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Early Childhood Development in Tajikistan:

A Rapid Review of the Regulatory

Framework, Governance Environment and

Current Programs

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Table of Contents

Acknowledgements ....................................................................................................................... 3

Abbreviations and Acronyms ...................................................................................................... 4

Executive Summary ...................................................................................................................... 6

1. Introduction ............................................................................................................................. 11

2. Regulatory Environment and Governance for ECD ........................................................... 19

Regulatory Framework for ECD provision............................................................................... 19

Laws and Regulations Related to Child Development ......................................................... 21

Laws and regulations related to parents’ ability to support child development ................... 24

Laws and regulations related to social protection ................................................................. 25

Governance ............................................................................................................................... 26

3. ECD Programs and Services .................................................................................................. 32

Comprehensive ECD ................................................................................................................ 32

Family Planning ........................................................................................................................ 32

Pre and Post-Natal Care and Attended Delivery....................................................................... 33

Child Growth and Developmental Monitoring ......................................................................... 33

Parenting Interventions ............................................................................................................. 34

Early Detection of Developmental Delays and Early Intervention .......................................... 35

Immunization ............................................................................................................................ 36

Nutrition Interventions .............................................................................................................. 36

Deworming ............................................................................................................................... 40

Water, Sanitation and Hygiene (WASH) .................................................................................. 40

Social protection interventions ................................................................................................. 41

Community-based Programs ..................................................................................................... 43

Alternative Preschool Programs ............................................................................................... 43

4. Conclusion ............................................................................................................................... 45

References .................................................................................................................................... 47

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Acknowledgements

This report was prepared by Ms. Lucy Bassett (Consultant, Education), Mr. Sabir Kurbanov

(Consultant, Health) and Mr. Cameron Haddad (Research Assistant) under the leadership of Ms.

Saodat Bazarova (Senior Education Specialist). The team would like to thank Ms. Ayesha Y.

Vawda (Lead Education Specialist) for intensive work on the report finalization and the following

for their contributions and comments: Mr. Marcelo Bortman (Lead Health Specialist), Ms. Mutriba

Latypova (Senior Health Specialist), Ms. Alexandria Valerio (Lead Education Specialist), Ms.

Kate Mandeville (Senior Public Health Specialist), Ms. Yoshini Naomi Rupasinghe (Health

Specialist) and Ms. Sanobar Khomidova (Consultant, Education).

The team would like to thank Mr. Harry Anthony Patrinos (ECA Education Practice Manager),

Ms. Tania Dmytraczenko (ECA Health, Nutrition and Population Practice Manager), Mr. Jan-Peter

Olters (WB Country Manager for Tajikistan), and Ms. Susanna Hayrapetyan (Program Leader for

Central Asia) for their guidance and support. The team also thanks Mr. Marc DeFrancis for the

editing work and Ms. Parvina Mahmadziyoeva (Consultant) and Ms. Shahlo Norova (Program

Assistant) for logistical support.

This review could not have been possible without the support of the management and staff of the

Ministry of Health and Social Protection of Population and the Ministry of Education and Science

who provided valuable information and advice. The team would like to thank development

partners that contributed to the report: UNICEF and Aga Khan Foundation.

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Abbreviations and Acronyms

AKF Aga Khan Foundation

BBP Basic Benefits Package

CIS Commonwealth of Independent States

CRC The Convention on the Rights of the Child

DHS Demographic and Health Survey

ECA Europe and Central Asia

ECD Early Childhood Development

ECEC Early Childhood Education and Care

eHCI Early Human Capability Index

ELDS The Early Child Learning and Development Standards

GAIN The Global Alliance for Improved Nutrition

GAVI Global Alliance for Vaccines and Immunization

GBAO Gorno-Badakhshan Autonomous Oblast

GDP Gross Domestic Product

GoT Government of Tajikistan

GPE Global Partnership for Education

IGME UN Inter-Agency Group for Child Mortality Estimation

IMR Infant Mortality Rate

JME Joint child malnutrition estimate based on UNICEF, WHO and WB harmonized

dataset

MCH Maternal and Child Health Handbook

MoES Ministry of Education and Science

MoHSP Ministry of Health and Social Protection

NGOs Non-governmental Organizations

OSI Open Society Institute

PHC Primary health care

PHCC Primary health care center

PMPCs Psychological, Medical and Pedagogical Committees

SUN Scaling Up Nutrition

TJS Tajikistan Somoni (currency of the Republic of Tajikistan)

TSA Targeted Social Assistance

UNFPA The United Nations Fund for Population Activities

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UNICEF United Nations Children's Fund

USAID United States Agency for International Development

WASH Water, Sanitation and Hygiene

WB World Bank

WFP World Food Programme

WHO World Health Organization

WRA Women of Reproductive Age

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Executive Summary

Tajikistan’s unique opportunity—investment in human capital through the development of its

youngest and most numerous members of society—that could change the country’s development

trajectory and help it attain social and economic well-being, has become a matter of national

emergency since the onset of the COVID-19 global pandemic.

The growth and development of the youngest children in a country is likely to be highly vulnerable

given the onset of a global recession and the resulting financial hardships on governments and

families, as well as the overload on the health system as it attempts to tackle the prevention and

treatment of the virus, the closure of school systems, and the heavy reliance on social security to

meet basic needs. Some estimates indicate that the global nutrition crisis following COVID-19

will be worse than the impact of the virus itself. If Tajikistan is unable to support the early

childhood development (ECD) needs of its population currently, it stands to lose its greatest

development opportunity.

In a child’s first five years, the brain matures the fastest and is more malleable than it will ever be

again. These early years are a critical period to get children the care, nutrition, health and

stimulation and learning opportunities they need to succeed in school and grow up to be healthy

and productive adults. Severe, lifelong impacts can result from deprivations during the early years

if children do not have these critical inputs to ensure optimal child development. Therefore, it will

be crucial to continue, and expand if possible, the government’s plans to provide appropriate

health, stimulation, education, and nutrition to its youngest.

Given the multisectoral nature of ECD services, effective ECD service delivery requires an

enabling environment created by: (i) an adequate regulatory framework (laws, policies and

strategic plans) to enable different actors to provide complementary services; (ii) governance

arrangements that facilitate coordination within and across institutions to ensure effective service

delivery; and (iii) an adequate supply of services to support the diverse needs of the sector. This

paper, which was prepared prior to the global pandemic, provides insights into the governance and

management of ECD in Tajikistan and provides a summary of present programs. It was requested

as an input to help the Government of Tajikistan (GoT) launch large-scale investments and policy

reform to support ECD.

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Key Findings

The context for improving ECD outcomes in Tajikistan is complex. Despite active measures,

progress on many ECD outcomes remains limited. Preventable illnesses cause most child and

maternal mortality. For example, the infant mortality rate (at 31 per 1,000 births) is among the

worst among all Central Asian countries. Maternal and child anemia (over 40%) and iodine

deficiency among women of reproductive age and children under 5 are prevalent (over 50 percent),

and only one-third of children are exclusively breast fed until 6 months of age. The preschool

enrollment rate, at 14 percent, is among the lowest in the region. Cognitive stimulation and positive

parenting in the early years is limited, resulting in a negative impact on early literacy and

numeracy. Food security is an ongoing challenge in Tajikistan, and one that has a significant

impact on the ECD agenda. Access to safe drinking water, sanitation, and hygiene (WASH)

services has a positive impact on children’s health and nutrition, and these facilities are

incrementally being provided to people in Tajikistan. Despite recent developments in enhancing

social protection and assistance, young children of the poor, and disabled children remain most at

risk at attaining adequate ECD outcomes.

While Tajikistan has established regulations affecting several aspects of ECD service

delivery, a comprehensive regulatory framework for ECD is yet to be developed. As in other

countries, the range of laws and regulations forming the ECD legal framework is wide,

representing the multiplicity of services and sectors that contribute to ECD outcomes targeting

different groups. Many areas of the ECD service delivery model—health, education, social

protection, family welfare, nutrition—are covered through distinct laws, codes, policies, and

strategies. The paper provides a snapshot of this wide web of regulations. Nevertheless, a fully

developed and integrated legal framework covering all target groups and aspects of ECD

holistically is not yet developed.

Fragmentation in the legal framework appears to be resulting from (i) the lack of a robust

collaboration and coordination mechanism for legislative development between the two core line

ministries responsible for ECD outcomes, the Ministry of Education and Science (MoES) and the

Ministry of Health and Social Protection (MoHSP); and (ii) limited articulation of the process of

and support to implementation of key legislation, for example the inadequate treatment of

breastfeeding promotion in the Health Code of 2017.

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Important legislation remains unenforced due to either the absence of sub-laws and normative acts,

and/or inadequate financing and capacity, risking service delivery to achieve ECD outcomes. For

example, the 2019 law on providing the population with fortified food products remains inactive

due to the absence of sub-laws, leaving a critical gap in regulations around important areas such

as salt iodization.

Рolitical commitment to ECD is high: the governance of ECD is challenged by absence of an

overarching institutional and policy anchor. Political commitment to improve ECD outcomes is

high in Tajikistan. For example, current national priorities include a dramatic reduction in stunting

among children under five years of age and an increase in preschool coverage of children ages

three to six. Several important regulations have been put into effect that demonstrate this

commitment. However, to date there is no single overarching national policy or strategy for ECD,

and therefore programs and services related to ECD lack integration and coordination.

Several agencies define the ECD governance and management system. The MoHSP and the MoES

play key roles in defining ECD policy and programs and in the key service delivery arrangements.

Local government authorities play a key role in the financing and provision of social services.

Other stakeholders involved mainly in the services provision include development partners,

international and local NGOs, private donors, and community organizations. In some cases, the

external support to essential ECD services exceeds by far the state contribution. Neither public-

private partnerships nor the outsourcing of social services has yet been developed.

