The first health institution built by our institutions in Pakistan was a 42-bed maternity hospital. Formerly known as the Janbai Maternity Home, it opened in Karachi in 1924. Today, while maintaining that early focus on maternal and child health, AKHS also offers services that range from primary health care to diagnostic services and curative care. We reach over 1.1 million people in rural and urban Sindh, Punjab and Gilgit-Baltistan and Chitral (GBC).

As the largest not-for-profit private healthcare system in Pakistan, our goal is to supplement the government's efforts in healthcare provision, especially in the areas of maternal and child health and primary health care.

Northern Pakistan Primary Health Care Programme

AKHS has been implementing the Northern Pakistan Primary Health Care Programme since 1987. Working in partnership with local communities, the government and other AKDN initiatives, like AKF’s Aga Khan Rural Support Programme, we have sought sustainable ways of financing and delivering primary health care in the high mountain valleys. This has led to a village-based approach – the designation of community health workers by the local village organisation, the training of these workers in community-based disease prevention, and the reorientation of government and private health professionals to primary health care.

We have trained over 1,000 community health workers in GBC, where we manage 56 basic health centres (BHCs), eight comprehensive health centres (CHCs) of 10 to 30 beds, and the 50-bed Gilgit Medical Centre. Four of these CHCs are run via public-private partnership (PPP) agreements with the government. These assets cover more than 700,000 people.

This health systems approach, with a traditional emphasis on maternal, neonatal and child health, is complemented by community-based models. These address the non-communicable disease burden, including mental health issues and palliative care. A digital health system is in place for three healthcare facilities: Gilgit, Booni and Garam Chashma.

In our strategic framework for GBC we aim to:

• support government health policies and plans, including the expansion of PPPs;


• support the health needs of GBC, including recalibrating and refocusing of the BHC services and strengthening of the secondary healthcare services;


• increase sustainability, including introducing and scaling up health insurance and social protection schemes; and


• implement and contribute to global standards in health and health care by working more closely with AKU and other partners in training and operations research.

Through this and related programmes, AKHS, AKF and AKU are working to promote a new orientation of health services in Pakistan towards primary health care. The three institutions are also collaborating in a drive to build health systems linking preventive and curative care efforts, as well as village health centres to the Aga Khan University Hospital in Karachi.

Founded in 1983, AKU educates healthcare professionals, generates knowledge pertinent to Pakistan and the developing world, and provides world-class health care at its hospitals and clinics.

At the heart of AKU is the 710-bed Aga Khan University Hospital, Karachi. It was the first hospital in Pakistan to meet the rigorous accreditation standards of the US-based Joint Commission International. It operates the country’s only clinical laboratory accredited by the US-based College of American Pathologists. The Hospital is the main teaching site for AKU’s Medical College and School of Nursing and Midwifery. AKU alumni have gone on to study, teach and research at the world’s most prestigious universities and healthcare institutions, and to play leading roles in improving health in Pakistan.

Six of Pakistan’s top 10 health researchers are AKU faculty, according to an analysis by the Pakistan Council for Science and Technology.

AKU also operates four women’s and children’s hospitals with a total of more than 200 beds, as well as over 290 outreach medical centres in 120 cities across the country. The University health system treats more than 1.5 million patients annually.

AKU’s Patient Welfare Programme enables low-income patients to obtain care at AKU’s hospitals and outreach centres. To date, it has provided 5.4 million patients with reduced-cost care worth US$ 210 million.

AKF works with local governments in Pakistan to help improve access to health care to those who may not be able to otherwise afford it. These initiatives have included training community midwives to make health care geographically more accessible and introducing micro health insurance to make health care financially more accessible.

