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Inégalités dans l'accès et le financement des soins au Tadjikistan : le rôle des stratégies informelles et des migrations

Abstract : This dissertation begins with the observation that informal payments to healthcare professionals in post-soviet health systems persisted well beyond the post-socialist transition and despite the successive waves of health care reform.During this transition period, since the independence of the Republic of Tajikistan, there has been a deterioration of trust towards certain health professionals which has been associated with increased forgone care, especially among vulnerable populations. What is the role played by the different informal payment practices? Are they a source of mistrust or a means of restoring trust? Are informal payments adjusted to patients' standard of living or a source of inequality between patients?According to the equity indicators mobilized and contrary to popular belief, informal payments do not make the system progressive and do not guarantee that there will be access for all. The poorest are more likely to forgo care.To cope with these barriers in accessing care, different strategies are put in place by households: informal solidarity, indebtedness, reliance on traditional medicine, mobilization of social capital.More specifically, we then study if migration, a relatively important phenomenon in Tajikistan, is part of these strategies and to what extent remittances enable beneficiary households to improve their access to healthcare.
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Sandra Pellet. Inégalités dans l'accès et le financement des soins au Tadjikistan : le rôle des stratégies informelles et des migrations. Economies et finances. PSL Research University; Université Paris Dauphine-PSL, 2018. Français. ⟨NNT : 2018PSLED068⟩. ⟨tel-02461192⟩

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