Overview

This analysis of the Tajik health system reviews developments in its organization, governance, financing, provision of services, health reforms and overall health system performance.

Health system governance is centralized and most health services are provided by the public sector

Health system governance and administration is mostly centralized, being controlled by the national government and managed by the Ministry of Health and Social Protection. The Ministry of Health and Social Protection runs national level health services, while local authorities administer most oblast, city/rayon and peripheral health services. The public sector continues to be the main provider of health services, although there is a small but growing private sector.

Health financing relies largely on private out-of-pocket spending

Public spending as a share of current health expenditure is one of the lowest in the region, amounting to only 1.9% of GDP in 2021 according to internationally comparable data. Tajikistan’s spending on health in absolute terms, at US$ 351 per capita in 2021 (adjusted for purchasing power), was the second lowest in the WHO European Region.

Out-of-pocket (OOP) payments from patients (both formal and informal) continue to dominate health spending and amounted to 63.5% of current health expenditure in 2021. Challenges connected to this reliance on patient payments include barriers to accessing services, poor financial protection, and high rates of catastrophic and impoverishing health spending.

There are challenges related to the health infrastructure and the health workforce

Tajikistan has made sustained efforts to reduce the excessive number of hospital beds that existed in the 1990s. The ratio of acute hospital beds to population has fallen during the past two decades, although it is still high compared to other European countries, particularly in view of the country’s young age structure and limited financial resources.

The number of health workers per population has fallen since the 1990s, partly due to high rates of outward migration. In 2008–2018, the absolute number of doctors increased but, due to Tajikistan’s growing population, per capita rates remain lower than either the WHO regional average or those of neighbouring countries. Health workers are concentrated in the capital, Dushanbe.

Health service provision is poorly integrated and primary care is underdeveloped

The provision of health services in Tajikistan is organized according to the country’s administrative tiers and differs in urban and rural areas. In rural areas, primary care is delivered through health houses, rural health centres and rural hospitals. In urban and semi-urban areas, primary and secondary care is delivered by rayon and city health centres (replacing the former polyclinics), basic secondary care by central rayon or city hospitals, specialized secondary care by oblast hospitals, and more complex care by national hospitals.

A broad national health strategy has been adopted

The latest National Health Strategy, covering 2021–2030, has established strategic priorities for health system development, many of which involve reforms to existing legislation or practices. Key reform areas include governance, sustainable financing, health workforce strengthening, IT development, and health service quality and accessibility.

The performance of Tajikistan’s health system is hindered by underdeveloped financial protection, poor quality of care, and allocative and technical inefficiencies

The main barrier to accessing health services remains high levels of formal (and informal) OOP payments by patients. Quality of care is another major challenge, affected by factors such as insufficient training, lack of evidence-based clinical guidelines, underuse of generic drugs, outdated facilities and equipment, and perverse financial incentives for physicians. Most health funding from both public and private sources still goes towards inpatient care, leading to limited resources for primary care and poor allocative efficiency. Technical efficiency continues to be hindered by a continued reliance on input-based budgeting. There is no real mechanism for the pooling of funds and no centralized purchasing of services or pharmaceuticals.