Celebrating African Motherhood - Amref

Celebrating African Motherhood
Annual Report 2009
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BEADS
“The beads represent the vibrant networks of empowered people and communities that
contribute to health care and strong health systems forming a beautiful chain of interactions
that create a tour de force of AMREF’s work in Africa.”

Strong woman, with weathered skin
Skin crackled from life’s hard demands,
She’s grown tough skin through the years
She’s left no time or room for fears
With all the hardships she’s been through,
She should be looking sad and blue.
Yet she smiles on and holds her head high,
With fi ery ambition fl ickering in her eyes.
Warrior woman, with mysterious ways,
Her magic and strength help me get through hard days.
And in times when I’m drowning in my own tears,
A touch from her hand makes it all disappear.
My mother is a fi ghter, who never gives in,
Both for me and herself she’s determined to win.
She’s my hero, my shelter, my best friend forever.
There’s no mountain too high as long as we’re together.
To a child, her mother is the most beautiful woman in the world.
Kirsten R Vinyeta
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CONTENTS
6 Messages from the Chair & Director General
11 AMREF Background
14 2009 Overview
30 Case Studies
56 National Offi ces
64 Financial Report
67 Senior Management Team
70 Contacts
74 Donors
79 Credits
... Strong woman, with weathered skin ...
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FROM THE CHAIRMAN
Dr Pascoal Mocumbi
With the world reeling from the eff ects and uncertainty of the global economic
crisis, AMREF approached the last year with caution. The global community was
experiencing a crisis of a magnitude not experienced in probably over 40 years.
In sub-Saharan Africa, the impact of the fi nancial crisis, coupled with prolonged
drought and increasing demands on dwindling government resources, meant that
the communities where AMREF works needed our interventions more than ever.
Right now indications are that the global economy may be slowly emerging from the
crunch of the last 18 months, but uncertainty still looms.
In spite of these major fi nancial challenges, AMREF managed to maintain our
programme portfolio at the same levels as previous years and even in some countries
increased our work. This was no mean feat. I have to thank our supporters, partners,
donors, governments and staff for their unwavering dedication under extremely
diffi cult circumstances. Through you, the communities AMREF works with continued
to get much needed support in the pursuit of better health. On their behalf, I would
like to say thank you and urge you to continue investing in and believing in AMREF
as we work to improve health amongst Africa’s most disadvantaged. Looking
forward, AMREF’s board and management will continue to plan with caution while
monitoring global developments. We will also strive to develop more ways to ensure
that every dollar makes a bigger diff erence and goes a longer way as we work
towards a healthier Africa.
In the year 2001, world leaders came together and agreed on a set of goals to spur
development and ensure equity and the rights of all citizens of the world. These eight
‘Millennium Development Goals’ (MDGs), targeting the most disadvantaged people
in the world, were to be achieved by 2015.
AMREF recognises that going by current trends, sub-Saharan Africa will not meet
that deadline. Specifi cally, MDGs 4 and 5 (to reduce child and maternal mortality
and morbidity respectively) are where least progress has been made. For instance,
one in 16 women is at risk of dying from pregnancy- and childbirth-related causes in
sub-Saharan Africa, compared with one in 30,000 in northern Europe. This remains
the largest health inequality in the world.
While global, regional and national policies to improve Maternal, Neonatal and
Child Health (MNCH) exist, the deaths of mothers and children in Africa remain
unacceptably high. Progress has been hampered by poor policy implementation and
weak health systems, which do not engage with or respond to community needs.
This has led to poor access to and use of preventive and curative health services.
Furthermore, issues such as gender inequalities curtail women’s ability to make
decisions about their own reproductive health. Gender-based violence, including
female genital mutilation, is high in many areas. Lack of access to health information
on family planning, birth preparedness and early identifi cation of birth complications
results in tragic endings, particularly for young mothers. Indirect costs of care such
as transport, poor infrastructure and lack of communication, combined with these
fragile health systems, pose additional barriers to accessing health care.
Over the next fi ve years, AMREF will resolutely play its role in order to address the
issues of women’s and children’s health. We intend to focus on improving maternal
and reproductive health services – from pre-conception through delivery to the
post-natal stage (family planning and reproductive health, ante-natal care, delivery
and post-natal care). Through its projects, AMREF will aim to increase the proportion
of women who have a skilled attendant at birth and the proportion of women who
access post natal care, a critically neglected area. By improving referral mechanisms
where we work, we shall be supporting the global eff ort of making sure that health
systems deliver for mothers and children. AMREF will also focus on mobilising
communities in order to sensitise parents, elders and health workers to the needs of
adolescents related to sexual and reproductive rights. Greater awareness will in the
short and longer term reduce the number of child mothers in Africa.
Children under fi ve will also benefi t from improved preventive and curative health
care, starting with access to Community Health Workers able to treat basic illnesses
close to their families, to trained health workers in their nearest health facility.
As I conclude and as we look ahead towards the coming years, I would like to
challenge you and me to raise our voices and take action. We must not stand aside as
the great tragedy facing African mothers and their babies unfolds before our eyes. I
urge you to join AMREF and let us ‘Stand Up for African Mothers’.
The year 2010 marks a change of leadership at AMREF. Dr Michael Smalley, who
has served as Director General for the past eight years, will be completing his term.
Under his stewardship, AMREF has achieved remarkable growth in terms of portfolio
and programmes. Michael has also dedicated himself to driving AMREF to continue
embracing communities as an important block within health systems, whilst taking
the voice of Africa’s most disadvantaged communities to major global platforms such
as the Blair Commission for Africa and the World Economic Forum. He has provided
great and committed service to AMREF and Africa.
I want to thank Michael for his hard work and dedication. I wish him and his family
all the best for the future.

FROM THE DIRECTOR GENERAL
Dr Michael Smalley
In Africa, motherhood is one the riskiest and potentially the most traumatic ventures
that a woman can undertake. It is a painful paradox that the birth of a baby, which
in other parts of the world is an uncomplicated and joyful occasion, too often brings
heartbreak and agony for African families. Every year, 280,000 women on the
continent lose their lives in pregnancy and childbirth, a crisis of enormous proportions
yet it receives too little attention and only half-hearted attempts to correct it.
The fi fth of the UN’s Millennium Development Goals – to reduce the deaths of
mothers by three-quarters by the year 2015 – is far from being achieved in Africa;
in some places the situation is getting worse. Although women are the purveyors
and nurturers of life, the carriers of water and producers of food, the caregivers when
family members are sick, they are treated as second-class citizens. They have few
opportunities to make their needs or preferences known, and little investment is
made in their health and wellbeing, either by their families or governments.
AMREF believes that it is of greatest urgency to address women’s health now. The
death of so many women in pregnancy and childbirth is a clear indicator that all is
not well with the health system in many African countries. Our Corporate Strategy
focuses attention on the urgent need to improve maternal health by giving girls and
women the knowledge to make informed choices about their health and sexuality;
by improving access to family planning, ante-natal and emergency obstetric services;
and by encouraging the support of their families and communities. AMREF has
already done a great deal to help African mothers in the last 52 years, but there is so
much more to be done.
For the next fi ve years, AMREF has made a conscious decision to channel more energy
and resources into reducing the deaths of mothers and children in sub-Saharan Africa.
We will bring their plight to the fore and speak about the issues. We will raise funds
for projects that promote the health of mothers and children at the community level
and improve their access to services. We will advocate for governments and donors
to put more money in training community health workers, nurses and midwives and
improving the delivery of health services to mothers and children.
As we work, we continue to seek solutions that are suitable for Africa, and to share
the knowledge that we generate with governments and development partners. This
Annual Report brings you examples of the innovative ways that AMREF has found
to improve the health of mothers and children across Africa. The critical shortage of
health workers presents one of the biggest challenges to the delivery of eff ective
and suffi cient health care. In Southern Sudan, three National Health Institutes run by
AMREF are supplying multi-skilled workers to urban and rural health facilities, where
they are using their knowledge to save the lives of mothers and children.
While training formal health workers certainly improves the quality of health care
available in clinics and hospitals, AMREF believes that communities must be involved
in health care if they are truly to be part of the health system. Ignorance, distance
from health facilities and poverty isolate large numbers of people from the health
system. AMREF has found that it is also vitally important to train community-based
health workers to work and teach girls and pregnant women about good health, how
to treat simple illnesses, and the importance of antenatal care and delivery.
Half a million community health workers trained by AMREF provide a life-line,
literally, to remote and poor communities that have little access to eff ective health
care. Known as Health Extension Workers in Ethiopia, these community workers are
using this training to give knowledge about good health practices to their fellow
villagers. By taking ante-natal care home to pregnant women, they increase the
chances of mothers and babies surviving the often traumatic experience of childbirth.
In northern Uganda, Community Medicine Distributors treat fellow villagers for
malaria, the largest child killer in Africa and a major cause of anaemia in pregnant
women, in the fi rst critical 24 hours.
Empowering communities with knowledge gives them a chance to save future
generations. This is particularly so in the case of HIV, another major killer in Africa.
Nine of ten children living with the virus worldwide are in sub-Saharan Africa, 90
per cent of them having been infected by their mothers during pregnancy, birth or
breastfeeding. Community health workers trained by AMREF in Ruvuma, Southern
Tanzania, are reducing the number of babies born with HIV by encouraging pregnant
women in the villages to be tested for HIV so that they can protect their children
from infection. With treatment and proper nutrition, the women can live full lives and
continue caring for their families.
Sadly, though, thousands of children are having to navigate through life alone,
having been robbed of their parents by HIV. The numbers are overwhelming and,
without proper community and government structures, many are falling through the
cracks. In Limpopo, South Africa, AMREF is helping to weave a network of agencies
and departments to seal those cracks and give orphans as normal a life as possible.
AMREF is also seeking ways to lighten the load of mothers aff ected by HIV. Not only
are women and girls more vulnerable to infection than men, they are the primary
caregivers in their families and communities, even when they are physically and
economically weakened by the virus.
The vulnerability of girls and women to HIV is the consequence of harmful cultural
practices and beliefs. In Kenya, AMREF is engaging with young people in the
conservative Maasai community to reduce the impact of traditional practices that
jeopardise the health of girls and women. By protecting themselves from HIV and
delaying the age at which they marry and have children, the girls boost their chances
of surviving childbirth and raising healthy children.
All of the stories we share with you in this report are about real people overcoming
real issues. We urge you to join with AMREF and help us improve the health and
wellbeing of mothers and children across Africa.
After eight years with AMREF, it is time to hand over the reins to a new Director General.
It has been a privilege to work with colleagues in AMREF and our partners. Together
we have made a diff erence. Thank you for all your support and encouragement.
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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.

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AMREF BACKGROUND
...Skin crackled from life’s hard demands...

Why Maternal, Neonatal and Child Health?
“What women in the developed world take for granted –
skilled midwives, an obstetrician and operating theatre if
needed, and the antibiotics and drugs to ensure that should
complications arise, the mother is rapidly brought back to
good health – these apparently basic things, are regarded
as a great luxury in Africa.” Dr John Nduba, AMREF Director for
Sexual, Reproductive and Child Health.
A woman in Africa has a one in 16 chance of dying in childbirth,
compared with a woman in Europe who has a one in 30,000 chance of
dying during delivery. This is the biggest health inequality in the world
today.
In sub-Saharan Africa 280,000 mothers a year are dying for lack of
simple, aff ordable and reachable medical care. The most aff ected
women and children are in the most remote and poorest places in
the continent. As a result, nearly 1.5 million African children a year
are left without a mother because she dies trying to give birth to a
brother or sister. It also goes without saying that without a mother,
this newborn baby is 10 times more likely to die within the fi rst two
years of its life.
In many sub-Saharan African countries the maternal death rate
is unfortunately getting worse, and it is unlikely that Millennium
Development Goal 5 (reducing maternal deaths by 75 per-cent by
2015) will be achieved without urgent action.
The direct causes of maternal deaths are bleeding, infection,
obstructed labour, hypertensive disorders in pregnancy, and
complications of unsafe abortion. At least 20 per cent of the burden
of disease in children below the age of fi ve is related to poor maternal
health and nutrition, as well as quality of care at delivery and in the
post-delivery period.
HIV infection is also a threat. Mother-to-child transmission of HIV in
sub-Saharan Africa, where infection in adults is continuing to grow
or has stabilised at very high levels, continues to be a major problem,
with up to 45 per cent of HIV-infected mothers transmitting infection
to their children. Further, HIV is becoming a major cause of maternal
mortality in parts of Africa.
A majority of these deaths are preventable, being mainly due to
insuffi cient care during pregnancy and delivery. About 15 per cent of
pregnancies and childbirths need emergency obstetric care because
of complications that are diffi cult to predict.
Access to skilled care during pregnancy, childbirth and the fi rst month
after delivery is key to saving a mother’s life and that of her baby.
AMREF is a leader in giving direct help to mothers and newborn
babies, and we provide showcase solutions that are adopted by other
organisations and governments across Africa. Over the next fi ve years
we want to grow our services even further. As always our focus will
be on the people who need help most: mothers and families in the
places least served by health services – from people in neglected
urban slums to poor and remote rural communities.
It is estimated that 60 per cent of deaths in children under fi ve can be
prevented, most through community-based interventions. Therefore
the strengthening of community-based health workers and links to
health centres will continue to be an essential element of AMREF’s
activities.
Dr John Nduba sums up AMREF’s vision:
“I can see a future where every woman in Africa understands her body
and the choices she has; a future where she chooses when she wants
to have children, or even if she wants to have children; a future where
she receives care during her pregnancy and birth from a trained
professional, and a future where her r newb newborn is delivered healthy.
In that future her baby is immunised unised shortly aafter
birth and receives
treatment from a trained health worker if the bab
baby gets sick.”
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2009 OVERVIEW
... She’s grown tough skin through the years ...
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FLYING DOCTOR EMERGENCY SERVICE
AMREF’s Flying Doctor Emergency Service provides emergency
evacuation of patients from remote areas and air ambulance services
in East Africa (Kenya, Tanzania and Uganda) as well as Ethiopia,
Eritrea, Rwanda, Burundi, Somalia and the Democratic Republic of
Congo. Increasingly, coverage has extended over the past 10 years
to the whole of Africa, the Middle East, India, Europe and beyond.
The Service also provides medical escort on commercial carriers
worldwide.
Air Rescue Team Brings Medicine – and Hope
Poor maintenance of roads, reckless driving and ineff ective attempts
by Government to enforce traffi c laws and regulations combine to
make road accidents one of the leading causes of death in Kenya.
Public service vehicles, in particular, are often driven carelessly, with
many drivers on the road for long hours without adequate rest. The
reduction in concentration and the desire to cover ver as many miles as
possible in as short a time as possible can lead ead to recklessness, reckl and
therefore accidents.
One such accident happened on January nuary 19, 2009 near Makindu on
the Mombasa-Nairobi Highway, where a bus collided head-on with a
lorry, killing 24 bus passengers rs on the spot. The survivors were rushed
to Makindu District Hospital, al, most with severe injuries.
Shortly after midday, y, AMREF AMRE REF F Flying Doctor Emergency Service received
a distress call from m Dr Shabaan Saidi, the medical superintendent at
the Makindu Hospital. The hospital was overwhelmed by the number
of critically ill patients and medical supplies were almost exhausted.
Vital oxygen supply had run out by 10 o’clock that morning. They
needed help – urgently.
Dr Saidi had managed to give anti-tetanus shots and taken basic
x-rays of some of the patients. The hospital’s tiny stock of pain killers
had to be shared by those most in need. Six patients were severely
injured and needed advanced life support, for which the hospital was
not equipped.
It would take three AMREF air ambulances to transport the six
patients to Nairobi for the specialised care they needed. Medical
Director Dr Bettina Vadera asked the Kenya Police for a helicopter that
could accommodate more stretchers, and they readily off ered one.
The aircraft lifted off from Nairobi’s Wilson Airport at 3.40pm, carrying
three emergency fl ight nurses, two medical doctors (anaesthetists),
equipment – including oxygen cylinders and ventilators (life support
machines) – as well as medical supplies.
The team landed at the Makindu Airstrip 40 minutes later and was
transported by Makindu Police to the hospital. Dr Saidi met them at
the gate, where two patients had been placed in vehicles as there was
no space for them in the hospital. One was a woman with a bloodsoaked
bandage on her head. She had severe head injury, including
a fractured skull, and had diffi culty breathing. The AMREF team
immediately inserted a tube through her mouth to deliver oxygen to
the lungs; connected her to a ventilator and gave her medicine for
pain.
The patient in the other car was a man who was in a lot of pain from
an injured arm. He began to receive fl uids through an intravenous (IV)
line and was also given pain killers. Inside the hospital, every available
bed was full, and some patients were lying on the fl oor. One man
who was lying in the male ward, totally still and barely breathing,
was connected to a ventilator, put in a neck collar and given fl uids
int intravenously; another with severe head injury and multiple cuts on
his face
was given a neck collar, oxygen and hooked up to a ventilator;
while anothe another with a broken leg was given pain medication, IV fl uids
and oxygen. A you young boy sitting quietly in a corner was suspected to
have internal bleeding or organ damage and given pain killers and
IV fl uids.

