UNDP Tajikistan, The Grants Implementation Unit
Bokhtar 37/1 Str.
Dushanbe, Tajikistan
ПРООН в Таджикистане, Подразделение по реализации грантов
Таджикистан, Душанбе
ул. Бохтар,37/1
Tel: (992 47) 441 06 68, 441 06 70; Fax: (992 37) 227 37 12
www.aids.undp.tj
QUARTERLY PROGRESS REPORT
(1 April – 30 June 2008)
General information
Donor:
The Global Fund to Fight AIDS, Tuberculosis and
Malaria (GFATM)
Principal Recipient:
United Nations Development Programme (UNDP),
Tajikistan
Number and Title of the Grant:
TAJ-506-G04-M– Grant of the Global Fund to Fight AIDS,
Tuberculosis and Malaria to support Program to fight tropical
diseases (malaria) in the Republic of Tajikistan for 2006-2010
Project Number:
TAJ-506-G04-M (00050923 in UNDP classification)
Place of Operation:
Republic of Tajikistan
Total Proposal Sum for 5 years:
5,383,510 US Dollars
Total Sum approved for two Phases:
5,383,510 US Dollars
Amount disbursed by GFATM to date:
4,133,876.67 US Dollars
Amount expended from the beginning
of the program implementation:
3,088,307.18 US Dollars
Start-up date:
1 April 2006
Duration of the programme:
4 years (second phase was decreased to two years)
1
Background Information
The UNDP Project Implementation Unit (PIU) continues the realization of Round 5 GFATM Malaria grant. The
grant aims at prevention of deaths caused by malaria, interruption of tropical malaria transmission, reduction of
malaria morbidity and containing and prevention of malaria outbreaks in Tajikistan. The project is implemented in
line with the country’s strategic “Program to fight tropical diseases (malaria) in the Republic of Tajikistan for 20062010”, which aims at strengthening existing activities and health care system on malaria control in the country. The
implementation of the project started in April 2006. To date, out of the totally allocated funds (USD 4,133,876.67),
approved for the first two years of the project, the amount of USD 3,088,307.18 was utilised. The most vulnerable
groups of people from 36 project districts of the country were reached in the course of nine quarters (from April
2006 to June 2008) through vector control activities. The main beneficiaries of the project are pregnant women,
children and general population.
An agreement with the Republican Centre to fight Tropical Diseases (RTDC) and the World Health Organization
(WHO) for the implementation of the third year of the project (Second Phase) has been signed. Sub-recipients for
ITNs distribution and awareness raising components are being defined. A tender was announced, conducted and the
results of it were submitted to ACP for consideration.
Malaria incidence in the country has decreased dramatically, from 2,309 cases in 2005 to 636 cases in 2007. In
November 2007, the NCC technical working group met to evaluate the implementation results of the 1st Phase and
to prepare a Request for Continued Funding of the Round 5 GFATM Malaria grant for Second Phase. Considering
limited funds (USD 2,611,510), allocated for the next three years of the project, and considerable reduction of
malaria cases (especially P.falciparum cases), NCC decided to reduce the number of years in Second Phase from
three to two (1 April 2008-1 April 2010). This will strengthen the achieved results and accelerate the process of
P.falciparum malaria elimination in Tajikistan. A total of USD 2,611,508 was requested for the period of two years.
The Request was submitted to and approved by GF Secretariat. To ensure back up of the achieved epidemiological
malaria situation and preparation for P.vivax malaria elimination in the Republic by 2015, a project proposal was
developed and submitted to GF for Round 8 for 2009-2015. The proposal is under the consideration.
Implementation of the program
Objective 1. To strengthen institutional capacities of national malaria control programme/general health
services and to enhance capacities for decision-making related to malaria
Service Delivery Area 1. Supportive environment: health system strengthening
Development of educational materials
Guidelines for the prevention and control of malaria in Tajikistan and for monitoring and evaluation of the impact of
malaria prevention activities were developed, approved by the Ministry of Health of the Republic of Tajikistan and
translated into local languages (Russian and Tajik). The guidelines were duplicated and distributed to all country's
health facilities.
Procurement of office furniture
Tender for procurement of necessary office furniture (tables, chairs, filling cabinets, wardrobes, pedestal etc.) was
conducted. The procured items were delivered and distributed to the Republican Tropical Diseases Centre (RTDC)
and Regional Tropical Disease Centers (TDCs) in two districts of GBAO, one district of RRS and nine districts of
Khatlon region.
