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Swiss-Tajik Cooperation: Nearly 20 Years of Primary Healthcare Development

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Swiss-Tajik Cooperation: Nearly 20 Years of Primary Healthcare Development Swiss-Tajik Cooperation: Nearly 20 years of Primary Healthcare Development Ministry of Health and Social Protection of Population of the Republic of Tajikistan Swiss-Tajik Collaboration: Nearly 20 years of Primary Healthcare Development With high levels of poverty and two thirds of its nurses. This was achieved by putting greater people living in rural areas, Tajikistan’s primary focus on practical, clinical skills, communica- health care system and the quality education of tion techniques and providing early exposure its health workers are essential to make health to rural practice realities, with students working care more accessible. The Enhancing Primary directly with patients under the guidance of ex- Health Care Services Project (Project Sino) and perienced colleagues – as is routinely done in the Medical Education Reform Project (MEP) Switzerland. have been committed to the pursuit of Univer- To achieve the health-related Sustaina- sal Health Coverage (UHC) through develop- ble Development Goals, Switzerland promotes ment of the health system and medical educa- UHC through activities that establish social pro- tion reform for close to 20 years. The projects tection mechanisms in health and advocate for are supported by the Swiss Agency for De- access to quality healthcare. SDC in particular velopment and Cooperation (SDC) and imple- supports the drive towards UHC and that atten- Swiss-Tajik Cooperation: mented by the Swiss Tropical and Public Health tion is paid to the needs of the poor, such as the Nearly 20 years of Primary Institute (Swiss TPH). assistance provided in Tajikistan. Healthcare Development The projects were conceived to sup- port, and work directly with, the Ministry of Russia Health and Social Protection (MoHSP), the Re- p. 3 Nearly 20 years of Primary Universal Health Coverage (UHC) Healthcare Development publican Clinical Centre for Family Medicine (RCCFM), the Republican Centre for Healthy p. 4 Project Sino: Primary Health Care UHC is a rallying call for the strengthening of Strengthening Lifestyle (RepHLSC), the Post Graduate Med- health systems that deliver basic, quality care to the most vulnerable populations. UHC is an Building Management Capacity: ical Institute (PGMI), the Tajik State Medical p. 8 investment that affects individuals, communities PHC Management Course University (TSMU) and selected Nursing Col- and even societies as a whole. A healthy society Astana p. 10 Business Planning leges, to make significant strides towards fami- is a more resilient one - one where individuals ly medicine-oriented primary health care (PHC). are able to get an education, be productive at p. 12 Community Engagement their workplace and create a more prosperous The projects have also ensured a sustainable life for their families. Rehabilitation of Facilities Kazakhstan p. 15 partnership between Switzerland and Tajikistan p. 17 Medical Education Reform Project through continued collaboration and improve- p. 18 MEP’s three-pronged ment, and serve as a model for other health approach sector reform initiatives. p. 26 Conclusion The aim of Project Sino is to develop af- Bishkek Uzbekistan fordable and sustainable models for PHC, as Kyrgystan Tashkent well as to build up management competencies in the health sector and strengthen the capaci- Turkmenistan ty of national institutions. The aim of the close- China Ashgabat Dushanbe Tajikistan ly linked, and now concluded, MEP project was to modernise the training of family doctors and Iran Kabul Islamabad Afghanistan India Pakistan 2 Swiss-Tajik Cooperation: 3 Nearly 20 years of Primary Healthcare Development Project Sino: Primary Health Care Strengthening What is Project Sino all about? Why is primary health care strengthening needed? Project Sino supports the MoHSP to achieve its strategic goals in health, promote family med- Tajikistan has made important progress to move icine, and increase the health literacy of the away from the heavily centralised and special- population. In addition to the development of ist-focused healthcare system that existed in appropriate health policies and interventions to the Soviet era, towards a family-medicine ori- strengthen management and improve the qual- ented PHC system. There is now a basis upon ity of care, social participation and community which to build, and the people of Tajikistan can health form an important cornerstone in the es- start to envisage the right to basic health care. tablishment of sustainable and equitable mod- Nonetheless, family medicine remains insuf- els of primary care services. ficiently acknowledged for the critical role in Project Sino seeks the involvement of com- securing population health, with family doc- munity leaders and direct interactions with the tors too often punished instead of praised, and population to engage in their own health. The the PHC system chronically underfunded. Ru- role of district level Healthy Lifestyle Centres ral communities in particular continue to face has been strengthened