The Aga Khan Health Services (AKHS) provides healthcare in 41 health centres and over 391 health posts in Badakhshan province. AKHS also manages the main government provincial hospitals in Bamyan and Badakhshan, along with two community midwifery schools in Bamyan and two community nursing schools in Badakhshan and Baghlan.
The health status of the populations in Afghanistan is poor. After more than 20 years of war, when the Aga Khan Development Network’s (AKDN)began working in 2002 health infrastructure was negligible. AKDN’s initial response was based on its experience in Northern Pakistan and Tajikistan. However, over the last two years, the Ministry of Health in Afghanistan – supported by UN organisations, donors and NGOs, including Aga Khan Health Services (AKHS) and the Aga Khan Foundation (AKF) has formulated years a strategy which includes a basic package of core services that any agency wishing to provide health services to Afghans must deliver 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, 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, which allows 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 AKHS since 2003. The hospital has seen a steady increase in patient visits since then.
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.
Bamyan Provincial Hospital
The Aga Khan Health Services (AKHS) began operating the Bamyan Hospital in 2004. At that time, the Hospital had only 35 beds – 15 of which were housed in a tent. Medical staff struggled to meet the needs of the population.
As part of a public-private partnership with the Government of Afghanistan, the Bamyan Provincial Government allocated 6.4 acres of land on the outskirts of the town and AKHS undertook the challenge of upgrading the hospital. The old facility was expanded to 100 beds, and new equipment was installed. Training was provided to staff and a steady supply of medicines was stocked.
The impact was remarkable: admissions rose from 1,900 in 2004 to more than 11,000 in 2016; outpatient attendances increased from 43,000 to 175,000; deliveries from 100 to more than 3,000 and the number of major operations from 150 to more than 600.
The new hospital was built by the Aga Khan Agency for Habitat, which specialises in ecologically friendly and seismic resistant construction. Over half of the facility’s power is supplied by solar panels located on a hilltop behind the hospital.