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Event - 1981-11-26
Thursday, 1981, November 26
Aga Khan IV (H.H. Prince Karim)

Mr Chairman, Distinguished guests and friends

It is a pleasure for me to be with you again. I thank you for giving me an opportunity to learn from your experience. Prior to coming here, I had known a few of you by your writings and reputation, and it is thus a special privilege for me to have met personally many of you who have contributed so much to hospital service, primary care and medical education. I thank you indeed for sharing your wisdom with us, and do hope that upon your return to your own lands, that you will continue your efforts in problem solving in health and in primary care with the same vigour and enthusiasm that you have shown this week.

While it is unfair for me to single out just a few from so many who have contributed so much this week, on behalf of the Foundation, I should like to express my appreciation to Drs Beausoleil, Taylor, Sebai and Banerji who laid the under-pinnings for your debate this week. I am informed that Dame Nita Barrow in her group worked until midnight, burning the midnight oil, preparing your thoughts and recommendations for all of us, so she and all the commentators and many others are much in our thoughts.

I would like to applaud most warmly the recommendations which you made. I had, before this gathering, a quick look at the main conclusions and recommendations which were prepared by this august body. You were discussing this morning and, obviously, they require further thought by my staff and myself. However, at this juncture, and in a preliminary sense, but a complete and sincere one, I have no hesitation in saying: Thank you, good job, well done.

Before I address a number of the special recommendations which you have made, I do wish, however, to make a few comments on those areas which were of particular interest to me -- which I mentioned earlier this week. I gather that some of the issues I raised in my talk in Islamabad were matters of great concern to many of you, and problems of financing, referral systems, a proper balance in preventive and curative services were themes which threaded their way throughout the entire week's discussions. I thus look forward with great interest to reading the details of the workshop summaries where, I am told, these items are so thoughtfully dealt with. I do have two early thoughts in two additional areas debated this week which I would like to share with you.

The first relates to the issue of community participation. I am not entirely sure, in a pure sense, how much primary health care we deliver throughout the world in our Aga Khan Health Services in the many countries under our Health Boards. Much work we do is in basic and rural health services. In any event, one element, I am sure, pervades our entire system, and that is community involvement and decision making at the grassroots level. This is not a 'custom more often honoured in breach than in practice'. Without it, our system does not work. How does one bring about this involvement? The answer to this does not lie in a sophisticated organisational structure and strategies that we, as managers, so often discuss at these ethereal levels, but upon a few hardy souls -- like yourselves -- that is seeking out leadership. It takes skill, and it takes commitment, but it can be achieved. I would, therefore, like to underline that we must not, and should not, underestimate our ability to locate proper leadership, and work with it so as to affect change -- not only at the village level where we are so heavily involved, but also at the highest level of the academic world.

Secondly, I have been much impressed by your discussion of the responsibilities of a university teaching hospital in the communities where they are located. Some of the ideas which you have discussed this week will have a profound impact on us as we chart the future course of our medical school. The issues related to the responsibilities of a university in a modern world are controversial and the subject of considerable debate. Quite obviously, there would have been no reason to bring about such a distinguished group if the subject in hand was trivial or non-controversial, or, if I may add, if we ourselves did not intend to act upon your recommendations. The Conference has raised a series of fundamental issues and we have learned from your deliberations.

Where do we go from here? Besides the publication and wide distribution of the Conference proceedings -- which we will guarantee -- there are a number of specific actions where I hope to have useful discussions with you and with my staff.

First, with regard to our Conference recommendations, I accept, on behalf of the Board of Trustees of the Foundation, without reservation, your challenge that we work with the Owners' Representative Board and the staff of the Aga Khan Hospital and Medical College, so that their efforts will be in full support of primary care. Specifically, along with those lines, I intend to encourage our local leadership to establish a department of community medicine in both the medical school and the university hospital. I intend to request the Dean and the Department Head to include primary care curriculum so that proper recognition is given to this subject.

Secondly, during this coming year, I will be asking my health staff at Aiglemont vigorously to pursue a series of selected primary health care interventions throughout our Aga Khan Health Services in the many countries where we serve. While working to enrich and extend primary health care as a whole, I intend to move ahead on specific target areas in a number of issues which will have a high health impact under currently existing conditions. They are obvious to you that I mention and nonetheless: diarrhoeal diseases control (using rehydration); immunisation activity (in collaboration with the World Health Organization expanded immunisation programme); malaria prevention and treatment, and perhaps a number of other areas such as tuberculosis, where a number of you today have made such fundamental contributions.

Thirdly, I am very much encouraged by Dr Mahler's comments yesterday at the Press Conference. Obviously, we here have not written an ultimate manifesto on primary care and hospitals. What we have done is to start a dialogue, and unfolded some of the problems and thorny issues which require mature and enlightened treatment. His useful presentation was brought to mind once again yesterday by Dr Mahler, who mentioned that one of the areas where the World Health Organization could be helpful would be in giving support to a series of specific applied research projects in primary health care and hospitals.

I will ask our Foundation and our Health Boards to keep in touch with WHO on this subject and to see where we can be supportive. More important, I intend to ask our Health Administrators throughout our Aga Khan Health Services to identify those areas of evaluation and applied research which need thought and work. We will endeavour to assist them in moving ahead in these areas as part of our regular operating programme under the Aga Khan Health Services for, as I am continuously reminded, applied research should be an integral part of regular service operations throughout any primary health care system, not just one associated with hospitals.

This seems to be a continuous process and I believe that our Foundation will want to consider holding another meeting of this nature in the appropriately near future. At that time we will be able to share with you our experience in primary health care and hospitals, nursing education, training of health managers and a variety of other issues which are so important in the delivery of health services. In other words, I hope to share with you what we would have learnt from your recommendations, that can play both ways.

Fourthly, I strongly support the creation of a WHO expert committee on primary care and hospitals, and commend Dr Mahler on his leadership in this area, and will look to him for wise advice and counsel when it is formed. If there are things which we can do to accelerate its creation, we would be very happy to cooperate.

Fifth, I was particularly pleased to read Dr Carl Taylor's paper on health service research. It struck me that this is an area within our system which we have, unhappily, almost totally neglected.

Lastly, I will give you my word that what you have said and done here will not go unnoticed throughout our system. The intellectual effort and energy which has been expended this week, in defining specific recommendations and conclusions, which you feel are serious and worthwhile for health professionals, will not be wasted. After internal evaluation, all these recommendations and conclusions will immediately be transmitted throughout our health systems so that your efforts can be applied where they count. I think, probably, the area of greatest importance of impact for us will be the interface between the system and the public.

In closing, I would like to come full circle and return to the inaugural address of President Zia-ul-Haq who opened our proceedings in Islamabad. In a spirit of humility, we need to remind ourselves, that some of the answers that we are seeking and, occasionally, rediscovering in the area of equity, service and coverage, are merely those that we learned as children, and are integral parts of our various religious and cultural heritages.

In the pomp and majesty of the National Assembly, therefore, the President brought us back to the fundamentals. You will remember that he only made one request of us, namely, that we do remember the ends that we are working for, that we must not loose the capacity of treating each other with dignity, compassion and respect. All of you approving this in your work and concern about the fundamental issues, which we have been debating this week, and I thank you. Ultimately, the question we are asking is, whether man will serve all of humanity or only certain segments of it. You are the motivators for the correct answer.

Thank you.

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