In the female ward a woman with a deep cut on her head received
oxygen and IV fl uids, and was also connected on a ventilator. Even
though the AMREF team found many more patients who would have
benefi tted from being moved to Nairobi immediately, they had to
make the diffi cult decision to airlift only seven, which was all the
chopper could accommodate.
The Makindu Police transported the medics and patients to the
airstrip, and they were airborne at 6.40pm. On board, the patients
were continuously monitored to ensure that they were as comfortable
as possible. When they landed at the Wilson Airport at 7.30, three
AMREF Flying Doctor Service ambulances and another from the
Kenyatta National Referral Hospital were waiting to take the patients
to the hospital.
And thus, as a result of the hard work of the staff at the Makindu
Hospital, the generous cooperation of the Police Air Wing and Makindu
Police, the speedy response of AMREF’s Flying Doctor Service, and the
professional care of the fl ight staff , seven Kenyans had been set on a
road to recovery that they might never otherwise have taken.
Facts and Figures
• In 2009 AMREF Flying Doctors Emergency Service (FDES) evacuated a
total of 737 patients by Air and/or Ground Ambulance. These included
388 non-members, 256 registered AMREF FDES clients, 48 members
of the Flying Doctor s’ Society of Africa, and 45 free evacuations.
• A total of 748,541 miles were fl own on evacuation fl ights, a decrease of
19 per cent, refl ecting eff ects of the recession on all levels of travel.
AMREF IN ETHIOPIA
AMREF in Ethiopia was established in 2002 and is working in four parts
of the country – Addis Ababa, Afar, Oromia and the Southern Nations,
Nationalities, and People’s Region. In 2009, the country programme was
able to grow despite the challenging environment created by the global
fi nancial crisis. Newly funded projects are bigger than previous ones – they
have larger budgets and longer programme duration.
AMREF in Ethiopia was successfully re-registered as an international Non-
Governmental Organisation in Ethiopia as per the requirements of the new
Civil Society Organisation (CSO) legislation, passed in January 2009. New
grants were received from the European Union and the Department for
International Development (DfID) in partnership with AMREF in UK, and
from AECID through AMREF in Spain to improve the health of pastoralist
communities in Afar and South Omo.
The Programme successfully published a compilation of its annual
performance reports and a booklet comprising 20 abstracts. Two research
fi ndings from Ethiopia were published in AMREF’s case studies series.
Challenges
• Skyrocketing cost of living and infl ation, high cost of construction
materials for building health infrastructure such as health posts, and
weak capacity of the local market to deliver goods and services on time
• Drought and epidemics such as acute watery diarrhoea in our areas of
operation
• Uncertainty over impact of the new CSO Law on the operations of
NGOs in the country
Programme Growth
The Programme’s budget increased from US$5.3 million in 2008 to US$6.3
million in 2009.
Achievements
In the year 2009, AMREF in Ethiopia reached more than 1,550,000
benefi ciaries (500,000 directly and over 1.05 million indirectly). The direct
benefi ciaries included 68,149 mothers, 4,701 children, 76,641 in-and-out of
school youth, 2,530 volunteer mother coordinators, 3,744 volunteer homebased
caregivers, 50,613 community leaders, 107,000 trachoma patients,
and 1,737 health care professionals. AMREF constructed 13 new health
posts and equipped 17 others. These benefi ciaries have received training
or information on HIV, trachoma, polio, malaria and harmful traditional
practices; reproductive health issues, water and sanitation, and skills in
income generation.
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AMREF has supported the formal training of over 200 Health Extension
Workers (HEW), and renovated two institutions to improve their capacity to
train HEWs. The offi ce acquired 121 motorbikes, constructed 18 communal
latrines and a maternity waiting block, all aimed at strengthening the
health system, particularly in pastoralist areas.
AMREF IN KENYA
AMREF has been working in Kenya since 1957. Its programmes cover over
100 districts in the country to address diverse health needs including HIV/
AIDS, maternal, adolescent and child health, water, sanitation, hygiene
and the clinical outreach surgical services. It is the largest and oldest of all
country programmes.
One of the highlights of 2009 was the visit of the President of
GlaxoSmithKline (GSK), Mr Andrew Witty, to the Personal Hygiene and
Sanitation Education (Phase) project in Kibera on July 14, 2009. Mr Witty
was accompanied the company’s Eastern Africa Managing Director, John
Musunga, and a team from the GSK UK. The Kibera Phase project is funded
by GSK with a budget of US$530,000 for a period of three years.
In November, AMREF hosted the second International Society of Obstetric
Fistula Surgeons Congress in Nairobi. A total of 307 participants from 31
countries attended the three-day conference, themed ‘Strengthening
Health Care Delivery Systems towards Elimination of Obstetric Fistula’.
New Funding
• Maanisha received additional funding from Sida to the tune of 30
million Swedish Kroner (US$3.5 million) for a period of two years,
which has gone into expansion of the programme
• Kibera Community Initiatives Project received new funding of Euro
650,000 from the European Commission to be used over three years
(Feb 2009- 2012)
• AMREF received US$700,000 for the 2009/10 period from the US
Centres for Disease Control and Prevention (CDC) to support the
activities of the National AIDS Control Council and the National AIDS/
STI Control Programme for the next fi ve years.
• AMREF in the Netherlands and VvAA (the leading Dutch fi nancial
service provider for health care professionals) are funding the scaleup
of Community-Based Health Management Information Systems in
four districts with a budget of Euro 480,000 for three years.
New Projects
• ‘Putting African Mothers and Children First’ Lamu project under the
Child and Reproductive Health Programme. This is a four-year project
funded by the European Union.
• Strengthening Community Capacity for improved maternal, new and
child health in hard-to-reach areas. The project is funded by the EU for
three years.
• Strengthening HIV monitoring and evaluation activities in Kenya. The
fi ve -year project is funded by CDC to the tune of US$5million.
AMREF formed an Ethics and Scientifi c Review Committee, with the
approval of the National Council for Science and Technology, to handle
ethical issues arising from increased research undertakings by the
foundation. The committee is responsible for ensuring that all research
and evaluation involving human subjects conducted by AMREF staff and its
strategic partners conforms to the highest ethical and scientifi c standards.
The formation of the Committee is expected to give momentum to research
in AMREF in Kenya, putting the organisation at the helm of health research
in the country. The committee has reviewed 10 research proposals so far.
The 12-member committee is chaired by the Deputy Country Director of
AMREF in Kenya, Dr Festus Ilako.
The Kenya programme budget grew by nearly 35 per cent over the previous
fi n a n c i a l ye a r.
AMREF IN SOUTHERN SUDAN
AMREF has been working in Southern Sudan since the civil war of the
1980s. As a full-fl edged country programme, AMREF in Southern Sudan
has been in existence since June 2009, the most recent of all AMREF country
programmes. Before that, the organisation’s Southern Sudan operations
were managed from the Headquarters in Nairobi.
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AMREF has been supporting the Government of Southern Sudan’s (GOSS)
Ministry of Health in the development of human resources for health and
therefore fi lling the huge gap created by decades of civil war. The GOSS
Ministry of Health values AMREF’s high technical competence and has
contracted the organisation to manage three National Health Training
Institutes: in Maridi (clinical offi cers and community midwives), in Lui
(community midwives) and in Juba (public and environmental health
offi cers).
In November 2009, a total of 96 Clinical Offi cers and 34 Community
Midwives graduated at a joint ceremony held in Maridi. The guest of honour
was the Minister for Social Development in West Equatoria State, HE Grace
Datiro. AMREF was represented by Deputy Director General Dr Florence
Muli-Musiime, Director for Capacity Building Dr Peter Ngatia, and Director
for Communications Bob Kioko. The event was also attended by Liz Wood,
daughter of AMREF pioneer, the late Prof Chris Wood; she commissioned
a building in her father’s memory. Prof Wood was key in establishing
AMREF’s training programme in Southern Sudan.
New Projects
• ‘Putting African Mothers and Children First’ Project in Terekeka County,
Central Equatoria State, part of a regional project covering Southern
Sudan, Kenya and Tanzania, will receive funding of US$1.2 million
over four years from the European Commission and AMREF in the
Netherlands.
• Primary Health Care and Water and Sanitation project in Rejaf, Juba
County, Central Equatoria State, funded by AECID via AMREF in Spain
for US$780,013 over two years
Challenges
• Insecurity due to inter-tribal clashes in rural areas continues to be a big
challenge to the proper running of AMREF’s fi eld activities
• High cost of fi eld operations due to poor road infrastructure and high
cost of living
• Possible outbreak of violence during the forthcoming elections in
April 2010 and the referendum in January 2011 could severely curtail
AMREF’s operations
Programme Growth
During the fi nancial year 2008/2009, expenditure fell by 34 per cent over
the previous fi nancial year due to two factors. First, funds expected in 2009
from the World Bank and the Government of Southern Sudan under the
Multi-Donor Trust Fund did not materialise. Secondly, two projects funded
by AECID via AMREF in Spain came to an end.
AMREF IN TANZANIA
AMREF in Tanzania was established 22 years ago as an autonomous Country
Programme. Prior to that, AMREF’s Tanzania offi ce had been run since 1957
directly from Headquarters in Nairobi, Kenya. AMREF’s engagement in
health in Tanzania has been evolutional, growing from service provision
into a platform for empowering communities, and supporting the
Government to identify and address community health needs.
AMREF in Tanzania launched and disseminated its strategic plan in February
2009 at an open house event at AMREF’s offi ces in Dar es Salaam. The Guest
of Honour at the ceremony was the Minister for Health and Social Welfare,
Prof David H Mwakyusa. The function was also attended by AMREF’s
Deputy Director General, Dr Florence Muli-Musiime.
Hon Mwakyusa noted that AMREF’s strategy is timely because its
direction has come at the right time, when the Government of Tanzania is
aggressively advocating for primary health development with improved
access and quality of health care services.
The launch brought together more than 100 AMREF partners, supporters
and friends of AMREF, including members of AMREF in Tanzania’s
Advisory Council, representatives from the Government of Tanzania, nongovernmental
organisations, diplomatic missions, embassies, communitybased
organisations and faith-based organisations.
April saw the launch of Angaza Zaidi (meaning ‘Shed more light’ in Swahili),
a fi ve-year counselling and testing programme funded by the American
people through the United States Agency for International Development
(USAID) as part of the President’s Emergency Plan for AIDS Relief. The
nation-wide initiative has an innovative decentralised structure that

eaches out to urban and a rural communities to provide HIV counselling and
testing, prevention oof
mother-to-child transmission, post-test associations
and referrals to oth other care and treatment facilities.
The launch nch was w
offi ciated by the President of the United Republic of
Tanzania, Hon Jakaya Mrisho Kikwete, at Mnazi Mmoja Grounds in Dar
es Salaam. Other guests included Health and Social Welfare Minister Prof
Mwakyusa, AMREF Deputy Director General Dr Muli-Musiime and the
Mission Director of USAID Tanzania, Mr Robert Cunnane.
Angaza Zaidi builds upon the successes of the Angaza programme and the
trusted Angaza brand, which has to date tested over 1.6 million people for
HIV through 60 counselling and testing centres.
Programme Growth
The Programme’s budget increased from US$17 million in 2008 to US$20
million in 2009.
AMREF IN UGANDA
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 engage in evidence-based advocacy to
infl uence policy and practice.
AMREF in Uganda and the District of Kabale in western Uganda held an
annual youth event in support of the Youth Empowerment Project in the
district. The event took place in March and was marked by educative drama
and music from the youth and speeches from district representatives. The
event also encouraged people to get tested for HIV and VCT services were
off ered at the venue: district local council offi ces.
In June 2009, a football tournament was held in Katine organised by
AMREF in partnership with the Guardian newspaper from the UK, COSSEDA
(a German organisation that seeks to build bridges between Europe and
Africa for economic development), the Soroti Rural Development Agency,
the Teso League Project and the Federation of Uganda Football Association.
The tournament was crowned with a duel between a local team and the
Uganda Cranes, the country’s national team. The Uganda cranes won the
match by scoring two goals to one.
In June, the Barclays Premier League trophy visited Soroti District and
Katine sub-County, courtesy of the AMREF Katine Community Partnership
project, to mark the launch of the Katine football tournament.
June 30 saw the commissioning of the Kyambogo School of Public Health in
Kampala. With fi nancial support from Irish Aid, AMREF built and furnished
two classrooms in the School, as well as a practical room, a dining hall
and kitchen, an administration block, a library and a computer room. In
addition, the college received a 30-seater bus, fi ve computers and four
microscopes. The increased capacity means that the college will now be
able to admit 30 students every year, up from 15. AMREF’s diploma course
in Community Health will also be taught at the college, increasing the
intake by another 30 students.
The President of GlaxoSmithKline (GSK), Mr Andrew Witty, visited Katine
in July and pledged support for AMREF and the project. A stakeholders and
donors’ conference was held in September following a mid-term review of
the project. And in November, Barclays CEO Mr John Varley and the editorin-chief
of the Guardian and Observer newspapers, Mr Alan Rusbridger,
visited the Katine project.
19

AMREF IN SOUTH AFRICA
AMREF started work in South Africa in the early 1990s. The establishment
of AMREF in South Africa country offi ce coincided with the election of the
fi rst democratic government in South Africa. In 1995, AMREF was offi cially
registered in South Africa as a Not-for-Profi t Organisation. From its small
beginnings, AMREF in South Africa has worked to assist in the development
of an effi cient, integrated health care system in the country based on
primary health care principles, gender equity and community participation,
and building on lessons learnt by AMREF in East Africa.
Achievements in 2009
In 2009, AMREF in South Africa continued to focus on strengthening the
capacity of the programme to deliver quality results.
• AMREF received funding for Maternal, Neonatal and Child Health
activities in South Africa. A new project on Child Survival project was
rolled out using lessons from the Kenya’s Busia Child Survival Project.
• AMREF in South Africa participated in the National Department of
Health and Social Development’s formulation of a Community Care
Givers Policy Framework, the only NGO involved in this important
process.
• AMREF and other PEPFAR partners working in Priority Health
Districts of the country took part in the South Africa PEPFAR Partner
Performance Assessment.
• AMREF translated the National Guide for Community Care Givers
on Integrated Management of Childhood illnesses into three local
languages – xiTsonga, Venda, and siPedi.
• A Mobile Phone project dubbed IMPILO – Life in Your Hands was
launched in partnership with HIV – 911 and CellLife to facilitate access
to information on available services using mobile phones.
• AMREF made a footprint in November at the Public Health Association
of South Africa 2009 Conference held in Durban by getting eight
abstracts accepted (three oral and fi ve posters presentations).
AMREF also had an exhibition booth at the conference showcasing
the work that the organisation is doing in Africa, and South Africa in
particular. The theme of the conference was ‘Millennium Development
Goals: Measuring Progress in Public Health in South Africa’. A strong
delegation of 10 AMREF staff from South Africa, Kenya Country Offi ce,
Headquarters and Tanzania attended the conference.
OUTREACH
AMREF’s Clinical Outreach Programme was established in 1957 to take
essential medical and surgical services to remote district level hospitals.
It is a regional programme covering Ethiopia, Kenya, Rwanda, Somalia,
Somaliland, Southern Sudan, Tanzania and Uganda. Every (few) weeks,
light AMREF aircraft make trips to diff erent ‘circuits’, dropping medical
specialists at hospitals along the route. The specialists are selected annually
depending based on requests from the hospitals and include general
surgeons, gynaecologists, reconstructive surgeons, medical engineers –
upto 23 areas of expertise.
The Outreach Programme operates in remote areas where communication
is poor and specialist medical and surgical services inaccessible. It has
expanded its role and now provides specialised health care and advice
to individual patients across eastern Africa. The programme also plays a
major role in building the skills and knowledge of health personnel: as they
work, the visiting specialists train local doctors and other hospital staff ,
building their capacity and paving the way for them to eventually perform
the tasks themselves. In this way, AMREF contributes to overall rural health
care development in eastern Africa. The Programme accommodates
surgeons in training, who accompany Specialists on outreach missions in
order to gain practical experience.
Over the past year, AMREF Outreach Programme covered 150 hospitals,
with specialists conducting 9,037 major operations, providing 32,189
21

22
consultations, making 1,779 joint ward rounds and facilitating a number
of training workshops. Several research topics were also carried out in
partnership with university teaching hospitals. The Outreach Programme
has only four surgeons on fulltime basis; the teaching hospitals provide
about 300 specialists as volunteers to the programme.
Safe Motherhood Project activities were piloted in 2009 in a total of 17
districts in East Africa (eight in Kenya, six in Uganda and three in Tanzania).
A Vesico Vaginal Fistula (VVF) centre of excellence has been established in
Kenya and others have been identifi ed in Uganda and Tanzania. AMREF
hosted a Regional Urology Conference attended by 19 participants
Programme Achievements
Category of Service
Provided
from seven countries. The conference was jointly funded by the Surgical
Outreach Programme and AMREF in USA.
The Clinical Outreach Programme is grateful to all donors, AMREF Country
Offi ces and National Offi ces, Ministries of Health, missions, university
teaching hospitals and the Governments of the region for their support.
Though the global economic recession aff ected partners’ contributions and
created some uncertainties within the fi nancial period, the Programme has
grown in budget, projects and activities over the previous years, with the
DANIDA-funded regional VVF/Safe Motherhood project being the latest
addition.
Specialist Outreach Surgical Outreach VVF& Safe Motherhood Leprosy/
Reconstructive
Outreach
Total Quantity of
Service Provided
Operations performed 5,673 534 1,012 1,818 9,037
Consultations provided 25,694 1,232 2,196 3,067 32,189
Joint ward
rounds
1,335 89 275 80 1,779
Number of doctors
trained
1,181 122 147 181 1,631
Number of nurses and
COs trained
3,784 398 488 528 5,198
Number of lab staff
trained
294 12 3 - 309
Number of support
staff trained
1,722 11 53 7 1,793
Hours of formal
training provided
1,629 78 146 101 1,954
Hours of informal
training provided
7,921 580 1,355 1,694 11,550
Number of hospitals
visited
87 35 30 60 150
Outreach fl ights made 171 12 14 - 197
Radio/radio
equipment repaired
60 - - - 60

