Kyrgyzstan's Health System
From 1996-2005 the Ministry of Health implemented its National Health Care Reform Programme “Manas” with a focus on the principles of equity, affordability and accessibility to health for the Kyrgyz population. Following the “Manas” Programme the “Manas Taalimi” Programme was established for the period 2006-2010. The focus of this new programme was to achieve the health Millennium Development Goals through the following improvements in the health system:
1. Achieve equity and accessibility
2. Decrease financial burden on population
3. Increase efficiency
4. Improve quality
5. Increase responsiveness
During these reforms fundamental changes have taken place in the health financing system. Tax revenues received by the government have served as the main source of health funding. In 1997 a Mandatory Health Insurance Fund (MHIF) was introduced with a view of attracting additional sources of funding to the health sector and ensuring social protection of population. This led to the establishment of the Mandatory Health Insurance Fund (MHIF) in 1996. The MHIF acts as a single payer in Kyrgyzstan for health. It pools the resources available and purchases health services. Funds for the MHIF are received from the Social Fund and the Republican (National) Budget depending on the person to be covered. Funds are pooled at the Oblast level. As of 2004, 84% of the population were covered.
Once insured through the MHIF the person is entitled to a package of free primary care from a specific Family Group Practice (FGP) at which the individual is registered. Inpatient care is covered if the person is referred from their FGP, but a copayment is necessary. Depending on the category of the population the person falls in referrals are free or nearly free. For people with diabetes these are free.8 Total expenditure on health per capita at PPP is estimated at US$ 127 with 6.4% of GDP being spent on health.
The Kyrgyz health system is trying to devolve care to FGPs and special training and programmes have been developed to strengthen this level.
With regards to medicines the Additional Drug Package of the MHIF was introduced during the period from 2000-2003 for outpatients. Under this package a proportion of the costs of medicines necessary for the management of conditions at the Primary Care Level are covered through the MHIF. These medicines are sold in private pharmacies that have a contract with the MHIF.
The Ministry of Health only has a supervisory role over the quality of the health provided to the Kyrgyz population except for some Tertiary facilities in Bishkek. Its responsibility is implementing the National Health Policies and coordinates and controls territorial health organisations (at Oblast level) through coordination commissions on health management.8
Health facilities are managed and owned by local governments. Through the coordination commissions on health management these organisations implement national health policy as determined by the Ministry of Health.
In 2006 there were 30,824 nurses and midwives (58.0 per 10,000 population) and 12,710 physicians (24 per 10,000 population) in Kyrgyzstan. A clear shortage of pharmacy personnel was noted with less than 1 pharmacist per 10,000 population.