Amref Health Africa 2018 Annual Report

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ACRONYMS & ABBREVIATIONS

AHAIC

Africa Health Agenda International Conference

AHBS

Africa Health Business Symposium

AMC

Amref Medical Centre

AMIU

Amref International University

ANC

Antenatal Care

ARP

Alternative Rite of Passage

ASRH

Adolescent, Sexual and Reproductive Health

BEmOC

Basic Emergency Obstetric Care

CAIA-MNCN Canada Africa Initiative to Address Maternal, New-born and Child
Mortality
CSR

Corporate Social Responsibility

CBO

Community Based Organisation

CBS

Community Based Surveillance

CDN

Canadian Dollar

CEFM

Child Early and Forced Marriage

CEO

Chief Executive Officer

CHEWs

Community Health Extension Workers

CHVs

Community Health Volunteers

CHWs

Community Health Workers

C-LMG

Community Leadership, Management and Governance

CPD

Continuous Professional Development

CSO

Civil Society Organisation

CURAFA

Cure and Afya

DHE

Department of Higher Education

DHIS

District Health Information System

FBO

Faith Based Organisation

FGM/C

Female Genital Mutilation/Cutting

FMO

Netherlands Development Finance Company

Family Planning

GDPR

General Data Protection Regulation

GIZ

Deutsche Gesellschaft für Internationale Zusammenarbeit

GSK

GlaxoSmithKline

HCW

Health Care Worker

H.E

His Excellency

HDIF

Human Development Innovation Fund

HIV/AIDS

Human Immunodeficiency Virus/Acquired Immunodeficiency

Syndrome
HMTs

Health Management Teams

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HRH

Human Resources for Health

HSAP

Health Systems Advocacy Partnership

HTI

Health Training Institution

HUMC

Health Unit Management Committee

ICD

Institute of Capacity Development

ICM

International Council of Midwives

ICT

Information Communication Technology

IEB

Independent Examination Board

IDF

International Diabetes Federation

IFC

International Finance Corporation

i-PUSH

Innovative Partnership for Universal Sustainable Healthcare

ITIJ

International Travel & Health Insurance Journal

JFY

JICA Financial Year

JICA

Japan International Cooperation Agency

KISSMEE

Kenya Innovative and Sustainable Solutions for Midwifery

Education and Employment

KQMH

Kenya Quality Model for Health

KYPA

Kenya Young Parliamentarians

LCD

Liquid Crystal Display

LGAs

Local Government Authorities (LGAs)

LMA

Leadership, Management and Advocacy

LMG

Leadership, Management and Governance

LMS

Learning Management System

MDI

Management Development Institute

MNCH

Maternal and Child Health

MoH

Ministry of Health

MSAS

Ministry of Health and Social Action

MYE

Meaningful Youth Engagement

NCDs

Non Communicable Diseases

NCK

Nursing Council of Kenya

NGO

Non-Governmental Organisation

NHIF

National Hospital Insurance Fund

NTIF

Nutrition Leverage and Influence for Transformation

NMs

Nurses and Midwives

NYC

New York City

ODF

Open Defecation Free

ODSS

Organisational Development and Systems Strengthening

OECD

Organization for Economic Cooperation and Development

OOP

Out-of-pocket

OPD

Out Patient Department

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PEPFAR

President’s emergency plan for AIDS Relief

PPP

Public Private Partnerships

Quality Improvement

RGIL

Reading Glasses for Improved Livelihoods

RMCH

Reproductive, Maternal, Neonatal and Child Health

RTCs

Regional Training Centres

RMNCAH

Reproductive, Maternal, New-born, Child and Adolescent Health

RTz

Rural Tanzania

SDG

Sustainable Development Goal

SEK

Swedish Krona

SU4AM

Stand Up for African Mothers

SPARC

Strategic Purchasing Africa Resource Centre

SRHR

Sexual and Reproductive Health and Rights

SSA

Sub Saharan Africa

STIs

Sexually Transmitted Diseases

SWM

Solid Waste Management

Tuberculosis

TCS

Tata Consultancy Services

THE

Total Health Expenditure

Television

UHC

Universal Health Coverage

United Kingdom

UMCU

University Medical Centre Utrecht

United Nations

UNFPA

United Nations Population Fund

UNGA

UN General Assembly

USA

United States of America

USAID

United States Agency for International Development

US$

United States Dollar

VHTs

Village Health Teams

WASH

Water Sanitation and Hygiene

WHO

World Health Organisation

WRA

Women of Reproductive Age

Y-ACT

Youth in Action Network

FOREWORD

Message from the

Chairman, International Board of Directors, Mr Omari Issa

n 2013, I took over the position of the Chairman of Amref Health Africa’s International Board of Directors from my
predecessor, Dr Noerine Kaleeba, a time when the organisation was undergoing transformation to deliver a proficient
and internationally representative structure.

The new board - comprising of representatives from national boards of Amref offices in the North and the South, and
independent members - had been in place for just a year. Though new, we were all ready for the task ahead of us - to
spearhead operations and activities of Amref and carry forward the vision of our founders in order to improve health of
Africa’s disadvantaged communities.
With the board having made significant progress in harmonising Amref’s governance structure, we were in consensus that
we needed to embrace new ways of operation – including a private sector approach, and broadening our sources of funding
beyond traditional donors. Six years later, we continue to reap fruits of the transformational strategy that we adopted then.
As the largest international health development organisation in Africa, Amref Health Africa boasts of a sustainable and
growing funding base of over US$100 million per annum and diverse partnerships with health stakeholders including private
sector players, who contribute immensely towards to achievement of our vision of creating lasting health change in African
communities.
Our strategic focus areas appropriately respond and address challenges faced by communities and health systems. Under
my leadership, Amref Health Africa launched its 2018-2022 Corporate Strategy in 2018, which promotes the achievement of
Universal Health Coverage (UHC) in our target countries by addressing challenges that hinder communities from accessing
equitable, quality and affordable health services.

As the largest international health

development organisation in Africa,

Amref Health Africa boasts of a

sustainable and growing funding base

of over US$100 million per annum

and diverse partnerships with health
stakeholders including private sector

players, who contribute immensely

towards to achievement of our vision

of creating lasting health change in

African communities.

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Three cross-cutting themes - policy and advocacy, gender, research and innovation - have been incorporated into our project design and new corporate strategy, which has three
strategic pillars - Human Resources for Health (HRH), Innovative Health Services and Solutions and Investing in Health.
Driven by our goal to deliver sustainable health access, since 2017, we have taken a leading role in the Universal Health Coverage discussion. We have been organising the Africa
Health Agenda International Conference (AHAIC) every two years, a testimony that we have African communities at heart and want to change their lives through improved health
coverage. This also demonstrates our commitment to inspire governments to prioritise healthcare in their national strategies. Through such conferences, Amref will continue to
bring diverse stakeholders in one platform to share and understand health challenges in Africa, identify opportunities to collaborate and be part of conversations that help influence
policymakers and donor priorities to advance UHC in Africa.
We have also achieved a major milestone receiving a Letter of Interim Authority from the Government of Kenya to run Amref International University, an institution focused on
health sciences training and especially middle level health professionals such as nurses and midwives, public and community health and health system specialists.
I believe we are heading towards the right direction. The number of our beneficiaries keeps increasing annually. The number of the health workers that we train is also rising. We
strive to deliver tangible impact on communities, and I am glad that I have been at the helm of one of the largest international health NGOs, spearheading its operations for six years.
In 2019, my tenure as the Chairman comes to an end and I will hand over the mantle to the new Chairperson who will propel Amref to great success for the next coming years. I
am certain that Amref will continue transforming lives of African communities, who are the centre of our work, and whom we have supported since 1957.
Together we can improve and change lives, together we can reform health systems, together we can achieve UHC, and together we can create lasting health change in Africa.

A word from the

Group Chief Executive Officer, Dr Githinji Gitahi

mref Health Africa remains committed to its bold vision of creating lasting health change in African communities
by increasing access to sustainable health through solutions in human resources for health, health service delivery
and investments in health, all geared towards a big ambition – Universal Health Coverage (UHC).

As leading champions of UHC in Africa, we strive to achieve and sustain our impact in African communities through
implementation of our 2018-2022 Corporate Strategy – our key highlight for 2018 – which undoubtedly mirror our
distinguished position as the leading Africa based international health development organisation.
Launched in 2018, the strategy demonstrates our commitment to UHC, to ensure individuals and communities - who are at
the centre of our programmatic work - access the essential and quality health services they need without suffering financial
hardship. We are glad that our integrated programmes reached a total of 15,267,875 people and trained 71,522 people
during the past year.
In recent years, the concept of UHC has gained momentum among governments, civil society, the private sector and donors,
across Africa and around the world. We are witnessing more countries recognise the importance of health in sustainable
development and are committed to achieving “health for all’’ both as a fundamental human right and a cornerstone for social
and economic development. The renewed focus on health particularly primary health care and the growing momentum
around UHC is a first and critical step towards providing quality, affordable, health care for all. Aside from the apparent
benefits of having a healthier population, UHC improves how health care is delivered and financed, so that it is more
accessible, more equitable and more effective.
Our Corporate Strategy takes into consideration, among others, the unique health challenges that Africa faces and builds
on our over 60 years of experience working with African communities. It also recognises the changing social-economic
environment, shifting demographics and changing disease patterns, which call for the need to do things differently for impact.

Amref Health Africa remains

committed to its bold vision of

creating lasting health change in

African communities.

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Our target to reach 100 million people in Sub-Saharan Africa over the next five years banks on partnerships with stakeholders, donors and African communities – who have all
continued to support our work. On behalf of Amref, I would like to recognise and appreciate the generous support and contribution of all of our partners towards our vision.
Certainly, realisation of UHC in Africa will require political will, committed resources and coordinated action among stakeholders. In the changing health landscape, private sector
players, foundations, civil society organisations and bilateral and multilateral donors agencies have a role to play. We will continue partnering with such partners, private sector,
communities, particularly, ministries of health/governments to integrate health agendas into their national plans. This is key in supporting mobilisation of adequate resources to ensure
equitable population coverage and the provision of quality primary health care by strengthening the health service delivery system, guaranteeing that health services are accessible
to all (especially poor and vulnerable individuals) and increasing financial protection.
In 2019, Amref’s resources will be channelled towards sustaining gains achieved through UHC and implementation of our Corporate Strategy with a strategic focus on three cross
cutting themes - policy and advocacy, gender, research and innovation. We will also increase our focus on entrepreneurial and sustainability approaches while taking bold steps to
increase efficiency and effectiveness in our core mission work with the communities and providing value for money.
As described in the pages following, Amref Health Africa’s programme activities and subsidiary’ work in 2018 were extensive, varied and impactful. We look forward to continued
partnerships in order to uplift lives of African communities and make UHC a reality.
I wish to thank all our partners, communities and staff across Africa, Europe and North America as well as our International Board for continuous believe in our vision of lasting health
change in Africa and its bold implementation converting promise into action.

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EXECUTIVE SUMMARY

am delighted to present to you the Amref Health Africa Year In Review 2018. We are proud of the achievements posted
by our programmes and subsidiaries, particularly, the positive impact that we continue to record on lives of communities
in various parts of the Continent.

Activities under Amref’s core pillars – Human Resources for Health (HRH), Innovative Health Services and Solutions,
Investing in Health – and our Subsidiaries - Amref Enterprises Limited (AEL), Amref International University (AMIU) and
Amref Flying Doctors – were all geared towards our vision of creating lasting health change in African communities.
Through our various programmes, we are glad to report that we reached a total of 15,267,875 people, and trained 71,522
health workers in 2018, a clear demonstration of our commitment to improve access of health services by all.

