Health reform: the human resource challenges for Central Asian Commonwealth of Independent States (CIS) countries

This paper examines the key human resource issues for health amongst mid-level workers in Central Asia CIS countries. It focuses on Azerbaijan, Tajikistan and Uzbekistan highlighting the human resource issues that are evident within these countries and illustrating how they differ from those described in the sub-Saharan developing countries. The key human resource issue highlighted by the World Health Organization Report [WHO. (2006). World Health Report: Working together for health. Geneva: WHO] was the scarcity of health workers. Four million health care workers were identified as essential if the health services of the world are able to meet current health needs. The primary area of need highlighted was in Africa. Africa bears the greatest burden of disease but has the lowest number of health care workers. In the CIS countries in Central Asia different human resource issues have emerged. The Soviet health care system was comprehensive but labour intensive it had a primarily acute and a specialist disease focused approach with little investment in primary and community health care. It was unsustainable and the legacy that it left the new Central Asian emerging nations was of a large workforce with poor levels of competence and outdated approaches to providing care along with a crumbling infrastructure. In response to this situation health reform has been introduced which focuses on a family model of primary health care with family doctors supported by Family Health Nurses. This approach is beginning to make a difference to the morbidity and mortality of the populations but still has a long way to go before its full benefits are realised.