Kyrgyzstan Table of Contents
Kyrgyzstan inherited the Soviet system of free universal health care, which in Kyrgyzstan's case generally provided sufficient numbers of doctors, nurses, and doctor's assistants, as well as medical clinics and hospitals. However, since 1991 citizens often have received inadequate care because medical personnel are not well trained; pharmaceuticals, medical supplies, and equipment are insufficient; and facilities are generally inadequate and unsanitary.
In 1991 Kyrgyzstan had 15,354 doctors, or 34.2 per 10,000 people. Paramedical workers totaled 42,448, or 94.6 per 10,000 people. Some 588 outpatient clinics were in operation, averaging 139 hours of patient visits per eight-hour shift. In addition, 246 general and twenty specialized hospitals were in operation; nearly one-third of all hospitals were located in Osh Province (which also had about one-third of the country's total population). By contrast, the capital city, Bishkek, had the fewest hospital facilities per capita of all regions, providing 1.55 general hospitals per 100,000 population. Like other Central Asian countries, Kyrgyzstan has continued the Soviet practice of state enterprises having their own clinics and sanatoriums. With the dissolution of the Soviet Union, Kyrgyzstan's residents lost the right to free treatment in the hospitals of other former republics, making unavailable many types of specialized treatment that the Soviet system had apportioned among adjacent republics.
Very few truly private health facilities have developed in the early post-Soviet period, and those that exist face very high licensing fees. Although it is illegal for state employees in the health field to diversify their activity into private practice, by 1993 many health workers were accepting unreported payments for providing additional treatment. In 1992 the maximum salary of a medical specialist such as a surgeon was only about 18 percent higher than the maximum salary of a technician or laboratory worker. Under such conditions, the rising cost of living in 1992 and 1993 forced many doctors to leave medicine for higher salaries in other professions.
Kyrgyzstan produces no vaccines of its own and almost no medicines or other pharmaceuticals. Drug availability is substantially higher at regional facilities than at smaller ones, but items such as antihistamines, insulin, antiseptics, vaccines, and some narcotics are either extremely scarce or extremely expensive. The other former Soviet republics now demand payment in United States dollars, which Kyrgyzstan does not have, for medical supplies. Because of the scarcity of vaccines, there is a greatly increased likelihood of epidemics of diseases such as diphtheria and measles. An outbreak of measles in Bishkek in early 1993 was said to be just below epidemic level. It has become common practice in hospitals and clinics to require patients to provide their own medicines for operations and other medical procedures. Because virtually the only available medicines are those for sale in the public bazaars, quality is questionable, and accidental poisonings caused by misuse and spoilage have been reported.
Kyrgyzstan's post-Soviet financial crisis has reduced government support of the Soviet-era health system, forcing government planners to formulate an ambitious health care delivery reform program. The center of the program is a transformation of the national health system into a system of public health insurance, in which compulsory employer fees and a health insurance tax on employees would support care for employees, and state contributions would support care for unemployed citizens. All employed citizens would be required to carry health insurance. All care providers would switch from the salary basis of the old system to a fee-for-service payment system. Because the banking, record-keeping, and tax systems of the country are not ready to support such a nationwide program, however, installation has lagged far behind the original timetable, which called for a pilot program in Bishkek in 1993.
Data as of March 1996
Kyrgyzstan Table of Contents