ORDER OF THE GOVERNMENT OF THE REPUBLIC OF TAJIKISTAN

of August 2, 2010 No. 368

About approval of National strategy of health of the population of the Republic of Tajikistan for 2010 - 2020

According to Article 6 (1) the Law of the Republic of Tajikistan "About the state forecasts, concepts, strategy and programs of social and economic development of the Republic of Tajikistan", for the purpose of determination of the strategy of development of health care and ensuring health of the population the Government of the Republic of Tajikistan decides:

1) to Approve the National strategy of health of the population of the Republic of Tajikistan for 2010-2020 it (is applied);

2) to the Ministry of Health of the Republic of Tajikistan:

a) approve the Plan of realization of "The national strategy of health of the population of the Republic of Tajikistan for 2010 - 2020" for 2010 - 2013;

b) together with other involved ministries and departments, local executive bodies of the government of the Gorno-Badakhshan Autonomous Region, areas, the city of Dushanbe, cities and areas to provide realization of this Strategy.

3) under the Government of the Republic of Tajikistan to provide to National council of health care coordination and technical support of realization of this Strategy.

4) to the Ministry of Health of the Republic of Tajikistan to provide to the Government of the Republic of Tajikistan information on results of realization of this Strategy annually till December 15.

Approved by the Order of the Government of the Republic of Tajikistan of August 2, 2010 No. 265

The national strategy of health of the population of the Republic of Tajikistan for 2010 - 2020

List of abbreviations

Apsp - PRT the Agency according to the statistics in case of the President of the Republic of Tajikistan

ARVT - Anti-retrovirus therapy

GDP - Gross domestic product

HIV - Human immunodeficiency virus

WHO - World Health Organization

GBAO - the Gorno-Badakhshan Autonomous Region

VHI - Voluntary medical insurance

DSSB - Document of strategy of decrease in poverty

DOTS - (DOTS) Short-term controlled chemotherapy of tuberculosis with priority to method of identification (Directly Observed Treatment Short Course)

EurAsEC - the Eurasian Economic Community

ERB WHO - European regional office of WHO

REGISTRY OFFICE - Bodies of civil registration

IVDBV - The integrated maintaining diseases of children's age

STD - Infections, sexually transmitted

Artificial satellite - Information system of health care

LZhV - The people living about HIV/AIDS

MPI - Treatment and prevention facility

MZ RT - Ministry of Health of RT

MCM - The men having sex with the man

MKB 10 - Medical classification of diseases

MF RT - Ministry of Finance of the Republic of Tajikistan

NGO - Non-governmental organizations

HCP PT - The national development strategy RT for 2007 - 2015.

NSZ - National accounts of health care

NSZN RT - The national strategy of health of the population of the Republic of Tajikistan for 2010 - 2020.

OAPZ - Department of the analysis of policy of health care

Compulsory health insurance - Compulsory medical insurance

OOP - United Nations

OPV - Vaccine against poliomyelitis

SHOUT - Sharp respiratory infections

OUZ - Regional management of health care

OUF - Regional management of finance

PGG - Program of the state guarantees

PIN - Consumers of injecting drugs

PHC - Primary health care

PROON - Development program of the United Nations

RKS - Workers of commercial sex

ROSES - District public health department

RRP - Areas of republican subordination

RT - the Republic of Tajikistan

RTsZ - District center of health

RTsMSI - Republican center of statistics and medical information

SanPiN - Health regulations and regulations

The CIS - the Commonwealth of Independent States

Media - Mass media

SOLS - List of the main medicines

SPGR - Medium-term program of the public expenditures

AIDS - Acquired immunodeficiency syndrome

STsZ - Rural center of health

The USA - the United States of America

SES - Sanitarno - epidemiological service

TB - Tuberculosis

TGMU - Tajik state medical university of Abuali ibn Sino

TGPU - Tajik state pedagogical university

TIPPMK - Tajik institute of postdegree preparation of medical personnel

TsZOZh - Center of healthy lifestyle

TsRB - Central district hospital

TsRZ - Center of reproductive health

TsRT - Millennium development goals

ShURS - The Swiss management on development and cooperation

ShSP - (SWAR) Is wide - sectoral approach

UNICEF - United Nations International Children's Emergency Fund

YuSAID - Agency of the USA on the international development of DHIS2 District Health Information Software

Dictionary of special terms (glossary)

Advokation is consecutive and adaptive process of information collection, its organization and formulation in the form of arguments which go on various channels of interpersonal communication and media for the purpose of mobilization of resources or ensuring support of the development program with political and public leaders that, in turn, will promote adoption of this program by society.

