Маблағгузории тандурустӣ, хароҷотҳои давлатӣ, Тоҷикистон, фарогирии умумии хизматрасониҳои тандурустӣ

Ҳисоботи мазкур мухтасари арзёбии Матритсаи Пешрафти Маблағгузории Тандурустӣ (HFPM) дар Тоҷикистонродар бар мегирад, ки ҷиҳатҳои қавӣ ва заъфи системаи мавҷудаи маблағгузории тандурустӣ ва инчунин онмушкилоти маблағгузории тандурустиро муайян мекунад, ки бояд барои ноил гардидан ба фарогирии умумиихизматрасониҳои тандурустӣ (ФУХТ) ҳал карда шаванд. Натиҷаҳо дар якчанд ҷадвалҳои гуногуни ҷамъбастӣдар асоси ҳафт соҳаи арзёбӣ ва 19 хусусияти дилхоҳи маблағгузории тандурустӣ пешниҳод карда мешаванд. Ботамаркуз ҳам ба вазъи кунунӣ ва ҳам самтҳои афзалиятноки ислоҳоти оянда, ин гузориш рӯзномаи афзалиятнокробарои корҳои таҳлилӣ ва дастгирии техникии марбут ба он пешниҳод мекунад. Маълумоти охирин дар бораинишондиҳандаҳои Тоҷикистон дар робита ба ФУХТ ва нишондиҳандаҳои асосии хароҷоти тандурустӣ низ пешниҳодкарда мешаванд. Ҷавобҳои муфассал ба саволҳои инфиродӣ дар пойгоҳи иттилоотии СУТ дар бораи арзёбиикишварҳо ё тибқи дархост дастрасанд.

Оценка системы финансирования здравоохранения, Таджикистан 2023: матрица оценки прогресса в области финансирования здравоохранения

В этом отчете представлено краткое изложение оценки Матрицы прогресса в области финансирования здравоохранения (МПФЗ)в Таджикистане, определяющее сильные и слабые стороны существующей системы финансирования здравоохранения, а такжете области финансирования здравоохранения, которые необходимо решить, чтобы обеспечить прогресс на пути к всеобщемуздравоохранению. покрытие (ВОУЗ). Результаты представлены в нескольких различных сводных таблицах, основанных на семиобластях оценки и 19 желательных атрибутах финансирования здравоохранения. Сосредоточив внимание как на текущей ситуации,так и на приоритетных направлениях будущих реформ, этот отчет представляет собой приоритетную программу аналитическойработы и соответствующей технической поддержки. Также представлена последняя информация о достижениях Таджикистана вобласти ВОУЗ и ключевых показателей расходов на здравоохранение. Подробные ответы на отдельные вопросы доступны в базеданных страновых оценок ВОЗ МПФЗ или по запросу.

Оё одамон имконияти молиявии пардохти хизматрасонии тиббиро доранд? Далелҳои нав оид ба ҳимояи молиявӣ дар Тоҷикистон

Дар ин гузориши ҷамъбастӣ арзёбӣ карда мешавад, ки то чӣ андоза мардум дар Тоҷикистон ҳангоми истифода аз хизматрасониҳои тиббӣ ва пардохти нақдӣ аз ҷайби худ ба мушкилоти молиявӣ дучор мешавад. Таҳлили ҳимояи молиявӣ одатан маълумотро дар бораи эҳтиёҷоти қонеънашуда ба кӯмаки тиббӣ дар бар мегирад, аммо ин маълумот барои Тоҷикистон дастрас нест. Дар гузориш маълумоти Тадқиқоти буҷети хонаводаҳо истифода карда шудааст, ки аз ҷониби Агентии омори назди Президенти Ҷумҳурии Тоҷикистон дар давраҳои аз соли 2016 то 2019 ва аз 2021 то 2022 гузаронида шудааст. Хулосаҳои асосии гузориш чунин мебошанд.

