Tajikistan is reforming Major Well being Care to succeed in Common Well being Protection


Tajikistan is remodeling its well being system to speed up progress towards Common Well being Protection (UHC). For the final 20 years, the nation has been endeavor vital reforms to shift in direction of a Major Well being Care (PHC) strategy with a powerful household medication focus conducive to strengthening the well being system to realize its targets of ‘well being for all’. 

Family nurse in a PHC facility in Bokthar, Tajikistan.

Household nurse in a PHC facility in Bokthar, Tajikistan. © Firuza Alieva

Placing PHC on the centre

Tajikistan’s transition from a extremely centralized healthcare system to PHC started with authorized reforms to determine new financing mechanisms to extend well being spending and enhance monetary safety for the inhabitants. The Tajikistan authorities has, in consequence, progressively elevated funding for major care providers, leading to increased authorities well being spending and an total enhance in public well being spending as a proportion of GDP.1Well being financing reforms are underway to offer a extra complete and unified strategy to healthcare financing, fostering a transfer from input-based useful resource allocations to strategic buying of major healthcare providers. Progressively growing public assets accessible for PHC is pivotal to bettering communities’ entry to important healthcare providers.

Enhancing the demand for and entry to major care providers is one other essential side of Tajikistan’s transition. The nation is shifting from a system closely reliant on hospital-based secondary and tertiary care in direction of major care and public well being, growing the portion of their public well being finances allotted to PHC, rising from 34.6% in 2010 to 40.7% in 2022.1 In consequence, the variety of PHC visits per individual has been rising steadily from 4.8 in 2010 to 7.6 in 2022.2 To additional enhance entry to important well being providers, particularly to the poorest and most weak households, Tajikistan can be revising the Fundamental Profit Bundle (BBP), utilizing a phased implementation beginning with precedence teams alongside further co-payment preparations. As of 2021, the BBP covers 33.1% of the Tajikistan inhabitants,2 with ongoing efforts to develop protection and harmonise totally different co-payment and fee-for-service preparations to scale back monetary boundaries to healthcare.

Tajikistan has additionally made strategic investments to enhance the organisation and strengthen the standard of major care providers. These investments are geared toward decreasing the fragmentation of providers by incorporating established vertical well being providers below a unified PHC construction throughout the framework set by the Nationwide PHC Improvement Grasp Plan.  Medical and nursing training adjustments have been applied to bridge human useful resource gaps in household medication docs (FMDs) and nurses (FMNs) to offer important major care providers. The proportion of major healthcare establishments practising household medication rules has elevated from 56% in 2010 to 88% in 2022. Between 2010 and 2022, the variety of docs who’ve had household medication coaching elevated from 271 (4.4%)  to 4597 (82.3%), with the variety of nurses additionally growing from 327 (3%)  to 9669 (73.4%).1

A nurse administers the MR vaccine to a small child sitting on his grandmothers lap in Vanj, Tajikistan.

A nurse administers the MR vaccine to a small little one sitting on his grandmothers lap in Vanj, Tajikistan. ©Judith Sprunken

Accelerating progress via collaboration

Collaboration has been essential in supporting Tajikistan’s PHC reforms. In 2019, Tajikistan joined the SDG3 World Motion Plan for Wholesome Lives and Effectively-being for All (SDG3 GAP) as a pilot nation, specializing in PHC and sustainable well being financing to speed up progress to realize the health-related SDGs. The collaboration includes 13 humanitarian, improvement, and well being companies. These companies and different companions, amongst them USAID, have more and more supported Tajikistan via collaborative approaches that leverage their respective strengths and experience. 

The primary companion coordination platform is the Improvement Coordination Council (DCC) well being. It fosters dialogue, coordination and joint implementation between companions and Tajikistan’s authorities companies. It additionally facilitates data change, agreements on collective outcomes and coordination, in alignment with Tajikistan’s Nationwide Well being Technique 2021-2030. Below its auspices, alternatives for joint advocacy and the event of a typical imaginative and prescient, exemplified by a joint place assertion on strengthening PHC in 2022, are made doable. The assertion was endorsed by all key improvement companions and signed personally by the Minister of Well being of Tajikistan. In September 2023, the Head of the Division of Well being Reforms and Worldwide Relations on the Ministry of Well being introduced the important thing priorities for bettering PHC to SDG3 GAP focal factors via the PHC Accelerator (PHC-A) working group. The dialogue recognized areas to strengthen PHC, akin to revising regulatory paperwork, enhancing administration expertise, implementing a Districts of Excellence PHC mannequin, and modernizing emergency medical providers.

