With nearly a quarter of Tajikistan's 10 million inhabitants estimated to require rehabilitation, the country has designated disability care as a primary concern, facilitating substantial progress in policies, services, and legislation.[1] This has included enacting the "Social Protection of People with Disabilities" law, and the provision of free assistive products through the State Enterprise of Orthotics and Prosthetics.[2] However, demand for assistive technology still outstrips supply, particularly in rural areas. To address this, the Government of Tajikistan, in collaboration with the World Health Organization (WHO), initiated a "One-stop shop" pilot project in the Rudaki district. Following its success in enhancing beneficiaries’ independence and community engagement, the Government requested project expansion nationwide. WHO subsequently secured approval to enlarge the project’s scope, not just within Tajikistan, but also in other European countries. This project, anticipated to impact hundreds of thousands of people over the next five years, promotes the integration of rehabilitation services into the wider healthcare system, marking an important step forward in disability care. Enhancing access to rehabilitation services and assistive products is a key priority in the 2024-2030 Joint Country Cooperation Strategy, aligns with the outcomes of the United Nations Sustainable Development Cooperation Framework, and supports the objectives of the World Health Assembly's resolution WHA76.6 on “Strengthening Rehabilitation in Health Systems.” It is a noteworthy example of actioning “Delivering United Action for Better Health – a strategy for collaboration between the WHO Regional Office for Europe and Member States in the WHO European Region,” through tailored support that balances addressing immediate needs with a longer-term strategic outlook.

''We introduced several new products to the community and have been getting hundreds of calls a day from people asking where they can get assistive products for their family or friends.’’

-Trainee nurse involved in assistive product provision, Tajikistan

How did Tajikistan, with the support of WHO, achieve this?

In the wake of a 2010 polio outbreak, Tajikistan, with WHO’s technical assistance, committed to improving disability rehabilitation. A significant development was the creation of a globally recognized 30-item Assistive Products List (APL) in 2018, which includes items such as wheelchairs, hearing aids, and prosthetics. The following year, the Government reaffirmed its commitment to enhancing care for individuals with disabilities through the Dushanbe Declaration on Disability Issues.[3] Currently, Tajikistan is among six countries benefitting from a five-year USAID project aimed at enhancing rehabilitation and assistive technology (AT).

In 2022, in partnership with Tajikistan's Ministry of Health and Social Protection, WHO conducted a comprehensive evaluation of the nation's rehabilitation capabilities, readiness to meet demands, and emergency response capacity. Using WHO’s Systematic Assessment of Rehabilitation Situation (STARS) tool, the team made 17 visits to healthcare facilities and engaged key stakeholders in focus group discussions.[4] This country situation analysis, which was supported through donor funding from USAID, was instrumental in enabling the Government    was   in shaping a new national action plan, succeeding the National Strategy on Rehabilitation that concluded in 2020. 

^{In Tajikistan, recipients of assistive products are equipped with thorough training and follow-up to ensure their optimal use.}
Photo credit: WHO Tajikistan

Drawing from the situational analysis that identified key challenges, the innovative "One-stop shop" assistive product (AP) service pilot project was launched in the Rudaki district. This joint effort between the Tajik Government and WHO involved comprehensive training of healthcare professionals on APs, delivered both in-person and through the WHO’s Training in Assistive Products (TAP) platform.[5] WHO funded training costs and deployed a team of rehabilitation professionals comprising an ophthalmologist, a physiotherapist, and a wheelchair technician to provide technical support to trainees. The TAP platform, continuously updated to include new assistive products, offers modules on selection, measurement, adjustment, fitting, and user training. To ensure broad accessibility in Tajikistan, WHO translated the platform into Russian.

The State Enterprise of Orthotics and Prosthetics offered 7 000 assistive products spanning 24 categories through healthcare facilities for the first time, while trained family doctors and nurses received continuous technical support from WHO mentors to ensure broad intervention coverage. A workshop was established within district primary healthcare centres (PHCs) to provide AP repairs and replacements promptly. WHO assumed the costs of basic repair equipment and consumables and supplemented the salary of a wheelchair technician for the initial year. Access to AP services improved markedly, as demonstrated by data collected by WHO in a survey of 200 wheelchair beneficiaries, which also revealed a significant increase in independence, community engagement, and participation, and a decrease in accidents and injuries.

“Ever since we began offering assistive technologies, we’ve seen many people using our products around the village – many of these people didn’t leave their homes before.”

-Trainee nurse involved in assistive product provision, Tajikistan

Motivated by these initial successes, the Tajik Government requested an expansion of the "One-stop shop" initiative in 2022. This led WHO to arrange a visit by senior leaders from ATscale – a global partnership for assistive technology - culminating in their decision to include Tajikistan, Georgia, and Azerbaijan in their initiative by 2027. The ambition is to roll out the "One-stop shop" project across Tajikistan, with the potential to directly benefit 15 000 individuals and indirectly impact 423 000 people over the next five years via the WHO/ATscale project. Backed by ATscale funding, WHO plans to replicate the initiative in four additional districts, encompassing the procurement of APs, training of PHC staff, and establishment of referral pathways. Furthermore, plans are underway to set up physiotherapy units in all pilot PHCs.

The initiative has not only built on local success but also boosted workforce competency, enhanced international collaboration, and expanded global opportunities for Tajikistan. It has underscored the impact of rehabilitation on reducing secondary health complications, increasing independence, lowering healthcare costs, and improving mental health. Now, with WHO support, a new national disability and rehabilitation programme for 2023-2028 is being developed, promising to further enhance Tajikistan's disability and rehabilitation services.