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ORDER OF THE GOVERNMENT OF THE REPUBLIC OF TAJIKISTAN

of March 4, 2002 No. 94

About approval of the Concept of reform of health care of the Republic of Tajikistan

For the purpose of implementation of reform of health care of the country oriented to the international practice, implementation of new more effective and economic approaches of the organization, development, improvement of quality and availability of the medical and sanitary help to the population and further development of international cooperation in this Government of the Republic of Tajikistan area decides:

Approve the enclosed Concept of reform of health care of the Republic of Tajikistan.

Prime Minister of the Republic of Tajikistan

E.Rakhmonov

Approved by the Order of the Government of the Republic of Tajikistan of March 4, 2002 No. 94

Concept of reform of health care of the Republic of Tajikistan

Health of the people is the most valuable richness, the most important factor of development and well-being of nation. From this point of view health care shall be considered not as the sphere of consumption, and as the sphere of the profitable capital investments directed to reducing poverty, mobilization of the resources drawing attention of the international community.

President of the Republic of Tajikistan Emomalii Rakhmonov

LIST OF ABBREVIATIONS

Open joint stock company - Public joint stock company

GDP - Gross domestic product

WHO - World Health Organization

GBAO - the Gorno-Badakhshan Autonomous Region

GNTsEL - State scientific center of examination of drugs

GTsZ - City center of health

ERB WHO = European Regional Office of the World Health Organization

MPI - Treatment and prevention facility

LRZ - Human resources of health care

MKB 10 - International Statistical Classification of the diseases and problems connected with health, the tenth review

NLP - National medicinal policy

PHC - Primary health care

RPO - Republican production association

RRP - Areas of republican subordination

RTsZ - District center of health

SVA - Rural medical out-patient clinic

STsZ - Rural center of health

SOLS - List of the main medicines

AIDS - Acquired immunodeficiency syndrome

SPTAFL - "Tajik Ajanta Pharm Limited" Joint business

SUB - Rural Local Hospital

SES - Sanitary and epidemiologic station

The USA - the United States of America

TGMU - Tajik State medical university

TIPPMK - Tajik institute of postdegree preparation of medical personnel

TsGB - Central city hospital

TsRB - Central district hospital

Summary

Tajikistan - the ancient state located in southeast part of Central Asia borders the Republic of Uzbekistan, the Kyrgyz Republic, People's Republic of China and the Islamic State Afghanistan. The thin strip of the territory of Afghanistan separates from Tajikistan India and Pakistan. The area of the republic constitutes sq.km 143,100 with density of population of 43,8 (the Comment 1) the person on sq.km. The number of resident population of Tajikistan for the end of 2000 constituted 6.250.000 (the Comment 1) the person. State language is Tajik.

After receipt of independence the country met not only economic difficulties, but also transferred the political and ethnic disagreements which led in the middle of 1992 to civil war. The country had no opportunities to concentrate attention on economic reforms until signing of the General Agreement about peace-making and national consent in Tajikistan on June 27, 1997.

GDP in 2000 constituted 159, 6 US dollars per capita (the Comment 1), (GDP in 1999 - 149,4). Referring to the statement of the World Bank (1998), about 80% of the population can be carried to poor layers in this connection restructuring of economy and adaptation to market conditions has huge value.

Economic, political and social degradation influenced deterioration in indicators of health of the population. Today, the majority of indicators of health of the nation characterize Tajikistan as the state having lower status of health in comparison with other states with the average level of the income. Growth of infectious diseases causes alarm.

Social and economic instability negatively affected health care system condition enough. At the same time the ineffective system of delivery of health care was aggravated by gap of commercial ties, output gap, financial and other difficulties. The corresponding downgrade of health of the population promoted awareness of urgent need in carrying out reforms in health care sector for the purpose of stabilization and improvement of the situation.

For implementation of these activities, with assistance of the World Health Organization, "The project of reforming of health care" within which the draft document "Concept of Reform of Health Care of the Republic of Tajikistan" (Master plan) determining the strategies of development for industry aimed at providing equal access to the health care services meeting requests and needs of poor segments of the population by prioritization and strengthening of services of primary health care is prepared began to function.

The service of the primary health care (PHC) will be strengthened by its reorganization and review of functions, redistributions of resources of health care, by implementation of family medicine, personnel training, improvement of physical infrastructure and quality of medical services, ensuring with medicines, products of medical appointment. Primary health care will be available to the population, to pursue the aim of strengthening of health and prevention of diseases. The organizational structure will include Houses of health (Bungokhi Salomati), the Rural Center of Health (RCH) { Markazi Salomatiya of Dekhot), the District Centers of Health (DCH) {Markazi Salomatiya Nokhiya) and the City Centers of Health (CCH) (Markazi Salomatiya Shakhri) in which beds of day and short stay can be developed. Family doctors and family nurses will be prime vendors of medical services. The new approach to rendering medical services based on brigade method will promote enhancement of skills of personnel, improvement of quality of medical care, integration of medical authorities and reducing spread of diseases.

