A new report from WHO/Europe titled “Primary health care financing: a situation assessment and policy options for Tajikistan” offers a detailed analysis of the current state of primary health care (PHC) in the country. Tajikistan is in the process of implementing ambitious health system reforms, including strengthening of its PHC system, to advance towards universal health coverage (UHC). The report presents a comprehensive set of recommended actions to guide reforms and improve the quality and efficiency of the PHC system for everyone, highlighting how more efficient health financing can accelerate this progress.
Strengthening PHC as the foundation of a stronger health system is at the heart of Tajikistan’s National Health Strategy 2021–2030. The overarching goal is to ensure affordable access to quality health services. With funding from the European Union (EU), WHO is providing substantial, ongoing support to reinforce every component of the country’s health system.
While progress has been made in recent years, including increased government spending on health, per-capita public spending on PHC in Tajikistan remains among the lowest in the WHO European Region. The service delivery system continues to face structural and resource-related constraints, including a growing shortage of family doctors, which threatens the availability and continuity of PHC services.
Guiding the PHC financing reforms in Tajikistan
The findings and recommended actions presented in the report are based on detailed policy and data analysis, in-depth interviews and consultations with key stakeholders from the Ministry of Health and Social Protection, the Ministry of Finance, regional health and financing departments and heads of PHC facilities, as well as a review of legislation and official national statistics.
Tajikistan’s PHC system, rooted in the family medicine model, operates through a network of 88 district and city health centres, offering free basic services to all and specific protections for vulnerable groups. However, service delivery continues to face structural and financial challenges:
- a narrow benefits package that excludes many services for noncommunicable diseases (NCDs), outpatient medicines and diagnostics;
- high levels of out-of-pocket expenditures: catastrophic health spending affecting nearly 1 in 5 households;
- fragmented and underresourced financing, with most local PHC budgets absorbed by salaries, leaving little for essential medicines and equipment;
- ambiguity between the roles of family doctors and specialists, leading to inefficiencies and weakened care continuity;
- parallel vertical disease programmes that duplicate services, fragment care and strain resources; and
- a declining number of family doctors, particularly in rural areas, due to limited incentives and low recruitment.
To address these challenges, the report sets policy recommendations for strengthening PHC in Tajikistan, with a focus on 4 key priority areas.
- Strengthen PHC service delivery by setting a clear national vision, integrating vertical programmes into district and city health centres, clarifying care pathways between generalists and specialists and expanding training and incentives for PHC providers.
- Revise the benefits package to better reflect population health needs, especially for NCDs, by improving coverage of essential outpatient medicines and diagnostics and enhancing exemption mechanisms and targeted policies to reduce high out-of-pocket payments, including informal ones.
- Implement new financing arrangements for PHC services by pooling funds and introducing strategic purchasing arrangements, including capitation-based payments linked to service contracts, improved financial management and the establishment of a dedicated purchasing function.
- Increase government spending on PHC, prioritizing it in budget planning while improving transparency and monitoring of PHC-specific expenditures.
WHO/Europe also recommends pooling PHC funds at the regional and eventually national level to reduce inequities and improve efficiency. Piloting these reforms in selected regions can help to build evidence and inform a broader nationwide scale-up.
Milestones in the health system reforms
The report on PHC financing in Tajikistan offers key insights into the country’s ongoing health system reforms. Over the past decade, WHO has worked closely with the Government of Tajikistan to modernize the health system, aiming to improve the population’s access to safe, quality health services while preventing impoverishing or catastrophic health spending.
A major milestone in these reforms is the implementation of an innovative UHC pilot, launched in 2025 in Sughd oblast in northern Tajikistan. With support from the EU, WHO assisted in designing this pilot to address inefficiencies in financing and service delivery. The pilot introduces new mechanisms such as strategic purchasing and fund pooling to improve the efficiency of the health system, increase service availability, reduce out-of-pocket payments for essential health services and raise awareness of health-care entitlements. This groundbreaking initiative underscores the commitment of the Government of Tajikistan to advance towards UHC by prioritizing financing for PHC. It demonstrates that PHC is the cornerstone of a modern health system and lays the foundation for broader, nationwide health financing reforms.
Another significant achievement supporting Tajikistan’s progress towards a stronger PHC system is the WHO Winter School, which recently marked its fifth edition. The Winter School has become an essential initiative for advancing health system reforms in Tajikistan. Over the past 5 years, it has fostered cross-sectoral collaboration by offering a platform for key stakeholders from diverse sectors to come together and share knowledge, discuss challenges and develop innovative solutions. Organized by WHO with funding from the EU and the UHC Partnership, the Winter School continues to build Tajikistan’s capacity to deliver equitable and affordable health care. It serves as an important model for other low- and middle-income countries pursuing UHC.
As Tajikistan continues to advance its health reforms, this report provides a roadmap to strengthen PHC financing and service delivery, enhance financial protection and ensure equitable access to essential health services for all.
You can explore more data and analysis on Tajikistan on “UHC watch”, a digital platform tracking progress on affordable access to health care in Europe and central Asia.