AMREF Annual Report Contents

Transcription

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2 Contents From the Chairman 3 From the Director General 4 About AMREF 7 Programme Highlights 9 AMREF at Work 19 National Office Highlights 37 Financial Report 43 Senior Management 45 AMREF Contacts and Board 46 Donors 50 1

3 Vision Better Health for Africa Mission AMREF is committed to improving health and health care in Africa. We aim to ensure that every African can enjoy the right to good health by helping to create vibrant networks of informed and empowered communities and health care providers working together in strong health systems. 2

4 Message from the Chairman The year 2008 was my first as the Chair of the AMREF Board. It has been exciting for me getting to know both the management team and heading the dedicated Board of Directors as we steer AMREF through the next 50 years. I would like to recognise the incredible role my predecessor Prof Miriam Were has played on the AMREF board. Her contribution to this organisation and to Africa s health saw her receive numerous awards - including the inaugural Hideyo Noguchi Africa Prize for medical services from the Government of Japan and the title of Knight of the Legion d Honneur (the Legion of Honour) from the Government of France. We, the AMREF family and Africa, salute you Prof Were. Last year AMREF launched the strategy that will drive our work over the next 10 years. The focus of AMREF s strategy is putting African communities first. However, communities cannot come first unless they have the capacity to negotiate their right to quality, affordable and sustainable health services. The key to opening this capacity is access to information on services and awareness of their right to health, On the other hand, the health system needs to know what the needs and priorities of the community are in order for the two to have a meaningful dialogue that can catalyse action towards better health. By understanding and appreciating each other, the two sides become responsive to each other and are therefore able to work together to strengthen the health system at all levels. The AMREF strategy has identified three pillars which, if used effectively, could galvanise collective action towards better health for Africa. These are: partnerships with the communities; building the capacity of both the community and the health system; and ensuring that health policy and practice create space for the community to participate and engage in strengthening the health system and promoting their own health. Partnerships with communities cut across everything that we do. On its own, AMREF can do very little for the community, but by working with the people we become a catalyst and where necessary a bridge for engagement with the health system. Within these partnerships, our focus is on the people together with their issues, be they access to a service or a disease burden. Instead of the issues becoming the focus, they become a channel through which the people and the system can work together towards a common goal. By doing this together with the people, we create the space for the communities to build their capacity and claim their right to health and when necessary to negotiate access to quality services. Therefore, when we look at children under five years old and newborn babies, we view everything we do from the babies perspective. In preventing the transmission of HIV from mothers to children, our focus is on ensuring that healthy babies are born free from HIV infection. By addressing the mother, we are literally addressing the unborn child. In keeping these babies safe from Malaria our focus is on ensuring that they live free of disease and grow up healthy. In the same vein, if a woman is healthy, she will produce healthy babies. To ensure that women are healthy when they get to reproductive age, we must address their health at pre-adolescence and adolescence. But first we have got to ensure that they reach that age healthy, because if anything happens to them before they are five years old, it undermines the possibility of girls and boys growing up to be healthy mothers and fathers who will in turn produce healthy children. Thus one has to address health from a circle of life, which means we start from before the baby is born, after birth, and the total life of the person in order to address issues that are pertinent at various points within that cycle. In view of the immense challenges Africa must tackle in 2009, fighting not only disease, but also drought and soaring food prices due to the ongoing financial crisis, we the AMREF Board, have an even greater responsibility to ensure that AMREF does not lose sight of each person. We must raise our voice on behalf of the millions across Africa who continue to suffer silently, and ensure that politicians, business leaders and all citizens of our world who believe in justice, fairness and our shared responsibility for one another do not forget that we all must give life in Africa a hand. By shepherding this approach within the institution, we ensure that the principle of right to health remains the centre of thinking in AMREF, and that the communities we work with make it an integral part of their culture. We cannot protect the right to health of our continent, our nations, of our community, of a particular group in the population, of a child born or unborn, unless we are willing to look at the totality of the person, driven by the conviction that each child is born with an inalienable right to health. Dr Pascoal Mocumbi AMREF Chairman 3

5 Message From the Director General In its 51 years, AMREF has learnt a lot about women s and children s health, two vulnerable groups that we have deliberately chosen to work with in our strategy. Vulnerability implies exposure to harmful situations and practices, lack of power to change their lot, and lack of a voice to speak out and be heard. And yet despite the many threats to their health and wellbeing, women are the bedrock of communities. They are responsible for caring for their families, ensuring that there is water, food and fuel in the home, and are the principal providers of labour in food production. In all societies across this continent, they are pivotal in ensuring the health and wellbeing of the present and next generations. AMREF believes that, until and unless women gain their rightful place in decisionmaking, there will be no real progress in any aspect of community life, including health. Children have no voice either, and are dependent on others, especially their mothers, to voice their needs and wants. Young people are often caught in the middle as they are neither children nor adults. Too often, health services are not tailored to meet the needs of the youth and they find them too intimidating. If we do not ensure that the youth have access to services designed to meet their needs, we run the risk of them being isolated from health care at a critical point in their lives. The stories in this report illustrate the ways in which AMREF is helping to strengthen health systems by working with communities to transfer skills to them so that they can actively participate in managing their own health. The Pastoralist Youth Reproductive Health Project in Ethiopia s Afar region and the Community Midwives Training School in Lui, Southern Sudan, are examples of how AMREF is supporting governments to provide quality reproductive health services to mothers and young people. In Kenya s border town of Busia, the community consults with health workers to determine the nature and quality of services provided in government health facilities. Women and children are speaking out about malaria, HIV and immunisation in a concerted effort to reduce child deaths in the district. In north-eastern Uganda, AMREF s ground-breaking Katine Community Partnership Project is transforming the lives of residents as they endeavour to recover from the devastation of the civil war. As a result of AMREF s working with the community, communities have a voice, children are receiving quality education, and women, equipped with new skills and knowledge, are confidently taking control of their families health. The equally innovative Gender-Based Violence Project in South Africa is working with the police to give women, youth, children and even men avenues to seek protection against and redress for rape and abuse. And in Tanzania the countrywide Ujana project is equipping young people with skills to cope with their unique social and health challenges, and working with government and other organisations to provide services that adequately cater to the needs of the youth. As we work with these and numerous other communities, governments and partners across the continent, AMREF continues to discover how relevant and timely our current strategy, now a year old, really is especially the central issue of ensuring that communities are integrated into their health systems. This reality is now recognised by professional health providers and policy makers: that a health system is much bigger than the Ministry of Health and must engage everyone, from the government bureaucrats at the top to the man who sells malaria tablets in the village duka. But this reality also needs to be recognized and embraced by the mid-level managers who are the implementers of policy if the system is to work at all. This shift in mindset and mode of operation will require training and awarenessraising based on evidence, not just externally with partners and stakeholders in health, but certainly internally for AMREF as well. We have made a lot of progress in the past year, propelled by the hard work and dedication of our staff, and the excitement and passion flowing through the organisation. But we still have a long way to go to before the substance and significance of our strategy is fully internalised. Similarly, we are struggling with donors who, for a variety of reasons, prefer to support vertical programmes rather than whole health systems. One of the great innovations of our strategy is the use of programme drivers crosscutting issues that reflect AMREF s values like pro-poor, sustainability and gender equity which are discreetly packaged so that, despite the verticality of the funding, we are still able to learn something about one of these issues. And so despite the hurdles, we are still on the right path. It is a continuous process of learning and reviewing the way we do things. Ultimately, introducing implementers and partners to different ways of thinking about health and health systems and retooling them in order to achieve our goals is greatly dependent on capacity building. It is to AMREF s advantage that we have 50 years of training experience, an activity that is central to our strategy and which is coordinated by the Directorate of Capacity Building, an AMREF-wide resource that not only trains individuals but strengthens institutions to ensure that the knowledge and skills acquired are given opportunity to take root and grow. As we cultivate these roots, we recognise that AMREF s roots lie with the Flying Doctors Emergency Service (FDES), whose work can be traced through to our new strategy. Closing the gap between the community and the formal health system requires that we have a hand on both sides, and the emergency service is specially positioned to help us learn and do this. An important part of our history is provision of emergency services, both through membership of the Flying Doctor 4

6 Society of East Africa, and by ensuring that those in need of evacuation, whatever their circumstances, have access to the service. I appreciate the extraordinary work that the FDES does, and the high quality of its service, which has earned it accreditation by the European Aeromedical Institute, the first non-european, non-us air rescue provider to receive such recognition. As we reflect on the year past, we must also contemplate the lessons learnt from the post-election conflict and violence that swept through Kenya early this year. AMREF was immediately involved in the work to support victims of that violence, but it became quickly apparent that, once again, our skills and experience were suited not so much to providing immediate emergency health relief, but for ensuring that families and communities were able to access the health care they needed despite damage to the health system. Our mobile health clinics took care of children, men and women suffering from the physical and emotional consequences of ethnic- and gender-based violence. What we did in Kenya reflects the way AMREF has worked in the past in Southern Sudan and builds on the work we do in other countries in similar situations. But above all, it demonstrates that no matter how fragile or battered a health system, creating community mechanisms for health is fundamental to rebuilding and strengthening that system. Dr Michael Smalley Director General, AMREF 5

7 Morocco Algeria Tunisia Western Sahara Libya Egypt Mauritania Mali The Guinea Bissau Guinea Liberia Cote D voire Burkina Faso Togo Benin Niger Cameroon Chad Central African Republic Dijbouti Equatorial Guinea Gabon Congo Democratic Republic of Congo Zanzibar Angola Lesotho Swaziland AMREF Programmes Countries where AMREF provides technical assistance Training Programme Reach 6

8 ABOUT AMREF Ensuring Better Health for Africa To date AMREF has trained over 500,000 health workers and reaches nearly 60 million people in Africa annually. Fifty years after inception, the African Medical and Research Foundation (AMREF) launched its strategy, Putting African Communities First At the heart of the strategy was an acknowledgement of some stark realities for Africa and for AMREF. These were a recognition that in spite of the huge investments in aid and development, Africa s key health indicators are worse now than they were 20 years ago; that unless a radically different approach to the health challenges is pursued, recognising the central role of the communities, governments and civil society, the huge efforts to improve health will not bear fruit; and that with only 3 per cent of the global health workforce, despite bearing 25 per cent of the world s diseases, Africa must innovate and find non-traditional ways to tackle the health challenges of the people. The health workforce is undoubtedly a driver of health. Founded by three surgeons, Sir Michael Wood, Dr Thomas Rees and Sir Archibald McIndoe as the Flying Doctor Service of East Africa in 1957, AMREF is an international African non-governmental organisation headquartered in Nairobi. When we started we used planes to take health care to people who could not access it in remote parts of East Africa. Today, our mission is much the same, 7

9 taking health care to those who cannot access it, but our mandate has evolved over time to cover all of sub-saharan Africa. AMREF continues to play a leading role in the continent s health development. We continue to innovate and find solutions that can be rolled out to partners and governments for maximum impact with limited resources. Our projects are implemented through country programmes in Ethiopia, Kenya, South Africa, Southern Sudan, Tanzania and Uganda. We also provide training and consulting support to an additional 35 African countries. Based on our belief that health is a basic human right, AMREF seeks to empower communities to take control of their health and to establish a vibrant and participatory health care system made up of communities, health workers and government. By focusing on the people that need better health care rather than diseases, AMREF wants to ensure that the communities it works with are not just recipients of health services but participants in the system and that they have a voice in determining their health priorities and the quality of the health care that they receive. Health must start from the homes and villages across Africa for any success to be achieved and the gains to be entrenched. A major determinant of success of health promotion and health care services is in AMREF s view, in pursuit of a bottom-up approach: from the families in our communities to the tertiary hospitals and the other arms of the health system. Through training, AMREF builds not only the capacities of health professionals and government health structures and institutions, but also focuses on ensuring that community members and grassroots institutions are also able to tackle the most basic health situations they face daily. This is a giant step towards closing the gap between communities and the rest of the health system. Ultimately, knowledge is at the core of AMREF s activities. AMREF implements projects to learn so that we can share this evidence-based knowledge with others and use it to advocate for changes in health policy and practice. We believe that Africa has the solutions to its health problems. AMREF believes in Africa and in the continent s potential to heal itself. 8

10 AMREF IN ETHIOPIA Background AMREF s programme in Ethiopia was established in 2002 and is currently working in four regions Addis Ababa, Afar, Oromiya and the Southern Nations, Nationalities, and Peoples Region. In addition, there are two projects that have been implemented at national level. Currently, AMREF in Ethiopia has 111 staff and runs 17 projects across the country. Achievements In the year 2008, AMREF in Ethiopia directly reached more than 122,000 beneficiaries (and over 1.5 million indirectly), including 50,000 mothers, and 60,000 children and youth. A total of 449 mother coordinators, over 500 homebased care givers as well as community leaders, and youth in and out of school were involved in educating community members on reproductive health and gender rights, including the elimination of female genital cutting. (FGC). Religious and community leaders established discussion forums on health issues with formal health providers to improve provision of services. Demand by communities for health posts, health personnel; and water points increased significantly. A total of 3,600 health professionals, community midwifes and health promoters were trained. The capacity of health facilities was strengthened through the provision of drugs, equipment and supplies, as well as construction and equipping of referral hospitals, health centres and health posts. Community capacity was built through training on water management, income generation activities, vocational training, malaria prevention, prevention of HIV, and care and support for people living with the virus. Training was held for staff and partners on operations research, and monitoring and evaluation. Project-related research products were produced and disseminated to partners and stakeholders, including one on health service delivery and qualitative data gathering on female genital cutting. Highlights 2008 Received a new country director, Dr João Soares Discussions were held with government officials, including President Meles Zenawi. AMREF in Ethiopia successfully hosted the international AMREF Board meeting Received new grants from European Union in partnership with AMREF in UK, AMREF in Spain and AMREF in Canada totalling over Euro 2 million to improve the health of pastoralist communities in Afar and South Omo regions Challenges 2008 Skyrocketing cost of living; inflation up to 50 per cent, high cost of construction materials for building health infrastructure Drought, ethnic conflict and epidemics such as acute water diarrhoea Frequent structural and policy changes by the government which may affect project implementation Programme Growth In 2008, there was a new impetus in the programme as the AMREF offices in Ethiopia continued to build on contacts with potential donors through AMREF s National Offices, other organisations working in the country and the government. The Programme s budget increased from US$3.9million in 2007 to US$5.3 million in

