TELFORD, United Kingdom — Tajikistan is the poorest country in Central Asia and since the collapse of the Soviet Union in 1991, its health care services have struggled. Poverty and poor health are in a close relationship. Although the Tajikistani economy has been growing, long-term economic problems have undermined the health system, resulting in underfunding. Tackling the associated problems could be a pivotal step in ensuring that all Tajik citizens, regardless of financial status and geographical location, are able to obtain quality health care services.
The Economic Context
Although its economy has managed to recover strongly from the COVID-19 pandemic in 2020, Tajikistan is heavily dependent on remittances and its citizens are suffering from rocketing food prices tied to the war between Russia and Ukraine.
The World Bank reports a “remarkable” poverty reduction in the country over the past decade, with a drastic drop in the poverty rate from 66.8% in 2003 to 26.3% as of 2019. However, rural areas still suffer disproportionately, with 73% of the country’s poor living in remote villages.
Health Care Access in Tajikistan
In the immediate aftermath of the collapse of the Soviet Union, Tajikistan’s levels of public spending on health were among the lowest in the Central Asian region, according to a 2022 report.
In recent years spending has increased, but some key problems persist that endanger the health of the general public and leave many without access to medical care.
First among these is the prohibitive cost of health care treatment. Expensive out-of-pocket payments can push vulnerable households into a spiral of poverty, according to the same report. This dissuades people from seeking health care when they need it for fear of the cost.
Another large obstacle is the mountainous terrain of the country. According to Muhiddin, the Partnerships and Fundraising Officer at NGO Sadoqat, around 70% of Tajikistan’s population lives in remote villages located in between high mountains. “When it is harsh winter, because of high levels of snow or because of natural disasters, sometimes some villages face isolation from other parts of the country,” he explains. “And this may also complicate the access to health care services.”
Many health care facilities are also working with outdated and poorly-maintained equipment, meaning that people cannot always get the care that they need in the local area.
It is not just the equipment that is antiquated – many existing hospitals and medical centers in the country were built before the 1970s, and the buildings have not necessarily been well-maintained over time, especially in rural areas.
This comes with the fact that running water, heating and a sewage system are not always working in many remote medical centers. These are necessities for proper sanitation, but many Tajikistani health care facilities simply do not have them, according to the European Health Observatory report.
In fact, a report from the International Partnership for Human Rights reveals that some medical facilities have to close during the harsh winters due to a lack of heating and in rural areas, even painkillers are not necessarily available to patients.
Despite the problems that many people face when it comes to health care access in Tajikistan, Muhiddin from NGO Sadoqat remains hopeful about the future: “The system is not perfect, but the government is really working on the improvement of health care services.” Registered with the Ministry of Justice in Tajikistan, the organization aims to “improve the living standards of our population in rural areas through structured partnership and sustainable practices”.
Originally founded in 2000, NGO Sadoqat is committed to implementing concrete improvements to services in remote areas. Its ongoing initiative at the Devashtich District Hospital, for example, has resulted in the renovation of four wards and Muhiddin is confident that more funding could secure improvements for the rest of the building too.
“We are also in a negotiation with other donors for renovation or maybe even construction of a new medical building in Panjakent district,” he explains. “But it doesn’t matter for us which region or part of the country, our main focus is on remote areas where people are vulnerable.”
The NGO focuses on a community-led approach and commits to accountability and transparency. This means that their initiatives are the result of direct consultation with health care workers and community members. For example, Muhiddin explains that when speaking to health care providers, one common issue was the lack of professional development opportunities in rural areas. To remedy this, NGO Sadoqat organized training sessions with national experts on pediatrics for doctors in remote areas.
Doctors also mentioned that the communities they served didn’t know much about health matters like childhood nutrition, so the organization “conducted some sessions where our best expert explained to women of reproductive age about the best practices in child feeding and about the importance of breastfeeding.”
There is still a lot of work to be done, but Muhiddin proudly states that through crowdfunding on GlobalGiving, NGO Sadoqat has already raised around $20,000 to invest in its projects. “We would appreciate it if kind people from different parts of the world would consider our project for making donations to help our people to get access to quality health care services and education services, which is the fundamental right of every citizen and every human being in this world.”
The future of health care access in Tajikistan is still unclear, but with further investment in services in remote areas, the country’s sizable rural population could see a much-needed improvement in the quality of local services. Thankfully, with support from organizations like NGO Sadoqat, concrete change is happening.
– Abbi Powell