Breaking the link between disability and exclusion in Tajikistan

WHO/Satish Mishra

Nine-year-old Robia Rahimova (right) plays with her friend Mariam Narzuloeva. Thanks to the rehabilitation interventions, Robia – who was affected by polio – has learned to walk using a support brace and forearm crutch, regaining functionality as well as her confidence and cheerfulness.

Disability changes lives – so do rehabilitation services

“Robia was 6 months old when she fell ill, with her legs paralysed. No one was able to identify her disease. Someone said that it was meningitis, someone just shrugged,” recalls Ms Hosiat Rahimova, Robia’s mother. “After a month in hospital, I was informed that Robia had polio, and that no treatment was available. We were sent to a rehabilitation centre but nothing much happened there. It was a depressing phase of our life.”

Several hundred Tajik people developed impairments and now need long-term rehabilitation care following a large poliomyelitis (polio) outbreak in 2010, which also spread to 3 neighbouring countries. They are just some of the approximately 180 000 registered children and adults across the country living with different impairments.

People with disabilities, older people and people with noncommunicable diseases (NCDs) make up the largest groups in need of rehabilitation services and assistive products. These services and products play a critical role in minimizing functional limitations related to, for example, mobility, cognition, respiration, vision and communication. They also reduce the social and economic impact of health conditions, and improve well-being.

Having increased by 18% in the last decade, NCDs are now the leading cause of disability and death in Tajikistan. Disabilities associated with NCDs, such as amputation, blindness or paralysis, have therefore also increased, placing significant demands on the country’s social welfare and health system.

Improving rehabilitation services from a health perspective

To support the Ministry of Health and Social Protection of Tajikistan in improving the provision of and access to rehabilitation services for people with disabilities, WHO set up a disability rehabilitation programme in 2013 that focuses on people affected by polio.

After conducting door-to-door assessments in all polio-affected districts, rehabilitation interventions managed to cover 85% of all children and young adults with the disease. WHO assisted the Ministry in conducting complex orthopaedic surgeries and training health professionals in these districts on polio rehabilitation.

“In 2013, the treatment in the rehabilitation centre began to change,” explains her mother. “Robia was given physiotherapy and we were trained on everyday life skills that could help Robia to be independent. The National Orthopaedic Centre prepared a more convenient orthosis [support brace] for Robia, which is adjusted as she grows. The rehabilitation centre taught her to walk with the orthosis and stick. This gave Robia more confidence to be independent.”

Ms Rahimova saw the impact this had on her daughter: “As a result, my child began to feel better, more active and cheerful. We visit the rehabilitation centre for periodical checks. Now she walks independently using brace and stick. She has friends, and helps me around the house. She started school and receives individual classes at home. At the last spring festival, she also performed on the stage. I am extremely glad to see how my child has developed.”

This and other successes of the WHO rehabilitation programme demonstrate its benefits, as well as the need for a national rehabilitation policy in line with international standards.

Scaling up the programme and involving other sectors

WHO assisted the Government of Tajikistan to develop its multisectoral National Programme on Rehabilitation of Persons with Disabilities (2017–2020) through a consultative process that involved different ministry representatives, disabled people’s organizations, national and international nongovernmental organizations, and donors. The United States Agency for International Development (USAID) and the United Nations Partnership to Promote the Rights of Persons with Disabilities (UNPRPD) provided financial support for the development of the multisectoral national programme.

In 2016, the Government of Tajikistan adopted the National Programme to improve health, rehabilitation, education and livelihood, and to provide social protection and equal opportunities for people with disabilities.

A national programme to leave no one behind

The National Programme focuses on all people with long-term impairments (physical, sensorial and intellectual impairments, and mental health conditions) as well as those with functional difficulties (due to NCDs, conditions following surgery, infectious diseases, neurological disorders, injuries or the ageing process). It seeks to provide them with high-quality services to ensure their full and equal enjoyment of human rights and to respect their dignity.

“On behalf of 80 000 people with disabilities from 50 member organizations of the National Association of Persons with Disabilities in Tajikistan, I want to express my sincere gratitude to all those involved in the development and adoption of the National Programme on Rehabilitation,” states Mr Asadullo Zikrihudoev, Chairman of the National Association of Disabled People of Tajikistan.

“The Programme is a big step forward and we are confident that it will improve the health of people with disabilities, as well as support their education, employment and self-esteem for full inclusion in society.”

A step forward in achieving the Sustainable Development Goals (SDGs)

The 2030 Agenda for Sustainable Development and its 17 SDGs support a holistic approach, and maintain that no one should be left behind in the achievement of health and well-being. Health 2020, the health policy framework for the WHO European Region, incorporates approaches and priorities common to the 2030 Agenda, and provides a stepping stone for achieving the SDGs in the Region.

In the absence of accessible, high-quality services, disability often means exclusion, poverty and isolation. Working to counter this trend, the intersectoral interventions and services established in Tajikistan’s National Programme are in line with the WHO global disability action plan 2014–2021, as well as Health 2020 and the SDGs.

These interventions and services contribute to ensuring health for all at all ages (SDG 3), but also to reducing poverty (SDG 1) by supporting economic security and promoting employment of people with disabilities. They also provide opportunities for education (SDG 4) through inclusive education programmes, and empower women and promote gender equality (SDG 5).

Tajikistan developed and implemented its National Programme through partnerships and collaborations among sectors, and with the participation of civil society – an approach consistent with the means of implementation recommended by the 2030 Agenda.

“The National Programme on Rehabilitation (2017–2020) aims to create an enabling environment with equal opportunities for all,” says Dr Saida Umarzoda, First Deputy Minister of Health and Social Protection of Tajikistan. “WHO’s support in involving diverse disability and development stakeholders has made a significant contribution to shaping the National Programme to better meet the needs of its users.”