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Closing the GapAMREF UKAnnual Review 2008

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Closing the GapAs the readers of this annual review will already

know, the majority of Africans do not have access even to basic health care. Many die from

preventable diseases, and many more slip into destitution simply because they’re too sick to work or study. Poor health creates poverty, which in turn creates more poor health. Economies falter. Societies struggle.

At AMREF, we refuse to accept this situation. We envision an Africa where health care is available to everyone. Where vibrant, resilient communities have the means to protect their own health and take care of those who do get ill. Where people have access to safe drinking water and affordable drugs. Where preventable diseases are prevented. An Africa where the future holds great promise for all.

Ultimately, our work is about closing gaps: between health systems and communities, between the healthy and the sick, between rich and poor. On one hand, we work with vulnerable communities to manage their health and advocate on their own behalf for the right to public health care. On the other, we work with governments, institutions, and other NGOs to improve the reach and effectiveness of health care systems.

In 2007-08, we continued to do what we do best: find innovative solutions to Africa’s most intractable health problems. Working in east and southern Africa, AMREF continued to develop a new model of health care delivery for nomadic communities.

We piloted a cost-effective, integrated disease management program that can be replicated and scaled up by governments. We delivered clean water and sanitation education to poor urban and rural communities alike.

Our health training and e-learning programs graduated thousands of qualified health workers from across the continent, while our Flying Doctors service helped saved the lives of people living beyond the pale of emergency care.

We launched an exciting media partnership with the Guardian and Barclays that brings lifesaving services to one of Uganda’s most war-affected communities while educating the UK public about health development in Africa.

Thanks to the generosity of our donors and the hard work of our staff and our board of directors, I’m proud to say that AMREF UK raised £5 million to support this important work. Every day, the future looks a little brighter for the thousands of people we work with in Africa.

Lorraine CliftonChief Executive Officer (Interim)

“AMREF’s work is about closing gaps: between health systems and communities, between the healthy and the sick, between rich and poor.”

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Where We Work

Main programme countries

Countries from which AMREF trainess have come

Sudan

Ethiopia

KenyaUganda

Tanzania

South Africa

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Building Healthy CommunitiesIn communities where there are no medical doctors or

affordable prescription drugs, the burden of health care falls instead on families and individuals. They must

depend on their own, often meagre resources and ingenuity to buy medicine and manage disease. This can leave whole families destitute when a breadwinner falls ill — even with a treatable illness such as TB or malaria.

Ultimately, good health begins with the community. AMREF equips communities with the knowledge, skills, and tools they need to manage their collective health, with or without support from the health care system.

Because the majority of our staff come from the cities, towns, and villages where they work, we’re able to form deep and lasting partnerships with vulnerable communities and together develop tailored, effective interventions.

The result? Healthy, vigorous people who can weather periods of drought, economic recession, and other challenges while at the same time advocating on their own behalf for the right to government-provided health services.

In 2007-08 we partnered with Diageo and the people of Kechene, the largest slum in Addis Ababa, to build clean water and sanitation facilities. We trained community health workers among nomadic communities in Ethiopia and Kenya so they are able to access free basic health care as they move along their ancestral routes.

We provided emergency care and HIV/AIDS testing and counselling to the people of Kibera, one of the areas of Nairobi worst affected by Kenya’s post-election violence in early 2008.

Meselu Aberham collects fresh water in Kechene. Both Photos: Tim Bishop/Diageo

“We worked with AMREF to make sure they knew what our community needed most. Now we are rarely sick.”

Meselu Abreham, mother and small business owner

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Building Healthy Communities

Over the many years she has lived in Kechene, Meselu Abreham has watched the children of her community succumb to chronic diarrhoea and parasitic infections. A mother of five, she feared the worst every time one of her own children drank the water she collected from a dirty spring in the slum.

“So many children used to die. We were exposed to many waterborne diseases,” she recalls. “I used to worry so much, but we had no alternative.”

A typical urban slum, Kechene’s makeshift houses and shops sprawl for miles, brimming with life — and rubbish. Food scraps, junk, and human and animal waste collect in the streets. Clean water is, or was, rare. The spectre of poverty and disease haunts this vibrant place, which Meselu loves in spite of its problems.

“I used to spend hours every week at the health clinic, and it took me away from my business,” says Meselu. “I struggled to make a living. But this is my home. I would never leave it.”