В состоянии ли люди платить за услуги здравоохранения? Новые данные о финансовой защите в Таджикистане: Сводный отчет

В этом сводном отчете оценивается степень, в которой население Таджикистана испытывают финансовые трудности при использовании услуг здравоохранения и осуществляют выплаты из кармана (прямые платежи, осуществляемые населением). Анализ финансовой защиты обычно включает данные о неудовлетворенных потребностях в услугах здравоохранения, но эти данные недоступны для Таджикистана. В отчете использованы микроданные обследований бюджетов домашних хозяйств, проведенных Агентством по статистике при Президенте Республики Таджикистан в период с 2016 по 2019 гг. и с 2021 по 2022 гг. Основные выводы отчета заключаются в следующем.

Can people afford to pay for health care? New evidence on financial protection in Tajikistan: summary

This summary report assesses the extent to which people in Tajikistan experience financial hardship when they use health services and pay out of pocket. Analysis of financial protection usually includes data on unmet need for health care, but these data are not available for Tajikistan. The report draws on microdata from household budget surveys carried out by the Statistical Agency under the President of the Republic of Tajikistan from 2016 to 2019 and 2021 to 2022. Its key findings are as follows.

Наличие основных лекарственных средств и цены на них в Республике Таджикистан в 2021 г.

Доступ к лекарствам, вакцинам и изделиям медицинского назначения является важнейшим компонентом в достижении всеобщего охвата услугами здравоохранения (ВОУЗ). Он представляет собой один из составных элементов эффективно функционирующей системы здравоохранения и является важным фактором, определяющим высокие показатели в области охраны здоровья на индивидуальном и популяционном уровнях. Чтобы обеспечить возможность регулярного мониторинга показателей доступа для пациентов, в 2016 г. Всемирная организация здравоохранения (ВОЗ) запустила мобильное приложение MedMon для мониторинга цен и наличия основных лекарственных средств и изделий медицинского назначения.В этом отчете представлены результаты исследования, проведенного в учреждениях здравоохранения с использованием инструмента MedMon в течение апреля и мая 2021 г. с целью оценки наличия основных лекарственных средств и цен на них в розничных аптеках Республики Таджикистан.

Availability and prices of essential medicines in Tajikistan in 2021

Access to medicines, vaccines and health products is an essential component of universal health coverage. It represents one of the building blocks of a well-functioning health system and is an essential determinant of better health outcomes at individual and population levels. To enable regular monitoring of patient-level indicators of access, in 2016 WHO launched the MedMon mobile application for monitoring price and availability of essential medicines and health products. This report presents results of a facility-based survey conducted in April–May 2021 on the availability and prices of essential medicines in community pharmacies in Tajikistan using MedMon.

Фазои буҷетӣ барои тандурустӣ дар Ҷумҳурии Тоҷикистон: имкониятҳои ҷалби захираҳои давлатии иловагӣ

Барномаи ислоҳоти соҳаи тандурустии Ҷумҳурии Тоҷикистон ҷиҳати ноил шудан ба фарогирии умумӣ бо хизматрасониҳои тандурустӣ (ФУХТ) аз беҳтар намудани дастрасии тамоми аҳолӣ ба хизматрасонии тиббии баландсифат ва истифодаи самараноки захираҳои давлатӣ иборат аст. Стратегияи миллии тандурустии ба наздикӣ қабулшуда (Стратегияи ҳифзи солимии аҳолии Ҷумҳурии Тоҷикистон барои давраи то соли 2030) ба далелҳо ва тавсияҳои глобалӣ пайравӣ намуда, ба тавсеаи кумаки аввалияи тиббию санитарӣ такя мекунад. Барои татбиқи стратегия ба Ҷумҳурии Тоҷикистон лозим аст, ки маблағгузории давлатиро ба соҳаи тандурустӣ ба таври қобили мулоҳиза зиёд намояд ва захираҳоро ба он соҳае ҷудо намояд, ки онҳо самараи бештар доранд. Дар айни замон, захираҳои буҷетӣ барои кӯмаки аввалияи тиббию санитарӣ кофӣ нестанд ва дар саросари кишвар нобаробар тақсим карда мешаванд, ки дар натиҷа камбудиҳои ноодилона дар дастрасии хизматрасонии тиббӣ ба вуҷуд меоянд. Аз ин рӯ, дар истифодаи соҳаи тандурустӣ фарқиятҳои беасос вуҷуд доранд. Дар гузориши мазкур имкониятҳои алтернативии зиёд кардани фазои буҷетӣ барои саломатӣ, аз ҷумла захираҳои кӯмаки аввалияи тиббию санитарӣ тавсиф, таҳлил ва муқоиса шудаанд.

