Evaluation of the Effectiveness of Quality Committees in Primary Health Care in Tajikistan

Ilker Dastan, Bunafsha Dzhonova, Salohiddin Miraliev, Parvina Makhmudova, Natascha Bohlmann, Lola Olimova

Keywords: quality committee, effectiveness, primary health care, maternal and child health, Tajikistan

Background:

Maternal and child health is a priority for the health system of Tajikistan. However, there are still significant challenges, such as limited access to quality antenatal and intranatal care, family planning, and emergency obstetric care. In addition, there is a high rate of premature births and iron and nutrient deficiencies.

Research questions:

To assess the effectiveness of Quality Committees as an innovative technology in improving the quality and availability of services at the PHC level.

Method:

A comparative assessment of the main indicators on maternal and child health was conducted before and after 5 years of activity of the QCs in 12 pilot districts of Khatlon region with a population of about 1 million people.

Results:

The analysis showed that the QCs were effective in improving the quality of services. The proportion of women who made four or more antenatal visits during the last pregnancy increased significantly from 56% in 2016 to 86% in 2019. The number of pregnant women receiving nutrition counseling also increased, from 16.3 thousand in 2016 to 51.5 thousand in 2019. The proportion of children aged 6-23 months who are not breastfed and receiving minimally acceptable nutrition significantly increased between 2016 and 2019, from 16% to 53%. The proportion of women who have reached a minimum level of dietary diversity reached 90% compared to 71% in control communities that are not pilot districts.

Conclusions:

The activities of the Quality Committees at the level of PHC institutions in the districts have improved the indicators of antenatal care and early childhood nutrition through internal monitoring, continuous education of doctors and nurses at the District and Rural Health Centers, as well as Health Houses on maternal and child health issues.

Points for discussion:

The QCs should be scaled up to all PHC facilities in Tajikistan. In addition, the government should provide more support for the QCs, such as training and funding.

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