ORDER OF THE GOVERNMENT OF THE REPUBLIC OF TAJIKISTAN

of November 5, 2002 No. 436

About approval of Strategy of the Republic of Tajikistan on public health care during the period till 2010

For the purpose of implementation of the World declaration on health care adopted at the Fifty first session of the World Assembly of health care in May, 1998, the Government of the Republic of Tajikistan decides:

1. Approve the Strategy of the Republic of Tajikistan on public health care during the period till 2010 it (is applied). (tables and schemes are not provided)

2. To executive bodies on places (hukumata) to adapt tasks of this Strategy for specific local conditions, requirements, opportunities and to provide their realization.

3. To the Ministry of Health of the Republic of Tajikistan:

introduce the offers on creation, structure, powers and functions of National council on health care approved with the ministries and departments of the Republic of Tajikistan under the Government of the Republic of Tajikistan;

notify in accordance with the established procedure the European Regional Office of the World Health Organization on acceptance of Strategy of the Republic of Tajikistan on public health care during the period till 2010;

bring this Strategy to all interested ministries and departments, executive bodies on places (hukumat).

4. Consider the order of the Government of the Republic of Tajikistan of January 6, 1997 No. 27 "About the draft of the National program "The Strategy of the Republic of Tajikistan on Public Health Care till 2005." invalid.

 

 

Approved by the Order of the Government of the Republic of Tajikistan of November 5, 2002 No. 436

The strategy of the Republic of Tajikistan on public health care during the period till 2010

PREFACE

Determinants (factors) of health very extensive also include complex of the individual, social, economic and ecological factors determining the state of health of certain people or national groups.

Therefore, effective approach on management of determinants of health is in that all sectors of society felt responsibility for impact of the strategy performed by them on health of the population and realized the advantage connected with strengthening and health protection of people. Relevance of this problem especially increased in transition period when owing to the known political instability in the early nineties and undue economic hardships, the negative factors exerting impacts on health of the population of the country became noticeable. Today the main problems of health care are caused by the increase in gap in the state of health between population socio-economic groups which is in more safe and less safe provision, the sharp growth of separate infectious and noninfectious diseases, preserving high frequency of injury rate, imperfect information base about health of the population, preserving old and inadequate system of financing, and also disproportion between primary health care and hospital medical authorities, etc.

It is unambiguously clear that without consecutive implementation of the complex actions based on the principles of multisectoral approach it is impossible to expect successful management of all factors of health. However, leadership in timely detection and assessment of social, ecological and other risk factors for health, respectively in the organization of intervention or influence for their elimination by removal of questions at the agenda of appropriate authorities and management, shall remain behind health care sector.

Resources for public health care are present not only at health care sector, but also at all other sectors, and also among the population which are attracted insufficiently.

Thus, multisectoral actions or partnership in questions of public health care and health care, consolidation of their resources in the solution of specific problems at the national, regional and local levels are serious reserve of successful strategy implementation of the country on achievement of health for all.

The government of the Republic of Tajikistan, attaching special significance to public health care and development of health care on the basis of multisectoral approach, in 1997, the Strategy of the Republic of Tajikistan on the public health care till 2005 based on recommendations of the European regional office of the World Health Organization for the first time was in the history accepted. It was dictated by life. In this strategy, the wished improvement of health of the population was formulated in 29 tasks. Since then there passed more than five years. As the analysis and assessment shows, adoption of this political document in the field of health care was important event and strengthened line item of national health care at the international level. The accepted strategy became in essence the first real attempt in the problem resolution of health of the population and health care on wide multisectoral basis. This political document became compass of actions for all interested sectors. For the period which passed after that, in implementation of the above-named Health strategy of the population certain steps are taken. However, at this stage there is need of its review. It is caused by the fact that in May, 1998, the world community on accepted policy of achievement "Health for all in the twenty first century" directed to implementation of the strategic concept of health for all which arose during the session of the World Assembly of Health care of 1977 and proclaimed the Almaty declaration in 1978. In connection therewith, in updated policy of achievement of health for all in the European region of WHO the global priorities calculated on the first two decades (2000-2020) of the twenty first century are stated and are formulated 21 tasks. In it one permanent purpose is in that all people could realize the "potential of health" in complete degree. Two other main objectives allowing to provide more best management and orientation of activities directed to strengthening and health protection of people throughout all life, decrease in prevalence and reduction of the sufferings caused by the main diseases, injuries and mutilations.

Three fundamental values determine ethical bases of realization of policy "Health in the 21st century", and are such as:

- health as one of important human rights;

- justice in health issues, its protection and efficient solidarity of the countries, groups and contingents of people within the country and representatives of both floors;

- participation in health activities of organizations, organizations and sectors, and also certain people, national groups.

