FY2009 TAFT FUND FOR REFUGEES PROPOSAL

UNCLAS SECTION 01 OF 04 DUSHANBE 000665

SIPDIS

DEPT FOR SCA/CEN, PRM/ECA

E.O. 12958: N/A
TAGS: PREF EAID TI
SUBJECT: FY2009 TAFT FUND FOR REFUGEES PROPOSAL

REF: STATE 14280

1.Summary: Per reftel, post would like to submit a proposal for
this year's Julia Taft Fund for Refugees that will benefit
Afghan refugees in the Vakhdat district outside of Dushanbe
where many Afghan refugees in Tajikistan have been forced to
settle. Post proposes supporting purchase of several pieces of
key medical equipment for the central hospital in this district
and using hospital facilities for basic healthcare training
sessions that will bring together NGO experts, hospital
specialists, and the local Tajik and refugee population on
healthy lifestyle practices and prevention of HIV/AIDS, STDs and
drug addiction. End summary.



Refugee Population in Tajikistan


2. The refugee population in Tajikistan is mainly Afghan -
almost 99% of ethnic Tajik background - and resides mainly in
the capital and surrounding regions and in the northern city of
Khujand in Sughd province. The refugee population includes
about 600 fairly integrated long staying refugees who arrived in
the early 1990s after the fall of the Najibullah regime. While
the number of these earlier Afghan refugees in Tajikistan
reduced dramatically since 2001 due to voluntary repatriation
and resettlement programs, recent developments in Afghanistan
have spurred an increase in new arrivals. As of April 2009,
Tajik government statistics indicated 2276 officially recognized
refugees and 466 asylum seekers in Tajikistan. According to
UNHCR there was an 80% increase in arrivals from Afghanistan in
2008 versus 2007. Given the current situation in Afghanistan
and the lack of options to go to other bordering countries, it
is expected this increase in arrivals from Afghanistan will
continue through 2009 and could result in some 4000 refugees in
Tajikistan by year end.




3. UNHCR notes the protection environment in the country is
being affected by the increase of new arrivals. The growing
need is placing a strain on the current care and maintenance
program, as the amount provided as cash assistance to vulnerable
families has almost tripled. The current difficult economic
situation in Tajikistan and the poverty level of the local
population often leads to a negative attitude towards Afghan
refugees.



The Vakhdat 'Region of Republican Subordination'




4. The proposed project is intended to benefit the Afghan
refugee population and local residents living in the Vakhdat
district, a semi-rural community about 25 kilometers east of
Dushanbe. In 2000, the Tajik government prohibited refugees
from living in 'urban' areas although fact that most of them
already had settled in the largest cities of Dushanbe and
Khujand. The UN views this action as in possible violation of
the Convention Relating to Status of Refugees. When the number
of Afghan refugees began to increase again in 2007-8, the
government started enforcing the earlier decrees through a door
to door campaign carried out by local militia, forcing those
with refugee status to move from the cities to outlying areas.
Outside of Dushanbe, refugees resettled in three major
communities, Rudaki, Gissar and Vakhdat. Vakhdat is the largest
community of Afghan refugees in Tajikistan - where roughly 1000
refugees are living among a local population of about 275,000.
Unlike some of the pre-2000 arrivals from Afghanistan, most of
the refugees in Vakhdat are relatively poor. The members of
this refugee community often depend on the head of household
working a 'trading' business in the local markets, tend to have
large extended families, and have found resettlement to a rural
area often lacking in basic services difficult.



The Healthcare Challenge




5. In general , according to UNHCR, many refugees in Tajikistan
are in poor health and some have serious disabilities or chronic
diseases which require ongoing medical treatment. Under UNHCR
auspices, refugees and asylum seekers are provided free medical
care in Dushanbe and Khujand. For residents of Vakhdat,
however, given the limited funds refugees have, the transport
costs to and from Dushanbe may be prohibitively expensive,
especially for ongoing treatments. Refugees in Vakhdat have
access to the local hospital and clinics for health care, but,
up to now, have had to pay for locally received medicine and

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services, often including 'unofficial' fees. In some cases,
they are charged the higher rates for foreigners. Negotiations
are underway between the Tajikistan Ministry of Health and the
NGO 'Refugee Children, Vulnerable Citizens' (RCVC) that partners
with UNHCR. The agreement would require the regional hospital
in Vakhdat - the intended recipient of equipment from this grant
- to ensure free basic medical services for refugees. Per the
agreement, UNHCR and the hospital would split the cost of
pharmaceuticals, surgery or hospitalization. Assistance to this
hospital would strengthen its ability to fulfill this agreement.



Needs of the Central Vakhdat Hospital




6. The Central Vakhdat Hospital and its affiliate 'policlinic'
is the largest healthcare facility in the district with over
13,000 patients, including many refugees, hospitalized there
during 2008. The hospital's Chief Physician, Dr. Mirzotillo
Umirzokov recently participated in a USAID-funded short term
exchange program on hospital management in the U.S. Among the
challenges the hospital faces, the doctors cite difficulties in
treating gastrointestinal illnesses and childhood diseases. One
deficiency in the hospital's ability to treat such conditions is
outdated or non-working medical equipment. In severe GI
illnesses, an endoscopy is often needed, but since fasting is
necessary beforehand and the patient may be weak, the travel to
Dushanbe where there is modern equipment can be risky. The
hospital has one outdated gastroscope that was 'being repaired'
when ConOff visited. Sick children often need a respirator or
extra oxygen. The hospital's respirators for children are from
the 1980s and do not function to full capacity. The hospital
has one oxygen supplying device donated by UNICEF, but can serve
only one patient at a time. All of these pieces of medical
equipment can be life-saving. Unlike in other refugee
communities in Tajikistan, Vakhdat's population has not been
educated on awareness and prevention of STDs or HIV/AIDS.



