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SUMMARY
1. IN 1999, THE NATIONAL HEALTH CARE SECTOR RECEIVED
FINANCING FROM THE STATE BUDGET IN THE AMOUNT OF
1,121.7 MILLION KYRGYZ SOM OR APPROXIMATELY USD 28
MILLION. BELOW ARE THE MAJOR CHARACTERISTICS OF THE
HEALTH CARE SYSTEM, INVESTMENT PROJECTS FOR HEALTH
REFORM, CUSTOMS RULES AND PROCEDURES FOR IMPORTING
MEDICATION AND MEDICAL EQUIPMENT, AS WELL AS CONTACT
INFORMATION. END SUMMARY.
STATISTICS
2. AS OF JANUARY 1, 2000, THE KYRGYZ POPULATION WAS
ESTIMATED AT 4.9 MILLION PEOPLE. CARDIO-VASCULAR
DISEASE IS THE MAJOR CAUSE OF DEATH, AND ACCOUNTS FOR
MORE THAN 40 PERCENT OF THE TOTAL MORTALITY RATE.
AMONG THE MAJOR CAUSES OF INFANT MORTALITY ARE
RESPIRATORY DISEASE AND POOR POST-NATAL HEALTH CARE.
3. IN 1999, THE INCIDENCE OF INFECTIOUS DISEASES
DECREASED. NEVERTHELESS, THE EPIDEMIOLOGICAL SITUATION
IN KYRGYZSTAN WAS CHARACTERIZED BY AN INCREASING
INCIDENCE OF TUBERCULOSES, INTESTINAL INFECTIONS,
DYSENTERY, AND BRUCELLOSIS.
REFORMING THE NATIONAL HEALTH CARE SYSTEM
4. IN 1996, THE GOVERNMENT ADOPTED THE "MANAS" PROGRAM
TO REFORM THE NATIONAL HEALTH CARE SYSTEM. IN ORDER TO
CHANGE THE OLD SOVIET SYSTEM OF HEALTH CARE, THE
PROGRAM FOCUSES ON PROVIDING MEDICAL ASSISTANCE AT THE
PRIMARY CARE LEVEL THROUGH FAMILY DOCTORS. CURRENTLY,
THERE ARE 800 GROUPS OF FAMILY DOCTORS. THE MANDATORY
MEDICAL INSURANCE FUND WAS ESTABLISHED IN KYRGYZSTAN IN
1997. SINCE THEN IT HAS BEEN EXPANDING THE COVERAGE IT
PROVIDES. SIXTY-FIVE HOSPITALS AND 350 GROUPS OF
FAMILY DOCTORS ARE NOW WORKING IN THE FRAMEWORK OF THE
MANDATORY MEDICAL INSURANCE FUND FOR 70 PERCENT OF THE
POPULATION IN KYRGYZSTAN.
PRIMARY HEALTH CARE AND DISEASE PREVENTION
5. PRIMARY HEALTH CARE REFORM WILL BE CARRIED OUT
UNDER THE SUB-PROGRAM ON PRIMARY HEALTH CARE AND
DISEASE PREVENTION SUPPORTED BY THE INTERNATIONAL
DEVELOPMENT ASSOCIATION (IDA) UNDER THE WORLD BANK,
ASIAN DEVELOPMENT BANK (ADB), AND THE GERMAN AND SWISS
GOVERNMENTS. KYRGYZSTAN HAS AN EXTENSIVE NETWORK OF
HEALTH CARE FACILITIES INHERITED FROM THE SOVIET ERA.
THESE FACILITIES INCLUDE 860 PARA-MEDIC POSTS, 220
RURAL MEDICAL UNITS AND 66 OUTPATIENT FACILITIES
AFFILIATED WITH DISTRICT AND REGIONAL HOSPITALS. THEY
OFFER PREVENTIVE CARE (INCLUDING IMMUNIZATIONS,
PRENATAL CARE, DENTAL CARE AND LIMITED FAMILY PLANNING
SERVICES), AND SOME DIAGNOSTIC SERVICES AND TREATMENT.
