Wall Street Journal (August 30, 2010)

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

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

AIDS Patients Hurt by South African Strike

The Associated Press (August 26, 2010)

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

Full Article at: 

The HIV Shift

The Independent (August 25, 2010)

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

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

South Africa Becomes a Victim of its ARV Treatment Success

IPS News (August 24, 2010)

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

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

South Sudan State Blames Spread of HIV/AiDS on Ignorance

Sudan Tribune (August 23, 2010)

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

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

AMREF has various job opportunities at its headquarters in Nairobi, country offices in Africa and national offices in Europe and North America. View all the current opportunities below:

Job Objective: To provide leadership for the development and implementation of AMREF’s Africa-wide malaria research, interventions and advocacy; adapting them to the changing needs of disadvantaged communities, ensuring that AMREF learns and shares its experiences on malaria; and to leading efforts to attract new partners and funding to expand its malaria programme.

Management Responsibility

1. Ensure that the Foundation’s work is cutting edge
2. Ensuring that AMREF learns and shares its experiences on malaria
3. Lead efforts to attract new partners and funding to expand malaria programme.

Description Of Duties

1. Provide strategic leadership for the Malaria Programme.
2. Design and coordinate in the implementation of the corporate Malaria programme based on the needs of disadvantaged communities in Africa in line with the AMREF corporate strategy;
3. Ensure implementation of the Malaria strategy throughout AMREF operational areas (countries) and provide technical support and other necessary resources;
4. Set the operations research agenda for malaria prevention, treatment and support beneficiary disadvantaged communities in the same
5. Liaise with AMREF partners and act as spokesman and advocate for corporate AMREF on malaria issues, and advocate globally for evidence based poverty-alleviation policies and
6. Contribute to resource mobilisation as necessary, in partnership with AMREF fundraising offices locally and in the north and ensure that these efforts are maintained at country level;
7. Monitor and evaluate the quality, content and delivery of AMREF’s malaria contribution and ensure that these are maintained at country level
8. Ensure constant documentation and dissemination of lessons and best practices through the network of AMREF operational bases and create an enabling environment for documenting and sharing organisational knowledge;
9. Deliver to the Director of Programmes the output agreed in annual work-plans and budget and provide all necessary technical financial reporting as required by AMREF and its investors.
10. Keep AMREF abreast of latest developments in community-based prevention and control of malaria, anticipating emerging issues and ensuring that they are incorporated into AMREF’s programme at the earliest possible moment.
11. Strengthen and increase the quality and funding of AMREF’s malaria programme. 

Accountability

• Supervision: Works independently under the authority of Director General and within strategy and policy guidelines
• Decision Making: Has full responsibility of decisions.
• Responsibility over data or information: Has access to important and highly confidential country data and information.
• Responsibility over assets: Overall responsibility for Programme budget and assets.
• Responsibility over Staff:  N/A

Professional Qualifications: Medical doctor with Masters in Public Health or infectious diseases or PHD in Public health or related field

Relevant Experience

• Practical field-based research and/or development experience relevant to community-based prevention and control of malaria (with a record of publications in peer-reviewed journals).
• Wide experience of current state of knowledge and of issues related to the prevention and control of malaria in rural and urban communities, preferably in Africa.
• Demonstrable network of contacts and high standing in his/her profession.
• Proven record of building effective partnerships and strategic alliances.
• Experience of international NGOs or UN bodies in Africa.
• Extensive experience in strategic planning, programme development and proposal writing
  

Length Of Experience: At least 7 years progressive working experience of conceptualizing, implementing and leading innovative malaria programmes, preferably in Africa.

Key Skills

• Demonstrated initiative and creativity; a strategic thinker.
• Demonstrable ability to anticipate emerging needs and integrate them speedily into priority setting.
• Proven record in raising substantial research/development funds.
• Superior analytical, communication and reporting skills.
  

Personal Attributes:

• Strong interpersonal and people management skills – a team player, builder and leader.
• Good command of written and spoken English. 
• Working knowledge of French will be an added advantage.

Performance Standard For This Job: Quality of work as indicated by achievement of specific outputs as detailed in the Programme work plan.

If your passion is to improve the health of the disadvantaged communities in Africa and you meet the above criteria, you are welcome to join us. Please quote the reference number CHR/10/08-11 and send your details including remuneration requirements and contact details of three work-related referees to, The Director of Human Resources, AMREF Headquarters by email to jobs@amref.org.

We encourage interested candidates to submit their applications by September 10, 2010 although the search will remain open until the position is filled.

AMREF is an equal opportunity employer and has a non-smoking environment policy.

Job Objective: To provide leadership for the development of AMREF’s HIV/AIDS/STIs/TB research, interventions and advocacy, adapting them to the changing needs of disadvantaged communities in Africa and leading efforts to attract new partners to develop the corporate HIV/AIDS/STI/TB programme.

