AIDS Foundation East West

Tajikistan remains the most impoverished country of the former Soviet Union with the lowest ranking on the Human Development Index and the majority of its citizens living in poverty . The social fallout from this economic situation is exacerbated by the evolution of a major transit route for narcotics through the country that has increased dependency among the local population. Added to that is an increase in female economic migration and a growing number of women engaging in sex work to support their families . At the same time, structural weaknesses in the healthcare system mean that socially marginalised and vulnerable people, such as injecting drug users, sex workers and people living with HIV, face significant barriers in accessing healthcare services and information.

AFEW has identified a clear need to build the capacity of local health service providers to better educate and deliver services to vulnerable groups particularly at risk of HIV, tuberculosis and water-borne illnesses (such as hepatitis A and E, cholera and other diarrheal diseases). A combined response to all these conditions is vital, given that they are commonly found as co-infections in patients.

For this reason, in July 2009, AFEW launched a new project ‘Improving Basic Health Services in the Khatlon and Soghd Provinces of Tajikistan’, which is particularly focused on expanding and improving services for vulnerable groups. Project activities are aimed at vulnerable women (sex workers, women led-households and care-givers), injecting drug users, people living with HIV and the general population.

The project has three main aims:

• To train and educate service providers (social and medical services, employment agencies, local self-support groups, NGOs, youth and women’s committees) on the needs of vulnerable groups and health promotion;
• To enhance the network of community-based social bureaus;
• And, to develop the capacity of local healthcare agencies to provide medical, social and prevention services through a system of staff training and third-party grants.

Over the next 18 months, AFEW will establish mechanisms to: facilitate coordination between the governmental and non-governmental healthcare sectors; expand access to public health information and services for target groups; and promote better sanitation and hygiene to both vulnerable people and service providers.

Core Objectives

Activities Defined By Needs and Requests from Stakeholders. A ‘Strategy and Approval Workshop’ will be held at the outset to determine the needs of vulnerable groups, revise plans and discuss lessons learnt from previous projects. Furthermore, a needs assessment is being conducted to better define which areas of knowledge and services need improvement in the project sites. Following on from this, a Project Steering Committee will meet on a regular basis to direct and review the project.

Continuous Education and Training for Professionals. A series of training sessions will be developed and delivered to local professionals who are points of contact for target groups. Themes will include basic sanitation, prevention education and delivery techniques for services aimed at injecting drug users, sex workers and other vulnerable people.

In order to ensure better access to training and educational materials, both during and after the project, AFEW will:

• Equip local healthcare and social service providers with technical and material support to expand and improve client management, prevention work and hygiene promotion;
• Establish a library on the site of a local partner organisation, where service providers and target groups can access informational, educational and promotional materials;
• Set-up a new Training Resource Centre and extend two existing centres in each target region;
• Conduct continuous monitoring of partner activities and provide consultation to project partners throughout the project cycle.

Equipping Vulnerable People with Knowledge. Vital to the long-term success of this initiative will be the delivery of information about healthcare and sanitation to vulnerable people in these regions. Equipping vulnerable people with the knowledge to make informed decisions about their own health is vital to improving the epidemiological situation. AFEW will conduct studies to determine the key areas of knowledge that are lacking or inadequate among vulnerable groups. On this basis, targeted information will be delivered to vulnerable groups and the general public on good hygiene and healthcare via: educational leaflets and publications; informational sessions and trainings; a mass media campaign.

In June 2010, AFEW launched a mass media campaign ‘Our Health is in Your Hands!’ in Tajikistan. The campaign was initiated in response to research that revealed a low level of awareness of sanitation and hygiene together with a lack of information on prevention of water-borne infections. Especially during the summer months, when flooding is common, the incidence of these infections begins to increase. 

Information is being disseminated through the mass media, billboards, poster campaigns and souvenirs. 

Results

By August 2010, the project has already achieved some solid results:

• 14 tonnes of chlorine-based disinfectants and 145 protective costumes have been delivered to the State Sanitary and Epidemiological Service;
• 11 governmental and non-governmental organisations have received mini-grants amounting to €80,000 in order to carry out sanitation and hygiene programmes;
• More than 2,000 medical specialists, representatives of local councils and members of the general public have received training in the prevention of water-borne infections.