Interview: Empowering Health

Misrak Makonnen is a seasoned public health professional with over 20 years of experience in international public health and development. Since 2016, she has served as the Country Director for Amref Health Africa in Ethiopia, where she leads a diverse program portfolio encompassing Reproductive, Maternal, Neonatal, and Child Health (RMNCH), Water, Sanitation, and Hygiene (WASH), and Neglected Tropical Diseases (NTD), with an annual budget exceeding $15 million.

Misrak’s extensive career includes overseeing a USAID-funded $30 million project on maternal and child health (MNCH) and the prevention of mother-to-child transmission of HIV (PMTCT) as IntraHealth’s Country Director/Chief of Party in Ethiopia. She has also held key roles in the PEPFAR-funded AIDS Relief program across Rwanda, Tanzania, and Uganda, and served as the Director of Programs for the University of Washington’s International Training and Education Center on HIV (ITECH) in Ethiopia.

Amref Health Africa, the largest African-based and led international health development organization, serves over 30 million people annually across 35 countries in sub-Saharan Africa. Driven by its vision to bring lasting health change in Africa, Amref engages communities, governments, and local partners to address social determinants of health. Since becoming fully operational in Ethiopia in 2002, Amref has partnered with the Ethiopian government and local communities to co-create solutions and implement diverse health programs.

In this interview with Capital Misrak discusses Amref’s contributions to Ethiopia’s health sector, the challenges and successes of her tenure, and her vision for the future of health development in Africa.

Capital: It is known that the health sector requires significant financial investment and support. What is Amref’s major contribution in addressing this?

Misrak Makonnen: I agree with you on the heavy financial investment needed. But we start with an emphasis on co-creating solutions with the communities we serve and not for them. The heaviest investment we make is in engaging local partners who share our sense of responsibility and accountability, especially in governance and leadership. This is where the key investments should be as we see the goal in mind.

 -Because we value authentic partnership, Amref is also very intentional about establishing strong relationships with donors who understand the complexity of the issues and Amref’s expertise in delivering excellence. This trust is crucial. It has allowed us to be agile and innovative in the face of disruptors such as Covid. Once donors and partners know how efficient and effective we are, we have been able to raise funds to meet our priorities.

Capitla: You are a non-profit organization. Who do you get financial support from to deliver your programmes?  Will you be able to sustain as a non-profit organization if your financial sources dry?

Misrak: We have a diversified pool of donors— from bilaterials such as USAID to foundations such as the Bill & Melinda Gates Foundation. We are dogged in aligning priorities among the government, donors, and our own strategy as we work with ministries of Health, Social Affairs, Women, Labor and Skills, Education and others, and their regional counterparts.

I think about sustainability a lot. That’s why we have started parallel means of resource mobilization through our European and North  American Offices – fundraising for unrestricted resources and headquarter led social enterprises that will offset our costs. Amref has major initiatives such as our Amref Flaying Doctors  and Amref international university  based in our headquarters in Nairobi. Our youth programmes include supporting start-ups where we are investors and partner with the private sector to build synergies. We want to create as many spin-offs from our programs as possible and serve as incubators for social enterprises. This is where we want to change all mindsets – starting with our own.

Capital:  What does Amref think of the localization agenda?

Misrak: Localization has been a well-intentioned buzzword in the development world. I am particularly proud that Amref is at the forefront of this agenda as an African-born and an African-led organization.  Localization is critical to build ownership and drive locally-designed solutions by co-creating with our communities while building the capabilities of our CSOs. We are uncompromising in not just being a strong African regional partner, but also creating a network of strong local partners – that’s what is going to drive change. We are clear-eyed about the  challenging task of building programmatic and operations capabilities of our networks, and that’s non-negotiable. Fortunately, frontloading impactful capacity development interventions and management systems of CSO partnership has enabled us to be a frontrunner in this space. We are essentially “plug and play” now.  New partners come in knowing that they have a dependable organization that has hard data backing its work and committed to elevate the role of local partners. 

Our latest outreach is to engage the local and burgeoning private sector, thus making sure everyone who has a stake in Ethiopia’s well-being has space in our Amref network. Our long-term vision includes an apparatus by which Ethiopian diasporans can start seeing Africa as an opportunity to engage and commit and not just as a charity case.

Capital: How do you weigh Amref Health Africa in Ethiopia’s success since it became operational in Ethiopia in 2002?

