The health care system in Azerbaijan continues to function in the Soviet-style, although several private clinics have opened and the government has partially switched to paid health care. Generally it is a state-subsidized sector, with a little-developed insurance system. Since the collapse of the Soviet Union, the efficiency of the medical care has undergone deterioration, especially at the primary level. Issues such as quality and access to medical services have become a subject for concern.²⁷ It is estimated that ‘most patients in Azerbaijan (78% in 1999) have to make “informal” payments both in money and in food, especially in rural areas.’²⁸

The problems of the health care system in Azerbaijan since the end of communism have been listed as:

• Lack of funding due to economic collapse;
• Lack of management capacity in-country as, historically, all decisions had been taken previously in Moscow;
• Failure to adapt to limited resources and to reduce overcapacity in accordance with agreed priorities;
• Disruption of the former soviet health network and the system of medical supplies;
• Weaknesses in primary health care;
• Low population coverage in the national transition;
• Disappearance of health promotion programmes.²⁹

In 2003, the total per capita expenditure on health care³⁰ was Intl $140 (3.6% of GDP).³¹ Among the Commonwealth of Independent States, this figure falls within a spending range of Intl $ 71 in Tajikistan (4.4 % of GDP) and Intl $570 in Belarus (6.4% of GDP). At 3.5%, the smallest spending as a percentage of GDP is in Kazakhstan (Tables 5 and 6).

The WHO overall health system performance score places Azerbaijan 103/191 countries. This composite measure of overall health system attainment³² is based on a country’s goals relating to health, responsiveness, and fairness in financing. The measure varies widely across countries and is highly correlated with general levels of human development as captured in the human development index.