Over the past two decades, health professionals have focused on building capacity within health systems to promote continuous and sustainable improvements in the quality of health care. Dr Azim Juma, a family physician and assistant professor at the University of Toronto, has been involved since his first volunteer assignment in Tajikistan over two decades ago. It was then that he became associated with an initiative to implement a nationwide family medicine programme with the Aga Khan Health Service and the Tajik government.
“Family medicine health professionals, including family doctors, were largely absent in Tajikistan, therefore, embarking on this work was entirely new territory,” said Dr Juma.
The project involved the re-training of local health professionals to focus on the health of families within communities and for physicians and registered nurses trained in family medicine to be the initial point of contact for primary health care. Dr Juma was asked to spearhead this initiative which included renovating facilities and establishing protocols for referrals and recordkeeping. With a single pilot project which began in 2007, there are now 250 centres in three provinces.
Dr Karim Damji, an Edmonton-based ophthalmologist and chair of the Department of Ophthalmology and Visual Sciences at the University of Alberta, recounts his efforts and that of local and visiting eye care professionals, including optometrists and nurses, to improve the quality of eye surgery and research in Kenya and Pakistan. From 1995 to 2001, various eyecare professionals from Canada had set up a rotating schedule such that every three to four months, someone was on the ground at the Aga Khan University (AKU) in Karachi to help build capacity. This involved mentoring local ophthalmologists to perform cataract and glaucoma surgeries in line with international standards and implementing ophthalmology training programmes within the curriculum for medical students and residents. Doctors from Nairobi who wished to continue their training in fellowship programmes were invited to train at the University of Alberta, or in other locations such as India, to further improve their skills. Currently, ophthalmologists in Nairobi are utilising cutting edge technology as well as engaging in and publishing regionally relevant research.
Dr Damji emphasises that “fostering professional development, including leadership skills, as well as partnerships to develop enabling local environments has been the key to the success of our endeavours.”
Allied health professionals have also been part of these engagements with AKDN institutions. Zabin Mawji, a radiation therapist from Toronto, travelled to the Aga Khan University Hospital in Karachi, Pakistan, to help develop a radiation oncology department that opened in 2006. Zabin’s work involved knowledge-exchange with local radiation therapists to improve quality of care and implement standardised policies and procedures for treatment. After her time as a volunteer was finished, she was employed by AKU to develop a training programme in radiation therapy, the first of its kind in Karachi. Zabin feels she “was part of something bigger as the work led to improving capacity within the entire country.”
The importance of generating local capacity through mutual knowledge-exchange, integrating regional expertise and experience, and understanding the local context, are common themes emphasized by all three health professionals, that were essential for the success of their respective projects.
Dr Juma highlighted his learning of the importance of allowing local leadership to make decisions that are appropriate for their contexts and environments. For instance, it was appropriate for registered nurses with training in family health to be the first point of contact with the health system in smaller villages.
Building strong relationships with people was an important learning for Dr Damji, as coordinating efforts was key to sustaining work over-time.
Zabin said she learned that anything is possible. She was able to recognise the creativity of her colleagues in Pakistan who shared with her different approaches to treating patients, which she now uses in her practice in Canada.
It is their hope that partnerships such as these will continue to be developed and strengthened to promote the unity and health of the global Jamat.
