Tajikistan country presentation
March 8-11 2011 года
Barcelona, Spain
Tajikistan
Current government
officials
Land area: 55,251 sq
mi (143,100 sq km);
total area: 55,251 sq
mi (143,100 sq km)
Population (2007
est.): (growth rate:
1.9%); birth rate:
27.3/1000; infant
mortality rate:
43.6/1000; life
expectancy: 64.6;
density per sq mi: 128
Capital and largest
city (2003 est.):
Dushanbe, 817,100
(metro. area)
Needs and situation assessment
Population of Tajikistan is 7 529 029 million and among of them the
man 3 776 254 million, women -3 752 775 million, children from 0 till
19 years - 3 504 011 million, people with age from 60 till 99 years 385
924
Annually in Tajikistan about 75 thousand persons need the palliative
care. Many patients live and die in unjustified sufferings without
adequate treatment of a pain and other pathological symptoms,
without the solving of psychological and social problems and
satisfaction of spiritual needs, frequently in a condition of constant
fear and loneliness.
While in the majority of the western countries the palliative care is
given on a level with other medical services in Tajikistan it remains
for patients almost inaccessible. The situation which has developed
in Tajikistan in the field of the palliative help, is aggravated with the
lowest social and economic a population standard of living. Control
and introduction of variety of prohibitive measures over a lawful
turn narcotic and psychotropic drugs has led to decrease in level of
availability of necessary opioid for patients.
Growth of cancer disease, chronic disease and HIV infections in
republic stress the importance of development of the Palliative Care
in Tajikistan.
Health care system main issues
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Insufficient financing of Public Health sector at both levels
(Republican centralized and local) -discrepancy to WHO standards
for health financing ( standard should be 5 % from GDP, we have
1,9 % from GDP national products)
Questions on public health system reforms, especially primary
health care level
Absence of treatment protocols which takes into account the
regional features
Absence of Palliative Care standards
Questions of effective management and human resources
Problems on rendering of the highly technological medical services
Issues of preventive medicine, early screening of profile diseases,
including cancer
Difficulties of realization on the ground the government programs
Absence of planned preventive actions (for example as it was
before on schools – once a year for all purple 1 in a year in
educational institutions)
Mortality rate
Official statistics
 Global mortality 414.6 for 100 000 of
population, mortality by cancer 33.7 for
100000- that is 8,1%,
 Total number deaths from disease in 2009 30895 people
 Deaths from cancer 2509 people, from other
chronic illness 18 946 чел people
Palliative Care
There is no united government program on Palliative
Care, however there are some PC elements in following
documents:
National Health Strategy of the population for the period
2010-2020
National Program confirmed on prevention, diagnostics
and treatment of Cancer diseases for period from 20102015 (approved by the Government RT №587 from
October, 31st, 2009)
National Program on counteraction of HIV/AIDS
epidemic for 2011-2015 (approved by the Government RT
№562 from 30.10.2010г.)
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Palliative Care services and models
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At level of hospitals the Palliative Care
appears in process of treatment during
stay of the patient in hospital,
unfortunately home care for patients with
life limited illnesses isn't present.
The existing center of day stay has no a
methodological basis and standards of
PC provision or rendering of the highly
technological help for the patient with
special needs
Estimation of coverage ( % of cancer and non-cancer dying
patients attending by palliative care services)
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There is no reliable statistic for coverage
The palliative care is given chaotically
and not in a full spectrum, oncology
centers provides it in a part of pain
management for cancer patients at the
clinics
Status of Palliative Care trainings
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With support from IPCI more than 120 specialist
got training on Palliative Care based on ELNEC
module
As follow up our grantees provides training for 45
nurses on PC
Start thinking about the institunalization of PC
approaches the Nursing college in Dushanbe
developed in 2010 the curriculum for the
students and guide for the teaches. The piloting
is in process. It is expected that from September
2011 in will be implemented National wide in all
17 medical colleges\ schools over the country
Medical University express interest to start the
curriculum development for the physician
Qualitative analysis- strong points
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Political support, recognition and understanding from the
Government expressed by approval of Strategy of health
of the population 2010-2020, which included PC for the
first time
2. Palliative Care specified in the national programs of
Cancer diseases and HIV\AIDS
3. Process of education of medical personnel at the
nursing level with PC knowledge have started
4. Piloting of grants at the level of Oncology and Nursing
Hospital
5. PC issues has started to be integrated into all
significant events in Republic (the Congress of
oncologists and radiologists of the CIS in October, 2010,
the Central-Asian Conference on a HIV and TB in
October, 2010, Conference by Medical University in
November, 2010 and etc)
Qualitative analysis- weak points
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Wrong accounting of requirements of republic (a quota
on import of opioid)
There is only one form( ampuls) of legal narcotic(
morphine) for pain relief
Long process of registration of medical productsfrom one till two years
The license for import for pain relief medication is
given only to the state enterprises
Lack on availability opiates for suffering patients
The low level of knowledge and awareness on PC,
absence of the PC standard
Absence of awareness of the population about the
Care approaches
Main Dilemmas
1. Process of getting the license
2. Absence of the state chemists\ drugstores
3. Control over legal drug trafficking is under the
tree Ministries MOH, MIA and DCA –that is a bit
complicated, because these ministries has their
own requirements and standards
4. Rigid control is connected with a non-admission
of possible leak in illegal trade channels
5. Absence of hospices or day centers for today
6. Absence of financial assets, inaccessibility and
high cost of pain relief drugs due to limited
imported numbers of opiods( morphine)
Main challenges\opportunities
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Developments of the National Palliative Care plan
Development of curriculums for social workers and other profile
occupations
Modification of law РТ about health of the population concerning the
guaranteed rendering by the state qualitative Palliative Care
Raising awareness of the population about PC and the rights of
patients for pain relief
To define requirements of the population and to develop the
mechanism of the reliable quota for country on purchase and
realization of opioid for needing patients
Working out of unified system of the account and control, availability,
sale, recipe extract, etc for pain relief medications.
Modification or additions in the existing national lists of essential
drugs including narcotics, psychotropic substances
To create a new position at the MOH level ,which responsibility will
include supervision for the organization and realization of execution
of the plan of PC in country