Landlocked, largely mountainous and with a population of just under 6 million in 2015, the Kyrgyz Republic is a vibrant democracy that adopted a parliamentary system in 2011. Since gaining independence, the country has undergone a complex phase of transition to a market economy, with macroeconomic adjustments and structural reforms. Kyrgyzstan scored 0.586 on the Human Development Index (HDI) in 2014 and 0.655 in 2010. Yet, despite the positive trend, this still ranges below the average for the Europe and Central Asia region (0.709) in which it is clustered, classifying Kyrgyzstan among the Medium Human Development countries.3
Gross national income (GNI) per capita has been calculated at $ 1553 in 2015, positioning the country among the lower middle income category of the World Bank (WB) lending group ranking.

Table 1. Economic indicators 2015, 2014

The health sector
Along with other sectors, after independence the health sector needed fundamental restructuring. There was an urgent need to achieve health equity; ensure state guaranteed benefits in health-care delivery; and develop primary health care and family medicine. In fact, both the prevalence of the hospital sector and excessive specialization of health services inherited from the Soviet period were strongly overstressing the system. For these reasons and other reasons, the Kyrgyz health system has undergone different stages of reform: the Manas reform from 1996 to 2005, the Manas Taalimi reform from 2006 to 2011 and the Den Sooluk programme covering 2012 to 2016. Both the Manas Taalimi and the Den Sooluk reforms foresaw a sector-wide approach (SWAp) mechanism (see Box 1), with development partners topping up state pledges over reform goals.
The main achievements of the reforms include the introduction of mandatory health insurance; introduction of a system for progressive results-based financing methods and the single-payer system; creation of family medicine centres and of family physician groups as first contact points with the health system; restructuring of many hospitals; introduction of a state guaranteed benefits package (SGBP) and the copayment; and a first phase of additional drug provision for all insured persons at primary health care level.
As a percentage of total government expenditure, health expenditure increased from 10.3% in 2005 to 13.2% in 2015 – achieving the 13% target value set by the Den Sooluk reform programme. Costs per capita increased from a baseline 353.3 Kyrgyz soms in 2004 to 2450 Kyrgyz soms in 2014. As a percentage of gross domestic product (GDP), public health expenditures increased from 1.9% in 2004 to 3.2% in 2014.

Table 2. Health financing in the Kyrgyz Republic, 2011–2015

  
Table 3. Public allocations to the health system, 2011–2015

   
Demographic situation
The resident population of the Kyrgyz Republic increased by 124.4 thousand (2.1%) in 2015 and by January 2016 had reached 6 020 000 people.
The maternal mortality rate shows a significant reduction: decreasing by 24% (50.7 per 100 000 live births) between 2015 and 2014.

Table 4. Health at a glance, 2015

In December 2015, there were 29 000 registered cases of infectious and parasitic diseases. Within this category, acute respiratory viral infections (65%) still dominate. At the same time, the epidemiological situation in 2015 was characterized by significant increases in rubella morbidity (3.4 times), whooping cough (2.4 times) and bacterial meningitis (1.4 times). High levels of measles cases remain – 299 cases per 100 000 population.
Between the periods January–December 2014 and January–December 2015, there were significant reductions in the incidence rates (per 100 000 population) of parotitis (1.6 times), syphilis (1.6 times), gonorrhoea (1.6 times), echinococcosis (6.7%) and brucellosis (20.6%). Intestinal infections showed a 3.8% reduction in the overall incidence rate – from 30 200 to 29 700 registered cases. Intensive indicators per 100 000 population were equal to 498.6 and 518.1, respectively. However, the incidence rate of bacillary dysentery grew by 15.4% – from 1809 cases (31.0) to 2131 cases (35.8). The incidence rate of bacterial meningitis increased by 41.4% – from 273 cases (4.7) to 394 cases (6.6).