain complications or retarded growth.

“We are integrating obstetric fistula into safe motherhood initiatives and equipping hospitals across the country with medical kits and qualified personnel to treat fistula,” Dr Wamae said in a speech she read on behalf of Public Health and Sanitation Minister Beth Mugo.

A number of local, regional and international non-government organisations have tried to supplement government efforts, but more resources are needed to eliminate fistula. In Kenya, AMREF has since 1992 been at the forefront of creating awareness about fistula and treating women affected by the condition. The organisation repairs 2,000 cases annually in East Africa.

“We want to train as many health workers as possible so that they take over the responsibilities of doing fistula repairs. Today, 80 per cent of surgeries are carried out by health specialists from countries where we operate and we only assist where complications occur,” said Mette Kjaer, Country Director of AMREF in Kenya.

Dr Festus Ilako, head of programmes and deputy country director of AMREF in Kenya, observed that partnership with the community is critical in preventing and treating fistula cases.

Other organisations are using innovative means to alleviate the suffering of fistula patients. Anne Gloag of the Freedom from Fistula organisation has combined radio campaigns and the popular mobile phone money transfer systems in Kenya to reach rural women with fistula and provide them with bus fare to health facilities.

It was a meeting of like souls, though on the surface they seemed like very dissimilar people. Indeed at first glance, one would not think that there was much in common between a senior, no-nonsense Kenyan minister and a lively community of disadvantaged children from a low-income Nairobi suburb. But when Hon John Michuki, Minister for the Environment and Mineral Resources, spent a day with the children of AMREF’s Dagoretti Child in Need Centre, they discovered that they were, indeed, kindred spirits.  

On Friday last week, the minister and the children were brought together by their mutual concern and passion for the environment. Hon Michuki joined the children and the Dagoretti community in planting trees at the Centre, and encouraged them not just to plant trees, but to ensure that those trees were nurtured to maturity. Touching on a major undertaking by his ministry to clean up rivers serving the city of Nairobi, the minister encouraged the community to take care of water sources.

“We have plenty of water – we just don’t take good care of it,” he said. “Water is life, yet we have polluted what we have and made it dirty. We are drinking this dirty water, and that is why instead of living to a ripe old age many people die young, while children are born stunted and weak. Many rivers have dried up because of man’s activities, such as cutting down of trees. We must look after the resources we have.”

Minister Michuki launched an e-Journal by the Different Perspectives group of the Dagoretti Child in Need Project, focusing on the Millennium Development Goals (MDGs). The online journal was developed by the Dagoretti team led by Project Manager John Muiruri, with assistance from Sayaka Hino, an intern at the centre. It features articles written by the children on progress on the ground towards achievement of the MDGs. At the same time, the Minister launched Millennium News, a documentary on the eight MDGs from the perspective of the children. Hon Michuki watched a segment of the documentary focusing on MDG 7 – environmental sustainability.

The minister was accompanied by Prof Hiriyuki Hino, economc advisor to Prime Minister Raila Odinga.

When he addressed the huge crowd that turned up at the centre, the minister was clearly impressed by the work done by the centre’s youth to promote environmental conservation, including the use of waste to make music.

“I never thought that such good music could come from plastic paper bags, or discarded water bottles, or rusty drums that others only deem fit for brewing chang’aa (an illicit alcoholic brew),” Hon Michuki said after watching a demonstration by the Jua Kali Drummers, who create music using instruments made from recycled waste. So taken was he with the performance that he invited the group to visit his Kangema Constituency in Kenya’s Central Province.

Minister Michuki is a stickler for time and detail. However, while his visit to the centre should have ended at 1pm, he agreed to visit to the children’s studios at the Dagoretti Theatre House. Here, the Different Perspectives Group interviewed the minister on environmental issues, ranging from how to care for trees to Kenya’s position at the recent global conference on climate change in Copenhagen. The minister then joined the children for a cup of tea, and told them of his childhood experiences. And herein lay the basis of a deep connection between the minister and the Dagoretti children.

