Better Maternal Health for 500,000 Women in Africa

by Amref Health Africa aka African Medical and Research Foundation
Almaz, a midwife in Ethiopia talking with a mother
Almaz, a midwife in Ethiopia talking with a mother

Dear donors,

We have decided to close this project, however you can still follow us through our Stand Up for African Mothers campaign ( 

Every year in Sub-Saharan Africa, upwards of 200,000 mothers die as a result of complications during pregnancy and childbirth. Because of this high maternal mortality rate, almost 950,000 children are left without a mother every year. Most of these deaths are easily preventable, as they are mainly caused by a lack of access to basic health care.

To efficiently reduce these numbers, AMREF has launched the Stand Up for African Mothers campaign to train more midwives, because midwives save lives. The aim of the campaign is to train 15,000 African midwives by 2015. So far, 4,909 are trained or in training in six countries in Africa. An AMREF-trained midwife can provide antenatal services - including examination of the mothers, referral services, counseling of HIV-positive mothers, nutritional education, maternity services, including delivery; and post-natal care. We estimate an AMREF-trained midwife can provide care to 500 mothers a year on average.

Thank you so much for supporting our "Better Maternal Health for 500,000 Women in Africa" project, and we hope you can be a partner with us in standing up for African mothers!


Esther Madudu with mother and newborn
Esther Madudu with mother and newborn

Americans certainly get fired up about the Oscars, the Golden Globes and Grammys. Every year, several awards are given to recognize the accomplishments of celebrities, actors, singers, athletes and entertainers. But what about the REAL people who don’t just play a doctor or nurse on TV?  The ones on the frontlines who are changing and saving lives every day?

This year people who rarely receive recognition or accolades are being honored – health workers around the world – with a REAL Award. 

According to the Frontline Health Workers Coalition and Save the Children, founders of the REAL Awards, they are a ‘first-of-its kind awards platform designed to develop greater respect for and appreciation of the life-saving care provided by health workers around the world'. The objective of the REAL Awards is to demonstrate the universal and urgent need for more trained, caring health workers on the frontlines. By some estimates, the world is short more than five million health workers including one million frontline health workers. Existing health workers are often overworked and under-appreciated.  REAL Awards should remind the public that people everywhere depend on health workers every day’.

At AMREF, we were thrilled to learn that one of the thousands of health workers we train or whose skills we upgrade through our eLearning, mHealth or onsite programs, was recently selected to receive one of the first, global REAL awards for the work they do as a REAL person on the frontlines of health care.

Esther Madudu, an AMREF-trained midwife working in rural Uganda in a remote health center, was presented last week with a REAL Award to celebrate and honor the life saving work she performs day in and day out.

In a small, poorly equipped health center, often under harsh conditions, Esther and her one midwife colleague are among the few skilled and trained professionals able to deliver babies and look after Moms who come not only from the immediate area, but often walk for miles from surrounding villages. 

This past week though, Esther’s health center was a place of celebration and support for frontline health workers.  The Ugandan Minister of Health herself, the Hon. Dr Christine Ondoa, presented Esther with her REAL Award which was presided over by Uganda’s Deputy Minister of Health and AMREF’s own Country Director in Uganda, Dr Abenet Berhanu, along with our Deputy Country Director, Dr Susan Wandera.   There were also a number of individuals from AMREF’s senior management team who attended the event, including many representatives of regional and local district government offices, with whom AMREF Uganda works hand-in-hand to implement our programs. 

The REAL Awards celebration in Uganda last week was just that – a lot of dancing, refreshments and overall jubilation to pause and take a moment to honor and celebrate frontline health workers everywhere whose dedication and commitment to their work is literally life-saving.

Esther Madudu with REAL Award
Esther Madudu with REAL Award


One of my ongoing pleasures is to welcome staff from AMREF headquarters in Nairobi.  It’s always so enlightening for our team to hear firsthand about their work and the outcome of AMREF’s programs as told by the experts who manage them.   This past week, AMREF’s eHealth Program Manager, Caroline Mbindyo, was in New York to speak at the UN GETHealth (Global Education & Technology) Summit where she was a panel member in two sessions – how IT can empower women and health workers and what strategies achieve program scalability and sustainability of IT innovations for health workers.