Four main strategies are picked up for ensuring scientific, economic, social and political stability as in realization "Health-21" is more whole than permanent premises and driving factor, namely:

- the multisectoral strategy directed to improvement of the determining factors (determinants) of health - taking into account the physical, economic, social, cultural and caused by sex perspectives, and the impacts providing use of estimates on health;

- the programs oriented to resulting effects and investments for development of health activities and the clinical help;

- the complex system of primary health care oriented to servicing at the family and utility and communal levels and supported by flexible, accurately regulated hospital system;

- joint health activities with broad participation and involvement of the corresponding partners in health activities at all levels (houses/families, school and places of employment, the local inhabited Item/population), promoting joint decision making processes, ensuring their accomplishment and the reporting.

The tasks provided in policy "Health for all in the 21st century" shall become some kind of criterion of assessment of work progress and achievements on improvement and health protection, and also on reduction of risk factors for health. These tasks represent basis for development and development of health policy in the European region.

With respect thereto this updated, long-term strategy on public health care of the country till 2010 in the context of "Health for all in the 21st century" in the European region of the World Health Organization is developed and accepted.

In this updated strategy eighteen tasks oriented to the purposes and tasks "Health for all in the 21st century" in the European region of the World Health Organization and on specific conditions, requirements and possibilities of the country are formulated.

It is aimed at the further development of tendencies of sustainable development of health care of the country and cooperation with the international community in this area. The tasks provided in it are basis for development and development of health policy and strategy at the regional, city and local levels within the country, taking into account their specific local conditions.

The note for readers

This strategy consists of four Sections.

In Section 1. "Achievement of the best health", tasks and the strategy of equality in questions of health protection between different national groups of the country, solidarity are reflected in providing for people of higher level of health throughout all their life, reducing noninfectious and infectious diseases, improvement of mental health, prevention and decrease in injury rate.

In Section 2. "More healthy lifestyle and the healthy environment", is determined the range of strategy and actions in public policy, multisectoral approach with sectoral responsibility by providing more favorable for health of the environment, premises and conditions in the field of healthy lifestyle, to reduction of damage and dependence on acceptance of tobacco, alcohol, narcotic and psychotropic drugs.

In Section 3. "The appropriate medical and sanitary assistance", subject of special attention is orientation of health care sector to resources, results of work and their efficiency, from the point of view of quality and economic costs.

In Section 4. "The development strategy for the purpose of achievement of health for all", new approaches to planning and implementation of scientific research, mobilization of partners for the benefit of health care, support of activities for achievement more best health for all segments of the population of the country are assumed.

Section 1. Dostideny the best health

Task 1 - Justice and equality in questions of health protection

Task 2 - the Healthy beginning of life

Task 3 - Health of teenagers, youth and adults, preserving health at advanced age

Task 4 - Reducing prevalence of noninfectious diseases

Task 5 - Reducing prevalence of infectious diseases

Task - Improvement of mental health

Task 7 - Prevention and decrease in injury rate

TASK 1 - JUSTICE AND EQUALITY IN QUESTIONS OF HEALTH PROTECTION

Analysis of situation

Now distinctions in questions of protection and gap in health level between socio-economic groups of the population of the country which are caused by impact of complex of the individual, social, economic and ecological factors determining condition of their health (health determinant) are considerably expressed. During transition period the number of the poor population considerably increased. The tendency to growth of the level of unemployment (number officially of the acknowledged unemployed in % to economically active population) was planned what the chart 1 confirms.

This problem is more expressed in Gorno-Badakhshan Autonomous and Sugdsky regions, areas of republican subordination. On the republic in age structure officially of the acknowledged unemployed of 11,8 of % persons aged up to 18 years constitute, % 28,7 - at the age of 18-24 years and 22,7 of % - at the age of 25-29 years (2000). Among officially acknowledged unemployed of person with the secondary general education constitute % 63,9, incomplete secondary education - % 13,8, secondary vocational education - 14,4 of % and the higher education - % 7,6.

From among the unemployed registered in the republic on the Sugdsky region the % (one thousand 15,1), is the share of the Gorno-Badakhshan Autonomous Region - % 27,7 (one thousand 13,8), of areas of republican subordination of 26,3 of % (one thousand 13,1), to Khatlon Region - % 13,8 (one thousand 6,9), to Dushanbe - % 1,6 (one thousand 0,8) 30,.

