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Assessing Turkmen Healthcare Like “Staring into Black Hole”

Leading expert says government fails to make basic facts public.
By Inga Sikorskaya

A London-based researcher on Turkmenistan’s healthcare system says the lack of useable data makes it impossible for outsiders to press for improvements in the Central Asian state.

Bernd Rechel of the London School of Hygiene and Tropical Medicine says the Turkmen authorities str not helping themselves when they misrepresent or cover up problems facing the health sector such as the spread of HIV.

On April 12, the international medical aid group Médecins Sans Frontières, MSF, published a report called Turkmenistan’s Opaque Health System raising key concerns facing the country. By way of response, the government held a meeting which, according to state news agency TDH, concluded that healthcare provision was “unique and well-organised”, and had “proved its accessibility and efficiency” since Turkmenistan became independent in 1991.

Inga Sikorskaya, NBCentralAsia: What do you think of the Turkmen healthcare system?

Bernd Rechel: The Turkmen health system is facing many of the same challenges as other countries in Central Asia – high rates of communicable diseases such as tuberculosis, as well as high infant and maternal mortality – but the situation in Turkmenistan is made worse by the lack of transparency. The government has often pursued a policy of denial and manipulation of data.

One of the main problems is that reliable data on the health system and the health of the population are simply missing. Government statistics are either not being published at all, or they are not credible. This applies, for example, to maternal mortality, where the reported mortality rate is lower than in the Netherlands, something which is completely impossible in a country such as Turkmenistan.

Furthermore, the Turkmen government claims that no HIV cases have been detected in recent years – this is completely unbelievable. Where government statistics are not available or reliable, we could in other countries use surveys to gain a better picture of the situation. However, independently conducted surveys are currently impossible in Turkmenistan. Trying to assess population health in Turkmenistan is like staring down a black hole.

SikorskayaIn its report, MSF points to the low quality of medical care and the poor qualifications of medical staff, due to such reasons as the poor training of medical workers and fear of the current political regime which, using personnel reshuffles, is creating an atmosphere of anxiety and insecurity among doctors

According to your information, what is the real situation in Turkmen healthcare?

Rechel: According to my information, the poor quality of care and in particular the lack of properly trained healthcare workers pose some of the main problems for day-to-day health care in the country. The Niazov government tremendously damaged the education sector, including for medical education, and although the duration of higher education has again been increased, the quality of education remains of very questionable value.

As in other countries of the former Soviet Union, informal under-the-counter payments are widespread. They complement low salaries of health care workers, but provide an incentive for unnecessary treatments and ultimately, low quality of care.

Sikorskaya: How does concealing the facts about infectious diseases, syphilis and HIV – as mentioned in the MSF report – affect the health of the population? To what extent can this be justified?

Rechel: Concealing the facts about communicable diseases cannot be justified by any means. It is counterproductive, denies patients necessary treatment, and exposes the population to greater risks. This can be illustrated by the SARS virus which was kept secret by the Chinese government, after which [the virus] caused a number of major outbreaks around the world.

Sikorskaya: In your opinion, to what extent are the Turkmen authorities ready to ensure transparency in the healthcare system? What should they do about it?

Rechel: We have been pressing for an independent assessment of the country’s health situation and health system for some time now, but all these efforts have been blocked. The international community should do more to insist on transparency in the health system. Without knowing the basics about the country’s health system, it will not be possible to improve it.

 

Bernd Rechel is lecturer in public health at the London School of Hygiene and Tropical Medicine, and a researcher at the European Observatory on Health System and Policies. He is co-author of the 2009 publication Health in Turkmenistan After Niyazov, and holds a BA in Sociology, an MA in Race and Ethnic Studies, and a PhD in Russian and East European Studies.

Inga Sikorskaya is IWPR’s chief editor for Turkmenistan and Uzbekistan.

This article was produced as part of IWPR’s News Briefing CentralAsia output, funded by the National Endowment for Democracy

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