| Table of contents |
ACKNOWLEDGEMENTS ........................................................................................................... iv
EXECUTIVE SUMMARY............................................................................................................. v
1. INTRODUCTION...................................................................................................................... 1
A. WHAT WILL THE PETXS ANALYSIS CONTRIBUTE? ........................................................... 1
B. RESULTS OF HEALTH SECTOR ANALYSIS........................................................................... 3
C. ORGANIZATION OF REPORT................................................................................................ 4
2. A DESCRIPTION OF THE HEALTH SECTOR...................................................................... 5
A. HEALTH OUTCOMES ........................................................................................................... 5
B. ORGANIZATIONAL STRUCTURE OF THE HEALTH SYSTEM ................................................. 7
C. OVERVIEW OF THE HEALTH BUDGET ALLOCATION........................................................... 9
D. CHALLENGES IN HEALTH FINANCING .............................................................................. 11
E. POLICY REFORMS IN THE HEALTH SECTOR..................................................................... 12
3. BUDGET MANAGEMENT IN THE HEALTH SECTOR..................................................... 15
A. THE HEALTH BUDGET ...................................................................................................... 15
B. PREPARATION OF THE HEALTH BUDGET.......................................................................... 26
C. BUDGET EXECUTION, FINANCIAL REPORTING, AND AUDITING....................................... 27
D. ISSUES IN BUDGET MANAGEMENT................................................................................... 32
E. TRACKING HEALTH EXPENDITURES................................................................................. 34
4. HUMAN RESOURCES FOR HEALTH................................................................................. 37
A. INTRODUCTION................................................................................................................. 37
B. TAJIKISTAN HEALTH WORK FORCE CHARACTERISTICS .................................................. 37
C. STAFF WAGES, STAVKA ALLOCATION, AND DECISION-MAKING POWER ....................... 40
D. COPING MECHANISMS, STAFF MORALE AND ABSENTEEISM........................................... 49
E. OTHER STAFF QUALITY MEASURES................................................................................. 60
5. MANAGEMENT OF OTHER INPUTS AND SERVICE OUTPUTS ................................... 63
A. CHARACTERISTICS OF THE FACILITIES............................................................................. 63
B. FACILITIES INPUTS............................................................................................................ 70
C. SERVICE OUTPUT.............................................................................................................. 83
D. RELATIONSHIP BETWEEN INPUTS AND SERVICE OUTPUTS .............................................. 92
E. CASE STUDY OF IMMUNIZATION SERVICES...................................................................... 96
6. CONCLUSIONS AND RECOMMENDATIONS................................................................... 99
A. MANAGEMENT OF THE HEALTH BUDGET......................................................................... 99
B. HUMAN RESOURCE MANAGEMENT................................................................................ 102
C. MANAGEMENT OF OTHER INPUTS AND SERVICE OUTPUTS ........................................... 104
ANNEX A: SURVEY METHODOLOGY AND IMPLEMENTATION................................... 106
A. INTRODUCTION............................................................................................................... 106
B. SAMPLING STRATEGY AND DESIGN ............................................................................... 106
C. SURVEY INSTRUMENTS................................................................................................... 110
D. SURVEY IMPLEMENTATION - THE FIELD WORK............................................................ 111
E. DATA ENTRY AND CODING ............................................................................................ 114
F. SURVEY EXPERIENCE ..................................................................................................... 115
G. LESSONS LEARNED AND RECOMMENDATIONS .............................................................. 118 |
