Day 2: Dispatch from Eldoret
August 13, 2009
Dr. Michael Merson and I left Nairobi yesterday to visit the AMPATH (Academic Model for Prevention and Treatment of HIV/AIDS) program in Eldoret. It's an impressive program and we had a great time!
Inspired by Dr. Joe Mamlin and launched with support from Indiana University (IU), AMPATH is driven by a unique partnership between the Moi Teaching and Referral Hospital, Moi University School of Medicine, and the Kenya Ministry of Health. Though it has tremendous outside support, the work program is Kenyan owned and Kenyan run.
AMPATH leads an aggressive approach to HIV treatment with Kenyan health workers going door to door, village to village collecting data on hand held devices. The aim is comprehensive testing and counseling to reduce total viral load in the region; they serve 90,000 people in their catchment area and aim to reach all 2 million. This decentralized work is complimented by the significant 'central nervous system' that is the referral hospital and Moi University working together. These institutions hold clinics, a pharmacy, a mother and baby facility, and serve as a hub for an exceptional electronic case management system that holds field data from their 90,000 patients scattered across the Rift Valley Province.
Care and treatment is the fundamental starting point for AMPATH, and they will receive a $60M USAID grant to prevent and treat HIV/AIDS between 2007 and 2012.
However-doctors and teachers have concluded that to get at the root of the problem, they must address the underlying causes: disease, hunger and poverty. AMPATH now focuses on treatment (health), food security and economic generation, and has programs to advance these concepts including: operating a farm to train farmers and distribute vegetables, organizing a micronutrient program with the World Food Program (WFP) and the Japanese, and starting-up a juice factory and restaurant to train people on business skills. These programs are all run by Kenyans.
Can a system that works to combat HIV/AIDS work for other maladies?
Armed with detailed health records of the local population, a base of community support, a strong medical team, and penchant for ingenuity, AMPATH is broadening its treatment scope well beyond HIV/AIDS. They have changed their name to Academic Model Providing Access to Care - continuing their HIV/AIDS treatment but setting a new course for comprehensive primary care as the principle focal point. During our visit we observed new programs to address primary care and chronic disease, and saw the beginnings of oncology and diabetes clinics.
AMPATH has developed important partnerships to supplement the existing workforce. It has formed the ASANTE consortium of U.S. universities, led by IU, to take advantage of technical support and operational experience that U.S. students and faculty offer. Dr. Mamlin and others have also leveraged significant additional funding from the private sector, including pharmaceutical companies.
Eldoret and the Rift Valley Province were close to the epicenter of political violence following the 2008 elections. AMPATH facilities had minimal disruption - a testament to their broad-based relationship with the community.
Can successful programs like AMPATH be scaled up? In fact the hospital already treats a massive population in Eldoret and across the province.
Whether AMPATH is replicable is a more appropriate question, and the answer is 'it depends'. AMPATH is an academic model. Instead of being driven by NGO involvement, it is driven by an academic medical center - a teaching hospital model. Replicability depends upon identifying a similar set of partners and it depends upon the role of academic medical centers in Africa. Are there other academic health centers in Africa that could incorporate a similar model? This is where the conversation should begin.
