The Aga Khan Development Network’s (AKDN) overall objective in the health sector in Tajikistan is a sustainable improvement in the health status of the community, with a particular focus on the health status of children under five years of age, women of reproductive age, the disadvantaged and the geographically remote.
The combination of the break-up of the Soviet Union, the end of subsidies and a civil war that lasted from 1992 to 1997 hit the geographical area of Gorno-Badakhshan especially hard. Health services, which previously had been financed relatively generously, had to operate with virtually no budget.
Although Moscow had invested heavily in the area and developed extensive health and education system, after the Soviet Union’s breakup the region suffered a worsening of health indicators, with a decline in life expectancy and increases in maternal and child mortality. The hospitals and health centres deteriorated, with buildings not repaired and medical equipment falling into disuse due to a lack of spare parts. It was difficult to stock drugs or supplies.
To create a sustainable, cost-effective health system accessible to all within this context, Tajikistan's reform priorities included implementing effective public health measures; enhancing primary care; reducing duplication and increasing efficiency in the hospital system; building the capacity of the health professionals; and involving the community in developing and governing the system.
The issue for the Aga Khan Development Network (AKDN) has been how to support the system in a situation where reform is the priority. The strategy in Gorno-Badakhshan, Rasht Valley and the three districts of Khatlon has been to work very closely with the government to help respond to the situation on the ground. AKDN’s objective was to support the system as it was reformed with the aim of improving access to quality care and at the same time pay attention to financial sustainability.
The Aga Khan Health Services (AKHS) has implemented, with support from the Aga Khan Foundation (AKF) and international donor agencies, the active participation of the communities and in partnership with the Departments of Health (DoH) of Gorno-Badakhshan, Rasht and Khatlon a wide range of interventions in health promotion, facility rehabilitation and equipping, pharmaceutical procurement, distribution and sales, and training in new clinical and managerial practices. Special attention is being given to "professionalising" nursing and family medicine with the introduction of a business planning and management module at the primary health care (PHC) level. All the programmatic interventions are designed to protect and promote the health status of the most vulnerable in Tajik society, and to shift from a focus on curative care provided in general and specialised hospitals to an emphasis on primary and family care supported by facility-based services. In a public-private partnership arrangement, AKHS is also managing the upgraded diagnostic services in the Khorog Oblast General Hospital.
New project interventions include Care for Child Development, which focuses on developing the physical, cognitive, emotional, and social functions of children under three years. AKHS is using eHealth to improve access to, and the quality of, healthcare by overcoming the barriers of distance and time. eHealth brings together providers based at separate institutions to offer coordinated care to clients, and provides health professionals working in remote facilities with access to continuing professional development (CPD) and training.
The cross-border health project aims to improve the quality of health care in the communities on both sides of the Afghanistan and Tajikistan border. The AKDN project, which started in 2010, shows that it is possible to treat critically ill patients from Afghan-Badakhshan in Tajik hospitals, for Tajik health professionals to provide health care in Afghanistan and for policy makers from both countries to make study tours across borders to observe other health care systems.
In addition, the increasing volumes, focus group discussions and in-depth interviews held with health professionals, patients, border authorities and policy-makers confirm that cross-border health care is achievable.