Among officially acknowledged unemployed in 2000 52,9 of % is constituted by women. At the same time it should be noted that the above-stated information is based only on officially the registered cases in bodies of employment service and it does not reflect real picture.

Despite tendency to growth, still there are low level of Gross domestic product and cash incomes per capita (payment on work of all categories of the population, pension, benefit, grant and other social payments, sales proceeds of products of agricultural industry, property incomes in the form of deposit interests, the income of persons occupied with business activity, insurance indemnities, etc.).

In comparison with 1992 sharp decrease in consumption of separate types of food per capita in year is noticeable and it considerably lags behind rational and medical regulations:

The population bulk (% 73,4) lives in the rural zone with the expressed problems of access to high-quality drinking water, utilities, transport and to other means of communication.

The health problems caused by preserving old system and insufficient level of financing are expressed. Besides, the imbalance in financing of health care on regions and on structures of medical authorities remains. Financing is generally oriented to hospital service and only about 15% of budget funds of health care is annually allocated for primary medical and sanitary service that in root is wrong.

At a low level there is physical condition of infrastructure of health care, and also equipment their medical equipment and products of medical appointment, security with medicines, especially in the rural zone.

Despite the happening changes in personnel policy of health care the expressed geographical imbalance, imbalance in employment and specialty remains. Reducing access to service of emergency medical service takes place. All this significantly influences access to high-quality services of primary medical and sanitary and hospital medical authorities.

In structure of general population morbidity, on the sequence, the most widespread are diseases of respiratory organs, infectious and parasitic diseases (generally diarrheal), diseases of endocrine system and frustration of food (generally at the expense of iodine-deficiency conditions), diseases of digestive organs, injuries and poisonings, diseases of nervous system and sense organs, blood and the haematogenic bodies.

Despite downward tendency, death rate of the population, child and maternal mortality, disability, reproductive health, especially among rural and the most vulnerable national groups remain problems.

According to 1997, life expectancy among men is 5,7 years lower, than among women (65,6 and 71,3 of years respectively).

Section 1.

PURPOSE: By 2010 the existing distinctions in questions of protection and gap in health level between population socio-economic groups within the country shall be reduced to 15% due to improvement of the situation in society and health of groups the population, the most subject to risk on incidence and death rate.

It assumes:

- Significant improvement of the social and economic and ecological conditions influencing health of the population, reducing distinctions in level of income of socio-economic groups of the population, development of access to employment.

- Achievement of stable tendency in the field of improvement of investments for implementation of the health strategy which are based on knowledge of health determinants.

- Improvement of physical condition and providing with the medical equipment and products of prime necessity, quality and access to services of organizations of primary health care.

- Achievement of reducing the most widespread diseases and death rates among different socio-economic groups of the population.

- Reducing gap among women and men, residents also sat down in life expectancies up to 2 years.

Strategy:

In social and economic policy:

- Development of focus of transformations in social and economic policy of the country on further reducing inequality in levels of the income and the social benefits, poverty, unemployment, inequalities in the relation, health for the reasons caused sexual, age and professional accessory.

- Development of address programs of social support of the most vulnerable national group.

- Development of tendency of further ensuring uniform social and economic development of all regions.

- Development of focus of social and economic programs of the country, and also projects of technical and financial aid in the area of the international solidarity on:

mitigation of problems of poverty and improvement of the situation of the least secure groups and categories of the population;

recovery of physical condition, equipment medical equipment and products of medical appointment of healthcare institutions;

development of pilot projects in high-quality transformation of primary health care within implementation of the Concept of reform of health care of the Republic of Tajikistan;

Development of high-quality actions for improvement of ecology;

Development of access to education, to favorable utility conditions;

Market development of work and improvement of the production circle.

On employment of the population:

- Further market development of work in the state and private sectors, employment of economically active population in economy, especially women, youth and persons, with the secondary general education.

- Enhancement of system of registration and social support of the unemployed.

- Implementation additional, privileges for creation and development in the state and private sectors of regions of the republic of the labor market, expansion of workplaces for women, youth, including persons with the secondary general education.

- Development of the actions directed to occupational retraining of persons recognized as the unemployed among women and youth and access to the labor market.

By training:

- Preserving high access to obtaining according to the legislation of the Republic of Tajikistan of initial, main and general average, and also secondary professional education, in particular, for children from social and vulnerable national groups (needy and incomplete families, the children who were left without care and guardianship, handicapped children from families of refugees and migrants, etc.).

- Enhancement at schools of general education type of programs and teaching bases of preserving the best health and prevention of diseases.

