Azerbaijan: Energy-Rich, Healthcare-Poor

Azerbaijan may have the mega-energy revenues needed to build roads and to refashion its military, but when it comes to regional healthcare, the country's attention appears to be focused elsewhere.

Like many rural Azerbaijanis, Intigam Mammadov, a resident of Imamgulubayli village in southern Azerbaijan's Agdam district, feels shortchanged by the situation. The lack of a well-quipped local hospital cost his father his life in 2006, Mammadov believes, adding that his father was a long-time sufferer from bronchial asthma. "The closest hospital is situated . . . four to five kilometers away from our village," he recounted to EurasiaNet. "But this hospital has neither suitable conditions nor educated doctors. Since the quality of medical service is not satisfactory, there are very few people who go there," he said.

Instead, twice a year, Mammadov's father traveled seven hours to Baku to receive the treatment his condition required. A few weeks after his last trip, though, his health became steadily worse. "I thought I would take him to Baku in the morning. But he passed away at dawn," Mammadov said.

Scores of similar stories abound. Clinics without regular supplies of gas, electricity or water. Doctors who may or may not come to work. Nursing staff with only a high school education.

Ministry of Health spokesperson Anar Gadirli said that the government is aware of the scope of the problem, and described it as a "regional gap syndrome." Healthcare facilities in Baku are "highly developed compared with the regions" and doctors are waiting to work there, Gadirli said. The regions, meanwhile, lack both doctors and clinics "providing specialized medical treatment."

"[D]octors do not want to work in the central regional clinics," he added.

The ministry estimates that Azerbaijan has a shortage of more than 2,000 doctors outside of Baku. While Baku contains 95 doctors per 10,000 residents, that number falls to a mere 15 physicians per 10,000 residents in the southern region of Lenkoran, and to rock-bottom at about 10 doctors per 10,000 residents in the southwestern region of Kelbajar-Lachin, the State Statistics Committee reports. Nationwide, Azerbaijan has 36 physicians for every 10,000 people out of its population of 8.62 million.

"The geography of healthcare services is very limited," noted the head of one humanitarian organization. Himayat Rizvangizi, director of Himayadar, estimates that some 29 villages in the southern region of Lenkoran, bordering Iran, have no medical facilities. That number climbs to 44 for the northern region of Tovuz and 123 for Guba in northeastern Azerbaijan. The findings are based on research done for Oxfam on child mortality rates in those three regions.

The health ministry's Gadirli puts the number of such villages in "the hundreds."

Given living conditions in Azerbaijan's regions, the situation comes as no surprise to some experts.

"There is a limited supply of power in the regions, and no gas and heating systems installed," commented Azer Mehtiyev, chairman of Assistance to Economic Initiatives, a non-governmental organization that monitors government budget spending. "Even the central regional hospitals do not receive electricity and it's impossible to sleep in cold hospital rooms in the winter. Lights can go out when there is a surgical operation. These problems discourage citizens from going to doctors."

Health Ministry spokesperson Gadirli argued that to correct the problem, faster "construction of new diagnostic treatment centers" and the establishment of "normal working conditions . . . for doctors" are required. According to the health ministry, some 58.4 million manats (about $72 million) were spent on upgrading and building "medical institutions" in 2007; the number is slotted to increase to 94.5 million manats (about $116.5 million) in 2008.

The government has announced plans to restore four hospitals in Baku this year and one in the central city of Ganja.

At the same time, Gadirli notes that it is not realistic to have a medical clinic in each village. Villages with "a population of less than 300 or 400 people" do not warrant the amount of funds required to construct such facilities, he said.

Himayadar's Rizvangizi contended that the ministry could get past that problem by selectively placing clinics in areas with limited public transportation, such as in the mountains. "In the winter, mountainous villages become isolated and cut-off, and people don't know what to do when there is a need for urgent medical aid. For instance, during the winter, patients who live in the mountainous villages of Guba have to walk up to 15 kilometers to reach the nearest medical facility."

Meanwhile, the health ministry has come up with a program with Baku's Medical University to prompt young doctors to head to the regions. Under the initiative, some 70 to 80 percent of the school's graduates will be sent in 2008 to work outside of Baku. Particular emphasis would be placed on sending gynecologists and those with midwifery skills.

"If the material and technical conditions are good, we will be able to send the majority of students to the regions," commented Nasimi Rasimov, the school's chief of training. Currently, no financial incentives exist for these young doctors to head to the regions, however.

Fourth-year medical student Samir Farajov is among those who agreed to work in a regional clinic. "The salary is the same everywhere, but the government should pay wages to medical personnel to the extent that a physician working in a remote village could focus all of his attention on caring for the sick. If this is not the case, nobody would want to work in a village," Samir said.

Shalala Habibova, a pediatrician, completed an internship in a village clinic last year, but she returned to Baku afterwards. "[I]t is better to be unemployed rather than to go and work in a hospital with no [proper working] conditions," she said.

The Medical University's Rasimov conceded that conditions at many village clinics are unacceptable. "I do not blame our students and graduates . . . In reality, you can't even consider village medical facilities as places of employment. Even patients wouldn't go to these facilities," Rasimov said.

The Ministry of Health says that a program is in the works to boost salaries and to provide accommodation and public utility benefits for young doctors who decide to work in the regions. Financing for the program remains undefined, however, and dependent on a further deliberation by government officials.

Elkhan Salahov is a freelance reporter based in Baku.

Azerbaijan: Energy-Rich, Healthcare-Poor

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