In 2018, activities under the Human Resources for Health pillar saw an increase in the number of skills matrix of health
workers, strengthened Leadership, Management and Governance (LMG) capabilities within health systems, and improved
HRH productivity.
In Kenya, Community Health Workers (CHWs) were trained using diverse approaches, including digital technologies. In
Ethiopia, Amref enhanced competencies of health workers through its Reproductive, Maternal, Neonatal and Child Health
(RMNCH) Programme, creating stronger health systems at the regional and national level. In Uganda, efforts to address
the health workers gap saw the implementation of projects spread across, and aligned to UHC, research and advocacy. In
Tanzania, there were key projects aimed at building skills for CHWs to bridge the gap between communities and health
care systems. Mozambique focused on training of mid-wives. In Malawi, Amref improved the reproductive health of women,
improved the health of children under-five and adolescents and trained health workers through eLearning.

In Kenya, Amref UK’s GSK funded NCDs
project built prevention and management
skills of health workers in counties where
NCD prevalence is high. Additionally,
through funding from USAID, Amref USA
implemented an anti-Female Genital
Mutilation (FGM) and Child, Early and
Forced Marriages (CEFM) project in
Kenya and provided scholarships to nurse-
midwife students. In South Africa, GSK’s
funded NCDs Project strengthened skills of
managers of regional training centres in two
provinces.
In terms of health systems advocacy,
Amref complemented government’s efforts
through the formal launch of the Health
Systems Advocacy Partnership (HSAP) in
Kenya, Malawi, Uganda and Zambia. With
the sole mandate to strengthen HRH, the
Amref Institute Capacity of Development
(ICD) recorded tremendous growth to
forge a new identity separate from its
primary role as a training centre. ICD’s key

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projects for 2018 were Advocacy Accelerator, E-campus, Innovate for Life Fund, and Youth in Action (Y-ACT).

During the year, Amref developed and delivered innovative health services and solutions that were geared towards creating
awareness for obstetric fistula, advancing health policies for sustainable service delivery, improving water access for
sustainable development, management and control of communicable diseases, health systems strengthening and reducing
illness and death.
Amref Ethiopia and Amref UK focussed on improving water and sanitation in Ethiopia. Amref Uganda delivered a significant
number of projects spread across, and aligned to Maternal and Child Health, HIV/AIDS, Tuberculosis (TB), Malaria, Water,
Sanitation and Hygiene (WASH), health systems strengthening, capacity building for health workers, and research and
advocacy themes. Also in Uganda, Amref implemented the Integrated Management of New-born and Childhood Illness/
Reaching Every Child Quality Improvement (IMNCI/Rec-Q) and built capacity of health workers to improve management
and control of communicable childhood diseases.
Amref UK pursued a tightly-focused programmatic agenda directing efforts on four thematic project areas (Maternal,
New-born and Child Health; Sexual and Reproductive Health and Rights; Health Worker Training; and WASH) projects
that were supported by GlaxoSmithKline (GSK). Also in partnership with GSK and Human Development Innovation Fund,
Amref UK deployed the Amref-developed Smartphone App mVaccination in Tanzania, a project aimed at reducing morbidity
and mortality caused by vaccine-preventable diseases in children. In the spirit of exploring technological solutions that
will accelerate UHC, Amref Health Africa organised the first meeting of Digital Health in Africa in West Africa. On its part,
Amref Germany contributed to humanitarian crisis response in South Sudan. In Kenya, Amref partnered with the First Lady’s
Beyond Zero Campaign, to launch the innovative integrated Medical Safari to boost health care among rural communities.
In partnership with GIZ Health Sector Programme, Amref supported the institutionalisation of the Kenya Quality Model
for Health (KQMH), a systems approach to promote quality health care through training and mentorship of health care
workers.

In Malawi, Amref in consortium with other
organisations implemented the Trachoma
Elimination

Project,

which

ensured

health facilities had running water and an
operational full package of sanitary facilities.

Contributing to the investments in health
pillar of our strategic plan, Amref Kenya
supported the Government to develop a
health financing strategic plan to guide the
country towards UHC and supported six
counties on budget advocacy for increased
allocation and utilisation of funds in the
health sector. Kenya also worked with
partners and civil society to enhance the
voice of citizens for improved access to
health services and financial protection.
Amref Uganda created enabling investments
in health by focusing on health advocacy
agenda towards increased contribution to
investments in health.

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Amref UK partnered with communities in more than 30 countries to secure the right to health and break the cycle
of poverty through Maternal & Child Health, Sexual & Reproductive Health & Rights, Water, Sanitation & Hygiene and
Training Health Workers projects. To support its activities, Amref UK secured funding from James Percy Foundation, the
Postcode African Trust, and Waterloo Foundation, Medicor Foundation and Allen & Nesta Ferguson Charitable Trusts, which
will funded a range of projects, including Sexual and Reproductive Health and Rights (SRHR) work in Tanzania, SRHR
work in Ethiopia and Malawi, FGM/C work in Kenya, and Mother and Child Health (MNCH) and WASH work in Uganda.
Amref Nordic developed methods for creating synergies by synchronising and centralising strategies and processes for
cost-effective fundraising activities throughout Amref. On its part, Amref USA raised funds to support the Strengthening
Laboratory and Blood Transfusion Services in South Sudan under the President’s Emergency Plan for AIDS Relief (PEPFAR)
and HRH 2030, which trains health workers to prevent maternal and child deaths, expand access to family planning, control
HIV/AIDS, and protect communities from infectious diseases. Major fundraising events for Amref USA were the annual
ArtBall and Tata Consultancy Services (TCS) New York City (NYC) Marathon. During 2018, Amref Health Africa Italy
supported 15 projects in 5 African countries.

Year 2018 was transformational for our three subsidiaries. As the social enterprise arm of Amref Health Africa, Amref
Enterprises Limited (AEL) launched several projects and products aimed at generating income to fund our projects. Key
among AEL’s achievements was the launch of Cure and Afya (CURAFA) project, which adopted a multi-level approach to
establish community care centres to make primary health care available to the underserved low income population. In
response to the challenge of inadequate human resources in the health care, Amref International University (AMIU) entered
into partnerships with key institutions in 2018 that will help strengthen the capacity and quality of the health workforce
in Africa. Through these partnerships, AMIU will build capacity of health workers by equipping graduates and middle-level
health care workers with knowledge and skills for operative implementation of the UHC 2030 Agenda.

Lastly, Amref Flying Doctors introduced
an enhanced Maisha Annual cover, known
as Maisha Diamond that includes post-
evacuation  hospitalisation  benefit  and
repatriation option to South Africa. Maisha
covers eight countries in the Eastern Africa
region.
Indeed, we are appreciative of the support
that we have received from our partners
that has enabled us implement our planned
activities for the year and contribute to
our vision. In 2019, our resources will be
channelled towards implementing our
Corporate  Strategy  and  executing  specific
projects  under  the  cross  cutting  themes  -
policy and advocacy, gender, research and
innovation.

uman Resources for Health (HRH) has long been recognised as the cornerstone of the health sector that produces, delivers
and manage services. Despite World Health Organisation’s (WHO) recommendation of a norm of 21.7 doctors per 100,000
population and 228 nurses per 100,000 population, Africa continues to face HRH challenges including shortages, capacity and

retention of health workers. Anchored on our 2018-2022 Corporate Strategy, the Human Resources for Health strategic objective
aims to develop and sustain HRH to catalyse the attainment of Universal Health Coverage (UHC) in Amref Health Africa’s target
countries. Activities under this pillar aim at increasing the number of skills matrix of mid-level and community level health workers,
strengthening Leadership, Management and Governance (LMG) capabilities within health systems, and improving HRH productivity.

Kenya: Investments in HRH in Kenya focused on building capacities of health workers, prevention, management and control of
Non Communicable Diseases (NCDs) and strengthening of LMG policies within health systems. Amref partnered with County
Governments to increase the skills-mix and numbers of health workers, which saw training of 30,725 mid-level health workers and
885 community-level health workers (Community Health Extension Workers - CHEWs and Community Health Workers - CHWs)
across Kenya’s 47 counties. The training enhanced the skills of in-service and community-level health service providers in health
service delivery, financing, information management systems, sexual and reproductive health and rights, education on Alternative Rites
Of Passage (ARP), Female Genital Mutilation/Cutting (FGM/C), Child Early and Forced Marriages (CEFM) and enhancement of child
protection.

HUMAN RESOURCES
FOR HEALTH

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During the same year, Amref Kenya built on decades of experience working within CSOs space and launched the Community
Leadership, Management and Governance (C-LMG) flagship initiative. This approach played a critical role in the health
ecosystem in delivery of health services through contribution to enhanced health care by providing affordable services in
response to community needs, lobbying for equity and adoption of pro-poor health policies and acting as an intermediary
between communities and government, among others. Employing Organisational Development and Systems Strengthening
(ODSS) model, the initiative enhanced the capacity of local organisations to design, execute, monitor and evaluate the effect
of their interventions. A total of 2,492 CSO representatives from several counties in Kenya such as Samburu and Turkana
received C-LMG training and 13,612 community health workers were engaged by Amref projects through this initiative.
In recognition of the threat posed by Non-Communicable Diseases (NCDs) to sustainable development, Amref Kenya
implemented Glaxo Smith Kline’s funded’ NCDs project that is managed by Amref UK. Supporting the prevention,
management and control of NCDs to help reverse disease burden of Asthma and Diabetes and reduce associated morbidity
and mortality, the project focused on building NCDs prevention and management skills of mid-level health workers and
CHWs in counties where the diseases’ prevalence is high. With a view to making potentially life-saving skills as widely
available as possible, Amref used both eLearning and face-to-face training, supporting the integration of childhood Asthma
and Diabetes into community health service provision at both health facilities and at the household level.
As a result of the training, health workers operating in both rural and urban settings provided over 3.7 million people with
information and services through community outreach, household visits, community screening and service delivery at health
facilities. By the end of the project, the percentage of health workers with improved NCD management skills had increased
from 40% to 95%, the proportion of health facilities with appropriate equipment and commodities for managing Diabetes
increased from 48% to 74%, while the percentage of community members seeking screening for Diabetes and Asthma rose
significantly, a shift in behaviour that suggests that the project impact will be felt for years to come.

Uganda: In Uganda, Amref Health Africa
continued to prioritise HRH development as one
of the key strategic focus areas, equipping 10,368
health workers with LMG capacity for HRH. In
2018, Amref Uganda’s eLearning programme
trained 25 priority health professionals.

2,492

CSO

Representatives
trained on
C-LMG
in several
counties
such as
sumburu
& turkana

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In addition, 80 health workers at management level had their skills in
leadership management strengthened, 4,149 gained from improved health
workforce performance through Continuous Professional Development
(CPD) and 1,322 CHWs were also trained in operationalising referral
system, which led to about 4,763 clients referred to health facilities by
Village Health Teams (VHTs)/CHWs in Uganda.
Under institutional capacity building, Amref Uganda successfully trained
leaders from 16 health training institutions through innovative e-health solutions enabling these institutions to undertake
eLearning courses to strengthen their capacity in delivering LMG. Following the initiative, Amref Uganda witnessed an
increased number and improved competency of health workforce of midwives. With 303 trained midwives, it meant that
1,280,000 expectant mothers could potentially access improved maternal health services across Uganda annually. Since we
launched eLearning in Uganda in 2012, nearly 400 nurses and midwives have graduated from the course.
To bridge the health workers gap and save lives lost at childbirth, Amref UK extended funding to support training of mid-
wives in Uganda through partnership with Glaxo Smith Kline (GSK), where Amref conducted eLearning courses for health
workers. The eLearning initiative allowed midwives to study at their pace with minimal disruption while taking into account
their work schedules.

Ethiopia:

In 2018, Amref made tremendous progress in achieving its objectives in Ethiopia to increase the competency of

25,000 health care workers, including community health workers, who are key towards sharing relevant health knowledge,
skills, and tools with communities to save lives and safeguard a healthy population. In terms of capacity building, Amref
Health Africa provided training support to 13,776 health workers in Ethiopia. In the Pre-Service programme, we trained
249, of which 127 graduated and 122 enrolled. Regarding the training of community health workers, Amref trained 16,903
health extension workers and members of development.

