Dr Githinji Gitahi has been Group CEO of Amref Health Africa since 2015. When COVID-19 broke out in early 2020, Amref’s community-centred approach to public health became critical in managing the pandemic across the continent. Here, he shares his own journey – and his vision for the future of health in Africa.
Looking back, I can see very clearly what has brought me to where I am today. I didn’t set out with a grand plan: but I always had a strong sense of justice, and a passion for people that propelled me forward.
I was born and raised in Central Province, Kenya, around one hundred and seventy kilometres from Nairobi. I was number eight of nine children. Food was scarce: like many other children in my village, we grew up living on one meal a day on some days, often boiled maize or green bananas and a cup of tea. Meat would be a special meal once or twice a year! My mother breastfed me for a long time, and I believe this is one of the reasons I went on to become a bright child, passing exam after exam at school. In fact, I consider my mother to be the most important public health officer in my life.
I studied medicine at university and went on to become a practising clinician, believing this would be the best way to help others in my community. As time went on, however, I began to realise there was only so much I could do by sitting in the clinic. Week after week, I would see the same people at my practice, coming to me with the same concerns. I started to ask myself: what needs to change so that the person who saw me last week doesn’t have to come and see me again this week, or next week? It was then that I decided to go out and speak to people, visiting their homes and companies, to find out why I was seeing the same patterns over and over again.
My public health journey
That is how my public health journey started: not with a master’s in public health, but with practice. As a doctor, you tend to see people in isolation – not as part of a wider ecosystem. When I went out and met people in the context of their everyday lives, I started to develop a clearer picture of what needed to change. I realised that when I was treating, for example, a girl who had attempted to get an illegal abortion, it was because she had no access to family planning services in her community and wasn’t able to make informed decisions about her reproductive health.
Later, I moved into the pharmaceutical arena, because there was a huge scarcity of medicines across Africa. I then worked for a period in medical insurance, in the hope that I could find a financing model that would help people pay for healthcare when they couldn’t afford it themselves. Finally, I made the decision to move into development, where I saw an opportunity to address the root issues of some of the challenges faced by Africa’s health systems.
My first role in development was for a US organisation called SmileTrain, which provides free surgery for children with cleft lips. I was responsible for the Africa region: working with governments to figure out how we could develop long-term capacity in Africa rather than flying surgeons in from London or Washington, as was standard at the time. That’s how I first came into direct contact with Amref Health Africa: we partnered with Amref to train local doctors in Ethiopia, Kenya, DR Congo, Uganda, and so on.
Putting communities first
When, in 2015, Amref approached me to join as the Group CEO, I did not hesitate. I had seen first-hand through my work with SmileTrain the immense potential for an Africa-based organisation to apply local African models to resolve Africa’s problems. With this in mind, we started to develop a new model: one that puts communities first. We knew that lack of access to healthcare was multidimensional. Low health coverage, scarce resources, limited facilities, lack of financing, insufficient education: they all play a role in Africa’s health systems’ challenges. There is no single quick fix. In order to sustainably strengthen health systems, we knew we had to develop a model that acknowledges the wider ecosystem. So, that’s the model Amref has built.
When the COVID-19 pandemic broke out in early 2020, Amref Health Africa was ready. Since then, we have come to be known as the people who work with communities to demystify misinformation, ensuring people know how to take care of themselves. We have established community water and sanitation points to reduce infection rates. We have worked with governments, as well as with the World Health Organization (WHO) and the Africa Centres for Disease Control and Prevention (Africa CDC) to ensure health policy is people-centric and community-driven. We are an organisation with communities at its heart, taking the lead from the people who experience these challenges every day.
It's listening to and learning from communities that has allowed us to develop strategies that work.
Africa’s dual catastrophe
The fact is that the challenges are numerous. Africa is experiencing a dual catastrophe: one of illness and deaths caused by the virus, and one of the pressures it has placed on communities already facing numerous other public health emergencies and socioeconomic challenges. The situation we are in is very worrying. But we now have a tool, and that tool is vaccines.
When vaccines first became available, Africa was left behind by the rest of the world. For a very long time, until around October 2021, the continent was forced to watch as wealthier regions stockpiled and went ahead with booster shots. Now, around 440 million doses have been administered in Africa, but we still have a long, long way to go: even now [20th March 2022], less than 15% of Africa’s population is fully vaccinated.
I am proud of the work that Amref has done to accelerate progress. We launched a global petition to end vaccine injustice, calling for the end of stockpiling and the sharing of licenses and tech to allow low-income countries to develop their own vaccines. We leveraged our long-standing relationships with national Ministries of Health and the WHO to improve the COVAX mechanism and ensure Africa’s voice is heard in the global arena.
Spent time in Kibra, Nairobi today attending a vaccination outreach by @AmrefUniversity students & @MOH_Kenya— Dr Githinji Gitahi, MBS (@daktari1) December 4, 2021
1. The challenge is not hesitancy - it’s lack of Access.
2. We don’t call a woman who delivers at home because of absence of skilled delivery ‘hesitant’ pic.twitter.com/1sP2lXBFcg
Reaching the last mile
The challenge we face today is one of inequitable access. While vaccination rates are increasing steadily in urban areas across Africa, they remain extremely low in rural areas, where 70% of the continent’s population resides. This is where Amref comes in. Through our vast network of Community Health Workers (CHWs), we have a presence in many rural communities that otherwise have very limited access to healthcare. We are able to understand exactly what barriers people in these communities face. For example, if someone is earning one to two dollars per day selling vegetables at a market, they will not abandon their vegetables to queue for hours at a health facility miles from home to get a vaccine that may not be available. They need to sell those vegetables to feed their family. By the time they have finished for the day, the health facility has closed. So, the cycle continues, and people remain unvaccinated.
To close these gaps, Amref Health Africa has been taking the vaccine to the people. We have used our fleet of aircraft to transport vaccines to remote areas. We are working closely with community leaders to overcome information gaps. We are making sure church leaders are aware of the importance of getting your vaccine – as well as where to get it – so they can share that information with their congregations. We have vaccinated people in barber shops; at social gatherings; outside market stalls. Our teams operate at weekends and late into the evening, meaning people don’t have to sacrifice income to visit a clinic. Once again, it’s listening to and learning from communities that has allowed us to develop strategies that work.
Amref’s approach is simple: we are removing barriers to access to make it compelling and convenient for people in Africa to be vaccinated. Until we have widespread vaccine coverage, we will be unable to begin to rebuild from COVID-19: a privilege many other regions are already enjoying.
I like to think the young me would be proud of the work I am doing with Amref. I know my mother is, and I still look to her for inspiration.