Volunteer Name: Dr. Azim Juma
Host Institution: Aga Khan Health Service (AKHS), Tajikistan
Duration of Assignment: July 2007 - Ongoing: Periodic site visits to Tajikistan combined with serving remotely from home base in Toronto
The fall of the Soviet Union resulted in a collapse of Tajikistan’s health system in the 1990’s. This was followed by a prolonged civil war and a long period of economic decline. The Tajik Government and the World Health Organization (WHO) jointly identified Family Medicine (FM) as a priority initiative in their 2005-2015 national strategy. In addition, Mawlana Hazar Imam gave guidance that Clinical Excellence (CE) should be introduced to ensure continuous quality improvements at all levels in the health care system.
AKHS required quality input from an experienced consultant with expertise in the development and implementation of FM and CE initiatives. Therefore, in July 2007, Dr. Azim Juma was recruited as a TKN volunteer to work with AKHS to help implement the Family Medicine and Clinical Excellence concepts in Badakshan.
Since 2007, Dr. Juma has been providing year-round remote support by telephone and via the internet, and he also makes site visits to implementation locations two to three times a year. The design of a family medicine system for Tajikistan was developed after researching “Best Practices” in family medicine in four countries: Canada, USA, UK and Australia. These best practices were integrated with the existing Tajik medical system to help build a robust FM network.
Implementation of the Family Medicine initiative has focused on achievement of the following key objectives:
- Create a strategic shift in the approach to medical care in Tajikistan, with emphasis on Family Medicine
- Develop administrative processes and supports for the operation of efficient family medicine centers
- Ensure re-training of local doctors and nurses to become Family Physicians and Nurses
- Renovate crumbling physical facilities
- Replace medical equipment and supplies
- Encourage FM as a first point of contact for medical care
- Ensure that family doctors coordinate care between specialists, laboratories and hospitals.
Implementation of the Clinical Excellence (CE) system has achieved the following major results:
- Establishment of a Clinical Governance Committee, with membership from the Ministry of Health and AKHS staff. This committee has been empowered to monitor all FMCs regularly, and to resolve any problems on an ongoing basis.
- Set up medical libraries and computer labs in the FMCs
- Ensured availability of a standard medical record system at all FMCs
- Established monthly sessions for continuing medical education at the FMCs
- Undertook “Peer Reviews” of clinical cases at FMCs
- Developed a Clinical Audit team to design and carry out clinical audits to continually improve quality of clinical care.
- Significant Outcomes:
- The high quality of FM implementation, complemented with a clinical excellence program, has been recognized by the Tajik government. In 2012 and 2013, AKHS was requested to expand its FM/CE program to the neighbouring provinces of Khatlon and Rasht.
- With a single pilot project which started in 2007, there are now 250 centers in 3 provinces providing quality Family Medicine services, with a clinical excellence system which ensures continuing professional development and clinical audits.
- The joint Clinical Governance Committee (AKHS and GB Ministry of Health) continues to oversee improvements in quality of care since its inception in 2007.
- Starting with one clinical audit per year in 2008 in a single district, the program has now grown to 10 clinical audits in 2016 in eight districts.
- The Swiss Agency for Development and Cooperation (SDC) has been a major donor for the program from its inception in 2007, and continues to renew its financial support every year for the past 10 years.
Dr. Juma emphasizes that capacity-building and mini-mentorships have been key elements of this TKN assignment. He says the success of the program “has been a team effort with doctors and nurses at AKHS. The AKHS team’s commitment and leadership has ensured the success of the program. The team’s proficiency and technical skills in implementing the FM/CE program has grown tremendously over the years, and they continue to promote this concept at the national level with the Ministry of Health for Tajikistan”.
AKHS Tajikistan is immensely grateful to Dr. Juma for his outstanding contribution and tireless support which has enabled AKHS and the Ministry of Health to establish a robust and comprehensive family medicine program complemented by a commitment to clinical excellence.
