Tajikistan

Background information

The “Community-Based Rehabilitation (CBR) Programme”, which addresses early detection and intervention for children with developmental difficulties in Tajikistan, is supported by Caritas Germany. It consists of two types of early intervention programmes. The first CBR programme focuses on the detection of children with risks through screening provided by family nurses, and in-depth screening provided by family doctors. The second programme, called “Portage and Group works through play-groups for Mom and Kids”, refer children for early intervention. The programme is directed at improving parenting skills, nutrition and addressing developmental difficulties. Parents/caregivers must participate, and the environment should be familiar to a child to avoid mental stress and other negative issues.

All programme activities are agreed to and implemented in line with the Ministry of Health and Social Protection in Tajikistan.
The CBR programme is not age-restricted but the age group for early intervention is 0 to 4 years of age. Caritas Germany is involved in the ECD-related national strategy as well as policy dialogues and discussions.

Achievements and challenges

The programme proved to be positive and extremely successful for ECD work at the PHC level (e.g. for trained nurses and doctors, the establishment of mother and child groups, and mobilizing community rehabilitation workers) and the referral system was well-functioning.

A number of improvements were needed including: supervising the work of nurses, especially at the reporting/recording level; considering the potential employment of other tools, such as the Guide for Monitoring Child Development (GMCD), which is more sensitive; and conducting a more multi-disciplinary-oriented approach for each particular case, when treatment specialists work closely with service providers.

The need for better collaboration in monitoring at the ministerial level, in order to nationalize the multi-disciplinary-oriented approach, was identified as a challenge. Another challenge was the shortage of human resources which may lead to children missing early screening opportunities. A lack of human resources also leads to a lack of further supervision and support. Other challenges included difficulties in working with families when there are conflicts of interest (mainly between mothers and mothers-in-law), illiteracy among parents, language barriers, and the remoteness of some areas (e.g. difficult access to mountainous areas).

Gaps and needs for ECD

The scope of gaps includes: the need for further elaboration on developing a system of screening and detection of developmental difficulties; training health workers, such as doctors and nurses, on specialized disciplines; training ECD pediatricians, physical therapists (especially from remote regions), and occupational therapy specialists; more involvement and training of speech therapists and communication pedagogical specialists; and equally aligning human resources across all of the regions of the country .

Moving forward requires the prioritization of human resources, strengthening intersectoral cooperation, educational programmes for children in kindergarten to prepare them for schooling, and prioritizing family-friendly environments.