Annex C1 FINAL Taj movement along dev continuum _rev4 12 08_.pdf

Annex C1: Tajikistan: Expectations of Movement Along the Development Continuum over the Next Two Years

With a gross national income per capita of $223 ($2,000 based on purchasing power parity), Tajikistan is a Low-Income country within the Developing Country category. Its GDP growth rate of 10.6% is on par with neighboring oil-rich Kazakhstan’s of 10.6%.

Tajikistan has a population of 7.08 million, compared to 15.3 million for Kazakhstan and

5.3 million for Kyrgyzstan.

Several years of civil war impeded Tajikistan’s health sector development. It is at least ten years behind the progress made in Kyrgyzstan, Kazakhstan, and Uzbekistan. Given its slow, though incremental, health reform progress, the changes expected in the health sector over the next two to seven years will not have an impact on the country’s movement along the continuum from the “Developing” to “Transforming” category.

Tajikistan ranks 27 of 28 countries in the 2007 Europe and Eurasia Health Vulnerability Analysis. The analysis identifies those countries in the region where health status is the poorest and where the transition to democracy and free-market economies may be most vulnerable because of health factors. See the report at:

http://www.usaid.gov/locations/europe_eurasia/dem_gov/docs/2007_ee_health_vulnerabi lity_analysis_report_final.pdf

The analysis identifies those countries in the region where health status is the poorest and where the transition to democracy and free-market economies may be most vulnerable because of health factors. The graph below draws on this data to compare Tajikistan’s health status to European Union and E&E regional averages. For each indicator, a score of 10 corresponds with the EU average, suggesting ideal performance. A score of 1 indicates the poorest performance in that indicator in the E&E region. The country’s performance is then plotted against this scale. A score of 10 is ideal performance for all indicators and all countries.

Tajikistan

Life Expectancy

Adult Mortality

Under-5 Mortality

Public Health Expenditure

TB incidence

HIV incidence

Tajikistan Northern Tier EU25 Mean

Northern Tier refers to the Czech Republic, Hungary, Poland, Slovakia, and Slovenia.

Tajikistan is far from approaching the levels of health sector development achieved by counties in the northern tier. The graph reflects Tajikistan ranking as the second worst in the region in life expectancy and public health expenditures. It ranks last in TB incidence; is among the 25 priority multi drug resistant TB countries in the world; and has the potential for explosive growth in HIV/AIDS incidence. Tajikistan’s resource-poor government is unable to contribute as much funding to health as its neighboring countries. Public expenditures as a percent of GDP were only 1% in 2004. Individuals must pay high out-of-pocket expenditures (76% of health care costs), often under-the-table, to compensate for the government’s lack of resources.

The graphic below shows Tajikistan’s performance on several key health systems development indicators relative to: (1) averages for Europe and Eurasia and other geographic regions, and (2) averages for country categories of the USG Foreign Assistance Framework. Indicators reflecting the extent of corruption and out of pocket expenditures put Tajikistan into the Developing Country category. The latter measure reflects the low level of public expenditures, which in Tajikistan, is more characteristic of the Rebuilding Country category. Nurses per 100,000 are high, putting Tajikistan in the Sustaining Country category. However, this is misleading as nurses receive low salaries and most require training to upgrade their skills. Access to essential drugs reflects the levels of Rebuilding Countries, reflecting the low level of public health expenditures and the limited ability of the population to pay for drugs.

Source: U.S. Agency for International Development, Bureau for Global Health; most data is 2006.

1—Corruption Index

2—Public Expenditures on Health as % of GDP

4—Nurses per 100,000

5—% of Population with Access to Essential Drugs

3—Out of Pocket Expenditures

0 2 4 6 8

95% Conf. Intervals Rebuilding Developing Transforming Sustaining

200 400 600 800

0 25 50 75 100

.4.20

.8

2 3 4 5

.6

LAC

ANE

E&E

E&E

AFR LAC

AFR

ANE

E&E

AFR

LAC ANE

E&E LAC

AFR

ANE

E&E

LAC

AFR

worst worst worst worst best best best best

ANE

Country=

Regional Mean=

Developing: Tajikistan Health Systems Indicators

The FY 2008 Millennium Challenge Corporation (MCC) scorecard above shows that Tajikistan exceeds the median for its MCC peer group on its immunization rate (86.5% coverage compared with a median of 84%) but is far below the median for public spending on health (1.14% of GNI compared with a median of 2.07%).

Over the next two years, the project may be constrained by the political leadership and may not be able to maintain the pace of progress in restructuring the health care system.

Instead, it may focus on issues where it has a strong local counterpart and champion of change. Examples are the Rector of the Medical Academy who is committed to introducing EBM into the curricula of medical schools and the head of the Drug Information Center who is using recently completed products to advocate for rational drug use. Other areas where there can be real headway in the next 2 years is in the expansion of the Safe Motherhood Program and integration of the educational program into services offered by primary care facilities. These focus areas are important to health sector reform, but will not represent the kind of comprehensive change needed to upgrade the category of this sector to the “Transforming Country” category.