TAJ-mapSlightly smaller than Wisconsin, Tajikistan is the poorest of the former Soviet republics. The mountainous country’s economy is dominated by minerals extraction, metals processing, agriculture, and reliance on remittances from citizens working abroad. Although it was always one of the poorest countries in the Soviet Union, Tajikistan suffered greatly after the Soviet Union dissolved and the 1992-1997 civil war lead to the collapse of social infrastructure and severely damaged an already weak economy.

The first years of independence were accompanied by a massive deterioration of the population’s health status, through the rise of some communicable and noncommunicable diseases and deteriorating access to health services. Tajikistan’s population faces a double burden of both high noncommunicable and communicable disease rates. Infant and maternal mortality rates are among the highest in the WHO European Region and malnutrition is a major public health concern. Poverty, poor diet, smoking, and drug use contribute to the nearly 30% of deaths caused by cancers, cardiovascular diseases, and diabetes in people ages 30 to 70.

Intravenous drug use is assumed to be the major source of HIV transmission. The Sentinel Surveillance Survey conducted in selected districts of Tajikistan in 2008 found a prevalence of HIV among injecting drug users of 19.4 percent, varying from 7.6 percent to 30 percent in different sites. Lack of HIV education is also a huge factor and future risk for HIV transition. The survey showed that only 16 percent of labor migrants and sex workers new HIV/AIDS prevention methods and only 13 percent used condoms. Young people’s knowledge is also poor, of people aged 14-17 in Tajikistan less than 24 percent were aware of the use of condoms.

According to WHO’s European Observatory on Health Systems and Policies’ health system review (HiT), Tajikistan’s health system has evolved from the Soviet model of health care, with so far few structural changes. Tajikistan has less health care professionals per capita than other countries in central Asia. Physicians are mainly specialized, but more and more are being retrained to become family physicians. There are marked inequities in Tajikistan’s health system with regard to both finance and the distribution of services and resources. Poverty and physical barriers present a significant barrier to accessing health services, the remote mountainous regions, where road conditions are poor causes many communities to no access to care during the winter season.