Supporting Community Midwives

Under the aegis of the Chitral Child Survival Programme, and in collaboration with the Department of Health in Khyber Pakhtunkhwa Province, 28 community midwives were trained, deployed and later supervised to help increase the percentage of assisted deliveries in Chitral. This initiative has been a great success and has been much appreciated by the local and provincial government, especially as these community midwives are now regular employees in the government’s Maternal, Newborn and Child Health (MNCH) programme. The community midwife model is being replicated and scaled up in partnership with the MNCH department of the Government of GBC, under other donor-funded programmes of Sihatmand Khandaan and Foundations for Health Empowerments.

Micro Health Insurance

Following a highly competitive process, a joint effort by AKF and its Aga Khan Rural Support Programme, AKHS and Jubilee Life Insurance was awarded a social protection project entitled the Micro Health Insurance Initiative, in Gilgit District. With the support of the German government's development bank KfW and the Government of Gilgit Baltistan, the initiative used data acquired from the Benazir Income Support programme to identify the poorest 21 percent of Gilgit. Their insurance premiums are paid by the KfW with a gradually increasing government contribution. The insured beneficiaries have access to cashless health services at the government, AKHS and private hospitals in Gilgit. The aim is to protect these families from the escalating cost of health incurred by common illnesses, maternity services and injuries due to road traffic accidents.

With the support of AKRSP community mobilisation and advocacy, many households are paying for the annual premium on a voluntary basis. To date, 5,340 households (against a target of 5,480 households) have been enrolled under the compulsory enrolment scheme. Under the voluntary enrolment scheme, 5,716 households have enrolled, against a target of 7,567. In total, 63,162 lives have been insured under the project.

Using Public-Private Partnerships to improve health services

AKDN has demonstrated the success of PPP models in managing the secondary-level health facilities of the governments in Chitral and Gilgit Baltistan, supported by the Italian, Norwegian, German and Canadian governments. With AKHS and the government sharing responsibilities, such partnerships build public-sector capacity and enhance trust amongst the communities served by these hospitals. They also complement the government’s agenda of providing equitable quality health care, by deploying and retaining trained obstetricians and nursing staff.

The Central Asia Health Systems Strengthening project, funded by Global Affairs Canada, has provided state-of-the-art diagnostic equipment, supplies, training and ehealth services to all the project facilities. The PPP model is further being strengthened by AKF in partnership with Global Affairs Canada – Foundations for Health and Empowerment programme and Sihatmand Khandaan.

Central Asia Stunting Initiative

AKF and AKDN agencies are working to reduce stunting amongst children under the age of five. We use a life-cycle approach from pregnancy to school-age children, focusing on the first thousand days. This holistic development initiative brings together healthcare providers, schools focusing on preschool learning and communities. It includes support for children’s physical, social and cognitive growth through nutrition, care and stimulation during the first five years.

The interventions improve infant and young child nutrition, prevent disease, identify and treat low-birthweight babies, and improve the nutritional status of pregnant and lactating women. To ensure sustainability and break the intergenerational cycle of undernutrition, these initiatives are linked with the agriculture and food security programmes; they create opportunities for income generation through economic inclusion programming; and they address the social determinants of poor nutrition, with a particular focus on girls’ and women’s empowerment. The initiative is also complemented by efforts to link communities to government health and nutrition programmes such as the Ehsaas Nashonuma Centres.

Engagement and Partnerships

We engage with stakeholders and take a partnership approach to ensure wider coverage and the sustainability of donor-funded initiatives.

AKF is consulting with the provincial governments of Gorno-Badakhshan and KP-Chitral for the Foundations for Health and Empowerment programme and the Sihat Mand Khandaan – Healthy Families programme, which seek to improve the health and well-being of women, girls, their families and communities. The Departments of Health, Population Welfare, Social Welfare, Women Development, Youth Affairs, Human and Child Rights, and Education are involved, with formal letters of collaborations ensuring integration and a continuum of care. A coordination mechanism is in place to review plans, progress and the extension of coverage to remote districts in Diamer and Baltistan.

A letter of collaboration has also been signed with the national Ehsaas Nashunuma programme being implemented by the Benazir Income Support (BISP) programme, acknowledging the Central Asia Stunting Initiative.