1. Development partners

According to the eligibility criteria outlined, 35 development partners were selected as eligible and invited to participate in the survey of 2017. Among these 35 development partners, 25 agencies responded to the invitation to take part in the survey. Seven (7) of these development partners reported that they did not have any active projects in 2017. Eighteen (18) organizations have implemented various projects and provided full information. It should be noted that one organization, the Global Fund, accepted the invitation to participate in the study, but the executive agency of their project was the United Nations Development Programme (UNDP).

Table 1. Development partners’ participation in the survey, 2017

Compared to the 2015 survey, participation was expanded. In 2015, only 22 organizations took part in the study, of which only 12 provided information on their projects. In the 2017 survey, project information was obtained from 18 donor organizations.
It should also be noted that, unlike in the first mapping round, UNDP, FAO, KFAED, and SFD joined the second round. Also, separate data from the Japanese Embassy in the Kyrgyz Republic and the Japan International Cooperation Agency were obtained.
Of the 18 development partners that provided information, ten are multilateral and eight are bilateral.


Figure 1. Bilateral and multilateral development partners, 2017

Projects covered by this study started, ran throughout, or ended in 2017. Overall, development partners reported 41 projects and programs (Fig. 2) totaling US $53 974 277. This total disbursement equals 23% of total health expenditures for 2017.

Figure 2. ODA projects or programs per donor, 2017

As can be seen from Fig.2, the largest number of projects were implemented by USAID, the KfW Development Bank (KfW) and the Swiss Embassy in the Kyrgyz Republic. They accounted for 56% of all donor projects in the health sector in 2017.
In terms of ODA allocated within the framework of bilateral and multilateral agreements, GFATM (through UNDP), KfW Development Bank, and USAID allocated the most significant financial assistance to the Kyrgyz Republic. The amount of aid provided equals US $15,797,109, US $9,772,972, and US $8,657,000, respectively. The sum of budgets of their projects equals 63.4% of the total amount of development projects in 2017.


Figure 3. Total ODA by type

Of the $53 974 277, 94% was disbursed through grant assistance and only 6% was provided in the form of a loan (Fig.3).
Regarding aid modalities, these can be divided into 3 large categories: SWAp, Project/Program aid, and Sector Budget Support.

Figure 4. SWAp/SBS/Project aid (by organizations), 2017

In 2017, the vast majority (82%) of the reported funds were allocated for program/project aid, and 18% of the funds were allocated for SWAp activities. No funds were allocated for Sector Budget Support in 2017.

Figure 5. Overall fund distribution by aid modalities.

As for the SWAp project, which is being implemented within the framework of the “Den Sooluk” National Health Reform Program, traditionally the main donors are the World Bank, KfW, and SDC.
The diagram below indicates the flow of funds to the SWAp basket from each of these organizations.


Figure 6. Funds allocated within SWAp  

Geographical coverage

Development partners’ projects have been classified as projects with national coverage, regional coverage, and pilot projects

Figure 7. Geographical coverage of donor projects

Figure 7 shows that seventeen (17) donors provide support at the national level; seven (7) of them have also implemented projects at the regional level. Four (4) out of 18 surveyed organizations are implementing pilot projects in pilot sites.

2. Funding categories, components, health system priorities

The distribution of disbursements for 2017 across different funding categories is illustrated in Fig. 8. The largest share is devoted to investments (57.92%), technical assistance accounts for 38.09%, and the remaining 3.99% are administrative costs. The Global Fund (through UNDP), KfW Development Bank, and WHO provided the largest investment support - 79% of total investments. In the 2015 survey, the leaders in this category were the World Bank, KfW, and the Swiss Agency for Development and Cooperation (SDC). Compared to 2015, the share of investments increased by 17.34%.
The share of technical assistance in 2017 was 38.09%, which is 15.97% less than in 2015.

Figure 8. Total disbursements by funding category, 2017

The following figure illustrates the distribution of the 38.09% 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). As can be seen from the figure, a stronger emphasis in 2017 was on capacity building (51.85%).

Figure 9. Technical assistance by components, 2017

Fig. 10 illustrates distribution of the investment quota – the 57.92% 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.

