# Academic Model Providing Access to Healthcare

The Academic Model Providing Access to Healthcare (AMPATH) is an academic medical partnership between leading North American academic health centers, primarily led by the Indiana University School of Medicine in Indianapolis, Indiana, and the Moi University School of Medicine based in Eldoret, Kenya. It is the first integrated healthcare model to be established in Africa, encompassing both medical treatment and pharmaceutical provisions. The program aims to deliver comprehensive HIV care services and is guided by a three-fold mission: providing care, conducting research, and offering training opportunities. Currently, AMPATH serves a population of 3.5 million individuals, operating over 60 clinics in urban and rural areas of Western Kenya.

## History

AMPATH originated in 1989 as a collaborative medical partnership between Indiana University Medical School (IUMS) and Moi University. The primary goal was to enhance healthcare services, engage in health research, and foster healthcare leadership in both the United States and Kenya. Indiana University played a significant role in establishing Moi University School of Medicine in 1990, which became Kenya's second medical school. Additionally, they contributed to the development of the healthcare system in western Kenya.
In 2001, in response to the devastating HIV/AIDS pandemic, the partners united their efforts to establish one of Africa's largest, most comprehensive, and effective HIV/AIDS control systems. The consortium consists of nine members: Indiana University School of Medicine, Brown University School of Medicine, Duke University Medical Center, Lehigh Valley Hospital–Cedar Crest, Providence Portland Medical Center, Purdue University, University of Utah School of Medicine, University of Texas at Austin Dell Medical School, and University of Toronto Faculty of Medicine. Today, in collaboration with the Kenyan Ministry of Health and the United States government, AMPATH is expanding its focus beyond HIV to address the pressing needs for primary healthcare, chronic disease care, and specialty care.

## Mission

AMPATH's approach to healthcare places a strong emphasis on patient-centered care rather than solely focusing on the disease itself. This commitment to holistic care means that AMPATH responds to the various needs of patients, including addressing issues such as hunger, unemployment, discrimination, and abuse. As a result, AMPATH not only provides treatment for over 140,000 individuals living with HIV across more than 60 urban and rural clinic sites in western Kenya but also collaborates with the UN World Food Programme to provide daily meals for 31,000 individuals affected by HIV. Additionally, AMPATH supports orphaned or vulnerable children by assisting with school fees, nutrition, and other forms of aid, benefiting more than 20,000 children impacted by HIV/AIDS. The program has also enrolled over 10,000 patients in income security initiatives, including agricultural extension services, micro-finance, and small business ventures. Moreover, AMPATH conducts prevention and early treatment programs that demonstrate the effectiveness of community-based efforts in significantly reducing the spread of HIV/AIDS.
AMPATH places great importance on local leadership to ensure the sustainability of global health initiatives. Therefore, all of AMPATH's programs are led and implemented by Kenyan professionals. Sustainability is ingrained at every level of AMPATH, as evidenced by the utilization of an advanced electronic medical record system, OpenMRS (Open Medical Records System), which enables cost savings through task-shifting in clinical care. This system is now hosted at over 100 sites worldwide. AMPATH also prioritizes program integration with the Kenyan government through a partnership with the Ministry of Health, ensuring long-term sustainability. Additionally, AMPATH focuses on empowering patients to achieve income security, with the goal of enabling them to contribute financially to their own healthcare.
Through the program, nearly 1,000 Kenyan and American medical students have received training. AMPATH has secured significant funding, with over $59 million received from prominent organizations such as the National Institutes of Health (NIH) and the Gates Foundation.

## Programs
### Agriculture & Nutrition

Many patients require more than just anti-retroviral drugs to achieve full recovery, as malnutrition and food insecurity often pose additional challenges. To address this, the partnership has implemented various initiatives to promote the overall health and well-being of its patients, including food support, agricultural, and nutrition programs. Collaborating with the World Food Program (WFP) and the United States Agency for International Development (USAID), the partnership has established high-production farms aimed at fostering local self-sustainability rather than solely relying on food distribution. Furthermore, a nutrition program is in place, providing nutrition assessment, education, and counseling to individuals.
To ensure efficient food distribution and management, a comprehensive electronic system called the Nutritional Information System (NIS) has been developed by the School of Industrial Engineering at Purdue University. This system records, organizes, and facilitates effective food distribution, enhancing the overall effectiveness of the programs.

