"These reforms are extremely important and if they work successfully they will produce more efficient, better quality health services, and empower the population to take greater responsibility for their health," Ed Harris, the country director for ZdravPlus, a foundation working on health-care reform, told IRIN from the capital, Dushanbe, on Wednesday. ZdravPlus has recently started training specialist doctors to become general practitioners able to offer a wider range of health services.
After independence, the Tajik government was unable to mobilise adequate fiscal resources to maintain the same scope of health services, and the health status of the population worsened. Major factors contributing to the decline include malnutrition, deteriorated living conditions, a reduction in government expenditure on health, migration of health workers, lower levels of immunisation, destruction of hospitals during the civil war and lack of safe drinking water. Incidence of infectious and poverty-related diseases such as typhoid, diarrhea, and tuberculosis has increased.
Tajikistan also has too many specialist doctors - this dates back to the days of the Soviet Union when well-staffed hospitals and clinics led to a diverse range of services that today are no longer sustainable.
The 11-month training programme, which started in January, is taking place at the postgraduate medical institute in Dushanbe. "The idea is that we train trainers who will in turn train others around the country, broadening their areas," Harris said. This, he said, was a key component of the health ministry's reform programme, placing greater emphasis on family medicine. "This will enable greater equity, responsiveness, quality of care and access," he noted.
In addition to this, there would be an emphasis on genuine participation. "We want to enable communities to apply for small grants so they can address health problems that are relevant to them," he said. Raising awareness of narcotics was also on the programme.
The launch of the reform programme follows the appointment of a new Tajik minister and deputy ministers of health in January. The need to turn specialists into family doctors in a country where health services are limited and the national health budget has only allocated US $0.8 per person per year is crucial. "There is an urgency also to look at financial sustainability in order to have a sustainable health-care system," the humanitarian affairs officer for the UN Office for the Coordination of Humanitarian Affairs, Paul Handley, told IRIN from Dushanbe.
This view is shared by Harris. "The levels of financing available to the health sector have plummeted since 1990," he said, adding that ZdravPlus would also help the government to improve the economic efficiency of its health system.
Commenting on how long it would take before changes would be felt in the health system, Handley said it was a gradual and transitional process. While it was clear that Tajikistan would continue to require assistance for health facilities in the coming years, the new move was an encouraging sign for aid workers. "Tajikistan has been heavily dependent on humanitarian aid in the health sector for a very long time now, and this is one step closer for the authorities to take this issue into their own hands," he added.
[This Item is Delivered to the "Asia-English" Service of the UN's IRIN humanitarian information unit, but may not necessarily reflect the views of the United Nations. For further information, free subscriptions, or to change your keywords, contact e-mail: IRIN@ocha.unon.org or Web: http://www.irinnews.org . If you re-print, copy, archive or re-post this item, please retain this credit and disclaimer. Reposting by commercial sites requires written IRIN permission.]
Copyright (c) UN Office for the Coordination of Humanitarian Affairs 2003