We Need Measures to Protect the Nation’s Gene Pool

Adil Qeybulla, MA at CityHospital Clinic, Independent Health Expert

– How do you assess the state of healthcare in the country? Can you, please, describe the recent achievements of healthcare in the country? How effective is communication and collaboration with the medical organizations of other countries and the WHO?

The state of healthcare in Azerbaijan cannot be compared with that in the West, because our reforms have not been fully implemented. The most important thing is that there is no differentiation of healthcare ownership forms: state, municipal and private. All types of insurance should be studied and applied individually, taking into account the specifics of Azerbaijan.

The population in Azerbaijan is small, and depending on allocations, it is necessary to ensure full coverage of the main aspects of check-up(s), various medical procedures and operations.

Recently, a lot has been done to improve the material and technical capacity of the healthcare system. A lot of hospitals were re-equipped, repaired, and reconstructed. Even in some of our clinics there is equipment that is not available in the peripheral regions in Iran, Georgia, Armenia, and so on. As for these changes, the most important thing is that the citizens of Azerbaijan benefit from this. This is the main point.

Unfortunately, the reforms and changes in Azerbaijan are not aimed at the welfare of citizens. Therefore, we must create a system that will meet the standards applied in the West.

The weakness consists in the fact that so far we have no compulsory health insurance. This has a very negative effect on the quality of medical services. I think that the issue of applying compulsory health insurance will be resolved in some time. Citizens will feel an improvement in the quality of healthcare system, they will have hope and confidence in our national healthcare.

Regarding international relations in the health sector, we have international relations with the World Health Organization and other medical structures in neighboring and western countries. If you remember, when avian flu spread in Azerbaijan, the WHO provided technical support for its elimination in Azerbaijan.

In addition, we adhere to all the recommendations of WHO, vaccinations are administered in Azerbaijan according to the WHO schedule and so on. That is, we have signed many WHO recommendations and, naturally, we must adhere to them. These links are not at a very high level, since our health caresystem does not meet international standards, we do not have compulsory health insurance, and without this, development of healthcare is almost impossible. Our current healthcare can be seen as a deformation of the Soviet healthcare system.

– Which segments of the population use free medical services, are these services of justifiable quality? Where do citizens most often go for treatment and mainly for what reasons?

In the Soviet times the majority of the population (pensioners, poor and lonely people) received certain benefits, including medical ones from the state.

At present, it has been announced that services at state medical institutions are free of charge, but this principle is not consistently implemented, with compliance in some places and violations in others. This causes some discontent among people due to the lack of medical equipment, medical supplies, consumables (bandages, cotton wool, syringes, etc.). In state medical institutions patients sometimes complain that doctors prescribe elementary medical supplies, such as bandages, cotton wool, syringes, and so on, and the patients’ relatives have to buy them in a pharmacy. This, of course, causes some discontent. Some services are paid, and in public institutions due to the lack of compulsory health insurance the burden falls on the shoulders of the citizens.

Therefore, the only way to ensure quality medicine is to complete the reforms, that is, to determine the ownership of medicine (state, private or municipal), including the introduction of compulsory health insurance.

It is also necessary to identify those segments of the population who need free medical care. We have roughly identified 4 layers of the population. The first category includes poor citizens, students, and pensioners. They are directly funded from the budget. The second category includes registered unemployed citizens, which is a common factor in Azerbaijan. Therefore, they should also be financed from the budget. The third category of the population are private sector employees, as well as the staff of state and municipal institutions. People of this category are funded at the expense of their salary. The fourth category is constituted by business people and officials. There is a special mode of insurance meant for this group. Each of these categories should be financed by specific parameters.

Despite the fact that a presidential decree on compulsory health insurance was adopted in 1999, it has not yet been implemented at the national level. It seems that it has been introduced in Yevlakh and Mingechaur, pilots were underway there over the past two years. But this does not mean anything.

