This is the fifth article I have written about the Aga Khan Development Network (AKDN) and the programs it includes. The others about which I have written are: The Aga Khan Foundation (AKF) the Aga Khan Education Services (AKES) the Aga Khan Agency For Microfinance (AKAM) .
The Aga Khan Health Services (AKHS) is one of the most comprehensive private not-for-profit health care systems in the developing world. It is comprised of 325 health centres, dispensaries, hospitals, diagnostic centres and community health outlets. Among these facilities are five general hospitals, seven maternity homes/hospitals and 187 health centres/dispensaries.
Being a natural outgrowth of the Ismaili Community's health care efforts that were began in the first half of the 20th century, AKHS currently provides primary health care and curative medical care in India, Pakistan, Kenya, Tanzania, and Syria.
And while the AKHS is devoted solely to health care, it is only one of three agencies of the Aga Khan Development Network (AKDN) that that are engaged in health initiatives. The other two are the Aga Khan Foundation, and the Aga Khan University. And AKHS works very closely with them both. Together these three agencies engage in the planning, training, and resource development for health care in their recipient communities and they also combine with the Aga Khan Education Services and the Aga Khan Planning and Building Services in order to integrate health issues into other specific projects. So, it is not difficult to see how the Aga Khan Development Network provides a fabric of community development services that are mutually supportive in an overall context.
The Social Welfare Department (SWD) of the The Aga Khan Health Services is located within the Secretariat of the Aga Khan in France, and co-ordinates the activities of the service companies through five-year plans, ten-year projections, annual budget submissions, and the provision of technical assistance. "They are also linked internationally through network-wide strategies in human resource development, hospital management, nursing development, and primary health care. While strengthening its institutions and the links between them, each health service company also joins government health services and other providers in building effective national health systems." Also, the Aga Khan Health Services is organized into national service companies in Kenya, Tanzania, India, and Pakistan.
The Aga Khan Health Services is also keen to reach vulnerable groups within its recipient communities. Those vulnerable groups in society, especially child-bearing women and young children, with low-cost, proven medical technologies are provided services in: immunisation, systematic prenatal care, aseptic deliveries, and oral rehydration therapy for diarrhoeal disease.
The importance and efficacy of primary health care in improving health status, and its cost-effectiveness has been confirmed by the experience with Public Health Centres within the Aga Khan Development Network. The AKHS web site states that: "Primary health care and prevention are considered as steps towards improved health status that must be linked to the availability of high quality medical care."
For this reason AKHS complements its work in maternity homes and full-service hospitals with curative services offered in institutions ranging from dispensaries through health centres as well. At every level of care, the AKHS focuses on providing services that are both needed and wanted by the community. The also pay close attention to building linkages within those systems and aims to ensure a quality of care that significantly raises local standards.
To the end of raising local standards, quality control in laboratory diagnosis, appropriate documentation in medical records, regular supply of pharmaceuticals and continuing education of nurses and doctors are some of the practices that AKHS emphasizes in its approach to institutional development.
Some of AKHS's Major Initiatives include:
- Assisting communities to develop, manage, and sustain the health care they need.
- Providing accessible medical care in modern, efficient, and cost-effective facilities.
- Working in partnership with other agencies in the development of communities and the enhancement of their health.
- Educating physicians, nurses, and allied health professionals.
- Conducting research relevant to environments in which AKHS institutions exist.
- Contributing to the development of national and international health policy.
In each country where it operates, AKHS registers a not-for-profit, non-governmental agency as a national service company. Each company has its own Board of Directors, and institutional leadership, some or all of whom are appointed by the sponsoring company, which is the Aga Khan Health Services S.A., a not-for-profit organisation registered in Switzerland.
According to AKHS: "Governing bodies and regional, community, and institutional committees are established to facilitate planning, operations, and funding activities of the national service companies. All directors serve as volunteers on an unremunerated basis. Typically, the board of each national service company is made up of eleven directors, of which nine are nationals, including the chairman. Each company board appoints a CEO who is responsible for the planning and management of all of the national service company's operations. The services, facilities, and programmes of the companies are funded through local fees charged for services, community support, international donors, as well as through contributions from His Highness. The Aga Khan Foundation assists the national service companies to seek funding and technical assistance from international and local donor agencies for appropriate development or service delivery initiatives.
Every company has a significant, on-going investment programme to develop both its management systems and the quality of its managerial and support staff. Network-wide, there is a strong emphasis on continuous quality improvement as a core organisational development strategy. This encompasses quality assurance, and preparation for accreditation either with a US-based hospital accreditation programme or the UK-based King's Fund/National Health Service accreditation process. The total quality management methodology was introduced to AKHS in 1992 and remains an important activity. There is significant investment in human resource development at every level of each national service company.
All companies also have a significant, continuous investment programme in computer-based management information systems and electronic communications. They also have a strong internal audit function. Each board has an active audit committee and every company undergoes an annual external audit. "
Because AKHS encourages an entrepreneurial approach by national service companies in all of their operations, some of the strategies for financial self-sufficiency include:
- a user charge, often complemented by other forms of community financing. The user charge is complemented by a welfare programme provision for those unable to afford the (often very small) fee; and
- in appropriate circumstances, cross subsidies are used to support community health activities that are not (yet) breaking even.
In East Africa, AKHS has facilities in Kenya and Tanzania. Those facilities provide over 600,000 patients per year with care in both rural and urban areas and they provide services in both the preventive and curative contexts.
Additionally, the Aga Khan Foundation, with branches in Kenya, Tanzania, and Uganda, works with a variety of grantees, including AKHS, to improve the health of vulnerable population groups, especially mothers and children, and promote health services development on the national and regional levels. The Aga Khan University's Faculty of Health Sciences has joined the AKF and the AKHS in their work in health care in East Africa in the areas of professional training, especially for nurses, and epidemiological research.
The aim of the AKDN work in health care in East Africa is to assist countries in the building of effective, sustainable health systems linking different kinds of services and levels of care.
Beginning in the 1930s, the AKHS hospitals and health centres have been in East Africa. Initially there was a health centre which expanded into a maternity and nursing home in Dar es Salaam. In the 1950, maternity homes in Mombasa and Kisumu became full-service hospitals. And in 1958 in the 1950s the Aga Khan Hospital in Nairobi (AKH-N), was opened. That hospital is now one of the leading hospitals in the region. Today, AKHS operates five health centres and four hospitals in East Africa, including the leading private hospitals in Kenya and Tanzania.
The AKHS is committed to developing effective approaches to disease prevention and health promotion in East Africa also. In the 1980s, AKHS and AKF created primary health care projects in Kisumu and Kwale, two rural districts in Kenya. The projects have trained people in the Kisumu and Kwale communities in primary health care technologies and management, and catalysed community-based efforts to increase safe water supplies.
"In other projects in Kenya and Zanzibar, AKF is working with government services to develop tools for health sector policy design and resource allocation. AKF international experience in primary health care management and information systems, acquired through its management advancement programme, is an important resource in this area. AKF is also supporting projects, which improve the health of vulnerable groups, like women, by enhancing their socio-economic status."
As you can imagine, I could go on and on about AKHS and the AKDN, but I must end here and direct you to their web site to finish reading about their wonderful work.
Aga Khan Health Services