Dushanbe, Tajikistan, June 24, 2013 – Key government officials, development partners and civil society organizations working on health care issues in Tajikistan discussed main findings of the new World Bank report “Getting Better: Improving Health System Outcomes in Europe and Central Asia”. According to the report, the progress in health outcomes in countries of Europe and Central Asia (ECA) has been among the slowest in the world over the past fifty years. The report makes recommendations to improve health outcomes, ensure proper financing, and strengthen institutional arrangements in order to enhance the health systems in the region.
“Health is a major determinant of overall welfare of the population, so health systems need to be affordable, efficient and they need to provide high quality of care,” said Marsha McGraw Olive, the World Bank Country Manager in Tajikistan. “In Tajikistan the programs financed by the World Bank, from addressing child malnutrition to improving financing, focus on one important outcome –improving the quality of health care for people.”
Both in ECA and globally, health financing is drawn largely from either household out-of-pocket sources or from the government budget, including social health insurance. Too much out-of-pocket spending for health care can undermine the financial stability of households and result in high inequality in access to care, while too much government spending poses a risk to fiscal sustainability. Tajikistan is among the countries, where the out-of-pocket spending for health care is between 40 and 70 percent, while the EU-15 average is 18 percent.
“To ensure that better health care is financed in a way that does not impose an excessive burden either on households or on governments, we recommend a set of actions to improve financial protection of vulnerable groups while increasing the efficiency of government health spending,” said Son Nam Nguyen, World Bank Senior Health Specialist and co-author of the report.
Improving financial protection will require some combination of expanded benefit packages, better targeting of health programs to vulnerable groups, and measures to reduce informal payments. To protect government budgets from wasteful health spending, the report suggests improving efficiency by eliminating excess hospital infrastructure, introducing service delivery innovations, and strengthening information about provider performance. Lastly, it will also be important to achieve lower pharmaceutical expenditures by households and governments alike by adopting more rational prescription practices and smarter procurement methods.
“The major cause of the populations’ ill health in ECA is heart disease,” said Owen Smith, World Bank Senior Health Economist and co-author of the report. “These conditions account for over half of the life expectancy gap between ECA and Western Europe. The predominance of cardiovascular disease across the whole region represents an obvious target for policy action.”
The starting point for reducing cardiovascular disease mortality is to address its major risk factors in the general population, before individuals need medical care. Tackling high blood pressure and cholesterol at the primary health care level will also significantly improve health outcomes in the region.
The report suggests that both prevention and treatment must play a central role in the future health agenda in countries across the region, in particular through wider implementation of cost-effective measures.
According to the report, there is no single ideal health system model or “recipe” for achieving better outcomes. Instead, the way to strengthen the institutional arrangements that govern health systems in the region is by adopting some key “ingredients” that are common to most advanced countries but still absent in much of ECA. The report identifies five such ingredients for reforming ECA’s health systems: introducing patient-based payment methods; offering a greater degree of autonomy to health providers; making better use of information for decision-making; ensuring adequate risk pooling; and supporting all these efforts with committed, credible leadership for health reform.
