Developing a national framework for community involvement in health promotion in Tajikistan

Abstract

Abstract Background In rural Tajikistan, various approaches have been taken to involve communities in health promotion, but many of them survived only as long as there was outside donor support. Methods In 2017, these approaches were examined and conceptualized, leading to the development of a “Guideline on Partnership with Communities on Health Issues” that was put into practice in 11 rural districts of the country. Results The Guideline sees Primary Health Care (PHC) staff trained as facilitators so as to conduct Participatory Reflection and Action (PRA) sessions with their local communities. Based on health priorities identified through these PRA sessions, and on national health priorities, the Health Promotion Institute chooses annual community activities facilitating behavioral change. Community Health Teams (CHTs) are formed, and the facilitators train them in disease prevention activities, and in how to plan initiatives to promote better health and well-being at village level. In the 5 initial districts, CHTs successfully mobilized community members to take part in activities related to identified health priorities e.g. health actions on Hypertension and Diabetes including free screenings. Furthermore, CHTs started to address determinants of health e.g. by supporting disabled people in their communities, organizing weekly waste removals, and initiating womens' walking groups. Conclusions Engaging communities by forming and capacitating teams, leads them to become a partner to the PHC system, and empowers them to tackle local determinants of health through their own initiatives. The capacity built in the local primary health care and health promotion structures hold potential for an expansion of this community-based approach to health promotion throughout the country. So what? By encouraging a government-recognized approach to community involvement in health, capacity and ownership of local institutions and stakeholders has increased, providing promise for long term sustainability. Key messages Community involvement in health remains central to primary health care. A government-recognised approach provides promise for sustainability.