Tajikistan: All for Health Issue January/February 2000

Report
from World Health Organization
Published on 29 Feb 2000
Compiled and circulated by the World Health Organization with support from the European
Roll Back Malaria Partnership Meeting

On 11 January 2000, a Roll Back Malaria Partnership Meeting was held. It was the first response of Republic of Tajikistan and its partners on WHO appeal "Roll Back Malaria". Representatives of all Governmental Organizations and NGOs accredited in Tajikistan, and also representatives of some CIS countries were invited to this meeting. The meeting was chaired by the Minister of Health, M. A. Akhmedov, and co-chaired by Professor L. Ivanov, Head of the WHO Office.

Ms N. Sharopova, Deputy Prime Minister of Tajikistan, welcomed all those present and opened the meeting. The main objectives of the meeting were:

To review technical and operational modalities for dealing with malaria and results achieved in the context of the National Programme of Tropical Disease Control (Malaria) in Republic of Tajikistan during 1999 -1999.

To develop a joint action plan for malaria control in the context of the National Programme of Tropical Disease Control ( Malaria ) and RBM Initiative in Republic of Tajikistan during 2000 - 2001.

To promote partnership among Government of Tajikistan/National Programme of Tropical Disease Control, EURO/WHO, EMRO/WHO and other UN agencies, international NGOs, research institutions, the media and other partners/donors as well in implementing cost-effective but technically sound and sustainable malaria control adapted to the country's conditions and responding to local needs.

Efficient proposals were made by Academician A. Lisenco (Russia), Mr A. Ahmedov (Minister of Health), Mr Tairov (Deputy Chairman of Hukumat in Kofarnigon), Dr Babadjanov (SES, Leninabad), Mr S. Kurbanov (UNICEF), Mr P. Marchant (ACTED) Dr N. Guliamovich (Khatlon area), Ms J. Bosscher (ECHO), and others.

The Roll Back Malaria (RBM) project was discussed and approved by the participants. It encouraged the partners to agree on common goals, synchronize their strategies and work together to reduce suffering from malaria. It was accepted that the implementation of the RBM Project in Tajikistan will be a collaborative effort of WHO, ECHO, UNICEF, WFP, ACTED, MERLIN and other partners in cooperation with the Ministry of Health.

The participants adopted the Dushanbe Declaration of Malaria.

Pharmaciens Sans Frontières :Committee International Mission

The non-governmental humanitarian organization "Pharmaciens Sans Frontières Committee International" (PSFCI) based in France was created in 1985. It was the initiative of five French pharmacists to distribute medicines to the some of the most vulnerable populations of the world. The organization works in the field in two ways: emergency missions and development missions.

Pharmaciens Sans Frontières Committee International began its work in Tajikistan in 1995. There are three bases (Dushanbe, Khojend and Khorog) operating in the regions of Dushanbe city and Region under Republican Subordination, Leninabad oblast, GBAO and Karategin valley. The main activities of the organization are:

  • Distribution of essential drugs and medical materials free of charge to hospitals and medical points.
  • Support of production of IV fluids. PSFCI provides raw materials, packaging items,analytical reagents and technical assistance to a laboratory on each base.
  • Training in different fields: drug management for proper management of pharmacies in hospital structures, seminars on antibiotherapy and hospital hygiene.
  • Introduction of training doctors in some hospitals to work in closer collaboration with the hospital doctors to enforce the policy of rationale drug use.
Currently, approximately 250 structures in the Republic of Tajikistan are benefiting from assistance provided by PSF CI, thanks to the funding support by the European Community Humanitarian Office (ECHO).

As pharmacists with experience in different countries around the world, PSF CI staff are always willing to provide aid and support appropriate to the specific requirements of the health system in the Republic of Tajikistan. PSF CI works in close collaboration with the Ministry of Health, the health care reform system groups organized by the Ministry of Health, WHO, and other international organizations.

The goal of PSFCI is to meet the immediate requirements of the population and to be able to provide sufficient aid tools and techniques to encourage the hospital care system to be self-reliant.

UNDP/UNOPS/RRDP
Health agencies in action

UNDP/UNOPS/RRDP work in various sectors, including the health and sanitation sector. One of the largest sub-projects in recent times was the rehabilitation of the Kulyab City Canalization System.

This provides the population with an additional 12.8 thousand cubic meters of clean drinking water per day. However, this has resulted in further straining of the city sewage system that was already severely overloaded and is now nearing collapse.

The Water Purification and Sanitation System in Kulyab City and District has taken on the rehabilitation and completion of the Kulyab City sewage canalization and water purification systems. This system complements the Kulyab City Water Supply System in eliminating the main causes of the sanitary crisis by drastically reducing the incidence of water-borne diseases. The Government at both central and local level, as well as the population of Kulyab, have identified this work as their main priority.

During the civil war years of 1992 and 1993, the sewerage system and water purification facilities were totally neglected. By 1995-1996, water purification facilities and biological pools initiated the process of purification but, in fact, the content of sewage before and after purification was almost the same. All facilities and pipelines were overfilled with silt and sewage and, in some places, it burst out into the street drainage gutters.

