Interview with new WHO head

Santino Severoni, the new head of the World Health Organization’s (WHO) mission in Tajikistan, outlined in an interview with IRIN the mission’s priorities in the former Soviet republic. Tajikistan is still reeling from the consequences of the five-year civil war in the 1990s that devastated public health in the country. Severoni, 42, worked as a surgeon for seven years in Somalia, Sudan, Kenya, Burundi and Tanzania, witnessing at least four civil wars in those countries. QUESTION: How would you describe Tajikistan’s public health system? ANSWER: During the Soviet period there was an advanced system of public health services in this country. However, during the civil war of 1992-1997, it was destroyed. Now there is a new set of problems – HIV/AIDS, tuberculosis and other infectious diseases. These problems are openly spoken about and efforts are being made to address them. Q: What is the situation with regard to access to health services in remote mountain villages? A: WHO is aware of the difficulties in the public health system of Tajikistan, including poor obstetric services, issues of infectious diseases, tuberculosis, malaria, HIV/AIDS and others. These difficulties also include the issues of access to quality healthcare in remote areas, and a lack of special equipment at health facilities. Therefore, it has been decided to increase WHO’s support to Tajikistan and to boost the staff of WHO’s mission in the country. WHO intends to provide quality resources to support the country’s public health system. Usually WHO does not work in the system of infrastructure, but provides technical assistance via the health ministry. However, experience shows that it is necessary to reinforce the work of local medical and obstetric facilities on the ground, particularly with regard to safe motherhood and childhood. Q: Infant and maternal mortality rates are growing in Tajikistan and 70 percent of women are not provided with pre-natal care. How is it possible to change this? A: We are well aware of these issues, which emerge not only because of unsatisfactory work of local medical and obstetric facilities, but also due to the low living standard of the population and low level of Gross Domestic Product (GDP) of the country. Many women prefer to deliver babies at home at the risk of their lives due to a lack of resources. Besides, geographical locations of certain areas, which do not have communication with the centre during autumn and winter, are another reason. This issue is a priority for WHO and efforts will be made to provide assistance on that front. Q: What other priorities does WHO in Tajikistan have? A: In general, WHO coordinates its activities in respect of the public health services with the Tajik government and the health ministry. We believe that such cooperation will promote improvements in the public health system. For this purpose, WHO provides technical aid and resources. The first one is assistance to the health ministry to choose a strategy while tackling issues according to WHO’s standards. The second one is financial aid in the sphere of the public health services, budget implementation and good management. The third one is mobilisation of resources. Adequate human resources management is needed to improve the work of the public health services system. Usually qualified specialists are concentrated in the capital, while the provinces lack health personnel. In this respect, we help the health ministry select, train and assign personnel. The fourth one is delivering medical and technical aid and professional training. In addition to these we should prevent spread of infectious diseases such as tuberculosis, malaria and others. Q: What about WHO’s joint projects in Tajikistan in 2006? A: Our direct and main partner is the Tajik health ministry. In addition to this, we have planned several projects for 2006 within the framework of the Improvement of Social Services and Reduction of Infectious Diseases Level Programme (ISSRIDP). These are projects on urgent obstetric care and improvement of reproductive health of teenagers together with the United Nations Population Fund (UNFPA) and the UN Children’s Fund (UNICEF). As a whole, US $1 million is required for WHO’s needs [in Tajikistan] in 2006.