Some interesting public health data have been made public reflecting on poor governance in the public health sector.
In 2021, the World Bank has approved USD 20 million for the Turkmenistan COVID-19 Response Project. The loan was borrowed by the Ministry of Finance and Economy of Turkmenistan (MoFE). The Ministry of Health and Medical Industry of Turkmenistan (MoHMI) was responsible for the overall coordination and oversight of the project. The United Nations Development Programme (UNDP) supported the project management and implementation, as a Project Implementing Entity (PIE).
As of 2025, the government of Turkmenistan has not reported COVID-19 related deaths, infections and recoveries. No epidemiological reports, updates had been shared with the public. The government has not named the virus and no public education happened.
This large-scale loan project has not been shared by the MoHMI on its website, nor does MoHMI provide health statistics there. Progres team read through the project documents on management of the sector, public health statistics and qualitative data in order to highlight and share this critical information with experts, researchers and journalists.
Project goals, stakeholders
Completed in December 31, 2023, the COVID-19 Response Project for Turkmenistan aimed at preventing, detecting, and responding to the threat posed by COVID-19 while strengthening public health systems. According to the WB, this will support priority activities under the National Pandemic Preparedness and Response Plan, which strengthen country-level coordination, upgrade risk communication and community outreach, and reinforce testing, response capacities, infection prevention and control, and case management practices in health care facilities.
The main stakeholders of the project, in addition to the above, were regional and local administrations, Ministry of Education, international development and financial partners, United Nations Agencies (WHO, UNICEF, UNFPA) and other international donors (EU, ADB, USAID, Russia, Japan, UAE, Turkey), that contributed medical supplies, funding, and expertise (Annex 3), as well as civil society organizations and local media.
The beneficiaries were public health workers and medical emergency personnel, including medical waste collection and disposal workers; as well as general population and high-risk groups. The latter includes COVID-19 infected people and people under COVID-19 quarantine, and relatives both categories; neighboring communities to laboratories, quarantine centers, testing facilities and screening posts; and finally, people at COVID-19 risks (elderly 60+, people living with AIDS/HIV, people with chronic medical conditions, such as diabetes and heart disease etc.).
Country assessment
Based on the Project Appraisal document, issued prior to the project implementation, the World Bank (WB) assessment on Turkmenistan identified major issues related to its ability to respond to COVID-19 effectively in the country, underlying that: “Despite recent economic successes, Turkmenistan lags behind most comparator countries in terms of key indicators of human development”.
To elaborate, as an upper-middle income country, Turkmenistan is ranked only 111th in the 2020 Human Development Index (HDI); it also faces lower life expectancy (68 years) and expected years of schooling are fewer (11.2 years) than in other Central Asian countries. Health challenges include a mix of chronic diseases and high neonatal mortality, while education quality and its alignment with economic needs remain unclear due to limited data.
In addition the WB clarified that: “Despite recent increases in income per capita, Turkmenistan still faces significant challenges in improving health and education outcomes. The COVID-19 pandemic, with its significant public health, social, and economic impacts will inevitably intensify these challenges still further. Challenges in accessing statistical information and a lack of collaboration on data standards and quality also complicate the assessment of economic developments and verification of officially reported growth performance outcomes and other socio-economic indicators”.
Furthermore, in its assessment, WB provides information on the existing reforms in the healthcare system, yet it states that despite these successful reforms, “many challenges remain in improving access and quality of care. Public-sector expenditures on health are estimated at 1.3% as a share of the national GDP and is at the lower end of the continuum among the WHO European Region countries”.
Furthermore, the WB assessment adds that in Turkmenistan “Out of pocket expenses were 72% of the total health expenditure in 2017 and continue to constitute a major barrier to universal access to health services”.
Reported statistics:
- Low outpatient contacts: 3.2 visits per person in 2018, lower than other countries in the WHO European Region.
- Limited hospital bed capacity: 403 beds per 100,000 people (2014), close to the Central Asian average.
- Poor quality of care:
- Only half of health facilities use clinical guidelines for non-communicable diseases (NCDs).
- Only half of hypertension patients receive treatment, and only 12% control their blood pressure.
- Concerns with data quality: Routine data shows a hypertension prevalence of 1.1%, while the 2018 WHO STEPS survey shows 26%.
- Prevalence of risk factors: 52% of adults are overweight.
- High premature mortality: 26.9% chance of dying prematurely (ages 30 – 70) from one of the four major NCDs, one of the highest rates in the WHO European Region.
Moreover, the report indicates that “While there is anecdotal evidence on shortages of healthcare inputs, limited information is available on the levels of unmet need, and there is only a (or very) limited opportunity for health care users to provide feedback on their needs and on health facility/provider performance”.
The WB provides that “While no COVID-19 cases have been formally reported in the country, many preparedness measures have already been put in place within the Government pandemic response strategy”.