HEADQUARTERS
Capacity Building
In 2007, AMREF launched a ten-year strategic plan focusing on ‘Enhancing
Capacity and Participation to close the Gap in Health Systems’. Consequently,
the Directorate of Capacity Building (DCB) was created as one of the three
core directorates of AMREF. The overall objective of DCB is to enhance the
organisational and technical capacity of health systems, communities
and civil society organisations so as to improve access and quality of care.
The directorate works with civil society organisations, communities and
Ministries of Health in Africa to build the capacity of health workers.
Basic and Post-Basic Training
• The Diploma in Community Health (DCH) Course was started in 1987 as
a partnership programme between AMREF and McMaster University
of Canada. The programme is accredited by Moi University in Kenya.
Since its onset, the programme has trained 531 students from 28
countries, including 23 students who graduated on December 2, 2009.
Out of the total of 531 students trained, 255 (48 per cent) are women
and 276 (52 per cent) men. These graduates are to be found at all levels
of the health system, leading and managing national health systems.
• AMREF has developed a Bachelor of Science degree course in
Community Health. The draft curriculum is undergoing review for
submission to the Senate of the Kenya Methodist University (KEMU)
for ratifi cation. The programme will be implemented jointly by AMREF
and KEMU.
• The second group of 44 students was admitted for AMREF’s two-year
Master’s degree in Public Health (MPH) course run in partnership with
Moi University. The fi rst batch of 27 students was admitted on January
28, 2008. Classes are held in the evenings at the AMREF International
Training Centre in Nairobi, Kenya.
Continuing Professional Development
• AMREF’s Short Courses are a response to the training needs of health
professionals in sub-Saharan Africa. The two- to four-week courses are
designed to meet the training needs and challenges of health workers
in their day-to-day work. In 2008/2009, a total of 876 participants
from 24 countries were trained, compared with 803 participants
from 28 countries in 2007/2008. The countries represented included
Afghanistan, Botswana, Burundi, Burkina Faso, Cameroon, Ethiopia,
Germany, Ghana, Italy, Kenya, Kyrgyzstan, Lesotho, Liberia, Malawi,
Nigeria, Rwanda, Sierra Leone, Somalia, South Africa, Sudan,
Seychelles, Tanzania and Zanzibar, Uganda and USA.
• 20 tailor-made courses were organised and conducted on consultancy
basis. These were mainly done in response to requests from
government agencies, NGOs and the private sector.
Distance Education Programme
AMREF pioneered the use of Distance Education in the 1980s to provide
continuing education to health workers in eastern Africa. The programme
has been popular mainly with health workers rural areas. In 2008/2009,
the programme enrolled 435 participants into its various courses. The
majority of students were from Kenya while the rest were from Somalia
and Southern Sudan.
eLearning Support Programme
• AMREF’S eLearning programme was started in September 2005.
The programme is a public-private partnership between the Nursing
Council of Kenya (NCK), AMREF, Accenture, the Kenya Medical Training
College and its constituent colleges, several private and faith-based
nursing schools and the Ministries of Health in Kenya. The programme
has so far enrolled 5,971 Kenyan nurses to be upgraded from certifi cate
(enrolled) level to diploma (registered) level. A replication strategy that
can be used to deploy eLearning across Africa has been developed and
is currently being applied in Uganda. A total of 32 nursing schools are
currently implementing eLearning across the country.
• AMREF’s Virtual Nursing School (AVNS) was launched in November
2006, with the fi rst intake of 50 students joining in March 2007. The
school was set up as a ‘laboratory’ to test how best to use eLearning
for providing quality nursing education in Kenya. As at September
23

24 2

2009, AVNS had enrolled 187 students. Of the 27 students from AVNS’s
inaugural class who sat for the NCK’s national examination in January
2009, 25 (93 per cent) passed. All 35 (100%) students who sat for the
exam in August 2009 passed.
AMREF Resource Centre
• AMREF’s Resource Centre is a clearing house for health information
and learning materials in sub-Saharan Africa. It maintains up-to-date
health information either in electronic or print form, mainly books
and journals. In 2008/9, the Resource Centre provided information
services to AMREF staff , health workers and the general public. Annual
subscription increased from 2,149 members in 2007/2008 to 2,379
members in 2008/2009, while monthly subscription increased by over
200 per cent, from 71 members to 228 members.
• The Resource Centre joined the Africa Water Information Service
(AWIS), a web-based platform, as one of 10 sub-regional hubs. The
main objective of the AWIS project is to enable sharing of information
and knowledge in water and sanitation. The Resource Centre is
involved with identifying and uploading the most current water and
sanitation knowledge and information into the AWIS portal. This is
a good opportunity for AMREF to share experiences and knowledge
gained from its water and sanitation projects.
Antiretroviral Therapy (ART) Knowledge Hub
The East and Southern African Knowledge Hubs Network (ESA KH) brings
together knowledge hubs from Uganda, Kenya, Sudan and South Africa.
Its aim is to develop regional centres of excellence in HIV/AIDS training,
research and technical assistance. In 2009, the network received grants
from the German BACKUP Initiative through Health Focus GmbH to
implement various activities. As the interim secretariat and treasurer of the
ESA Knowledge Hubs network, the ART Knowledge Hub was involved in
several activities:
• The ART Knowledge Hub was involved in the writing and presentation
of a paper titled ‘Learning on the Run: Leveraging the e-Learning
Model to Scale up the Capacity Building of Health Workers Providing
HIV/AIDS HIV
Services’, which was presented at the ESA Knowledge Hubs
Network regional meeting in June in Kigali, Rwanda Conference.
The Hub participated in the African Knowledge Hubs Conference in
Durban, South Africa, in July and presented a paper entitled ‘Evaluating
Training Programmes: The AMREF Experience’.
• The hub set up an ART information desk which is situated at the AMREF
resource centre. It provides real time information response to the
Resource centre users with inquiries on HIV and AIDS and conducted
literature searches for at least 450-500 library users every week.
Advocacy and Policy Infl uencing
AMREF sits on three global and regional Human Resources for Health (HRH)
committees: the Global Health Workforce Alliance (GHWA), the African HRH
Observatory and the African Platform on HRH. Furthermore, AMREF hosts
and chairs the African Leadership and Management Network.
Future Plans
The Directorate’s Vision 2020 envisions an evolution of the AMREF Training
Centre to AMREF International College and subsequently to AMREF
International University.
Health Policy and Systems Research
The Directorate of Health Policy and Systems Research was formed in
2007 as one of three core directorates in line with AMREF’s 2007-2017
strategy. The directorate’s strategic objectives are to infl uence policy and
practice using evidence and lessons learned, and knowledge management
for generating, organising, and sharing of health policy and systems
knowledge.
Core Research
In 2009, the Directorate championed the production of case studies
on AMREF’s programmes and project. Two series with a total of seven
case studies were published and a new series of Discussion Papers was
launched with the publication of two papers: ‘Impact Assessment of
25

26
Health Interventions by AMREF in Kajiado District, Kenya’; and ‘Effi cacy of
Community-based Health Care in Kenya: Evaluation of AMREF’s 30 Years in
Kibwezi’.
Institutional Capacity Building
• The Directorate continued building research capacities for AMREF
staff , both in the directorate and in the diff erent AMREF Country
Programmes. The main activities focused on conceptualisation of
research problems, development of research questions, development
of research methodology, as well as preparation of case studies and
discussion papers.
• The Directorate has been involved in the teaching and supervision of
students in AMREF’s Diploma in Community Health and Master’s in
Public Health courses. The Directorate also participated in preparation
of the curriculum for the proposed BSc in Community Health course.
• AMREF worked together with other civil society groups at the G8
2009 Conference to ensure that the critical issue of strengthening
Human Resources for Health in Africa was discussed at the meeting.
A publication in the G8 newsletter on ‘Crippling Global Health Worker
Shortage’ was developed in collaboration with the Health Workforce
Advocacy Initiative (HWAI).
At the same time, a briefi ng note to the G8 health expert group titled
‘The role of mid-level and community health workers: A systemic
approach to task shifting’ was developed in collaboration with HWAI.
• The Directorate’s research initiatives have enlisted collaboration with
Moi University (Kenya), Makerere University (Uganda), Kenyatta
University (Kenya) and University of Nairobi (Kenya).
Health Learning Materials
AMREF’s Health Learning Materials unit contributes to health development,
improved service provision in general and to training of health workers in
particular, through production of a broad range of up-to-date learning and
teaching materials, periodicals and manuals. These are targeted at clinical
offi cers, medical assistants, nurses and midwives, laboratory technicians,
public health offi cers and other frontline health workers in developing
countries.
In 2009, the unit published several publications including ‘Training Health
Care Professionals’; ‘Community Health (3rd edition)’; and the second
edition of the ‘Procedure Manual for Nurses and Midwives’.
Community Partnering
The Directorate of Community Partnering at AMREF is grounded on
the premise that for health systems to meet the needs of the poor, they
must be centred on people and communities. The Directorate’s objective
is to harness community resources to improve health service delivery and
to create grassroots movements and organisations which ensure that
communities are an integral part of health systems that are responsive to
their needs. It supports fi eld programmes in the various countries where
AMREF works through creation of tools, skills development and provision
of technical support.
Gender Mainstreaming
Gender is now largely mainstreamed in projects in the Country
Programmes, with tools for appraisal of individual activities, data collection
and analysis for reporting, and for monitoring and evaluation. Close to 400
AMREF staff have now been trained on gender, and have begun to pass on
the lessons to the partners on the ground.
Sexual Reproduction and Child Health
The Directorate is progressively introducing a regional approach to
programme development and management, which creates greater
opportunities for research and cross-border learning and sharing of
lessons for more eff ective solving of community health problems. The
regional Nomadic Youth Reproductive Health programme that is being
implemented in Kenya, Ethiopia and Tanzania is carrying out major
research that will lead to greater understanding of nomadic health issues
and models for service delivery in nomadic settings. Collaboration with
the Royal Tropical Institute of the Netherlands is helping build the research
skills of the 30 staff members involved, something that is catalysing greater
interest in operations research in other projects in the country programmes.

An exciting new regional Maternal, Neonatal and Child Health Project,
funded by the EU and to be implemented in Kenya, Southern Sudan and
Tanzania, was approved for funding in November 2009 and launched in Dar
es Salaam in January 2010. The objective of the project is to strengthen the
capacity of health services to provide high quality services to mothers and
children in the communities; build community knowledge and capacity
to tackle maternal and child health issues; increase use of skilled delivery
services at health centres; and to generate knowledge and lessons that can
be disseminated to accelerate progress towards achievement of MDGs 4
and 5. An advocacy component for which funding is being sought has been
developed to further support lesson learning and dissemination in this and
other similar initiatives.
Advocacy
• AMREF was integral to the formation of the White Ribbon Alliance
for Safe Motherhood, Kenya Chapter. The fi rst meeting of the alliance
was supported by the Directorate of Community Partnering, with
funding from AMREF in the Netherlands. The White Ribbon Alliance
for Safe Motherhood is an international coalition of organisations
and individuals whose goal is to help ensure that safe pregnancy and
childbirth are an attainable priority for all mothers and their newborns.
• Internal advocacy resulted in adoption of MNCH as a target programme
for unrestricted fundraising across the organisation, and one of the key
three pillars in the draft organisational advocacy strategy
• A study on the need for policy review to support advocacy on female
genital cutting was completed in Ethiopia through the regional
Nomadic Youth Reproductive Health Programme
• A baseline survey for the Makhudumanga District Child Survival
Project in Limpopo Province gave a solid start to future research in
this important fi eld, expected to generate important evidence for
advocacy on child health issues.
Coalition Building
The Dutch Ministry of Foreign Aff airs, which funds the Nomadic Youth
Reproductive Health Programme through AMREF in the Netherlands ,
requested situation context analyses in benefi ciary countries to be carried
by Dutch coalitions of NGOs with their southern partners, within the new
approach of the Ministry to fund coalitions rather than single NGOs. AMREF
is the lead agency in the sexual reproductive health and rights (SRHR) and
water, sanitation and hygiene – WASH - (new funding area) coalitions
in East Africa (excluding Uganda where WFP leads). The directorate has
worked with AMREF in the Netherlands to organise consultations with
a wide variety of partners in both SRHR and WASH. This has presented
a unique opportunity to interact with similar minded but also diff erent
advocacy organisations that will create powerful networks for advocacy
and greater infl uence in the region, not to mention additional resources in
these programme areas in the coming programming year.
27

CASE STUDIES
...She’s left no time or room for fears ....
29

SOUTHERN SUDAN
Training of Clinical Offi cers, Maridi National Health Training
Institute
Two decades of civil war in Southern Sudan, from 1983 to 2005, resulted
in a tattered health system, a critical health worker shortage and some
of the worst health indicators in the world. AMREF began training clinical
offi cers in Southern Sudan during the war. Though the training was
disrupted during the fi ghting, AMREF continued to train clinical offi cers
and community midwives in Sudan People’s Liberation Army (SPLA)
controlled areas.
Following the signing of the Comprehensive Peace Agreement that granted
Southern Sudan semi-autonomy in 2005, AMREF, at the request of the
Government of Southern Sudan, developed standardised curricula for the
training of community midwives, clinical offi cers, nurses and community
health workers. The standardisation has helped the government to
harmonise its training system.
Clinical Offi cers and other health personnel trained by AMREF, including
public health and environmental offi cers, community midwives and
nurses, are helping the Government of Southern Sudan to move towards
its goal of taking good quality health care to its people so that they can be
healthier and more productive.
The Maridi NHTI is a government institute supported by AMREF, the
only one that trains clinical offi cers in Southern Sudan. Clinical offi cers,
previously known as medical assistants, are a cadre of middle-level health
professionals, falling between physicians and nurses. They are trained to do
70 per cent of the work that physicians do, including preventive, curative,
promotive and emergency health services using the primary health care
approach.
Since its inception in 1998, 269 clinical offi cers (219 male and 50 female)
have graduated from the Maridi NHTI – approximately 75 per cent of the
total working in Southern Sudan. The institute produces about 40 clinical
offi cers annually and has a total student enrolment of 133 students in the
three-year programme. This however, is a drop in the ocean, considering
the country’s estimated need of 1,066 clinical offi cers. With the current
output, and assuming there is no other source of trained clinical offi cers, it
would take over 20 years to fi ll this gap.
The three-year course prepares students to develop critical thinking,
clinical reasoning and problem-solving skills in managing patients and
providing services at diff erent levels of the health delivery system. With the
dire shortage of health workers in Southern Sudan, the graduates of the
Maridi Institute are playing a critical role in bridging the health care gap. In
a country with only 39 doctors, they are considered by the communities as
‘the doctors of Southern Sudan.’
FACTS AND FIGURES
• Sothern Sudan has a maternal mortality rate of 2056 per
100,000 mothers
• 250 of every 1000 children in Southern Sudan die before
their fi fth birthday.
• A clinical offi cer attends to an average of 80 patients every
day
• Since 2008, AMREF has 76 community midwives, 46 at the
Maridi NHTI and 30 at the Lui NHTI
• On average, a community midwife attends to 20 women
every week for ante-natal care and delivery
• Southern Sudan requires an additional 2,000 community
midwives and 1,070 clinical offi cers to meet the health
needs of communities
• It costs US$13,500 to train a clinical offi cer for three years
• It costs US$6,500 to train a community midwife for 18
months
DONORS
• AMREF in Italy
• AMREF in Germany
• AMREF in the USA
• Direct Relief International (UK)
• USAID through American Schools and Hospitals Abroad
(ASHA)
31 3

