Institute for War and Peace Reporting | Giving Voice, Driving Change
Tajikistan: Corrupt Medics Foiled
The Tajik government has moved to crack down on a wave of corruption within the health service.
Low wages and economic difficulties had led many healthcare workers to take money from patients for services that should be provided free of charge.
The problem has spiralled to the extent that the public no longer trusts medical staff, with the expression "Allah preserve us from hospitals and doctors!" in common use.
The authorities issued a decree at the end of January, which demands that the health authorities take a tough stance on graft, and recommends that compulsory health insurance be introduced to ease the burden on the service.
Any doctor caught taking money from his patients will be considered to have accepted a bribe - and could face a suspended prison sentence of up to three years or a substantial fine.
The news has been welcomed by ordinary Tajiks, fed up of being fleeced by hospital staff.
Dushanbe resident Marifat Saidova told IWPR that her ten-year-old son was rushed to casualty last autumn with suspected typhoid - only to be kept waiting for an hour while a doctor demanded cash for a diagnosis.
"Money isn't an issue when you are trying to save your child's life. As a mother, I would be prepared to pay any sum even if I had to borrow it," she said.
"But when Tajik doctors first see a patient, they no longer think about how to treat him, but how much money can be made from him. Until that is established they won't do anything."
Saidova's son was treated and cured for 150 US dollars - a massive sum for Tajiks whose average salary is between ten and 15 dollars a month.
The medics in turn claim their low salaries have left them with no choice but to take cash from sick people and their families.
According to data from the health ministry, surgeons earn around two dollars 40 cents a month, marginally more than nurses and orderlies. The cost of a basic monthly household basket is as much as 23 dollars.
"I am forced to take money from patients for treatment," said the head of one state funded hospital in Dushanbe, who wished to remain anonymous. "I have a good team. I selected the employees myself, down to the last sanitary worker, and I have to pay them so they don't leave. Where else can I find the money?"
A recent dip in the supply of vital medicines such as painkillers has created new opportunities to abuse the system.
One young nurse, who treats cancer sufferers in the capital, said, "I've earned 17 dollars this month already from only five painkilling injections. If only there were more patients like that."
Those who have quit the profession because they've refused to abuse the system claim pressure from corrupt colleagues is intolerable. "A doctor who doesn't want to take money from patients is simply forced to leave," said a former surgeon who gave his name only as Shuhrat.
It is generally agreed that the system is crying out for change, but international health organisations and civil society representatives say the government's programme of health reforms - which began in 2000 - is progressing very slowly.
Analysts believe the process is being held up by resistance from medical staff, with doctors in particular unhappy about the introduction of compulsory medical insurance, which will prevent them pocketing patients' money.
The measure is popular with public not only because it will prevent such abuse but because funds from the scheme will be ploughed into the service to pay for improved health services.
Analysts have warned that if the changes outlined in the January decree are not implemented, and if the reform process continues to stall, medical care will only be accessible to the very richest Tajiks.
This would leave more than 60 per cent of the population - regarded by the World Bank as living below the poverty line - with no access to even the most basic medical treatment.
Veronika Habib Nur is the pseudonym of an independent journalist and Lidya Isamova is IWPR director in Tajikistan
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