Tajikistan: Improved Maternal and Child Health through Connectivity

Sovereign Project | 46077-001

Summary

The primary objective of the project is to improve maternal and child health results for isolated rural communities of five jamoats in Rasht district, one of the poorest regions of the country with the highest rate of food insecurity. Health services are poor and knowledge of health-promoting behavior is limited. The situation has worsened since March 2009 when the only bridge connecting the communities to the district center was destroyed by flooding. Residents now have to make a 17 kilometer detour to access the road to the district center. This has seriously constrained access to social services, especially health-care facilities, for communities lacking adequate local health services. The project outcome will be improved access of the marginalized rural poor in five jamoats in Rasht district to strengthened health services.

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Project Name Improved Maternal and Child Health through Connectivity
Project Number 46077-001
Country Tajikistan
Project Status Approved
Project Type / Modality of Assistance Grant
Source of Funding / Amount
Grant 9171-TAJ: Improved Maternal and Child Health through Connectivity
Japan Fund for Poverty Reduction US$ 2.50 million
Strategic Agendas Inclusive economic growth
Drivers of Change Partnerships
Sector / Subsector

Transport - Road transport (non-urban)

Gender Equity and Mainstreaming Some gender elements
Description The primary objective of the project is to improve maternal and child health results for isolated rural communities of five jamoats in Rasht district, one of the poorest regions of the country with the highest rate of food insecurity. Health services are poor and knowledge of health-promoting behavior is limited. The situation has worsened since March 2009 when the only bridge connecting the communities to the district center was destroyed by flooding. Residents now have to make a 17 kilometer detour to access the road to the district center. This has seriously constrained access to social services, especially health-care facilities, for communities lacking adequate local health services. The project outcome will be improved access of the marginalized rural poor in five jamoats in Rasht district to strengthened health services. The project will support (i) rehabilitation of the bridge and improvement of the rural road, which is linked to Central Asia Regional Economic Cooperation (CAREC) corridors 3 and 5; and (ii) increased use of effective health services and nutrition practices in communities. About 40,000 villagers will benefit from these interventions.
Project Rationale and Linkage to Country/Regional Strategy

The Government of Tajikistan identifies primary health care and Maternal and Child Health as top priorities in its comprehensive National Health Sector Strategy, 2010-2020. Poor child health outcomes in Tajikistan are caused by systemic health sector issues, including chronically limited financing and poor quality health services; poverty, particularly in rural areas; limited knowledge of health-promoting behavior; and poor access to clean water. The general population has insufficient access to health-related information and lacks awareness of the causes of ill health. The project area (Rasht district) is one of the most traditional and conservative areas in Tajikistan. Women from the area are less likely than women from other regions to participate in community activities or seek health services. Both the Infant Mortality Rate and Under-five Mortality Rate are 10%-15% higher in Rasht district compared with other regions. The district is one of the poorest in the country and has the highest rate of food insecurity (11%-18% of the population is classified as extremely food insecure and 74% as moderately food insecure).

The project would support combined and interlinked health and transport interventions to improve the health of mothers and children. The bridge access and road improvement together with health interventions will have multiple synergetic social and economic effects; (i) improved transport services (e.g., availability, frequency, reliability, and costs); (ii) greater accessibility to health care resulting in improved health outcomes for women and children (due to an increased number of people seeking treatment for illness due to reduced travel times); (iii) better access to education opportunities; (iv) uninterrupted flow of agricultural goods and services (such as seed, fertilizer, and crops) across the river; and (v) growth in livestock raising through improved access to veterinary services and better access to market opportunities. The improved accessibility will increase economic opportunities of poor rural households, which in turn will contribute to increased income and, thus, improved health outcomes among women and children. The health information component of the project will increase demand for health services, and the project will support activities to match the demand by increasing the supply and quality of health services. The project will help ensure this supply by enhancing the mobility of health personnel and supplies by reestablishing the bridge and road connection and equipping the rural hospital in Navobod with a safe and operating ambulance.

The Country Partnership Strategy for 2010-2014 emphasizes ADB's continuing involvement in the transport sector through investments in domestic and regional road links, and includes gender mainstreaming as a core cross-cutting theme. The Project will contribute to achieving MDG 4 (reduce child mortality) and MDG 5 (improve maternal health) in the project area.

Impact Improved child and maternal health results in five isolated jamoats in Rasht district
Project Outcome
Description of Outcome Improved access of the marginalized rural poor in five jamoats in Rasht district to strengthened health services
Progress Toward Outcome The progress is on track. Assessment of the project progress towards outcome will be made by the end of 2015.
Implementation Progress
Description of Project Outputs

58 communities in Rasht valley have improved access to transport and social facilities

Targeted communities effectively use health services and nutrition practices

Effective project management, monitoring and evaluation of results

Status of Implementation Progress (Outputs, Activities, and Issues)

(1) The civil works contract for rehabilitation of an existing 66-meter bridge over the Sarbog river and improvement of 18 km road from the bridge to the Rasht district center access road was signed on 5 September 2014; rehabilitation works started in October 2014. The construction / rehabilitation works are progressing well (about 25%). As of 31 December 2015, the Contractor completed earthworks, drilling-and-blasting operations, base course installation (2.0 km), asphalt covering (1.0 km), and bank protection works for the bridge. The civil works will be completed by 31 December 2015, as scheduled.

(2) The project team in consultation with MOHSP and local authorities has identified the training needs of health workers (October 2013) and delivered training programs on obstetric/infant care (May 2014) (covering 80 staff or 100% of the targeted health workers), Integrated Management of Childhood Illnesses (IMCI) (October 2014), and TOT trainings (February 2015). Implementation of the awareness raising activities will commence upon completion of the ongoing current practices, beliefs and perceptions assessment.

