In November 2024, UNDP Turkmenistan published a report on “Qualitative assessment of community participation, human rights and gender perspectives in the context of tuberculosis in Turkmenistan”. The survey has been conducted by the Ministry of Health and Medical Industry, in collaboration with the UNDP, the Centre for Health Policies and Studies (PAS Centre) and funded by the Global Fund. The survey aimed to assess the gender dimensions of tuberculosis (TB), identify challenges related to stigma and discrimination, and evaluate the accessibility and quality of TB services in Turkmenistan.
The Progres editorial team analyzed the report. We share the summary highlighting its key messages and takeaways concerning Turkmenistan’s progress in tuberculosis control (TB), challenges, insights and recommendations from the report. The Ministry of Health does not publish public health data including the national TB program, policies and treatment protocols.
Tuberculosis in Turkmenistan
Turkmenistan is identified as a priority country for tuberculosis control within the WHO European Region. Over recent years, the country has made significant strides, particularly in reducing TB incidence rates. In 2022, the estimated incidence was 48 per 100,000 people, a substantial decrease of 33% from 2015, when the rate was 71 per 100,000.
Despite this progress, mortality rates have shown less dramatic improvement, decreasing marginally from 12 per 100,000 population in 2015 to 10 per 100,000 in 2022.
A major ongoing challenge is drug-resistant TB (DR-TB). Data from a 2018 study revealed that 23% of new TB cases and 54% of previously treated cases were resistant to rifampicin (RR) or exhibited multidrug resistance (MDR-TB). Since 2019, Turkmenistan has implemented shorter treatment regimens (mSTR) and adopted the BPal regimen in 2020 under Global Fund grants. These measures have reduced treatment durations to nine months.
Survey Insights and Key Challenges
The survey included 44 participants (26 men and 18 women), aged 15 to 54, with 75% residing in urban areas. Among the respondents, 86% were affected by drug-resistant TB (DR-TB), and 14% had drug-susceptible TB (DS-TB). This initiative was part of broader efforts to strengthen Turkmenistan’s national TB response.
Key Findings from the Survey in Turkmenistan
- Knowledge Gaps: Only 32% of respondents identified TB as a lung disease, highlighting a lack of public awareness about the disease’s nature and symptoms.
- Stigma and Social Support: Approximately 9% of respondents reported experiencing stigma from family members. However, most participants noted receiving support and understanding from close friends and relatives.
- Access to Free Treatment: All participants confirmed that TB treatment was provided free of charge, with satisfactory feedback regarding the attitudes of medical personnel.
- Gender-Specific Insights: Women were perceived as more responsible in adhering to treatment, while men often required additional psychological support to ensure compliance.
Funding and Management of the National TB Program
The National TB Program (NTP) in Turkmenistan is primarily funded by the state budget, supplemented by over $37 million in Global Fund grants since 2016. These resources have been directed toward providing free treatment, supporting medical institutions, and conducting educational campaigns.
Since 2017, the government has fully funded medications for drug-sensitive TB, and since 2019, it has financed second-line drugs and diagnostic tools for DR-TB.
TB incidence rates are notably higher among men aged 35–54 and women aged 25–34. Women face specific barriers, such as financial dependency, family stigma, and fear of social exclusion. Homemakers are particularly vulnerable, often fearing severed family ties and losing support networks. Additionally, women represent a significant proportion of workers in education, healthcare, and social services, making them more susceptible to stigma.
In contrast, men exhibit lower treatment adherence often requiring enhanced psychological and emotional support. These dynamics underscore the importance of integrating gender-sensitive strategies into TB programs to address the unique needs of both women and men.
Stigma remains a pervasive issue, exacerbated by misinformation about TB’s transmission and treatment. Self-stigmatization is particularly prevalent, with many patients isolating themselves due to fear of discrimination or loss of support.
The “Patient School” initiative, implemented by the National Red Crescent Society, educates patients and their families about TB, their rights, and available support services. Despite these efforts, public awareness about complaint mechanisms and legal protections remains limited. Turkmenistan’s National Action Plan on Gender Equality (2021–2025) aims to eliminate these barriers through educational programs, social support for women, and improved access to healthcare. Its implementation and details are not available to the public.
Conclusions and Recommendations
According to UNDP’s assessment, Turkmenistan has made significant progress in reducing TB incidence and improving treatment regimens. However, challenges such as DR-TB, gender disparities, stigma, and knowledge gaps persist.
UNDP’s recommendations include:
- Enhancing Psychological Support: Expanding counseling services for TB patients and their families.
- Raising Public Awareness: Conducting targeted informational campaigns to dispel myths and reduce stigma.
- Strengthening Gender-Sensitive Interventions: Training healthcare personnel on gender equality and addressing barriers faced by women, such as financial dependency and stigma.
Addressing these challenges requires sustained collaboration among government institutions, civil society, and international partners to ensure an inclusive and effective TB response in Turkmenistan.
