tajik health sector overview

WHO/Europe Country Office, Tajikistan

Tajik health sector overviewTajik health sector overview

PrincipalsPrincipals’’

Group MeetingGroup MeetingDushanbe, 13 Dec 2007Dushanbe, 13 Dec 2007

Dr. Santino SeveroniDr. Santino SeveroniWHO Country OfficeWHO Country Office


ContextContextIndicatorIndicator SourceSource

PopulationPopulation 6,992,1006,992,100 MedStatMedStat

20062006

Population birth ratePopulation birth rate 3.533.53 WHO Health for All, 2005WHO Health for All, 2005

Poverty ratePoverty rate 64%64% World Bank, 2003World Bank, 2003

GNI per capitaGNI per capita 390 USD390 USD World Bank, 2007World Bank, 2007

GDPGDP 3.588 m USD3.588 m USD 20072007

Total health expenditure Total health expenditure as % of GDPas % of GDP

1.1%1.1% WHO Health for All, 2006WHO Health for All, 2006

Per capita health Per capita health expenditureexpenditure

16 USD16 USD WHO Health for All, 2005WHO Health for All, 2005


Health expenditure as % of GDPHealth expenditure as % of GDP

0

2

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8

10

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Den

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Nor

way

Mal

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Uni

ted

King

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Spai

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Serb

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Isra

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Turk

ey

Finl

and

Irela

nd

Slov

akia

TFYR

Mac

edon

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epub

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4 or

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Uzb

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Kyrg

yzst

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Alba

nia

Kaza

khst

an

Tajik

ista

n

WHO Regional Office for Europe 2007

EU Average

Tajikistan


Health care infrastructureHealth care infrastructure

IndicatorIndicator TajikistanTajikistan SourceSource EU EU averageaverage

Number of hospitalsNumber of hospitals 360360 MoHMoH, 2006, 2006

Number of primary health care unitsNumber of primary health care units 24132413 MoHMoH, 2006, 2006

Hospital beds per 1000 peopleHospital beds per 1000 people 5.85.8 MoHMoH, 2006, 2006 4.24.2

Physicians per 10000Physicians per 10000 18.818.8 MedStatMedStat, 2006, 2006 3535

Nurses per 10000Nurses per 10000 41.241.2 MohMoh, 2006, 2006 7272

Acute care hospital admissions per Acute care hospital admissions per 100.000100.000

105.8105.8 MedStatMedStat, 2006, 2006 1750017500

Number of annual average contacts/ Number of annual average contacts/ visits per person with PHCvisits per person with PHC

44 MedStatMedStat, 2006, 2006


Mother and child careMother and child care

IndicatorIndicator TajikistanTajikistan SourceSource EUEU

Infant mortality rateInfant mortality rate 65 per 1000 life 65 per 1000 life birthsbirths

MICS, MICS, GoskomstatGoskomstat/UNICEF 2005/UNICEF 2005

4.8 per 1000 life 4.8 per 1000 life birthsbirths

Under 5 mortality rateUnder 5 mortality rate 79 per 1000 life 79 per 1000 life birthsbirths

MICS, MICS, GoskomstatGoskomstat/UNICEF 2005/UNICEF 2005

Contraceptive Contraceptive coveragecoverage

38%38% MICS, MICS, GoskomstatGoskomstat/UNICEF 2005/UNICEF 2005

75%75%

Maternal mortality per Maternal mortality per 100,000 live births100,000 live births

33.233.2 MedStatMedStat

20062006

7.17.1120120 MICS/UNICEF 2005MICS/UNICEF 2005

Abortions per 1000 live Abortions per 1000 live birthsbirths

54.3954.39 WHO, Health for all, 2006WHO, Health for all, 2006

166166 WHO/UNFPA 2007WHO/UNFPA 2007


Disease burden in TajikistanDisease burden in Tajikistan

IndicatorIndicator SourceSourceTuberculosis (cases Tuberculosis (cases registered)registered)

44.7 cases per 44.7 cases per 100,000100,000

WHO Health for All, 2006WHO Health for All, 2006

Tuberculosis mortality Tuberculosis mortality raterate

7.2 deaths per 7.2 deaths per 100,000100,000

Rep TB Center, 2006Rep TB Center, 2006

Malaria cases per yearMalaria cases per year 596 596 (up to October)(up to October)

MoHMoH, 2007, 2007

Number of people Number of people infected with HIVinfected with HIV

872872 MoHMoH, 2007, 2007


Main infectious diseases Main infectious diseases outbreaks in 2007outbreaks in 2007

