2.4 UNDAF Outcome: There is improved access for the vulnerable to quality basic
services in health, education and social protection.
HEALTH
Rationale. The government has identified the health care system as a key sector in
meeting the MDGs. National health priorities, with respect to the MDGs, are to reduce
infant, child and maternal mortality rates; to achieve universal access to reproductive
health; and reverse the spread of major communicable diseases, particularly HIV/AIDS,
tuberculosis, and malaria among returning migrants. At 42 per 1,000 live births, the child
mortality rate (a key health indicator) is the highest in the region.
The UNCT’s comparative advantages in the health sector include the following: access to
international networks of technical expertise, evidence-based health solutions, specialised
medical supplies, and knowledgeable medical resources. The UNCT has accumulated years
of experience working in health at all levels in Tajikistan. Important contributions have been
made to the normative environment, particularly building health system capacities in
stewardship and service delivery, as well as providing physical resources.
The main challenges facing the system are weak governance and inadequate, inefficiently
used resources. This has led to a significant weakening of medical institutions, particularly
those providing primary health care, and limited public awareness about healthy lifestyles.
As noted in the PRSP, reforms will improve public health, which in turn will promote
sustainable economic growth and development of the country’s human potential.
Results. Where the UNCT has demonstrated comparative advantage, this UNDAF will
support the accomplishment of key sectoral reform tasks identified by the government and
its partners. In particular, the UNCT will strengthen the health system, such that:
- The Ministry of Health (MoH) and selected local health authorities will be better able
to steward the health system and perform core functions related to policy (in the
areas of communicable diseases and maternal / child health and nutrition), priority
setting, regulation, monitoring and evaluation, and building strategic alliances;
- The MoH will be able to use financial and human resources more efficiently, and to
understand the equity effects of health financing reforms;
- The MoH will be better able to implement the national strategy on hospital
restructuring and to manage the distribution and prescription of drugs and;
- A national blood safety service will be implemented that supplies safe blood and
blood products.
The UNCT will also support the health system to increase the effective coverage of basic
health services for the most vulnerable in selected districts:
- In maternal and child health and nutrition, the focus will be to manage reproductive
health services, including the following: reproductive health information, counselling
and contraception; the management of normal and complicated pregnancies,
deliveries and post-partum periods; neonatal and early childhood care; and common
childhood diseases
- Communicable diseases, with a special emphasis on combating HIV/AIDS and
tuberculosis and eliminating malaria (particularly among returning migrants)
This will be achieved through the introduction or revision of evidence-based standards and
guidelines; improved clinical and management capacities of medical staff; and increasing
the availability of medical supplies, particularly essential drugs and vaccines.
The UNCT will also work closely with the health system, civil society organisations, and local
communities (special emphasis on returning migrants) to improve knowledge about how to
avoid health risks and practice healthy behaviours. This will lead to improved health and
nutritional outcomes for women and children, and for those who have, or are at-risk of
contracting, a communicable disease.
In addition, efforts will be made to better prepare the health system to deal with emergency
situations. This will be achieved through development of emergency management guidelines
and appropriate procedures/practices. Support will be provided to enhance emergency care
capacity of pre-hospital and hospital response to disasters and emergencies. To achieve this,
UNCT will ensure that there is a national policy in place on reorganisation and integration of
Emergency Medical Systems and emergency care for disaster response. Essential health
services will be supplied with minimum necessary equipment and supplies.
Partners and Coordination. The main partners are the MoH, MoF, regional and district
health departments, service delivery institutions, and non-governmental organizations.
Work towards these results will be coordinated by the Health and Food Coordination Groups.
Work on HIV/AIDS will be coordinated by the UN Theme Group on HIV, in close cooperation
with the National Coordination Committee on HIV/AIDS, TB and Malaria. Certain activities
will be funded through a pooled fund mechanism and overseen by the Joint UN Team on
AIDS; this funding will be disbursed directly to implementing partners. Critical synergies
will arise from the combination of the WHO’s technical guidance and other agencies’ field
presence and service delivery experience.
EDUCATION
Rationale. The government has identified education as a key sector for achieving the goals
of the PRSP, as progress in education ultimately promotes governance and sustainable
economic growth and the development of the country’s human potential. The major
challenges facing the education system (for which the UNCT has a comparative advantage
in resolving) include: low completion rates of basic education by vulnerable groups (e.g. the
financially poor and girls); schools provide limited instruction in building life skills; access to
pre-school education is constrained; and policy does not drive the use of resources.
Improving management systems and reforming other levels of the education system will be
addressed by other donor organisations with specific skills and knowledge in these areas.
Results. To ensure more children complete basic education, the UNCT will work to
implement the following by 2015:
- Scalable schemes that have (i) successfully addressed household-based constraints
on participation and (ii) significantly raised enrolment and attendance rates at the
higher grades of basic education.
- Legislation, policies, budgets, social protection programmes, and curricula that have
been reformed to better promote the completion of education, especially by girls.
- Alliances that support the common objective of education completion.
- The provision of food to students in food-insecure areas.
The UNCT is committed to ensuring that by 2015, 30% of general secondary schools are
teaching life skills in the areas of hygiene education, gender, violence prevention, critical
thinking, disaster reduction, and HIV/AIDS. Ideally, the developed curricula and materials
will be used nation-wide. In the schools themselves, the UNCT will work with partners to
provide teaching and learning materials; to train and coach teachers; mobilise communities;
and install essential water and sanitation infrastructure, to enable the practice of hygiene
education at school and in the home.
