Progress towards health reform in Tajikistan.
OBJECTIVE
The purpose of this paper is to provide an up-to-date overview of Tajikistan's health system, focusing on the main factors affecting health systems development. The wider contextual environment is to be explored, focusing on political, social and economic issues. Different elements of the health system including health policy, governance, service delivery, human resources and health financing are reviewed in the light of their development over the past decade.


METHODS
The paper shows that the Republic of Tajikistan is in transition. Formerly one of the most neglected republics within the USSR, the country became independent in 1990 and faced the civil conflict shortly thereafter. In the last few years there have been major public sector reforms with health reforms formally launched in the late 1990s. Little information about current Tajikistan is widely available.


RESULTS
The paper finds that the progress of health reforms in Tajikistan has been relatively slow compared with neighbouring Kazakhstan and Kyrgyzstan. This is largely due to the effects of civil war in the mid-1990s and significant out-migration of qualified experts, but it can also be attributed to an inability of central government to adequately adapt to the requirements of transition.


CONCLUSIONS
The paper shows that many problems are still to be overcome by the health system, ranging from operational issues related to service delivery to strategic issues such as formulating an explicit privatisation policy, reducing fragmentation of, and aligning, external aid. However, some recent developments, such as adoption of a country health reform conception, a health financing strategy, and willingness of central government to improve coordination, suggest that improvements are possible.
University of Leeds, Leeds, UK. t.mirzoev@leeds.ac.uk
Tolib N
TN
Mirzoev
Andrew T
AT
Green
James N
JN
Newell
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003695:Delivery of Health Care / Q000458:organization & administration*; D005260:Female; D018166:Health Care Reform / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D013620:Tajikistan