Recaliberation of Aga Khan Health Service, Pakistan necessary for increasing efficiency: Official Statement

Karachi: Hospitals and health centers operated by the Aga Khan Health Service, Pakistan in different parts of Giglit-Baltistan and Chitral have been closed for the last three days, as employees went on a strike, rejecting the management’s decision of closing small health units in various localities, and terminating job contracts.

A delegation of the protesting employees yesterday called on the Chief Minister of Gilgit-Baltistan, urging him to take the issue up with the higher management of the organization, and save jobs of a couple of hundred people, mostly working as auxiliary staff in various centers. They have also threatened to challenge the decision in courts.

AKHS,P, on its part, has attempted to clarify the situation, and provide a rationale for the decision, by sending out the following statement, highlighting the need for adoption of a new service-delivery model, to increase organizational efficiency, and provide quality care to the patients. The organization maintains that many of the centers being closed are not performing to capacity, due to lack of demand, and also due to availability of alternate health facilities.

Official Statement: “The Aga Khan Health Services (AKHS) is one of the agencies of the Aga Khan Development Network (AKDN) that supports activities in health in Pakistan and several countries around the world. Together, AKDN health activities reach 5 million people annually globally and over 2.2 million per year in Pakistan.  The agencies also work closely on planning health delivery improvements in Pakistan, training and resource development.

In recent years, emerging health care needs, a rapid increase in additional and alternative health care providers, a rise in innovative techniques and the need for greater access to other healthcare facilities has required AKHS to develop a more effective delivery model.

In order to increase efficiency and serve growing needs of its patients, AKHS is recalibrating its health service delivery to ensure that it can remain independent and self-sustainable. A cornerstone of this approach is to ensure partnerships with national and local governments and other health service providers – both within AKDN, such as the Aga Khan University, and outside AKDN, such as government health facilities — to ensure improved health services in the long term.

In some cases, the recalibration will mean that certain health functions will be built on an effective hub and spoke model. The AKHS,P Service Model will feature:

• Hubs: The Gilgit Medical Centre and the Booni Medical Centre, which will consist of 46 and 37 bed secondary health care units, respectively, with ‘core’ specialised services in paediatrics, obstetrics/gynaecology, internal medicine and surgery, as well as other specialised services in e.g. orthopaedics, ophthalmology, psychiatry etc., that are reflective of local needs. The Gilgit and Booni Medical Centres are connected with the ‘super-hub’ at the Aga Khan University Hospital in Karachi for e-health services. The two Medical Centres serve as the referral units for the Compehensive Health Centres (CHCs) and play an active role in supervision and capacity building of the CHCs’ staff, including via outreach and e-health.

• Sub-hubs: The six CHCs (7-18 beds) are to be staffed by generalist rural family medicine physicians trained to diagnose and treat a large variety of common diseases, g., obstetric complications, emergency surgeries and stabilisation of severe medical and paediatric conditions. CHCs are the referral units for the BHCs, and CHC staff also provide outreach clinics in BHCs.

• Spokes: Staffed with Lady Health Visitors (LHVs) and Community Health Nurses (CHNs), the Basic Health Centres (BHCs) offer health promotion and disease prevention services, including screening for non- communicable diseases (NCDs). There are advanced discussions with AKU’s School of Nursing and Midwifery (AKU-SONAM) to start modular upgrading courses for the LHVs, as well as primary health care services with a focus on reproductive, maternal (including normal deliveries), and child The BHCs are the link between the formal health system and the community; and these will be linked via mobile health (m-health) services.

The recalibration is essential to improve efficiency so that AKHS, a non-profit organization, can continue to provide affordable healthcare to the community. The new model will ensure both quality and affordability.”