Winter 1995 (3.4)
World Health Organization Regional Office
for Europe (WHO/EURO) in Azerbaijan
by Dr. Vladimir Verbitski
As in other countries of Central and Eastern Europe (CCEE) and the Newly Independent States (NIS) of the former USSR, all sectors of society in Azerbaijan, including health, are undergoing rapid and profound change. Normal post-Soviet transition problems have been exacerbated in Azerbaijan by major political difficulties, and in particular, the Nagorno-Karabakh conflict, an undeclared war with Armenia which has been going on for almost eight years.
The leading cause of mortality in Azerbaijan is (1) cardiovascular disease, followed by (2) cancer, (3) respiratory infections, and (4) accidents. However, the incidence of communicable diseases is increasing. In 1994, Azerbaijan reported 841 cases of diphtheria compared with 166 in 1993. Tuberculosis, hepatitis A, diarrheal and acute respiratory infections are important public health problems. The armed conflict has caused a large number of severe injuries including amputations which has resulted in the permanent disability of people and the need for rehabilitation and other services.
Left: Water is one of the most critical health problems in Azerbaijan-particularly having access to a clean, drinkable supply. This scene is from Shusha in 1991 after the water supply had been destroyed. Shusha has been occupied by Armenians since 1992. All Azerbaijanis have fled this area which was known for its strong musical traditions, and sometimes called the "Conservatory of the Caucasus." Photo: Oleg Litvin.
The deteriorating health status of the population is of serious concern. Many refugees and displaced people are still living with host communities in overcrowded, unsanitary conditions. Hundreds of thousands still live in tents or improvised mud brick shelters along the highways.
Both chemical and biological indicators show Azerbaijan to have high levels of water pollution, especially due to oil leakage from petroleum plants and from the dumping of untreated sewage into the Caspian Sea. Half the population is without safe drinking water, and both the water supply and sewerage systems are in disrepair. In Baku, it is necessary to boil all water for human consumption.
Azerbaijan has inherited a rather elaborate health care system but currently lacks the means to support it. There are acute shortages of vaccines, pharmaceuticals and medical equipment. Almost 95% of medicine, medical equipment and supplies are provided through international humanitarian assistance. Working conditions and the quality of life of medical personnel are below standard. Current reform plans call for a shift towards primary health care but due to severe financial constraints, implementation of reforms has been difficult and slow.
The World Health Organization Regional Office for Europe (Copenhagen, Denmark) has been actively collaborating with the fifty countries that now make up the WHO European region. In response to the dramatic changes in Eastern Europe after 1989, the EURO office reorganized to focus on the needs of CCEE/NIS. Customized programs of work have been developed which address both emergency and developmental needs of member states.
WHO's work with Azerbaijan was initially focused on the urgent need to prevent complete breakdown in the supply of essential vaccines, life-saving drugs and basic medical equipment. Standard WHO kits of various types (epidemic, pneumonia, mental health, emergency, TB treatment, TB diagnostic) have been supplied by WHO in 1994/95.
Emergency assistance continues to be an important part of WHO's activities. One example is the Metro accident in Baku on October 28, 1995, when a fire broke out on a Metro train. On November 1st, WHO received a request from the Government of Azerbaijan for assistance because victims of the accident who had been discharged from the hospital after first aid treatment were having to be re-admitted. The local authorities were at a loss to know how to treat the unusual symptoms.
Immediately WHO/EURO, via the Bilthoven Office of its European Centre for Environment and Health, identified two Dutch experts, a toxicologist and a technician, who left for Baku on November 2nd.
WHO/EURO also contacted the Mediterranean Burns Club, who nominated a burns specialist to join the team. He left Cairo for Baku on November 3rd. An emergency health kit providing supplies necessary for the treatment of 1000 patients for three months was flown to Baku on November 3rd. All the necessary advice and technical assistance was rendered to local medical structures immediately.
Rebuilding the Health Care System
A collaborative agreement between WHO and Azerbaijan was signed in September 1994, and activities within the framework of the EUROHEALTH program* have aimed at achieving self-sustainable positive change in the health situation started. A WHO Liaison Office was established in Baku in July 1994.
WHO/EURO provided assistance in developing a national Expanded Program of Immunization (EPI) in accordance with new cost effective global EPI policy and strategy.
