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Event - 1982-11-25
Thursday, 1982, November 25
Aga Khan IV (H.H. Prince Karim)

Honourable Minister,
Distinguished Guests,

Ladies and Gentlemen.

It gives me great pleasure to be here today for a ceremony which both celebrates the Silver Jubilee of my accession to the Imamat of the Ismaili Muslim Community and underlines the service we are providing to other communities in Tanzania. I am only sorry that 'Natural Causes' have caused the demise of the ceremony at the Aga Khan Hospital itself. Nonetheless it is good news that the Hospital is being extended because the demand for its outpatient services far outstrips present cap

I warmly welcome the Honourable Minister's confirmation that this expansion is in keeping with Government policies and the appreciation he expressed for the Ismaili Community's Health Care activities in Tanzania. Our health services have indeed a long and honourable history in this country, as Mohammed Shivji has outlined. He has given us some statistics, which showed graphically how high demand is for the medical services we provide. I will only add that I am told this demand is certain to increase dramatically. We are budgeting for over 251,000 out-patients in 1983 of whom 95,000 will attend this hospital, largely urban poor from the expanding suburbs of the city.

In 1979 the population of the Dar es salaam Region was estimated at 932,000 and had increased by four and half times over the previous 30 years. Assuming the Government's de-centralisation plans are successful, it will be two and half million by the end of the century. If there were no such plans, historical growth patterns would bring it to four million.

Set against this background, increased outpatient facilities are a necessity. As all of you who are connected with this hospital are well aware, the outpatient departments are already congested and we risk a deterioration in the quality of the care given if they are not expanded soon. The Aga Khan hospital is generally recognised as one of the foremost medical institutions in the city and it is vital for us to maintain our standards.

Accordingly the Jubilee project I am proud and happy to inaugurate here today will provide space for the expansion of outpatient and diagnostic work. At the same time there will be renovation and rehabilitation of other areas of the hospital, with the installation of new equipment. I have read the full project proposal and wish to pay tribute to all those who participated in preparing it, as I consider it to be one of the most complete proposals I have received for many years.

I was interested to read the President's speech at Moshi last week, when he emphasised that 'Creating a good health service is a question of balance'. The problem, as the President explained, is the problem of how to allocate limited resources between all the different requirements of a health service, including hospitals, health centres, mobile clinics, dispensaries, and health education.

This is, of course, a problem to which the Aga Khan Health Services have addressed themselves ever since they were initiated by my Grandfather, Sir Sultan Mohammedshah Aga Khan, in the 1880s. There will always be limits on what we can do and priorities to be established. My Grandfather attached great importance to the prevention of diseases. This and the improvement of public health have been major aims of our health services ever since. As the health Minister Dr. Aaron Chiduo, pointed out at recent 6th Plenary Meeting of the 35th World Health Assembly,'prevention is better, and in most cases cheaper, than cure ..... and is vital to solving a community's problems in the long run'.

In recent years we have become more and more concerned with the inter-action between hospitals and smaller institutions, especially at the level of primary health care.

Last November, Aga Khan Foundation sponsored an international conference jointly with the World Health Organisation on the role of hospitals in primary health care, because an increasing number of people feel that the hospitals in the Third World are not having as much impact as they could on primary health. The aim of the conference was to concentrate the best professional medical thinking on this question.

One conclusion reached by the conference was that there must be political commitment to primary health care. That is, of course, completely the case here in Tanzania, whose Governmental health efforts have been the envy of other African Nations. Other conference conclusions dealt with the support hospitals can give to primary health care programmes and the co-ordination which is necessary between hospitals, health centres, primary care workers, and the community.

Accordingly we shall be appointing a Director of Primary Health Care as a Member of our hospital staff here to liaise the seven Aga Khan Medical Centres up-country.

Both this appointment and the extent of the hospital conform to an important condition imposed by my Grandfather on all his Jubilee projects; namely that they must be of benefit not only to our community, but to humanity at large, which in this context means the Tanzanian Nation. Here I would like to mention that already 91% of the out-patients we treat are non-Ismailis.

I am glad that this hospital has become an integral part of the Government's Health service in various ways, drawing on the wide experience we have acquired in the developing countries. I am a great believer in transferring knowledge from one institution to another, from one country to another. Today our operations in the Third World include numerous programmes in health education, immunisation, child health, the training of para medicals as well as other aspects of the local care and preventive medicine; Our facilities include 112 health centres and sub-centres, 18 dispensaries, 5 child health care centres, 4 maternity hospitals and 4 multi-speciality hospitals. These include the hospital and medical college currently under construction in Karachi.

With this background of activity and experience we are in a position to assist Government, not least by bringing in technical and management expertise, as well as providing equipment and supplies, often utilizing our own foreign exchange. As Mohammed Shivji observed, we enjoy a high level of co-operation with International Agencies and I must warmly echo his tribute to UNICEF (whose representative I am pleased to see here today) which helps provide us with essential drugs and medicines.

There is, as you all know, a severe shortage of trained professional manpower in the social welfare sector in Tanzania. The Aga Khan health services are in a position to recruit - and do recruit - expatriates to fill some of the gaps. But this is hampered by many problems, lack of housing among them. In any case it should not be a long term solution. More locally trained professionals, administrators as well as doctors, are urgently needed.

In the meantime, we are making ever greater demands upon volunteers to maintain the standards of administration which we believe essential. The Honourable Minister paid tribute a few minutes ago to the dedication, discipline, hard work and kind heartedness of workers in voluntary agency hospitals. In whatever we do, at whatever level, we have always been reliant upon volunteers. I would like to leave you with a final thought. It is that, especially in today's difficult circumstances, we must never lose sight of nor undervalue the secret of our Aga Khan Network's success, the element which underpins its professionalism. The heart and lifeblood of our network is the Voluntary Workers; the Boards, the Committees, the Volunteers young and old who contribute their time and efforts. Believe me that your work has not gone unnoticed. Without it there would be no Aga Khan Hospital and I would not be here today to share with you the happy moments of inaugurating this much,much,needed extension.

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