Poverty, out-of-pocket payments and access to health care: evidence from Tajikistan

Rethinking informal payments by patients in Europe: An institutional approach

“…This has been identified in studies conducted in large geographical areas, such as in 35 European countries [26], Central Asia [30] as well as in 33 African countries [31], or in smaller studies comprising only one nation as, for example, Bulgaria [1,6,13,32,33], Poland [34,35], Hungary [2,[36][37][38][39][40], Greece [4,41], Lithuania [34,42], Russia [43,44]; Ukraine [34,45], Moldova [46], Serbia [47], Kazakhstan [48], Albania [5,49,50], Kosovo [8], Tajikistan [51,52], Kyrgyzstan [53], Taiwan [54], Cameroon [55], Tanzania [3,56] and Turkey [57]. Nevertheless, informal patient payments phenomenon is poorly examined at a cross-country level.…”

Governance In Health Care Delivery : Raising Performance

“…Studies in China of "red packages" paid to providers report that payments average between US$16-36 per hospital visit, with referral hospitals averaging US$44, roughly 90 percent of average half-monthly income (Bloom, Han, and Li 2001). Data from a Living Standard Survey in Tajikistan showed that informal payments deterred poorer households from seeking care, and also affected the appropriateness of care received (Falkingham 2004). In some cases, informal payments drive households into poverty by forcing them to sell assets or borrow at unfavorable rates to pay for health care (Lewis 2000;Falkingham 2002).…”

“…A special case of informal payments involves supplementary in-kind medical costs for necessary medical supplies and care that should be provided by the health facility but are not. In Tajikistan, family members bathed, fed, provided medical and non-medical supplies, and even administered injections to their relatives (Falkingham 2004). While part of these costs are incurred as voluntary activities by families to help defray the costs of medical care, some of these also reflect governance failure on the part of health care providers, especially when these activities include responsibilities such as administering medications and injections, which should be carried out by medical professionals.…”

Civil Society Organizations and Policy Process in Tajikistan

“…During the period when Tajikistan was part of the Soviet Union, strict control was exercised over initiatives and most societal needs provided by the heads of state, and other nongovernmental activities were strongly discouraged if not prohibited (Falkingham, 2004). Moreover, multi-vector diplomacy prevented Tajikistan and several other countries from direct communication with the rest of the world, except through Russia.…”