Different aid engagement,
different health system
outcomes: Two decades of transition
for the Central Asian Post-Soviet states
Anar Ulikpan, PhD student, School of Population Health,
University of Queensland, Australia
Tolib Mirzoev, Nuffield Centre for International Health & Development,
Leeds Institute of Health Sciences, University of Leeds
Eliana Jimenez, School of Population Health, University of Queensland,
Australia
Asmat Malik, Integrated Health Services, Islamabad, Pakistan
Peter S Hill, School of Population Health, University of Queensland,
Australia
HISTORICAL BACKGROUND
CRICOS Provider No 00025B
Single country
dominance
Collapse of the Soviet Union
Methods
Documentary Review:
•
•
•
•
Extensive document review (English, Russian, and Mongolian)
Pubmed, Scopus, ProQuest and Google Scholar
Institutional websites (ODI, WHO, WB, UN agencies)
Grey literature
Key informant interview:
• In-depth interviews were conducted with 11 key informants with
experiences in Kyrgyzstan, Mongolia and Uzbekistan
Participatory observations:
•
Two authors 10-12 years experience in participating in the policy development
process in Mongolia and Tajikistan
• Least studied (0.16-1.71 publn/100.000 popn)
• Language barrier
• Overlooked by international community
Limitations
• Few published evidences
• Limited access to study countries
information
• Key informants: secondary source
Health sector in crisis during 1990s
• Sharp fall of GDP by 4060% (except Uzbekistan
as 15%)
• Health spending fall to
1.1%-3.4% as percentage
of GDP
• Key health indicators
declined
• Introduction of social
health insurance and
user fees
• Profound
“revolution” at every
level of the system
• Arrival of new
donors (financial,
technical, policy
support)
From single country dominance to
Multi-actor relationship
Kazakhstan
Kyrgyzstan
Mongolia
Tajikistan
Turkmenistan
Uzbekistan
South
Korea
Net ODA received per capita in selected
Post-Soviet Central Asian countries
Uniqueness of aid relationship
• Not too many donors
• New as an aid recipient
• No longstanding culture of aid coordination
Differing paths and destiny
Kyrgyzstan
Mongolia
Tajikistan
Turkmenistan
Uzbekistan
Geopolitics play
• Rich natural resources
• Geo-strategically favourable position between the three
giants
These countries are neglected in
development discussions despite
their growing inequality in health
and poverty
Where to from here?
• New aid relationships
offer new opportunities
for both donors and
recipients
• Fewer partners do not
necessarily mean less
fragmentation
Where to from here?
• Aid modalities must
reinforce ownership
and sustainability
• Always consider
factors beyond the
health