International staff: 5
National staff: 51
Azerbaijan may be sitting on a potential oil bonanza, but riches from this valuable resource have not flowed down to the people. Nearly 70% of the population lives in poverty.
MSF works with the country's most vulnerable people: some of Azerbaijan's 600,000 internally displaced persons (IDPs) and a large number of residents who also suffer from poverty and the lack of government resources. The IDPs are Azerbaijanis who fled the predominantly ethnically Armenian enclave of Nagorno-Karabakh (see box).
Though most of the IDPs do not live in camps, they are not "at home." Though the residents are "at home," they suffer from poverty and severe economic dislocation. The IDPs and residents share an impoverished state and a lack of access to affordable, quality health care.
Cost recovery system to improve health care services
Over the past four years, MSF has provided free care at four health centers in the ex-industrial city of Sumgayit. However, the slow pace of change in the health sector and the entrenched poverty of the local population have combined to prevent quality care from being truly self-sustaining.
Against this backdrop, MSF is testing a pilot cost recovery program in two health centers where the organization already works. Patients will be charged a small fee for family-oriented and primary health care. The development of a partial cost recovery system should in turn strengthen and improve the health care services. MSF will continue, however, to offer free care at a clinic in Saragaya, a mixed IDP and resident community just outside Sumgayit. This clinic is the only health facility in the area.
Health education is an important part of MSF's work in Azerbaijan. In the wake of a scabies epidemic last year, MSF began an education program teaching hygiene measures to at-risk groups. This drew to a close in May 2000. In July, a new nine-month program began. It focuses on educating the people near the two pilot clinics in subjects they are interested in, ranging from reproductive physiology, family planning, STDs, pregnancy and care of newborns.
In southwestern Azerbaijan, a focus on reproductive care
In southwestern Azerbaijan, MSF also works in the Imishli, Saatli and Fizuli regions. The population of the three regions is about 270,000 people, a quarter of whom are IDPs. The program includes reproductive health training and supervision of midwives and gynecologists, support for the immunization programs, supply of drugs and equipment to maternity wards and STD treatment. MSF also helped define a national protocol for STD management and will train all doctors in Saatli and Imishli on the new protocol.
This year, MSF is ending emergency activities such as free drug distribution to public health facilities and support of a small health center. A laboratory training program ended in July 2000, after training lab technicians from two regional reference hospitals and two STD clinics.