Besides, in December 2014 the project completed rehabilitation of a Diagnostic Center building of Rural Medical Facility in Jamoat Navobod (Rasht District). The project also procured a new ambulance (September 2014) and the required basic essential medical equipment, furniture, tools (December 2014) for the rural hospital in Navobod township.

Geographical Location Rasht district, Tajikistan
Safeguard Categories
Environment B
Involuntary Resettlement C
Indigenous Peoples C
Summary of Environmental and Social Aspects
Environmental Aspects The due diligence confirmed that the Project does not pass through any environmentally sensitive areas and will not result in significantly negative environmental impacts, and therefore, for environmental safeguards the Project is classified as having environmental category B. MOT prepared an initial environmental examination (IEE) according to ADB's Safeguard Policy Statement (2009) and national legislation and regulations. The IEE was disclosed on ADB website on 24 September 2012. Project-affected people were duly consulted. The IEE includes an environmental management plan to minimize the Project's potential environmental impacts. MOT, assisted by an environmental expert, will be responsible for implementing the plan and submitting to ADB a semi-annual monitoring report.
Involuntary Resettlement The Project is categorized C for potential involuntary resettlement (IR) and indigenous peoples (IP) impacts since no land acquisition and impacts on IPs are foreseen. All activities will be conducted in the existing Right of Way (ROW) and other available land with no IR impacts. A due diligence mission to the project site was fielded and a report was prepared accordingly.
Indigenous Peoples No ethnic minorities that fall under the definition of ADB SPS (2009) on Indigenous Peoples are identified in the project site to trigger the policy application. The Project categorized as C.
Stakeholder Communication, Participation, and Consultation
During Project Design

The project was formulated in consultation with Ministry of Transport, the Ministry of Health, local governments, rural communities, and development partners concerned, particularly the Embassy of Japan in Tajikistan and the Japan International Cooperation Agency, as well as people affected by the project. ADB held several consultations with district authorities, communities, and women's groups to identify primary and secondary stakeholders, their perceptions of current problems, and interest in the project.

The project scope and approach have also been discussed with World Health Organization, United Nations Children's Fund, World Bank, GIZ, and Global Funds. All development partners agree on the importance of the project.

During Project Implementation

The project design promotes consultation among all stakeholders, including Ministry of Transport, Ministry of Health, the Ministry of Finance, local governments with active participation of community and jamoat leaders, district administrators, the Embassy of Japan in Tajikistan, Japan International Cooperation Agency, World Health Organization, United Nations Development Programme, United Nations Children's Fund, World Bank, GIZ, and Global Funds. Ministry of Transport will provide national coordination of the project and disseminate information on project activities to all project stakeholders and partners through consultation workshops, seminars, and public awareness campaigns.

The project will build the capacity of key local stakeholders (local government, community-based organizations, and contractors) to carry out community-based maintenance work through participatory planning and mobilizing local resources. The project will rely on a variety of training and awareness-raising channels, including community-based education, counseling, schools, parent-teacher associations, local organizations (i.e., farmer associations, village infrastructure maintenance associations) in developing and implementing behavior change communication activities.

Business Opportunities
Consulting Services MOT will recruit all consultants under the project in consultation with ADB according to ADB's Guidelines on the Use of Consultants (2010, as amended from time to time). Individual international and national experts are expected to be hired for the positions of project manager (national, 36 person-months), technical advisor (international, 3 person-months), health coordinator (national, 36 person-months), environmental expert (national, 3 person-months), baseline survey and impact assessment, and monitoring and evaluation (4 person-months). MOT will recruit the independent external auditor using the consultants' qualifications selection (CQS).
Procurement Procurement under the project will be conducted in accordance with the Asian Development Bank (ADB) Procurement Guidelines (2010, as amended from time to time). Procurement of civil works will follow (i) international competitive bidding (ICB) procedure for bridge rehabilitation and/or road improvement contract that exceeds ICB threshold indicated in the procurement plan, and (ii) national competitive bidding (NCB) procedure for renovation of health facilities contract, a value of which meets the NCB threshold in the procurement plan. The shopping method will be used for procuring contracts less than the threshold indicated in the procurement plan for basic essential medical equipment, furniture, tools, new ambulance, and small-valued items, including office furniture. Local consulting firms will be engaged for printing information, education, and communication materials using a national short-listing given the small contracts amounts.
Responsible ADB Officer Farrukh Nuriddinov
Responsible ADB Department Central and West Asia Department
Responsible ADB Division Tajikistan Resident Mission
Executing Agencies
Ministry of TransportMT-RT@MAIL.RU14, Aini Street
Dushanbe 734042
Tajikistan
Timetable
Concept Clearance 01 Dec 2011
Fact Finding 06 Jun 2012 to 06 Jun 2012
MRM 03 Oct 2012
Approval 07 Mar 2013
Last Review Mission -
Last PDS Update 20 Mar 2015

Grant 9171-TAJ

Milestones
Approval Signing Date Effectivity Date Closing
Original Revised Actual
07 Mar 2013 09 Apr 2013 09 Apr 2013 31 Mar 2016 - -
Financing Plan Grant Utilization
Total (Amount in US$ million) Date ADB Others Net Percentage
Project Cost 2.93 Cumulative Contract Awards
ADB 0.00 07 Mar 2013 0.00 2.35 94%
Counterpart 0.43 Cumulative Disbursements
Cofinancing 2.50 07 Mar 2013 0.00 1.55 62%

Evaluation Documents

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