Karakalpakstan as an autonomous republic represented 38% of the territory, but only 6% of the population of Uzbekistan. Decades of monoculture based on irrigation of dry lands had led to an ecological disaster: depletion of the Aral Sea, soil erosion and salinisation, loss of biodiversity and air pollution. The health situation of the impoverished population was much worse than in the rest of Uzbekistan. Anaemia, cardio-vascular diseases (CVD) and Acute Respiratory Infections (ARI) were predominant as are seasonal diarrhoea, tuberculosis, and kidney diseases. A mission of two experts analysed the strengths, weaknesses, threats and opportunities (SWOT) of health care and health management and elaborated a proposal for appropriate support. Afterwards, a training programme suggested by the mission was implemented with further support by an EPOS expert. GTZ complemented this by the delivery of medical supplies and basic equipment (based on WHO recommended DOTS TB treatment and UNICEF essential drug list).
The experts analysed the conditions and modalities of support to the health sector in the rural areas south of the Aral Sea, in particular: - The strengthening of diagnostic competence - The improvement of supply of drugs and consumables - Staff training with regard to rational use of drugs in therapy and to health management. The experts proposed the following short-term interventions which were planned and implemented jointly with UNICEF, WHO and the GTZ-EPOS family planning project: - Supply of drugs, consumables, laboratory and other equipment - Training workshops concerning the predominant diseases, tuberculosis, anaemia, acute respiratory infections and diarrheal diseases, district health management, rational use of antibiotics and other drugs, family planning methods and measures against high maternal mortality. For additional mid-term interventions, they proposed the following: - Combating tuberculosis in the areas south of the Aral Sea - Installation of a drug revolving fund in a rural district - Improvement of health area management in the rural district with currently the weakest structures.