AMPATH-UofT Program





AMPATH-UofT partners the University of Toronto with Moi University and its teaching hospital in Eldoret to improve reproductive health in Western Kenya 

Representatives of AMPATH-UofT  co-lead the Reproductive Health component of the Academic Model Providing Access to Healthcare – Reproductive Health (AMPATH-RH).

AMPATH assists the Government of Kenya in improving primary health care throughout western Kenya. AMPATH is centered in Eldoret, the location of Moi University School of Medicine and the Moi Teaching and Referral Hospital.



The University of Toronto Department of Obstetrics & Gynaecology is the lead North American member of the Reproductive Health component of AMPATH. Indiana University School of Medicine is the lead North American institution of AMPATH.

AMPATH-UofT is improving the quality of women’s and reproductive health care in western Kenya through a sustained partnership between Moi University School of Medicine / Moi University Teaching and Referral Hospital and the Faculty of Medicine of the University of Toronto. The partnership supports the bilateral exchange of students, residents, and faculty, between Toronto and Eldoret. The exchanges, integrated across several programs, emphasize mutual benefit, professional development and education, and long-term commitment.

Our success is a result of the generous support of individuals, foundations, organizations, and institutions. Your support of AMPATH-UofT is very much appreciated. Please take a look at our Winter Newsletter 2016 and donate now. You can also view our Winter Newsletter 2015 and Summer Newsletter 2016.

Vision, Goal & Objectives



Academic health centres linked to all citizens have a critical role as a foundation of a sustainable health system able to address the health needs of a community.


The goal of our partnership is to improve the quality of women’s and reproductive health care in Western Kenya through the development of a sustained partnership between the Medical School of Moi University and the Faculty of Medicine of the University of Toronto focused on improving maternal and gynaecological services, continuing medical education and research.


  • Reduce maternal mortality and morbidity
  • Prevent and treat gynecologic cancers
  • Improve maternal and infant nutrition

Guiding Principles

  • Lead with Care
  • Reciprocity
  • Equity
  • Peer support
  • Integration with the Ministry of Health

Leadership Team 


Dr. Rachel Spitzer
Director, AMPATH-UofT
Vice-Chair, Global Women's Health 
Assistant Professor, Department of Obstetrics & Gynaecology, Faculty of Medicine, University of Toronto

Dr. Astrid Christoffersen-Deb 
Field Director, AMPATH-RH
Assistant Professor, Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Toronto

Dr. Heather Millar
Team Leader, AMPATH-RH (2015-2016)

Dr. Barry Rosen, Gynaecologic Oncology
Section Lead, Gynaecologic Oncology, Beaumont Health System

Dr. Nan Okun
Head, Division of Maternal-Fetal Medicine
Associate Professor, Department of Obstetrics & Gynaecology, Faculty of Medicine, University of Toronto

Dr. Paula Braitstein, Epidemiology
Associate Professor, Dalla Lama School of Public Health, University of Toronto

Dr. Michael Milosevic, PMH Lead
Associate Director, Radiation Medicine Program, Princess Margaret Hospital
Professor, Department of Radiation Oncology, University of Toronto

Joe George
Administrator, AMPATH-UofT 
Department of Obstetrics & Gynaecology 

AMPATH-RH Activities 

As academic health centers, the North American partners who form the AMPATH Consortium are guided by a tripartite mission that includes patient care (service), education (training), and research. While education and research are critically important to achieving our goals, AMPATH is determined to lead with care. All members of AMPATH believe beginning with service is crucial since we work with populations that are terribly underserved in health. In addition, leading with care often helps to instill a belief that the health conditions of populations can be improved. In addition, service is the foundation upon which the necessary training and research is conducted.


Research is critical to improving medical care and sustaining a health system. A robust medical information system is required to provide data for research. The AMPATH medical record system (AMRS), originally conceived by the AMPATH Informatics team, is a centerpiece of AMPATH Informatics and is a cornerstone of the AMPATH initiative.

Current research projects are ongoing in the focus areas of our collaboration, such as maternal, newborn and child health, gynecologic oncology, and public health. Much of our research is programmatic, focusing on evaluating our clinical care programs to assess and improve the health outcomes for women in western Kenya. Many of our findings though are relevant in other regions of Kenya and sub-Saharan Africa.