Management Responsibility

1. Ensure that the Foundation’s work is cutting edge
2. Ensuring that AMREF learns and shares its experiences on HIV/AIDS//TB
3. Lead efforts to attract new partners and funding to expand HIV/AIDS//TB programmes

Description Of Duties

• Coordinate the Regional HIV/AIDS/ TB programme
• Design and coordinate in the implementation of the corporate HIV/AIDS//TB programme based on the needs of disadvantaged communities in Africa in line with the AMREF corporate strategy;
• Ensure implementation of the HIV/AIDS//TB strategy throughout AMREF operational areas (countries) and provide technical support and other necessary resources;
• Set the research agenda in the areas of HIV/AIDS//TB prevention, treatment care and support that benefit disadvantage communities, in partnership with local and global research institutions;
• Liaise with AMREF partners and act as spokesman and advocate for corporate AMREF on HIV/AIDS//TB issues, and advocate globally for poverty-alleviation policies and practices based on evidence;
• Contribute to resource mobilisation as necessary, in partnership with AMREF fundraising offices locally and in the north and with global  HIV/AIDS/TB contribution and ensure that these are maintained at country level;
• Monitor and Evaluate the quality, content and delivery of AMREF’s HIV/AIDS//TB contribution and ensure that these are maintained at country level
• Coordinate and manage a capacity building initiative that will strength delivery at operations (country) level to respond effectively to the HIV/AIDS//TB at community level;
• Ensure constant documentation and dissemination of lessons and best practices;
• Develop organisation procedures to gather knowledge from communities through the network of AMREF operational areas (countries) and create an enabling environment for documenting and sharing organisational knowledge
• Deliver to the Director of Programmes the output agreed in annual work-plans and budget and provide all necessary technical financial reporting as required by AMREF and its investors.
• Strengthen and increase the quality and funding of AMREF’s HIV/AIDS/TB programmes.

Accountability:

1. Supervision: Works independently under the authority of Director of Programme development and within strategy and policy guidelines
2. Decision Making: Has full responsibility of decisions
3. Responsibility over data or information: Has access to important and highly confidential country data and information
4. Responsibility over assets: Overall responsibility for Programme budget and assets
5. Responsibility over Staff:  N/A
   

Professional Qualifications: Medical Doctor with Masters in Public Health or related field, preferably PhD in Public Health or related field

Relevant Experience

• at least 7 years working experience in the are of HIV/AIDS or TB with international NGO’s or UN bodies
• demonstrated capacity to manage a National or Regional Programme which is integrated with reproductive health and/HIV/AIDS
• extensive experience in strategic planning, programme development including design and proposal writing;
• superior analytical presentation, communication and reporting skills
• sound IT knowledge, word processing, spreadsheets, databases, presentations and statistical applications (SPSS and EPI Info etc)
• good command of English language. Working knowledge of French will be an added advantage
  

Length Of Experience: At least 7 years progressive working experience of conceptualizing, implementing and leading innovative malaria programmes, preferably in Africa.

Key Skills

• Demonstrated initiative and creativity; a strategic thinker.
• Demonstrable ability to anticipate emerging needs and integrate them speedily into priority setting.
  
• Proven record in raising substantial research/development funds.
• Superior analytical, communication and reporting skills.
  

Personal Attributes

• Strong interpersonal and people management skills – a team player, builder and leader
• Communication and networking skills,
• Good command of written and spoken English. 
• Working knowledge of French, Spanish, Portuguese/or Kiswahili will be an added advantage.
  

Performance Standard For This Job: Quality of work as indicated by quality of work as indicated by achievement of specific outputs as detailed in the Programme work plan

If your passion is to improve the health of the disadvantaged communities in Africa and you meet the above criteria, you are welcome to join us. Please quote the reference number CHR/10/08-10 and send your details including remuneration requirements and contact details of three work-related referees to, The Director of Human Resources, AMREF Headquarters by email to jobs@amref.org.

We encourage interested candidates to submit their applications by September 10, 2010 although the search will remain open until the position is filled.

AMREF is an equal opportunity employer and has a non-smoking environment policy.

Monitoring and Evaluation

Fees: US$1200

Course Dates:

March 8 - April 2

June 21 - July 16

September 6 - October 1

November 8 - December 3

This course equips participants with competencies in monitoring and evaluation of health and development interventions at project, programme and organisational level. The course takes four weeks.

Course Objectives

By the end of the four weeks, participants would have gained:

• Concise understanding of the concepts, principles and processes of monitoring and evaluation
• Knowledge and skills in designing monitoring and evaluation (M&E) systems
• Competence in formulation of change-oriented indicators and change monitoring frameworks
• Knowledge and skills in using different tools and methods for data collection
• Competence in application of qualitative and quantitative data analysis tools and methods, effective report writing and presentation
  

PART ONE
Content

CONCEPTUAL UNDERSTANDING OF MONITORING AND EVALUATION

Areas of coverage

• Operational definitions of monitoring, evaluation, review and assessment
• Difference between monitoring, evaluation, review and assessment
• Importance of monitoring and evaluation in project/programme development
• Types of monitoring and evaluation
• Planning and implementing participatory monitoring
• Performance indicators.
  

