The Health sector has been a priority domain of intervention for Switzerland in its last Cooperation Strategy for Central Asia 2008-2011 and remains so in the current one (2012 — 2015). SDC supports three main complementary projects in this sector in Tajikistan,

— The "Tajik-Swiss health care Reform and Family Medicine Project" (Phase 4), hereafter called Sino, which works in 4 districts of Tajikistan: Vose, Khamadoni, Tursunzade and Shahrinav,

— The "Community Based Familiy medicine project" (Phase 2), which covers entire Gorno-Badakhshan Oblast (GBAO) and three districts of Khatlon in the East and South of Tajikistan,

— The "Medical Education Reform project" (Phase 2) implemented by the STPH, working in the same districts as the Sino project.

Since 2003 Project Sino has contributed significantly to the establishment of family medicine in Tajikistan, in particular through the introduction of district planning of primary care services, retraining of family doctors and nurses, development of clinical protocols, introduction of peer review groups, rehabilitation and equipment of rural health houses and creation of community groups active in health.

This planned new project phase will concentrate on replicating and improving its experiences in district planning and management of primary care services, and on scaling up experiences with communities. The expected outcomes of the project are: Outcome 1: Primary health care service delivery is improved through better planning and management at district and local level, more transparency and greater involvement of the community, in selected districts. The following main steps are planned: a) The project will replicate geographically experiences gained and improve the tools used (with regards to sustainability, performance monitoring and collaboration with the communities). It will strengthen the capacity of the Republican Centre for Family Medicine and regional health authorities in view of sustainability and further scaling up. b) Experience gained in this field will be fed back to national policy level, including through participation in the National Health Coordination Council and its technical Working groups such as the one on Governance or Service delivery and/or Resources. The project will also continue to monitor the implementation of health financing mechanisms (such as the Basic Benefit Package or Performance Based Payment at primary health care level) in selected districts and report to relevant national level working groups on its findings.

Outcome 2: Community Health: Communities are empowered to take more responsibility for their health through the establishment and functioning of community groups in at least 75 % of all villages in selected districts. This outcome can be reached: a) Based on a national agreement on which model of community health should be replicated and how, the project will scale up its work on community and introduce community groups in all villages of the selected districts. It will pay particular attention to sustainability. The capacity of the Health Lifestyle Centres will be strengthened at local and national level to be able to steer health promotion at community level and develop health actions in the future independently.

b) Experience gained in this field will be fed back to national policy level, including through participation in the National Health Coordination Council

— Working groups.

Rehabilitation and equipment: PHC and/or health relevant infrastructure will be renovated and essential equipment purchased for rural health houses, in selected districts for a total amount of about CHF 1.5 mio. This shall not be a separate outcome but integrated into the previous ones to support their realization. Infrastructure is often in a poor state in the selected areas, and rehabilitation gives a signal of change, which should be carried out also in the way services are delivered. It also helps mobilize communities. Essential equipment will be procured to primary care facilities, in a way to strengthen other components of the project and the MEP.

In phase 5, the project Sino will gradually phase out of Shahrinav and Tursunzade and phase into two new districts.

— Farkhor and Temurmalik,

— to be confirmed at the end of the six initial months of implementation, focusing on sustainability and scaling up Synergies will be sought between the different components to reinforce each other, and with the Medical Education project which will conduct retraining of family doctors and nurses in districts where this new project phase will be active.

The upper credit limit for the first four years of the project is CHF 4 700 000. Additional funds might be allocated subsequently. The overall project idea is a midterm engagement that is conceived with a time horizon of approx. 7 years with two phases: a first phase of four years followed by the exit phase of three years. Phase 5 is planned to start in April 2013.