Establishing an overarching coordinating body and institutional anchor for ECD has been

challenging in Tajikistan. Efforts to coordinate across the various multisectoral services have been

made since 2005-06 with limited results. An ECD Council was established under the Deputy Prime

Minister on Social Issues, but it stopped functioning. A National Early Childhood Development

Council (NECDC) is expected to be established. It will be chaired by the Deputy Prime Minister

for Social Sectors, with the Minister of Finance as deputy chair, and will comprise the ministers

of all concerned ministries, including MoES, MoHSP, and others (Labor, Agriculture, Water, etc.)

as well as the Executive Office of the President. Once established, it is anticipated that this council

will convene various ministries and agencies involved in ECD service delivery.

Several programs are providing support to various elements of ECD service provision. These

include support to family planning, pre- and post-natal care and attended delivery, growth and

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development monitoring, parenting support, early detection of development delays and early

intervention, immunization, nutrition interventions, interventions to improve feeding practices,

micronutrient supplementation and food fortification, management of severe diarrhea, deworming,

water, sanitation and hygiene, social protection and social assistance, child protection and school

feeding, and alternative and community-based preschool programs. The most comprehensive

among these is the recently approved Early Childhood Development for Building Tajikistan’s

Human Development Project.

Conclusion

The country is to be commended for its decision to invest in the health, education, and development

of its youngest citizens. Realizing improved ECD outcomes will require more than good will and

financial investments, however. Three overarching findings should inform efforts going forward.

First, achieving improved outcomes will require a robust regulatory foundation that enables the

many diverse actors to work toward a common purpose. It could begin with a national policy

framework for ECD. A policy framework typically includes both a policy statement and a

description of institutional and administrative structures to implement the policy. The policy

statement includes a vision of where the ECD is heading, a set of goals or objectives that the

government would like to achieve, and strategies for achieving them. It is important for the ECD

policy to be coherent with other related sectoral policies. Government responsibility for the

provision or supervision of ECD services is often scattered across ministries, often according to

the age of the child. An ECD policy framework can help harmonize the goals and strategies of

these institutions horizontally. Good governance of ECD rests upon high-level political

commitment, the involvement of stakeholders from a range of sectors – with both policy and

implementation expertise – and defined roles and responsibilities, and an institutional anchor to

coordinate horizontally across sectors and vertically within the government. A policy framework

inter alia identifies the lead agency and the entities that will implement, manage, monitor, and

evaluate ECD programs.

Second, as the first and primary care givers, the role of parents and communities cannot be

underestimated in achieving positive ECD outcomes. Parental education can focus on raising

awareness among parents on the importance of ECD, informing them of what services are available

and how to access them, setting realistic expectations for child development at different ages and

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promoting early stimulation. Therefore, behavior change communication is a critical foundation

for generating positive ECD outcomes.

Third and finally, co-location of ECD services can enable positive ECD outcomes. Co-location

means implementing different ECD services in an integrated way and in the same geographic areas

so that children reap the greatest benefit. In Tajikistan this would mean coordinating across

ministries and other actors to ensure the presence of strengthened health sector support for ECD,

a more child-sensitive social assistance program, ongoing parental education, and high-quality

preschool services (among other things) that are provided in the same geographic areas.

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1. Introduction

The Government of Tajikistan places a high priority on early child development (ECD) as a

tool for social and economic transformation of the nation. According to analyses by the World

Bank’s Human Capital Project, a child born in Tajikistan today is expected to be 53 percent as

productive as he or she could be with full health and complete education.1 High rates of childhood

stunting, low preschool coverage, and low learning outcomes are the major reasons for

underperformance. Given the high proportion of the population that is under six years of age,

Tajikistan has made it a development priority to invest in high quality ECD.

Prior to launching large scale investments and embarking on policy changes, the government

requested the World Bank and the Global Partnership for Education (GPE)2 to support a

series of reviews that would enable a deeper understanding of the ECD sector. The first review

was concluded in June 2019 and focused on a detailed analysis of the status, policies, and outcomes

in early childhood education and care (World Bank, 2019a). The current note focuses on the

regulatory environment for provision of ECD services, provides a summary of present programs,

and makes policy recommendations for enhancing ECD outcomes in Tajikistan. It is based on a

desk review of the regulatory documents, available reports, surveys and statistical information,

and interviews with key counterparts and development partners.

ECD Is Multisectoral

ECD interventions include a set of activities to support children’s development in four

domains—physical, cognitive, linguistic, and socioemotional—over the course of their early

years, from conception (pregnancy) through to the first years of their primary schooling (6-8 years

of age). Development across the four ECD domains is cumulative throughout early childhood, yet

some interventions are particularly critical during specific periods (or windows of opportunity)

and should therefore be prioritized in decisions on appropriate interventions for different ages

(Naudeau et al., 2011) (Figure 1). Because of the multidimensional nature of children’s

1 The World Bank Group launched the Human Capital Project (HCP) in 2018 to accelerate more and better investments in people

for greater equity and economic growth. A human capital index (HCI) score is generated for each country, indicating the level of

human capital opportunity. The HCI defines full health as no stunting and 100 percent adult survival, complete education as 14

years of high-quality school by age 18. 2 Through the Education Sector Plan Development Grant (ESPDG).

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development, improving development during early childhood additionally requires adequate and

complementary legislation in multiple sectors; the main sectors in this regard are health, education,

water, sanitation and hygiene (WASH), nutrition, and social protection (Figure 2).

ECD in Tajikistan

Despite active measures, progress on many ECD outcomes remains limited. The Government

undertook substantial efforts to improve ECD outcomes in the country including adopting and

implementing several laws on nutrition and social protection, promoting exclusive breastfeeding,

and piloting a new health financing mechanism. However, progress on some ECD indicators

remains low, and performance on several indicators remains a concern (Table 1). The infant

mortality rate (IMR) at 31 deaths per 1,000 live births, although it represents a decrease from 2012,

is still the worst among the Commonwealth of Independent States after Turkmenistan (41).3

The rate of immunization of children (24-35-months of age) with the compulsory free basic set of

vaccines is 82 percent (DHS, 2017). Preventable illnesses contribute largely to all child and

maternal deaths in Tajikistan (UNICEF, 2012; MOHSP, 2018). Both child and maternal anemia

rates (both 41.6 percent) are above the threshold for a severe public health problem (DHS, 2017).

Prevalence of iodine deficiency among women of reproductive age and children under five was

58.7 and 52.9 percent, respectively. The stunting rate for children under five decreased from 26

percent in 2012 to 17 percent in 2017, with high regional variation (ranging from 15 to 32) (DHS,

2017). Only 36 percent of the infants under six months were exclusively breastfed (DHS, 2017).

Programs to address nutrition related issues include salt iodization, food fortification and

micronutrient supplementation. The latter is predominantly implemented with donor funding and

limited in scope.

3 Author’s compilation from the United Nation Inter-Agency Group for Child Mortality Estimation (IGME) data base for 2017.

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Figure 1. How ECD Interventions Vary with Child’s Age

Timing of intervention

Domains of child

development

In utero Birth to 6 months 7 months to 2 years 3 to 5 years

Physical

Cognitive

Language

Socioemotional

Source: Naudeau et al., 2011.

Note: Investing in young children domains represented in the figure are interlinked and provide few examples.

Exclusive

breastfeeding

Adequate nutrition

to prevent stunting

and promote

healthy growth

Continued investments in

adequate nutrition

Mother’s health and nutrition

Immunizations and regular health check-ups

Early stimulation by caregivers and/or

ECD teachers (manipulation of different

objects and textures, hide-and-seek, self

and object, etc.)

Early stimulation by caregivers

and/or ECD teachers (exposure

to simple concepts, shapes,

numbers, colors, etc. through

games and daily routines)

Early stimulation by caregivers and/or ECD teachers (exposure to language through talking,

reading, singing, etc.)

Positive caring practices by caregivers to

promote healthy emotional development

Interactions with peers (in

structured group settings) to

promote positive social

development

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Figure 2. ECD beneficiaries and key services across sectors

Source: Adapted from the Global Partnership for Education, 2014.

Table 1. Key ECD related indicators

Indicator Value Source Comparators

Fertility rate (children per

WRA \a) 3.8 2017, DHS

Kyrgyzstan, 3.3; Uzbekistan, 2.4;

Kazakhstan, 2.8; Armenia, 1.8

(2018) \b

Share of births of children of 0-

5 YO registered (%) 96% (88%) 2017 (2012), DHS Kazakhstan, 100% (2015);

Kyrgyzstan – 98 (2014) \c

Infant mortality rate

(per 1,000 live births) 27 (31) 2017, DHS (IGME).

The worst among the CIS countries

after Turkmenistan (41) in 2017 \d:

Uzbekistan, 20; Azerbaijan, 18;

Armenia, 12; Kazakhstan, 9

Under 5 mortality rate

(per 1,000 live births) 33 2017, DHS Kazakhstan, 9.9; Armenia, 12;

Kyrgyzstan, 18.9 \e

Maternal mortality rate

(per 100,000 live births) 24.7 2017, MoHSP Armenia, 21.9 (2018) \f;

Kyrgyzstan, 31.3 (2017) \g

Malnutrition (0 to 5 years) (%) 2017 (2012), DHS

Prevalence of wasting (%) 5.6%

BENEFICIARIES

Children

-0 to 2 years -3 to 5 years -6 to 8 years Mothers

Both pregnant and breastfeeding

Parents/Caregivers Communication/education on good parental care

Health (infant, child and

maternal) and hygiene:

- Prenatal and postnatal care

- Vaccination

- Other preventive care and

treatment of common child

illnesses

- The monitoring of child

growth, development and

promotion of early child

stimulation

Nutrition:

- Exclusive breastfeeding

- Dietary supplements

- Vitamin A supplements

- Iron supplements

Education:

- Preprimary education (3

to 5 years)

- Infant care services (0 to

2 years): day nurseries and

child day-care services

- Parental education

Protection:

- Birth registration

- Domestic violence

- Legislation on the early

marriage of girls, child

labor, female genital

mutilation, etc.

