Results 2018 - 2019

1. Level of participation and total amount of ODA

An invitation for participation in 2018-2019 survey was sent to 30 organizations (in 2017 - 35; in 2015 - 35) providing assistance to the health sector of the Kyrgyz Republic, who met the OECD criteria . Since the data collection period coincided with the exacerbation of the COVID-19 pandemic in the country, and many embassies and organizations were forced to suspend their activities and switch to working online, only 20 representatives (in 2017 - 25; in 2015 - 21) of the donor community responded to the invitation to participate in the study. 6 of these development partners reported having no active projects in 2018-2019, 2 organizations had active projects only in 2019, and 12 organizations had active projects in both 2018 and 2019 and provided full information on them (in 2017 – 18 organizations; in 2015 – 12 organizations).
It should that the Japanese Agency for International Cooperation provided information on behalf of the Embassy of Japan in the Kyrgyz Republic, and the Swiss Agency for Development and Cooperation submitted information on behalf of the Embassy of the Swiss Confederation in the Kyrgyz Republic. Data on the projects of the Embassy of the Republic of Turkey were provided by the Turkish International Cooperation Agency. Information on implementation of the Global Fund grant was kindly provided by the local office of the United Nations Development Programme, as an implementing agency for this grant.

Table 1: Development partner participation in the 2018-2019 survey.

Partner organization No active projects in 2018  Active projects in 2018 No active projects in 2019 Active projects in 2019
Asian Development Bank (ADB)      
Embassy of the People’s Republic of China in the Kyrgyz Republic *        
Eurasian Development Bank *        
European Bank for Reconstruction and Development *        
Food and Agriculture Organization of the United Nations (FAO)     √  
Global Alliance for Vaccines and Immunization (GAVI)  √      √
German Agency for International Cooperation (GIZ)    √    √
Islamic Development Bank (IsDB)    √   √   
Embassy of India *        
Embassy of the Islamic Republic of Iran *         
Embassy of Japan - Japan International Cooperation Agency (JICA)   √     √
Kuwait Fund for Arab Economic Development*        
KfW Development Bank    √    √
Korea International Cooperation Agency (KOICA)  √   √   
Embassy of the Republic of Korea  √   √   
Embassy of the State of Qatar *        
Embassy of the Russian Federation  √    √   
Russian-Kyrgyz Development Fund *         
Saudi Fund for Development (SFD)  √     √ 
Embassy of the Swiss Confederation - Swiss Agency for Development and Cooperation (SDC)    √   √ 
Embassy of the Republic of Turkey in the Kyrgyz Republic - Turkish International Cooperation Agency (TIKA)    √   √ 
Joint United Nations Program on HIV / AIDS (UNAIDS)    √   √ 
Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) - United Nations Development Program (UNDP)    √  
United Nations Population Fund (UNFPA)    
United Nations International Children's Emergency Fund (UNICEF)      
United Nations Office on Drugs and Crime (UNODC)*        
United States Agency for International Development (USAID)    √   √ 
World Bank    √   √ 
World Food Programme (WFP)*        
World Health Organization (WHO)     √ 

* - organizations highlighted in gray did not respond to the invitation to participate in this survey.

Among the 14 development partners that had active projects, seven are multilateral and seven are bilateral.

Figure 3. Bilateral and multilateral development partners

The projects covered in this survey were separated into 2 years: some started, continued, or ended in 2018 and others in 2019. Overall, development partners reported 34 projects and programs in 2018 and 40 projects in 2019. Total disbursements in 2018 were $46,739,638 and $39,546,260 in 2019, representing
22% and 19% of total health expenditures, respectively. Despite an increase in the number of projects, amount of funding from nearly the same donors decreased by 15% in 2019 compared to 2018.

Figure 4. ODA projects or programmes per donor, 2018-2019

As can be seen from the figure above, the absolute leader in terms of the number of projects in the health sector in both 2018 and 2019 is the KfW Development Bank. Looking at 2018 and 2019 separately, the KfW Development Bank, the Turkish International Cooperation Agency (TIKA), and the United Nations Population Fund (UNFPA) account for 56% of all projects in 2018 and 50% in 2019.

In terms of ODA amounts, the KfW Development Bank was also the leader in terms of disbursement with $15,139,249 in 2018 and $11,835,931 in 2019. The second by volume of disbursements in 2018 is the Turkish International Cooperation Agency with $11,273,428; and UNDP implementing the Global Fund grant owns the thrid place with $8,660,213 in disbursements.
In 2019, UNDP takes the second place with the same amount of disbursements as in 2018, and the Swiss Agency for Development and Cooperation takes the third place with $4,439,651.

