Reforms to modernize health financing and governance in Tajikistan are being tested as part of a universal health coverage (UHC) pilot in the north of the country. The pilot, which launched in January 2025, has received presidential approval and is being implemented in Sughd region. The initiative paves the way for a nationwide scaling-up of the reforms, which are designed to deliver real, measurable improvements that matter to people, and to the health system as a whole. Funded by the European Union (EU) and the Universal Health Coverage Partnership (UHC-P) and supported by WHO, these reforms improve both the availability and the affordability of essential health services in the country.
Early data and testimonies from the pilot initiative indicate that facilities exercising new budgetary autonomy have begun streamlining procurement of essential medicines, investing in services which meet the specific community needs, and attracting and motivating much needed primary health care nurses and doctors. Districts with pooled budgets report more balanced distribution of resources across health facilities.
“This pilot is not just about new health financing mechanisms, it’s about people in Tajikistan getting the care they need without financial hardship,” said Dr Victor Olsavszky, WHO Representative in Tajikistan. “We’re already seeing encouraging signs that these changes can strengthen health service delivery on the ground.”
Financing reforms to improve access to health
Tajikistan is the poorest country in the WHO European Region. In absolute terms, government spending on health remains low, and the heavy reliance on out-of-pocket payments undermines financial protection, particularly for low-income and vulnerable groups. An estimated 1 in 5 households face catastrophic health expenses annually, pushing them below or further below the poverty line.
Under the current National Health Strategy, the government of Tajikistan is committed to achieving UHC for the population by 2030. UHC ensures everyone has access to essential health services and is protected from financial hardship. Strengthening primary health care is key to achieving this goal, to make preventative and curative health services more accessible to the population, manage services more efficiently and make more effective use of available resources.
The UHC pilot in Sughd region contributes to this objective by testing new financing mechanisms. By combining targeted financing and governance reforms, these reforms demonstrate a scalable path towards UHC, ensuring that everyone in Tajikistan can access quality care without financial hardship.
The pilot’s core transformative changes include the following:
- Pooling of local health budgets at the regional level has already begun. This combining of district health budgets has started to smooth disparities in funding between districts.
- A regional purchasing body is operational, allocating resources strategically based on population health needs.
- Per-capita financing for expenditures has been introduced, giving facilities predictable budgets for supplies and maintenance.
- A transparent, unified benefits package for primary and outpatient care is in effect, clarifying entitlements for patients and providers alike.
- Increased autonomy for health facilities is empowering managers to make timely financial and operational decisions based on the needs they see.
Stronger primary health care for healthier communities
Primary health care is the first and most important point of contact for people with the health system. Yet, in many places, outdated financing and rigid governance prevent health centres from responding to people’s real needs. The pilot introduces new health financing mechanisms to transform the way primary health care is financed in Tajikistan:
- Improved equitable allocation of resources: by pooling district-level budgets and deploying strategic purchasing, resources will be distributed based on population need rather than historical spending patterns.
- More responsive primary health care facilities: health centres gain greater control over their budgets for medicines, supplies and maintenance – increasing managerial autonomy and allowing them to respond better to the health facilities’ needs and community priorities.
- Expanded access to health services: a unified benefits package clarifies entitlements and, combined with better-resourced health facilities, will extend essential primary and outpatient care.
- Stronger financial protection: moving to per-capita financing and transparent benefit package entitlements will reduce out-of-pocket payments, shielding vulnerable households from catastrophic health costs.
- Foundation for nationwide reforms: the pilot is not just about one region, it is building the systems, tools and evidence base needed to scale up these reforms across the country, including establishing a national purchasing agency.
A shared commitment to change
WHO has been instrumental in designing and guiding development of the UHC pilot, which builds on more than a decade of support for Tajikistan’s broader health system reforms. The pilot’s design was informed by extensive data collection and analysis, and adheres to international best practices for people-centred, resilient health systems.
To support implementation, WHO has facilitated capacity-building in health financing and governance across every level of the Tajikistan government. The pilot reflects close collaboration between the Ministry of Health and Social Protection, the Ministry of Finance, the Ministry of Economic Development and Trade, and the Sughd regional administration. Financial support from the EU and the UHC-P has been fundamental to moving the pilot from design to implementation.
As the initiative unfolds across 5 districts in Sughd region, WHO will continue to provide technical guidance, facilitate monitoring and evaluation, and support adaptive learning.
A roadmap for nationwide reforms
As the UHC pilot progresses, it will serve as a learning platform for the whole country, offering a scalable approach to build a health system which is more equitable, resilient and responsive to people’s needs. The experiences gained in Sughd region will inform the further implementation of nationwide health financing reforms and the establishment of a national purchasing agency, modernizing Tajikistan’s health system and realizing its ambition of UHC.
WHO remains committed to accompanying Tajikistan on its path towards UHC, working alongside national institutions and a broad community of partners – including the EU and UHC-P, to ensure that the gains achieved through this pilot lead to lasting improvements in the health and well-being of the population.