AKHS's community health programmes are designed to reach the most vulnerable in society, especially child-bearing women and young children, with low-cost, high quality, proven medical technologies: immunisation, systematic prenatal care, safe deliveries, and oral rehydration therapy for diarrhoeal disease.

Our experience has confirmed both the efficacy of primary health care 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, our focus is on providing services that are needed and wanted by the community and on building linkages within the system. We also aim to ensure a quality of care that significantly raises local standards.

With community health programmes in large geographical areas in Central and South Asia, as well as East Africa and the Middle East, and more than 700 health facilities including 22 hospitals, AKHS is one of the most comprehensive private not-for-profit health care systems in the developing world. AKHS's overall major initiatives currently include:

• assisting communities to develop, manage, and sustain the health care they need;


• providing accessible medical care in modern, efficient, and cost-effective facilities;


• working in partnership with other agencies in the development of communities and the enhancement of their health;


• educating physicians, nurses, and allied health professionals;


• conducting research relevant to environments in which AKHS institutions exist; and


• contributing to the development of national and international health policy.

While taking care not to compromise its social mission, AKHS encourages an entrepreneurial approach by national service companies in all of their operations. All AKHS community health programmes and services have strategies to achieve financial self-sufficiency.

For poorer communities, this may require a timeframe of 15 years or more, but a strategy is developed for each programme to achieve financial self-sufficiency as soon as the economic status of the community served is likely to permit this. Therefore:

• where possible there is a user charge, often complemented by other forms of risk pooling and community financing;


• there is increasing awareness that patients and their families are taking the clinical, technological and scientific aspects of health care for granted. Still equally or more meaningful and memorable to them are compassionate interactions, access to information, involvement, a healing physical environment and an approach that supports mind, body and spirit. Therefore, much more attention is being given to patient and family-centred care.


• the user charge is complemented by a welfare programme provision for those unable to afford the (often very small) fee; and


• in appropriate circumstances, cross subsidies are used to support health activities that are not (yet) breaking even.