Budgetary space for health in the Republic of Tajikistan: options for more public resources

The Republic of Tajikistan’s health reform agenda to achieve universal health coverage includes improved access to high-quality health care for the entire population and more efficient use of public resources. The recently adopted National Health Strategy (Strategy for the Healthcare of the Population of the Republic of Tajikistan, 2021–2030) follows global evidence and recommendations, and builds on expanding primary health care. To implement the strategy, Tajikistan needs to increase considerably public funding for health and allocate resources to where they will have the most effect. Currently, budget resources for primary health care are lagging behind, and are unevenly distributed across the country, resulting in unjust gaps in health care access. Consequently, there are unjustified differences in health care utilization.This report describes, analyses and compares alternative opportunities to increase budgetary space for health, in particular resources for primary health care.

Assessment of serological responses following vaccination campaigns with type 2 novel oral polio vaccine: a population-based study in Tajikistan in 2021.

BACKGROUND: Novel oral poliovirus vaccine type 2 (nOPV2) was used to control an outbreak of type 2 circulating vaccine derived poliovirus (cVDPV2) in Tajikistan, in 2021. We measured seroconversion and seroprevalence of type 2 polio antibodies in children who were reported to have received two doses of nOPV2 in outbreak response campaigns. METHODS: In this community serosurvey, children born after Jan 1, 2016 were enrolled from seven districts in Tajikistan. Dried blood spot cards were collected before nOPV2 campaigns and after the first and second rounds of the campaigns and were sent to the Centers for Disease Control and Prevention (Atlanta, GA, USA) for microneutralisation assay to determine presence of polio antibodies. The primary endpoint was to assess change in seroprevalence and seroconversion against poliovirus serotype 2 after one and two doses of nOPV2. FINDINGS: 228 (97%) of 236 enrolled children were included in the analysis. The type 2 antibody seroprevalence was 26% (53/204; 95% CI 20 to 33) before nOPV2, 77% (161/210; 70 to 82) after one dose of nOPV2, and 83% (174/209; 77 to 88) after two doses of nOPV2. The increase in seroprevalence was statistically significant between baseline and after one nOPV2 dose (51 percentage points [42 to 59], p<0·0001), but not between the first and second doses (6 percentage points [-2 to 15], p=0·12). Seroconversion from the first nOPV2 dose, 67% (89/132; 59 to 75), was significantly greater than that from the second nOPV2 dose, 44% (20/45; 30 to 60; χ2 p=0·010). Total seroconversion after two nOPV2 doses was 77% (101/132; 68 to 83). INTERPRETATION: Our study demonstrated strong immune responses following nOPV2 outbreak response campaigns in Tajikistan. Our results support previous clinical trial data on the generation of poliovirus type 2 immunity by nOPV2 and provide evidence that nOPV2 can be appropriate for the cVDPV2 outbreak response. The licensure and WHO prequalification of nOPV2 should be accelerated to facilitate wider use of the vaccine. FUNDING: World Health Organization, Centers for Disease Control and Prevention, and Rotary International.

Resilience against the pandemic: The impact of COVID-19 on migration and household welfare in Tajikistan.

The COVID-19 pandemic is likely to have adverse effects on the economy through damage to migration and remittances. We use a unique monthly household panel dataset that covers the period both before and after the outbreak to examine the impacts of COVID-19 on a variety of household welfare outcomes in Tajikistan, where remittance inflows in recent years have exceeded a quarter of annual GDP. We provide several findings. First, after April 2020, the adverse effects of the pandemic on household welfare were significantly observed and were particularly pronounced in the second quarter of 2020. Second, in contrast to expectation, the pandemic had a sharp but only transitory effect on the stock of migrants working abroad in the spring. Some expected migrants were forced to remain in their home country during the border closures, while some incumbent migrants expecting to return were unable to do so and remained employed in their destination countries. Both departures and returns started to increase again from summer. Employment and remittances of the migrants quickly recovered to levels seen in previous years after a sharp decline in April and May. Third, regression analyses reveal that both migration and remittances have helped to mitigate the adverse economic outcomes at home during the "with-COVID-19" period, suggesting that they served as a form of insurance. Overall, the unfavorable effects of the COVID-19 pandemic were severe and temporary right after the outbreak, but households with migrants were more resilient against the pandemic.