32
Fighting a New Enemy
By nine o’clock every morning, the Outpatient’s Department of Juba’s
Military Hospital is teeming with patients. The largest health facility in the
Southern Sudanese capital, the 110-bed hospital serves soldiers and their
families, but is also open to civilians. Just recovering from a 21-year-old
civil war, more than half of the country’s population was or still is in the
military. Every day, over 100 patients are seen at the hospital’s Outpatients
Department, most of them children.
On a hot November morning, Clinical Offi cer Peter Kuol is on duty in one of
the two consultation rooms, each of which is manned by two medics. Many
of the men and women in the waiting room are in military uniform, most of
them accompanied by children. A mother brings in a fi ve-year-old boy with
a swollen face. He has a fever and no appetite, she says. After examining the
child and ascertaining his vaccination history, Kuol prescribes a painkiller
and plenty of rest. He suspects mumps and asks them to return if the
symptoms have not gone after three days.
The next patient is a nine-year-old boy who has a headache, cough and
nausea. He has been ill for three days, but his mother was too busy to bring
him to hospital earlier. Kuol sends him to the laboratory to be tested for
malaria and typhoid.
“Both diseases could easily kill a child. Seventy per cent of the patients we
see are children. You see, their immunity is not as strong as that of adults;
they are also care-free and prone to illness and injury – dirt easily fi nds
its way into their mouths, and they get hurt as they play. Children are the
future of this country so we have to do our best to care for them.”
Himself a member of the Sudanese People’s Liberation Army, Sgt Kuol is a
graduate of the National Health Training Institute in Maridi, where AMREF
has been training clinical offi cers since 1998. The Institute’s comprehensive
three-year course prepares students to manage patients and provide
services at diff erent levels of the health delivery system. Courses range
from anatomy, paediatrics and pathology to obstetrics, gynaecology and
psychology. The students also learn public health care, nursing care and
surgical procedures.
Says Kuol: “The courses I took in Maridi gave me knowledge and skills to
handle a wide range of diseases and illnesses. Because Southern Sudan has

very few health centres and heath workers, many people go to traditional
healers when they fall ill. There is a lot of ignorance. People come to hospital
only when their conditions are at an advanced stage”
As the queue of patients begins to taper in the early afternoon, Kuol heads
for the Gynaecology Ward, which hosts sick pregnant women. At the door
of the ward, a woman who is clearly in pain is being brought in by a group
of worried relatives. Kuol directs them to a bed behind a screen and quickly
dons a pair of gloves to examine her. He orders laboratory tests. “The most
common reasons for admission here are malaria, pelvic infl ammatory
diseases, urinary tract infections, bleeding, abortions, and abdominal pain,
mostly caused by sexually transmitted infections. Sick mothers who are
over fi ve months pregnant are admitted in the maternity ward.”
“Women and children suff er most from lack of health care,” observes Kuol.
“Although there are very few of us, I will do my best for everyone that I treat.
I spent years protecting my country in the war. Now I want Southern Sudan
to benefi t from the health training that I got from AMREF.”
Margaret Ayen, 29
Margaret Ayen, 29, is a clerk with the Ministry of Roads and Transport. Her
six-month old baby has been admitted at the Juba Military Hospital. The
paediatric ‘ward’ has been hived off a section of the general ward, as there
is no space in the hospital for a separate room for children.
“We have been here for three days. We live at the Shilak Military Barrack
because my husband works for the Sudan People’s Liberation Army. This
is the second time my baby has fallen ill. Last month, she had fever and
diarrhoea, and she was vomiting. I took her to a private clinic in Jebel Kujur,
near our home, but she fell sick again a few days ago. They gave her some
medicine, but I did not see any improvement. She still had a fever, so I
brought her here.
I have been told that she has malaria. I like this hospital because they have
better services than the private clinics, and they have qualifi ed people to
look after us. You see, she is already cool. The private clinics just want to
take our money, but here they are giving proper treatment. They know
what they are doing. I feel confi dent that she will get better.”
33

ETHIOPIA
South Omo Health Programme
AMREF has been working in South Omo since 2007 to support the Federal
Government’s eff orts to improve health care in the underserved zone. To
increase access to health facilities for the poor population of this vast and
remote region, AMREF has in the past two years built and equipped 14
health posts. To facilitate communication between the remote health units
and the District Health Offi ce, AMREF has installed a radio system linking
the health centres and the Headquarters in Malle. This has made it easier
for the Government to coordinate health campaigns and keep track of
drug and vaccine supplies. AMREF has also provided solar-powered fridges
in all health posts and trained Health Extension Workers (HEWs) in their
maintenance so that vaccines are stored properly.
A major focus of AMREF’s work is strengthening the skills and knowledge
of mid-level health workers (such as nurses) and of the community-based
HEWs in tackling maternal and child health, as well as malaria, sexually
transmitted illnesses, TB and HIV. Due to a shortage of health workers, the
Ethiopian Government has deployed two HEWs in every kebele (village) in
the country. The HEWs are selected from the local communities because
they understand the local languages and cultures, and are therefore more
easily accepted.
Health Extension Workers are a vital component in strengthening
Ethiopia’s fragile health system. They are charged with the responsibility of
improving basic health care at household level in order to prevent disease
and promote healthy living, and referring serious cases to health facilities
for treatment. AMREF’s training equips them with knowledge and skills
to work eff ectively with communities and their leaders, and even to train
volunteers to help them in providing care at household level. So far, AMREF
has trained a total of 207 HEWs in South Omo, serving a population of
347,000 people. The impact of this work is beginning to show. For instance,
the number of deliveries in health centres has risen to 50 per cent in the past
two years from an average of below 30 per cent previously. Consequently,
maternal and infant death rates are declining.
FACTS AND FIGURES
• 673 of every 100,000 mothers die in pregnancy and
childbirth in Ethiopia
• Number of deliveries in health centres has risen to 50 per
cent of expectant mothers over the past two years from an
average of below 30 per cent previously
• During the last one month only, the 207 health extension
workers trained by AMREF are expected to reach 82,800
• AMREF has built and equipped 14 health posts
• AMREF has trained a total of 207 HEWs in South Omo
serving a population of 347,000 people
DONORS
• The European Commission
• AECID - the Spanish Cooperation for International
Development
• Ferguson Trust UK
• Lundin Foundation for Africa from Canada
• Department for International Development, UK
35

36
Door-to-Door Health Care
Tadelech Schibesh is a Health Extension Worker stationed at Kamba Bobo
Health Post. On Mondays and Fridays, she gives basic services at the clinic
– family planning, ante-natal care, dressing wounds and treating children
for fever or diarrhoea. Then for four days, she makes house-to-house
visits, armed with a stethoscope, a wooden foetoscope (for checking the
heartbeat of unborn babies), a register and picture booklets that she uses
to give health education.
“There are 711 households in Kamba Bobo village, with a population of
3,555 people. When I visit, I tell them the importance of keeping their
bodies, homes and utensils clean, and of using latrines. I also talk about
family planning, antenatal care for pregnant women, and immunisation
for children. I encourage them to use mosquito nets to prevent malaria. If
someone is sick and the case is too complicated for me, I refer the person to
the Doiso Health Centre.”
After she fi nished high school, Tadelech attended a Health Extension
Workers’ course in 2006.
“In 2007, AMREF gave me more intense training on family planning,
community mobilisation, TB and HIV, malaria and vaccination. The training
helped to refresh my knowledge and gave me skills in how to deal with
the community to make my work more eff ective. These skills have helped
me work well with community leaders, and even to train some members
of the community who can be models for their neighbours. Last year,
I received an award from the zonal health department for training the
largest number of models in the district. So far I have trained 170.”
The training has also enabled her to promote health in Kamba Bobo.
Every two weeks, she holds meetings with the community to address
health issues. She uses the meetings to bring up discussions on traditional
practices like abduction of girls, early marriage, rape and polygamy because
these have a direct eff ect on health, particularly of women and children.
“Women are particularly vulnerable because they have a low social
status,” says Tadelech. “The men do not listen to them, and their health
is not considered a matter of importance. Yet they work so hard, walking
for hours to fetch water and to get food from the farms. The exhausting
physical work takes a toll on their bodies.”
Moreover, women do not eat well, she adds. “They tend to give the best
food to their husbands and children, and deny themselves. As a result,

many pregnant women are defi cient of iron, which puts them at risk of
complications when giving birth. The diffi cult terrain and the distance to
health centres also make it diffi cult for women to access health services
when they have complicated deliveries. Doiso Health Centre is the nearest,
but it is not adequately equipped to deal with emergencies. Jinka is too far
– there are no vehicles from here, and it would take at least a day to walk
there.”
“Shortage of water is a big problem. Women have to walk for three or four
hours to the river every day. It is a problem for me too, because after visiting
people in their homes all day, I still have to fetch water for my own use. We
do not have water in the health post for mixing medicines, so we have to
ask the patients to bring their own. I am very happy that AMREF is working
on a project to bring water here. It will make my work a lot easier and it will
take a big burden off the women.”
Despite the many challenges, Tadelech has seen some encouraging change
in the community as a result of her work. While there were only 20 latrines
in the village when she started working here, there are 300 now. While only
16 women were using family planning methods, the number has risen to
80. There were only four women attending ante-natal clinic at the health
post every year, and now she sees up to 40 pregnant clients, and many
others at home. And whereas people used to hide their children whenever
immunisation camps were held, they now bring them voluntarily because
they see the benefi ts.
“The women tell me that their children used to die a lot, but not any more. I
know it is because of immunisation and better hygiene. There are still some
people who do not accept what I teach, and some even say they don’t want
to see me again because I am wasting their time. But when I help a woman
to deliver safely, or when I treat their children with medicine and they
become better, they are very happy. Some have even asked me to name
their children, which is a great honour.”
Karababo Kiyo , 30
“I live here in Kamba Bobo kebele. My house is not very far away from here.
I have come to the health post because I am pregnant, and I want the nurse
to check if my baby is alright.
My husband and I have four children. They are seven, fi ve, three and two
years old. They were all born at home. I did not have any ante-natal care for
them, because I did not know about it then. I only came to learn about it
when Tadelech came to our house and told me.
I am now seven months pregnant. I feel that I need good care because
I am older than I used to be, and I have many children. Sometimes I feel
unwell – nausea and dizziness. I try to follow all the advice that I am given
by Tadelech. I eat good food, and I come regularly for check-ups. But I get
very tired when I go to fetch water. I have to walk for two hours to the
river every day, and then I walk back home for another two hours with the
20-litre jerrican of water on my back. It is hard. I have to stop many times
on the way to rest. I fear that this will aff ect my baby, so I come here often
because believe that if I am checked regularly, my baby will be fi ne. These
people can tell the position of the baby. They know everything.
Tadelech told me about family planning, and I used the pill for two months.
But then she went away to school for two weeks and there was nobody
else to do her work. I got pregnant because I could not get the pills. Now I
am happy because she is always here on Mondays and Fridays, and there
is another nurse who has come to help her. I feel safe having them here
because I know that I can get help any time I need it. I am sure that my
baby will be fi ne.”
37

UGANDA
Home-based Care Management of Childhood Illnesses
Northern Uganda is in the process of healing and reconstruction after two
decades of civil war between Joseph Kony’s Lord’s Resistance Army rebel
group and Government forces that violently disrupted life in the region.
Hundreds of people were killed and maimed, and close to two million were
displaced from their homes. About 40,000 children were abducted to serve
as fi ghters, porters or sex slaves in the rebel army. The regional economy
was destroyed and as the fi ghting intensifi ed, the Government moved
people into protective camps, severely disrupting their social, economic
and cultural lives. Basic essential services like education, health and water
supply were thrown into disarray.
AMREF has been working in Northern Uganda since 1998. Even during
the war, AMREF worked in the volatile region, vaccinating children, and
providing clean water and sanitation in the camps for internally displaced
people in Gulu, Pader and Kitgum. In Gulu, AMREF opened a shelter where
children could take refuge every night to escape abduction by rebels.
With the end of hostilities, the people of Northern Uganda are struggling
to rebuild their lives. However, they are doing this within a context of
poverty and tattered social infrastructure, including a very fragile health
system. Strengthening of the health care system is crucial to improving
the living conditions of the population and achieving sustainable postconfl
ict development. AMREF’s work in Northern Uganda is driven by the
vision of a health care system that operates eff ectively, interacting with
local administrative structures and the communities themselves, which is
therefore responsive to the needs of the people.
Of major concern is the high rate of illness and death among children. In
Gulu for example 250 out of every 1,000 children under fi ve die every year,
mostly as a result of malaria, respiratory and intestinal infections.
Since 2006, AMREF has been addressing children’s health in Pader and
Kitgum districts through its Home-based Management of Childhood
Illnesses project. By training Village Health Teams, including community
vaccinators and community medicine distributors, AMREF ensures that
the major health needs of the communities are met. In particular, AMREF
supports local capacity to provide home-based services for preventing
and treating malaria, the leading cause of child deaths in Uganda, and
for vaccination of children. Through training of health workers, provision
of equipment, including motorcycles to facilitate movement to distant
villages, and strengthening of referral systems, the programme ensures
that health centres in the region are better able to perform their preventive,
diagnostic and treatment functions, especially with regard to malaria.
So far, AMREF has trained 1,570 VHT members, 1,002 men and 568 women.
The project has resulted in a drastic drop in the number of malaria cases in
the two districts. This is because children are treated for malaria within the
crucial fi rst 24 hours of the onset of fever. Malaria in pregnant women has
fallen too, improving chances of survival for the mothers and their babies.
FACTS AND FIGURES
• 28,912 children were treated for malaria by Village Health
Teams in 2009
• 80 per cent of children under fi ve in the project area receive
antimalarial medicine within the fi rst 24 hours of the onset
of fever, compared with 63 per cent before the project
• AMREF has dug over 100 boreholes in Gulu, Pader and
Kitgum Districts. Each borehole is used by about 170
people.
DONORS
• Compagnia San Paolo
• Fondazione Carparma
• Fondazione Cariplo
• Monte dei Paschi di Siena
39

40
My Neighbour, My ‘Doctor’
Little Auma Scovian clings to her mother and protests with little cries every time
an attempt is made to remove her from the comfort of her mother’s arms.
This is not normal behaviour for the 18-month-old, says her mother, Ajok
Catherine. “She has not been feeling well since yesterday.”
“The child has malaria,” explains John Achar, a member of the Village
Health Team (VHT) in Arum Central Village Acholpii parish in Pader District.
Achar is also a peer supervisor for other community health workers who
make up the VHT, and is on his rounds to check that they have responded
appropriately to cases of illness in the village. Baby Auma’s father, Okot
Solomon, is a member of the VHT. When she developed a fever and became
irritable, Okot gave her medicine for malaria.
Another house that Achar is visiting today is that of Onencan David and
his wife, Joy, whose one-year-old son, Benson, has malaria and a cough.
Achar had prescribed Coartem anti-malarial syrup and Junior Septrin, an
antibiotic. Onencan, too, is a member of the VHT. Achar has paid him a visit
to appraise his client records and check on Benson’s progress.
Onencan, Solomon, and Achar are community health volunteers who play
a crucial role in providing basic health services to their fellow villagers. As
members of the VHT, they are charged with reducing the deaths of children
and encouraging general good health practices in their community in
order to prevent disease. This they do by dispensing medicine for common
ailments and by organising health-related activities, like immunisation
days, communal maintenance of sanitation facilities, and drama
performances to deliver crucial health messages. They are the fi rst port of
call when illness strikes. Their village-mates call them ‘doctors’.
“AMREF taught us how to identify severely sick or malnourished children,
and to promote personal hygiene and cleanliness at home,” says Onencan.
“We also had lessons on HIV, eye and skin infections, accidents and injuries,
malaria, diarrhoea, pneumonia and newborn care. We were taught how
to keep records of our clients and the medicines we give them or actions
that we take.” As peer supervisor, Apar received further training on data
collection, coordination of health activities, and counselling of caregivers
and parents.
The VHT members serve as a vital link between the villages and formal
health providers. They refer patients whose cases they are unable to
handle to the nearest health centre and then follow them up once they
are discharged. For example, early in 2009, a VHT member was called to a

house in Atanga sub-county where a child begun to develop paralysis. He
immediately referred the child to the local health centre, where a specimen
was taken for laboratory tests and sent to Entebbe for analysis. The results
were positive for polio. The child was taken through therapy to exercise the
lower limbs and is now walking.
“I am happy to be making a diff erence in my community. The work that we
do is important because we save lives,” says Apar.
Labul Sabina, 40
I live in Locimidik village in Lawieoduny Parish, Kitgum District. The VHT
members, Philip and Lucy, are very helpful to us. We can always reach them
because they are not far. Look at how healthy the children are. It is because
whenever they fall ill, Philip and Lucy are always there to help. When they
have malaria, the children are given medicine and they do not have to go
to hospital. The nearest health centre is in Madi Opei, which is 12km from
here. It was too far for people to take their children quickly enough when
they fell sick. Malaria and cholera used to give us so many problems. Our
children used to die very easily from these diseases, but not anymore. Help
is so near now.
The big disease [Hepatitis E] which broke out here in 2007 would have killed
so many of us if it was not for the VHTs. I myself was a victim. I fell ill and
I couldn’t tell or even guess what the problem was. I was vomiting and
feeling very weak. I didn’t know what was happening to me. Then the VHTs
advised me to go to the hospital. Even though it is far, I went because they
insisted. They suspected that I had the disease. I now believe that were it
not for them and AMREF, I would not be here today.
Philip and Lucy also taught us the importance of washing our hands and
maintaining cleanliness in our homes to avoid spreading disease. I value
this lesson, and I teach others to do the same.
One of the biggest problems we had was lack of water, but AMREF came
and dug a borehole for us and it has really helped. Now as people return
from the camps we need another borehole and more people like Philip and
Lucy to help our village.
41