Click here to access the most current list of research publications by AMPATH that includes UofT authors.


Faculty and trainees from Moi University and the University of Toronto have the opportunity to participate in placements in reproductive health in Toronto and Eldoret, respectively.  If you wish to participate, visit the Get Involved page on the AMPATH-UofT website.

Since 2005, faculty members from the University of Toronto’s Department of Obstetrics & Gynaecology have participated in placements at Moi University’s School of Medicine/Moi Teaching and Referral Hospital (MUSOM/MTRH), supporting undergraduate and faculty education. This included important core development of both Maternal-Fetal Medicine and Gynaecologic Oncology, two reproductive health subspecialties that are lacking in Kenya.

In order to provide education opportunities for House Staff at MTRH, “MTRH-Toronto Teaching Rounds” have been instituted every Friday at noon. These rounds provide informal teaching and open a dialogue for the Interns and Medical Officers at MRTH. All Toronto visitors are encouraged to attend.

Several Kenyan Department of Reproductive Health (DRH) physicians from MUSOM/MTRH have visited the University of Toronto, conducting observerships in cervical cancer care. Each year two senior Kenyan undergraduate medical students from MUSOM completed a six-week medical rotation at Mount Sinai Hospital, St. Michael’s Hospital and Sunnybrook Health Sciences Centre in Toronto. Kenyan postgraduate OBGYN residents also conduct electives in Toronto. This allows for the development of both personal and professional relationships, a broad exposure to high-quality medical care, and a vision for Kenya’s potential. You can read student reflections here

Kenyan students

Current Objectives for Educational Activities 

Improved Maternal Health

  • Support the implementation MUSOM new Master's of Medicine postgraduate training programme in Reproductive Health, including third-year elective placements in Toronto; 
  • Training and support for Community Health Workers;
  • Involve medical and MPH students and residents from UofT, and MUSOM and other Kenyan universities in maternal health program; 
  • Implementation of the ALARM (Advances in Labour and Risk Management) International Program.

Treatment and Prevention of Cervical Cancer

  • Provide continuing medical education and clinical support for cervical cancer screening, treatment of precancerous abnormalities and treatment of cancer with surgery and chemotherapy;
  • Involve medical and MPH students and residents from UofT, MUSOM and other Kenyan universities in the oncology program.

Treatment and Prevention of Obstetric Fistulas

  • Provide continuing medical education in surgical skills to treat completed fistualas to the head of MTRH’s Fistula Centre;
  • Assist with development of a Centre of Excellence in fistula repair and surgical training of other local surgeons and research into issues of fistula repair;
  • Involve medical and MPH students and residents from UofT and other Kenyan universities in obstetric fistula activities.


Current services provided through AMPATH-UofT include:

  • Maternal, newborn and child health (MNCH) services
  • Cervical cancer screening
  • Surgery to repair obstetric fistulas
  • Gynaecologic oncology treatment

Service Activity Objectives 

Improved Maternal Health

  • at MTRH
  • at Webuye District Hospital
  • Improve mentorship in PHC health centers and dispensaries
  • Improve group care in Teso District
  • Support of Community Health Workers (CHWs)

Treatment and Prevention of Cervical Cancer

  • Cervical Cancer Screening Program (CCSP)
  • Cryotherapy (SEE AND TREAT)
  • Colposcopy and LEEP
  • Radical Hysterectomy
  • Gynaecologic Cancer Treatment

Treatment and Prevention of Obstetric Fistulas

  • Increase the quality and quantity of fistula surgery that can be performed at the MTRH Health Centre.


AMPATH-UofT runs many programs in conjunction with the Moi University School of Medicine and the Moi Teaching and Referral Hospital, including training and teaching programs in gynaecologic oncology, maternal-fetal medicine, radiology, immunology, and others. 

