A community-based approach to health centers in Tajikistan is providing access to health in areas with high rates of infant and maternal mortality.
Kyzrok Village, Tajikistan - At first glance the new health center in Kyzrok Village may seem modest, but it is a far cry from the old train carriage that for many years received patients in this remote district about five hours northeast of Tajikistan's capital, Dushanbe.
"We certainly didn't have the type of facility we have now," laughs Valijon Hakimov, a doctor who has worked in Rasht District for 35 years. "The old structure was just a wagon, so we couldn't provide timely or good quality services to the local population."
In the past, doctors in rural areas such as the Rasht district would often treat patients in mosques, schools, kindergartens, or any other available spaces.
By contrast, the new health center in Kyzrok Village was designed and constructed specifically to serve the medical needs of the community. The bright and cheerful space - two large treatment rooms separated by a welcoming reception and waiting area - now serves a population of some 18,000 people.
Reforming Tajikistan's Health Sector
The facility is one of 27 health centers constructed in Tajikistan under the Health Sector Reform Project, funded by ADB. The project was designed to provide equitable access to health services in poor areas with high rates of infant and maternal mortality.
The project offers a free health package to patients including basic neonatal and postnatal care, immunizations, treatment for common diseases such as tuberculosis, and regular checkups.
Financed by a US$7.5 million ADB loan, the project has also set up quality control mechanisms for medicines, and constructed two regional warehouses for storing pharmaceuticals.
Reducing the travel time that once separated large regional hospitals and remote rural areas has been a key component of the project: With the introduction or rehabilitation of family health centers, people no longer need to travel long distances for most types of medical treatment.
Reaching Patients, Reducing Mortality
Local health officials say this community-based approach has yielded instant results.
Hakimov says he has seen a massive drop in infant mortality rates since the Kyzrok Village health center was completed in 2008.
"We don't have infant mortality cases like before," he said. "It used to be that we'd have 10 to 12 cases of infant mortality every year. But now, pregnant women are getting the timely support that they need, and so last year we did not have any cases at all."
The project also places a strong emphasis on retraining medical personnel to better serve community needs in rural areas rather than at large-but-distant district hospitals.
A training program at Rasht District Hospital is helping specialist doctors and nurses become family practitioners capable of handling a wide range of common ailments at the local level.
To date, the Health Sector Reform Project has trained 134 doctors and 588 nurses in family group practice.
"A person is much more likely to visit a local health center a kilometer away as opposed to traveling 30 kilometers to a large district hospital," said Hakimov. "The proximity of efficient health centers to the rural population means we've seen an acute drop in infectious diseases such as typhoid and tuberculosis."