Development Partners Contribution into NHS 2010-2020: Impact and Indicators

This report discusses the contribution of development partners into the National Health Strategy 2010-2020, focusing on key impact indicators such as government health expenditure, maternal mortality ratio, road traffic mortality rate, and mortality ratio attributed to air pollution. It presents data from various countries in the region and highlights the progress and challenges in improving mother, newborn, and child health. The report also outlines activities and strategies for the way forward in developing a new National Health Strategy.

• Development Partners
• National Health Strategy
• Impact Indicators
• Health Expenditure
• Maternal Mortality

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1. Development Partners Contribution into NHS 2010-2020 Implementation during 2018 November 2, 2018 Dushanbe, Tajikistan

2. Outline Key impact indicators SDGs targets DPs key contributions during 2018 Focus areas and activities terms A way forward New National Health Strategy development

3. Indicator 1.a-General Government Health Expenditure as a % of General Government Expenditure, 2015 Lithuania 12.2 Moldova 12.2 Estonia 12.2 Kazakhstan 10.9 Georgia 10.5 Kyrgyzstan 9.9 Russia 9.6 Uzbekistan 9.3 Latvia 8.9 Turkmenistan 8.7 Belarus 8.5 Ukraine 8.3 Armenia 6.1 Tajikistan 6.1 Azerbaijan 4.1 Data source: World Health Statistic, WHO, 2018

4. Indicator 3.1-Maternal mortality ratio, 2015 (per 100 000 live births) Kyrgyzstan 76 Turkmenistan 42 Uzbekistan 36 Georgia 36 Tajikistan 32 Russia 25 Armenia 25 Azerbaijan 25 Ukraine 24 Moldova 23 Latvia 18 Kazakhstan 12 Lithuania 10 Estonia 9 Belarus 4 Data source: World Health Statistic, WHO, 2018

5. Indicator 3.7-Road traffic mortality rate, 2013 (per 100 000 population) Kazakhstan 24.2 Kyrgyzstan 22 Russia 18.9 Tajikistan 18.8 Armenia 18.3 Turkmenistan 17.4 Belarus 13.7 Moldova 12.5 Georgia 11.8 Uzbekistan 11.2 Ukraine 10.8 Lithuania 10.6 Latvia 10 Azerbaijan 10 Estonia 7 Data source: World Health Statistic, WHO, 2018

6. Indicator 3.9.1-Mortality ratio attributed to household and ambient air pollution, 2016 (per 100 000 population) 129.3 110.7 101.8 81.1 79.3 78.3 70.7 63.9 62.7 60.7 54.8 49.4 41.3 34 25 Data source: World Health Statistic, WHO, 2018

7. -1. Impact to the mother, newly born and child health Indicators 2010 2017 2020 16.8 20 -1.1. Infant mortality rate per 1 000 live births 13.3 20.9 20 -1.2. Under 5 child mortality rate (per 1 000 live births) 21 45.0 25,0 -1.3. Maternal mortality rate per 100 000 live births 24.1

8. -1. Impact to the mother, newly born and child health Component Activities Demographic and Health Survey-2017; Scaling Up Nutrition (SUN) frame; Surviving and thriving in the early years; Full participation of adolescents; Enhancing a protective environment for children; National Plan on Family Planning services; Global Maternal and neonatal sepsis study; Country adaptation of Every Newborn Action plan Technical assistance Effective Perinatal Care Training, ToT on Antenatal Care for Reproductive Health Centre, intercountry capacity building on RMNCAH and other trainings on MCH Capacity building Equipment for MCH services, neonatal equipment, IMCI drugs, vaccines, cold chain equipment, and therapeutic food (Vitamin), equipment for maternity and new-born departments, and laboratory titration equipment for national and regional laboratories of SES Provision of drugs and equipments Reconstruction and rehabilitation of two oblast level hospitals in Kulob and Kurgan Tube and four other district level mother and child hospitals Construction

9. -2. Impact to the communicable diseases Indicators 2010 2017 2020 59.2 6.2 40,0 -2.1. TB morbidity rate per 100 000 population 4.0 133.3 2.0 -2.2. TB mortality rate per 100 000 population 60.7 13.2 100 .2.3. Hepatitis morbidity rate per 100 000 population

10. -2. Impact to the communicable diseases Component Activities Improving access and quality of TB prevention and control: including nationwide Drug Resistant Survey 2017; Country scaled up electronic TB register system Open MRS; Case finding and patient-oriented model of care; Introduction of new treatment regimens and new drugs for drug-resistant TB treatment; National pharmacovigilance system established Technical assistance Trainings on hospital management, equipment maintenance and waste management; ART training national & regional Capacity building Lab commodities procurement under Stop TB Partnership, Donation of BDQ and DLM under USG Drug Donation Program, TB drugs Provision of drugs and equipments Rehabilitation of the infrastructure of National Center for TB, Pulmonology and Thoracic Surgery Macheton and Regional TB Referral Hospital in Digmoi Construction