“But for the grace of God, I would have been a street child,” he said. He went on to explain: “I was born into a large, wealthy family. My father was a chief with 43 wives, and in my early years, I lived a very privileged life. But when I was nine, my father died, and my mother and I were not able to get any of his wealth. Life changed for me. However, my illiterate mother was very keen that I get an education, and that is what got me where I am today.”

For the next couple of hours, the Minister spoke with the children, answering their questions and giving them advise. He urged them to be disciplined, committed and organised, and to study hard. Using himself as an example, he told them that it was possible to rise from obscurity to a place where they could make an impact in the world.

It was indeed a meeting of kindred spirits. At the end of the day, a special bond had been formed between the minister and the children. Each had discovered a part of themselves in the other.

For further information please contact:

Betty Muriuki- AMREF Writing Manager, on +254 20 6993327, email: betty.muriuki@amref.org

Nash Colundalur: The Guardian

The vast expanse of the harsh landscape is broken by a gathering of a few hundred people, standing and crouched down in an unruly circle, all eyes focused on the centre. Emotions are running high among the ashen women, with some having slumped and collapsed to the ground. The men, desperately trying to take control of the situation, wave their long sticks furiously and yell agitatedly into the circle. Bellowing goats, sheep and cattle recklessly try to break into the ring.

They are all desperate for water. Abumon throws her arms up in the air, breaks out of the circle and in resignation crashes to the ground. She looks fretfully into the horizon. "I don't care any more, I will die here." She lifts a weak arm to point at the mountains. 'They will come and take everything." She beckons her small, severely malnourished child towards her. Suddenly there is great clamour from within the circle. A small container is making its way up, passed from hand to hand. A fresh flurry of yelling and stick-brandishing follows from the men, until the yellow plastic container finally arrives. The black sludgy water is first fed to the children, who lap it up quickly and cry for more.

It has not rained adequately for four years in Turkana, northern Kenya. The district is 80,000 sq km and is populated by nearly 500,000 nomadic pastoralists. For hundreds of years, the Turkana people have been herdsmen, rearing cattle, sheep and goat. They are one of the most nomadic people in the world, at times moving every month looking for pasture for their livestock. Climate change and marginalisation by successive governments have seen resources deplete at an alarming rate across their traditional home.

Lorus, where the tribe has gathered to fetch water, is a natural underground spring close to the Sudan border. In desperation, they have dug and blasted their way to the eye of the spring to get to the water, which is several metres from the scorched surface. Sand, mud and faeces from livestock slither into the rocky well, turning the water into a dangerous, dark sludge. The threat of heavily armed, ruthless cattle-raiders from neighbouring countries constantly hangs in the air. "The Topoza from Sudan took away 60 of my cattle," Namuge gestures with his head at the mountains. "I now have four left and they are dying." He pours the black liquid into a trough for the cattle; one of them has gone down on its knees, refusing the water. "I am waiting for it to die." he says, adjusting a long knife fastened around his waist.

Eberhard Zeyhle, a German parasitologist, came to Kenya 28 years ago to investigate Hydatid disease, a tapeworm infestation passed on from livestock to humans. Since then, as part of Amref (African Medical Research Foundation), he has been involved in providing general healthcare and facilitating social development for this remote community.

"Turkana district has enough water resources to feed the entire population, it just needs to be scientifically harnessed," he says. He also thinks that large parts of the land are fertile. If irrigated, farming could become an additional and fall back source of income for the Turkana. He points into the depths of the blasted rock "We need to protect the eye of the spring. It needs to be sealed and the water led to an underground tank. This will ensure clean water without any contamination." Though the solution seems simple, he says it is hard to do it now because the Turkana are terrified of the water depleting if the eye of the spring is sealed.

Eberhard thinks that donors, NGOs and the government can do their part, but the Turkana have to co-operate and the initiative has to come from within. This opinion is shared by Alex Lama, coordinator at Akosi (which translated from the Turkana language means "ours") an organisation involved in various development projects.

"The CDF [community development fund] allocated to the district, by the government is a drop in the ocean," says Lama.

Ekono is a 60-year-old man of very few words. He sports a grey cap with a feather in it and a large ivory coloured finger ring that he polishes constantly. Ekono is an Emeron, a revered spiritual leader for the whole of the Turkana district.

