Kyrgyzstan examines transforming national health system towards Universal Health Coverage

UNCT-KG-WHO-Transform

Improving financial protection and access to health care for citizens was explored in in-depth technical discussions, organized in Kyrgyzstan, to coincide with the 20th anniversary of the health insurance system, on 27-30 September 2016.

The Ministry of Health of Kyrgyzstan celebrated the anniversary of the mandatory health insurance system – the main vehicle of Universal Health Coverage (UHC) – with a thematic week on health financing which culminated in a high level policy dialogue.

The policy dialogue – Senior Policy Forum on Moving towards UHC under the Den Sooluk health care reform programme – brought key messages from the technical discussions to the attention of policy makers from the government, parliament and regional authorities. Senior managers of the World Bank, KfW – the German Development Bank, Swiss Development Cooperation, WHO and other development partners participated in the forum and showed support for dialogue on inter-sectoral issues related to health financing.

Dr Hans Kluge, director of Health Systems Division and Public Health at WHO/Europe, during the meeting with Dr Talantbek Batyraliev, minister of health of Kyrgyzstan, and at the Senior Policy Forum, called for the introduction of good governance principles throughout the health system to ensure effective use of public funds. He provided three key messages for country policy makers:

  1. Kyrgyzstan is moving along the path to universal health coverage and its health system architecture is in line with the general recommendations for UHC
  2. It is essential to improve the efficiency and targeting of public spending on medicines in order to improve financial protection of the population, including of the poor  
  3. Moving towards universal health coverage requires a clearly articulated vision of service delivery and a transformation path.

At the conclusion of the policy dialogue, WHO representative Dr Jarno Habicht noted: “We have now the opportunity to seek solutions on improving health financing and its governance arrangement, protect citizens from financial hardship, increase access to medicines, address burden of noncommunicable diseases and ensure continuity of care. Despite all the challenges, Kyrgyzstan has taken bold steps towards Universal Health Coverage. Now, in the era of the UN Sustainable Development Goals, we should continue with the health sector strategies to leave no one behind”.

The challenges of health financing in Kyrgyzstan  

The week included technical discussions on key health financing and service delivery issues affecting progress towards UHC. The recent round of the Kyrgyz Integrated Household Survey (KIHS) shows that household financial burden has increased significantly since 2009 including in the poorest two quintiles. Outpatient medicines drive the increase in out-of-pocket payments and discussions focused on: 

  • factors contributing to this;
  • policy options on how to improve efficiency in the public pharmaceutical expenditure; and
  • identification of actions in the short and longer term to reduce out-of-pocket payment.

Kyrgyzstan has been prioritizing health and allocating significant public resources to health sector over several consecutive years. The discussions on improving the efficiency of health expenditures focused on several common sources of inefficiency:  

  • revision of purchasing mechanisms including the proposed move to mixed payments in primary health care;
  • address the mismatch between demand and supply;
  • lever back the predominant focus on hospitals at the expense of Public Health Care with improved referral system; and
  • improving targeting of the state-guaranteed benefit package with a focus on poverty.

Nowadays the challenge for the sustainability of health-system financing is the integration of four additional specialized programs: oncology, hematology, cardio-surgery and psychiatry into the State Guaranteed Benefit Package. The focus was on its potential impact on the quality and accessibility of these services for the population and the assessment of risks for the sustainability of the entire Single Payer System. The objective was to find out and agree on ways to mitigate these risks.

Considering the current and future challenges in health financing and the crucial role of the Mandatory Health Insurance Fund (MHIF) a special session was dedicated on discussions on how to strengthen the governance of health financing via the development of an institutional strategy of the MHIF.

The Round Table on perspectives for the development of health financing systems and mandatory health insurance brought together the representatives of health insurance agencies from Estonia, Kazakhstan, Lithuania and Republic of Moldova to exchange experience and lessons learnt with Kyrgyz colleagues.    

Participants agreed that there are still many conceptual and operational questions that need to be addressed in order to strengthen the health financing system. Attention needs to be paid to raising sufficient funds, minimizing out-of-pocket payments through prepayment and pooling, and using available funds efficiently and equitably.

The support to Den Sooluk program-related-policy dialogue is among the activities envisaged under the biennial collaborative agreement between WHO/Europe and Kyrgyzstan, and is financially supported by the WHO/Swiss Agency for Development and Cooperation project “Strengthening monitoring and evaluation and policy dialogue for Den Sooluk”.