Swiss Tropical Institute, Tajikistan

Health Reform and Family Medicine Support Project (Sino)

Poverty is a central development issue in Tajikistan. Since its independence from the former Soviet Union in 1991, the country has undergone profound economic and social changes, having major effects on health and health service delivery. As a consequence, health sector reform is seen as a priority of the Government of the country. Important elements of the reform are the strengthening of Primary Health Care (PHC) through the promotion of family practice models, a shift in budgeting and allocation of public resources towards more regional equities and the rationalisation of services.

The Swiss Agency for Development and Cooperation SDC through the “Health Reform and Family Medicine Support Project (Sino)” helps the Ministry of Health of Tajikistan to develop affordable and sustainable models for Primary Health Care, ensuring increased access for the poor. Activities concentrate on the two pilot rayons Dangara and Varzob. The Swiss Centre for International Health of the Swiss Tropical Institute acts as implementing agency of the project.

Besides the development of appropriate health policies and the strengthening of family health services, social participation and community health is seen by the project as an important cornerstone towards the establishment of sustainable and equitable models of primary care services.

The ensuring of active population involvement in care of one’s own health and health of surrounding people is conducted by Sino through various activities. They include the design, implementation and assessment of health education measures in broad ranging areas such as HIV/AIDS, reproductive health, tuberculosis and worm infection. Comprehensive, precise, and timely information of issues with respect to health, health care and prevention through information campaigns and media coverage are developed and carried out. Activities seek the involvement of community leaders and direct interactions with the population in view of their engagement in health care issues.

In addition to health education measures, the project supports the development of a Community Health Resource Centre in a pilot district. Consisting of one room and lead by one local resource person, the centre provides written and oral information to the surrounding community on a range of issues, including changes relating to health reform such as family medicine services as well as entitlements, exemptions and payments related to the utilisation of these services. Close collaborations do also exist with the local administration. The centre is also regularly involved in public events, such as the local conduct of the World AIDS or tuberculosis day. Further, the centre provides feedback on behalf of the community to health services providers and the district administration. This feedback raises issues relating to perceived needs of the communities and working with providers to promote responsiveness and quality of care.

Country/region: Tajikistan, Dangara and Varzob rayon

Duration: Phase 1: 2003-2006; Phase I1: 2006-2009

Swiss Organisation: Swiss Centre for International Health of the Swiss Tropical Institute

Website: www.sti.ch

Contact: Kaspar Wyss, kaspar.wyss@unibas.ch

Partners: Ministry of Health Tajikistan; Swiss Agency for Development and Cooperation; local district administration in pilot districts; community based organisations

Information: Wyss K, Djamalova M. Sharing responsibility for better health care. Carrying forward health sector reform in Tajikistan. in: Bulletin of Medicus Mundi Switzerland 88, 2003: 13-15. A DVD and a CD-Rom on project activities are available upon request.