ARVT - the treatment which is slowing down reproduction of human immunodeficiency virus. Allows on to extend long life term in case of HIV infection, and also to suspend development AIDS.

Accumulation of means is the level of consolidation of the budget of health care (republican, regional, city or district).

The government employee - the citizen of the Republic of Tajikistan holding on professional basis paid state position of public service for the purpose of ensuring execution of powers of persons holding the state positions of the government and realization of competence of state bodies:

The citizen - in constitutional right person belonging on the legal basis to certain state.

Groupings of cases - set of criteria and process of distribution of hospital cases in clinical groups with similar clinical characteristics and intensity of resources.

Activities of communities for health protection - the joint efforts directed to strengthening of public control over the determining health factors, promoting thereby its strengthening.

Health determinants - complex of the individual, social, economic and ecological factors determining the state of health of certain people and kontyngent, or national groups.

Jamia - the administrative division consisting of kishlaks and headed by the chairman who is elected on general meeting of the delegated representatives of kishlaks.

Life skills - personal, social, informative and physical skills and abilities of the person thanks to which people control and direct the life, and also develop the capabilities allowing them to alter the environment and to adapt to its changes

Health care is system of the public and governmental social and economic and medical activities providing the high level of protection and improvement of health of the population.

Health is condition of complete physical, spiritual and social wellbeing, and not just absence of diseases or physical defects.

Healthy lifestyle - typical for this socioeconomic formations the types, types, methods of activity of the person strengthening the adaptive opportunities of its organism promoting full accomplishment of social functions by it and to achievement of active longevity.

Communication for change of behavior is evidence-based consultative process which covers knowledge, representations and practice by means of determination, the analysis and segmentation of audiences and participants of programs and provision by it of the relevant information and motivation during realization of accurately certain strategy and use of the correct combination of channels of interpersonal and group communication and media, including interactive methods.

Mentality, mentality - views, set of the intellectual skills, spiritual installations and cultural traditions inherent in the certain person or human community

Intersectoral actions - actions in case of which the cooperation of health care sector and the answering other sectors for achievement to common goal is performed, in case of exact coordination of contribution of various sectors.

The intersectoral cooperation - is meant the conventional interrelation between part or parts of various layers or sectors of society which is established for taking measures

The migrant - person making the interlodged territorial movement for the purpose of change of the permanent residence, work, study, rest, etc., forever or certain term (from 1 day to several years).

Conduct of life - set of specific approaches of each person to use of the resources and opportunities represented to it by social conditions, traditions, education and the market relations.

Public health care is science and art of prevention of diseases, continuations of life and ensuring health by means of organized efforts of society.

Community or community - certain group of the people who are often living in certain geographical area, dividing general values, regulations and cultural features, united within one social structure, depending on communications and the relations, the populations which developed at this contingent, in this community throughout certain period of time.

Payment for the treated case - payment for the actual amounts of the provided medical care.

The program of the state guarantees - determines types, amount and conditions of provision of the medical and sanitary help in State Healthcare Institutions is free also on the terms of copayment (partnership of the population).

The Primary Health Care (PHC) - is the main link of health care system of any country, the main service of rendering the medical and sanitary help constructed by the principle "from the periphery to the center". PHC is the integral component of social and economic development of this or that country.

The buyer of medical services - the subject listing the accumulated health care resources to suppliers in payment for provision of services certain national group.

Policy of health care - the official, formal declaration or the procedure in organizations (namely governmental) allowing to determine priority and parameters of activities according to the procedure of response to health requirements, the available resources and other types of political pressure.

