Analysis of the implementation of family medicine practice in Tajikistan

Ilker Dastan, Bunafsha Dzhonova, Salohiddin Miraliev, Parvina Makhmudova, Natascha Bohlmann, Evgeny Zheleznyakov, Zulfiya Pirova, Jens Wilkens

Keywords: family medicine, Tajikistan, optimization, primary health care

Background:
Tajikistan, where 73% of the country's population lives in rural areas, has adopted a PHC model based on the principles of family medicine.

Research questions:
Analysis of the current situation at the level of a network of PHC facilities in 30 cities and regions serving more than 4 million people, in order to identify achievements and problems in optimizing the practice of family medicine.

Method:
Quantitative and qualitative research methods were used: two-sided questionnaire interviews, analysis of medical records and the use of official statistics.

Results:
In 93.3% of cases, the population is divided among family doctors. A common registry is available for all examined PHC, standard paper medical forms of accounting and reporting documentation are used. A pre-doctor's office is available in 73.3% of PHC facilities and in 82.9% of cases, family doctors' offices are located at the entrance to the PHC, in which: anthropometry, measurement of blood pressure, pulse, temperature, pulse oximetry, shoulder circumference and head circumference in children are performed, providing assistance to difficult patients. In general, the first visit to the family doctor was noted in 78.7% of cases. At the level of cities and districts, a family doctor serves an average of 2948 people, and at the level of rural areas 4289 people, while the norm is 1500 per 1 doctor. 95% of family doctors are certified. The presence of categories among family doctors was 61.24%.

Conclusions:
Family medicine has taken root in country. Family doctors can work multipolar, with family doctors and family nurses playing a major role in prevention, treatment, follow-up and immunization during the COVID-19 pandemic. There is a significant shortage of family doctors in the country, which reduces the efficiency and effectiveness of their work in rural areas. Due to the integration of the services of vertical centers, the burden on the family doctor has increased.

Points for discussion:
The position and status of family medicine in the country's health care system should be continuously strengthened. To increase the population's access to quality healthcare services, it is necessary to develop and implement a model of integrated services at the PHC level, leverage to motivate family doctors in order to attract young cadres to family medicine, to stop the outflow of professional cadres outside the country.