Since 2007, AMREF and partner Diageo have worked with Meselu’s community to build water kiosks — taps, showers, and latrines — and educate residents about the benefits of handwashing and hygiene. Seventeen

Our Work: Clean Water for Urban Slums

kiosks have been completed and handed over to water management committees that have been trained to maintain them. More are under construction.

“Now my family is rarely sick. I can devote more time to my pottery and injera-selling business and make more money,” says Meselu. “Even more importantly, the children do not have to miss classes. They say ‘I go to school on time, my grades are improving!’”

With their large and shifting populations, slums are notoriously difficult places to achieve lasting community development. AMREF project manager Gadisa Hailu believes the kiosks will translate into long-term improvements in community health and an easier, more stable life in Kechene.

“The kiosks seem to be a real source of pride in the community,” he says. “People walk away smiling after they have used them. It is my hope and expectation that better health in Kechene will lead to economic and social benefits as well.”

Meselu is optimistic, too: “We worked with AMREF and our kebele [the smallest local administration offices] to make sure they knew what we needed most. Because of this, I know the kiosks will succeed.”

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Strengthening Health SystemsAfrican societies are intensely multicultural. They are

patchworks of diverse communities with diverse health needs. Health care systems often struggle with this.

They lack the resources to reach vulnerable communities and the expertise to address the health issues specific to them.

Out of necessity, a one size-fits-all approach is taken. Where the health care system even reaches slums, rural communities and nomadic groups, it delivers services that may not account for the high levels of mobility, poverty, or certain diseases among them.

Effective health care requires social transformation — changes in the behaviour of whole communities. This can be as simple as the incorporation of handwashing into mealtime routines, or as complicated as the changing of attitudes towards women and their right to sex with a condom. Ultimately, social transformation requires health care systems that work with communities and make strategic investments in equipment, facilities, and health workers.

AMREF helps African governments to do just that. In 2007-08, we continued to develop our groundbreaking model for healthcare delivery in the nomadic pastoralist communities of Ethiopia, Kenya, and Sudan. In South Africa, we worked with local government and traditional leaders to address the problem of gender-based violence, integrating specialist care, counselling, and a referral system into the local health system and educating the broader community about the problem.

Photo: Dan Chung/The Guardian

“People think we must change the way nomadic people live. But we need only to provide them with water and medical services and their lives will be complete.”

Peter Ngala, public health officer and AMREF staff member

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On the plains of Kenya’s northwestern frontier, a group of nomads march their herds of bony cattle to water. The dry season has begun and the reservoir, constructed by AMREF in 2001, is a vital source of water in this harsh, drought-prone region.

“During the rainy season, we bring our livestock for watering almost every day. When it becomes dry and we must search for pasture, we come here less often because it involves walking very far,” says Lorot Lorimor.

Tall, thin, and armed with a Kalashnikov rifle, Lorimor will spend a week camped near the reservoir with his adakar, a group of 50-100 families that forms the basic social unit of Turkana society. The Turkana are nomadic pastoralists who have for centuries migrated across the region as part of their traditional way of life.

“You can see the men carry guns,” says Peter Ngala, a public health officer who works closely with AMREF here. “This is for protection. Because of the droughts, they must travel long distances to find water and pasture and this brings them into conflict with neighbouring tribes.”

Climate change has made life increasingly difficult for the Turkana. As water becomes scarcer, they struggle with parasitic infections. Kenya’s health care system, already weak, does not reach them because they’re always on the move, travelling from one swath of pastureland to the next. The lack of services, coupled with disease and gun violence, has made them one of the country’s most vulnerable groups.

Our Work: Mobile Health Care for Kenya’s Nomadic PeoplesWith input from Ngala and the Ministry of Health, AMREF has developed an innovative programme to bring clean water and health care to the Turkana people. Using maps of the migratory routes, we have begun to establish dispensaries and health clinics along them. Each medical outpost will, upon completion, feature a borehole and/or rain catchments.

“The idea is that the adakars will be able to access health care and clean water as they move. This will help prevent disease and reduce conflict — they will no longer have to cross into enemy territory to water their livestock,” says AMREF programme manager John Kener.

To this end, AMREF is also training community health workers from within the adakars to diagnose and treat common illnesses. They refer serious cases to the hospital in the nearby town of Lokichoggio.

“Ultimately, we’re developing a new model of health care delivery for nomads, one that is cost-effective and can be taken over by the government and replicated in nomadic communities across the country.” says Kener.

