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Miriam K. Were
Chair, International Board
Africa Medical and Research Foundation, (AMREF)
Bill Gates, Sr., Dr. Nils Daulaire, CEO of Global Health Council, the Honoured People at the High Table and all of us in this distinguished audience, we in AMREF are honoured and delighted to accept this award. We are thrilled to join the line of prestigious and deserving organizations who have received the award before us:
The Centre for Health and Population Research, in Dhaka, Bangladesh, for pioneering work on oral rehydration solution (ORS),
The Rotary Foundation of Rotary International, with its 1.2 million members working to improve health and health equity around the world,
Brazil's National AIDS programme, and their quest to get free access to antiretroviral drugs for all, and last year's winners,
BRAC - also based in Bangladesh, serving over 31 million people through a network of health clinics, community nutrition centres, and grassroots health workers.
It is particularly important that in this year-dubbed Africa Year due to increased focus on Africa--a deserving African organization is honoured through this award and AMREF is delighted to be the first African organization to win the Gates Award for Global Health. We accept the award on behalf of the communities and people across Africa with whom AMREF has worked for nearly 50 years and to whom we dedicate this award, along with our Founders, our Partners in AMREF National Offices as well as our staff, past and present. We see this award as a recognition of the determination of the people of Africa who continue working on the improvement of the quality of their lives and continuing to contribute to global well being. We deeply appreciated all those working with us from everywhere. Thank you.
For me personally, being at this conference stirs up memories of my attendance of conferences of the National Council of International Health which got renamed the Global Health Council. I was thrilled to receive the Council's George Tolbert Award in 1980.
Underlying Africa's development challenges are dehumanising levels of poverty that seem almost intractable due to various reasons that I believe this distinguished audience is familiar with. Such extreme poverty goes hand in hand with a huge burden of disease that further entrenches the lives of the people into deeper levels of poverty.
Over 1 million children under 5 die of malaria every year in sub Saharan Africa. A child dies every 30 seconds. Families in Africa spend 25% of their income on treatment for malaria. We also know that around 30 million Africans are HIV+. I am not going to dwell on any of these disease catastrophes. Most of you know the huge health problems we have. I believe you also know that Africa services a huge debt burden.
As I have said, poverty in Africa seems intractable but we all know it need not be so. If we removed the debt burden alone, we would thin out the blanket of poverty suffocating Africa and prevent a lot of these diseases. AMREF hosted one of the Regional Consultations of British Government's Commission for Africa. Our people's aspirations are clearly stated in the recommendations that emerged from that consultations. We implore all G8 leaders to listen to the voice of Africa at the G8 this year. History clearly indicates that the world has not always been fair to Africa and even pushed Africa into modes of existence that undermine the well-being of its people. Let the history of the 21st Century tell a different story; a story of a turning point in the history of humankind. Let future historians record that this was the century when all of us worked together as members of one family: the family of the human race; a family whose various members stopped the tradition of passing the buck and even blaming the victims. We in Africa invite the world to work with us in the Spirit of true Sisterhood and Brotherhood. We are fully engaged and pledge to continue to do everything possible to be reliable partners in the improvement of the life of our people and other peoples across the globe.
AMREF recognises that given the community set up of the life in Africa, if it doesn't happen in the communities, then it doesn't happen! On the other hand, AMREF fully recognises that if it happened in all our communities, it would happen in the nations. And so we focus on working with communities. Progressively, we establish dialogue with people in their communities. We recognise that there are strength in people in their communities and work with them to build those strength. We seek to build bridges between what the people know supports life and well-being and new information and technologies that can be grafted onto their pre-existing strength to build on the solutions that improve the quality of life. We are convinced that if the development agenda had recognised the existing strengths in the African people and had built on them, we would have gotten much further than with the approach of treating African people as if all they have is ignorance to be gotten rid of and presenting them with solutions with no bridges to their reality.
And so AMREF's main approach to health improvement is that of Community-Based Health Care (CBHC). Through CBHC, AMREF works with communities to promote health through appropriate measures. AMREF works with communities to prevent disease through increasing access to safe water, access to immunisations services, prevention and treatment of malaria and promotion of appropriate behaviour change in a variety of situations including for the reduction of new HIV infections. I invite members of the audience to peruse the AMREF web site and get the feel of the range of our work with over 100 communities. We in AMREF believe that improved health can be a major strategy to move people out of poverty. However, the challenge is to improve health of people in ways that empowers them to manages their lives better. The CBHC approach makes this possible and contributes to long term sustainability.
Funds made available from the Gates Award for Global Health will enable AMREF to work on a systematic look at the Interface between Community-Based Health Care and formal health Systems and, based on the evidence that AMREF collects, to propose changes to policies and practice so that the disadvantaged communities can truly escape poverty. Let me explain. Communities do not exist in a vacuum. They exist within national contexts that have formal health systems and there is an interface between communities and formal health systems. Failure to address the interface between Communities and formal Health Systems has resulted in the failure of the CBHC approach so far. Unfortunately, this failure and the consequent turning away from the CBHC approach has been the typical case of jumping from the frying pan into the fire. Things have not gotten better. They have got worse. AMREF is particularly suited to take the bull by the horns and address this challenge.
AMREF is presently working with over 120 communities in 7 countries - Ethiopia, Kenya, Uganda, Somalia, South Africa, southern Sudan and Tanzania. AMREF seeks to build models in the course of working with communities. Thus we learn what works and we share it. We use our experience and knowledge to argue for changes to national and international health policies and practices. We work with partners to help make health delivery more effective and more relevant to the needs of those living on
$1-2 per day in the communities with which we work and others like them across Africa.
While AMREF works directly with Communities, we do so with the full understanding and appreciation of National Health Systems. In fact, it was these officials of our governments that nominated AMREF for the Award and supported it.
AMREF always has and will intensify its efforts to advocate for the changes which we believe are necessary within the health systems in order for the CBHC approach to truly constitute the first line of health care/development as stated in the Declaration of Alma Ata. But advocacy alone hasn't been sufficient. Just as we have been modelling what works at the community level, this award will now make it possible for us to research and model what it will take to solve the health problems of people in ways that will empower them whilst finding the best "FIT" in National health Systems. AMREF will use the Gates Award to research the links between communities and health facilities; we will explore policy options and best practice to close the gap and to point the Way Forward for health delivery and development approaches that do all communities, particularly those far away from the capital cities and those in which poor people live even within those capital cities.
In his recent speech to the World Health Organization, Bill Gates said one of the key priorities for health equity was "delivering interventions - not just discovering them" and that we needed to focus on "deliverable technology" - which means getting healthcare to the people who need it. We believe that what AMREF is doing and what it plans to do with the Award money directly address this issue.
Let me end my comments by thanking again the Bill Gates family for the contribution they are making to address the health challenges of this century from its very first decade. We in AMREF see this award as the first step in a long relationship in addressing this particular area of strengthening the CBHC approach and providing models for addressing the interface between communities and formal health systems. Thank you again for choosing AMREF for the Gates Global Health Award for 2005.
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