KENYA
Nomadic Youth Reproductive Health Project
Adolescents and youth in the developing world face major reproductive
health challenges related to HIV, early and unwanted pregnancies, sexually
transmitted infections and female genital cutting (FGC). Though they are
vulnerable for both physical and socio-cultural reasons, often suff ering
serious long-term health consequences, adolescents and youth are often
neglected by national health programmes and policy across Africa.
Marginalised communities pay the highest price for this neglect. In Kenya
for example, the maternal and mortality rates in Kajiado and Loitokitok
districts, home to the conservative Maasai community, are very high.
About 680 out of every 100,000 mothers lose their lives in pregnancy or
childbirth, compared with the national average of 414. The reasons for this
particularly high maternal mortality include poverty, low literacy levels,
gender inequality, poor infrastructure and reproductive health services,
poor access to health services as well as deeply entrenched harmful
cultural beliefs and practices. To this end, AMREF is implementing a fouryear
project (2007-2010) in Kajiado and Loitokitok districts of Kenya. The
goal of the project is to improve the reproductive health of the nomadic
communities living in the two districts, and in this way reduce the deaths
of mothers among the young people in the community in line with the
Millennium Development Goals ( 4, 5, & 6). The project is part of a wider
initiative also covering Ethiopia and Tanzania. It plans to reach more than
135,000 nomadic youth aged 10 to 24 over the four years.
The Nomadic Youth Reproductive Health Programme also seeks to
strengthen the capacity of grassroots civil society organisations, health
facilities, traditional leaders and other community structures to improve
access to quality health services for young people. It empowers young men
and women, boys and girls, both in and out of school, to make informed
decisions on their reproductive health and to increase their use of health
services.
The Maasai have a rich cultural tradition with well defi ned structures
and systems. AMREF uses these structures and systems to integrate
reproductive health into their lifestyles. Age-set leaders of the young,
macho morans (warriors of the community aged between 15 and 25)
are trained as peer educators so that they can reach out to fellow morans.
Lessons are taught during Olpul (moran meetings) – when the young
people go into seclusion in the mountain and are free to speak openly.
By involving the community’s powerful and infl uential traditional elders
in the activities, AMREF has also been able to gain acceptance for the
programme and make headway with sensitive cultural issues such as early
marriage and FGC.
FACTS AND FIGURES
• 414 of every 100,000 mothers in Kenya die in pregnancy
and childbirth
• 70 moran chiefs trained in Magadi and Loitokitok
• 370 peer educators and 1,042 youth volunteers have been
trained, and they have so far reached a total of 63,611
youth
• 180 elders have been sensitised to the dangers of genderbased
violence and FGC
• 70 community leaders have been trained on advocacy on
reproductive health issues, targeting risky cultural practices
like FGC, early marriage and gender-based violence
DONORS
• The Netherlands Foreign Ministry
• AMREF in the Netherlands
43

44
A Blend of Health and Culture
A thick ceiling of branches provides a shaded enclosure for morans taking
part in the Olpul session in a grove of trees on a forested mountainside in
Entasoopia, Magadi Division. ‘Stop FGM!’ screams a poster pinned to the
trunk of a tree. In the privacy and familiar surroundings of a bush a little
way off , a nurse from the Olkirimatian health centre counsels and tests
morans who want to know their HIV status.
“Our cultural practices used to put us in danger of getting HIV, but we
did not realise it,” says Lelein Kanunga, chief of the morans of Magadi
Division. Morans are young, circumcised Maasai men aged between 14-25
years. They are the warriors of the community, charged with duties such
as searching for stolen livestock and defending the community against
attack. Renowned for their proud cultural heritage and traditional way of
life, the Maasai are a very conservative people. As chief, 18-year-old Lelein,
is the spokesperson for his age group, consulting elders on their behalf and
communicating key decisions to his peers. He has been trained by AMREF
as a peer educator for youth on reproductive health issues, including HIV.
Morans would share one razor to shave their heads. Morans are also very
popular with girls; in fact, they are encouraged to have many girlfriends,
but this again makes them vulnerable to HIV. They would get sick but did
not know why. Then AMREF trained a group of moran chiefs about HIV and
other health issues so that they could go and teach their fellow morans.
They realised that there were a lot of things that needed to change in their
community to stop their people from dying. The moran chiefs are ‘mobile
peer educators’ and are able to move with the morans when they migrate
to search for pasture and water for their livestock. And so the morans
can always access reproductive health information and services such as
condoms and referral for STI treatment.
“The girl morans are known as esiankikin. They have unique problems
which we are now addressing. Our girls are circumcised, and yet there
is really no good reason for doing it; it’s based on the belief that it will
prevent women from straying from their marital homes. As soon as they
are circumcised, the young girls are married off , often to much older men. .
The girls get pregnant when they are very young and their bodies es are not
strong enough to have babies. Many men beat their wives and all this is

ad for the health of the women. If mothers are not healthy, children will
not be healthy.
“After my training, I called the morans together and discussed these issues
with them. I talked with the girls as well. So far, I have seen a lot of change
in the behaviour of young people in Magadi, and it is beginning to be felt in
the rest of the community. Girls are gaining courage to refuse circumcision,
and they are even refusing to be married off while they are still young.
Morans are now telling parents that we will not marry their daughters if
they are circumcised. Young people are being tested for HIV and they are
using condoms. Even the girls are demanding that their boyfriends use
condoms.”
The Kenya Government has registered Osiligi le Maa (Hope of the Maasai),
a youth group formed by Lelein and his morans to teach the larger
community about the danger of HIV and the eff ects of harmful traditional
practices on the health of women and children.
“We have the blessings of the elders, so when we speak, the community
listens. This is important because times have changed, and if we don’t
change too, our people will be wiped out,” says the chief of Magadi
morans.
Timbiyan Kipas, 20
“Even though a lot of my agemates are married, I have refused to get
married to an old man. I will get married when I am ready to. I already have
two children though. My daughter is four years old. The little one is a boy,
he is two. I was young when I had my children. When I went into labour the
fi rst time, I bled so much that I passed out. I was at home. The traditional
midwife told me it was a curse to bleed like that. An old man was called to
come and tie a piece of hide on my leg to stop the bleeding.
When I had my second child, I was wiser. By then I had gone for moran Olpul
sessions, and I knew that I should go to the health centre for check-ups. I
started going to the Olkirimatian Health Centre when I was four months
pregnant. I was told I had very little blood, so I had to eat food like tomatoes,
beans, vegetables and liver, and that when the time came to have the baby,
I should sh go to the centre. But I gave birth at home again because my mother
was away a
when I went into labour. The women who helped me deliver did
not approve of a woman giving birth in hospital, and it was too far for me to
go on my own. So again I bled a lot. I took a long time to recover.
My eyes have been opened by the things I have learnt in the Olpul sessions.
Now I am using the injection method of family planning. I also use condoms
to protect myself from HIV. I was circumcised when I was a little girl. If I had
known that it was useless for my health, I would not have agreed to it. My
daughter Nanamar will not be circumcised, and I have told my mother and
my brothers as much. I want her to learn and go to secondary school or
even further. I do not want her to get married when she is young because
girls who do that end up bleeding or their babies die because their bodies
are not ready for motherhood. I tell other mothers to take care of their
daughters too. Yes, things are changing in our community because of the
lessons that we are learning from AMREF.”
45

TANZANIA
ANGAZA ZAIDI – Prevention of Mother to Child Transmission
(PMTCT)
Over the past ten years the death rates of mothers (578/100 000) and
newborns (32 per 1,000) have remained persistently high. National
AIDS-related morbidity and mortality in Tanzania is higher in women
of child-bearing age, and more than 60 per cent of new infections occur
among young people, particularly young women. About 90 per cent of
HIV infection in children below 15 years is acquired through their mothers.
Estimated prevalence of HIV among pregnant women at antenatal clinic
is 8.7 per cent. Given that about 1.4 million deliveries occur annually in
Tanzania, an estimated 122,000 women living with HIV deliver annually.
Without intervention 25-40 per cent of these women will transmit the
virus to their babies during pregnancy, delivery, or through breast-feeding.
Most children born with HIV die early in their infancy, while the underfi
ve mortality attributable to paediatric AIDS is 16 per cent. The Tanzanian
Government introduced a programme for Prevention of Mother-to-Child
Transmission (PMTCT) of HIV in 2000 as a critical element of the national
HIV response. AMREF’s work in PMTCT began in 2004 as a component
of the successful nation-wide ANGAZA VCT (Voluntary Counselling and
Testing) Project, now called ANGAZA ZAIDI (meaning ‘to shed more light’ in
Swahili). Following a decision by the Ministry of Health to allocate regions
to specifi c organisations, Ruvuma Region became AMREF’s PMTCT zone.
The project is implemented in three districts – Songea Urban, Songea
Rural, and Namtumbo.
HIV prevalence in Ruvuma, an agricultural region in southern Tanzania, is
5.9, just below the national six per cent average. In 2009, the death rate
for children under fi ve in the region was 90 for every 1,000 born. The
mineral-rich Ruvuma attracts people from diff erent parts of the country,
including neighbouring Iringa, which has the highest HIV prevalence in the
country - 15 per cent. The fact that 53 per cent of women in the region have
their babies at home raises the threat of HIV transmission from mothers to
children, considering that 90 per cent of HIV infection in children is passed
on in this way.
PMTCT has traditionally been facility-based, involving training of
health care providers, provision of supplies, and putting up necessary
infrastructure for its implementation. A way needed to be found to take
information and services to the large number of women who deliver
at home. AMREF devised an integrated programme that introduced
the direct involvement of communities by training community-owned
resource persons (CORPS) to take health messages to the villages. Through
public meetings and home-to-home visits, the CORPS talk about a range of
maternal and child health issues – from antenatal care and safe delivery,
to sexually transmitted illnesses, HIV and VCT. They help the community
to understand what PMTCT is about, and encourage women and their
husbands to go to the health centre. The project is deliberately designed
to encourage men to participate because they are main decision-makers
in the household; having them on board increases the chances of success
of the programme.
AMREF has also trained 400 health workers in 66 health centres to reinforce
the information given by the community volunteers at village level, and
has provided HIV test kits, delivery beds and other equipment to improve
services at the facilities. With the complementary facility-based and
community-based components, AMREF provides a vital link between
communities and health facilities, making the project highly eff ective.
FACTS AND FIGURES
• Maternal mortality in Tanzania is 578 for every 100,000
mothers
• 90 – the percentage of HIV infection in children arising
from transmission from mothers
• 2,181 – the number of community service providers
trained by AMREF in Ruvuma Region
• AMREF partners with a total of 66 service outlets, and have
trained a total of 400 service providers
• Community Health Workers have reached 87,914 people in
Ruvuma since 2004
DONOR
• PEPFAR funding through USAID
47 4

48
Giving Babies a Clean Start
It is approaching midday when the powerful voice of Fausta Mwimba calls
out a greeting outside Sholastika Fussi’s modest brick house in Songea
Rural District: “Hodi huku? Hamjambo?” (Are you there? How are you?)
“Karibu!” (Welcome) comes the response, as the door swings open.
The host brings out two chairs and sets them out on the porch. After
exchanging niceties for a few more minutes, the two women settle down
to discuss health matters.
Sholastika is a mother of three. She discovered that she had HIV when she
was pregnant with her youngest child, now 18 months old. Sholastika had
heard from community health workers in her village that mothers-to-be
should be tested for HIV, so when she went to the Namabengo Health
Centre for her fi rst ante-natal visit, she readily agreed to it.
“I did not suspect anything was wrong because I was not feeling unwell. I
was shocked when the results were positive.”
While she was worried about her health, she was more concerned about
her unborn baby. She remembered that the community health worker in
the village had said that a woman could give birth to a healthy baby even if
she had the virus. This information was now reiterated by the nurse at the
health centre. Her baby would be fi ne, the nurse assured her, as long as she
followed the advice she was given.
She did follow the advice, eating nutritious foods to keep her body healthy
and to feed the baby growing inside her. And then when she eventually
went into labour, she was taken to the health centre and given some
medicine just before she gave birth. She breastfed the baby exclusively
for six months, and then introduced her to milk and porridge. The baby
has recently been tested and found to be negative, much to the delight of
Sholatica’s family.
Trained as a community health worker for AMREF’s Prevention of Motherto-Child
Transmission of HIV Project, Fausta spends her days holding
discussions in the community and in homes to encourage the people to
get tested so that they can protect their unborn children from HIV. She
has trained 12 health volunteers in Tanga ward, two for each village in the
ward, so that they can help her spread the message.
“I was trained in June 2004 on issues relating to mothers. AMREF wanted
to train people from the community to teach others about HIV and the
local council committee selected me. I learnt about HIV and its prevention,
family planning, nutrition, how to mobilise people for health discussions,
encouraging them to get tested, and encouraging those who are HIVpositive
to take their treatment as required and look after themselves.”
Fausta felt that she would be more eff ective in persuading others to go for
Voluntary Counselling and Testing if she herself were tested. “I was found
to be HIV positive. As a trainer, I decided to be open about it. I organised
meetings, and I went to all the villages to announce my status. I told them
that I had gone for the test I had been telling them about, and I had been
found to be positive.”
That message had a positive impact. “More people came forward for
testing, and now the number of women who have been tested and
are actively telling others about it is 1,640. As a result, more women are
using the services off ered at health centres, with the support of AMREF, to
prevent babies being born with HIV.

“To tell the truth, many mothers and children were dying and it wasn’t
clear why. Now the deaths have reduced greatly and I believe it is the result
of the work that we are doing. Pregnant women are getting information
in the villages and at the clinics. And now we are advising them to go with
their husbands to the clinics, so that they too can be tested. Many men are
reluctant to be tested; yet knowing their status would benefi t the whole
family.” Fausta would know – her husband died in the year 2000, and it
was only after she started on AMREF’s PMTCT programme that she realised
his death might have been HIV- related. She now raises their three children
alone through small-scale farming.
Fausta’s work requires her to walk long distances to cover the six villages.
She is nevertheless enthusiastic about what she does. Her work in AMREF’s
programme for the last fi ve years has now led to her appointment as a
member of the ward’s HIV and AIDS committee, where she represents the
voice of the community.
“I thank AMREF for its support. Through this programme, AMREF has
shown that it truly cares for people who are infected. It has motivated me
to continue helping my community.”
Sholastika Fussi, 35
“Two days ago, I was told that my baby does not have HIV. I was so
excited and so grateful! Everybody in my house was very happy, even the
neighbours.
Since she was born 18 months ago, I have spent many anxious months
waiting to know whether my daughter is alright. Just before I had her, I
learnt that I had HIV. The community health workers had been telling us in
the village that if you were pregnant, you should be tested so that you do
not pass the infection to the baby. Because my two other children are fi ne,
and I did not feel unwell, I did not think there was anything to worry about.
I went to Namabengo Health Centre for my fi rst ante-natal check when
I was two months pregnant. I counselled and tested for HIV on that fi rst
visit. I was shocked when they told me that I was positive. Although I had
not expected such a result, I had to accept the reality. My husband also
accepted it when I shared the information with him.
I was advised to ensure that I delivered at the health centre and not at
home. So when I went into labour, I went there. I was given some medicine
just before I delivered the baby. Since then I take ARVs two times every day.
I get the medicine free of charge from the health centre.
I gave my baby breast milk alone for six months. Now she takes other foods.
She is very healthy and rarely falls ill. We had to wait a long time to know
for sure that she does not have the virus. Now that we do, I will continue to
encourage other women to go and get tested so that they can be sure of
getting healthy babies.
I would like to stay healthy for a long time so that I can raise my children.
My biggest problem is that I do not always get enough nutritious food to
keep my body strong. It is hard taking the ARVs without eating properly.
But I am trying to make money by rearing pigs and chicken so that we can
aff ord better food.
My husband is very happy too. Now that our daughter is healthy, he has
agreed to go and get tested for HIV. So far, he has been very reluctant to
go, but now he says he will even take our two other children to be tested. I
have truly benefi ted from this programme. I pray that AMREF will not stop
helping us.”
49

SOUTH AFRICA
Orphans and Vulnerable Children Project
HIV and AIDS have had a devastating impact on the wellbeing of children
in South Africa over the last two decades. The South African National HIV
Survey, 2008, found the prevalence of infection among children aged
2-14 to be 2.5 per cent. It is estimated that by 2015, 5.6 million children
under the age of 18 will have lost one or both parents to an HIV-related
illness. The process of orphanhood often starts long before the death of the
parent. Children are made vulnerable by the fact that they live with and
are often responsible for the care of terminally ill family members. This
compromises their access to health care, education and social support.
Their vulnerability is compounded by the fact that many communities with
high HIV prevalence also have high rates of poverty.
Women and young girls are especially vulnerable to HIV – 56 per cent of
all infections are in women. They also suff er the extra burden of providing
care, yet their low social and economic status gives them less ways and
means to deal with this role eff ectively. Women have less power to speak
out about the issues that aff ect them and advocate for the resources they
need to cope with the increasing pressures of HIV on their health and wellbeing.
The rapid growth of the HIV epidemic in South Africa has made it necessary
to expand the focus of response activities from prevention and treatment
to a wider, integrated approach which, among other things, addresses the
health, education, welfare and psycho-social needs of children, and how
these can be met within a supportive community setting. In this regard,
AMREF in South Africa, through its Orphans and Vulnerable Children (OVC)
Project, is working with key stakeholders in Sekhukhune District, Limpopo
Province and Umkhanyakude District, KwaZulu Natal Province to provide
an environment in which children can get comprehensive, compassionate
care, support and services. This includes strengthening collaboration
between, and building the capacity of, local service providers, Government
departments and civil society groups to promote the wellbeing and
interests of children. By linking the various players, AMREF helps to
minimise duplication and overlapping of services, and facilitates setting up
of referral channels so that children’s needs are addressed as effi ciently as
possible.
AMREF’s programme also provides support for primary care givers,
including HIV-positive mothers, grandmothers and guardians, through
counselling, teaching them how to take care of sick family members, and
encouraging them to form support groups. In Sekhukhune District, AMREF
works with 4,350 children, aged between 0-18.
FACTS AND FIGURES
• AMREF is working with 13,500 orphans in Limpopo and
KwaZulu Natal Provinces
• 233 community health workers have been trained to work
with orphans and vulnerable children
• 56 per cent of all HIV infections are in women and girls.
• It is estimated that by 2015, 5.6 million children under
the age of 18 will have lost one or both parents to an HIVrelated
illness
DONORS
• PEPFAR
• Department of Social Development of Limpopo Province
51