11 FLYING DOCTOR EMERGENCY SERVICE Delivering Health Care on Wings Since the founding of AMREF in 1957, AMREF s Flying Doctor Emergency Service (FDES) has been involved in air rescue and evacuation of patients from remote areas to hospitals, mostly in East Africa, but increasingly in Ethiopia, Eritrea, Rwanda, Burundi, Somalia, Democratic Republic of Congo and other African countries. AMREF FDES has now extended its activities to international evacuation and has forged a partnership with Phoenix Aviation, a charter company that owns three Beechcraft King Air aircraft and three Cessna Citation Bravo jets, all fitted with modern stretcher systems. This allows the repatriation of patients to South Africa, Europe, Asia, the Middle East and beyond by private air ambulance using jet aircraft. FDES also provides medical escort on commercial carriers worldwide. Members of the Flying Doctors Society of Africa (FDSA) receive air ambulance service and medical advice. The service employs an emergency physician and eight flight nurses on full-time basis, while others are engaged on an on-call basis to ensure the services are available for 24 hours. The airborne service is supported by AMREF s aviation unit, which has a hangar at Wilson Airport in Nairobi and owns and operates a fleet of aircraft flown by three full-time pilots. The service s 24-hour Emergency Control Centre at Wilson Airport Nairobi responds to emergency calls and is able to organise evacuation flights to the most remote areas where medical care is insufficient or unavailable. This vital service is also provided free of charge to people who cannot afford to pay. Medical equipment on board the aircraft ranges from trauma to intensive care facilities, and even premature neonates can be carried safely in an on-board incubator. Apart from the air ambulance and emergency services, FDES provides ground assistance to international insurance and assistance companies, using local knowledge and expertise. With the 2007 EURAMI (European Aeromedical Institute) audit that awarded FDES the highest level certification for an Air Ambulance organisation, FDES became the first air ambulance service to be officially accredited on the continent. Its reputation has expanded beyond the Africa region and its professionalism enjoys worldwide recognition, particularly for the service s ability to operate under difficult circumstances at high standards. Activities in 2008 AMREF FDES s air and ground ambulances evacuated 593 patients in 2008, flying a total of 924,051 miles a 60 per cent increase on the previous year s 363,684 miles. The evacuations ranged from 118 cases of accident-related trauma, 73 of cardiovascular cases and 59 of infectious diseases, to 59 cases of gastrointestinal incidents, 16 gynaecology cases, and 11 arising from animal attacks. In addition, using the three jet aircraft, AMREF FDES provided 91 long-distance evacuation flights to destinations including South Africa, Europe and the Middle 10

12 East, a 43 per cent increase on the previous year. With two leading European air ambulance providers, AMREF FDES has promoted the concept of wing-to-wing evacuations where an air ambulance flight is provided by two aircraft meeting at a mutually arranged spot to transfer the patient to the other carrier, in order to save time and costs. Seventeen such flights were carried out during the year. AMREF provided seven international medical escorts on commercial flights to Europe, West Africa and the USA. Other services provided by FDES during this year included: 23 free evacuations Medical coverage during events with high-risk involvement for participants and the public, including the Safaricom Marathon in Lewa Downs Conservancy Three-day course in Emergency First Aid First Aid Training to guides in the Maasai Mara Game Reserve Medical and logistics assistance to international insurance and assistance organisations, based on Service Provider Agreements, increased by a total of 67 such agreements during the year. The programme also assesses medical facilities on request and advises insurance companies when evacuation is necessary based on a service provider agreement. In addition, 112 Registration Agreements were signed between AMREF FDES and NGOs, para-statals, insurances and corporate companies for the provision of emergency and other related services. AMREF FDES provides medical advice for health and other facilities in remote areas, who can contact AMREF s emergency control centre 24 hours a day for advice and assistance at no fee. Nationalities of patients evacuated in 2008: During the year, nine doctors from Germany, Australia, Italy, Ireland and the UK took part in the Volunteer Physician Programme, which was started in 1997 to enable emergency physicians from all over the world to work with FDES on a voluntary basis. In the process AMREF s aero-medical staff is updated on developments in emergency care, exchanging experiences and skills with international experts. A brand new Cessna Caravan C-208B arrived in November 2007 and will support the outreach programme. The Visitors Centre at the FDES offices received several groups, including schools and local organisations, as well as international representatives and other individuals. A tour of the museum, control centre, aviation gallery and viewing of a 15 minute film gave visitors detailed information on the Flying Doctor s 50 year history. Project Duration: Continuous since 1957 Funding: - Income generation through service delivery - Direct cost recovery - Cost recovery from FDSA Member flights - Grant from AMREF in Italy for charity evacuations - Grant from FDSA for charity evacuations - AMREF in Canada for the Visitors Centre Kenyan British American German French Tanzanian Israeli Danish Swiss Somali Canadian Spanish Austalian Ugandan Irish Austrian Congolese Zimbabwean Sudanese Norwegian Ethopian Others 11

13 AMREF IN KENYA Background AMREF has been working in Kenya since Its programmes, which cover over 100 districts in the country, address diverse health needs including HIV/AIDS, maternal, adolescent and child health, water, sanitation, hygiene and clinical outreach surgical services. Highlights and Challenges 2008 Kenya is still trying to heal from the effects of the post-election crisis that saw more than 1,000 people killed and 300,000 displaced at the beginning of the year. AMREF moved quickly to avert disease in camps for internally displaced people, providing water and sanitation, hygiene and diagnostic services. AMREF responded to a silent emergency affecting hundreds of people who were unable to access health care for fear of leaving their homes. With generous donor support, it set up mobile clinics for people in Kibera and Dagoretti informal settlements throughout the year. The Kenyan Health Ministry was split into two in the new government Medical Services and Public Health and Sanitation posing a challenge to AMREF s working relations with the two as they defined their roles at national and district level. AMREF hosted the Pan African Conference on Safe Delivery of Anaesthesia funded by Smile Train USA and attended by 340 anaesthetists, anaestheologists, surgeons, nurses and health managers from 20 African countries. Goodwill ambassador Robert Greene, goalkeeper for English Premier League team Westham, played a major role in championing peace through Football for Peace tournaments in Dagoretti and Kibera. Six UK MPs and a team from Sight Savers visited the Maanisha HIV and AIDS Programme in Kisumu, Nyanza Province, and the National Integrated Trachoma Control Programme in Samburu in the Rift Valley Province. The Dutch Minister for Development Bert Koenders visited AMREF medical camps in Kibera following the post-election crisis. Programme Expansion The country s annual programme budget increased from US$13 million in 2007 to US$16 million in With funding from Danida, the Outreach programme expanded to cover Safe Motherhood and fistula repair in Kenya, Tanzania and Uganda. The reconstructive surgery project, supported by Smile Train USA, grew to cover 43 hospitals in Kenya, Tanzania, Uganda, Ethiopia, Southern Sudan, Somaliland and Rwanda The Laboratory Services department developed several publications, including a Clinicians Guide to Quality Outpatient Diagnosis, Collection, Storage and Transport of Specimens, and a series of reference documents for the ministries in charge of Health. The Maanisha HIV and AIDS Programme, funded by DFID and Sida, expanded from the original 20 districts in Nyanza and Western provinces to 82 across the country. The programme was presented as a case study at the International AIDS Society Conference in Mexico to illustrate how strengthening civil society organisations could be improved for effective HIV interventions, and at the International Conference on AIDS and STIs in Senegal to demonstrate aid effectiveness at the community level. The Turkana Integrated Project in northern Kenya was scaled up, supported by the EU and the Big Lottery, UK. The model aims at testing the government s Community Health Worker Strategy in a nomadic setting. 12

14 AMREF IN SOUTH AFRICA Background AMREF started work in South Africa in the early 1990s. The establishment of the country office coincided with the election of the first democratic government. In 1995, AMREF was registered as a Not-For-Profit Organisation. At the time, many exiles who had moved to East Africa were returning at the time and health services were being transformed to a primary health care model, promoting health at the household level from a hospital-centred system. Since then, AMREF has been working to promote the development of an efficient, integrated health care system based on the principles of gender equity and community participation in Eastern Cape, KwaZulu Natal, Limpopo and Mpumalanga. Our work in South Africa includes: Improving the quality of services such as medical, psycho-social and education offered to Orphans and Vulnerable Children in Limpopo and KwaZulu Natal Provinces Research into strengthening voluntary counselling and testing services for AIDS and TB patients, and promoting the integration of HIV and TB services Building the capacity of traditional healers to respond to the challenge of HIV, AIDS and other sexually transmitted illnesses and closing the gap between the informal and formal health care services in KwaZulu Natal Improving governance and management of community-based organisations through training and mentoring in Limpopo and KwaZulu-Natal Improving the health of communities by boosting sanitation in schools in Eastern Cape Empowering communities to protect women s rights and reducing the vulnerability of women and girls to gender-based violence and HIV in Jozini, Umkhanyakude District Improving Child Survival among children under five years in Sekhukhune District, Limpopo Province Highlights 2008 US$294,867was secured for a project that uses a new strategic approach as a standard for improving child survival. AMREF in South Africa was identified as a key development partner by the National Department of Health to support the government in determining which projects should be rolled out to the 18 Priority Districts Project. AMREF was the only NGO that took part in the formation of the National Department of Health and Social Development policy on the Community Care Givers Policy Framework. AMREF s programme for Orphans and Vulnerable Children showcased its database system at an annual USAID partner meeting. USAID Manager Anita Simpson recommended that it be shared with the National Department of Social Development as good practice in Monitoring and Evaluation (M&E). AMREF presented the Community-Based Organisation Training and Mentoring Project and the VCT-TB programme at the Public Health Association of South Africa Conference in Cape Town and the first ever TB Conference in Durban. Programme Expansion The country s annual programme budget increased from US$4,106,440 in 2007 to US$4,462,000 in

15 AMREF IN SOUTHERN SUDAN Background Following the end of the civil war in Sudan, the signing of the Comprehensive Peace Agreement (CPA), between the Government and the Sudan People s Liberation Movement in January 2005 marked the shaping of a new political landscape that created favourable conditions for re-building all sectors. It led to the formation of the Government of National Unity (GoNU) and the Government of Southern Sudan (GoSS), which have formulated clear policies addressing international agreements, especially on health care. The main thrust is to strengthen decentralised governance, and to empower communities and civil society organisations with a special focus on the disadvantaged. AMREF has run a Primary Health Care project in the country since the 1970s. Since 2005, AMREF has had a significant engagement with MOH-GOSS in developing health systems, shaping policy and strategic decisions for human resources for health. It has also established links in training, and integrated primary health care, and water and sanitation activities in Terekeka County. Achievements Phase 1 of the development of health training systems was concluded, including the drawing up of a Human Resource Policy and Strategic Plan. AMREF has since 1998 trained Clinical Officers at the Maridi National Health Training Institute. It also runs midwifery training schools in Lui and Yei. The Health ministry requested AMREF to run an additional school to train Public Health Technicians in Juba. AMREF works at both facility and community level improving communities health care access. The programme uses the community as an entry point, working closely with management boards, county/payam health department committees, community-based organisations (CBOs) and nongovernmental organisations (NGOs). AMREF has built the capacity of partner CBOs and NGOs to enable them to be an active part of the health system. Highlights 2008 Opening of a new training school Juba National Health Training Institute which AMREF is running on behalf of the Government. The first batch of 21 students was enrolled in October, while 36 community midwives graduated in June Construction or repair of 90 per cent of targetted primary health care facilities Completion of water infrastructure development in Tali, funded by the UK s Development Fund for International Development The drilling of 18 boreholes in Tindilo Payam of Terekeka County Conclusion of the MTDF-funded project in development of health training systems Appointment of a new Country Director, Dr John Mwesigwa, who was previously with the Regional AIDS Training Network Challenges 2008 Shortage of.skilled health workers, including mid-wifery tutors and lack of a college principal in Lui Heavy rains delayed the implementation of the Tali project since most of the sites were cut off by floods for more than three months Programme Growth The budget was US$5,203,164. The Southern Sudan programme expanded through the establishment of the Juba Training Institute. 14

16 AMREF IN TANZANIA Background The Tanzania Country office is 21 years old since it was established as an autonomous programme in 1987, having been run from the headquarters in Nairobi, Kenya since AMREF s engagement in health in Tanzania has been remarkable, growing from mere service provision to a platform for empowering communities and supporting the government in addressing health needs. Programme. It received approval for continual funding for Phase 2 of Global Fund Round 4. To meet specific technical needs, AMREF in Tanzania created technical leadership positions for water and sanitation, as well as maternal, newborn and child health, and reproductive health. AMREF took part in the International AIDS Conference in Mexico and the International Conference on AIDS and STIs in Africa in Dakar, Senegal. In 2008, AMREF had 30 projects, a few of which are now complete, while others are only starting. The projects are divided into three broad categories: Regional interventions run concurrently with other AMREF Country programmes, such as the Nomadic Youth Reproductive Health, and Water and Sanitation projects. National projects are implemented countrywide, either through direct AMREF engagement with the Ministry of Health and regional authorities, or through partners such as the Global Fund Project, Laboratory Strengthening Project, ANGAZA VCT and obstetric fistula repair. Local interventions take place in a defined administrative area with the aim of developing models and advocating scaling up. These include projects like Mema Kwa Vijana (MkV), Prevention of Mother-to-Child Transmission of HIV and Jijenge. Highlights and Challenges The organisation won another USAID grant for a testing and counselling programme known as Angaza Zaidi as a follow-on for the previous Angaza Blanche Pitt was named Country Director, moving from the South Africa office. The country programme achieved a 92 per cent performance rating despite project implementation delays, with satisfactory audit reports for MkV projects and Global Fund Round 3. The programme faced unique challenges in partnership relations, particularly in sub-granting due to critical delays of accountability by subgrantees. Programme Growth Four projects MkV, Angaza, Home-based Care and Post-Test Club Strengthening - were completed. The budget in 2008 was US$17,099,

