Public health is one of the key factors that directly determines the quality of life, the development of human capital, and the sustainable socio-economic development of the country. For Tajikistan, improving the healthcare system is primarily associated with increasing the accessibility and quality of medical care, especially at the level of primary healthcare.
The project “Healthy Nation of Tajikistan” (“Millati solimi Tojikiston”) is aimed at improving the quality and effectiveness of primary healthcare and strengthening the national capacity to respond to emergencies in the field of public health.
The project supports interconnected areas — strengthening primary care, improving financing approaches, digitalization of healthcare, developing human resources, and increasing system resilience.
On the eve of the 35th anniversary of the republic’s independence, “Asia-Plus” spoke with the coordinator of the “Healthy Nation of Tajikistan” project, Bakhodur Kholnazar, about what changes are necessary for the healthcare system, what they mean for an ordinary citizen, and why investments in primary healthcare are investments in the country’s future.
“We need to view the healthcare system through the eyes of the patient”
– If we talk about the healthcare system as a whole, what changes are most necessary today to ensure that medical care is accessible and of high quality for the population?
– In my view, the most important thing is to view the healthcare system through the eyes of the patient. It is important for a person that medical care is nearby, that they can timely turn to a qualified specialist, undergo necessary examinations, and receive treatment without unnecessary organizational barriers.
For this, it is not enough to improve only individual institutions or purchase new equipment. A comprehensive approach is needed: strong primary healthcare, trained medical personnel, modern infrastructure, effective use of financial resources, digital solutions, and clear mechanisms for patient referral.
Preventive focus is of particular importance. A modern healthcare system should not only treat disease after it has developed, but also identify risk factors, conduct prevention, early diagnosis, and medical supervision. The earlier a problem is identified at the primary care level, the higher the likelihood of avoiding complications, hospitalization, and significant expenses for both families and the state.
This is why strengthening primary care is one of the central directions of the ongoing reforms.
– Please tell us in simple terms: what is the main idea of the “Healthy Nation of Tajikistan” project?
– To put it very simply, the main idea of the project is to bring quality medical care closer to people.
Most people first turn not to a specialized hospital, but to a family doctor, to a rural, district, or city health center. Therefore, it is important that at this level there are the necessary conditions: qualified specialists, equipment, medicines, modern approaches to diagnosis and treatment, digital tools, and effective organization of work.
At the same time, the project is not limited to building repairs or the purchase of medical equipment. We view primary healthcare as a unified system. It includes personnel, infrastructure, financing, information, digitalization, quality of medical services, and interaction with the population.
Ultimately, all these changes should lead to one result — a person should receive more accessible, timely, and quality medical care regardless of whether they live in a major city or in a remote area.
– One of the key directions of the project is strengthening primary healthcare, including district, city, and rural health centers and the development of family medicine. Why is primary care so important for the entire healthcare system?
— Primary healthcare is the foundation of the healthcare system. This is where a person’s first contact with the system occurs: preventive examinations, vaccinations, monitoring of children and pregnant women, identification of hypertension and diabetes, treatment of common diseases, medical supervision, and referral of the patient to the next level when necessary.
If primary care works effectively, a significant portion of diseases can be identified and controlled at an early stage. This reduces the burden on hospitals and narrow specialists, reduces the number of complications, and makes the use of healthcare resources more rational.
The role of family medicine is also very important. A family doctor knows not only the disease of a particular patient, but also their living conditions, risk factors, and family history. This approach allows for a transition from episodic disease treatment to continuous monitoring of a person’s health.
Therefore, investments in primary care have an effect on the entire healthcare system.
Digitalization is part of the reform
— Improvement of infrastructure, equipping medical institutions, and developing human resources in pilot districts. How will this affect the accessibility and quality of medical care?
— It is important here that these directions are not implemented in isolation from each other. Modern equipment by itself does not ensure quality if a specialist does not know how to use it effectively. Similarly, it is difficult for a well-trained doctor to provide care at the proper level if the institution lacks the necessary conditions for diagnosis and treatment.
Therefore, we strive to combine several elements: improving conditions in primary care institutions, providing necessary equipment, professional development of doctors and nursing staff, implementing modern clinical approaches, and improving the organization of medical care.