Sitting at one of Amref's container clinics, a robust health centre made from a shipping container located along the Turkana's migratory routes, he says slowly: "I will mobilise my people to part with a cow each, we can raise half the money needed for a borehole." He looks around the people gathered. "My people are dying, I only ask the government and donors to contribute the other half."

Elimnon Peunon, a Turkana from a neighbouring village who is squatting beside Ekono, stares intensely at the ground. "I had nine children," he says. "The drought killed two of my youngest children and two more were gunned down by the Topoza. We have tried to contact the government many times through our councillors. Our so-called MP has not once come here."

Raising his voice and standing up, he continues: "We want the government to give us protection and water." He sweeps his hand across the never-ending landscape and lowering his voice as if to tell a secret. "This land is fertile, the water is there, all it needs is irrigation; we are willing to diversify."

John Munyes is the elected MP for the district and a cabinet minister in the Kenyan government. Over the years he has been minister for various departments including water. "The reason the Turkana are being marginalised is political," he says. "The executives in the government see Turkana as a low-potential area. They are seen as not contributing to the GDP." He says because of bureaucracy the government of Kenya has not raised the threat level high enough to provide security along the border to tackle raids from Sudan and Uganda. "We need to improve our water sources to target dry-season grazing. We can plan water pans and boreholes along migratory routes and allow a system where it is used only during the dry season."

There has been pressure from the state for the Turkana to lead a more sedentary life, making it easier for services to be provided. Experts believe this will only devastate the climate even more. As pastures start dwindling, the Turkana target trees and large shrubs, cutting them down unscrupulously and burning them to produce charcoal. Sarah Mathew, a doctoral research student from the University of California, Los Angeles, says that there is general misconception that the nomadism of the Turkana is the problem, whereas nomadism is actually the solution to it.

Namuge has taken a break from retrieving water from the spring. He looks plainly at his collapsed cow. "We are nomadic; give us water during the dry season and then we will move on," he says. With collected energy the cow jerks its head, lets out a moan and dies. Namuge has come prepared. The withered animal is dragged away from the spring and with the help of his four sons, butchered into smaller pieces, to be carried back to the village. "At least my family can eat for a few days; I did not have the heart to slaughter it while it was alive."

AMREF’s Katine Community Partnering Project in Uganda and Maji ni Uhai (Water is Life) Project in Tanzania have received recognition for the role they play in the achievement of and sustained commitment to the UN Millennium Development Goals (MDGs).

Business in the Community (BITC) Coffey International Example of Excellence Award

The Katine Project has won the Business in the Community (BITC) Coffey International Example of Excellence award. Supported by the Department for International Development (DFID), the Coffey International Award recognises companies who have shown innovation, creativity and a sustained commitment to one or more of the UN Millennium Development Goals.

Barclays, The Guardian, AMREF launched the Katine project in 2007 to improve education, health, livelihoods, and sanitation in the village of Katine, a 25,000-strong community in north-eastern Uganda, which has suffered civil war, drought and extreme poverty.

Charles Duff, Chairman of the International Award judging panel believed Katine showcased a strong partnership to effectively address the MDGs, whose learning could be rolled out to other parts of Africa.

"It is easy to see that the work through this partnership has great potential for being scaled up and is replicable in other communities in Africa and beyond. Bringing together inclusive financial products and the power of the media with the expertise of an NGO is something very exciting," said Mr Duff.

Grace Mukasa, AMREF in the UK’s Chief Executive said, ''By engaging the community from the start, we have ensured sustainability has been built into every level. It's an approach we hope will ensure continued progress towards the MDGs long into the future''.

International Cooperation for Sustainable Development Award

At the same time, a partnership bringing together Ferrovial, a global infrastructure builder and AMREF, has further received the International Cooperation for Sustainable Development Award bestowed to enterprises by the European Commission at the European Business Awards for the Environment 2010. This is in recognition of the Maji ni Uhai (Water is Life) project, a water and sanitation project in Tanzania, implemented by AMREF in Tanzania and funded by Ferrovial through AMREF in Spain.

