DUSHANBE -- Poverty reduction in Tajikistan has been significant over the past couple of decades. From 2000 to 2015, poverty fell from more than 83% to about 31%, while economic growth averaged 7.7% per year.
Despite this progress, however, adequate access to quality health care, education, heating, water and sanitation remains a challenge for many people, especially families in rural areas.
Access to piped drinking water and to sanitation, in particular, is unequally distributed, with major implications for public health and well-being. As such, infectious diarrhea and other serious water-borne illnesses are considered to be leading causes of infant and child mortality and malnutrition in Tajikistan.
From 1992 to 2015, the level of undernourishment among the general population in Tajikistan increased from 28% to 33%, compared to just 6% in the neighbouring Kyrgyz Republic. In 2012, the stunting rate among under-five-year-olds in the country was 26% of all children and 32% of poor children. Children who are poorly nourished, who are stunted, and who do not receive adequate parenting or stimulation before their fifth birthday are likely to learn less at school and earn less as adults; they are also less ready to compete as adults in an increasingly globalised economy.
The World Bank is working closely with the government of Tajikistan to improve maternal and child health and nutrition in the country, through two ongoing projects.
The Japan Social Development Fund funds one nutritional project. The other endeavour is the Health Services Improvement Project.
The Japan Social Development Fund, through a grant, is helping improve health and nutrition among children under five years of age, as well as among pregnant and breast-feeding mothers, in 14 food-insecure districts of Khatlon Province.
The project tackles issues at community level, providing quality seeds and fertilisers to help families grow nutritious food, delivering critical micro-nutrient supplements to pregnant mothers and children, and raising awareness among women and volunteers about how to detect and prevent childhood illnesses.
In less than two years, the project has started showing positive results: the number of underweight children under five years of age in the project districts decreased by 20%; levels of stunting decreased by 2% and wasting (acute malnutrition) decreased by more than 8%. In addition, more than 100,000 mothers, 1,000 health workers and 300 community volunteers were educated about better nutrition practices, the benefits of exclusive breastfeeding, and ways to detect signs of childhood diseases.
Improving medical care
The Health Services Improvement Project focuses on upgrading service delivery and quality in primary healthcare facilities, including those in remote areas. By providing training to medical personnel, renovating and equipping healthcare facilities and, most important, by providing hands-on guidance and incentive payments to health workers for better results through an approach called "performance-based financing", the project aims to increase both the coverage and the quality of basic primary healthcare services.
Performance-based financing is designed to reward primary healthcare workers and facilities for their good performance -- but only after they have been found to have successfully met targets that were agreed upon beforehand. The results reported by healthcare facilities are checked and verified rigorously every quarter, before they can receive incentive payments.
This new system has been piloted in 10 districts of Tajikistan so far, and results have been significant: in just one year, the reported number of fully vaccinated children increased by 26%, the number of women receiving four or more antenatal care visits increased by 14%, and the number of women using contraceptives increased by more than 27%, while the average score of service quality remains more than 85%. In addition, the project has trained over 500 health workers on family medicine and over 5,000 on clinical and non-clinical topics.
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