Tanzania:

In Tanzania, Amref’s work

complemented the government’s efforts
to provide quality health care to citizens
as outlined in Tanzania’s Health Sector
Strategic Plan’s (2015-2020).

Key projects aimed at building skills
for CHWs to bridge the gap between
communities and health care systems.
Under the Global Health Security Agenda
Project, Amref trained Health Care Workers
(HCWs) and CHWs to detect and report
epidemic-prone diseases. The project
implemented in Arusha, Kilimanjaro, Kagera,
Kigoma, Katavi and Mbeya regions reached
669 CHWs and trained 132 HCWs on
Community Based Surveillance (CBS) and
how to collect, organise, analyse and report
data on weekly and monthly basis. A total of
144,428 households were visited by CHWs
in their villages. Of the cases detected,
76.8% were reported to the health facility
by CHWs.

Close to

5,000

clients

were referred to health
facilities by

1,322

trained

Village Health Teams and
Community Health Workers
in Uganda

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In collaboration with the Government of Tanzania, Amref implemented the Mafunzo Project, More and Better Midwives, Stand
Up for African Mothers (SU4AM), e-Learning and Jenga Uwezo Projects to upgrade and enhance the skills and capacities of
health care providers. The project was undertaken with a number of stakeholders including those from the private sector,
and community health workers and trained 383 needy Nurses and Midwives (NMs) students under scholarship and bonding
retention model where 312 NMs graduated and 135 NMs were employed.

Mozambique: In Mozambique, the Amref Nurses and Midwives Capacity Building Project targeted reduction of maternal
and under-five mortality rates by increasing access to quality healthcare. The project improved the capacity of 90 nurses/
midwives to manage priority MNCH issues and strengthened the capacity of 30 tutors from four training institutes to offer
quality Basic Emergency Obstetric Care (BEmOC) training for students.

Malawi: In 2018, Amref started implementing the 2018-2022 Strategic Plan for Malawi, which focuses on improving
reproductive health of women, improving health of children under-five and adolescents, capacity building and training of
health workers through eLearning, Trachoma elimination (WASH programme) and health systems advocacy. To upgrade
the qualifications and knowledge base of HRH, Amref pursued eLearning initiatives to accelerate the upgrading of Malawi’s
Nurses and Midwives Project, which finally enrolled students. Piloted at Ekwendeni College of Health Sciences and the
Malawi College of Health Sciences (Blantyre Campus), the project enrolled 89 students and offered opportunities to nurse-
technicians to upgrade their qualifications while they are working, thus minimising disruptions.

South Africa: Amref Health Africa South Africa implemented the GSK funded NCDs Project with the aim of enhancing
the prevention, management and control of Obesity, Hypertension and Diabetes at the community and health facility levels
in Gauteng and Limpopo Provinces.The project strengthened regionaltraining centres in the two provinces to sustainably
address human resources for health challenges both in terms of numbers and skills development for prevention, management

and control of the target NCDs.

The project trained 139 leaders and
managers from 20 Regional Training Centres
(RTC) in LMG.
Amref conducted in-service training courses
for 878 professional health workers in the
two provinces; exceeding the target by 698.
A further 1,353 community health workers/
health promoters were also reached to
improve their knowledge on NCDs in the
two provinces.

878

professional

health workers
from Limpopo
and Gauteng
Provinces
in South Africa
benefited from
in-service
training
courses

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The training module of the Health Promotion Officers Course on Public & Community Health Support was converted into
eLearning with technical assistance from the Amref Institute of Capacity Development (ICD). In 2018, Amref registered
as a Training Service Provider by the Independent Examination Board (IEB), the governmental agency responsible for the
final examinations of the Health Promotion Officers learners. Amref is already registered with the Department of Higher
Education (DHE) in order to comply with the regulations and procedures of the regulatory authorities in South Africa.
Amref Health Africa implemented a nutrition project in Ethiopia, Kenya, Malawi, Senegal, South Sudan, Tanzania, Uganda and
Zambia in partnership with Nutrition International through Nutrition Leverage and Influence for Transformation (NLIFT)
and Government of Canada through Global Affairs Canada to ensure that vulnerable populations reached through our
programmes have access to nutrition interventions. The project involved systematic integration of nutrition into Amref
Health Africa’s programmes and countries; improved access to nutrition interventions for adolescent girls, women of
reproductive age and children; and increased demand for and uptake of nutrition interventions by adolescent girls, women
of reproductive age and children. As a result of the interventions, up to 10 million people benefited including adolescent
girls, women of reproductive age, children and health workers both directly and indirectly. The project runs till 2019.
In terms of strengthening health systems, Amref launched and implemented the Health Systems Advocacy Partnership
(HSAP) Project in Kenya, Malawi, Uganda and Zambia. The project supported the Ministry of Health in Malawi to disseminate
Health Sector Strategic Plan II and the National Community Strategy, and to develop and print role clarity guidelines for
CHWs, guidelines for health centre management committees and community centre action groups. Additionally, the project
supported CSOs and CBOs in Malawi to advocate and lobby for increased number of HRH in rural areas. It also facilitated
the formation of the African Media Network for Health (Malawi Chapter) and built capacity of journalists to report on HRH
and sexual and reproductive health issues.

2 5 | A N N U A L R E P O RT 2 0 1 8

Amref Institute of Capacity Development

With the sole mandate to strengthen HRH, ICD implemented activities and developed capacities of individuals, institutions and health systems through innovative approaches for
improved health service delivery. In 2018, ICD recorded tremendous growth to forge a new identity separate from its primary role as a training centre. The Institute enhanced its
visibility through an improved communications plan, launched targeted training to boost the capacity of its staff, enhanced existing networks and built new partnerships as well as
increased efficiency of processes within Amref Health Africa. The year highlighted key contributions by ICD in catalysing HRH to attain UHC in Amref’s target countries. As envisioned
by the spirit of ‘Ubuntu’, a core value of Amref Health Africa alongside integrity and respect, the critical milestones achieved were made possible by the relentless team effort by 43
dedicated staff across 17 countries in Africa managing 16 lead projects serving populations in urban, rural and marginalised areas.

ICD’s key projects for 2018 were Advocacy Accelerator, E-campus, Innovate for Life Fund, and Youth in Action (Y-ACT).

Advocacy Accelerator:

In its second year

since  inception,  the Advocacy Accelerator  Project
amplified  its  engagements  in  undertaking  effective
advocacy on policy and resource priorities focusing
on  Gender  Equality  and  Sexual  and  Reproductive
Health and Rights (SRHR) across Africa.
The programme reached over 350 advocates
through in-person events, with almost one-quarter
being youth, and over 250 advocates through a
series of webinars in an effort to strengthen the
capacity of the African advocates.

e-Campus

ICD developed the e-Campus Learning Management
System (LMS) based on a user-centred design for
internal and external audience. The platform is
currently in use in Kenya, Malawi and Tanzania, as
well as in countries implementing the LMG course.

Innovate for Life Fund:

Following the launch

of Innovate for Life Fund that supports African
entrepreneurs to develop innovative, sustainable
and scalable solutions for a healthy Africa, the fund
mapped out and on-boarded six most innovative
entrepreneurs to take part in its 2018 Annual
Accelerator Programme.

The entrepreneurs were coached, mentored and
skilled to be investor-ready.

The Innovate for Life Fund has proven how critical

an African health tech accelerator is, bridging a

very real gap between brilliant ideas and investors

in Africa. The 2018 cohort of entrepreneurs will

further stimulate tech-driven health solutions for

and by Africans.

Ylann Schemm, Director of the Elsevier Foundation and founding

partner of Innovate for Life Fund.

2 6 | A N N U A L R E P O RT 2 0 1 8

Youth in Action:

In 2018, Y-ACT trained 84

youth advocates from 51 youth-led organisations.
With over 3,000 youth advocates and 750 youth-
led organisations from across 44 counties already
registered to the online portal, Y-ACT has become
one of the largest youth advocacy network in Kenya.
Following the trainings, the advocates achieved
significant success in influencing policy on sexual
and reproductive health, and rights and gender
issues in counties.
Y-ACT successfully advocated for inclusion of
priority interventions in the Kenya National Youth
Development Policy, and for the Nairobi County
Government to develop an Adolescent, Sexual and
Reproductive Health (ASRH) policy framework.
Y-ACT also supported documentation of elements
of Meaningful Youth Engagement (MYE), which
resulted in the development of minimum standards
and a scorecard, which were implemented in
the pilot phase across Nairobi, Kakamega, Kilifi,
Samburu and Marsabit counties.

As a direct result of these efforts, the Nairobi
County Government created a technical working
group, half of which was comprised of young adults,
which then developed the County ASRH Policy.

Leadership, Management and Advocacy:

The Leadership, Management and Advocacy (LMA)
Programme subscribed a total of 43 surgical,
anaesthetic, obstetric and trauma care providers
who  were  equipped  with  leadership,  management
and  advocacy  capability  to  enhance  efficiency
and effectiveness of Public, Private and NGO
stakeholders and institutions in the surgical health
sub-sector. The  programme  improved  the  quality
and increased access to surgical services in Kenya.

Management Development Institute:

The

Management Development Institute (MDI) Program
is a result based management course designed to
assist African ministries of health in implementing
their particular national health priorities. The
course enhanced leadership and management
skills of leaders of organisations that are devoted
to delivering health care services to underserved
populations across 40 countries in Africa with 1,632
trained leaders and managers.

HRH Kenya Deans Forum:

In 2018, ICD

convened the 2

HRH Deans Forum that was

graced by four Vice Chancellors and one Deputy
Vice Chancellor from various universities. The
forum showcased sustained efforts of improving the
quality of medical education in faculty and curricula
development, learning environment, accreditation
journey of health facilities to become expert clinical
practicum sites for strengthening training in HIV,
RMNCAH and other priority health services.

With over

3,000

youth advocates and

750

youth-led

organisations registered
to the online portal,

Y-ACT

has become

the largest youth
advocacy network in

Kenya

2 8 | A N N U A L R E P O RT 2 0 1 8

COMMUNITY VOICES

Married off at 14, Community Health Worker Returns to Primary School at 22

he looks youthful in her neatly dressed school outfit, but she is 22 and already a mother of three.

Marisa Lenaitorono, a Community Health Worker (CHW) is in class three at Nkopeliani Primary School in Samburu
County. The young woman was 14 when she dropped out of school.

“I was forced to undergo FGM and then married off to a man the age of my father. Not because I was in love with the man,
but because of my tradition dictated so. I had no voice to say no,” she narrates.

Faced with hard reality of motherhood at a tender age, Marisa’s dream of acquiring education and later becoming a doctor
was in shambles. At some point she says she wanted to return to school, but her husband wouldn’t allow her.

The year 2014 was a turning point in her life after she joined a community health unit in her village that was supported
by Amref Health Africa’s Uzazi Salama Project. The project exposed her to m-learning (Leap) innovation (integrated mobile
platform which provides avenue to train health workers through text and audio messages).

Despite being illiterate, Marisa had the passion and determination to complete her trainings aided by the platform.

“I was passionate about helping my community live healthy lives. Unfortunately, I didn’t have sufficient reading and writing
skills. I was relying on my friends to help, but this wasn’t reliable as sometimes they didn’t have time to listen to me,” she says.

With the little support she received, the young woman managed to cover a number of topics including, maternal, child and
reproductive health issues and antenatal care. Additionally, being passionate about saving lives, she also learnt how to take care
of pregnant mothers and children under five.

Marisa in Class

lthough many African countries have made considerable progress in strengthening health care systems, there are huge
disparities in the availability of the essential health packages, health facilities and health workers resulting in inequities in
service use among communities.

Innovative health services and solutions are key to achieving sustainable health access for

the African communities that Amref Health Africa supports. As a key pillar of our work, the innovative health services and solutions
strategic objective focuses on developing and delivering health services and solutions for improved access to and utilisation of quality
preventive, curative and restorative health services. Specifically, this pillar aims to increase use of health services, innovatively improve
quality health service, and increase access to quality promotive, preventive and curative and restorative health services among
women, children, adolescents and youth.