The European Business Awards for the Environment recognise and promote today’s pioneers in green innovation within the context that any business, large or small, can make a difference in the fight against climate change and help to solve today’s environmental challenges, from the decline in biodiversity to the unsustainable use of natural resources.

Ferrovial, AMREF in Spain and AMREF in Tanzania are working towards providing clean water to more than 50,000 people (40% of the population of Serengeti District) by building sanitary and water supply infrastructure, with the aim of improving health and the quality of life of local communities, supplying safe water and sanitary facilities and educating the communities on good hygiene practices.

This award falls under the International Cooperation for Sustainable Development category and was presented by Mr Janez Potocnik, the EU Environment Commissioner, to Mr Íñigo Meirás, Ferrovial’s Chief Executive Officer.

Mr Íñigo Meirás welcomed the award by saying, “This project responds to the United Nations’ MDGs that Ferrovial subscribed to in 2002 with the aim of promoting enterprises’ involvement in the fight against poverty and promote a world association for development. For both reasons, through AMREF’s Maji ni Uhai, Ferrovial is directly involved in Development Cooperation.”

By the end of the project, AMREF will have trained 131 water and health technicians and 1,300 people - half of them women, on good hygiene and health practice promotion and the infrastructure built in the area will become the basis of sustainable, economic development for the Serengeti region.

Find out more about the BITC award.

More about the Katine Community Partnering Project (KCPP)

More about the Maji ni Uhai  - Serengeti Water, Hygiene and Sanitation Project

Canada and G8 partner countries need to direct these funds to basic, frontline health services in sub-Saharan Africa in order to significantly improve the survival of women and children. AMREF’s experience demonstrates that a community-based approach is the most successful strategy for reducing deaths of mothers and children and is essential to achieving all health Millennium Development Goals. Further, African governments need to be supported and held accountable for their part in the delivery of health interventions in the communities.

“We know that having access to frontline health facilities in Africa that are adequately staffed with trained health workers result in dramatic and immediate improvements in the health of mothers and children,” according to Dr John Nduba, AMREF’s Director of Reproductive and Child Health. “Only healthy communities can begin to address issues of poverty and economic development.” 

Specifically, AMREF recommends integrating NGOs and ministries of health in the design and delivery of primary health care services. To be effective, strategies must include the following:

• Address the crisis in shortages of health workers with training and support for the right mix of community health workers (midwives, nurses, health extension workers) who are paid a living wage and integrated into the formal national health systems
• Invest and maintain basic health facilities (health centres, dispensaries and clinics) with essential medical and pharmaceutical supplies
• Remove all direct and indirect user fees for women and children
• Ensure communities are full participants in the management of their health services

AMREF’s extensive and lengthy work in health development demonstrates that to achieve successful outcomes, health services must be organised and developed around communities as key participants. This must include the training of community members to act as bridges and facilitators with the formal health service. This approach results in acceptance and strong community engagement in better health for all. 

 “We must remember that Africa has 13 percent of the world’s population and 25 percent of the global disease burden but only 1.3 percent of the world’s health workforce,” said Dr Nduba, “AMREF’s experience in strengthening health development in Africa demonstrates that  increasing investments in maternal and child health can achieve dramatic results.” 

The e-learning programme builds on the successful one-week training programme that the Management Development Institute (MDI), run by AMREF and UCLA, has been offering in Kenya, Ghana and later this year in South Africa. J&J have been supporting the programme since 2006.

The guest of honour at the launch, Acting Permanent Secretary in the Ministry of State for Special Programmes Mr Moses Gitari, said the Government is keen to harness the benefits of AMREF’s experience in training health personnel through eLearning.

The Ministry’s vision, he said, is to have a safer, sustainable and resilient society in order to be able to achieve Kenya’s Vision 2030. “Kenya has made great strides in reducing the stigma associated with HIV, and as a result more people are voluntary being tested for the virus. So far, 56 per cent of Kenyans know their status, while the government’s goal is to reach 90 per cent,” the PS said.

But there is still so much more to be done, he added. At present, there are 1.4 million people living with HIV in Kenya, while 2.5 million have died from HIV-related illnesses. “We must find ways of delivering quality services if we are to deal successfully with this national disaster.”

