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Tajikistan : Review of Public Expenditures on HealthThis policy note is part of the World
 Bank's Programmatic Public Expenditure Review (PER)
 work program for FY2012-2014. The PER consists of a series
 of fiscal policy notes, which aim at providing the
 Government of Tajikistan with recommendations to strengthen
 budgetary processes and analysis. This policy note, the
 second in the series, examines public expenditures on health
 in Tajikistan. After an introductory section, the note
 describes the institutional and administrative structure of
 the health sector. Section 3 presents health outcomes and
 health care utilization indicators. Section 4 describes
 health financing in Tajikistan and presents the main options
 to expand fiscal space for health. Section 5 reviews the
 health financing and organizational reforms implemented in
 Tajikistan. Section 6 provides the main conclusions: 1)
 despite progress, health sector outcomes are mixed in
 Tajikistan and utilization pattern of health services is
 characterized by significant inequalities; 2) public
 spending on health is relatively low and skewed towards
 hospitals rather than outpatient care; 3) the hospital
 sector is characterized by oversupply of beds, avoidable
 inpatient admissions, low occupancy rates, and excessive
 average length of stay; 4) an increase in public health
 expenditures since 2000 was largely driven by the expanding
 wage bill, while other expenditures had been compressed; 5)
 public health expenditures show a regressive incidence, with
 the distribution of inpatient care more pro-rich than
 outpatient care; 6) the large reliance on out-of-pocket
 produces a high incidence of catastrophic spending; 7) a
 number of health financing and organizational reforms have
 been initiated since 2000, but the scope and coverage is
 still limited; and 8) the overall prospect for increasing
 fiscal space for health in Tajikistan are positive, with
 rationalization of both the overall budget and the public
 health delivery system.
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Governance in the Health Sector : A Strategy for Measuring Determinants and PerformanceMany different strategies have been proposed to improve the delivery of health care services, from capacity building to establishing new payment mechanisms. Recent attention has also asked whether improvements in the way health care services are governed could make a difference. These approaches ask which factors -- such as rules and institutions -- influence the behavior of the system in ways that are associated with better performance and outcomes. This paper reviews the concept of governance as it is used in the literature on private firms, public administration, international development and health. It distinguishes between indicators that measure governance determinants from those that measure governance performance in order to propose a framework that is analytically coherent and empirically useful. The framework shows how these indicators can be used to test hypotheses about which governance forms are more useful for improving health system performance. The paper concludes by proposing specific measures of governance determinants and performance and describes the instruments available to collect and interpret them.
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Tajikistan - Second Programmatic Public Expenditure Review : Volume 4. Public Expenditure Ttracking Survey (PETS), Health SectorThis report, Second Programmatic Public
 Expenditure Review (PPER 2), is a sequel to PPER, which was
 published in July 2007. PPER 2 provides a detailed analysis
 of key public expenditure issues in Tajikistan and reports
 on the nonlending policy dialogue and technical assistance
 programs managed and coordinated by the World Bank. PPER 2
 has a special focus on social sectors, especially the health
 and education sectors. Public Expenditure Tracking Surveys
 (PETS) carried out for the first time in Tajikistan in 2007
 contributed to the findings in this report. The report also
 updates the macroeconomic and fiscal situation to take
 account of important developments in 2007 and analyzes the
 implications of energy sector reforms and investments for
 fiscal sustainability. This report is intended to contribute
 to improving the quality of life in Tajikistan through a
 comprehensive reform program. It spells out the
 macroeconomic, energy, and budget reforms necessary to
 achieve the growth the country seeks and, at the same time
 (and frequently via the same measures) the social welfare
 targets of the Millennium Development Goals (MDGs).