Issued with barely any consultation, Saparmurat Niyazov's presidential order on Tuesday is intended to achieve "budgetary economies" – according to government officials in the central Asian republic.

While healthcare experts have urged reforms to the top-down management found in many former Soviet republics, Niyazov's plan has sent shock-waves through Turkmenistan's struggling health system.
  
The decree declares that sacking thousands of nurses will encourage "effective use of [remaining] medical personnel and the transition to a system of private or partly self-financing health care".

Hospital reaction

At one hospital in the capital Ashgabat the chief doctor told journalists that all the hospital's nurses and orderlies were to be replaced by conscript soldiers.

Paid considerably less than the average $50 dollars per month, the military will replace all junior staff as of 1 March. 
  
"Already we don't have enough specialists as many have left the country or been pensioned off," an Asghabat midwife said.

"Will young people lacking specialist education really be able to help deliver babies or give injections?"
  
Autocracy

Despite Turkmenistan's huge natural gas reserves much of the population lives in poverty. 
  

"Will young people [military conscripts] lacking specialist education really be able to help deliver babies or give injections?"

Turkmen midwife

Since Soviet rule ended in 1991, Niyazov has presided with an iron first over his desert republic of around five million people.

He appointed himself president-for-life and Turkmenbashi (father-of-all-Turkmen) in 1999.
  
Decline

But his presidency has seen a severe decline in skilled personnel. Niyazov reduced the school leaving age to 16 for most students and the number entering higher education last year was just 3,900, or a tenth of the Soviet era figure.
  
A law passed last year clamped down on any vestiges of public debate by making it a crime punishable by life imprisonment to "sow doubt about presidential policy" or "provoke discord between state and people."
  
Increasingly, activities such as road-mending, cotton-harvesting and providing emergency services are carried out by conscript soldiers, with 100,000 young men called up each year.