11. -3. Impact to non-communicable and chronic diseases Indicators 2010 2017 2020 -3.1. Cardiovascular (CVD) disease mortality rate per 100 000 population Coronary heart disease (CHD) 100,6 212.4 160.0 -3.2. Diabetes morbidity rate per 100 000 population (primary) 56.5 58.4 88.9 -3.3. Malignant tumours morbidity rate per 100 000 population 35.9 38.2 52.0 -3.4. Injuries mortality rate per 100 000 population 22.5 2.9 3.5

12. -3. Impact to non-communicable and chronic diseases Component Activities Technical assistance Introduction of the first pilot Project on Cervical Cancer Prevention Programme in Khatlon and Sogd; Implementation of country wide cancer registration; Management and control on hypertension in pilots; Tobacco law enforcement Capacity building Improve quality of education of health care staff, particularly of family doctors and nurses; increase access to diagnostic equipment; ; increase health literacy rate among the population and etc , intercountry capacity building on NCDs Provision of drugs and equipments Provision of treatment and diagnostics equipment and ambulance for tertiary level in Dushanbe is planned

13. -1. Improvement of access to health care services and equity Indicators 2010 2017 2020 -1.1. Average number of visits to PHC facilities per one inhabitant 4.8 4.3 5.9 -1.2. % of population who do not apply for needed healthcare due to financial and regional reasons by socio- economic status (quintiles) n/a n/a n/a

14. -1. Improvement of access to health care services and equity Component Activities Technical assistance Implementation of the PHC strategic plan; Implementation of the per-capita and RBF financing; Improve connection with communities via community health promoters and health committees; Public health laboratories optimization; developed national Influenza bulletin Capacity building Trainings on family medicine, PHC management course, business planning; cost calculation per lab tests; Provision of drugs and equipments Provision of basic equipment for PHC facilities Construction Construction and rehabilitation of PHC facilities

15. -2. Improvement of the quality of health care services Indicators 2010 2017 2020 -2.1. % of children under 1 year old fully immunized according to the national vaccination plan 96.5 95 94.2 -2.2. % of patients with malignant tumours detected at primary stages (early detection) 70.5 60.5 70-75 -2.3. Hypertension rate among population per 100 000 population 100 100 586,1 89.9 (2016) -2.4. % of new patients with B+, successfully completed treatment 80.2 98.0 1207 -2.5. Number of newly detected HIV cases 1004 1000 80.8 (2016) -2.6. Drug abuse morbidity rate per 100 000 population 92.4 98.2 13.5 -2.7. % of smoking prevalence among population 0 25.0

16. -2. Improvement of the quality of health care services Component Activities Technical assistance Introduction of Inactivated Polio Vaccine (IPV) into the routine immunization schedule; Assessment of immunization supply chain data management; Cold chain equipment inventory; Improved case HIV finding through innovative rapid testing model; Advocacy for rights of PLHIV; Improved case finding and case management in penitentiary system Capacity building Training on immunization in practice (IIP), improving managerial capacity of EPI managers (MLM), pediatric AIDS, epidemiology of HIV, testing, ARV therapy and psychosocial support, the application of the Vaccine Needs Estimation and Budgeting tools; ART trainings national & regional Provision of drugs and equipments Provision of vaccine, cold chain equipment, tests and drugs for HIV

17. -3. Increase in effectiveness Indicators 2010 2017 2020 -3.1. % of public expenditures on PHC level as total public health expenses 34.9 34.6 45 -3.2. % of public expenses on drugs in total public health expenditures 3.5 3.4 6

18. -3. Increase in effectiveness Component Activities Technical assistance Implementation of the per-capita and RBF financing; Study on availability and affordability of pharmaceuticals; Introduction of PHC Business planning; Establishment of Interagency Expert Group on implementation of new health financing mechanisms under MoF Capacity building Training on PHC Business planning, per-capita and RBF financing Provision of drugs and equipments Provision of basic equipment for PHC facilities in RBF pilot rayons Construction Construction and rehabilitation of PHC facilities in RBF pilot rayons

19. -4. Increase in transparency Indicators 2010 2017 2020 n/a 57.0 90.0 -4.1. % of population who aware about their rights under Basic Benefit Programme (BBP) n/a -4.2. % of the patients who pay informally while receiving healthcare services (drugs, medical consumables, medical staff, etc.) 42 33

20. -4. Increase in transparency Component Activities Technical assistance Implementation of State Guarantee Benefit Package(SBGP) for 2017-2019 in pilot rayons; Monitoring of SGBP for 2017-2019 Capacity building Trainings on SGBP in pilot rayons, dissemination of the brochure to increase awareness of the population about the BBP

21. -5. Reduction of the financial burden of patients Indicators 2010 2017 2020 -5.1. % of out of pocket payments total health expenditures (THE) 67.5 63.9 50

22. -5. Reduction of the financial burden of patients Component Activities Technical assistance Implementation of HF Strategy 2015-2018; Development of new HF Strategy for 2019-2021; Monitoring of UHC Matrix under HBS Agency of Statistics as part of move to UHC; National Health Accounts development Capacity building Training on Health Module of Household Budget survey for Agency of Statistics interviewers; intercountry trainings on National Health Accounts development and validation

23. New National Health Strategy development NHS 2010-2020 assessment; Development of the new NHS Concept; Establishment of the Intersectoral TWG; Development and costing of the new NHS

24. THANKS -