AKHS in Central Asia and the Middle East

The Aga Khan Health Service, Afghanistan (AKHS, A) was established in 2003 to provide primary health care and curative medical care to the people of Afghanistan, while offering technical assistance in health service delivery to the government. AKHS, A is an active partner of the Ministry of Public Health in the implementation of the Basic Package of Health Services (BPHS) and the Essential Package of Hospital Services (EPHS).

AKHS, A provides basic health and hospital services to a population of more than 1.5 million people in some of Afghanistan's most remote and inaccessible districts in the provinces of Badakhshan, Baghlan, and Bamyan through over 1,015 health posts (within villages), 158 basic and primary health centres, 25 comprehensive health centres (around 10 beds each), five district hospitals (30 beds each), and the two ISO-certified provincial hospitals in Faizabad and Bamyan.

We work with Afghanistan authorities to develop and maintain qualified health human resources in all areas of health care. We offer continuous education for doctors, nurses, health professionals and administrators, and provide technical advice and support on health policy, nursing standards and midwifery education.

The health programme in the Kyrgyz Republic aims to enhance the health status of communities in the remote, mountainous regions of the country by improving access to quality health care at the local level and advancing health promotion, with a special focus on women of reproductive age and children under five.

The main strategic directions of the health programme include community health promotion, capacity building of health professionals as well as health promoters, and strengthening health service delivery. AKHS also manages a health centre in Naryn, providing family medicine, specialist clinics, dentistry, basic laboratory, imaging and pharmacy services to the general population as well as UCA students and staff.

The focus of the AKHS programme in Salamieh district (population size 240,000) in Syria is health system strengthening. This is done by supporting the diagnostic and therapeutic capacities of the existing public health system, composed of 24 health centres and the district hospital, as well as developing a Package of Integrated Essential Health Services at national level. In addition to this, AKHS, Syria is operating mobile health activities to increase access for difficult-to-reach communities in the district.

While there is continued attention to reproductive, maternal, neonatal and child health and communicable diseases, the emphasis is shifting towards strengthening the management of non-communicable diseases (NCDs) and mental health issues in the district. AKHS is introducing, via a Health Counselling centre, evidence-based protocols and procedures, capacity building of health professionals, and paying adequate attention to health promotion and disease prevention.

The HCC model is also the programmatic basis for the new Aga Khan Medical Centre-Salamieh (AKMC-S). The private, not-for-profit AKMC-S, with a major focus on complementary, locally non-available services for NCDs and mental health issues, is forecast to commence OP and day-care services in 2022.

AKDN started health activities in Gorno-Badakshan Autonomous Oblast (GBAO) in 1997. The break-up of the Soviet Union and loss of subsidies, along with the civil war of 1992-1997, had hit the area especially hard. Health services, previously relatively generously financed, had virtually no budget any more.

Moscow had once invested heavily in the region and had developed extensive health and education systems. This created a deep dependency on Moscow for strategic direction and even survival. The 1990s saw a worsening of health indicators, with a decline in life expectancy and increases in maternal and child mortality. The hospitals and health centres deteriorated: buildings were not repaired, much of the medical equipment was unusable, and there were no drugs or supplies.

To achieve its vision of a sustainable, cost-effective health system that would be accessible to all, Tajikistan's reform priorities included:

• implementing effective public health measures;


• enhancing primary care;


• reducing duplication and increasing efficiency in the hospital system;


• building the capacity of health professionals; and


• involving the community in developing and governing the system.

The issue for AKDN has been how to support the system in a situation where reform is the priority. Unlike Northern Pakistan, the strategy in GBAO has been to work very closely with the government to help build its capacities to respond to a new situation and to reform the overall system with the goal of improving access to quality care with an eye towards maintaining financial sustainability.

With support from AKF and other international donor agencies, the active participation of local communities, and in partnership with GBAO’s Department of Health, we have implemented a wide range of interventions including health promotion, rehabilitation of healthcare facilities and equipment, pharmaceutical procurement, distribution and sales, and training in new clinical and managerial practices. Special attention is being given to "professionalising" nursing and family medicine. Each intervention is designed to protect and promote the health status of the most vulnerable in Tajik society (i.e. women of reproductive age and children under five years of age) and to encourage the health ministry to directly target these interventions towards the 220,000 people living in the Oblast. AKHS also aims to shift focus from curative care that is provided through specialised hospitals to primary and family care supported by facility-based services.

Making use of this experience, we are now expanding our community health programme into other geographical areas of the country, namely Katlon and Rasht. The Aga Khan Medical Centre in Khorog commenced operations in 2019. The 50-bed Centre is purpose-built, private and not-for-profit.