For the population, the result should be very concrete: more medical services will be available directly at the place of residence, the possibility of early disease detection will increase, and the need for unjustified referrals to higher levels of medical care will decrease.
These changes are especially important for rural and remote areas, where access to specialized services has traditionally been more difficult. Our task is to help narrow this gap.
– Strategic procurement of primary healthcare services. What does this term mean in practice and why is a change in the financing approach important for the quality of medical care?
— The term does sound quite technical, but its meaning is clear: it is important not only how much funding is allocated to healthcare, but also what results it is used for.
Traditionally, the financing of a medical institution has been largely related to maintaining its structure — buildings, staff positions, and current expenses. Strategic procurement involves a gradual transition to a more results-oriented approach, where the volume and quality of services provided, the needs of the population, and the performance indicators of medical organizations are taken into account when planning and using funds.
That is, financing should create incentives for an institution to be interested not simply in functioning, but in improving results: disease prevention, quality patient monitoring, early identification of risk factors, and compliance with medical care standards.
This is a serious systemic change. It requires reliable data, transparent rules, information systems, and objective quality indicators. Therefore, financing reform is closely linked to digitalization and the development of a monitoring system.
Ultimately, financial mechanisms should work in the interests of the patient.
– Digitalization is also part of the primary healthcare reform. What contribution does the project make to the digitalization of the healthcare system?
— For us, digitalization is not simply converting a paper document into electronic format. Its main task is to make the healthcare system more manageable, transparent, and convenient for both medical workers and patients.
When necessary medical data is available in structured electronic form, it is easier for a doctor to see the patient’s observation history, for an institution’s manager to analyze the organization’s work, and for the healthcare system to plan resources and make decisions based on real data.
The project supports the development of key elements of the digital infrastructure of primary healthcare, including electronic information systems, data accounting and management tools, as well as providing institutions with necessary computer equipment.
At the same time, digitalization requires not only software and equipment. Personal data protection, compatibility of information systems, training of medical workers, and changes to work processes are equally important.
Our goal is not digitalization for the sake of digitalization itself. Technology should help doctors spend more time with patients and provide managers with quality data for decision-making.
Without a trained healthcare worker, there will be no results
— What directions related to the training and professional development of doctors and nursing staff are provided for in the project?
— Personnel is one of the main factors in the quality of medical care. You can build a modern institution and purchase the best equipment, but without a trained healthcare worker, the expected result will not be achieved.
Therefore, the project places great emphasis on the professional development of primary care specialists. Programs for training and retraining in family medicine are supported, continuing education for doctors and nursing staff, improvement of practical skills, and implementation of modern teaching methods.
A separate direction is the modernization of postgraduate medical education. The project reviews the standards and educational programs of clinical residency to ensure that specialist training better corresponds to the real needs of the primary healthcare system.
Work has already been completed in the areas of cardiology, endocrinology, neurology, and pediatrics with an emphasis on practical training, competency-based approach, simulation training, and modern assessment methods.
For us, it is fundamentally important that training does not end with the issuance of a certificate. The knowledge and skills acquired should be reflected in the daily practice of healthcare workers and, most importantly, in the quality of patient care.
Investments in medical personnel are one of the most long-term investments of the project, because a trained specialist continues to benefit the population for many years after the completion of specific activities.
— On the eve of an important holiday for the entire country, what would you like to wish to healthcare workers and residents of Tajikistan?
— First of all, I want to congratulate all residents of our country on the 35th anniversary of the State Independence of the Republic of Tajikistan.
Over the years of independence, our country has made great strides in development, and strengthening the healthcare system is an important part of this process. The health of the people is not only a task of the medical sector. It is the foundation of human capital, family well-being, economic development, and the future of the state.
I want to express special words of gratitude to healthcare workers. Their daily work, especially in rural and remote areas, requires high responsibility, professionalism, and dedication to their profession.
I wish all our healthcare workers good health, well-being, new professional achievements, and worthy working conditions. And to every resident of Tajikistan — health, peace, family well-being, and confidence in the future.
I am confident that consistent reforms, the development of the professional potential of our specialists, and the joint work of the state and partners will create an even more accessible, quality, and sustainable healthcare system.
Happy Independence Day! May independent Tajikistan develop and prosper, and its main capital — the health of its people — grow stronger with each passing year.
