Regions and Countries

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p. 11 of 20 BACK | NEXT I. Country Performance Assessment II. Country Operational Strategy III. Sector Strategies A. Agriculture B. Infrastructure C. Social Infrastructure and Environment D. Governance Dimensions of ADB Operations F. Gender Dimensions of ADB Operations G. Private Sector Development IV. Regional Cooperation V. Donor Activities and Aid Coordination VI. Cofinancing and Catalyzing External Resources VII. ADB’s Operational Program VIII. Economic and Sector Work Program IX. Local Cost Financing

Country Assistance Plans - Tajikistan : III. Sector Strategies

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C. Social Infrastructure and Environment

1. Social Infrastructure

42. Under the severe budget constraints after independence, public expenditure on the social sectors (health, education, and social protection) fell from 19.8 percent of GDP in 1992 to 4.2 percent in 1998 and arrears in payments grew. In addition, during the civil war, intensive fighting prevented the Government from delivering social services and assistance to certain areas.

43. With the completion of the peace process in March 2000, the Government has started trying to improve delivery of various social services. It is committed to maintaining a budget allocation of 35 percent for overall social sector expenditures, including 21 percent for education and health. Many challenges, however, still remain. The most critical issue is the need for sustainable financing mechanisms to continue support in the social sector.

44. The very serious deterioration in living standards and the massive problem of poverty that has emerged since independence indicate that ADB should attempt to alleviate this situation with an early intervention in the social sectors. It was in this context that the Social Sector Rehabilitation Project, the second ADB loan following the Postconflict Infrastructure Program loan, was approved in 1999. The project re-activates delivery of essential social services through capacity building of local government and community structures. As is reflected in the Project approach, ADB social sector strategies are to improve social services in a way to support sustainable long-term development. By focusing on rural and underprivileged areas, ADB assistance also contributes to reducing poverty. The Project focuses on Leninabad and Khatlon areas for the training and rehabilitation components, but also brings nation-wide benefits with the distribution of textbooks, medical equipment, and supplies; public information campaigns; and management information systems for the Social Fund. ADB plans to further support the overall social sector reform through the Social Sector Development Project in 2002. Social sector interventions are being planned and pursued in close coordination with other donors and NGOs, especially with the UN and WB, which are also active in the sector.

2. Education

45. Since independence, the share of educational expenditure fell from 11 percent of GDP in 1992 to 2.1 percent in 1997. As a result, education services have deteriorated, many qualified teachers have left their profession or the country, teaching hours have been reduced, and school supplies have become scarce. Major educational indicators show that people's access to basic education declined. For the nation as a whole, about 97 percent of children are reported to be enrolled at primary school and about 85 percent at lower secondary school. Although these rates are still high considering the country's per capita income level, they show a marked decline compared to the country's historically strong and almost universal access to basic education. Many poor families are unable to purchase textbooks, adequate clothes, and other belongings, and to cover transport expenditures. Moreover, the number of students enrolled in higher secondary school drastically declined by 42 percent between 1994 and 1998. In contrast, enrollment in higher education has remained remarkably constant. However, due to the lack of job opportunities, young people often have to engage in activities other than those for which they were trained, and some of them leave the country.

46. In the face of the deterioration of education services and to address the issues in the new economic environment, the Government allowed the private sector to get involved in education in 1994. Also, steps were taken to reform the curricula and textbooks, and new education standards were introduced in 1996. In addition, fees and user charges were introduced in schools and universities. Textbooks are no longer provided free, although the current charge is only a fraction of the actual cost. The Government's support to the education sector has been strengthened since 1997, the share of educational expenses in the state budget began to rise in 1998, and a further increase of public support was committed in 2000.

47. The major objectives of ADB assistance are to (i) further enhance sector reforms to enable the education system to meet the needs of a market economy, and (ii) rehabilitate education infrastructure to improve access to and quality of basic education services. ADB assistance will focus on building institutional capacities to improve education management, encouraging private sector participation in financing and provision of education services, facilitating curriculum and textbook development, strengthening teachers' training and vocational training needed for a market economy, rehabilitating the damaged primary and secondary school buildings, and implementing remedial and catch-up educational programs to ensure continued access to education services by disadvantaged groups.

3. Health

48. The health care system also experienced a crisis after 1991. The network of basic health care provision broke down, people's access to basic health care became limited, and the quality of health services deteriorated. The war and natural disasters destroyed a large number of health facilities. Although official statistics show a decrease in the maternal mortality rate and infant mortality rate during the 1990s, UNDP reported concerns about the accuracy of registration data after an administrative charge was introduced for the registration of births and deaths⁹. The share for health expenditure in the state budget fell from 5.7 percent in 1992 to 1.3 percent in 1997. The supply of medicine had dropped to 30 percent of the 1989 level by 1996. The civil war and economic difficulties have also forced may qualified physicians to either emigrate or move to other sectors; the number of doctors fell by 11 percent from 1990 to 1997.

49. The Government made an initial response to the difficult situation in health. A Health Law passed in 1997 allows private medical centers to be established and permitted doctors working in public hospitals to engage in private practice located on private property. The Government also took measures to reduce operational costs by cutting the number of hospital beds from 55,000 in 1992 to 44,000 in 1997, and by introducing charges for certain health services. To further improve health care, the Government adopted the national strategy "Health For All Up To 2005", and the implementation of the strategy, "The National Program of Health Care Reform in Tajikistan" was adopted in 1998. The share of health expenses in the state budget increased in 1998 and the further increase has been committed by the Government in 2000.

4. Environment

50. Based on the findings from ADB's Social Needs Assessment in 1999, ADB provides support to the health sector under the ongoing Social Sector Rehabilitation Project to (i) rehabilitate and refurbish primary health facilities; (ii) provide essential drugs and medical supplies, including disinfectant, to primary health facilities; and (iii) re-train health workers for family doctor practice. ADB's further intervention in the health sector will be considered within the framework of the Social Sector Development Project in the pipeline.

51. Achieving environmentally sustainable development is a challenge for Tajikistan given past damage, competing demands on public resources, and lack of effective environmental policies and institutional capacity. Efforts for managing environmental issues will have to be carefully focused and prioritized as resources continue to be scarce. A strategy of "build now and clean later" is often expensive and unsustainable. As peace is being restored and the economy has started recovering after the civil war, there are opportunities to establish an effective environmental management system to prevent further degradation of the environment and reduce the existing environmental damage.

52. In 1998, the Government approved the National Ecological Program. ADB agreed to assist in implementing the Program and for this purpose, an ADTA for Environmental Monitoring Capacity Building is included in the program. ADB conducted an environmental study and provided the Tajikistan Environmental Profile in 1999. Based on the findings of the study, ADB will support the Government's initiatives on environmental protection, emphasizing (i) environmental legislation and institutional strengthening through non-lending activities and (ii) improved management of water, land, energy, and other natural resources by integrating environmental considerations into lending projects.

53. The IOS includes a focus on disaster management to address Tajikistan's particular susceptibility to natural disasters. Accordingly, ADB focused its environment-oriented activities on improving flood management. Following the successful implementation of a $5 million Emergency Flood Rehabilitation loan in 1999, an ADTA for Strategy for Improved Flood Management is being implemented. The ADTA will provide the basis for further ADB assistance.

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