Tajikistan’s success against COVID-19 using hybrid top-down and bottom up approaches

Friday, March 12, 2021

COVID-19 has taught us the importance of good leadership, management, and prioritizing science from a top-down approach as well as society and individuals in agreement with their attitudes and behaviors with leadership as a bottom-up approach. These approaches showed us that progress and failure were not entirely related to access to technology, income of countries or situations of individuals. Tajikistan can be an example for good practice in how to handle COVID-19 as a diverse low-income country. Tajikistan contributed its success to the use of hybrid bottom-up and top-down approaches. This hybrid method involves a balance between leadership developing and implementing good policy and the capacity of the public and local organizations to identify and act upon their specific community’s needs. Tajik leadership reunited their society, prioritized science, used resources in efficient ways, and built hope in their diverse society. Society followed the suggestions of professionals by wearing masks, socially distancing, accepting government decisions, and posting supportive messages and knowledge on their social media. Since December 31, 2020, Tajikistan’s Ministry of Health has reported no new diagnosed COVID-19 cases, while thousands of tests continue in 15 facilities nationwide.

Tajikistan’s MoH reports the COVID-19 case mortality rate is 0.7% with only 0.99 deaths per 100,000 population. There is an argument that there may be more COVID-19 cases and the mortality rate may actually be higher. However, when looking at data collected about patients with signs or symptoms of COVID-19 and pneumonia, regardless of COVID-19 test results, the data shows that there is only one peak in late spring and summer. The number of pneumonia cases in January and February of 2021 are no higher than before the pandemic.

The Tajikistan health system has progressed over the last two decades. Maternal mortality rate dropped from 53 deaths per 100,000 live births in 2000 to just 17 in 2017, and child mortality rate dropped from 155 deaths of children under five years of age per 1000 live births in 1972 to 35 in 2018.

Unlike Tajikistan, the leadership in the United States failed to use the hybrid approach and continues to have thousands of deaths due to COVID-19 every day. Each political party had their own strategy for handling COVID-19, causing recovery efforts to become politicized. Some American leadership did not acknowledge scientific suggestions and used divisive rhetoric that split the nation. Additionally, organizations were formed by people who denied the existence of the pandemic and encouraged their members not to listen to scientists. Despite the state mandated mask requirements, many public places, like stores, gyms, and restaurants refused to follow prevention methods.

The government of Tajikistan, led by President Rahmon, established and led the national committee to control COVID-19, which included key decision makers from the government, scientists, and society. To prevent the coronavirus from entering the country, there was a quarantine for all travelers entering the country regardless of nationality, and soon after the borders were closed for months despite their major loss of income from tourism and remittances, which makes up close to one third of the nation’s GDP. However, society trusted leadership and accepted the major loss in income.

Fear and panic rushed through Tajikistan when the country saw its first cases and people overwhelmed the health system and hospitals. To respond to this, the president reunited all national, regional and district mass media and television channels and created a nonpartisan public awareness and education campaign to reduce fear, prevent the use of non-scientific messages, and increase hope and attention to COVID-19. International experts were invited to share their expertise to the public for the first time. Soon after, the spring peak of infection and the mortality rate started declining. Mobile phones and the internet were used successfully to build public awareness, conduct professional training, and connect international experts with local professionals and society.

The Ministry of Health implemented innovative home care services and conducted active surveillance to find cases in early stages. This allowed hospitals and specialists to provide services to complicated and critical cases without overloading hospitals. The home care approach supported clients by allowing them to receive mental and social support by their families and partners and daily medical care virtually and in-person by nurses and family physicians from the comforts of home, avoiding isolation in the challenging hospital environment. The Minister of Health provided ongoing monitoring and evaluation services to solve any local logistical and managerial issues and technical questions in collaboration with international experts.

To build trust and empathy, the president and key social and political decision makers modeled safe behaviors while engaging with society and during public speeches. This approach avoided miscommunications and divisions within the country.

Individual knowledge sharing on blogs and social media, campaigning by civil society organizations and community key stakeholders, and having an overall united attitude towards COVID-19 recovery were successful bottom-up approaches.

Overall, countries could benefit from hybrid approaches used in Tajikistan where the president’s effective and efficient leadership and society’s united attitudes and responses reduced the mortality rate and new cases of COVID-19.

Category:COVID-19 Category:Tajikistan Category:Health

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