Project Rationale




7. Post proposes a project that will 1) increase the capacity of
the main local hospital in Vakhdat handling local refugee
medical needs 2) ensure that free of charge medical services for
refugees and 3) use the increased collaboration of the hospital
with the refugee community to provide a basic health education
seminars. Any assistance to this hospital would benefit the
overall population of Vakhdat in addition to refugee groups.
This is in line with encouraging integration of refugees into
the local population and greater acceptance of refugees among
the general population.



Implementing Partner: NGO Fidokor




8. Post selected the NGO Fidokor to implement this project.
Founded in 1996 with an overall mission of developing civil
society in Tajikistan, Fidokor has carried out regional and
local projects - many targeted to assisting vulnerable
populations. For ten years Fidokor was an implementing partner
with UNHCR. Two major programs have focused on HIV prevention
and integration of Afghan refugees in Tajikistan. Fidokor
representatives are tapped into the leadership of the Afghan
refugee community in Vakhdat and have access to regional
institutions there as well as trainers and experts in public
health issues. Fidokor has been involved in Post-supported
refugee projects in the past and is known to Post through work
with USAID and other USG grant projects.



Proposed Project: Enhancement of Healthcare for Refugee and
Local Population of Vakhdat




9. Through the Taft Fund, Post would like to provide the Central
Vakhdat Hospital the following three key pieces of needed
medical equipment:

Respirator (for children up to age 14) - $5,000

Gastroscope - $11,000


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Oxygen Supplying Device - $500

Estimated prices were obtained through initial research with
medical suppliers in Dushanbe, but time for thorough
price/quality comparison is built into project. Project
organizers have been assured that the hospital already has the
technical expertise and capacity to immediately utilize this
equipment.




10. Project details and timeline follow (timetable is flexible
depending on project approval):

June - July, 2009

Fidokor Project Director in collaboration with hospital managers
will lead comparative analysis of medical equipment suppliers,
determine best option for price/quality/local delivery of
gastroscope, respirator and oxygen supplying device.

July 2009

Purchase and delivery of equipment to Vakhdat Central Hospital.

July 2009

Translation of existing Fidokor educational/prevention pamphlets
on HIV/AIDS and STDs into FARSI (materials used in trainings in
other parts of Tajikistan already exist in Russian and Tajik)

August 2009

Inaugural event at Vakhdat Central Hospital: Fidokor will
gather Afghan refugee group leaders and Vakhdat local community
(jamiyat) leaders for a presentation at the hospital regarding
new medical equipment/services. Educational pamphlets on
HIV/AIDS and STD prevention will be made available and upcoming
health seminars will be announced.

August -September 2009

Preparation and conducting of three one day seminars by experts
hired by Fidokor on awareness and prevention of HIV/AIDs, STDs,
drug addiction and other aspects of maintaining a healthy
lifestyle. Each seminar will have a specific target audience -
three separate seminars for men, women and youth - an approach
that has worked well in the past on these topics. The Vakhdat
Central Hospital again will provide a space for these seminars
which will include participation of some physicians from the
hospital for consultations during the seminars.

October 2009

Final report due to donor.

Note: throughout the course of the project , project leaders
will monitor the provision of free medical services to refugee
per agreement with UNHCR.




11. Detailed Budget

Respirator $5,000

Gastroscope $11,000

Oxygen device $500

Seminar costs

Supplies for participants $240 (20
participants x $4 x 3)

Supplies for trainers $150 ($50 x 3)

Training module development $150 (COST
SHARE BY FIDOKOR)

Lunch/coffee for participants $330 ($5 x 22
participants x 3)

Trainer honoraria $150 ($25 x 2
trainers x 3)

24% salary tax $37.50

Publishing

Development of health pamphlet $400 ($200 x 2
COST SHARE BY FIDOKOR)

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Translation of pamphlet (FARSI) $100 ($50
x 2)

Duplication $800 ($2 x
400)

25% salary tax $25

Other Expenses

Salary of Project Director $600 ($140 x 4
months)

Salary of Project Accountant $400 ($100 x 4)

Organizational development $380

25% salary tax $250

Totals: $19,962 (proposed for Taft Fund) $550
(cost share by Fidokor)



Expected project results



12.Through provision of medical equipment to the key hospital in
the Vakhdat District, this project is intended to address an
immediate gap in healthcare services that will impact the large
refugee population living in this area. At least 60 local
refugees and local Vakhdat residents will receive targeted
training on healthy lifestyle practices and specifically on
HIV/AIDS, STDs and drug prevention awareness through training
modules that have proven successful in other parts of
Tajikistan. Educational pamphlets will be distributed more
broadly to the population visiting the hospital and policlinic.
We anticipate that the project will enhance the hospital's
ability to provide free health services to the refugee
population and at the same encourage greater interaction between
the refugee and local population jointly attending the health
seminars. If this project receives funding, we hope it will
open the door for different forms of ongoing collaboration with
the hospital in this area where larger number of refugee
settlers may be expected and healthcare needs will also
increase.




13. Post consulted the Excluded Parties List System and the
Department of Treasury Office of Foreign Assets Control before
selecting Fidokor as our implementing partner on this project.
Post certifies that it has the authority and capacity to award
a grant to the intended recipient agency prior to September 30,

2009. Post will forward to PRM via e-mail a signed code of
conduct from the intended grantee, Fidokor. Embassy Dushanbe's
point of contact for this project is Consular Officer Elisabeth
Wilson (WilsonE@state.gov). Post is ready to provide further
information as might be needed to assist PRM in considering this
project for support by the Julia Taft Refugee Fund.
QUAST