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, AustraliaAsmat Malik, Integrated Health Services, Islamabad, Pakistan Peter S Hill, School of Population Health, University of Queensland, Australia

CRICOS Provider No 00025B

HISTORICAL BACKGROUND

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 40-60% (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

United StatesJapan

European Union

Nordic

countries

UN

agencies

South Korea

World

Bank

Asian

Developmen

t bank

KyrgyzstanMongoliaTajikistan

Kazakhstan

TurkmenistanUzbekistan

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

TurkmenistanUzbekistan

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