When subsidies for the health sector were withdrawn following the demise of the Soviet Union, the Tajik health system faced collapse. The hospital-based curative care programme was costly – and unsustainable in many areas. In response, AKDN worked with the Tajik Government in poor areas, such as the remote Gorno-Badakhshan Autonomous Oblast, to make the transition to community-based primary preventive care. Particular attention was given to young children and to women’s reproductive health.

To facilitate this shift, a supply of low-cost, high-quality essential pharmaceuticals was made available to 220,000 people whose supplies had been drastically reduced. To help sustain the system, 100 percent of the direct cost of the pharmaceuticals was recovered through an initiative that combined an adequate supply of these drugs with AKDN programmes that defined a formulary and trained providers on the rational use of drugs. As a result, patients receive more precise prescriptions, have lower pharmaceutical costs and are less exposed to drug resistance. At the same time, community health promoters inform the public about basic practices that can help reduce the burden of preventable diseases.

"I am sure that we can agree that at the most general level, the goal of all development efforts ... is to stimulate and facilitate change that is positive in character, significant in impact, long-lasting in consequence, and sustainable into the future." His Highness the Aga Khan at the Annual Meeting of the European Bank for Reconstruction and Development, Tashkent, Uzbekistan - 5 May 2003