These include Emergency Anti-Epidemic Commission (EAEC) Operational Headquarters, established to coordinate the national pandemic preparedness and response effort and led by the Deputy Prime Minister under the Council of Ministers with operational headquarters at the MoHMI. The document also mentions the following plans: the Decree of the President of Turkmenistan on the Comprehensive Plan of Measures to Prevent the Importation of COVID-19 into Turkmenistan; Preparedness and Response Plan for Acute Infectious Disease/Country Preparedness and Response Plan; and the national socio-economic impact plan. These plans aimed to prepare the country for a range of possible transmission scenarios.
Hence despite its above assessment and as a result of the WB’s mission visit to the country in July 2020, the central recommendation to Turkmenistan were “to continue and accelerate Turkmenistan’s efforts towards preventing transmission in the community and activating a scaled-up health sector response”.
Project results
The following section is based on the data derived from the Implementation Status and Results Report. The main sectors of the COVID-19 Response Project for Turkmenistan were Public Administration (10%), Health (5%), and Health Facilities and Construction (85%), with the latter constituting the majority focus of the project.
The project consisted of 3 components:
- Improving COVID-19 Prevention, Detection and Emergency Response (US$5.9 million):
- strengthening surveillance and rapid response to suspected cases of COVID-19; and
- strengthening risk communication and community engagement;
- improving health system preparedness, including expanding capacity for treating COVID-19 and severe acute respiratory infection cases, improving infection prevention and control in health facilities (US$12.1 million);
- supporting project management, monitoring, and evaluation, covering administration, fiduciary functions, and implementation reporting (US$2.0 million).
The activities focused on urgent assistance were limited to those requested by the Government, and were identified through meetings with the MoFE, MoHMI, and the UN partners.
By completion, the COVID-19 Response Project was rated “Highly Satisfactory” in both achievement of development objectives and implementation progress. It was indicated that all activities had been successfully completed, and all targets for both the project development objective and intermediate results indicators were met or exceeded. However, as indicated on the WB website, the project did not undergo an independent evaluation.
QUALITATIVE DATA:
COVID-19 public communication: at the start of the project, Turkmenistan lacked a national COVID-19 risk communication plan. By its conclusion, a comprehensive, evidence-based strategy was developed in collaboration with the Dornsife School of Public Health, MoHMI, and other national partners, targeting different population groups. However, the project failed to ensure periodic updates, as outlined in the end target.
As of March 18, 2025, the government of Turkmenistan has made no effort to report COVID-19 deaths or recoveries, and the project did not influence a shift in the official narrative on COVID-19. In contrast, grassroots initiatives and independent media continued to compile COVID-19 mortality data from various sources, highlighting ongoing gaps in official transparency.
National plan: at the start of the project, there was an already adopted National Pandemic Preparedness and Response Plan, and by completion, it was being implemented without the anticipated regional tailoring or regular updates, as was set in the end target.
Clinical protocols: there were already clinical protocols at the start of the project, including a referral system, for COVID-19 patients. The end target aimed for COVID-19 patients to be regularly reviewed or updated as necessary. By the end of the project new clinical protocols were approved and seminars and workshops on the new protocols were conducted. However, regular updates or COVID-19 patients were not explicitly mentioned.
Tracking and monitoring contacts: no electronic program for tracking and monitoring contacts existed prior to the project. The aim was to develop and set up an electronic program for tracking and monitoring contacts in Sanitary and Epidemiological Safety and Control offices (SESC) in Ashgabat and in five velayats. By the end of the project the mentioned electronic program was installed and is available on the state telecom company server with access for the SESC staff; and training delivered in early December 2023 (from Component 1: Improving COVID-19 Prevention, Detection and Emergency Response).
Equipment and medicine: no verified list of equipment, consumables and medications for resuscitation and management of COVID-19 and SARI patients with lung function disorders existed prior to the project. The project was set to have in place a verified list of equipment, consumables and medications for resuscitation and management of COVID-19 and SARI patients with lung function disorders defined and regularly updated. As a result, a verified list of equipment, consumables and medications for resuscitation and management of SARI patients with lung function disorders was defined, with no updates required. However, there was no mention of COVID-19 in the achieved results, despite the fact that it was part of the target (from Component 2. Improving health system preparedness for COVID-19).
Regardless of some gaps, all indicators above were marked as “Achieved” in the report.
KEY QUANTITATIVE DATA:
Health Staff Training and Preparedness:
- 4001 health staff trained in infection prevention and control;
- 2164 physicians trained in COVID-19 and SARI management;
- 103 public health specialists trained on climate-induced vector-borne and waterborne diseases;
- 100% increase in COVID-19 risk awareness among PHC nurses;
- 5 infectious disease hospitals in 5 districts with COVID-19 preparedness plans and trained health workers.
COVID-19 Infrastructure, Diagnosis and Equipment:
- 1000 designated beds with continuous oxygen supply for COVID-19 patients;
- 18 COVID-19 designated laboratories with trained staff for diagnosis;
- 18 COVID-19 designated laboratories with verified diagnostic equipment and test kits.
Community Engagement, Awareness and Education:
- 75% of participants in community meetings/events find local outreach and engagement effective;
- 16 focus groups conducted for community engagement and feedback;
- 4 risk communication messages targeting different population groups;
- 2 gender-specific information campaigns delivered.