So far, companions from numerous sectors have joined forces to implement Tajikistan’s Nationwide Well being Technique 2021-2030. This collaborative effort includes shared funding and initiatives in direction of PHC reforms. Notably, the Ministry of Finance and the Ministry of Well being and Social Safety, together with the World Financing Facility for Girls, Youngsters, and Adolescents (GFF), have taken a lead function in creating a Prioritized Funding Plan (PIP). This plan, created in shut cooperation with all companions, serves as a roadmap for implementing the 2030 Nationwide Well being Technique. Throughout the PIP, clear particulars concerning the prices of precedence actions and investments have been outlined for the following three years, permitting improvement companions to align their applications and investments within the healthcare sector. Concurrently, the World Financial institution and the GFF are actively supporting a authorities funding plan, spearheaded by Tajikistan’s Ministries of Finance and Well being. This funding plan locations a major emphasis on strengthening PHC and goals to contribute to the targets set forth in Tajikistan’s Nationwide Well being Technique 2021-2030.

Collaboration extends to the joint implementation of PHC reforms as properly. As an example, the European Union (EU)-funded Well being Improvement Program, applied by WHO, UNICEF, and GIZ, is strengthening health-sector governance, financing, and entry to high quality built-in major care providers. WHO, the GFF and the World Financial institution work carefully collectively to help the Authorities in implementing crucial well being financing and repair supply reforms to enhance the effectivity of PHC. WHO is supporting the piloting of strategic buying of PHC providers, whereas the World Financial institution’s new Undertaking, the Tajikistan Millati Solim Undertaking, will scale up these reforms. Additional situations of collaborative efforts embrace UNICEF’s partnership with the Asian Improvement Financial institution for the Maternal and Youngster Well being Integration Undertaking, and the collaboration between the Swiss Authorities and the EU to boost public finance administration.

Monitoring for sustained PHC enchancment

Tajikistan’s journey in direction of its PHC objectives is but confronted with key challenges, notably the necessity for elevated per capita spending for more practical major care, addressing the rising burden of out-of-pocket expenditure, and totally integrating vertical applications into major care. To maintain present momentum in addressing these key challenges, SDG3 GAP companions have piloted a monitoring framework on their joint efforts in international locations together with Tajikistan. This framework goals to  encourage ongoing authorities suggestions, enabling steady enhancements of their coordinated help to authorities to align higher with nationwide priorities, plans and coordination mechanisms and techniques. In 2022, the federal government of Tajikistan reported profitable collaboration practices throughout the nationwide COVID-19 response and companions aligning their help with nationwide plans, with elevated donor funding alignment to  finances priorities. The federal government additionally highlighted companions’ elevated use of native monitoring techniques and improved joint technical help. 

The federal government really helpful additional enhancements of their suggestions, together with enhancing coordination throughout the Ministry of Well being and Social Safety, strengthening the DCC well being platform, and creating a unified useful resource mapping instrument to forestall duplication. In response, companions have launched new coordination mechanisms, together with the brand new technical subgroups, to boost coordination throughout the DCC well being platform. To additional enhance high quality, Tajikistan is utilizing a data-driven strategy to speed up progress in major healthcare and different precedence well being areas, via the WHO Supply for Influence 100-day problem. As a pilot nation on this problem, the federal government of Tajikistan is utilizing information to determine precedence areas and develop joint supply plans, constructing on the collaborative buildings established.

Tajikistan authorities’s sturdy political will and stakeholder collaboration continues to drive progress towards UHC through PHC.

What’s the SDG3 GAP?

The World Motion Plan for Wholesome Lives and Wellbeing for All (SDG3 GAP) is a set of commitments by 13 companies that play vital roles in well being, improvement, and humanitarian responses to assist international locations speed up progress on the health-related SDG targets. The added worth of the SDG3 GAP lies in strengthening collaboration throughout the companies to take joint motion and supply extra coordinated help aligned to nation owned and led nationwide plans and techniques.


References

  1. Tajikistan Ministry of Well being and Social Safety
  2. In the direction of common protection of maternal well being providers in Tajikistan

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