1. March 8-11 2011 года Barcelona, Spain Tajikistan country presentation

2. Tajikistan Current government officials Land area: 55,251 sq mi (143,100 sq km); total area: 55,251 sq mi (143,100 sq km) Population (2007 est.): (growth rate: 1.9%); birth rate: 27.3/1000; infant mortality rate: 43.6/1000; life expectancy: 64.6; density per sq mi: 128 Capital and largest city (2003 est.): Capital and largest city (2003 est.): Dushanbe, 817,100 (metro. area)

3. Population of Tajikistan is 7 529 029 million and among of them the man 3 776 254 million, women -3 752 775 million, children from 0 till 19 years - 3 504 011 million, people with age from 60 till 99 years 385 924 Annually in Tajikistan about 75 thousand persons need the palliative care. Many patients live and die in unjustified sufferings without adequate treatment of a pain and other pathological symptoms, without the solving of psychological and social problems and satisfaction of spiritual needs, frequently in a condition of constant fear and loneliness. While in the majority of the western countries the palliative care is given on a level with other medical services in Tajikistan it remains for patients almost inaccessible. The situation which has developed in Tajikistan in the field of the palliative help, is aggravated with the lowest social and economic a population standard of living. Control and introduction of variety of prohibitive measures over a lawful turn narcotic and psychotropic drugs has led to decrease in level of availability of necessary opioid for patients. Growth of cancer disease, chronic disease and HIV infections in republic stress the importance of development of the Palliative Care in Tajikistan. Needs and situation assessment

4. Insufficient financing of Public Health sector at both levels (Republican centralized and local) -discrepancy to WHO standards for health financing ( standard should be 5 % from GDP, we have 1,9 % from GDP national products) Questions on public health system reforms, especially primary health care level Absence of treatment protocols which takes into account the regional features Absence of Palliative Care standards Questions of effective management and human resources Problems on rendering of the highly technological medical services Issues of preventive medicine, early screening of profile diseases, including cancer Difficulties of realization on the ground the government programs Absence of planned preventive actions (for example as it was before on schools – once a year for all purple 1 in a year in educational institutions) Health care system main issues

5. Official statistics Global mortality 414.6 for 100 000 of population, mortality by cancer 33.7 for 100000- that is 8,1%, Total number deaths from disease in 2009 - 30895 people Deaths from cancer 2509 people, from other chronic illness 18 946 чел people Mortality rate

6. There is no united government program on Palliative Care, however there are some PC elements in following documents: National Health Strategy of the population for the period 2010-2020 National Program confirmed on prevention, diagnostics and treatment of Cancer diseases for period from 2010- 2015 (approved by the Government RT №587 from October, 31st, 2009) National Program on counteraction of HIV/AIDS epidemic for 2011-2015 (approved by the Government RT №562 from 30.10.2010г.) Palliative Care

7. At level of hospitals the Palliative Care appears in process of treatment during stay of the patient in hospital, unfortunately home care for patients with life limited illnesses isn't present. The existing center of day stay has no a methodological basis and standards of PC provision or rendering of the highly technological help for the patient with special needs Palliative Care services and models

8. There is no reliable statistic for coverage The palliative care is given chaotically and not in a full spectrum, oncology centers provides it in a part of pain management for cancer patients at the clinics Estimation of coverage ( % of cancer and non-cancer dying patients attending by palliative care services)

9. With support from IPCI more than 120 specialist got training on Palliative Care based on ELNEC module As follow up our grantees provides training for 45 nurses on PC Start thinking about the institunalization of PC approaches the Nursing college in Dushanbe developed in 2010 the curriculum for the students and guide for the teaches. The piloting is in process. It is expected that from September 2011 in will be implemented National wide in all 17 medical colleges\ schools over the country Medical University express interest to start the curriculum development for the physician Status of Palliative Care trainings

10. 1. Political support, recognition and understanding from the Government expressed by approval of Strategy of health of the population 2010-2020, which included PC for the first time 2. 2. Palliative Care specified in the national programs of Cancer diseases and HIV\AIDS 3. 3. Process of education of medical personnel at the nursing level with PC knowledge have started 4. 4. Piloting of grants at the level of Oncology and Nursing Hospital 5. 5. PC issues has started to be integrated into all significant events in Republic (the Congress of oncologists and radiologists of the CIS in October, 2010, the Central-Asian Conference on a HIV and TB in October, 2010, Conference by Medical University in November, 2010 and etc) Qualitative analysis- strong points

11. 1. Wrong accounting of requirements of republic (a quota on import of opioid) 2. There is only one form( ampuls) of legal narcotic( morphine) for pain relief 3. Long process of registration of medical products- from one till two years 4. The license for import for pain relief medication is given only to the state enterprises 5. Lack on availability opiates for suffering patients 6. The low level of knowledge and awareness on PC, absence of the PC standard 7. Absence of awareness of the population about the Care approaches Qualitative analysis- weak points

12. 1.Process of getting the license 2.Absence of the state chemists\ drugstores 3.Control over legal drug trafficking is under the tree Ministries MOH, MIA and DCA –that is a bit complicated, because these ministries has their own requirements and standards 4.Rigid control is connected with a non-admission of possible leak in illegal trade channels 5.Absence of hospices or day centers for today 6.Absence of financial assets, inaccessibility and high cost of pain relief drugs due to limited imported numbers of opiods( morphine) Main Dilemmas

13. Developments of the National Palliative Care plan Development of curriculums for social workers and other profile occupations Modification of law РТ about health of the population concerning the guaranteed rendering by the state qualitative Palliative Care Raising awareness of the population about PC and the rights of patients for pain relief To define requirements of the population and to develop the mechanism of the reliable quota for country on purchase and realization of opioid for needing patients Working out of unified system of the account and control, availability, sale, recipe extract, etc for pain relief medications. Modification or additions in the existing national lists of essential drugs including narcotics, psychotropic substances To create a new position at the MOH level,which responsibility will include supervision for the organization and realization of execution of the plan of PC in country Main challenges\opportunities