Reforms of hospital service will achieve the objectives in case of exception of duplication and rational use of the available resources. The hospital service will consist of 2 levels - hospitals of wide profile and beds specialized with optimum quantity. Considering that autonomy and the heavy responsibilities will be provided to hospitals, their heads will be trained to skills of management (management). Enhancement of information system, managerial functions in hospitals, such as financial management, management of clinical departments, fixed assets and personnel resources is planned. Development of nurse business, quality assurance of clinical practice will lead to effective use of hospital beds. Implementation of modern organizational and economic controling mechanisms, including financings will promote development of independence and commercialization of hospital service.

The existing functions and organizational structure of bodies and organizations of sanitary and epidemiologic service of the Ministry of Health of the Republic of Tajikistan will be changed at all levels (central, regional, city and district). Based on sanitary and epidemiologic stations the centers of sanitary and epidemiological surveillance will be created. Some functions of service in the field of hygiene of the environment will be integrated with PHC, the intersectoral cooperation will gain further development.

Financing will be performed from the government budget, and also from other additional sources. Physical infrastructure of service will be improved. For enhancement of skills and knowledge of personnel of service the training programs will be developed and implemented.

Ensuring availability of high-quality medicines to the population, requirement determination, their proper appointment and use, will be the cornerstone of National medicinal policy. Control procedures for quality of the imported medicines will be enhanced. Further privatization of drugstores and development of local pharmaceutical production is expected. Rationalization of pharmacy chain, preferential licensing will promote opening of drugstores in the remote areas, will expand availability of the population to medicines. In case of registration of drugs preference will be given to the medicines corresponding to the List of the Main Medicines (LMM), and also generic medicines. Further development will be gained by preferential leave of medicines and the address help to certain contingent of the population. It is planned to create Information Centre on medicines for ensuring exchange of information and communication with treatment and prevention facilities. Managements on clinical practice at the level of PHC will be developed that will improve practice of prescription of medicines.

Training of family doctors and family nurses for the purpose of transition from specialized services to all-medical (family) practice will become fundamentals of policy of human resources of health care. Planning of human resources will happen not only taking into account ratio of medical personnel to the population, but also developments of the system based on operational load. Improvement of human resources management will be provided with development of effective incentive system and rationalization of functions of personnel. The mechanism will be developed for attraction of medical personnel to work in areas with their low supply and in nepristizhny specialties, at the same time the special importance will be had by state regulation. Increase in responsibility at each level of health care will lift the status of doctors and specialists of nurse business. The promotion structure on office ladder of doctors, specialists of nurse business will be reviewed. Certification of separate types of activity of specialists is planned to be carried out at once after the termination of medical educational institution and, further, every 5 years. Licensing will be carried out in the procedure established by the legislation.

The government budget will remain the main source of financing of medical authorities, additional sources of financing will gain development. Conditions of stay in hospitals shall be improved, and the payment system of medical services will correspond to criteria of their complexity of urgency and urgency. The payment system of suppliers of medical services will be changed for achievement of low-cost intensity. In hospitals the payment mechanism for the treated case will be entered, and PHC organization will receive means on requirement of the served population (per capita financing). Priority services of health care for which general financing will go will be determined. Medical insurance of citizens will be entered during creation of the corresponding conditions.

Decentralization, development of intersectoral cooperation and participation of the population will become the basic principles of the organization and management of medical authorities. Training in management will serve as prerequisite for distribution of powers. The National Council of health care will direct intersectoral cooperation. There will be sovershenstvovana the leading role of the Ministry of Health by means of creation of new organizational structures, training of human resources in management and analytical skills, improvement of information system. Development and realization of single state policy in the field of public health care and health care will be the main function of the Ministry of Health. With respect thereto planning, development and deployment of policy and strategy, state regulation will become its main tasks. Regional and city managements of health care will be reorganized according to changes of their functional activities.

In the cities and areas of the republic structural divisions of executive bodies on places (Hukumata), responsible for management of city, district health care system will be determined.

Functions of the Republican Center of medical statistics and information will be expanded. The center will be engaged in data collection from organizations of system of the Ministry of Health and from medical institutions of other departments (irrespective of patterns of ownership), including information on financing to participate in establishment of system of the statistical recording and reporting in the field of public health care and health care. It will demand extension of the list of indicators, development of forms of data collection. Indicators shall be comparable with international. Medical information technologies will gain development as soon as financing allows. The personnel of information system of health care will study at the newest technologies of collection and data analysis. Information about health will become available to sectors of society and the population.

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