Figure 10. Investment funds by components, 2017

Fig. 11 illustrates the distribution of total disbursements among four health system functions: (i) health service delivery, (ii) resource generation, (iii) health financing, and (iv) stewardship and governance. The figure demonstrates that the main share of disbursements is allocated to health service delivery (71.7%).
However, no significant changes were observed in this category in comparison with 2015.

Figure 11. Disbursements by health system functions, 2017

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. 12). Hospital care remains the main area of focus. In 2017, the percentage of funds allocated for emergency care has increased compared to 2015 (15.6% vs 2.2%).

Figure 12. Distribution of health service delivery quota, 2017
Fig. 13 shows the distribution of total ODA disbursements across different health priority program areas. This clearly shows that the two areas with the largest share of financing are communicable diseases (36.55%), and maternal and child health and reproductive health (28.82%). Non-communicable diseases rank third (11.90%). Less attention is paid to adolescent health (3.22%), injuries and violence (9.2%), and other areas (11.06%).

Figure 13. ODA distribution according to health priority program areas, 2017

3. Alignment with national priorities

The alignment of aid flows with health-sector policies, strategies, and programs is shown in Table 5. Not all development partners completed this table. However, the data obtained allows to conclude that half of the development partners implement their projects in view of the objectives set forth in national strategies: National Sustainable Development Strategy of the Kyrgyz Republic for 2013-2017 (eight donors) and “Den Sooluk” National Health Reform Program of the Kyrgyz Republic for 2012-2018 (ten donors).

Table 2. Development partner alignment with national frameworks, 2017

4. Financial management systems

Section VI of the questionnaire requested development partner agencies to indicate their use of the country’s financial tools and/or national procurement systems. Ten (10) development partners indicated whether their ODA was recorded in the national health budget or not; eight (8) development partners did not have this information (Fig.14).

Figure 14. Was your ODA recorded in the annual 2017 sector budget?

Four (4) agencies provided a positive response to this question: KfW, World Bank, GAVI, and UNFPA.
Five (5) organizations provided data on the usage of national procedures (budget execution, financial reporting, auditing, procurement). Two (2) of these donors reported usage of national budget execution, financial reporting and auditing procedures. Among the non-SWAp partners, only UNFPA reported using national procurement system.

5. Aid predictability

This survey covered 41 projects and programs: 34 of these are ongoing, five (5) were completed by 31 December 2017, one (1) project was approved but not started, and one (1) project was suspended.
The majority of development partners (9) committed to providing support in 2018. Of these, six (6) partners intend to continue support in 2019 and four (4) in 2020. The Swiss Agency for Development and Cooperation and the World Food Programme have already committed to support the Kyrgyz health sector until 2022 (Fig.15).

Figure 15. Development partner commitment to provide future support to the Kyrgyz health sector

Among partners continuing to support the Kyrgyz health sector in 2018, seven
(7) agencies confirmed that they would be increasing their disbursements and two
(2) agencies reported plans to decrease their contributions.


Figure 16. Pledged amounts for 2018

6. Coordination and complementarity

Eight (8) development partners reported that a total of 120 missions were conducted during 2017; most of them (105) were conducted by the WHO. WHO remains the most active donor in this regard, as in 2015. In addition, GIZ, SDC, UNFPA, and WHO reported on analytical works carried out in 2017. Twenty (20) analytical works were conducted in total.


Figure 17. Development partner health-sector missions and analytical works, 2017

Nine (9) of 14 development partners who rated partner coordination in the health sector reported a good level. Three (3) development partners said that coordination was at a medium level. One partner was very satisfied with the quality of coordination and marked it as excellent.

Figure 18. Rating of partner coordination in the health sector

Eleven (11) development partners provided feedback on the effectiveness of political dialogue between the Ministry of Health of the Kyrgyz Republic and their organizations. Donor opinions were different: WHO and UNDP believe that political dialogue has a great impact. Seven (7) organizations report medium impact between their organizations and the Ministry of Health. Four (4) organizations indicated only some impact of political dialogue.


Figure 19. Perceived impact of policy dialogue, 2017