Kenya

: Amref Kenya leveraged on government’s policies, opportunities and partnerships to influence policy through development of

innovative models that contribute to improved access to and utilisation of quality preventive, curative and restorative health services.
Amref demonstrated its commitment to promote access and utilisation of health services and solutions by targeting the remote, hard-
to-reach and other underserved communities reaching 6,268,570 people in 2018. Through innovative community-based participatory
approaches such as ‘Kimormor’ (a cross-sector approach to reach nomadic pastoral communities in Turkana) and mobile outreach to
remote communities, Amref mobilised and encouraged communities to seek health services so as to achieve reliable and sustainable

INNOVATIVE HEALTH
SERVICES AND SOLUTIONS

3 0 | A N N U A L R E P O RT 2 0 1 8

3 1 | A N N U A L R E P O RT 2 0 1 8

healthy lifestyles and behaviour change. Through support from CHWs, we facilitated access to life-saving health services at
household level. In contribution to the achievement of the UHC goal, Amref Kenya partnered with the First Lady’s Beyond
Zero Campaign to launch the innovative integrated Medical Safari, an initiative that aims to boost health care among rural
communities. In this partnership, Amref’s increased awareness about obstetric fistula and provided reconstructive surgery
for women living with the condition. Obstetric fistula continues to afflict the most impoverished women and girls in the
developing world, mainly those in rural and remote areas.

In partnership with GIZ Health Sector Programme, Amref Kenya supported the institutionalisation of the Kenya Quality
Model for Health (KQMH), a systems approach to promote quality health care through training and mentorship of HCWs.
In 2018, over 120 health workers from county and sub-county health facilities in Nairobi, Kwale, Kisumu and Vihiga counties
were sensitised, reaching over 38 public, private and faith-based health facilities. The health workers were charged with
ensuring quality improvement structures were formed and supported at the facility.
Although FGM and CEFM were outlawed in Kenya in 2001, some nomadic communities covertly continue with the practices.
Amref USA extended support to the Koota Injena Programme in Kenya whose goal was to engage clan elders to ensure
abandonment of these practices was upheld and was community-led. Funded by USAID, ‘Koota Injena’ (“Come, Let Us Talk” in
Borana language) targeted and engaged semi-nomadic clans (Borana, Gabra, Rendille and Samburu) that continue to practice
FGM/C and CEFM and worked with them to change their attitudes about the practices and the value that girls bring to
their communities. The project helped the nomadic clans reach collective agreement to take up new norms and values that
support the safety, rights, and empowerment of girls. Through the project, Amref identifies and trains influential people in
the community to be Community Champions and facilitates dialogue between different generations and helps their peers,
family and friends re-envision how girls are treated, why their rights should be respected and why they should be supported
to finish their education.

The project also established a scholarship
programme to support girls living in
communities where there is a high prevalence
of FGM and CEFM to continue with their
secondary education and to become anti-FGM
ambassadors.

Koota Injena
Project trained

champions

to mobilise their
nomadic
communities
(Borana,
Gabra, Rendile,
Samburu) to
abandon
FGM/C and
CEFM in Kenya

3 2 | A N N U A L R E P O RT 2 0 1 8

The project identified and trained 60 champions to mobilise their nomadic communities to abandon FGM/C and CEFM,
reached 99 top-level clan elders through meetings organised by champions, reached 646 middle-level clan elders, 662
women, 122 female and 136 male youth during monthly clan meetings facilitated by champions and provided 119 students
(110 girls and nine boys) with either one-or two-year scholarships to pay for their secondary school fees.
The project also worked directly with the government to strengthen the existing Kenyan structures for child rights
protection, anti-FGM/C, and anti-CEFM law. Amref Kenya, through the Institute of Capacity Building (ICD) implemented
the Uzazi Salama Project, which focused on improving maternal and neonatal health in Samburu County, Kenya. The project
concluded its Phase II (2015-2018) increasing access to quality health services by over 200,000 people. The number of fully
immunised children increased from 4,193 in 2015 to 13,752 in 2018. Additionally, the number of pregnant women attending
4 ANC visits increased to 8,282 in 2018 from 3,210 in 2015, while the percentage of skilled deliveries increased by 23.5%
as at the end of 2018.

Ethiopia:

Amref made tremendous progress in achieving its objectives in Ethiopia to reach 1.7 million communities through

different programme services. As part of its efforts to achieve the WASH SDGs – ‘Leveraging resources for achieving
universal and equitable access to safe and affordable drinking water for all by 2030’, Amref Ethiopia concentrated on the
WASH project reaching nearly 2 million (1,934,678 million) in 2018 (52% being females). Amref ensured access to, and the
utilisation of basic and improved WASH services by creating safe and adequate water supplies, improving sanitation and
hygiene services, and institutional capacity development, which targeted communities, schools, and health facilities. The year
saw 97 WASH schemes constructed, 58 water schemes improved and 39 sanitation schemes improved and developed for
project beneficiaries.

Still in Ethiopia, Amref UK worked with Comic Relief to improve water and sanitation - and by extension, health - in
the country’s capital, Addis Ababa. Our work targeted two sub-cities (administrative divisions) of Akaki-Kality and Yeka,

where we built four school-based and
seven communal-based sanitation facilities
in 2018, bringing to 24 the number of
sanitation facilities constructed since the
project  started,  and  reaching  a  total  of
8,141 community members.
A mid-term evaluation showed that over
70% of households in the sub-cities had
access to an improved latrine facility, a
significant  increase  from  17%  when  the
project  started.  Consequently,  96%  of
households had access to a safe water
source within a 15-minute walk.

1,934,678

million

reached

WASH schemes

constructed

water

schemes
improved

sanitation
schemes
developed

3 3 | A N N U A L R E P O RT 2 0 1 8

Crucially, the incidence of diseases associated with poor hygiene and sanitation fell; our household survey showed a 12%
reduction in the prevalence of diarrheal disease among children under-five.
Now in its third year of implementation, the Ethiopia WASH Project sponsored by Amref UK has so far directly benefited
9,593 community members whilst 2,091 frontline workers have received training and support.

Uganda:

Amref Uganda delivered a significant number of projects spread across, and aligned to maternal and child health,

HIV/AIDs, Tuberculosis (TB) and Malaria, WASH, health systems strengthening, capacity building for HWs, and research
and advocacy themes. These were implemented in six regions and 57 districts and a total of 15 projects were executed
with support of 105 staff members. To improve management of childhood illnesses, Amref implemented the Integrated
Management of New-born and Childhood Illness/Reaching Every Child Quality Improvement (IMNCI/Rec-Q) and built
capacity of health workers. In the same year, Amref Uganda set up 58 youth friendly service centres at health facilities for
school going children and adolescents between the ages of 6-24 years. The integrated innovation provided essential clinical
and rehabilitative care to 192,333 babies delivered by skilled health professionals and managed to control and prevent
communicable diseases by vaccinating those under-five. This approach saw reduction in Out Patient Department (OPD)
attendance, clinical malaria, pneumonia and diarrhoea in targeted facilities. Diphtheria-Tetanus-Pertussis (DPT-3) coverage
and Antenatal Clinic (ANC) 4

visit attendance improved. Also, through a joint interim Health Unit Management Committee

(HUMC) created by Amref Uganda, there was improved uptake of medical consultation in refugee settings in Aura.

Our WASH programme in Uganda increased access to clean, safe water and environment through construction and
rehabilitation of 754 water and sanitation facilities. We also improved the latrines coverage by 4,000, increasing access to
safe water by 8,750 people and improved sanitation to 18,477.
Through the FINNISH Mondial Project in Western Uganda, Amref achieved significant changes at beneficiary’s level; latrine

coverage increased from 23% to 72% in
27 villages of Lamogi, Amuru, Pabbo and
Atiak Sub-counties. These villages have
been turned into model villages of Open
Defecation Free (ODF).
Uganda’s effort also renovated and
improved WASH initiatives in targeted
health facilities in Amur District resulting in
increased utilisation of MNCH services by
mothers and children.
Due to availability of running water in
targeted facilities, cleanliness improved
within maternity wards and hand washing
practices among health workers were
upheld contributing to the reduction in
Neonatal Sepsis.
Recognising the key role that women
play in sustainable development, Amref in
Uganda participated in the ‘What Women
Want’ Uganda Chapter Campaign that

3 4 | A N N U A L R E P O RT 2 0 1 8

was launched in April during the International Maternal Health and Rights Day. A total of over 92,000 women and girls
participated and gave their voices in ensuring quality, equitable health and well-being is elevated through different platforms
and forums to reach the decision making tables at district, national and global levels.

Tanzania:

With research showing that technological innovations can significantly improve health care delivery systems

including early detection of illnesses, Amref UK deployed the Amref-developed Smartphone App mVacciNation in Tanzania,
a project aimed at reducing morbidity and mortality caused by vaccine-preventable diseases in children. The App., developed
in partnership with the Human Development Innovation Fund (HDIF) and GSK allows health workers to capture individual
records of vaccinated children and record vaccine temperatures and stock levels. It collects real-time synchronised data,
sends reminder to parents/caregivers on next vaccination visit, informs immunisation officers of stock levels, and alerts
technicians for cold chain maintenance. This bridges the gap in service provision to regions that are out-of-reach and
strengthens the health system thereby increasing immunisation coverage. Since the introduction of the mVaccination in
2016, Amref has used the mobile platform to train 100 HCWs from 50 facilities across Tanzania resulting in registration of
121,224 children and caregivers, 402,922 immunisations per antigen, 23,857 stock updates captured, 30,297 temperature
updates submitted, and SMS reminders sent to 60,612 registered caregivers.

Our Taka ni Mali Solid Waste Management (SWM) Project aimed at improving the health and livelihoods of the population in
Ilala Municipality of Dar es Salaam, Tanzania through an integrated management of urban solid waste and use of CHWs for
household was

te management. A total of 982 people were directly reached on the SWM awareness and 66,800 (equivalent

to 20% of the population) indirectly, and 140 solid waste separation containers distributed in schools and institutions.

mVacciNation – Boresha Chanjo is a
mobile health technology solution that
complement VIMS and other technology
solutions being implemented in Tanzania
by addressing informational bottlenecks
that prevent facilities closest to the
population from consistently delivering
immunisations.
The project aim is to reduce morbidity
and mortality caused by vaccine
preventable diseases in children by
decreasing immunisation regimen dropout
rates in the Geita and Sinyanga Regions of
Northern of Tanzania.

3 5 | A N N U A L R E P O RT 2 0 1 8

With the support of the Government of Canada through Global Affairs Canada, the four-year Uzazi Uzima (Kiswahili for
‘Safe Deliveries’) Project saw 2,356 clients receive integrated family planning (FP) services, which included counselling
and provision of a range of FP methods, 7,430 clients reached with FP services generating a total of 29,223 Couple-
Year Protection (CYPs) thus reducing the risk of unintended pregnancies and maternal deaths and approximately 7,000
community members were reached through the Uzazi Uzima Champions Soccer League. So far, 348,567 women/adolescent
girls and 334,515 men/adolescent boys in 6 district councils in the region of Simiyu have been directly reached

Malawi:

Through the Trachoma Elimination Project in Malawi, Amref in consortium with other organisations achieved the

goal of eliminating blinding Trachoma ahead of time in 2018. The project attained its target to have five health facilities with
running water, and five health facilities with an operational full package of sanitary facilities (latrines, bath shelter for pregnant
and postnatal women, incinerator placenta pit and ash pits). Further, at the close of 2018, four out of the targeted 10 villages
had been provided with boreholes, and six more boreholes were under construction. The project, alongside the Deliver Life
I Project is expected to wind up in March 2019. Also in Malawi, the LEAP project, a mHealth platform designed in Africa for
Africa, which empowers health workers with knowledge to transform the health outcomes of the communities they serve,

was implemented by Amref Netherlands
through funding from the Dutch Lottery
Postcode.