#### Food Distribution

The partnership between WFP and AMPATH was established in 2005 and has made significant contributions to addressing food insecurity in the region. To date, over 250 metric tons of food have been distributed, providing daily meals for more than 30,000 individuals and 7,000 households. Each patient receives a monthly supply of essential food items, including 6 kg of maize, 1.8 kg of pulses, and 0.45 kg of vegetable oil. The program ensures that all patients with nutrition deficiencies, including those with tuberculosis and cancer, as well as orphans and eligible HIV+ prisoners with a BMI below 18.5, receive the necessary nutritional support.
The food assistance comprises dry foods such as maize, beans, lentils, palm oil, Ready-to-Use Therapeutic Food (RUTF), and fortified corn-soy blend, which are provided by the WFP and USAID. Additionally, fresh vegetables are sourced from production and training farms, further diversifying the nutritional offerings.

### Production Farms

There are four high-production farms and two teaching model farms within the partnership. These farms collectively produce approximately 6 tons of vegetables per week, with a capacity that can reach up to 11 tons per week. These farms have a reliable year-round supply of fresh vegetables due to their continuous access to water.
In addition to food production, the partnership emphasizes sustainability and provides training in modern farming techniques to patients in recovery. This empowers them to cultivate their own food. A novel approach known as the "client feed client" model of farming has been introduced. Under this model, clients who receive monthly food prescriptions can conveniently collect their prescribed amount from the nearest AMPATH farm. The food they receive is produced by other clients, providing them with income opportunities.

### Children's Services

The Orphans and Vulnerable Children (OVC) program within AMPATH offers a range of essential support to children who are orphaned or vulnerable within the AMPATH catchment area. This program ensures access to education, protection, shelter, food security, psychosocial support, medical care, and economic security for these children. Currently, there are over 20,000 children registered in the program, which operates in seven main clinic areas: Eldoret, Burnt Forest, Iten, Kabarnet, Mosoriot, Port Victoria, and Turbo.

### Clinical & Public Health Services

Several partnerships within the AMPATH consortium are dedicated to enhancing clinical and public health services in Kenya. These collaborations cover various areas of healthcare, including dentistry, emergency medicine, orthopedics, surgery, anesthesia, radiology, medicine, family medicine, and palliative care. While many of these programs focus on training, there are also specialized centers such as the Drug Information Centre (DIC) that provide valuable support and resources.

### Communicable Diseases
#### Household Counseling and Testing Program (HCT)

HCT workers actively engage with individuals in each community and ensure their enrollment and registration in a comprehensive database. Alongside HIV testing, they conduct screenings for tuberculosis and other chronic diseases like diabetes and hypertension. They also provide treatment for intestinal worms in children, distribute treated bed nets to prevent malaria, and offer nutritional counseling. The cost of delivering these services through HCT is $1.50 per person, excluding the expense of the treated bed nets.

#### Maji Safi (Safe Water)

The Maji Safi program is dedicated to ensuring access to safe and clean water for all individuals, both at the community and household levels. It provides water treatment packets specifically designed to eliminate bacteria causing cholera and typhoid fever. These packets are made available for purchase through local shops (dukas). Additionally, the program is working on developing community water wells and implementing a hand washing curriculum. The ultimate goal is to expand the program and provide safe and accessible water to the 2 million individuals residing within the AMPATH catchment area.

### Family Preservation Initiative

The Family Preservation Initiative (FPI) aims to provide financial support to its clients while promoting self-sufficiency. FPI offers income-generating programs that provide opportunities for self-sustainability. These programs include capacity building services such as business and agricultural training courses, business and agricultural consultancy, and access to loans and savings. Additionally, FPI develops various enterprises, including Valley Orchards, Green World Nursery, Cool Stream Restaurant, and Imani Workshops. The goal is to empower individuals and promote economic independence within the community.

#### Imani Workshops

Imani Workshops is a handmade crafts business that reinvests 100% of its income to benefit its employees, all of whom are HIV-positive patients in Western Kenya. Many patients face challenges with financial security and independence, exacerbated by the social stigma surrounding HIV-positive individuals. Established in January 2005 as part of The Family Preservation Initiative, Imani Workshops aims to provide income-generating opportunities to its patients, with a particular focus on women, enabling them to achieve self-sustainability and support their families. The workshops create employment for these women, producing high-quality handmade jewelry, accessories, clothing, bags, and other items.

