CHICAGO, Illinois — Healthcare in Tajikistan is in dire need of reform as the country has one of the lowest levels of health expenditure in Central Asia. Access to medical care is sparse for many Tajiks who rely heavily on government and foreign aid. While the current state of the healthcare system exacerbates conditions for those in poverty, help seems to be on the way in the form of targeted programs and policy amendments hoping to bring about change.
The Current State of Medical Care in Tajikistan
Tajikistan endured years of political instability after the collapse of the Soviet Union in 1991 and the subsequent civil war that followed. Though the economy has since experienced promising growth with the increase of GDP levels, the foundation of Tajakistan’s healthcare system remains reminiscent of the past. With much of it funded by private out-of-pocket payments, the efficiency and accessibility of healthcare in Tajikistan pose a problem for close to three-quarters of the population who reside in rural areas.
Funding is extremely limited in regions outside of major cities, with hospitals lacking basic necessities such as heating, water, electricity and working equipment. Tajikistan employs only 170 physicians for every 100,00 people, not nearly enough to handle the demand. Furthermore, “outdated provider payment mechanisms” undermine the quality and equity of care, which also contributes to the lack of training and guidelines required to safely provide medical care in the first place.
The Disproportionate Impact on the Impoverished
The fact remains that a significant number of Tajiks are unable to afford medical care. Access to healthcare in Tajikistan largely depends on private payments and bribery, which essentially prevents those in poverty from getting the help they need. Roughly 26.7% of households fall into immense debt as their spending on healthcare exceeds 40% of their non-subsistence spending. Furthermore, in 2020, 20% of households were not able to receive medical care at all.
The dwindling condition of medical care in the country means the nation is unable to treat the crisis of widespread disease prevalent among impoverished groups. Poor diets lead to anemia and iodine deficiency disorders for thousands. The lack of preventative disease education also allows pneumonia, tuberculosis and HIV/AIDS to run rampant. Currently, “Tajikistan has one of the world’s highest rates of multidrug-resistant” tuberculosis for this very reason. Furthermore, in areas where residents do not have access to safe water sources, large parts of the population remain exposed to water-borne illnesses.
It is not only people who fall into debt from the lack of social safety nets but entire hospitals as well. Many rural hospitals are indebted to electricity companies and are forced to close during the wintertime because heating systems are too expensive to run. The rundown conditions of smaller hospitals often mean that regional facilities become overcrowded with people seeking better medical care. This overcrowding puts even more strain on the limited number of equipment, beds and staff that hospitals have to provide. The low wages doctors and nurses are subjected to leaves them dependent on out-of-pocket spending to make a living, feeding into the corruption within healthcare in Tajikistan.
Help in a Time of Need
Currently, nonprofit organizations such as Sadoqat are running programs to provide access to healthcare in rural areas of Tajikistan. Aiming to improve outdated facilities and replace equipment, Sadoqat’s main goal is saving lives. The project is raising funds that will go toward pulse oximeters, cardiac monitors and autoclaves, all of which will help those in poverty receive proper care.
While the situation is unlikely to change without major healthcare reform, the government is taking a number of steps to improve access to healthcare in Tajikistan. After expanding educational and medical resources for treating tuberculosis, the success rate for treating TB cases rose to 89%. Since 2017, successful treatment programs have been enacted around the country in accordance with the national tuberculosis protocol. The state of maternal and child care has also improved with help from USAID. USAID helped train more than 4,900 healthcare workers in treating malnutrition.
Pandemic Assistance From the World Bank
Most recently, Tajikistan was one of the first nations in 2020 to receive pandemic assistance from the World Bank. The World Bank provided an $11.3 million grant for the Tajikistan Emergency COVID-19 Project. The project focused on improving “healthcare capacity,” providing emergency cash assistance to impoverished families and supporting nationwide communication on preventative measures to help mitigate the spread of COVID-19.
Many hospitals were able to receive critical supplies such as ventilators, ICU beds, X-Rays, infusion pumps, PPE and defibrillators. Furthermore, 65,000 people in poverty were able to receive timely cash assistance through a partnership with UNICEF and the World Bank.
The efforts of the government and outside organizations have made considerable progress in reducing the poverty surrounding healthcare in Tajikistan. Future initiatives should look toward introducing policies that help lessen widespread corruption and expand healthcare access to rural areas of the country.
– Nicole Yaroslavsky