DESIGNING AN EVALUATION

Areas of coverage

• Developing terms of reference for an evaluation
• Tools and methods relevant for data collection
• Sampling methods
• Importance of triangulation in evaluations
• Quality control
• Formulation of questionnaires
• General guidelines to asking questions
  

CONDUCTING AN EVALUATION

Areas of coverage

• Steps in organising and conducting a preparatory training for evaluation teams
• Testing tools for data collection
• Data collection
  

FIELD VISIT

• Data collection
• Experiential learning
• Field reporting

PART TWO
Part two focuses on data analysis, report writing and presentation of monitoring and evaluation results.

Content

QUALITATIVE ANALYSIS

Areas of coverage

• Data reduction, organisation and interpretation.
• Methods of qualitative analysis:
  • Successive approximation
  • Analytic comparison: Method of agreement, method of difference
  • Cultural analysis
  • Contact summary sheet
  • Codes and coding
  • Site analysis meeting
• How to interpret qualitative data.
  

QUANTITATIVE ANALYSIS METHODS

Areas of coverage

• Tools and methods for analysing and interpreting quantitative data
• Assessing and judging results
• Computer applications using SPSS Package:
  • Introduction to data analysis
  • Introduction to SPSS
  • Structure of data bases
  • Getting from completed questionnaires to a database-coding keys, closed and open ended questions, data entry
  • Data cleaning- ensuring data is entered correctly
  • Types of variables; uni- and bi- variate analysis; planning your analysis.
  • Univariate analysis-frequency distributions, measures of central tendency and dispersion
  • Bivariate analysis: cross-tabulations, measures of significance and correlation
  • Data interpretation
  • Printing data
    

REPORT WRITING AND PRESENTATION

Areas of coverage

• Contents and format of an evaluation report
• Report writing skills
• Report presentation skills
• Organising and conducting user workshops
  

PART THREE

Content

DESIGNING M&E SYSTEM AND CHANGE MONITORING

Designing a Monitoring and Evaluation (M&E) System: definition, aims and objectives of the system; selection of relevant information and indicators; tools and methods relevant for data collection and analysis in a M&E system; organisation for M&E; presentation and use of results derived from a M&E system.

Performance indicators: What are they? Criteria for selecting performance indicators.

Impact Monitoring: Why impact monitoring; impact monitoring framework.

Apply Online

Download the short courses application form

Refresher Course in Essential Laboratory Services

Cost:
US$ 1,440 - tuition, books, course materials, and field trips, stationary, photocopies, pupil’s pass and health insurance

US$ 1,920 - accommodation, food, local travel, living allowance

Introduction

Laboratory services are an essential part of health care delivery, particularly in tropical countries where simple tests play a major role in the diagnosis and management of common diseases and conditions, in the rational use of essential drugs and in the control of diseases of public health importance.

Few opportunities for continuing education of laboratory workers exist in Africa. With several years of experience in running refresher courses for laboratory workers in East Africa, AMREF has developed a course designed to assist in the complete management of a laboratory at peripheral level.

Objectives

• Perform essential laboratory tests to a high standard, incorporating appropriate quality control procedures;
• Perform simple maintenance procedures on equipment;
• Carry out all laboratory management activities;
• Develop an approach to disease control and the investigation of epidemics

The course emphasises the importance of communication and collaboration between laboratory workers and health staff of all cadres.

Content

The Refresher Course in Essential Laboratory Services leads to a certificate on completion. The contents of the course are

• Setting up the laboratory
• Laboratory ethics
• Basic maintenance of procedures for laboratory equipment
• Systematic approach to laboratory investigations
• Interpretation & clinical significance of tests
• Laboratory safety
• Laboratory mathematics
• Field work
• Special projects
  

Entry prerequisites

Participants should be a holder of certificate or diploma in medical laboratory technology, with at least 2 years practical experience. If no formal laboratory training has been received, completion of pre- secondary education and at least 3 years practical experience are required. Participants must be competent in written and spoken English.

Duration and location

The course will run for 12 weeks starting between March 8 and May 28, 2010 at the AMREF Kenya Country Office at Wilson Airport

For further details about the course and to request for application forms please contact amref.clinical@amref.org or kenya.lab@amref.org

In 2010, AMREF will run the following short courses: (Click on the course title to view details)

***Please note: Phase Two of this year's training is currently in progress and will end on August 27. Phase Three will run from September 6 to November 26, 2010.

