In considering implementing an alternative program for mothers and babies in Tajikistan, let me first brief you about Tajikistan’s health system, so you have a better idea of the local situation.


At one point (during the Soviet time) Tajikistan’s health care system had wide coverage of public health initiatives, although with a strong facility-based emphasis and had the health indicators of middle-income countries. Unfortunately the health system was ravaged during the destructive five-year civil war from 1992-97 following independence.


Since then, the failing health-care delivery system deteriorated further due to chronic underfunding, inadequate supplies and outmoded equipment, deteriorating facilities, poor morale with few incentives for health care workers, and consumer dissatisfaction.


Currently, service delivery for Maternal, Newborn and Child Health and Nutrition in Tajikistan is built around three major programmatic challenges that face the country, and two systemic problems.

The three programmatic challenges are:
1. Significant nutritional problems impede child survival, growth and development (i.e. anemia of women and children, stunting, iodine deficiency and other micronutrient deficiencies);
2. High maternal and neonatal mortality rates — largely the result of women’s malnutrition, poor health care, and status in society;
3. Persistent communicable diseases in young children, including pneumonia, diarrhea and other diseases that are clearly associated with poor environmental and personal hygiene, deteriorating water sources and poor sanitation.


The two systemic problems are interrelated:

1. The apparent loss of public confidence in the health system as reflected in declining utilization rates of health services, and
2. Deterioration in the quality of care, in part the result of a poorly paid and under-motivated medical and health staff.


International organizations including the UN that operate in the country are trying to address the programatic problems, while the World Bank is working on reforming health-care financing. Some programs are showing more progress than others, but overall the utilization of health services is continuing to decline, especially in rural areas.


The Program for Mothers and Babies you are discussing at this conference is similar to the practice in Tajikistan during the Soviet era. Each women with her baby was followed by a pediatrician and nurse with frequent home visits. Massage for the babies was popular, although not for mothers. Currently only high-income people (mostly from the capital city) can afford a better standard of health care in delivery facilities, and aftercare (babies massage, etc) upon their discharge from the hospital. The Mother-Baby Program might be applicable, and even be welcomed by the Ministry of Health if appropriate funding will come with it.