Misrak: It’s hard to believe that just that a little over 20 years ago, Amref in Ethiopia was set up as a small outpost established to address HIV AIDS. Over the years, we have grown to become one of the most trusted partners to the Government of Ethiopia, international donors, development organizations and Ethiopian civic society organizations (CSO). Our overarching mission is to build lasting health systems for the communities we serve—paying particular attention to women and young people.

 Today, we have programs in all 12 regions and two administrative cities. We are deeply rooted in the communities we serve—we work in close collaboration in 600 districts, support over 500 health facilities and around 70 higher education institutes.  We have prioritized the marginalized group of our population including communities in the developing regions. I like to think of Amref as an “equity ambassador.”

 So, from that one-room office back in 2002, we are now a team of 350 staff members working to bring lasting health change in Ethiopia. We are helping set a new path of irreversible positive change in Ethiopia.

Capital: What are your main program focus areas and implementation regions currently?

Misrak: We believe that a strong health system is the sun around which all our programs orbit. A healthy society means economic prosperity, agency in one’s life, freedom to innovate and be part of a thriving community. Therefore, we align our focus areas on the country’s priorities and measure our success using strongly backed data.

Amref invests in people-centered, community-led health systems. We deliver services such as training frontline health workers, providing health facilities with immediate and long-term technical assistance, and advocacy work to address social behaviors that negatively impact communities such as early marriage, female genital cutting, and gender-based violence. With this as our framework, our programs focus areas include:  Health Systems Strengthening , Reproductive, Maternal, Neonatal, Child, Adolescent & Youth Health and Nutrition ,Integrated Youth Development, Water, Sanitation and Hygiene ,Disease Prevention and Control.

We are big believers in integrating our work so none of our programming I mentioned above is siloed. For example, our Water, Sanitation and Hygiene Program includes helping young women solid waste collectors organize in cooperatives so that they gain meaningful employment and make a dignified living. In turn, they then become advocates for a cleaner environment.

Our transformative youth integrated program, Kefeta, a game-changing partnership with the United States Agency for International Development ( (USAID), invests in the power of young people to advance their own economic, civic and social development. Kefeta’s youth promote development within their communities and contribute to the country’s peace and prosperity. Think of Amref as a connective tissue that feeds all the major organs so that the body functions well.

Capital: How many people have you been able to reach with your programs so far? And in which areas of the country can the most vulnerable people be supported by your programs?

Misrak: To date, we have served over 26 million people, of which 56 percent are women. To highlight a couple of our flagship investments, our work in developing regions is emblematic of the way we operate—with intentionality, expertise, and careful planning for long-term solutions.

For example, Afar is home to pastoralists who live in some of the most remote and inhospitable terrains in Ethiopia. This makes having access to healthcare a huge challenge, especially for women who are traditionally last in seeking healthcare for themselves and their children.

 Imagine how difficult it is for a pregnant afar women to travel hundreds of kilometers by foot to get even the most basic health service in a sparsely staffed health post. We helped design a program focusing on training local midwives to provide a wide range of health services and then deploying them to these remote areas. Now, instead of vulnerable women going to faraway places, Amref facilitates regular and closer access to quality healthcare through outreach services.

 We didn’t stop there. As healthcare providers establish trust in the communities, they expand the scope of services they are able to provide. For example, our frontline health care worker training includes provision of operating portable, solar-powered sonogram machines, which were previously only available at urban health facilities and inaccessible to women in small, remote villages. Now, an increased number of Afar women have access to crucial, preventive prenatal care. Early detection of pregnancy abnormalities has cut down child mortality dramatically. But calculate into all of the above a young Afar midwife who now has professional skills that also elevate her livelihood and her status in the community. 

Capital:  As you leap into the third decade, what is your aspiration for the coming years?

Misrak: I am a big believer in asking, “What is the 2.0?” That keeps us striving to re-define and re-imagine the development sector. We are well on our way to becoming the leading non-state champion in and on the health development agenda in Africa. As we grow, we want to position Amref to be beyond a lead convener on the health agenda for Ethiopia and beyond.  We want Amref to be a household brand in each of our communities as a catalyst for change in health with proven impact.

In many ways, our battle is with time: a disenfranchised, ballooning young population is either a time bomb or unharnessed potential. If we are able to address that issue, we will be breaking a cycle of poverty that had previously seemed intractable. Amref’s legacy will be leaving a healed, invested, and hopeful generation of Africans. We welcome the challenge.

The article was first published on https://www.capitalethiopia.com/2024/07/08/empowering-health/