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The Aga Khan University Medical Centre - Karachi.

Dedicated to establishing and maintaining internationally accepted medical education standards, the Aga Khan University has as its objective the development of human resources to respond to problems which are of particular relevance to the developing world. The Faculty of Health Sciences in Karachi, the first faculty of the Aga Khan University, consists of a Medical College and a School of Nursing. Students gain clinical experience at the 654-bed University Teaching Hospital located on the same Campus.

Recognising a lack of adequate hospital and training facilities in medicine, His Highness the Aga Khan announced his intention to build the Aga Khan Hospital and Medical College in Karachi. Its foundation ceremony was performed in 1971 - a thousand years after Al Azhar University was formed in Cairo in 971 A.D., by the Aga Khan's ancestor, Caliph Muizz of the Fatimid Dynasty. Through a charter granted by the Government of Pakistan in 1983, the Aga Khan University was established as the first private university in Pakistan. The University's Board of Trustees, under the Chairmanship of Sahabzada Yaqub Khan, (the former Foreign Minister of Pakistan), consists of a number of distinguished individuals from Pakistan and overseas who, by bringing to the Institution their extensive academic and administrative experience, assist in guiding the University in the attainment of its objectives.

The management of the Aga Khan University is supervised by a Board of Governors, whose membership reflects wide professional, academic and administrative experience.

Admissions to the University are strictly based on merit and potential for leadership. The Institution is accessible to students of all economic backgrounds and no one is denied admission to the University because of his or her inability to pay tuition fees. Financial assistance is provided to students who have been selected on merit and are in need of the same. Presently 40 per cent of the students are on some form of financial assistance, which is intended to favour and encourage qualified students from families with low incomes, as well as those from rural and underdeveloped areas of the country.

Mission and Goals

His Highness the Aga Khan, sponsor of this US $300 million complex, clearly set forth the task of the Institution. He wanted to promote stronger academic and clinical training for doctors and nurses, a higher standard of hospital care, and a scholarly approach to the study of health problems of the developing world. Research efforts were to apply the highest international standards to the solutions of health problems of developing countries. At the same time, financial subsidies would make the University accessible to students selected on the basis of merit, and the Hospital open to patients admitted on the basis of need. The Aga Khan University Medical Centre is dedicated to providing exemplary education, research and service, oriented towards finding and disseminating innovations to improve the health of the people of Pakistan and the developing world.

Out Reach

A major objective of the Medical Centre is to also serve as a focal point of the Aga Khan Health services (AKHS), an international network of over 200 health care units. It provides technical assistance, training and advanced referral services to five other AKHS hospitals in South Asia and East Africa, as well as to the primary health care activities of AKHS that serve some two million patients in these regions each year. Integration of the Medical Centre's activities with the maternity homes and community health programmes of the AKHS in Karachi, the province of Sindh, and the Northern areas of Pakistan, is already well advanced.

Departing from traditional concepts of medical education, the curriculum of the 5 years MB.,BS. programme at the Medical College places particular emphasis on preparing future physicians to deal with the specific medical problems of a developing country both in an urban as well as a rural context.

Primary Health Care

One fifth of the curriculum in each of the five years of the medical course at AKU is dedicated to Community Health Sciences (CHS). The programme aims to introduce students to concepts and skills required in dealing with a wide range of patient cases and health systems. The CHS Department is helping to develop Primary health Care systems at the community level, where students are exposed to the planning, management and evaluation of such systems. These programmes are largely community and problem based, and considerable responsibility is placed on students to identify and deal with problems in the very settings in which they exist. A major achievement of the preventive disease control methods, taught through the community based medical curriculum, is the impressive drop by 50 per cent in infant mortality statistics over the last seven years in the six urban squatter settlements of Karachi where the programme is in operation. The CHS Department works closely with the School of Nursing in the implementation of this programme.
Sponsor : His Highness the Aga Khan
Established : Faculty of Health Sciences, Karachi
 School of Nursing (R N Diploma) 1980
 Medical College (M.B.B.S.) 1983
 School of Nursing (BSc. Nursing) 1988
 The Aga Khan University Hospital 1985
Location : Karachi, Pakistan
Land Area : 84 Acres
Builtup area : 1 million sq. ft.
Cost of Project: US $300 million

AKU Programmes

Medical College offers a 5 years MB.,BS degree programme, and Post graduate residency programmes in:

1. Medicine 2. Surgery 3. Paediatrics 4. Obstetrics and Gynecology 5. Radiology 6. Pathology 7. Anesthesiology 8. Family Medicine (Community Health Sciences)

Research priority areas:

* Epidemiology

* Infectious diseases

* Health Care Delivery

Milestones in Nursing

The School of Nursing is dedicated to establishing a new tradition and standard in the profession, as well as enhancing its prestige and recognition. In doing so, the School aspires to encourage a growing number of young women in Pakistan, where there are four physicians for every one nurse, to seek nursing careers in order to strengthen the health services in the country, and in the process encourage women to play a more meaningful role in the nation's development. The School offers a three-year Diploma course, and the curriculum places emphasis on the care of patients with medical, surgical, paediatric and psychiatric problems.