To increase access to pre-school education and promote early childhood stimulation, the
UNCT will strive to implement:
- A national strategy and standards for early learning, developed by government and
key stakeholders and adapted to current realities.
- A large number of low-cost, community-based pre-schools that are affordable for
families and scalable, given national budgetary constraints.
- Greater awareness of the importance of early childhood education and stimulation
among decision-makers, parents and civil society members.
To ensure disaster preparedness
from early stages in schools, UNCT
is committed to supporting the
government adopt minimum
standards for education in
emergencies. National education
and district education authorities
will be trained to assist local
initiatives in risk reduction, as well
as disaster preparedness and
response. A select number of
schools will be supported with
temporary learning spaces for
disaster - affected children.
Working in close collaboration with
partners, particularly the
government and the World Bank,
the UNCT also expects that by 2015,
a national testing centre will be
operational. This centre will
measure learning achievements and
administer an exam to determine
access to higher education. These
tools will measure system
effectiveness and efficiency, and
assist in realising one of the
national priorities in education:
merit-based access to higher levels
of education.
Synergies are expected between
the complementary approaches of
UNICEF and the International
Labour Organization (ILO) towards
ensuring the completion of basic
education. UNICEF will focus on improving access while the ILO will highlight the issue of child labour. Technical support will be provided by UNESCO for curricular reform and pre-service institutions while the service delivery components will be supported by UNICEF, UNDP and WFP.
Partners and Coordination. The main partners are the MoE, Oblast/District Education
Departments, schools, and community-based organizations. The UN’s contributions will
take place within a framework of donor coordination, currently led by a UNCT member,
which covers the whole education sector. The coordination mechanism (partly driven by
Tajikistan’s status as a recipient of a Fast Track Initiative grant) will be strengthened over
the life of the UNDAF to move the education sector support towards a sector-wide approach
(SWA), and to increase the capacity of the MoE to coordinate all partners.
SOCIAL PROTECTION
Rationale. The UNCT will work to ensure that by 2015, more vulnerable individuals,
households and groups have access to improved quality social protection through gainful
employment, social insurance, and targeted social assistance. Reform of the social welfare
system is necessary to enable the delivery of socio-economic benefits; protect vulnerable
members of the population against unemployment and inflation; and reintegrate them in
the home society; and achieve the MDG on poverty. There are several challenges that the
UNCT is well-positioned to address:
- Many vulnerable persons are particularly at risk of unemployment as a result of their
limited marketable skills.
- The social security system is biased against women; does not exist for refugees and
migrants; is not fully rights-or needs-based; and is under-funded and expensive to
administer.
- Residential care institutions are over-used as a protection response for vulnerable
children.
- The social work profession is underdeveloped.
- There is a lack of adequate/coordinated social security provision for assisting the
returnee migrants in the country and no state programmes to assist this group
The UNCT’s specific areas of support will be governed by its comparative advantages, in
particular the ability to draw on international treaties; its access to international networks of
technical expertise and models of good practice; and its long-term working relations with
partners at national and local levels.
Results. With respect to empowering vulnerable groups (particularly rural women,
returning migrants, and refugees) the UNCT is committed to ensuring that by 2015, these
groups acquire marketable knowledge, skills and resources. This will be achieved through
the improvement of vocational training curricula; capacity building to provide vocational
training; supporting training initiatives; and enabling initiatives that provide clients with
business development skills and resources.
The UNCT and its partners will also work to ensure that social insurance, quality social
services and social assistance are more accessible to vulnerable groups, particularly at-risk
children, women, refugees, and persons living with HIV/AIDS. In particular, by 2015:
- The Ministry of Labour and Social Protection (MoLSP) will be better able to assess
needs and tailor social assistance.
- A selection of community-based services will be implemented that are more
accessible, affordable, and tailored to needs (to be designed and costed by the
MoLSP).
- The social work profession will be integrated into university training and social
service delivery.
- People will have greater awareness of their social assistance entitlements
The UNCT will also support special measures to prevent and address violence against
children, women, refugees, and migrants (who are particularly vulnerable to abuse when
travelling to, or living in, their country of destination).
With regard to child protection, the UNCT will support implementation of the government’s
policy on de-institutionalisation. Through to 2015, the UNCT is committed to work with
government, NGOs, and community-based organisations to extend current initiatives and
embed them within public systems, ensuring that:
- Non-residential family-support services are operating in 10 districts, and are
supported by national and local budgets; and
- Community-based alternatives (to closed custodial sentencing for children in conflict
with the law) are operating in 15 districts;
Concerning the migrants, given the fact that destination countries like Russia and
Kazakhstan are employing restrictive migration policies, the UNCT will establish a
specialized programme to address the needs of returning migrants, as well as migrants to
alternative countries. This program will:
- Provide special language programmes for potential migrants to find other markets;
- Work with diasporas on securing jobs in destination countries
Finally, with a view to ensuring that the social protection system is enabled to develop and
implement policies based on standards and data, the UNCT will support the government to
align its legislation, policies and implementation mechanisms with international standards.
Furthermore, the UNCT will help integrate international standards for monitoring vulnerable
groups into national statistics.
Partners and Coordination. The main partners are the MoLSP and its local Departments,
the National Commission on Child Rights, Child Rights Departments, the Ministry of Finance,
the Executive Office of the President, and local NGOs or CBOs that provide family support
services. The UN Thematic Working Groups (TWG) of Social Protection will continue to meet
to coordinate and monitor UNDAF activities and results, as well as partnership
arrangements. The TWG will work closely with national mechanisms for coordination,
particularly with regard to the provision of social work services.