Maternal and Child Health


  • 92% of pregnant women attend at least one antenatal visit
  • 43% deliver in a health facility
  • 44% of births are attended by a skilled attendant
  • Maternal Mortality Rate: 448/100,000

About 99% of maternal mortality deaths occur in developing countries. Kenya’s maternal mortality rate, like many countries in sub-Saharan Africa, is extremely high. It is estimated that there are 400 maternal deaths per 100,000 live births in the East African country (The World Bank 2014). In comparison, there are 11 per 100,000 maternal deaths in Canada. The main causes of maternal deaths include: haemorrhage, sepsis, hypertensive disorders, unsafe abortions, and obstructed labour (UNICEF 2015). A Kenyan woman has a 1 in 39 lifetime risk of maternal death and an even higher risk of suffering from disease or disability after pregnancy. As a consequence of obstructed labour, obstetric fistula are very common in this region and lead to devastating consequences for women, not only physically but emotionally as a result of the fistula and being ostracized by their families and society.

The root causes of Kenya’s high maternal mortality lie in access to health care and quality of care. Access to care is affected by the widespread poverty in which many Kenyan women live, a culture of gender inequality that requires a husband’s permission to leave home, and the long distances that need to be traveled in order to see a health care worker. Less than 50% of Kenyan births take place in a health facility (public health facility, mission health facility or a private facility). The majority of births take place at home or a non-hospital setting in the absence of a skilled health professional (defined as a midwife, nurse trained as midwife, or doctor).

Should a woman be able to access care, referral linkages are weak and the clinics are often poorly resourced. The majority of Kenyan health facilities are not equipped for managing obstetric complications, and most public health facilities do not have a vehicle or driver available for emergencies. Twenty to forty percent of these facilities do not have a dependable source of electricity or water. The restricted availability of medicines, supplies, and equipment compromise the ability to deliver adequate care. Staff shortages are common, due to both a freeze in employment and frequent employee transfers.

The Kenyan medical education system is limited in its ability to prepare its doctors to deliver care in their unique and often isolated practice environment. Inconsistent educational experiences, under-resourced teaching centers, and a compartmentalization of care into specialties with little integration have hindered development of provider competence and skills. The lack of supportive supervision and continuing medical education further exacerbates the problem. These factors have led to low public confidence in public health facilities, long delays in the referral of pregnancy-related complications, and the observed high rates of maternal mortality and morbidity.

Governmental and non-governmental organizations have used several strategies to address maternal health issues. These include: supporting education for girls and financial independence for women; educating communities on safe motherhood practices; improving HIV/AIDS prevention, treatment and care; capacity building of health centers; improved service delivery of essential supplies and equipment; strengthening infrastructure such as power and water supply; and providing better training and supervision of health workers.

The objectives of the maternal, newborn and child health component of AMPATH are to:

  • Improve the quality of reproductive health in western Kenya through the improvement of community and facility-based care for women and their children;
  • Develop a post-graduate program of study at Moi University in Reproductive Health to train the next generation of leaders in Women’s Health;
  • Intensify research collaborations; and
  • Support further development of the infrastructure for care, education and research.

Gynaecologic oncology

By 2020, there will be 16 million new cases of cancer worldwide; 70% of them are expected to occur in the developing world. In Africa, many of these cancers will be gynaecologic in origin with cervical cancer being the most predominant. In contrast to Canada where cervical cancer is only the 11th most common and where cure rates are high (>90%), in Kenya, cervical cancer is almost never cured and kills more women than any other type of cancer.

Many Western countries have substantially decreased cervical cancer mortality rates with the implementation of screening programs (i.e. Pap smears), which identify abnormalities before they become cancerous. Patients who present with abnormalities receive early treatment and are frequently cured. Later stages of cervical cancer are treated aggressively with radiation and chemotherapy.

Such prevention and treatment programs are rare in Sub-Saharan Africa. Due to the lack of screening programs in Kenya, most women present cervical cancer that is already matured to its later stages and is difficult to treat, even with high quality medical care. Radiation and chemotherapy are common treatments for these stages of cancer yet there is only one radiation machine in all of Kenya.

Cervical cancer kills women in the prime of their lives, devastating the families and communities that are left behind.

The substantial number of cancer cases in Sub-Saharan Africa is largely due to a lack of cancer awareness, knowledge of prevention, and diagnostic and treatment expertise. The Gynaecological Oncology representatives of AMPATH-UofT are working in partnership with Moi University representatives and other representatives of the AMPATH Consortium to address inequalities in gynecologic cancer care and improve the health of women in western Kenya.

The team is lead by Dr. Barry Rosen, Division Head of Gynaecologic Oncology at the University Health Network and Head of the Familial Breast & Ovarian Cancer Clinic at Princess Margaret Hospital.

