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The authors would like to express their gratitude to Yuri Loshmanov for his help in sourcing relevant documents and translating Russian language sources into English; to Jesus Maria Garcia Calleja, WHO, and Batyr Berdyklychev, WHO Regional Office for Europe, for providing helpful information and commenting on an earlier draft of this report; to Tim...
Context in source publication
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... defaults by gas importers in the former Soviet Union led to a further decline in both gas exports and GDP (Mamedkuliev et al. 2000). Official statistics suggest a recent growth in GDP per capita although it remains far below the average for the countries of the World Bank's Europe and Central Asia region (Figure 1). However, as with all The country is currently reported to have amassed a huge external debt, although it refuses to report the magnitude of this debt. ...
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This paper presents the study of an anonymous painting on canvas with the representation of The Virgin with the Sleeping Child Jesus. During the restoration process, an underlying paint was detected and the radiograph showed the existence of an underlying composition. The theme is the same, apparently in the finished pictorial phase, but flipped ho...
Citations
... Environmental health regulations, even where they exist, do not tend to be implemented in practice, partly due to weak judicial systems (Agyeman & Ogneva-Himmelberger, 2009). Lack of democracy in the more authoritarian countries of the region is another reason for the neglect of environmental health (Rechel & McKee, 2005). ...
Background: The paper presents the results of community consultations about the health needs and healthcare experiences of the population of Ukraine. The objective of community consultations is to engage a community in which a research project is studying, and to gauge feedback, criticism and suggestions. It is designed to seek advice or information from participants directly affected by the study subject of interest. The purpose of this study was to collect first-hand perceptions about daily life, health concerns and experiences with the healthcare system. This study provides policy-makers with additional evidence to ensure that health reforms would include a focus not only on health system changes but also social determinants of health (SDH).
Methods: The data collection consisted of the 21 community consultations conducted in 2012 in eleven regions of Ukraine in a mix of urban and rural settings. The qualitative data was coded in MAXQDA 11 software and thematic analysis was used as a method of summarizing and interpreting the results.
Results: The key findings of this study point out the importance of the SDH in the lives of Ukrainians and how the residents of Ukraine perceive that health inequities and premature mortality are shaped by the circumstances of their daily lives, such as: political and economic instability, environmental pollution, low wages, poor diet, insufficient physical activity, and unsatisfactory state of public services. Study participants repeatedly discussed these conditions as the reasons for the perceived health crisis in Ukraine. The dilapidated state of the healthcare system was discussed as well; high out-of-pocket (OOP) payments and lack of trust in doctors appeared as significant barriers in accessing healthcare services. Additionally, the consultations highlighted the economic and health gaps between residents of rural and urban areas, naming rural populations among the most vulnerable social groups in Ukraine.
Conclusion: The study concludes that any meaningful reforms of the health sector in Ukraine must include a broad range of factors, including the healthcare system but importantly, must extend to SDH approach and include the prioritization of health promotion, limiting alcohol and tobacco availability and enforcing environmental protection.
... Environmental health regulations, even where they exist, do not tend to be implemented in practice, partly due to weak judicial systems (Agyeman & Ogneva-Himmelberger, 2009). Lack of democracy in the more authoritarian countries of the region is another reason for the neglect of environmental health (Rechel & McKee, 2005). ...
... There are also financial barriers to access. The decline of government expenditure on health, with the accompanying widespread reliance on out-of-pocket expenditure (both formal and informal) has major implications for the accessibility of health services to poorer groups of the population, as has been shown in Kazakhstan (Ensor and Savelyeva 1998;Danilovich 2010), Tajikistan (Cashin 2004a;Cashin 2004b;Falkingham 2004;Habibov and Fan 2008;Tediosi et al. 2008;Fan and Habibov 2009;Habibov 2009), and Turkmenistan (Rechel and McKee 2005;Rechel et al. 2009a;MSF 2010). In Kyrgyzstan, however, the introduction of a single payer system, an expanded state-guaranteed benefit package, the introduction of formal co-payments and patient information campaigns have improved financial protection and reduced informal payments (Kutzin et al. 2009b;Falkingham et al. 2010). ...
Since becoming independent at the break-up of the Soviet Union in 1991, the countries of Central Asia have made profound changes
to their health systems, affecting organization and governance, financing and delivery of care. The changes took place in
a context of adversity, with major political transition, economic recession, and, in the case of Tajikistan, civil war, and
with varying degrees of success. In this paper we review these experiences in this rarely studied part of the world to identify
what has worked. This includes effective governance, the co-ordination of donor activities, linkage of health care restructuring
to new economic instruments, and the importance of pilot projects as precursors to national implementation, as well as gathering
support among both health workers and the public.
... This paper updates and extends the findings of a report on human rights and health in Turkmenistan that we published in April 2005 [11]. The original report was based on a systematic review of evidence available on the internet and in reports from international and non-governmental organisations, and on information obtained from telephone interviews with key informants, comprising Turkmen exiles, staff of international and non-governmental agencies, and staff of foreign embassies in Turkmenistan. ...
... There are credible accounts of how impoverishment and lack of opportunities are leading to increasing sex work, domestic violence and drug use. The suppression of civil society, the growing isolation of the country and the general climate of fear, repression and corruption are likely to contribute to deteriorating population health, as are the violations of the right to education [11]. ...
... While the right to "seek, receive and impart information and ideas through any media and regardless of frontiers" [14] has been enshrined in Article 19 of the Universal Declaration of Human Rights, in Turkmenistan, violations of the right to information have become common. In our 2005 report we have described these violations as a policy of "secrecy and denial" [11]. The United Nations Resident Coordinator in Turkmenistan noted in a similar vein in 2006 that "the lack of reliable data still remains a major challenge for UN agencies" [15], while the most recent country report of the US Department of State found that "most statistical data was considered a state secret" [5]. ...
