african medical and research foundation by tlindeman


									 African Medical and Research
    Foundation’s (AMREF’s)
   Support to RBM Efforts in
  Eastern and Southern Africa
     By Eliab Seroney Some, AMREF HQ
Fourth Global Partnership Meeting to Roll Back
      The World Bank, Washington, DC
               18-19 April 2001
        What Is AMREF?
 International health NGO founded in
 Headquarters in Nairobi, Kenya

 Operates in nine (9) countries in
  eastern and southern Africa:
    – Kenya, Uganda, Tanzania, south Africa
    – Mozambique, Rwanda, Somalia, Sudan,
     Range of Support to
          RBM (1)
   Preventive interventions
    – Testing models of delivering insecticide-treated
      mosquito nets (ITNs) (Kenya, Uganda,
    – Workplace health promotion (HIV/AIDS &
      Malaria) (Kenya, Tanzania, Republic of South
    – Health promotion and education (all countries)
    – Integrated management of childhood illness
      (Kenya, Uganda, Tanzania, consultancy to other
      African countries and agencies)
     Range of Support to
          RBM (2)
   Curative interventions
    – Surveillance anti-malarial drug sensitivity and
      treatment failures (Kenya, Tanzania, Uganda)
    – Quality control of laboratory tests and clinical
      practice at primary health care levels (K, Ug, Tz,
      Sudan, Somalia, Mozambique)
    – Emergency response to malaria epidemics (K,
      Ug, Mz, Tz)
     Range of Support to
          RBM (3)
   Support to health systems
    – Capacity building through
          Face-to-face interactions (seminars, workshops),
          Distance education/continuing education (over 2,000
           students per year) (K, Ug, Tz, Sudan, Somalia and
           other countries)
          One-year diploma in community health
          Production of health promotion and learning materials
           through AMREF’s rural health series of books and
 Increasing Scale of Action:
Case One: Community-based
      ITNs Promotion
   Local stitching, promotion, sale and re-
    impregnation involving 75,000 people in
    four sites, 1992-1996:
    – Sagana (near rice scheme); Taveta (sisal
      estate); Migori (Around Lake Victoria); Turkana
      (Migratory community, arid area with seasonal
Case One: Community-based
      ITNs Promotion
   Strategies
    – Organized community groups
    – ITNs as an income generating activity
    – Modes of payment adapted to local purchasing
    – Community’s own people used for awareness
      and demand creation
    – Linkage to commercial sources of ITN goods
         Case One: Findings

Site      Baseline Nets After   Re-         Status
          Coverage made 3       impregnatio 2001
                        years   n
Sagana 17%        1 508   34%   25%         Active

Taveta    0%      452     32%   4%          Active

Migori    9%      434     11%   **          Inactiv
Turkana 0%        652     ***   **          Active
       Case One: Lessons
   Organized community groups (OCGs) are
    present in most communities and the could
    be successfully introduced to ITNs for malaria
   Linkage to income generation is crucial for
    ITN sustainability at community level
   OCGs create awareness and demand for
    eventual commercial sector up take of ITNs
   OCGs facilitate targeted delivery of ITNs to
    specific areas and sub-population groups
   NGOs in partnership with Governments most
    suited to empower OCGs and communities
Case Two: Integrating Malaria
Into Other Health Programmes
   Malaria integrated into a child survival
    programme in Luwero and Nakasongola
    districts in Uganda, 1992 – 1999.
   Other elements: Immunization; Control of
    diarrhoeal diseases, Nutrition; Acute lower
    respiratory infections; Maternal care/Family
    planning; HIV/AIDS, orphans support.
   Malaria: ITNs, Treatment, Information,
    education and communication.
      Case Two: Strategies
   Community-based health care system
   Capacity building of Village Health
    Committees, Community Health Workers;
    Youth peer Educators, Traditional Birth
   Shared resources, with synergism with other
   First line drug (Chloroquine) availed to CHWs
    for malaria treatment
   ITNs sold without subsidy
    Case Two: Findings
   Functional community based health care systems
    established in all four (4) sub-counties for health
    and other development initiatives.
   Use of ITNs.
    –   Mothers: 31 - 40%.
    –   Children: 40 – 49%.
    –   Father: 20 – 22%.
    –   Others: 0 – 2%.
   First line drugs available 100%.
   Incidence of malaria in children below 2 years:
    – Baseline: 230 – 450 per 1000.
    – Post-intervention: 160 – 190 per 1000.
    Case Three: Employer-
    based Malaria Control
   Network of workplaces/employers
    – potential system for scaling up
   Starting April 1998 to September 2000 and with
    funding from DFID, AMREF in partnership with
    MoH, Kenya, mobilized employers and
    Organized Community Groups to promote ITNs
   Main strategies
     – Acquisition of ITN through salary deductions
     – OCGs in collaboration with medical department
       of the employers handled all aspects of ITNs
     – OCGs supplied ITNs to surrounding
       communities and other employers
    Case Three: Findings
   14 employers and 80 Organized Community
    Groups in coastal and western parts of Kenya, with
    97,000 beneficiaries
   26,000 ITNs sold to employers and surrounding
    communities, 11,400 direct to employees and their
   Net coverage: 8-100%; Re-impregnation 25-80%
   Reduction in malaria illness: 25 – 87%
   Reduction in expenditure on anti-malarial drugs 23
    – 97%
   Government-NGO partnerships most
    appropriate to explore introduction of malaria
    into and capacity building of communities and
    private sector
   NGOs most suitable to facilitate targeted
    delivery of ITNs to difficult areas and not-easily-
    reached populations by capacity building local
    organized community groups
   Enabling Mechanisms
    –   Grants
    –   Memorandum of understanding
    –   Joint planning, monitoring and evaluation
    –   Co-resourcing
   Limited access of NGOs to resources, e.g.
    those channeled through Governments, for
    testing of innovative approaches.
   Empowerment of communities by
    Governments as the key development
   Limited resources to scale up innovative

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