Urban Health Program at Aga Khan University
Department of Community Health Services
2,313 in Spring 2012
Aga Khan University in Pakistan realized there was a flaw with its medical education program: its students were learning entirely inside of a hospital. The institution understood that it should be dealing with the actual problems of the population. In order to fix this problem, in 1985 a link was created with local communities through the Urban Health Program. Over the past 30 years, the program has addressed social issues by installing new water and sanitation lines, reducing maternal and infant mortality, enhancing students’ learning, and improving overall community health.
With an ever-expanding population of more than 16 million residents, Karachi is the largest city in Pakistan. Of these 16 million people, one third reside in squatter settlements that lack safe drinking water, adequate sanitation, or proper waste disposal systems. The city’s 50 percent poverty rate is an expression of the inequities in health care, living, and working conditions.
In 1981, the WHO, UNICEF, and Aga Khan Foundation organized a conference to discuss the function of hospitals in primary health care (PHC) in Pakistan and found that medical training had been limited to hospitals; the relationship with communities was missing. Ultimately, the conference recommended that medical schools establish a specific department for community health sciences which should be complemented with community-based programs. This led to the creation of the Department of Community Health Sciences (CHS) at Aga Khan University (AKU), a private international university formed in Pakistan in 1983. AKU is a component of the Aga Khan Development Network, which tackles issues of community development, health, and education in multiple countries. AKU created the Urban Health Program (UHP) to develop community-based knowledge and abilities among students and train them as leaders in planning and management of healthcare systems. To accomplish this goal, 20 percent of curriculum time was allotted to providing local health services and required medical students to conduct research in poor neighborhoods. Over the last 30 years, the program has evolved through three phases.
Phase 1 (1985-1994): Through its Urban Health Program, CHS instigated PHC projects in squatter settlements throughout Karachi; the first was established in Orangi in 1985. These PHC units serve between 8,000 and 10,000 people, out of a total population of 50,000. Initially, the PHC focused on improving the health of mothers and young children, but later expanded to include families. Community women were trained as health workers to provide services in immunization, family planning, nutritional counseling, and more to 100-150 families each. Three university departments came together to provide health services to disadvantaged communities.
Phase 2 (1994-1999): In 1996, the catchment population included 110,000 people and a comprehensive baseline survey was conducted, with emphasis on mother and child health and gender sensitivity. The focus moved to community involvement and economic determinants of health. The objectives included organizing marginalized communities, seeking knowledge on community empowerment, developing PHC services, and serving as a catalyst for change. The new health and socio-development initiatives involved training volunteers for vaccination and family planning; workshops on proposal writing and financing; improving the quality of the water supply; providing outreach services to the general population; and programs aimed toward women, including the development of sewing centers.
Phase 3 (2000-present): Currently, the program concentrates on four particular areas: education and training, capacity building, PHC, and research with an emphasis on affordable and sustainable preventive and curative health services.
Phase 1 showed a substantial influence in coverage and impact indicators. For every 1,000 children: the infant mortality rate fell from 126 to 64; the mortality rate of children between ages one and four declined from 51 to 19; and the under-five mortality rate dropped from 177 to 83. Overall, this showed a 40 percent decrease in child death between 1985 and 1989. The changes observed in Phase 2 were equally significant. More houses had water taps, there was an increase in general sanitation, more women were involved in income generating activities, immunization coverage increased, and mothers were better at recognizing signs of dehydration and diarrhea.
In the end, Aga Khan University discovered the importance of collaborating with local partners. Their innovative approach to teaching improved what students learned, made it more relevant, and solved real-world problems by aiding impoverished families in Karachi. Many graduates of the program have gone on to work in public health or poverty alleviation. Thanks to its integrated model of primary health care and social development, the UHP has become an example to health and academic programs not only in South Asia, but across the world.