6. EACH VILLAGE HAS A PARA-MEDIC POST, STAFFED BY A
PHYSICIAN'S ASSISTANT, A NURSE AND A MIDWIFE. RURAL
MEDICAL UNITS WHERE A DOCTOR, A NURSE, A PEDIATRICIAN,
AND A DENTIST MAY BE FOUND, ARE LOCATED IN EACH DISTRICT.
7. SEVERE BUDGET CONSTRAINTS HAVE RESULTED IN THE
DETERIORATION OF PRIMARY HEALTH CARE, WHILE WORSENING
LIVING CONDITIONS HAVE LED TO AN OVERALL DECLINE IN THE
HEALTH OF THE POPULATION. SERVICES AT PRIMARY HEALTH
CARE FACILITIES ARE FLAWED DUE TO OUTDATED EQUIPMENT OR
SHORTAGES OF MEDICATION AND OTHER MEDICAL SUPPLIES,
OBSOLETE DIAGNOSTIC PROCEDURES, AND POORLY MAINTAINED
FACILITIES. A GENERAL DETERIORATION OF MEDICAL CARE
QUALITY AND AVAILABILITY OF AFFORDABLE MEDICATIONS HAS
BEEN REFLECTED IN WORSENING HEALTH INDICATORS OVER THE
PAST FEW YEARS. OF PARTICULAR CONCERN IS THE RAPID
INCREASE IN THE INCIDENCE OF SEXUALLY TRANSMITTED DISEASES.
8. THE GOVERNMENT INTENDS TO FOCUS ON PRIMARY HEALTH
SERVICES AS THE MOST COST-EFFECTIVE METHOD OF
DELIVERING HEALTH CARE. THIS SUB-PROGRAM INVOLVES:
REMODELING PRIMARY HEALTH CARE FACILITIES AND PROVISION
OF ESSENTIAL EQUIPMENT FOR THESE FACILITIES;
INTRODUCTION OF PREVENTIVE AND CONTROL MEASURES FOR
PREVENTABLE DISEASES SUCH AS TUBERCULOSIS AND
INTESTINAL DISEASES; MEASURES AGAINST THE SPREAD OF
SEXUALLY TRANSMITTED DISEASES, INCLUDING AIDS; AND
REFORM OF THE MANAGMENT OF THE PRIMARY HEALTH CARE SYSTEM.
HOSPITAL SERVICES REFORM AND REHABILITATION
9. HOSPITAL SERVICES REFORM WILL BE IMPLEMENTED UNDER
A REHABILITATION PROGRAM SUPPORTED BY THE IDA, ISLAMIC
DEVELOPMENT BANK (IDB), AND THE GOVERNMENTS OF
SWITZERLAND AND JAPAN. IN-PATIENT CARE IS PROVIDED
THROUGH A SYSTEM OF REFFERALS THROUGHOUT SEVERAL LEVELS
OF THE HEALTH CARE SYSTEM. IN-PATIENT TREATMENT IS
PROVIDED IN 464 TOWNS, DISTRIC, REGIONAL, AND NATIONAL
HOSPITALS, OFFERING BOTH GENERAL AND SPECIALIZED
MEDICAL CARE (INCLUDING PEDIATRIC AND
OBSTETRIC/GYNECOLOGICAL). THE GOAL IS TO REDUCE THE
NUMBER OF BEDS AND MERGE SPECIALIZED HOSPITALS AT THE
REGIONAL LEVEL INTO GENERAL HOSPITALS.
PHARMACEUTICAL DISTRIBUTION AND MANAGEMENT
10. KYRGYZSTAN’S PHARMACEUTICAL INDUSTRY CURRENTLY
CONSISTS OF A PHARMACEUTICAL PLANT WHICH PRODUCES
HERBAL MEDICATIONS AND OTHER PHARMACEUTICALS. IT MEETS
ABOUT THREE PERCENT OF THE COUNTRY’S PHARMACEUTICAL
NEEDS. THERE IS ALSO AN ANTIBIOTICS PLANT WHICH
PRODUCES MEDICINES FOR VETERINARY PURPOSES, BUT ITS
PRODUCTION IS CURRENTLY IN SUSPENSION. THE DRUG SUPPLY
NETWORK CONSISTS OF THE CENTRAL PHARMACEUTICAL
DISTRIBUTION COMPANY “PHARMACIA” LOCATED IN BISHKEK,
AND THREE REGIONAL DEPARTMENTS IN JALAL-ABAD, BALYKCHI,
AND OSH. THE REGIONAL DEPARTMENTS PROVIDE
PHARMACEUTICALS TO RETAIL PHARMACIES AND DIRECTLY TO
HOSPITALS. THERE ARE 430 PHARMACIES, OF WHICH A SMALL
BUT GROWING NUMBER ARE PRIVATELY OWNED.