Taking into consideration the desperate economic situation and financial difficulties in the country, on 21 October 1997, the Prime Minister addressed a letter to the UNOPS office requesting assistance to reconstruct the 3,235 meters long sewerage system from 800 m and 1000 mm diameter prefabricated reinforced concrete pipes as well as to rehabilitate the existing water purification facilities. The implementation of the project was started on 8 October 1998 after a comprehensive and thorough survey and analysis of the project and selection of implementing agents.

The project was included in the 1998 Kulyab Area Office Work Plan and was considered to be one of the highest priorities in all of the Kulyab area, based on extensive studies done by the local authorities, UNOPS staff members and DDAC (District Development Advisory Committee) of Kulyab area.

Identification of projects is conducted in close consultation with DDAC of Kulyab area. Annual work plans are then compiled by the PIO and endorsed by the local authorities and community representatives. The identified priorities usually reflect the most urgent community needs for strategic interventions. Prior to implementation of any project, it is studied in detail and its cost estimation is determined by UNOPS experts. The PIO designs the project and identifies, through an open and transparent tender bidding process, the implementing agents who are contracted to undertake the projects. Subsequently, progressive payments are released to the contractors only after certification by the Sector Specialist and verification by the Area Manager confirming that the sub-project is proceeding as detailed in the Memorandum of Agreement. Through close and constant monitoring of the sub-projects, a high success rate is achieved.

The project commenced on 8 October 1998 and was completed within twelve months. The total budget of the project was US$ 320,233 and the total amount has been disbursed. The project was funded mainly by the European Community Humanitarian Office (ECHO) with a total amount of US$ 295,233 and to a lesser extent by the United States Agency for International Development (USAID) with a contribution of US$ 25,000.

The inauguration ceremony of the project took place on 5 October 1999 where the local authorities and community, a representative from central Government, Ms Janny Bosscher, ECHO Representative in Tajikistan, Mr. Basil Comnas, PM/CTA, UNOPS and mass media represesntatives participated.

From the very beginning, UNOPS Kulyab Area Office, the local authorities of Kulyab City, the Department of Water Resources and City Canalization and the DDAC have all participated in the regular monitoring of the project. From a technical and financial point of view, UNOPS is satisfied that the project has been successfully completed and that the city sewerage system which was in critical state, was fully rehabilitated and reconstructed.

In the course of the implementation of project activities and upon their completion, the Department of Water Resources and City Canalization has tested the system several tim es. The system works as a single unit and purifies water according to approved sanitary norms and requirements.

Workshop on 'Humanitarian aid/Drugs in the Republic of Tajikistan: Past, Present, Future'

On 9 February 2000, a workshop on'Humanitarian aid/Drugs in the Republic of Tajikistan: Past, Present, Future' was held. It was organized with the active support of the WHO European Office and was funded by ECHO. The following bodies took part in the workshop: Ministry of Health of the Republic of Tajikistan, Agency on the Control for Narcotic Substances attached to the Government of the Republic of Tajikistan, Ministry of Foreign Affairs, Customs Committee, and representatives of international humanitarian organizations providing donated drugs to Tajikistan. More than 60 participants took part in the workshop.

The workshop was aimed at:

  • Considering major difficulties faced in the field of donated drug supplies;
  • Presenting possible solutions to the above problems;
  • Discussing the future of humanitarian assistance.
  • Discussing and assessing the state of donated drug supplies in the past, nowadays and define the prognosis for humanitarian aid/drugs in the future.
  • Discussing problems that hinder mutual understanding and cooperation between public bodies and international humanitarian organizations and NGOs.
  • Working out constructive ways of solving these problems in order to increase humanitarian drug aid efficiency.
  • Strengthening the systems of:
    • communication and coordination of activities being implemented by international humanitarian organizations Workshop on 'Humanitarian aid/Drugs in the Republic of Tajikistan:Past, Present, Future' and NGOs, ministries and other governmental bodies of the Republic of Tajikistan;
    • quality control of humanitarian aid donated to the Republic of Tajikistan;
    • information exchange system on humanitarian drug aid
  • Defining and coordinating international humanitarian organizations' reporting system with public structures.
    • Discussing ways of shifting from humanitarian assistance to long-term development cooperation.
The workshop was chaired by the Minister of Health, Mr.A.Akhmedov. He welcomed all those present and opened the workshop. Outlining the importance of humanitarian assistance, he noted the difficulties facing humanitarian organizations, recipients and the Ministry of Health in the field of drug donations.

A situation assessment report in the field of drug donations in the Republic of Tajikistan has been made using data collected by WHO NPT. This was presented by the Head of the National Pharmaceutical Taskforce, Dr Salomiddin Isupov..

The discussions held during the workshop covered three key issues:

  • Information exchange in the field of drug donations;
  • Drug donations procedures;
  • Future of drug donations.
During discussions, an active dialogue between recipients of humanitarian aid, international organizations and non-governmental agencies and the Ministry of Health was initiated. Difficulties encountered in the field of drug donations were outlined, possible solutions presented and issues of transition from emergency humanitarian assistance to cooperation on implementation of medium- and long-term humanitarian aid programmes aimed at development of national drug policy within the frameworks of reforming the pharmaceutical and health care sector of the country discussed.