WASH: Water, sanitation

and hygiene

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Indicator Value Source Comparators

Prevalence of stunting (%) 17% (26%)

The highest in ECA: Kyrgyzstan,

11.8 (2018); Uzbekistan, 10.8

(2017); Kazakhstan, 8.0 (2015) \h

Prevalence of underweight (%) (8%)

Prevalence of child overweight

(%) 3.3% (1%)

Child anemia (6-59 months)

(%) 41.6% 2017, DHS

Kazakhstan, 29.3 (2016) \i;

Armenia, 31.5% (2016) \j;

Kyrgyzstan 38.3% (2016) \k

Maternal anemia (%) 41.6% 2017, DHS Kazakhstan, 30% (2016); Armenia,

36% (2016); Kyrgyzstan, 40% \l

Child under 5 Iodine deficiency

(%) 52.9% 2012, MoHSP \m

Reproductive age women

iodine deficiency (%) 58.7% 2012, MoHSP

Child under 5 vitamin A

deficiency (%) 37% 2016, UNICEF

Immunization rate: coverage of

children with DTP3 (%) \n 82% 2017, DHS \o

Exclusive breastfeeding for

children under 6 months (%) 36% 2017, UNICEF

Armenia, 44% (2016; under 5

months);

Households using

improved/basic water (%) 78% 2016, WB

Preschool enrollment for

children ages 3 to 6 (%) 14.4% 2019, MoES

Uzbekistan, 29%; Kazakhstan,

60%; Moldova, Russia, 82% \p

Notes and sources:

(a) WRA = Women of Reproductive Age.

(b) JME - Joint child malnutrition estimate based on UNICEF, WHO and WB harmonized dataset.

(c ) UNICEF Data: Monitoring the situation of children and women.

(d) UN IGME.

(e) UNICEF Data: Monitoring the situation of children and women (2018).

(f) Armenia’s Statistical Service.

(g) http://en.kabar.kg/news/unfpa-maternal-mortality-rates-in-kyrgyzstan-remain-high/

(h) JME.

(i) https://www.indexmundi.com/facts/kazakhstan/prevalence-of-anemia.

(j) https://www.indexmundi.com/facts/armenia/prevalence-of-anemia.

(k) https://tradingeconomics.com/kyrgyzstan/prevalence-of-anemia-among-children-percent-of-children-under-5-

wb-data.html

(l) https://data.worldbank.org/indicator/SH.PRG.ANEM

(m) MoHSP, Nutrition and Physical Activity Strategy for 2015-2024.

(n) Combined diphtheria-tetanus toxoid and pertussis vaccine.

(o) Percent represents all children of 24-35-month age.

(p) UIS (2018)

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Beyond health and nutrition services, cognitive simulation and positive parenting in the

early years can be improved in Tajikistan. The brain matures fastest during the early years.

When adults respond appropriately to a baby’s gestures, neural connections are strengthened,

thereby contributing to communication and social skills. Children need stimulation, which has

been shown to improve their cognitive functions, language skills, and educational outcomes.

Traditional practices of child development abound in the country, which have some positive and

some potential negative repercussions for

child development.

According to the Early Human Capability

Index (eHCI)4 survey of 2019 (World Bank),

within the previous three days 42.1 percent of

children had been read a book, 52.5 percent

had been told a story, 69.2 percent had had

songs sung to them, including lullabies, 65.6

percent had been taken outside, 71.3 percent

had been played with, and 46.3 percent had

been engaged through naming, counting, or

drawing. Parenting practices were consistent

across child gender, age, region and caregiver

education, for both positive and negative

dimensions of parenting. Regarding the home

learning environment, 56.2 percent of

caregivers reported having no books for their

children.

Food security is an ongoing challenge in

Tajikistan, and one that has a significant

impact on the ECD agenda. Food security can be defined as having physical and economic access

4 The survey is nationally representative and provides information on a short set of indicators, including the caregivers’ style of

interaction with their children (warm, hostile) and whether household members engaged in activities with their 0-59-month-old

children that promote child development. These activities include reading books or looking at picture books; telling stories;

singing songs; taking children outside the home, compound or yard; playing with children; and spending time with children

naming, counting, or drawing things.

After birth there is a tradition of chillla—a

period of rest for the mother and baby—for 40

days. This time not only allows bonding

between mother and baby, but also minimizes

the risk of exposure to infections by limiting

access to visitors.

The practice of tightly cradling the baby in a

gavora cradle, up to 10 months keeps children

warm, but may be restricting opportunities for

cognitive simulation and development.

Kolak, or cutting to remove newborn

children’s “dirty” blood, although less

commonly practiced, can increase risk of

infections as it is done without appropriate

medical supervision.

Save the Children

Traditional Child Development Practices in Tajikistan

17

to sufficient, safe, and nutritious food that meets dietary needs and food preferences (FAO, 2006).

On average, food constitutes 50-60 percent of household expenditure (WFP, 2018). Poor

households spend about 75 percent of their income on food and, for these families, acquiring

sufficient food is often a concern, particularly during the lean season (January to May) (Lavado et

al., 2017). According to the Listening-to-Tajikistan survey of well-being, the availability of food

(especially for children) plays an important role in determining life satisfaction in Tajikistan

(Azevedo and Seitz 2017). Furthermore, having access to “sufficient daily calories” has been found

to reduce the relative risk of stunting by about 37 percent (World Bank, 2017).

Access to safe drinking water, sanitation, and hygiene (WASH) services has a positive impact

on children’s health and nutrition (WHO, 2015) and these facilities are incrementally being

provided to people in Tajikistan. While the exact relationship between nutrition and WASH is

difficult to measure and remains unclear5, it is well established that the supply and quality of water

and access to sanitation facilities have a direct impact on stunting through biological channels like

helminths and diarrhea. Access to “adequate water and sanitation” reduces the relative risk of

stunting by about 29 percent; access to “adequate care” reduces it by 35 percent, and access to

“sufficient daily calories” reduces it by about 37 percent (World Bank, 2017b). Between 2000 and

2016, use of improved/basic water increased from about 55 percent of households to 78 percent of

households, and the share of those relying on surface water for their main drinking water source

declined from 33 percent to 15 percent (World Bank, 2017a). This advance was driven primarily

by improvements among the two lowest income quintiles of households and have varied

significantly between rural and urban settlements. Also, the quality of household sanitation

facilities varies by region, with approximately 80-90 percent of households in Gorno-Badakhshan

Autonomous Oblast (GBAO) and Khatlon still relying on pit latrines, while an estimated 80

percent of households in Dushanbe use flush-to-pipe sewer systems (World Bank, 2017a).

Despite recent developments in enhancing social protection and assistance, young children

of the poor and disabled children remain most at risk to low ECD outcomes. Ninety-six

percent of births of children ages zero to five are registered, up from 88 percent in 2012 (DHS,

2017), and 91 percent of children under five have a birth certificate. However, 15 percent of the

5 A meta-analysis of the expected impact of improved sanitation interventions on reducing stunting found mixed results

(Cumming and Cairncross, 2016)

18

poorest children who do not have birth certificates are at a high risk of not being able to access

public services and social assistance schemes (DHS, 2017). A new Targeted Social Assistance

(TSA) was introduced in 2011 and has been gradually extended nationally.6 However, it provides

a limited unconditional cash benefit of TJS 464 per year7. Children with disabilities are among the

most vulnerable children in Tajikistan. Based on World Health Organization (WHO) estimates of

the global prevalence of childhood disability, Tajikistan had about 150,000 children with

disabilities—nearly six times the 26,000 who were officially registered as such—in 2015.8

However, the number, quality, and integration of services for these children and support for their

parents remain highly restricted in Tajikistan.

6 The Government of the Republic of Tajikistan, Decree № 271 “On the Introduction of Identification and Payment Mechanism

for the Targeted Social Assistance in the Republic of Tajikistan”, May 14, 2020 7 The cash benefit value is of May 2020 8 ‘Evaluation of UNICEF Tajikistan’s work in priority districts during the 2010–2015 Country Programme,’ 2016.

19

2. Regulatory Environment and Governance for ECD

Given the multisectoral nature of ECD services, effective ECD service delivery requires an

enabling environment created by (i) an adequate regulatory framework (laws, policies and strategic

plans) to enable different actors to provide complementary services; and (ii) governance

arrangements that facilitate coordination within and across institutions to ensure effective service

delivery (GPE, 2014).

Regulatory Framework for ECD provision

While Tajikistan has established regulations affecting several aspects of ECD service

delivery, a comprehensive regulatory framework for ECD is yet to be developed. Since

several sectors contribute to ECD outcomes targeting different groups (pregnant women,

parents/caregivers, children, schools, health facilities, etc.), the range of laws and regulations

forming the ECD legal framework is usually wide. According to a 2013 assessment using the

SABER-ECD framework (World Bank, 2013), the legal framework for ECD in Tajikistan, as in

other countries in the region,9 can be considered “established.”10 This means that there are existing

legislative norms and regulations for various aspects of ECD policy (Neuman and Devercelli,

2013). In order to move to an “advanced” level, a country needs to have a fully developed

integrated legal framework covering all target groups and aspects of ECD holistically. This would

include laws and regulations on healthcare for pregnant and lactating women and children, laws

and regulations that promote appropriate dietary consumption by pregnant women and young

children, support for women to care for children in the first year of life (e.g. paid parental leave,

job protection, etc.), and child protection and social protection policies and services. Not only must

these policies exist, but they must also be enforced.11

The regulatory framework is fragmented. The Early Child Learning and Development

Standards (ELDS), developed by the MoES in 2010 establish requirements related to preschool

education and care for children from birth to seven years, including elements of child development

and care. However, they were not jointly developed with, and have not been integrated with,

9 Albania (2015), Armenia (2012), Azerbaijan (2018), and Kyrgyz Republic (2013). 10 This represents the third level in a scale of four: latent, emerging, established, and advanced. 11 SABER framework paper.