Care: Prevention through Treatment 

Cervical Cancer Screening

Prior to 2009 there were no prevention or treatment services for cervical cancer in western Kenya. AMPATH initiated cervical cancer screening in 2009. In the first year, 150 women were screened at MTRH and since then, over 14,000 women have been screened at 7 clinics in Western Kenya.

As awareness increases and demand for the screening program grows, AMPATH is training more health care professionals to provide the needed services.

Cryotherapy (SEE AND TREAT)

The screening program has a multidisciplinary team to treat abnormalities found using the VIA technique. Nurses perform cryotherapy (removal by freezing of the abnormal cells). The programs uses a “See and Treat” approach meaning they are treated the same visit the VIA shows abnormal cells, reducing travel costs.

Colposcopy and LEEP

For patients with abnormal lesions, trained gynecologists view using colposcopy and excise using a technique called LEEP (Loop Electrosurgical Excision Procedure).

Radical Hysterectomy

For patients with early stage cervical cancer, a surgical procedure called a radical hysterectomy (removal of uterus and upper vagina) can be curative. AMPATH-UofT representative, Dr. Barry Rosen, developed a protocol collaboratively with gynecologic oncologists from across Canada through the Gynaecological Oncology of Canada Society to train Kenyan gynaecologists to perform this life-saving surgery. To date over 50 radical hysterectomies have been performed successfully.


Fellowship in Gynecologic Oncology

Building on the success of the Cervical Cancer Screening Program and enthusiasm for change, the next advancement was to train Kenyan gynecologists to be local leaders and experts in the treatment Gynecologic cancers so that the program can be sustained locally.

AMPATH-UofT is supporting Moi University School of Medicine in establishing a Master’s Program in Gynecologic Oncology. It is the first program of its type in all of Kenya, and is training practicing physicians in the care of gynecologic cancers. The goal of the program is to develop local expertise in all aspects of cancer care including counseling, screening, diagnosis, radiotherapy, surgical and chemotherapy treatment and end-of-life care. Educating physicians to be experts in the field of gynecologic oncology promotes sustainability of the AMPATH-RH Oncology program with the goal that the current students will be the teachers of the future.

The teaching faculty is made up of top professionals in gynecologic oncology from Canada, led by Dr. Rosen, and in the oncology field from Kenya. The fellowship program incorporates principles of student-centered learning, evidence-based clinical decisions and community-oriented practice.


The strength of the AMPATH-UofT Oncology program relies on a solid foundation of research to identify the health care needs of the community. Each project involves a principal investigator from North America and Kenya and focuses on projects relevant to Gynecologic Oncology in western Kenya.

Patient Data Collection

Data collection for patients at the Moi Teaching and Referral Hospital exists in the form of relational databases. These databases capture relevant patient information, at point of care, for clinical use and research purposes. Disease specific databases have been established for Cervical Cancer, Ovarian Cancer, Vaginal Cancer, Vulvar Cancer and Gestational Trophoblastic Neoplasia (GTN). Through a strong data management system; patients are tracked so that the quality of service and education programs are continuously evaluated and improved upon and to fuel potential research questions and projects within the area.

Public Health

The World Health Organization (WHO) states:

"Public health refers to all organized measures (whether public or private) to prevent disease, promote health, and prolong life among the population as a whole. Its activities aim to provide conditions in which people can be healthy and focus on entire populations, not on individual patients or diseases. Thus, public health is concerned with the total system and not only the eradication of a particular disease."

AMPATH took a population-based approach to developing one of the most successful anti-retroviral therapy (ART) programs in sub-Saharan Africa. Since 2009, we have been building on this success to bring primary health care to the entire population of western Kenya, 3.5 million people.

Public health expertise in biostatics, epidemiology, occupational and environmental health, social and behavioural health sciences and public health policy is helping to AMPATH support the development of a robust primary health care program throughout western Kenya.

As with all AMPATH programming, we strive to integrate care (clinical public health) with education and research.


Immunology is the biomedical science field that studies the immune system of organisms. Education and research in this field is critical to the development of good health professionals and health systems.

Professor Eleanor Fish of U of T’s Department of Immunology and a Canada Research Chair in Women’s Health & Immunobiology has been involved in AMPATH-UofT since 2011.