Caroline is responsible for the development and implementation of AMREF’s eHealth programs, including eLearning and m(mobile)Health, across sub- Saharan Africa.  She leads the team that implemented the pioneering eLearning program for nurses in Kenya, which significantly impacted the delivery of sustainable, cost-effective training for health workers in remote and low resource settings.

Over 60 per cent of Africans live in rural areas, far from any health facility or hospital.  Most of them will never see a doctor in their lifetimes.  Instead, they depend on the care of community health workers, nurses, traditional birth attendants and midwives, if they are lucky enough to have one who lives nearby and is qualified to deliver effective health care. 

The lack of health workers is one of the key barriers to improving health in developing countries.  Begun in 2005, AMREF’s eLearning program in Kenya aimed to upgrade the skills of certificate level nurses to that of Registered Nurse over two years.  At that time, there were four nursing schools in Kenya with a total of 125 students, an enrollment rate of 100 students per year, and an additional 20,000 nurses in the wings waiting to get in.  

In both panel discussions, Caroline spoke about the seemingly overwhelming challenges of building this program.   How to set up electronic learning when less than 30% of Africans have access to electricity?  There was no infrastructure, no mobile phones and no computers.  How do you motivate a health worker in isolation – how do you support her? How to introduce nurses to infectious diseases like HIV/AIDS or the multiple mutations of malaria treatment, when none of that existed in their former training?  What technology partners were willing to take on the challenge and how could the outcomes be beneficial to all stakeholders?   With more nurses trained, would there be adequate clinical practice facilities?  Could the newly certified nurses expect pay increases when they graduated?  The questions were endless.

The program was a public private partnership led by AMREF, the Ministry of Health, the nursing regulatory body in Kenya, and funded by Accenture, a global management consulting firm. It involved setting up a national eLearning platform, development of the eLearning curriculum and content, building the capacity of nursing schools to use the eLearning approach to teach nurses, 98% of whom had never used a computer before, setting up supporting and supervisory mechanisms to ensure learning of both theoretical and practical skills and creating a monitoring and evaluation framework to enable all partners to track the key performance indicators (KPIs) in which they were interested.

Slowly the program took off and the health impact has been quite remarkable.  From four schools with a total of 125 students, there are now 34 eLearning centers enrolling 1,400 students each year.  Over 7,000 nurses have graduated since the inception of the program, which was handed over to the Ministry of Health and the Nursing Association in Kenya, thereby assuring its long term sustainability.  In fact, that ability to develop local capacity in creating lasting health change that is sustainable by local communities is a hallmark of AMREF’s work.  It is also what sets us apart from other organizations.

Remarking on the program partnership, the moderator of Caroline’s second panel discussion, Dr Esther Ogara, Head of eHealth, Continuing Professional Development at Kenya’s Ministry of Health, noted “AMREF is fantastic because they mobilize resources and we, as the government, provide human resources and infrastructure.  It becomes easy to work with them.  That is why their programs are successful and sustainable – unlike the others.”

Now considered an ‘African’ program, the success of AMREF’s eLearning initiative is being replicated by the Ministries of Health in Uganda, Rwanda, Tanzania, Zambia, Lesotho, Malawi, Senegal and Zanzibar with a focus on various cadres of health workers. 

And Caroline, well, she and others recognize the growth of mobile devices as the “computer of Africa”.  Following her eLearning success, Caroline is now directing a two year multi-country study on how mobile devices can be leveraged to improve health care delivery in sub-Saharan Africa.  

Until next time, Lisa


Clinical Officer in South Sudan - Grace
Clinical Officer in South Sudan - Grace

Grace Konga is training to be a clinical officer at the Maridi National Health Training Institute (NHTI) in South Sudan. A clinical officer is a cadre between physician and nurse who can be trained in half the time and at one-fifth the cost to carry out 70% of the work a physician does. AMREF is training Grace and other Clinical Officers at the NHTI. Grace is proud to be helping other women access good quality health care.

I am aged 27 years and married with one child. I come from Eastern Equatoria State, Torit County in South Sudan. Torit County has an approximate population of 260,000 people with poor infrastructure, social and health delivery services.