17 AMREF IN UGANDA Background AMREF has been working in Uganda since the mid-1980s with projects in more than 100 urban and rural communities in 10 districts. Its work involves promoting and improving access to health care and water and sanitation for groups that are vulnerable to disease. AMREF s approach has been to implement new approaches to improve community health, build the capacity of health workers and community volunteers, and engage in evidence-based advocacy to influence policy. Highlights and Challenges 2008 When Hepatitis E broke out in northern Uganda, AMREF s system of community-based approaches came in very handy. Village health teams, equipped with knowledge and skills for promoting sanitation and hygiene, used simple communication tools to teach the community about hygiene. No new cases of the disease have been reported in areas in which AMREF intervened. Also, when floods hit Soroti District in mid-2007, AMREF collaborated with other partners on the ground to provide health care, water and sanitation sevices. AMREF supplied emergency drug kits and long-lasting insecticide treated nets for five distircts in north-eastern Uganda. President Yoweri Museveni visited the Kabale Youth Empowerment Project in September, while Prince Charles of Wales toured the Kawempe Community Health Development Project( aka the Sex Workers Project ) in Kampala. The Oscar-nominated movie War/Dance premiered at a function officiated by Education Minister Namirembe Bitamazire. The Health Minister, Dr Stephen Malinga, led celebrations to mark the first anniversary of the Malaria, AIDS and TB integrated project funded by Astra Zeneca, UK, in December. The Canadian Secretary of State for Foreign Affairs, Helena Guergis, visited the Kawempe Water and Sanitation Project. Achievements AMREF is piloting a ground breaking model of promoting an intergrated approach to managing Malaria, TB and HIV/AIDS, the country s three main killer diseases (at both community and health facility level). On request from the Ministry of Health (MOH), AMREF led the secretariat during the Joint Review Mission of the Health Sector, and was key in producing a Position Paper. AMREF was for the third time re-elected as chair of the International NGOs HIV/AIDS Forum, a self co-ordinating entity under the Uganda AIDS Commission, aimed at facilitating a well-coordinated response to the pandemic. AMREF is engaged with the MOH in developing a strategic leadership proposal, looking at long term development of human resources for health. Minister of Health Stephen Malinga commended AMREF s approach in empowering communities living in IDP camps in northern Uganda to construct their own latrines during the Hepatitis E outbreak. Through its work in the Laboratory Services Strengthening Programme, AMREF contributed to an increase in the average national laboratory use by clinicians from 27.5 per cent to 32.1 per cent. AMREF enhanced the capacity of Nakasongola district to roll out the new antimalarial policy on using Coartem. AMREF in conjuction with the MOH developed a manual for CHWs carrying out vaccination in a post-conflict zone. AMREF s work with urban commercial sex workers has helped to reduce the social stigma associated with them. This model for empowering young vulnerable women, and a similar one empowering young people in Kabala were endorsed by President Yoweri Museveni. In October, AMREF contributed to the global WHO debate in Geneva on community health workers and their relevance to health development. Programme Growth Funding for the 2008/9 financial year was US$9,245,

18 AMREF Headquarters Directorate of Capacity Building Training for human resources for health is at the core of AMREF s operations, and has been since 1962, when the organisation began teaching people in villages to talk to their neighbours about health. What was then known as the Training Department has today grown into a vibrant Directorate of Capacity Building, which trains thousands of health workers in close to 40 African countries and beyond. By equipping health workers at all levels right from community health workers and community midwives to nurses, doctors and managers of health institutions, AMREF aims to strengthen the capacity and capability of health and health-related professionals and institutions in Africa to provide quality health care and services across the continent. Health services cannot function well without sufficient numbers of skilled, motivated and supported health workers. Yet Africa has an acute shortage of doctors, nurses, midwives to name just a few cadres, and needs one million more health workers in order to ensure that health care reaches all communities and that Africa meets the Millennium Development Goals for health. In a continent with limited resources and an enormous health burden, the Directorate of Capacity Building uses innovative ways to help bridge Africa s health worker crisis. AMREF s training takes place in communities, health centres and hospitals in six African countries, as well as in AMREF s International Training Centre in Nairobi and satellite training centres in Tanzania, Uganda, Ghana and South Africa. Highlights 2008 The Directorate has developed several tools. These include tools for assessing the capacity of communities, community-based and non-governmental organisations and government institutions; assessing training needs of community health workers; monitoring and evaluation (M&E) of AMREF s training programme; guidelines for course facilitators; and a comprehensive curriculum for training community health workers in Africa. The Directorate is the lead agency for the Africa Health Leadership and Management Network and a key player in the Global Health Workforce Alliance and its Africa platform. The Directorate of Capacity Building is organised around four main areas: Continuing Professional Development, Basic and Post-Basic Training, e-learning and the Resource Centre. Continuing Professional Development In this area a total of 803 participants from 28 countries were trained in 2007/2008 in 19 different short courses, compared with 835 the previous year. The countries represented included: Zambia, Uganda, Tanzania, Zanzibar, Swaziland, Southern Sudan, South Africa, Somalia, Sierra Leone, 17

19 Nigeria, Namibia, Rwanda, Malawi, Liberia, Kenya, Ghana, Equatorial Guinea, Ethiopia, Eritrea, DRC Congo, Chad, Cameroon, Burkina Faso, Botswana, Belgium, Pakistan, the United Kingdom and the USA. The slight drop in enrolment is attributable to the post-election violence experienced in Kenya at the beginning of Three new courses were introduced: Trauma Counselling and Management; Strategic Management; and Practical Project Management; the four-week M&E course was converted into elearning mode, and several tailor-made courses were conducted during the year. AMREF has established strategic collaboration for training in several areas, including: The six-month Advanced Health Care Management Programme implemented jointly with Strathmore University s Business School, which has had three intakes with a total of 43 participants since inception in October The UCLA/AMREF/Johnson&Johnson Management Development Programme, which attracted 106 participants from 14 African countries in The one-week programme for senior managers of African HIV/AIDS organisations started in 2006 and is held twice a year at AMREF International Training Centre, and once a year at Ghana Institute of Management and Public Administration. E-learning Support Programme Insecurity caused by the post election violence in Kenya adversely affected coordination and technical support for the elearning programme in the first three months of The elearning Support Programmme, supported by Accenture, to upgrade community health nurses has so far enrolled 5,144 students. A total of 590 nurses have qualified. There are 105 Regional Training Centres established in 29 nursing schools across the country. AMREF and Accenture have also developed a replication strategy that can be used to deploy elearning across Africa. A short-term elearning course on AMREF AT A GLANCE infection control has been developed jointly with Centres for Disease Control (CDC), Nairobi. AMREF IMPACT & FIGURES To develop guiding principles on how to implement an elearning model, AMREF set up a Virtual Nursing School to research and test e-learning practices as a method for up-skilling nurses, and to a larger extent the health workforce in Kenya and Africa. Basic and Post-Basic Training Diploma in Community Health course, accredited to Moi University in Kenya, graduated 25 students in The students were from Kenya, Uganda, Tanzania, Zanzibar, Sierra Leone, Somalia, Southern Sudan, Cameroon, Ethiopia and Rwanda. The course has been converted into elearning mode, and is being taken by the first group of seven students. The two-year Masters in Public Health course accredited to Moi University started on January The first group of 27 students have completed the first academic year. AMREF Resource Centre The Resource Centre at AMREF Headquarters assisted the Maridi National Health Training Institute to improve information management and dissemination. Books and journals worth US$30,000 were sent to Maridi which also acquired 18 new computers. The Resource Centre was involved in the development of AMREF s Corporate Intranet and Corporate Knowledge Management Strategy. AMREF hosted the second Meeting of the Eastern and Southern Africa Network of HIV/AIDS Knowledge Hubs through Health Focus to develop regional centres of excellence in HIV/AIDS training, research and technical assistance. Sponsored by GTZ, the meeting was attended by 11 members from Kenya, Uganda, Sudan, and South Africa. The monthly e-bulletin on HIV/AIDS treatment attracted 2,900 subscribers from 35 countries in Africa. In addition, the Hub s walk-in access service received 64 new titles on HIV/AIDS. 18 AMREF was founded by three surgeons, Sir Michael Wood, Dr Thomas Rees and Sir Archibald McIndoe as the Flying Doctor Service of East Africa in 1957 War/Dance a documentary following the lives of three children from AMREF s project in Gulu, Northern Uganda won a Sundance Film Festival Award and was nominated for an Academy Award Oscar. AMREF Flying Doctor Emergency Service s air and ground ambulances evacuate 600 patients every year. In 2008, FDES flew a total of 924,051 miles and conducted 23 free evacuations.

20 SOUTH AFRICA Who to turn to for help? Nipping crime in the bud A compact crowd of 900 students mills around a large, fruit-laden amarula tree, all striving to hide under its wide branches from the blazing summer sun, while paying keen attention to the tall policeman who is addressing them. There is a lot of liquor being brewed in your homes this amarula season, but while you are still in school, you should concentrate on your studies and avoid drinking, Insp Mkhanyiseni Laurence Mngomezulu advises the students of Nkulisweni Primary and Hhoye Secondary Schools. Drunkenness leads people to commit violent crimes like rape and assault. Insp Mkhanyiseni is a member of South Africa Police Service s Social Crime Prevention Unit in Jozini Municipality, KwaZulu Natal. Every day, he visits communities around Ingwavuma area, among them 155 schools, where he speaks about preventing crime, including gender-based violence, and encourages people to report incidents of harassment and assault. Since we began talking about gender-based violence, there is a lot of awareness in the community. People were reluctant to report that they had been raped because they were afraid they would somehow be blamed for it. We get a lot of reports at the police station now. Wives come to us for help when they are being abused, students report incidents of harassment, and even battered men are opening up because they know that we will help them. We protect the victims and charge the culprits. This is serving as a big deterrent to others. 19

21 Let s stand up and take action against Gender-Based Violence MASISUKUME Project Jozini Municipality in KwaZulu Natal s Umkhanyakhude District experienced an exceptionally high level of violence against women and children in the 1990s. Not knowing who to turn to for help, they suffered in silence, accepting the abuse and violation as their fate. Gender-based violence (GBV) happens mostly in the family setting. In Jozini, women and children were habitually abused, physically and emotionally; children, including infants, were raped in their homes and at school; and when robbers broke into homes to steal, they also raped the girls and women. Besides the physical injuries, many of the victims were infected with sexually transmitted illnesses and HIV. Alarmed by the frequency and verocity of the attacks, Mayor Thembeni Madlopha-Mthethwa turned to AMREF for help, leading to the establishment of the Gender-Based Violence Project in With a focus on women and children, the project addresses a gap in the health system by building the capacity of the community and service providers to prevent gender-based violence and its associated health risks, as well as to protect and support victims. It empowers the community with knowledge of their rights and avenues for protection and redress, and builds effective linkages for referrals from the community to the service providers, including the police, social services, the judiciary and health care providers. An initial survey revealed that most people in Jozini were not aware of their rights or of laws protecting them against abuse. Many were not even aware of the concept of gender-based violence, and those who did had nowhere to turn as relevant services such as police and social service departments did not have the capacity to help. To create awareness in the community about GBV, its linkage with HIV, human and children s rights, and to establish channels for victims to seek help, AMREF worked with the municipality to revive and restructure Community Policing Forums to detect and alert the police to cases of abuse. Training was held for traditional leaders and their wives so that they could in turn inform their constituents. Also targeted were men as the main perpetrators of gender-based violence; teachers and youth advocates who could reach out to young people in AMREF IMPACT & FIGURES and out of school; for counsellors, judicial officials, health and social workers, and various non-governmental organisations to close gaps and create linkages in provision of services; and officers of the South Africa Police Service on rights and laws relating to gender-based and domestic violence, and effective support of victims, including trauma counselling and referrals. Mayor Madlopha-Mthethwa is pleased with the progress thus far. Whereas people used to cover-up, GBV issues are being discussed more openly in the community. Before people used to cover up domestic violence, but now they are starting to open up about themselves and others. The number of rapes reported is rising, and even men, who have been socialised not to show weakness, are increasingly reporting domestic abuse. Police respond quickly when they are Policing Forums to detect & alert the police to cases of abuse called, and people are confident of getting help. An unexpected outcome of the project is the discovery, during the traditional testing for virginity, of sexual abuse of young girls that may otherwise have remained unknown, but which is now being reported, the culprits punished and the girls counselled and protected. Tribal leaders too take cases of domestic violence seriously, referring those they cannot handle to the nearest court. Facts Project Duration: youth advocates trained, reaching a total of 2,400 youth in and out of school 15 police officers trained, reaching 5,000 people in traditional leaders and 23 wives trained, reaching 16,800 in 2008 Every year AMREF s work in maternal and sexual reproductive health impacts over 11 million women aged between 15 and 49 in Africa In 2008, nearly 1,000 women received Vesico Vaginal Fistula - VVF - repairs and were restored back to social life after many years through the AMREF Surgical Outreach programme. Fistula is a condition caused by prolonged labour that inflicts a dreadful internal injury on mothers, lleaving them incontinent and soaked in urine. It affects an additional 10,000 women in sub-saharan Africa every year. 20

22 Secure behind the law My boyfriend had been giving me a lot of problems. He kept taking things from our house and giving them to his relatives. When I complained he would beat me. He would also beat me when I asked for money to buy food for the children. Eventually I ran away but he kept stalking me. I felt very unsafe, so I decided to go to the police station. I had heard the police on the radio telling people that they must report abuse. I knew I could go there for help. My boyfriend has apologised for his behaviour and now things are quiet at home. The police and the counsellor have visited me to find out how I am. I feel safer now because the issue is no longer mine alone the police and the magistrate are behind me. Thulisiwe Jobe, 31 When I went to the station, they were very kind. The police have a crisis centre at the station, and they took me there so that I could talk to a counsellor. Then I was taken to the magistrate. He gave me a protection order and gave a copy to the police. They took it to my boyfriend. After two months, my boyfriend and I were summoned to the court. The magistrate gave him a strong warning not to insult me or beat me again. Donors: Department for International Development, UK 21