Service Delivery Area 1. Supportive environment: human resources
Indicator:
Number of health authorities, laboratory staff, entomologists and health staff trained/re-trained
in malaria case management, treatment and epidemic control and data collection, processing
and analysis
Two 15-day courses on malaria microscopy for 20 laboratory doctors and technicians from health facilities of all
regions were conducted by RTDC experts. In accordance with pre- and post-tests result the participants’ theoretical
knowledge has increased by 42.5% and practical knowledge by 65%. By the end of the course each participant has
received handouts.
From 20 to 24 May 2008, a five-day training on Malaria vector control methods and evaluation of their efficacy for
20 health workers (parasitologists, epidemiologists, entomologists and entomology assistants) was carried out in
RTDC premises. RTDC specialists have facilitated the training. According to pre- and post-tests result, the
2
participants increased their knowledge on the topic by 37.8 %. By the end of the training each participant received
lectures of the training and certificates.
During the period from 4 to 16 June 2008, four 3day seminars on epidemiology, treatment and
prevention of malaria for 80 health workers from
Dushanbe, Tursunzoda, Khojent and Kanibadam
cities were carried out. The seminars were
facilitated by the involvement of experts from the
Republican and Sughd regional TDCs. According
to pre- and post-tests result, the health workers
increased their knowledge on the topic by 51%.
The seminars were conducted for health staff at
SUB, SVA and FAP level.
RTDC specialist is conducting a training on epidemiology,
treatment and prevention of malaria for health workers in Sughd region
Unplanned three-day training on usage of an epidemiological and operational malaria database for TDC IT
specialists (at regional level) was conducted. In total, 10 TDC IT specialists (from Kulyab, Kurgan-tube, GBAO
and Sughd region) were trained. By the end of the training knowledge of the participants was tested through
specially developed questionnaire, which showed that their knowledge increased by 80.6%. The participants were
provided with guidelines on data-base use and flash disks.
Objective 2. Improvement of capacities for and access to early diagnosis and adequate treatment of malaria
Service Delivery Area 1. Treatment: Prompt, effective diagnosis and anti-malarial treatment
Indicator:
Number of health and laboratory facilities sufficiently supplied with items for disease
diagnosis, treatment and prevention, and implementing quality control procedures
During the reporting period, anti-malarial drugs (primaquine, chloroquine, quinine sulphate and coartem) were
distributed to health and laboratory facilities to 64 districts of the country and 145 respirators, 142 automaxes, 145
protection clothes, 145 pairs of shoes and etc., were distributed to 17 districts of the country, where the vector
control activities were implemented.
Parasitological laboratories
The Republican TDC national consultants conducted a quality control of parasitological laboratories in Gissar
district of Rayons of Republican Subordination (RRS). The monitoring result showed that all target laboratories are
adequately equipped and all revealed cases of malaria are appropriately treated. However, knowledge of some
laboratory technicians is not adequate.
Indicator:
Number and percentage of patients receiving treatment of P.vivax malaria from all
P.vivax malaria cases detected
Number and percentage of patients receiving treatment of P.falciparum malaria
from all detected P.falciparum malaria cases
Number and percentage of patients receiving treatment of severe and complicated
P.falciparum malaria from all P.falciparum malaria cases detected
52 cases of P. vivax malaria were detected and registered in the country, which is 71.6% less compared to the same
period last year when 183 cases were registered. All patients were treated as in- or out-patients through local health
care facilities. It is worth mentioning that no any case of P.falciparum and severe and/or complicated P.falciparum
malaria was registered in the country during the reporting period.
3
Objective 3. To promote cost-effective and sustainable vector control
Service Delivery Area 1&2. Prevention: Indoor Residual sprayings/vector control and ITNs
Indicator:
Number of health districts in epidemic regions implementing vector control
measures
18 project districts were covered with vector control activities (IRS and gambusia fish distribution). Out of them, 6
districts were covered with both gambusia fish distribution and IRS activities. Prior to implementation of the
activities the RTDC representatives held discussions with local governmental authorities, leaders of Jamoats and
villagers to inform them of the purpose and importance of vector control measures.
On 14 April 2008, gambusia fish distribution activities were initiated in seven districts of Khatlon region. Prior to
implementation of the activity a team consisting of entomologists-instructors and volunteers from the target
communities was formed and provided with a vehicle and necessary equipment (scoop-nets, nets, canteens, overalls,
buckets, pumps and etc.) In addition, they were instructed on how and where to conduct the distribution. To date,
420 stagnant ponds and rice fields were covered with gambusia fish distribution. For details please refer to the
Table below.