General Information:

• Certification - The participants, upon successful attendance of each short course will be awarded an AMREF certificate of participation stipulating the topics covered.
• Learning Resources:- Computer laboratory with internet access; A well-equipped clinical laboratory where trainees carry out practical examinations; A state-of-the-art health library which provides access to information that is otherwise unavailable locally.
• Costs: - Training costs covers lunch, stationery, field trips and all course related learning materials.- Accommodation (US$ 48 per day) To cover half board accommodation (bed, dinner and breakfast) including daily transport to and from the training venue using the AMREF bus.-Mode of payment All payments to the course should be made two weeks to the commencement of each course in cheques payable to AMREF or through bank transfer to the AMREF account
• Tailor made courses: AMREF organises customised short courses for groups of not less than 15 participants in health and health-related fields, tailored to the needs of individuals or organisations. Our clients have included NGOs and Ministries of Health in Sudan, Malawi, Somalia, Kenya, Ethiopia and Eritrea.

Apply Online

Download the Short Courses Application Form

Amina Saidi is a 37 year old mother of five, residing in Mkamba ward of Mkuranga District, an hour’s drive southeast of Dar es Salaam. Mkuranga is one of the poorest districts in southern Tanzania.

Amina’s life is one of poverty which is evident in the structure of her house. The two room house constructed from wood and earth has the roof of the section that serves as the kitchen partially thatched in grass with most of it left open, exposing her and her children to the elements of rain and the scorching sun. The adjoining ‘room’ serves as the bedroom for the family of seven with a single makeshift bed.

Majority of the residents of this area are Muslim and largely rely on farming as a source of food and income. Amina is no exception; she has a garden right next to her house in which she plants cassava, cashew nuts and maize that she uses to feed her family. She also makes cooking pots which she sells at the nearby market providing a minimal source of income for her family. The family also has three chickens running around the compound that are a valuable source of eggs. She fetches water for her family at a nearby borehole provided by AMREF as part of the Mkuranga Water and Sanitation Project.

As she pounds dried cassava to make flour for the family’s evening meal with the help of her nine year old daughter Khadija Athumani, Amina talks about her family.

“My husband and I have lost two children, one at 6 months in 1996 and the other at four years in late October this year. One died in his sleep with no prior illness or complications and the other just fell ill one day and died the next.”

A matter of life and death

In 2002, several villages in this district got together to approach AMREF to address the problem of high numbers of pregnant mothers dying at childbirth. One of the issues which arose was the lack of transport available for expectant mothers when they went into labour. Also, attending the health facilities when delivering was difficult as there was no place to stay overnight.

In response, AMREF through the Mkuranga Reproductive Health Project constructed maternity homes at seven health facilities to increase the utilisation of the services during pregnancy and at childbirth, as well as increase the number of women delivering with the assistance of trained attendants. The local communities contributed by provided all the bricks and sand for the facilities. The maternity home at Mkamba dispensary where Amina delivered her son Rashid is one such facility.

Amina is fortunate enough to live near the health centre as it is just a 15 minute walk from her home. Others are not as lucky and have to travel long distances with no formal means of transportation and poor road networks to access these facilities. The district has grown in size and now has more sub divisions. Many of the villages don’t have any health facilities or trained community owned resource persons (CORPs) to educate the community members on health matters.

“I am HIV positive. I discovered when I got tested during a routine ante-natal clinic check up when I was expecting my last child Rashid, almost two years ago,” she says. At the dispensary, she received reproductive health services, information on family planning and anti-Malaria medication to protect her and her unborn child from malaria which is rampant in the village. She delivered her baby boy safely at the health centre.
“Rashid recently got tested for HIV, I am praying to God as I await the results,” she says anxiously.

Long journey to protect your baby

Despite the availability of basic reproductive health services at these village health facilities, services like prevention of mother to child transmission and anti-retroviral therapy are still not available. To access these, mothers like Amina have to cover long distances to the District hospital where they are available.

“I was shocked about my HIV status as I had not felt unwell,” she says.

Amina was referred to Mkuranga District hospital, a little over 70kms away, where she receives her anti-retroviral therapy (ART) treatment and information on nutrition and diet to date.

“I got hope that I can live a full life like others I met at the hospital. My husband refuses to accept my HIV status. He says I still look healthy and has refused to go to the dispensary to get tested. But my plan is to continue encouraging him to get tested,” she adds.

Amina has not suffered from any major health problems other than a chronic headache that normally goes away with medication.  To date, she still has not disclosed her HIV status to other family members other than a close relative who lives in the city - she was comfortable enough to tell him of her status as he lives far away. She is still afraid of being stigmatised by her family that lives nearby and is also concerned about what her neighbours would say if they found out.

Changing Plans

Before Amina learnt of her health status, she had plans to move away from Mkamba with her family to seek a better life elsewhere but upon discovering she is HIV positive, she has decided to stay on.

“But I am hopeful that I can live a long, full life with the ART treatment and advice I receive on my diet,” she says with a smile. “I plan to adhere to the treatment as I hope to see all my children grow up and mature. I do not see myself as any different from other people who are HIV negative,” she adds stoically.