On the organization and delivery of health care:

- Development on basis so-so and long-term programs of cooperation with World the Organizations of Health care and other external donors in the field of reforming of health care, realization of the purpose and task of Strategy of achievement of health for all, physical and medical rehabilitation of organizations of primary and secondary levels of medical care in regions of the country due to joint use of resources, knowledge, information and approaches.

- Develop and implement the health indicators acceptable for assessment of manifestations of inequality of access to medical attendance.

- Development of process of reforming of primary health care (rationalization, physical rehabilitation, equipment, retraining of personnel, development of medical services, including emergency aid based on organizations of primary health care; development and deployment of methods of application of the principle of per capita financing in primary link of health care system) by expansion of pilot projects due to the International solidarity and joint use of resources and approaches.

- Develop the program of urgent measures for enhancement of management of the state health care system.

- Enhance system of information of health care which shall be oriented to implementation of accounting of important social and economic variable indicators and their analysis in interrelation with the state of health of the population.

Indicators for assessment:

- Assessment of the key social and economic parameters (the education level, average per capita comprehensive income of the population on one family member a month, consumption of food per capita in year, the level of unemployment and poverty).

- Expenses on health care and its service.

- Life expectancy of men and women, residents also sat down.

- Incidence, disability, death rate on gender and age, maternal death rate, and also access to medical authorities (including on materials of researches).

TASK 2 - THE HEALTHY BEGINNING OF LIFE

Analysis of situation

In lifecycle of the person the important transition periods characteristic on this or that event of its destiny are allocated. These are such periods as the birth, receipt of certain education, the beginning of labor activity, marriage, creation of family and family cares, the birth of the first child in family, any circumstances in labor activity, care of the parents, loss of close relatives, possible development of chronic diseases, preserving social activity after retirement, old age.

In each transition period of lifecycle adequate support on macro - and microlevels, directed to favorable impact on his health and wellbeing is necessary. Support at the macrolevel consists in creation of the circle surrounding the person allowing it to realize throughout all life in full the potential of health. Support at the microlevel consists in the efforts made in specific conditions - in life, at school, on workplace, etc. From this point of view social services, in particular the services of primary health care oriented to servicing of families at the place of residence, the working population on place of employment and also separate groups of local population with special requests, are important in respect of rendering systematic support to individuals and communities for all lifecycle, including the critical moments.

The birth of the healthy child in many respects depends on economic and social situation and the education level of family, health of parents and full support, including access to high-quality primary medical and sanitary and qualified obstetric care.

In state policy of the country care of motherhood and the childhood holds specific place. During transition to market economy, despite economic difficulties, measures for development of the legislation of maternity welfare and the childhood where are provided are taken: equality of the man and woman in family; the right of the woman most to solve motherhood; use at will contraceptive means and methods, including surgical sterilization; safety arrangements of pregnant women and nursing mothers; the extended terms of maternity leaves (it is total 140, and in case of the complicated childbirth - 156, in case of the birth of two and more children - 180 calendar days) with allowance payment on national insurance; provision of child care leave before achievement of age of one and a half years by it with allowance payment on the national social insurance and additional vacation, non-paid on child care before achievement of age of three years by it, etc. the President of the country it is issued and the special Presidential decree of the Republic of Tajikistan "About advancement of women in society" is implemented. The obligations following from the Beijing declaration and the Platform for actions, the Action program of the international conference on the population and development are realized (1999, Cairo). The Target National programs for the most priority problems of health of mother and the child supported by the Government of the country and also due to the international solidarity are adopted and are implemented.

Despite all this, in the country of problem of health of women and children remain quite sharp and deserve close comprehensive attention.

In structure of resident population of the country 49, the % makes the female population, from them - 49,3 of % of the woman of childbearing age, 9,4 of % is more senior than childbearing age. More than 72% of the female population live in the rural zone, with different geographical, climatic, social and economic and ecological features, the absolute majority of them lives in families in which the income is 1 person lower than the size of subsistence minimum.

Among women such diseases as anemia (anemia), infectious diseases, diseases of endocrine system (at the expense of iodine-deficiency conditions) and the blood circulatory systems are widespread.

All this significantly affects the state of health of pregnant women, women in labor and women in childbirth.

The different diseases complicating pregnancy occur among pregnant women in 68%, in particular anemia (anemia), infection of urinogenital ways, disease of endocrine system, venous complications, blood circulatory system diseases, etc.

Frequency of the complicated childbirth among which anemia or anemia, toxicoses of pregnant women, diseases of urinogenital system and the blood circulatory system, dysfunction of thyroid gland, etc. are most expressed is high.

Disclaimer! This text was translated by AI translator and is not a valid juridical document. No warranty. No claim. More info