“We have witnessed the Covid-19 pandemic stretch the capacity of healthcare systems all over the world. But in countries like Tajikistan it has revealed a system struggling to cope after decades of under-investment and failure to retain enough trained medical staff” Brigitte Dufour, Director of International Partnership for Human Rights (IPHR).
Part of a new series looking at the health systems in Central Asia which aims to highlight issues related to human development in Central Asia impacting on state security in the region, this paper examines the ongoing challenges in the healthcare system in Tajikistan.
“The weaknesses in the medical system are part of a deep and long-standing problem in Tajikistan, one of the poorest countries in Asia, which has seen a significant deterioration in the quality of its healthcare provision in recent decades”, said Sebastien Peyrouse (Central Asia Program, IERES), George Washington University and Member of IPHR
The report explains how difficult working conditions and the excessively low salaries of doctors and nurses discourage young people from entering into the medical profession, fuel pervasive corruption, and provide incentives for doctors to emigrate. Of all the states of the former Soviet Union, Tajikistan invests the least in health, only $ 55 per capita, an amount essentially equivalent to that in Afghanistan.
For several decades, the lack of investment combined with the authoritarian nature of the leadership has had a negative impact on the medical system and has concomitantly undermined the effective communication between the administration, medical staff and civil society that is essential to its improvement. Some of President Rahmon’s decisions appear to have been driven more by political concerns than by medical considerations, as evidenced by the pressure put on doctors early in 2020 not to report Covid-19 cases in the country.
Although undertaking the fundamental reforms necessary to address the challenges facing the health system is the responsibility of the authorities and local stakeholders, international donors could make a real difference in line with the often modest investment capacities of today. The paper recommends some initiatives that could have a direct and positive impact on the local population, including through targeted, smaller assistance programmes and through bolstering the capacity of local civil society.
Download the report here.