PSFCI Tajikistan Assessment of psychiatric institutions in the Republic of Tajikistan Conducted with

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PSFCI TajikistanAssessment of
psychiatric institutions in the Republic of
Tajikistan Conducted with the financial support
of the European Commission Directorate General
for Humanitarian aid (ECHO)2005/2006
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Assessment of psychiatric institutions in the
Republic of Tajikistan
ORGANISATION AND FINANCING OF PSYCHIATRIC CARE IN
TAJIKISTAN
Ministry of Finance
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Assessment of psychiatric institutions in the
Republic of Tajikistan

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Assessment of psychiatric institutions in the
Republic of Tajikistan
Location of the psychiatric institutions in RT
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Assessment of psychiatric institutions in the
Republic of Tajikistan
HISTORICAL BACKGROUND OF HUMANITARIAN AID TO
PSYCHIATRIC INSTITUTIONS

• Distributions of medicines, medical material and
  equipment.
• From 1997 to 2003 by Medecins Sans Frontieres
  Holland (including relief items and
  rehabilitation), funded by ECHO and MSF
• Since 2003 and until mid 2007 by Pharmaciens
  Sans Frontieres Comite International under ECHO
  funding
• Other assistance Project HOPE, Misereor, in-kind
  donations etc.
• Food distributions to the patients of psychiatric
  institutions
• From 1999 to 2005 by the UN World Food Programme

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Assessment of psychiatric institutions in the
Republic of Tajikistan

• OBJECTIVE OF THE ASSESSMENT
• Evaluation of the current overall situation in
  the 17 psychiatric institutions (PI) of the
  Republic of Tajikistan
• Analysis of the revealed problems and elaboration
  of recommendations
• METHODOLOGY
• Monitoring document and questionnaire designed in
  coordination with AAH and WFP
• Visit of all 17 the psychiatric institutions
  countrywide
• Evaluation through interviews of the medical
  staff or through direct observation of the
  patients and the premises.
• The field assessment was performed from December
  13th 2005 to January 3rd 2006.

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Assessment of psychiatric institutions in the
Republic of Tajikistan

• ASSESSED PARAMETERS
• The assessment aimed at evaluating the situation
  regarding
• Budget resources of the institutions
• Food supply
• Medicines and pharmaceuticals supply
• Burden of diseases
• Hygiene of the patients and in the institutions
• Overall conditions of the premises

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Assessment of psychiatric institutions in the
Republic of Tajikistan
RESULT 1 TYPICAL BUDGET BREAKDOWN
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Assessment of psychiatric institutions in the
Republic of Tajikistan

• RESULT 1 BUDGET RESOURCES
• The Example of the psycho-neurological dispensary
  in Dushanbe

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Assessment of psychiatric institutions in the
Republic of Tajikistan

• RESULT 2 FOOD SUPPLY
• The Example of the Psychiatric hospital in Lakkon

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Assessment of psychiatric institutions in the
Republic of Tajikistan

• RESULT 3 MAIN SOURCES OF MEDICINE SUPPLY

Needs coverage for somatic medicines
Needs coverage for psychotropic medicines
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Assessment of psychiatric institutions in the
Republic of Tajikistan

• RESULT 4 BURDEN OF DISEASES

Breakdown of psychiatric diseases in psychiatric
institutions
Breakdown of somatic diseases in psychiatric
institutions
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Assessment of psychiatric institutions in the
Republic of Tajikistan

• RESULT 5 HYGIENE
• Very low hygiene conditions of bed clothes and
  patients underwear changed either once every 10
  days or only when absolutely required.
• The patients are bathed only once every 10 days.
• Lack of towel, tooth-paste and brush.
• The condition of the buildings in most structures
  is bad

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Assessment of psychiatric institutions in the
Republic of Tajikistan

• RESULT 6 OVERALL CONDITION OF THE PREMISES
• Most structures are in a state of advanced decay
  and are not able to perform rehabilitation or
  repairs due to a shortage of State budget
• Electricity is not available all day long, only
  for a few hours in the morning and in the
  evening.
• The heating system in most institutions is
  deficient and requires rehabilitation or even
  reconstruction.

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Assessment of psychiatric institutions in the
Republic of Tajikistan

• REVEALED PROBLEMS (1/2)
• The State budget allocated once a year covers
  only from 30 to 50 of the real needs of these
  facilities.
• 70 of the psychiatric institutions do not
  receive funding for the procurement of equipment
  and for municipal service payment.
• The patients diet is very meagre causing
  malnutrition, anaemia, alimentary dropsy,
  diarrhoea.

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Assessment of psychiatric institutions in the
Republic of Tajikistan

• REVEALED PROBLEMS (2/2)
• The duration of new patients hospitalization is
  limited because of the hospitals incapacity to
  provide decent living conditions.
• State budget for medicines procurement is notably
  insufficient. Institutions are very dependant on
  humanitarian free-of-charge support.
• Sanitary and personal means (such as washing
  agents, bed clothes and underwear) are
  insufficient.
• The overall conditions of the hospitals premises
  are very poor. The scarce budget resources are
  only sufficient for small reparations.

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Assessment of psychiatric institutions in the
Republic of Tajikistan

• RECOMMENDATIONS (1/2)
• For the government
• To increase the overall level of State funding
  for the psychiatric institutions and to
  rationalise the overall psychiatric system.
• To increase MOH capacity in regularly monitoring
  the psychiatric institutions.
• To recommend to MoH and the Ministry of Social
  Care to develop a rational and sustainable system
  of pension payment and benefits for the
  psychiatric patients
• To recommend to MoH to regularly conduct
  refreshmet and post-graduate courses to the
  doctors based in Khatlon, Soghd and GBAO.

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Assessment of psychiatric institutions in the
Republic of Tajikistan
RECOMMENDATIONS (2/2)

• For the international community
• To encourage information sharing on psychiatric
  institutions among the main stakeholders in the
  health/social sector in Tajikistan.
• To scale up existing projects aiming at food
  self-sufficiency (such as farming projects) with
  the support of international agencies.
• To provide emergency funding for basic
  rehabilitations in the most decayed psychiatric
  institutions, in coordination with the MoH and
  organisations involved in the rationalisation of
  the system.