Tajikistan: UNICEF Humanitarian Appeal for Children and Women: Jan-Dec 2000

COUNTRY SITUATION

• Poorest republic in the former Soviet Union, with highest fertility, birth, infant morbidity and mortality rates
• Decade-long brutal civil war
• An estimated 100,000 internally displaced persons (IDPs)
• 85 per cent of population lives in poverty
• Only 40 per cent of the population have access to health care
• Brain drain
• Refugee children require education
• Once highest in literacy rates, now among lowest

UNICEF COUNTRY FOCUS

• Provide vaccines to 200,000 children under age two;
• Provide measles control for 600,000 children ages one to six years old;
• Provide 700 rural health centre kits and 300 health clinic kits;
• Provide 360 schools in four districts with locally produced filters, hand-washing basins, tools and materials for upgrading latrines and handpumps;
• Provide textbooks, posters and teacher training on proper hygiene;
• Provide school materials and kits, plastic sheeting for school buildings, winter clothing and transportation for 200,000 students.

The health sector has been hardest hit by deteriorating economic conditions and the long-standing civil war. Professionals have largely abandoned the country, leaving behind an environment of unchecked epidemics, deplorable sanitation and low case-management capacity. UNICEF will focus on health sector interventions in the year 2000, while seeking to improve immunization coverage, re-supply rural health centres and improve sanitation and hygiene practices through increased instruction and awareness programmes in the schools. UNICEF will also provide supplies, materials and training for teachers and to rehabilitate schools. While the overall drop-out rate among Tajikistan's children is climbing, the low attendance rate of girls is a great concern. UNICEF will continue to investigate, monitor and advocate for the rights of girls to education.

TOTAL FUNDING REQUEST: $2,235,000

EMERGENCY CONTEXT

Tajikistan has suffered numerous challenges since its independence from the former Soviet Union. The resulting governance structure was weak from years of reliance upon Russia.

Tajikistan has been plagued by insecurity since the civil war that erupted in 1992. Fifty thousand people have been killed, with 100,000 displaced. The civil war resulted in the deaths of an estimated 50,000 people and the displacement of over 100,000. Over 600,000 people left the country. Flooding in 1993 and a severe diphtheria epidemic in 1995 left the population weakened. The final blow was the collapse of the Russian economy, after which the Government could no longer provide desperately needed services.

Health and education have been hardest hit. Professionals first left government service and now are increasingly emigrating to other countries. Communicable diseases spread unchecked. Safe water and lack of adequate water supply remain a huge problem. There is high mortality from water-borne diseases, with a 4 per cent fatality rate for typhoid fever. Primary health care systems are woefully inadequate. Only 40 per cent of the population have access to health care. Humanitarian aid provides 80 per cent of vital health sector needs.

The educational system, once the pride of the country, is now in ruins. Schools were looted and transformed into IDP transit camps. Teachers and other professionals are leaving government service - and leaving the country - due to lack of pay. Education of girls is not a priority. Many children do not attend school during the harsh winter months due to lack of warm clothing, school materials and heat. Tajikistan requires assistance to revive its economy to provide vital social services.

Delivery of relief assistance is hampered by insecurity. Four UN staff workers were killed in 1998.

UNICEF PROGRAMMATIC INTERVENTIONS IN 1999

UNICEF is requesting slightly more for Expanded Programme of Immunization (EPI) (+$75,000) and WES (+$20,000) this year and a little less for education (-$40,000) than in the 1999 CAP, an indication of continued concern with deteriorating health conditions among women and children.

• UNICEF is addressing the critical shortage of essential drugs by building institutional capacity to distribute drugs within the health care system. Working directly with government agencies and non-governmental organizations (NGOs), UNICEF promotes and assists in planning interventions targeting underserved areas;
• Since 1997, direct support to health institutions has been replaced by a community empowerment component involving teachers, community elders and other leaders, in addition to health care workers. Communities are urged to monitor drug distribution and use, and are given a stake in retaining trained health care workers;
• UNICEF provides school materials and school kits (pens, pencils, notebooks, chalk, plastic sheeting for windows, etc.) each year. Distribution of educational supplies was until recently channelled through the Ministry of Education (MoE). UNICEF has incorporated the distribution of education kits with that of health kits and, using community-based institutions, encourages local distribution networks in order to create stakeholders in this vital intervention.

The Ministry of Water Supply and Irrigation provides piped water to only 35 per cent of the population and cannot afford maintenance of water projects required to supply water to the remaining 65 per cent of the population.

• UNICEF has contracted with the NGO Ecologia to implement water and sanitation projects in partnership with the Government in the Khatlon Oblast. Local authorities and communities are increasingly involved in improving water supplies and sanitation. This intervention is expected to directly impact and facilitate behavioural changes among school-aged children, and is now being replicated by the International Federation of the Red Cross (IFRC), Mission East, and UNOPS;
• UNICEF, in partnership with UNOPS, rehabilitated water systems in medium-sized towns, provided small-scale solutions to hygiene in schools and has made progress in urban areas. Needs in many rural areas have yet to be addressed.

The health care environment is deteriorating due to lack of resources.

• Epidemics of communicable diseases were controlled in 1999; however, data indicates poor public health conditions continue to spur the transmission of communicable diseases. The focus, therefore, remains on life-saving and essential public health interventions - specifically, a reduction in mortality and morbidity from communicable diseases.

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