Her advice to other mothers and community members in general is to get tested and know their status as this may save their lives and the lives of their children as well.

View a slideshow of Amina Saidi

* Copy not available online, request for a copy.

AMREF will gladly consider any request for permission to reproduce part or the whole of these publications with the intention of increasing its availability to those who need it. AMREF welcomes enquiries from individuals or organisations wishing to use the content for non-commercial purposes. The organisation would also be grateful to learn how you are using the publications and welcomes constructive comments and suggestions.

Please address any correspondence to: 
The Communications Directorate
AMREF Headquarters
PO Box 27691 – 00506,
Nairobi, Kenya
Email: info@amref.org

AMREF believes that timely free flow of information in simple and accessible language, form and format is essential for ensuring accountability, learning, trust and good performance.

This policy is guided by AMREFcommitment to transparency and to sharing of information. We are also directly accountable to our staff, partners, donors and host governments.

The purpose of this policy is to guide all staff and the whole organisation for open sharing of information. Another purpose is to inform people outside AMREF what they can expect or demand, in terms of information, from AMREF.

This policy describes how and what minimum information AMREF will share proactively with the general public.

AMREF will share additional information with staff, partners, associates, people and organisations we work with in a timely and accessible manner to ensure respect and accountability to the specific relationship.

This additional sharing of information will be guided by the relevant policies, procedures (and agreements or contracts) related to the specific relationship.

Information to be shared freely and openly

The following sets of information of various categories will be shared freely, openly and proactively:

• Fundamentals: AMREF’s vision, mission, values, goals and objectives, strategies, legal registration and status and registered office address.

• Governance & Key Functionaries: Names and brief biographies of members of Board of Directors, Chair, Chief Executive, Senior Management Team Members.

• Organisational policies: Key decision making process, in terms of who makes the decision for Directors’ appointment, staff recruitment; performance appraisal; staff development and promotion; strategies, plans and budget approval; reviews and evaluations. For other decision-making processes the organisation’s current organisational policy and operational manuals/documents should also be shared freely and openly.

• Performance: Current account of lessons, achievements, success, failures, constraints, innovations either directly or through annual reports, review reports and audit statements at least on an annual basis.

• Staff: Number of staff, gender, nationality, aggregated staff costs, departments and staff per department, staff benefits and allowances. Personal Identifiable Information (PII) will only be disclosed where there is a legal or legitimate business purpose.

• Funds and finance: Types, proportion and absolute figures of income; sources of income, expenditure by categories and heads; planned and actual cost ratio for staff cost, support cost, project cost, fundraising cost, administration cost; funding structure; types and location of fund investments; fundraising methods and products. Information on income and expenditure will be aggregated into sums of $100,000 and above.

• Relationships: Key relationships we have in terms of which groups of who our partners are, which networks, coalitions, and alliances we belong to and work with, who do we receive money from, where do we invest our money, who are our bankers, auditors, lawyers.

• Issue-based positions: Our guiding thinking and positions on issues related to our mission, objectives and strategies, particularly those related to active advocacy work.

• Feedback: A periodic presentation of our stakeholders’ views of us and our performance through annual reports and reports of external evaluations conducted by donors, in conjunction with AMREF.

Ways and means of sharing information

• AMREF will be primarily responsible for sharing information related to its own areas and domains of responsibilities according to this policy.

• All information shared will be timely. Information shared will be dated to indicate the timeliness.

• AMREF will share information mentioned above in English.

• Information mentioned above under the headings of ‘Fundamentals’ and ‘Key functionaries’ related to AMREF’s international organisation will be used by all parts of the organisation to share together with their national or regional details. In addition, AMREF’s country offices and national offices will also use each other’s information to share with their constituencies, especially when they are accountably linked.

• AMREF will ensure that all partners and interested parties, including poor and marginalised people and their organisations, have access to timely and quality information in accessible forms and formats.

• AMREF’s website will be the main venue for sharing the information mentioned above proactively to wider range of audience. AMREF within the limits of its resources, will also send information as requested (as per this policy) in electronic or printed form to an authentic address of the person or the organisation requesting information.

• Anonymous requests for information will not be responded to.

• Reviewing compliance of this policy will be the function of such staff and units responsible for AMREF’s Monitoring and Evaluation System. Such review reports will be presented and discussed in SMT and Board meetings at least once year.

Confidentiality

AMREF shall not disclose the following kinds of information:

• Personal details of staff: address, family details, income, property, sexual orientation, illness and similar information.

• Intellectual property or other information which has been disclosed or provided to AMREF under any obligation of confidentiality or which is subject to legal disclosure restrictions, or intellectual property of AMREF, unless consent of such disclosure has been obtained from the owner of such intellectual property.

• Legal advice and matters in dispute or under negotiation including disciplinary and investigative information generated in or for AMREF.

• Information dealing entirely with internal administration, management or operating systems which has no direct effect outside the organisation, or internal documents written by staff to their colleagues, supervisors or subordinates, unless those documents are intended for public circulation.