South Sudan:

In 2018, Amref Health

Africa  Germany  significantly  contributed
to Amref’s response to the humanitarian
crisis in South Sudan that saw many people
displaced and threatened health wise due
to poor nutrition and hygiene, and outbreak
of  diseases  such  as  Cholera. This  project
benefited  refugees  as  well  as  the  host
communities.  Amref carried out activities
that were aligned to the local necessities
in  the  project  areas,  which  were  mainly
prevention of disease outbreaks like cholera.
In  all  our  projects  in  South  Sudan, WASH
was an important component. During
the year under review, Amref Germany
supported twelve projects in South Sudan,
Uganda, Tanzania, Kenya and Senegal with
WASH activities.

Dry waste

wet waste

Hazardous waste

Sanitary waste

3 6 | A N N U A L R E P O RT 2 0 1 8

West Africa:

In the spirit of exploring national strategies and technological solutions that will accelerate UHC, Amref

Health Africa organised the first meeting of Digital Health in Africa in 2018 in West Africa. This initiative, which mobilised
policy makers, national and international experts, digital solutions stakeholders and users of e-health applications, was a
powerful moment of exchange and production of ideas for digital health. The meeting provided a platform for exchange of
experiences and a coordination framework for actors and partners involved in the development and deployment of digital
solutions in favour of UHC. In this respect, ICT was presented as an opportunity to address the constraints of access to
care and the use of quality services.

In 2018, Amref promoted the use of digital technology in accessing heath care by communities’ especially Cellal e Kisal
and telemedicine suitcase, which linked health structures to communities and improved coordination of care and quality
of services. Launched in 2015, the Digital Health and Innovative Solutions for Safer Pregnancy, Child Survival and Nutrition:
Cellal e Kisal, deploys a digital device composed of 3 elements: a mobile application used by community relays to link
with health facilities (collection and transfer of health data, recall of appointments for pre/post antenatal consultations for
pregnant women/growth monitoring/vaccination for children under 5); an e-health platform for health workers (connected
to the mobile application) allowing them to follow digitised medical files and access to eLearning content, both on tablet/
computer and a telemedicine suitcase deployed for the realisation of sharp examinations in remote areas (ultrasound,
electrocardiogram etc.).
Likewise, the use of telemedicine suitcase and its mobile ultrasound system made it possible to consult 735 pregnant
women who were too isolated to access antenatal consultations in a facility, and to take charge of risky pregnancies through
telemedicine (detachments, threats of miscarriage, twin pregnancies, etc.) which, without screening, would have been fatal for
the mothers and their children.
Between 2016 and 2018, 9,899 pregnant women and 67,662 children aged zero to five years were registered and followed
up. The health professionals involved testified to the concrete effect noted in their structure on the indicators tracked

by the Ministry of Health and Social Action
(MSAS), particularly the completion rate
of prenatal consultations and the rate of
assisted deliveries. The highest performance
was recorded at Medina Yoro Foulah, the
most isolated of the 3 departments that
make up the Kolda region - demonstrating
the interest generated by the device in
remote areas.

Amref Health Africa UK

pursued a

tightly-focused programmatic agenda in
2018 concentrating efforts on four thematic
project areas (maternal, new-born and child
health; sexual and reproductive health
and rights; health worker training; and
WASH), that were implemented in Africa.
Throughout 2017/2018, GSK continued to
support our health system strengthening
interventions through the training of
frontline health workers in 17 countries,
namely, Angola, Burundi, Botswana, Djibouti,
Ethiopia, Kenya, Lesotho, Madagascar,

3 7 | A N N U A L R E P O RT 2 0 1 8

Malawi, Mozambique, Namibia, Rwanda, South Africa, South Sudan, Tanzania, Uganda and Zambia. The trained health workers
address an array of health challenges including infectious diseases, NCDs, sexual and reproductive health and maternal and
child health. At the end of 2018, Amref and GSK partnered to develop an advocacy-based programme to scale up the use
of chlorhexidine in Kenya, a WHO approved antiseptic gel, which can be used to stop umbilical cord infections in new-born
babies thereby reducing neonatal sepsis and death. Through 14 projects in 17 countries, Amref and GSK reached 383,843
people, this included women, children and health workers.

In another development, in recognition of Amref Health Africa’s overriding vision,

Amref in Canada

provided programme

oversight and management, raised funds and engaged Canadians on African health issues in 2018. To improve health care
and access to services that are essential for the survival of women, adolescents’ girls and their children, the Canada-Africa
Initiative to Address Maternal, Newborn and Child Mortality (CAIA) Project was implemented in Ethiopia (Afar and Amhara
regions), Kenya (Nyanza region), Malawi (Southern and Central regions), Tanzania (Geita region). In total, the project covered
20 districts all of which have unique health challenges that require a range of approaches.

The project was funded by Amref Health Africa in partnership with the Centre for Global Child Health at The Hospital for
Sick Children (SickKids) in Toronto, Christian Children’s Fund of Canada and WaterAid Canada. Reaching 1.7 million people
with a focus on women, new-borns, children and adolescents, the project’s financial support of US$24.9 million (CDN) came
from the Government of Canada (85% of the total project budget). Amref Health Africa in Canada is currently fundraising
for the remaining $1.8 million (CDN) to complete the project.

Amref Health

Africa UK

supported

projects in

reaching

383,843

people in

african

countries

3 8 | A N N U A L R E P O RT 2 0 1 8

COMMUNITY VOICES

Creating Equitable Access to Health Services through Innovative Approaches - Kimormor Outreach

tir Erot, 32, is a mother
of 12 children. Her
four month old baby

and 12

child has been having

a persistent three-week cough
and the paste she was given by
the traditional healer to apply on her body for cleansing
and in turn cure the baby has not worked.

She did not want to lose her child like her neighbour
whose four children succumbed to pneumonia and
diarrhoea. Pneumonia, malaria and diarrhoea are the
leading causes of death among children under the age
of five years in rural areas.

She therefore decided to heed the community health
volunteer’s advice to seek health services at the
Kimormor Outreach. Atir is all too familiar with the
outcomes of childhood illness, having lost three of her
children to childhood diseases in the past.

Her last born baby has just received treatment for
pneumonia at the Kimormor Outreach.

Kimormor, a Turkana word translating to ‘all under
one roof,’ is an innovative cross-sector mobile
approach to reach nomadic pastoral communities
with essential primary health care, animal health and
social development services. Services offered at the
Outreaches include antenatal and postnatal care,
short term family planning, immunisation and nutrition
screening services, civil and NHIF registration, food and
supplement distribution, cash transfers for vulnerable
populations, among other services.

Through funding from USAID, Afya Timiza collaborates
with the County Government of Turkana to build the
capacity of community health volunteers on how to
actively identify and effectively refer cases for treatment
through integrated community case management
(iCCM) training.

At the Kimormor Outreach, children are immunised
and referrals made for serious cases. In the last year,
780 children from hard-to-reach communities were fully
immunised through the Kimormor Outreach.

My Pain Has Gone: Ending Obstetric Fistula
through Case Identification

lem Sifab, 16, lives in Kalala Worda, Wollo,
Amhara Regional State. She was pregnant and
expecting a healthy baby. When the time came

for her to deliver, her labour lasted several days.

Finally she was taken to a health centre, and gave
birth to a stillborn baby. As a result of a difficult and
prolonged labour, Alem developed obstetric fistula. She
began to leak urine.

Kimormor is an innovative cross-sector

mobile approach to reach nomadic pastoral

communities with essential primary health

care, animal health and social development

services.

3 9 | A N N U A L R E P O RT 2 0 1 8

During Amref Health Africa fistula identification
campaign conducted in collaboration with Bahir Dar
Hamlin Fistula Centre and South Wollo Zone health
offices, she was identified as one of fistula cases in her
area.

Alem described the situation in her own words: “I was a
12 years old girl when I got married. I gave birth to my
first child at the age of 16. I underwent and endured
prolonged labour, which took three days. My labour
showed no progress. I was then taken to a nearby health
centre but it was late. I finally gave birth to a stillborn
baby, which did not survive. I later recognised I began
to leak my urine. I learnt from health care providers
that it was the prolong labour that caused this. I was
advised to go to Addis Ababa to get better treatment. I
couldn’t manage to travel to Addis Ababa due to family
and financial issues.

What I would do is nothing, but longing for just a day
some miracle to happen. I suffered from this tragedy
for almost 8 months until one day a Health Extension
Worker, who knew my situation came to my house with
good news. It was the brightest day in my life. This

health worker told me that there is an organisation
called Amref Health Africa, which provides outreach
services to those who suffer from obstetric fistula. She
gave me details saying, “Amref Health Africa would
arrange everything to help you get treatment, including
your transport cost. Your responsibility is to get ready to
go to Kelela health facility where this service is offered
to patients like you.”

Not long after hearing this news, Alem was able to
attend the first screening at Kelela Health Centre and
travel to BahirDar Fistula Centre where she received the
treatment, which involved surgery.

Amref Health Africa made all the necessary arrangement
and paid for her transportation to BahirDar. Her surgery
went well and her injury has gone. Alem is grateful that
the pain she went through has now gone.

“Thanks to Amref Health Africa and the Government,
I am now free from the burden of obstetric fistula and
associated social problems; I can attend any family and
community gathering without fear and embarrassment
as I do not leak urine anymore,” Alem said with smile
on her faces.

Alem is receiving training from the rehabilitation centre
she is in.

“The centre provides me with training based on my
interest and I have already chosen a business area I
would like to engage in. I hope that I will get the skills I
need and start my own business after I get back home,”
she said.

Alem promised to share with her community the
dire  experience  she  went  through  as  well  as  how
she  has  benefited  from Amref  Health Africa’s  Fistula
Identification  and  Treatment
Programme. She also vowed to
support others in connecting
themselves to the treatment
centre and get the support she
has obtained.

Amref would arrange everything to help you

get treatment, including your transport cost.

Your responsibility is to get ready to go to

Kelela health facility where this service is given

to patients like you.

pproximately 1.3 billion people worldwide lack access to adequate health care due to weak health care financing systems
leading households to incur high financial burden. Out-Of-Pocket (OOP) spending accounts for over 60% of Total Health
Expenditure (THE) in many developing countries (OECD, 2016).

Amref Health Africa contributes to increased investments in health to achieve UHC by developing and implementing sustainable and
scalable models to invest in health, increase financial protection for disadvantaged communities in target countries in order to reduce
OOP expenditure and advocate for increased investments and financial protection of citizens in Sub Saharan Africa (SSA).
To contribute to Amref’s vision of lasting health change in Africa and improving health of communities, Amref forged partnerships with
various organisations to boost access to health services; empower, communities, health authorities, Governments and strengthen
health systems. Through Amref Enterprises Limited (AEL), Amref Health Africa launched projects and products aimed at generating
income to fund our humanitarian activities. Among these projects were the Cure and Afya (CURAFA), Makueni Partnership for
Primary Care (Makueni P4PC) and the Reading Glasses for Improved Livelihoods (RgiL) Project.
The CURAFA Project was launched in 2018 courtesy of a partnership between MERCK Pharmaceuticals and Amref Health Africa
with a goal of addressing the gap in health care awareness, availability, accessibility and affordability for the underserved population.
The project adopted a multi-level approach to establish community care centres, each managed by a Pharmaceutical Technologist and
a Nurse to make primary health care available to the underserved low income population.
Amref Health Africa, Royal Philips and Makueni County initiated a Public Private Partnership (PPP) which enhanced the County’s
primary health care system to improve access to high quality primary care by Makueni County residents in a financially sustainable
and scalable way. The Makueni Partnership for Primary Care (Makueni P4PC) was piloted in Emali Model Health Centre, Tutini
Dispensary and Matiku Dispensary.

