Tajikistan is reportedly preparing to accelerate reforms that will lead Central Asia’s poorest country toward universal health coverage for its citizens. To better understand the potential changes ahead, Novastan explores the contrasting reality of Tajikistan’s health system.
Remaining largely in the hands of the public service due to its Soviet heritage (with the exception of outpatient and dental care), the health system in Tajikistan remains largely shaped by the reforms and state initiatives of the past 30 years.
Under the responsibility of the Ministry of Health and Social Protection, the public hospital has been the target of numerous reforms improving access to care.
Vaccination and prevention strategies that bear fruit
First, close and effective collaboration between the Tajik government, the United Nations Children’s Fund (UNICEF), the World Health Organization (WHO) and Gavi the Vaccine Alliance has enabled Tajikistan to achieve a more than satisfactory level of vaccination coverage. According to l’UNICEF96% of young children under 12 months are now immunized through the Expanded Program on Immunization: through this tool, Tajikistan has gone from an infant mortality rate of 105 deaths per 1000 births in 1990 to 34 in 2017.
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The Basic Benefit Package (BBP) of 2005, extended in 2022 to 31 districts out of the country’s 65, is also another program that is crucial for the functioning of the Tajik health system, reports l’OMS. This government initiative defines the number of services that are to be free and their beneficiaries. These are mainly emergency services, but also some diagnostics, dental care and preventive immunization care.
Still according to theOMSthe National Health Strategy 2010-2020 has also largely established the necessary foundations for improving access to care, compliance with international standards, health promotion and active prevention of infectious diseases.
A strategy to change: towards universal health coverage?
The post-coronavirus period marks a decisive stage in the transformation of the health system in Tajikistan. For l’OMSthe country is moving from a highly centralized system to an approach based on Primary Health Care, which is more efficient and tailored to the needs of Tajik families.
Read also on Novastan: Covid-19 officially returns to Tajikistan
From 2010 to 2022, the share of public health expenditure allocated to primary health care increased from 34.6% to 40.7%. As a direct result, the number of visits per person to a primary care center increased from one average from 4.8 in 2010 to 7.22 in 2022.
Still in the spirit of a global reflection concerning the public health strategy in Tajikistan, the WHO organized last February four days of « marathon »enabling dialogues and conferences between Tajik political representatives and WHO members.
International initiatives and collaborations
If international organizations such as the WHO or the United Nations play a leading role in the transformation of the health system in Tajikistan, and the collaborations maintained do not stop at NGOs to ensure the daily care of Tajiks.
At the initiative of the marathon last February, the European Union (EU) is a major partner in supporting this transition towards universal health coverage, having invested over 60 million euros in this regard over the last ten years.
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Raimundas KaroblisEuropean Union Ambassador to Tajikistan, said on the occasion of the marathon: “There is a strong need to strengthen the health system in the country and make it work better and better. The EU has committed, both in Tajikistan and in the rest of the world, to dedicate at least 20% of its financial allocation for the period 2021-2027 to human development, including health for all.”
Foreign aid to compensate for national shortcomings
The role taken on by some foreign health initiatives, however, tends to point to significant gaps rather than progress. Last June, the Tajik media Asia-Plus reported the example of 500 cataract operations performed free of charge by Chinese doctors in Dushanbe, part of an initiative organized by the Chinese Ministry of Health. China also announced a donation of medical equipment to Tajikistan worth one million yuan (127,000 euros).
Similarly, bilateral cooperation between Tajikistan and Iran extends to the medical field through the organization of seminars between Iranian and Tajik specialists, as reported by Khovarbut also by setting up structures at the initiative of Iranian investors such as the Ibn Sina international clinic in Dushanbe.
Read also on Novastan: Health in Kyrgyzstan: “We lack everything”
Kazakhstan has also made numerous donations of medical equipment, such as the sending of three devices for the treatment of pneumonia last January, Asia-Plus reports.
In addition to its Asian neighbors, Western countries such as Germany or the UNITED STATES have also directly provided financial support for improving healthcare, infrastructure and training for healthcare professionals in Tajikistan.
Economic difficulties
The medical aid provided to Tajikistan by a wide variety of countries is no accident. In Tajikistan, access to healthcare remains restricted by exorbitant costs for a large part of the population, adding to many infrastructural problems as simple and restrictive as the lack of clinics and hospitals in different areas.
Regarding costs, access to care through the BBP program, underlines l’OMSapplies to World War II veterans, orphans, children under one year old and adults over 80 years old. It also extends to patients suffering from HIV, tuberculosis, cholera, diphtheria, hemophilia and diabetes.
Also read on Novastan: Contaminate your wife then accuse her: these HIV-positive Tajik women face social discrimination
However, outside of these fairly restricted conditions, direct patient expenditure regularly reaches 50 to 70% of total costs. Symbolizing the disparities present even on this scale, regions where the BBP program is not extended see direct expenditure of up to 80%.
Infrastructure needs
This real obstacle to access to care makes Tajikistan the country with the lowest per capita expenditure on health in the entire WHO Europe programme.
At the infrastructure level, reports from non-governmental organizations as well as the press have widely reported a lack of suitable structures and medical personnel in the country. In addition to a rate of doctors and nurses well below According to the WHO Europe averages, the absence of hospitals in rural areas greatly affects access to care for a population that has gone so far as to replace state prerogatives in this area.
Radio Freedomthe Tajik branch of the American media outlet Radio Free Europe, reported last May on the case of the village of Kalai Doust in the north of the country, where the population of 2,000 inhabitants clubbed together to try to build a clinic in the locality themselves.
An environment that suffers from low wages and corruption
As a result, and in addition to difficult access to care, corruption affects the medical community. Asian Challenge describes her as “Corruption without fear or reproach” from doctors demanding additional payments. This practice, mainly due to very low remuneration of medical staff, is described as very common and the measures taken to reduce it remain insufficient.
While this routine corruption suffers from a lack of concrete means to reduce it, it finds a strong echo in larger-scale corruption in the pharmaceutical sector, involving its leading political players.
In October 2023, Radio Liberty reported the active role of the Tajik president’s daughter Emomali Rahman as well as the latter’s assistance within the pharmaceutical company Sifat Pharma. This laboratory would benefit from government privileges as well as extensive state promotion, allowing it to take control of the Tajik pharmaceutical market and even serve as an intermediary between Tajikistan and the European Union in matters of health. The French laboratory Innotech is currently one of Sifat Pharma’s partners.
A lack of confidence to be restored
Faced with the difficulties of accessing healthcare in Tajikistan, a resident of Dushanbe tells Novastan: “ I think the main problem with the Tajik health system is that doctors are rarely trusted. Precisely because until you put a note where you need to be and when you need to be, you are not sure that you will get the right diagnosis or the right follow-up. For example, they wanted to operate on me for appendicitis when it was obvious that I didn’t have it, probably just to take the $500 for the operation.”
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On the other hand, the lack of personnel is once again highlighted: ” If you are sick, hospitalized and alone, no one can go and get your medication, drop off tests or get the results because there is no staff to do it.
“Even when you are hospitalized (at least in a public hospital, it is probably a little better in private clinics), doctors often do not have the necessary medications on hand and a relative has to go and get them from the pharmacy, even for emergencies. As a result, in front of some hospitals, there are people who camp for days so that they are always ready to run somewhere when a relative is hospitalized.”she says.
Helmand Guards
Editor for Novastan