52
Catch Me Before I Fall
The delightful sound of children singing fl ows from an offi ce trailer at the
Dindela Community Home-Based Care Centre in Sekhukhune District,
Limpopo. It is lunchtime, and a group of teenagers is making music as they
wait for the smaller children to eat before they take their turn in the dining
room. Three girls swing hoolahoops outside, a few metres away from the
open door of a shed in which two women are fussing over huge, steaming
pots.
In another offi ce trailer, Miriam Sibongile is winding up a meeting of
community care workers to review the past month’s activities and plan
for the next. There are 22 community organisations working in Dindela.
Sibongile supervises the 35 care workers drawn from these organisations
who work with the 3,230 children who have so far been identifi ed for the
programme.
“Every day, we go house-to-house looking for children living in diffi cult
circumstances and checking on the progress of those already registered,”
says Sibongile. “They may be orphaned and alone, or they may have
guardians, a parent, or two sick parents who are unable to look after them.
We monitor the health of the children and assess their needs for food,
school uniform, medication or psychological support.”
The Dindela Centre, one of 16 drop-in centres in Sekhukhune, off ers
the children a place where they can get a meal, companionship and
psychological support. “We serve the children breakfast before they go to
school, then they come back for lunch. We help them with homework, and
they also have time for drama, singing and dancing.”
The caregivers take the children through life skills sessions, including lessons
on sexuality and how to cope with stressful situations. They are encouraged
to make ‘memory boxes’ in which to store jewellery, photographs, letters
and other keepsakes of loved ones who have died.
The community care workers link needy parents and guardians with the
social welfare offi ce so that they can get grants for child support – R240
(US$32) per month – given by the Government. A major challenge has been
lack of vital documents, such as birth certifi cates or parents’ identity cards,
which must be produced before they get the money. To ease the process of
getting the papers and processing of grants, AMREF has helped to create
a referral system between the community care givers, Department of
Social Services and relevant Government departments. The Department of
Health refers sick and needy children who show up at health facilities to
social workers, who link them up with the community care workers.
“By bringing together all the stakeholders, AMREF has helped us to
reach out to more children and give them substantial support,” Sibongile
observes. “We have been given tools to collect data about the children,
making it easier to meet their needs. The training we received from AMREF
has given us skills and knowledge to help the families to improve their
lives as we are able to advise parents and guardians on issues like good
management of their money and how to monitor the progress of their
children in school.”
Sibongile’s expression turns to one of concern as her gaze settles on a sad,
12-year-old girl sitting quietly alone. The girl’s leg is swollen and she has
bruises on her face. The night before, she had appeared at Sibongile’s door,
saying that she had been beaten by her grandfather, whom she and her
sister had gone to live with when their parents died. This is the third time
this has happened.
“I have spoken to the grandparents before and asked them not to mistreat treat

the child, but now I have had to involve a social worker so that the child
is removed to a safe place. She also needs treatment for her injuries and
counselling. The networks that have been created by this programme have
made it easier for us to deal with cases like this because we know who to
contact for help. I am glad the children have somebody to turn to and I am
happy that we are making a diff erence because these are our children,
abantwana bentu.”
Voices of Abantwana Benthu (Our Children)
Nquobile Nancy, 14
“After my father died, Mum was unable to provide for me and my four
siblings. We did not have food, even soap. Now I eat at the centre, and Mum
gets food parcels containing mealie meal, beans, oil and sugar.”
Molebegeng Stovovo, 9
“The centre is nice. I come here with my sister. They give us food and then
we play a lot of games. They teach us many things here that we were not
told in school. I have been taught how to keep myself clean.”
Millicent Mahlangu, 13
“My brother and I live with our grandmother. We like to come to the centre
after school because we do a lot of things here, like dancing and singing.
They also help us to do the homework that we have been given in school.”
Dimpo Mahobo, 5
“I like to look at the pictures and jewellery in my memory box, because they
remind me of my mother. When I go to the centre, I like to dance, sing and
act. I want to be a policeman when I grow up so that I can build my own
house.”
Sonke Skasana, 17
“After my Mum died, our grandmother took me and my two brothers
in. My grandmother did not have money to buy us things, but now I
have a school uniform like my classmates, and I even went on a trip
to Johannesburg.”
Phindile Maseko, 13
“My father and mother are both not well. Many times my mother used to
go to my grandmother’s house to ask for food because there was nothing
for us to eat. Now we do not go hungry because we get food parcels. I am
happy because I have school uniform.”
53

NATIONAL OFFICES
...A touch from her hand makes it all disappear...
55

56
AMREF NATIONAL OFFICES
AUSTRIA
A record number of over 4,600 athletes from more than 30 countries ran
for better health for Africa when they took part in the sixth International
Salzburg AMREF Marathon on May 3. The winner of the men’s marathon
was Austria’s Christian Pfl ügl. Kennedy Matolo from Kenya was second,
while Karl Aumayer, a native of Salzburg, came in third. The women’s
race was won by Ursula Bredlinger, followed by Maria Zechmeister and
Sabine Hofer in second and third places respectively. The marathon was
once again accredited with a Bronze Label by the International Association
of Athletics Federations (IAAF). As in the past few years, the marathon
received support from several celebrities such as actress Caterina Murino,
her partner Pierre Rabadan and the Austrian Paralympics gold medal
winner Thomas Geierspichler.
In the week leading up to the marathon, AMREF in Austria organised a
cultural programme dubbed ‘Days of Dialogue’, made up of a series of
activities such as an African fi lm festival, lectures and workshops. One
highlight of the Days of Dialogue was an information tour by the Austrian
government which showed the broad sustainable work with the so-called
‘developing countries’. AMREF’s gala at the Gössl Gwandhaus marked
another highlight, and guests included the Vice Governor of Salzburg,
David Brenner, Kenya’s Charge d’Aff airs in Vienna, Consolata Kiragu, and the
Austrian singer, Klaus Eberhartinger. From AMREF Headquarters, Deputy
Director General Dr Florence Muli-Musiime, Director for Capacity Building
Dr Peter Ngatia and Communications Director Bob Kioko attended.
Another running event, a relay marathon, was organised to benefi t AMREF
took place from October 9-11 on the Tour de Tirol in Söll, the location of
the World’s Long Distance Mountain Running Challenge. There were over
1,000 participants, including four Kenyan runners – Hellen Jepkurgat,
Robert Kipkemoi Yegon, Raymond Kemboi Chemongor and Daniel Kiplimo
Bett. The Kenyans won the team score gold medal.
On September 17, AMREF in Austria organised an event featuring two
cabaret artists, Heilbutt & Rosen, at the Schloss Goldegg near Salzburg.
This was an enjoyable evening for the nearly 200 spectators.
From October 19-25, the broadcasting company ORF broadcast the AMREF
spot ‘Die Zukunft Afrikas ist schwarz’ (The future of Africa is black) during
prime time all over Austria. The spot was kindly provided by AMREF in Italy.
The Austrian Development Agency (ADA) supported two AMREF
Programmes – a Distance Learning project in Ethiopia which was also
funded by AMREF in Austria and AMREF in Germany, and the Manyattabased
Health Delivery Model for Maternal and Child Health in Magadi, cofi
nanced by AMREF in the Netherlands. The Magadi project was successfully
completed at the end of 2009.
CANADA

In February, AMREF in Canada led a donor visit to Ethiopia and Uganda.
The visit was a success, fostering increased support and commitment to
AMREF’s work, including the welcoming of two new Board members and
Can$165,000 in funding for the Atanga Girls School Project in Uganda. A
related co-branded product launch through AG Hair Cosmetics sold out
12,500 packages in two months, raising an extra $50,000.
In May, Toronto’s waterfront came alive with the sights, sounds and tastes
of Africa at the 13th Annual African Marketplace Gala. Brian Stewart, one
of Canada’s best known journalists, shared his experiences of four decades
of reporting from Africa and his insights into the potential of African
communities. Emcee and AMREF supporter Lotte Davis inspired guests
with her fundraising campaign through AG Hair Cosmetics, and AMREF in
Tanzania’s Country Director, Blanche Pitt, talked about the success AMREF
has seen working with communities and governments. The evening was a
great success, raising almost $200,000 for AMREF’s work.
In the fall, Measha Brueggergosman, AMREF in Canada’s Goodwill
Ambassador, gave her fi rst benefi t concert in support of AMREF. During a
live Q&A on stage with top-rated Canadian CBC radio host, Jian Ghomeshi,
Measha brought AMREF’s message to over 400 guests. Following the
concert, AMREF hosted a cocktail reception for VIP guests, raising $20,000.
DENMARK
The Board of AMREF in Denmark welcomed two new members, Mrs Ellen
Bleeg and Mr Morten Hesseldahl.
AMREF in Denmark is awaiting the response of several foundations to
requests for support for the Comprehensive and Integrated Trachoma
Control Project j among g nomadic communities.
Flying Doctors’ Society of Africa
The Flying Doctors’ Society of Africa (FDSA) held a charity Golf Tournament
in March at the Karen Country Club in Nairobi with the aim of raising
Ksh2 million (US$26,000) for Vesico Vaginal Fistula (VVF) surgeries. With
that amount, the Flying Doctors’ society would be able to fund over 100
operations for needy women across the country.
The Organisation of Women in International trade (OWIT), Nairobi,
selected VVF as its fundraising activity for 2009. It organised a movie
night on September 11 to help the FDSA raise funds for VVF. The sponsor,
the Standard Chartered Diva Account, paid the direct costs of the Theatre,
and Nairobi divas were treated to a delightful evening. The event raised
Ksh500,000 (US$6,700).
In October, the Diplomatic Spouses’ Association organised a fundraising Golf
Tournament and Walkathon to raise funds for corrective surgery for fi stula
patients in rural Kenya. The money raised, Ksh1.5 million (US$20,000), will
help 75 women from across Kenya to receive surgical treatment for VVF
during the Kenyatta National Hospital camp to be held in June 2010.
57

58
FRANCE
AMREF Ambassador, actress Caterina Murino, attended the opening
party of Naoura Barrière (white fl ower), a new hotel in Marrakech,
Morocco. An auction was held at the party, which took place in May, and
Chaumet jewels were sold to raise money for AMREF.
In April, Caterina and the Casino Barrière at Enghien les Bains held a party
in honour of AMREF. The event included a poker tournament. Registration
fees paid by the players went to AMREF in France.
GERMANY
The year 2009 was a year of transition. After 45 years as founder and Chair
of AMREF in Germany, Leonore Semler handed over chairmanship to Dr
Goswin von Mallinckrodt, who served for many years as a Board member of
AMREF in Germany. Leonore will continue to support AMREF in her capacity
as Honourary President. AMREF in Germany now has a new Director/CEO,
Dr Marcus Leonhardt. Further expansion of the Board is underway. The
offi ce also welcomed Dr Nikolaus Schumacher to the Board. He is a qualifi ed
medical doctor and a business consultant, having more than 18 years of
experience in research, medical service, and international consulting.
AMREF in Germany was honoured by a visit of the Deputy Director General,
Dr Florence Muli-Musiime, and the Director of Capacity Building, Dr Peter
Ngatia, who were welcomed by a faithful supporter and donor to the
Maridi Training School, HRE the Duke of Bavaria. Further meetings took
place with the Fresenius-Foundations, a generous donor supporting the
AVNS (eLearning) and the ART Knowledge Hub. The Fresenius Foundation
has also agreed to support replication of AMREF’s Virtual Nursing School in
Uganda.
In June, Dr Goswin von Mallinckrodt hosted his traditional annual golf cup
in support of Flying Doctors/Clinical Outreach. A member of AMREF’s board,
Prof Volker Klauß, was appointed European Chairman of the International
Agency for the Prevention of Blindness, while another Board member, Dr
Ulrich Laukamm-Josten, continues to chair AMREF’s International Forum.
AMREF in Germany is particularly proud to have received, for the next three
years, institutional funding from BMZ, the Federal Ministry for Economic
Cooperation and Development, to support a project for ‘Acceleration of
retroviral therapy’. Furthermore, AMREF in Germany has initiated eff orts
to establish partnerships with leading corporates and other health-related
organisations for the implementation of Cervical Cancer Prevention in
Tanzania in line with AMREF’s focus on maternal health.
AMREF in Germany was pleased that in October, Axel Vassen,
Communications Director of Lanxess AG, visited the Phase Water and
Hygiene Project for Schools in Mkuranga, Tanzania. In 2010, AMREF in
Germany is planning to host an exhibition documenting the work of the
Flying Doctors at the Museum for Aviation History in Hannover. We feel
honoured to have been accepted to the Ecumenical Kirchentag 2010, which
is expected to attract an audience of 300,000 visitors.

ITALY NETHERLANDS
Many people in developing countries have a profound and daily experience
of poverty but lack access to information and an avenue to address social
injustice. Millennium News, a news documentary project made with the
support of the Italian Ministry of Foreign Aff airs, Municipality of Milan
and Water Right Foundation, seeks to close that gap by explaining the
problems of those who are living in poverty.
Eighty boys and girls from the slums of Nairobi – between eight and 20
years old – all involved in AMREF’s Children in Need Project for rehabilitation
of street children, produced a newspaper and eight episodes of ‘street
news’ about the Millennium Development Goals (MDGs). The children
become street journalists and talk openly and spontaneously about the
harsh realities they face every day. They talk about the drugs, violence and
loneliness that fi ll their young lives, but also about the dreams, thoughts
and creative solutions to their problems.
RAI Tre – the third largest national television channel – broadcast the
eight ‘street news’ in a programme for young viewers. Eight electronic
newsletters on AMREF’s activities and the MDGs have been sent out
by e-mail, while the Millennium News documentaries will be shown
in Italian secondary schools. The schools that join AMREF’s Millennium
News campaign will receive a free dvd of the street news, the newspaper
and several teaching units to help them analyse the topics discussed in
Millennium News.
In spite of the economic crisis, 2009 proved to be a successful fundraising
year for AMREF in the Netherlands. The National Postcode Lottery was once
again one of AMREF’s main donors, with a donation of one million Euros.
The Lottery has been a constant and long-term supporter of our activities.
AMREF entered into a long-term partnership with VvAA, the leading Dutch
fi nancial service provider for health care professionals. VvAA will give funds
as well as management and health care expertise to AMREF. QNH, a market
leader in business integration in the Netherlands, committed to a threeyear
partnership with AMREF. QNH will fi nance part of the AMREF Virtual
Nursing School through a salary donation programme.
As for private fundraising, AMREF in the Netherlands registered our
35,680th donor in 2009, a 4.2 per cent increase from 2008. The Dutch
public’s willingness to contribute to development organisations appears
to be stable, even as the country experiences the consequences of the
fi nancial crisis.
In 2009, the Dutch Ministry of Foreign Aff airs again contributed to AMREF’s
programme for Reproductive Health among Nomadic Youth in Kenya,
Ethiopia and Tanzania. The programme was launched in 2007 and runs up
to 2011. Total funding for this period is Euro 7,991,402.
In March and April, Mapenzi Tamu, the performance about love in a time
of HIV by children from the Dagoretti Children in Need project successfully
59

60 6
toured Dutch theatres. The awareness event was co-organised by AMREF
in the Netherlands and the opening night was attended by our patron,
the Prince of Orange, and his spouse. Bert Koenders, Dutch Minister of
Development Cooperation, was also a guest of honour.
On the public awareness front, AMREF in the Netherlands contributed
to a popular Dutch television series about a hospital and its staff . Several
episodes in the 2010 edition are set in Africa, highlighting AMREF’s work
in Kenya.
Several members of staff from Africa visited the Netherlands in 2009,
including Dr Thomas Kibua, Ravi Ram, Dr John Nduba, Dr Florence Muli-
Musiime, Bob Kioko and Emily Mworia. Jacqueline Lampe, executive
director of AMREF in the Netherlands, visited a number of AMREF projects
in Africa throughout the year, and was accompanied on several of her trips
by members of the Board of Directors.
SPAIN
AMREF in Spain announced the appointment of Manuel Campo Vidal as
its Goodwill Ambassador. A well known Spanish TV journalist, Mr Vidal is
also President of the Spanish TV Academy. He is committed to upholding
AMREF’s values and objectives, and will speak about our work at public
meetings and AMREF events.
AMREF in Spain launched a publication, ‘AMREF Report about Health in
Africa’, to the media and general public. The document highlights the state
of health in African, the work that AMREF is doing, and the importance of
supporting that work.
Dr Alfonso Villalonga, Chairman of AMREF in Spain, was a speaker at two
conferences, both relevant to health and corporate social responsibility.
At the ‘Doing Good and Doing Well’ Conference at the IESE Business
School in Barcelona, Dr Villalonga’s talk took place in a panel to discuss
‘How to improve access to health care for people at the BOP (Bottom of
the Pyramid)’. The other was at the ‘Foro de Soria XXI’ on sustainable
development. In a panel to discuss health problems among young people,
the Chairman spoke about the health challenges of African youth.
SWEDEN
AMREF in Sweden hired its fi rst employee, Country Director Caroline
Edelstam Molin, in 2009 and opened up an offi ce in Stockholm. A Creative
Advisory Board was appointed.
AMREF in Sweden received a grant from the Swedish Broadcasting
Corporation to support the second phase of the Trachoma Prevention and
Control Project in Ethiopia.
The partnership between AMREF and the Swedish International
Development Agency (Sida) included activities to reduce the prevalence
and impact of HIV and AIDS in East Africa.
AMREF in Sweden successfully launched an AMREF bracelet, a silver piece of
jewelry by a Swedish designer. The bracelet has received media attention
because one of Sweden’s most prestigious interior design shops, Svenskt
Tenn, is selling it.
Sweden’s new Country Director visited AMREF’s Kibera Health Care Project
during her fi rst visit to Nairobi.