INVESTMENTS IN HEALTH

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4 1 | A N N U A L R E P O RT 2 0 1 8

These facilities were upgraded: stocked with drugs, equipped with technology equipment and accredited as National Hospital Insurance Fund (NHIF) outpatient centres. The project
trained 60 CHVs who mapped 24,000 households and 20 registered groups for recruitment of household members onto NHIF. Leveraging on mHealth innovations such as Leap and
M-Jali and community Radio, the project advocated for the adoption of NHIF medical card. Also, 12 health providers were trained on supplies forecasting as well as Kenya Quality
Model for Health (KQMH). To create awareness of eye-related problems in Kenya, Amref Health Africa through AEL established the Reading Glasses for Improved Livelihoods (RgiL)
Project in 2018 courtesy of a partnership between Amref Health Africa and Vision Spring. Targeting mainly people aged 35 years and above from low- and middle-income backgrounds,
the key objectives were to avail near-vision glasses at an affordable price in line with the government’s Big Four Agenda.

Kenya: Amref Kenya supported Homa Bay, Kajiado, Samburu, Siaya, Turkana and West Pokot counties on budget advocacy for increased allocation and utilisation of funds in the health
sector, supporting government’s efforts to create a health financing strategic plan in 2009. Following Amref’s intervention, the counties reported an increase in resources for health
that included allocation for CHW stipends as well as increased budget for provision of family planning commodities.

In 2018, Amref Kenya took its social accountability efforts a notch higher with the development of a social accountability framework and two-year social accountability execution
plan. This effort saw Amref contribute to the achievement of UHC by working with partners to enhance the voice of citizens for improved access to health services and financial
protection. This was realised through partnerships with civil society that put citizens at the centre, mobilising youth and community health workers, which ensured that the voices of
vulnerable and marginalised populations were amplified. Amref also engaged expertise in social and technological innovation, which expanded the reach of social accountability efforts.
Some of our Funding partners include:

4 2 | A N N U A L R E P O RT 2 0 1 8

Amref UK: Amref UK partnered with communities in more than 30 countries to secure the right to health and break
the cycle of poverty through maternal & child health, sexual & reproductive health & rights, Water, Sanitation and Hygiene
(WASH) and training health workers projects.

Year 2017/18 saw a stable period of growth for the UK fundraising team, which succeeded in raising a total of GB£596,347
unrestricted funds and GB£429,276 restricted funds. The most significant growth came from Trusts and Foundations, with
GB£1.48 million pledged in 2017/18 (some of this for the years ahead), compared to GB£60,000 in the previous year. Three
major six-figure grants were secured from new partners - James Percy Foundation, the Postcode African Trust and Waterloo
Foundation, and two from former partners, Medicor Foundation and Allen & Nesta Ferguson Charitable Trusts.
These grants will support a range of projects, including Sexual and Reproductive Health and Rights (SRHR) work in Tanzania,
SRHR work in Ethiopia and Malawi, FGM/C work in Kenya, and Mother and Child Health (MNCH) and WASH work in
Uganda.
Other major achievements include the highest ever total for the City of London School Charity Partnership (just over
GB£70,000) and securing UK Aid Match (an initiative of the UK Government’s Department for International Development) for
2019, which will help generate significant restricted and unrestricted funds. All donations made by the public before June
7, 2019 will be matched by the UK government, up to a possible total of GB£2 million. Public donations to the ‘Health in
Her Hands’ Campaign will support work across Amref UK’s portfolio, while match funding from the UK government will
support the training of nurses and midwives in Uganda.
The UK team also continued to invest in new and improved systems and processes, ensuring we continue to provide an
enjoyable and engaging experience for supporters. Indeed, individual giving generated the most income during the reporting
period, totalling GB£429,604.

Thirty years on, Amref UK’s unique
relationship with GSK continues to endure.
GSK contributed GB£2.2 million to Amref
Health Africa UK’s income during the
reporting period. In 2017/18, Amref UK
continued to partner with GSK to train
health workers across the continent.
Through the Health Worker Training
Programme, previously known as the 20%
Reinvestment Initiative, we continued to
work in 13 low-income countries in Eastern
and Southern Africa. The past year saw a
considerable shift in GSK’s strategy which
led to a change in the way GSK operates
in emerging markets, including most African
countries.
As a result, GSK will have less physical
presence in these markets and a much more
impact-oriented global health programming
strategy.

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Amref Nordic: In line with the new 5-year strategy of Amref Health Africa, Amref Nordic’s activities in 2018 focused on
building and expanding the fundraising activities in the Nordic region. Working in close collaboration with the global fundraising
development office, we progressed in developing methods for creating synergies by synchronising and centralising strategies
and processes for cost-effective fundraising activities throughout Amref. At the same time, the process for recruiting and
maintaining private donor fundraising through direct mailings was optimised during the year. To diversify our income flows,
we approached institutional donors, family trusts and business foundations, including submitting a proposal to the Postcode
Lottery. As a part of expanding fundraising into other Nordic countries, we employed direct mailing as a strategy to reach
private donors in Norway and Sweden.

The focus for Amref Nordic during 2018
was to raise unrestricted funds for Amref
Health Africa, which were then disbursed
to programmes such as Outreach in Kenya,
Uganda and Tanzania, WASH-programmes
in Ethiopia and Uganda, as well as FGM in
Kilindi, Zanzibar, and other programmes
focusing on girls’ and women’s health such
as child and maternity care and midwife
training. A research project was carried out
by a group of volunteers during the summer
of 2018, and results showed that Swedish
International Development Cooperation
Agency (SIDA) contributed more than SEK
300 million to Amref’s operations in Africa
over the past 20 years.
Amref Nordic raised funds through
telemarketing and newsletters, which
were distributed to existing donors and
conducted the so-called “Walking for Water”
in collaboration with 600 students and
teachers at the International English School
in Årsta, Stockholm, Grade 4-8.

4 4 | A N N U A L R E P O RT 2 0 1 8

Amref USA raised a total of over US$5million through fundraising from US Government Agencies, foundations, corporations
and individuals, and supported eight programmes including the Strengthening Laboratory and Blood Transfusion Services
project in South Sudan under the President’s Emergency Plan for AIDS Relief (PEPFAR) and HRH 2030, which trains health
workers to prevent maternal and child deaths, expand access to family planning, control HIV/AIDS, and protect communities
from infectious diseases.

In 2018, Amref USA held its annual ArtBall, a Gala event that celebrates African art and music and provides its guests with
opportunities to learn more about the work that Amref Health Africa does. ArtBall 2018 was attended by over 750 guests
and raised US$300,000 through the art auction, ticket sales and other contributions. For the fifth year in a row, Amref Health
Africa USA was an official charity partner of the TCS New York City (NYC) Marathon in 2018, the largest major marathon
in the world. Over 52,000 runners participated in 2018. Our small but powerful team of seven runners, including American
actress Megalyn Echikunwoke all finished the race with great times and raised over US$54,000 in total. Over the last four
years, our runners have collectively raised over US$178,000 to support our work on the ground.

Amref Health Africa in Italy supported
15 projects in 5 African countries - Ethiopia
(3), South Sudan (5), Uganda (1), Mozambique
(1) and Kenya (5). Eight of these were
mainly focused on sensitisation activities and
education.

Amref Health Africa in Uganda created
enabling investments in health by focusing on
health advocacy agenda towards achieving
UHC.

Through the Health Systems Advocacy
Programme, Amref Uganda collaborated
with African Centre for Global Health
Transformation, Coalition for Health
Promotion and Social Development, White
Ribbon Alliance, PATH-Uganda, United Nations
Population Fund (UNFPA), the Netherlands
Embassy, the Swedish Embassy, Reach Out
and Community-Based Organisations like
Kabale Women in Development, Hope After
Rape in Serere, BIDs Foundation in Dhokolo,
Diocese of Muhabura-Kisoro, Pentecostal

4 5 | A N N U A L R E P O RT 2 0 1 8

Assemblies of God-Soroti  and Gloford in Lira to  create a pathway to health for all by organising primary health care
through  the family medicine approach, which enables teams of health professionals to practice and provide health care
nearer the communities they serve.
This approach required presence of a working linkage and referral systems of the smallest unit in a community which is
the family. Through this collaboration, we have continued to front and advocate for recognition and remuneration of village
health team members who are the bridge builder to health equality.

Key outcomes at National level

• Budget for reproductive health was increased from UgSh8bn (US$ 2.4m) to UgSh16bn (US$ 4.2m).

• Approval of Sexuality Education Framework that sought to complement efforts to equip young people with

information about sexuality to make healthy choices about their sexual and reproductive health and utilise life-skills
in developing values. Amref under the Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH)
coalition strongly influenced this agenda, in the National Dialogue on SRHR for young people.

• Increased engagement of policy makers in policy dialogues; Members of Parliament through sectoral committees, The

Uganda Parliamentary Forum on Quality Health Services delivery, Uganda Women Parliamentarians’ Association, the
Health Services and budget committees.

Key outcomes at District Level

• Role of the District Advocacy

Working Groups in influencing
district budgeting processes saw
inclusion of FP funds and capital funds
in the district budget framework
papers across the six project districts.

• Districts of Kabale, Lira, Dokolo

and Kisoro improved leadership
and involvement in ensuring that
family planning service standards
were met. This was evident in the
way the districts and sub-county
leaders participated and engaged to
streamline FP financing and service
delivery.

• Improved functionality of Health Unit

Management Committees (HUMCs)
in health facility governance that
further improved service monitoring
and supervision at facility level.

OUR

SUBSIDIARIES

Amref Enterprises Limited

mref Enterprises (AEL)
supports Amref’s vision by
contributing to the lasting health

change in Africa and improving health
of communities by partnering with, and empowering,
communities, health authorities, Governments and
strengthening health systems.
Since the establishment of the social enterprise arm of
Amref Health Africa, AEL is responsible for delivering
sustainable social value through incubation and
commercialisation of innovative solutions conceptualised
and developed throughout the organisation. AEL is
keen to uplift communities in SSA through provision of
innovative and sustainable products and solutions for
Health Technology Business, UHC and Clinical Services
portfolio.

AEL’s key 2018 projects are detailed as follows:
Strategic Purchasing Africa Resource Centre: Following a highly competitive partner selection process,
Amref Health Africa was chosen to host Strategic Purchasing Africa Resource Centre (SPARC). SPARC is
a new initiative aimed at strengthening strategic health purchasing in Africa to get more value for money
from health spending on health services and medicines on behalf of populations. SPARC co-delivered WHO
strategic purchasing high level course in Rwanda; developed draft Country Engagement, Coaching & Mentoring
and Knowledge Management strategies; mobilised initial cohort of experts (The Force); engaged with Amref
International University (AMIU) to co-develop capacity building initiatives on Strategic Purchasing and initiated
plans for its official launch at the 2019 Africa Health Agenda International Conference (AHAIC 2019).

Amref Medical Centre: Amref Medical Centre (AMC) introduced a wellness campaign in 2018 where staff
visited the Centre for a wellness check. AMC received NHIF accreditation allowing both staff and members of
the public to select it as their preferred outpatient centre.

Other initiatives: In 2018, Innovative Partnership for Universal Sustainable Healthcare (i-PUSH) continued
with implementation of the second phase in Nairobi and Kakamega counties, Kenya with support from
the Dutch Postcode Lottery. The project aims to achieve: better RMNCH outcomes for women and their
children; improved utilisation, access, quality and health seeking behaviour of RMNCH services. The Innovative
Partnership for Universal Sustainable Healthcare (i-PUSH) sensitised 81 Community Health Assistants and 69
Sub-County Health Management Team (HMT) members on mHealth innovations.