FayzabadFayzabad (RRS):(RRS): LeptospirosisLeptospirosisKulyabKulyab ((KhatlonKhatlon):): TyphoidTyphoid


Draft health system strategy map for the Tajik Draft health system strategy map for the Tajik health systemhealth system

Improve quality andrelevance of information

for decision-making,monitoring and

assessment

Increase efficiencyand effectiveness

in use of resourcesincluding through

health systemfinancing and

payment systemsfor providers

Increase and improvehealth system capacity &

resources invested inhealth

Influence broaderdeterminants of healththrough advocacy and

inter-sectoral action

Improve healthybehaviors, health

promotion and diseaseprevention

Improve effectiveness,efficiency and quality

of health servicesImprove clinical

outcomes

Improve the healthstatus of the Tajik

population

Improve access tosafe essential drugsand health services

Shift the deliverysystem towards a

Primary Health CareBased System

Improve equity of thehealth system and

especially coverageand access of poorest

populations

Refocus the Ministry ofHealth on its leadership

and policy-makingfunction

Modernize andrationalize thehospital sector


Health reform in Tajikistan: Health reform in Tajikistan: immediate goalsimmediate goals

equity in accessequity in accesspersonal affordability for allpersonal affordability for allsustainability of servicessustainability of services


Health reform in Tajikistan, Health reform in Tajikistan, new challenges:new challenges:

increasing financial barriers to health care increasing financial barriers to health care low demand by the population for qualitylow demand by the population for qualitylow personal responsibility for health low personal responsibility for health vague long term reforms agendavague long term reforms agendahuman capacity building: quantity vs. qualityhuman capacity building: quantity vs. qualityhuman resources vs. infrastructurehuman resources vs. infrastructuredrugs and consumables: availability vs. qualitydrugs and consumables: availability vs. qualitywho will design, plan, and implement reforms?who will design, plan, and implement reforms?


Where do patients pay Where do patients pay and for what? and for what? Patients pay everywherePatients pay everywhere

––

in allin all

districtsdistricts

and for all servicesand for all services, , starting from starting from ambulance careambulance care

((on averageon average

13 13 somonisomoni), ),

to hospitalization and cleaning services.to hospitalization and cleaning services.

GBP GBP baselinebaseline survey 2007, Panoramasurvey 2007, Panorama


Average total expenditures for health care Average total expenditures for health care (inpatient care)(inpatient care)

InIn10 10 districts on averagedistricts on average

––

130 130 somonisomoniIn pilot districtsIn pilot districts::

highest amounthighest amount

––

DangaraDangara

171 171 somonisomonilowest amountlowest amount

––

RashtRasht

92 92 somonisomoni

In control districtsIn control districts::highest amounthighest amount

––

DjDj..

RasulovRasulov

155 155 somsom

lowest amountlowest amount

––

AiniAini

59 59 somonisomoniGBP GBP baselinebaseline survey 2007, Panoramasurvey 2007, Panorama


How much do people pay when attending How much do people pay when attending an outpatient health care facility?an outpatient health care facility?

Pilot districtsPilot districtsRashtRasht

––

2727..1 1 somsom. . DangaraDangara

––

5151..55

somsom..TursunTursun--ZadeZade

––

2828..4 4 somsom..SpitamenSpitamen

––

4141..0 0 somsom..

NonNon--project districts for comparisonproject districts for comparisonFayzabadFayzabad

––

2424..4 4 somsom. . KhurosonKhuroson

––

3232..1 1 somsom. . GissarGissar

––

2525..4 4 somsom. . DjDj. . RasulovRasulov

––

5858..66

somsom..


NonNon--pilot districtspilot districtsAiniAini

--

16,7 16,7 somonisomoni

NurekNurek

--

19,7 19,7 somonisomoni


Health reform in Tajikistan, new Health reform in Tajikistan, new challenges: low population demand challenges: low population demand for qualityfor quality

SatisfiedSatisfied with health care:with health care:

Pilot districtsPilot districtsFrom From 76% (76% (TursunTursun--ZadeZade) ) up toup to

94% (94% (DangaraDangara) )

Control districtsControl districtsFromFrom

80% (80% (KhurosonKhuroson) ) up toup to

97% (97% (AiniAini))



Health reform in Tajikistan, new Health reform in Tajikistan, new challenges: Low population demand for qualitychallenges: Low population demand for quality

Were you confident in Were you confident in competence of competence of health personnelhealth personnel’’? ?

