Tajikistan: strengthening rehabilitation to leave no one behind
Robia was only 6 months old when she fell ill in 2009 and was unable to move her legs. After a month, doctors diagnosed her with polio and she was sent to a rehabilitation centre, but for several years she made no progress. In 2013, however, things changed. Robia started to have physiotherapy and received training in everyday life-skills that could make her independent. She received a support brace from the National Orthopaedic Centre, which is adjusted as she grows.
She is now thriving at school, getting good grades, and continues to visit the rehabilitation centre twice a week. Her mother knows how important the services have been. “As a result, Robia began to feel better, more active, more cheerful. Now she walks independently using a brace and stick. She has friends and helps me around the house.”
Robia is just 1 of over 180 000 children and adults registered with disabilities who have benefited from the Government of Tajikistan’s work to establish a strong national rehabilitation programme.
2010 polio outbreak: catalyst for transforming rehabilitation services
In 2010, a large polio outbreak affected several hundred adults and children, who had irreversible impairments and urgently needed rehabilitation services. However, Tajikistan’s traditional
approach to rehabilitation, based on an outdated model, was not working. The government approached WHO in 2012 for support in improving these crucial services.
Supported by WHO and other partners, the Ministry of Health and Social Protection committed to transforming rehabilitation by establishing:
- a fit-for-purpose national programme
- adequate levels and quality of assistive products
- a strong health workforce
- accurate and up-to-date information.
National programmes to achieve universal health coverage
Rehabilitation services are an important part of primary health care and achieving universal health coverage. By taking a primary health care approach, the government has been transforming access to services and reaching parts of the population often left behind. It now offers services free of charge to those who need them.
The National Programme on Rehabilitation of Persons with Disabilities (2017–2020) is one of the cornerstones of the transformation of the health system and is the result of a consultative process involving ministry representatives, disabled people’s organizations, national and international nongovernmental organizations, and donors.
“The National Programme on Rehabilitation aims to create an enabling environment with equal opportunities for all. 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,” says Dr Saida Umarzoda, First Deputy Minister of Health and Social Protection.
WHO supported the Programme through a policy development process with advocacy and technical advice, and collaborating with development partners like the United States Agency for International Development (USAID) and United Nations Partnership to Promote the Rights of Persons with Disabilities (UNPRPD) to mobilize funds for Tajikistan.
Assistive products benefitting over 180 000
Assistive products are a key aspect of rehabilitation. Following the launch of the programme, rehabilitation and assistive products were included in the state-guaranteed health service (the basic benefit package). The package ensures guaranteed and free services for certain segments of the population, especially the poor. To date, over 180 000 men, women and children have benefitted.
However, while a national priority assistive products list has been developed to guide future activities – such as product development and production, service delivery, market shaping, procurement and reimbursement – a WHO report in early 2019 shows that Tajikistan’s current numbers of quality wheelchairs are still insufficient, and maintenance and repair centres are not provided for or are underfunded. To reach universal coverage for wheelchairs, the government needs 10 000 wheelchairs annually over the next 3–5 years.
Strong health workforce for rehabilitation
A strong multidisciplinary rehabilitation workforce, and the promotion of rehabilitation concepts in all health workforce education, are crucial to provide comprehensive rehabilitation services.
The Ministry of Health and Social Protection has improved the capacity of rehabilitation centre staff, including physiotherapists and occupational therapists, who attended national training workshops. This has led to the establishment of rehabilitation units within hospitals and strengthening of existing rehabilitation centres. The Ministry is supporting 6 local health workers – physiotherapists, occupational therapist and therapy assistants – to attend formal long-term training programmes outside Tajikistan, with the obligation to return to the country to support rehabilitation services nationwide.
WHO is also collaborating with the World Confederation for Physical Therapy (WCPT) and the World Federation of Occupational Therapists (WFOT) to further strengthen rehabilitation in Tajikistan.
Accurate and up-to-date data for evidence-informed decisions
Collecting accurate and up-to-date information about health and rehabilitation is one of the most important elements in making evidence-informed decisions and progress towards universal health coverage for the Government of Tajikistan. WHO provided technical support to the Statistics Agency on how to gather reliable data on areas such as health service use, unmet needs and the financial burden on households of paying for health.
The Tajikistan Household Budget Survey now contains a health and disability module, and those who conduct the interviews for the survey have received in-depth training on using interview technology and processing the data. Information on health and disability will also be included in the national census, due to take place in 2020.