23 ETHIOPIA Building Health Systems A kind cut Garbed in theatre green, Dr Teshome Kassaye stands over a sink at the Awash Health Centre scrubbing up for a Caesarean section operation on a mother whose baby is lying in breech position. Soon he disappears into the theatre, where a nurse and anaesthetist are fussing over the patient. Fifteen minutes later, a lusty cry announces the arrival of a baby girl. As the nurse cleans up and weighs the baby, Dr Teshome stitches up the sleeping mother, then trades his greens for a white coat and gloves and goes into the delivery room next door to assist a midwife attending to a normal birth. In the two months he has been here, Dr Teshome, an obstetric gynaecologist employed by AMREF, has performed six Caesarian sections. Before that, residents of Awash District were forced to travel by public transport to Nazareth, 120km away, for such operations and other surgical emergencies. Besides Dr Teshome, the health centre s maternal and child health clinic has five nurses and three midwives. While about 100 women come for ante-natal check-up, only about 10 ever gave birth here every month, most preferring to have their babies at home. In the past two months, though, the numbers have doubled and are increasing. It is important that we get more women coming. Female genital cutting is widely practised here - most girls have their labia minora, labia majora and clitoris cut off when they are barely two weeks old, and then the whole area is sewed up, leaving only a tiny hole for urine. When she gets married, the opening is cut a little to widen it for sex, and then in labour, it is cut open with her husband s hunting knife for the baby to pass, putting her at great risk of bleeding to death or infection. Through community education, we are encouraging the women to come here for delivery so that we can give them proper care. 22

24 Afar Pastoralist Youth Reproductive Health Project Since 2007, AMREF has been implementing a four-year project in Ethiopia s mostly arid Afar Region to support the regional government s efforts in providing health care for its 1.6 million people. With a special focus on reproductive health, the project intends to reduce the incidence of HIV, sexually transmitted diseases and unwanted pregnancies; contribute to the reduction of female genital cutting among girls; and to reduce the deaths of mothers and children. It is an ambitious undertaking, considering that this is a hardship area, a large proportion of the people in Afar is always on the move, and there are only three hospitals and 32 health centres in the region s entire 96,707 square kilometres. One of the ways in which AMREF is helping to build the health system s capacity is through training of health workers, in line with the government s health development plan. So far, 148 health extension workers have been trained in partnership with the Abala Vocational Training centre and Tigray Region Health Bureau. So successful has the programme been that the government has asked for another 404 to be trained, which will provide the region with the full number of health extension workers needed to take health services into the community. Their duties include community education and referrals to health centres, and they work both with static populations and the pastoralists. Training has also been held to improve the skills of doctors, nurses and district health officials. AMREF has further facilitated the employment of two gynaecologists in Dupti and Awash, the only such professionals in the entire region. A Reproductive Health Journal is produced every quarter, identifying problems, solutions, trends and new developments. The information is shared with stakeholders, including government and non-governmental organisations. AMREF has also procured drug and supplies for the entire region, including items like painkillers, antibiotics, antihistamines and bandages, which it will continue to provide for the duration of the project. The project s focus is youth and women of reproductive age, with emphasis on prevention of HIV and sexually transmitted illnesses, family planning, and maternal and child health. Another major concern in the region is female genital cutting, a deeply-rooted cultural practice that results in the deaths and infection of hundreds of girls and women every year especially as a result of complications at childbirth. The regional government has taken a lead in tackling the issue, in collaboration with the Regional Supreme Council, the Department of Women Affairs and non-governmental organisations. AMREF facilitates the airing of radio programmes in local Afari languages educating the public on the dangers of circumcising girls. Building health systems capacity through training health workers AMREF facilitated discussion and training sessions with traditional circumcisors. Intent on fighting the practice, the regional government has established laws banning it, though it is still done in secret. Nevertheless, the interventions are slowly bearing fruit, as increasing numbers of parents are deciding not to subject their daughters to the rite. Traditional circumcisors too, afraid of prosecution and aware of the danger to which they expose their patients, are beginning to look for alternative ways of making a living. Facts Project Duration: January December health extension workers, 182 traditional birth attendants and 185 health workers trained, reaching 60,000 people Euro 80,000 worth of drugs benefiting 1.6 million people Reproductive health services such as anti natal and post natal care, family planning, and others delivered to 60,000 people More than 100,000 people reached through health education AMREF IMPACT & FIGURES 7,775 operations performed by AMREF Specialist, Surgical and Reconstructive Outreach teams. Over 60 per cent of those operated are children. A total of 1, 300 cleft patients were operated on and given a smile in 2008 through the Cleft Surgery Project funded by Smile Train USA. 23

25 Awash with gratitude I live 400km away, in Logia town. My husband is a soldier stationed here in Awash. I decided to come and have my baby here because my relatives told me that the health centre has good facilities and they can even perform operations. I have two other children who were both at home. I did not have them in hospital because there was no need I was younger then, so I was strong enough to push. I had my first baby when I was 13 and the second one when I was 20. But now I am older I want to make sure that my baby and I will be safe, so I want to give birth here in the health centre where there are doctors and nurses who can take care of me. This is my second visit to the health centre. Before I came, I was worried because I did not know what would happen. When I saw many other mothers I relaxed. I have been treated very well. I was counselled and tested for HIV, then they advised me to eat well and not to work too hard. Today, the doctor examined me and checked the baby using a machine. He assured me that the baby is in a good position and that I will have a normal delivery in two weeks time. I am very happy because I know that I will be fine, and my baby too. - Aster Getahun, 30 Donors: Ministry of Foreign Affairs, the Netherlands and AMREF in the Netherlands 24

26 UGANDA Road to self-reliance Eat, drink and be healthy A loud voice sliced through the stillness of the cool morning as Christmas Day 2008 dawned on Abata village in Katine. Today is a big day! I know you have prepared a lot of food for the festivities. But before you begin, I want to remind you do not give the food to your children before you heat it. Even if you are feeling tired or the fire has gone out, you must light it up and warm the food so that they do not get sick. It is your duty to protect the children! While the village slept, Ruth Emolu had woken up early to prepare the messages she was going to broadcast on her megaphone. One of four members of the Village Health Team, Ruth goes about her work with great gusto visiting families to teach them how to keep their homes and bodies clean, use mosquito nets, and ensure the water they fetch from the borehole is kept clean and safe. She encourages pregnant women to go to the health centre for check-up and, using her megaphone, announces visits by mobile immunisation teams from the health centre. When a child falls ill with malaria, Ruth provides treatment in the first crucial 24-hours, and refers those she is unable to help to the health centre. She shows mothers how to prepare oral rehydration salts when their children have diarrhoea. There are 100 homes in my village. We used to lose three or four children to malaria every week, but now those who fall ill in my village do not die from it. Women too used to die at childbirth, but these days the Traditional Birth Attendants refer them to the health centre for delivery. Only the few foolish ones who refuse to go to the health centre end up dying. People are clean and healthy, and our children are going to school. I have seen a great change since AMREF came to work with us, and that is why I will not tire of teaching my people

27 Katine Community Partnership Project In October 2007, AMREF launched a three-year project to kick-start development in the Katine sub-county in Soroti District, North-Eastern Uganda, which was struggling to get on its feet after its residents were dislocated for four years due to civil war. Supported by Barclays and the Guardian News and Media, this integrated project aims to improve life in Katine by focusing on five areas health, water and sanitation, education, livelihoods, as well as governance and empowerment. The project is implemented in partnership with the Katine community and Soroti District local government. The health component involves working with 272 Village Health Team members to promote health in the community, and provision of drugs and training of health workers to improve services in government facilities. To provide safe water and promote hygiene, AMREF works with subcounty health committees, parish sanitation committees and government technical experts to construct, rehabilitate and maintain boreholes. And in partnership with 13 Parents and Teachers Associations, the project has built 12 new classrooms, is almost completing another five, has renovated 10 others and has built 13 latrine blocks. AMREF is working with 104 teachers to implement child-centred learning to encourage creativity and ensure relevance. The livelihoods component involves collaboration with Farm Africa, which provides technical support for 18 farmer groups formed by AMREF, all working with agricultural extension workers to improve food yields and diversify cash crops. AMREF also works with Uweso, a local non-governmental organisation that is helping the farmers to access banking and credit facilities through 18 Village Savings and Loans Associations. Slowly but surely, under the watchful eye of the public via the Guardian s regular reportage, life in Katine is changing for the better. One year into the project, hundreds of excited pupils are flocking to new classrooms that have replaced crumbling mud structures, reading from new books and using a curriculum designed to meet their needs and interests. At home, mothers are seeing less incidents of malaria, diarrhoea and other childhood illnesses, while the easy availability of safe water from 16 new and rehabilitated boreholes has freed time for women to care for their farms and homes, and for children to go to school. Availability of vaccines at health centres has resulted in improved immunisation coverage; 80 per cent of children under five have been vaccinated, up from 35 per cent. With the introduction of drought-resistant, high-yielding cassava and new cash crops like fruit, farmers are guaranteed food security for their families and an increased source of income. Better education, health, access to water and better incomes, have put the Strengthening community structures people of Katine firmly on the road to self-reliance. By strengthening community structures like Village Health Teams and Parents and Teachers Associations, AMREF ensures that the people are aware of their rights and have the voice to demand them. A weekly local radio talk show provides the people with information, while 15 members of the community have been trained to use the internet and to share what they learn with others. Facts Project Duration: village health team members trained, reaching a total of 25,000 people 2,678 nets distributed to children under five and expectant mothers 13,770 children immunised, 80 per cent of all children under five 12 (five nearing completion) new classrooms built, benefiting 660 pupils 13 boreholes dug or rehabilitated, and five shallow wells dug, reaching 6,500 people 270 parents and 32 teachers trained on local teaching materials development 90 trained teachers in Personal Hygiene and Sanitation Education Sensitisation seminars held for 3,600 people on how to care for and support orphans and other vulnerable children AMREF IMPACT & FIGURES AMREF s work improves the lives of nearly 20 million children every year in sub Saharan Africa. Our work with children focuses on HIV and AIDS, Malaria, Personal Hygiene and Sanitation Education ( PHASE) 26

28 More money, less disease I am a farmer in Abata village. My wife Margaret and I have 12 children. Ruth visits us often and we try to follow all her instructions. When she started coming a year ago, we already had a latrine and a dish rack, but we did not have a pit for the rubbish, so I dug one. We have two mosquito nets for our family. Before, malaria struck almost every week, but now we can go for upto two months without an incident. Even diarrhoea has become rare. My children no longer miss school due to illness. Besides, I have been able to save some money since I do not take them to the health centre as often as I used to. I put that money into my farm, and because I use the farming techniques I learn from Farm Africa, I hope to have higher yields of my cassava, potatoes, sorghum, millet, maize and oranges. I like to listen to AMREF s programme on Delta Radio because it gives me information that will help me and my family. For example, we are told the importance of eating a balanced diet and getting enough rest, and that we should play with our children to strengthen family ties. I know too that when my wife goes to the health centre when she is pregnant or when she has had a baby, she can ask for a mosquito net. Thomas Ecweru Donors: Barclays Bank, Guardian News and Media and readers 27

29 KENYA Spreading Awareness From the mouths of babes Tuesday evening after school at Namasali Primary School near Sio Port Town in Samia District, members of the Child-to-Child group are meeting in one of the classrooms for a practice session. Also in the room are a few teachers and health workers from Sio Port District Hospital. Today, Doreen Ehaba is the teacher. Chalk in hand, Doreen takes the class through a question-and-answer session, alternating between Swahili and English, reframing questions to make them clearer for her students. What causes malaria? Who is at greatest risk of getting malaria? What are the symptoms? What should you do when you notice these symptoms? What drugs are recommended for treating malaria? she asks. Doreen is clearly in her element, relishing her role as a peer educator. I like this role because I am passing very important messages. I talk about the spread and prevention of HIV and malaria. I also discuss facts and myths, because some people believe that malaria is caused by eating mature sugarcane or sitting too long in the sun. I tell them that malaria is transmitted by the anopheles mosquito and symptoms may include high body temperature, diarrhoea and vomiting. It is important to seek treatment if one suspects malaria. A child who cries a lot and refuses to eat should be checked for malaria. I tell my peers that there is no cure for HIV and urge them to keep off activities that could endanger them. I pass the same messages to my parents and other members of my community. The Namasali Child-to-Child club was started in 2007 and has a membership of 55 pupils. Besides peer education, the club members clean up around the school and go out on community outreach to speak about malaria. AMREF designs the messages that they use and provides trainers for the peer educators and their teachers. 28