Additionally, a two year programme leading to BScN degree is also available to registered nurses (RN) who have completed their Diploma course, and is the first programme of its kind in Pakistan. This programme requires the RNs to have at least two years of work experience before they are admitted, and is designed to provide them an opportunity to upgrade their education and prepare them for leadership roles in management in hospitals, teaching and community health nursing. The Aga Khan University School of Nursing (AKUSON) has also been asked to serve as a consultant on a Nursing Task Force recently established by the Secretary of Health to develop a Baccalaureate Nursing Programme, similar to the one at the AKUSON, at the government sponsored College of Nursing in Islamabad.
Annual intake of students:
School of Nursing (3-year Diploma) 100
School of Nursing (2-year BScN) 30
Medical College 70
Alumni (1992):
School of Nursing (RN Diploma) 611
School of Nursing (BScN degree) 53
Medical College 263

Tertiary Care Facilities

The primary purpose of the 654 bed Aga Khan University Hospital, is to provide inpatient and outpatient services that are oriented to the health needs of the general population of Karachi and Pakistan. As the Hospital volumes have grown and its services have become well recognized, there has been an increasing demand to provide specialised services. Responding to these needs of the country, the Hospital has initiated tertiary care facilities well ahead of their anticipated evolution. The include:

Oncology: Treatment of cancer (starting with chemotherapy)

Lithotripsy: Non-invasive, non-surgical removal of kidney and gall bladder stones through shock wave treatment.

AKUH already has a strong base in paediatrics, neonatal intensive care, and management of high risk pregnancy. The National Intensive Care Unit (NICU) is one of the very few such units available in Pakistan, and is in great demand particularly for the care of premature babies. To combat preventable childhood diseases, the Hospital also has a Diarrhoea and Nutrition Unit in the Department of Paediatrics.

Mammography facilities are available at the Breast Clinics, where patients are given counseling and screened for early detection of breast cancer. A coronary care unit commissioned in 1990 represents a first step in the development of a comprehensive cardiology programme. The Orthopaedic Department now offers many specialised services such as joint replacements, treatment of complex fractures and microscopical repair of nerves due to bone injuries. An Infertility, Gynecology and Endocrinology Clinic provides service to infertile couples and patients suffering from endocrinological problems.

Subsidized Medical Care

The Hospital's philanthropic mission is to serve people in need of medical care, irrespective of race, religion or ability to pay; and to conduct and support programmes and activities that reflect human values and genuine concern for the welfare of the community it serves. In the process of achieving this objective, the Aga Khan University Hospital has a differential charge structure which is higher for the affluent, and heavily subsidized for the poor. In addition, each year substantial funding is allocated for indigent patients who cannot even afford the subsidized cost of the the services.
Beds at AKUH

Capacity: 654 beds
 (being phased into service)

Operational: 370 beds (1992)
Annual patient: 32,000 inpatients
Volumes at full
operations: 250,000 outpatients
Patient Welfare:
Budget - US $2.5 million annually
(In direct and Programme indirect charity)

Number of patients
treated todate - Over 50,000.

AKUMC has attracted the generous participation of a large number of national and international donors, including individuals, corporation and aid agencies. Whilst a significant proportion of this support has funded programmes, the bulk of the funds have gone towards the creation of endowments, and already thirty Professorships at AKU have been endowed. Similar endowments at the Hospital provide medical care to over 12,000 poor and needy in and outpatients annually.

Finance and Funding

In a span of just six years from its first full year of operation, the Aga Khan University Hospital has progressed from a cash operating deficit of Rs. 84 million in 1986 to a positive cash-flow of Rs. 48 million in 1992, before allowing for the expense of depreciation of assets. The positive cash generation amounts to approximately two-thirds of the Hospital's depreciation expense. The 1992 operational results include Rs. 28 million spent on underwriting patient welfare subsidies. Besides these subsidies, another Rs. 28 million of patient charges were waived for indigent patients through AKUH's Patient Welfare Programme. This direct welfare was achieved through the generosity of its donors. To perpetuate the welfare programme, an AKUH welfare endowment has been created from such donations and only the income is used towards the annual expense of waiving charges for indigent patients. The charts given below illustrate the Hospital's Source and Application of Funds for 1992.

While AKU & AKUH are separate entities, their interests are closely intertwined. In fact, sound progress of the Medical Centre can only be assured if both entities advance simultaneously. Financial self-sufficiency and the ability to self-propel growth are the most challenging goals for academic medical centres. Attaining this at the Aga Khan University Medical Centre will require continuing sound management and innovation, which will ensure that expansion of services can occur while maintaining a tighter control on costs. It is also certain that external support through grants and donations will be crucial to enable the Medical Centre to respond to the challenges and demands of the future.
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Title Annotation:Pakistan
Publication:Economic Review
Date:Aug 1, 1993
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