During her visits to Eldoret she teaches disease-relevant immunology to medical trainees, nursing students, undergraduate immunology students and graduate immunology students; and assists with curriculum development for MUCHS Department of Immunology.

She has been appointed as a Visiting Professor to the Department of Immunology at Moi University, with the mandate to work with faculty and students to provide information on most recent advances in immunology as relevant to health and diseases in Kenya and throughout Africa. Her scope of work has expanded to help with curriculum development for the MSc program and, most recently, to help with establishing dedicated research facilities for a PhD program. She also mentors faculty of the Department of Immunology at Moi University.


  • Introduction to Immunology: immune cell populations, cytokines, cytokine regulation of immune cell responses, cytokine regulation of immune cell development, cytokine regulation of inflammation;
  • Immunodeficiency Diseases;
  • Host-pathogen interactions: focusing on virus infections.

Principal Activities

  • Educate undergraduate and graduate students, medical trainees, nursing students; 
  • Evaluate Department of Immunology graduate program on an ongoing basis; 
  • Co-supervise Department of Immunology MSc students;
  • Establish an annual research exchange program.


Our radiology team has been introducing and encouraging improved gyneacological imaging (endovaginal ultrasound approach) and teaching sterilization and disinfection techniques for a number of years now.

New and well-functional used ultrasound machines have been donated to Moi Teaching and Referral Hospital (MTRH) and rural hospitals. Training has been conducted when these donations have been made to ensure the potential benefits of the equipment are realized and the equipment is well maintained.

Current and future activities in this area include:

  • Basic ultrasound instruction to medical officers
    • Fetal assessment / Fetal lie
    • Evaluation of amniotic fluid volume
    • Placental position
    • Fetal activity
    • Cervix
  • More sophisticated instruction for radiology residents
    • Obstetrical imaging
    • Gynecological imagine
    • Other
  • Supporting interaction between OBGYN and radiology professionals
  • Taking basic ultrasound to villages

Basic science 

Since 1910 and the publication of The Flexner Report, Medical education in the United States and Canada, the importance of medical students having a good foundation in the sciences has been acknowledged. AMPATH-UofT supports this through its support of undergraduate and post-graduate education at Moi University School of Medicine.

For example, Professor (Emeritus) Jim Inlges, Department of Biochemistry, has been conducting annual visits to Eldoret to deliver a variety of lectures to an array of trainees. This includes:

  • Introduction to genetics and mutations
  • Mechanisms of inheritance
  • Genetic technologies
  • Cytogenetics
  • Pharmacogenetics
  • Cancer genetics
  • Genetic medicine & human genome studies
  • Stem cell therapy


AMPATH has incorporated nutrition activities into its clinical care since it began anti-retroviral therapy (ART) in 2001. Good nutrition is a significant challenge for many people throughout western Kenya for a number of reasons, including poverty and lack of a diverse dietary intake. AMPATH-UofT representatives have been involved in a number of AMPATH nutrition activities and we are intensifying our involvement. Improving the nutritional status of woman, newborn and child health is essential to achieve the goal of our program.


Partnerships are integral to the work of AMPATH. North American academic institutions join together to make up the AMPATH Consortium, which in turn partners with Moi University School of Medicine, Moi Teaching and Referral Hospital and Kenya’s Ministry of Health in Western Kenya. These partnerships have demonstrated how academic medical centers united by a common vision can change the face of healthcare. Each partner plays a distinct and critical role in the overall success of the program.

The following are the AMPATH Consortium members:

Partners in Toronto

In the core of Toronto exists an incredible number of organizations involved in health care. Walking up University Avenue and along College Street one passes numerous organizations involved in the Toronto Academic Health Science Network (TAHSN). This is an impressive network providing health care, conducting biomedical research, and teaching undergraduate, postgraduate, medical, and healthcare professional students. AMPATH-UofT draws on this vast expertise in health for its success.

