The Alarming State of the Healthcare System in Tajikistan

By Sebastien Peyrouse
Central Asia Program, IERES, George Washington University
Member of International Partnership for Human Rights (IPHR)

Published by International Partnership for Human Rights (IPHR)

Health and healthcare are central to human security, while poor health is intrinsically linked
to poverty and under-development. This paper is part of a 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 first paper, which is based on internal research and
interviews, also provides recommendations for how the international community could contribute
to meeting the healthcare challenges in Tajikistan.

The Covid-19 crisis has highlighted shortcomings in healthcare systems around the world,
including the unpreparedness of medical facilities and professionals for a pandemic
situation. In some states, however, the medical system’s shortcomings are part of a much
deeper and long-standing problem. This is the case in Tajikistan, one of the poorest
countries in Asia, which lacks a sufficient number of medical facilities to serve the 9.5 million
population and where those that do exist are in poor shape. Moreover, the country has seen
a significant deterioration in the number and quality of its health professionals over the last
two decades. 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 more than 30 years,
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. Instead, 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. Despite the undeniable complexity of providing assistance to authoritarian regimes,
some initiatives could provide concrete support and 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.