30 Busia Child Survival Project Kenya s Demographic Health Survey 2003 indicated very high death rates for mothers and children under five in Busia District 680/100,000 and 144/1,000 respectively prompting AMREF and the Busia District Health Management Team to seek ways to improve the health and quality of life for women and children in the district. AMREF considers women s and children s health as key to improving the health of communities. The Busia Child Survival Project aims to reduce infant and maternal mortality and morbidity rates in the district, targeting 50,000 women of reproductive age and 32,000 children aged under five in Butula and Funyula divisions. The project is also in line with the UN s Millennium Development Targets to reduce child and maternal mortality. The project focuses on preventing malaria through use of anti-malarial medication for pregnant women and long-lasting treated mosquito nets by mothers and their children; ensuring that pregnant women attend antenatal clinic and are delivered by skilled professionals; and encouraging women to get tested for HIV so that they can protect their babies from the virus. Proper nutrition for both mothers and infants is emphasised. Spreading awareness on the prevention of HIV & malaria The project uses a community-based strategy to encourage behaviour change, including child-to-child and mother-to-mother communication approaches to share information on matters such as consistent use of insecticide-treated nets to prevent malaria, or the importance of immunisation, ante-natal care and HIV testing. Emphasis is laid on health promotion, and organising health days where community health and health extension workers and the community meet to discuss issues affecting them. To improve services in government health facilities, health workers and the District Health Management Team have been training in Integrated Management of Childhood Illnesses, management and prevention of malaria, obstetric care and newborn care. AMREF has also provided equipment such as chairs, suction machines, delivery couches and mattresses for the postnatal, labour and paediatric wards; lanterns to use when there is no electricity, and a generator to pump water into the main tank so that staff do not have to ferry it by jerry can. As a key partner in the project, the community defines standards of quality for the health centres using the PDQ (Partnership Defined Quality) tool, which brings the staff of the facility and the community together to identify shortfalls and strengths, enabling them to address the various needs and build on the positive. The system ensures that the facilities are run efficiently and that they provide services that are relevant to the needs of the community. The interventions are bearing fruit. At Bumala B Health Centre the number of deliveries has increased from an average eight per month to about 30. The number of pregnant women seeking ante-natal services in the catchment area has risen significantly, and those counselled for PMTCT services from 53 to 83 per cent. Up to 100,000 pupils in 190 primary schools and 1,712 teachers as well as education officers have been trained on malaria control and prevention, helping to reduce the malaria burden in schools and contributing to the development of a school malaria policy. Facts Project Duration: Number of ante-natal clinic visits rose from 32 per cent in 2005 to?? in 2008 Number of PMTCT visits rose from 53 per cent in 2005 to 83 per cent in Deliveries at the health facility rose from 20 per cent in 2005 to 30 per cent in 2008 AMREF IMPACT & FIGURES 100: The number of years the Kenya government would have needed to upgrade the 85 per cent of Kenya s 20,000 nurses from certificate level to registered diploma level. Certificate level nurses are inadequately qualified to treat major diseases, such as HIV, TB and malaria. Five: The number of years it will take for all nurses to be upgraded using AMREF s e - learning model. 29

31 Better safe than sorry This is my first pregnancy. My baby is due later this month. Lilian [the Community Health Worker] visits me at home at least once a month. She has advised me to go to the health centre to ensure that I have a safe delivery, and I have even packed the essential items she told me to buy a razor blade, clothes for the child and string. I want to do everything to make sure that my child will be healthy. We have discussed the dangers of home delivery: the traditional birth attendant may not wear gloves, the environment may not be clean enough, and she might not use a new razor. But at the centre hygiene is observed, and the baby is handled by professionals. The baby will also be immunised and I will receive useful information about how to care for him. I have been to the ante-natal clinic at Bumala B Health Centre six times. They examined me and also checked the baby, and for the first time I took an HIV test. Though we went through group counselling, the results were communicated individually. I am HIV negative. Those who tested positive were counselled further and put on treatment to ensure they do not pass the virus to their babies. I have been taught about the danger malaria can put me or my child in if it is not treated well and on time. I was given a mosquito net. I have learnt the importance of eating a balanced diet for me and my baby. Lilian has taught me about hygiene and why I should boil drinking water, ensure the compound is clean, dry clean utensils on a rack and ensure there is a clean pit latrine at home. Millicent Auma, 19 Donors: USAID, AMREF in the Netherlands, AMREF in Spain and matching funds from AMREF in Kenya and AMREF in USA. 30

32 TANZANIA Lead by example Dramatic turn of events A heated argument breaks out between a man and woman near Mwananyamala market in Kinondoni municipality, and immediately a crowd begins to gather around them. It turns out that the young man has just been tested for HIV and is trying to convince his sister to go too. But she will hear none of it, arguing that she and her husband are healthy and do not need any tests to tell them so. Moreover, if they go for the test, won t people assume they are infected? The young man is adamant, insisting that his kin should be tested so that they can take better care of themselves. Eventually they ask the by-standers for their opinions. If you find out you are positive you will die quickly; it is better not to know at all, advises a young man. No, shouts another, you should go so that if you are positive you can take care of yourself. Do you want to die and leave your children without parents yet you could have lived longer if you knew? The arguments fly back and forth, but eventually she is convinced to go for the test with her husband. The brother and sister are members of Youth Organisation Programme, one of three youth groups in Kinondoni, Jitambue Arts Group that use drama, music and dance to pass health messages to the community. Ali Mwinyi, 20, joined the group in People listen to us and ask questions, and many get tested in the mobile clinics and at the AMREF centre. We have received a lot of training from AMREF on life skills and health which we use in our messages. We also lead by example. I myself have been tested thrice and I always encourage my friends to know their health status. 31

33 The UJANA Project UJANA, the Swahili word for youthfulness, captures the essence of this national project that harnesses the dynamic spirit of youth for promotion of behaviour change and reduction of HIV infection. Many young Tanzanians still engage in risky behaviour despite having heard of HIV and AIDS, either because they do not consider themselves to be at risk, are not able to make decisions to protect themselves or have no access to services and support. By focusing on behaviour change, UJANA seeks to arm the youth with the attitudes and skills to prevent HIV and other sexually transmitted illnesses (STIs). The programme also works with the youth, parents, community and government leaders to create environments that are conducive for youth to get information and services. Ujana is being implemented in Iringa, Morogoro and Dar es Salaam regions by a partnership of four organisations Family Health International, Organisational Development Training and Facilitation Centre (TRACE) Tanzania, Femina Health Information Project and AMREF. Having successfully implemented the ANGAZA programme nationwide to promote HIV testing and treatment, AMREF s role in the UJANA partnership is to provide technical leadership and training in provision of youth-friendly services; strengthen referral networks between Counselling and Testing sites and providers of treatment, care and support; and improve health-seeking behaviour among young people. If you are positive you can take care of yourself At Mwananyamala Youth Centre in Kinondoni Municipality, an economically disadvantaged surburb of Dar es Salaam, AMREF provides counselling and testing services tailored for youth, who form 34 per cent of the surburb s population. To counter the high prevalence of substance abuse, HIV, STIs and early pregnancies in the area, AMREF provides life skills education to youth aged to equip them with such coping techniques as assertiveness, problem solving, negotiation and peer pressure resistance. These skills enable them to better handle risky life situations and protect themselves from harmful practices like early sexual activity and drug abuse. The centre offers recreational and AMREF IMPACT & FIGURES edutainment activities like sports and drama to give the youth an outlet for their energy and creativity. AMREF provides mobile counselling and testing services in schools, markets and shops, gives health talks to youth in and out of school, and helps to organise post-test clubs. The success of the project in large part derives from the close working relationship and partnership between AMREF, community leaders and local municipalities, in line with AMREF s strategy. Local leaders have been trained on social and community support for reducing risk of HIV among young people, while access to youth-friendly services has improved. AMREF strongly believes that adolescents and youth are an important entry point to enhancing improved health in the community, and that they must be given a voice in decisions about their sexual and reproductive health. The implementation of UJANA has resulted in an increased uptake of healthseeking behaviour in Kinondoni and other project sites across the country as young people flock to ANGAZA centres for testing, and to referral services like family planning, treatment or psychosocial support. At the Mwananyamala Centre, 7, 413 people were tested for HIV in A total of 6,200 youth were reached with messages between January and September 2008, resulting in increased knowledge and appropriate attitudes and skills to reduce their risk of HIV infection. As awareness increases, the tide is turning against HIVrelated stigma and discrimination, and towards acceptance and support by the community. Project Duration: October 2006 to September , 413 people were tested in 2008 compared with 2, 709 in , 700 people were reached by messages through community drama and dance performances 4,191 school children reached with health messages 8, 883 young people used the VCT services and attended health discussions at the Mwananyamala Centre Health funded by DSW and AMREF in Germany (1995) and Life Skills Education funded by UNFPA (1999) Over 8 million young people received services such as medical, psycho-social and HIV and AIDS education in 2008 through AMREF s work in Eastern and Southern Africa. 32

34 Scoring goals for life I come to the Mwananyamala Youth Centre to play basketball. I am in Form 5 at Perfect Vision High School. I used to live here in Kinondoni, then my family moved to Kigogo, about half an hour s drive from here. Nevertheless I still come here every day after school. I started coming to this centre in I had heard about HIV, but I learnt many new things here. I learnt how infection is spread, and ways to protect myself. I was taught about the dangers of early sex and drug abuse. I have also received training on how to deal with different situations in life like peer pressure, stress and conflict. We have seminars from time to time where we learn many things. I like it here because we are free to ask questions that are bothering us and they tell us what we need to know in a way that we understand. I feel that they care about us. Coming here for sports every day helps to keep me busy. When school is over I usually go home, change from my school uniform and have some refreshments, then I come to the court. I will play until around 7pm before I go home. Some young men who do not come here just hang around the estate talking about girls, and indulging in beer and drugs, but when I get home I am usually tired, so I just bathe, have my dinner and get ready for school the next day. - Fadhili Jabili, 21 Donors : Family Health International, Barrington Educational Initiative and Kenya Airways 33

35 SOUTHERN SUDAN Attentive Ears Working in the Light At 10 o clock in the morning, the maternity ward at the Lui Referral Hospital is teeming with clients. The women are all waiting waiting in a queue for antenatal check-ups, waiting for medicine from the pharmacy, waiting for a baby to be born in the labour ward. In contrast, one woman seems trapped in a constant wave of activity. Alice Taabu calls clients, one by one, into the consultation room, where she takes their histories, discusses the importance of hospital delivery, counsels them on social problems, healthy living and proper nutrition, and performs physical examinations. At intervals, Alice rushes off to check on the progress of the mothers in labour. On her return, she dispenses some medicine, and then returns to the ante-natal clinic. Alice is one of only two qualified midwives at the 75-bed hospital, which serves over 200,000 people mainly from Tali, Rumbek, Mundri and Lakamadi counties. Her colleague is not at work today, so she is forced to handle all the work on her own. I attend up to 40 ANC clinic clients daily, another eight inpatients, as well as deliveries. It can be tedious when one is all alone, especially when a delivery is due. I am forced to rush back and forth between the ANC clinic and the wards to monitor the patients, dispense drugs, admit sick mothers and when the delivery is due, abandon all else to attend to it. Alice dropped out of school after Senior 1 for lack of fees. A benevolent uncle sponsored her for maternal and child health (MCH) training in 2002, after which she worked briefly at Katigiri Primary Health Care Centre before joining the MCH unit at Lui Hospital, where she worked as a nurse s aide and then as a community midwife. She joined the Lui Institute in November 2006 and graduated in June 2008, returning to the hospital as a qualified community midwife. The training I received at the Lui Institute has helped me a great deal, declares Alice. Previously, I was working blindly but now I am in the light. Before, I was never sure what really qualified as an emergency or demanded a referral to a doctor but now I do. I can tell when labour is obstructed, an abnormal lie of the foetus, a contracted pelvis; I can comfortably identify and deal with cases of postpartum bleeding. I can diagnose and offer treatment, I can make an episiotomy [vaginal cut] during birth and stitch it up; fix nasal-gastric tubes for feeding and urinary catheters; and I can transfuse blood and set up intravenous lines. I am grateful to AMREF for enabling me to do all this. 34

36 Lui National Health Training Institute Health care delivery in Southern Sudan is extremely poor as a result of the 21- year civil war, which destroyed infrastructure and other aspects of the health care system. AMREF has a strong working relationship with the Government of Southern Sudan (GoSS), particularly with the Ministries of Health and Education at national level and within the 10 states. Through funds from the international Multi-Donor Trust Fund allocated to the government for development, AMREF is building the capacity of various cadres of health workers to support the country s efforts of reconstructing its health system. AMREF develops the curricula and consults constantly with the government on the running of the institutions it manages. This relationship gives AMREF a unique opportunity to engage with the government and to influence policy and practice in the development of human resources. The newly established Public Health Training Institute in Juba is training its first class of 20 students in Public and Environmental Health. At the Lui National Health Training Institute, AMREF has been training Community Midwives since AMREF has also supported Yei National Health Training Institute in collaboration with the national Ministry of Health. Furthermore, AMREF has trained a total of 213 clinical officers since 1988 at the Maridi National Training Institute with the support of donors from USA, Germany, the UK, Austria, and Italy, and the Southern Sudanese Ministry of Health. AMREF further acts as an agent of the government to train candidates for a Post-Graduate Diploma in Community Southern Sudan is facing a major health personnel crisis Health in Kenya, Medical Education in Tanzania and Surgery and Public Health in Uganda and Kenya. One of the oldest colleges in the country, the Lui National Health Training Institute closed down during the war. AMREF took over the running of the school in 2006 to train community midwives. In a country with the worst maternal mortality rate in the world 2,057 per 100,000 live births community midwives play a vital role in ensuring the health and safety of mothers, and consequently of their children. Indeed, Southern Sudan is facing a major health personnel crisis, with too few qualified workers thinly distributed across the country. The country has only 1,005 (14%) trained midwives, including traditional birth attendants, against 2,150 needed in the entire health system. Students are selected by the government, though it is difficult to find enough qualified candidates owing to the effects of the war years on education across Southern Sudan. The course is ideally for Senior 4 graduates already serving as community health workers, auxiliary nurses or vaccinators, but girls with lower qualifications are also admitted to make up for the shortfall. Finding qualified tutors is even more challenging. Nevertheless, 15 students have graduated from the Institute so far, with another 13 in their first year and 18 in their second. Those who graduate are certified by the Ministry of Health and posted back to their states. The Lui Institute works closely with the local administration, Ministry of Education and the Ministry of Health. Students are attached for practical training to the adjacent Lui Hospital, on whose board the principal of the school sits. Students are also placed on attachment in neighbouring communities and other health facilities to practise community diagnosis. Facts Project Duration: Continuous since 2007 AMREF has worked in Southern Sudan since 1975 Over 1,800 women reached by midwives trained by AMREF AMREF IMPACT & FIGURES Over 40,000 formal health workers and 460,000 community health workers trained by AMREF to date 78 per cent of qualified health workers in Southern Sudan trained by AMREF 35

