Health spending in the Kyrgyz Republic declined rapidly 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 the country’s large debt burden and irregular revenues, which had been affected significantly by the regional financial crisis in 1998 and slow growth in the years thereafter. This situation reduced the funding available for essential health services. As a result, healthcare providers demanded steep increases in patient out-of-pocket premiums. Not surprisingly, declining 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, including the World Bank, DfID, KfW, SDC, and Sida, agreed to pool their funds and allocate them directly to the country’s health budget. 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 utilization of primary care and hospital services, and improved the targeting of fee exemptions for health services. People’s access to healthcare has improved.
Highlights:
- In 2001, 14.6 percent of people did not seek needed healthcare due to financial or physical barriers. This number dropped to only 3.6 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.
- “Gift-giving” to healthcare providers has declined. In 2001, 32 percent of respondents had given “gifts” to healthcare providers; in 2007, the figure was 17 percent.
- Access to pharmaceutical drugs has 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.
- Primary care use and hospitalization rates have increased, indicating better access to care. The average hospital stay fell from 15.3 days in 2004 to 12.7 days in 2007, indicating more efficient service delivery.
This project was the third in a series of successful IDA projects supporting the Kyrgyz health sector. IDA contributed US$15 million towards the program, which started in 2005 and is expected to continue through to 2011. IDA’s unique perspective enabled it to draw connections from across multiple sectors and reform areas such as health, 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 Manas Taalimi Strategy and Health SWAp recently had a mid-term review at which the above results were confirmed and discussed. While reforms in health financing will continue to need attention, to sustain these results, the Government and donors agreed on the need for greater attention to issues concerning healthcare quality, including medical education, continuous professional development, evidence-based medicine, and other areas that have received less attention to date.
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