Ngala, who is himself Turkana, underlines the importance of this culturally sensitive approach: “People think we must change these people. But the Turkana are comfortable with their way of life. We need only to provide them with water and medical services and their lives will be complete.”

This project is funded by the Big Lottery Fund and the European Commission.

Turkana nomads at rest. Photo: Tyler Stiem/AMREF

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Fighting DiseaseThe numbers are sobering: Africa bears one-quarter of

the world’s disease burden yet accounts for less than 1% of global health expenditure. Most of what little

money is spent on health goes to treating diseases rather than preventing or tracking them. The result is a sticking-plaster solution to a chronic and very serious problem.

Africa’s health crisis is an issue of resources, but it’s also an issue of strategy. Even relatively minor illnesses such as diarrhoea and eye infections can have far-reaching economic and social effects. Adults miss work, children miss school, and communities grow poorer. Treatment ensures recovery, but only when combined with far-sighted prevention and surveillance strategies can it break the cycle of poverty and ill-health.

AMREF takes a holistic approach that combines all three activities in the fight against disease. Recognising that diseases do not exist in isolation, we strive to understand them in their proper contexts and respond accordingly. We also recognise that the fight against disease begins in the home. Where the skills and knowledge exist, 75% of all diseases can be prevented or treated without recourse to medical facilities.

In 2007-08, we piloted an innovative new approach to the management of HIV/AIDS, TB, and malaria that tracks, treats, and prevents the three diseases in tandem, reducing mortality and improving overall community health.

In Mtwara, Tanzania, where malaria is the leading cause of death among mothers and children, we distributed insecticide-treated bed nets and trained community health workers diagnose and treat the disease. Families were educated to recognise symptoms and seek treatment.

Nell Freeman/Reportage by Getty

“My patients thank me. They say, ‘we are no longer in the dark about killer diseases like before.’”

Ester Nakamya, community health educator

For years, Ester Nakamya struggled with stigma. A health assistant at Kasana Health Centre in Luwero, Uganda, her job was to educate people about TB and encourage them to be tested and treated if they were infected.

But TB was not well understood and that made her job difficult.

“Someone with TB was assumed to be promiscuous. People believed that TB was fatal and you would die very quickly,” she says.

Compounding the problem, the links between TB and other diseases, such as HIV/AIDS and malaria — the diseases responsible for the greatest number of deaths in Luwero — were not well delineated. Patients were often tested and treated for one disease but not necessarily all three.

Yet research shows that half of all TB patients in Uganda are also HIV-positive, and nearly a third of AIDS deaths are the result of TB-related complications. Likewise, an HIV-positive person is more likely to die from malaria, and malaria can increase viral loads and the risk of mother-to-child transmission.

When a person is infected with multiple diseases but diagnosed and treated for only one of them, they are much less likely to recover. This in turn reinforces the perception that TB and HIV/AIDS are devastating, terminal illnesses.

“People who were infected [with TB] didn’t want to go to the hospital,” says Ester. “They were ashamed, and they saw no point.”

Our Work: Better Disease Management in Central UgandaYet when treated at the same time, TB and malaria can be cured and HIV/AIDS can be managed effectively. In 2006, with support from AstraZeneca, AMREF launched MAT, an integrated disease management programme in central Uganda.

Designed to tackle all three diseases simultaneously, MAT trains village health volunteers like Ester to collect data using questionnaires translated into local languages and then feed them into the district health management information system.

Health authorities in the Luwero and Kiboga districts now have a more accurate picture of the local disease burden and are thus better able to manage drug supplies and allocate resources.

Through an integrated referral system, the MAT programme also helps government health departments to work more seamlessly together, taking a big-picture approach to disease management.

Two years into the five-year pilot programme, AMREF and Ester have already seen changes, both in the health of patients and in overall attitudes towards TB and HIV.

“People seek treatment more often now,” says Ester. “I was touched to hear one of my patients tell me that ‘Tetukyali babisi ku ndwadde zi namutta ng’edda,’ meaning, we are no longer ignorant about the killer diseases like before.”

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A baby boy receives his first immunisation shot. Photo: Dan Chung/The Guardian

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At the root of Africa’s health crisis is a critical shortage of health workers – the fewest, globally, per capita. In the UK, for example, there are 250 doctors

per 100,000 people while in Sudan, only 16.

