Child Survival and Development

Issue

Tajikistan spends the equivalent of only 1.9% of its GDP on health (2010). This is barely adequate to maintain existing systems, let alone to finance the required improvements and expansions in service delivery. Three quarters of national expenditure on health is out-of-pocket expenditure[1] leaving the poor particularly vulnerable to the consequences of ill health.

Child survival remains the greatest challenge for the country’s fragile health system. In recent years Tajikistan succeeded in decreasing sharply the Infant Mortality Rate (IMR) from 75 per 1,000 live births in 2000 to 52 in 2010 and the Child Mortality Rate (U5MR) from 93 in 2000 to 63 in 2010 [2]. The neonatal mortality has been estimated to be as high as 25 deaths per 1000 live births in 2010[3], with more than 50% of neonates dying of preventable causes despite the fact that 88 per cent are delivered by a skilled attendant[4]. The maternal mortality ratio is higher than the region’s average – 86 per 100,000 live births[5]. This indicates that there are considerable gaps in the antenatal, intra-partum and postnatal care being offered to the patients by the health professionals.

In 2010, Tajikistan suffered from the world’s biggest Polio outbreak with 458 confirmed cases of infection with wild Polio virus type 1. The analysis of the causes of the outbreak demonstrated that immunisation services provided in the country were inadequate to protect all children. The low level of knowledge and skills of immunisation personnel in vaccine and cold chain management, administration of immunisation and safe immunisation practices, surveillance and case definition and management all contributed to the outbreak. Joint efforts of the Ministry of Health and development partners halted this deadly outbreak and no new cases of Polio have been registered in the country since July 2010.

Roughly one third of children aged 6-59 months are stunted and half of children suffer from iodine deficiency. This situation is compounded by chronic food insecurity and vulnerability to increases in food and energy prices. Indirectly, malnutrition is also caused by household poverty, improperly balanced diets, weak public management and promotion of nutrition, including poor public education, and inadequate food fortification and micronutrient supplementation programmes. Although breastfeeding is practised among families, exclusive breastfeeding is not sufficiently widespread.

Family knowledge and child care practices are inadequate. Only six per cent of children with diarrhoea received increased fluids and continued feeding, three per cent of women know the two danger signs of pneumonia.

Action

To address the health sector problems mentioned above, UNICEF supports initiatives in child survival and development through a programme consisting of a mother and child health component, a nutrition component and an HIV/AIDS prevention and treatment component. In addition emergency preparedness and response is incorporated into the capacity development activities of this programme component. The programme is being implemented in partnership with the Ministry of Health, other United Nations agencies and local and international non-governmental organizations.

Under the mother and child health project, UNICEF is supporting efforts made to strengthen systems to manage the immunisation services, vaccine supplies and cold chain; and to generate the demand for quality services. It will continue its engagement in health coordination and health sector reform. 

In Nutrition, UNICEF is prioritising  the promotion of infant and young child feeding and care practices and prevention of stunting and micronutrient deficiencies.  The results of the most recent National Nutrition Survey are used to influence policy decisions at national level and in the development of the required nutritional interventions at community level.

Through the HIV/AIDS project, UNICEF focuses on increasing access of the most vulnerable young people and pregnant women to quality voluntary counselling and testing (VCT) and treatment, as well as prevention and reduction of sexually transmitted illnesses (STI) and HIV, specifically to newborns. The project uses policy advocacy and capacity building for paediatric AIDS and ensures that HIV-infected children have access to social assistance. UNICEF continues to support comprehensive outreach services for Most At Risk Adolescents (MARA), HIV-infected pregnant women and children as well as prevention of nosocomial infections.

UNICEF incorporates emergency preparedness and response into the capacity development activities of its programmes.

Impact

UNICEF has been able to boost access to improved health services for children and women. With technical support from UNICEF, health workers have been made more aware of national protocols and standards for antenatal and perinatal care, and service delivery has been enhanced at the national and district levels, including in very remote parts of the country. A dozen hospitals have been certified as "baby friendly", bringing the total number of maternity hospitals certified as such in the country to 52 (out of 71)..

In partnership with World Health Organization and World Bank and with funding from the Global Alliance for Vaccines and Immunisation (GAVI) and the Japanese International Cooperation Agency (JICA), the programme supported national immunisation. As a result, the government substantially increased the immunisation coverage to more than 90 per cent in 2010. Government financing for immunisation shows a steady increase - from 12% of all requirements in 2009 to 17.5% currently.

UNICEF’s support to semi-annual national vitamin A supplementation days contributed to the government increasing the coverage of 6-59 months children to 98 per cent in 2011. Over 230 severely malnourished children received therapeutic food and medicines supplied by UNICEF.  UNICEF supported a nation-wide communication campaign as part of National Breastfeeding Week, reaching over 90,000 women and 1,000 primary healthcare workers. Household practices on child survival, care and nutrition in priority districts were strengthened with the introduction of a 'wedding package' in Isfara district, to improve the nutritional status of first-time mothers. The package contains iodised salt, soap and education materials on maternal nutrition and child feeding. So far, 450 packages were distributed. The impact of the initiative on nutrition indicators is being tracked. The National MCH Coordination Council approved the National Infant and Young Child Feeding Guidebook for Parents with support from UNICEF. More than 80,000 families with newborns, primarily in priority districts, will benefit from the booklet. Around 40,000 children 6-24 months in priority districts benefited from micronutrient supplements; 134,000 children aged 2-6 years (80%) received anti-helminthic treatment; around 42,000 (90%) pregnant women and 24,000 lactating women received iron and micronutrient supplements. 

UNICEF, in partnership with the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), helped the Government to model youth-friendly health services for most at-risk adolescents (MARA). The sustainability of youth-friendly health services (YFHS) was enhanced by integrating the YFHS budget into the health sector budget. Government expanded the number of YFHS from 18 to 21 in 2011. More than 21 thousand young people used these services in 2010-2011 and received knowledge on prevention of HIV/AIDS and STIs. This partnership also assisted the Ministry of Health to introduce the prevention of mother-to-child transmission (PMTCT) in 21 districts, enabling 74 percent of pregnant women in these districts to receive voluntary counselling and testing (VCT), compared to 11 per cent in 2005. Furthermore, 80 per cent of registered HIV positive pregnant women nationwide received preventive anti-retroviral (ARV) therapy compared to the 2009 coverage of 30 per cent.