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With community health programmes in large geographical
areas in Central and South Asia, as well as East Africa,
and more than 200 health facilities including nine
hospitals, the Aga Khan Health Services (AKHS) is one
of the most comprehensive private not-for-profit health
care systems in the developing world. Building on the
Ismaili Community's health care efforts in the first
half of the 20th century, AKHS now provides primary
health care and curative medical care in Afghanistan,
India, Kenya, Pakistan, and Tanzania, and provides
technical assistance to government in health service
delivery in Kenya, Syria and Tajikistan.
Please
also see the Aga Khan Foundation's
health activities.
Introduction
AKHS
is one of three agencies of the Aga Khan Development
Network (AKDN) that support activities in the field of
health, the others being the Aga Khan Foundation
(AKF),
and the Aga Khan University
(AKU). It works closely with
both of these agencies on planning, training, and resource
development and with the Aga Khan Education Services and
the Aga Khan Planning and Building
Services on the integration
of health issues into specific projects.
AKHS
is organised into national service companies in Afghanistan,
India, Kenya, Pakistan, Syria, Tajikistan, Tanzania,
and Uganda. The Social Welfare Department (SWD) located
within the Secretariat of the Aga Khan in France, 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.
Programmes Designed to Reach Vulnerable
Groups
AKHS's community health programmes are designed to reach
vulnerable groups in society, especially child-bearing
women and young children, with low-cost, proven medical
technologies: immunisation, systematic prenatal care, aseptic
deliveries, and oral rehydration therapy for diarrhoeal
disease. Experience with Public Health Centres within the
Aga Khan Development Network has confirmed both the efficacy
of primary health care in improving health status, and
its cost-effectiveness.
In AKHS's approach to health services,
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. To complement
its work in primary health care, AKHS offers curative
services in institutions ranging from dispensaries through
health centres to full-service hospitals. At each level
of care, the AKHS focus is on providing services that are
needed and wanted by the community and on building linkages
within the system. It also aims to ensure a quality of
care that significantly raises 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 emphasises in its approach to institutional
development.
Major Initiatives
AKHS's overall major initiatives currently
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.
Governance
and management
In
each country of operation, AKHS registers a National
Service Company as a not-for-profit, non-governmental
agency. Each company has a Board of Directors, Chairman
and directors some or all of whom are appointed by the
sponsoring company, Aga Khan Health Services S.A., a
not-for-profit organisation registered in Switzerland.
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.
Strategies
for Financial Self-sufficiency
While
taking care not to compromise its social mission, AKHS
encourages an entrepreneurial approach by national service
companies in all of their operations. All AKHS community
health programmes and services have strategies to achieve
financial self-sufficiency. For poorer communities, this
may require a timeframe of 15 years or more, but a strategy
is developed for each programme to achieve financial
self-sufficiency as soon as the economic status of the
community served is likely to permit this.
Therefore:
- there
is always a user charge, often complemented by
other forms of risk pooling and 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.
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