Table 1. Number and the area of stagnant ponds and rice fields covered with gambusia fish distribution
№
1
2
3
4
5
6
7
Districts
Jilikul
Vakhsh
Bokhtar
Shaartuz
Jomi
Khamadoni
Tursunzoda
Total
Covered area (ha)
Stagnant ponds
Rice fields
29
32
31
28
27
29
27
203
33
30
29
32
33
31
29
217
No. of distributed
gambusia fishes
1 240 000
1 235 000
1 200 000
1 200 000
1 200 000
1 200 000
1 120 000
8 395 000
Monitoring of gambusia fish distribution
was conducted by RTDC and UNDP/PIU
staff in Khatlon region. The conducted
monitoring showed the following errors:
 Jilikul district: Overalls for gambusia
fish distributors were not distributed.
Interview with distributors showed
that they do not know the purpose of
gambusia fish distribution and norms
to be adhered during the distribution.
 Monitoring conducted in seven
districts revealed that 50% of
stagnant ponds have gambusia fish
and there is no need to conduct this
activity in those ponds.
The gambusia fishes were distributed according to entomological
standards, i.e. two fishes per square meter
Indicator:
Number and percentage of houses in malaria affected areas receiving indoor residual
spraying (proxy for people reached)
17 most malaria prone districts of the country were covered with first round of indoor residual spraying (IRS). A
disinfection team was formed in each district and equipped with overalls, sprayers, insecticides, a rent vehicle and
etc. In total, 39,476 households and the area of 9826500 square metres were sprayed. For details please refer to the
table below. On parity with the IRS the disinfection team disseminated knowledge on malaria prevention among the
beneficiaries.
4
Table 2. Number of households and areas covered and insecticides utilised
Region/ District No. of h/h
Population
Sprayed
Insecticide
h/h
Area (ha) Received
Used
(kg)
(kg)
1631
11417
1599
399750
204
200
1 Dushanbe
1504
10528
802
200500
100
100
2 Tursunzoda
1938
14286
836
209000
110
102
3 Rudaki
2898
24182
1484
371000
202
185
4 Vakhdat
RRS
6340
48996
3122
780500
412
387
6188
33778
4558
1139500
570
570
5 Bokhtar
4420
27596
4232
944250
468
468
6 Pyanj
3328
26990
3120
780000
390
390
7 Kumsangir
1323
12166
1310
396930
200
198
8 Vakhsh
4129
27816
3920
980000
490
490
9 Kubodiyon
1698
10152
1520
380000
190
190
10 Jilikul
1047
6999
960
240000
120
120
11 Jomi
3746
22476
3595
898750
450
450
12 Shaartuz
655
4770
648
162500
83
83
13 Nurek
3389
24494
3359
839750
424
420
14 Yavan
Kurgan-tube area
29923
197237
27222
6761680
3385
3379
1986
21801
1958
490820
248
245
15 Vose
2461
14766
2427
606750
308
304
16 Temurmalik
3208
23466
3148
787000
401
396
17 Dangara
7655
60033
7533
1884570
957
946
Kulyab area
Total in the Republic
45549
317683
39476
9826500
4958
4912
A follow-up monitoring of activities implemented by RTDC disinfection teams on gambusia fish distribution was
conducted by the Republican TDC and UNDP/PIU staff. The result of monitoring visit to Vakhdat district of RRS
revealed the following omission:

6 disinfectors, out of twelve hired, conduct gambusia fish distribution and none of three hired disinfection
instructors perform their responsibilities.
Discussions with Republican TDC Director and Head physician of Sanitary and Epidemiological Supervision Centre
in Vakhdat districts were conducted to solve the issue.
Indicator:
Number of bed nets distributed (proxy for people reached)
The activities under this indicator were not conducted due to delay with selection of a new sub-recipient for
implementation of this component. Therefore, the activities on ITNs' distribution were postponed to next quarter.
Objective 4. To improve capacities for timely response to and prevention of malaria outbreaks and epidemics
Service Delivery Area 1. Prevention: ITNs and malaria prevention during pregnancy
Indicator:
Indicator:
Number of children under 5 who slept under an ITN the previous night
Number of pregnant women who slept under an ITN the previous night
Due to late signing of an agreement (29 June 2007) with ACTED, which lead to extension of project implementation
until 1 July 2008, the information, on night monitoring results and KAP survey will be reflected in the next
reporting period.