The supplier of medical services - the subjects rendering medical services.

Per capita financing - forming of the budget on per capita basis for formula which proceeds from three parameters: budget of health care of the area; quantity of the population of the area and polo / age coefficient.

Prevention - the actions directed to reduction of probability of emergence of disease or violation, to interruption or delay of progressing of diseases, to preserving working capacity.

Prevention of diseases - actions, directed not only on preventions of disease, such as immunization, fight against carriers of diseases or company on fight against smoking, but also that to constrain its development and to reduce its consequences after factual determination of disease.

Seasonal migration - movement, mainly, able-bodied population to places of temporary work (harvesting, construction works, etc.) and residence for the term, usually several months, with preserving possibility of return to permanent addresses.

The health care sector - consists of organized public, public and private services of health (including strengthening of health, prevention of diseases, services of diagnostics, treatment and patient care), rates of policy and activities of departments/managements and the Ministry of Health, non-governmental organizations connected with health and groups of municipal and communal nature or level, and also professional associations and associations.

The family doctor - the specialist with the higher medical education having the legal right to give primary multi-profile, continuous medical and sanitary help to the population or individuals and families, irrespective of age, sex and type of disease.

Social marketing - marketing, consisting in development, realization and control of the social programs directed to increase in level of perception of certain layers of the public of certain social ideas, movements or practical actions. Usually social marketing is used by the state and public organizations.

Social mobilization is process of consolidation of all potential partners and allies representing both the state, and non-state organizations for the purpose of detection of notable need for specific purpose of development, attraction to it of attention and increase in demand for it. Social mobilization assumes ensuring participation of these partners, including the organizations, groups, networks and the public, in identification of human and material resources, their mobilization and management of them that, in turn, will strengthen achievements and will promote their sustainable development.

Strategy - expected long-term outlook, complex type of activity within which separate actions and types of activity are performed.

Labor migration (labor migration) - the interlodged movements of able-bodied population having, as a rule, returnable nature after completion of labor activity.

Strengthening of health is the process allowing people to increase control over the health, and also to improve it.

Risk factors - the factors of external and internal environment of organism, behavioural features promoting increase in probability of development of diseases, their progressing and failure.

Financing - source of means, for holding certain actions.

Forming of healthy lifestyle - the complex problem requiring integrated approach to research of conduct of life of health of the population and also attention of health workers, teachers, psychologists, also depends on specifics from macrosocial environment of the person, its labor, social and preventive activity.

Introduction

The national strategy of health of the population of the Republic of Tajikistan for 2010 - 2020, hereinafter referred to as (Strategy), generalizes long-term goals of the country in the field of protection of public health and way of achievement of these purposes, namely: strategy, programs and resources of upgrade of health care sector.

Strategy expresses will and interests of sovereign Tajikistan in the field of health protection. It is the complex and fundamental document of long-term planning which describes future program directions of the country leaders leading to comprehensive planning, implemented on evidential approaches. Strategy reflects opinions and prospects of the central governing bodies, local executive bodies of the government, and also opinion of suppliers of medical services and general population of Tajikistan.

Strategy covers the period from 2010 to 2020. It is the tool for support of succession and coordination and is integral part of national policy of social and economic development. This strategy is continuation of the document "The Strategy of the Republic of Tajikistan on Public Health Care during the Period till 2010", and considers the directions specified in other strategic documents such as: The national strategy of development for the Republic of Tajikistan for the period till 2015 and the Strategy of decrease in poverty. She also specifies strategic directions, especially in the field of separate services of health care sector.

Strategy is developed during cooperation of leading experts of the Republic of Tajikistan with the foreign experts representing the best international practices of system planning in the field of health care. Strategy promotes coordination of national and international programs, plans of support of development of health care sector in the Republic of Tajikistan. Without renouncing national priorities, it is oriented to global tasks of health care and the approaches to their decision approved in the world.