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MoHSP’s own set of protocols12 related to child development and care. Updated laws and

framework appear to have left important gaps in the regulatory regime. For example, the National

Health Code of 2017 has invalidated the 2006 law on breastfeeding promotion. The 2006 law was

consistent with most of the provisions set forth in the International Code of Marketing of Breast

Milk Substitutes, an international health policy framework for breastfeeding promotion adopted

by the World Health Assembly in 1981. The 2017 code declares the importance of breastfeeding,

but leaves gaps in key areas, such as articulating the means of promoting it (for example through

health workers or mass media), the role of central and local institutions in enabling it, and ways to

create favorable conditions for breastfeeding infants in public institutions and organizations (for

mothers).

Another example is the Family Code, which contradicts international legal practice and signed

treaties regarding child adoption as it prohibits the adoption of Tajik children by non-Tajik citizens.

This is in violation of the Child Rights Convention (CRC), Article 21, of which Tajikistan is a

signatory, and which includes the obligation to “ensure that the child concerned by intercountry

adoption enjoys safeguards and standards equivalent to those existing in the case of national

adoption.”

The regulatory framework in Tajikistan is not universally activated, due to the absence of

sub-laws and normative acts and to inadequate financing and capacity, risking service

delivery to achieve ECD outcomes. Although designed to be mandatory, the ELDS remain

limited in practice due to capacity constraints and complexity. The 2019 law on providing the

population with fortified food products (2019), which aimed to regulate provision of fortified food

products to the population and establish the legal framework for prevention of micronutrient

deficiency and related diseases, remains inactive due to the absence of sub-laws. So while it

replaces the 2019 Law of the Republic of Tajikistan on Salt Iodization (2002), which made salt

iodization mandatory in order to reduce the prevalence of iodine deficiency among all citizens

(particularly young children), its delay in activation leaves a gap in the regulatory regime around

salt iodization.

The most relevant codes, laws, strategies and policies are listed next.

12 For example, the MoHSP order of 20.09.2018, #873 “Well child care from 0 to 24 months of age” sets the expected child

growth outcomes.

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Laws and Regulations Related to Child Development

Tajikistan is a signatory to more than 60 universal ratified declarations and agreements that ensure

protection of the rights to health, education, and social services. In 1993, Tajikistan ratified the

CRC and the Convention to Eliminate All Forms of Discrimination Against Women (CEDAW).

In 2018 it ratified the Convention on the Rights of Persons with Disabilities. The ratified

conventions set the stage for legal and policy development in the related areas.

The Family Code of Tajikistan (2017). This code was originally endorsed in 1998 and most

recently amended in 2017. It defines a family as “natural and fundamental nucleus of society and

it needs to be protected.” The child protection provisions in this law are strong with respect to the

child’s right to life, to grow up in a family with parents, to receive special service if they have a

disability, to be eligible for free services and education and to be protected from abuse and use of

drugs. The code stipulates the responsibility of both parents for the growth, education, and

emotional, social, and material welfare of their children until they reach 18 years of age, and in

case of the parents’ divorce. The code guarantees access to social protection for orphaned and

disabled children.

Labor Code of Tajikistan (2006). Like other countries in the region, Tajikistan guarantees paid

maternity leave and allows for prolonging unpaid parental leave. Endorsed in 1998 and amended

in 2006, this code guarantees maternity leave, protection from pregnancy-related employment

discrimination, and breaks for breastfeeding upon return to work. This code is applicable to women

working in the formal sector. At 140 days of paid leave (70 days prior to delivery and 70 days

after) and potential to extend further,13 Tajikistan’s maternity leave is comparable to that in

Armenia and the Russian Federation, and it is more extensive than that of the Kyrgyz Republic

(World Bank, 2013). All children in the country who have birth certificates are eligible to receive

social allowances (50 Tajik somoni per month in 2017) up until they are 1.5 years old. Women

can also receive leave without pay until the child turns three years.

Law on parents’ responsibility on upbringing of children and their education (2011): This law

regulates the responsibility of parents for child-rearing and education, including giving the child a

decent name, having the child registered in a civil registration office, and supporting child’s health,

13 Maternity leave is 140 days (70 days prior to delivery, and 70 days after) and, in the case of complicated labor (birth), 86 days

and is paid at 100 percent of wages by the GoT.

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physical, cognitive and socioemotional development. The Law stresses the responsibility of both

parents for creation of favorable conditions for child development.

Law on education (2013): This law sets core principles of state policy in the education sector. It

provides an overarching framework for education system service delivery and institutional and

governance arrangements.

Law on preschool education and care (2013): This law establishes the legal, institutional,

economic, and social frameworks for preschool education and care in Tajikistan.

National Health Code (2017): National laws mandate the provision of healthcare for pregnant

women and young children. The introduction of a new National Health Code in 2017 replaced 16

previously existing laws, including those on immunizations and breastfeeding. The new code

includes some general clauses on maternal and child health (guarantees the child’s right to healthy

physical, cognitive, spiritual, moral, and social development),14 and there is an effort underway to

ensure that the code includes more details to address the needs of young children.

The Tajikistan Sustainable Development Goal (SDG) strategy for 2016-2030: This strategy

includes a focus on improving food security and ensuring access to good quality nutrition;

however, it does not explicitly focus on ECD. The strategy aims to promote an effective

multisectoral approach to ensure adequate nutrition by means of policy coordination in the fields

of agriculture, public health, social protection, and raising awareness about quality of nutrition and

effective financing. There is scope to increase the focus on ECD and work with these sectors to

improve coordination of services for young children.

National Development Strategy 2016-2030: The strategy prioritizes the development of primary

healthcare and preschool education that foster ECD, the importance of strengthening public-

private partnerships in social sectors, inclusive education, and the development of a targeted

assistance system for low-income households. The strategy sets a goal to increase preschool

enrollment from 12.4 percent in 2016 to 50 percent in 2030.

National Health Strategy for Tajikistan 2020-2030: This strategy is currently being developed

and will replace the National Health Strategy of the Republic of Tajikistan for the period 2010-

14 Maternal health protection, underlined in article 45, states that: the State should provide appropriate condition for maternal health,

social and material support of motherhood; pregnant women should get the social support within state approved benefits; a child

right’s to health under article 46 guarantees child’s right to healthy physical, cognitive, spiritual, moral and social development.

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2020 (endorsed in 2010). The existing strategy, which remains in effect until the new one is

finalized, prioritizes newborn, child, and adolescent health and nutrition as well as reproductive

health and safe maternity practices and contributes to achieving the goals of the Tajikistan SDG

2030 strategy. The current draft emphasizes strengthening integrated primary health care (PHC)

services, enhancing early identification and interventions. One of the draft strategy’s objectives is

to ensure sustainability and high coverage with essential health and nutrition interventions for the

improvement of mothers’ and children’s health and nutrition status. The draft stresses the

establishment of a multi-tiered and unified system to manage the protection of children’s rights.

National Education Development Strategy of Tajikistan 2021-2030: This strategy is currently

being finalized and will replace the National Education Development Strategy for the period 2012-

2020. The current draft emphasizes increasing access to quality early learning services for children

1.5 to six years of age and reaching 50 percent preschool enrolment for children age six by 2030

by, among other means, adopting alternative preschool models, improving the quality of preschool

personnel, upgrading preschool facilities, reforming preschool financing, and strengthening the

monitoring of early child development.

State standard for preschool education (2014): The standard establishes single requirements for

preschool education and care including academic workload for students, the graduates’ level of

competence, organization of educational process, timelines for preschool learning and care etc.

Early learning and development standards (from birth to 7(6) years) (2010): The standards

promote the understanding of early learning and development, provide a comprehensive and

coherent set of early childhood educational expectations for children’s development and learning,

and guide the design and implementation of curriculum, assessment and instructional practices

with young children.

Draft National Social and Behavior Change Strategy to Improve Childhood Nutrition in the

First 1,000 Golden Days of Life (pending endorsement): This is the first draft national strategy

on behavior change in the country. It targets all levels of stakeholders, from policy decision

makers, health workers to families. The draft provides clear, concise, easily adaptable and practical

guidance on the approaches to effectively promote and support appropriate maternal nutrition and

infant and young child feeding (IYCF). This draft strategy has a comprehensive five-year

implementation plan.

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Law on providing the population with fortified food product (2019): This law aims to regulate

provision of fortified food products to the population and establish the legal framework for

prevention of micronutrient deficiency and related diseases. The Law obliges food product

producers, sellers etc. to enrich their products with micronutrients. The products include wheat

flour, baker's yeast, flour products, confectionery, milk and dairy products, including those

intended for baby food, juices, drinking water, soft drinks, edible salt, etc. By this law, the

production, import and sale of fortified wheat flour and other food products and non-iodized salt

are prohibited in the country. While the law is a huge step forward in tackling malnutrition issues

in the country at the legal level, it is not yet operationalized due to absence of sub-laws, and

therefore a gap is created in critical areas of regulation. For example, the Law of the Republic of

Tajikistan on Salt Iodization (adopted in 2002) which made salt iodization mandatory in order

to reduce the prevalence of iodine deficiency amongst all citizens, particularly young children,

became invalid upon issuance of the 2019 law, but because the 2019 law is not yet operationalized,

there are no regulation in effect for salt iodization in the country at the moment.