Sustainable and equitable provision of wheelchairs in low- and middle-income countries: an economic assessment of the models for wheelchair provision in Tajikistan.

INTRODUCTION: Reaching universal coverage of assistive technologies remains a challenge in many low- and middle-income countries. Tajikistan has recently adopted several policies and national strategies to strengthen the rights of people with disabilities and improve the provision of assistive products. However, Tajikistan faces a number of challenges, including ensuring sustainable funding for the provision of wheelchairs in the medium and long term. METHODS: This study presents the results of a recent analysis of the economic aspects of the provision of wheelchairs in Tajikistan to inform policy making in other low- and middle-income countries. The study draws on several sources of information, including local cost data, consultations with national and international experts and stakeholders, and reviews of the existing evidence. RESULTS: Countries are advised to adopt an incremental approach to wheelchair provision. In the short term, countries may wish to import wheelchairs to move towards universal coverage. In the medium-to-long term, countries may wish to invest in national capacities for local production. CONCLUSION: Countries will need to continue implementing strategies to ensure universal access to wheelchairs without the risk of financial hardship for users, regardless of the approach to provision that has been chosen.Implication for RehabilitationReaching universal coverage of assistive technologies remains a challenge in many low- and middle-income countries.Countries are advised to adopt an incremental approach to wheelchair provision.The model of wheelchair importation may be a realistic model over the short- to medium-term for many LMICs countries to ensure effective and equitable provision of wheelchairs.In this article, we identify that sufficient funding needs to be allocated to the provision of wheelchairs regardless of the model of provision.

National priority assistive product list development in low resource countries: lessons learned from Tajikistan.

INTRODUCTION: Developing a national assistive products list is an important part of an assistive technology policy and requires knowledge of total population need, and product costs and benefits; information is not always readily available in low-income countries. Our experience in Tajikistan of developing a national assistive products list provides guidance for others. METHODS: Two hundred people with disabilities participated in a survey on self-reported need for assistive products, user experiences and barriers to access; 12 focus groups, of over 100 people with disabilities and older adults, conducted discussions on assistive technology. Major providers of assistive technology (government, nongovernmental organizations, local producers) were interviewed. RESULTS: These results were presented at a meeting with government and other stakeholders, which led to a consensus on 30 assistive products for the national assistive products list. CONCLUSION: We identified the essential stakeholders responsible for developing the assistive products list, and discussed the data needed (total need, cost-effectiveness, unmet need, resources, barriers, system analysis) to make an informed decision on which products to include. This work can be used as a case study for developing an assistive products list quickly on a small budget without compromising on a user-centred approach or active participation of stakeholders.Implications for RehabilitationIncorporating rehabilitation and assistive technology in universal health coverage.Establishing and strengthening networks and partnerships in rehabilitation and building on existing resources (stakeholders, knowledge, government policy documents) to strengthen rehabilitation and assistive technology particularly in low- and middle-income countries.Developing a national assistive products list is an important part of an assistive technology policy.Creating a national assistive products list requires knowledge of population need, and product costs and benefits; information that is not always readily available in low-income countries.In this article, we identify the essential stakeholders responsible for developing the assistive products list and the data needed for informed decisions.We demonstrate that developing an assistive products list can be carried out quickly and on a small budget.

Women's decision-making autonomy and utilization of antenatal, natal and post-natal healthcare services: Insights from Tajikistan's national surveys.

BACKGROUND: The purpose of this article is to investigate the link between women's autonomy and their utilization of antenatal, natal and post-natal healthcare services in Tajikistan. Previous studies focused only on a single dimension of such services, for instance, utilization of antenatal care. By contrast, we explore antenatal, natal and post-natal healthcare services utilization using the number of indicator for each of the dimensions. METHODS: Data come from two national surveys that were conducted in 2012 and 2017. The target population is women of reproductive age (16-49) who were married or cohabitating with a partner (N = 7540). Several regression models were estimated to quantify association between women's autonomy and the utilization. RESULTS: Lack of women's autonomy is associated with a lower probability of: (a) having had at least four antenatal check-ups during pregnancy, (b) beginning first antenatal check-up early, (c) delivering in a healthcare facility, (d) having the skilled attendance during pregnancy, (e) having a mother post-delivery check-up, and (f) having a child post-delivery check-up. The size effect of women's autonomy is stronger than that of well-developed precursors of utilization such as poverty and mothers' education. CONCLUSION: Women autonomy should be improved to achieve higher rates of child and maternal healthcare utilization. Studies of maternal and child healthcare utilization should control explicitly for women's autonomy.

