Tajikistan. Health care system overview

The health care system in Tajikistan was based on the system of the former Soviet Union, the Semashko model, which emphasizes a curative focus with an extensive infrastructure and large numbers of health professionals. Health care was comprehensive, but patients had limited choices due to the hierarchical management system. The system stayed in place after the collapse of the Soviet Union, but facilities and equipment were destroyed in the civil war or became outdated due to economic constraints. The workforce rapidly decreased due to high emigration rates.

The health system therefore needed to change and is currently undergoing significant transition. Organization of health care services complies with the general administrative structure of the country, meaning the MoH is responsible for health services at national level and local authorities at oblast and rayon levels for most regional, rayon and rural health services. The MoH does not control the total health budget; health budgets are allocated centrally from the Ministry of Finance directly to financial units at oblast level.

The MoH directly controls the budgets of health care facilities at republican levels. The Law on Health Protection was adopted in 1997 and updated in 2002. It describes the tasks of the MoH and, although complete implementation has not been achieved, addresses important issues such as the development of a national health policy, development and implementation of national disease-control programmes, pharmaceutical policy development and licensing control, and certification of institutions and personnel in the health care sector.

Total health expenditure per capita is low compared to other countries in the Region (Table 1) and is higher only than Kazakhstan among CIS countries in relation to proportion of GDP spent on health. The cost of health care, however, remains largely with the population, as out-of-pocket payments comprise 60.06% of total health expenditure, which is by far the highest in the Region. Information on health care resources and utilization is provided in Table 7.

The number of hospitals and hospital beds is high compared to other countries, but health personnel numbers across all categories are low. Low GP numbers are similar to elsewhere in the Region, but the number of physicians is lowest. This is reflected in the number of outpatient surgical procedures per year per 100 000 people: Tajiks make an average of 4.2 outpatient visits per year, which is low compared to other countries. The number of dentists is extremely low (0.7 per 100 000 population).

Table 1. Selected health care expenditure indicators, 2012