This case study was published on 8 December 2022 as part of the WHO delivering results and making an impact: stories from the ground report, which presents a snapshot of how WHO has delivered on its mission in countries and contributed to health outcomes across a wide range of issues during 2020-2021.
Tajikistan’s health system is structured around input-based financing and significant out-of-pocket payments.1 As a result, access to quality essential health services and products is inequitable. Universal health coverage (UHC) means that all people have access to the health services they need, when and where they need them, without financial hardship.2 To achieve UHC in Tajikistan, strengthened leadership, governance and advocacy for health are essential.
Tajikistan was one of the global pilot countries for the implementation of the Global Action Plan for Healthy Lives and Well-being for All (SDG3 GAP). Introduced in the country in 2019, it has been instrumental in bringing together and better aligning multilateral health, development and humanitarian partners, enabling them to better support the Government of Tajikistan in moving towards UHC. Between 2019 and 2021, Tajikistan’s UHC service coverage index – a measure of indicator 3.8.1 of the Sustainable Development Goals (SDGs) – moved in a positive trajectory, increasing from 66 to 68. WHO continues to work on improving partner coordination under the umbrella of SDG3 GAP in Tajikistan, helping to better position local and international health partners to achieve not only UHC, but also all health related SDGs by 2030.
A Tajik family visiting a primary health-care clinic. ©WHO Country Office in Tajikistan/Mukhsin Abidzhanov
The health financing mission organized by WHO and the World Bank as part of a European Union-funded project. ©WHO Country Office in Tajikistan/Mukhsin Abidzhanov.
How did Tajikistan, with the support of the WHO Secretariat, achieve this?
- Strengthening the Development Coordination Council on Health
Tajikistan’s Development Coordination Council on Health was established to foster collaboration and dialogue, both within the development community and with the Government of Tajikistan. Co-chaired by the European Union and the WHO Country Office in Tajikistan, the Development Coordination Council on Health has held regular meetings and developed tools to facilitate information exchange and discussion on health-related activities. A retreat organized by the WHO Country Office for development partners – in collaboration with the European Union; the Global Financing Facility for Women, Children and Adolescents; and the World Bank – enabled the partners to solidify working structures and coordination mechanisms, facilitating better and more aligned support for Tajikistan’s Ministry of Health and Social Protection of the Population. Recently, five subgroups of the Development Coordination Council on Health were established and aligned with the strategic priorities of the recently launched National Health Strategy 2021–2030, in which UHC is a key objective.
- Producing joint position statements that presented a common vision
Joint position statements on health financing and primary health care (PHC) were developed by the partners, and position statements on health management information systems and human resources for health are in progress. Presenting the joint vision of health development partners, the position statements provide high-level guidance to Tajikistan, while aligning and coordinating partners’ technical assistance and financial support with government agenda and country needs. On health financing, the joint statement urges the country to modernize budgeting and payment systems, increase domestic funding for health and distribute resources equitably. The joint statement on strengthening PHC was signed by both development partners and the Ministry of Health and Social Protection of the Population, which share a common vision and ambition to build an effective PHC model in Tajikistan. These living documents will be updated as new issues emerge and as the country’s health system is strengthened over time.
- Engaging in policy dialogue to learn from past implementation and plan for the future
The WHO Country Office organized policy dialogues to discuss topics addressed in the joint statements, review the first year of implementation of the new National Health Strategy and develop concrete implementation plans. This helped to further align health partners’ support provided to the Government of Tajikistan.
- Partnering up to pivot towards health financing reforms
The UHC Partnership is one of WHO’s largest platforms for international cooperation on UHC and PHC. Tajikistan joined the UHC Partnership in 2016. Furthermore, the WHO Country Office is currently implementing a European Union-funded UHC programme with Deutsche Gesellschaft für Internationale Zusammenarbeit GmbH (GIZ) and the United Nations Children’s Fund (UNICEF). Thanks to these partnerships and the joint statement on health financing, the Ministry of Health and Social Protection of the Population and the Ministry of Finance are discussing significant changes to the health financing system, which will be instrumental to achieving UHC.
Aligning partners has been critical to moving towards UHC in Tajikistan. The WHO Country Office in Tajikistan has played a crucial role, using its convening power to strengthen overall leadership, governance and advocacy for health. In addition to
its convening role, the WHO Country Office has collaborated with health partners on various pilot projects and provided technical support to ministries and national and regional bodies in furthering the implementation of health financing reforms
for achieving UHC.
References
- Tajikistan [website]. Geneva: Universal Health Coverage Partnership; 2022 (accessed 14 August 2022).
- Universal health coverage [website]. Geneva: World Health Organization; 2022 (accessed 14 August 2022).