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      Central Asian Post-Soviet health systems in transition: has different aid engagement produced different outcomes?

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          The collapse of the Soviet Union in 1991 resulted in a transition from centrally planned socialist systems to largely free-market systems for post-Soviet states. The health systems of Central Asian Post-Soviet (CAPS) countries (Kyrgyzstan, Mongolia, Tajikistan, Turkmenistan, and Uzbekistan) have undergone a profound revolution. External development partners have been crucial to this reorientation through financial and technical support, though both relationships and outcomes have varied. This research provides a comparative review of the development assistance provided in the health systems of CAPS countries and proposes future policy options to improve the effectiveness of development.


          Extensive documentary review was conducted using Pubmed, Medline/Ovid, Scopus, and Google scholar search engines, local websites, donor reports, and grey literature. The review was supplemented by key informant interviews and participant observation.


          The collapse of the Soviet dominance of the region brought many health system challenges. Donors have played an essential role in the reform of health systems. However, as new aid beneficiaries, neither CAPS countries’ governments nor the donors had the experience of development collaboration in this context.

          The scale of development assistance for health in CAPS countries has been limited compared to other countries with similar income, partly due to their limited history with the donor community, lack of experience in managing donors, and a limited history of transparency in international dealings. Despite commonalities at the start, two distinctive trajectories formed in CAPS countries, due to their differing politics and governance context.


          The influence of donors, both financially and technically, remains crucial to health sector reform, despite their relatively small contribution to overall health budgets. Kyrgyzstan, Mongolia, and Tajikistan have demonstrated more effective development cooperation and improved health outcomes; arguably, Uzbekistan and Turkmenistan have made slower progress in their health and socio-economic indices because of their resistance to open and accountable development relationships.

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          Most cited references 97

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              Health reform in central and eastern Europe and the former Soviet Union.

              In the two decades since the fall of the Berlin Wall, former communist countries in Europe have pursued wide-ranging changes to their health systems. We describe three key aspects of these changes-an almost universal switch to health insurance systems, a growing reliance on out-of-pocket payments (both formal and informal), and efforts to strengthen primary health care, often with a model of family medicine delivered by general practitioners. Many decisions about health policy, such as the introduction of health insurance systems or general practice, took into account political issues more than they did evidence. Evidence for whether health reforms have achieved their intended results is sparse. Of crucial importance is that lessons are learnt from experiences of countries to enable development of health systems that meet present and future health needs of populations.

                Author and article information

                Glob Health Action
                Glob Health Action
                Global Health Action
                Co-Action Publishing
                16 September 2014
                : 7
                [1 ]School of Population Health, The University of Queensland, Herston, QLD, Australia
                [2 ]Nuffield Centre for International Health & Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
                [3 ]Integrated Health Services, Islamabad, Pakistan
                Author notes
                [* ]Correspondence to: Anar Ulikpan, School of Population Health, University of Queensland, Herston Road Herston, QLD 4006, Australia, Email: anar.ulikpan@

                Responsible Editor: Lars Lindholm, Umeå University, Sweden.

                © 2014 Anar Ulikpan et al.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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