Laws and regulations related to parents’ ability to support child development

The State Guaranteed Package of Health Services (Basic Benefits Package): In 2007, the GoT

introduced a pilot program on State Guaranteed Package of Health Services (BBP) in 4 districts to

improve equitable coverage of medical services. The pilot program is now operational in 19 out of

65 districts nationally. The BBP regulates entitlement for a variety of free / discounted services at

primary and secondary levels of the health system. The eligible groups represent large segments

of the population. At the PHC level, the BBP covers services for children under one-year-old,

delivery in the hospital, antenatal care, immunizations, emergency care, and care for Acute

Respiratory Infection and diarrhea according to the Integrated Management of Child Illness

guidelines etc. The BBP does not cover support for preventative care, particularly for young

children’s nutrition, micronutrient supplementation and child development. An independent

evaluation of the earlier stage of BBP in 200936 suggested “erratic implementation of BBP

payment guidelines” which led to “excessive charging, including 100% fees for district residents,

who are entitled to reduced rates, and payment for nominally free PHC services.”37 The revised

design of the BBP of 2017 has expanded the BBP eligibility criteria38. There are no available

evaluations of the latest stages of BBP implementation. The BBP was revised and, in May 2020,

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the GoT approved this program for the period of 2020 to 2022. The scope of services and eligibility

criteria of the BBP for the period of 2020-2022 is being finalized now with other ministries and

relevant bodies.

Government Resolution on payments for children in state preschool institutions (2016): Prior to

the resolution, parental contributions in the form of fees were non-transparent and unregulated

across the country’s public kindergartens. The 2016 resolution has standardized fees for services

provided by state kindergartens by articulating the eligibility regulations guiding payment, an

acceptable range of fees and payment methods. In 2018, the fee varied from TJS 50 to TJS 100

per child per month depending on the district (poor, not poor).

Laws and regulations related to social protection

There are several policies which promote social protection. However, those policies do not focus

specifically on providing access for children or meeting children’s nutritional or developmental

needs.

Law of the Republic of Tajikistan on Social Services (2008): This law specifies that vulnerable

children and young people, pregnant women, elderly persons and disabled persons should have

priority in the provision of social welfare services.

Concept of Social Protection of the Population of the Republic of Tajikistan (2006): This

Concept states that the basic social rights of the citizens should be preserved and supported, such

as the right to a state pension in case of disability, reaching retirement age, loss of breadwinner

and other cases, as determined by law.

Law on the Child Rights Protection (2015): This law stipulates the rights and freedoms of the

child, including, inter alia, right to life, freedom, inviolability, personality, health care, dwelling,

education, rest, protection of rights of the child in special educational institutions; protection of

orphaned children and children without parental care; protection of rights of the disabled children.

Regulation for Guardianship and Trusteeship Authorities (2017): This regulation protects

children’s interests and ensures care in the case of a parent’s death or inability to care for the child.

Law on Social Protection of People with Disabilities (2010): This law includes a plan of action

on implementation of the Convention on the Rights of Persons with Disabilities. According to this

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law the state should provide the disabled with free pre-school, general and primary vocational

education.

National Concept Note on Inclusive Education for 2011-2015 and for 2016-2020: This concept

note mandates cross-sectoral services and support for children with special needs. It has

contributed to the creation of favorable conditions for children with disabilities in kindergartens

and schools. For example, school infrastructure has begun to incorporate design that is more

conducive for children with physical disabilities, teachers have been trained in inclusive pedagogy,

and specialized kindergartens have been established for children with disabilities.

National Programme on Rehabilitation of Disabled People 2017-2020 (2016): This program

stipulates the provision of free medical and rehabilitation services to all people with disabilities,

including children. However, the program does not provide for early identification of disabilities

and early intervention among infants.

There is a growing recognition that long-term institutional care for children is not an effective and

efficient approach in response to the specific social and economic vulnerabilities of children and

their caregivers. MoHSP is working on a new regulation on transforming institutional care for

children, which will involve incremental transformation of the existing residential institutions for

children under four (known as baby homes). Under the regulation, among other things the families

at risk of placing their children in baby homes will be supported to keep children at home and will

receive daycare services free of charge.

Governance

Good governance of ECD rests upon high-level political commitment, the involvement of

stakeholders from a range of sectors (with both policy and implementation expertise) and defined

roles and responsibilities (Naudeau et. al, 2011), and an institutional anchor to coordinate

horizontally across sectors and vertically within the government.

Political commitment for ECD is high in Tajikistan. Current national priorities include a

dramatic reduction in stunting among children under age five and an increase in preschool

coverage of children ages three to six. Several important regulations have been put into effect, as

mentioned in the previous section, which demonstrate this commitment. However, to date there is

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no single overarching national policy or strategy for ECD, and therefore programs and services

related to ECD lack integration and coordination. To support the government’s priorities in ECD,

the Donor Coordination Council in Tajikistan identified ECD as one of its priority areas under the

Human Development cluster.

Several agencies define the ECD governance and management system. The MoHSP and the

MoES play key roles in defining ECD policy and programs and in key service delivery

arrangements. The MoHSP defines and supports the provision of health, nutrition, and social

protection services during pregnancy, childbirth, postpartum, and in early childhood, and the

MoES supports the provision of education and care services for children 1.5 to six(seven) years

old. Through their subordinates, the two ministries develop and implement state policies and

strategies, set priorities for child development, protection, and care, and approve standards for

service provision (process, content, and monitoring).

Local government authorities play a key role in financing and provision of social services. They

appoint heads of public institutions under their subordination (e.g., education district/city

department, district/city PHC manager, hospital head, social protection and education departments

heads, heads of PHC centers (PHCCs) and preschool institutions, etc.) with concurrence from the

relevant line ministry. Other stakeholders involved mainly in the services provision include

development partners, international and local nongovernmental organizations (NGOs), private

donors, and community organizations. In some cases, the external support to essential ECD

services exceeds by far the state contribution (e.g., in immunization, vitamins and micronutrients

supplementation).

Public-private partnerships as well as outsourcing of social services are not yet developed. In the

health sector, the private sector is not active in the ECD space except in the provision of laboratory

services. There are private healthcare institutions that provide outpatient and inpatient services for

all age groups, but their focus on specific ECD-related issues (like prenatal and postnatal care,

child growth and development monitoring) is limited. In education, the private-sector provides

ECD-related services by opening private preschool institutions (kindergartens, early learning

centers, family care) and offering private child development programs. However, its coverage is

low: less than 4 percent of all preschool institutions are private. At the policy level, the government

works with development partners in the areas of data analysis, program evaluation and

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development of strategic documents. However, there are no broad public consultations on the

strategies, initiatives, and programs, and no feedback mechanisms have yet been developed.

Establishing an overarching coordinating body and institutional anchor for ECD has been

challenging in Tajikistan. Efforts to coordinate across the various multisectoral services have

been made since 2005-06 with the support of UNICEF and the Open Society Institute (OSI). The

National Child Rights Commission was established in 2008 to facilitate implementation of the

provisions of the Convention on the Rights of the Child ratified by Tajikistan in 1993. A national

ECD Forum was held in 2009 to create an intersectoral ECD framework.15 The forum created

awareness about ECD in the country but could not succeed in establishing an institutional anchor

for ECD (World Bank, 2013). An ECD Council was established under the Deputy Prime Minister

on Social Issues but it stopped functioning shortly after establishment due to limited funding. There

are two high- level councils—the National Council on Health and Social Protection of the

Population under the Government of the Republic of Tajikistan and the National Council on

Education under the MoES—but neither are coordinating ECD in the country. In 2013, Tajikistan

joined the Scaling Up Nutrition (SUN) initiative, an umbrella to gather all stakeholders working

on nutrition to adopt a coordinated approach. With this came the development of a multisectoral

platform, the Multi-Sectoral Coordination Council, chaired by the SUN focal person, the First

Deputy Minister of MoHSP. Joining SUN has provided an opportunity to enhance multisectoral

cooperation in nutrition.

Despite the challenges, Tajikistan is moving closer to establishing a high-level coordination

mechanism for ECD. The National Committee on Population and Human Development was

established in 2014 with support from the United Nations Fund for Population Activities

(UNFPA). It is a platform for assessing development concerns, recommending and monitoring the

implementation of solutions for a wide range of issues related to the population and human

development. It includes representatives from the Parliament, government agencies (ministries,

committees and agencies), civil society, and mass media. For the past two years, development

partners and relevant government agencies have been engaged in an active dialogue on establishing

a similar high-level coordination mechanism for ECD. There is a clear need for such a

15 Participants in the ECD Forum, including the Ministry of Health and Social Protection, Ministry of Labor and Social Protection,

Ministry of Education, Ministry of Finance, the Executive Office of the President, regional and district authorities, and national

and international partners, agreed on a ten-point plan of action for ECD to increase political commitment, integrate ECD services

into regional and district development plans along with budget support, and encourage donor investment in ECD.

29

multisectoral mechanism, one that would include the Deputy Prime Minister for Social Affairs,

Minister of Finance, and other ministers of all concerned ministries, including MoES, MoHSP,

and others (Labor, Agriculture, Water, etc.).

The government is moving toward establishing a National Early Childhood Development

Council (NECDC). The NECDC would potentially be a venue to convene various ministries and

agencies involved in ECD service delivery. Inter alia, it would (a) guide the development of ECD

policies; and (b) provide strategic orientation of medium- and long-term ECD plans aligned with

the country’s development objectives.

Key Agencies Under Ministry of Health and Social Protection

The following are among the key health and social protection agencies responsible for supporting

ECD in the country.

