Tajikistan: Health System Review

Abstract

This analysis of the Tajik health system reviews developments in its organization, governance, financing, provision of services, health reforms and health system performance. Tajikistan has made progress in reforming its health system away from the model inherited from the Soviet period, but challenges remain. In 2022 the country had the second lowest health spending per capita in the WHO European Region, and health spending is dominated by private out-of-pocket payments (both formal and informal) which undermines a range of health system goals, including financial protection. A basic benefits package was piloted for over 15 years but ended in 2023, and while a new package is in development it had not been introduced as of August 2024. Public financing depends primarily on regional and local authorities, which contributes to regional inequalities in funding. Health system efficiency is undermined by outdated provider payment mechanisms, although there have been efforts to introduce changes such as partial capitation-based payments. Quality of care is an ongoing concern, with challenges including insufficient health data, underinvestment in infrastructure and equipment, staff turnover, deficiencies in the training of health workers, and limited access to pharmaceuticals. The number of doctors and nurses per population in Tajikistan is lower than in other countries in Central Asia, although the number of nurses has increased in recent years. There is a particularly pronounced shortage of doctors in rural areas and a high rate of medical staff migration. Medical education has been a key area of reform, but family medicine continues to suffer from low prestige. Health reforms have aimed to strengthen primary health care, with other priorities including health financing, regulation and financial protection. Under its current national health strategy, the government is committed to promoting universal health coverage for the population by 2030, and has established strategic priorities for health system development in key areas such as governance, financing, workforce and health service quality. A substantial number of reforms and an increase in government spending will be required to deliver this vision.