JOSHUA KYALLO is the Country Director for the African Medical Research Foundation (Amref). Among other things, the 50-year-old NGO is implementing the Katine Project in Soroti District, in which The Weekly Observer is a partner. RICHARD M. KAVUMA spoke to him about Amref's work in Katine and elsewhere in Uganda.

Amref is marking 50 years; what lessons you have learnt over the decades?

Amref was founded around 1957 on the foot of Mt. Kilimanjaro by three [non-African] medical doctors who were trying to bring healthcare to rural communities. And one of the lessons that Amref learnt right at the start was the role of communities in health development. Amref has learnt that unless communities are fully engaged and become an integral and active part of the health system rather than passive recipients, then that system will never be fully functional.

Amref has learnt that for health to be effective, it needs to be created at the household level (promotive and preventive health), with the formal health systems repairing only a small percentage (treatment). Amref is increasingly placing more emphasis not just on the treatment of people but also on the prevention of diseases. We are putting emphasis on primary healthcare - on stages and steps that give knowledge [and] skills to communities and community health workers to prevent diseases.

What kind of research do you do?

In everything we do, we work with communities, government structures, civil society organisations and all the people involved in development to try and find new knowledge; to find new solutions to health challenges. At the heart of what Amref does is what we call operations research. The approaches are systematically followed, documented and we set models of development or best practices. And where they have been proven to work, they are packaged and shared either for replication by Amref or government or to influence policy.

Any examples of models you have developed here?

There are many. Around 15 or 20 years ago, Amref was very interested in improving the skills of health workers in the country. As you know, Uganda has about 3,500 medical doctors against a population of 30 million and Amref wanted to identify a group of health workers that would make the greatest difference in the work that Amref does. We came up with what we called comprehensive enrolled nursing training, where with support from the Irish government and working with the ministries of Health and Education, we have been involved in providing support to health training institutions in Uganda for 12 years.

Another example: about three years ago, Amref partnered with the Ministry of Health and other NGOs to implement the Uganda Malaria Partnership Programme, where we demonstrated what can be done if you train community medicine distributors. These are people with no medical background but who are able to prevent fever within the first 24 hours from progressing to real malaria which can kill people. And that approach has been incorporated into the Uganda National Malaria Strategy.

You talk of the 'Amref development model': what are its main features?

The Amref development model is an operational expression of our strategy to close the gap - catalyzing a community movement to improve health in Africa through community partnering, health-systems strengthening and research or evidence-based practice

How does this differ from other NGOs?

I have now worked with five international NGOs and Amref has made a [very] deliberate effort to work with communities. We have put them at the centre of what we do and the key difference is the approach. We see communities as equal players/partners in development not just recipients of aid. In any project, we put emphasis on partnering with structures that exist and supporting them so that they can do what they do best.

How was Amref chosen to implement the Katine project?

It was a very competitive race. The Guardian newspapers in the UK advertised and Amref was one of the many organisations that applied and we competed for it. Towards the end it came down to three organisations - Amref, Oxfam, Care and Amref triumphed. I believe it [came down to] our track record in Africa; the fact that we put emphasis on communities; and the uniqueness of Amref as a truly African-focused organisation with 90 percent of staff who are Africans.

As part of the project, you have journalists constantly tracking your activities: that is unusual.

It is very unique because, over the last 50 years, Amref has remained a very modest organisation. We do things that are cutting edge or groundbreaking but we always have a saying that let the work speak for itself. Secondly, working with the media wasn't what Amref did at first; and I believe for The Guardian working with an NGO wasn't a priority; so it is a strategic partnership between Guardian, Barclays Bank, Amref and all the other players involved.

Was it a tough decision? I think we thought hard and long about it. But we saw the opportunities because Amref believes in thinking outside the box. We believe in the infinite possibilities of imagination in development because unless we did, we would never convince communities that they can dream beyond the realities of their lives. Of course the challenges were obvious. It was a new territory for us but it was one that we wanted to embrace with total commitment.

Eight months on: how has Katine faired?

Very well! It is not usual in my 15 years in international development, to see a project start that quickly. We've got a solid project and solid team on the ground and extremely dedicated communities. There are also community structures that have been formed - for water and sanitation, groups for managing education and village health teams and health workers. We have also seen clear accomplishments in increasing access to water and sanitation facilities; schools have been improved; children are going to school, books are being supplied; training of teachers. Katine continues to grow from strength to strength

We also have a project steering committee that is chaired not by Amref but by the Chief Administrative Officer for Soroti. And the interest Katine has raised within this country and also the work the Guardian and Observer have done have been immense.

Nearly $6 million over three years: Some commentators argue that too much money is being injected in a single sub-county.

The money may look much on paper but the needs are many and there's still a gap. In water and sanitation, for instance, after drilling 8 new boreholes, rehabilitating 5 boreholes the safe water coverage has only increased from 42% to 56% yet the budget for water provision is already exhausted. The livelihoods component has managed to reach only 18 out of 66 villages. Forty-six are not covered. In education the schools need 26,000 text books but the project is able to provide only 6,000 over the three years. Forty-three classrooms are needed but only 20 will be provided by the project over three years. Forty-one classrooms need to be rehabilitated but we are rehabilitating only 13. Yet enrolment is increasing every year.

What else is Amref doing in Uganda?

Amref works in three dimensions in Uganda and we cover more than 78 districts in one way or the other. I am not saying that we are present in all of them.

[Some of the activities are]Providing high-quality training courses and teaching materials for the next generation of primary health workers, nurses and laboratory staff; Promoting community-based care for orphans affected by HIV/AIDS in Luwero district; Vaccinating children and providing clean water and sanitation in IDP camps in northern Uganda; Preventing and managing HIV, TB, malaria and waterborne diseases in Soroti district by strengthening health care systems and Empowering young people in Kabale to demand their right to access health services.