• State Supervision Service for Medical Activities and Social Protection of Population, which

carries out state supervision of all medical activities (including pharmaceutical and sanitary-

epidemiological activities) and social protection of the population;

• State Sanitary and Epidemiological Supervision Service, which is authorized to conduct state

supervision in the field of ensuring the sanitary and epidemiological safety of the population;

• State Agency for Social Protection, which is responsible for implementation of state policy

in the social protection of retirees, people with disabilities, and other vulnerable groups in

the population, and provides methodological guidance to and supervision of activities of the

bodies and institutions under the social protection system (including local social protection

departments);

• Republican Center for Immuno-Prophylaxis and its local branches (in each district), which

are responsible for all immunization activities in the country such as vaccination planning,

vaccines delivery, storage and distribution; monitoring of immunization services, which are

mainly provided by the PHC institutions/centers; and training to staff involved in

immunization;

30

• Republican Nutrition Center, which in collaboration with the Scientific Research Institute

“Ghizo” (under the Ministry of Industry and New Technologies) is to develop general

nutrition policy and norms;

• Republican Training and Clinical Center on Family Medicine, which develops and provides

training programs for family medicine staff on family medicine services delivery (e.g.

immunization, counselling, growth monitoring, nutrition, early screening and identification,

and referrals); and

• Republican Center of Medical Statistics and Information, which is responsible for medical

data gathering and the preparation of annual medical statistical books and thematic statistical

notes (e.g., on maternal and child health and nutrition).

Key Agencies Under the Ministry of Education and Science

The following are among the key education and science agencies responsible for supporting ECD

in the country.

• State Agency for Supervision in the Sphere of Education (SASSE), which conducts licensing,

attestation, and accreditation for all preschool institutions (the agency is transitioning to

direct government subordination);

• Academy of Education, which determines the directions of scientific and research work in

pedagogy, conducts such work and coordinates it at pedagogical institutions,16 conducts an

expertise of pedagogical materials, and jointly with other academic institutions develops

methodological guides for teachers and educators;

• Center for development, publishing and distribution of textbooks and scientific books, which

defines the needed content in textbooks, develops the textbook publication procedures,

arranges for the development of textbooks and scientific books (including review of

manuscripts and feedback collection), and publishes and distributes textbooks; and

16 Institute for Education Development (IED), Republican Training and Methodological Center (RTMC), Republican Institute for

In-Service Teacher Training (RIITT), Pedagogical Higher Education Institutions.

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• Republican Centre for Information Technologies and Communications, which develops and

introduces new technologies in education, develops e-materials for education, including for

distance learning (lessons, teachers’ guides on the use of ICT in education, teaching and

learning materials), and supports the establishment and maintenance of computer networks

at the MoES and for regional educational departments.

Other Agencies

The following agencies and authorities, external to the MoHSP and the MoES, are involved in

health, social protection and education aspects of ECD.

• State Women’s and Family Affairs Committee, Government of Tajikistan, which is mandated

to conduct state policy to protect and ensure the rights and interests of women and families,

create equal opportunities for the implementation of their rights and interests, and help

achieve gender equality, expanding women’s participation in socioeconomic spheres. This

committee is also tasked with monitoring the implementation of the state programs and laws

related to women and families;

• Agency on Construction and Architecture, which is responsible for establishing construction

standards for social infrastructure, including health facilities and preschools;

• Regional health, social protection, and education departments, which are responsible for

implementing state policy in their related sectors in the region and monitoring the provision

of social services in the districts; and

• Local government authorities, such as district/city governments and municipalities, are

responsible for implementing state policies at local level, including those in health, social

protection, and education, and for ensuring provision of social services, following the

centrally adopted state norms and regulations. Local authorities play a key role in decisions

about the local network of social service provision, and they cover much of the cost of public

health, social protection, and education services. They appoint heads of the social entities

under their subordination (e.g. district/city PHC manager, hospital head, social protection

and education departments heads etc.) with concurrence from a line ministry.

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3. ECD Programs and Services

While many programs and services are offered for improving ECD outcomes across the country,

the following is a list of the key interventions by theme.

Comprehensive ECD

In April 2020, the International Development Association and the Global Financing Facility for

Women, Children and Adolescents approved a $73 million17 grant for the Early Childhood

Development to Build Tajikistan’s Human Capital Project. The project objective is to increase

utilization of a basic package of health and preschool education services for children ages zero to

six. The primary beneficiaries of the project are all children in that age range in Tajikistan (an

estimated 1.5 million children), with enhanced support provided to children in this age group and

their families in 14 targeted districts (an estimated 70,000 children). To achieve its objectives, the

project will develop and support a Basic Package of integrated services to tackle the most pressing

needs affecting child development outcomes while building sustainable foundations for cross-

sectoral service delivery for improved ECD outcomes for all children. The Basic Package is

designed to: (i) ensure that each child’s growth and development is monitored systematically

across the country; and (ii) ensure that children in targeted districts enjoy quality health and early

education services that promote improved ECD outcomes at an essential level. The proposed

project will help establish the foundations for holistic and integrated services promoting improved

ECD outcomes at the national and local levels, while testing the delivery of integrated services

where the needs are most urgent.

Family Planning

MoHSP partners with UNFPA, WHO, and regional and district health authorities to increase

family planning initiatives among women of reproductive age (15 to 49 years). According to the

2017 Demographic and Health Survey, some women of reproductive age use at least one method

of contraception. National contraception-use rates are estimated to be about 29.3 percent among

currently married women ages 15 to 49. Regional variations exist; for example, 40.0 percent of

17 Here and throughout this report, all dollars amounts are in US dollars.

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women from the Sugd province and 36.4 percent of women from the GBAO province use

contraception.

Pre and Post-Natal Care and Attended Delivery

MoHSP, in coordination with regional and district health authorities, is partnering with the World

Bank, UNFPA, UNICEF, WHO, GIZ (the German development agency), and the US Agency for

International Development (USAID) to implement antenatal visits (or antenatal care). Based on

the Soviet system, antenatal care in Tajikistan is expected to include at least seven visits, during

which health practitioners provide advice to families on health, nutrition, parenting, and prevention

and testing for sexually transmitted diseases, including the Human Immunodeficiency Virus.

According to the 2017 DHS, the program has achieved a coverage rate of 91.8 percent for women

nationwide.

In 2017, approximately 94.8 percent of all births were attended by trained health staff with some

provincial disparities. For example, the Sugd province has a coverage rate of 99.5 percent, whereas

Khatlon reported 91.9 percent coverage. There has also been an increase in births occurring in a

health facility, with an increase from 77 percent in 2012 to 88 percent in 2017. Postnatal visits for

mothers at home are supposed to occur, but coverage and quality are uncertain.

Following the birth of the child, MoHSP and donor organizations collaborate to increase maternal

education through postnatal care visits. Postpartum care is supposed to include an educational

component covering the importance of proper nutrition, newborn care, and breastfeeding practices.

However, there are no data on quality of the visits and on addressing postpartum depression.

Child Growth and Developmental Monitoring

Back in Soviet times, growth monitoring was practiced in the healthcare system, focusing mainly

on the physical development of the child. However, due to a weakening of the health system and

an outflow of health specialists, almost all services have worsened, including the monitoring of

child growth and development. MoHSP received significant support from development partners

to improve monitoring of child growth and development protocols and guidelines, training, and

required equipment. According to existing protocols, home visits (patronage) and growth

developmental monitoring and promotion are an integral part of services provided by family

medicine staff at health institutions and during home visits. These should be conducted once a

34

month in the first year of life, once per quarter in the second year, every six months in the third

year, and once a year during the fourth and fifth year of life. In practice, however, such monitoring

is not conducted according to the guidelines (WHO, 2014; World Bank, 2017c). According to a

2016 UNICEF nutrition survey, 87 percent of caregivers with children under age two had contact

with health workers to assess child health and development within the previous six months

(UNICEF, 2016). Health systems need a more robust monitoring program for child growth and

development that will include all aspects of development (social, cognitive, language, and motor

skills) and will be based on the recent new learning about child brain development.

In 2016, the Maternal and Child Health Handbook (MCH) (also known as “Rohnamo”) was

introduced on a pilot basis with technical and financial support from the projects funded by

UNICEF, GIZ, the World Bank, and USAID. The MCH handbook is a home-based record for

pregnant women and mothers, which contains not only information about maternal and child health

but also comprehensive records of pregnancy, childbirth, postpartum care, and children's

vaccinations and nutrition. According to the Family Medicine Center Report (2019) there is a need

to revise some components of this book. Currently, implementation is limited to around 30 districts

in the country. There are no resources (either state budget or external) to expand the coverage to

the rest of the country and to make the book available to all pregnant women.

Parenting Interventions

There are examples of small-scale parenting interventions in Tajikistan, mostly supported by

donors and NGOs. UNICEF has been supporting small-scale implementation of Care for Child

Development, an approach in which health workers encourage play and communication activities

for families to stimulate the learning of their children (Figure 3). Care for Child Development has

been integrated into the Integrated Management of Childhood Illnesses training curriculum since

2005 in 12 priority districts out of the 65 districts in the country. There is no clear information or

data on the latest status of Care for Child Development training, including the number of trained

health workers or the number of children reached. With support from the Open Society Institute

Tajikistan, the parents’ organization for children with disabilities provides training for parents and

early child identification services for children with developmental delays and disabilities. Other

examples include the Aga Khan Foundation’s (AKF’s) training program for community volunteers

and health workers, which covers early stimulation as well as health and nutrition in seven districts

35

of the GBAO region, and the Open Society Foundation’s Learning through Play program that

educates parents in three districts of the country about how to promote children’s holistic and

healthy development up to age six.

Figure 3. Care for Child Development: Sample Materials

Early Detection of Developmental Delays and Early Intervention

Early screening programs require significant health resources, infrastructure, and functional health

systems to be effective. As indicated in the previous paragraph, in Tajikistan early identification

of developmental delays is assigned to the PHC level, whose capacity is not adequate for standard

Child Growth and Development Monitoring procedures. Current activities on early intervention

mostly focus on services for children with disabilities. According to MoHSP, there were 26,000

children with disabilities registered in 2015. In 2017, about 1,800 children in Tajikistan were

enrolled in baby homes for orphans and for children with disabilities ages 0–4 years old, in

residential and half-day institutions for children with disabilities, and in specialized and regular

kindergartens (World Bank, 2019a).

