Lahore Office :
LGS-07, Abrar Center, Wahdat Road, Lahore.
Tel : 042-37503151.
Mob : 0300-8664919, 0321-4538193, 0315-8532963
Cities Of Tajikistan :
Health, Hospitals, Ambulance Services Tajikistan
Hospitals Health Services
The number of hospitals including acute care hospitals has increased in
Tajikistan during the 1990s, despite the devastation caused by the war. There
were 365 hospitals in 1990 and 411 in 1997. Of these, these were 349 were
acute care hospitals in 1990 and 396 in 1997. First, the number of
hospitals has increased and second, most hospitals in Tajikistan are categorized
as acute care hospitals despite very long lengths of stay. The overall number of
hospitals in Tajikistan apparently increased by 13% between 1990 and 1997.
As pointed out earlier, however, most small village hospitals can hardly be
categorized as hospitals and many have ceased functioning as such.
The President of the Republic of Tajikistan issued an order (prikaz) in 1993
that hospital beds should be reduced by 30%. In 1996, a prikaz was issued to
reduce beds by another 20%. Between 1992 and 1997, using WHO figures,
there was a 32% decrease in the number of all hospital beds, and a 27% reduction
in acute care hospital beds.
The extent of the real reduction is difficult to interpret. First, many beds
were no longer in use due to war damage or lack of funds; second, some beds
existed in the hospital budget statistics but were not actually occupied by
patients; third, there was less than 60% bed occupancy in 1996 suggesting
excess bed capacity. Nevertheless, there has been a significant reduction in the
official number of hospital beds. Whether this reduction will bring a reduction
in costs is another matter, since the number of hospitals has not been reduced.
Significant budget savings are made by closing hospitals not hospital beds.
The number of acute hospital
beds per 1000 population in Tajikistan has fallen sharply since 1993 but is still
well above the average for European Union countries. This level of
provision is beyond the capacity of the health budget.
Admissions to hospital have halved from 21.5 per 100 population in 1990
to 11.0 in 1997. This is among the lowest population admission
rates among the countries in the WHO European Region. The bed
occupancy in acute care hospitals has also dropped substantially from 94%
occupancy in 1990 to 60% in 1996. Most countries have hospital
occupancy rates of 80% or above. These two indicators suggest severe
deterioration in the capacity of the hospital system to provide services.
The rates for illegal drug use, HIV and sexually transmitted diseases (STDs)
have also risen recently . STDs are likely to be considerably under-reported
since a diagnosis of syphilis often brings hospitalization, job loss and the tracing
Heroin use is an increasing problem, particularly among young
injecting drug users. Tajikistan is located in a region where opium poppies are
grown and the country is on the illegal drugs trade route, particularly across
the border from Afghanistan, with the associated problems of criminality,
bribery and corruption.
Communicable disease has returned as a major threat to Tajikistan population,
with the breakdown in the clean water supply and sewage infrastructure, as
well as a breakdown in public health measures such as mosquito control and
immunization. Statistics for 1995–1997 show large increases in cases of tuberculosis,
malaria, typhoid fever and diphtheria . Waterborne diseases have
increased as the water supply is not safe and less than 10% of the population
are connected to a sewage system .
The rising incidence of tuberculosis constitutes a major crisis with 34 cases
per 100 000 reported in 1997 compared to the low European Union rate of
14 cases per 100 000. Tuberculosis incidence has risen also in the other countries
of the former USSR and is classically associated with poverty. TB prevalence
in 1997 was 8297 cases .
The incidence of malaria has risen alarmingly to 612 per 100 000 in 1998.
There were 6103 cases reported in 1995, 29 064 in 1997, and an outbreak
in early summer 1998 before the anti-mosquito campaign was implemented
. This rise is said to be associated with a breakdown in spraying with
insecticide. The rising incidence is particularly alarming since this disease is
relatively new for Tajikistan and the population has little immunity.
The rates for waterborne diseases such as typhoid fever and cholera have
continued to rise, as have acute intestinal infections. There were more outbreaks
of typhoid fever and salmonella during 1997 . There were 382 fatal cases
among the 29 738 reported with typhoid fever in 1997.
Viral hepatitis (276 per 100 000) is almost ten times higher than the European Union average,
but lower than the central Asian republics average.
Diphtheria re-emerged in 1993 with rates much higher than in neighboring
central Asian republics. The USA Center for Disease Control and Prevention
reported 1464 cases of diphtheria in Tajikistan in 1996, which was the highest
population percentage in the former USSR. The incidence of diphtheria
began to drop from 1996 after an active immunization campaign with the help
of UNICEF. In 1997, 94% of children were reported as immunized against
measles (the lowest percentage was 80.0 in 1995), but this rate is doubtful
since there were 64.2 per 100 000 cases of measles in 1997. In 1997, 3540
cases of measles were reported.
Non Communicable Diseases
The picture for no communicable disease is not clear as yet since systematic
and reliable statistics are not available. The drop in some rates could be due to
a drop in reporting due to the civil disruptions in the country and to a lack of
suitable diagnostic techniques. Age-standardized death rates of ischemic heart
disease apparently fell during the mid-1990s to 285 per 10 000 in 1995. This
seems unlikely since rates in other central Asian republics have been increasing
since the early 1980s. The 1995 Tajikistan rate of 285 per 10 000 is lower than
other central Asian republics, lower than the 405 in the other newly independent
states of the former USSR, but higher than the 117 in the European Union.
Age-standardized death rates for circulatory disease rose during the 1990s.
Mortality rates for cerebra vascular disease have fluctuated, and cancer mortality
has apparently dropped. Age-standardized death rates from injury and accidents
rose during the civil war, especially in 1993, the peak year of the war.
Conditions associated with nutritional deficiencies are common. The
mountainous soil lacks many micronutrients, and iodine deficiency disorders
such as goiter and intellectual retardation have risen during the 1990s. About
35% of the population is said to be iodine deficient, which is wholly preventable
if the iodized salt program was properly implemented. Most women
are said to suffer from anemia, associated with iron deficiencies from various
causes. There is limited dietary information but the traditional diet is high
in fatty meat and refined carbohydrates (most food is fried) with little vegetables
and fruit consumed despite being easily grown. A survey of children under
five years in 1999 in Khatlon in the south, the poorest of the oblasts, found
acute malnutrition among 6–7% of the children, but adequate weight for height
among over 90%. There was also evidence of iron and iodine deficiencies,
while access to health services was poor, especially since families had to pay a
small (unofficial) fee for even basic services such as immunization.
The lifting of import restrictions in the 1990s has been accompanied by
increased consumption of tobacco and alcohol, which are contributing factors
to some non communicable diseases.
All district, regional and national hospitals have ambulance services for