‘Brain drain’ is part of the problem. Health workers are often underpaid and underequipped to meet demand for their services, especially in rural and slum areas where the burden of care is heaviest. Understandably, they are drawn to better-paying jobs in the major cities and abroad.

To make matters worse, many African countries simply do not have the capacity to train enough doctors, nurses, and clinical officers. Demand is high and tuition can be prohibitively expensive.

As part of its commitment to strengthening health systems and building healthy communities, AMREF trains health workers from across Africa every year. These include people from vulnerable communities as well as professionals attached to the formal health care system.

In 2007-08 alone, we trained 10,000 health workers from Sudan to Swaziland, Nigeria to Namibia. We trained traditional birth attendants and vaccinators embedded in nomadic groups; midwives and community health workers intent on giving back to their communities; and laboratory technicians keen to help fight the spread of disease.

Our computer-based e-Learning program in Kenya allowed experienced nurses to upgrade their skills without leaving the communities where they provide essential services. As of September 2008, there were 5,144 students enrolled in the program.

Training Health Workers

A midwife checks on one of her patients. Photo: Stevie Mann/AMREF

“Thanks to AMREF, I can tell when labour is obstructed. I can even transfuse blood and set up intravenous lines. I can deal with cases of postpartum bleeding.”

Alice Taabu, midwife

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It’s 10 a.m. and the maternity ward at Lui Referral Hospital teems with patients. New and expectant mothers queue patiently in the hallways and waiting rooms. They wait to receive antenatal check-ups, fill prescriptions, even give birth.

In the middle of everything is Alice Taabu. One of only two qualified midwives at the 75-bed hospital, Alice calls her patients into the consultation room, one by one. They come from as far as two, three counties away.

“I attend up to 40 patients every day, another eight inpatients, as well as deliveries. It can be challenging, says Alice. especially when a delivery is due,” Alice says.

Alice handles the pressure well. She takes her patients’ histories, discusses the importance of a hospital delivery, counsels them on family issues, provides advice about nutrition, and performs physical examinations. At intervals she checks on the progress of patients in labour.

“I divide my time between the antenatal clinic and the delivery wards to monitor the mothers. When a delivery is due, I often have to abandon all else to attend to it.”

A few years ago, Alice could not have imagined she would be shouldering such responsibilities. She dropped out of secondary school after only a year because she couldn’t afford the fees. Medical training was a faraway dream.

But with support and encouragement from her family, Alice entered the AMREF-run Lui National Health Training

Our Work: Reversing Brain Drain in Southern Sudan

Institute in 2006, where she trained as a community midwife. She graduated with her certificate in 2008. “The training I received from AMREF has helped me a great deal,” she says, proudly. “I can tell when labour is obstructed; I can identify and deal with cases of post-partum bleeding. I can fix nasal-gastric tubes for feeding, I can even transfuse blood and set up intravenous lines.”

Alice is one of the building blocks of southern Sudan’s fledgling health system. Decades of civil war destroyed most of the region’s hospitals and health clinics. Many of the region’s health professionals fled the country, leaving fewer than 1,000 to serve a population of over 8 million.

Working with the Ministry of Health in southern Sudan, AMREF is helping to rebuild the health system from the ground up. Every year we train thousands of health workers like Alice, graduating midwives, laboratory technicians, nurse’s aides, clinical officers, and more.

“Before I was in darkness, but now I am in the light,” says Alice. “I am grateful to AMREF. Without their help, this would not be possible.”

Southern Sudan still needs health workers. But with talented, enthusiastic people like Alice in place, there is hope.

Our work in Sudan is supported by Direct Relief International.

Katine Community Partnership ProjectIn October 2007, AMREF launched a groundbreaking

three-year development project in the Katine sub-district of northeastern Uganda, one of the country’s

most impoverished regions. Created in partnership with the Guardian and Barclays, the project works with the people of Katine to improve their lives while at the same time educating the UK public about international development.

Katine was badly affected by civil war in the first half of this decade. Many residents lost their homes, their belongings, even their lives when rebels from the Lord’s Resistance Army ransacked the area in 2003 and again in 2005. As the people of Katine returned to what was left of their villages, they faced destitution.

Because the needs there are so great, the Katine Community Partnership Project (KCPP) focuses not only on health and water and sanitation but also on education, livelihoods, and governance. The Guardian, meanwhile, brings the story of Katine to as many as 400,000 readers every week through the project website (www.guardian.co.uk/katine) and the newspaper itself.

