Case Synopsis

Access to Quality Care through Extending and Strengthening Health Systems (AQCESS) is an Aga Khan Development Network (AKDN) initiative that works in partnership with underserved populations in Kenya, Pakistan, Mali, and Mozambique to improve maternal, newborn, and child health. The project targets regions and populations where MNCH indicators such as maternal mortality, under-five mortality, and stunting rates are particularly high. In these regions, women and children still lack access to essential, quality health services. AQCESS projects help reduce maternal and child mortality in targeted regions by focusing on improving delivery of essential MNCH health services, improving utilization of essential MNCH services by region, and improving dissemination of MNCH information and evidence.

Rachel Pell, a Program Manager at Aga Khan Foundation Canada, is approached by a private donor who has seen the positive outcomes of the AQCESS intervention in Kilifi, Kenya. He wants to donate to the Aga Khan Foundation Canada to expand the project to other East African countries, specifically to Tanzania and Uganda, in which AKDN is already present. Rachel realizes that not all communities in these countries have a need for AQCESS. Consequently, she has to prepare a needs assessment to help determine which areas, if any, need such a program. Her goal is to research and identify statistics on the health status in Tanzania and Uganda to determine their health care requirements and present these results to the donor.

Rachel decides to prepare a community health needs assessment plan, focusing only on steps one to four and not on the full nine-step evaluation. By focusing on these specific steps, Rachel can collect the relevant information she needs to analyze and make conclusions about the regional health care requirements. Along with determining whether Tanzania and Uganda need a project such as AQCESS, Rachel must use the available data to determine which specific regions have the highest need.

Case Objectives

1. Select appropriate data collection methods appropriate for a specific public health context.

2. Interpret the results of data analysis for public health practice.

3. Apply systems thinking tools to demonstrate need in a given public health context.

4. Assess various determinants and factors to determine which regions are more in need.

Case Study Questions

1. What types of statistics are needed to make an informed decision and where can they be found?

2. What information is already available?

3. What information is still needed?

4. What determinants or factors should be researched in order to determine which regions in Tanzania and Uganda are in need?

5. Which areas are similar, in terms of health and MNCH statistics and demographics, to the ones AQCESS is currently serving?


Maternal, newborn, and child health; health systems strengthening; international development; primary care; sexual and reproductive health and rights

Additional Author Information

Rukhsar Jetha, BHSc, MPH

Rachel Pell, BA, MSc, Program Manager, Health

Fawad Akbari, MD, MPH, Senior Program Manager, Health

Amardeep Thind, MD, PhD, Professor



Recommended Citation

Jetha, R., Pell, R., Akbari, F. & Thind, A. (2019). AQCESS: Access to Quality Care through Extending and Strengthening Health Systems. In: Sibbald, S.L. & McKinley, G. [eds] Western Public Health Casebook 2019. London, ON: Public Health Casebook Publishing.