Joint Annual Review—Eight Years of the Implementation of the National Health Strategy of the Republic of Tajikistan 2010–20
Jan-Peter Olters, World Bank Country Manager
Chair of the Development Coordination Council
Health is often taken for granted by those fortunate enough not to be sick or injured, but it becomes the most precious good once a family member or oneself become a patient and fully dependent on the knowledge and skills of doctors and health experts and the medical infrastructure within which they work. While a value in itself, health has important effects on decisions people make and, ultimately, on economic performance, both directly and indirectly, whether they relate to frequent or prolonged sick leaves, reduced productivity, and/or the lack of focus on the work at hand.
Most critically, ill health and poor nutrition among young children have permanently detrimental impacts on cognitive skills and, ultimately, professional perspectives. For low-income families, the high seasonality of food prices increases their vulnerability to malnutrition and stunting. In the currently fast-changing world, which values increasingly cognitive skills, malnutrition and stunting will cement inequalities of opportunity and constrain a country’s socio-economic development potential.
While easy to achieve an ‘in principle’ political consensus on this challenge, many countries suffer in their development policies from the inherent incentive incompatibility between large, but long-run benefits of interventions in health and early childhood development and the immediate fiscal and political costs of defining related health expenditures an immediate policy priority. It thus reflects the Government’s particular commitment to see the National Health Strategy’s first chapter be devoted to measures on ‘strengthening maternal, new-born, child, and adolescent health’, which we see reflected in the considerable drop, since the adoption of theNational Health Strategy 2010–20, in most relevant indicators, including those on stunting, malnutrition, or child mortality rates (notwithstanding still high levels and the need for a continued focus).
Whether it is the Sustainable Development Goal № 3 aimed at ensuring healthy lives and promoting the well-being for all at all ages or the Human Capital Index recently introduced by the World Bank, Tajikistan and development partners will continue, if not increase, their collaboration on policies needed to strengthen human capital. Beyond nutrition, clean water and sanitation, and education, the access to quality healthcare—often a critical constraint in rural areas—remains a central policy challenge for Tajikistan in its efforts to strengthen human capital and its population’s overall health.
Against this backdrop, it is with gratitude to be able to confirm today development partners’ sincere appreciation for the strong efforts made by the Government of Tajikistan and Ministry of Health and Social Protection and their continuously close and constructive collaboration with the Ministry and its committed staff. Today’s event and, especially, all the work that has gone into preparing the Joint Annual Review,allow for the shared assessment of the as-of-yet unaddressed challenges contained in the National Health Strategy, of ongoing efforts being made, and—based on available data and evidence—of the priorities that need to be addressed in the upcoming strategy.
Tajikistan’s investment in human capital, its focus on health has, of course, budgetary and policy implications. It requires investments in physical infrastructure and equipment, it requires the commitment to institutional reform and the upgrade of medical practices, but it also demands care for those who provide care for everyone in pain and need. The Government would have to agree on salaries of doctors and health practitioners that are commensurate with their qualifications, responsibility, and work pressure. It would have to ensure that the capacity of human resources in health sector are supported and reinforced to ensure the delivery of high-quality services to those most in need, including specialty training, business planning, and management training for health facility managers. The collaboration with development partners in these areas is particularly impactful.
Central to efforts of strengthening further s the health sector are reforms needed to improve health financing, to ensure universal access to healthcare, not least by expanding nation-wide the provision of the Basic Benefit Package so as to reduce—ideally eliminate—informal out-of-pocket payments. And finally, success cannot be had without strong inter-sectoral collaboration, whether in water, hygiene, sanitation, ICT and digital connectivity, or the education of new generations of doctors and healthcare experts, and a focus by Government and development partners to avoid the duplication of work and ensure the efficient use of scarce, but urgently needed resources.
The Joint Annual Review represents an excellent tradition and unique opportunity to facilitate the communication, knowledge exchange, and collaboration with all critical stakeholders in the health sector. DCC members appreciate and count on the Government’s and Ministry’s leadership in their efforts to realise objectives in the 2010–20 National Health Strategy and the follow-up strategies to be adopted.