Turkmenistan's Healthcare System: Organisation, Access for a Foreigner and Health Risks

According to the European Observatory on Health Systems and Policies (WHO), the Cabinet of Ministers defines health sector policy and the Ministry of Health and Medical Industry is responsible for running the services. Each of the five regions is headed by a governor appointed by the president, the velayat hakim, who funds regional health services; the central state collects national taxes and distributes the proceeds among the regions and the city of Ashgabat, and the president can allocate additional funds to health.

Primary care institutions act as a filter and direct, when necessary, to an affiliated district (etrap) or city hospital. The types of hospitals are rural, district and city hospitals, dispensaries (specialised hospitals), regional hospitals and central clinical centres. The Observatory specifies that hospitals admit patients only on referral from primary care, except for emergencies or for patients willing to pay, and that informal payments are widespread but difficult to quantify. This description dates from the year 2000: it gives the framework, not the current state of the facilities, which WHO Europe describes as being modernised under the national health programme “Saglyk”.

The official pages consulted present no rule for enrolment in a local scheme for a foreign resident; access, cost and any reimbursements should be confirmed with the employer and the Ministry of Health and Medical Industry. France Diplomatie is clear on the principle: in Turkmen hospitals, care, accommodation, linen, medicines and food are at the foreign patient’s expense, with no cover by the embassy nor by a local scheme accessible to French nationals passing through.

The page also specifies that many international insurances do not cover Turkmenistan. Before taking out a contract, you should obtain from the insurer written confirmation that the country is covered, as well as the annual limit, the exclusions and the repatriation conditions. See the pages healthcare reimbursement in Turkmenistan and living in Turkmenistan.

France Diplomatie describes health infrastructure as insufficient. In the event of serious illness or accident, medical repatriation is necessary. The contact details of doctors, hospitals and pharmacies appear on the French embassy site, under the heading “In case of emergency”. The page gives no local emergency number: the French embassy in Ashgabat (+993 12 36 35 50) and the French embassy in Baku, competent for Turkmenistan (+994 12 490 8100), are the contacts cited. Outside opening hours, the Safety page gives +993 63 42 96 60.

For leisure, France Diplomatie reminds that local medical assistance after an accident is limited: activities such as horse riding are advised against, and certain extreme practices (diving, parachuting, climbing) are prohibited by the local authorities. Traffic, with poorly maintained roads and animals outside the capital, remains an accident factor.

The French ministry advises taking only the strictly necessary medicines, in their original packaging, with a prescription giving the names as international non-proprietary names, and checking that they are permitted in Turkmenistan and never buying medicines in the street, because of counterfeits. The quality of local medicines is not assured: for regular treatment, take a sufficient quantity and the prescription.

For water and food, drink only bottled or capped beverages, or water made drinkable by filtration, boiling or, failing that, disinfectant; wash your hands regularly; cook meat, fish and poultry well; avoid raw milk, raw vegetables, shellfish, reheated dishes and cold buffets; peel or carefully wash fruit and vegetables with safe water.

France Diplomatie recommends checking the French vaccination schedule (diphtheria, tetanus, poliomyelitis, whooping cough, measles), then studying with the doctor or an international vaccination centre hepatitis A, typhoid, hepatitis B for frequent or prolonged stays, tuberculosis (BCG) for children under 15 in the event of frequent or prolonged stays and rabies for young children and stays in rural areas or far from the large cities.

• Typhoid fever: transmitted by contaminated water or food or from person to person; symptoms about three weeks after contamination; can be fatal without treatment; prevention through hygiene and vaccination.
• Rabies: a fatal viral disease, transmitted by bite, scratch or contact of saliva with broken skin; consult immediately after any exposure, even if vaccinated.
• Sexually transmitted infections: avoid risky behaviour and consult as early as possible in the event of exposure.
• Heat, sun, road, swimming: other risks cited, to be anticipated depending on the season.

France has no social security agreement with Turkmenistan (CLEISS list; CLEISS is the French Centre for European and International Social Security Liaison): the carte Vitale is not used on the spot. An assistance contract covering all medical costs, surgery, hospitalisation and medical repatriation is indispensable: without it, access to care can be refused, even in a life-threatening emergency, and the embassy does not pay these costs. The choice is made on written confirmation that the country is covered, the annual limit, evacuation, geographical exclusions and the handling of medical history. See the page expat health insurance.