Objective 5. To reinforce malaria surveillance including in-built mechanisms for monitoring and evaluation
Service Delivery Area 1. Supportive environment: health system strengthening
Indicator:
Number of districts, where epidemiological and operational malaria database existed and where
their capacities are adequate (existence of computer-based malaria information and reporting
systems)
5
Establishment of an epidemiological and operational malaria database
During the reporting period, 32 computers and 2 notebooks were procured and distributed to RTDC and 17 TDCs.
Currently an epidemiological and operational malaria database exists in 20 districts of the country. Trainings on
data-base usage were conducted for IT specialists, at regional level. For more details on the training please refer to
Objective 1.
Mobile teams
On 26 May 2008, RTDC mobile team examined malaria foci in Vakhdat district of RRS. During the mass
observation of people visiting the TDC in Vakhdat district, two P. Vivax malaria patients were revealed and treated.
Families and neighbors of the patients were tested for malaria but no sick people were detected. Entomological
surveillance conducted in utility and living areas did not show/reveal any mosquitoes.
Considering the fact that malaria cases are detected only in two districts in GBAO (Darvaz and Vanj) as well as the
distance between Khorog (where a mobile team was established) and those districts (about 250 km), it was decided
to inactivate this team and, instead, to establish two mobile teams – one in Darvaz and another in Vanj.
Objective 6. To strengthen research capabilities
Indicators:
Number of operational studies planned and implemented within project areas
The operational research under GFATM’s malaria control project in Tajikistan on rearing and distribution of the
larvivorous fish (Poecilia reticulata) as alternative method on vector control is going on. Two districts were selected
as project districts in Khatlon region – Pharkhor and Shaartuz. During the reported period first and second batches
of fish (a total of 80 specimens (30 of them male and 50 females)) and necessary equipment were purchased
(aquariums, water heaters, compressors, lighter, filters, water thermometers, landing-nets, aquarium plants, living
and dry feed, special boxes for laboratory tests, cavities, tanks for water (bucket, jerry cans, tank), with feed,
retaining foam, large kiln for the content of mosquitoes, etc.) One driver and four entomologists (two entomologist
from RTDC and two district entomologists) were contracted. Three field visits were undertaken to pilot district to
prepare pilot rice fields. In laboratory conditions during reproduction of fish 500 guppi were received. Pregnant
females were separated after manure to additional aquarium. It should be noted that for an unknown reasons, part of
the purchased fish (guppi) died. Experimental part of fish was distributed to rice fields in Farhorsky and
Shahrituzsky districts. In 2008, the rice growing in these areas started at a later date, from 15 June to 25 June, the
height of pilot rice fields over the water reached 8-10 cm and first mosquito larvae were found (1-2 on animals at 1
m2). Laboratory tests have been initiated at the end of June in order to determine the number of mosquito larvae
(An. Superpictus- principal vector of malaria in Tajikistan) ate by guppi (compared to gambuzia fish).
Objective 7. To increase community awareness and participation in malaria prevention.
Service Delivery Area 1. Prevention: BCC - community outreach
Indicators:
Number of people in affected areas reached by the community preventive programs
The awareness raising activities were not conducted during the reporting period due to delay with selection of a new
sub-recipient for this component.
MONITORING AND EVALUATION
During the reporting period, M&E team conducted three monitoring visits to RRS, Sughd and Khatlon regions. In
total, 13 districts (Kurgan-Tube, Jami, Bakhsh, Bokhtar, Jilikul, Shaartuz, Kulyab, Dangara, Vakhdat, Khamadoni,
Kanibadam, Isfara and Khojent) were visited. It is worth mentioning that most of those monitoring visits were
conducted jointly with specialists of Republican and Regional TDCs. They made valuable recommendations
regarding the quality of IRS and gambusia fish distribution activities and contributed to immediate solving of
problems. For more details on monitoring results please refer to Objective 3.
CONCLUSION
All activities of the project were undertaken according to the work plan and most of the indicators set for the current
period were successfully achieved. Knowledge and skills of 130 health workers, at all levels, was enhanced through
trainings. 54 malaria patients accessed health services and were treated. Health and laboratory facilities in 64
districts of the country were sufficiently supplied with anti-malarial drugs. People leaving in 18 malaria-prone
districts benefited from complex vector control activities (indoor residual spraying and gambusia fish distribution).
6
The overall health status and health related quality of life among the beneficiaries increased through awareness
raising and health promotion activities.
Due to delay with selection of sub-recipient for bed-nets distribution and awareness raising activities, these activities
were not implemented as planned.
7