World Bank supports primary health in Tajikistan

WASHINGTON, March 7, 2000 The World Bank today approved a US$5.4 million credit (SDR 3.9 million equivalent) to Tajikistan for a Primary Health Care Project. The project will help to replace the current hierarchical, specialty driven approach to health care in Tajikistan with a primary care model.
The project has four components, which will be initially implemented in two pilot regions, Varzob and Dangara. These regions were selected based on several factors: proximity to Dushanbe; openness to reform of local medical and municipal leadership; security; and the presence of other projects by other development or relief agencies.

The project is comprised of the following components:

- Primary Health Care Development and Training. This component will include the development of training programs and retraining of existing primary health care doctors working within the two pilot regions, which will support implementation of the country's approved primary health care policy at the service delivery level. The component will also build on developments to date in health training, and attempt to bring the skill levels of existing physicians working in primary care to a common, basic level for a limited number of interventions reflecting the most common types of medical conditions.

- Health Facilities Rationalization and Development. This component involves developing and implementing health system development and service rationalization plans in the two regions, in consultation with the local regional administration, service providers, and other stakeholders.

- Health Care Financing SystemPopulation-Based Funding. This component will help develop a methodology for funding health care at the regional level, using a capitation system adjusted for age, gender, and disease incidence, and testing this methodology in the pilot regions. The methodology will, for this project, be designed for the regional level only, and would not be extended to the provider payment level (physicians or hospitals/clinics).

- Capacity Building and Project Management. This component will strengthen the management and institutional capacity within the Ministry of Health and the administration in the pilot regions and hospitals.

The total cost of the project is estimated at US$6.24 million, including contingencies. Additional financing includes US$0.30 million from the Swiss Agency for Cooperation and Development and government financing of about $0.54 million. The credit will be disbursed on standard IDA terms with a maturity of 40 years, including a 10-year grace period. Since joining the World Bank in 1993, commitments to Tajikistan total approximately US$190 million for 11 projects.