Swiss-Tajik Cooperation: Nearly 20 Years of Primary Healthcare Development

With high levels of poverty and two thirds of its people living in rural areas, Tajikistan's primary healthcare system and the quality education of its health workers are essential to make healthcare more accessible. To address this, the Enhancing Primary Health Care Services Project (Project Sino) and the Medical Education Reform Project (MEP) have been committed to the pursuit of Univer­sal Health Coverage (UHC) through develop­ment of the health system and medical educa­tion reform for nearly 20 years.

The projects were supported by the Swiss Agency for De­velopment and Cooperation (SDC) and imple­mented by Swiss TPH. "Tajikistan has made important progress to move away from the centralised and specialist-focused healthcare system that existed in the Soviet era, towards a family-medicine oriented primary healthcare system. There is now a basis upon which to build, and the people of Tajikistan can start to envisage the right to basic healthcare," said Helen Prytherch, Project Sino Director and Head of Health Systems Support unit at Swiss TPH. "Nonetheless, there is still a need for primary healthcare strengthening as people continue to face healthcare barriers resulting from under-funding, infrastructure problems, poor education of health workers and deficiencies in the quality of care - this is where the Project Sino leaves such an important legacy."

The aim of Project Sino was to develop af­fordable and sustainable models for PHC, as well as to build up management competencies in the health sector and strengthen the capaci­ty of national institutions. The aim of the MEP project was to modernise the training of family doctors and nurses. This was achieved by putting greater focus on practical, clinical skills, communica­tion techniques and providing early exposure to rural practice realities, with students working directly with patients under the guidance of ex­perienced colleagues - as is routinely done in Switzerland.

A lasting legacy in primary healthcare

"The most important legacy of Project Sino is twofold. Firstly, the project has worked closely with national and local institutions to sow the seeds of sustainability from the beginning - recognizing that to build capacities takes a long time. Secondly, the project has always promoted the principles of good governance," said Muazamma Dzhamalova, Senior Health Advisor, SDC. "It has done this in a very tangible way and on a daily basis: modernizing the education of health workers; improving the quality of care; empowering community members to participate in health planning, disseminating information about peoples' rights and entitlements to services; enabling health managers to hear the voice of communities; and ensuring greater accountability for healthcare service delivery."

Universal Health Coverage

To achieve the health-related Sustaina­ble Development Goals, Switzerland promotes UHC through activities that establish social pro­tection mechanisms in health and advocate for access to quality healthcare. SDC in particular supports the drive towards UHC and that atten­tion is paid to the needs of the poor, such as the assistance provided in Tajikistan. Through the strengthening of primary healthcare and the building of a workforce of well-trained doctors and nurses, Swiss support had contributed to the improvement of health outcomes in Tajik­istan and acts as a model for other countries working towards achieving UHC through a mul­tifaceted systems strengthening approach.

Project partners

The projects aim to support and work directly with, the Ministry of Health and Social Protection (MoHSP), the Re­publican Clinical Centre for Family Medicine (RCCFM), the Republican Centre for Healthy Lifestyle (RepHLSC), the Post Graduate Med­ical Institute (PGMI), the Tajik State Medical University (TSMU) and selected Nursing Col­leges, to make significant strides towards fami­ly medicine-oriented primary health care (PHC).