WHO rapid health assessment

Hospital facilities, essential drugs and consumable supplies in Tajikistan (Dushanbe, RRS, Soghd regions)
From 7 to 13 February 2008, the WHO Country Office, Tajikistan, carried out rapid health assessments in several facilities, which can be seen as representative for the situation in the country:

  • Dushanbe City Medical Centre (Dushanbe)
  • Rudaki Central District Hospital (Rudaki Region, RRS)
  • Shahrinav Central District Hospital (Shahrinav, RRS)
  • Khujand Regional Clinical Hospital (Khujiand, Soghd)
  • Khujand City Clinical Hospital (Khujand, Soghd)
  • Soghd Regional Maternity Hospital (Khujiand, Soghd)
  • Kulyab Regional Hospital.

The Central District Hospital in Chkalovsk (Soghd Region) was also visited, but, although the hospital was considered open and doctors and nurses were present, there were no patients. Hospital size ranged from 210 beds (Soghd Regional Maternity Hospital) to 680 beds (Kujand Regional Clinical Hospital).


Main findings

The main findings were derived from collected data, direct observation and interviews with leading hospital staff.

  • Primary health care was almost completely paralysed; no services were delivered to the population.
  • Shortage of energy, water and food supplies in Tajikistan produced a sharp increase in the inflation rate, causing and increase in the price of drugs, fuel and portable heaters.
  • All hospitals suffered from energy cuts for several hours per day. The water supply is also affected and proper heating of hospital wards is impossible.
  • In most hospitals, central heating systems were not functioning due to a lack of maintenance.
  • The few medical instruments that were still operative (diagnostic and curative) were usually outdated and unreliable, and could not work without electricity.
  • All hospitals were, therefore, unable to deliver assistance and appropriate care. Moreover, the ongoing shortage of resources strongly hampered food and essential drug supplies to patients (on average, only 5–10% of their needs was purchased by the hospitals).
  • The temperature inside hospitals was extremely low (no more than 5 ºC) and living conditions were unacceptable for patients as well as for healthy visitors and staff.

Access to hospitals was also hampered by other factors such as road conditions, lack of money for hospital fees and “unofficial” payments for staff. The poor quality of hospital services also seemed to keep potential patients away. Nevertheless, primary care had vanished and hospitals still represented the only option for severely sick patients.

  • Some hospital admission rates had increased up to 50%, although they had cancelled all “non urgent” elective medical and surgical care.
  • Hospital activities and beds were “spontaneously” gathered in selected areas of the hospital buildings to save energy and optimize the use of equipment.
  • Hospitals had emergency plans in place but these plans were inappropriate to face an energy shortage. Hence, most hospitals were continuing to operate and trying to maintain all services previously scheduled, even under the worsened conditions.
  • Some district hospitals were still open and operating in theory only, since they were not admitting patients anymore, as those desperately requiring hospital care preferred city hospitals. 

Proposals for immediate action 

  • Selection of a number of key hospitals (based on geographical, demographical and epidemiological criteria) and redirecting patients from the rural areas to them

  • Transfer of fuel, drugs and other needed resources from less needed hospitals towards key hospitals

  • Redirection of hospital staff for assistance to families at the local level and utilization of ambulances for selected cases

  • Careful assessment of the distribution of resources, based on the population’s needs

  • Establishment of a daily reporting system for hospitals operating with the Ministry of Health and WHO support to provide the basis for a strict follow up on clinical and epidemiological findings


Drugs and consumable supplies

Most hospitals had a very small supply of drugs that were procured independently. This amount represents only 5–10% of actual patient needs. Funds allocated to the health facilities for procurement of medicines were minimal per day per patient) and a large portion (around 50%) was made available through humanitarian efforts only.

Some examples from the Rudaki Hospital are found below.

  • Project HOPE provided funds for medication and supplies for tuberculosis patients. A portion of these funds goes towards salary payments for doctors.
  • The United Nations Children’s Fund (UNICEF) provided medication for children.
  • The immunization department maintained a dedicated cold supply chain for vaccines, which could be implemented due to support of UNICEF as well.

With the above donations, the Hospital is able to supply up to 35% of the patients’ needs for essential medicines. Except for Rudaki, the hospitals usually did not have a dedicated supply room and medication was scattered throughout all departments. Although it was stated that these medications were reserved for patients in dire need or for extreme emergencies, the selection criteria were not clear. Patients interviewed by WHO staff in some facilities stressed that they had to purchase their own supplies from a private pharmacy upon prescription by the hospital. Such private pharmacies are usually found to be on the facility premises.


General shortages were:

  • blood and blood products
  • wide-spectrum antibiotics
  • diabetic medicines (insulin was provided free of charge to patients)
  • antihypertensive medications
  • analgesics
  • narcotics
  • antiseptics (hospitals generally lacked disinfectants and antiseptics)
  • infusions.

Consumable supplies

Consumable supplies were also mainly acquired through humanitarian activities. In other instances (80%), patients were required to bring disposable supplies of needles, syringes, bandages etc. themselves.


Proposals for action

  • A list of urgently needed supplies should be provided by facility heads in remote or hard to reach areas. Needs assessments should be conducted in primary and secondary health care facilities as much as possible and procurement and distribution of emergency health kits in collaboration with the Ministry of Health after the proper assessment of the current situation, using clearly defined assessment criteria.
  • Redirection or reallocation of primary health care and surplus hospital staff to families in need at the local level was recommended. However, this might generate additional needs at the community level. Supplies such as non-specialized medicines (e.g. paracetamol, amoxicillin, antiseptics) should be made available from donor agencies in these circumstances.
  • In the long run, governmental reforms of the pharmaceutical sector should be supported. An increase in drug budget provision for hospitals as well as reforms in the procurement, registration and distribution procedures was recommended.