YesYes –– 98,1%98,1%

NoNo –– 1,9%1,9%


98,1

1,9

да нет


Current organizationCurrent organization

TertiaryCare

Republican Centres

and diagnostic centres(laboratories)

PRESIDENT

PRESIDENTIAL OFFICE

Health Representative

Ministry of Health

RRSRegional (Oblast) level Care

Med Houses

Primary Health CareMHC

Secondary CareHospitals

Kathlon Sugd GBAO

District level Care


Who will design, plan, Who will design, plan, and implement reforms?and implement reforms?

Administrative department

MINISTER OF HEALTHAbdurakhmanova

Ranokhon

First Deputy Minister

Human resource and

science department

Statistics

Deputy Minister

Head of Reform

planning,

International relations

department

Deputy Minister

Management of medical service

organization, Primary and Secondary

(hospitals) Care; TB

Emergency situation and emergency medical aid department

Pharmaceutical and medical equipment department

Economy and finance

planning management

Mother and child health care

Service organization department

Sanitary …epidemiological

department

HIV/AIDS; Malaria; Healthy life style

GF PIU on

HIV/AIDS

Malaria

GF PIU on TB

WB PIU Statistics

)

total number of staff at the MoH

52


Health reform in Health reform in Tajikistan: Tajikistan: prioritization of investments. Is the prioritization of investments. Is the current approach rational?current approach rational?Externally financed projects in the Tajik health Externally financed projects in the Tajik health

sector in 2006: an analysis by the WHO Country sector in 2006: an analysis by the WHO Country Office, December 2007.Office, December 2007.

Main results Main results


Main findings of the inventoryMain findings of the inventory

97 projects identified in the health sector97 projects identified in the health sector33 different donors33 different donors39 agencies as the main implementers39 agencies as the main implementersUS $ 136 002 353 was allocated to the 97 US $ 136 002 353 was allocated to the 97 projects between 2002 and 2010projects between 2002 and 2010In 2006, on average over US $31 million In 2006, on average over US $31 million was spent.was spent.

WHO/Europe Country Office, TajikistanTime range of 97 projects analyzed

0

5,000,000

10,000,000

15,000,000

20,000,000

25,000,000

30,000,000

35,000,000

2002 2003 2004 2005 2006 2007 2008 2009 20100

20

40

60

80

100

120

Average budget Number of projects

Average budget per year Number of projects


2 Loans: 18,005,000 USD (13%)

95 Grants: 117,997,353 USD(87%)

Total contribution to the Tajik health sector:

US$ 136 002 353 through 97 externally funded projects.

Type of funds distributedType of funds distributed


US$ 131

506 712

US$ 4 495 641

Humanitarian

3%

Development

97%

Distribution of funds by project aimDistribution of funds by project aim


Primary health care22,716,708

17%

Secondary and hospitals35,255,098

26%

Public Health22,148,750

16%

Institution building28,470,022

21%

Community health27,411,775

20%

Distribution of externally funded projects Distribution of externally funded projects by area of workby area of work


Distribution of externally funded projects Distribution of externally funded projects by componentby component

Equipment 14%

Civil work 7%

Drugs & Supplies 12%

Other 3%Technical assistance 27%

Training 37%

WHO/Europe Country Office, TajikistanTechnical Technical assistanceassistance TrainingTraining Civil workCivil work EquipmentEquipment Drugs & Drugs &

SuppliesSupplies OtherOther TotalTotal

Primary health carePrimary health care

ProjectsProjects 2020 3939 99 1515 2929 33

BudgetBudget 3 854 7883 854 788 7 153 6037 153 603 3 502 5933 502 593 2 845 5332 845 533 4 743 5244 743 524 616 667616 667 22 716 70822 716 708

Secondary and hospitalsSecondary and hospitals


BudgetBudget 4 712 2804 712 280 11 512 94711 512 947 5 206 4765 206 476 9 893 0139 893 013 3 375 5723 375 572 554 810554 810 35 255 09835 255 098

Community healthCommunity health


BudgetBudget 3 381 8203 381 820 18 157 87818 157 878 657 614657 614 1 006 9271 006 927 3 056 3393 056 339 1 151 1981 151 198 27 411 77527 411 775

Public HealthPublic Health


BudgetBudget 9 215 2339 215 233 6 702 7696 702 769 318 750318 750 2 196 0532 196 053 3 140 9803 140 980 574 966574 966 22 148 75022 148 750

