Cities Of Tajikistan :

Hospitals Health Services



Hospitals System


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.

Drugs, HIV



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 of contacts.

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 Diseases



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 .

Tuberclosis



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 .

Malaria



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.

Waterborne Diseases



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.

Hapatitis



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



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.

Ambulance services


All district, regional and national hospitals have ambulance services for emergency care.  

Health, Hospitals, Ambulance Services Tajikistan