As under the Soviet system, health care continues to be universally available to all citizens without charge. The health care system that Turkmenistan inherited from the Soviet regime is fraught with deficiencies, however. On the whole, physicians are poorly trained, modern medical technologies are almost unheard of, and many basic medicines are in short supply. Although health care is available to most urban residents, the system is financially bankrupt, and treatment is often primitive. Only recently have some medical professionals been allowed to offer private medical care, and the state maintains a near monopoly of health care.
Structure of Health Care
Health and welfare institutions are administered by the ministries of health, culture, education, and social welfare. Various coordination committees also operate under the aegis of presidential advisers. Between 1989 and 1992, health care as a share of the state budget declined from 11.2 to 6.9 percent, leaving inadequate local budgets to bear the brunt of expenditures. The comparison of health care statistics before and after 1991 is somewhat misleading, however, because the statistics do not account for changes in health budgeting at the end of the communist era.
In 1989 the republic had about 13,000 doctors and 298 hospitals, totaling more than 40,000 beds (111 per 10,000 persons). Some industrial enterprises had separate clinics for their workers. The number of doctors reached 13,800 or (36.2 per 10,000 persons) in 1991; at that time, medical personnel numbered 40,600, or 106.9 per 10,000. Until the early 1990s, all health personnel were government employees.
Health Care Conditions
Despite the nominally universal availability of free health care, in the rural areas medical care often is deplorable by Western standards. In both rural and urban areas, undertrained physicians and staff, underequipped facilities, shortages of medicines and supplies, and chronic sanitation problems contribute to the system's inadequacy. For example, one study found that because 70 percent of the obstetricians and gynecologists in Dashhowuz Province lacked adequate surgical training, half of their patients died. A factor in the high mortality rate is the provision of piped-in water to only 15 percent of maternity clinics in the republic. Because of the disruption of trade at the end of the Soviet period, pharmaceuticals must be obtained with hard currency, making them even more scarce than before. Of particular concern are shortages of oral rehydration salts for children, syringes and needles, and vaccines, which previously had been imported from Russia and Finland. According to experts, current conditions of conventional medical care may prompt many Turkmen to turn once again to "traditional" medicine. Healers employing herbs and prayer are common, and in some rural areas this type of treatment may be the only medical attention that is available.
According to health statistics, life expectancy in Turkmenistan (62.9 for males, 69.7 for females) is the lowest in the CIS. The relatively high rate of natural population growth (2.0 percent per year), is based on a birth rate of 29.9 per 1,000 persons and a death rate of 7.3 per 1,000 persons. In 1992 cardiovascular disease was the most common cause of death, followed by cancer, respiratory disease, and accidents (see table 5, Appendix). Poor diet, polluted drinking water, and industrial wastes and pesticides cause or exacerbate many medical problems, which are especially acute in the northeastern areas of the country near the Amu Darya and Aral Sea. Women in their child-bearing years and children appear to be in the poorest health and the most susceptible to disease and sickness. Of CIS countries, in 1991 Turkmenistan ranked first in infant mortality rate, with forty-seven deaths per 1,000 live births, and very high on maternal death rate, with fifty-five deaths per 100,000 births. Some specialists attribute high infant mortality to factors of diet and health care while others relate it to poor hygienic practices and lack of family planning.
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