4 7 | A N N U A L R E P O RT 2 0 1 8

Through i-PUSH, 2,220 CHVs were trained on 11 RMNCH-related topics through Leap, and on data collection using m-Jali
and registering Women of Reproductive Age (WRA) on m-TIBA platform (Safaricom), which has reached over 57,000 have
with health services. Amref supported Sub-County Health Management Team to participate in National Technical Working
Groups supporting Kenya’s UHC roadmap.
AEL undertook content development and conversion initiatives for Leap; a mHealth learning platform. This saw six new
topics being fully converted to mobile learning, 12 developed for conversion, eight reviewed, one developed on key
messages, one introductory script developed, and two curricula developed for face-to-face training in conjunction with
Ministry of Health (MoH).
The topics comprised of UHC, Cancer for CHVs, Stakeholder Engagement, Community Health Insurance, Health Financing,
Chikungunya Key Messages, Inuka Modules, Cleft Lip and Palate, Mental Health, Cancer for Primary Health Care Providers
and Organisation Development & Systems Strengthening. The team also conducted training on mHealth innovations
courtesy of various projects within Amref Health Africa and in partnership with other organisations.
This saw a total of 4,637 CHVs and HCWs trained on various health topics through Leap and a total of 3,943 CHVs on
m-Jali. Through m-Jali, a total of 794,209 households (reaching over 2 million) were mapped by CHVs in various initiatives,
including NHIF registration, community demographics and socio-economic indicators, screening for Non-Communicable
Diseases (Hypertension and Diabetes) and disease surveillance.

Key activities
• Transform Africa Summit 2018, May 7 –

10, Rwanda

• eLearning Africa 2018, September 26 –

28, Rwanda

• Africa Health Business Symposium

(AHBS) 2018, September, South Africa

• UN General Assembly (UNGA) 2018,

September, USA

• International Conference on Urban

Health 2018, November 26 – 30, Uganda

• The team also participated as peer

reviewers for AHAIC 2019 and also got
approvals for two abstracts submitted to
AHAIC 2019!

• Sensitised 81 Community Health

Assistants & 69 Sub County Health
Management Team members on mHealth
innovations

• Registered 24,758 Households on m-Jali

platform

• Reached 57,399 people with health

services.

Amref International University

mref International University (AMIU)
programmes contribute to capacity
building of health workers by equipping

graduates and middle-level health care workers
with knowledge and skills for operative implementation
of UHC2030 Agenda.  With courses and programmes
aligned to Amref Health Africa’s HRH strategic objective,
AMIU plans to train over 3,500 highly skilled health
workers over the next 5 years who will help provide
solutions to the existing and emerging health challenges
in Africa.
AMIU is an accredited institution of higher learning
focused on training in health sciences. The University
tagline ‘Inspiring Lasting Health Change’ embodies
the  vision  of Amref  Health Africa,  affirming  the  brand
philosophy and core values.  Through our training, AMIU
graduates acquire necessary experience and knowledge
to address the challenges faced in the delivery of health
care, which is key in reducing child mortality rates as well
as linking families to essential services and equipping them
with information and skills to prevent disease, promote
good nutrition, sanitation and hygiene.

Key partnerships
In 2018, AMIU signed a five year contract with St. Mary’s Hospital to establish a training partnership for Diploma
and Degree (BSc. Nursing and BSc. Midwifery) Programmes, and the Julius Centre Global Health and Elevate
Health, which are part of University Medical Centre Utrecht (UMCU) and Maastricht University. The objective
of these agreements was to explore and initiate opportunities to collaborate and share expertise with the
aim of creating mutually beneficial outcomes. Under the arrangements, St. Mary’s Hospital will offer clinical
placements opportunities for student nurses and midwives being trained at AMIU. The students will also benefit
opportunities to undertake health professional training, health system research and actively seek potential areas
for co-operation to facilitate holistic education for AMIU students through internships. On the other hand,
AMIU and the University Medical Centre Utrecht (UMCU) and Maastricht University have agreed to promote
innovations in health care technology and capacity building in health sciences including promoting online health
care courses, alignment of educational content, co-creation and expansion of programmes, development of the
Amref E-campus among other initiatives.

Health Systems Strengthening
Amref in partnership with the Ministry of Health (MOH) Kenya and the Japan International Cooperation
Agency (JICA) commenced the implementation of a five-year (2016-2021) regional project on Partnership
Health System Strengthening in Africa (PHSSA) through the development and implementation of a generic
curriculum on Leadership, Management and Governance (LMG) in Africa. The 2018/19 JICA Financial Year (JFY)
was largely successful with 99% budget utilisation representing 88% planned activity coverage that saw several
activities planned and executed. Some of these activities are: LMG-HSS curriculum and training materials were
reviewed and updated (training will be delivered on an eLearning platform for middle-level managers and senior policy
makers during the project implementation period); Advocacy for LMG-HSS Course was scaled up for increased
government resource allocation in support of eLMG-HSS training, developed a functional online platform to

facilitate networking and knowledge sharing on eLMG-HSS among practitioners and training institutions; LMG-HSS training
graduates were followed up plans and feedback reports generated; and best practices and lessons learnt in implementing
eLMG-HSS training programme were documented.

Community Health and Health Systems Management
AMIU commenced its maiden degree programme in Community Health Practice, and introduced a BSc. in Health Systems
Management and Development to ensure that current and future health systems managers are professionally prepared.
The development of the degree courses was informed by the experience and intellect of Amref Health Africa, which is
renowned with over 60 years of quality and innovative community health interventions, training and education. Shortage
of trained community health practitioners continues to hamper delivery of health services in SSA region.

Contribution to maternal and child health
AMIU contributed towards maternal and child health through the implementation of the Kenya Innovative and Sustainable
Solutions for Midwifery Education and Employment (KISSMEE) Project, a model social enterprise intervention geared
towards improving maternal, new-born and infant health indicators within the first 1000 days of life while transforming
the social-economic lives of unemployed and underemployed midwives. The project is funded by Danone Nutricia and
Danone Ecosystem. The goal of the project is to empower perinatal educators and mid-wives under the Tunza Mama
brand with a three-month entrepreneurship skills training to enable them start businesses. In 2018, training was conducted
in two pilot counties (Nairobi and Kisii) in Kenya reaching 190 students.

Nursing Class Graduation
In October 2018, the March 2016 Nursing Class graduated. The cohort also passed the National Licensing Examinations
administered by National Nursing Council of Kenya (NCK). Over the last 10 years, AMIU has been recording consistent
good results.

4 9 | A N N U A L R E P O RT 2 0 1 8

Key Milestones during the 2018/19 JFY
• eLMG Course uptake from 209

participants in April 2018 to 2,133
participants by end of 2018.

• 11 new countries visited, and all are

currently implementing the eLMG-HSS
course for mid-level managers;

• 28 institutions engaged with all

institutions expressing interest to take
up the eLMG-HSS course for mid-level
managers;

• Curriculum development process for

senior policymakers at very advanced
stage; and

• 20 eMentors engaged during the 3-month

eMentorship pilot programme for the
English eLMG-HSS course

Amref Flying Doctors

mref Flying Doctors work
and services fits within the
Innovative Health Services

and Solutions pillar of Amref’s Health
Africa’s Corporate Strategy. As a subsidiary of Amref
Health Africa, we are dedicated to Amref’s work and
offer a wide range of services in line with its vision and
goals. This include medical services, medical assistance
services, and Emergency Life Support skills training, where
surplus generated by AMREF Flying Doctors supports
Amref humanitarian’s work to transform lives of African
communities. Through our Air Ambulance Scheme,
AMREF Flying Doctors aims at providing quality and
affordable medical evacuation services throughout the
Eastern Africa region. With a dedicated fleet of short-and
long range air ambulance aircraft operating from Wilson
Airport, Nairobi, and highly skilled staff, we evacuate and
repatriate up to 1,000 patients annually from remote and
critical areas to destinations as far as Europe, Asia and
the Far East. This vital service is supported by our 24hr
Operations & Emergency Control Centre as well as a
fleet of Advanced Life Support Ground Ambulances.

In 2018, AMREF Flying Doctors introduced an enhanced Maisha Annual cover, known as Maisha Diamond that
includes post-evacuation hospitalisation benefit and repatriation option to South Africa (if the required specialised
treatment is not available in Nairobi). Maisha covers eight countries in the Eastern Africa region, including: Kenya,
Uganda, Tanzania, Rwanda, Burundi, Zanzibar, Ethiopia and South Sudan – all clustered into four cover regions.
Maisha Air Ambulance Cover, the flagship medical evacuation product from Amref Flying Doctors is the region’s
first and only professional direct air ambulance subscription.
Maisha (meaning, life, in Swahili) offers different levels of cover – targeting individuals, families, small groups and
corporates – determined by the area of coverage. In addition, Maisha offers options of short-term covers designed
for the tourism industry. Maisha Tourist and Maisha Tourist Scheme B are a thirty-day cover for clients who are
not keen on the twelve-month cover.

The

Amref Flying Doctors in Netherlands carried out various activities in 2018

that are summarised below.
• January: Through the contributions of generous travellers at Schiphol Airport and

through fundraising campaigns by Schiphol employees, we financed education of
1,000 health care providers in Africa.

• February: Dutch TV host Caroline Tensen offered us a cheque of almost €2 million

for our Malawi Guardians Project. With this extra support from the Dutch Postcode
Lottery, we will be able to finance the training of 5,000 CHWs (including 1,500 new
CHWs) in Malawi via mobile platform Leap.

• March: 4,400 students raised more than €126,621 for our work in Ethiopia around

World Water Day. Just like in previous years, Aqua for All added 80% on top of this,
bringing the total proceeds of Walking for Water to €227,918.

• April: Our international anti-FGM/C Ambassador Nice Leng’ete was named in the

Time 100, the list of the 100 Most Influential People in the world.

• May: Complied with the new European Privacy Law: the General Data Protection

Regulation (GDPR).

• June: Through intensive lobbying within the HSA Partnership by Amref in Uganda, the

Ugandan government doubled the budget for reproductive health from €1,897,385
to €3,794,769.

• July: Together with Philips (Foundation), Dutch Development Bank, FMO and the

Government of Makueni County (Kenya), we joined forces to ensure good health
care for 20,000 people.

We trained local health care providers and provided information. Philips is responsible

for the infrastructure and medical equipment of hospitals and the local government
is responsible for policy, regulation and quality management. FMO offers legal and
business knowledge.

• August: Neelie Kroes, member of our Committee of Recommendation, visited

the Maasai tribe in Loitokitok where 300 girls took part in an Alternative Rite of
Passage. They’ll grow up without being circumcised.

• September: For the six selected entrepreneurs in the Innovate for Life Fund, we

organised two “intensive weeks” in which the entrepreneurs got the opportunity
to pitch their innovations at the International Finance Corporation (IFC) and the
Kenyan Ministry of Health.

• October: Participants of the two Africa Classic Tanzania Editions raised a record

amount of sponsor money of €1,010,110. The even more intense Uganda Challenge
yielded another €508,884 earlier in 2018.

• November: Cynthia Oning’oi from Kenya - circumcised at the age of 12 against the

will of her parents - gave an unparalleled speech at TEDx Schiphol. She spoke about
her life story and work to banish the tradition.

• December: Our Goodwill Ambassador Saskia Noort was introduced to our

work in Kenya. The Alternative Rite of Passage made an impression on her: “A lot is
happening here and the majority is positive. They themselves are fighting very hard against
female circumcision.”

OUR

LEADERSHIP

Our International Board
Amref Health Africa is governed by a Board of Directors (the “International Board”) comprising of members from a wide range of backgrounds, bringing a great wealth of wisdom,
insight and experience to the organisation. Amref Health Africa has established offices in various countries within and outside of Africa in connection with achieving its objectives
(“Country Offices”). The Amref Health Africa Country Offices in Europe and North America which are established as separate legal entities have separate Boards of Directors
(“National Boards”), while Country Offices established within Africa are governed through advisory bodies (“Advisory Councils”). The Board is at the core of the organisation’s system
of corporate governance and is ultimately accountable and responsible for the performance and affairs of the organisation. The primary role of the International Board is to provide
policy guidance, financial oversight, strategic orientation and leadership to Amref Health Africa. It is also expected to support the Management of Amref Health Africa in fulfilling its
vision and implementation of the Strategic Plan.

