Family Medicine in Tajikistan

Photo: Training new family doctors in Devastich Family Medicine centre - three family doctors who are trainers (standing in front) with six young residents in their 1st and 2nd year of training for the specialty of Family Medicine.

Dr Greta Ross (pictured) tells us more about the situation in Tajikistan.

General Practice, or Family Medicine (FM), is one of the newer ‘specialties’ in the Republic of Tajikistan, but the take-up by graduates of a Family Medicine career remains low.

Tajikistan is amongst the poorest of the Central Asian countries formerly part of the Soviet Union. A combination of underfunding, a perceived low status of Family Medicine, and low income compared to potential earnings by so-called “narrow” specialists, has delayed the establishment of a thriving GP-led healthcare system. This said, Tajikistan’s Ministry of Health and Social Protection (MoHSP) has made meaningful steps in the last few years, citing Family Medicine as a priority in its National Health Strategies.

Of the 3211 doctors originally trained in Family Medicine, 2813 of them are still actively working as family doctors with an almost equal spread between urban and rural centres. The challenge for Family Medicine in Tajikistan is how to persuade family doctors not to emigrate to other countries (notably Russia) where earnings are much higher, or to revert to working in narrow specialties. This is a problem faced not only by Tajikistan but many other countries.

The Association of Family Medicine of Tajikistan has recently applied to join WONCA and hopes this will help raise the profile of Family Medicine in the eyes of new graduates and the population. As of January 2018, there are 329 family doctors who are registered members of the Association; others are becoming aware of the benefits of membership and may start to support the Association more strongly once it is part of WONCA.

The Swiss Agency for Development and Cooperation’s Medical Education Reform Project (MEP) is implemented by the Swiss Tropical and Public Health Institute based in Basel, Switzerland. The MEP project started in 2009 and works at both the strategic level and the service level. It aims to raise the quality of health services provided by family doctors (general practitioners) and family nurses at the Primary Health Care (PHC) level by supporting the country's undergraduate and postgraduate educational institutions and providing material support (renovating and outfitting clinics, training staff, providing literature, modernising the curricula for both medical and nursing students, and so on); the project at the same time works closely with the MoHSP (Ministry of Health and Social Protection of the Population of the Republic of Tajikistan) and with various government agencies and other international development partners. This year the MEP is introducing an approved national programme of “master-apprentice” mentorship for all family doctors.

There are still problems with insufficient resources, patient acceptance and geographical isolation, but also these are being tackled. Facilitating change takes time, as all of us know who recall the difficult early years of promoting full understanding about general practice, and the eventual mature development of the specialty in Europe and the rest of the world.

About Dr Greta Ross: Greta graduated in Australia and worked in Canada in paediatrics and then went into general practice in England. She has been working in international Primary Health Care (PHC) development projects, mainly in Eastern Europe and post-Soviet countries for the past 20 years, having retired from general practice work in the UK. In 2017, Greta joined the Swiss Agency for Development and Cooperation’s Medical Education Reform project (MEP) in Tajikistan.