Assessment of sexual, reproductive, maternal, newborn, child and adolescent health in the context of universal health coverage in Tajikistan

Achieving universal health coverage (UHC) – meaning that everyone, everywhere can access essential high-quality health services without facing financial hardship – is a key target of the Sustainable Development Goals. Sexual, reproductive, maternal, newborn, child and adolescent health (SRMNCAH) is at the core of the UHC agenda and is among the 16 essential health services that WHO uses as indicators of the level and equity of coverage in countries. In this context, WHO undertook an assessment of SRMNCAH in Tajikistan.This report examines which SRMNCAH services are included in policies concerning UHC in the specific country context; assesses the extent to which the services are available to the people for whom they are intended, and at what cost; identifies potential health system barriers to the provision of SRMNCAH services, using a tracer methodology and equity lens; and identifies priority areas for action. A set of policy recommendations provides the basis for policy changes and implementation arrangements for better SRMNCAH services and outcomes in the context of UHC.

Demystifying the factors associated with rural-urban gaps in severe acute malnutrition among under-five children in low- and middle-income countries: a decomposition analysis.

What explains the underlying causes of rural-urban differentials in severe acute malnutrition (SAM) among under-five children is poorly exploited, operationalized, studied and understood in low- and middle-income countries (LMIC). We decomposed the rural-urban inequalities in the associated factors of SAM while controlling for individual, household, and neighbourhood factors using datasets from successive demographic and health survey conducted between 2010 and 2018 in 51 LMIC. The data consisted of 532,680 under-five children nested within 55,823 neighbourhoods across the 51 countries. We applied the Blinder-Oaxaca decomposition technique to quantify the contribution of various associated factors to the observed rural-urban disparities in SAM. In all, 69% of the children lived in rural areas, ranging from 16% in Gabon to 81% in Chad. The overall prevalence of SAM among rural children was 4.8% compared with 4.2% among urban children. SAM prevalence in rural areas was highest in Timor-Leste (11.1%) while the highest urban prevalence was in Honduras (8.5%). Nine countries had statistically significant pro-rural (significantly higher odds of SAM in rural areas) inequality while only Tajikistan and Malawi showed statistically significant pro-urban inequality (p < 0.05). Overall, neighbourhood socioeconomic status, wealth index, toilet types and sources of drinking water were the most significant contributors to pro-rural inequalities. Other contributors to the pro-rural inequalities are birth weight, maternal age and maternal education. Pro-urban inequalities were mostly affected by neighbourhood socioeconomic status and wealth index. Having SAM among under-five children was explained by the individual-, household- and neighbourhood-level factors. However, we found variations in the contributions of these factors. The rural-urban dichotomy in the prevalence of SAM was generally significant with higher odds found in the rural areas. Our findings suggest the need for urgent intervention on child nutrition in the rural areas of most LMIC.

Out of pocket expenditures of patients with a chronic condition consulting a primary care provider in Tajikistan: a cross-sectional household survey.

