Tajikistan: health system review
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World Health Organization. Regional Office for Europe
Abstract
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154 p.
The Health Systems in Transition (HiT) profiles are country-based reportsthat provide a detailed description of a health system and of policyinitiatives in progress or under development. HiTs examine differentapproaches to the organization, financing and delivery of health services and therole of the main actors in health systems; describe the institutional framework,process, content and implementation of health and health care policies; andhighlight challenges and areas that require more in-depth analysis.Tajikistan is undergoing a complex transition from a health system inheritedfrom the Soviet period to new forms of management, financing and healthcare provision. Following independence and the consequences of the civil war,health funding collapsed and informal out-of-pocket payments became the mainsource of revenue, with particularly severe consequences for the poor. With theaim of ensuring equitable access to health care and formalizing out-of-pocketpayments, the Ministry of Health developed a programme that encompassed abasic benefit package (also known as the guaranteed benefit package) for peoplein need and formal co-payments for other groups of the population.One of the main challenges for the future will be to reorient the health systemtowards primary care and public health rather than hospital-based secondaryand tertiary care. Pilots of primary care reform, introducing per capita financing,are under way in three of the country’s oblasts. There are marked geographicalimbalances in health care resources and financing, favouring the capital andregional centres over rural areas. There are also significant inequities inhealth care expenditures across regions. The quality of care is another majorconcern, owing to the lack of investment in health facilities and technologies,an insufficient supply of pharmaceuticals, poorly trained health care workers,and a lack of medical protocols and systems for quality improvement.
The Health Systems in Transition (HiT) profiles are country-based reportsthat provide a detailed description of a health system and of policyinitiatives in progress or under development. HiTs examine differentapproaches to the organization, financing and delivery of health services and therole of the main actors in health systems; describe the institutional framework,process, content and implementation of health and health care policies; andhighlight challenges and areas that require more in-depth analysis.Tajikistan is undergoing a complex transition from a health system inheritedfrom the Soviet period to new forms of management, financing and healthcare provision. Following independence and the consequences of the civil war,health funding collapsed and informal out-of-pocket payments became the mainsource of revenue, with particularly severe consequences for the poor. With theaim of ensuring equitable access to health care and formalizing out-of-pocketpayments, the Ministry of Health developed a programme that encompassed abasic benefit package (also known as the guaranteed benefit package) for peoplein need and formal co-payments for other groups of the population.One of the main challenges for the future will be to reorient the health systemtowards primary care and public health rather than hospital-based secondaryand tertiary care. Pilots of primary care reform, introducing per capita financing,are under way in three of the country’s oblasts. There are marked geographicalimbalances in health care resources and financing, favouring the capital andregional centres over rural areas. There are also significant inequities inhealth care expenditures across regions. The quality of care is another majorconcern, owing to the lack of investment in health facilities and technologies,an insufficient supply of pharmaceuticals, poorly trained health care workers,and a lack of medical protocols and systems for quality improvement.