2019 Assessment of business planning in primary care facilities in Tajikistan Assessment of business planning in primary care facilities in Tajikistan Abstract This report presents the main findings and recommendations of the assessment of the business planning implementation in primary health care facilities in Tajikistan. Since it was introduced in 2005, business planning in Tajikistan has grown into a nationally adopted mechanism for strengthening district and primary health care facility management. In 2019, an assessment took place to evaluate the results of the business planning implementation. The findings revealed that business planning was regarded as an efective managerial tool that improved the health of and relationships with the populations served. The most important outcome of business planning is the reported improved responsiveness to the health needs of the population, especially more vulnerable groups. Implementation of business planning has increased the transparency of the health facilities’ activities and resources and has strengthened the primary care management capacity. Nevertheless, the health system has challenges afecting the success of business planning that need to be addressed for its further success and sustainability in the country. Address requests about publications of the WHO Regional Ofce for Europe to: Publications WHO Regional Ofce for Europe UN City, Marmorvej 51 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 Ofce website (http://www.euro.who.int/pubrequest). Document number: WHO/EURO:2020-1518-41268-56164 © World Health Organization 2020 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). 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In no event shall WHO be liable for damages arising from its use. 2 Cover page photo: © WHO Contents Abbreviations 4 Tables and figures 4 Executive summary 6 Introduction 11 Background 11 Aim of the assessment 18 Methods 19 Qualitative component 19 Quantitative component 22 Findings 25 Community health team perspectives 25 Rural health facility managers and health 30 professionals’ perspectives Perspectives of the district primary health care 38 management teams Policy-makers’ perspectives 42 International partners’ perspectives 43 Analysis of the findings 45 Achievements resulting from business planning 45 Contributing factor one: 46 community engagement Contributing factor two: 46 strengthening health services Contributing factor three: 47 management responsiveness Challenges afecting the success 49 and sustainability of business planning Recommendations 51 Annex 1 Interview protocol for policy-makers 54 Annex 2 Interview protocol for international partners 55 Annex 3 Interview protocol for district primary 56 health care management teams Annex 4 Interview protocol for rural health centre 57 managers Annex 5 Interview protocol for community members 58 Annex 6 Indicators relevant to business planning 59 in primary health care 3 Annex 7 Characteristics of rural health centres 65 Abbreviations PHC primary health care TB tuberculosis Tables and figures Tables Table 1 Introducing business planning in PHC facilities in Tajikistan 13 Table 2 Interviews by district and management position 21 Table 3 Business planning districts involved in other pilot programmes 23 Table 4 List of all health priorities by frequency of reporting during 31 the interviews with managers of rural health facilities Table 5 Percentage change in antenatal services 33 Figures Fig. 1 Districts implementing business planning across Tajikistan, 2018 16 Fig. 2 Total number of visits by business planning districts, 2014–2018 26 Fig. 3 Causes of visits — business planning districts, 2014–2018 28 Fig. 4 Causes of visits — non-business planning districts, 2014–2018 28 Fig. 5 Maternal and child health — business planning districts, 2014–2018 32 Fig. 6 Maternal and child health — non-business planning district, 2014–2018 32 Fig. 7 Maternal mortality rate per 100 000 live births, 2014–2018 39 Fig. 8 Diabetes morbidity in business planning districts and non-business planning 40 district, 2014–2018 Fig. 9 How top-down vertical programmes conflict with bottom-up business planning 48 Fig. 10 Integrated vertical programmes in primary health care 52 4 Acknowledgements This report has been prepared by the WHO European Centre for Primary Health Care of the Division of Health Systems and Public Health under the guidance of WHO Regional Director for Europe Hans Kluge. The assessment is the result of the shared commitment and technical contributions of the Ministry of Health and Social Protection of the Population of the Republic of Tajikistan, the WHO Regional Ofce for Europe through the WHO European Centre for Primary Health Care in Almaty and the WHO Country Ofce in Tajikistan, and the Representative Ofce of the Swiss Tropical and Public Health Institute in Tajikistan/Enhancing Primary Health Care Services Project in Tajikistan (Sino Project). The assessment has been completed under the oversight of Dilorom Sadykova (Ministry of Health and Social Protection of the Population of Tajikistan) and Gulara Afandiyeva (Representative Ofce of the Swiss Tropical and Public Health Institute in Tajikistan/ Enhancing Primary Health Care Services Project in Tajikistan). Authors Brett J. Craig, Consultant, WHO Regional Ofce for Europe Zulfiya Pirova, Technical Ofcer, WHO European Centre for Primary Health Care Farrukh Egamov, Consultant, WHO Regional Ofce for Europe Arnoldas Jurgutis, Consultant, WHO Regional Ofce for Europe Rhys Lewis, Consultant, WHO Regional Ofce for Europe Technical review Ayesha De Lorenzo, WHO European Centre for Primary Health Care Anne Johansen, WHO European Centre for Primary Health Care Sabine Kiefer, Swiss Tropical and Public Health Institute Juan Tello, WHO Regional Ofce for Europe Other contributors Nasrullo Abdujabborov, Representative Ofce of the Swiss Tropical and Public Health Institute in Tajikistan/Sino Project; Ilkhom Bandaev, Republican Family Medicine Clinical and Training Centre; Mouazamma Djamalova, Swiss Cooperation Ofce in Tajikistan; Bunafsha Dzhonova, Republican Family Medicine Clinical and Training Centre; Zarofat Hamidova, Representative Ofce of the Swiss Tropical and Public Health Institute in Tajikistan/Sino Project; Gulzira Karimova, Representative Ofce of the