Lessons learned from primary health care programs funded by the Aga Khan Foundation.

Abstract

Focusing upon the delivery of primary health care (PHC) the Aga Khan Foundation has been a major donor agency over the past ten years supporting health care initiatives in southeast Asia and other later developing countries. Eight programs of the foundation are the subject of a special 1992 report prepared by the University Research Corporation Center for Human Services. Mainly rural programs funded during the 1980s in Bangladesh India Kenya and Pakistan are covered. They serve almost 500000 people but focus upon 150000 women of childbearing age and children under five years old. Although different in approach the principal interventions of all programs were community education and consumer motivation and emphasized the mobilization of community involvement and how that participation contributed to increased program effectiveness and sustainability. That community mobilization was key to program success. The report also found the following to be essential to the success of PHC: good preferably computerized management information systems; locally-enrolled community health workers who can serve as links to other health personnel rather than as independent providers; and founding increased program effectiveness upon the delivery of basic health services such as increased immunizations maternal care family planning growth monitoring and nutrition and the treatment of common diseases like diarrhea malaria and anemia. All residents now live within five kilometers of health services. The most effective health care interventions were immunizations for young children and tetanus toxoid for pregnant women while increased oral rehydration therapy for diarrhea proved to be moderately successful. On the down side there has been only minimal cost recovery for services and no measurable effect upon socioeconomic status in any of the project communities. Moreover there was a noted lack of cost data for most programs. Succeeding efforts must focus upon longer-term planning including finance and management structures and the establishment of cost effectiveness criteria as a foundation for operations research to tailor services offered and service delivery mechanisms.