U.S. development assistance should be flexible enough to address the multiple needs that arise when fighting poverty.
Eldoret, Kenya—In Kenya, HIV-positive people are realizing something once they begin taking the anti-retroviral medications that save their lives: They’re hungry.
People whose immune systems are severely compromised often lose their appetites. As they regain their strength, they regain their appetites. But in Kenya, all too often these people are the ones responsible for growing the food they and their families eat. Most likely they have been so sick they’ve had to neglect their crops. Then mothers and fathers find themselves without enough food to satisfy their own needs, much less the hunger of their children.
Doctors at the AMPATH Center quickly recognized this dilemma. AMPATH (Academic Model for Providing Access to Healthcare) is a system of HIV/AIDS care and treatment centers in western Kenya. It grew out of a long-standing collaboration between Indiana University in the United States and Moi University in Kenya.
When the project started in 2001, it was treating 250 patients a year. In 2004, it began receiving U.S. development assistance through the President’s Emergency Plan for AIDS Relief (PEPFAR). Now AMPATH doctors are treating more than 70,000 patients a year, and hope to see that number grow to 150,000. Bread for the World members have worked to secure funding for PEPFAR since its incepton.
When treating their patients, the doctors realized how important nutrition is to a comprehensive treatment plan. Good nutrition can delay the development of HIV into full-blown AIDS. But the food must be available and affordable. Too often it wasn’t for AMPATH’s patients. Some of the doctors began buying food themselves to give to their patients. But of course, that’s not a sustainable solution.
So they decided to incorporate nutrition prescriptions into their treatment. AMPATH staff members assess the nutritional status of every patient, along with their household food security (the food available for the patient and each family member). This latter point is crucial, as they discovered the futility in asking an HIV-positive mother to keep food for herself when faced with hungry children. When beginning treatment, patients receive food to feed themselves and their households—fruits, vegetables, beans, corn, oil, and sugar.
AMPATH recognized that providing food for their patients can also create an unhealthy dependency on their services. So they explored the next need: livelihood programs. As their strength returns, patients enroll in business or agricultural training. For example, AMPATH is training clients to grow passion fruits with the idea of setting up a factory to make passion fruit juice, a very popular treat in Kenya.
This stage of services is called the Family Preservation Initiative, because it’s doing just that: keeping families together and helping them become self-sufficient. The majority of patients cared for by AMPATH are among the poorest in the world. Many of the patients have already lost their spouses to the disease. Though sick themselves, they are often solely responsible for caring for their own children as well as for orphaned children of family members. In the face of these needs, for AMPATH, comprehensive treatment must take on a whole new meaning and a sense of urgency.
But here’s the snag: AMPATH has had to struggle to get the Family Preservation Initiative funded. PEPFAR is intended to fund prevention, treatment, and care for those suffering from HIV and AIDS; its focus is not on livelihood training programs. For instance, PEPFAR funds cannot purchase farming inputs like seeds or systems to help with irrigation. When farming input costs triple, as they have over the last year, the program runs up against severe shortages.
“We learned from our patients that drugs alone are not enough, just as food alone is not enough,” says Fran Quigley, a Bread for the World member from Indianapolis who works with AMPATH. “For many Kenyans, they need a hand-up, not a hand-out, to learn new skills or get some farm inputs or get started on a small business that will lead them to self-sufficiency.”
AMPATH has the right approach, what they describe as “building a road and following it.”
“A holistic approach is essential to the overall success of this program,” says Steven Lewis, who created the initial AMPATH farms. “Not only are we providing people with drugs, which is one major component to actually bring them back up, they also then need school fees. They need food. They need income generation. They need to get their lives back up in order again. So, what we’re looking at is just building up their self-confidence and encouraging them to be self-reliant.”
When designed well, with more flexibility, development assistance from the United States can provide this holistic approach.
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