Establishing Palliative Care across the AKDN Health Services: Opportunities and Challenges.

AKDN has one of the most comprehensive private not-for-profit health care systems in the developing world. It has state-of-the-art urban academic tertiary care centers, service hospitals and community based primary care centers spread across the most remote areas of Central and South Asia and East Africa. In response to a global initiative to make palliative care widely available, the AKDN is spearheading the integration of palliative care across its international health network. The scope includes specialist palliative care services in urban tertiary care centers across secondary and outreach programs to home based palliative care services. The ultimate goal is to develop a comprehensive structure of palliative care services which, in addition tofulfilling the vision of quality, also fulfills the needs of the communities that it serves. This article describes the international undertaking; its challenges and the key contextual design principles of the implementation.

The role of patients: Perspectives from a large, not-for-profit, tertiary care teaching hospital in the developing world.

Recent literature and studies show the significant role that patients and families can play during their transition through different points along the continuum of care. To date, our observation is that in our environment, patients and families input and engagement in the health care process has remained passive, with most of the decisions related to patient care being reserved for health care providers. Health care in many parts of the developing world still faces a similar challenge. This paper presents the initiatives of a large, not-for-profit, tertiary care teaching hospital in Karachi, Pakistan, on planning and implementing some best evidence-based practices in re-shaping the role of patients and families with the goal of enhancing the quality of their care. It also points out the effect of local cultures in making the role of the patient and family in their care as beneficial as it can be to improve clinical outcomes and their quality of life. Additionally, factors such as literacy, education, socioeconomic class and the attitude of health care providers in underdeveloped countries requires a significant change for the effective involvement of patients in their own care.

Implementation lessons on the use of innovation in information technology in the developing world.

Information Technology (IT) innovation and its impact on health care is of particular relevance to the developing world, which spends a fraction of what health systems spend in OECD countries. Given the issues of accessibility, affordability and quality health services in the developing world, IT can play an important role by bringing marginalized communities closer to health care systems. Aga Khan University (AKU) and the eHealth Resource Center (eHRC), which are part of Aga Khan Development Network (AKDN), are active in the developing regions of East Africa, Central Asia and South East Asia and are currently initiating new changes in the use of IT and also the manner in which it is deployed. The eHealth programmes implemented and the lessons learned by AKU and eHRC in achieving its core values of impact, access, relevance, and quality through implementation of these innovations are described. These can be of value to health systems and academic medical centres in the developing world wanting to leverage scarce resources to create meaningful impact using IT.

The risks and opportunities of the globalization of health care delivery.

The pace and scale of globalization in health care services delivery have accelerated over the past decade. There have been numerous collaborations in health care service delivery between the private sector in North America and Europe with public and private entities in various emerging markets. These partnerships can be extremely fruitful, but also carry significant challenges. Johns Hopkins Medicine International (JHI) has been active for more than a decade in supporting international partners in building capacity and improving delivery systems. In addressing the challenges of globalization we have learned a number of lessons and have come up with several innovations to better help providers in emerging markets respond to the health care needs unique to their regions.

Is there a role for academic medical centers in emerging markets?

Governments in emerging markets face mounting challenges in managing health spending, building capability and capacity, modernizing ageing infrastructure, and investing in skills and resources. One path to overcoming these challenges is to establish new public-private models of health care development and delivery based on United States academic medical centers, whose missions are to advance medical education and clinical delivery. Johns Hopkins Medicine is a participant in the collaboration developing between the Perdana University Hospital and the Perdana University Graduate School of Medicine in Malaysia. These two organizations comprise an academic health science center based on the United States model. The Perdana project provides constructive insights into the opportunities and challenges that governments, universities, and the private sector face when introducing new models of patient care that are integrated with medical education, clinical training, and biomedical research.