The Aga Khan Health Services works to improve the health of the Jamat and its neighbours, through health promotion, disease prevention, and health service delivery. It ensures that people have access to health care at the right level, which is accessible, affordable, and makes sense for each particular family and the wider population.
As a tropical doctor, Gijs always wanted to work in a low-income setting, and was soon put in charge of a district hospital in northwest Tanzania. Observing the major problems with maternal mortality, he later undertook doctoral studies in the area. He spent seven years working for the British Medical Research Council in The Gambia before joining AKHS.
In this interview, Gijs explains the evolution of AKHS, beginning in South Asia and East Africa in the 1920s, with maternity homes and dispensaries. By the 1980s, a more comprehensive approach was taken. Health systems were created according to the needs of each community, ensuring consistency with government priorities. Secondary and tertiary care hospitals followed, featuring teaching and research as well as complex care. Today, AKHS is still expanding, and has recently established the first health centre in Salamieh, Syria.
“Mortality rates in the Jamat related to Covid-19 was lower in many circumstances than the populations among whom they lived,” says Gijs, illustrating the positive impact of AKHS. “And part of that, I think, is real influencing and coming together globally, both on the Jamati side with Jamati leadership and the health boards, and the Aga Khan Health Services. The input of the Time and Knowledge Nazrana volunteers is fantastic. But if you ask them, they say ‘We're learning so much.’ It's a unique experience to be able to provide this kind of service but also get a lot back.”
The principles of AKHS include access, quality of care, affordability and role modelling.
Access
“The hub and spokes model is about ensuring that people have access to health care as close as their home as possible, but also ensuring that you have the right use of limited resources,” explains Gijs. Community health workers focus on health promotion and disease prevention, with limited curative care at the community level. Patients are referred within the system to access the appropriate level of health care for their problem, from local health posts, through district hospitals, up to specialist facilities.
Affordability
Gijs emphasises the interconnectedness of the problems AKDN agencies are working together to solve. “Poverty leads to poor health. If you're born poor your nutrition might not be so good and you might be more ill as a small child. You might have more absenteeism from school if you don't have the proper food or the proper vaccinations. But poor health also leads to poverty. If you’re ill and you don't have a stable income, how are you going to access and pay for your health care?”
He describes a micro health insurance project with Jubilee Insurance in northern Pakistan, and work with the First Microfinance Bank, Pamir Energy and Tcell, who inform clients about access to medical care in Tajikistan.
“It's absolutely amazing and unique that you can bring all these entities together for one goal, which is improving the quality of life of the Jamat and its neighbours.”
Quality
Thirty-eight AKHS facilities have achieved Joint Commission International accreditation, demonstrating the highest standards of care. The SafeCare tool developed by AKDN and partners tailors these standards for the situations in which AKDN works. “Many things we are doing in our own settings, I think the so-called developed world could learn from”, observes Gijs.
Role Modelling
“We can't provide health care everywhere. We do it where the Jamat is present. But we really hope by measuring and documenting that well, that others learn from us. Governments, not-for-profit and for-profit providers alike are interested in using SafeCare.”
AKHS is also sharing its World Health Organization-endorsed carbon emissions calculator with the public. The tool is set to help AKHS reduce its emissions by 60 percent in the next five years and has aroused interest from universities, international NGOs, and consultancies.
The organisation is also setting an example in gender equity. The majority of patients and staff, including managerial staff, are women, as are four of the nine CEOs.
“But I think we should not overdo the impact of health care,” concludes Gijs. “It's also about education, especially education of girls. It's also about safe water, adequate sanitation, proper housing, etc. And the uniqueness of AKDN is that it brings it all together.”
