Primary health care financing: a situation assessment and policy options for Tajikistan

Overview

In Tajikistan, developing the primary health care system is crucial to ongoing health sector transformation. Primary care is rooted in a family medicine model and is regarded by the Government of Tajikistan as a priority sector for future reforms. This policy paper, informed by global best practices in primary care financing, aims to evaluate the current state of primary health care financing in Tajikistan and offer policy considerations to further strengthen it. Despite the increase in primary health care financing over the years, per-capita public spending on primary care is among the lowest in the WHO European Region, and remains based on an historical financing system which draws from local budgets and has not yet been updated to reflect new financing methods. Progress can be seen, in terms of making the primary health care benefits package more explicit, but informal payments prevail and some essential services are not covered through the public budget. Primary health care services (‎together with outpatient specialist care)‎ are organizationally and financially separate from hospital services. The model of care is yet to be developed, and a shortage of family doctors prevails. To strengthen primary health care financing, Tajikistan should implement strategic purchasing reforms, starting with regional pilot of a per-capita payment system for primary health care services, reviewing the benefits package to allow better access to essential services, and supplementing the financing reforms with service delivery reform and development.