Katine has also attracted the attention of some of the UK’s and Europe’s leading think tanks and funders, who are interested

in Katine as a new model for community development and NGO transparency. AMREF and Guardian staff participated in a roundtable discussion of the role of media in development hosted by Polis, a media policy group based out of the London School of Economics.

At the time of publication, Guardian readers had donated £1.2 million to the Katine project, which Barclays has generously agreed to match.

13,777 Children immunised (from 4,957), increasing coverage to 80% of all children under five, reducing incidences of childhood illnesses.

21Boreholes and shallow wells dug, repaired, or refurbished, increasing access to clean water from 42.2% of the population to 63%

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Ruth Emolu spreads health messages through her village on Christmas day. Photo: Stevie Mann/AMREF

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On Christmas morning, a voice rings out across Abata village in Katine.

“Today is a big day! I know you’ve prepared a lot of food for the festivities. But before you begin, I want to remind you — do not give the food to your children before you heat it.”

It’s the voice of Ruth Emolu, a member of one of the village health teams trained by AMREF. She has risen early this morning to deliver a message of goodwill and healthy eating to the residents of her community. She strides purposefully among the huts, megaphone in hand.

“Even if you are feeling tired or the fire has gone out, you must light it up and warm the food so they do not get sick!”

Ruth takes her role on the village health team very seriously, educating her community with equal part concern and enthusiasm. Every week she visits families to teach them how to keep their homes clean, ensure they use mosquito nets, and protect the water they collect from the new village borehole from contamination.

In nearby Soroti town, Margaret Aniko spreads similar messages across Katine on AMREF’s weekly radio show on Delta FM. Every Friday from six to seven in the evening, volunteers and staff from the Katine project deliver the latest project news and discuss the issues affecting the people of the sub-district.

Our Work: Bringing Hope — and Talk Radio — to Katine

Speaking in Kumam, a local language, Margaret encourages pregnant women to go to their local health centres for checkups and announces visits by the mobile immunisation teams. Listeners from all over the region call in to ask her questions about health and sanitation, which Margaret, a member of one of 272 AMREF-trained village health teams, answers confidently.

In areas where there are few doctors, village health teams play a vital role. Comprised of trained volunteers like Ruth and Margaret, they provide treatment and advice and make referrals for their patients.

“There are 100 homes in my village,” says Ruth. “People are clean and healthy, and our children are going to school. I have seen a great change since AMREF came to work with us.”

Margaret sees personal as well as communal benefits: “I feel I am more empowered and valued with equal footing with my husband,” she says.

Nowadays, she’s a minor celebrity — people approach her for health advice even when she is not on the radio.

Ruth Emolu spreads health messages through her village on Christmas day. Photo: Stevie Mann/AMREF

Photo: Dan Chung/The Guardian

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Flying DoctorsFor over 50 years, AMREF’s Flying Doctor Emergency

Service has provided medical outreach and air rescue services to east and central Africa’s most remote

communities. AMREF’s pilots and doctors provide emergency care, specialist surgical services, and training in areas where the only health facility might literally be a person selling paracetamol from a roadside shop.

In 2007-08, our doctors offered surgical clinics in places like Dodoma, Tanzania, where they treated patients with fistula — a serious injury that afflicts thousands of African women each year during childbirth, often leaving them incontinent and soaked in urine. Local doctors and nurses were taught how to perform the operation themselves so that this vital service could be offered regularly to women in need.

AMREF’s Flying Doctor air and ground ambulances meanwhile evacuated 593 patients from all over east and central Africa, flying a total of 924,051 miles — a 60% increase on the previous year’s total. The evacuations ranged from 118 cases of accident-related trauma, 73 of cardiovascular cases, 59 cases of infectious disease, 59 cases of gastrointestinal incidents, 16 gynaecologal emergencies cases, and 11 arising from animal attacks.

This 24-hour service employed a full-time emergency physician and eight flight nurses, as well as on-call personnel, and is provided free of charge to people who cannot afford to pay. Medical equipment on board the aircrafts includes trauma and intensive care facilities, as well as an on-board incubator for infants in crisis.

This year Flying Doctors also become the first air ambulance service in Africa to be accredited by the European Aeromedical Institute with the highest level certification for an air ambulance organisation. We extended our emergency services to include international evacuations, flying patients South Africa, Europe, Asia, the Middle East and beyond for specialist medical treatment.

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Flying Doctors

At AMREF we recognise that Africa’s health crisis can only be overcome through a combination of frontline health development work and advocacy.

