DUSHANBE, May 30, 2013, Asia-Plus Health indicators in Tajikistan are among the lowest in the Europe and Central Asia (ECA) region; however, some key indicators, such as the infant mortality rate, decreased from 65 per 1,000 live births in 2005 (UNICEF) to 34 per 1,000 live births in 2012 (Tajikistan Demographic and Health Survey), the World Bank’s
Tajikistan Partnership Snapshot
reports.
According to the report, the overall under-5 mortality rate for the period 2008–12 is 43 per 1,000. Total health expenditure has reportedly been quite stable over the past decade, ranging from 4.6 to 5.3 percent of GDP, which is now comparable to other countries in the region. However, the proportion of health spending provided by public funds is still the lowest and, conversely, the proportion of out-of-pocket health spending is higher than in many comparator countries in the ECA region, which raises concerns about equity of access.
The report notes that there is inefficiency in the production of health care and the allocation of resources. The health sector is characterized by poor health outcomes, misallocation of staff and other resources, inefficient production of care, and hospital overcapacities. The provider payment system worsened the problem of excess capacity, as it is based on the number of hospital beds. These are unequally distributed between urban and rural areas, resulting in inequity of access. A lack of pooling of health funds has contributed to geographic divisions and underfunding, which hamper the efficient use of resources and pose a threat to access to care for low-income groups, particularly in rural areas, the report says.
The Bank is one of the largest development partners and has the longest history of engagement supporting the health sector in Tajikistan. The first Primary Health Care Project (2000–05) introduced a model of health care delivery based on primary care and the construction of 25 rural health facilities. The subsequent project, the Community and Basic Health Project (2006–12), co-financed by the Swedish International Development Agency and the Swiss Development Cooperation, aimed to increase access to, utilization of, and patient satisfaction with health services in project-supported areas, and to build capacity and efficiency at national, oblast, and rayon (district) levels in administering a basic package of health benefits. Significantly, it also introduced financing reforms in primary health care (PHC). The Bank has since 2011 also been supporting the Ministry of Health in the implementation of community-based activities aimed at addressing the high rates of childhood malnutrition observed in the Khatlon province. This project (2010–13) is being implemented with the support of a Japanese Social Development Fund grant. The Bank is currently working with the Government to prepare a new health project focused on linking payment to performance for PHC facilities, and continuing to build capacity for improved quality of PHC services through training and facility rehabilitation.
