Health Planning Approach Integrating a Health Literacy Concept and Using Community Health Teams in Tajikistan: 'Work for the Sake of my Health and the Health of the Community'

The Enhancing Primary Health Care Services project supported the Ministry of Health and Social Protection in nine pilot health districts in Tajikistan to strengthen family medicine-oriented primary health care services. The project actively involved the community in this process by implementing a participatory health business planning process and health promotion approach. This study evaluated the degree of communities' involvement in health planning processes and its effect on the population's health literacy regarding risk factors of cardiovascular disease.The mixed-method longitudinal cross-sectional study design included a repeated community-based survey targeting Community Health Team representatives on their involvement in health business planning and health promotion activities and a health literacy survey on knowledge and behavior related to cardiovascular disease and risk factors among adults. The studies were conducted in four project districts in 2015 (only health literacy survey), 2017 and 2020, whereby rural communities were selected and then repeatedly visited. In each community, three community health team representatives were interviewed and 20 eligible adult women and men from randomly selected households.A total of 121 community health team representatives from 40 communities participated in the health business planning and health promotion surveys in 2017, and 154 from 55 communities in 2020. We analyzed complete data from 1,183 adult women and men from 60 communities participating in the health literacy surveys in 2015, 1,418 from 71 communities in 2017, and 1,111 from 55 communities in 2020. We found that the health business planning and promotion approach fostered the collaboration between the primary health care services, community authorities and the population through actively involving community health team representatives in these processes. The population's overall knowledge of cardiovascular risk factors rated as 'good' increased from 31% in the baseline to 46% in the endline. The respondent's belief that changing their lifestyle affects their health increased from 60% to 86%, respectively. The health business planning and health literacy approaches empowered communities to successfully shape health planning by putting forward their health needs. This contributed to increasing people's trust in primary health care services and enhanced the primary health care team's accountability for progress towards the communities.