In the expired decade health care of the Republic of Tajikistan took upgrades of the resource and clinical base, and also systems of financing and the organization of the treatment-and-prophylactic help way. Revival of rates of economic growth, continued attention of the country leaders to priority tasks of social development, and also effective contribution of the international donor community to public health care of the country favorably affected development of industry.

Decrease in maternal and child mortality became result of efforts of the last decade. Incidence from infectious, in particular, vaktsinoupravlyaemy diseases was reduced. Modern clinical protocols and other standards of medical care are developed and take root. Certification of "the benevolent relation to the child" there underwent over a half of maternity hospitals.

In development of system of provision of medical services to the population the strategic turn of health care towards the integrated model of the primary health care based on family medicine began. Training of doctors and nurses of family medicine became priority in programs of dodiplomny, post-qualifying and life-long medical education of medical personnel. Important steps are taken for structural optimization of treatment-and-prophylactic network, in particular, due to carrying out restructuring of hospital service. Supervision of medical and pharmaceutical activities is strengthened.

Financing of health care took place the lower point in adverse dynamics of the last 20 years and returned on trajectory of strong growth. Step-by-step wages increase of workers of industry in the last three years reflects contribution of the state on recovery of their material welfare, and also the professional and public status. The wages rise was added with pilot modern methods of financing. There was understanding that for improvement of quality and efficiency of services of health care, it is necessary to carry out the analysis of the salary and other financial encouragement for health workers. Orientation of financing of health care to requirements of social justice amplified: The packet of the state guarantees, though took root in the conditions of acute shortage of resources, increased availability of free and preferential treatment-and-prophylactic services to many needy families and people needing more expensive medical care.

Ongoing work on updating legislative and regulatory framework of health care creates prerequisites for continuation of reforms. Despite progress of the last decade, in health care sector the problems inherited from the Soviet and transitional periods are revealed. Among such problems:

- outdate financially - the ZHGU technical base and shortage of investment funds for its timely updating;

- incompleteness of reforms in system of medical and sisterly education;

- ongoing brain drain from health care sector in connection with labor migration out of limits of Tajikistan;

- unsound methods and standards in the field of provision of medicines;

- the accruing lagging on implementation of the advanced international practice in techniques of diagnostics and treatment of widespread diseases;

- lack of modern system of standards and quality control of medical care.

The economy of health care remains not at the high level of financing., In 2009 the level of total expenses on health care sector constituted 1,9 of % of GDP that it is much less, than in 1991 (% 4,5). The developed level of financing is not able to remove burden, accumulated for the last two decades. By estimates, over 70% of total amount of financing are the share of payments from personal means of the population, only 16% for budgetary appropriations, and about 14% fees of donors (1). Payments of the population have generally informal character and, owing to this fact are hard controlled. Needy citizens of Tajikistan are not protected from excessive financial burdens in case of serious illness. Level of the paid nature is poorly connected with quality of the given help. Informal payments of patients raise the income of physicians, but do not exert impact on other Articles of the current financing and capital costs. Structural imbalance of the state costs for health care is shown in their uneven distribution between regions of the country and levels of assistance. Workers of health care have no due material and professional incentives to productive and high-quality work with emphasis on interests of patients.

Effectiveness of treatment-and-prophylactic work suffers from prevalence of help given by specialists of the specialized out-patient and hospital system over specialists of family medicine.

Insufficient quantity of some important types of the organizations promoting reduction of flow of patients for hospitalization and to reducing koyko-days, in particular:

- day hospitals;

- centers of out-patient surgery;

- houses of sisterly leaving;

- services of the patronage help and other services of social and medical and rehabilitation support.

Sanitarno - epidemiological wellbeing of the population of the country almost entirely depends on activities of services and healthcare institutions. At the same time there is no cross-industry cooperation, vital for decrease in environmental and social risks of incidence.

Community, including separate families, are not considered and are not used as independent resource for prevention, early recognition and treatment of diseases.

Rehabilitation and adaptation of patients-hronikov and disabled people, being the most important factor of decrease in burden of disease, nevertheless, did not become integral part of system of prevention and treatment yet.

