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      Leveraging the power of partnerships: spreading the vision for a population health care delivery model in western Kenya

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          Abstract

          Background

          The Academic Model Providing Access to Healthcare (AMPATH) has been a model academic partnership in global health for nearly three decades, leveraging the power of a public-sector academic medical center and the tripartite academic mission – service, education, and research – to the challenges of delivering health care in a low-income setting. Drawing our mandate from the health needs of the population, we have scaled up service delivery for HIV care, and over the last decade, expanded our focus on non-communicable chronic diseases, health system strengthening, and population health more broadly. Success of such a transformative endeavor requires new partnerships, as well as a unification of vision and alignment of strategy among all partners involved.

          Leveraging the Power of Partnerships and Spreading the Vision for Population Health.

          We describe how AMPATH built on its collective experience as an academic partnership to support the public-sector health care system, with a major focus on scaling up HIV care in western Kenya, to a system poised to take responsibility for the health of an entire population. We highlight global trends and local contextual factors that led to the genesis of this new vision, and then describe the key tenets of AMPATH’s population health care delivery model: comprehensive, integrated, community-centered, and financially sustainable with a path to universal health coverage. Finally, we share how AMPATH partnered with strategic planning and change management experts from the private sector to use a novel approach called a ‘Learning Map®’ to collaboratively develop and share a vision of population health, and achieve strategic alignment with key stakeholders at all levels of the public-sector health system in western Kenya.

          Conclusion

          We describe how AMPATH has leveraged the power of partnerships to move beyond the traditional disease-specific silos in global health to a model focused on health systems strengthening and population health. Furthermore, we highlight a novel, collaborative tool to communicate our vision and achieve strategic alignment among stakeholders at all levels of the health system. We hope this paper can serve as a roadmap for other global health partners to develop and share transformative visions for improving population health globally.

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          Most cited references46

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          An assessment of interactions between global health initiatives and country health systems.

          (2009)
          Since 2000, the emergence of several large disease-specific global health initiatives (GHIs) has changed the way in which international donors provide assistance for public health. Some critics have claimed that these initiatives burden health systems that are already fragile in countries with few resources, whereas others have asserted that weak health systems prevent progress in meeting disease-specific targets. So far, most of the evidence for this debate has been provided by speculation and anecdotes. We use a review and analysis of existing data, and 15 new studies that were submitted to WHO for the purpose of writing this Report to describe the complex nature of the interplay between country health systems and GHIs. We suggest that this Report provides the most detailed compilation of published and emerging evidence so far, and provides a basis for identification of the ways in which GHIs and health systems can interact to mutually reinforce their effects. On the basis of the findings, we make some general recommendations and identify a series of action points for international partners, governments, and other stakeholders that will help ensure that investments in GHIs and country health systems can fulfil their potential to produce comprehensive and lasting results in disease-specific work, and advance the general public health agenda. The target date for achievement of the health-related Millennium Development Goals is drawing close, and the economic downturn threatens to undermine the improvements in health outcomes that have been achieved in the past few years. If adjustments to the interactions between GHIs and country health systems will improve efficiency, equity, value for money, and outcomes in global public health, then these opportunities should not be missed.
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            Responding to the HIV pandemic: the power of an academic medical partnership.

            Partnerships between academic medical center (AMCs) in North America and the developing world are uniquely capable of fulfilling the tripartite needs of care, training, and research required to address health care crises in the developing world. Moreover, the institutional resources and credibility of AMCs can provide the foundation to build systems of care with long-term sustainability, even in resource-poor settings. The authors describe a partnership between Indiana University School of Medicine and Moi University and Moi Teaching and Referral Hospital in Kenya that demonstrates the power of an academic medical partnership in its response to the HIV/AIDS pandemic in sub-Saharan Africa. Through the Academic Model for the Prevention and Treatment of HIV/AIDS, the partnership currently treats over 40,000 HIV-positive patients at 19 urban and rural sites in western Kenya, now enrolls nearly 2,000 new HIV positive patients every month, feeds up to 30,000 people weekly, enables economic security, fosters HIV prevention, tests more than 25,000 pregnant women annually for HIV, engages communities, and is developing a robust electronic information system. The partnership evolved from a program of limited size and a focus on general internal medicine into one of the largest and most comprehensive HIV/AIDS-control systems in sub-Saharan Africa. The partnership's rapid increase in scale, combined with the comprehensive and long-term approach to the region's health care needs, provides a twinning model that can and should be replicated to address the shameful fact that millions are dying of preventable and treatable diseases in the developing world.
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              The Global Health System: Strengthening National Health Systems as the Next Step for Global Progress

