Primary care reforms in Central Asia - On the path to universal health coverage?

This article reviews progress in primary care reforms in the four Central Asian countries Kazakhstan, Kyrgyzstan, Tajikistan and Uzbekistan. It draws on the country monitoring work of the European Observatory on Health Systems and Policies, a review of the peer-reviewed literature and an analysis of data available in international databases. The retrieved information was organized according to key health system functions (governance, provision, financing and resource generation), as well as key aims of universal health coverage (access to and quality of primary care and financial protection). The article finds that the four countries have made substantial reforms in all of these areas, but that there is still some way to go towards universal health coverage. Key challenges are the overall lack of public funding for primary care, poor financial protection due to prescribed outpatient medications being generally outside of publicly funded benefits packages, the low status and salary of primary care workers, problems of access to primary care in rural areas, and underdeveloped quality monitoring and improvement systems.

Kyrgyzstan: Health System Review.

This analysis of the Kyrgyz health system reviews developments in its organization and governance, financing, provision of services, health reforms and health system performance. A mandatory health insurance is in place, with the Mandatory Health Insurance Fund (MHIF) under the Ministry of Health acting as single public payer for almost all hospitals and providers of primary care. The benefits package of publicly covered services is defined in the State-Guaranteed Benefits Programme (SGBP). However, many services require co-payments and in 2019 only 69% of the population was covered by mandatory health insurance. Health expenditure per capita is one of the lowest in the WHO European Region, due to the country's small GDP per capita. Private spending, almost entirely in the form of out-of-pocket expenditure and including informal payments, accounted for 46.3% of health expenditure in 2019. Financial protection is undermined by low levels of public spending for health, resulting in financial hardship for people using health services. While there is a well-developed network of health facilities, the geographical distribution of health workers is uneven and there is an overall shortage of family doctors. Access to health services remains a challenge, which has been exacerbated by the COVID-19 pandemic. While improvements have been made in recent years, communicable and noncommunicable diseases still pose a major problem and life expectancy prior to the COVID-19 pandemic was one of the lowest in the WHO European Region.