Major changes in the Health care system in Kyrgyzstan occurred following the collapse of the USSR:

‘Before independence in 1991, the Ministry of Health in the Kyrgyz Republic administered policies made in Moscow through a centrally organised hierarchical structure. The Kyrgyz Republic is now developing its own health care policy in response to changing social and economic conditions and the worsening health status of its population.’²⁹

Health reform was initially a lower priority after independence than the economy. The objectives of the so-called MANAS health care reform programme, developed from 1994 are to: improve the health status of the population, to improve quality, promote equity and to make more effective use of resources. External agencies and NGOs have played a major part in the reform process. The Medical Insurance Law of 1992 provided a new basis for financing the health care system. Major restructuring of the primary health care system took place in 1995-96. Mandatory health insurance was introduced in 1997 and the fund was brought under the Ministry of Health the following year. Many other changes have been introduced as pilot projects yet their effectiveness remains unproven. Four key issues remain high on the agenda: matching expenditure to needs (investment is still well below the required levels); rationalizing the hospital system (a central strategy for this has yet to be implemented); strengthening primary care (retraining of generalists is underway and the model of family group practices is being extended throughout the country); equity (this was a key feature of the Soviet model, but people now increasingly pay for health services and drugs or make under the counter payments, disadvantaging those on low incomes).³⁰

In 2003, the total per capita expenditure³¹ on health care was Intl $161 (5.3% of GDP).³² Among the Commonwealth of Independent States, this figure falls within a spending range of Intl $ 71 in Tajikistan (4.4 % of GDP) and Intl $570 in Belarus (6.4% of GDP). At 3.5%, the smallest spending as a percentage of GDP is in Kazakhstan (Tables 5 and 6).

The WHO overall health system performance score places Kyrgyzstan 135/191 countries. This composite measure of overall health system attainment³³ is based on a country’s goals relating to health, responsiveness, and fairness in financing. The measure varies widely across countries and is highly correlated with general levels of human development as captured in the human development index.

Mary Lou Hathaway sums up the health care system in Kyrgyzstan:

‘There is no longer free health care. Health care insurance has recently become available, though it is still distrusted by many citizens. Health care is paid for “out of pocket” and is quite unaffordable for the majority. Nurses’ value in health care is vastly underrated and they work for “miserable wages”. There is almost no access to narcotics for pain relief, and proper equipment is lacking.’³⁴