PUBLIC HEALTH SYSTEM IN AZERBAIJAN

During the period of over 70 years public health care system in Azerbaijan Republic was regulated based on direct one-way administration, not corrected for economic regulations. Funding of medical facilities was based on quantitative factors, primarily on the number of beds, medical staff and pharmacists and other subjective indices.

Medical services, particularly medical-prophylaxis and sanitary facilities were based on unified all-union standards, without adjustment for specific features of the republic, its regions and administrative sectors, their actual infrastructure, endemicity, country-specific pathologies, environment, sanitary conditions etc.

Administrative management methods along with the funding based on qualitative indices resulted in an extensive type of public health system development. Modest funds assigned to public health care system were spent to increase the number of new medical workers instead of building new facilities, obtaining new technologies and equipment, improving personnel practical skills etc.

Contrary to the declared principles of humanity, the system actually viewed a person not as an individual with the right to freely choose a medical specialist and facility and to demand quality medical care but as an object of public health care system.

It was completely evident that the declared humanistic values and aims could not be achieved in separation from current economic methods following their own rules.

Ultimately, the resources of public health care system were exhausted in the most ineffective way and medical workers' non-professional attitude to their duties became obvious, leaving alone the quality of medical care.

After the collapse of the Soviet Union along with economic relations between its states modifications in the state's economic and political system required fundamental reforms in economics, social life and other fields and, of course, public health care.

In the background of military operations, occupation of 20 percents of Azerbaijan territory, presence of approximately 1 million refugees and internally displaced persons, migration of population, disorganized settling and social crisis health care system faced an unprecedented crisis of its resources, being unable to deliver even the most basic medical and sanitary care to the population.

In 1991-1993 years the funds assigned to public health care were reduced dozens of times adjusted for inflation. With the work in immune prophylaxis virtually halted, residual infection diseases foci sharply reactivated and epidemics starting to reappear, free medical care system was gradually destroyed (pic. 1).

From 1991 till 1996 the birth rate (with the average annual rate of 12000) had been progressively decreasing and the situation became even worse in 1998 with preliminary data indicating the birth rate of 123966.

Due to the efforts required by the reforms in public health care system the death rate was stopped at 6.4-6.2 level. In 1998 the death rate averaged 5.8 per 1000 population.

However, if in 70-80 years the natality averaged 20-23 in peacetime, in the last years this index was dynamically reduced down to 9.8 in 1998 year.

From the social point of view the sharp spread of dangerous diseases presented a particular threat. Reduced attention to prophylaxis services and neglect of epidemics prevention measures led to epidemics of poliomyelitis, diphtheria and malaria and the increased morbidity rate of rabies, anthrax, tuberculosis and other infection diseases.

The continuing presence of these conditions might have left Azerbaijan population and public health system completely defenseless. Health care system itself faced the danger of complete devastation. In addition to the material and technical maintenance, strategic and current planning, a very important feature of the former management system was lost along with some positive features of the former formation. A comprehensive analysis of the existing situation, coordination of the state's resources and responsibilities in the field of health care, adjustment of planning under new conditions, definition of natural stages in the implementation of the reforms were strongly required.

Only in 1993 the situation in public health sector was realistically evaluated and the search for measures to recover the branch from the long-lasting deep crisis was launched.

Since the first days of government of the national leader Heydar Aliev the primary problems of public health care system - conduction of professional analytical work, coordination of public health network and its whole potentials under the new conditions based on social-economical formation principles have been raised among urgent political, economical and social needs. Among positive changes, social and political stabilization by the state's government, cease of all skirmishes along the frontline, implementation of the new social care program and compensation mechanisms for refugees and internally displaced persons must be particularly stressed.

Redirection of public health system development, reforms in the field of medical care delivery to the population and organization of this delivery were recognized as a part of country's global strategic program to develop economic and social infrastructure based on the principles of market economy society formation.

Predicted high rates of inflation in 1992-1994 years (1012,3% in 1992; 1229,1% in 1993 and 1763.5% in 1994, respectively), along with virtually unchanged cost of medical services and drastic decrease of budget funds provided grounds for public health deterioration and were the reason of technological stagnation in the sphere.

Along with the worsening of demographic indices the dynamics of socially threatening infection diseases was also negatively affected.

Thus, one of the reasons of the crisis that affected public health system was a gradual decrease of state funding with a misbalance between existing structures. In the last years, measures assumed by the Azerbaijan government, development of paid medical services and assistance of international humanitarian organizations along with several positive changes in the public health system partially attenuated or completely taken away the problem. Overall, the implementation of well-grounded reforms in public health care system is one of the most important tasks of the new Azerbaijan economic and social politics.
top