36

Currently, in Tajikistan there are several international and local NGOs working on early

identification and intervention by engaging in capacity building for PHC workers and in opening

the early child identification rooms in PHC facilities to support families in pilot districts of Sugd,

GBAO, Dushanbe, and Khatlon. Their target groups include children with autism, children with

Down Syndrome, children with physical and mental disabilities, and caregivers of children with

disabilities with limited geographical coverage. UNICEF supported the establishment of

Psychological, Medical and Pedagogical Committees (PMPCs) in the PHCCs to support the

system’s activities in identifying children with disabilities and early intervention, rehabilitation,

and parent education. Currently there are 10 PMPCs operating in different parts of the country

under the supervision of local PHCCs and funded from local budgets. The PMPCs are staffed by

neuropathologists, speech therapists, and psychologists. Among other services, they also provide

legal advice and consultation to parents of children with disabilities and supervise children with

disabilities living in specialized institutions. Some PMPCs in selected districts provide early

intervention services for children with developmental delays and disabilities, working in

cooperation with organizations of parents of children with disabilities.

Immunization

MoHSP, with support from WHO, UNICEF, the Global Alliance for Vaccines and Immunization

(GAVI), and USAID, implements an extensive immunization program throughout the country for

children between the ages of 24 and 35 months. The compulsory basic set of vaccinations, which

is free, includes a single dose of Bacille Calmette-Guerin vaccine, three doses of the DPT-HepB-

Hib, three doses of the polio vaccine, and one dose of the measles vaccine. According to the 2017

DHS, 82 percent of all children in the 24-35-month age category have received all these basic

vaccinations.

Nutrition Interventions

A 2012 report indicated that the burden of undernutrition in Tajikistan is substantial, and that

deaths in the labor force from undernutrition cost the country nearly $12.3 million a year, while

productivity lost due to low birth weight, stunting, iodine deficiency, and anemia costs an

estimated $28.6 million to the economy. At least $15 million of the country’s economic losses

from undernutrition can be prevented by improving nutrition through a combination of behavioral

changes and strengthening and scaling up of existing programs (World Bank, UNICEF, 2012).

37

The country has many programs to target malnutrition and under nutrition across the lifecycle.

Key programs among them are listed next.

Interventions to Improve Feeding Practices

Breastfeeding. MoHSP works with UNICEF, WHO, various NGOs, and local health institutions

to promote exclusive breastfeeding practices for children from 0-6 months. Over 245,000 pregnant

and postpartum women and 232,000 children under six months of age are targeted through clinics

and home-based visits. Family doctors, neonatologists, pediatricians and medical nurses provide

counseling at various stages during pregnancy and after an institutional birth. However, despite

these initiatives only 35.8 percent of children under six months of age are exclusively breastfed;

5.4 percent of children in this age category were not breastfed at all, and the remaining 58.8 percent

of children received breastfeeding and some form of complementary feeding (e.g., water, milk).

Complementary feeding. The MoHSP advocates complementary feeding programs to children

between the ages of six and 24 months through clinic and home-based visits by PHC staff with

support from UNICEF, WHO, and USAID.

Nutrition counseling. Nutrition counseling is an integral component of PHC services, which are

carried out through antenatal care, home visits, and well-child visits. According to the antenatal

care visit standards, women should receive nutrition counseling (concerning the importance of

micronutrient supplementation, nutrition during pregnancy, breastfeeding, complementary food,

etc.) during each visit to a PHCC. Nutrition counseling for all family members, including the

feeding of young children, is covered by the protocols for home visiting by nurses. The government

recently endorsed a “draft national social and behavior change strategy to improve childhood

nutrition in the first 1,000 golden days of life,” which integrates key counseling messages for

health workers to reinforce activities related to nutrition counselling. Nutrition counseling is

supported and monitored by different development partner projects: performance-based financing

(World Bank), Feed the Future (USAID), and others.

Micronutrient Supplementation and Fortification

Vitamin A. With support from development partners like UNICEF, MoHSP implements a vitamin

A campaign twice a year, targeting children between the ages of six and 59 months. The 2017

Demographic and Health Survey found that about 46 percent of children ages six to 23 months

38

had consumed vitamin-A-rich food in the previous 24 hours, but a much higher percentage (77.9

percent) had received vitamin A supplements in the past six months: 79.4 percent in rural areas vs.

72.5 percent in urban areas. This is above a coverage threshold of 70 percent, which represents the

minimal coverage of vitamin A supplementation at which countries can expect to observe

reductions in child mortality (UNICEF, 2007). A UNICEF report further evidences this rural-urban

divide and finds that coverage of vitamin A capsules varied more significantly between provinces:

91.6 percent (the highest) in Sugd vs. 59.7 percent in Khatlon (the lowest).

Iron. Iron deficiency, or anemia, can be prevented through the provision of iron supplements or

through fortifying food with iron, but coverage of iron supplements is low nationally. According

to DHS 2017, only 25.5 percent of children ages six to 59 months surveyed were reporting to have

taken iron supplements in the previous seven days, and just 45 percent of women took iron

supplements during pregnancy. Iron-folate supplementation efforts for women have been

unsuccessful for two reasons. First, there has been a limited supply of the supplements, and second,

only a small proportion of women receive these for free, so many do not take the complete course

of treatment (DHS, 2017).

Iodine. The consumption of iodized salt is critical to ensure adequate consumption of iodine in

Tajikistan which, as a land-locked country, does not naturally have iodine in the soil or food

supply. A lack of iodine can cause cognitive impairment as well as goiter and cretinism. The

MoHSP implements salt iodization programs in collaboration with the MoES, the Committee on

TV and Radio under the Government of the Republic of Tajikistan, and the Agency for

Standardization, Metrology, Certification and Trade Inspection. These government agencies

partner with UNICEF, WHO, and the World Food Programme (WFP) with the goal of achieving

universal salt iodization for all ages. In 2013, the Global Alliance for Improved Nutrition (GAIN)

and UNICEF, with support from USAID, began a pilot project on strengthening capacity in salt

iodization and supporting a universal salt iodization program in the Khatlon province. From 2015,

MoHSP, with support from UNICEF, started national implementation of social mobilization and

awareness raising among the salt producers and consumers about the benefits of iodized salt and

began work to advocate for universal salt iodization. While there is some discrepancy in data on

39

the utilization of iodized salt,18 Tajikistan should aim to achieve a household coverage of 90

percent to eliminate iodine deficiency, according to WHO guidelines. 19

Zinc. The MoHSP partners with UNICEF and the WHO to work with PHCCs to administer zinc

treatments for children under five who are being treated for acute diarrhea. The medication is

supplied by the Government of Japan. On average, 19.2 percent of children under five who visit

PHCCs for acute diarrhea receive zinc treatments (as opposed to 100 percent), with unequal

coverage in urban and rural areas (25.6 percent versus 18.2 percent, respectively) (SA, 2018).

Multiple Micronutrients. Although there have been several pilots (some very successful) to

provide micronutrient powders or “Sprinkles” for home-based fortification of complementary food

for children between the ages of six and 24 months, there is no such program in the country at

present. In the past, the initiative has received support from donor agencies, such as the World

Bank, USAID, UNICEF, the AKF, and the Russian Federation. One initiative, supported by the

World Bank and UNICEF, delivered 280,000 boxes of Sprinkles to 140,000 children through

PHCCs, resulting in a 5 percentage-point reduction in anemia (World Bank, 2018). Currently,

coverage of micronutrient powders is quite variable and dependent on the province and external

funding. The DHS found that nationally only 17.2 percent of children between six and 24 months

were reported to have received the micronutrient powders within the past week. However, 29.2

percent of the targeted children in the Khatlon province had received the Micronutrient Powders .

Uptake in the Sughd province was significantly lower at a reported 6.4 percent.

Management of Moderate and Severe Malnutrition

MoHSP and various international donors and NGOs oversee the management of acute malnutrition

in children under the age of five through a variety of interventions. UNICEF-supported therapeutic

feeding centers have been scaled up nationwide, and responsible health staff from each district

have been trained in the management of severe acute malnutrition. In cases of severe acute

malnutrition, trained health practitioners provide specialized nutrition product (F75 and F100

formulas, deworming, amoxicillin, etc.) for inpatient facilities and oral rehydration salts at PHC

facilities. However, there is limited monitoring of these services at the local level. The 2017

18 According to the UNICEF Micronutrient Status Survey (MNSS) 2016, salt iodization declined between 2009 and 2016, while

the 2017 DHS indicates that salt utilization increased notably from 84 percent in 2012 to 92 percent in 2017. 19 Assessment of iodine deficiency disorders and monitoring their elimination, WHO.

40

Demographic and Health Survey did report that among children under the age of five who visited

a facility for diarrhea within the past two weeks, around 62 percent had received oral rehydration

salt packets for treatment. But generally, information is limited. In order to address moderate

malnutrition, WFP provides treatment for moderate acute malnourished children. The project has

been piloted in five districts and provides a specialized nutritious food – Super Cereal Plus – for

such children. Currently, over 6,000 children are enrolled in this supplementary feeding program.

Deworming

Parasitic worms cause diseases in humans and deworming medication is a low-cost way to treat

infected individuals and reduce illness in children and allow them to better absorb nutrients, which

is critical during early childhood to prevent malnutrition (Andrews, Bogoch and Utzinger, 2017).

In 2012-2013, the Rostropovich-Vishnevskaya Foundation supported national deworming

campaign covering more than 4.3 million children and adults who received deworming tablets and

hygiene promotion messages. The campaign was followed by the development of national

guidelines on epidemiology, diagnosis, clinic, treatment and prevention of helminth infections,

and capacity building activities for laboratory staff and parasitologists in modern methods for

diagnosing parasitic diseases. According to the 2017 Demographic and Health Survey, 14.8

percent of children of six to 59 months of age received deworming medication in the six months

preceding the survey.

