From all the countries in the so-called European region from the World Health Organisation (WHO), Azerbaijan offers the worst health care. Nowhere life expectancy dropped so dramatically. Men live about 62 years, women 68 years – the lowest age in all of Europe. Nowhere so many children under five years die. Nowhere is the maternal mortality rate so high – with forty dead babies per hundred thousand live births, eight time higher than the average level in Europe. Because income is so extremely low, women more and more have a home delivery because they can’t afford to visit health facilities. According to the World Bank Poverty Assessment, patients pay unofficial fees for service provision. Thus charges for births can range between hunderd to hundred and fifty dollar in smaller towns to fivehundred and even sevenhundred dollar in Baku hospitals – up to eightteen the average salary. Because women simply can’t afford, money is often the reason that abortion per thousand women in Azerbaijan is the second highest in the European region – only Georgia records higher rates.
The appalingly picture of health care in Azerbaijan is painted in reports from the World Health Organisation(WHO), Unicef, World Bank and the International Medical Corps – statistics being brougth together in the Health Care Systems in Transition Country profiles. Azerbayan faces problems often associated with low income countries. Figures available untill 2003 said that half of the population (four milion people) have an income from less than 25 dollar a month. One third of them live in extreme poverty with a consumption level of even less than 15 dollar.
Unemployment level under the age of 35 years is nearly seventy percent. An additional problem is the relatively high levels of infectious diseases, malnutrition among children and high rates of common childhood diseases. Partly caused by the Nagorno-Karabagkh conflict, Azerbayan experienced also a resurgence of other communicable diseases such as tuberculosis, diphteria and syphillus. The country also is – confronted with poverty and heroine production and trafficking – vulnarable to the further spread of HIV/Aids.

Reporting about children after the Nagorno-Karabakh conflict, it is mentioned that a quarter of the children under five years were severly underweight. Children in internally displaced families sufferend diarrhoea, an important contributor to the burden of ill health. Reason also is that a quarter of the population has no access to safe water. In fact in the south of Azerbaijan seventy procent of the population lacks clean piped water.

The different reports about health care in Azerbaijan also indicate that in the country exists an extensive ‘ under the table’ payment system. In this way patients direct formal and informal payments that have been estimated about sixty percent of the total health expenditure. In a country were the average salaries ware estimated to be about forty dollar a month, even relatively small direct charges can create hurdles for many who need to acces health care. Among the poor, almost forty percent is unable to use necessary health services.

Indeed, the average salary for workers in health care is 78 dollar a month.There is a huge discrepancy in male and female salaries. But the salaries of (female) nurses are extremely low. ‘ Consequently there is a strong incentive to charge patients both formally and informally. In these circumstances informal payments are seen as a mechanism for financing basis health care because of limited state resources – rather than a form of corruption’ the report of the regional World Health Organisation says.
Finally the reports say that the quality of many pharmaceuticals and drugs are often dubious. Although a varity of laws govern the import of pharmacenticals, it is estimated that up to seventy percent of all imports neither pass through customs nor undergo inspection. ‘Many people are forced to purchase essential drugs through the largely unregulated private health care sector. This all has to do with a lack of capacity of the ministery of Health,’ reports conclude.

The inventarisation from WHO and World Bank made clear that health care in Azerdbaijan turned in a dramatic situation after the collapse of Sowjet Union. The Sovjet health system was state-owned and centrally planned, services were intended to be free and accesible to the whole population. However it had many weaknesses. While providing extensive basic care, the Sovjet Union was unable to develop the new forms of treatment introduced in the west from the midst of the sixties last century. But after the independence of Azerbaijan in 1991 health care went down swift as an arrow. In the first year of his independence, Azerbaijan still allocated 4.3 percent of the Gross Domestic Product(GDP) – now the number is under 1 (one)percent. The expenditure to public health is indeed very low now. It dropped from 148 dollar per person in 1991 to about 25 dollar per person – far below the average in the European region. In fact public health care in Azerbaijan turned out to be a mess.

Rudie van Meurs / POLDERPERS.NL
Baku, Azerbaijan December 15th, 2005