The IntraHealth International-led Tajikistan Health & Nutrition Activity (THNA) has achieved a major landmark in the country’s approach to improving the quality of its maternal health care. THNA’s in-depth assessments of 14 hospital maternity wards and six primary care centers mark the first significant assessment of hospitals in the country.

Tajikistan is the poorest country in central Asia, and health care for pregnant women, mothers, and newborns is inadequate. Using an assessment protocol established by the World Health Organization, THNA experts and specialists from Tajikistan's Scientific Research Institute of Obstetrics, Gynecology (SRIOG) worked to:

• Identify the availability and level of basic health care services for women and newborns at the outpatient level, the support system for the outpatient facilities, quality-improvement processes regarding clinical conditions, and facilities’ guiding and organizational principles.
• Identify key problems to be resolved in the provision of better medical care.
• Initiate an evidence-based discussion with health facility staff on needed improvements.
• Begin designing an action plan for improving the quality of services provided at each facility—a joint process including management and staff at the facilities, trainers from SRIOG, and THNA staff.

With field work in May and analysis in June, the team was challenged to reconcile significant discrepancies between the real and the reported situation. Official reports, it appears, are "optimized to meet the national requirements"—for example,  facilities reported that 100% of newborns received all four elements of essential care, in compliance with the national requirement, but interviews with clients and medical personnel during the assessment revealed that this is not the case.

Working in teams of six, the assessors observed clinical procedures, interviewed staff and clients, audited records, and inventoried equipment for a complete picture of maternity care operations.

On aggregate, the findings are bleak. As a group, the maternity wards are chronically understaffed, underequipped, short on most medical supplies, and suffer from poor quality control and managerial oversight. In brief:

• In most of the facilities there are problems with the water supply—either no running water or only intermittent service—and water reservoirs must be used.
• At least partly as a result of the water problem, handwashing practices are not diligently followed, and infection rates are higher than they should be.
• In almost all facilities, laundries and incinerators are either not available or malfunctioning. 
• Management and disposal of hazardous waste is universally poor.
• Equipment is old, in poor condition, or missing altogether.
• There are chronic shortages of disposables.

That said, the health facility staff members are generally motivated to learn and eager to work with THNA to enhance their knowledge and skills.

THNA will use this assessment to identify the specific assistance required at each facility. This assessment is the starting point for long-term support and will form the baseline for facility progress over the coming four years.

By Jon Thiele. The Feed the Future Tajikistan Health and Nutrition Activity is funded by the US Agency for International Development.