Institution buildingInstitution building


BudgetBudget 15 292 74715 292 747 7 241 8077 241 807 300 000300 000 2 629 1282 629 128 1 335 4721 335 472 1 670 8671 670 867 28 470 02228 470 022

Total budgetTotal budget 36 456 86936 456 869 50 769 00450 769 004 9 985 4339 985 433 18 570 65318 570 653 15 651 88715 651 887 4 568 5074 568 507 136 002 353136 002 353

Areas of work

Components


Health sector reform in Tajikistan: Health sector reform in Tajikistan: some thoughts for the futuresome thoughts for the future

COORDINATIONCOORDINATION

Country ownership of the coordination and overall reformsCountry ownership of the coordination and overall reformsPrioritization of investmentsPrioritization of investmentsLinking strategies with the existing capacities/resourcesLinking strategies with the existing capacities/resourcesLong term donor commitment Long term donor commitment Apply the principles of the Joint Country Support Strategy in moApply the principles of the Joint Country Support Strategy in moving ving towards a sectortowards a sector--wide approach to programming wide approach to programming Prioritization of public health, food, blood, environmental safePrioritization of public health, food, blood, environmental safety ty issuesissuesRegional integrationRegional integration

WHO/Europe Country Office, TajikistanPRESIDENT

PRESIDENTIAL OFFICE

Project Implementation Units

International aid flowing

directly to the GoT

Government PrinciplesNDS/PRSP

Donor Coordination

CouncilNDS/PRSP

Sector Coordination MeetingJC

SS

Gro

up

Ministries

Dialogue on strategiesMoney flows

Bilateral meetings Donor/Ministry

Ground of implementation

Working groups


1

Enhances Tajikistan’s ability to fulfil all its ambitions

i.e. achieving MDG

fighting corruption PRSP

…

Gives more control over investment funding

Provides consistent, consolidated advice

2

Reduces wasteful use of donor’s funds

Planned, prioritized investments

No duplication, correct sequencing

Why is donor coordination important?Why is donor coordination important?


including:

• national priorities through sectorial and territorial strategies

• link between all national long-term development frameworks including Millennium Development Goals, regional integration, etc.

Cooperation FrameworkCooperation Framework

National Development Strategy (NDS)/Poverty Reduction Strategy Paper (PRSP)


Donors Government of Tajikistan Cooperating

Collaborating

Concentrating

Redistributing

Supporting government priorities, using government

structures and systems

Administering

Monitoring

Evaluating

Procuring

Auditing

Strategizing

Prioritizing and programming

Designing and costing


Future visionFuture vision


To align external assistance along the NDS/PRSP in order to avoid overlapping and gaps

Harmonize all partners programming, financing and reporting

Provide a connection between the NDS/PRSP and the MTBF to ensure that all national priorities are funded

Partners’ coordination is not an end in itself or a separate function

It is rather an operational function, integrated into the government’s economic management

Why fit into a coordination framework?Why fit into a coordination framework?


Partnership mechanisms at country levelPartnership mechanisms at country levelN

DS

/PR

SP

Heads of embassies, United Nations agencies, aid agencies

Partner Technical

secretariat

Partner Technical

secretariat

Partner Technical

secretariat

Social economic develop.

Agriculture, rural development

Education

Energy

Health

Natural resources management

Water and sanitation

Transportation

Private sector development

Social protection

Tourism

Telecommunication

…

Public administration reform, anti-corruptionLocal governance decentralization and urban development

Civil societyDisaster management

…

Police border managementAsylum and migration, anti-traffickingLegal/judiciary/penal reformDefence/security…

Partner Technical

secretariat

Rule of law and security

Parliament electionsMedia and human rightsLand and property issuesMinorities…

Democratization & Human rights

Governance and capacity

building

Government joint technical

secretariat

Ministry

of

Health

President’s Office Prime Minister’s office Ministry of Finance State Committee on Property and Foreign

Investment and others

HEALTH COMPONENTS


Conclusions/Conclusions/ recommendationsrecommendations

The health system faces complex problems. The health system faces complex problems. It is crucial to coordinate activities to achieve the It is crucial to coordinate activities to achieve the health systemhealth system’’s goals.s goals.Shifting and prioritizing the coordination Shifting and prioritizing the coordination mechanisms is needed at government level. mechanisms is needed at government level. Continuous and consistent support of the Continuous and consistent support of the strategic areas in health is needed for strategic areas in health is needed for immediate better health services provision.immediate better health services provision.

tajik health sector overview

Documents