Rohila Boboeva, a 33-year-old gynecologist, battles each day with overcrowding and a lack of proper tools to meet the needs of mothers and infants in the maternity ward she manages at the Rasht District Central Hospital in Tajikistan.

Some days, that battle is lost. In the first 6 months of 2019, two babies died despite the best efforts of medical staff because of limitations imposed by the hospital’s outdated facilities and lack of equipment.

Rohila says emergencies pose particularly dangerous problems. “For example, when the placenta separates from a mother’s uterus prematurely, the first 5 minutes are critical for saving the woman and her baby. Yet precious time is lost to transferring the patient downstairs from the second to the first floor because there’s neither a fully equipped surgery room in the maternity ward nor a hospital elevator.”

Urgent or not, specialized maternity treatment requires a 180-kilometer road transfer to Dushanbe, the country’s capital.

Built in the 1970s, the hospital helps deliver up to 15 babies a day. As well as caring for mothers and children after birth, the maternity ward must treat pregnant women struggling with health issues.

Expectant mother Munira Pirjonova, 22, learned how important this is. “I’m making sure this pregnancy is monitored,” she said during a 3-week stay in the ward in 2019, after losing her baby at home in the Rasht District village of Kochon because of the complications of high blood pressure during her first pregnancy.

Rohila says the ward’s 24 beds are old, unsuitable, and insufficient in number. Doorways and corridors are too narrow to accommodate patient stretchers, and such basic equipment as modern X-ray and lung ventilation machines is lacking. So are financial resources, even though the hospital is expected to serve 400,000 people across five districts.

“The doctors and nurses do their utmost,” Rohila says, “but the facilities cannot safely meet the community’s needs.”

“Some men in conservative districts stop their wives from visiting local hospitals and clinics. The communication and outreach plan will strengthen understanding and encourage the use of local services by people in our communities, especially women.”

Isfandiyor Mahmudzoda, project manager

Rohila’s hospital is not alone, a fact recognized by ADB’s approval of a $32 million ADF 12 grant to help deliver better quality health care in three districts, including Rasht, that have the highest rates of maternal and child mortality.

Underinvestment has left many of the country’s hospitals and health centers with outdated buildings and obsolete equipment. Communication between primary care providers and hospitals, staff capacity, and patient follow-up are poor, lacking, or absent. As a result, Tajikistan lags the subregional and global averages for maternal and child health indicators, as well as on progress toward the Sustainable Development Goal target for reducing child mortality rates.

The Maternal and Child Health Integrated Care Project funded by the ADF 12 grant is improving hospital and health-care center infrastructure and equipment and helping staff and oversight agencies plan and deploy human resources more effectively. It is developing a system to provide continuous medical education for doctors and midwives to improve the quality of health care on an ongoing basis.

The project includes a campaign to reach 85% of the pregnant women in the project area and change the sociocultural attitudes and behavior that can deter women from seeking timely maternal and child health care.

“Some men in conservative districts stop their wives from visiting local hospitals and clinics,” says Isfandiyor Mahmudzoda, who is managing the project for the executing agency, the Ministry of Health and Social Protection. “The communication outreach plan will strengthen understanding and encourage the use of local services by people in our communities, especially women,” he adds.

Learn more about the Asian Development Fund (ADF).

This article was originally published in Together We Deliver, a publication highlighting successful ADB projects across Asia and the Pacific that demonstrated development impacts, best practice, and innovation.