There is a health crisis in Turkmenistan similar to, but more severe than, in other Central Asian countries. This paper asks whether the health crisis in Turkmenistan is attributable to the consequences of the dictatorship under president Niyazov, who died in 2006.
The basis for this paper was a series of semi-structured in-depth interviews with key informants complemented by an iterative search of internet sites, initially published as a report in April 2005, and subsequently updated with feedback on the report as well as a comprehensive search of secondary information sources and databases.
This paper describes in depth three areas in which the dictatorship in Turkmenistan had a negative impact on population health: the regime's policy of secrecy and denial, which sees the "solution" to health care problems in concealment rather than prevention; its complicity in the trafficking of drugs from Afghanistan; and the neglect of its health care system.
The paper concludes that dictatorship has contributed to the health crisis facing Turkmenistan. One of the first tests of the new regime will be whether it can address this crisis.
... Le Turkménistan constitue un cas à part puisqu'il est impossible d'y fournir des données fiables sur l'étendue de l'infection par le VIH dans le pays. Depuis mai 2004 en effet, interdiction y est faite de mentionner certaines maladies comme la tuberculose, la dysenterie, le choléra ou l'hépatite dans le but de « rassurer la communauté internationale en se targuant de l'absolu bien-être qui règne au Turkménistan et de l'inexistence dans ce pays de toute maladie contagieuse et de tout problème ayant trait aux médications et aux traitements thérapeutiques » (« Health and dictatorship », 2003 ;Rechel & McKee, 2005). On peut supposer que cette interdiction s'étend aux VIH/sida, le gouvernement turkmène n'ayant déclaré que deux cas d'infection dans le pays depuis 2004. ...
L’Asie centrale connaît, depuis le milieu des années 1990, une véritable
explosion de la toxicomanie. Dans ce contexte, deux stratégies d’assistance aux
toxicomanes sont déployées dans les pays de la région : l’une est directement
héritée de la période soviétique, l’autre est portée par certaines organisations
internationales d’aide humanitaire et de développement telle que la Fondation
Soros. Bien qu’elles relèvent partiellement de la santé publique, nous montrerons
que ce sont avant tout deux visions politiques qui s’affrontent.
... Others have yet to establish democratic systems and a few, such as Uzbekistan and Turkmenistan, there is widespread denial of human rights. In Turkmenistan this has a direct impact on health, as the increasingly eccentric President Niyazov has recently ordered the closure of all hospitals outside the capital city [35]. Obviously these factors also play a part in varying degrees in other parts of the world. ...
Einst als „Kuwait Zentralasiens“ gehandelt wurde die Entwicklung Turkmenistans stark beeinträchtigt durch den Autoritarismus der politischen Macht, materialisiert durch einen stalinistischen Personenkult, eine isolationistische Außenpolitik und nur minimale Wirtschaftsreformen. Darüber hinaus ist das Land in der schwersten wirtschaftlichen und sozialen Krise seit seiner Unabhängigkeit gefangen. Es wird erheblich beeinträchtigt durch den Rückgang des Humankapitals und den Verfall der Weltmarktpreise für Energieträger im Jahr 2014, welches den Großteil seiner Wirtschaft ausmacht. Dieses Kapitel untersucht den Kontext dieser Gegensätze und ihre Auswirkungen auf die künftige Entwicklung des Landes.
The relationship between humanitarian agencies and authoritarian states is of growing concern to Médecins Sans Frontières (MSF), given the recurring difficulties experienced in negotiating access and implementing operations in such contexts. The effort to negotiate and gain approval from states to operate on their territory prompts reflection on the sources of legitimacy for action. Drawing on direct field examples in two countries only very rarely examined-Turkmenistan and Uzbekistan-this paper explores MSF's attempts to offer live-saving medical care there. It shows that successful access negotiations hinged heavily on demonstrating added value (medical relevance) while simultaneously building relationships with authorities, identifying possible allies within health ministries, and hoping that such measures could promote a level of acceptance or trust needed to operate. It is clear that the operational space achieved is bound to remain limited and fragile, and that many compromises have to be considered and judged against ethical principles and the overall impact of the intervention.
Le volume d′aide au développement apporté par la Turquie aux pays du sud les moins avancés a augmenté progressivement depuis 2002. Cependant, les profils des flux d′aide varient de façon curieuse. L′Agence Turque d′Aide au Développement (TIKA) travaille systématiquement avec les ONG islamiques pour mettre en œuvre des projets de développement médical en Afrique subsaharienne; en revanche, la coopération entre TIKA et les ONG islamiques dans le domaine d′aide à l′Asie Centrale reste faible voire non existante. Comment expliquer que les profils de coopération pour l′aide au développement entre les organisations étatiques et privées varient tant en fonction des régions du monde concernées par l’aide au développement ? Cet article soutient que le type de régime et l′idéologie officielle des pays destinataires expliquent en grande partie ces différences. En cherchant à évaluer le rôle des puissances émergentes dans la politique mondiale de développement, cette étude comparative met en lumière le rôle des acteurs non étatiques et des dynamiques politiques internes dans l′organisation de l’aide au développement.
This paper describes HIV risk behaviour patterns among street- and bar-based female sex workers in the Turkmenistan cities of Ashgabat and Mary. Street-based sex workers had little to no knowledge of HIV and primarily used condoms when condom use was initiated by clients. Bar-based sex workers had HIV knowledge and reported regularly using condoms mainly with first-time clients. While sex workers perceived themselves to be at low risk for acquiring HIV, they were aware of other sexually transmitted infections (STI) and expressed a strong desire for free STI testing and treatment services.
