Tajikistan: Improved Maternal and Child Health through Connectivity

Transport / Road transport (non-urban)

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.

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

ROAD REHABILITATION: The civil works contract for rehabilitation of 9 km road and bridge was awarded on 3 September 2014 and signed on 5 September 2014. The main civil works were substantially completed by the end of 2015. In February 2016, ADB approved the Governments request to extend the main civil work contract until 30 June 2016 to allow improvement of further 1.5 km road section using remaining grant funds. Rehabilitation was completed by the end of June 2016.

Local contractors and communities in five targeted djamoats of Rasht district were trained in conducting day-to-day infrastructure maintenance and minor repair works. Besides, a joint road maintenance association was established among all five djamoats to enhance communities capacity for routine road maintenance. The joint association pooled together existing machinery and equipment from five djamoats. As the result, the association owned a grader, an excavator, and a loader, in addition to the available tools (clothing, shovels, pickaxes, etc). The project filled in the available gap in this list by procuring a dump-track, which was considered to be crucial for proper and timely cleaning of the road during mudflows and rock falls.

HEALTH COMPONENT: 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 was completed in September 2016.

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.

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.

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