Spending with purpose: tracking health expenditures in Tajikistan to inform progress toward UHC.

This analysis examines trends in health spending in Tajikistan from 2000 to 2022 and situates them within the country's key health financing reforms, with the aim of informing progress toward Universal Health Coverage (UHC) and identifying persistent gaps. By applying data from the WHO Global Health Expenditure Database (GHED), which is structured according to the System of Health Accounts (SHA 2011), and contextualizing results with national policy documents and relevant literature, the paper assesses both expenditure patterns and reform dynamics. While government health spending has increased in absolute terms, it remains modest as a share of GDP and general government expenditure. Out of pocket payments have declined slightly as a share of current health spending, yet they still account for nearly two-thirds, posing barriers to equitable access and financial protection. Recent reform initiatives, such as pooling and strategic purchasing pilots, show potential to improve equity and efficiency; however, their long-term impact will depend on sustained implementation and systematic tracking of expenditures. The findings underscore the importance of tracking expenditure in a systematic way to guide health reform. Institutionalizing the routine production of health accounts using SHA 2011 would improve transparency, strengthen allocative efficiency, and support more strategic resource allocation and informed policy dialogue. Ultimately, tracking health spending is not just a technical exercise, but a strategic tool to align financing with policy priorities and advance UHC.