Rendering of the planned 100-acre site.

Planning continues for academic system development in Pakistan

Saturday, November 15, 2008

In recent months Partners Harvard Medical International has helped move forward a complex new health care and education development in Pakistan. The Federal University of Health Sciences, planned for a 100-acre site outside of Islamabad, is envisioned as a world-class academic medical campus that will include colleges of medicine, nursing, dentistry, and allied health, as well as research facilities and a 350-bed teaching hospital.

The project is being backed by the Defence Housing Authority Islamabad (DHAI), a group focused on infrastructure and land development in Pakistan. DHAI is working in cooperation with the Overseas Management Group (OMG) and the Higher Education Commission (HEC) of Pakistan to develop the academic and health care vision of the project. Leadership from DHAI, along with members of a project task force made up of experts from various institutions in Pakistan, have worked closely with PHMI on the initial planning.

“In creating a state-of-the-art academic medical center, this project will address health care, research, and education needs of the region and nation, and we hope that it will become a recognized center of excellence beyond the borders of Pakistan,” said Tom Aretz, MD, Vice President of Global Programs at PHMI. “We are convinced that the present first phase of the project will only be the beginning and that the university, the hospital, and its associated research and education community will grow for the foreseeable future.”

Although in recent years Pakistan has made considerable improvements to its general infrastructure, many in both urban and rural areas still live in unsanitary conditions or lack access to reliably safe drinking water. Certainly the majority of the country’s 150 million people still do not have access to high-quality, affordable care. The Aga Khan University Hospital in Karachi is accredited by Joint Commission International, but currently there is no match for it in the northern part of the country where the DHAI project is based.

There is a dire shortage of well trained health care professionals as well—paradoxically, unemployment is high among physicians, largely due to inadequate investment in local health care systems. Seeking better prospects, large numbers of Pakistan-trained physicians continue to leave to practice in other countries. A study published in the New England Journal of Medicine in 2005 (Mullan) found that Pakistan was the third-ranking source of foreign trained physicians for both the United States (more than 9,600 physicians) and the United Kingdom (more than 2,600). Pakistan also has one of the lowest nurse-to-population ratios in the world: fewer than one nurse for every 1,000 people, according to the World Health Organization’s 2004 survey. This is in stark contrast to the likes of the United Kingdom (12:1,000 ratio) and the United States (9:1,000 ratio) and behind many of the poorest nations in Africa, Asia, and Latin America.

Meanwhile Islamabad and sister-city Rawalpindi are growing rapidly, with population growth around five percent per year (as compared to under two percent in the rest of the country). The leadership of DHAI hope that through the Federal University of Health Sciences, they can not only foster high-quality care, but also provide an attractive venue for practice and research, and serve as an engine for workforce development, particularly in the area of nursing, as well as biomedical research and industry.

During the summer PHMI hosted two delegations from Pakistan who came to Boston to work through important components of the project’s strategy. One of the primary objectives of these visits, said PHMI Director Lorain Matthews, AIA LEED AP, was to “create a roadmap for the process going forward.”

The project task force convened in July to visit several exemplary health care centers in the Boston area, including the Yawkey Outpatient Center at Massachusetts General Hospital, the new simulation center at Beth Israel Deaconess Medical Center, and other clinical and educational facilities. They also toured the campus of the University of Massachusetts Medical Campus, which served as an excellent example of the type of integrated campus environment that DHAI is planning to create.

During these visits, the PHMI team worked with the task force to identify and define the myriad priorities associated with the project, including everything from the need to recruit academic and clinical leadership and develop systems for governance and decision-making, to the need to prioritize the development of the campus’s many components. The PHMI team then worked with the leadership team to order these priorities and identify required resources and key action steps required in the immediate, medium, and long term.  

PHMI and DHAI achieved a major project milestone by reaching consensus on the master plan for the campus, which will be located in a greenfield site on the outskirts of Islamabad near the twin city of Rawalpindi. Matthews explained that they are attempting to create an environment that maximizes synergies between the hospital, colleges, and research facilities, and also fosters a sense of community that integrates retail, residential, and campus developments in a unique natural landscape.

The design of permanent facilities for the nursing and medical colleges is expected to commence in early 2009, with Sasaki Associates selected by DHAI to lead the design. DHAI plans to open the nursing college in a temporary facility for 50 students in fall 2009, and the medical college is slated to welcome its first class in 2012. Ellerbe Becket, which worked closely with PHMI on the design of the University Hospital in Dubai, will lead the design of the teaching hospital, starting in early 2009. DHAI plans to open the hospital in early 2013.