AMPATH: An Integrated Model of Healthcare in Rift Valley Province, Kenya
August 15, 2009
AMPATH is widely recognized as one of the largest and most effective responses to the HIV pandemic in Sub-Saharan Africa. Which is why Commissioner Mike Merson and Karen Meachem were quite surprised to learn that "AMPATH doesn't actually exist." Contrary to popular opinion, AMPATH is not an NGO. There are no AMPATH employees. Rather, AMPATH is a name that symbolizes a partnership between Moi Teaching and Referral Hospital (Kenyan Ministry of Health), Moi University School of Medicine (Kenyan Ministry of Education), and a consortium of North American Institutions led by Indiana University.
In other words, AMPATH is the name of an alliance formed within the existing framework of Kenya's government. And the model AMPATH has developed through this alliance demonstrates how health system strengthening can happen within that very framework. It's a unique and often misunderstood approach to international development. But in the view of AMPATH field director Dr. Joe Mamlin and program manager Dr. Sylvester Kimaiyo it is an approach that is both scalable and sustainable. As evidence, AMPATH now provides treatment to over 90,000 HIV+ patients - up from just 1,000 in 2003. And with the launch of AMPATH's household counseling and testing (HCT) program, their patient population is expected to increase dramatically as they go door to door across their entire 2 million person catchment area in western Kenya. It's an aggressive initiative that will not only save the lives of those unknowingly living with HIV but it will reduce the number of new HIV infections. In the absence of an HIV vaccine, HCT appears to be the most effective means to roll back the pandemic. And deployed through AMPATH's model, the HCT program can not only stem the spread of HIV but it will further expand the reach and strength of Kenya's national health system.
When most people think of "global health" they think of disease. Specially, they think of the big three: HIV/AIDS, malaria, and tuberculosis. But the model AMPATH has developed to respond to the health crisis in Sub-Saharan Africa demonstrates a much different understanding of global health. AMPATH makes it clear that health can not be viewed as a medical condition alone. In fact, many determinants of health are sociocultural, not medical.
For example, antiretrovirals (ARVs) are largely rendered ineffective if a patient is undernourished. ARVs are free in Kenya. But food is not. So HIV+ patients can get the drugs they need to stay alive, but without food the so-called Lazarus Effect can not commence. Which is why AMPATH not only prescribes ARVs to its HIV+ positive patients, it prescribes food to patients who are undernourished. Through it's network of vegetable farms, AMPATH now provides over 40,000 patients with food per month. Of course, to simply provide medicine and food to a patient population would just create a model of dependency - a pandemic in and of itself. Enter FPI - AMPATH's robust portfolio of income security programs. These programs help ensure that AMPATH is providing a hand up to those in need, not just hand outs.
Everything from microfinance to agricultural training, a handicraft workshop to a juice factory, and business consulting to a seedling nursery are designed to provide AMPATH clients the help they need to become self-reliant citizens capable of building a better life for themselves, their families, and their communities. At AMPATH, health lies at the intersection of medical care, food security, and income stability. Perhaps those of us in global health need to rethink what we mean by the "big three."