Tajikistan
Slightly smaller than Wisconsin, Tajikistan is the poorest of the former Soviet republics. The mountainous country’s economy is dominated by minerals extraction, metals processing, agriculture, and reliance on remittances from citizens working abroad. Although it was always one of the poorest countries in the Soviet Union, Tajikistan suffered greatly after the Soviet Union dissolved and the 1992-1997 civil war lead to the collapse of social infrastructure and severely damaged an already weak economy.
The first years of independence were accompanied by a massive deterioration of the population’s health status, through the rise of some communicable and noncommunicable diseases and deteriorating access to health services. Tajikistan’s population faces a double burden of both high noncommunicable and communicable disease rates. Infant and maternal mortality rates are among the highest in the WHO European Region and malnutrition is a major public health concern. Poverty, poor diet, smoking, and drug use contribute to the nearly 30% of deaths caused by cancers, cardiovascular diseases, and diabetes in people ages 30 to 70.
Intravenous drug use is assumed to be the major source of HIV transmission. The Sentinel Surveillance Survey conducted in selected districts of Tajikistan in 2008 found a prevalence of HIV among injecting drug users of 19.4 percent, varying from 7.6 percent to 30 percent in different sites. Lack of HIV education is also a huge factor and future risk for HIV transition. The survey showed that only 16 percent of labor migrants and sex workers new HIV/AIDS prevention methods and only 13 percent used condoms. Young people’s knowledge is also poor, of people aged 14-17 in Tajikistan less than 24 percent were aware of the use of condoms.
According to WHO’s European Observatory on Health Systems and Policies’ health system review (HiT), Tajikistan’s health system has evolved from the Soviet model of health care, with so far few structural changes. Tajikistan has less health care professionals per capita than other countries in central Asia. Physicians are mainly specialized, but more and more are being retrained to become family physicians. There are marked inequities in Tajikistan’s health system with regard to both finance and the distribution of services and resources. Poverty and physical barriers present a significant barrier to accessing health services, the remote mountainous regions, where road conditions are poor causes many communities to no access to care during the winter season.
Project to Strengthen Blood Services in Central Asia, Ukraine, and Cambodia
(2012 – 2015)
Under our CDC-supported Project to Strengthen Blood Services in Central Asia, Ukraine, and Cambodia, AIHA began providing technical assistance to Tajikistan in 2015, focusing primarily on improving quality management capacity and transfusion medicine.
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In January 2013, AIHA traveled to Tajikistan to meet with CDC/Asia and Ministry of Health (MoH) to introduce the project and agree on the preliminary plans to conduct the initial assessment. AIHA returned in February 2013 with representatives from CDC and technical consultants in order to conduct pre- assessment visits in Dushanbe and Khatlon Oblast.
Unfortunately, the trip was cut short following a meeting with Dr. Aziz Odineav, the Director of the RBC, who refused technical assistance from the project. As a result, the project was forced to come to a halt.
However, on October 23, 2014, the MoH approved the request by CDC / Central Asia on behalf of AIHA to provide technical assistance in Tajikistan. A work plan was agreed on by Dr. Odinaev for technical assistance consisting of a course on clinical use of blood and training on the pathology of hemostasis.
Transfusion Medicine
AIHA conducted the first of three bedside training on the clinical use of blood at three Republican hospitals in Dushanbe. A two-day training session was presented on February 3-4, 2015, at the Republican Medical Center, the largest medical facility in Tajikistan. AIHA also facilitated two on day training sessions at the Republican Oncologic Hospital and at the Republican Perinatal Center prescribing clinicians and senior nursing staff were trained. Additional trainings were conducted in Hudjan and Kurgan-Tyube in May 2015 and, respectively 72 and 65 clinicians were trained.
A bedside training for clinicians on the clinical use of blood took place October 28 – 30, 2015, in the Kulyab oblast. The trainings included presentations on blood components, including the indications, dosage, pre-transfusion testing, and contraindications; hemostasis; assessment on the efficiency of transfusion in emergency care; and post-transfusion adverse events – diagnosis, classification and emergency care. Clinical cases on adverse events and reactions following transfusion were presented for discussion.
AIHA provided technical assistance to the Republican Blood Center (RBC) and facilitated a round table discussion on December 13, 2016 with representatives from RBC and Oblast Blood Center (OBC), and other key clinicians to review the National Guideline on the Clinical Use of Blood. From January to March 2017, AIHA provided technical assistance on finalizing the guideline. In June 2017, AIHA printed and distributed one thousand copies of the guideline to the blood service. The guideline is a formative document for Tajikistan on the storage, transportation, and clinical use of blood and its components. The guideline is in both Russian and Tajik.
On March 16, 2017, AIHA conducted a conference for 57 participants, including RBC staff, OBC staff, and hospital clinicians, to discuss the implementation of the National Guideline on the Clinical Use of Blood.
AIHA also developed monitoring forms to assess the clinical transfusion process at hospitals. AIHA used the monitoring forms developed for AIHA’s Blood Safety Project in Kyrgyzstan and adapted them for the blood service in Tajikistan.
Quality Management
A quality management assessment was conducted from February 7 – 13, 2016 at the RBC in Dushanbe using the assessment checklist created for Kyrgyzstan. International consultant, Dr. Zinkin, and Dr. Makhmudova conducted the assessment and provided on-site training and guidance in quality system documentation, shared a template for SOPs, assisted in the development of an organogram, and an inventory list of equipment.
National training on quality management systems and development of clinical guidelines was conducted in Dushanbe by Dr. Zinkin and Dr. Makhmudova on May 30-June 3, 2016 for 30 participants from the RBC and at the national level. The aim of the training was to strengthen the QMS on a national level and to develop national guidelines on the clinical use of blood.
AIHA concluded its support to Tajikistan under this PEPFAR-funded blood safety project in 2017.
To read the full closeout report for Central Asia and Ukraine, click here.