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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
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CRICOS Provider No 00025B
HISTORICAL BACKGROUND
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Single country dominance
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Collapse of the Soviet Union
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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
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• Least studied (0.16-1.71 publn/100.000 popn)• Language barrier• Overlooked by international community
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Limitations
• Few published evidences• Limited access to study countries
information• Key informants: secondary source
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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)
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From single country dominance to Multi-actor relationship
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United StatesJapan
European Union
Nordic
countries
UN
agencies
South Korea
World
Bank
Asian
Developmen
t bank
KyrgyzstanMongoliaTajikistan
Kazakhstan
TurkmenistanUzbekistan
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Net ODA received per capita in selected Post-Soviet Central Asian countries
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Uniqueness of aid relationship
• Not too many donors• New as an aid recipient• No longstanding culture of aid coordination
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Differing paths and destiny
Kyrgyzstan Mongolia Tajikistan
TurkmenistanUzbekistan
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Geopolitics play• Rich natural resources • Geo-strategically favourable position between the three
giants
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These countries are neglected in development discussions despite their growing inequality in health
and poverty
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Where to from here?
• New aid relationships offer new opportunities for both donors and recipients
• Fewer partners do not necessarily mean less fragmentation
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Where to from here?
• Aid modalities must reinforce ownership and sustainability
• Always consider factors beyond the health
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