Country programme 2005 - 2009
Health infrastructure suffered a great deal during the civil war. Many health facilities were destroyed, and numerous health staff migrated to other countries. Because of financial constraints and the lack of proper maintenance, health infrastructure requires repair and renovation and obsolete equipment must be replaced.
The maternal mortality rate is high, at 100 per 100,000 live births, because of poor antenatal and postnatal care. The provision of emergency obstetric care for complications during pregnancy and birth is poorly managed.
Roughly half the population does not have access to safe drinking water. This problem is compounded by inadequate hygiene practices. Waterborne diseases are thus a major killer among children under 5 and contribute to the high morbidity among infants and children.
Malnutrition is a substantial health problem affecting a very large number of children and women. Anaemia, iodine deficiency disorders and other micronutrient deficiencies are prevalent among children and among women of childbearing age. According to the 2003 national micronutrient status survey, a low body mass index (<18.5 kg/m2) was observed in about 9 per cent of women. Iron deficiency was a major cause of anaemia. The prevalence of iron deficiency anaemia among women and among children aged 6-59 months was high, 41 per cent and 38 per cent, respectively, though there were large disparities within regions. Low urinary iodine excretion was observed in 57 per cent of women and 64 per cent of children. Vitamin-A deficiency continues to threaten the health of about one fourth of the child population.
Indirectly, these conditions are being 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.
To address these and other health problems, UNICEF supports initiatives in maternal and childcare through a programme consisting of an integrated early childhood development component, a safe motherhood and neonatal care component, a nutrition component and an immunization component. The programme is being implemented in partnership with the Ministry of Health, other United Nations agencies and local and international non-governmental organizations.
UNICEF is emphasizing improvement in antenatal and delivery care, child-care practices, the management of childhood illnesses and good nutrition. An effort is being undertaken to ensure that mothers and children can obtain adequate access to quality health consultation services and antenatal, perinatal and postnatal care.
UNICEF is working to protect children from vaccine-preventable diseases by strengthening routine immunization and supporting public campaigns to reach the entire population. In the past few years, through advocacy and funding by UNICEF and other partners such as the Global Alliance for Vaccines and Immunization, routine immunization programmes have been reinvigorated. The management of the expanded programme on immunization (or EPI) has been decentralized through the delegation of planning, implementation and monitoring to district immunization units.
UNICEF has been supplying vaccines for the national EPI initiative for the past 11 years. In 2005, vaccines were procured through Japanese assistance, and UNICEF provided some vaccines to meet a shortfall. The immunization component undertakes diphtheria-pertussis-tetanus, measles, oral polio and tuberculosis vaccination among children 0 to 1 year of age via health facilities and community outreach programmes. According to the national vaccination schedule, in order to immunize a child fully, six separate contacts between vaccinators and the child are needed. "EPI plus" refers to the addition of oral vitamin-A supplementation, which relies on the EPI infrastructure, but requires only two contacts.
UNICEF has been consistently advocating with the Government and national partners for practical steps to prevent iron deficiency anaemia and iodine deficiency disorders through universal salt iodization and wheat flour fortification. UNICEF realizes that the timely elimination of iodine deficiency disorders in Tajikistan through universal salt iodization requires the strengthening of partnerships among public, private and civic entities.
During the past five years, UNICEF has helped to procure and deliver salt iodization and laboratory equipment and 3,000 kg of potassium iodate to processing facilities at salt deposits at Asht and Vose. It has distributed rapid test kits to processing facilities, inspectors with the Sanitary Epidemiological Service, schools and clinics. It has strengthened the quality control capacity and iodine assessment capacity (including a salt and urine iodine laboratory at Dushanbe Endocrinology Dispensary) of entities working in salt iodization. It has helped develop appropriate legal frameworks and supported communications and educational activities with the involvement of grass-roots organizations and the media. Finally, it has assisted in training and orientation among various professionals.
UNICEF has been able to boost access to improved services for children and women in the health sector. 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".
The rate of exclusive breastfeeding among infants aged under 3 months rose from 19 to 64 per cent between 2000 and 2003.
Tajikistan has been polio-free since 2002. Vaccine-preventable diseases have been targeted through the national EPI initiative. A nationwide government campaign in September and October 2004 to eradicate measles reached 3 million children through vaccinations and other relevant initiatives. These children represented 97 per cent of the campaign target and nearly half the population of the country. Thanks to the campaign, the number of cases of measles dropped dramatically, and Tajikistan was spared a major measles outbreak in 2005.
The immunization rate among infants 0 to 1 year of age for the third dose of diphtheria-pertussis-tetanus was 82 percent in 2004, and, for polio, it was 84 per cent. For measles, the rate was 89 per cent, and, for the third dose of hepatitis B, it was 81 per cent.
UNICEF has been particularly fortunate in its partnership with the Government. Substantive policies and laws have been adopted that have provided the possibility for ministries, UNICEF and other partners to conduct health information campaigns among families and communities in order to communicate basic messages that can raise awareness and allow parents to make informed choices.
Through the efforts of UNICEF and its partners, 2.7 million women have been provided with iron pills and vitamin-A supplements, and iodized salt has become available to a much larger number of households. In 2000, only 20 per cent of households were using properly iodized salt (>15 ppm), while the proportion was 28 per cent in 2003.
Because of the initiatives of UNICEF, the Government and other partners, there has been a significant reduction in severe malnutrition, from 4.2 per cent in 2001 to 0.64 per cent in 2003. Similarly, the incidence of moderate-to-severe malnutrition fell from 17.3 per cent in 2003 to 4.7 per cent in 2004.