Maternal and Child Health Integrated Care Project (RRP TAJ 51010)
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Maternal and Child Health Integrated Care Project (RRP TAJ 51010) DEVELOPMENT COORDINATION A. Major Development Partners: Strategic Foci and Key Activities 1. Multilateral and bilateral development agencies have been very active in Tajikistan’s health sector since the mid-1990s. The initial and continuous efforts to rehabilitate and reform the post-civil war health system was supported by the Asian Development Bank (ADB), the European Union (EU), German development cooperation through KfW, Japan International Cooperation Agency (JICA), United Nations (UN) agencies, the United States Agency for International Development, the World Bank, and other major international partners. The government defined primary health care (PHC) as a key focus area for the initial round of reforms in the early years of the millennium, and multilateral development partners have since primarily supported PHC infrastructure development. 2. Development partners then began a gradual shift toward rehabilitating hospitals and improving hospital service delivery. This would go together with reforms in health financing and governance in a further devolution of the health system, in line with the government’s decentralization process. Although administrative and budget-allocation functions were delegated to regional health and local government authorities, decision-making related to sector policy and standards is still retained by the Ministry of Health and Social Protection of the Population of the Republic of Tajikistan (MOHSPP), necessitating development partners’ attention to introducing output-based payment systems and facility autonomy. Major Development Partners, 2012 to present Development Project Name Duration Amount Partner ($ million) Prevention of Communicable Diseases USAID TB control, Feed the Future 2014–2020 30.0 World Bank Health Services Improvement Project 2016–2017 2.5 WHO/GFATM HIV/AIDS, Tuberculosis 2018–2020 31.5 UNODC Central Asia program on HIV advocacy 2016–2018 0.09 UNAIDS HIV prevention program 2016–2018 0.9 IOM Strengthening of cross border TB control for 2016–2018 0.2 labor migrants US CDC Strengthening the Republican HIV and 2017–2019 0.8 Narcology centers PSI USAID-funded project on HIV in Central Asia 2017–2021 9.1 MSF HIV & TB prevention (children and family 2017–2018 2.5 members) in Kulyab district of Khatlon Maternal and Child Health KfW Modernization of Regional Hospitals 2012–2018 44.6 (maternity) JICA MCH 2 2017−2021 4.9 Save the children Improving MCH services at the PHC level in 2017–2018 0.5 Vahdat, Varzob & Tursunzoda World Bank Health Services Improvement Project 2013–2019 33.0 UNICEF Immunization, MCH, IMCI 2016–2020 15.0 GIZ Support of MCH 2016–2019 7.5 UNFPA Reproductive Health Project and Gender equality program 2 Development Project Name Duration Amount Partner ($ million) Health Financing World Bank Health Services Improvement Project 2013–2019 33.0 EU Technical Assistance on health reforms 2015–2018 4.0 Family Medicine World Bank Health Services Improvement Project 2013–2019 33.0 SDC Family Medicine Project in GBAO 2013−2021 15.0 Nutrition GIZ Nutrition project 2016−2019 3.0 UNICEF Nutrition, Scale up Nutrition Project 2016–2019 1.6 USAID Nutrition Project 2015–2020 13.1 EU = European Union, GBAO = Gorno-Badakhshan Autonomous Oblast, GFATM = The Global Fund to fight Aids, Tuberculosis and Malaria, GIZ = Deutsche Gesellschaft für Internationale Zusammenarbeit (German Corporation for International Cooperation), IMCI = integrated management of childhood illnesses, IOM = International Organization for Migration, JICA = Japan International Cooperation Agency, MCH – maternal and child health, MSF = Médecins sans Frontières, PHC = primary health care, PSI = Population Service International, SDC = Swiss Agency for Development and Cooperation, UNAIDS = The Joint United Nations Programme on HIV/AIDS, UNFPA = United Nations Population Fund, UNICEF = United Nations Children’s Fund, UNODC = United Nations Office on Drugs and Crime, USAID = United States Agency for International Development, US CDC = United States Centers of Disease Control and Prevention, WHO = World Health Organization. *last ADB project was in 2004-2009 Source: Ministry of Health and Social Protection of Population of Republic of Tajikistan. B. Institutional Arrangements and Processes for Development Coordination 3. The Development Coordination Council (DCC) was established to ease information exchange and collaboration within the development community, as well as foster dialogue on shared priorities with the Government of Tajikistan. The DCC functions as development partners’ coordination mechanism with the government, in support of the National Development Strategy 2016–2030 and the Mid-term Development Strategy 2016–2020.1 The chair of the DCC serves as the spokesperson for development partners at formal meetings with the government and is the official point of contact on general coordination matters. The heads (or in their absence, deputies) of 28 bilateral, multilateral, and UN agencies are the DCC members. 