11. THERE IS A SHORTAGE OF AFFORDABLE DRUGS AND
VACCINES. ESSENTIAL DRUGS ARE BEING PROVIDED THROUGH
HUMANITARIAN ASSISTANCE PROGRAMS. THE HEALTH CARE
MINISTRY DEVELOPED AN ESSENTIAL DRUG LIST, WHICH ALLOWS
IN-PATIENTS TO RECEIVE ESSENTIAL DRUGS FREE OF CHARGE.
FAMILY GROUP PRACTICES ARE ALSO DISTRIBUTING
CONTRACEPTIVES FREE OF CHARGE. NEVERTHELESS, WHILE THE
RETAIL NETWORKS ARE SAID TO HAVE A SUFFICIENT STOCK OF
DRUGS, MANY PEOPLE CANNOT AFFORD THE DRUGS THEY NEED,
AND MOST OF THE DRUGS ARE IMPORTED BY SMALL TRADERS,
WITHOUT OBSERVING ADEQUATE PROCEDURES TO ENSURE QUALITY
AND SAFETY.
12. THE AIDAN-PHARMA PHARMACEUTICAL PLANT WAS RECENTLY
BUILT WITH FINANCIAL SUPPORT FROM PAKISTAN. CURRENTLY,
THE PLANT IS DELIVERING MEDICATIONS FOR THE PARA-
MEDICAL SECTOR ONLY, WHILE OTHER MEDICATIONS WORTH
MILLIONS OF DOLLARS ARE IMPORTED TO KYRGYZSTAN. THE
GOVERNMENT PLANS TO ALLOCATE MORE BUDGET FUNDS FOR
PURCHASING MEDICATIONS PRODUCED BY THE PLANT.
HEALTH SERVICES MANAGEMENT AND DELIVERY
13. THIS SUB-PROGRAM, SUPPORTED BY IDA, ADDRESSES SUCH
ISSUES AS THE OPTIMUM NUMBER AND LOCATION OF
FACILITIES, THE NUMBER OF DOCTORS AND OTHER MEDICAL
PERSONNEL, APPROPRIATE TRAINING AND CURRICULA FOR
MEDICAL STAFF, AND MANAGEMENT AND FINANCIAL.
ADMINISTRATION OF THE SYSTEM, INCLUDING COST-RECOVERY
MECHANISMS.
14. EQUIPMENT CURRENTLY USED BY KYRGYZ CLINICS AND
HOSPITALS IS OBSOLETE, AND 75 PERCENT OF IT NEEDS TO BE
REPLACED OR UPGRADED. ACCORDING TO THE DEPARTMENT OF
MEDICATION AND MEDICAL EQUIPMENT SUPPLY UNDER THE
MINISTRY OF HEALTH, ONLY 20 PERCENT OF THE NEEDS OF
KYRGYZ MEDICAL INSTITUTIONS FOR MEDICAL EQUIPMENT ARE
MET. THERE IS A SIGNIFICANT SHORTAGE OF X-RAY,
ANESTHESIA, AND SURGICAL EQUIPMENT.
USAID ASSISTANCE TO HEALTH CARE REFORM
15. USAID ASSISTS THE MINISTRY OF HEALTH WITH
IMPLEMENTING COMPREHENSIVE REFORMS OF THE HEALTH CARE
SECTOR. REFORMS CONSIST OF RESTRUCTURING THE HEALTH
CARE SYSTEM WITH A FOCUS ON PRIMARY HEALTH CARE AND
CHANGING FINANCING OF HEALTH CARE BY INSTITUTING NEW
PAYMENT METHODS THROUGH THE MANDATORY MEDICAL INSURANCE
FUND. USAID IS WORKING TO CREATE GREATER COMPETITION
IN THE HEALTH SECTOR, ACHIEVE HIGHER EFFICIENCY IN THE
ALLOCATION OF RESOURCES, AND GREATER INVOLVEMENT OF THE
POPULATION IN DECISION-MAKING RELATED TO HEALTH CARE.