• Fundraising information, sharing of which will jeopardise AMREF’s competitiveness in a fundraising capacity.

• It is only in exceptional cases and circumstances that AMREF can temporarily suspend part or whole of this policy. Such suspension will require approval from AMREF’s Chair and the Chief Executive. Suspension of the policy will be clearly explained with reasons to people we work with and the general public through the mechanisms mentioned above.

• In unusual situations (e.g., war, insurgency) of insecurity, threat and vulnerability to the organisation, staff or partners, AMREF may choose not to share any or selected information for a specified period.

• Similarly, if sharing of certain information in the specific local situation will make staff and the organisation highly insecure and vulnerable; the relevant AMREF office may choose not to share the particular information for a specified period.

Board approved November 2007

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Leaders and activists demand increased funding to ensure universal HIV treatment

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Children die at home, with little or no contact with the formal health services, from diseases that can be prevented and treated through action at the household level. This project will develop community-based approaches to improve knowledge and awareness on MNCH; understanding of vulnerable groups’ rights, entitlements, and the corresponding responsibilities & government structures, leading to preventive behaviour and early identification of health complications; and improved community actions on MNCH. The action expects to see increased availability, accessibility, quality and as a result, utilisation of MNCH services to improve health outcomes. The project will offer a continuum of care approach to meet the needs and constraints of the target groups. This runs from pre-pregnancy (ensuring access to family planning/reproductive health services, specifically for vulnerable groups including youth), through to pregnancy (antenatal care, birth preparedness), safe delivery (including strong referral systems and access to skilled, emergency care in the case of complications) and post natal care for mothers and newborns that includes counseling for family planning, through to management of childhood health

The four-year project works in rural coastal communities in Mtwara and Tandahimba (Tanzania), indigenous communities in Lamu District (Kenya), and internally displaced people and host communities in post-conflict Terekeka (S. Sudan). The project is implemented by AMREF in each of the targeted countries in partnership with Ministries of Health and local-level stakeholders; and is regionally co-ordinated by AMREF’s Headquarters in Nairobi, Kenya. 

Overall Project Objective of the Project

To strengthen capacity of communities, civil society organisations and local authorities (District Health management Teams/Boards) to promote maternal, newborn and child health among marginalized communities in four districts by 2013.

Key Result Areas & Expected Outcomes of the Project

Result Area 1: Communities especially women and girls, are empowered with the knowledge to promote health seeking behaviour, demand and access MNCH services.

Result Area 2: Local health systems have increased capacity to manage & deliver inclusive, comprehensive & community-responsive MNCH services

Result Area 3: Civil society organisations (CSOs) have increased capacity to participate in decision-making & influence MNCH policies & practices at local, national & international levels

Result Area 4: Regional knowledge-base is established on community-based solutions to improving MNCH & used to inform policy making at national, regional & international level (Please refer to Annex A for details on the Expected Outcomes of the Project)

Objectives and Scope of Work of the Consultancy

The main objective of the consultancy is to establish a regional level base-line status on access and provision of maternal, new born and child health services. Base-line surveys will be carried out in each of the districts targeted by this project and the findings will be consolidated to establish a regional understanding on MNCH across the three countries.  The base-line will determine bench-marks for target setting within each result area, as per indicators set out in the original log-frame; validate if the activities within the project design are sufficient in scale and scope, in order to meet these targets; and identify opportunities for sustainability of project activities within each country.

The specific objectives of the base-line survey will be to:

• Establish the prevailing health conditions, and health problems including diseases affecting mothers, infants and children under the age of five within each of the three targeted countries
• Determine current levels of knowledge, attitudes and practice towards MNCH issues and access to MNCH services in each of the targeted communities.
• Determine the capacity of the district health systems (including public, private and community-based health systems) to provide MNCH services. This includes the availability and accessibility of health facilities and services offered for mothers, new born and children under the age of five, in terms of distances, cultural acceptability, affordability, availability and appropriateness (client-friendly, inclusive, responsive, hygienic etc)
• Establish the capacity of communities, community structures and Civil Society Organisation partners to address MNCH and improve over-all health status of targeted communities
• Establish the capacity and opportunities for institutionalization and sustainability of MNCH initiatives among the stakeholders and the communities.

The results will be used to develop an evidence base for advocacy for MNCH interventions in all three targeted countries.

