Tajikistan paves the way for universal health coverage with strong primary health care

Rafoat Sanginova is a family nurse and over her 34-year career she has witnessed huge improvements in people's health.

"In 1989, when I began my career as a nurse, home births were common, and pregnant women rarely registered at health facilities. There was a high mortality rate among women and children," recalls Rafoat.

Today, much has changed as Tajikistan has oriented its health strategy towards a PHC approach, bringing health care closer to communities. The health facility where Rafoat works is now a model of this PHC approach, offering a range of services in one place close to where people live, including dentistry, non-communicable diseases, and child and maternal health.

"I came to Rudaki District Centre to see my doctor. The doctor helped me. They have all the necessary facilities," says Safarova Manija, a patient who benefits from local primary health care services.

Tajikistan's long-term investment in primary health care (PHC) has significantly reduced maternal and infant mortality rates and the prevalence of various diseases, showcasing a successful journey towards universal health coverage (UHC). As Tajikistan continues to navigate healthcare reform, the emphasis on primary health care remains at the core of its pursuit for a healthier future for its population.

Over 20 years ago, the Government of the Republic of Tajikistan adopted a PHC model based on family medicine and invested in PHC infrastructure and systems, as well as in training and supporting its health workforce.

^{Nurses attend a training session at Rudaki District Primary Healthcare Centre, 28 September 2023. Photo credit: WHO/Mukhsin Abidzhanov}

In 2021, Tajikistan adopted the 'Strategy on Healthcare of the Population of the Republic of Tajikistan for the period to 2030' emphasizing a robust PHC component to accelerate healthcare reform and ensure comprehensive service delivery. Several reforms were implemented including service delivery, financing, integration of vertical programmes, and strengthening the health workforce.

WHO supporting transformation in PHC

WHO, through the UHC Partnership, has collaborated with the Government of Tajikistan since 2016 at multiple stages of policy development, design, and implementation of PHC. In the last 5 years, WHO 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 in Tajikistan.

The UHC Partnership assists over 125 countries in accelerating progress towards UHC through funding provided by the European Union (EU), the Grand Duchy of Luxembourg, Irish Aid, the Government of Japan, the French Ministry for Europe and Foreign Affairs, the United Kingdom Department for International Development, and the Kingdom of Belgium

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