Key points ● Tajikistan’s health system provides a publicly financed basic benefits package of services, but a significant number of people fall outside the scope of eligibility. ● Health spending per capita is the second lowest in the WHO European Region in absolute terms, although public spending on health has increased over the past two decades. Out-of-pocket (OOP) payments have declined slightly but remain high, amounting to 63.5% of health spending in 2021. ● Life expectancy has improved, reaching 74.5 years in 2017. This was higher than in neighbouring Central Asian countries but still below the average in the WHO European Region. ● Infant and maternal mortality in Tajikistan remain relatively high but have seen steady improvements over the past two decades. Childhood vaccination coverage rates are high. ● Rates for many communicable diseases have improved, but access to pharmaceuticals is an ongoing challenge to further improvement. ● Noncommunicable diseases (NCDs) are a major driver of mortality, accounting for 24 718 deaths in 2017, with cardiovascular disease the most common cause of death. ● Leading risk factors affecting health include high blood pressure, poor nutrition and high blood sugar. Overweight and obesity are not a major concern – although rates are slowly rising – but child and maternal malnutrition are still a challenge. ● The COVID-19 pandemic is estimated to have affected overall mortality rates, but to a lesser degree than in many other countries in the WHO European Region. ● Ratios of health workers to population are well below regional averages, and there are major regional inequalities in the geographic distribution of health workers. A high rate of migration exacerbates health workforce gaps, particularly for skilled workers.