              In the second in a series of articles on the changing nature of global health institutions, Julio Frenk offers a framework to better understand national health systems and their role in global health.
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                Author and article information

                Contributors
                tim.merc@gmail.com
                adriangardner1@gmail.com
                andamabenjamin@gmail.com
                cleophas.chesoli@ampathplus.or.ke
                astridcdeb@gmail.com
                jonathan.j.dick@gmail.com
                reinterz@iu.edu
                gray@dow.com
                skimaiyo@ampath.or.ke
                shoine.hoine@gmail.com
                bmaritim@ampathplus.or.ke
                nkmorehead@yahoo.com
                spastaki@gmail.com
                ljruhl@gmail.com
                juliasongok@gmail.com
                jlaktabai@ampathplus.or.ke
                Journal
                Global Health
                Global Health
                Globalization and Health
                BioMed Central (London )
                1744-8603
                8 May 2018
                8 May 2018
                2018
                : 14
                : 44
                Affiliations
                [1 ]ISNI 0000 0004 1936 9924, GRID grid.89336.37, Department of Population Health, , The University of Texas at Austin Dell Medical School, ; 1701 Trinity St, Austin, TX 78712 USA
                [2 ]ISNI 0000 0001 2287 3919, GRID grid.257413.6, Department of Medicine, , Indiana University School of Medicine, ; 535 Barnhill Dr, Indianapolis, IN 46202 USA
                [3 ]ISNI 0000 0001 0495 4256, GRID grid.79730.3a, Department of Medicine, , Moi University School of Medicine, ; PO Box 4606 30100, Eldoret, Kenya
                [4 ]Academic Model Providing Access to Health Care (AMPATH), PO Box 4606 30100, Eldoret, Kenya
                [5 ]ISNI 0000 0001 2157 2938, GRID grid.17063.33, Department of Obstetrics and Gynaecology, , University of Toronto Faculty of Medicine, ; 123 Edward Street, Suite 1200, Toronto, ON M5G1E2 Canada
                [6 ]ISNI 0000 0001 0495 4256, GRID grid.79730.3a, Department of Reproductive Health, , Moi University School of Medicine, ; Eldoret, Kenya
                [7 ]ISNI 0000 0004 0616 2342, GRID grid.473039.a, Dow AgroSciences, ; 9330 Zionsville Rd, Indianapolis, IN 46268 USA
                [8 ]ISNI 0000 0004 1937 2197, GRID grid.169077.e, Purdue University College of Pharmacy, ; 575 Stadium Mall Dr, West Lafayette, IN 47907 USA
                [9 ]ISNI 0000 0001 0495 4256, GRID grid.79730.3a, Department of Pharmacology, , Moi University School of Medicine, ; Eldoret, Kenya
                [10 ]ISNI 0000 0001 2287 3919, GRID grid.257413.6, Department of Pediatrics, , Indiana University School of Medicine, ; 705 Riley Hospital Dr, Indianapolis, IN 46202 USA
                [11 ]ISNI 0000 0001 0495 4256, GRID grid.79730.3a, Department of Child Health and Paediatrics, , Moi University School of Medicine, ; PO Box 4606 30100, Eldoret, Kenya
                [12 ]ISNI 0000 0001 0495 4256, GRID grid.79730.3a, Department of Family Medicine, , Moi University School of Medicine, ; PO Box 4606 30100, Eldoret, Kenya
                Article
                366
                10.1186/s12992-018-0366-5
                5941561
                29739421
                414ea81d-7415-446a-9c92-177b12771d74
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 5 May 2017
                : 1 May 2018
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                © The Author(s) 2018

                Health & Social care
                population health,global health,health care delivery system,vision,strategy,partnerships,kenya,low- and middle-income countries (lmics)

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