Abstract
BackgroundThe Government of Tajikistan is reforming its health system to make access more equitable. Nonetheless, out-of-pocket expenditures (OPE) remain a key modality for purchasing health care. Drugs remain a major driver of household expenditures for health. We conducted a household survey to investigate drug prescribing patterns at primary health care (PHC) level as well as the related OPE.MethodsAdult patients in eight districts who had visited a PHC facility in the period March to May 2014 were interviewed at home, using a structured questionnaire. A descriptive analysis was conducted and regression models were constructed to identify factors influencing the number of drugs provided and the types of drugs prescribed.ResultsThere were 1281 (80.1 %) patients who received a drug prescription after visiting a doctor at PHC level. 16.2 % of them had five or more drugs prescribed concomitantly. The number of drugs prescribed to patients ranged from 0 to 8 and was statistically different across regions (RRS region =3.3; Khatlon region = 3.1; p = 0.05), after adjusting for age and sex. In 31.1 % of cases, prescriptions included an intra-venous (IV) injection; in 45.6 % of cases, a non-IV injection; in 52.9 % of cases, an antibiotic; and in 61.0 % of cases, vitamins. Patients suffering from a respiratory disease had higher odds of being prescribed an IV injection and antibiotics. Vitamins were widely prescribed across all diseases. In 94.5 % of cases, the patients interviewed procured at least one of the prescribed drugs. Among those who received a prescription, 2.0 % were not able to procure at least one drug due to a lack of money. In 94.9 % of cases, respondents reported purchasing drugs in private pharmacies. Median expenditures for drugs procured following consultation were 45 TS (US$ 6.9) corresponding to 77.6 % of total expenditures related to the visit (58 TS, US$ 8.8).ConclusionsIn a context where OPE are important, drugs represent an important income source for health service providers. Such a situation does not favour rational prescribing nor efficient service delivery, and is potentially harmful for patients. In particular, the economic ramifications cause high levels of expenditure for patients and households with detrimental, knock-on effects in the more vulnerable segments of the population.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1799-2) contains supplementary material, which is available to authorized users.
Highlights
The Government of Tajikistan is reforming its health system to make access more equitable
Tajikistan is a landlocked and mountainous country in Central Asia with approximately 8.3 million inhabitants, most of whom (73.3 %) live in rural areas [1]. It is classified as a lower middle income country with a Gross Domestic Product (GDP) per capita of US$ 2655 in 2014 and a GDP growth of 6.7 % in 2014 [1]
Focusing on secondary and tertiary health care, since 2002 the government has shown commitment to foster the role of primary health care (PHC), the share of government funds devoted to PHC, at 34.8 % in 2013 [5], remains comparatively low
Summary
The Government of Tajikistan is reforming its health system to make access more equitable. Tajikistan is a landlocked and mountainous country in Central Asia with approximately 8.3 million inhabitants, most of whom (73.3 %) live in rural areas [1]. It is classified as a lower middle income country with a Gross Domestic Product (GDP) per capita of US$ 2655 (in current international dollar, purchasing power parity) in 2014 and a GDP growth of 6.7 % in 2014 [1]. Family doctors working at PHC level earn low wages They were estimated to range between US$ 123 and US$ 153 per month in 2013 such that workers often rely on informal payments and in-kind contributions to earn additional income [5]
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