Acting Director of NACC, Mr Dennis Kamuren, said the council had identified capacity gaps in implementation and management of projects and embarked on a two-pronged approach to tackle them. The first, he said, is by adopting AMREF’s Maanisha model on a national level to strengthen management of community-based organisations working in the field of HIV and AIDS. (Through Maanisha, which means ‘give meaning to’, AMREF works with over 700 Civil Society Organisations across Kenya, strengthening their capacities in technical, financial and organisational management of HIV interventions, and equipping them with advocacy and fundraising skills.) The second is through the new eLearning MDI (eMDI) programme, which targets various levels of personnel in NACC, from secretariat and senior management staff, to regional, district and constituency managers. For both approaches, AMREF will be the coordinating agency and quality assurance provider.

"With the launch of the eMDI, world-class management education can now be delivered to so many more leaders of  HIV/AIDS organisations dedicated to treatment, care, support and prevention,” said Prof Victor Tabbush of The Anderson School at UCLA. “The potential impact of this programme on the quality and length of the lives of those infected and affected by this dreadful disease can be enormous as these leaders deploy their newly developed management and leadership skills to enhance the effectiveness of their organisations."

“Johnson & Johnson is truly privileged to support such a unique partnership between world-class organisations, AMREF and UCLA, that have over the years developed top-notch leaders and managers,” said Rene Kiamba, Manager, Johnson & Johnson Family of Companies Contribution Fund, Sub-Saharan Africa. “We have already seen hundreds of managers in HIV and AIDS across Africa transformed by the core MDI through these partners, and now the e-MDI makes this blue-chip programme available more widely. We are delighted that NACC has agreed to use this programme to train their managers.”

AMREF’s Director for Capacity Building, Dr Peter Ngatia, said the eMDI project had brought together three great institutions – the Anderson School at UCLA, a world-class training school; AMREF, a tested and proven health development African organisation; Johnson & Johnson, a company committed to supporting programmes that build health care capacity; and through NACC, the Kenya Government, which is dedicated to eradicating HIV. 

“We at AMREF are delighted to be associated with an initiative whose primary aim is to address leadership and management for health managers in Kenya,” said Dr Ngatia. “We are humbled to see a concept we grappled with only three years ago become accepted as the modus operandi for scaling up, skilling and retooling the health workforce in leadership and management. In this we relive the words of our Founder, Sir Michael Wood, who once said that ‘AMREF uses the tools of our times to deliver services where they are needed most’. Sir Wood used a single engine plane to take health to the most remote corners of the continent. Today we use ICT – the tools of our times – to take medical education to the remotest corners of our country, and indeed our continent, and to make learning available to all, not a preserve of only those who can access the classroom.”

The eMDI, said Dr Ngatia, aims to address the severe shortage of health workers by providing technical and management skills, including financial management, organisational planning, monitoring and evaluation, human resources management and health information management. “The eMDI aims to provide these skills all in one package, which the health manager can take at his own time and at 20 per cent the cost of what it would cost in a workshop or classroom setting.”

Dr Ngatia thanked UCLA for its support in developing the eMDI content and for joining with J&J to provide the funding and strategic oversight for its programme. The eMDI has been customised for the target audience, while navigation has been made easy to enable even those will minimal ICT skills to access the information. “AMREF appreciates the support of NACC and Ministries of Health, UCLA, J&J, and all development partners who support AMREF’s vision for ‘better health for Africa’.”

Others who attended the function included the chairperson of NACC, Prof Mary Getui, Prof Al Osborne and Dr Eric Tonui of UCLA, the Country Director of AMREF in Kenya, Mette Kjaer, and Mr Michael Mills, a lead economist at the World Bank’s Kenya Country Office.

South African President, Jacob Zuma was among the first to arrive, followed by Nigerian President  Goodluck Jonathan, one of several leaders from non G8-G20 countries invited to participate.

Both leaders attended the G20 Business Leaders Conference, geared at business investment in African markets. Dr John Nduba, AMREF’s Director of Reproductive and Child Health, was among 200 guests who were present for President Zuma’s lunchtime keynote address.

