AKHS in East Africa

The history of AKHS hospitals and health centres in East Africa begins with facilities in the cities and towns of the colonial period, including a health centre established in 1929 in Dar es Salaam, which expanded into a maternity and nursing home, and into a hospital in 1964.

It also includes maternity homes in Mombasa and Kisumu, which became full-service hospitals in the 1950s. The Aga Khan Hospital in Nairobi opened in 1958 and is now one of the leading hospitals in the region. The Aga Khan University Hospital (AKUH-N) was established in 2005 and received its Charter from the Government of Kenya in 2021.

These institutions entered a new period of development when Kenya and Tanganyika gained independence in the 1960s. Today, AKDN operates around 100 health centres and four hospitals in East Africa, including the leading private, not-for-profit hospitals in Kenya and Tanzania. We deliver high-quality care, in-service training, formal health sciences education programmes, care in the community and public health services. The corporate clientele of our hospitals has given AKDN expertise in essential and neglected areas of public health in the developing world – the promotion of workers' health.

Both AKUH-N and the Aga Khan Hospital in Dar es Salaam (AKH-Dar) are teaching hospitals, offering selected postgraduate medical education programmes. They have expanded in recent years, including an increase in the number of beds. The simultaneous expansion of ambulatory services and day care allows for the provision of more cost-effective care.

The expansion programmes emphasise introducing new diagnostic services, which will improve the function of both hospitals as referral centres. For example, programmes for the development of clinical specialties, including investments in non-communicable diseases such as cardiology, oncology and traumatology, are increasing the range of secondary and tertiary services that these hospitals are able to offer their patients.

The high quality, high-technology heart and cancer programmes and the laboratory medicine and radiology services are also enhancing the capability of AKH-Dar to provide referral services in Tanzania (providing patients with the option to seek care at home rather than in another country or region). AKUH-N, which is closely linked with the AKUH in Karachi and other hospitals through an integrated health network in East Africa, is developing its services to strengthen the whole health sector in the country and the region.

Along with this investment in hospital services, AKDN’s work in the health sector in East Africa also entails a commitment to developing effective approaches to disease prevention and health promotion. In a health system framework, care begins outside the hospital or health centre, with community-based primary health care. In the 1980s, AKHS and AKF created primary health care projects in Kisumu and Kwale, two rural districts in Kenya.

The projects have trained people in the Kisumu and Kwale communities in primary health care technologies and management, and catalysed community-based efforts to increase safe water supplies. In other projects in East Africa, AKF and AKHS are working with government services to develop tools for health sector policy design and resource allocation.

AKDN’s international experience in primary health care management and information systems, acquired through its management advancement programme, is an important resource in this area. AKDN is also supporting projects that improve the health of vulnerable groups, like women, by enhancing their socio-economic status.

Hospitals use any operating surpluses to subsidise the increasing cost of care, using the principle of differential pricing to create access for those who cannot afford care.

Developing effective mechanisms for referral is another way of improving access. AKDN’s current hospital expansion will improve referral processes through better diagnostic services at all levels.

The Community Health Department (CHD) in Mombasa works in partnership with community-based health and social organisations, non-governmental organisations (NGOs), and the Ministry of Health in providing support from the dispensary level through to the national level. It works to demonstrate the effective provision of primary care services through capacity building (training), the development of efficient and useful Health Management Information Systems (HMIS) at household (community-based HIS), and facilities at all levels of care.

The regional health programme also includes human resource and training components for personnel from other institutions in the region, both public and private, as well as AKDN’s own facilities. AKUH-N, and increasingly Aga Khan Hospital, Dar, are becoming major regional centres for postgraduate education programmes for nurses and physicians.

AKHS's community health programmes are designed to reach vulnerable groups in society, especially childbearing women and young children, with low-cost, proven medical technologies: immunisation, systematic prenatal care, safe deliveries, and oral rehydration therapy for diarrhoeal disease. Experience within AKDN has confirmed primary health care’s efficacy in improving health status and its cost-effectiveness.

In AKHS's approach to health services, primary health care and prevention are considered as steps towards improved health status that must be linked to the availability of high-quality medical care. To complement our work in primary health care, AKHS offers curative services in institutions ranging from dispensaries through health centres to full-service hospitals. At each level of care, the AKHS focus is on providing services that are needed and wanted by the community and on building links within the system. We also aim to ensure a quality of care that significantly raises local standards.