Implementing family health nursing in Tajikistan: from policy to practice in primary health care reform

Barbara A. Parfitt, Flora Cornish

Research output: Contribution to journalArticle

Abstract

The health systems of former Soviet Union countries are undergoing reform away from the highly centralised, resource-intensive, specialised and hierarchical Soviet system, towards a more generalist, efficient health service with greater focus on primary health care. Family Health Nursing is a new model designed by WHO Europe in which skilled generalist community nurses deliver primary health care to local communities. This paper presents a qualitative evaluation of the implementation of Family Health Nursing in Tajikistan. Using Stufflebeam's ‘Context, Input, Process, and Product’ model, the paper aims to evaluate the progress of this reform, and to understand the factors that help or hinder its implementation. A four-phase research design investigates the development of the Family Health Nurse role over time. In 5 rural areas, 6 focus groups and 18 interviews with Family Health Nurses, 4 observations of their practice, 7 interviews with families and 9 interviews with physicians were carried out. Data were analysed according to the components of Stufflebeam's model. Although the legacy of the Soviet health system did not set a precedent for a nurse who is capable of decision-making and who works in partnership with the physician, Family Health Nurses were successfully implementing new practices. Crucial to their ability to do so were the co-operation of physicians and families. Physicians were impressed by the nurses’ development of knowledge, and families were impressed that the nurses could offer real solutions to their problems. However, failure to pay the nurses regular salaries had led to serious attrition of the workforce. We conclude that the success of the Family Health Nurse role in other countries will depend upon its position in relation to the historical health care system.

Original languageEnglish
Pages (from-to)1720-1729
Number of pages10
JournalSocial Science and Medicine
Volume65
Issue number8
DOIs
Publication statusPublished - 1 Oct 2007

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Tajikistan
Family Nursing
Health Care Reform
Family Health
Primary Health Care
nursing
nurse
Nurses
health care
reform
health
Nurse's Role
Interviews
Physicians
physician
Aptitude
interview
USSR
Salaries and Fringe Benefits
Family Physicians

Keywords

  • health care
  • family health nursing

Cite this

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Implementing family health nursing in Tajikistan: from policy to practice in primary health care reform. / Parfitt, Barbara A.; Cornish, Flora.

In: Social Science and Medicine, Vol. 65, No. 8, 01.10.2007, p. 1720-1729.

Research output: Contribution to journalArticle

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