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Central Asia: Tajiksitan, Kyrgyzstan Making Efforts To Reform Health-Care Systems

  • Farangis Najibullah

Officially, health care is free in all five Central Asian countries. In reality, however, doctors charge their patients for medical treatment and medications. The Kyrgyz government has introduced a compulsory medical insurance scheme to fight corruption and bribery in the system, while Tajikistan is amending its constitution to abolish a law relating to free health care.

Prague, 27 March 2003 (RFE/RL) -- The Tajik parliament is expected to adopt a new law that will abolish the current system of free health care in the country. Many Tajiks believe the law will only legalize a system that is already in place -- that is, patients paying money to doctors for health care.

Tajikistan's new health-care law will set fixed prices for medical coverage, in an effort to eliminate price gouging and fraud. The changes in the country's health care system are part of a package of measures that will be voted on in a public referendum on 22 June.

Ubaidullo Qurbonov, the head of the Microsurgery Department at the National Center for Cardiovascular Diseases, welcomes the changes in the Tajik constitution. He says the government has no choice but to acknowledge reality and put a stop to bribery and corruption in the country's health-care system: "Tajikistan should have adopted this law a long time ago. This is a very important issue. According to our current law, health care is free of charge. But in reality, it is simply impossible."

The first private medical clinics opened in Central Asian soon after the collapse of the Soviet Union, but most of the medical sector officially remains state-funded. However, it is an open secret that free medical treatment simply does not exist.

Ishaq Zokirov, a Tashkent resident, says patients pay for everything, starting from medicine and bandages all the way to blood: "Our government says, 'Health care is free in Uzbekistan.' But it is quite the opposite in our hospitals. If you ask doctors about it, they would say, 'We don't get any medication from the state. You have to bring it yourself or pay for them.' "

Quality health care is beyond the reach of most ordinary people in Central Asia, who cannot afford to pay medical staff. But the rich are being abused by the system, too. Doctors sometimes prescribe unnecessary medicine, vitamins, or physical therapy for their more well-off patients simply to make more money.

Safo Ahrorov, a resident of the Sukh region of Uzbekistan, says that in rural areas, people cannot call an ambulance in an emergency situation unless a promise is first made to pay for the service: "If you call an ambulance, you have either buy fuel for them or pay money."

The nations of Central Asia are not lacking medical institutions. The large number of hospitals and specialized dispensaries, both in cities and rural areas, is a Soviet-era legacy. Even remote villages have small medical clinics. There is also no shortage of medical staff. Tajikistan alone has two medical universities in its two major cities and medical colleges and schools in almost every town.

However, hospitals and clinics far from the larger cities often lack modern medical equipment. Many hospital buildings have not been renovated in years. During the winter, they sometimes face shortages of electricity. In emergencies, it is not uncommon for doctors to perform surgery by the light of candles.

Some doctors say their working conditions have improved in recent years. As part of humanitarian programs, international aid organizations have provided medications for hospitals in Central Asia. The hospitals also have received modern medical equipment from the U.S. and Germany, among other countries.

Ubaidullo Qurbonov says foreign aid enables them to treat some patients free of charge: "Three [to] five surgeries out of 10 are being performed free of charge. We use humanitarian aid for these surgeries. Well, we cannot say free health care does not exist at all. We have patients who cannot afford paying money for their surgeries, and we cannot send them home without performing the operation they need."

However, some patients complain that doctors even sell donated supplies and procedures that are made possible through humanitarian aid. Local experts say it is not easy to change the situation. Medical workers in many Central Asian countries receive miserable wages. For instance, a nurse in a state-run hospital in Tajikistan receives approximately $5 a month, while an experienced heart surgeon's monthly salary hardly exceeds $15.

The situation is not much better in neighboring Uzbekistan and Kyrgyzstan, where medical doctors receive no more than $20 a month.

Doctors in Turkmenistan earn slightly more than $80 a month, while nurses in the country receive around $70 per month.

With an average salary of $300 a month, doctors in Kazakhstan receive the highest wages among medical workers in the region. Private clinics in big cities in Kazakhstan pay up to $1,000 monthly to experienced doctors.

The Kyrgyz government introduced compulsory medical insurance to fight corruption and to provide adequate health care to its people. The national insurance plan, which is funded mostly by the state budget and partly by employers, covers more than 85 percent of the population.

Lidiya Fomova, a pensioner and former head of the National Social Services, tells RFE/RL that, despite some shortcomings, many people are satisfied with the system: "We support the insurance program. Under the new system, we -- pensioners -- pay only 190 som (about $4) for receiving treatment in the hospital. Others would pay 570 som (about $12). There is a privilege for us."

Unlike Kyrgyzstan, Tajikistan is not planning a medical insurance scheme anytime soon. Qurbonov says the country cannot afford such a system: "We need to find an ideal solution for Tajikistan. You cannot have medical insurance or guaranteed health care without a strong economy and at least a relevantly well-off country. When people live in poverty and the economy is crippled, it is impossible to establish a medical insurance system."

While the country may still have a long way to go to create a health insurance plan, Jum'a Sanginov, the head of the Committee for Health and Social Services in the Tajik Parliament, says the country will make progress in the quality of its private health care: "I think the private health care system will expand in near future. There is a high demand for that."

However, local experts argue that despite the expansion of the private medical sector, more than half of the population of the region will rely on state-run hospitals and humanitarian medical aid for many years to come.

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