WHO course on health financing for universal health coverage in Tajikistan
On 25–29 September 2017 WHO provided country-specific training on health financing for universal health coverage (UHC) in Dushanbe, Tajikistan. The week-long intensive course was offered by the WHO Regional Office for Europe, with the support of a collaboration between WHO, the European Union (EU) and Luxembourg: the EU-Luxembourg-WHO UHC Partnership.
Over the past decade Tajikistan has undertaken a series of comprehensive health sector reforms aimed at moving towards UHC. The government has developed a number of health policies and programmes with the support of international development partners, but despite these efforts more work and support are needed, particularly for the key component of strengthening local capacity in the field of health financing.
The course was offered by the WHO Barcelona Office, which coordinates training activities in the area of health financing. It combined lectures, group work, intensive homework tasks and simulation exercises, as well as a panel discussion with key stakeholders’ representatives. Thirty-six participants representing state entities and development partners gathered to develop their expertise in the areas of health financing and UHC.
“Hosting the WHO Barcelona course on health financing for UHC in Dushanbe is a great honour. It is a unique opportunity for us to build a stronger platform for policy dialogue and capacity-building within and beyond the health sector,” said Nasim Olimzoda, the Minister of Health and Social Protection of Population of Tajikistan, at the conclusion of the course.
Framing health financing reforms: from root-cause analysis to coordination of reform
This country-specific course was tailored to the Tajik policy context and to the specific interests of policy-makers in Tajikistan. It was built around in-depth discussions on key health financing functions such as raising revenue, policy options for pooling of health revenues, strategic purchasing of health services, financial protection mechanisms, designing a benefit package and overall alignment of reforms in health care sector. It offered practical sessions on how to track health expenditure for better policy impact and how to align policy instruments with policy objectives, and covered experience and lessons learnt from countries implementing health financing reforms over the past 10 years.
Participants were introduced to a methodology for in-depth situation analysis, and were encouraged to frame the pending reforms in Tajikistan within the Tajik context and existing challenges. The course also discussed how to align policy instruments with policy objectives and provided an appropriate framework and sequence for addressing the pending changes in the health financing reforms in Tajikistan.
“No one should be left behind when using health services in Tajikistan: people should have access to health care and be protected financially,” stated Farhod Nurgulov, Chief of the Budget Department, Department of Finance, Gorno-Badakhshan Autonomous Region.
Gathering perspectives through broad stakeholder participation
The course was aimed at senior policy-makers and technical experts across various sectors and key ministries in Tajikistan. These included the Ministry of Health and Social Protection, Ministry of Finance, Ministry of Economic Development and Trade, Tax Committee, State Committee on Investment and State Property Management, Agency on Social Insurance and Pensions and development partners.
Broad participation and the different roles of participants in implementation of health financing reforms in Tajikistan ensured a variety of perspectives in discussions throughout the course and at the panel discussion. For instance, participants discussed increasing government expenditure in the light of current fiscal constraints in Tajikistan and its commitment that UHC should improve financial protection, political challenges in pooling arrangements, issues of low efficiency of services and challenges in optimization of service delivery network; insights were received from many different professional backgrounds.
Ten representatives among the key stakeholders, including core trainers, had an opportunity to discuss questions including “Where is Tajikistan on the road to UHC?” and “What does Tajikistan have to do to achieve it?” at the panel discussion at the end of the fourth day. All participants shared interesting views, thoughts and insights on the challenges of moving towards UHC.
“The way towards UHC should be home grown and owned. Everyone agrees with broad UHC goals, but specific challenges differ from country to country: the starting-point for each country is unique, and mixed fiscal and other contextual factors are unique. We also know what works and does not work. Therefore, do not copy the experience of other countries, but learn from it and make your own way towards UHC,” said Baktygul Akkazieva, Health Finance Expert at the WHO Regional Office for Europe and Course Coordinator.
Supporting the implementation of health reforms
“The health sector is currently a priority sector for us, because, as the saying goes, ‘a healthy nation is the wealth of the state’. The WHO Barcelona course on health financing for UHC was very relevant to me. Knowledge I have gained will be useful in my future work: it provided us an opportunity to create a new vision of how we can eliminate the inefficiency of the current system and provide the population with fair and inexpensive medical services,” said Hayriddin Najmiddinov, Head of the Budget Planning Department of the Main Department of Finance in Khatlon Region.
“This course was very important for health managers who are directly involved in the implementation of reform. It was very informative, and provided answers to all the questions asked about health financing. The experience of other countries in implementing health financing reform was also demonstrated, which proves the need to reform the financing system,” agreed Gulnor Zoirbekova, Primary Care Manager from Gorno-Badakhshan Autonomous Region.