37 Making double sure I am a housewife expecting twins from my ninth pregnancy. I arrived here from Lakamadi village, 32km away. I came partly by public transport and for the rest of the way I got a lift. I have been attending ante-natal clinic at Lakamadi Primary Health Care Centre. When they realised that I had a twin pregnancy, they advised me to ensure I delivered at the Lui Hospital. This is my first visit here. I have been given a nice welcome. The midwife told me that the position in which the twins are lying will require them to be delivered by Caesarean Section. The operation will be done today. I have had tests done in the laboratory for malaria, syphilis and to check if my blood is healthy; Lakamadi has no laboratory facility to do such tests. They said I was fine except for an infection for which they gave me medicine. Of my past eight pregnancies, I delivered five at home and three at Lakamadi health centre. I began going to the centre after two of my children died while I was being assisted by traditional birth attendants. All the children I delivered in hospital survived. Agnes Kamisa, 40. Donors: Multi-Donor Trust Fund and UNFPA 36

38 AMREF NATIONAL OFFICES AMREF every year raises money and advocates for African health through its National Offices in Europe and North America. These offices with dedicated staff, remarkable Board members and hundreds of volunteers work tirelessly to support AMREF s activities in Africa. AMREF has National Offices in Austria, Canada, Denmark, France, Germany, Italy, Monaco, Netherlands, Spain, Sweden, UK and the USA. Austria AMREF Deputy Director General Dr Florence Muli-Musiime and AMREF Director for Capacity Building Dr Peter Ngatia. During the evening, Dr Walter Schmidjell was honoured by Prof Saitoti, who awarded him the Kenyan Order of the Golden Warrior for his humanitarian service to the people of Africa. Local artists like Fritz Egger, Wolfgang Ambros, Rainhard Fendrich and Franz Buchrieser made it an unforgettable evening. The governor of Salzburg Mag Gaby Burgstaller facilitated a meeting between Prof George Saitoti, Dr Walter Schmidjell and former UN-Secretary General Mr Kofi Annan. Over the year 2008 the Austrian Development Agency supported two AMREF Programmes Distance Learning, which was supported by AMREF in Austria and AMREF in Germany, and the Manyatta-based Health Delivery Model for Maternal and Child Health in Magadi, co-financed by AMREF in the Netherlands. Canada The 5th International Salzburg AMREF Marathon was held in 2008, and again attracted record participation. Over 3,300 athletes from 27 nations ran for both AMREF and better health for the people of Africa. The winner of the men s marathon was John Kirwa from Kenya, followed by his fellow countryman Josephat Rotich. The women s race was won by Sabine Hofer from Austria, while Sheila Mbaku of Kenya came in second. In 2008 the Salzburg AMREF marathon was awarded the IAAF Label by the International Association of Athletics Federations, becoming one of only two marathons in Austria awarded with such a label, the other being the Vienna Marathon. The AMREF Marathon also received support from several celebrities such as the actress Caterina Murino and the Austrian 2008 Paralympics gold medal winner Thomas Geierspichler. Two days before the marathon, an AMREF gala at the Gwandhaus of Gössl marked another highlight of our Days of Dialogue, which have become an integral part of the cultural scene of Salzburg. Guests included Kenyan Minister for Internal Security Prof George Saitoti, Kenyan Ambassador Julius Kiplagat Kandie, In November 2007, members of the Canadian Government, including Secretary of State Helena Guergis and Member of Parliament Rahim Jaffer, visited AMREF s work in Kawempe, Uganda. Each took time out from the Commonwealth Heads of Government Meeting to see how AMREF s work is transforming the lives of Kawempe residents. In January 2008, Canadians were called upon to support Kenya during its postelection crisis. Thousands of Canadians responded. Among them was a group of 37

39 dedicated AMREF supporters who organised a Kenyan Harambee to raise funds. Overall, more than $50,000 was collected through the generosity of supporters to provide life-saving health care to Kenyans who were most affected by the crisis. Flying Doctors Society of Africa In May, AMREF in Canada held its 12th Annual African Marketplace Gala. Among special guests was xylophonist Dominic Akena from War/Dance, the awardwinning documentary inspired by AMREF s work. Other special guests were Dr Florence Muli-Musiime, Deputy Director General of AMREF, and AMREF in Canada s Goodwill Ambassador, opera sensation Measha Brueggergosman. Over $315,000 was raised for AMREF s work in Africa by lead sponsor Barrick Gold Corporation, 23 corporate sponsors, 400 guests, numerous donors and over 100 volunteers. The year also saw new supporters join AMREF in Canada. With funding from Addax Petroleum Foundation, AMREF has expanded its malaria prevention and treatment project in Afar, Ethiopia. The Lundin for Africa Foundation partnered with AMREF in Canada to develop a safe water and sanitation component to AMREFs Community Health Project in South Omo, Ethiopia. AG Hair Cosmetics helped AMREF revitalise five public schools in Kibera, Kenya s largest urban slum area. M A C Cosmetics helped AMREF train traditional healers in South Africa, who can now reach, treat and refer the critically ill for immediate care at health centres. Denmark AMREF in Denmark successfully raised US$38,000 from 10 foundations to fund an expansion of the Dagoretti Child in Need project following the post-election violence in Nairobi. The amount was donated at the end of June Chairman Thomas Federspiel and long-term member Niels Thygesen resigned in June 2008 after many years of service on the AMREF in Denmark Board. The new chairman is Christian Alsøe. Two new Board members Sven Riskjær and Klaus Winkel have joined AMREF in Denmark. The post-election violence in Kenya led to a drop in the number of visitors to the country, making it a difficult year for the Flying Doctors Society of Africa, whose business is partly dependent on tourists. Nevertheless, the Society was able to fulfill its obligations to AMREF by giving 68 per cent of its total income towards the work of the organisation. Donations by the Society in 2008 were as follows: AMREF Outreach Programmes US$176,228.7 Flying Doctor Emergency Service 265,171.8 Donations to victims of political violence 25,071.1 AMREF Virtual Nursing School 16,528.9 AMREF Monitoring and Evaluation 49,753.6 AMREF website maintenance 2,803.5 Total: 535,557.6 In response to the suffering caused by the political conflict in Kenya, Society Chair Dr Eunice Muringo Kiereini presented a cheque for US$14,285.7 to the Nairobi Women s Hospital following media reports of girls, boys and women being treated for rape there. The Society also donated an additional US$10,771.4 to internally displaced people in Limuru and Nakuru. 38

40 France In 2008, AMREF in France worked hard towards AMREF s expansion to West Africa an attractive and promising prospect that will hopefully be realised in In September, four officials of AMREF in France, including AMREF goodwill ambassador Caterina Murino, visited Ethiopia and toured AMREF projects in the Afar Region. AMREF in France developed a new website AMREF in Germany was honoured that Board Chairman Dr Pascoal Mocumbi visited Munich in April Dr Mocumbi had been invited to Germany to lecture at the International Conference Stop Malaria Now. A private dinner was arranged for him to meet AMREF Board members, donors and staff. Herzog Franz von Bayern, a great supporter of the Maridi Training School in Southern Sudan, arranged a private audience in Schloss Nymphenburg for the Chair. AMREF s Director for Capacity Building, Dr Peter Ngatia, also visited Munich in May and explained the implementation of AMREF s strategic plan. The Else-Kroener- Fresenius-Foundation not only continues to fund AMREF s Virtual Nursing School, but has given further substantial grant for continuation of the ART Knowledge hub. After 45 years as founder, Chair and Chief Executive Officer, Leonore Semler has become Honorary President of AMREF in Germany and in this capacity will continue her exceptional fundraising efforts. Dr Goswin von Mallinckrodt, who already served for many years as a member of the Board of AMREF in Germany has become the new Chairman, while Marcus Leonhardt is the new CEO. Italy Germany AMREF and Fondation Dulcimer pour la Musique, which is committed to the promotion of innovative forms of musical education, are collaborating in a musical laboratory within the activities of AMREF s Children in Need Project for the reintegration of street children into social life. 39

41 Headed by Italian musician/percussionist Giovanni Lo Cascio working with local social workers, the laboratory aims at motivating children, both as individuals and as members of the community. Activities take place throughout the year and involve rhythm, singing, research on timbre and all other basic elements of music. Most of the instruments used are inspired by African tradition and are made of recycled material. The use of waste carries an ecological and functional value. A barrel can be a drum or a pipe can be a flute, freeing them from specific cultural references. The rhythm played is of African origin but re-interpreted to suit the new instruments. All songs are created ad hoc and inspired by African tradition. The programme was started in July 2005 based on a sequence of four workshops per year headed by the project leader, and weekly training carried out by local social workers. To date, eight workshops have been held with the participation of foreign musicians. Monaco The project was presented to HSH the Sovereign Prince on March 18 during a ceremony organised by the Office of International Cooperation and Development and in the presence of HSH Princess Stéphanie and all participating nongovernmental organisations (NGOs). AMREF in Monaco donated US$5,000 to AMREF s Heritage Department for celebrations of the 10th anniversary of Anne Spoerry s death. In June, at a charity gala to celebrate the fifth birthday of the Corriere della Costa Azzurra, a Monegasque magazine, AMREF in Monaco presented a video illustrating its activities and distributed information material. A tombola was organised and the proceeds given to AMREF. AMREF in Monaco collaborated with the Office of International Cooperation and Development of the Monegasque Government by providing information and images that were used for an official publication on Monegasque NGOs. Netherlands In 2008, on the occasion of the 50th birthday of HSH the Sovereign Prince, AMREF in Monaco participated in the Monaco Collectif Humanitaire project, in which 18 Monegasque Associations are involved. Its aim is to perform surgery on children who cannot get such treatment in their own countries, including heart and orthopaedic surgery. To date, 39 children have been operated on under the project. After the post-election violence in Kenya, the Dutch Development Cooperation Minister, Mr Bert Koenders, visited AMREF mobile clinics in Kibera and donated Euro 300,000 to boost the clinics. Halfway through the year AMREF in the Netherlands welcomed its 30,000th private donor. The private donor market is critical to AMREF in the Netherlands since it generates a stable, reliable income. The office aim is to have 35,000 private donors in With a yearly donation of one million Euros, the Dutch Postcode 40

42 Lottery is one of the largest donors. AMREF in the Netherlands was pleased by an invitation to the lottery to make a commercial of the outreach activities. The clip was shot in Tanzania in May (starring Dr John Wachira) and aired in June and August on national television. AMREF s Director in the Netherlands, Ms Jacqueline Lampe, travelled with some lottery delegates to the same area in September to do it all over again. Throughout the year many AMREF staff from Africa visited the Netherlands. Joshua Kyallo from Uganda and Melusi Ndhlalambi from South Africa attended the Viongozi (Leaders ) Dinner in November organised by the Supervisory Board to familiarise guests with AMREF s Flying Doctors and the Millennium Development Goal to improve maternal health. The presence of other African colleagues was very useful at several conferences and workshops to which AMREF in the Netherlands was invited. Spain and the installation of systems for the development of rainwater harvesting in five districts in northern Tanzania. An agreement was also reached with the cosmetics company L OREAL to raise funds for AMREF. Similarly, AMREF and AENA the Spanish Airports and Sailing Area agreed on the display of AMREF at 50 photographic exhibition in various Spanish airports. Collaboration between AMREF and RENFE National Network of Spanish Railways saw 12 major Spanish NGOs of Spain develop a joint programme A train of values for a better world committed to the attainment of the Millennium Development Goals. In June 2008, Dr Gerald Rukunga, head of Water and Sanitation at AMREF in Kenya, participated in the International Exhibition of Water Zaragoza 2008 whose theme was Water and Health in Africa. A photographic exhibition titled Africa Responds to AIDS in Africa, and a documentary, Ye Addis Abebawochu (Flowers of Addis), were shown in the Courts of Castile and Leon under the leadership of Dr Joao Soares, the Director of AMREF in Ethiopia,. Sweden An agreement of collaboration was reached between AMREF and Ferrovial, an infrastructure company with more than 100,000 employees and a presence in 43 countries. The agreement will see the construction of 20 boreholes in three years The partnership between AMREF and the Swedish International Development Agency (Sida) in 2008 included activities to reduce the prevalence and impact of HIV and AIDS in East Africa. AMREF AT A GLANCE Over 57 million people impacted by AMREF s work in 2008 AMREF s PHASE model, piloted in Kenya in 1998, has now been adopted nationally in Kenya, and in Nicaragua, Peru, Zambia, Uganda, Bangladesh, Mexico, Tajikistan, Bolivia and Indonesia, targeting primary school children as drivers of change. Our Clinical Outreach surgeons conducted 27,357 consultations and 8,205 operations between 2007 and 2008 AMREF s Clinical Outreach Programme visited over 135 hospitals in Kenya, Uganda, Tanzania, Ethiopia and Rwanda 41

43 Donations from the Swedish Broadcasting Corporation supported projects in Luwero, Uganda, and Lumi, Ethiopia. Kaupthing Bank, Sweden, is supporting a water project in Butuntumula, Uganda. AMREF was for the first time invited to the yearly World Water Week in Stockholm, a unique event for research exchange. AMREF presented an abstract titled The effects of Water and Sanitation Interventions in Laini Saba Village of Kibera Settlement: A case-control study in Kibera, Nairobi. Dr Florence Muli Musiime and Mr Gerald Rukunga presented the study, which was very well received. During the week, Swedish Board member Kersti Adams-Ray and Dr Muli-Musiime also took part in the open-air art exhibition Where would you hide. UK West Ham goalkeeper and AMREF in UK ambassador Rob Green visited AMREF s projects in Nairobi, Kenya and helped raise 30,000 when he conquered Mount Kilimanjaro. Giving up his time during the summer holidays, he used his football fame to help raise awareness about AMREF s efforts among the UK public. Following its submission of written evidence, AMREF in UK was selected by the All-Party Parliamentary Group on Population, Development, and Reproductive Health to provide further evidence about its experience of maternal morbidity in Africa. This evidence will inform UK government policy on its support of African development. AMREF in UK and AMREF in Uganda launched their groundbreaking Katine Community Partnership Project in cooperation with the Guardian newspaper, Barclays Bank, and FARM-Africa. The project takes an integrated approach to development, bringing health care, education, water and other fundamental services to the impoverished Katine District with emphasis on community involvement. The project is entering its second year and, as of late 2008, over 600,000 had been raised. USA In 2008, AMREF in UK continued its funding, advocacy and communications strategies, which allowed it to reach and exceed all of its financial targets, raising 990,002 of unrestricted funds and 4,079,232 for its programmes. During the year, AMREF in UK worked on a number of issues, such as mother and child health in Kenya and Ethiopia, the rights of people living with HIV and AIDS in Tanzania, and a successful emergency appeal for those affected by post-election violence in Kenya. The appeal raised significant amounts of money which provided immediate health care and sanitation in refugee camps, and helped set up mobile health clinics in and around Nairobi. In February 2008, AMREF in USA s Goodwill Ambassador, Academy Awardnominated actress Mena Suvari, visited AMREF projects in Ethiopia and Uganda accompanied by AMREF in USA Executive Director Lisa Meadowcroft and Fundraising and Communications Manager Jasmin Farmer. In Mena s words, The people of Africa are beautiful. They are full of love and light just like the rest of us and deserve the basic human rights of being given a chance in life to be given the tools to make it through. I feel that AMREF holds this belief to the utmost, which is why I am so passionate about the work that they do and being a part of their prestigious organisation. 42

