Disease surveillance, suppression of information and data transparency are the key challenges in the healthcare system of Turkmenistan. The national institutions in Turkmenistan do not address the challenges highlighted by international organizations neither on their websites nor the media.
The Ministry of Health of Turkmenistan does not publish any data and information on laboratory services including clinical protocols: number of laboratories, their addresses, their effectiveness, investments made and challenges. A glimpse into opaque operations can be gained by reading the projects funded by international organizations.
In February 2023, UNDP Turkmenistan launched a project “Strengthening Clinical Laboratory Services in Turkmenistan” that aims to enhance the national healthcare system’s capacity for accurate and timely disease diagnosis. Focusing on primary healthcare (PHC) laboratories, which serve most of the population, the project seeks to ensure the availability, accessibility, and reliability of laboratory investigations. This initiative is particularly significant for women and girls, as it reduces gender-related barriers by providing essential lab tests during pregnancy, childbirth, and the postnatal period. Additionally, the project aims to modernize laboratory facilities, train specialists, and promote digitalization to improve efficiency and quality.
The project is set to conclude in December 2025 with its progress and budget sheets available for the public to track it online. However, detailed project documentation, including specific implementation plans, procurement strategies, and impact assessment frameworks, have not been made publicly accessible.
Observations on Budget and Project Implementation
The project is funded by the Government of Turkmenistan, which has allocated approximately $14.15 million, and the United Nations Development Programme (UNDP), contributing $29,999. The budget mainly covers procuring laboratory equipment and reagents (~8 mln USD), with additional allocations for digitalization efforts, training programs for laboratory specialists, and administrative costs. While the investment in infrastructure is substantial, it raises several key concerns regarding long-term sustainability and impact:
- The relatively modest allocation for training and quality assurance (~$41,000) raises concerns about whether laboratory specialists will receive adequate training to effectively utilize new equipment and maintain quality standards.
- How will the procurement of laboratory equipment be monitored to ensure efficiency and cost-effectiveness?
- Is the Information Technology Equipment purchase for $300,000 enough for meaningful digitalization of lab services, or will additional funding be required?
- Why is training for lab specialists receiving only $10,000, and will this be enough to ensure proper use of new equipment?
- What transparency measures are in place to track the effectiveness of spending on consultancy services and monitoring?
- How is the distribution of funds planned across different regions of Turkmenistan to ensure equal access to improved laboratory services and avoid regional disparities?
- Additionally, there is little publicly available information on whether cost reductions for patients – a stated project objective – have been realized in practice. How will the project ensure that affordability and accessibility are genuinely improved for vulnerable populations (women during pregnancy and childbirth, people living in remote areas, populations with chronic diseases or with low-income)?
National Health System’s Laboratory Diagnostics Capacity per UNDP
Turkmenistan’s national laboratory system has been recognized for its capabilities and capacity in human health. As of May 2024, UNDP reported the successful upgrade of 114 laboratories across Turkmenistan (10 in Ahal, 19 in Mary, 27 in Lebap, 16 in Dashoguz, 14 in Balkan, 28 in Ashgabat). These upgrades included the installation of modern equipment and training for specialists in various regions, enhancing the capacity for a wide range of tests, such as blood analyses and microscopy.
During the COVID-19 pandemic in 2020, a WHO team visited Turkmenistan and identified that the country had a high-level commitment to prevention of the disease with an approved national plan as well as a multisectoral approach and the availability of critical supplies (13 laboratories, 35 virologists and 35 virology laboratory technicians).
International organizations reporting challenges in Turkmenistan
The country allocates only 1.3% of its national GDP to public health which is considered very low in the WHO European Region. Out of pocket expenses (72% in 2017) and a low number of health facility visits (3.2 in 2018) also remain to be a challenge in accessing universal health services. Although the probability of dying from one of the four major non-communicable diseases in Turkmenistan is high at 26.9%, only around half of the health care facilities adhere to clinical practice guidelines for these conditions, and patients are given little to no opportunity to provide feedback on health services or unmet needs.
There is also an absence of programs for the surveillance and control of multiple zoonotic diseases, with insufficient public evidence of a dedicated agency for zoonotic diseases, as highlighted by the Global Health Security Index.
Additionally, concerns about the opacity of Turkmenistan’s health system have been raised, particularly regarding the accuracy of reported mortality data and the existence of emerging diseases within the country’s borders. This has been seen once again in the country’s COVID pandemic preparedness and response. Despite getting 20 mln USD funding from the World Bank for COVID-19 response and improving its testing and surveillance capacity, Turkmenistan’s government withheld critical public health information, including the number of COVID-19 cases and deaths, did not provide vital statistics such as birth and death rates, and removed the word “coronavirus” from health information brochures, thereby hindering citizens’ ability to protect themselves. The World Bank further reported that “health staffing levels and designated infrastructure are unlikely to be a match to new cases surge” and raised concerns about the lack of information on the institutional capacity of the health system.
These mixed assessments suggest that while certain aspects of the laboratory system are undergoing some positive developments, there are areas requiring improvement, particularly in disease surveillance and data transparency. The current UNDP project aims to address some of these gaps by enhancing laboratory services at the PHC level, thereby improving the accuracy and timeliness of diagnoses for common diseases, including infectious and non-infectious conditions, surgical cases, emergencies, and maternal and child health issues.
While the project aligns with UNDP’s broader goals of strengthening healthcare infrastructure, several gaps remain. The lack of detailed implementation reports and progress updates limits transparency. Additionally, while there is a focus on accessibility, there is insufficient data on whether services have genuinely become more affordable for vulnerable populations. More emphasis on long-term sustainability, particularly in integrating digital systems and continuous training for Turkmen specialists, is needed.