Water, Sanitation and Hygiene (WASH)

The Tajikistan Water Supply and Sanitation Network (TajWSS Network) is a collaborative effort

among 17 different ministries, international agencies, and stakeholders with the goal of improving

WASH-related interventions throughout the country. The government has adopted the 2016–2025

Water Sector Reform Program, which aims to ensure the use of integrated water resource

management, among other things. The sector relies heavily on international funding to fill the

existing financing gap, with most of the funding being allocated to irrigation and the integrated

water resource management agenda. The rural water supply commitments of $47 million are

spread over small 21 projects. These rural projects have covered half of the country’s districts,

with most of the projects concerned with rehabilitation, reconstruction, water governance, and

social accountability (World Bank, 2019b). The new World Bank Rural Water Supply and

Sanitation Project, at $59 million, aims to improve access to basic water supply and sanitation

41

services in selected districts and to strengthen the capacity of institutions in the water supply and

sanitation sector.

Social protection interventions

Social protection interventions can provide resources and a safety net to families who have young

children, thus buffering them from risks that can affect ECD. The coverage of social protection

programs in Tajikistan remains limited, and these programs do not necessarily target the most

vulnerable population groups, including families with young children and those in the informal

sector.

Social Assistance

According to the World Bank’s 2018 report on the State of Social Safety Nets, Tajikistan lags

behind most other Europe and Central Asia (ECA) countries with respect to total spending on its

social protection programs. Thus, mean spending in the ECA region is about 2.2 percent of gross

domestic product (GDP), four times higher than Tajikistan’s 2014 spending level. In addition to

low fiscal support, social assistance programs in Tajikistan had poor targeting. In 2014, the

government started piloting and is gradually introducing a new Targeted Social Assistance (TSA)

program to replace its previous energy subsidy and school allowance programs. The purpose of

the TSA is to target scarce budget resources to the neediest population through an unconditional

transfer to selected households on a quarterly basis. It provides each registered household with an

unconditional cash benefit of TJS 464 per year. Eligibility criteria are based on proxy means and

include—among others— the composition and age of all family members, presence of elderly

parents, children under 15 years of age, presence of disabled people or children with disabilities,

housing conditions, and information on the property of all family members in the household. The

annual cash benefit of TJS 464 may seem small, but eligible households receive additional benefits

(burial allowance, fee discount on some public health facility services apart from the BBP, higher

education tuition discounts, etc.). Outside these benefits set centrally for the entire country, local

authorities can add more benefits for registered TSA households, such as a public transport fee

exemption and utility cost subsidy. After the TSA’s national scale-up in May 2020, it is expected

to cover around 200,000 households (close to 15 percent of all households in the country).

42

Child Protection Services

Child protection policies and services are in the process of being established in Tajikistan. The

dominant approach is to provide orphans and vulnerable children, including children with

disabilities, with services in institutions, such as orphanages and residential care institutions,

including boarding schools. Overall, services for children with disabilities have limited outreach,

and community-based services are at their early stages in Tajikistan (also, see above under the

early intervention section in this chapter). The Mellow Parenting Program has worked with parents

since 2010 to keep babies and children out of institutional care. It uses trained facilitators to work

with parents who might need additional support to prevent children being placed in institutional

care by strengthening parent-child relationships. Results have shown that participating families

have predominantly kept their children out of institutional homes.20 Currently, with support from

UNICEF and Healthprom, MoHSP’s Hayot dar oila is transforming exiting four Baby Homes to

Family and Child Support Centers. The Centers are to provide community-based support services

for vulnerable families and children under seven years old. The Centers work in strong

collaboration with the Commission on Child Rights and the Child Rights Units as well as with

community agencies and public organizations to promote child welfare and strengthen protection

systems and services.

School Feeding

The WFP began piloting a school feeding program in Tajikistan in 1999. Over the past two

decades, the WFP has rapidly scaled up the school feeding program to 60 percent of all rural

schools in the country, and the program now reaches 370,000 school children with major financial

support from the Russian Federation. The state budget has not taken over financing of this

program. There is no similar program for children below school age.

The WFP also recently began its Food Assistance for Assets program in Tajikistan. This program

provides food, vouchers, or cash transfers to vulnerable populations in order to increase food

security. In return, communities work on improving assets and infrastructure within their

community to increase protections from shocks, while subsequently improving their food security

and nutrition status. Additionally, the WFP works with the government’s Committee for

20 Mellow Parenting poster at https://www.mellowparenting.org/wp-content/uploads/2016/06/Tajik-Poster-for-WAIMH-May-

16.pdf

43

Emergency Situations and Civil Defense to maintain a contingency stock that can be distributed

in the event of a natural disaster. In 2016 and 2017 the WFP provided food assistance worth up to

$90,000 to people affected by natural disasters in Tajikistan.

Community-based Programs

In December 2014, the MoHSP and WHO organized the first national conference on community-

based interventions, called "Reaching the Unreached.” The conference provided guiding principles

to implement community-based programs and laid the foundation for initiating government-

managed community-based programs in Tajikistan.

Starting in 2015, the international NGO Caritas supported a community-based program in three

districts of the country (Vahdat, Konibodom and Devashtich), reaching 31,631 children under age

three with early screening for developmental delays and with interventions to address them. The

screening tool was adapted and endorsed by the MoHSP, and a pool of national trainers has been

trained in ECD.

Alternative Preschool Programs

In 2010-2011, a new alternative model of preschool education – Early Learning Centers (ELCs) –

was piloted with support from UNICEF and AKF. From 2012, following the government’s

instructions, local government authorities started establishing ELCs in a national scale. As a result,

the Early Child Education and Care (ECEC) services provision increased almost fivefold from

2010 to 2017. The increase was mainly driven by the ELCs: from 23 in 2010 to 1,671 in 2017.

Tajikistan’s ELCs reflect the country’s first efforts toward its strategic goal of investing in

alternative preschool types. An ELC provides half-day services at a location and a price that make

it more accessible than a traditional full-day kindergarten. By 2017, ELCs accommodated almost

one-third of children enrolled in preschool. Yet ELCs still lack secure public funding and a

regulatory framework, limiting their quality and sustainability.

ELCs are being established by the government, private sector, and local communities. The latter

are supported by development partners (AKF, UNICEF, OSI). Thus, AKF facilitates establishment

of ECD support groups, which in turn support community based ELCs. In remote areas, AKF also

supports community play groups – a model that promotes caregiver and child interaction in an

educational and stimulating play-based environment.

44

The new World Bank-funded ECD Project envisages supporting around 500 ELCs and 1,500 play

groups through upgrades in small physical premises, teacher training and mentoring support, and

TLMs provision.

45

4. Conclusion

Tajikistan faces a unique opportunity today. Investing in human capital can change the country’s

development trajectory. Given the large proportion of the population under six years of age, there

is no doubt that investing in improving ECD outcomes is the best national investment that

Tajikistan can make. The country is to be commended for its decision to invest in the health,

education, and development of its youngest citizens.

Realizing improved ECD outcomes will require more than good will and financial investments,

however. It will need a robust regulatory foundation that enables the many diverse actors to work

toward a common purpose. It could begin with a national policy framework for ECD. Such a

framework would raise the visibility of ECD for young children and their families and identify

strategies to address their needs. A policy framework typically includes both a policy statement

and a description of institutional and administrative structures to implement the policy. The policy

statement includes a vision of where the ECD is heading, a set of goals or objectives that the

government would like to achieve, and strategies for achieving them. It is important for the ECD

policy to harmonize with other, related sectoral policies. As was discussed in this policy note,

several elements of this framework exist in Tajikistan. It will be crucial to bring them under one

umbrella.

Government responsibility for the provision or supervision of ECD services is often scattered

across ministries, often according to the age of the child. An ECD policy framework can help

harmonize the goals and strategies of these institutions horizontally. The policy framework

identifies the lead agency and the entities that will implement, manage, monitor, and evaluate

ECD programs. A policy can engage new ministries that have not traditionally been engaged in

ECD, such as Agriculture and Finance. Furthermore, responsibility may also be distributed

vertically among multiple levels of government, such as the national/central, provincial, district,

and community levels. Once the policy framework is in place, it is possible to streamline

legislation, removing duplications and adding regulations that are crucial yet missing. As discussed

in this policy note, the lead agency coordinating ECD needs to be designated and empowered to

play that role in Tajikistan, and legislation needs to be enforced through creation of adequate sub-

laws, financing, and capacity strengthening. Currently, legislative gaps exist concerning support

for pregnant and lactating women, for children under age seven, and for children with disabilities.

46

As the first and primary caregivers, the role of parents and communities cannot be underestimated

in achieving positive ECD outcomes. Parental education can focus on raising awareness among

parents on the importance of ECD, informing them of what services are available and how to

access them, setting realistic expectations for child development at different ages and promoting

early stimulation. Early stimulation consists of doing simple, everyday activities with a child—

talking, singing, reading, and playing—in a way that is attentive and responsive. Parenting

education can be integrated into existing service delivery mechanisms—civil registration offices

(ZAGS), health center waiting rooms, home visits by PHC staff, community health workers, and

specialized trainings—to cover the full scope of the ECD life course. Awareness raising, and

especially behavior change communication, can be very powerful using mass media and simple

communication technologies, such as regular text messages to parents. Parental capacity

strengthening can and should proceed while the regulatory framework is being upgraded.

Finally, co-location of ECD services can enable positive ECD outcomes. Co-location means

implementing different ECD services an integrated way and in in the same geographic areas so

that children reap the greatest benefit. In Tajikistan this would mean coordinating across ministries

and other actors to ensure the provision of strengthened health sector support for ECD, a more

child-sensitive TSA, ongoing parental education, and high-quality preschool services (among

other things) in the same geographic areas.

47

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https://www.who.int/water_sanitation_health/publications/washandnutrition/en/

World Health Organization. 2018. “Infant and Young Child Feeding.” Fact Sheet.

https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding