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Tajikistan Expat Health Insurance

Home to some of the highest mountains in the world, Tajikistan is a landlocked country sharing borders with Kyrgyzstan in the north, Uzbekistan to the west, Afghanistan in the south, and China to the east. Encompassing a land area of 143,100 square kilometers and supporting a population of an estimated 7.37 million (EIU, 2010) the Republic of Tajikistan has a rugged and predominately mountainous terrain; lush valleys and hundreds of canyons mark the landscape. Opportunities exist for tourists to enjoy remote and dramatic mountain scenery, explore ancient cities and experience the culture and warm hospitality of the people.

Even though Russian is widely spoken in government and business, the official language (as of 1994) is Tajik, which the rural communities - who make up approximately 74 percent of the population - generally use. Winter, from November to February can see temperatures vary from near freezing in the capital city of Dushanbe, to -40 degrees Celsius on the Pamir plateau. The temperatures in northern, central and southern areas of Tajikistan can exceed 40 degrees Celsius during the summer from June to September. Despite steady economic growth from exports of cotton and aluminum, Tajikistan is Central Asia’s poorest nation, with GDP still the lowest of all the former Soviet Republics.

Relatively new at self-government, Tajikistan gained independence in 1991 at the dissolution of the Soviet Union. Having received a fraction of the average funding available to the rest of the Soviet republics, Tajikistan inherited a chronically underfunded and neglected infrastructure, and the health status of the population deteriorated substantially. According to Government statistics, males in Tajikistan have a life expectancy of 65 years, and females 70 years (2010).

Tajikistan Healthcare System

The Government is the main provider of health care services, through both local government and its national Ministry of Health (MOH). There are four administrative levels being national, which the MOH manages, regional, and district and village levels which are financed and administered through local authorities. The MOH is responsible for development, implementation, monitoring and evaluation of policy, and for controlling the quality and effectiveness of health care delivery. The health system faces a number of challenges from inadequate funding with which to maintain facilities and purchase sufficient medical supplies, to ageing equipment and an imbalance in distribution of health care. The system is also struggling with human resources, reflected in the fact Tajikistan has less medical professionals per capita than any of the other countries in Central Asia.

A private healthcare sector also operates within the country, and the Government has legalized private ownership of medical facilities. The development of this sector has been slow, however new consultation and diagnostic centers have been established in larger cities. While these structures are in place, the facilities are of poor quality and hospitals face acute shortages of basic necessities such as disposable needles, medications such as antibiotics, and prescription drugs. It is therefore recommended that comprehensive international medical insurance with an evacuation provision be arranged prior to travel. Aid agencies operate with objectives to assist the government in implementing reforms and ensuring access to quality and cost-effective primary health care through effective financing and technical assistance in combating infectious diseases. The country still depends on international assistance for some of is basic subsistence needs.

Travel advisories from developed nations share common themes, advising against all tourist and non-essential travel to areas bordering Kyrgyzstan, Afghanistan, and Uzbekistan due to the uncertain security situation and presence of landmines. The border areas are noted as having both marked and unmarked minefields, and therefore travel should be confined to main roads only. Personal safety is considered to be at “high risk”. Tajikistan shares a 1344 kilometre border with Afghanistan and is the first stop on the drug trafficking route from there to Russia and onward to the West and there are regular armed skirmishes between border forces and drug smugglers.

Advisories note that elsewhere in Tajikistan there is a “high threat” of terrorism, and that attacks have previously involved the use of suicide bombers. Expats are advised to remain vigilant in public places and maintain a high degree of security awareness. A lack of media freedom in Tajikistan hinders the availability of up-to-date and accurate information and ultimately, informed decisions about safety. Foreigners should however be alert to any government-imposed travel restrictions or security-related announcements. High unemployment and a struggling economy have resulted in a moderate to high level of crime, ranging from pick-pocketing to muggings and armed robberies. A threat of kidnapping exists and organised crime is of concern. Advisories also note that driving can be risky as the local driving standards are basic and drunk driving is common. Petrol stations are rare and road conditions poor outside of the main towns and some interior roads only open during the summer months. Some areas are accessible by four-wheel drive vehicles only, and sufficient minor repair equipment is advised due to no breakdown-assistance services. Carrying a satellite phone in case of emergency is also recommended.

The World Health Organization has verified a recent outbreak of Polio in Tajikistan, with the number of reported cases at 712, much higher than any of the cases reported by the country’s immediate neighbors. 29 deaths were attributed to the disease in 2010, and the Government is working with the WHO on an immunization program and receiving ongoing technical guidance on dealing with the outbreak. Typhoid has occurred including in the capital and Tajikistan has also seen an outbreak of Crimean-Congo Hemorrhagic Fever, which is a tick-borne virus with a 30 percent mortality rate. Infection rates of Hepatitis and Tuberculosis are reportedly on the rise throughout Central Asia, and the risk of contracting Malaria, Cholera and water-borne illnesses is considered “high”.

The US Centers for Disease Control and Prevention (CDC) recommends that before travelling to Tajikistan, vaccinations are required for Hepatitis A, Hepatitis B, Typhoid, Polio and Rabies. Depending on individuals’ health, immunization history and planned activities, the requirements for vaccines may vary, but seeing a health-care provider ideally 4-6 weeks before departure in order to allow effectiveness of vaccines and medication, is recommended. The CDC notes that one of the most common vaccine-preventable diseases contracted while travelling is Hepatitis A, with exposure to the virus occurring through food or water. Likewise, Cholera, Polio and Typhoid are contracted through this means and therefore strict hygiene practices should be used, even if vaccinated. Care should be taken to regularly wash hands with soap or use an alcohol-based hand gel, particularly prior to eating. Drinking only bottled or boiled water is suggested and particular care taken with uncooked food. The Hepatitis B virus can be transmitted through infected blood or body fluids, and is recommended in the event travelers might be exposed through medical or dental treatment or through engaging in risky behavior such as unprotected sexual contact or needle-sharing.

The CDC notes there is a risk of Malaria from June to October, particularly in areas around the southern border. Transmitted through the bite of an infected mosquito, preventative measures are recommended, such as applying insect repellent regularly, covering exposed skin, spraying rooms with bug-spray and using mosquito-nets treated with Permethrin when sleeping.

The main carriers of Rabies are dogs which can transmit the virus via saliva, most often through a bite or lick to an open wound. Rabies is a preventable disease, therefore where travelers spend considerable time outdoors, especially in rural areas the pre-exposure vaccine is recommended. Prevention of animal bites and scratches through avoidance is suggested, as risk increases with the likelihood of animal contact, type of activity or extended travel.

As Tajikistan is in a high altitude region, with over half of the country at 3,000m (10,000ft) above sea-level, altitude sickness is a risk. Usually afflicting people at elevations of approximately 2,500m – 3,000m and above, lack of oxygen can produce a range of symptoms, from headaches, nausea and dizziness, to sleeplessness, loss of appetite and in extreme cases, death. Risk factors include the rate of ascent, and the altitude gained. Travelers are at higher risk when gaining altitude too quickly without a period of acclimatization. There is also a potential of natural disasters as Tajikistan is in an active seismic zone. Earthquakes of varying degrees occur frequently, and landslides and avalanches regularly cause casualties and significant economic damage.

Tajikistan Expat Health Insurance

Medical facilities within Tajikistan are limited and serious injury or illness will likely require medical evacuation out of Tajikistan. Expat health insurance and comprehensive insurance is strongly recommended. Global Health Insurance has various worldwide medical insurance plans available and policies can be tailored to meet the specific needs of those travelling to Tajikistan. Expat health insurance policies are transferable globally and include emergency evacuation and repatriation, inpatient services, doctor consultations, medication, specialist and alternative care, maternity, optional dental coverage and many more. For professional Tajikistan Expat Health Insurance advice at no cost, contact one of our insurance advisors.