Country context 2018 - 2019

The Kyrgyz Republic is committed to implementing the UN 2030 Agenda for Sustainable Development. The Sustainable Development Goals (SDGs) are included in government policy and reflected in the National Development Strategy (2018-2040), the "Unity. Trust. Creation" Programme (2018-2022), which were based on a humancentered approach. The concept of the 2040 Strategy is to ensure a high quality and decent standard of human life, with a special emphasis and priority attention to the most vulnerable populations.
To achieve the SDGs by 2030, the Kyrgyz Republic has established a key priority: policy focus on human development. To this end, national strategies are being implemented to guarantee legal and judicial protection of human and civil rights and freedoms, reduce inequality, eradicate poverty, mitigate climate change, reduce disaster risk, invest in human development, build skills and knowledge for all segments of society, create jobs and support healthy lifestyles, promote gender equality.
As part of the National Development Strategy of the Kyrgyz Republic for 20182040, the long-term priority of social development is to change systemic approaches in health.
In the long term, the health system shall become accessible, high quality, safe system using innovative approaches, focused on human needs, and the population of the Kyrgyz Republic enjoys the maximum improvement in health indicators.
In June 2018, the Joint Annual Review of the Den Sooluk National Health System Reform Programme for 2012-2018 (the "Den Sooluk Program") was conducted. Den Sooluk Programme focused on achieving specific health indicator targets by providing expanded coverage of key services, improving the quality of care provided, and addressing barriers in the health system that had not been addressed by the previous two programs.
Within the framework of Den Sooluk Programme implementation, there was a stable donward trend of the total cardiovascular mortality rate from 331.3 per 100 thousand population in 2012 to 265.7 per 100 thousand population in 2018. Thus, the activities implemented in the CVD priority area show significant progress on the presented indicators, which demonstrates the correct selection of the strategy for strengthening the outreach activities and primary health care system.
Significant progress was observed in achieving the expected results in the priority area of Maternal and Child Health. An approach has been introduced to improve the quality of obstetric care based on lessons learned. The quality of maternal and newborn care in obstetric health organizations and at the level of primary health care has been assessed. The infant and child mortality rate in the country has a steady downward trend. In 2015, Kyrgyz Republic was among the countries that achieved MDG-4.
Early neonatal mortality rate has been reduced by 10% by 2018. In 2011 the early neonatal mortality rate was 15.0 per 1,000 live births - a decrease of 27.3% in 2018.
The goal of limiting the under-5 mortality rate at max 21.0 per 1,000 live births in 2017-2018 has been achieved.
The maternal mortality rate in 2018 was 30.4 per 100,000 live births, a decrease by 36% compared to 2011 (baseline).
Within the framework of international cooperation, great results were achieved in modernizing and improving the infrastructure of regional health organizations. The construction of the Bishkek Kyrgyz-Turkish Fraternity Hospital, the construction of a new building at Osh City Hospital, and the renovation and equipping of the National Center for Oncology with modern equipment have been completed. Mobile autolaboratories and mobile clinics were received.
Hemodialysis centers were established under a public-private partnership with grant support from the German Development Bank (KfW).
Completion of the Den Sooluk Programme, taking into account the successes and progress of this Program, has driven the need to develop a new Government Programme for health protection and health system development until 2030.
Programme of the Government of the Kyrgyz Republic on health protection and health system development “Healthy person – prosperous country” for 2019-2030 was developed taking into account the objectives outlined in the SDGs and the National Development Strategy of the Kyrgyz Republic (2018-2040). The new Programme was approved by the Decree of the Government of the Kyrgyz Republic № 600 on December 20, 2018.
The main purpose of the Programme is to strengthen people-centered systems that ensure public health and provide quality services through the life course, aiming to maximize health outcomes, reduce health inequalities, and provide financial protection.
Priority areas:
• Public Health and Prevention
• Development of primary health care
• Improvement and rationalization of the hospital system
• Development of Emergency Medical Care
• Laboratory services
• Medicines and medical products
• Health Stewardship
• Human Resources in Health
• E-Health development
• Financing System development
During the Joint Annual Review and Health Summit in April 2019, a Joint Statement for Partnership was signed between the Government of the Kyrgyz Republic and Development Partners regarding the Programme of the Government of the Kyrgyz Republic on health protection and health system development “Healthy person – prosperous country” for 2019-2030
In order to strengthen the mechanisms of intersectoral cooperation and integration of health issues into the local governments' activities, Government Decree No. 458 of September 6, 2019 approved the Model Regulation on the Health Coordination Commission in regions, districts and cities of the Kyrgyz Republic. Amendments were introduced into the Decree No. 352 of the Government of the Kyrgyz Republic "On the Public Health Coordination Council under the Government of the Kyrgyz Republic" of June 26, 2014.
In order to strengthen the institutional mechanisms of the monitoring and evaluation system under 2030 Programme, the Order of the Ministry of Health of the Kyrgyz Republic № 198 of 05.04.2019 approved the Methodological Guidelines for Monitoring and Evaluation.
In the first year of the 2030 Programme, the Ministry of Health of the Kyrgyz Republic focused efforts at strengthening primary health care.
Government is taking a number of steps to address the issue of staffing. Starting from the end of 2018, it was decided to significantly increase the salaries of family physicians in PHC organizations, depending on the performance results. In accordance with the Decree of the Government of the Kyrgyz Republic № 640 of 20.12.2018, a new mechanism of performance-based incentives at PHC level was introduced based on indicators. Due to this incentives, the salaries of family physicians almost doubled. The salaries of family physicians, depending on the achievement of indicators for performance, averaged from 18.1 thousand soms to 27.8 thousand soms.
As a result of PHC optimization, legally independent FMCs were merged into 4 united district FMCs of Bishkek, thus ensuring the availability and improving the quality of primary health care services provided to the population.
In 2019, a Primary Health Care Quality Improvement Program has been developed to support the implementation of 2030 Programme. This Program is based on the use of a tool called "Program-for-Results" (PfoR) to encourage commitment of the client and ensure the achievement of specific results. In order to effectively implement the Program, the Law of the Kyrgyz Republic № 132 of December 3, 2019 ratified the Financing Agreement for the Primary Health Care Quality Improvement Program between the Kyrgyz Republic and the International Development Association (World Bank) in the amount of 20 million US dollars, signed on September 9, 2019 in Bishkek.

