Mirzoev Tolib N, Green Andrew T, Newell James N
University of Leeds, Leeds, UK.
J Health Organ Manag. 2007;21(6):495-505. doi: 10.1108/14777260710834292.
The purpose of this paper is to provide an up-to-date overview of Tajikistan's health system, focusing on the main factors affecting health systems development. The wider contextual environment is to be explored, focusing on political, social and economic issues. Different elements of the health system including health policy, governance, service delivery, human resources and health financing are reviewed in the light of their development over the past decade.
DESIGN/METHODOLOGY/APPROACH: The paper shows that the Republic of Tajikistan is in transition. Formerly one of the most neglected republics within the USSR, the country became independent in 1990 and faced the civil conflict shortly thereafter. In the last few years there have been major public sector reforms with health reforms formally launched in the late 1990s. Little information about current Tajikistan is widely available.
The paper finds that the progress of health reforms in Tajikistan has been relatively slow compared with neighbouring Kazakhstan and Kyrgyzstan. This is largely due to the effects of civil war in the mid-1990s and significant out-migration of qualified experts, but it can also be attributed to an inability of central government to adequately adapt to the requirements of transition.
ORIGINALITY/VALUE: The paper shows that many problems are still to be overcome by the health system, ranging from operational issues related to service delivery to strategic issues such as formulating an explicit privatisation policy, reducing fragmentation of, and aligning, external aid. However, some recent developments, such as adoption of a country health reform conception, a health financing strategy, and willingness of central government to improve coordination, suggest that improvements are possible.
本文旨在提供塔吉克斯坦卫生系统的最新概况，重点关注影响卫生系统发展的主要因素。将探讨更广泛的背景环境，重点关注政治、社会和经济问题。根据过去十年的发展情况，对卫生系统的不同要素，包括卫生政策、治理、服务提供、人力资源和卫生筹资进行了回顾。
设计/方法/途径：本文表明塔吉克斯坦共和国正处于转型期。该国曾是苏联最被忽视的共和国之一，于1990年独立，此后不久便面临内战。在过去几年里，公共部门进行了重大改革，卫生改革于20世纪90年代末正式启动。关于当前塔吉克斯坦的信息很少广泛可得。
本文发现，与邻国哈萨克斯坦和吉尔吉斯斯坦相比，塔吉克斯坦卫生改革的进展相对缓慢。这在很大程度上是由于20世纪90年代中期内战的影响以及合格专家的大量外流，但也可归因于中央政府无法充分适应转型的要求。
原创性/价值：本文表明，卫生系统仍有许多问题有待克服，从与服务提供相关的运营问题到制定明确的私有化政策、减少外部援助的分散性和协调性等战略问题。然而，一些近期的发展，如通过国家卫生改革概念、卫生筹资战略以及中央政府改善协调的意愿，表明情况有可能得到改善。
