Progress towards health reform in Tajikistan

Tolib N Mirzoev · Andrew T Green · James Nicholas Newell

32 citations0/0 files storedJournal of Health Organization and Management

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Healthcare Systems and Reforms Healthcare Systems and Practices Public health and occupational medicine

Abstract

PURPOSE: The purpose of this paper is to provide an up-to-date overview of Tajikistan's health system, focusing on the main factors affecting health systems development. The wider contextual environment is to be explored, focusing on political, social and economic issues. Different elements of the health system including health policy, governance, service delivery, human resources and health financing are reviewed in the light of their development over the past decade. DESIGN/METHODOLOGY/APPROACH: The paper shows that the Republic of Tajikistan is in transition. Formerly one of the most neglected republics within the USSR, the country became independent in 1990 and faced the civil conflict shortly thereafter. In the last few years there have been major public sector reforms with health reforms formally launched in the late 1990s. Little information about current Tajikistan is widely available. FINDINGS: The paper finds that the progress of health reforms in Tajikistan has been relatively slow compared with neighbouring Kazakhstan and Kyrgyzstan. This is largely due to the effects of civil war in the mid-1990s and significant out-migration of qualified experts, but it can also be attributed to an inability of central government to adequately adapt to the requirements of transition. ORIGINALITY/VALUE: The paper shows that many problems are still to be overcome by the health system, ranging from operational issues related to service delivery to strategic issues such as formulating an explicit privatisation policy, reducing fragmentation of, and aligning, external aid. However, some recent developments, such as adoption of a country health reform conception, a health financing strategy, and willingness of central government to improve coordination, suggest that improvements are possible.

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References

2003Poverty, out-of-pocket payments and access to health care: evidence from Tajikistan 2002Health Care in Central Asia 1991Health services in central and eastern Europe: past problems and future prospects.1998Health sector reform in the former Soviet republics of Central Asia

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2010Hospitalization in Tajikistan: determinants of admission, length of stay, and out‐of‐pocket expenditures. Results of a national survey 2010The inequity in out-of-pocket expenditures for healthcare in Tajikistan: evidence and implications from a nationally representative survey 2011New Public Management and Health Reform in Kazakhstan 2010International involvement and national health governance: The basic benefit package in Tajikistan 2020Local health governance in Tajikistan: accountability and power relations at the district level

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