As a young woman, I feel challenged with the high maternal mortality rate in Eastern Equatoria and as whole in South Sudan. On realization of the huge contribution I could make to change this situation, I decided to enroll for the Diploma in Clinical and Public Health. The skills and knowledge I obtain will help create confidence in the women of South Sudan and motivate them to seek medical assistance in health facilities.

In my culture, it is seen as a taboo for women to be physically examined by a male who is not the husband of the women being examined. Because of this, women tend to refrain from seeking medical assistance in health facilities, especially the antenatal clinics, and turn to Traditional Birth Attendants for help. This is because most of the health practitioners in the health facilities are men.

The knowledge I acquired in clinical medicine and public health has helped me to develop in many ways, and I have learnt about the prevention diagnosis and treatment of many diseases. Currently, I am working at Nimule Hospital, for my internship practice where I am able to translate the knowledge gained in the class into practice through hands-on experience. My patients have become impressed with my work and have developed more trust in me. This has given me courage and pride to be a clinical officer.

I wish more young women could be trained as clinical officers to help treat the women's health issues like HIV/AIDS, antenatal care, breast and cervical cancer awareness, child health and nutrition in my country.


An AMREF midwife at work
An AMREF midwife at work

Though AMREF brings health and hope to all African families in need, beginning in 2010, we made a conscious decision to focus more heavily on maternal and child health. Currently, we are hoping to make the most impact in the Millennium Development Goal #5 (improvement of maternal health).

What women in the developed world take for granted - skilled midwives, an obstetrician and operating theatre if needed, and the antibiotics and drugs to ensure that should complications arise, the mother is rapidly brought back to good health – all these apparently basic things, are great luxuries in Africa.

In particular, women in poor and remote communities, far from the nearest health services are most at risk- with young women and girls are in the most danger. In many communities girls still marry at very young ages and contraceptive advice is poor or non-existent. Many of the worst complications in pregnancy are suffered by teenage mothers; giving birth is a physically traumatic experience for a girl whose body is still developing.

Based on current trends, Sub-Saharan Africa will not attain the Millennium Development Goals (MDGs) by 2015. MDGs 4 and 5, to reduce maternal and child mortality and morbidity, are those towards which the least progress has been made. At the current rate of progress in Sub-Saharan Africa, MDG 4 to reduce child mortality will not be met until 2165 in Africa. Evidence suggests that over 60% of deaths in children less than five years old could be prevented by existing interventions. Of deaths in new-borns, 41 to 72 % are preventable using a high coverage of available interventions. Half of these deaths could be avoided through the use of community-based programs. MDG 5 which aims to “improve maternal health” is desperately off-track. The shortfall in funds to meet the MDGs for maternal and child health amounts to only 2% of current development aid – a small fraction of world spending. Yet investing in women and their health strengthens families, communities and countries. Family budgets, local productivity and national wealth all flourish where maternal health is prioritized. In many countries, weak and fragmented health systems, and in particular inadequate human resources do not permit the scaling-up of crucial interventions for maternal, new-born and child health.

To fight for more skilled medical training and assistance for women in Africa is not only a justice battle or an ethical need. It is owed to present and future generations for a fair and sustainable economic and social development, it is part of our common survival, and it is a gain for our intercultural world that we hope for. We need to support the creation of healthy conditions for women and children which deserve their full dignity to continue their contribution to life.

177,000 mothers are dying each year in pregnancy and child birth in Sub-Saharan Africa and the chances of dying are actually going up in some countries. But, it does not have to be this way; most of the deaths are avoidable. Simple affordable training and equipment saves lives and ensures that having a baby is a time of joy for the whole family.

AMREF is already working hard to help mothers. Our conviction is that there is now an urgent need to do more. It is simply unacceptable that more women will suffer and die when simple affordable solutions are at hand.



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Organization Information

Amref Health Africa aka African Medical and Research Foundation

Location: New York, NY - USA
Website: http:/​/​
Project Leader:
Bernhard Bauer
New York, NY United States

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Combined with other sources of funding, this project raised enough money to fund the outlined activities and is no longer accepting donations.

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