The Aga Khan Health Services (AKHS) provides healthcare in 25 health centres and over 125 health posts in Badakhshan province. AKHS also manages the main government provincial hospitals in Bamyan and Badakhshan and three government community midwifery schools in Bamyan, Badakhshan and Baghlan.
The health status of the populations in Afghanistan is poor. After more than 20 years of war, the health infrastructure by the time of AKDN’s entry in 2002 was negligible. AKDN’s response in the health sector in Afghanistan so far has been a mix and match from its experience in Northern Pakistan and Tajikistan. In addition, the Ministry of Health in Afghanistan, supported by UN organizations, donors and NGOs including AKHS and AKF has formulated a strategy which includes a basic package of core services, that any agency wishing to provide health services to Afghans must deliver first before adding any other services.
Many health care facilities were damaged in the wars of the last quarter century, and needed to be restored, but there were also many locations which had never had formal health care. In 2002, AKDN began a programme to focus on building a health care delivery system. This system included the construction of basic health centres – often in locations which had never had such a facility. The work, organised by the shura, the village council, and supported by the Aga Khan Foundation, is carried out by village labourers. Most of the centres consist of two observation or treatment rooms, a training room, pharmacy, laboratory, kitchen, a residence for staff, a pit latrine and bathroom.
The Basic Health Centres are only one component of a four-tiered approach. In the first tier, Community Health Workers, who are volunteers working out of Health Posts manned by one male and one female, are trained to provide health education, administer and advise on treatment for minor ailments and identify diseases for referral to Basic Health Centres. They are trained, supervised and given basic provisions by AKDN and remunerated by the communities served.
The Basic Health Centres, serving populations of 15,000 to 30,000 form the second tier and offer essential curative care and comprehensive maternal and child health care. Twelve such centres are now operational in Badakshan province.
A third tier of Comprehensive Health Centres serving populations of 30,000 to 60,000, offers basic health care and includes diagnostic, treatment and referral services, in addition to emergency obstetric care. Four such facilities have been constructed or rehabilitated, and are being managed and operated by AKDN in Badakshan on land donated by the communities to the Ministry of Health.
Between the Basic and Comprehensive Centres as well as District Hospitals (AKDN operates a District Hospital in Baharak, Badakhsan), a basic essential healthcare provision infrastructure is put in place for 320,000 people. Per capita payment arrangements with the government are the current policy direction in Afghanistan and allow AKDN to partly share the costs of service provision.
Referral Hospitals, the fourth tier, are similar to District/ Provincial Hospitals and offer referral and secondary care and other specialist services including obstetrics/gynaecology, surgery, paediatrics and general medicine. One of these referral hospitals, the Bamyan hospital, has been managed by the Aga Khan Health Services since 2003. The hospital has seen a steady increase in patient visits since then.
In addition AKDN managed the construction a of the new Bamyan Provincial hospital that opened in August 2016.
Another hospital, which is managed by AKHS since 2009, is the Faizabad provincial hospital, which serves as the only referral center for the majority of health facilities in Badakhshan province. AKDN manages the rehabilitation of Faizabad Provincial Hospital in three phases of construction. Furthermore, both hospitals are connected through eHealth with, which is effectively used for tele-consultation, tele-diagnosis and staff capacity building. Bamyan and Faizabad Hospitals are the first Provincial Hospitals in Afghanistan that received ISO certification for quality management.
AKHS operates three Community Midwifery Training schools; in Bamyan, Bdakhshan and Baghlan provinces. Till date 342 studnest have been graduated from AKHS managed CMEs in Bamyan (132), Badakhshan (137) and Baghlan (73).
AKHS also manages Community Health Nursing Education Schools in Badakhshan and Baghlan Provicnes, and till date 131 students have been graduated from AKHS managed CHNEPs in Bamyan (37), Badakhshan (59) and Baghlan (35).
In Afghanistan, the Aga Khan University manages the French Medical Institute for Children as part of a partnership with the governments of France and Afghanistan and the French NGO La Chaîne de L’Espoir.
AKDN also manages the flagship French Medical Institute for Children in Kabul (FMIC). Completed in 2005, the FMIC offers inpatient and outpatient services, paediatric medicine and surgery, cardiology, and orthopaedics. The Institute is one of the few facilities of its kind in Afghanistan to offer screening and diagnosis in a range of radiology services. Equipped to international standards, the hospital provides state-of-the-art medical and surgical techniques. Its laboratory, affiliated with the Aga Khan University (AKU) in Karachi, is developing expertise in microbiology, haematology, serology and biochemistry services.
In addition, AKDN has refurbished a number of facilities, including health centres which had been damaged or neglected. AKU has also contributed to the revitalisation of national institutions, such as the Government’s Institute of Health Sciences (IHS). Among other institution-strengthening activities, AKDN has set up a science laboratory at HIS and assisted with a revision of the pre-Soviet curriculum, English language skills and computer training.
One of Afghanistan’s greatest challenges is the lack of trained personnel. The combination of the emigration of trained personnel, nearly 25 years of war and a lack of technical training, especially in the health care field, has left the ranks of qualified medical personnel severely decimated. Many training programmes, particularly for midwives and nurses, did not operate for up to ten years. In addition, tradition prevented women from seeking treatment from male doctors, exacerbating the state of women’s health. Training – and particularly training for women health care providers – therefore plays an important part in improving the quality of, and accessibility to, health care. To expand the number of health care workers and to assist health professionals update their knowledge and skills, AKDN agencies run a number of training and re-training programmes.
Through the Aga Khan University, AKDN has revised Afghanistan’s nursing curriculum. Today, all of the country’s pre-service nurses are trained through this curriculum. To enhance the capacity of existing and future health professionals, AKDN also conducts refresher training for doctors, nurses, and midwives; operates two Community Midwifery Training schools; and assists in the management of the Government’s Institute for Health Sciences in Kabul. The AKU has also provided postgraduate medical education to Afghan physicians enrolled in residency programmes at AKU in Karachi.