ABSTRACT

Background A new two-year Post University Specialty Training (PUST) programme in family medicine was introduced to improve the quality of postgraduate speciality medical education in Tajikistan. Postgraduate education of family doctors (FDs) needs to be urgently scaled up, as 38% of FD positions in Tajikistan remained unfilled in 2018. Moreover, the international financial support for the PUST programme is ending. This investment case assesses the minimum funding needed for the continuation and scale-up of PUST and establishes the rationale for the investment in the light of a recent evaluation. Methods The costs of the programme were calculated for 2018 and a scale-up forecast made for the period 2019–2023. The impact of the scale-up on the shortage of FDs was assessed. An evaluation using a Multiple Choice Questionnaire and Objective Structured Clinical Examination (OSCE) assessed and compared theoretical knowledge, clinical skills and competencies of PUST trained and conventionally trained FDs. Results The annual costs of the programme were US$ 228,000 in 2018. The total investment needed for scaling up PUST from 31 new FDs in 2018 to 100 FD graduates each year by 2023 was US$ 802,000.However, when the retirement of FDs and population growth are considered, the scale-up will result only in maintaining the current level of FDs working and not solve the country’s FD shortage. The PUST FDs demonstrated significantly better clinical skills than the conventionally trained interns, scoring 60 and 45% of OSCE points, respectively. Theoretical knowledge showed a similar trend; PUST FDs answered 44% and interns 38% of the questions correctly. Conclusions The two-year PUST programme has clearly demonstrated it produces better skilled family doctors than the conventional one-year internship, albeit some enduring quality concerns do still prevail. The discontinuation of international support for PUST would be a major setback and risks potentially losing the benefits of the programme for family medicine and also other specialities. To guarantee the supply of adequately trained FDs and address the FD shortage, the PUST should be continued and scaled up. Therefore, it is essential that international support is extended and a gradual transition to sustainable national financing gets underway.

No abstract

Clostridium perfringens spore destruction, aerobic plate counts (APCs), and counts of Enterobacteriaceae, coliforms, and Escherichia coli during baking of sambusa (a traditional Tajik food) were evaluated. Control of germination and outgrowth of C. perfringens spores in sambusa during cooling at room or refrigerated temperatures was evaluated using organic acid salts (buffered sodium citrate [Ional] and 1 and 2% potassium lactate, wt/wt). Sambusa were prepared with 40 g of either inoculated or noninoculated meat and baked for 45 min at 180 degrees C. For evaluation of destruction of C. perfringens spores during heating and germination and outgrowth of spores during cooling, ground beef was inoculated and mixed with a three-strain cocktail of C. perfringens spores. Aerobic bacteria, Enterobacteriaceae, coliforms, and E. coli were enumerated in noninoculated sambusa before and after baking and after cooling at room or refrigeration temperatures. After baking, APCs and Enterobacteriaceae and coliform counts were reduced by 4.32, 2.55, and 1.96 log CFU/g, respectively. E. coli counts were below detectable levels in ground beef and sambusa samples. Enterobacteriaceae, coliform, and E. coli counts were below detectable levels (< 0.04 log CFU/g) in sambusa after cooling by both methods. Total C. perfringens populations increased (4.67 log CFU/g) during cooling at room temperature, but minimal increases (0.31 log CFU/g) were observed during cooling under refrigeration. Incorporation of 2% (wt/wt) buffered sodium citrate controlled C. perfringens spore germination and outgrowth (0.25 log CFU/g), whereas incorporation of up to 2% (wt/wt) potassium lactate did not prevent C. perfringens spore germination and outgrowth. Incorporation of organic acid salts at appropriate concentrations can prevent germination and outgrowth of C. perfringens in improperly cooled sambusa.

Background For many countries, overcoming problems related to human resources is critical for progress towards Universal Health Coverage. Planning the workforce means to make decisions on required number, qualification and distribution of health workers. In Tajikistan, despite significant reforms, the health workforce is unequally distributed with physicians being mainly specialized and concentrated in urban areas. Description Using the Tajik case, we present a first comprehensive assessment of the Primary Health Care (PHC) staffing situation in a Central Asian setting applying and critically discussing the Workload Indicators of Staffing Need (WISN) method developed by the World Health Organization. Staffing requirements were derived using annual service statistics, obtained from a re-count of monthly routine data from registration books at facility level in the year 2016. Available health cadres in PHC at district and facility level were compared to the according staffing needs. Sensitivity analysis was performed to test the robustness of the predictions, and to identify the main contributors to uncertainty in the predicted staff requirements. Results For doctors performing general tasks in the PHC, there is currently an excess of full time equivalents. Moreover, health centres are overstaffed in terms of nurse positions. If the various speciality doctors currently working at rural health centres are not included, there is a shortage of family doctors in place. Sensitivity analysis revealed that staffing requirements in the PHC sector in Tajikistan are most importantly influenced by antenatal care visits. Lessons The present study concludes that there is an oversupply of doctors and nurses at PHC and a shortage of family doctors working at the level of health centres. Consequently, a more rational health workforce planning based on well-grounded methodology such as WISN has potential to contribute to more efficient and effective health service delivery in Tajikistan. Key messages Countries shifting towards a family medicine model face challenges like an oversupply of specialists performing general medical tasks and a lack of general/family doctors in the transition phase. To identify staffing requirements a transparent and reproducible approach, such as the WISN methodology, is required to steer future staffing needs and possible re-training of current staff.