to provide information healthcare barriers such as stock-outs of med- to the surrounding community. This information icines and other supplies, poor infrastructure, covers a range of issues, including changes re- and deficiencies in the quality of care provided. lating to health reform such as family medicine services, entitlements under the basic benefit package and exemptions and payments relat- What is unique about the ongoing ed to the utilisation of these services. The ca- primary health care reform? pacity built in the local health system structures to work in partnership with communities will The ongoing reform aims to improve the deliv- remain after the projects’ end and opens the ery of PHC through stronger and more trans- chance to expand the programme throughout parent planning processes. In doing so, it seeks the country. to build management capacity at the district Moreover, capacity at national level has and health facility level, and to raise awareness been created so that streamlined, quality re- of resource use. In addition, PHC reform em- sources exist on a variety of health issues in- powers communities to take more responsibil- cluding HIV/AIDS, reproductive health, tuber- ity for their health and facilitates greater health culosis and worm infections. Comprehensive, literacy by supporting the involvement of PHC precise, and timely information of issues with staff in health promotion and disease preven- respect to health, healthcare and prevention tion activities, and overseeing the establish- through information campaigns and media ment of Community Health Teams. coverage are developed and carried out. This In the context of the COVID-19 pandem- could all be leveraged to issue timely informa- ic, the role of PHC has been shown to be more tion about COVID-19, containing the spread of important than ever. PHC can differentiate pa- misinformation and reducing the risk of panic. tients with respiratory symptoms from those with COVID-19, make early diagnosis, help vul- nerable people cope with their anxiety about the virus, and reduce the demand for hospital services. 4 Swiss-Tajik Cooperation: 5 Nearly 20 years of Primary Healthcare Development What is the rationale behind PHC strengthening? An endline survey into out of pocket expenditures for health was conducted in 2019 and compared to a previous survey conducted The goal of Project Sino is that individuals in ru- in 2016. It was designed as a cross-sectional ral areas of Tajikistan enjoy better health thanks community based survey and was conducted in 8 districts. The respondents were adult patients to improved and transparent family medi- that had visited a health centre in the previous cine-oriented primary healthcare services and 3 months. community involvement. By working closely From the total 1,600 interviewed respondents with the MOHSP and its associated institutions, in 2019, the majority were women (88.3%) and both Project Sino and MEP contribute to PHC of median age 31 years old. The main reason for visiting a family doctor was pregnancy strengthening, and in turn the improvement of (44.9%); other highly reported reasons included population health in Tajikistan. cardiovascular (25.9%), respiratory (15.6%), acute digestive (15.0%) and genitourinary The 2017 Demographic and Health Sur- (12.5%) problems and diabetes (14.8%). 82% vey for Tajikistan already showed important im- of respondents reported the prescription of provements in health outcomes for mothers and medicines during the last consultation and from those, every fifth patient (20.8%) received five children – indicators that are highly sensitive to prescriptions or more. Among the prescriptions capacities and quality of care at the PHC level. were a high number of injections and almost half received an antibiotic. It indicated that under-five mortality rates had declined from 51 deaths per 1000 live births in 42% reported to have paid money on a formal the 2003–2007 survey to 33 deaths per 1000 basis at an average cost of $3.2 USD. The majority of patients reported formal fees for the live births in the 2013–2017 survey. According diagnostic tests, however about 15% reported to these surveys, some indicators of maternal payment for the consultation itself. Giving money on an informal basis to the family doctor health have also improved, including the num- was reported by 23.9% with a mean amount ber of antenatal care visits, or births occurring of $1 USD. Even though the rate of informal in a health facility, although there is no infor- payments have increased since 2016 (15.6%), the frequency of informal payments is less than mation regarding perinatal maternal death. This half of the amount reported in the much earlier aside, most of the surrogate markers for health iterations of the survey in 2005 and 2011. reported in the survey had shown an improve- In 2019, 80.2% spent at least some money ment¹. on medicines and medicine prescriptions and the high rate of polypharmacy still requires urgent attention. Community engagement and continuing efforts to make the fee system more transparent remain further important factors for patients to act on their own agency and to demand fair and quality treatment.
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