The UNDP has published a brochure highlighting Turkmenistan’s progress in treating tuberculosis (TB) during the last 14 years as a result of its collaboration with the Global Fund and UNDP. This partnership has helped improve diagnosis, expand access to quality healthcare and treatment and save lives. However, a high burden of drug-resistant TB, persistent funding gaps, and limited integration of critical interventions into the national system present major challenges.
Since 2010, Turkmenistan has achieved measurable reductions in TB:
- TB incidence dropped by 35%, from 56 per 100,000 in 2010 to 49 in 2023.
- TB-related mortality declined by 29%, from 14 to 10 per 100,000.
The country met the WHO End TB Strategy milestone for 2020, with more than a 20% decline in incidence from 2015 levels.
Figure 1. TB Epidemiology Trends in Turkmenistan 2010-2022
Thanks to Global Fund support, TB diagnostics and treatment have significantly improved:
- Drug susceptibility testing (DST) coverage increased from 28% in 2011 to 98% in 2023.
- Culture investigations rose from 2,284 to over 45,000 during the same period.
- Rapid molecular testing (Xpert MTB/RIF), introduced in 2012, slashed diagnostic time from months to hours and expanded from 7 to 24 testing units by 2025.
- Treatment success rates for drug-sensitive TB reached 83%, surpassing the WHO Europe average (72%).
- For drug-resistant TB, the success rate is 55%, near the regional average (57%).
Figure 2. Coverage with Culture Investigations and Drug Susceptibility Testing
Challenges: Drug-Resistant TB and Access Gaps
Despite these gains, Turkmenistan faces major challenges in tackling drug-resistant TB (DR-TB) and extensively drug-resistant TB (XDR-TB):
- 23% of new and 54% of retreatment TB cases are resistant to rifampicin or multiple drugs.
- 31% of patients show resistance to fluoroquinolones, indicating high XDR-TB prevalence.
- In 2023, only 960 out of an estimated 1,600 MDR/RR-TB cases received treatment – leaving 40% undiagnosed or untreated.
Gender Disparities and Social Barriers: Men tend to delay care-seeking due to social stigma. Meanwhile, women, especially in rural areas, face caregiving responsibilities and societal barriers that restrict timely access to diagnosis and treatment. A Gender Action Plan was created to address these inequalities.
Turkmenistan remains one of the 18 high-priority TB countries in the WHO Europe region, underlining the importance of sustained, multi-sectoral investment in this critical health challenge.
The Government of Turkmenistan is the principal financier of the National TB Programme (NTP), covering 87% of annual costs, projected to reach $5 million in 2024. Global Fund has contributed $45.26 million over five grant cycles, including $3.4 million during COVID-19 for TB-related efforts. This accounts for 5% of the total financing needs. Despite these efforts, an 8% annual funding gap persists, affecting DR-TB treatment scale-up, new diagnostic technologies and outreach to high-risk groups. The current Global Fund grant ends in December 2027, and sustained support beyond that date is considered criticalfor a smooth transition and continuity of care.
A wide network supports Turkmenistan’s TB response including:
- UNDP: Serves as the Principal Recipient of Global Fund grants, ensuring programmatic and fiduciary standards.
- Ministry of Health and Medical Industry (MoHMI): Leads the national TB response, setting policy and overseeing service delivery.
- National TB Programme (NTP): Manages diagnosis, treatment, and surveillance.
- Ministry of Internal Affairs: Addresses TB in penitentiary institutions.
- National Red Crescent Society: Provides psychosocial support, patient education, and community-based care.
- World Health Organization (WHO): Offers technical guidance and supports strategic planning.
- Stop TB Partnership and Global Drug Facility (GDF): Ensures access to quality-assured medicines and diagnostics.
- Country Coordinating Mechanism (CCM): Ensures inclusive governance with representation from government, civil society, and affected communities.
- Local Fund Agent (LFA): Provides independent oversight to ensure grant implementation aligns with plans.
Overall, Turkmenistan’s TB response has benefited greatly from international partnerships, especially with the Global Fund and UNDP, achieving milestones in incidence reduction and diagnostics. However, the high burden of DR-TB, gender-related care barriers, and a persistent funding gap threaten to reverse progress. A sustainable transition will require continued Global Fund support beyond 2027, deeper domestic investment in TB care, strong integration of innovative and high-impact interventions into the national system, and continued civil society engagement for an inclusive, community-driven response.
