28 – 29 September 2011 Vedic Village Spa Resort Kolkata, India. Dr. Zafar Ahmed General Manager Aga Khan Health Services, Pakistan.

28 – 29 September 2011Vedic Village Spa Resort Kolkata, India.

Dr. Zafar Ahmed

General Manager

Aga Khan Health Services, Pakistan


Rural Health Center, Shagram

•Facility constructed by government•No staffing•Limited quality•Serves population of 48,000•Secondary healthcare facility•Remote and isolated


1.1. Total Population of Torkhow TehsilTotal Population of Torkhow Tehsil 32,00032,000

2.2. Adjacent population of Mulkhow Tehsil Adjacent population of Mulkhow Tehsil 16,000 16,000

3.3. Child Bearing Age Women (CBAs) Child Bearing Age Women (CBAs) 8,640 8,640

4.4. < 5 Years Children < 5 Years Children 7,6807,680

5.5. < 1 Years Children < 1 Years Children 1,6801,680

Demographic Data Demographic Data


• Integrated PPP between government and NGO

• Government provides facility, budget, and some human resources

• AKHS,P:

• manages the facility

• ensures supplies and medicine

• strengthens human resources (particularly female doctors and nurses)

• includes community participation

• District Advisory Committee


• Department of Health Government of Khyber Pakhtunkhwa, Pakistan

• Aga Khan Health Service, Pakistan

• District government

• Local community


• To provide quality health care services for common illnesses to the community

• To improve availability and access to Basic and Comprehensive emergency obstetric and neonatal care (EmONC) services.

• To involve local community in the management of the facility

• To develop plans for the sustainability of the services

• To share the experience at national and international levels for replication in other part of the world


• Situation analysis

• Consultation with local community and district government

• Signing MoU with Department of Health

• Developing implementation strategies

• Provision of human and material resources

• Community involvement

• Implementation of user fee

• Sustainability plan

• Project implementation

• Progress review with stakeholders


• Standard package of services available at the RHC

• Increased outpatient and inpatient volume

• Improved coverage of key maternal and child indicators

• Antenatal care, TT vaccine, skilled deliveries (normal and C-section), immunization

• RHC budget available from government

• Implementation of user fee at RHC

• Funds available for non-affording patients

• Referrals strengthened from primary health care and community to RHC

• Health committees active at facility and district level

• Strong relationship with Provincial Health Sector Reform Unit


Challenges Mitigation Plans

Human resources (availability & retention)

Provision of hardship allowance for recruitment and retention

Local politics Active health committee with diverse membership

Lack of community awareness, particularly in Sunni areas

Health education sessions and other awareness program at community level

Weather -Promoting and encouraging indigenous way of transportation of patient-Presumptive shifting

Poverty Remission for poor patients


Indicators 2008 2009 2010 Jan-Aug 2011

OPD 2468 4657 5196 3,488

Admission 404 618 761 521

Deliveries 142 165 193 171

Minor surgeries 34 65 120 92

C-Section 0 6 6 5

Ultrasound 362 503 830 627

Lab. Tests 2107 4867 5,664 4,596

B O (%) 27% 29% 38% 36%


Indicators 2008 2009 2010 Jan-Aug 2011

To RHC (PPP) from lower level healthcare

From Lady Health Workers (community level)

87 115 1732 778

From AKHS,P Facilities 45 24 31 45

From RHC (PPP) to higher level heatlhcareTo Booni Medical Center (secondary facility)

41 37 34 21

To District Headquarter Hospital 7 15 23 14To Provincial Tertiary Hospital 1 8 5 4


Description Jan-Dec 2010 Jan-July 2011

Operating income PKR PKR User Fee 4,580 2,853

Government grant: In cash 1,333 1,859

Government grant: In kind (Staff salaries) 2,033 1,312

Total Income 7,946 6,024

Operating expenditure

Medical and Surgical Supplies 2,101 1,374

Support and administrative 1,764 1,248

AKHS,P Staff Cost 4,661 3,490

Government staff cost 2,033 1,312

Total Expenses 10,558 7,423 Funding Gap (Operating + capital) (2,990) (1,439)Sustainability % 75% 81%


• Pooling resources (public and private) can improve health services

• Effective involvement of community plays critical role in PPPs and sustaining services

• Strong linkages with community health providers strengthens referrals

• Improved community awareness enhances the services utilization

• Involving communities increases ownership, and therefore utilization, of health services


KFW team Visit to Shagram


28 – 29 September 2011 Vedic Village Spa Resort Kolkata, India. Dr. Zafar Ahmed General Manager Aga Khan Health Services, Pakistan.

Documents

pakistan slide

quality health care

primary health care

stakeholders slide

isolated slide

world slide

rural health center

rhc health committees