As a tropical doctor, Gijs 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 undertook a PhD in this area. He spent seven years working for the British Medical Research Council in The Gambia before joining the Aga Khan Health Services (AKHS).

AKHS works to improve the health of the Jamat (the Ismaili Muslim community) and its neighbours. It does that 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 that particular family and the population.

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 complementarity 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 just established the first health centre in Salamieh, Syria.

Access

“The hub and spokes model is about ensuring that people have access to health care as close to 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.

Quality of care

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.

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.”

Role modelling

"We can't provide health care everywhere. We do it where the Jamat is present," says Gijs. "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 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.”