Health sector

The health of the population has traditionally been a priority of government policy in the Kyrgyz Republic. The health of the population is one of the indicators of socioeconomic development of the country.
According to the National Statistical Committee of the Kyrgyz Republic, by the end of 2019, the gross domestic product (GDP) amounted to KGS 590.0 billion and the real growth rate was 4.5% (in 2018 - 103.8%); If enterprises developing the Kumtor deposit are excluded than the growth rate was 103.8% (in 2018 - 103.7%). GDP deflator was at the level of 99.2 %.

Table 1: Public expenditures in 2018-2019

Indicator 2018 2019
Total amount of public expenditures (million KGS)  157 796,0  167 843,9
Total health expenditures (million KGS)  14 594,9  14 611,7
Health expenditures as a % of total public expenditures  9 9

The Table above shows that in both 2018 and 2019, health expenditures averaged 9% of total public expenditures, which is lower than in 2017 (13%).

Table 2: Age-specific fertility rates in 2018-2019.

Years  Number of average births per year per 1000 women aged:
< 20 20-24  25-29 30-34 35-39 40-44 45-49 50-54 Total 15-49
2018 35,9 207,9 185,9 130,4 77,5 21,3 1,3 0,0 106,8
2019 37,7 208,8 189,0 129,8 80,1 22,0 1,3 0,0 107,2

The general population morbidity rate in 2019 decreased slightly compared to 2018, amounting to 19121.5 per 100,000 population among adults and adolescents (in 2018 -20110.1; - 4.9%) and among children up to 31666.1 per 100,000 children population (in 2018 -33287.9; - 4.9%).
Respiratory diseases (22.3%), genitourinary diseases (10.6%), digestive diseases (13.3%), injuries and poisonings (7.6%), eye diseases (7.2%) and circulatory diseases (8.5%) were the leading causes of morbidity in adults and adolescents.
In 2019, the maternal mortality rate decreased from 24.8 (in 2018 -30.1) per 100,000 live births. The main causes of maternal mortality in 2019 were extragenital diseases (30.2%), bleeding (23.3%), septic complications (18.6%) and hypertensive disorders (16.3%). In 2019, the percentage of deaths during pregnancy was 11.6%, during childbirth and postpartum - 83.7%, and from abortions and ectopic pregnancies - 2.3%.

