Tajikistan: Maternal and Child Health Integrated Care Project

Health / Health sector development and reform

The project is aligned with the following impact: improved health status and well-being of mothers and children in the project districts. The project will have the following outcome: improved coverage of women and children with quality maternal and child health (MCH) services in the project districts. Project districts are: Fayzobod, Rasht and Shamsiddin Shohin.

The project outputs are (i) integrated delivery of quality maternal and child care services in project districts improved; (ii) infrastructure and equipment for MCH services in project districts rationalized and improved; and (iii) knowledge of maternal and child health and health seeking behaviors in project districts improved.

Output 1: Integrated delivery of quality maternal and child care services in project districts improved.

The project will: (i) formulate a strategy for planning and deploying human resources, build institutional capacity for CME; and strengthen clinical capacities in the project districts; (ii) create an effective referral system between the various MCH service levels as well as a sound feedback mechanism and integration of vertical programs into PHC; (iii) institutionalize

continuous quality improvement (CQI) system at national, sub-national and facility levels and establish a supportive supervision system; and (iv) pilot case-based payment system at project district hospitals.

Output 2: Infrastructure and equipment for MCH services in project districts rationalized and improved.

The project will support: (i) upgrade of central district hospitals (CDHs) and DHCs; (ii) supply of medical equipment and medical furniture to refurbished CDHs and DHCs, and provision of basic medical kits to PHC facilities; and (iii) piloting of the equipment management system in project facilities. The project will also support the Government's efforts in

establishing a national equipment management system in close coordination with KfW and JICA.

Output 3: Knowledge on maternal and child health and health seeking behaviors in project districts improved.

Knowledge of MCH and health seeking behaviors in project districts improved. The project will help (i) build the capacity of the Republican Healthy Lifestyle Center for developing a behavior change communication (BCC) plan, and for monitoring, evaluating, and reporting the plan; (ii) design and implement district-specific knowledge, attitude, and practice (KAP) surveys; and design district-specific BCC implementation plans based on the findings of the baseline KAP survey; (iii) carry out community mobilization activities to promote social norms that support collective MCH objectives and challenge harmful practices; and (iv) develop the BCC skills of health workers and community members.

The pursuit of sustainable development goals is echoed in the National Health Strategy for Tajikistan 2010-2020, which envisions strengthening of maternal, newborn, child and adolescent health, prevention and control of infectious diseases, decreasing the burden of preventable non-communicable diseases, and strengthening PHC. The government approved the Strategic Plan for the Rationalization of Medical Facilities in the Republic of Tajikistan for 2010-2020 (No. 169 dated 1 April 2011) to rationalize health service delivery. The rationalization plan envisions an integration of health services across levels of care and types of providers.

The project builds on ADB's operational plan for health to support inclusiveness and reduce vulnerabilities in Asia and the Pacific. ADB will contribute to the integration of primary and secondary care concentrating on maternal and child health, which is key for better quality and efficient provision of services. The project will consolidate different pilots of development partners, which focuses on either primary health care or secondary care, into an integrated concept. Integrated care refers to integration across primary, secondary, and tertiary health services to provide more continuous care to patients with the aim of achieving improved patient care through better coordination of services provided. ADB will bring in regional lessons on integrating health care services, and improving efficiencies in health service delivery to inform the project and the ongoing country health reforms.

Health status and well-being of mothers and children in the project districts improved

(Sustainable Development Goals 3).

Coverage of women and children with quality MCH services in the project districts improved

Integrated delivery of quality maternal and child care services in project districts improved

Infrastructure and equipment for MCH services in project districts rationalized and improved

Knowledge on maternal and child health and health seeking behaviors in project districts improved

The project will require an estimated 1,071 person-months of national individual consultants (including project administration group staff); 6 person-months international and 5 person-months national individual consultants; 461 person-months for project consulting firms (of which 79 person-months international and 323 person-months national consultants; 12 person-months audit firm; and 324 person-months for UNICEF.

Advance contracting will be undertaken for the recruitment of project administration group manager and key technical staff, project implementation support firm, design and civil works supervision firm, integrated maternal and child health and behavior change communication firm, financial management consultant, and integrated care consultant.

The project will construct/renovate district hospitals and district health centers. The project will provide various medical equipment, IT equipment and other related accessories to the hospitals and district primary health care clinics to cost more than $100,000, using open competitive bidding (OCB) procedures. Office equipment, furniture and vehicle for the use of the project administration group staff to cost less than $100,000, the Request for quotations will be used for procurement of off-the-shelf equipment.

Advance contracting will be undertaken for the procurement of project administration group office furniture, office equipment and vehicles.