Major Toronto-based partners include:

Partners in Kenya 

Our partners in Kenya include: 

Partners in Canada 

AMPATH-UofT links with specific organizations and networks in Canada to bring additional innovative idea additional expertise to allow even greater results to be achieved in western Kenya. 
A number of the main partnerships to date have been with the following organizations: 

  • Society of Gynecologic Oncologists of Canada (GOC) in developing the gynaecological oncology program.
  • Society of Obstetricians and Gynaecologists of Canada (SOGC) shared their ALARM International Program. The SOGC’s ALARM (Advances in Labour and Risk Management) International Program is a training tool designed to reduce maternal death or injury in developing countries. The five-day program targets health professionals who provide obstetrical care, reviewing the top maternal killers and suggesting essential tools and problem management with the goal of improving care for mothers and newborns.
  • South Community Birth Program: The SCBP brings pregnancy and birth back to a community-based, peer-supported, primary care experience and aims to improve the health outcomes of women and their families by developing an environment in which the SCBP team:
    • Collaborates with families to meet the needs of childbearing women in their community;
    • Assists women and their families to identify their own strengths and build confidence in their ability to give birth and become parents;
    • Encourages women and their families to assume an active role in their own health care;
    • Provides a safe, positive birth experience through the reduction of interventions;
    • Provides support following the birth so that women can have a shortened hospital stay;
    • Encourages developing a strong sense of peer support among the women and their families, helping them to build community, reduce isolation, and provide ongoing support for each other when their care at SCBP is complete.

 Map of Clinical Sites

1 Angurai Health Centre
2 Bokolu Health Centre
3 Bumala A Health Centre
4 Bumala B Health Centre
5 Burnt Forest Sub-District Hospital
6 Busia District Hospital
7 Chebiemit District Hospital
8 Chepkorio Health Centre
9 Cherangany Health Centre
10 Chulaimbo Sub-District Hospital
11 Huruma Sub-District Hospital
12 Iten District Hospital
13 Endebess Sub-District Hospital
14 Kacheliba District Hospital
15 Kapenguria District Hospital
16 Kapsara District Hospital
17 Khunyangu Sub-District Hospital
18 Kitale District Hospital
19 Matayos Health Centre
20 Moi Teaching and Referral Hospital (modules 1-4)
21 Moi’s Bridge Health Centre
22 Mosoriot Rural Health Training Centre
23 Mt. Elgon District Hospital
24 Mukhobola Health Centre
25 Osieko Dispensary
26 Port Victoria Sub-District Hospital
27 Saboti Sub-District Hospital
28 Sigor Sub-District Hospital
29 Soy Health Centre
30 Teso District Hospital
31 Tot District Hospital
32 Turbo Health Centre
33 Uasin Gishu District Hospital
34 Webuye District Hospital
35 Ziwa Sub-District Hospital
Satelite Clinic [Satellite to] 
Busia Prison [Busia District Hospital]
Changara Calvary Dispensary [Teso]
Chepsaita Dispensary [Turbo Health Centre]
Diguna Dispensary [Mosoriot Rural Health Training Centre]
Elgeyo Border Dispensary [MTRH Modules]
GK Prison [Huruma Sub-District Hospital]
Kamolo Dispensary [Teso]
Kaptama Health Centre [Mt Elgon District Hospital]
Kapteren Health Centre [Iten District Hospital]
Kesses Health Centre [Huruma Sub-District Hospital] 
Kitale Prison [Kitale District Hospital]
Malaba Health Centre [Teso]
Mihuu Dispensary [Webuye District Hospital]
Milo Dispensary [Webuye District Hospital]
Moi University Clinic [MTRH Modules]
Moiben Health Centre [MTRH Modules]
Ngeria Prison [Huruma Sub-District Hospital]
Pioneer Health Centre [Huruma Sub-District Hospital]
Plateau Mission Hospital [Burnt Forest Health Centre]
Rai-Ply Clinic [Huruma Sub-District Hospital]
Riat Dispensary [Chulaimbo Sub-District Hospital]
Sinoko Dispensary [Webuye District Hospital] 
Siriba Dispensary [Chulaimbo Sub-District Hospital] 
Sunga Dispensary [Chulaimbo Sub-District Hospital] 
Tambach Sub-District Hospital [Iten District Hospital]
Tulwet Dispensary [Kitale District Hospital

Contact Us

Medical students and residents who are interested in completing an elective with AMPATH should contact:

Dr. Rachel Spitzer
Assistant Professor, Department of Obstetrics and Gynaecology, University of Toronto

Joe George
Administrator, Department of Obstetrics and Gynaecology, University of Toronto