Of the eight million population of Tajikistan, 46.7% live below the poverty line. Remittances from the 1 .5 million Tajik labour migrants (mainly in Russia) amount to 52% of the country's $6.9 billion GDP. In 2013, the National Health expenditure represented a low 2.2% of GDP. The country is facing a double burden of communicable and non communicable diseases. Since 2002, the Ministry ot Health and Social Protection is implementing a set of healthcare reforms to introduce structural changes. The National Health Strategy 2010-2020 aims to optimize healthcare service delivery by focusing on Primary Health Care system delivered through a family medicine approach. However, insufficient institutional and management capacities within the government agencies, huge need to retrain PHC personal and rehabilitate and equip deteriorated health facilities, coupled with inadequate budgetary allocations pose serious challenges to the achievement of the objectives of the Strategy.

To improve the health status ot the population of Gorno-Badakhshan Autonomous Oblast (GBAO) and Khatbon Province of Tajikistan.

• The target population (400'000) who shall be enabled to practice positive health behaviour and will benefit from a strengthened and denser network of PHC centres providing services ot better quality
• Primary health care statf (doctors and nurses)benefiting from training an family medicine including refresher training courses organised within the reformed continuous medical education system
• Primary health care managers who are elaborating business plans to improve their planning and management capacities
• Staff of the Healthy Life Style Centres increasing their competencies for implementing their mandate (health promotion)

• Increased access to comprehensive and quality-assured Family Medicine Services
• Increased health knowledge and practice of positive and healthy behavior of community members

Results from previous phases:  

In the previous phases of the project, launched in 2006, the Family medicine approach was introduced in 10 districts (out of 65) ot the country (Gorno Badakhshan Autonomous Oblast-GBAO, and three districts in the Khatbon region). A Peer Review conducted in October 2013 reconfirmed the positive contribution of the project to the overall healthcare reform. Family Medicine services have been successfully introduced in the 10 remotest and poorest districts of Tajikistan making these services accessible to more than 50% of their 400'000 residents. This was mainly achieved through the rehabilitation and equipment ot 111 Primary Health Care centers, the training of 83 doctors and 250 nurses on family medicine, and a strengthened cooperation between FM-practitioners and the 916 Community Health Promoters (CHPs). 210'000 people gained access to affordable and high-quality essential drugs and this project component became self-sustainable in the whole of GBAO. Finally, a community based health financing (CBHF) scheme to cover transportation costs in emergency cases was successfully tested in a limited number of villages in two GBAO districts.

Phase 3 01.06.2014 - 31.12.2018   (Completed)