1. Development partners

According to the eligibility criteria outlined, 22 development partners were identified as eligible and hence invited to participate in the survey. Nine of these development partners did not have active projects in 2015 but 12 agencies were active and provided full information.

Table 1. Development partners’ participation in the survey, 2015

Of the 12 development partners that provided information, seven are multilateral and five are bilateral.

Fig. 1. Bilateral and multilateral development partners, 2015


Projects covered by this study started, ran throughout or ended in 2015. Overall, development partners reported 42 projects and programmes (Fig. 2) totalling US$ 40 932 763. This total disbursement equals 21% of total public health expenditure for 2015.

Fig. 2. ODA projects or programmes per donor, 2015

In terms of ODA allocated within the framework of bilateral and multilateral agreements, the United States and Switzerland allocated the most significant financial assistance to the Kyrgyz Republic. Both partners used different aid modalities.
Of the US$ 40 932 763, only 10% was disbursed through concessional loans, while
90% was funded through grants. This amounted to US$ 4 260 000 and
US$ 36 672 763 respectively (Fig. 3).

Fig. 3. Total ODA by type

Fig. 4 illustrates the distribution of the total ODA by aid modalities: project-based aid; SBS; pooled funds under SWAp; and other pooled financing.

Box 1. SWAp-2 and the Den Sooluk

SWAp-2 and the Den Sooluk National Health Reform Programme of the Kyrgyz Republic for 2012–2016
The OECD defines SWAp as a circumstance whereby all significant funding coming from development partners supports a single, comprehensive sector policy and independent programme, consistent with a sound macro-economic framework, under government leadership. OECD also specifies that partners’ support for a SWAp can take any form – project aid, technical assistance or budget support – although there should be a commitment to progressive reliance on government procedures to disburse and account for all funds.
In the case of the Kyrgyz health sector, the SWAp-2 involves three partners: WB, KfW and the SDC. It supports the Den Sooluk reform programme with a total of US$ 41.4 million.

Fig. 4. SWAp2 contributions (2012–2016)

The Den Sooluk National Health Reform Programme of the Kyrgyz Republic has been developed for 2012–2016 and is a continuation of the preceding national health reform programmes – Manas (1996–2005) and Manas Taalimi (2006–2011). The Den Sooluk programme was developed through a participatory and collaborative effort under the leadership of the Ministry of Health and supported by WHO and other development partners active in the SWAp.
The mission of the programme is to establish conditions for health protection and improvement of the whole population and each individual, irrespective of social status and gender differences. Based on the disease burden structure and the Kyrgyz Government’s commitments to achieve the Millennium Development Goals (MDGs), four priority areas to improve health indicators have been selected for the Den Sooluk programme: (i) cardiovascular disease; (ii) maternal and child health; (iii) tuberculosis; and (iv) HIV infection.
The Den Sooluk programme is based on the strengths and gains of prior national health reform programmes, with its own distinctive features.
- Structure considers the established priorities with clear identification of the expected outcomes in each area.
- All programme activities are determined by the agreed expected outcomes in improvement of health outcomes.
- Improvement of key health services at both individual and population level is the basis for this programme.
- Health system strengthening will be strongly oriented at removal of the barriers hindering delivery of key health services in four selected priority areas.
- selected priority areas.



Fig. 5. Project aid, SWAp and other SBS, 2015

It is worth noting that WHO provides the only SBS outside the SWAp.

Fig. 6. Overall fund distribution by aid modalities, 2015

2. Geographical coverage

Almost all development partners (11 out of 12) indicated that they provide support to national level/structures; eight also implemented projects at regional levels. Pilot projects are carried out in pilot sites by eight of the 12 agencies interviewed.


Fig. 7. Development partners by coverage, 2015

Table 7. Development partners by district, 2015

The location of all partners and their respective projects recorded by this survey is illustrated below (Fig. 8). A few towns were not
covered by pilots: Batken, Sulyukta, Kadamjay, Kerben and Naryn.

Fig. 8. Development partners by district, 2015

3. Funding categories, components, health system priorities

The distribution of disbursements for 2015 across different types of funding category is illustrated in Fig. 9. The largest share is devoted to technical assistance (54.06%), investments account for 40.58%; and the remaining 5.36% are administrative costs. USAID, the SDC and the Global Fund provided the largest amount of support in the form of technical assistance – 66% of the total. Three development partners provided the largest share of investments (83%) in terms of both grants and loans: the WB, KfW and the SDC.

Fig. 9. Total disbursements by funding category, 2015

The following figure illustrates the distribution of the 54.1% of technical assistance funds across five components – (i) policy development; (ii) capacity building; (iii) guideline and protocol development; (iv) legal and regulatory framework; and (v) other (includes communication, consulting and similar services).

