Bernd Rechel: Assessing population health in Turkmenistan is like staring down a black hole Interview
On April, 12, the international medical humanitarian organization Médecins Sans Frontières, that stopped its activities in the country last December, published its report “Turkmenistan’s opaque health system” that raised several key issues in the Turkmen healthcare. The Turkmen authorities negatively responded to the report. The state news agency TDH reported that at the last Cabinet meeting the ministers discussed the country’s healthcare and concluded that today Turkmenistan has “a unique and smoothly working healthcare system that during the years of independence proved its accessibility and efficiency”.
Bernd Rechel told about the Turkmen healthcare system in his interview to NBCentral Asia. Bernd Rechel is Lecturer in Public Health at the London School of Hygiene & Tropical Medicine and Researcher at the European Observatory on Health System and Policies, co-author “Health in Turkmenistan after Niyazov”. Bernd holds a BA in Sociology, an MA in Race and Ethnic Studies, and a PhD in Russian and East European Studies.
NBCA: What do you think of the Turkmen healthcare system?
Rechel: The Turkmen health system is facing many of the same challenges as other countries in Central Asia – high rates of communicable diseases such as tuberculosis, as well as high infant and maternal mortality – but the situation in Turkmenistan is made worse by the lack of transparency. The government has often pursued a policy of denial and manipulation of data. One of the main problems is that reliable data on the health system and the health of the population are simply missing. Government statistics are either not being published at all or they are not credible. This applies for example to maternal mortality, where the reported mortality rate is lower than in the Netherlands – something which is completely impossible in a country such as Turkmenistan. Furthermore, the Turkmen government claims that no HIV cases have been detected in recent years – this is completely unbelievable. Where government statistics are not available or reliable, we could in other countries use surveys to gain a better picture of the situation. However, independently conducted surveys are currently impossible in Turkmenistan. Trying to assess population health in Turkmenistan is like staring down a black hole.
NBCA: In its report, the MSF points out to the low quality of medical care and poor qualification of medical staff due to such reasons as poor training of medical workers and the fear of the current political regime that with the help of staff reshuffles is creating the atmosphere of anxiety and insecurity among doctors According to your information, what is the real situation in the Turkmen healthcare?
Rechel: According to my information, the poor quality of care and in particular the lack of properly trained health care workers pose some of the main problems for day-to-day health care in the country. The Niyazov government has tremendously damaged the education sector, including for medical education, and although the duration of higher education has again been increased, the quality of education remains of very questionable value. As in other countries of the former Soviet Union, informal under-the-counter payments are widespread. They complement low salaries of health care workers, but provide an incentive for unnecessary treatments and ultimately low quality of care.
NBCA: How does concealing the facts about infectious diseases, syphilis and HIV – as it is mentioned in the MSF report – affect the health of the population? To what extent can this measure be justified?
Rechel:Concealing the facts about communicable diseases cannot be justified by any means. It is counterproductive, denies patients necessary treatment, and exposes the population to greater risks. This can be illustrated by the SARS virus which was kept secret by the Chinese government, after which it caused a number of major outbreaks around the world.
NBCA: In your opinion, to what extent are the Turkmen authorities ready to ensure transparency in the healthcare system? What should they do about it?
Rechel: We have been pressing for an independent assessment of the country’s health situation and health system for some time now, but all these efforts have been blocked. The international community should do more to insist on transparency in the health system. Without knowing the basics about the country’s health system, it will not be possible to improve it.
Inga Sikorskaya is IWPR chief editor for Turkmenistan and Uzbekistan
The article was prepared under the News Briefing Central Asia programme funded by the foundation National Endowment for Democracy.