Review of Public Health Expenditure in the Republic of Tajikistan : Discussion Paper
This Public Expenditure Review updates previous assessments of the levels and efficiency of health financing in Tajikistan and its consequences for healthcare access and health of the Tajik population. Funding for the public healthcare system which...
| Main Authors: | , , , |
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| Format: | Working Paper |
| Language: | English |
| Published: |
World Bank, Washington, DC
2021
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| Subjects: | |
| Online Access: | http://documents.worldbank.org/curated/en/139391628147971743/Discussion-Paper http://hdl.handle.net/10986/36125 |
| Summary: | This Public Expenditure Review updates
previous assessments of the levels and efficiency of health
financing in Tajikistan and its consequences for healthcare
access and health of the Tajik population. Funding for the
public healthcare system which provides almost all
healthcare remains far short of levels required to provide a
universal basic benefit package. As a result, household
out-of-pocket payments account for most healthcare spending
in the country, and Tajiks frequently forgo needed care for
financial reasons. The underfunding of public healthcare in
part results from an overall lack of public revenues. It is,
however, exacerbated by the health sector enjoying limited
priority, with a health share in total government spending
far below internationally recognized targets. Inefficiencies
in the spending of the limited public funds further
undermine the system’s ability to provide the population
with basic healthcare of appropriate quality. Despite
efforts in the past two decades to introduce elements of
strategic purchasing and direct a higher share of funding
towards primary care, public health financing in Tajikistan
still largely follows the centrally planned,
hospital-focused, and mainly input-financed Semashko model.
The result are substantial regional inequalities in per
capita government health spending which reflect differences
in health facility and health worker densities rather than
healthcare need, a continued overemphasis on hospital and
specialist care, and an inability of facility managers to
take efficiency-oriented staffing decisions. Key
recommendation to address these shortcoming are that a
substantially higher share of public revenues be allocated
to the health sector, that an independent, single payer
organization, a fully-fledged capitation mechanism for
primary care and elements of strategic purchasing for
inpatient care be gradually introduced, and that current
benefit packages are revised and extended to achieve more
rational and equitable healthcare utilization. Broad
consensus building among stakeholders will be essential for
the success of such reforms. |
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