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).
Health Care System
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.
The life expectancy of a male born in Tajikistan in 1989 was 66.8 years, and of a female, 71.7 years. In 1989 this was the longest life span projection among the five Central Asian republics, but it was shorter than those of all the other Soviet republics except Moldavia. In Tajikistan, urban women had the longest life expectancy (72.9 years), and urban men had the shortest (65.2 years). According to the 1989 census, the most frequent causes of death in Tajikistan were infections and parasitic diseases, circulatory disorders, respiratory disorders, tumors, and accidents. Those causes accounted for 78 percent of the 33,395 deaths in that year. In the 1970s and the 1980s, Tajikistan's mortality rate rose from 8.5 to 9.8 per 100 male inhabitants and from 6.7 to 7.3 per 100 female inhabitants.
In the mid-1990s, the health of Tajikistan's citizens was threatened increasingly by the condition of the country's water supply, which conveyed disease-causing organisms as well as toxic chemicals from agricultural and industrial origins to the population. By the late Soviet era, cases of typhoid occurred thirteen times more frequently in Tajikistan than in the Soviet Union as a whole. The health of rural inhabitants was jeopardized by inadequate sanitation and improper storage of toxic substances, and by environmental pollution (see Environmental Problems, this ch.).
Maternal and infant mortality remained serious problems in Tajikistan in the 1990s. In 1988 Tajikistani women were 1.6 times more likely to die in childbirth than were women in the Soviet Union as a whole. By 1989, according to official statistics, forty of every 1,000 babies born in Tajikistan did not survive to the age of one year. In many parts of southern Tajikistan, the rate was more than sixty per thousand. (The rate of infant mortality was higher than indicated by official Soviet statistics, which were underreported in rural areas and often were adjusted downward.) Factors contributing to infant mortality include family poverty; inadequate nutrition for nursing mothers, babies, and schoolchildren (who receive inadequate meals in school); and a lack of safe drinking water. Experts believe that environmental pollution, especially that caused by the agricultural chemicals used in cotton production, plays a major role in the rising rates of maternal and child mortality, as well as in the relatively high incidence of birth defects.
Employment in heavy industry also poses health risks for women and their children. By the late 1980s, some 80 percent of low birth-weight babies were born to women employed in heavy industry at jobs posing the risk of physical injury. Most important of all was the poor quality of health care that mothers and infants received and the inadequacy of the maternal and child care facilities where care was delivered. By Soviet national standards, Tajikistan in the late 1980s lacked 8,000 beds in maternity facilities and 13,000 bed for infants. Problems related to infant and maternal health were more serious in rural areas than in the cities. Soviet studies linked infant death to poor preventive health care, a lack of proper medication, and a lack of professional medical care.
Narcotics use in Tajikistan is rated as a minor health problem; in 1995 there were an estimated 40,000 drug users in the country (see Internal Security, this ch.). Authorities discovered heroin traffic into the country in 1995. As of the end of 1995, Tajikistan had reported no cases of acquired immune deficiency syndrome (AIDS) to the World Health Organization, although the Ministry of Health reported that twenty-four AIDS diagnostic laboratories were in operation in 1993.
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