Health care reform has not been a priority in Tajikistan. It does, however, face many similar problems to other former Soviet countries, though greater prosperity will be required before these can be tackled effectively. In the meantime the ‘Somoni’ project has got underway which seeks to develop a national health care policy for the country.²⁷

‘The structure of the present health system has evolved from the Soviet model of health care with so far few structural changes. The state remains the main public funder and provider of health care services in Tajikistan. Private payments, however, are believed to now be larger than public sources of revenue.’ ²⁸

Surayo Mirzoeva states that:

‘Following the disintegration of the USSR and civil war in Tajikistan, there was a disorder of the state system of rendering of free-of-charge medical aid for patients, including rendering of palliative care to incurable patients. According to the World Bank the state pays only 13 % of charges on health care.’²⁹

Tajikistan is not aware of the Council of Europe (2003) report on palliative care (Recommendation 24 of the Committee of Ministers to member states on the organisation of palliative care).³⁰

In 2003, the total per capita expenditure on health care³¹ was Intl $71 (4.4% of GDP).³² 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 Tajikistan 127/191 countries. This composite measure of overall health system attainment³³ 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.