President Jonathan stated with pride that South Africa hosting the 2010 World Cup is making world history and that once again, football is connecting countries and people around the world. Citing the AMREF–Unicef campaign – One Goal for Africa – Zuma stated his wish: that every South African child be enrolled in school and receiving education by the next World Cup in 2014 and that both South Africa and developed nations should invest in this vision. He then pronounced boldly, “Africa is open for business”.

At the same time, just a few kilometers south, AMREF’s Research Lead, Victoria Kimotho, explored the G8 and G20 International Media Centre, complete with a visit to the “Fake Lake”. Even sitting in the reportedly uncomfortable Muskoka Chairs couldn’t provide and idea of what it would feel like to be up north in cottage country with the G8 leaders. 

But it was a busy day for Ms Kimotho, who spent most of the day taking interviews with local media, stressing the importance of the G8 Summit in putting forth commitments and action to deliver on maternal health. This followed an early morning meeting that Dr John Nduba had with G8 Sherpas to discuss Africa’s need for greater investment in this area. It was a productive meeting and AMREF hopes that it will be beneficial in putting forth a strong case for investment in mothers in Africa.

With just a few hours to go, all are excited and eagerly anticipating the updates and announcements that come forth from the Summits.

Stay tuned for daily G8 and G20 updates from AMREF Canada at www.canada.amref.org or follow us on Twitter or Facebook.

1. Closing the Gap Between Communities and Health Services

This gap can be cultural, physical, infrastructural, policy (for example user fees) poor access to information, low quality or absence of services, or directly arising from poverty.

AMREF strongly believes that health services must be organised and developed around communities as key participants, including the training of their own resource persons to act as a bridge and facilitator with the formal health service. Such community health workers have to be included in the remuneration system of the health service as they form the first tier of human resources for health, and can be held accountable for a defined set of tasks. Expecting them to be volunteers has not worked in the past, and yet they have a crucial role to play.

2. Combating the Human Resources Crisis

Africa has 13 per cent of the global population and 25 per cent of the global burden of disease but only 1.3 per cent of the global workforce.

Globalisation, vertical funding for programmes, low resource allocation to training, poor remuneration packages, and poor human resource management all combine to create this crisis that makes it impossible to deliver on health development targets including the Millennium Development Goals.

More investment and dependable funding arising from a shared sense of responsibility between developing and developed countries in this matter will alleviate this problem for developing nations. Support to innovative training methods especially the use of technology and retraining of staff are essential in rapid and efficient production of health workers. Task shifting is a policy that should be supported to ease shortages of key staff

3. Improve Weak and  Under-Financed Health Care System

Especially basic or primary health care services that are not able to provide a minimum package of adolescent and adult reproductive health, and maternal and child health services, contribute to poor maternal health and high child mortality. While vertical programme funding is useful and effective in control of endemic and epidemic diseases, such funding can be used within a health systems framework based on the WHO building blocks to strengthen the health system for effective primary health care delivery.

AMREF prioritises resource allocation and management support to the health centre and community levels of the health system because 80% of maternal and child health problems can be solved there. Support and supervision from the district level is a crucial element in health systems management

4. Integral parts of all Health Interventions must include Cross cutting issues of gender, gender-based violence, and the lack of male involvement in maternal and child health care

Malnutrition, both protein calorie and micronutrient is highly prevalent in African communities and contributes to both maternal and child mortality significantly. Few or no resources are currently allocated to this major underlying problem which needs to be brought under view once more.

5. Ensure 0.7% ODA for Development Partners and 15% of Recipient Countries Budgets go Towards Health Spending

Development partners and recipient countries need to refocus on the meaning of the new global health paradigm and find ways of actualizing the many international commitments already made, in particular meeting the thresholds of 0.7% of GDP for ODA allocation, and 15% allocation of budgets to health in recipient countries

6. Support Civil Society

Civil Society has increasingly played a productive and complementary role to governments in raising the profile of maternal and child mortality and the other health MDGs. This role needs to be supported and adequate resources allocated so the civil society can increasingly take more responsibility for service delivery issues that they are better at. Their operating space needs to be expanded in countries that have major restrictions.

Dr John Nduba
Director of Reproductive and Child Health
AMREF