As a result of a series of extremely problematic reforms and everyday practices, which were introduced under President Niyazov at the instigation of the then Minister of Health Bedimuhamedow and which have remained unchanged to the present day, contrary to official statements, the Turkmenistan health system is on the verge of collapse – or, according to some observers, is already collapsed. Especially since all hospitals were closed outside the capital under President Niyazov in 2005, the situation has not improved substantially. Since 2005 reports (denied by the government) of regional outbreaks of the bubonic plague have been coming out of the country. It is generally assumed that the actual situation in the country is much more dramatic than in the official statements will be presented. Accordingly, the country is now regarded as a prime example of the effects of authoritarian rule on the healthcare system.
According to the World Health Organization (WHO), Turkmenistan is one of the 30 countries with the worst doctor / resident ratio in the world. At the same time, visiting foreign hospitals is made more difficult for Turkmenistan and has often been banned entirely since 2012. In no country in the world is the average state of health worse at the age of 60. Average life expectancy is given as the third lowest in Asia after Cambodia and Afghanistan and at the same time the lowest of all successor states of the former Soviet Union. However, in the summer of 2012, President Berdimuhamedov promised life expectancy at 85 years to raise. Regardless of whether the official figures of 3.4%, the figures of independent data processors with 4.3% or the figures of USAID with 7.4% are used, it is clear that the infant mortality in Turkmenistan is by far the highest of all successor states of the Soviet Union is, in any case, extraordinarily high and, depending on the source, even one of the highest in the world.
The hygienic situation in the few remaining children’s hospitals and hospitals with children’s wards has been described as unchanged catastrophic for more than a decade. To a large extent, the population relies on traditional methods to fight diseases – including infants and small children – and in particular on infusions, teas and other forms of preparation of local herbs and prayers. Not least for these reasons, the Humanium, an NGO that monitors and supports the observance of children’s rights in Turkmenistan, sees a ” difficult situation “.
According to insidewatch, the annual expenditures of the Turkmenistan health care with 78 US- $ per resident are in the global comparison in the lower middle field. However, most of this expenditure goes to prestigious new buildings. In particular, extended President Berdimuhamedov, initiated already under President Niyazov program for the construction of numerous new clinics significantly from.
These state-of-the-art and opulently decorated clinics have not yet seen any significant use and according to the staff of Doctors Without Borders, the staff is not trained in handling the (often very expensive, new) devices and has no routine in handling them. There is also a lack of technical maintenance and spare parts as well as the capacities and skills to resolve problems. Without any significant medical benefit, these numerous new buildings are at the same time a considerable burden on the budget of the Turkmenistan health care system. According to the organization, the main purpose is to enhance the prestige of the capital by means of large buildings and to simulate internationality and modernity. In addition, the health budget can be managed much more efficiently through individual, expensive large-scale projects than through equally expensive but significantly more complex reform measures and comprehensive modernizations. According to this misallocation, only a small fraction of the health expenditure mentioned at the beginning of the paragraph actually benefits the population.
The reforms passed by President Niyazov are the main cause of the current health care situation. In 2004, President Niyazov announced the layoff of approximately 15,000 health care workers. Some of the doctors and midwives who had been dismissed were replaced by conscripts.
In 2005, President Niyazov ordered the closure of all hospitals outside the capital. He is quoted as saying: “Why do we need these hospitals? If people get sick, they can come to Ashgabat”. At the same time, President Niyazov announced the new building for the Ministry of Health from the health care budget (see figure above left).
President Berdimuhamedow describes his country as generally free from infectious diseases and has therefore expanded a ban on the diagnosis of infectious diseases that was informally introduced under President Niyazov. In particular, the diagnosis of cholera, hepatitis (A, B and C), HIV, measles, anthrax, plague, dysentery, tuberculosis (TBC) and typhoid is prohibited. Consequently, according to the organization Doctors Without Borders, there is a lack of knowledge about infection prevention, the generally poorly trained health workers deal with infected people in a generally uninformed manner and patients receive neither the necessary care nor the necessary medication. This significantly reduces the chances of survival and recovery even with diseases that are comparatively easy to treat. According to official figures, there have been only two new HIV infections since Turkmenistan independence, none of them since President Berdimuhamedov took office. The government therefore describes the country as HIV-free. Independent observers rate these reports as implausible due to the large number of heroin addicts and the general background of the accelerated spread of HIV throughout Central Asia. Since TB has not been diagnosed for more than ten years due to the bans, President Berdimuhamedow called the last remaining TB prevention center superfluous and ordered it to be closed. With the same order, he also announced the closure of the national blood bank, a venereal disease prevention center and a hospital specializing in infectious diseases in Ashgabat.
Because of these measures, the organization designates Doctors Without Borders that the situation of the Turkmenistan health care system as catastrophic. According to the organization, the focus of health policy is not on supplying the population and combating diseases, but rather on concealing them. On the other hand, the Turkmenistan government emphasizes the international standard of its health care system with great regularity. Prestigious new buildings in the south of the capital should testify to the high level of Turkmenistan health care. President Berdimuhamedow presents himself as a promoter of national health and demonstrates his personal skills. For example, when he opened a cancer clinic in the south of Ashgabat on the occasion of Health Care Day, the president appeared in a doctor’s coat and announced that removing a tumor growing behind the right ear from a patient. According to information from the Turkmenistan media, it was then run by the president performed the operation successfully and was symbolic of his qualifications and concern for the nation’s health.