Institutionalizing health financing reform through strategic governance in Tajikistan

Abstract In Tajikistan, the UHC Partnership, working in tandem with the EU-funded Health Development Programme (HDP), has played a catalytic role in strengthening health system governance and public financial management, particularly within the primary health care sector. Building on years of technical dialogue and co-creation, the UHC-P facilitated a landmark reform: the presidential endorsement and interministerial adoption of new regulations on health facility autonomy and performance-based financing, with initial implementation now underway in Sughd oblast. This reform is a systemic response to longstanding bottlenecks in Tajikistan's health financing architecture, such as rigid line-item budgeting, limited managerial autonomy, fragmented funding channels, and high out-of-pocket payments. The new framework introduces per capita financing, performance-linked budgeting, and strategic purchasing arrangements tailored to PHC, aiming to realign resource flows with service delivery priorities and improve the accountability and efficiency of public spending. Though still in its early implementation phase, the reform is grounded in a clear health systems approach: enhancing provider-level governance, reinforcing intersectoral collaboration between the Ministries of Health and Finance, and embedding learning mechanisms through facility-level capacity building and national dialogue platforms. The UHC-P's strategic positioning, combined with WHO's neutral convening power, was instrumental in aligning technical partners, government leadership, and donors around a common reform vision.