BACKGROUND: Within its reform efforts, the Government of Tajikistan is embracing the essential role of primary health care (PHC) in decreasing out of pocket (OOP) expenditures and increasing equity in access to health services. In the light of the increasing burden of disease relating to chronic conditions, we investigated OOP expenditures of patients with chronic conditions within a PHC setting; and if and how those expenditures are impacted by several interventions currently being implemented within Tajikistan. METHODS: A cross-sectional survey among 1600 adult patients who had visited a PHC facility was conducted. The data obtained through interviews were descriptively analysed, and logistic regressions and gamma generalized linear models were performed. RESULTS: The total OOP expenditures related to a patient's last visit to the PHC facility were 17.2 USD for those with chronic conditions and 13.9 USD for those visiting due to an acute condition. Adjustment for potential confounders reduced the discrepancy from 3.3 USD to 0.5 USD. This convergence of costs was only observed in districts covered by the Basic Benefit Package (BBP), a governmental pilot project, aiming to standardise exemptions for payment and formal co-payments for health care services. Hence, we found the BBP to have a protective impact for patients with chronic conditions. However, considering the demographics of these patients (older in age, with greater dependency on pensions and social aid, and lower socio-economic status) in combination with the 40% higher utilisation rate of PHC and the high rate of onward referrals to specialists; it is clear that patients with chronic conditions continue to face substantial long-term costs and disadvantages. CONCLUSIONS: After accounting for confounders, patients with chronic and acute conditions faced similar costs related to a single visit to a PHC facility in districts covered by the BBP. However, greater efforts are required to ensure that citizens are well informed about their rights to health care, the BBP and the services that should be provided at no cost at the point of delivery. Moreover, the needs of patients with chronic conditions warrant a more integrative approach that takes long-term expenditures and services beyond the level of PHC into account.

Preferences of livestock owners for sharing the cost of brucellosis control in Tajikistan.

In the context of significant public health benefits of brucellosis control and shrinking public resources for livestock vaccination, this paper considers the willingness of small ruminant livestock owners to pay for vaccination of their animals against brucellosis. The willingness to pay is estimated through a binary choice contingent valuation approach using data from a rural household survey specially designed for this purpose. The survey was conducted in southern Tajikistan, one of its poorest regions, in March 2009. The study used a non-parametric method for estimating the willingness to pay and a parametric (Probit) model for identifying determinants. The results show that households, including poor households, were willing to pay for continuing vaccination of their sheep and goats against brucellosis. Controlling for other attributes of willingness to pay, there was practically no correlation between willingness to pay and household asset level. This means both poor and rich alike are willing to pay for the service. On the other hand, the results also show that the willingness to pay was comparatively higher in households with relatively higher levels of education of adult females. This suggests that an awareness campaign targeted at female members of households would enhance the ownership and coverage of cost recovery programs and should form an integral part of any efforts towards introducing financial participation from sheep and goat owners for brucellosis vaccination.

Standardized framework for evaluating costs of active case-finding programs: An analysis of two programs in Cambodia and Tajikistan.

INTRODUCTION: Over the years, technological and process innovations enabled active case finding (ACF) programs to expand their capacities and scope to have evolved to close gaps in missing TB patients globally. However, with increased ACF program's operational complexity and a need for significant resource commitments, a comprehensive, transparent, and standardized approach in evaluating costs of ACF programs is needed to properly determine costs and value of ACF programs. METHODS: Based on reviews of program activity and financial reports, multiple interviews with program managers of two TB REACH funded ACF programs deployed in Cambodia and Tajikistan, we first identified common program components, which formed the basis of the cost data collection, analysis, reporting framework. Within each program component and sub-activity group, cost data were collected and organized by relevant resource types (human resource, capital, recurrent, and overhead costs). Total shared, indirect and overhead costs were apportioned into each activity category based on direct human resource contribution (e.g. a number of staff and their relative level of effort dedicated to each program component). Capital assets were assessed specific to program components and were annualized based on their expected useful life and a 3% discount rate. All costs were assessed based on the service provider perspective and expressed in 2015 USD. RESULTS: Over the two program years (April 2013 to December 2015), the Cambodia and Tajikistan ACF programs cumulated a total cost of $336,951 and $771,429 to screen 68,846 and 1,980,516 target population, bacteriologically test 4,589 and 19,764 presumptive TB, diagnose 731 and 2,246 TB patients in the respective programs. Recurrent costs were the largest cost components (54% and 34%) of the total costs for the respective programs and Xpert MTB/RIF (Xpert) testing incurred largest program component/activity cost for both programs. Cost per screening was $0.63 and $0.10 and cost per Xpert test was $25 and $18; Cost per TB case detected (Xpert) was $373 and $343 in Cambodia and Tajikistan. CONCLUSIONS: Results from two contextually and programmatically different multi-component ACF programs demonstrate that our tool is fully capable of comprehensively and transparently evaluating and comparing costs of various ACF programs.