Kyrgyzstan has undertaken wide-ranging reforms of its health system
in a challenging socioeconomic and political context. The country
has developed two major health reform programmes after becoming
independent: Manas (1996–2006) and Manas Taalimi (2006–2010). These
reforms introduced comprehensive structural changes to the health care delivery
system with the aim of strengthening primary health care, developing family
medicine and restructuring the hospital sector.
Major service delivery improvements have included the introduction
of new clinical practice guidelines, improvements in the provision and use
of pharmaceuticals, quality improvements in the priority programmes for
mother and child health, cardiovascular diseases, tuberculosis and HIV/
AIDS, strengthening of public health and improvements in medical education.
A Community Action for Health programme was introduced through new
village health committees, enhancing health promotion and allowing individuals
and communities to take more responsibility for their own health.
Health financing reform consisted of the introduction of a purchaser–
provider split and the establishment of a “single payer” for health services under
the state-guaranteed benefit package (SGBP). Responsibility for purchasing
health services has been consolidated under the Mandatory Health Insurance
Fund (MHIF), which pools general revenue and health insurance funding.
Funds have been pooled at national level since 2006, replacing the previous
pooling at oblast level. The transition from oblast-based pooling of funds
to pooling at the national level allowed the MHIF to distribute funds more
equitably for the SGBP and the Additional Drug Package. Although utilization
of both primary care and hospital services declined during the 1990s and early
2000s, it is increasing again. There is increasing equality of access across
regions, improved financial protection and a decline in informal payments, but
more efforts will be required in these areas in the future.