With this in mind, we make sure our work in the field — the lessons we learn and the evidence we gather — impacts our work with policymakers.

Our advocacy work in 2007-08 focused on the critical shortage of health workers across sub-Saharan Africa. Recognising the need for more — and better trained — doctors, nurses, and community health workers, AMREF lobbied policymakers in the UK, European Union, and beyond to increase funding and address the acute need for more health training institutions.

On behalf of the Health Workers Advocacy Initiative, AMREF UK director of programmes Grace Mukasa presented a paper at the first global consultation on the new International Health Partnership (IHP+) between the

Influencing PolicyWorld Bank, WHO, and donor governments. The paper called for all IHP+ signatories to ensure that national health strategies prioritise health workers.

We also worked with the Global Health Workforce Advocacy Initiative, a group of civil society organisations that push donors and policymakers to recognise the importance of human resources in health.

Most recently, AMREF engaged in advocacy work related to maternal health. In 2008, Dr. John Nduba presented written evidence on maternal morbidity in Africa to the All-Party Parliamentary Group on Population, Development, and Reproductive Health.

All of this is part of our ongoing work to link research and advocacy as closely as possible, so that our field work can become a model for change in policy debates.

Photo: Tyler Stiem/AMREF

Fundraising Highlights

Last summer, West Ham United goalkeeper Robert Green gave up his beach holiday to raise more than £30,000 for AMREF programmes in Africa.

Opting instead to volunteer as an AMREF ambassador, Rob hosted a series of events to raise money and awareness about our lifesaving work.

In May, Rob recruited football colleagues Paul Robinson, Dean Keily, Craig Gordon, Ray Wilkins, Alan Lee, and Jimmy Walker for a celebrity golf event. He also hosted the inaugural Boleyn Cup, a five-a-side football tournament. Together, the two events raised over £20,000.

In June, Rob tackled what he calls “the hardest thing I’ve ever done,” climbing Mount Kilimanjaro — the world’s largest freestanding mountain, at 5,985 metres.

“Football’s a great life, but it’s a very closed life — you don’t get a chance to see different things,” says Rob. “I wanted to experience something other than lying on the beach, and the climb was a wonderful challenge.”

Not only did the climb raise over £10,000, it attracted vital media attention to AMREF’s work in the sports pages of the Sun and Independent newspapers. Rob also appeared on Sky’s Soccer AM and on radio stations from London to Norwich.

Most importantly of all, Rob hosted the AMREF Football Tournament for Peace, set up following Kenya’s post-election violence. The tournament brought together young people from the different groups who clashed violently after the presidential election.

A role model to the aspiring footballers, he spoke to them about the importance of tolerance and cooperation, on and off the football pitch. Clearly in awe of the Premiership player, the kids responded enthusiastically to his words of encouragement.

“I’m in a fortunate position to be able to affect people through football and use it to do something to help,” Rob says. “The satisfaction I go was far greater than if I had gone to a resort.” Thank you, Rob!

Robert Green’s Kilimanjaro Ascent

Robert Green (centre) with AMREF volunteers. Photo: Arthur Edwards/The Sun

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Inspired to help out after reading about our work in Africa, singer-songwriter Mark Knopfler generously donated one of his electric guitars, as well as proceeds from a concert, to AMREF in 2008. Knopfler, a solo artist and former lead singer/guitarist of the Dire Straits, invited AMREF project manager John Muiruri to speak at one of his Royal Albert Hall show last May. Muiruri told the audience of 4,000 about Nairobi’s street children and how AMREF’s Dagoretti Child in Need project is giving them a second chance. ‘By supporting AMREF you are helping African communities to help themselves,’ Knopfler told his fans. Knopfler also donated one of his Fender Stratocaster guitars to be auctioned off in support of the Katine Community Partnerships Project.

He graciously welcomed the winning bidder into his London studio, where he showed him around and played on the prized instrument.

Thank you, Mark!

On a warm Saturday in June, AMREF hosted a masquerade ball for supporters at the Cobden Club in Ladbroke Grove. One-hundred-and-twenty masked guests — including AMREF staff and board members, volunteers, and supporters new and old — enjoyed an evening of dancing and cocktails. The evening raised over £2,500.

Whether looking for true love or just an excuse to have fun and raise funds for a good cause, the participants at AMREF’s September speed dating event helped raise close to £1,000. Twenty men and twenty women turned out for a series of three-minute ‘mini-dates’ with each member of the opposite sex. Thanks to Punch Tavern on Fleet Street for hosting the event.

