MINISTRY OF HEALTH Health Assessment for Tajikistan NOVEMBER 2008 THE HEALTH CLUSTER LEAD BY WORLD HEALTH ORGANIZATION – TAJIKISTAN COUNTRY OFFICE IN COLLABORATION WITH THE MINISTRY OF HEALTH OF THE REPUBLIC OF TAJIKISTAN WITH SPECIAL THANKS TO: UNFPA MERCY CORPS MEDICAL TEAMS INTERNATIONAL Address requests about publications of the WHO Regional Office for Europe to: Publications WHO Regional Office for Europe Scherfigsvej 8 DK-2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office web site (http://www.euro.who.int/pubrequest). © World Health Organization 2010 All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. 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However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The views expressed by authors, editors, or expert groups do not necessarily represent the decisions or the stated policy of the World Health Organization. Table of Contents I. Introduction INFRASTRUCTURE Survey Objective …………………………………………….……. 3 Available resources …………………………………….……… 17 Availability of water ASSESSMENT METHODOLOGY ……………………………… 3 Power supplies to facilities Guiding Principles Heating systems Data collection. Alternative heating stocks Standard measures Sanitation Limitations Food stocks Study coverage Essential medical equipment II. Context and Background Availability of drugs and consumables Availability of consumables Country profile …………………………………………………….. 6 Personnel Demographics History of disaster HEALTH PROFILE Winter‐crisis/Compound crisis Mortality ……………………………………..…………………….. 21 Role of the State Morbidity Stakeholders and development assistance Outbreaks Possible scenarios for the near future Trends in morbidity Early Warning Capabilities Vaccination coverage Performance of health facilities HEALTH STATUS OF POPULATION Functioning of sectors and sub‐sectors Main causes of mortality ……………………………………. 10 Nutrition IV. Analysis Morbidity Affected population……………………………………………. 24 Diarrhoeal disease Ongoing impact of the compound crisis/ Measles Lessons learned from the winter crisis………… Acute respiratory illness Needs and resources Malaria Capacities HIV Current Reponses FACTORS CONTRIBUTING TO ILL HEALTH CONCLUSIONS AND RECOMMENDATIONS Environmental health ……………………………………….… 12 Impact of current conditions ………………………..……. 26 Food security Current state of the health delivery system Poverty Disabled access Climate/temperature Continuing or emerging threats Shelter/housing Immediate health gaps Livelihoods and employment Response strategy Education Forthcoming reports Health services performance EMS, emergency care and referral services ANNEXES ………………………………………………..………….. 32 Human resources Availability of drugs and supplies Skilled birthing/maternal care III. Survey Results AVAILABLE RESOURCES Physical access ……………………………………………….... 16 Medical transport Communication Community health Planned activities/ Current humanitarian interventions Tajikistan Rapid Health Assessment, October – November 2008 I. Introduction Survey Objective: The Rapid Health Assessment was initiated on the behalf of the Health Cluster to establish systemic links between three categories of health needs ‐ health risks, available health care, and health status ‐ and to define the possible role of humanitarian aid to improve the health status of the affected population, addressing its determinants in a systemic way1. We will illustrate and differentiate between basic emerging needs (not covered owing to the limited or decreased capacity of health services), pre‐existing needs that are exacerbated by the disaster (e.g. infrastructure) and additional needs created by the disaster (e.g. injuries). The assessment concentrates on Primary Health Care and Emergency Services, in particular access to care; infrastructure (energy/electricity and water supply and structural/functional resilience); mother and child malnutrition and illness; morbidity and mortality related to communicable diseases; health care management, performance and human resources; provision of medicines and medical commodities; coordination and disaster readiness. The assessment will yield evidence based data on the current public health profile and operational situation for an up to date analysis of the current challenges and gaps faced by the health sector as a whole and its ability to provide patient care services during an emergency. This information and analysis is provided to support the on‐going planning and response efforts of the MoH RT and the Health Cluster partners. We intend to answer the following questions: What has happened? Is there an emergency situation and, if so, what are its key features? How has the population been affected by the emergency? Are interventions required to prevent further harm or loss of life? If so, what are top priorities? What are continuing or emerging threats that may escalate the emergency? What resources and capacities are already present (e.g., infrastructure and institutions) that could contribute to the response, and what are the immediate capacity gaps? ASSESSMENT METHODOLOGY Guiding Principles: The health sector assessment was designed in such a way as to include a review of existing information, interviews and observations: cover the whole country, focusing the analysis on the current situation in Tajikistan; to yield valid evidence on the current operational situation; report on health status and risks, health resources (including services being delivered), health system performance, and the progress and effectiveness of health responses; pay particular attention to the key and critical health care facilities and their ability to function in crisis; provide up to date information as a follow‐up to the recent Multi‐cluster Assessment; use a recognized survey tool, the IASC RHA questionnaire, with situation specific modifications was used with format modifications for ease of data entry and modifications and additions in collaboration with the MoH and agency partners (Annex 12); follow a purposive sampling approach based on well‐defined criteria; involve the MoH RT and International Health Cluster partner agencies in questionnaire development, assessment interviews and analysis; identify varying levels of severity for comparison and targeting purposes; make the analysis relevant for decision‐making and programming. 1 Global Health Cluster Rapid Health Assessment, M. Michael, February 2007 4 Tajikistan Rapid Health Assessment, October – November 2008 Data collection: Field interviews began with questionnaire testing, which resulted in the format modifications; questionnaires were available in Russian. All interviews were conducted by WHO, UNFPA, Mercy Corps, Medical Teams International and MoH staff; who received specific instruction and briefings on the process. Chief Doctors (or their Deputies if not available) were interviewed along with chiefs of clinical care and administrative managers. The survey was conducted during the end of October into November 2008. Limitations: There are certain limitations regarding the data sources and the background documents that have been consulted and used for this assessment. The format of the questionnaire and RHA method tends to be more qualitative than quantitative, and therefore subject to biases, measurement errors and the pitfalls of convenience sampling. For example one of the biggest limitations of the survey was that people who collected data were often not familiar with what should be in place and could not use “observation” technique, e.g. medical waste management. Chief Doctors expressed their opinion; it was not based on observation of facts by someone familiar with what medical waste management should be.The quality of medical and demographic information is partially of insufficient reliability. The available country information is generally limited due to the lack of sophisticated information systems and the limited local capacity. Time and travel distances limited access to some areas. Study coverage: The analysis presented is based on the data of 107 questionnaires, which have been filled out in the framework of the rapid assessment of the access of population to health services, population health profile and effectiveness and