44 FINANCIAL REPORTS ANNUAL EXPENDITURE BY ACTIVITY Financial Year 2007/8 ANNUAL EXPENDITURE Financial Year

45 DISTRIBUTION OF EXPENDITURE Financial Year 2007/8 DISTRIBUTION OF EXPENDITURE Financial Year 2007/8 44

46 AMREF Senior Management Team Dr Michael Smalley Director General Dr Florence Muli-Musiime Deputy Director General Dr Peter Ngatia - Headquarters Nancy Muriuki - Headquarters Dr Thomas Kibua - Headquarters Stephen Andrews Headquarters Dr John Nduba Headquarters (Ag) Bob Kioko Headquarters (Ag) Jim Heather- Hayes Flying Doctor Emergency Service Dr Bettina Vadera Flying Doctor Emergency Service Dr Joao Soares - Ethiopia Mette Kjaer - Kenya Penina Ochola - South Africa (Ag) Blanche Pitt - Tanzania Joshua Kyallo - Uganda Dr John Mwesigwa - Southern Sudan (Ag) Karina Katzelberger Austria Warren Spires Canada Christian Alsøe Denmark Tanya Nduati Flying Doctors Society of Africa Zarina Bagneux France Dr Marcus Leonhardt Germany Tommy Simmons - Italy Riccardo Arvati Monaco Dr Jacqueline Lampe Netherlands Alfonso Rodriguez Spain Helena Bonnier - Sweden Lorraine Clifton UK Lisa Meadowcroft USA 45

47 Contacts AMREF in Austria Waagplatz Salzburg Austria Tel: +43/662/ Fax: +43/662/ office@amref.at Website: Chairman Dr Walter Schmidjell Board Members Anna Maria Schwaiger (Vice- Chairman, International Coordinator) Mag Alexander Viehauser Dr Monika Schmidjell Ernst Ischovits Egmont Kap-herr Irene Broda Margit Ambros Prim Dr Klaus Täuber Dieter Schleehauf Univ Prof Dr Kurt Weithaler Franz-Eduard Hamersky AMREF in Canada 489 College Street, Suite 407 Toronto, Ontario, Canada M6G1A5 Tel: Fax: info@amrefcanada.org Website: Chairman Keith Thomson Vice Chair Gordon Capern Laurence Goldberg Executive Director Warren Spires Board Members Lori-Ann Beausoleil Christopher Dawson Charles Field-Marsham Scott Griffin Stephen Hafner Douglas Heighington John Lee Diane MacDiarmid Caro Macdonald Peter Sinclair Alan Torrie AMREF in Denmark Den Afrikanske Laegefond Gorrissen Federspiel Kierkegaard 12 H.C. Andersens Boulevard DK-1553 Copenhagen V Tel: Fax: Website: Chairman Christian Alsøe Executive Director Christian Alsøe Board Members Finn Black Svend Riskaer Klaus Winkel Lise Lassen AMREF in Ethiopia House Number 629, Kebele, 12, Wereda 16 Djibouti Road, opposite St. Gabriel Hospital P.O. Box 20855, Code 1000 Addis Ababa, Ethiopia Tel: / Fax: E mail: info.ethiopia@amref.org Country Director Dr João Soares AMREF in France 19 rue Cassette Paris France Tel/Fax : +33(0) Mobile: +33(0) info@amref.fr Website: Director Zarina de Bagneux Board Members Marc Odendall (President) Marie-Paule Laval (General Secretary) Gilles August (Treasurer) Nathalie Delapalme Alejandro Martinez-Castro Bernard Lozé Jean-Charles Decaux Zarina de Bagneux AMREF in Germany AMREF Gesellschaft für Medizin und Forschung in Afrika e.v. Mauerkircherstr. 155 D München Tel: (0) Fax: (0) info@amrefgermany.de Website: Honorary President Leonore Semler Chairman Dr Goswin von Mallinckrodt Executive Director Dr Marcus Leonhardt Board Members Prof Dr Volker Klauß Dr Ulrich Laukamm-Josten Dr Hans Werner Mundt Gerd Pelz 46

48 Dr Wilhelm von Trott zu Solz Dr Johannes Zahn Michael Wollert AMREF Headquarters P0 Box Nairobi, Kenya Tel Fax info@amref.org Website: Founders Sir Archibald McIndoe Dr Thomas D Rees Sir Michael Wood Honorary Directors Dr Thomas D Rees Leonore Semler Chairman Prof Miriam Were - upto March 2008 Dr Pascoal Mocumbi - from March 2008 Director General Dr Michael Smalley Deputy Director General Dr Florence Muli-Musiime Board of Directors Prof Adetokunbo O Lucas Anthony Durrant Dr Fatma Hafidh Mrisho Iain Knapman Dr Laeticia Rispel Marc Odendall Mwikali Muthiani Dr Nizar Verjee Dr Pascoal Mocumbi Dr Paul Zuckerman Scott Griffith Prof Souleymane Mboup Dr Stephen C Joseph Dr Thomas van der Heidjen Dr Ulrich Laukamm-Josten AMREF in Italy Via Boezio, Roma, Italia AMREF Italia (Branch Office) Via Carroccio, Milano, Italia Tel: Fax: info@amref.it Website: Chairman Ilaria Borletti Honarary Chairman Susanna Agnelli Vice President Thomas Simmons Board Members Valerio Caracciolo Antonello Corrado Marinella De Paoli Maurizio De Romedis Daniela Ghisalberti Maurizio Paganelli Immacolata Pellegrino Andrea Ripa di Meana Renata Zegna AMREF in Kenya PO Box Nairobi, Kenya Tel: Fax: info.kenya@amref.org Country Director Mette Kjaer Advisory Council Prof Mohamed Abdullah (Chairman) Prof Violet Kimani Prof Japheth Mati Dr Nizar Verjee Dr Ann Wamae Lawrence Ndombi Dr Richard Muga Dr Michael Smalley Dr Florence Muli-Musiime Mette Kjaer AMREF in Monaco Le Saint-André 20, Boulevard de Suisse MC Monaco Tel.: info@amrefmonaco.com Website: Chairman & Executive Director Riccardo Arvati Board Members Niccolo Caissotti di Chiusano Fabrizio Carbone Giuseppe Spinetta Jean-Philippe Bertani AMREF in Netherlands Stichting AMREF Nederland Haagse Schouwweg 6G 2332 KG Leiden Tel: Fax: info@amref.nl Website: Patron HRH The Prince of Orange, Crown Prince of the Netherlands Chairman MTH de Gaay Fortman Director Dr Jacqueline GAM Lampe Board Members T Gardeniers DM van Gorp Dr JF Maljers M Pieters SA Sichtman MBA MPC 47

49 AMREF in South Africa Hillcrest Forum 731 Duncan Street Hillcrest Pretoria Postal Address Postnet Suite 92 Private Bag 19 Menlo Park Pretoria 0102 Tel: /36/37 Fax: Chairperson Refiloe Joka-Serote Vice Chairperson Dr Irwin Friedman Board Members Albert Mdaka Dr Irwin Friedman Nosisa Tshangana Aletta Masinya Dr Brian Brink AMREF in Spain Almagro 14, 3ª Madrid Spain Tel: Fax: Website: Chairman Alfonso Villalonga Navarro Executive Director Alfonso Rodríguez Maroto Board Members José Luís Alonso Gutiérrez Gabriel Guzmán Uribe Juan Pedro Medina López Pedro Alonso Fernández Javier Gimeno de Príede Jorge Planas Ribó Rafael Mateu de Ros Cerezo Carlos Dahlman Leo Ricardo Farache King José Luís Yela Pañeda AMREF in Sweden c/o Helena Bonnier Karlavägen 91 S Stockholm Tel: Fax: amref@telia.com Website: Patron HM King Carl XVI Gustaf Chairperson Helena Bonnier Board Members Kersti Adams-Ray Lottie Bysell John Eckerberg Annika Elmlund Maria Lannér Charlotte Nordenfalk Charlotta Rapacioli Pär Vikström Vera Axson Johnson (Honorary member) AMREF in Tanzania 1019 Ali Hassan Mwinyi Road Upanga PO Box 2773 Dar es Salaam Tel: Fax: info.tanzania@amref.org Country Director Blanche Pitt Advisory Council Members Hon Dr Hussein Mwinyi- Chairman R. Tuluhungwa A. Kilewo E. Ndyetabura Dr C. Simbakalia Ananilea Nkya Dr Eve Hawa Sinare. Mary Rusimbi M. K. Rwebangira. Dr Fatma Mrisho AMREF in Uganda Plot 29 Nakasero Road P.O.Box Kampala Tel: /9 Fax: info.uganda@amref.org Country Director Joshua Kyallo Advisory Council Members Christine Kabugo (Acting Chairperson) Dr Jessica Jitta Prof Mangen Wabwire Stephen Mutyaba Tom Matte Eng Mugisha Shillingi AMREF in UK Clifford s Inn Fetter Lane London EC4A 1BZ United Kingdom Tel: +44 (0) info@amrefuk.org Web: Patron HRH The Prince of Wales 48

50 President The Duke of Richmond & Gordon Chairperson Mary Jane Potter Chairman Lady Hollick Executive Director Lisa Meadowcroft Executive Director Ms Joanna Ensor Executive Director (Interim) Lorraine Clifton Board Members Lady Hollick (Chair) Gautam Dalal (Treasurer) Paul Davey Ian Edwards Matthew Edwards Ian Gill Mark Goldring CBE Samara Hammond Katherine Mathers Inosi Nyatta Board Members Paul T Antony, MD, MPH Ned W Bandler, Vice Chairman Charles HF Garner Christine L Grogan Carol Holding Carol Jenkins Stephen C Joseph, MD Robert WC Lilley, Secretary William H MacArthur, Treasurer Lisa Meadowcroft, Ex-Officio Elliott J Millenson Michael Smalley, PhD Timothy S Wilson AMREF in USA 4 West 43rd Street 2nd Floor New York, NY Tel: Fax: amrefusa@amrefusa.org Website: Founder Thomas D Rees, MD 49

51 Donors AMREF in Austria Actavis GmbH ADA (Austrian Development Agency) Ad.Pri.Co a division of 01.print & copy GmbH African Safari Club Reisebüro GmbH Afro-Asiatisches Institut Afro Café Salzburg AFS-Flüchtlingshilfe-Stiftung Agentur COCO Agentur Rahofer Alpenresort Schwarz Altstadt Marketing GmbH Ambros Wolfgang ASKÖ Landesverband Salzburg Austrian Airlines AG AWD-Kinderstiftung Bank Austria Buchrieser Franz Carpe Diem Coca-Cola GmbH DasKino Diani Marine Ltd Dorotheum Druckerei Roser Eberhartinger Klaus Egger Fritz Eiswerk GmbH EU Europäische Union EZA Fairer Handel GmbH Fiebig Hartmut grenzgang GbR Fröstl Peter G Pappas Automobil AG Going International Golfpark Mieminger Plateau Haus der Natur Hypo Salzburg HPD Security Karl Fritz Krassnitzer Harald Kulturverein Schloss Goldegg Literaturhaus Salzburg Management Rehling ORF ORF Landesstudio Salzburg Österreichischer Genossenschaftsverband Palfinger KR Ing Hubert und Josefine Palfinger AG Pannobile OHG Paracelsus Medizinische Privatuniversität PUMA Radiofabrik Red Bull GmbH Roundtable 36 Gmunden Salzburger Ärztekammer Salzburger Ihr Landesversicherer Salzburger Nachrichten SEER Viertbauer Promotion GmbH SFÄ Dr Klinger & Rieger Steuerberatung für Ärzte KG Spielzeugmuseum Stadt Salzburg Stepan Druck Stieglbrauerei zu Salzburg Sportimpuls Hannes Langer SWISS Tele2 Tyrolean Air Ambulance Vita Club Salzburg UNIQA Universität Innsbruck Universität Salzburg USI Salzburg Volksbank Salzburg ynet Agentur für Kommunikation und Mediendesign Zoo Salzburg AMREF in Canada Acqua Ristorante AG Professional Hair Care Products Ltd Alan & Susan Torrie Alanna Rondi & Allen Garson Alceo DeAnna Alice Irwin Ammar & Vicky Al-Joundi Andre Boysen Athletes for Africa Atlas Copco Ava Hillier Barrick Gold Corporation Bentall Capital Corporation Brendan Caldwell Brian & Carol Walker Bridget Lawson Bruce & Emily Burgetz Butterfield & Robinson C & D Graphics Canaccord Capital Canadian Auto Workers Union Social Justice Fund Caro Macdonald & Mark McCain Centro Restaurant & Lounge Charles & Rita Field-Marsham Christopher Dawson & Elizabeth Malcolm CIDA - Canadian International Development Agency Clarke & Catherine Herring Cleantech Group Compass Group Canada Cowan International Davies Ward Phillips & Vineberg LP Denise Young Diane MacDiarmid & Ian MacDonald Douglas Heighington Elisa Nuyten Estate of Erika Leu George Edward Taylor GlaxoSmithKline Canada Inc. Global Resolutions Inc Goldberg Family Gordon Capern & Kelly Driscoll Greg Couillard s Spice Room & Chutney Bar Holmes & Lee House of Anansi Press IAMGOLD Corporation Interagency Coalition on AIDS and Development J. Edward & Margaret Boyce James Johnson Janice Wright Joanne Dereta & Bill Papageorge John Lee & Melissa Evans John R & Gay Evans John Sinclair Keith & Tanja Thomson Laurence Goldberg & Diane Spivak Lori-Ann & Winston Beausoleil Lundin for Africa Foundation M.A.C. AIDS Fund Manyata Courtyard Café & Spice 50

