While Tajikistan has made significant strides recovering from the collapse of the Soviet Union and ensuing civil war, challenges remain due to low financing, limited health sector management capacity, and lack of competencies on improving quality of care. The number of health workers has decreased significantly since independence, while limited health financing has stalled continuing medical education opportunities for in-service professionals, resulting in the use of outdated and ineffective clinical practices. This is compounded by geographical imbalances in health care resources and financing, contributed to poor maternal, new-born, and child health outcomes in rural areas. The emergence of the novel coronavirus in early 2020 has stressed Tajikistan’s health system further.
AKF and Aga Khan Health Services (AKHS) aim to enable individuals and communities to optimise their health and wellbeing to reach their full potential through an integrated range of interventions in communities, schools, facilities and health systems. Over the past six years, 650,000 individuals have access to improved primary healthcare services through the capacitation of over 1,000 doctors and nurses, and construction or rehabilitation and equipping of 292 primary healthcare facilities.
AKHS has implemented, with support from 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.
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.
Cross-border Health
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.
The Aga Khan Foundation and the Aga Khan Health Services support teachers and students to incorporate hygiene, sanitation, and nutrition into their lessons, lead school-based cooking demonstrations, and organise awareness-raising events via school councils.
AKF and AKHS partner with primary healthcare professionals and over 1,600 community health promoters to improve community health, with a focus on breaking the inter-generational cycle of stunting through intensive nutritional interventions.
AKF and AKHS enhance systems for the continuing professional development of healthcare professionals. Through our clinical excellence programme, the Foundation promotes the adoption of best clinical practices and family medicine services, with an emphasis on clinical audits to ensure adherence to evidence-informed protocols.
Meanwhile, AKF and AKHS’s low-cost, community-based health financing model is promoting universal healthcare coverage by mobilising existing resources and governance structures, with minimal reliance on external assistance. 220 schemes in five districts have accumulated over TJS 1.9 million – ensuring an estimated 70,200 people have funds immediately available in times of critical need.
AKF works with communities and young people to mobilise and support influencers to maximise their contributions to adolescent health and wellbeing. This includes increasing young people’s access to core services and support networks, thus improving their transition from childhood through adolescence to adulthood.
AKF and AKHS works with communities to ensure access to safe drinking water and sanitation along with improve hygienic practices. The construction of 176 drinking water systems has served 140,000 rural community members with safe water, contributing to the prevention of waterborne and water related diseases and reducing the burden on women, children, and adolescents for fetching water.
Qurbonbi Ashurova, a mother of nine children in Kulob, used to walk a long distance to Yakhsu river and spend almost two hours during the journey to bring water. “The situation got worse in winter and we faced lots of difficulties while collecting water from the river. I was especially worried for the safety of my small children while collecting water in winter. They got sick and even remained behind from school. For years, we were thinking with all neighbours about how to solve our water issue.” Safe drinking water supply systems installed nearby her home relieved Qurbonbi’s water burden. Moreover, it enabled her to construct an indoor washroom and eased her daily household chores. She no longer has to worry about her children fetching water from the river and allocates more quality time to their upbringing and development.
