An Assessment of Labor Productivity of Primary Healthcare Networks in Tajikistan (English)

Despite impressive improvements in population health over the past decade, Tajikistan continues to face challenges in providing adequate healthcare to its population, with an estimated 10,000 excess deaths annually due to lacking care access and quality [1]. Population growth and a rising burden of non-communicable diseases with their often complex and costly treatment needs add pressure on a healthcare system which, with government current health spending of only US$20 per capita1 (2021), is already severely underfunded [2]. Efficient use of the scarce resources is therefore imperative, and effective primary healthcare (PHC) is recognized by the Government of Tajikistan as the most cost-effective way to improve population health [3]. Despite this, very little is known about how effectively PHC funding is used, especially for the 90 percent that account for PHC worker salaries. A rare exception is a 2018 survey of rural PHC facilities in two of the country's four regions, which finds PHC worker productivity as measured by staff caseloads amounting to only 6-7 patients per day [4]. PHC worker productivity is particularly poorly understood for the regular patronage patient home visits which account for half of PHC nurses' workdays and have not been previously quantified. A better understanding of the volume, nature, and drivers of PHC outputs is urgently needed to inform PHC investment and organizational reform priorities. This note is a first attempt to address this need by (a) discussing availability and suitability of current administrative data for PHC productivity measurement, (b) providing the first nationwide estimates of labor productivity in PHC provider networks, including distinction between in-facility and home visits, and (c) identifying ways to improve PHC data availability and priority areas of future inquiry. The note is structured as follows: Sections 2 and 3 give brief overviews of PHC in Tajikistan, and of PHC productivity measurement, respectively. Section 4 describes the available PHC productivity data in Tajikistan and their operationalization for this study, and Section 5 presents empirical findings which are contextualized in Section 6. Section 7 concludes with three recommendations to improve PHC productivity measurement for Tajikistan.