4. Since 2010, the DCC has intensified efforts to improve donor coordination and interaction with the government, working closely with the Ministry of Economic Development and Trade, the State Committee on Investments and State Property Management, the Executive Office of the President, and the Economic Advisor to President. Currently, foreign aid for development in Tajikistan involves about 80 partners, from bilateral and multilateral donors to nongovernment organizations. Since the Paris Forum in 2005, Tajikistan has actively participated in international dialogue on aid effectiveness.2 5. Tajikistan joined ADB in 1998 and by the end of 2016, ADB had approved more than $1.5 billion in concessional loans, grants, and technical assistance to the country. ADB’s country partnership strategy, 2016–2020 for Tajikistan focuses on improving infrastructure, reforming the investment climate, and increasing food security.3 ADB contributed to the development of health care in the country. Its last major intervention in the health sector was the Health Sector Reform Project in 2004–2009. It had three outcomes: (i) management capacity and system efficiency of 1 Development Coordination Council homepage: http://untj.org/dcc/. 2 State Committee on Investment and State Property Management website: http://investcom.tj. 3 ADB. 2016. Tajikistan Country Partnership Strategy 2016-2020. Manila. 3 the health sector improved through institutional strengthening and reforms; (ii) equitable access to and use of high-quality basic health services by the poor, women, and children increased; and (iii) informed policy dialogue to pursue reforms supported. The project’s support for PHC made health service delivery more efficient and was consistent with Tajikistan's National Development Strategy. C. Achievements and Issues 6. Development partners’ health working group (under DCC’s Human Development cluster) and the maternal and child health (MCH) working group of MOHSPP largely informed the design of the proposed ADB project. The design is well aligned with the main development partners’ work in the health sector. Close coordination is especially envisaged on the following components: (i) Hospital infrastructure development will be financed by ADB and KfW in ongoing projects in different districts of the country, and both partners will promote rationalization of bed capacity, infrastructure improvement, provision of MCH care equipment, and staff training. (ii) Case-based payment system. ADB will share with KfW the concept for case- based payment system to be piloted in the hospitals financed under the ADB project. Subject to the discussion with the government, KfW is envisaging to introduce case-based payment system in the hospitals supported under the KfW programs. ADB project will be collaborating with the World Health Organization and the World Bank on national policy dialogue. (iii) National maintenance concept. A national equipment maintenance system will be developed by a working group established by MOHSPP and supported by Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), KfW, and JICA. KfW is planning to contribute to the national maintenance concept by supporting the establishment of an electronic equipment inventory system. ADB will support equipment inventories in project districts and will finance training of maintenance specialists in project hospitals. (iv) Continuous quality improvement and supportive supervision. Based on continuous quality improvement and supportive supervision pilots supported by the United Nations Children’s Fund (UNICEF), the ADB project will promote the institutionalization of such systems across the country. (v) Building the capacity of the maternal and child health workforce. The ADB project will, jointly with UNICEF, work on developing a comprehensive training program covering the full cycle of MCH services at all levels of the health system in project districts. (vi) Planning and development of health human resources. The project will expand the health human resource registry developed with EU support and build the organizational capacity of the Science and Human Resources Department of MOHSPP. (vii) Behavior change communication. Based on the MCH handbook concept introduced by JICA and incorporating lessons from its pilot, the project will extend the coverage of the MCH handbook to ADB project districts. D. Summary and Recommendations 7. The project provides an excellent opportunity to build on ADB’s previous experience in advancing health sector infrastructure and financing reform, leverage technical expertise from other partners, and ensure that this project fits well with the government’s program and agenda 4 as well as with ongoing development partner activities and initiatives. The project will help ADB to take a lead role in assisting MOHSP in further reforming hospital system financing, quality of care, and infrastructure. .