Health services management is undertaken at 2 levels: the Ministry of Health and Medical Industry and the velayat (region) health administrations. As elsewhere in the region, there have been several reorganizations of the health ministry over a short period of time post-transition. Management of the health care system continues to be bureaucratic and hierarchical, with restricted flexibility and adherence to established norms determined centrally. The health care system is mainly funded (about 90 per cent) from national state government revenues. A voluntary health insurance scheme was introduced in 1996, which the following year contributed about 7 per cent of total health care expenditures. Discussion is underway on the idea of a compulsory health insurance scheme and the extent of user charges (fees for services have been introduced incrementally since independence.¹⁸ Health Care Systems in Transition (2000) suggests that: ‘Informal payments are widespread, but difficult to quantify.’¹⁹

Since 1991, the Turkmen government has made drastic cutbacks in the healthcare system while discouraging the compilation and distribution of data that could help contain the spread of deadly diseases. Public health conditions in Turkmenistan could be described as alarming, and most signs point to the continuing decay of the quality of life in the country. In 2004, President Niyazov ordered the dismissals of an estimated 15,000 health care workers, replacing skilled professionals in most instances with military conscripts. In February of 2005, Niyazov suggested closing all hospitals outside of the capital Ashgabat.²⁰

In 2003, the total per capita expenditure on health care²¹ was Intl $221 (3.9% of GDP).²² 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 Turkmenistan 130/191 countries. This composite measure of overall health system attainment²³ 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.