Main Tasks of the Consultancy

The consultant will work in conjunction with the M&E Technical Lead and the Director for Reproductive and Child Health at AMREF HQ to finalise the design and inception plan for the study. Within each country, the consultant will work with the Project Teams, which include the Project Manager, Project Assistants, Technical Lead and Deputy Director and local stakeholders to co-ordinate, conduct the study and disseminate the base-line findings. The consultant is expected to undertake the following tasks:

1. Carry out a desk-review of relevant project documents (listed in Annex A), including project proposal, log-frame, budget and other relevant documents, a range of which will be agreed upon and made available prior to the implementation of the study
2. Develop an inception report, detailing the evaluation design, methodology, indicators, tools, work plan schedule and budget to carry out the assignment in each country. This will be developed and finalized in consultation with AMREF HQ and Country teams.
3. Form a Base-line Assessment Coordinating Team, which includes AMREF staff, local community members and other partners involved in the project.
4. Develop a Sampling Design and Data Collection & Management Protocol that is standardized for the three areas. Basic demographic variables including religion, and socio-cultural practices should be captured within space limitations of the study tools
5. Facilitate recruitment and training of field staff (supervisors, interviewers, observers/record reviewers) and pre-testing of data collection tools.
6. Co-ordinate collection of data, and its entry into a suitable platform for cleaning and analysis
7. Analyse and interpret the findings
8. Develop and submit the first draft of the base-line assessment report and debriefing to AMREF HQ, Country Teams and local partners. The report will include three country level reports, which will feed into a regional level (Ke, Tz, SS) base-line report on MNCH. The reports should be comprehensive and provide detailed specific findings within each result area, providing key recommendations for implementation
9. Submit the final evaluation report to AMREF Headquarters in Nairobi, Kenya i.e. 6 Hard Copies and a soft copy in CD-Rom. The raw data, the data-base which has been cleaned (both qualitative and quantitative, including original field notes for in-depth interviews and focus group discussions, as well as recorded audio material), and data collection tools used in the evaluation should be submitted together with the report. A simple inventory of material handed over will be part of the record. AMREF has sole ownership of all final data and any findings shall only be shared or reproduced with the permission of AMREF.
   

The consultant will be expected to compile and submit the draft report, make a presentation to AMREF, incorporate comments and submit a final report within 30 days of the end of the evaluation.

Deliverables

1. Inception Report detailing the evaluation design, methodology, tools, work plan and budget
2. Data collection tools, data set with codebook
3. Draft and final Base-line Survey Reports at country and Regional levels.
4. Copies of original and cleaned data sets including field notes, audio tapes, and transcribed material

Please note that the contents of the report will be analyzed and final payment will only be made upon agreement on the final Base-line Survey Report from the AMREF Teams at HQ and Country level.

Time-frame

The assignment is expected to commence starting August 1, 2010 and is expected to take a maximum of 45 days (approx.15 days in each country), which includes desk-review, preparation, implementation, report-writing

Role of AMREF and collaborators

AMREF will provide the logistics and programme documents and be the link between the consultant and the project sites. AMREF will also review tools and provide support in the evaluation process. AMREF will provide venues for discussion and mobilize the required persons for interviews. The collaborators/partners will provide the necessary resources/facilities and required persons for interviews. The consultant will be responsible for guiding the entire Evaluation process and all other specific responsibilities as stipulated in the TOR. 

Expected Profile of the Consultant

• The consultant is expected to hold the following qualifications in order to be eligible for this position:
• A recognised university degree in public health, international development, medical anthropology or related social science (at a minimum of Masters level, but preferably at doctorate level).
• Sound knowledge of major development issues, especially maternal, new born and child health issues. Knowledge of the East African region is a requirement.
• At least 10 years of consultancy experience in  the area of public health and reproductive health/gender issues both in organisations and in projects
• Experience in the formulation, monitoring and evaluation of projects in Maternal, New Born and Child Health/Public Health
• Similar work in the last 3 years (to provide copies of reports).
• A demonstrated high level of professionalism and an ability to work independently and in high-pressure situations under tight deadlines.
• Strong interpersonal and communication skills
• High proficiency in written and spoken English.

Response Proposal Specifications

Those interested in the consultancy must include in their application a detailed technical and financial proposal with the following components:

11.1 Technical
11.1.1 Understanding and interpretation of the TOR
11.1.2 Methodology to be used in undertaking the assignment
11.1.3 Time and activity schedule

11.2 Financial
11.2.1 Consultant’s daily rate in Kenyan shillings and USD
11.2.2 Other costs, eg; accommodation, travel and printing

11.3 Organisational and Personnel Capacity Statement
11.3.1 Relevant experience related to the assignment
11.3.2 Contacts of organisations previously worked for
11.3.3 Curriculum Vitae of key personnel

Submission of Proposals

The proposal can be sent by post, hand delivered or e-mailed so as to reach the undersigned by August 5, 2010:

Dr. John Nduba,
AMREF Headquarters,
P.O. Box 27691-00506
Nairobi, Kenya;
E-mail: john.nduba@amref.org ; cc helen.kairu@amref.org; bindu.sunny@amrefuk.org

Evaluation and Award of Consultancy

AMREF in consultation with the project partners will evaluate the proposals and award the assignment based on technical and financial feasibility. AMREF in consultation with the partners reserves the right to accept or reject any proposal received without giving reasons and is not bound to accept the lowest, the highest or any bidder.