UK
AMREF in UK diversifi ed its resources so that it was able to expand and
build on its programmes, and continued successful collaborations with
partners such as the Department for International Development (DfID), the
European Union, and many other companies, trusts, and foundations in the
UK. In 2009-10 AMREF in UK is making a strategic investment in fundraising
activities. With a new strategy and better-resourced team in place, we
expect to grow our income over the next year.
The Zingatia Maisha Programme, a partnership between AMREF, the
Kenyan Ministry of Health and GlaxoSmithKline, continued to bring
antiretroviral drugs (ARVs) to thousands of people living with HIV. Adapted
to both rural and urban contexts, the programme brings together health
workers and HIV-positive people within support groups. As a result, more
people are receiving ARVs and sticking to their drug regimens.
In 2008-09, AMREF entered the second year of its innovative development
project in Katine, north-eastern Uganda. Created in partnership with the
Guardian and Barclays, the project works with the communities in Katine
to help them recover from years of war, drought, cattle rustling and neglect
while at the same time educating the British public about international
development via regular media coverage in the Guardian newspaper and
on www.guardian.co.uk. The project has made signifi cant improvements
to the quality of life in Katine, increasing standards of education, water and
health.
Our pilot integrated disease management programme in the Luwero and
Kiboga districts of Uganda, a partnership with AstraZeneca, has made it
much easier for people to be tested and treated for HIV, TB, and malaria
co-infection — one of the deadliest and most overlooked problems in the
region.
AMREF in UK continued to make maternal, newborn, and child health one
of the cornerstones of our research and advocacy programme, pressuring
donors, African governments and international organisations such as the
UK DfID, International Monetary Fund and World Bank to increased their
support for family planning, midwife training and malaria prevention.
USA
In 2009, for the fi fth year in a row, AMREF in USA received Charity Navigator’s
highest four-star rating for sound fi scal management – a distinction that
only 4 per cent of charities have received. AMREF in USA is also proud that
the Better Business Bureau approved us to use their Charity Seal – assuring
our donors that we meet the 20 rigorous standards of the BBB Wise Giving
Alliance.
On September 23, during the week of the United Nations General Assembly
in New York, AMREF in USA partnered with the Global Health Council to
co-host the Africa First Ladies Breakfast focusing on improving maternal
and child health. Among the First Ladies who attended was Mrs Ida Betty
Odinga, the Kenyan Prime Minister’s wife, who observed that “AMREF goes
where no other NGOs go” – to the farthest rural community to save lives.
61

FINANCIAL REPORT
...With all the hardship she’s been through ...
63

64
Indirect Costs
14.4%
Family Health
17%
Malaria
1%
Training & HLM
9.8%
80
70
60
50
40
30
20
10
0
19.0
FY2001
19.0
ANNUAL EXPENDITURE BY ACTIVITY
2008/2009
19.1
FY2002
19.1
ANNUAL EXPENDITURE
2001-2009
24.0
FY2003
24.0
24.8
FY2004
24.8
30.2
FY2005
30.2
44.0
FY2006
44.0
58.1
FY2007
58.1
Disaster Preparedness &
Clinical Response
8.5%
HIV/AIDS
38.3%
Safe Water &
Basic Sanitation
11%
69.5
FY2008
69.5
74.6
FY2009
74.6

Other Regions
3.1%
7%
6.5%
4.6%
2.5%
4.5%
12.5%
ANNUAL EXPENDITURE BY ACTIVITY
2008/2009
33.3%
26%
65

SENIOR MANAGEMENT TEAM
Dr Michael Smalley - Director General
Dr Florence Muli-Musiime - Deputy Director General
Jenny Panow - Headquarters
Dr Peter Ngatia - Headquarters
Dr Thomas Kibua - Headquarters
Nancy Muriuki - Headquarters
Dr John Nduba - Headquarters
Bob Kioko - Headquarters
Steve Andrews - Headquarters
Dr Jane Carter - Headquarters
Dr Joao Soares - Ethiopia
Mette Kjaer - Kenya
Penina Ochola - South Africa
Dr John Mwesigwa - Southern Sudan
Blanche Pitt - Tanzania
Joshua Kyallo - Uganda
Jim Heather-Hayes - Flying Doctor Emergency Service
Dr Bettina Vadera - Flying Doctor Emergency Service
Egmont KAP-HERR - Austria
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 Maroto - Spain
Carol Edelstam Molin - Sweden
Grace Mukasa - UK
Lisa Meadowcroft - USA
67

CONTACTS
... My mother is a fi ghter, who never gives in .....
69

70
AMREF in Austria
Waagplatz 3
5020 Salzburg
AUSTRIA
Tel: +43/662/84 01 01
Fax: +43/662/84 01 01-13
Email: offi ce@amref.at
Website:http://www.amref.at/
Chairman
Dr Walter Schmidjell
Vice Chairman
Mag Karl Scheliessnig
Board Members
Margit Ambros
Mag Heidi Ganzera
Franz-Eduard Hamersky
Ernst Ischovits
Egmont Kap-herr
Mag Susanne Kregsamer
Dr Rainer Revers
Dieter Schleehauf
Dr Monika Schmidjell
Anna Maria Schwaiger
Prim Dr Klaus Täuber
Mag Alexander Viehauser
Univ Prof Dr Kurt Weithaler
AMREF in Canada
489 College Street, Suite 407
Toronto, Ontario, Canada
M6G1A5
Tel: +416-961-6981
Fax: +416-961-6984
Email:info@amrefcanada.org
Website: www.amrefcanada.org
Chairman
Keith Thomson
Vice Chair
Gordon Capern
Laurence Goldberg
Board Members
Lori-Ann Beausoleil (Treasurer)
Christopher Dawson
Charles Field-Marsham
Scott Griffi n
Stephen Hafner
Doug Heighington
Jette James
Zaheer Lakhani
Diane Macdiarmid
Saleem Janmohamed
Peter Sinclair
Will Tiviluk
Alan Torrie
AMREF in Denmark
Den Afrikanske Laegefond
Gorrissen Federspiel
12 HC Andersens Boulevard
DK-1553
Copenhagen V
Tel: + 45 33 41 41 41
Fax: + 45 33 41 41 28
Email: ca@gorrissenfederspiel.com and
liselassen@c.dk
Website: www.amrefdenmark.dk
Chairman
Christian Alsøe
Executive Director
Christian Alsøe
Board Members
Finn Black
Svend Riskaer
Klaus Winkel
Ellen Bleeg
Morten Hesseldahl
Lise Lassen
AMREF in Ethiopia
Diaspora Square
Yeka sub city Kebele 15
House Number 059
P.O.Box 20855 code 1000
Tel: +251-116627851/0116630613
Fax: +251-116627887
Email: Joao.soares@amref.org or
alemayehu.seifu@amref.org
Website: www.amref.org
Country Director
Joao Soares
Flying Doctor’s Society
of Africa
P O Box 30125-00100
Nairobi, Kenya
Tel: +254 20 6994410-13
Fax: +254 20 601594
Mobile: +254 722 205084
Email: fl ying.doctors@amref.org
Website Address: www.amref.org
Chairman
Dr Eunice Kiereini
Chief Executive
Tanya Nduati
Council Members
John Mramba (Vice Chairman)
Ashwin Patel (Treasurer)
Njambi Kiritu
Connie Maina
B S Bharat
Illa Devani
Dr Michael Smalley
AMREF in France
134 bd Hausman
Paris 75008
Tel: +33(0)1 42 25 03 67
Mobile: +33(0) 6 74 72 57 77
Email: info@amref.fr
Website: www.amref.fr
Board Members
Nicolas Mérindol (President)
Zarina de Bagneux (Director)
Gilles August
Jean-Charles Decaux
Marie Paul Laval
Mathias Léridon
Bernard Lozé
Alejendro Martinez-Castro
AMREF in Germany
AMREF Gesellschaft für Medizin und
Forschung in Afrika e.V.
Mauerkircherst. 155
D-81925 München
Germany
Tel: +49 89 17876085 or
+ 49 162 427 29 17
Fax: +49 89 17876087
Email: m.leonhardt@amrefgermany.de
Website: www.amrefgermany.de
Honorary President
Leonore Semler
Chairman
Dr Goswin von Mallinckrodt
Executive Director
Dr Marcus Leonhardt
Board Members
Dipl Kfm Gerd Pelz (Deputy Chairman)
Prof Dr Volker Klauß
Dr Ulrich Laukamm-Josten
Dr Hans Werner Mundt,
Dr Wilhelm von Trott zu Solz
Dipl kfm Michael Wollert
Dr Johannes Zahn
Dr Nikolaus Schumacher
AMREF in Italy
AMREF Italia Onlus (Main Offi ce)
Via Boezio, 17
00192 Roma, Italia
AMREF Italia Onlus (Branch Offi ce)
Via Carroccio, 12
20123 Milano, Italia
Tel: +39.06.99704650
Fax: +39.06.3202227
Email: info@amref.it
Website: www.amref.it
Executive Director
Thomas Simmons
Chair
Ilaria Borletti
Board of Members
Valerio Caracciolo (Vice Chair)
Antonello Corrado
Marinella De Paoli
Maurizio De Romedis
Daniela Ghisalberti
Maurizio Paganelli
Andrea Ripa di Meana
Renata Zegna
AMREF in Kenya
PO Box 30125 – 00100
Nairobi, Kenya
Tel: +254 20 6994000
Fax: +254 20 606340
Email: info.amref@amref.org
Website: www.amref.org
Country Director
Mette Kjaer
Advisory Council Members
Prof Mohammed Abdullah (Chair)
Mette Kjaer (Secretary)
Prof Violet Kimani
Lawrence Ndombi
Dr Wycliff e Mogoa
Ms Eunice Mathu
Dr Florence Muli-Musiime
Prof Japheth Mati
Prof Richard Muga
Judy Thongori
Dr Anne Wamae
AMREF in Monaco
Le Saint-André
20, Boulevard de Suisse
MC 98000 Monaco

Tel.: 00377 97 77 08 08
Email: info@amrefmonaco.com
Website: www.amrefmonaco.com
Chairman & Executive Director
Riccardo Arvati
Board Members
Niccolo’ Caissotti di Chiusano
Fabrizio Carbone
Giuseppe Spinetta
Jean-Philippe Bertani
AMREF in the Netherlands
Stichting AMREF Flying Doctors Nederland
Haagse Schouwweg 6G
2332 KG Leiden
Tel: +31 71-576 9476
Fax: +31 71-576 3777
Email: info@amref.nl
Website: www.amref.nl
Patron
HRH The Prince of Orange
Chairperson
MTH de Gaay Fortman
Executive Director
Dr Jacqueline Lampe
Board Members
T Gardeniers
DM van Gorp
Ing TRC de Lange
Dr JF Maljers
SA Sichtman MBA MPC
ARMEF in South Africa
Hillcrest Forum Building,
731 Duncan Street (Corner Lynwood Rd)
Pretoria, South Africa.
PostNet Suite 92,
Private Bag X19,
Menlo Park, 0102
Tel: +2712 362 3135/6/3127
Fax: +2712 362 3102
Email: info.southafrica@amref.org
Website: www.amref.org
Country Director
Penina Ochola
Board Members
Refi loe Serote (Chairperson)
Dr Brian Brink (Treasurer)
Nosisa Tshangana
Prof Pauline Kuzwayo
Aletta Masenya
Dr Roland Eddie Mhlanga
AMREF in Spain
Almagro, 14,
3rd fl oor – 28010
Madrid, Spain
Tel: +34 91 310 27 86 and +34 902 375
902
Fax: +34 91 319 68 12
Email: marketing@amref.es
Website: www.amref.es
Executive Director
Alfonso Rodríguez Maroto
Chairman
Dr Alfonso Villalonga
Board Members
José Luis Alonso Gutiérrez
Juan Pedro Medina López
Gabriel Guzmán Uribe
Javier Gimeno de Priede
Jorge Planas Ribó
Rafael Mateu de Ros Cerezo
Carlos Dahlman
Pedro Alonso Fernández
Leo Ricardo Farache King
José Luis Yela Pañeda
Carmen Posadas Mañé
AMREF in Sweden
Östermalmsgatan 84
SE-114 50 Stockholm
Tel: +46 8 562 500 90 / +46 707 95 78 40
Fax: +46 8 660 02 43
Email: info@amref.se or caroline.edelstam.
molin@amref.se
Website: www.amref.se
Patron
HM King Carl XVI Gustaf
Chairperson
Helena Bonnier
Executive Director
Caroline Edelstam Molin
Board Members
Annika Elmlund
Charlotta Rapacioli
Charlotte Enderlein
Charlotte Nordenfalk
Kersti-Adams Ray
Pär Vikström
AMREF in Tanzania
1019 Ali Hassan Mwinyi Road
Upanga
PO Box 2773
Dar es Salaam
Tel: +255 222 116 610
Fax: +255 222 115 823
Email: info.tanzania@amref.org
Website: www.amref.org
Country Director
Blanche Pitt
Advisory Council Members
Hon Dr Hussein Mwinyi (Chairman)
R Tuluhungwa
A Kilewo
E Ndyetabura
Dr C Simbakalia
Mrs Ananilea Nkya
Dr Eve Hawa Sinare.
Mrs Mary Rusimbi
Mrs M K Rwebangira.
Dr Fatma Mrisho
AMREF in Uganda
Plot 29, Nakasero Road
POBox 10663,
Kampala
Tel: +256 41 4 250319/ 344579/346822
+256 31 2 261418/261419
Fax: +256 41 4 344565
Email: info.uganda@amref.org
Website: www.amref.org
Country Director
Joshua Kyallo
Advisory Council Members
Christine Kabugo (Acting Chair)
Dr Jessica Jitta
Prof Mangen Wabwire
Mr Stephen Mutyaba
Mr Tom Matte
Eng Mugisha Shillingi
AMREK in UK
Cliff ord’s Inn,
Fetter Lane,
London, EC4A 1BZ,
UK
Tel: +44 0207 269 5520
Email address: info@amrefuk.org
Website address: www.amref.org/uk
Executive Director
Jo Ensor
Patron
HRH The Prince of Wales
President
The Duke of Richmond and Gordon
Board Members
Lady H ollick (Chair)
Gautam Dalal (Treasurer)
Paul Davey
Matthew Edwards
Liam Fisher Jones
Mark Goldring
Ian Gill
Murray Grant
Fiona Napier
Inosi Nyatta
AMREF in USA
4 West 43rd Street
2nd Floor
New York, NY 10036
Tel: +212-768-2440
Fax: +212-7684230
Email: amrefusa@amrefusa.org
Website: www.usa.amref.org
Founder
Thomas D Rees, MD
Chairperson
Mary Jane Potter
Executive Director
Lisa Meadowcroft
Board Members
Paul T Antony MD, MPH
Ned W. Bandler, (Vice Chairman)
Rodney Davis, MD, FACS
Pamela I Ellsworth, MD
Charles HF Garner
Christine L Grogan
Victoria L Obst Hasuman
Carol Holding
Carol Jenkins
Stephen C Joseph, MD
Robert WC Lilley (Secretary)
William H MacArthur (Treasurer)
Lisa Meadowcroft (Ex-Offi cio)
Elliott J. Millenson
Michael Smalley, PhD (Ex-Offi cio)
Timothy S. Wilson
71

