Andrea Vogt Operation Mercy for the Delegation from Tajikistan

7.565 million population (Census 2010) 40 % of the population under 18 73% of population living in rural areas (Census 2010) 93% of its territory is mountainous Only 7% of arable land Level 127 in HDI 47 % of GDP from remittances (World Bank 2012) (highest in the world)

Operation Mercy, Handicap International, CARITAS, EU –MLSP, in cooperation with UNICEF

Tajikistan became independent from the Soviet Union in In the Soviet Union the primary health system was well developed and even small villages had a nurse or a medical contact point. Disabled people were organized under state DPOs and sheltered workshops – especially the blind and deaf. Theory on walkability and workability. (Katsui, H. 2005)

Approach to rehabilitation and education is based on the Soviet defectology model. This is a very medical / corrective model of disability which still prevails. Few specialists are responsible for the care of CWDs in special institutions. There are no PTs, OTs or other therapists that focus on functionality and activities of daily live. PT and OT recently included in the list of professions but the education process still unclear. Social work as a profession at its initial stages SW graduating from the Tajik National University in 2013

A group of parents approached Operation Mercy about support and rehabilitation for their children. A small group started 2x a week in Khujand. Training of mothers was key which led to Mothers becoming volunteers and staff of the project.

In 2007 the project moved into a state kindergarten upon signing a contract with the city education department. A day care group and 4 early intervention groups started. The goal of the projects became clearly defined as Inclusion of CWDs in school and community CBM came on board as a partner in strategy and funding first rural CBR early years group has started parents started a local NGO “Manbai Mehr” to continue the programme.

Today the „All about children programme“ is in regular contact with about 150 children. Over 25 children have been successfully included in education in schools and Kindergartens. Local teachers and community leaders are trained and more community groups are planned to be started soon.

2007 several international NGOs in partnership with local NGOs started day care centres for CWD at the district level, initially supported by EU the Agency of Social Protection under the Ministry of Labour starting purchasing services of NGOs through an annual tender process.

2010: Polio outbreak in Tajikistan over 700 people affected by AFPs Introduction of CBR for polio victims seen as an entry point to promote services for all children with disabilities Government, especially MoH asked for a community-based approach UNICEF, WHO, Operation Mercy, Handicap International got involved UNICEF funded project under the overall supervision of the MoH and implemented by Operation Mercy, Handicap International and VSO in the 25 most polio affected districts in the South with support from the MoLSP and MoE WHO assessment team for rehabilitation visits Tajikistan twice.

CBR Working Group among international organisations established to coordinate their efforts and share expertise more, with some involvement of national partners. Awareness of the population and especially parents raised through dissemination of 6000 brochures on polio rehabilitation, and airing of 3 one minute advocacy clips and a 15 minute health show promoting inclusion 167 doctors and nurses from national and regional hospitals received acute level training More then 800 health care workers, social workers, education staff, community leaders and volunteers have basic knowledge on rehabilitation and inclusion

21 CBR support rooms established staffed by a mix of nurses, doctors, social workers About 350 children received orthotics through the new mobile team of the orthopaedic workshop under the MLSP 18 schools have been made accessibility in terms of ramps (more needs to be done for toilettes, and changing mindsets) DPOs and parents associations for CWD mobilised to support the CBR process In total more than 1000 children with disabilities reached in 25 districts

Operation Mercy in partnership with CBM Eastern Mediterranean Regional office is currently developing a model for Inclusive development on district level – as a follow up of the CBR response to polio. In the project we are looking at the families of CWDs as stakeholders for development of their communities. Beside the rehabilitation and inclusion of CWDs we want to introduce health prevention lessons, agricultural and income generation projects. We also want to mobilize the community youth through existing child to child projects to be more involved in the social inclusion of young PWDs.

Sadly the role of DPOs has been small to date this is changing! DPOs and parents organizations are key to the development and sustainability of inclusive community development. Reviving or strengthening DPOs in our target districts is key. SHG is something we are like to explore for Tajikistan in combination with parents or DPO groups

The beginnings of CBR in Tajikistan are made! In a way the tragedy of the polio outbreak 10 years after being certified polio free – became a catalyst for community based approaches in disability for Tajikistan and fast forwarded the process. International organizations played a big role in setting initial examples and in facilitating the emergency response CBR during the polio outbreak. The CBR network is currently still dominated by INGOs and UN organizations – we hope that this congress and the dynamics we have as Tajik delegation here representing government, local NGO and DPOs as well as INGOs will move us forward into a new partnership for CBR in Tajikistan.