### Maternal & Child Health

AMPATH has collaborated with the Kenyan government to enhance access to primary healthcare for all children and deliver comprehensive medical care to over 22,000 children infected with or exposed to HIV. The program focuses on children who have acquired or been exposed to HIV from HIV-positive mothers. It provides HIV testing, antiretroviral medicine, preventive medicine, nutritional assistance, disclosure counseling, and support groups for adolescents. These services are available at 55 different locations across Western Kenya.

#### Reproductive Health

Established in 2007 through a partnership between the University of Toronto, Duke University, and Indiana University, the Reproductive Health program strives to enhance reproductive health in Western Kenya. This is achieved through the implementation of two key initiatives: the ALARM international program and the Cervical Cancer Screening and Treatment Program.
The ALARM (Advances in Labor and Risk Management) international training program is a five-day program primarily aimed at healthcare professionals. Developed by the Society of Obstetricians and Gynaecologists of Canada, the program's primary objective is to reduce maternal and infant mortality and injuries resulting from pregnancy, childbirth, and unsafe abortions. The program incorporates discussions on sexual and reproductive rights and provides hands-on training in clinical procedures.
The Cervical Cancer Screening Program (CCSP) was initiated in 2008 with the goal of reducing the incidence of cervical cancer in Kenya. To date, over 1,100 women have undergone screening through the program. Among them, 80 have received curative treatment for cervical dysplasia using the loop electrosurgical excision procedure (LEEP), and 19 have undergone hysterectomies as part of their treatment.

#### Riley Mother and Baby Hospital

Riley Mother and Baby Hospital (RMBHK), conceived by Dr. James A. Lemons of Indiana University School of Medicine, officially opened its doors on April 29, 2009, in Eldoret, Kenya. It operates as a vital component of the Moi Teaching and Referral Hospital. RMBHK is dedicated to providing comprehensive services for expectant mothers and their infants, with a strong emphasis on education, training, and research. The hospital handles approximately 12,000 deliveries annually, playing a pivotal role as a teaching hospital for nearly one-third of all doctors in Kenya. Notably, RMBHK houses the first and sole neonatal intensive care unit in East Africa.

### Primary Care & Chronic Diseases

The partnership aims to provide comprehensive primary healthcare services to a target population of 500,000 individuals through five innovative sites, with a focus on essential healthcare delivery at the community, dispensary, and health center levels.
In addition to its HIV clinics, the partnership is expanding its services to encompass a wide range of chronic diseases. This includes the establishment of a diabetes program, an oncology center, and the provision of cardiovascular and pulmonary care. The goal is to address the healthcare needs of the community by offering comprehensive care for various chronic conditions.

### Research

The AMPATH Research Network was established in 1998 to coordinate research initiatives aimed at enhancing the health and healthcare systems in Kenya. Through collaborations with over 19 universities including Brown, Yale, Columbia, UCSF, Duke, Purdue, Stanford, NYU, and the University of Toronto, the network has facilitated numerous research projects. These collaborations have resulted in over 170 publications to date. The research program has been supported by research grants totaling over $67 million in direct costs.

### Social Health

AMPATH is also engaged in several social work projects, with a team of 35 social workers providing support to over 100,000 individuals. One such initiative is the B-Fine Women's Project (Burnt Forest Initiative for the Empowerment of Women), which focuses on reducing HIV risk among commercial sex workers in the Burnt Forest area. The project offers services such as diagnosis and treatment of sexually transmitted infections (STIs), HIV testing, counseling, cervical cancer screening, and gynecology care.
In addition to the B-Fine Women's Project, AMPATH provides mental health services and operates a women's shelter called Amani Women's Shelter.

## Current Work

AMPATH currently operates more than 60 clinic sites in both urban and rural areas. The map provided displays some of the specific sites and provides information about their involvement and activities.
While the program remains committed to providing comprehensive care for HIV-positive patients, it has also expanded its focus to include research initiatives, particularly in the field of cancer research. Additionally, AMPATH has embraced modern technology by utilizing Google's open-source mobile operating system, Android, as a data collection tool for its Home-based Counseling and Testing (HCT) program.