Considering the virtual absence of modern health care in Tajikistan at the start of the Soviet era, the quality of medical services had improved markedly by the close of that era. Statistically, Tajikistan rated at or below the average for Soviet republics for most indicators of health conditions and health care delivery (see table 5, Appendix).
After nearly seventy years of inclusion in the Soviet state, with its avowed aim of modernization, Tajikistan had a level of health care that was low both in absolute terms and by Soviet standards. State spending for health care and medical equipment in Tajikistan was a fraction of the average for the Soviet Union. Tajikistani regimes had long regarded social needs such as medical care as less important than economic development. Admission standards for the republic's best medical school, the Abu Ali ibn Sino Institute of Medicine in Dushanbe, were notoriously lax. In 1986, according to government statistics, Tajikistan had 325 hospitals with a total of 50,115 beds, 697 outpatient clinics, 1,313 paramedic and midwife facilities, and 567 maternity and pediatric clinics and hospitals. In 1994 the Ministry of Health reported 59,000 hospital beds. As in other parts of Central Asia, a large proportion of health care professionals in Tajikistan were members of nonindigenous nationalities, especially Russians, Ukrainians, and Jews, many of whom emigrated after 1989. Within months of the February 1990 disturbances in Dushanbe, about 1,300 doctors and nurses emigrated from the republic.
In 1994 the republic had 13,000 doctors, one for every 447 inhabitants, by far the worst proportion among the Central Asian republics. The number of other health care workers, 80.3 per 1,000 inhabitants, was also far below the level for other republics. Rural Tajikistan suffered a particular deficiency of health care professionals. Dushanbe felt this scarcity less than the rest of the country.
In the late 1980s, the average number of hospital beds per 10,000 inhabitants in the Soviet Union was 130, but Tajikistan's proportion was 104.3 per 10,000. The figure was half that in rural areas. Dushanbe was estimated to have a 5,000-bed shortage, according to Soviet standards, in 1990. In the mid-1990s, there was a great backlog in the construction of new medical facilities. More than 80 percent of Tajikistan's health care facilities were evaluated as substandard, and most lacked running water and central heating. Only one drug treatment center existed in Dushanbe, with twenty to thirty beds, and there was no rehabilitation program (see Internal Security, this ch.).
Acquiring medicines is difficult or impossible for ordinary citizens. In some areas, one drug dispensary serves as many as 20,000 inhabitants, compared with the Soviet standard of one dispensary for every 8,000 people. According to one health organization, when the Soviet distribution system disappeared in 1992, Tajikistan, which had no modern pharmaceutical plants, lost access to 258 different kinds of drugs, including streptomycin and analgesics.
Since independence, steady reductions in the state health budget have further eroded the salaries of medical professionals and the availability of care. (In 1992 the Ministry of Health already had the smallest budget of the state ministries.) For that reason, health planners have considered privatization of the national health system an urgent priority. In the mid-1990s, however, little progress had been made toward that goal.
Data as of March 1996