In the course of nearly two decades, UNICEF’s programming in Turkmenistan has shifted from project-based approach to working at the policy level and towards influencing national laws, developing national capacity and building the critical linkages that enable professionals in the country to access the best international practices. Work in the health sector reflects this shift in approach. Significantly, in April 2009, a national Law on the Protection and Promotion of Breastfeeding and Requirements for Infant Feeding Products was adopted with UNICEF support. Efforts are on to support the country to implement the law effectively.
The UNICEF health and nutrition programme in Turkmenistan mainly focuses on maternal and child health care and balanced nutrition. This covers immunisation, integrated management of childhood illnesses (IMCI) such as diarrhoea and acute respiratory infections, detection of childhood disabilities, early childhood care and safe motherhood initiatives, as well as flour fortification.
The IMCI initiative is part of the Early Childhood Development component of UNICEF’s programme. Within the context of health and nutrition, the ECD project also seeks to shore up health care houses, hospitals and kindergartens with the capacity to support the protection of newborns, safe motherhood, immunization, disease surveillance, growth and physical monitoring and adequate nutrition for children.
Three MDG (Millennium Development Goals) related to health – reduction of child mortality; improving maternal health; and combating HIV/AIDS, malaria and other communicable diseases are also priority.
In particular, health goals to be achieved in the current country programme include the reduction of under-5 mortality rate from 50 to 33 per 1,000 live births through stronger neo-natal care, safe motherhood practices and community support. Another target that has to be met is the reduction in proportion of underweight children through improved nutrition and feeding practices.
According to the Multi Indicator Cluster Survey (2006) almost 1 in every 9 children under the age of five is moderately underweight, while less than 2 per cent can be classified as severely underweight. Nearly 15 per cent of children are moderately stunted, or too short for their age, and slightly above 6 per cent are moderately wasted, or too thin for their age. Though exclusive breastfeeding and initiation of infants to mother’s milk is improving, according to data, 15 per cent (KAPB study) of children younger than six months are exclusively breastfed.
The country has had success in improving maternal and child health. Immunization coverage rates have been consistently high and the country was certified as polio-free in 2002. In 2004, Turkmenistan was recognized as the first country in the CIS and 4th in the world to ensure Universal Salt Iodization in accordance with generally accepted international standards. The Government also finances food fortification and sustains Universal Salt Iodisation by distributing iodized salt at periodic intervals.
UNICEF advocacy and capacity building efforts have resulted in substantial revision of existing training curricula on major MCH components. Pre-service and in service training institutions have aligned their training guidelines with Government endorsed programme strategies on MCH, nutrition and HIV/AIDS.
Sustained UNICEF efforts resulted in certification of almost all hospitals in the country (64 out 65) as baby-friendly. However, exclusive breastfeeding rate is still low, which requires further strengthening of monitoring system and reassessment of already certified hospitals.
A comprehensive Child and Adolescent Health, Nutrition and Development Strategy, that provides directives on how to achieve health and nutrition goals has been initiated by the Government. This strategy will stress key cost-effective interventions based on international standards. UNICEF supported the development of the Nutrition component of this strategy, which undertakes a cost benefit analysis of various nutrition interventions.