IN ADDITION, USAID HAS PLANS TO MODERNIZE, EXPAND AND
IMPROVE THE QUALITY AND SUSTAINABILITY OF REPRODUCTIVE
HEALTH SERVICES WITHIN THE FAMILY GROUP PRACTICES.
16. USAID SUPPORTS PARTNERSHIP BETWEEN THE UNIVERSITY
OF NEVADA SCHOOL OF MEDICINE AND THE KYRGYZ STATE
MEDICAL ACADEMY IN BISHKEK. THE PROGRAM USES THE
PRACTICAL KNOWLEDGE AND EXPERTISE OF U.S. HEALTH CARE
PROVIDERS TO CLOSE GAPS IN LOCAL HEALTH CARE PRACTICES
THROUGH EXCHANGES, AND TO IMPROVE EFFICIENCY OF HEALTH
CARE PROVIDERS THROUGH TRAINING IN MANAGEMENT AND
ADMINISTRATION. USAID ALSO PROVIDES TECHNICAL
ASSISTANCE AND TRAINING IN ORDER TO DEVELOP MODERN
FOLLOW-UP METHODS IN KYRGYZSTAN, PARTICULARLY FOR HIGH-
INCIDENCE INFECTIOUS DISEASES, SUCH AS HEPATITIS,
POLIO, DIPHTHERIA, AND TUBERCULOSIS.
CUSTOMS RULES AND NECESSARY PROCEDURES
17. IN ORDER TO IMPORT MEDICATIONS AND MEDICAL
EQUIPMENT TO KYRGYZSTAN, VENDORS MUST COMPLY WITH
KYRGYZ CUSTOMS REGULATIONS (SEE 98 BISHKEK 3653) AND
THE LIST OF PRODUCTS, OPERATIONS, AND SERVICES SUBJECT
TO OBLIGATORY SAFETY CERTIFICATION (SEE 98 BISHKEK
3500). BELOW IS THE CONTACT INFORMATION FOR THE STATE
CUSTOMS AGENCY AND KYRGYZSTANDARD. ACCORDING TO THE
LAW ON CUSTOMS DUTIES FOR 2000, MEDICATIONS AND MEDICAL
EQUIPMENT ARE NOT SUBJECT TO CUSTOM DUTIES IN 2000.
THERE IS STILL A REQUIREMENT TO PAY FEES FOR PROCESSING
DOCUMENTS (0.15 PERCENT OF COMMODITY CUSTOMS COST) AND
VAT (20 PERCENT OF COMMODITY CUSTOMS COST). THE
FOLLOWING MEDICAL SUPPLIES ARE VAT-EXEMPT:
-- MEDICATIONS AND MEDICAL EQUIPMENT MADE IN RUSSIA,
AZERBAIJAN, AND BELARUS;
-- MEDICATIONS AND MEDICAL EQUIPMENT IMPORTED AS
HUMANITARIAN AID;
-- MEDICATIONS INCLUDED IN THE LIST OF ESSENTIAL DRUGS.
18. IN ORDER TO IMPORT MEDICATIONS AND MEDICAL
EQUIPMENT TO KYRGYZSTAN, THE IMPORTER MUST REGISTER THE
SUPPLIES AT THE DEPARTMENT OF MEDICATION AND MEDICAL
EQUIPMENT SUPPLIES UNDER THE MINISTRY OF HEALTH. SINCE
THIS PROCESS TAKES FROM ONE TO TWO MONTHS, IT IS
RECOMMENDED TO HAVE THIS DONE BEFORE SENDING THE
SHIPMENT TO BISHKEK. THE FEE FOR REGISTRATION OF
MEDICATION RANGES FROM USD 1,250 TO 2,500, AND OF
MEDICAL EQUIPMENT - FROM USD 50 TO 1,500. THERE ARE NO
LIMITATIONS ON IMPORTS OF USED MEDICAL EQUIPMENT. ALL
CUSTOMS RULES AS WELL AS REGISTRATION PROCEDURES ARE
SIMILAR FOR BOTH NEW AND USED ITEMS.
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