Improving the Health Sector in Kyrgyz Republic

Health spending in the Kyrgyz Republic declined in absolute and relative terms from 1996 to 2004, falling from 3 percent of GDP in 1996 to around 1.8 percent in 2004. This was due in part to slow economic growth after the 1998 crisis and the country’s large debt burden that limited resources for health. As a result, healthcare providers demanded steep increases in patient out-of-pocket premiums. Not surprisingly, declining public health spending led to reduced access.

In 2004, a consortium of 10 donors led by IDA agreed to adopt a Sector-Wide Approach (SWAp) to support the health sector in Kyrgyz Republic. This health SWAp, the first in the Europe and Central Asia region, made reducing financial barriers to access its major focus. Five donors agreed to pool their funds and allocate them directly to the country’s health budget—these donors were the World Bank Group, the UK’s Department for International Development, Germany’s KfW, the Swiss Agency for Development and Cooperation, and the Swedish International Development Cooperation Agency. In return, the government committed to a program of phased improvements in the stability and level of healthcare financing, and agreed to implement a range of reforms as part of its new “Manas Taalimi” health reform program.

In only three years, the program has reduced financial barriers to access for healthcare services, reduced out-of-pocket spending on healthcare, increased the use of primary care and hospital services, and improved the targeting of fee exemptions for health services. In particular, the success of the programme is demonstrated by the following achievements:
 In 2001, 14.6 percent of people did not seek needed healthcare due to financial or physical barriers. This number dropped to only 3.1 percent in 2007.

 The system of fee exemptions is working more effectively. In 2004, 15 percent of exempt patients reported making payments to state providers compared to 9 percent in 2007.

 In 2001, 32 percent of respondents had given “gifts” to healthcare providers; in 2007, the figure was 17 percent.

 Access to pharmaceutical drugs improved. The proportion of respondents able to obtain all items prescribed during a doctor’s visit increased from 77 percent in 2001 to 92 percent in 2007, and of those who did not obtain medicines, the proportion citing cost as the primary factor decreased from 54 to 43 percent.

 As primary care improved and service delivery was more efficient, the average hospital stay fell from 15.3 days in 2004 to 12.7 days in 2007.

 Pregnant women living with HIV who received antiretroviral therapy to reduce the risk of mother-to-child-transmission increased from 61.5 percent in 2005 to 74.3 percent by 2008.

The Health and Social Protection project was the third in a series of successful IDA projects supporting the Kyrgyz health sector. IDA contributed US$15 million to this US$652 million project which started in 2005 and is expected to continue through to 2011.

In June 2008, additional financing in the amount of US$6 million was provided to address impacts of the international food crisis, focusing on protecting and improving the nutritional status of pregnant women and young children. It also scaled up targeted cash transfers to help poor families mitigate the impact of food price shocks. The EU is also providing cash supplements to targeted families.

IDA’s involvement in the health sector was coordinated with several sectors’ public financial management, civil service reform, and fiduciary functions. IDA focused specifically on supporting the “Manas Taalimi” Health Reform program and strengthening the administrative system of the Ministry of Labor and Social Protection.
The Kyrgyz Republic’s health sector has benefited from a Sector-Wide Approach. Five major donors continue to collaborate. They are the World Bank Group, the UK’s Department for International Development, Germany’s KfW, the Swiss Agency for Development and Cooperation, and the Swedish International Development Cooperation Agency. The government is financing the bulk of project’s total cost.

To sustain these initial results, the government and donors have agreed to focus more on healthcare quality, including medical education, continuous professional development, and evidence-based medicine.

Source: http://web.worldbank.org