Central Asian Post-Soviet health systems in transition: has different aid engagement produced different outcomes?
نویسندگان
چکیده
BACKGROUND 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. DESIGN 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. FINDINGS 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. CONCLUSIONS 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.
منابع مشابه
Europe and central Asia's great post-communist social health insurance experiment: Aggregate impacts on health sector outcomes.
The post-Communist transition to social health insurance in many of the Central and Eastern European and Central Asian countries provides a unique opportunity to try to answer some of the unresolved issues in the debate over the relative merits of social health insurance and tax-financed health systems. This paper employs regression-based generalizations of the difference-in-differences method ...
متن کاملA Transformation Model for Banking Systems in Transition Economies
In a number of transition economies the banking systems are at different stages of the transformation process from mostly planned to market economy structures. But the past turbulent year led to further distinctions in development within these countries. While FSU (the former Soviet Union) countries, in particular Russia, were deeply shattered by the SouthEast Asian financial crisis and have su...
متن کاملHealth sector reforms in central and eastern Europe: how well are health services responding to changing patterns of health?
The political and economic transition of the 1990s in the countries of central and eastern Europe has been accompanied by wide ranging health care reform. The initial Soviet model has given way to a variety of forms of health insurance. Yet, as this paper argues, reform has too often been preoccupied with ideological imperatives, such as provider autonomy and the creation of funds separate from...
متن کاملIran and Central Asia: Chances or Challenges?
The fall of Soviet Union and independence of republics of central Asia as well as South Caucasus have brought both chances and challenges for Iran. At first it seemed that Muslim republics, which broke from Soviet Union, might have brought great chances for Iran to promote her ideological claims and economic interests. Dreams of Islamic revolution in new independent central Asian republics invo...
متن کاملAnalyzing ways of transition in the pattern of urban growth
Today each city due to natural limitations, facilities and planning policies has different growth pattern which according to its spread, has different consequences and results. Although there is a wide range of urban growth patterns, but the important thing is not diversity and number of models but is the absence of rules and methods of transition from one to another pattern (form). So this art...
متن کامل