Omari Issa,
Chair

Judith Chinkumbi,

Director

Tjark De Lange,
Director

Tito Alai,
Director

Dr Teshome Gebre,

Director

Jacques van Dijken,

Director

Dr Githinji Gitahi,
Ex-Official Member

Mary Ann Mackenzie,

Director

Kellen E Kariuki,

Director

Timothy S Wilson,

Director

5 3 | A N N U A L R E P O RT 2 0 1 8

In carrying out its mandate, the Board is supported
by several internal committees. These include:

Human Resources, Nominations and
Governance Committee (HRNGC)
The purpose of the Human Resources, Nominations
and Governance Committee is to assist the Board
in fulfilling its director nomination and corporate
governance development responsibilities.
The HRNGC also advises the International Board
and the Group Chief Executive Officer on policies
and strategic issues with regard to the management
of the human resources of One Amref.

Health Programmes Committee (HPC)
The Health Programmes Committee has a major
role given the nature of Amref Health Africa’s
standing as a leading public health organisation.
It advises the Group Chief Executive Officer and
International Board on strategic and policy issues
with regard to health development.

Audit, Risk and Compliance Committee
(ARC)
The main purpose of the Committee is to assist
the International Board in fulfilling its responsibility
relative to the compliance of Amref Health Africa
Headquarters  and  Country  Offices  with  all
International Board approved/endorsed Corporate
Policies/Agreements and Procedures. This includes,
inter alia, compliance with international accounting
standards  financial  management  procedures  and
reporting  requirements;  and  the  management
of other risks (governance, general management,
operational, human resource, reputational).

Finance and Investment Committee (FIC)
The Finance and Investment Committee provides
oversight over Amref Health Africa’s financial
planning and management. The FIC also assists
the Board in setting the investment policy to be
adopted for Amref Health Africa’s funds and reviews,
evaluates and approves investment projects and
operational expenditure relating to Amref Health
Africa’s business as planned.

Fundraising and Communications
Committee (FRANCC)
The Fundraising and Communications Committee’s
role is to support the mission, goals, and programmes
of Amref Health Africa by reviewing and monitoring
the organisation’s annual fundraising strategy,
targets and budgets.
This Committee also monitors Amref Health Africa’s
communication strategy, budget and execution
and makes appropriate recommendations to the
International Board.

Our Senior Leadership Team (SLT)
Amref Health Africa by design has attracted the
largest collection of international development
professionals and technical experts in the globe
tasked with the responsibility spearheading Amref’s
accomplishment of its objectives.
This global team is responsible for planning,
organising, leading and controlling the efforts
of organisational members, making use of
organisational resources to achieve the stated
organisational goals and objectives.

5 4 | A N N U A L R E P O RT 2 0 1 8

OUR

GLOBAL OFFICES

Amref Health Africa, Headquarters

P O Box 27691-00506, Nairobi, Kenya
Tel + 254 20 699 3000
Fax + 254 20 609 518
Email:

[email protected]

Website:

www.amref.org

AMREF Flying Doctors

P O Box 18617-00500, Lang’ata Rd,
inside Wilson Airport, Nairobi, Kenya
Tel +254 6000 090, +254 699 2299
Mobile: +254 733 639 088, +254 722 314 239
Fax: +254 (0) 20 3344 170
Email:

[email protected]

Website:

www.flydoc.org

Austria

Nonntaler Hauptstraße 61 5020 Salzburg
Tel: +43 662 840 101
Mobile: +43 664 914 5204
Fax: +43 662 821 224
Email:

[email protected]

Website:

www.amref.at

Canada

Amref Health Africa in Canada
489 College Street, Suite 403 Toronto,
Ontario Canada M6G 1A5
Tel: +1.416.961.6981
Toll-free: +1.888.318.4442
Fax: +1.416.961.6984
Email:

[email protected]

Website:

www.amrefcanada.org

Ethiopia

Bole Sub City, Woreda 03, House #2310
P O Box: 20855 Code 1000
Addis Ababa, Ethiopia
Tel:+251 11 662 7851
Fax: +251 11 662 7887
Email:

[email protected]

Website:

www.amref.org/ethiopia/

France

Amref Flying Doctors, France
23 Quai Alphonse Le Gallo - 92100
Boulogne-Billancourt France
Tel : + 33 (0)1 41 13 07 41
Tel : (Direct Line) +33 (0)1 41 13 07 45
Email:

[email protected]

Website:

www.amref.fr

Germany

Brunnenstrasse 185, 10119 Berlin
Tel: +49 (0)30 288 733 81
Email:

[email protected]

Website:

www.amrefgermany.de

Italy

Via degli Scialoja n. 3 - 00196, Rome - Italy
Tel: +39 0 699 704 650
Fax +39 0 632 02227
Email:

[email protected]

Website:

www.amref.it

Kenya

Amref Health Africa Kenya
P O Box 30125, 00100, Nairobi, Kenya
Tel: +254 20 699 4000
Fax: +254 20 600 6340
Email:

[email protected]

Website:

www.amref.org/Kenya/

Malawi

Amref Health Africa in Malawi
Linthipe Road, Plot No. 47/2/32
P O Box 30768, Lilongwe, Malawi
Tel: +265 1 762 808/809/810/
Email:

[email protected]

Website:

www.amref.org/malaw

Monaco

Le Saint Andre 20 Boulevard de Suisse
Monaco 98 000 MC
Tel: +377 97 77 08 08
Email:

[email protected]

Website:

www.amrefmonaco.org

5 5 | A N N U A L R E P O RT 2 0 1 8

Netherlands

Amref Flying Doctors
Schuttersveld 9 2316 XG Leiden
The Netherlands
Tel: +31 (0)71 576 9476
Email:

[email protected]

Website:

www.amref.nl

Nordic

Amref Health Africa Nordic Office
c/o Impact Hub,
Luntmakargatan 25, 111 37 Stockholm
Tel: +46 8 410 883 44
Email:

[email protected]

Website:

www.amref.se

Southern Africa

Hillcrest Forum Building
731 Duncan Street (Corner Lynwood Rd)
Pretoria, South Africa (Post Net Suite 92,
Private Bag X19, Menlo Park, 0102)
Tel: +2712 362 3135/6/3127
Fax: +2712 362 3102
Email:

[email protected]

Website:

www.amref.org/south-africa/

South Sudan

Off Airport Road to the Ministries Opp UN-
OCHA Juba
Tel: +249 955 442 486
Email:

[email protected]

Website:

www.amref.org

Spain

Amref Salud África (

Amref Health Africa in Spain

)

Paseo de las Delicias, 20 2ºC, 28045 Madrid,
Spain
Tel: (+34) 91 310 27 86
Email:

[email protected]

Website:

www.amref.es

Tanzania

Amref Health Africa in Tanzania
Ali Hassan Mwinyi Road, Plot No: 1019,
Box 2773, Dar es Salaam, Tanzania
Tel: +255 22 211 6610/ 213 0860
Fax: +255 22 211 5823
Email:

[email protected]

Website:

www.amref.org/tanzania/

Uganda

Amref Health Africa in Uganda
Plot 01, Okurut Road Kololo, Kamwokya
Kampala ,Uganda
Tel: +256 414 346 822
Email:

[email protected]

Website:

www.amref.org/uganda/

Amref Health Africa UK
Lower Ground Floor
15-18 White Lion Street
London N1 9PD, United Kingdom
Tel: +44 (0)207 269 5520
Email:

[email protected]

Web:

www.amrefuk.org

USA

Amref Health Africa in the USA
75 Broad Street, Suite 703
New York, NY 10004
United States of America
Tel: +1 212 768 2440
Email:

[email protected]

Website:

www.amrefusa.org

West Africa Region

Amref Health Africa
Sacre Couer 3, Extension Villa No 105 en
face de l’école Sédar, Dakar, Senegal
Telephone: +33 860 6008
Fax: +33 860 6003
Website:

www.amref.org/senegal/

Zambia

Amref Health Africa in Zambia
Plot No 10484 Dambo Close
Olympia Extension
P O Box 31678, Lusaka
Website:

www.amref.org/zambia/

5 6 | A N N U A L R E P O RT 2 0 1 8

OUR

PARTNERS

Grants expenditure by donor FY2018

S.No Donor

Amount

US$'000

Percentage

Global Fund

19,432

20.00

USAID

17,103

18.00

CDC

8,774

9.00

Dutch Ministry of Foreign Affairs

7,193

7.00

Global Affairs Canada

5,628

6.00

GSK

3,540

4.00

Amref Netherlands

2,756

3.00

European Union

2,551

3.00

Amref Italy

1,792

2.00

UNFPA

1,427

1.00

UNOPS

1,417

1.00

GIZ

1,124

1.00

COCA COLA

1,103

1.00

World Bank

1,091

1.00

S.No Donor

Amount

US$'000

Percentage

Gates Foundation

908

1.00

Hewlett Foundation

899

1.00

Dutch Postcode Lottery

859

1.00

Comic relief

847

1.00

Sight Savers

839

1.00

Nutrition International

832

1.00

Safaricom & Mpesa Foundation

802

1.00

Italian Agency for Development Cooperation

764

1.00

UNICEF

661

1.00

JSI

656

1.00

Stichting ondersteuningsfonds zorg, welzijn and sport

642

1.00

UK AID

601

1.00

Aqua for all

563

1.00

Health Pool Fund

546

1.00

5 7 | A N N U A L R E P O RT 2 0 1 8

S.No Donor

Amount

US$'000

Percentage

FMO Bank

506

1.00

ASTRAZENECA

500

1.00

DFID

472

0.00

PHARMACIENS SANS FRONTIERES GERMANY

465

0.00

JICA

460

0.00

IRISH AID

445

0.00

HDIF

327

0.00

Spanish Corporation/AESID

327

0.00

JHIEPAGO

323

0.00

UN WOMEN

314

0.00

CARTIER

309

0.00

Dutch Ministry of Trade & Development Cooperation

301

0.00

AMREF SPAIN

297

0.00

Johnson & Johnson

287

0.00

Coca-Cola

285

0.00

Queen Elizabeth Jubilee Foundation

273

0.00

Danone

265

0.00

BMZ

227

0.00

PACKARD

220

0.00

S.No Donor

Amount

US$'000

Percentage

NANDO PERETTI FOUNDATION

213

0.00

Porticus

185

0.00

Bread for the World - German

174

0.00

Elsevier Foundation

169

0.00

UNDP

163

0.00

SENMINES

155

0.00

TAKEDA

155

0.00

Achmea Foundation

153

0.00

FONDATION ORANGE FRANCE

149

0.00

Old grants

148

0.00

STERNSTUNDEN

139

0.00

R4D

127

0.00

AMREF UK

125

0.00

Comic relief-USA

124

0.00

CIFF

115

0.00

IDRC

111

0.00

PATH

111

0.00

AICS

110

0.00

107

0.00

5 8 | A N N U A L R E P O RT 2 0 1 8

S.No Donor

Amount

US$'000

Percentage

IOM

105

0.00

FINISH MONDIAL

102

0.00

STRAVROS ET CSA

100

0.00

Amref Germany

0.00

END Fund

0.00

Amref USA

0.00

DCI

0.00

Hivos & Busara Centre

0.00

TBL/SBL

0.00

BMS

0.00

The Grand Challenge Canada

0.00

DHL

0.00

ENTERPRISE

0.00

MANI

0.00

Intur burn

0.00

WHO

0.00

Amref Austria

0.00

Childfund International

0.00

University of Antwerpen

0.00

S.No Donor

Amount

US$'000

Percentage

Global Good Fund IVL

0.00

Princess Charlène of Monaco Foundation

0.00

Child Doctor

0.00

Philips

0.00

FCF

0.00

Monaco Government

0.00

Philips

0.00

Malteser International

0.00

Madrid City Council

0.00

MSF

0.00

Ministry of Devolution Kenya

0.00

CCRDA

0.00

PAI

0.00

Smile Train

0.00

100

Kaves

0.00

101

EABL

0.00

102

Euro Money

0.00

103

UNILEVER

0.00

Total grants

96,187

93.00