This survey covers the period of 2018-2019. According to the data submitted for 2018, 12 development partners implemented 34 health projects for a total of $46,739,638, representing 22% of total health expenditures. In 2019, 14 development partners (additional data from GAVI and Saudi Fund for Development) were implementing 40 health projects for a total of $39,546,260, representing 19% of total health expenditures. There is a 15% decrease in funding in 2019 compared to 2018. If we compare the 2018 figures to the same figures for 2017, funding decreased by 13.4% ($53,974,277 in 2017).
Of the total ODA funds for 2018, only ~ 4% ($2,000,000) were received in form of loan, with the rest being grants. In 2019, the loan element is even lower - 1%.
In recent years, there has been a significant downward trend in the loan element of ODA - for example, in 2015, 10% of total ODA was loan, and in 2017 it was 6%.
Since the implementation of one of the largest projects in the health sector (SWAp) was almost completed, a separate analysis of SWAp funds in this round of the study was not conducted. It should be recalled that in previous years (2015, 2017), SWAp funds accounted for 18-28% of total donor funds in the health sector.
Almost all of the respondents implement their projects in line with the goals set out in national strategies: "Den Sooluk" National Health Reform Programme of the Kyrgyz Republic for 2012 - 2018, the National Development Strategy of the Kyrgyz Republic for the period of 2018 - 2040, and the Programme of the Government of the Kyrgyz Republic on health protection and health system development “Healthy person – prosperous country” for 2019-2030.
Regarding the UN Sustainable Development Goals, partner agencies are placing greater emphasis on goals related to reducing maternal mortality, preventing infant mortality and under-5 mortality, eliminating AIDS, tuberculosis and malaria, and achieving universal health coverage. Seven of the 14 development partners are involved in achieving these goals.
Geographically, development partners covered all areas of the country. In both 2018 and 2019, almost all partners worked at the national level. Separate projects focused on specific regions. Only one donor had a project focused only on Bishkek, with no national coverage.
In both 2018 and 2019, investments account for the largest share of payments, at 69% in 2018 and 54.9% in 2019. However, the structure of investments differs in these years. For example, while in 2018 more than half of the investments were allocated for construction and refurbishment, in 2019 more than 83% was spent for the provision of medical supplies and medical equipment. It can be assumed that the construction and renovation of facilities have been completed and the stage of equipping has been started.
Technical assistance funds, as the second most important funding category, are primarily allocated for capacity building. In 2019, the share of technical assistance increased by 9% compared to 2018.
In terms of health system functions, 73% of ODA in 2018 and 60% of ODA in 2019 was disbursed for the health services delivery area. In 2018, within this category, there was more emphasis on public health services (52%) and slightly less on PHC (37.1%). In 2019, these categories have rough parity (42.6% for public health and 40.6% for PHC). Referring back to a similar study in 2017, hospital care was the primary focus in 2017 (37.2% of total ODA). Over the 2 reviewed years, the focus of development partners has shifted significantly toward public health services and primary health care.
In terms of priority health areas, communicable disease prevention and control receives the largest share of ODA, accounting for 46.72% of total ODA in 2018 and 58.75% of ODA in 2019.
In-depth analysis of donor use of the country's financial instruments was not possible this time, as almost half of development partners had no information about whether or not their aid was recorded in the annual budget for the relevant year. Perhaps this is due to the peculiarities of public recording of donor proceeds. In any case, local institutions should consolidate information and share information about existing mechanisms, and the development community should work more closely with them.
Most agencies noted that the level of coordination in the health sector is good and policy dialogue has some impact. However, they highlighted a number of challenges that, if addressed, would allow to achieve full alignment and harmonization with health sector priorities.
Despite these challenges, the donor community remains committed to supporting Kyrgyzstan's health sector in the medium and long term.