At the end of the workshop the following decisions were taken by the participants:

  • to ensure coordination of medical and pharmaceutical activities of international organizations, involved in drug donations in the Republic of Tajikistan, their close collaboration with the Ministry of Health, ministries and departments of the Republic of Tajikistan with direct involvement of WHO;
  • to ensure appropriate drug selection systems:

    1. taking account of the needs of medical facilities in Tajikistan;

    2. in compliance with the Essential Drugs List;

    3. in accordance with Standard Treatment Guidelines, which will be developed in foreseeable future;

  • to improve donated drugs quality control system by:

    1 supplying drugs from reliable sources;

    2. following the International System of Quality Certification (by WHO);

    3. no drugs should be donated/issued to patients and then returned to pharmacies

    4. shelf-life of drugs (not less that one year after arrival in Tajikistan);

    5. accessibility of drug information (non-proprietary names, medical instructions, etc.);

  • to ensure a coordinated reporting system by international organizations to public structures;
  • to improve unified common information and management systems by supplying international organizations with information about all drug donations made and their cost;
  • to recommend a humanitarian drug supply with simultaneous implementation of training programmes for health personnel;
  • to develop mechanisms and carry out monitoring of drug use in collaboration with the Ministry of Health;
  • to elaborate Guidelines for Donations of Pharmaceutical and Medical Production in the Republic of Tajikistan taking account of the amendments and additions incorporated in the1999 WHO Guidelines for Drug Donations as well as comments and suggestions made during the workshop, and to distribute it to donated drugs suppliers and recipients.
  • to follow key principles of the WHO Guidelines for Drug Donations when donating drugs.
Workshop participants received the pack of documentation (WHO Guidelines for Drug Donations, 1999 (Russian and English versions), Guidelines for Donations of Medical and Pharmaceutical Production in the Republic of Tajikistan (Russian and English versions), draft reporting forms.

Finally, the workshop participants noted the urgency and importance of the workshop. The workshop was conducted in an atmosphere of mutual understanding and constructiveness.

Primary Health Care project

The Tajikistan Primary Health Care project, supported by the World Bank, is funded by a long-term loan through the International Development Association (IDA) in the name of the World Bank, given to the Government of the Republic of Tajikistan for the purpose of carrying out reforms in the primary health care delivery in two pilot districts (Dangara and Varzob) and identifying the future strategy of the health sector reforms in Tajikistan.

  • The project will be realized in two stages: nine months for preparatory activities and three years for the project itself. The total cost of the project is US$ 5,5 million. It will be financed from the IDA credit in the amount of US$ 5 million and a contribution of the Government of Tajikistan in the amount of US$ 500,000. A new model of primary health care deliver y will be run in two pilot districts that have been chosen by the Ministry of Health of Tajikistan and approved by Government of Tajikistan. These are Varzob and Dangara districts.
PROJECT DEVELOPMENT OBJECTIVE

The Project Development objective is to test and demonstrate a model of health care delivery based on primary care and per capita resource allocation as a means of improving service delivery and the quality of care in the Republic of Tajikistan.

Project objectives are:

  • To support the ongoing reforms in the health sector and the process of rationalization of the health care services Financing should be mainly targeted on the primary health care with the possibility of supporting other areas that elp implement reforms and also on the national level
  • Institutional building in the areas of health planning and financing,pharmaceuticals and management information systems
  • To attract additional partners (including UN agencies, donors, NGOs) for collaboration in reforming the sector
  • Social status and institutional structure assessment
Project components are:

1. Primary health care development;

2. Health facilities rationalization and development;

3. Health care finance system;

4. Capacity building and project management.

Community Mental Health Programme

Programme of Medécins sans Frontières (MSF) in cooperation with the Ministry of Health
Duration: 2 years. Start: November 1999

Project purpose:

Community-based mental health programme model established in Dushanbe

Objectives:

1. Pool of certified psycho-social consultants developed in Dushanbe

2. Psycho-social counseling services, integrated in the Ministry of Health system, established in Dushanbe

3. Public awareness/ education campaign designed and implemented

4. Strategic plan for service and training in regional areas of need completed

Actual program development:

  • 12 Tajik psychosocial consultants have been trained
  • psychosocial services are provided in four polyclinics in the city: polyclinic nos. 1,2,8,10
  • an information leaflet has been printed
  • small seminars on PTSD (post traumatic stress disorders) are being conducted in polyclinics
Future plans:
  • Conducting an educational awareness campaign regarding post-traumatic stress
  • training of another group of counselors
  • recruitment of trainers to train counselors
Please send contribution to the WHO Office in Dushanbe:

Deadline for next issue: 10.04.2000
Druzba Narodov, 106
Tel/fax. 21 48 71
E-mail: lotjk@who.tajik.net

DISCLAIMER This is not an official WHO publication. It is intended for public information expressed by contributors to this document are solely the responsibility of those necessarily represent the official WHO positions. The document may be freely copied .

For formated version (pdf.format)
* Get Adobe Acrobat Viewer (free)