From volunteer to COO: Working on Tanzania’s first ever HIV/AIDS treatment plan

I joined CHAI as a volunteer in February 2003. I had just graduated with a Master’s degree in economics from the London School of Economics and returned home to Kenya. While on the job hunt, a friend of mine volunteering with CHAI from McKinsey and Company asked if I would be interested in joining their team in Tanzania. Soon, I was working on the first ever HIV/AIDS care and treatment plan.

At the time, a majority of developing countries battling HIV/AIDS did not have national care and treatment programs due to the high cost of treatment and the inadequacy of health systems. The focus and funding skewed towards HIV prevention and behavior change programs and there were only a few non-governmental actors supporting treatment. Many infected patients were dying.

Alice Kang'ethe, Acting Chief Operating Officer

When I joined CHAI, I did not have any public health knowledge. I was thrown into the deep end and asked to develop the laboratory section of the Tanzania care and treatment plan as well as the overall budget. I had to work with top doctors and scientists in Tanzania as well as leading global HIV specialists. I had a very steep learning curve.

Within a day of joining, the entire team (all volunteers) left Tanzania and I was asked to plan a conference that would bring together key stakeholders in the country to present and review the draft plan. I had no office, no title, no money, no team members co-located, and only a phone and a laptop in a hotel room in Dar es Salaam. My parents could not understand how I had taken up a volunteer position in health, having paid a lot of money for my postgraduate degree in economics.

I managed to pull together the meeting and in three months we presented the first national care and treatment plan to the President of Tanzania. It was then that I met our CEO, Ira Magaziner. I was planning on going back to Kenya, but Ira asked me to join our team in South Africa. I took up the challenge, this time with even more intensity.

In a span of six months I learned more than I had in my formal education. I lived and internalized CHAI’s mission to save lives. People were dying in every hospital we visited because of the lack of HIV/AIDS care. There was an urgent need to act and we had to put together the plans, secure funding, and roll out programs in what others would describe as an unreasonable timeline. I was there during the revolution that shone the light on care and treatment against all odds and CHAI’s pioneering work in HIV/AIDS.

In need of a paying job however, I joined KPMG Strategy after six months with CHAI. While at KPMG, I was part of the team appointed as the Local Fund Agent for the Global Fund to Fight AIDS, Tuberculosis and Malaria in the Eastern African region, helping to oversee a US$320 million grant for Kenya. Within a year of working at KPMG, I learned that CHAI was planning to set up operations in Nairobi, Kenya. I was excited about the prospect to again join CHAI and soon became one of its first official employees.

I started as an analyst on the Procurement (now Access) team where I helped countries access competitively priced antiretroviral (ARV) drugs. Having seen the devastation in Tanzania and South Africa, I was determined to see as many people as possible access HIV care and treatment. I had a firsthand appreciation of the direct correlation between lower prices and increased access for those in need.

Alice Kang'ethe, Acting Chief Operating Officer

I then became CHAI’s first Deputy Country Director in Kenya. CHAI had been working with countries in the East African Region to provide access to lower priced ARVs, but had not yet established an office in Kenya. My role was fundamentally challenging but also allowed me to have great impact as a young African woman in a largely patriarchal society.

I set up the Kenya office including hiring my boss, the Country Director. I worked with the government to help bridge the health workforce gap and helped design a program that used donor funding to hire nurses and clinical officers on contract, allowing the government to build costs into their budgets over a period of three years and eventually absorb the staff. The program was a great success and, as a result, the Ministry of Health required all other partners willing to support the government with additional human resources to adopt this model.

In this position, I also worked with my colleagues to launch the pediatrics HIV/AIDS care and treatment program in Kenya. Our target was to get 1500 new children on treatment within one year. This experience drew on many of CHAI’s strengths: brokering partnerships; expanding access to life-saving products; and taking on a high-risk project that had the potential for large-scale transformational impact.

I was then asked to lead a new effort as the Director of the Global Prevention of Mother-to-Child Transmission of HIV (PMTCT) in a number of countries in Asia and Africa. It was challenging to develop approaches to distinct issues in the two continents. In Asia we came close to virtual elimination. In Africa however, we faced greater challenges. Many children born free of HIV contracted the virus while breastfeeding. It broke my heart. In order to break this cycle, CHAI determined it was necessary to provide full treatment for all HIV positive pregnant women in Malawi. Although this decision was contrary to guidelines from the World Health Organization (WHO) at the time, this effort saved countless lives. Seven years later the WHO also adopted these guidelines.

Amidst the challenges, there were also successes. I remember visiting a facility in the mountains of Lesotho and found a couple that had just received a confirmatory test of a HIV negative baby at 18 months. For me, there is no greater fulfillment!

In 2009, I became CHAI’s Regional Director for Southern Africa, overseeing work in Lesotho, Swaziland, Mozambique, Uganda, Zambia and Malawi. A year later, I was promoted to Executive Vice President in charge of Vaccine Delivery, Family Planning and Human Resources for Health. In that role, I led the team that worked with a number of countries to deliver vaccines to tackle pneumonia and diarrhea, two of the largest killers of children in developing countries. CHAI helped governments rapidly introduce these vaccines and reach all targeted children. I also lead the team that saw the rapid scale up of long-acting reversible contraceptives.

As the Chief Operating Officer at CHAI, I aim to efficiently manage the CHAI matrix of country, global and operations teams with a lens on excellence in program performance. I would like to see us galvanize our efforts in maternal and child health. I am also eager to grow the next generation of leaders who will take over and help the world tackle the outstanding and potentially new challenges in global health.

I have had the opportunity to deliver bottom lines for corporations, but nothing compares to saving a life— especially someone who is less fortunate. Serving at CHAI has offered me this opportunity for which I will forever be grateful. I cannot think of any other organization that could have believed in me at such a young age. I have been proud to learn and grow alongside CHAI.

More World Aids Day coverage:

Blog: How ‘miracle’ of AIDS patients’ survival gives hope for future
The state of the antiretroviral market today
CHAI Access Program launches online HIV product toolkit