Maternal, neonatal and child health (MNCH) project

Project description

Title: Maternal, neonatal and child health (MNCH) project
Commissioned by: Federal Ministry for Economic Cooperation and Development
Country: Tajikistan
Lead executing agency: Ministry of Health and Social Protection of the Population (MoHSPP) of the Republic of Tajikistan
Overall term: 2016 to 2019

Context

Although Tajikistan was already the poorest of the Central Asian Republics during the Soviet era, the country’s education and health care system had achieved a comparatively high standard. Since gaining independence, however, the country has not invested sufficiently in these areas. As a result, the social infrastructure of Tajikistan is crumbling. Women, children, the elderly and people with disabilities are particularly affected by this. The incidence of child mortality is 43 deaths per 1,000 live births, while neonatal mortality is 22 deaths (2015). The maternal mortality rate, which fell from 116 deaths (1996) to 32 deaths per 100,000 live births (2015), is also still very high by global standards. Diseases such as tuberculosis and typhoid are on the rise. Around one third of the population, especially children, are suffering from undernourishment or malnutrition. In addition, around one quarter of Tajikistan’s citizens do not have access to clean drinking water.

One of the goals set by the Government of Tajikistan in its National Health Strategy 2010–2020 is to reduce the mortality rate and significantly improve the health care services on offer. For this purpose, the Government has set up working groups in the areas of health management/governance, finances, resources and services. Furthermore, the Tajikistan Ministry of Health and Social Protection of the Population has made the improvement of health care services, in particular for mothers, children and newborns, a top priority.

Unfortunately, there are not enough qualified staff to take proper care of women, newborns and children, especially in rural areas of the project region. Diagnostic and treatment options either do not exist at all or are available only to a limited extent. As a result, the health care staff do not recognise emergencies in time and patients do not receive life-saving treatment. Quite apart from that, most hospitals do not have appropriate technical medical equipment.

Objective

The neonatal mortality rate (deaths in the first 28 days after birth) has decreased significantly in the ten districts of the Kulob region in the Khatlon oblast (Southern Tajikistan).

Approach

Using a baseline study, the project identifies specific requirements of the individual hospitals and develops appropriate measures in cooperation with the Ministry of Health and Social Protection of the Population.

Medical Accreditation Centre (MAC)

In addition, the governing parties have agreed to establish a Medical Accreditation Centre (MAC). The task of this centre is to accredit the medical care facilities and to improve the quality of the services provided. The project supports MAC in terms of expertise, personnel and organisation, allowing it to specifically prepare the medical facilities for successful accreditation. The project also advises MAC on business matters. The objective is for MAC to be able support itself financially with the help of a business plan.

Curricula

The measure is revising study regulations in the disciplines gynaecology, obstetrics, neonatology and midwifery.

Maternal and child health records

Together with the Tajikistan Ministry of Health and Social Protection of the Population, the United Nations Children’s Fund (UNICEF) has developed maternal and child health records. The aim is to inform families and raise their awareness so that they actually take advantage of health care services before, during and after birth.

The records also include any complications that occurred during previous pregnancies so that preventive measures can be taken in the event of another pregnancy.

Paediatricians also monitor children’s growth until their second year and include this in the records. This allows them to recognise developmental issues at an early stage. In addition, the records contain an overview of all vaccinations and information on possible developmental issues to help mothers deal with pregnancy, childbirth and child development.

Results

  • To enable the Medical Accreditation Centre (MAC) to function properly, the project modernised the centre’s IT equipment.
  • With the agreement of the Tajikistan Health Minister, MAC has started preparing selected hospitals in the project region for the upcoming accreditation.
  • The accreditation of health care facilities that MAC is aiming to implement requires the facilities to be able to perform a complex self-assessment.
  • The project has collected baseline data on neonatal and maternal mortality in each of the eight district hospitals in the project region.
  • A working group formed specifically for the purpose, managed by Medical Education & Partnership from Lithuania, has revised and updated the existing neonatology standards. To prepare for these standards to be implemented as quickly and smoothly as possible, a study trip to Lithuania has been planned for representatives of Tajik health care facilities in spring 2019.
  • With support from GIZ, midwives in Tajikistan were able to set up their own association in 2015. In 2016, the Tajik authorities recognised the association as an independent organisation. The Midwives Association of Tajikistan has now also joined the International Confederation of Midwives. The project runs workshops to strengthen the still young association in terms of personnel and organisation. The association has now grown to include 300 members and has a management team in an office equipped by GIZ.