Azerbaijan, 1998

International staff : 17 National staff : 124 LARGE DISPLACED POPULATION AT RISK map Reforms to rationalise and privatise the health system complicate access for the most vulnerable, including 700,000 internally displaced people from Nagorno-Karabakh. MSF targets medical assistance to over half a million vulnerable people in Sumgayt region, including a large number of IDPs. This includes four free dispensaries, assistance to government health structures and raising awareness of prevention and treatment for common diseases. In several districts in Central Azerbaijan, where IDPs are widely dispersed, often living with local families, a team helps to train primary health staff and establish a vaccine cold chain. Training in reproductive health care is provided for gynaecologists and midwives, as well as management support in rationalising drug use. MSF set up a dispensary in Imishli and trains laboratory technicians with an emphasis on malaria identification. STD smear identification training was introduced in February 1998. MSF implements a programme in six districts in the northwest, close to the border with Nagorno-Karabakh. A team trains medical staff and midwives in family planning methods and works to improve the immunisation programme, including the establishment of an effective cold chain, in order to strengthen the weak links in existing Ministry of Health public health initiatives. A drug distribution programme covering 80 health facilities in these districts concluded in December 1997. MSF assists the Ministry of Health and UNICEF with vaccination management and works with other NGOs and UN agencies to persuade the government to implement a national TB programme. MSF has run seminars and put together a manual on antibiotic management. NAGORNO-KARABAKH map Although Nagorno-Karabakh remains a potential flashpoint, both Armenia and Azerbaijan are influenced by a desire for a peaceful resolution of the conflict over the enclave, which is geographically and historically part of Azerbaijan but with a population now exclusively Armenian. MSF is working with patients in a TB hospital in Stepanakert, which is being renovated by the team. DOTS treatment is given free of charge. With an emphasis on passive detection, training is provided for medical and paramedical personnel both in DOTS and in sputum analysis. The target is to achieve an 85% cure rate for new TB cases annually.