DONORS
... She smiles on and holds her head high ...
73

74
AMREF in Austria
Actavis GmbH
ADA (Austrian Development Agency)
Ad Pri Co – a division of 01 print &
copy GmbH
Afro-Asiatisches Institut
AFS-Flüchtlingshilfe-Stiftung
Agentur COCO
Agentur Rahofer
Altstadt Marketing GmbH
Ambros Wolfgang
athletika AG
Austrian Airlines AG
Buchrieser Franz
Coca-Cola GmbH
DasKino
Dorotheum Salzburg
Dr Klinger & Rieger OG
Druckerei Roser
E R JARL invest n-joy gmbh
Eberhartinger Klaus - EAV
Egger Fritz - Aff ront Theater
Eiswerk GmbH
EU - Europäische Union
EZA Fairer Handel GmbH
Fendrich Rainhard
Fiebig Hartmut - grenzgang GbR
Fröstl Peter - music promotions
veranstaltungsgmbh
Glomser Gerrit
Going International
Hotel Altstadt Radisson SAS
Hotel Neutor
HPD Security
Imlauer Hotels & Restaurants GmbH
Jolsport GmbH - Tour de Tirol
Krassnitzer Harald
Kulturverein Schloss Goldegg
Literaturhaus Salzburg
Mad Mike Küng
Management Rehling
Media & Design - Dr Stefan
Aglassinger
ORF
ORF - Landesstudio Salzburg
Österreichischer
Genossenschaftsverband
Palfi nger AG
Pannobile OHG
Paracelsus Medizinische
Privatuniversität
PUMA
Radiofabrik
Red Bull GmbH
Salzburger Ärztekammer
Salzburger - Ihr Landesversicherer
Salzburger Landes - Hypothekenbank
AG
Salzburger Nachrichten
Salzburger Spielzeugmuseum
Sportimpuls Hannes Langer
Stadt Salzburg
Stepan Druck
Stieglbrauerei zu Salzburg
Superfund Marketing GmbH
SWISS
Taxi 8111
Tele2
Travel Safe - Dr Arno Lechner
Vita Club Salzburg
UniCredit Bank Austria AG
UNIQA
USI Salzburg
Volksbank Salzburg
ynet - Agentur für Kommunikation
und Mediendesign
Zoo Salzburg
AMREF in Ethiopia
AECID - Spanish Agency for
International Cooperation and
Development
Agencia Catalana
Allan Nesta & Ferguson Trust
Austrian Government
Band Aid
CRDA/Core Group
DFID - UK Department for
International Development
Diageo Foundation
Dutch Ministry of Foreign Aff airs/MFS
European Commission (EC)
Foundation Retourschip - Netherlands
Fundación La Caixa/Fundación África
Viva
GAVI - The Global Alliance for Vaccines
and Immunisation
Generalitat Valenciana
Headley Trust
Jersey Overseas Aid Commission
Lundin for Africa
Madrid Regional Government
Navarra Bank
PRANA Foundation
PSO - Netherlands
Swedish Broad Cast Corporation
USAID/Geneva Global
AMREF in France
Agence de Bassin Seine-Normandie
Art Valorem
August & Debouzy
Casino Barrière
Caterina Murino
Chaumet
François Bennaour
Groupe Lucien Barrière
J- Pierre Lamic
James Bond
JC Decaux
Lozé Associés
Mestari Taoufi k
MPL Consulting
SPAC
AMREF in Germany
Institutions
BMZ – Federal Ministry for Economic
Cooperation and Development
NGOs/Foundations
Barmherzigkeit Verein
Deutsche Lepra- und Tuberkulosehilfe
(Link Clinical Outreach)
Deutsche Stiftung Weltbevölkerung
Else-Kröner-Fresenius-Stiftung
Hilfsverein Nymphenburg
HABERGER-Stiftung
Kindernothilfe
PRANA-Stiftung
Sternsinger/Päpstliches Missionswerk
Sternstunden e.V.
Stiftung Mittelsten Scheid
Stiftung Überseehilfswerk
Stiftung Van Meeteren
Corporates
BHF Bank
Boehringer-Ingelheim
EADS GmbH
Ferrero AG
Fracht AG
HypoVereinsbank AG
Kriege GmbH, Lumatec GmbH
LANXESS Deutschland GmbH
MAN-Ferrostaal AG
Merck Finck Bank
Oskar Schunck AG
Siemens AG
Rohde & Schwarz GmbH
TUI Touristik AG
Sachspender
Aeskulap
Aumüller Druck KG
Swarovski AG
Workshop GmbH

AMREF in Italy
Angelo Loy
Arena
Caterina Murino
Comune di Milano, di Montemurlo, di
Roma, di Perugia
Dario Cozzolino
Dipharma
Direzione Generale per la
Cooperazione allo Sviluppo del
Ministero Aff ari
Esteri
Enrico De Angelis
Fondazione BNL
Fondazione Zegna
Fondazioni 4 Africa
Francesco Gambella
Franco Schiavon
Giovanni Cataldi
Jacuzzi
KLM
L’Oreal
Lottomatica
MED Media Education
Oto Research
Poste Italiane
Provincia di Milano, di Roma
Raff aella Cuccia
RAI TRE – Struttura Bambini e Ragazzi
e GT Ragazzi
RCS
Regione Campania, Emilia Romagna,
Lazio, Liguria, Lombardia, Toscana,
Umbria
Reggio Children
Rosso Pomodoro
Sanpellegrino
Sebach
Segretariato Sociale RAI
Servair Air Chef
Swimming World Championships
Rome 2009
Takeda
Teatro delle Briciole
Uffi cio Scolastico Regionale per la
Lombardia U.S. Provinciale di Milano
Water Right Foundation
Yamamay
AMREF in the Netherlands
Agis Zorgverzekeringen
Amsterdam RAI
Aqua for All
Bartels Advocaten B.V.
Basisschool CNS Oranje Nassau
MT Bello
JG van Belzen
RD Bleeker
J Blok
JNH Bongaards-Batema
Boubeek Communicatie
F H Bruna
BS Donatushof
Mr/Mrs. PLM Bussemakers
Cheops B.V.
CJP
D Clark
CNS Basisschool Prins Floris
Mr/Mrs JAM Delmee
De Sterredans
Diakonie Hervormde Kerk
CYG Dijksterhuis
KL van den Doel
Mr/Mrs Van Doorn
Ds van Lingenschool
HE Dubbeldam
FMM Dukkers
Elmec Handels-en Ing.Bureau
Eurocross
KT Feenstra
Geef Een Gift
IVHJ Geraedts
MA van Gestel
M C Gongriep
K Gorter
Mr/Mrs MAE Groenewoud
CA Haagsma Wieringa
Heerema Marine Contractors
Nederland B.V.
Hervormde Gemeente Wierden
RJM Hoozemans
IBA Silk Screen Productions
Insinger de Beaufort
Insinger Stichting
J Jaarsma
WJ Jansen
Jansen Installatiebedrijf
Johannes Stichting
AJ Klein
M Klein
HE Koeslag
ALM Kok
Koningin Beatrixschool
G de Koster-Burgersdijk
Mr/ Mrs Kramers
JPMG Lammers
K de Lange
MP Langerak-Blokland
H Langman
HK Lanting
AM Lensing-Cousins
GW van Leeuwen-Cauven
C Lichtveld
Lionsclub Appingedam-Delfzijl
Loc 7000 Events
Maas-Delta Deurwaarders GGN
Mediq N.V.
S van der Meij
AC Meijer
HB van Meelis
CHA Meulendijk
Mr/Mrs EJMT Meuwissen
JIF de Meyere
HEJ Mirandolle
HJE Modderman
Mr/Mrs K von Morgen
Nationaal Lucht - en Ruimtevaart
Laboratorium
Nationale Postcode Loterij
Ned Prov van de Congregatie
OBS de Wiekslag
OBS De Meent - Ommeren
OBS Prins Clausschool
E Ode
Otten Philipsfonds
M Overbeek
Pereira, Van Vliet & Partners
WJ Petersen
M Pieters
Mr/ Mrs Pietersen
Plexus
DW Porte
PSO
QNH Holding BV
Robert & Denise Zeilstra Foundation
M van Rouwendaal-Das
C Ruiter-Bijman
S&H Productfulfi lment BV
SCA
JJ Schaap
IN van Schaik
MM Sluis
SNS Property Finance Nederland
Sotrax BV.
Sponsor Bingo Loterij
Staalbankiers
PJ de Sterke
Stichting Community Service
Stichting Doelwijk
Stichting Eekhoorn Leiden
Stichting Flexi-Plan
Stichting Goede Doelen
Stichting Malaria no More
Netherlands
Stichting Martinusschool
Stichting Mundo Crastino Meliori
Stichting N. van Ballegooijen Fonds
Stichting Pelgrimshoeve
Stichting van Kampen
Stichting VDU Care
E Talens
W van Tellingen
Tetterode Nederland BV
The Broere Charitable Foundation
MLAJ Thissen
Mr/ Mrs TS.Tukker
Twe Beheer BV
MH Vaandrager
Velo Beheer
C Verhoeven
AC Vermaat
A Th Vogler
Mr/Mrs JJEM Vrancken
AJ de Vries
S Vrijlink
VvAA
75

76
TB de Waart
Waterleidingmaatschappij Drenthe
Waterleiding Maatschappij Limburg
N Weijland-de Kuijper
FMG Wekker-Heitbrink
FG Weverling-Teenstra
G Wezel
Mr/Mrs. HJA Wijnen
Willem Nico Scheepstra Stichting
LC Willemse-Hollestelle
FR de Winter
Mr/Mrs Woerden van Lauwaars
C van der Zalm
JSC de Zeeuw
ATM van der Zon
Zuijderduijn Art Productions
Zusters Ursulinen van St Salvator
AMREF in South Africa
AECI Spain
AMREF in France
AMREF in Italy
AMREF in the Netherlands
AMREF in UK
Centres for Disease Control – Atlanta
(CDC)
DFID
European Union (EU)
US President’s Emergency Plan for
AIDS Relief (PEPFAR)
AMREF in Sweden
Confederation of Swedish Churches
IBM Staff Association
NordaxFinans
Swedish Broadcasting Corp.
Swedish International Development
Cooperation (Sida)
The Bonnier Holding
AMREF in Spain
Public donors
Agència Catalana de Cooperació al
Desenvolupament
Agencia Española de Cooperación
Internacional para el Desarrollo
(AECID)
Ayuntamiento de Madrid
Comunidad de Madrid
Comunidad Foral de Navarra
Generalitat Valenciana
Junta de Castilla y León
Junta de Castilla-La Mancha
Private donors
AENA
Bancaja
Bankinter
Biblioteca de Castilla-La Mancha
Caja Segovia
Concepto Staff
El Corte Inglés
Endesa
Ferrovial
Fundación ACS
Fundación Alex
Globomedia
Grupo Redislogar
Hospital General Universitario de
Valencia
Hospital La Fe de Valencia
INDRA
In-Store Media
L’Oréal
La Caixa
La Casa Encendida – Obra Social Caja
Madrid
Margi
Mas Cuota
NET2U
Obra Social de Caja Castilla - La
Mancha
Ramón & Cajal Abogados
RENFE
Riocampo Media
San Juan & Yela Abogados
SANCA
Sermepa S.A. (Servired, s.c.)
USP Hospitales
AMREF in Tanzania
Audrey Irmas Foundation for Social
Justice
Azania Bank Ltd, Tanzania
Barrington Educational Initiative
Benjamin William Mkapa HIV/ AIDS
Foundation
Castila & Leone Council
Centres for Disease Control and
Prevention (CDC)
DANIDA
Department for International
Development (DfID)
DIAGEO
Direct Relief International
Dutch Ministry of Foreign Aff airs
European Commission
Embassy of the Kingdom of
Netherlands (EKN)
Family Health International
Geita Gold Mine (Anglo Gold Ashanti)
Global Rubber Company
Global Water Challenges Fund, USA
International Development Agency
(Ministry of Foreign Aff airs)
International Federation of
Gynaecology and Obstetrics (FIGO)
Izumi Corporation, USA
Jersey Overseas Aid Commission
(JOAC)
Junta Castilla Leone Council
Junta Castilla La Mancha Lanxess -
Germany
Madrid Regional Government, Spain
Madrid City Council, Spain
North Mara Gold Mine (Barrick)
Pharm Access International
Royal Dutch Government
SIDA
Tanga Urban Water Supply and
Sewerage Authority
Tanzania International Container
Terminal Services
The Ferrovial Company, Spain
The Global Fund to Fight AIDS,
Tuberculosis and Malaria
The Medical Research Council in UK
UNFPA
USAID
Vocational Education and Training
Authority (VETA), Tanzania
VICFISH, Mwanza
AMREF in Uganda
A&E Education Trust
AMREF Canada
AMREF France
AMREF Italy
AMREF Netherlands
AMREF Spain
AMREF Sweden
AMREF UK
AMREF USA
Athletes for Africa /Guluwalk
Austrian Aid
Astra Zeneca
AVIS,
Ayuntamiento de Madrid
Azimut
Barclays
Banca UCB
Betterway Foundation
Caro Macdonald &Mark McCain
Capp Plast
CAW Social Justice Fund
Center 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
McLean Foundation
McKnight foundation
Merck & Company, Inc
Metero MMS,
Mondadori
Ontario Secondary Schools Teacher’s
Federation – International Assistance
Program 3.
Oto Research
PFIZER
Plan Netherlands
Planetarium
Provincia Milano
Raff aella Cuccia
Regione Lombardia
RENFE
Rosslyn Swanson
Ruff ord Maurice Laing Foundation
Stephen Lewis foundation
Tessilform
The KM Hunter Charitable Foundation
UNFPA – United Nations Population
Fund
Venere
Wolfson College, Oxford University
AMREF in UK
A & E Education Trust
Abercrombie & Kent
Action for Global Health
Allan & Nesta Ferguson Charitable
Trust
Association of Commonwealth
Universities
AstraZeneca
Band Aid Charitable Trust
Barclays
Big Lottery Fund
British Council
Department For International
Development (DFID)
Diageo
Direct Relief International
Dulverton Trust
European Commission
Evan Cornish Foundation
International Federation of
Gynaecology and Obstetrics (FIGO)
Gerald Palmer Eling Trust
GlaxoSmithKline
Guernsey Overseas Aid Committee
Headley Trust
Health Workforce Advocacy Initiative
Jersey Overseas Aid Commission
Kentz Global Oil & Gas Process
Systems LTD
Lord Deedes of Aldington Charitable
Trust
Mayer Brown International LLP
Medicor Trust
Rayne Foundation
Rowan Charitable Trust
Ruff ord Maurice Laing Foundation
Somerset Local Medical Benevolent
Fund
Stop AIDS Campaign
The Bulldog Trust
The Hollick Family Charitable Trust
Wolfson College
AMREF in USA
(Gifts of US$5,000 and above)
AJA Charitable Fund
The Allergan Foundation
Anonymous (2)
The Louis Auer Foundation
Ned and Jean Bandler
Bridgewood Fieldwater Foundation
Cobb Income Charitable Fund
John Cogman
The CORE Group
The Joanne & John Dalle Pezze
Foundation
Fifth Avenue Presbyterian Church
Ernst & Young
Charles H. and Jill Garner
The Glastenbury Foundation
Global Impact
Global Water Challenge
The Richard and Rhoda Goldman Fund
Peter S. Goldstein
Mr and Mrs Michael Hecht
Ibrahim el-Hefni Technical Training
Foundation
The IZUMI Foundation
Johnson & Johnson
Joseph and Sally Handleman
Charitable Foundation Trust C
Ted Leonsis
Luz and William H. MacArthur
Management Sciences for Health
Medical Care Development
International
Merck & Co, Inc
Elliott J. Millenson
Network for Good
Newman’s Own Foundation
The Jay and Rose Phillips Family
Foundation
Mary Jane Potter
Nan and Tom Rees
Miriam M Rosenn
Tides Foundation
The Smile Train
The Starr Foundation
Craig Saxton
United States Agency for International
Development
United Way of Chittenden County
USAID - American Schools and
Hospitals Abroad
Timothy S Wilson
77

78
AMREF Headquarters
P0 Box 27691-00506
Nairobi, Kenya
Tel + 254 20 6993000
Fax + 254 20 609518
Email: info@amref.org
Website: www.amref.org
Founders
Sir Archibald McIndoe
Dr Thomas D Rees
Sir Michael Wood
Honorary Directors
Dr Thomas D Rees
Leonore Semler
Chairman
Dr Pascoal Mocumbi
Director General
Dr Michael Smalley
Deputy Director General
Dr Florence Muli-Musiime
Board of Directors
Dr Paul Zuckerman
Mr Scott Griffi n
Mr Anthony P W Durrant
Dr Stephen C Joseph
Prof Lucas Adetokunbo O
Dr Ulrich Laukamm-Josten
Prof Souleymane Mboup
Prof Laetitia Rispel
Mrs Mwikali Muthiani
Prof Mutuma Mugambi
Dr Noerine Kaleeba
Mrs Muthoni Kuria
Lady Sue Woodford Hollick
AMREF would like to recognise the generous support of
Swedish International Development Agency Canadian International Development Agency

CREDITS
Photography
Boniface Mwangi
Bruce Kynes
Jerry Riley
Shravan Vidyarthi
Sven Torfi nn
Writing
Betty Muriuki
Bob Kioko
Contributors
AMREF Communications Team
Agency
Nuturn Ltd
Direction
Bob Kioko
Betty Muriuki
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80 8
AMREF Headquarters
PO Box 27691-00506 Nairobi, Kenya
Tel +254 20 6993000
Fax +254 20 609518
Email: info@amref.org
Website: www.amref.org