Azerbaijan's health ministry has shut down a series of private medical clinics for alleged irregularities, throwing the country's health system into confusion.

There are widely differing accounts of the reasons for the suspensions ordered by the new health minister, with few of the clinics concerned being prepared to comment in public on the situation.

The clampdown, which began at the end of June, has resulted in the closure of six big private clinics and 153 dental surgeries. Four other clinics and 110 surgeries were warned that they should correct faults in their procedures.

All the establishments were given one month to bring themselves up to health ministry standards, but none of the shut clinics has so far reopened.

Health ministry spokesman Anar Gadirli told IWPR a new round of monitoring was due to take place soon, after which some of the clinics could reopen.

The closed clinics are still doing outpatient care and carrying out tests, but their work is severely restricted.

Their managers are mostly keeping quiet and hoping that they can open their doors again soon. Patients in two clinics categorically refused to speak to IWPR.

Gadirli told IWPR that clinics that had been shut had allegedly infringed rules by, for instance, using expired reagents, recruiting staff illegally and failing to maintain necessary sanitary and licensing standards.

Of Azerbaijan's 263 dentist surgeries, it transpired that only 153 had health ministry licenses.

According to health ministry figures, there are 400 private medical facilities in Azerbaijan, employing 5,000 people.

The crackdown is part of a campaign by Azerbaijan's new energetic health minister, Oktai Shiraliev, formerly director of the country's Republican Diagnostic Centre, and appointed after his predecessor, Ali Insanov, was arrested last year.

Shiraliev has publicly called upon citizens to trust the government health system, which he said was extremely professional.

"Doctors who work in state institutions have acquired enormous experience over many years of professional activity," the minister told journalists. "Some of them can make a diagnosis simply by looking at a patient. And government establishments have all the necessary equipment to carry out research."

Some of the private clinics are submitting to the government campaign in good humour. The director of the Funda medical centre said his staff were working in two shifts to correct faults identified by government inspectors.

However, Aitan Kulieva, founder and general director of the Diamed clinic, has complained that her centre has been shut down unjustly.

One doctor working at the Diamed clinic, who asked to remain anonymous, said it had been closed because it had been linked to ex-minister Insanov, accused of plotting a coup d'etat against President Ilham Aliev, and former speaker of parliament Rasul Guliev, now in exile in the United States.

Kulieva herself said there was another reason for the closure, but said she was not ready to divulge it.

"If the health ministry does not give our clinic permission to work soon I will call a press conference at which I will say the real reasons it has been shut down," said Kulieva.

Gadirli said he did not understood why Diamed was protesting, as inspectors claimed to have discovered the clinic was using out-of-date reagents to test for hepatitis-C.

As a result of the closures, a number of clinics are incurring financial losses, but none of them wished to comment on how much they were losing.

There is keen speculation in Azerbaijan about what lies behind the campaign. Outwardly, Azerbaijan's private clinics do not appear to differ very much from government ones.

Dr Arif Makhmudov, who works in both sectors, told IWPR that the quality of care was the same in both, but private clinics generally had more up-to-date equipment. They also generally charge high prices, while government healthcare is still theoretically free.

Many Baku residents feel that private clinics and their state counterparts have failings.

"I went for a check-up in the Diamed clinic,' said Eivaza Kerimov, 27. "And although I spent approximately 70 [US] dollars I have no regrets because they use modern equipment to make their tests. And in state hospitals they used old equipment left over from Soviet times."

Emin Husseinov, 29, had just undergone tests in the Republican Drugs Clinic to persuade his girlfriend that he was not an addict. He was dissatisfied with the service the state system had provided.

"The doctors don't do any kind of tests and they decide if someone has an addiction just on the basis of questioning," he said. "But the private clinics don't deal with this subject at all."

One possible unstated reason for the crackdown is that the health ministry is trying to restrict state doctors from working for private clinics.

Sahib, a doctor who asked to be identified only by his first name, works in one of Baku's state-run clinics, but earns up to 500 dollars for his private work. "For work in a state establishment I get just 80 dollars a month," he said. "The salary of junior medical staff is 35-40 dollars and of a head doctor is 150 dollars. If we're not allowed to work for private clinics what do we have to live on?"

Shirvaliev alleged that doctors who worked for state clinics frequently sent their patients for tests to private clinics and then were rewarded with a percentage of the fee that the private clinic charged.

"It's true this does happen," said Sahib. "But I go to work in a private clinic only after I have worked my regulation five hours in my state clinic."

According to the latest information obtained by IWPR, the health ministry plans to extend its monitoring to the state health system and the work of some public health clinics will be suspended. But the ministry insists that as soon as problems are fixed, it will allow all clinics to reopen.

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