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The World Health Organization (WHO) regional Director for Europe, Dr. Marc Danzon, believes that situation in Tajikistan is ‘dramatic and difficult’.

During his third visit to Tajikistan Dr. Danzon held talks with President Rahmon, the Minister of Health Nusratulla Salimov and the Foreign Minister Hamrakhan Zarifi last week to discuss the winter crisis and its impact on the country’s healthcare system.

After his official meetings Marc Danzon gave an exclusive interview to the BBC Persian Service.

Tajikistan’s health system will receive $900 000 out of over $25 million requested from donor countries and organizations, he said. The total need for ten coming years has not been calculated yet. Therefore, there is a probability of the increase in the aid.

As his first recommendation to Tajik authorities Dr. Danzon mentioned establishing a proper information bank with all necessary healthcare data. "We don’t know exactly how badly the cold has affected the country’s health situation", he said. "But we would like to transform this bad news of crisis into good news of a real long-term health system".

Marc Danzon confirmed that many hospitals and health centres in Tajikistan had neither power nor water during the cold crisis. He was shown a mixed picture, he said. Some of hospitals had nothing for patients to eat, were freezing cold and in a very bad situation, while some others had power and water. But, he emphasized, nobody could be blamed for it, because the winter misery ‘was provided by God, not the authorities.’ "I tell you, probably God had a big role to play in it," he reiterated humorously. "Unfortunately, the WHO is not in direct contact with him. So, I cannot say anything."

In this case, God must be fond of showing this kind of winter tricks to Tajikistan on a systematic basis. Certainly, this year the most spectacular winter drama of last decades was staged in Tajikistan, however, power cuts have been a necessary element of Tajik winters since long ago.

"That is a problem of energy," replied Danzon. "That is a deep problem of economy. I am here to look at the status. From what the President told me, there were some cold weeks and days during these three months that have occurred only 65 years before. The planning is very difficult. You can plan for a catastrophe every year. That would be a good planning. But no country can afford that… Yes, people will pay the price for that by falling ill. But how to prevent it? You have to be extremely clever. WHO is working on it."

The WHO regional director expressed his unawareness about the cold-related mortality figures, especially among newborns. He agreed that Tajik healthcare system lacks transparency and information is scarce. But the he added, "They (Tajik authorities) let me do what I wanted. I went wherever I wanted to go and I am speaking to you freely. This for me is a type of transparency. The President told me that this system was very week. He was concerned how patients are being treated. We don’t have figures. It’s true. I imagine that the government doesn’t have them either. That’s why the WHO says, transparency, knowledge of information, is the first step. On that I have the agreement of the President and the Minister of Health. Let’s see if it will be done. If it’s not done, I will tell you."

As if forgetting his own words after a couple of minutes, Dr. Danzon contradicts his own statement by saying "I am an outside visitor and I am not shown everything. They are showing me what they want. I can tell you what I saw. I’m not stupid. I know that when I visit a country, I’m shown good places. But I am clever and experienced enough to look at other places too."

Marc Danzon accentuated that the WHO aims to build a proper record-keeping system for Tajikistan’s healthcare. But his next words almost evaporate all hopes for a forthcoming improvement: "What I want to tell you is that the same is everywhere. Even in rich countries. It’s very difficult to put a system in place. Is it because health is a sensitive issue and there is some reluctance? Perhaps. I think it’s difficult mainly because it requires a lot of information."

Dr. Danzon did not agree with the journalist’s suggestion that WHO lacks efficient means of pressure on government to reform their health systems: "I tell you, talking to the BBC is an excellent means of pressure," he said. "The pressure could be done by law or by voice. Governments know that I will talk to media and the assembly. It’s not totally true that they do whatever I advise. But they can do better, yes… It’s easy to criticize, difficult to change."

Returning to his previous talks with Emomali Rahmon, Marc Danzon said: "The President is clearly not satisfied with the situation. He wants a better health system. We have to advise and help him."

Dr. Danzon believes that there was some improvement in the country’s health system during last 10 years. "You cannot say nothing has been done," he stated. "Health professionals are good, although we need to continue our trainings, but generally they are good. Some of health facilities, like mental health care, were not good. Some others are lacking drugs, but they are not in a catastrophic situation. Everywhere people are not satisfied with their health systems. The neighbour is always better. But when I go to the neighbour, they say: our neighbour is better."

Marc Danzon will recommend to Tajik health authorities not to build new hospitals. Because "it’s not the building that makes a hospital. It’s all about qualified doctors, nurses and their devotion to work. Don’t build a new one, destroy some old ones."

He thinks private hospitals should not be a matter of necessity either, since "privatization is not the guarantee of quality. This is a fantasy. And privatization is not a paradise."

To the journalist’s question about his view on corruption in the Tajik health system, Marc Danzon replies: "If there is corruption in your health system, you as a citizen of your country should act. I cannot act. Corruption is not good for the system, but it’s not a responsibility of an international organization [to deal with it]."

Then referring to the Tajik authorities and their silence on the issue of corruption in the healthcare system, Dr. Danzon suddenly makes a U-turn by saying: "Of course, you are right. They don’t tell you the truth. Why should they tell me? So, we are in the same situation."

There are widespread rumours in Tajikistan about parts of the humanitarian aid, including medicine, being sold in market places. Marc Danzon regards them as sheer rumours. Nevertheless, he gives his detailed point of view on the topic:

"The WHO investments are going to the right place at least not worse than anywhere else. In addition, we are not giving money, we are giving technical advice."

The WHO regional director advises the Tajik journalist to think twice before uttering a word about corruption in the healthcare system.

"By saying that, you are making donors less and less ready to give [money]," he says. "You take your own responsibility, I take mine. It’s a very dangerous statement, unless you have evidence and we’ll do a scandal… At the end of the day, there will be no more donation. You will find yourself isolated and we will cry that the time when there was at least perhaps 80 % [of the investment reaching their targets] is gone… I’d say 80% for me is good. I would like to have 100%, but 80 will do as well. If it is only 20%, I will feel I should withdraw from my job."

Drawing a conclusion from his lengthy talk Marc Danzon says: "I try to give conditions for a success story in two years. If you then tell me I didn’t succeed, I won’t mind, because I will leave in any case."