Fig. 10. Technical assistance by components, 2015

Fig. 11 illustrates the distribution of the investment quota – the 40.6% of the total ODA disbursed – across five components: (i) construction and refurbishment; (ii) medical equipment and technology; (iii) IT; (iv) medical supplies; and (v) other. Medical equipment and technology receives the largest share of investments.

Fig. 11. Investment funds by components, 2015


Fig. 12 illustrates the distribution of the total disbursements among four health system functions: (i) health service delivery; (ii) resource generation; (iii) health financing; and (iv) stewardship and governance.


Fig. 12. Disbursements by health system functions, 2015

The health service delivery component can be broken down into four categories: (i) primary health care; (ii) hospital care; (iii) public health services; and (iv) emergency care (Fig. 13). Hospital care remains the main area of focus. Only 2% of total disbursements in 2015 targets emergency care.



Fig. 13. Distribution of health service delivery quota, 2015

Fig. 14 shows the distribution of total ODA disbursements across different health priority programme areas. This clearly shows that the two areas with the largest share of financing are communicable diseases (48.70%), and maternal and child health and reproductive health (33.85%). Noncommunicable diseases rank third (11.90%). Less attention is paid to the areas of adolescent health (2.05%), injuries and violence (1.77%) and other areas (1.73%).



Fig. 14. ODA distribution according to health priority programme areas, 2015

4. Alignment with national priorities

The alignment of aid flows with health-sector policies, strategies and programmes is shown in Table 8. Almost all the development partners interviewed are implementing their projects with consideration of the goals set out in the national general strategies – the National Sustainable Development Strategy of the Kyrgyz Republic for 2013– 2017 (eight donors) and the Den Sooluk National Health Reform Programme of the Kyrgyz Republic for 2012–2016 (10 donors). One partner (Japanese Embassy – JICA) reported that it is working towards only subsectoral strategies; one partner did not answer this section.
Table 8. Development partner alignment with national frameworks, 2015

5. Financial management systems

Section VI of the questionnaire requested development partner agencies to indicate their use of a country’s financial tools and/or national procurement systems. Eight development partners indicated whether or not their ODA was recorded in the national health budget; four development partners lacked this information (Fig.15).

Fig. 15. Was your ODA recorded in the annual 2015 sector budget?

Four agencies provided a positive response to this question: three involved in the SWAp mechanism (KfW, SDC, WB) plus UNAIDS.
Only five organizations provided data on the usage of national procedures (budget execution, financial reporting, auditing, procurement). All of these donors reported usage of national budget execution, financial reporting and auditing procedures.
Among the non-SWAp partners, only UNAIDS reported use of a national procurement system.

6. Aid predictability

This survey covered 42 projects and programmes: 30 of these are ongoing and 12 were accomplished by 31 December 2015.
The majority of development partners (eight of 12) committed to provide support in 2016. Of these, six partners intend to continue support in 2017 and five in 2018. WHO and the SDC have already committed to support the Kyrgyz health sector until 2020 (Fig.16).

Fig. 16. Development partner commitment to provide future support to Kyrgyz health sector

Among partners continuing to support the Kyrgyz health sector in 2016, two agencies confirmed that they would be increasing their disbursements and six agencies reported plans to decrease their contributions.

Fig. 17. Pledged amounts for 2016

7. Coordination and complementarity

Six development partners reported undertaking a total of 48 missions during 2015; just under 69% (33) of these conducted by WHO. In addition, only WHO and the SDC reported analytical works in 2015.

Fig. 18. Development partner health-sector missions and analytical works, 2015

Five of the 11 development partners who rated partner coordination in the health sector reported a good level. Three development partners said that coordination was at medium level.

Fig. 19. Rating of partner coordination in the health sector

Eleven development partners provided feedback on the policy dialogue between the Ministry of Health of the Kyrgyz Republic and their organizations. Perceptions differed between donor agencies: five considered that the policy dialogue is of high impact (WFP, WB, SDC, KfW, WHO). The WFP mentioned that the Ministry of Health is always readily available to coordinate, discuss and facilitate development actions.

Fig. 20. Perceived impact of the policy dialogue, 2015

Problems mentioned concerning the coordination mechanism included competing and unaligned interests of development partners, as well as different procedures; new and un-traditional partners emerging in the health sector that are not engaged with SWAp and have parallel structures; Ministry of Health providing insufficient leadership and ownership to ensure good quality implantation of health programmes; low level of predictability and coordination of non-traditional donors; and high turnover rates. Partner agencies proposed several improvements, including:
• Ministry of Health to lead, take ownership of the whole process and drive policy dialogue;
• strengthening the capacity of senior management in the Ministry of Health;
• channeling every donor commitment through SWAp (although this appears unrealistic);
• increasing Ministry of Health remuneration in order to cut staff turnover;
• setting up regular information exchange between Ministry of Health and development partners; and
• increasing transparency on ODA and partners’ activities.