Annex A: Expected Outcomes:

As seen in the log-frame, indicators selected within each result area are the same across all three target countries. Individual targets within each country will be determined based on country level base-line studies (and secondary data) carried out. Achievements by the end of the project will be tracked using the following indicators:

Result Area 1:

• Percentage of maternal morbidity from obstetric causes;
• Proportion of children at the right weight for age;
• Incidence of childhood illness due to immunisable diseases; and
• Incidence of still birth and neo natal infections.
• Contraception and utilisation of family planning services
  • % of women and sexually active girls utilising modern family planning methods; 
  • % of non-pregnant women seeking care for reproductive health problems; 
  • % of households who report having necessary supplies for birth and plan in the event of complications;
• Ante-natal and Post-natal Care attendance at health facility/health post
  • % of pregnant women receiving 4 episodes of antenatal care 
  • % of pregnant women receiving 2 doses of Tetanus Toxoid 
  • % of mothers receiving post-natal care within 42 days of delivery; 
  • % of pregnant women who sleep under a mosquito net; 
  • % of mothers who access maternal health services within their sub-location from a trained health worker in Kenya, Tanzania and S. Sudan. 
  • % of men will be actively involved in health care of their pregnant wives (attendance at ANC and delivery) and care of their young children (taking children for immunisation and treatment)
  • % of women and men who can state danger signs of obstetric and neonatal complications; childhood illnesses (eg; malaria); % of target communities who have adequate knowledge on harmful traditional practices (HTPs) 
• Births attended by skilled health personnel
  • % of pregnant women delivered by skilled health workers 
  • % decrease of women with obstetric complications
  • % of women with obstetric complications treated within 12 hrs of onset of labour/2 hrs on arrival at facility;
  • % of mothers receiving post-natal care within 42 days of delivery
• New Borns and Children under Five receiving care and treatment 
  • % of children under 1 receiving immunisation for MMR; 
  • % of children under 5 accessing child health services within their ward, sub-location, Payam 
  • % of children under 5 with fever getting treatment within 24 hrs of onset of fever;
  • % of newborns starting breast feeding within an hour of delivery; 
  • % of children under 6 months are exclusively breast fed;
  • % of children above 6 months who receive correct complementary feeding;
  • % of children under five years of age sleep under a mosquito net consistently;
  • % of children under five who are underweight
  • % of mothers who breastfeed their infants exclusively
• No. of CHWs currently serving their communities with preventive, promotive and curative health care at the Sub-location, village and Boma level in Kenya, Tanzania and S Sudan respectively, strengthening the lowest level of formal health care provision in the target districts.
  

Result Area 2:
Coverage of services:

• % of health facilities in the four target districts offering basic and emergency obstetric care;
• % of health facilities offering comprehensive MCH services including family planning; counselling and testing for HIV
• Quality of services 
  • %of Health care Providers with requisite skills to provide MNCH services provision, and adherance to quality assurance checklists  
  • % of facilities exhibiting client friendly sensitivity in the service delivery environment (e.g. gender and youth friendly services) 
  • % of mid-level health workers in four target districts (ie nurses, midwives, medical assistants and environmental health officers) trained in managing MNCH services, delivery of high quality services,  community mobilisation for increased participation in health development; community and formal health information systems to track progress, and in community based referral systems that increase access to emergency services for emergency treatment of obstetric complications and for ill  children.
• Responsiveness: Evidence of strong, institutionalised links between communities and health systems
  • % of referrals made by Community Health Workers (CHW) in the target four districts;
  • % of back-referrals for follow up from the health facilities back to CHW; 
  • % of health management teams meeting with CHWs and CBOs every quarter
• Improved capacity/management systems: 
  • Existence and utilisation of current Health information system (HIS) across targeted facilities, 
  • No. of referrals, back-referrals made by health workers to follow-up patient care and treatment
  • % of women and young people participating in health management decision-making structures from the village to the district levels in the four target districts
    

Result Area 3:

• % of District and County level Health Management Teams who have received training in planning, managing, monitoring and evaluating district health services, responsive to the health needs of women and children primarily and whole communities in general
• % of managers of LA health services and development structures in 4 target districts, trained to effectively plan, implement, monitor and evaluate health programmes in a community-inclusive and participatory manner
• % of CSOs represented in annual budgeting and planning meetings with the local authorities at all levels from the village to the district level in the target districts;  
• % improvement in CSO capacity in establishing
  • appropriate governance structures
  • management policies/systems
  • HR systems/policies
  • Finance resource mobilisation and management
  • External relationships management
  • Gender sensitive policies;
  • technical skills for participatory/inclusive service provision
    

Result Area 4:

• Participation at policy forums at district, national and regional levels at which the project lessons learnt can be disseminated;
• Participation in at least 2 networks and alliances that the project is a member
• % allocation of resources (private, public and not for profit sector) for community focused MNCH programmes
  

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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