Figure 1. Maternal mortality in Kyrgyz Republic by oblasts, 2018-2019 (per 100,000 live births)

The infant mortality rate, despite a slight decrease, remains high. In 2019, 2,621 children under one year of age died from various diseases, poisonings and injuries (15.1 children per 1,000 live births). The main causes of infant mortality are diseases and conditions arising in the perinatal (postnatal) period (1,806 children or 68.9% of the total number of deaths of children under 1 year of age), and congenital malformations (410 infants or 15.6%).

Figure 2. Infant mortality rate, Kyrgyz Republic (per 1,000 live births)

The average annual resident population of the Kyrgyz Republic as of December 31, 2019 was 6.524 million people.
In 2019, the growth rate of the population, due to the increase in the birth rate, amounted to 2.1%, which is quite high by world standards. The highest rate was noted in Bishkek and Osh cities - 2.6-4.3%, lowest - in Naryn and Issyk-Kul regions - 0.91.3% (Table 3).
Table 3: Resident population of the Kyrgyz Republic as at the beginning of 2018-2019

  Resident population, thousands Due to
as of December 31, 2018 as of December 31, 2019 natural change, % net migration, %
Kyrgyz Republic 6389,5 6523,5 2,2 -0,1
Batken oblast 525,1 537,3 2,5 -0,2
Jalal-Abad oblast     1214,4 1238,8 2,2 -0,2
Issyk-Kul oblast 489,8 496,1 1,5 -0,2
Naryn oblast 287,0 289,6 1,4 -0,5
Osh oblast 1341,9 1368,1 2,3 -0,3
Talas oblast 263,5 267,4 1,8 -0,3
Chui oblast     941,1 959,8 2,0 0,0
Bishkek city 1027,2 1053,9 2,4 0,2
Osh city 299,5 312,5 3,9 0,4

Among the total population of the republic, the majority are women. At the end of 2019, 3.238 million people (49.6%) were men and 3.286 million (50.4%) - women. But in regions with a high birth rate (Batken, Osh, and Jalal-Abad oblasts), the male population exceeds the female population.
Most part of the total population lives in rural areas (4,292,000 people), which is two-thirds of the total population, and the urban population is 2,231,000 people. Population density averaged 33 people per square kilometer.
Population change is influenced by natural population growth, which is formed under the influence of changes in birth and death rates, as well as the level of migration. Since the migration balance is still represented by an excess of emigrants over immigrants, population growth is only achieved through natural growth. In 2019, the population growth rate was 2.1 percent, which is quite high according to world standards. The highest rate was observed in Bishkek and Osh cities - 2.6-4.3 percent, and the lowest in Naryn and Issyk-Kul oblasts - 0.9-1.3 percent.
An important characteristic of the republic's population is the ratio of age groups: below working age, working age, and above working age . At the end of 2019, 34.6 percent of the total population were children and adolescents, 57.4 percent were persons of working age, and 8.0 percent were above working age.
Gender imbalance is noted in about 40 years of age, and at ages over 80, the number of women is almost twice as high as the number of men. This prevalence is mainly due to differences in the age-specific mortality rates of the male and female populations. The average age of the population is gradually increasing and at the end of 2019 it was 27.8 years for both genders in average: 26.8 years for men and 28.7 years for women.
The change in the total population of the country is significantly influenced by migration. In 2015-2019 there was a significant decrease in emigration in the republic. One of the main factors of the decrease in external migration is the expiration of the bilateral intergovernmental agreement on simplified citizenship between Kyrgyzstan and Russia (which is a destination for most of the emigrants), as well as changes in the migration legislation of Russia and economic challenges..
Thus, the demographic processes observed in the Kyrgyz Republic in recent years are characterized by a fairly high rate of population growth. A high level of fertility is maintained, ensuring expanded reproduction of the population. The balance of external migration remains negative, but its value has significantly decreased in recent years.
As for the main socio-economic indicators of the living standards of the population, the average monthly nominal wage per employee in Kyrgyzstan was 16,427 soms in 2018 and 17,166 soms in 2019. The subsistence minimum (average per capita) in 2018 was set at 4,792.54 soms, and in 2019 - 4,806.32 soms. The main sources of income of the population are still employment earnings, social benefits, income from private farm households, as well as other earnings. Thus, in 2019, the nominal monetary income of the population from all the above sources amounted to 447,879.7 million soms, which is 8% higher than the same indicator in 2018, which amounted to 412,964.5 million soms.