Despite repeated efforts by the Tajik government to improve and expand health care, the system remains extremely underdeveloped and poor, with severe shortages of medical supplies. The state's Ministry of Labor and Social Welfare reported that 104,272 disabled people are registered in Tajikistan (2000). This group of people suffers most from poverty in Tajikistan. The government of Tajikistan and the World Bank considered activities to support this part of the population described in the World Bank's Poverty Reduction Strategy Paper. Public expenditure on health was at 1% of the GDP in 2004.