The extensive health care and education systems inherited from the Soviets, covering even remotest villages of the Pamir-Alai region, is hardly to be maintained. Basic equipment and materials are often lacking and service quality is decreasing, particularly in remote areas. Responsibilities and duties concerning the use of land resources changed with independence leaving decision-making and land use regulations to a great extent unclear or intransparent.
The health care system is highly dependent on external support. Aid organizations such as Médecins or Pharmaciens Sans Frontières and the Aga Khan Foundation provide medical posts and community hospitals with the necessary basic medicine and equipment. Since emergency transport is commonly not available adequate treatment in district or oblast hospitals is hardly accessible for rural inhabitants. Electricity as an important commodity for the operation of a hospital is unreliable and commonly missing in winter, so are sufficient heating resources. Medicines are expensive and the needed pharmaceuticals to treat common diseases, such as respiratory infections, mange, nephritis, gastritis, kidney stones, anemia, hepatitis, skin diseases and ulcers, are often not available. Bad ventilation at indoor cooking places, poor drinking water quality, labor-intensive agriculture and energy resource allocation, malnutrition as well as the close contact to domestic animals may be main reasons for health problems. As reported particularly sedatives, special care for pregnant women and qualified medical personnel are lacking.
The extensive education infrastructure shows serious signs of deterioration. School buildings are in poor condition, classrooms usually overcrowded and places in boarding schools (Eastern Pamirs) not sufficient to accommodate all students. Teaching material is hardly available and object to poor quality. Often only one single teaching book, a remnant from Soviet times, is available per class if any at all. Innovative teachers thus design learning tools and visuals on their own with the limited means they have. It is reported that due to very low salaries qualified personnel migrates to urban centers or shifts to other occupation in the hope for better employment leaving the school with no or unqualified teaching staff. High number of pupils considerably stresses the household's budget. The compulsory school uniform is expensive and due to the shortage of energy supply students have to bring fuel to school for heating in winter. During the coldest month, usually in January or February, schools are closed since energy supplies are not sufficient to heat classrooms to acceptable temperatures. Electricity, an essential commodity for audio-visual teaching tools, is lacking or object to irregular supply. The low official school budget is supplemented by additional incomes from timber, fruit tree and crop cultivations on the school's territory. As reported repair of school buildings, additional classrooms, provision of school books and teaching material, sufficient heating resources and electric power as well as refresher courses and higher salaries for staff are urgent needs in the educational sector.
Land Use Regulation and Control
State farms were dissolved and land use has been progressively privatized after independence. Still, land and its resources water, air, flora and fauna and other natural resources are exclusive property of the state, but physical and legal entities have the right to lease land at perpetual and accrual terms or receive land as a lifelong heritage. Land use regulations are no more strictly enforced by public authorities thus paving the way for extensive resource depletion. Lack of control systems, widespread corruption and inappropriate legislative framework are main reasons for overtaxing forest resources and overstocking pastures. Moreover, legal unawareness of the population and uncertainties concerning responsibilities and competences between different political levels and institutions define a vague framework for land use and resource exploitation. As frequently reported by the population, there is a great need for easing access to rights of use, strengthening local responsibilities and the legal status of community associations. Moreover, locals demand better involvement in decision-making and more transparency in the distribution of land use rights. Further, laws for environmental protection have to be harmonized in accordance with the sustainable use of land resources.