Medical tourism is when citizens go abroad for medical care, diagnostics, and treatment. The leading country, the majority of the population leaves for for treatment, is neighboring Iran. It should be noted that medicine in Iran is based on Western principles of practicing medicine, but in the outskirts of Iran, medical equipment is sometimes inferior to ours. I think our equipment is much better than theirs. But despite this, medical services there are much cheaper than ours. This is the main reason for medical tourism to Iran.

The part of the population that is unhappy with our medicine leaves for Europe and Turkey. This is the better-off part of the population that has financial capacity to pay for expensive medical services. People leave for the US in very rare cases, as it costs a pretty penny. I think that the phenomenon of medical tourism exists in all countries, even in European ones. Even if at a small scale, it does exist. People sometimes leave Europe for the US, but again in very small numbers. In our case, medical tourism exceeds all norms and all standards, and it is confusing. This is due to distrust towards national medicine. And as a result, a very large amount of money is spent on medical treatment abroad. If this money circulated within the republic, this would certainly have affected the living standards of the population, the economy, and so on. If such an amount of foreign currency leaves the country, it affects everything. Therefore, it is necessary to align all health care reforms with modern standards.

– Are there any statistics on which diseases are the most common ones among the population today? Why do you think people go to doctors mostly only if they have acute health problems? Is it because of insufficiency or lack of funds, specificity of mentality or something else?

According to statistics, cardiovascular, oncological, and mental diseases are the most common among the population. Today, the registry includes a special type of diseases – these are autoimmune diseases, which means that the body considered its own organs (kidneys, liver, pancreas) as alien and fights against them. This type of diseases has recently been widely spread throughout the world, and especially in Azerbaijan.

Oncological diseases are very widespread. This can be explained by environmental issues. The environmental situation is worsening every year around the world. Drinking water, food, medicine and air quality affect health. Water, air and soil pollution, as well as artificial, genetically modified, substandard canned foods, and so on affect the health of the population. Due to the lifestyle, some diseases, for example, cardiovascular diseases, hit younger groups of the population, and oncological diseases have become more frequent. It should be taken into account that, despite the efforts of the Ministry of Health and the Oncology Center, the latter does not yet address all cancers. Some surgeries are performed in other clinics. They often remain outside the scope of collected statistical data. Therefore, the real data clearly exceed the official ones. This also needs to be considered.

– What urgent measures are needed to improve the healthcare system?

I think that we first of all need to take measures to protect the nation’s gene pool. Why is this happening? What factors lead to these diseases? How can these diseases be detected in a timely manner? How can they be prevented? All these questions require a specific program. This should be done by the Ministry of Health, since this body is responsible for the state of the gene pool. It is necessary to take comprehensive measures to eliminate the causes and deficiencies that harm the health of the nation. Immunization of the population is also important. There was a time when the state allocated funds for the immunization of the population, which was carried out in polyclinics. However, this system is also failing.

Certain diseases (measles, rubella, whooping cough, and others) have become quite frequent now. It is necessary to strictly follow all the recommendations of the WHO, to adhere to the WHO principles that are applied in developed countries with regard to the organization of healthcare and the protection of public health. Otherwise, our gene pool will suffer greatly. Such practices will already have an impact on the future generation and cause the retardation of certain diseases.

It is also necessary to take into account that, due to close kin marriages in Azerbaijan, there are a lot of mutations, genetic diseases such as thalassemia.

We still have a tolerant form of tuberculosis, which spreads directly from prisons in Russia. Therefore, it is necessary to take all measures to comply with international health principles and protect the health of the gene pool.

I think that the state should involve all specialists in this process, regardless of their political and religious views or their nationality. It is necessary to take comprehensive measures also for the organization of compulsory health insurance, as I have already indicated above. Here, one can take into account the practices of Turkey, because this country borders with Azerbaijan and is close to us in terms of its national composition and historical traditions. We can follow the footsteps of Turkey in the organization of health care in our further development.