«Some aspects of uniform system Policy of family medicine,s introduction in Tajikistan »
Salimov N.F., Zaripov S.Z., Sadikova D.N.
(Tajikistan Health Ministry)

        The family medicine is a priority direction of Tajikistan Health Ministry’s activity   and the processes  acceleration of its introduction is one of paramount and urgent tasks which its implementation  will allow an effective realization of  the national strategic documents on reforming the system of public health services of the country. The question of family medicine  adoption in our country has been predetermined in 1998 by the order of the Health Ministry  from June, 26th, 1998 « About stage-by-stage transferring to the organization of primary medical care by a principle of the general practitioner (the family doctor) which  is consider to be « a reporting point » the Tajik family medicine.  As  it is known, in the Tajikistan governmental order from June, 6th, 2005 « About  Tajikistan Health Ministry’s activity »  The Health Ministry  was entrusted to  assume the measures on  further development activities  directed on system expansion of the primary medical care , founded upon a principles and family medicine practice. It is worthy to mention that on December, 2005 also was held a  National conference entitled  « The family medicine and  a  public health  »  as a result which was acceptance of uniform model of family medicine for Tajikistan, and, probably ,came already that  time to comprehend  an existing situation on family medicine - that is made by us, and what we have achieved also what results we would like to achieve. First of all it is necessary to note, that there are positive moments  in the last years, especially the questions concerning to health manpower training, of family medicine, that there was established  a departments of family medicine on the basis of after  the institution of higher education  family medicine on preparation and retraining experts of  the  family medicine .It is necessary to note that in the framework of Tajikistan Health Ministry’s cooperation with the   Control Centre of  the Project on public health services  reforming system of Tajikistan there was reached a  positive results that is  an opening the second faculty of family medicine on the basis of Tajik State Health University TSHU which will be supported by the Project in  plan of technique and a renovation its premises. It is worthy to note that the positive shifts in successful cooperation of the Health Ministry with the international donors on implementation their components institutional developments of  family medicine experts.  One of  that active cooperation’s result with our partners is  a creation of databank  on  cadres potential  development, revision and the statement of a norm-legal documents on family medicine, cooperation concerning  the development of uniform methodology of personal  financings. The national strategy of hospital sector rationalization , licensing system improvement  and development of independent structure of public health service’s transform at reduction of  the state quality assurance system  of medicines and an establishment  the effective custom center and  a drug disposition.

 The acceleration of Tajikistan economic development  , is necessary for achievement of human and social progress closely related to structural reforms, priorities and the script of financing in such spheres, as development of an agriculture, educations, public health services, water supply, sanitary and environment which are a basis for development of the practical program coordinated with the Purposes of  the Millennium Development, Strategy of poverty reduction  and economic development for 2006 2008.

 It is necessary `to develop the system of the Government odder caring out a For principle of equal opportunities in reception  medical services ,this implies the preference was given those services which cost is inaccessible to the majority of the population. From here follows, that the state should concentrate all the efforts and opportunities on maintenance of the population with expensive services, and accessible kinds of treatment would be given from a none - budget  means, means of the patient,  and etc.

For principle effectiveness increase of the  institution activity  of primary health care , including  a family medicine institution  is necessary  the problem solution  directed on realization  main principles of the World organization of public health services on ХХ1  century : availability, validity, solidarity and responsiveness.

The first block of questions  it is  the organizational strategic planning including forecasting of a network of the medical organizations, the medical staff, including experts of family medicine, their formation established on real needs, the guaranteed obligations of employment of graduates, maintenance of interrelation of processes of licensing, certification, accreditation and an estimation of medical aid’s quality . There should be a coordination of all parts activity of the control system by public health services.

The existing situation in public health services is characterized by dynamics of expansion of a network is out-patient - a polyclinic part. Sector of the stationary expensive aid. At the same time,  the hospitals will remain the largest component of the industry of medical services, and occurring shifts aside mainly polyclinic part, items of acute care dictate the necessity of the reasonable approach and a choice of kinds of medical aid which should be rendered at a level of establishments PHC. And certainly, in this case a question of development of family medicine institute as  a leading member of primary health care is one  of actual problems of  the  public health services system.

The second block of questions -The changing public health  in conditions of market economy. at first there will come a  questions of the state support of public health services, insurance and a privet medicine. The state insurance more preferable, as it more fair.

The third block of questions  it is a growth  of  investments in a medical science  development and new technologies for realization  the wide range of researches, accentuation on importance of good preparation of the medical staff, including experts of family medicine that will assist in  increase of medical care and satisfaction  of patients need.