Tajikistan Launches Pilot to Improve Health Access and Reduce Patient Costs

Tajikistan has launched a pilot in the Sughd region to reform health financing by pooling funds, improving payment systems and strengthening primary care to make services more affordable and equitable. The initiative aims to reduce out-of-pocket costs, address gaps in chronic disease care and build a scalable model for nationwide health system reform.

In a quiet but ambitious shift, Tajikistan has launched a pilot programme that could redefine how health care is financed and delivered. Led by the World Health Organization Regional Office for Europe in collaboration with the Ministry of Health and Social Protection, the Ministry of Finance, the Sughd Regional Administration, and supported by the World Bank and the European Union, the initiative began in January 2025 in the Sughd region.

The pilot is designed as a real-world test of reforms that have long been planned but never fully implemented. Its goal is simple but powerful: make health care more affordable, fair and effective for everyone.

Why Health Care Is Still Costly for Many

For many people in Tajikistan, visiting a doctor or buying medicines still comes with a heavy financial burden. Most costs are paid directly by patients, especially for medicines needed outside hospitals. This often pushes families, particularly poorer ones, into financial hardship.

The problem is not just about money. Many people suffer from chronic illnesses like high blood pressure and diabetes, but these conditions often go undiagnosed or untreated. Surveys show that the real number of cases is much higher than official records. Without early treatment, these illnesses can lead to serious complications and even early death.

A System Facing Deep Structural Issues

The report highlights several long-standing weaknesses in the health system. Government spending on health is relatively low, limiting the services that can be offered. At the same time, funding is collected and managed mostly at local levels, which creates big differences between regions.

Wealthier districts can afford better services, while poorer ones struggle. Health facilities also have little flexibility in how they use their budgets. Strict rules prevent managers from shifting funds where they are most needed. In addition, the list of free or covered services is not always clear or consistent, leaving gaps in essential care like diagnostics and medicines.

Pooling Funds for Fairer Access

One of the biggest changes in the Sughd pilot is how money is managed. Instead of each district handling its own health budget, funds are now pooled at the regional level. This allows resources to be distributed more fairly, based on people’s needs rather than on how much money a district has.

The pilot also introduces a new system where the regional health department acts as a purchaser of services. It signs contracts with health providers and decides how funds are allocated. This approach helps ensure that money is spent more effectively and transparently.

Changing How Health Facilities Are Paid

Another key reform is the way health facilities receive funding. The pilot uses a mix of two methods. Salaries are covered through fixed budgets to ensure stability, while other costs are based on the number of people served.

This new system aims to reduce gaps between facilities and give them more resources overall. It also allows managers to have more control over how funds are used. For example, they can introduce performance-based incentives to reward staff and improve service quality.

At the same time, efforts are being made to bring different health services together under primary care. This helps simplify the system and ensures patients receive more complete care in one place.

Challenges Now, Opportunities Ahead

Like any major reform, the pilot has faced early challenges. Technical issues in financial systems have delayed some payments, and administrative processes are still being adjusted. Managing taxes and procurement under the new system has also required changes.

Despite these hurdles, the pilot is seen as an important step forward. It offers valuable lessons that can guide future reforms across the country. There are plans to expand the model to more regions and strengthen areas like workforce training and access to medicines.

For Tajikistan, this initiative represents a shift toward a more balanced and people-focused health system. By improving how money is spent and services are delivered, the country is taking meaningful steps toward making health care accessible and affordable for all.