Mark Knopfler Donates Guitar and Concert Proceeds

Midsummer Supporter Party & Speed Dating

£5 millionFunds provided by donors in support of AMREF’s lifesaving work.

Thank You to Our DonorsA & E Education TrustAccentureAdam WilliamsAllan & Nesta Ferguson Charitable TrustAnna McKayAnne FilatochevAstraZenecaAttila KatonaBand Aid Charitable TrustBarclaysBig Lottery FundBrian ChurchyardBrian KinderBritish CouncilThe Chalker Foundation for AfricaChris Winnington-IngramDan BattertonDavid DalgarnoDavid J CauserDavid K BrewerDavid RadfordDFIDDiageo

Direct Relief International Dulverton TrustEuropean Commission FIGOGarth C EdwardGlaxoSmithKlineGuardian News & MediaGuernsey Overseas Aid CommitteeHeadley TrustIshmail AmlaJ J DavyJames HancocksJenny BreakerJersey Overseas Aid CommissionJo VesteyJohn PoolJohn R ArnoldJonathon SiveJonathon KenworthyJoseph Leitch Joshua LayishLeonard GahanLiz GyekyeLucy Scanlon

Mark KnopflerMark Rushbrooke May ScottMichael and Joan Bosworth Michael F RuddellNora HarraginPhilip HulmePhoebe BladesPrimrose StobbsRichard HoareRobert Green Roger J AllportRufford Maurice Laing Foundation Simon JonesSomerset Local Medical Benevolent FundStephen and Trixie BrenninkmeijerWolfson College

In Memoriam Annette M VincentAnn FraserChristopher BalstoneJeff Baker

18Photo: Dan Chung/The Guardian

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Treasurer’s Report

71%

25%

3% 1%

83%

16%

1%

Income

Expenditure

Gross income for the year was £5,069,234 – an increase of more than 58% (2007: £3,201,769)

Grants for projects £3,572,962Fundraising £1,267,842Gifts in Kind £162,109Bank interest £66,322

Grants for projects £3,658,973Cost of charitable activities & fundraising £717,814Governance costs £39,337

This year, 2007–08, has been another excellent one for AMREF UK, as the organisation has continued to grow in profile, size, capacity and influence.

Gross income (including gifts in kind) for the year was £5,069,234 (by comparison — £3,201,769 in 2007) an increase of over 58%. This increase was largely due to the continued increase in the grant funding for projects in Africa from institutional and corporate donors in particular Europe Aid (European Commission), AstraZeneca and Barclays Bank.

For every £1 of gross income, 15p is spent to generate the income and provide technical support to AMREF in Africa, and 1p on governance, office and administrative support. The balance of 84p is available for funding projects in Africa. This is an indication of AMREF UK’s commitment to be as cost-effective as possible in all its activities.

We continue to be generously supported by Institutions, Companies, Trusts and Foundations and individuals, to all of whom we are extremely grateful and have been pleased to receive support from new donors during the year.

Gautam DalalTreasurer

AMREF UK

Patron HRH The Prince of Wales President The Duke of Richmond & Gordon Board of Directors Mr Gautam Dalal (treasurer)Mr Paul Davey Ms Claire Davidson (Retired: 17 January 2008) Mr Ian Edwards Mr Matthew Edwards Mr Ian Gill Mr. Mark Goldring (Appointed: 17 April 2008)Mrs Samara HammondLady Susan Woodford Hollick (chair)Sir Jeffrey James (Retired: 17 January 2008) Mr Joel Kibazo (Retired: 17 January 2008)Mrs Katherine Mathers Ms Inosi Nyatta (Appointed: 17 April 2008)Mr John Pool (Resigned: 17 January 2008) Chief ExecutiveMrs Lorraine Clifton (interim)Ms Joanna Ensor (on maternity leave)

Clifford’s InnFetter LaneLondonEC4A 1BZ

Tel: 0207 269 5520Email: info@amrefuk.orgWeb: www.amrefuk.org

Text/art direction: Tyler StiemDesign: Raymond Helkio

Cover photo: Dan Chung/The Guardian Printing: Stephen Austin & Sons

Registered charity number: 261488Limited by guarantee. Not for profit.

Printed on 50% recovered fibre and 50% virgin fibre from sustainable sources.