The suspense of the problems given above, in combination with the remaining level of development of the country where social and economic disorder of considerable part of the population is noted is obstacle for dynamic development. It leads to the low level of number of important indicators of health, including average life expectancy, maternal, infantile and child mortality, incidence of tuberculosis and HIV/AIDS.

Proceeding from it, the Government of the Republic of Tajikistan concentrated attention to rendering efficient and effective social services to the poor population, rationalization of expenses on the social sector for ensuring fair access to health care services. In this direction the United Nations Declaration "The Development Purposes on the Dawn of the Millennium by 2015" was adopted. In particular, the purposes on health care include:

- reducing on 2/3 death rates among children under 5 years;

- reducing on 3/4 maternal death rates;

- distribution stop HIV/AIDS and to lay the foundation for tendency to reducing its scales;

- stop of spread of malaria and other main diseases and to lay the foundation for tendency to reducing its scales.

The ideas containing in the above-named political documents represent basis of development programs of health care sector within the Strategy of reducing poverty and the Concept of reform of health care of the Republic of Tajikistan.

The reform model concerning provision of medical services includes improvement of availability by restructuring and integration of system of provision of the medical and sanitary help, improvement of management of both levels of provision of medical and sanitary services by organizations (PHC, hospital service and public health care), high-quality development of the primary health care based on model of family practice; rationalization of bed fund and structure of hospital organizations, strengthening of personnel capacity of PHC organizations, hospital services and public health care, improvement of infrastructure, enhancement of provision of medicines, change of payment system of suppliers of medical services differentially at the level of PHC by the per capita principle and at the hospital level - for the treated case; implementation of scientific achievements and new methods of prevention, diagnostics and treatment using high technologies; participation of the population in the solution of questions of health care; rehabilitations of patients and disabled people, organizations of palliative care, enhancement of information base of management and some other actions.

The national strategy of health of the next decade will fully rely on achievements of preceding period, and is aimed at effective solution of the imminent problems.

Main goal of Strategy is strengthening of health of the population of the country and creation of the healthy environment.

For successful achievement of effective objective within Strategy the following priorities are allocated:

- system transformations in health care: strengthening and upgrade of management system industry for creation of the productive, social and acceptable, steadily working and transparent system of public health care of Tajikistan;

- improvement of availability, quality and efficiency of medical and sanitary services;

- development of resources of health care.

Successful strategy implementation will entirely depend on integrated approach to resources, systems and results of management in health care. The logic of management is that resources provide functioning of systems, and systems work for results. In the context of strategic planning and system and resources are subordinated to results. For this reason anticipation of results is regarded as of paramount importance strategic thinking and is the basis for this document. According to this logical scheme, the end state of health care of Tajikistan and way of its achievement reveal in three levels:

1. Results: decrease in level of risks and indicators of incidence on separate conditions, life cycles, national groups;

2. Systems:

a) enhancement of management and operational management of health care industry;

b) implementation of progressive models of the organization and techniques of delivery of health care;

c) enhancement of quality control and stimulation of improvement of quality of treatment-and-prophylactic work;

d) licensing and certification of health workers;

e) accreditation lechebno - preventive, medical (pharmaceutical) educational institutions;

e) ensuring equal availability of all residents of the country to health care sector resources.

3. Resources:

a) updating is material - technical base of treatment-and-prophylactic organizations and systems;

b) supply of the country with modern vaccines, medicines and medical goods;

c) increase in effectiveness of work of medical personnel by implementation of modern programs of preparation in the field of basic and life-long medical education and implementation of scientifically based approaches;

d) steady inflow of financial resources for health protection and their effective expenditure.

All three levels and their components are equally important and are the Strategy priority. In this sense, statement of priorities is not so much quantitative, and high-quality approach to implementation. These approaches in step-by-step form will be reflected in the actions plan.

Comprehensive priority of the next decade is ensuring system, integrated approach in increase in effectiveness of health care system. It will be reached by the approved upgrade of management systems of health care based on more rational organization, effective use and the strengthened resource providing. Within such approach, productive, system and complete and well-resourced health care will become result of successful strategy implementation.

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