Introduction

Introduction

 

Introduction

© UNICEF Turkmenistan / 2004/Pirozzi

Exclusive breastfeeding is the first vaccine a child gets.

Three MDG (Millennium Development Goals) related to health: reducing child mortality, improving maternal health and combating HIV/AIDS, malaria and other communicable diseases remain a priority for the Government of Turkmenistan. The health care system continues to face a number of challenges in achieving these important goals.

In 1995, the President introduced a Health Programme which included cost reduction as part of overall reform of the health system.  At this time, mandatory fees for health insurance and the practice of payment for services were established, creating barriers for families struggling economically.  On the 10th anniversary of the programme, the President and Khalk Maslakhat (Parliament) have announced a significant reduction in these fees. 

Still, an imbalance in the allocation of resources for the health care sector has resulted in what is generally accepted as a decline in the quality of the system.  Resources are focused on tertiary care and high-tech diagnostic equipment, while the number of front line health workers responsible for primary health care delivery has decreased.  An aging infrastructure at the primary health care level, an insufficient knowledge base among health professionals along with a shortage of essential drugs and medical supplies all represent areas for improvement.

According to official statistics reported annually by the Ministry of Health and Medical Industry, the infant mortality rate (IMR) remains high but is gradually decreasing, from 42 per 1000 live births in 1996 to 13 in 2004. However, the Turkmenistan Demographic Health Survey (DHS, 2000) estimates of IMR significantly exceed those reflected in official government data. The survey also found significant differences in the IMR between urban areas (60 per 1000 of live births) and rural areas (80 per 1000 of live births). The main causes of infant mortality are respiratory infections, which account for about 70% of infant deaths annually, as well as diarrhoeal diseases and perinatal conditions.

Despite what appears to be a continual reduction of maternal mortality rates in Turkmenistan, they nevertheless remain quite high, at 16 per 100,000 live births.  Hemorrhage and toxemia are the main direct causes of maternal mortality, while infections, abortions and extra-genital conditions represent other dominant causes.

The DHS (2000) shows that 47 percent of women of reproductive age (15-49) and 36 percent of children under five have anemia.  Contributing to a decline in child nutrition and overall development has been a decrease in the natural practice of exclusive breastfeeding.  Less than 49 percent of women in Turkmenistan breast feed exclusively during the first six crucial months in a child’s life.

In spite of these challenges, the country has had success in improving maternal and child health.  Immunization coverage rates remain 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 UNICEF health and nutrition programme in Turkmenistan is mainly focused on maternal and child health care and better 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 food 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.