Healthcare centers in rural areas of Tajikistan are in disrepair, crumbled or unsuitable for receiving patients, and remain one of the acute problems.
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The authorities claim that almost all healthcare centers (previously they were called ‘rural outpatient clinics’ – Ed.) are restored or renovated, but residents of remote villages and doctors who work there complain about various difficulties in healthcare.
Khatlon Region: Healthcare Centers Are Crumbling
Lolazor-2 village of Mashal jamoat is located 50 kilometers from the regional center of Vakhsh district (108 km south of Dushanbe). For more than 20 years, its residents were not able to obtain a good health center. About 70 families live in this village.
Gulmahmad Kishvarov, the village doctor, told CABAR.asia that it is very difficult to see patients in the current conditions in which he works.
“There is no medical center in the village, I work in a cargo container. Imagine the conditions inside. The patient comes; he has nowhere to lie down, it is impossible to put a drip. It is cold in winter, hot in summer. Of course, I will do my job in any case, but I would like the conditions to be better,” says Gulmahmad Kishvarov.
According to him, the villagers addressed the authorities requesting to build a new healthcare center for them, but so far, there is no reply. The villagers tried to build a healthcare center themselves by hashar method (when villagers unite and build a construction by own force – Ed.), but they could not complete the construction without authorities’ assistance. Now, the walls they built are crumbling.
The health center partially constructed by the residents of Lolazor-2village of is crumbling under the influence of natural forces. Photo: CABAR.asiа
In Kushoniyon district of Khatlon region, the rural healthcare centers also do not meet the norms and standards.
Health center in Chapaev village is crumbling for many years. The doctor Muhsiddini Dovud said that this building has been in disrepair for a long time. Employees work here in fear. The population of this village is 4.5 thousand people, and only two doctors provide them with medical assistance.
“If, God forbid, an earthquake occurs, this building will collapse. The floor is broken. We do not have beds,” says the doctor.
The building has two rooms. According to the residents, the building of the health center was constructed in 1958. Zubaydullo Kurbonov, the resident of the village, says they are not satisfied with the conditions in the health center.
“The conditions are bad, walls are crumbling. The population is large here. We wish we had a new healthcare center,” said Kurbonov.
The authorities promised to build a new center and claimed that the land for the construction of a new medical center was already allocated. This was in 2016; a new healthcare center should have been built for the 30th anniversary of the independence of the Republic of Tajikistan.
“Less than a year is left until this day, but there is no news about the start of construction,” added Muhsiddini Dovud.
Meanwhile, the representatives of the Department of Health of Khatlon region say that there are no dangerous healthcare centers or medical posts in the region that require major repairs.
However, the cracks in the walls of the clinic in Shvernik village of Yakatut jamoat in Jomi district demonstrate the opposite situation. Local nurse Lutfiya Mahmadieva says the building was constructed not long ago, after the Soviet Union collapse, but it needs renovations.
“The land for the construction of a medical institution was allocated in another place, but so far, there is no information about its construction. The population of this village is 3928 people. The building has three rooms that require urgent repair,” said the nurse.
According to the head of the emergency medical service of Jomi region Amriddin Solikhov, there are 52 medical centers in the region now. As part of the celebration of the 30th anniversary of independence, it is planned to construct six new healthcare centers, three of which already started working.
“There are no medical centers in the region that need repair. All of them are already renovated,” Solikhov says.
According to the chief economist and planner of the Khatlon Department of Health Kurbonali Nematov, there are 709 polyclinics and 369 healthcare centers in the region.
During seven months of 2020, 10 medical institutions were constructed and commissioned in the region, including one healthcare center and 9 medical posts, for 878 thousand somoni ($85,242).
“By the 30th anniversary of Tajikistan’s independence, it was planned to construct 50 healthcare centers, 25 of which were already built and commissioned. This is 50% of the approved plan. It was also planned to construct 112 medical posts, 90 of which are already built,” says Nematov.
He also stated that every year, the medical institutions requiring repair are renovated at the expense of the local authorities or entrepreneurs.
According to the website of Khatlon region’s khukumat, in the first seven months of this year, 255 million 33 thousand 300 somoni (about $24.76 million) were allocated from the local budget for the healthcare sector, and the work in this direction is ongoing.
Nematov said that according to the analysis by the representatives of the Department of Health, there is not a single clinic in Southern Tajikistan in disrepair. However, according to observations and calculations of the local journalists, 28 medical posts are still located in houses, cargo containers, schools and other buildings.
Sughd Region: Healthcare Centers Need Support
In the northern Sughd region, residents also complain about the lack of doctors and poor conditions in a number of rural clinics even though local authorities report about the construction of many healthcare centers in villages.
Patar jamoat is located in Konibodom district. It consists of six villages. To provide medical services in this jamoat, three healthcare centers and two rural medical posts operate here.
The healthcare center in Galaba village works for two villages: Galaba and Dehkonobod. The population of these villages is 4200 people. The village healthcare center is located next to a cotton plant. The one-story building with an attic was constructed in 1936. At first, the building was planned as a residential house for cotton workers. However, in the same year, the first floor was allocated for the village healthcare center.
Several years ago, the attic was sold to private entrepreneurs. Today, the rural healthcare center is renting the first floor. The building is on the balance sheet of the “Khabib” cotton processing plant.
The rural healthcare center has three small rooms and two utility rooms. There is no family doctor here. Once every two weeks, a doctor comes from the city. The medical staff consists of nine people: the head of the rural healthcare center, a paramedic, a dentist, four nurses, a receptionist, a nurse and a security guard. There is no water in the center, no toilets and it was never renovated. The furniture and equipment are old.
In total, 16 rural healthcare centers and 18 rural health posts work in Konibodom district. In 2017, Konibodom was selected as a pilot district for the international project “Enhancing Primary Health Care Services in the Republic of Tajikistan – Exit Phase (Project “Sino”)”. The duration of the project is four years. Within the framework of the project, the major repairs were carried out in 13 rural healthcare centers.
Some healthcare centers were not included in the project, for example, the rural healthcare center, which is on the balance sheet of the cotton plant. The residents of two more villages wanted to construct a new building by their own money and include it in the project, but the residents’ addresses were ignored.
The healthcare center of Saro village is located 7 km from the center of Asht district and provides medical care to 5870 residents. The building has six rooms. The medical staff of the rural healthcare center consists of 13 people: one family doctor, eight nurses, the rest are technical workers. However, even this number of medical personnel does not meet the needs of the villagers.
According to the head of the healthcare center Khudoiberdi Obidov, they need more specialists to provide high-quality medical services.
“For such a large population, according to the standards, four doctors should work. We do not have enough specialists. During the pandemic, the shortage is even more obvious,” said Khudoiberdi Obidov.
The building was constructed in 1980 at the foot of the mountain. Back in 2003, with the financial support of the Asian Development Bank, some repairs were carried out. However, the equipment and furniture are old. Due to the location of the building, there are constant problems with water. The trees and flowers planted around the center dry up each year. The building is requiring the major repairs for a long time.
The high-quality healthcare is an indicator of a modern welfare state. Due to the absence or poor condition of healthcare centers in remote villages of Tajikistan, people are forced to drive tens of kilometers to hospitals in cities and districts. This is especially obvious during the pandemic, when there are not enough beds in central hospitals due to the large number of patients. In such a situation, rural healthcare centers could provide significant assistance in reducing the pressure on the central hospitals.