Azerbaijan participated in a major WHO project on the control of poliomyelitis along with a number of WHO/ EURO Member States in the Mediterranean, Caucasus and Central Asian regions (MECACAR). Ninety-five per cent of all children under five years of age were successfully immunized with two doses of oral poliomyelitis vaccine between March and May 1995. Through participation in the WHO Information Service on Medical Supplies (ISMS), Azerbaijan has managed to keep donors informed of its needs in vaccines and maintain its national immunization program.
Azerbaijan is participating in a Trans-Caucasus project on tuberculosis control. Tuberculosis is seen as serious in Azerbaijan. From a mortality rate of 4.6 per 100,000 in 1990, it increased rapidly to 10.4 per 100,000 in 1993. This rate corresponds to 761 deaths.
On behalf of WHO, Dr. Richard Zalesky went to Tbilisi (Georgia) for 11 months to coordinate the project for the entire Caucasus.
The WHO policy included a new, more efficient treatment which primarily uses short courses of anti-TB drugs. In this way resources saved can now be invested in other priority areas. Numerous training seminars have been held in which Azerbaijani health specialists have participated.
Three sites have been chosen for TB pilot projects: Baku, Khachmaz and Lankaran. The projects cover a total of 2.1 million people (31% of the total population) and assist approximately 500 tuberculosis patients a year.
One of WHO's basic functions is to act as overall health coordinator for international agencies, governmental bodies, NGOs and other organizations that are providing within health sector. This function has been fulfilled to a large extent in the Caucasus through consultations with the relevant Ministries of Health, by WHO consultants visiting the countries to assess the situation and meet with local experts, by the activities of the WHO Liaison Office in Baku, and by close cooperation with other international agencies and NGOs in the area.
The following priorities have been outlined in a new program of collaboration between Azerbaijan and WHO/EURO for the 1996-1997 biennium:
1. Control of communicable diseases (tuberculosis, EPI including diphtheria control, MECACAR).
2. Reforms of the health care services, strengthening of the national capacity to use available health information for planning, management and monitoring.
3. Participation in major WHO/EURO inter-country programs: the Countrywide Integrated Non-communicable Disease Intervention (CINDI), and the Healthy Cities project.
4. Women's and Children's health (family planning, breastfeeding, nutrition).
5. Assistance to patients with amputations (prosthetic fittings).
WHO is also committed to providing health-related humanitarian assistance. Emphasis is placed on normative and technical guidance functions with long-term benefits, based on the latest strategies using a cost-efficient approach to combat certain diseases rather than continuing to support present practices. Training is an essential element of almost all projects and quality, rather than quantity and speed of delivery has been stressed.
It is impossible for WHO to finance all the activities from its regular budget and the voluntary donations it receives are crucial to its work. In the latest UN Interagency Appeal covering the period April 1995-March 1996, in addition to ongoing activities, emphasis has been placed on the needs of vulnerable and needy groups, specifically, refugees, internally displaced persons, host families, the elderly, the disabled and the handicapped.
Other areas of particular interest include reproductive health in prolonged emergencies (access to family planning), community-based rehabilitation, and the improvement in living conditions of psychiatric and physically handicapped patients.
The WHO strategy strongly focuses on implementation, calling for greater efforts in health promotion, disease prevention, environmental health, appropriate care and health development support. It is based on action, partnership and innovation at the international and country levels. Successful collaboration in health between WHO and Azerbaijan is a guarantee of turning policy intentions into health results for people.
* Note - The drastic political and economic changes in Europe have increased the number of Member States of the WHO European Region from 32 to 50, and about half of these new Member States are in a very difficult situation. From the beginning, bilateral and multilateral partners, including non-governmental organizations, private corporations, groups and others, have supported these changes. So far, however, their actions have lacked a common focus. The time seemed right for WHO/EURO to consider how to support the CCEE/NIS in this critical phase of development.
Therefore, a program of intensified cooperation in health with these countries was elaborated and launched by WHO/EURO in the early 90s. This program was named WHO/EUROHEALTH.
Information in this article has been provided by Dr. Vladimir Verbitski, Disaster Preparedness and Humanitarian Assistance, Coordination and Resource Mobilization, Country Health Development, WHO/EURO in Copenhagen, Denmark. Tel: (4539)171-339; Fax: (4539) 171-856; e-mail: <firstname.lastname@example.org>
Dr. Richard Zalesky (Head of the Chair of Tuberculosis of the Latvian Medical Academy) also contributed to this article.
From Azerbaijan International (3.4) Winter 1995.
© Azerbaijan International 1995. All rights reserved.