Tajikistan's unwavering commitment to UHC is reflected in its substantial long -term investments in PHC. The proportion of the national health budget allocated to PHC has increased from 34.6% in 2010 to 40.7% in 2022. The Government has constructed and renovated PHC centers, introduced digitization elements, developed over 110 clinical protocols, trained health workers, and improved emergency medical services.

The transformation in PHC is evident as the entire population now has access to and can use health services, including those in remote and rural areas. The share of primary care health facilities operating under the family medicine model rose from 56% in 2010 to 86% in 2023, and the average number of visits to health facilities increased from 4.8 visits per person per year to 7.4 visits per year in the same period.

Training programmes have played a crucial role in strengthening the PHC workforce. 
Over the past 10 years, more than 5 000 doctors and 10 000 nurses have received training at their local PHC centres, eliminating the need to travel to the capital, Dushanbe. Nurses in particular play a key role in managing PHC centres, conducting home visits, and participating in community outreach.

“Today, it has become easier for all medical workers in the district polyclinic. They do not have to go to Dushanbe to attend advanced training courses and new seminars,” says Dr Shahlo Rahimova, who benefitted from the training.

These investments in PHC have not only improved the infrastructure and capacity of the healthcare system but also led to tangible health outcomes, including reduced mortality rates and the prevalence of diseases. The maternal mortality rate decreased from 68 per 100 000 live births in 2000 to 16.63 in 2020, and the infant mortality rate decreased from 36 to 28 between 2011 and 2021. The prioritization of PHC has also contributed to achieving high immunization coverage rates. In 2022, for example, 97% of children under one year received a third dose of pentavalent vaccine. WHO declared Tajikistan polio-free in 2002, and malaria-free in 2023.

"The funding for primary health care has increased tenfold. 80% of primary health care facilities are now equipped with modern medical equipment. As a result, the maternal and child mortality rate and the number of infectious and non-infectious diseases have decreased nationwide," said Dr. Ilkhom Bandaev, Head of the Department of Reforms, PHC, and International Relations of the Ministry of Health and Social Protection of the Population of the Republic of Tajikistan.

However, despite these advancements, overall health spending per capita remains low, and out-of-pocket expenditures are still substantially high. This underscores the critical need for continued prioritization and increased investment in health and PHC to achieve sustainable and significant health outcomes for the population.
 

In the last 5 years, WHO, through the UHC Partnership, has supported the Government in developing national health workforce strategies informed by comprehensive health labour market analyses. These strategies aim to address critical issues such as health worker availability and the quality of medical and nursing education.

WHO also facilitated policy dialogues and capacity-building initiatives to enhance strategic purchasing and resource mobilization. This has contributed to the creation of a political consensus on health financing reforms and strengthening the Basic Health Benefit Package at the national level.

Improving PHC services has been a key focus, with WHO assisting in developing a new national PHC plan. This plan addresses service delivery bottlenecks and strengthens partner commitment and coordination. Efforts include transforming per capita funding into a payment mechanism for PHC and improving PHC reporting forms to create an integrated information system for health financing reform.

WHO also played a crucial role in strengthening the strategic collaboration of health development partners in Tajikistan. WHO’s leadership has significantly enhanced the Development Coordination Council on health, facilitating regular information exchange and aligning projects and programmes to improve health and well-being in the country.

“Over the past decades, Tajikistan has made great strides to make essential healthcare and services more accessible to the population. WHO will continue to support Tajikistan to prioritize primary health care as this is a fundamental necessity for building resilient and equitable societies," says Dr Victor Olsavszky, WHO Representative to Tajikistan.  

Commitment to enhance the health system and achieve UHC

 

As Tajikistan looks to the future, the commitment to enhancing its healthcare system remains steadfast. WHO continues to play a pivotal role in supporting the country's efforts to implement reforms that will further improve governance, financing, and the delivery of healthcare services, with a strong emphasis on primary health care.

Key focus areas include increasing financial protection for the population, promoting innovation and technology to strengthen service delivery, expanding the scope of PHC practice, and further strengthening the role of family doctors and family nurses, and raising the prestige of primary health care among the health workforce. By investing in the development and training of healthcare professionals and strengthening PHC infrastructure, Tajikistan is laying the foundation for a more resilient and capable healthcare system.