Ministry of Health and Social Protection of the Population of the Republic of Tajikistan, Dushanbe, Tajikistan.
WHO Regional Office for Europe, Copenhagen, Denmark.
Hum Resour Health. 2024 Sep 12;22(1):63. doi: 10.1186/s12960-024-00946-5.
Tajikistan has embarked on health reforms to orient the health system towards primary health care (PHC). The health labour market analysis (HLMA) was initiated by the Ministry of Health with the World Health Organization (WHO) on policy questions related to the PHC workforce team. This article presents the results with focus on family doctors as a critical part of the PHC team, providing lessons for strengthening family medicine and PHC in the European Region and central Asia.
The HLMA framework was used to guide the analysis. The data for analysis were provided by the Ministry of Health and Social Protection of the Population of the Republic of Tajikistan. Descriptive means were used to analyse the data. A Technical Working Group guided the process.
There has been an increase in the number of health workers in the country over the last 7 years. However, there is a huge shortage of family doctors when compared with norms, with decreasing family doctor densities over the last 7 years. Family doctors have the highest vacancy rates among specialists and also constitute the highest proportion of specialists who migrate. There is inequitable distribution of doctors across the regions. Overall number of enrolments and graduates in family medicine are declining. Although salaries in PHC are higher than in hospitals, the overall health workforce salaries are lower than the national average. While there have been efforts to retain and attract doctors to PHC in rural and remote regions, challenges exist. The attraction of doctors to narrow specialties may be leading to undermining PHC and family medicine. While the optimal skill-mix and availability of nurses provide an opportunity to strengthen multi-disciplinary teams at the PHC level, shortages and unequal distribution of doctors are affecting health services coverage and health indicators.
Application of the HLMA framework has helped identify the bottlenecks in the health labour market flows and the possible explanations for them. The policy considerations emerging out of the HLMA have contributed to improving evidence-based planning for retention and recruitment of the PHC workforce, improvements in medical and nursing education, and higher investments in the PHC workforce and particularly in family doctors. Implementation of the Action Plan will require political commitment, financial resources, strong inter-sectoral collaboration, stakeholder management, and cross-country learning of best practices. Through this process, Tajikistan has shown the way forward in implementing the Central Roadmap for health and well-being in Central Asia and the Framework for Action on the Health and Care Workforce in the WHO European Region.
塔吉克斯坦已启动卫生改革，将卫生系统转向以初级卫生保健（PHC）为重点。卫生劳动力市场分析（HLMA）是由卫生部与世界卫生组织（WHO）共同发起的，旨在解决与 PHC 劳动力团队相关的政策问题。本文介绍了分析结果，重点介绍了家庭医生作为 PHC 团队的重要组成部分，为加强欧洲区域和中亚的家庭医学和 PHC 提供了经验教训。
HLMA 框架用于指导分析。分析数据由塔吉克斯坦共和国卫生部和社会保护部提供。采用描述性方法对数据进行分析。一个技术工作组指导了整个过程。
过去 7 年来，该国卫生工作者的数量有所增加。然而，与规范相比，家庭医生严重短缺，过去 7 年来家庭医生的密度一直在下降。家庭医生的空缺率在专家中最高，也是移民专家中比例最高的。医生在各地区的分布不均。家庭医学的注册和毕业人数总体呈下降趋势。尽管 PHC 的工资高于医院，但整个卫生劳动力的工资低于全国平均水平。尽管一直在努力留住和吸引医生到农村和偏远地区从事 PHC 工作，但仍面临挑战。吸引医生从事狭窄专业可能会破坏 PHC 和家庭医学。虽然护士的最佳技能组合和可用性为加强 PHC 层面的多学科团队提供了机会，但医生的短缺和分布不均正在影响卫生服务的覆盖范围和卫生指标。
HLMA 框架的应用有助于确定卫生劳动力市场流动的瓶颈及其可能的解释。HLMA 产生的政策考虑因素有助于改进基于证据的 PHC 劳动力保留和招聘规划，改进医学和护理教育，并增加对 PHC 劳动力的投资，特别是对家庭医生的投资。行动计划的实施需要政治承诺、财政资源、强有力的部门间合作、利益相关者管理以及跨境学习最佳实践。通过这一过程，塔吉克斯坦为实施中亚卫生与福祉中央路线图和世卫组织欧洲区域卫生保健工作者框架指明了前进方向。