52 Room SNC LAVALIN Det Obelske Familiefond JCDecaux Margaret Zeidler Markus & Measha Brueggergosman Marstone Management Inc Mary K. Nixon Mary Nixon Sodexo Canada & Sodexo AMECAA Stephen & Mary Hafner Stonegate Private Counsel LP Suresh Singh Telus Cares Oticon Fonden William Demant og Hustru Ida Emilies Fond Tuborg Fondet ØK s Almennyttige Fond Lozé Associés MPL Consulting Ministère des Affaires Etrangères Omega SPAC Michael & Valerie Bertouche Michael de Pencier Michael Penner Mimi Joh-Carnella Morneau Sobeco Naylor Group Inc Newport Partners Ontario Secondary School Teachers Federation Osler, Hoskin & Harcourt LLP Paliare Roland Barristers PanAfrican Mining Services (Tanzania) Ltd Paradigm Capital Paul & Cathy Inglis Peter & Ailsa Sinclair Platinum Legal Group Inc Presidential Gourmet Fine Catering Quantum Murray LP Randall Kaye & Judy Watson RBC Foundation Reza Satchu Richard & Patricia Fogler Robert & Gayle Cronin Robert & Joan Wright Ron & Flip Oberth Rotoract Club of Toronto Russ and Kim Howe Rustam Satchu Scott & Krystyne Griffin Serving Charity - Abbas Jahangiri The Glazin Group Executive Search The John David & Signy Eaton Foundation The K. M. Hunter Charitable Foundation The McLean Foundation The Stephen Lewis Foundation Thomas Lane Tim & Frances Price Toronto French School TYPE books Visual Fixations W. Vernon and Edie Howe Wilfred & Anne Lewitt William & Mary Horan AMREF in Denmark Dronning Magrethes og Prins Henriks Fond Alm. Brand Fond Civilingenioer HC Baekgaard og hustru Ella Baekgaards Fond Dampskibsselskabet Orients Fond Fonden af 8 juli 1983 Hans Foxbys Fond Konsul Georg Jorck og Hustru Emma Jorcks Fond Augustinus Fonden Bestsellerfonden Fabrikant Mads Clausens Fond JL Fonden Oak Foundation, Danmark AMREF in Ethiopia AMREF in Austria AMREF in Spain AMREF in Sweden (Swedish Broadcasting Corporation SBC) AMREF in the Netherlands AMREF in UK AMREF in Spain (AECI, Government of Catalunya, Government of Valencia) Band Aid Trust Canadian International Development Agency (CIDA) Core Group and CRDA Diageo Foundation European Union Ferguson Trust Foundation Dioraphte Geneva Global Hedley Trust Jersey Overseas AID Liberty Foundation) Light for the World MFS AMREF in France Agence de Bassin Seine-Normandie August&Debouzy Caterina Murino Chaumet Fondation Stravos Niarchos James Bond Club AMREF in Germany Companies AUDI AG BHF Bank Deutsche Bank AG BAUR AG DeloitteTouche EADS GmbH HypoVereinsbank AG Kriege GmbH, Lumatec GmbH MAN-Ferrostahl AG Merck Finck Bank Osram AG Siemens AG Rohde&Schwarz GmbH TUI Touristik AG Foundations Barmherzigkeit Verein Deutsche Lepra- und Tuberkulosestiftung Hilfsverein Nymphenburg Else-Kröner-Fresenius-Stiftung Haberger Stiftung Kindernothilfe Sternsinger/ Päpstliches Missionswerk Stiftung Mittelsten Scheid Stiftung Überseehilfswerk Stiftung Van Meeteren 51

53 Gifts in Kind Aumüller Druck AG Swarovski AG Wenig Print Workshop Institutions/Government BMZ Federal Ministry for Economic Cooperation and Development AMREF in Italy 4 FONDAZIONI Arena Biblioteche di Roma Circolo Auser Il Gabbiano Comune di Milano Comune di Napoli Assessorato alla Cultura Comune di Roma Fondation Altamane Fondation Dulcimer Pour La Musique Fondazione Banca del Monte di Lombardia Fondazione Cariplo Fondazione Cariverona Fondazione Grisanti Santarato Fondazione Monte dei Paschi di Siena Fondazione Zegna Francesco Gambella Gabriele Galateri di Genola Gruppo RCS Istituto Degli Innocenti Di Firenze Lottomatica OTO Research Provincia di Milano Regione Lombardia Regione Toscana Rezophonic Sanpellegrino Sebeto srl Teatro delle Briciole Università La Sapienza Facoltà di Scienze della Comunicazione Walter Veltroni Water Right Foundation I volontari di Torino, Milano, Verona, Bologna, Perugia, Correggio, Genova, Firenze, Lucca, Roma, Napoli, Palermo AMREF in Kenya AMREF in France AMREF in AUSTRIA AMREF in Canada AMREF in Germany AMREF in Italy AMREF in Netherlands AMREF in Spain AMREF in UK AMREF in USA Big Lottery Centre for Disease Control (CDC) CORDAID Core Group DANIDA European Commission Ferguson Charitable Trust Flying Doctors Society of Africa GlaxoSmithKline Global Fund KindernothHilfe GTZ Internal Recovery Income Izumi JHPIEGO John Ellerman Foundation Zain KBL MCDI SIDA Smile Train Terra Nuova Tuscany UNICEF USAID Water for Maasai Foundation AMREF in Monaco CAF (Charity Aid Foundation) Liverpool Julius Baer Trust Company - Island Dante Alighieri Monaco Association BSC Associes - Monaco Pastore HSBC - Monaco General Finance - Biella - Italy Espeira srl - Padova - Italy Spinetta Family - Monaco Vik Family Group - Monaco Migliorero Family - Monaco Bernasconi Jewels - Monaco Mincey Family Group - USA Private Donors Mr Giorgio Angelozzi - Monaco Mr Von-Morl Galeazzo - Monaco Mrs Claudia Fromenti - Menton - French Mr Mario Semprini - Cannes - French Mr Alessandro Pacchioni - Verona - Italy AMREF in Netherlands AGIS Zorgverzekeringen Amsterdam RAI Anna Muntz Stichting Aqua for All Basisschool de Bron Beltex BV PJ Berveling J Blok P Boekestijn Boubeek Communicatie Th H Brons L de Bruijn FH Bruna RJW Cortenraad CJP EMJ Damen J Donk-Grote Stichting Dutch Postcode Lottery Elmec Handels Ing Bureau JH Friesemann Vië Tor Geef Een Gift IVHJ Geraedts MJS Geurts CJ van Ginneken S de Graaf Grodan BV S Heijdra Heirs JA Rood AA van der Helm CM van der Hoeven PA Huysmans Insinger Stichting CT Jansze Johannes Stichting M Klein AJ Klein Lionsclub Appingedam JS Meijer Ministry of Foreign Affairs HJE Modderman 52

54 NACO BV National Aerospace Laboratory ODS BV Otten Philipsfonds F Pasman Petercam Bank NV M Pieters S Plantenga Plexus Medical Group BV PSO M van Rouwendaal Das B van Schöll ME van Setten-Landré A Soetelmans-Visser GA Spanninga Sponsor Bingo Loterij Stichting Malaria No More! Stichting BBV Stichting Chrito Stichting Leprahulp St Lazarus Orde Stichting Ravu Stichting Thurkowfonds Stichting Toegepast Waterbeheer Stichting van Ballegooijen Fonds Stichting van Kampen The Broere Charitable Foundation TS Tukker MH Vaandrager D Ven Wieringa Advocaten Wilde Ganzen FR de Winter Zuijderduijn Media Zusters Ursulinen van St. Salvator And more than 30,000 private donors AMREF in South Africa AECI, Spain AMREF in France AMREF in the Netherlands Centres for Disease Control (CDC) DFID EU in South Africa MAC Canada National Department of Health, South Africa PEPFAR AMREF in Spain Public: Agencia Española de Cooperación Internacional para el Desarrollo (AECID) Junta de Castilla y León Generalitat Valenciana Comunidad de Madrid Ayuntamiento de Madrid Agència Catalana de Cooperació al Desenvolupament Junta de Castilla-La Mancha Private: Fundación ACS Endesa Ferrovial Sermepa S.A. (Servired, s.c.) Grupo Redislogar El Corte Inglés RENFE AENA Renta Corporación Ramón & Cajal Abogados San Juan & Yela Abogados Concepto Staff NET2U RCR Films Bankinter BCN-Godia S.L. INDRA L Oréal Día SA Reebok Sports Club Obra Social de Caja Castilla La Mancha La Casa Encendida Obra Social Caja Madrid Globomedia In-Store Media SANCA Riocampo Media AMREF in Sweden Confederation of Swedish Churches Erik Söderberg Esq IBM staff association Kaupthing Bank Partner Print AB Swedish Broadcasting Corp. Swedish International Development Cooperation (Sida) The Bonnier Group Treehouse Communication Design Nordax Finans Roger Olsson Esq Ms Emma Nygren Fazer Amica AB Nina and Gunnar Lagergren Örtofta Scout Corps Strömma Kanalbolag AMREF in Tanzania American School and Hospitals Abroad (ASHA) Castila & Leone Council Centres for Disease Control and Prevention (CDC) CIDA - Canada Department For International Development (DFID) Direct Relief International Family Health International Farm Access International Geita Gold Mine (Anglo Gold Ashanti) Global Rubber Company International Development Agency (Ministry of Foreign Affairs, Spain) Irish Aid Madrid Regional Government, Spain North Mara Gold Mine (Barrick) Royal Dutch Government Royal Netherlands Embassy (RNE) Stanley Mining Service Ltd The Bush Hospital Foundation The European Union The Ferrovial Company, Spain The Global Fund to Fight AIDS, Tuberculosis and Malaria The Health Foundation The International Federation of Gynaecology and Obstetrics (FIGO) UNFPA USAID AMREF in Uganda A&E Education Trust AMREF in Canada AMREF in France AMREF in Italy AMREF in Netherlands AMREF in Spain AMREF in Sweden AMREF in UK AMREF in USA Astra Zeneca Athletes for Africa /Guluwalk Austrian Aid AVIS Ayuntamiento de Madrid Azimut Banca UCB Barclays 53

55 Betterway Foundation Capp Plast Caro Macdonald &Mark McCain CAW Social Justice Fund Centres for Disease Control Cesare Cusan CIDA DFID Dipharma Estate of Erika Leu European Union Federazione Motociclistica Italiana Fondazione Zegna Foundation Zonnige Jeugd Foundation Anton Jurgens Foundation Vonk Futuritalia Gd Spa Generalitat Valenciana GlaxoSmithKline Guardian News and Media Ltd Health Foundation Irish Aid Jersey Overseas Aid Commission Lundin for Africa Foundation McKnight foundation McLean Foundation Merck & Company, Inc Metero MMS Mondadori Ontario Secondary Schools Teacher s Federation International Assistance Programme 3 Oto Research PFIZER Plan Netherlands Planetarium Provincia Milano Raffaella Cuccia Regione Lombardia RENFE Rosslyn Swanson Rufford Maurice Laing Foundation Stephen Lewis Foundation Tessilform The K M Hunter Charitable Foundation UNFPA Venere Wolfson College, Oxford University AMREF in UK A&E Education Trust Accenture Allan & Nesta Ferguson Charitable Trust AstraZeneca Band Aid Charitable Trust Barclays Big Lottery Fund The Chalker Foundation for Africa Department for International Development Diageo Dulverton Trust Direct Relief International European Commission FIGO GlaxoSmithKline Guardian News & Media Guernsey Overseas Aid Committee Headley Trust Isle of Man Overseas Aid Committee Jersey Overseas Aid Commission John Ellerman Foundation Rowan Charitable Trust Rufford Maurice Laing Foundation Somerset Local Medical Benevolent Fund UBS Optimus Foundation UBS Investment Bank An anonymous corporate donor Wolfson College AMREF in USA AJA Charitable Fund The Allergan Foundation Anonymous The Louis Auer Foundation Ned W and Jean Bandler BP Foundation, Inc Bradley-Turner Foundation, Inc Bridgewood Fieldwater Foundation Centres for Disease Control and Prevention The CORE Group The Joanne and John Dalle Pezze Foundation Miriam and Peter Daneker Doris Duke Charitable Foundation Mary Cooney and Edward Essl Foundation, Inc Fifth Avenue Presbyterian Church Jill and Charles Garner The Glastenbury Foundation Global Impact Global Water Challenge The Richard and Rhoda Goldman Fund Peter S Goldstein Google Grants Christine Grogan Mr and Mrs Michael Hecht Ibrahim el-hefni Technical Training Foundation The Izumi Foundation Johnson & Johnson Joseph and Sally Handleman Charitable Foundation Trust Ted Leonsis Susan and Robert Lilley Luz and William H MacArthur Anna McDonnell The McKnight Foundation Medical Care Development International Melamed International, Inc Merck & Co, Inc Elliott J Millenson Network for Good Newman s Own The Nielsen Company Pfizer, Inc The Jay and Rose Phillips Family Foundation Mary Jane Potter Premiere Land Services Nan and Tom Rees Re-Imagine Kenya Miriam M Rosenn Mark Schaffer The Smile Train The Sopris Foundation Brian W Spitzer Ted and Vada Stanley Foundation The Starr Foundation United States Agency for International Development United Way USAID - American Schools and Hospitals Abroad Timothy S Wilson 54

56 AMREF would like to recognise the generous support of Swedish International Development Agency Canadian International Development Agency

57

58