Figure 5 shows that only 4% of the total 2018 ODA covered in this report has been received in the form of loan. In fact, only World Bank support for the SWAp project was received in the form of a concessional loan.As for 2019, the loan element was only 1% - these were the disbursements under the Saudi Development Fund project for construction and equipping the Public Pediatric Emergency Hospital.

Figure 5. Total ODA by types.

Compared to 2015 and 2017 surveys, the loan element has significantly decreased. For example, in 2015 it was 10% of total ODA, and in 2017 - 6%7.

2. Geographic coverage

Information on the geographic coverage of partners’ projects is presented in Figure 6.

Figure 6. Development partners by geographic coverage, 2018-2019

2018: All twelve organizations indicated that they provided support at the national level; of those, two organizations indicated that they worked at both the national and regional levels, and two partners had national level projects with pilot sites.
2019: Thirteen organizations implemented projects at the national level; of those, five organizations worked at both the national and regional levels, two partners had national coverage projects with pilots, and only one partner, the Saudi Fund for Development, had a project without national coverage, focusing only on Bishkek city.

Table 2: Development partners by geographic coverage, 2018-2019

Geographic coverage Donor agencies
Regional Bishkek city GAVI, GIZ, KfW, SFD, UNAIDS, UNFPA, USAID, WHO
  Batken oblast SDC, UNAIDS, USAID
  Jalal-Abad oblast GAVI, KfW, SDC, UNAIDS, USAID
  Issyk-Kul oblast GAVI, SDC, UNAIDS
  Naryn oblast GAVI, GIZ, SDC, UNAIDS
  Talas oblast GAVI, SDC, USAID

According to the table, it can be concluded that in general all regions of the country are covered by the projects of development partners.

3. Funding categories, components, health system priorities

Distribution of disbursements for 2018 and 2019 by three funding categories is shown in Figure 7. In 2018, the largest share are investments (69.0%); technical assistance accounts for 21.7%; and the remaining 9.3% of ODA are administrative costs. In 2019, the share of investments decreases to 54.9% and technical assistance increases up to 30.9%. As for administrative costs, they have also increased by almost 5% (14.1%) compared to 2018. In percentage terms, the difference seems small, but in monetary terms, the amount of investments, for example, dropped by $10.5 million.

Figure 7. Total disbursements by funding categories, 2018-2019

The following figure illustrates the distribution of technical assistance funds across five components: (i) policy development; (ii) capacity building; (iii) development of guidelines and protocols; (iv) regulatory framework; and (v) other (including communications, consulting, etc). The largest share of technical assistance in both 2018 and 2019 is for capacity building (73.5% and 48.6%, respectively)

Figure 8. Technical Assistance by components, 2018-2019

Figure 9 demonstrates the distribution of the investment quota of total ODA by five components: (i) construction and refurbishment; (ii) medical supplies; (iii) information technology; (iv) medical equipment and technology; and (v) other. The largest share of investment in 2018 was provided for construction and refurbishment (56.7%), but things have changed in 2019 and investment in medical equipment and technology is predominant. This results from the completion of construction on major projects in 2018 and start of their equipment in 2019. As can be seen from the diagram, investments in information technology remain at a rather low level in both years.
Investments by components


Figure 9. Distribution of investment quota, 2018-2019

Figure 10 illustrates the distribution of total disbursements across four health system functions: (i) health services delivery; (ii) resource generation; (iii) health financing; b (iv) leadership and governance. The figure clearly demonstrates that the main priority of most partners is in the area of health services delivery. Resource generation and Leadership and governance also have some share of support. The lowest disbursement numbers were allocated for the function of health financing.

Figure 10. Disbursements by health system functions, 2018 – 2019

The area of Health Services Delivery can be divided into four main categories: (i) primary care; (ii) hospitals; (iii) public health services; and (iv) emergency care (Figure 11). Public health services remain the primary focus area (52% in 2018 and 42.6% in 2019). Nearly similar numbers are observed for the primary care component (37.1% in 2018 and 40.6% in 2019). The most neglected area is emergency care.

Figure 11. Distribution of health service delivery quota, 2018 – 2019

Figure 12 shows the distribution of all ODA disbursements across the various priority areas of health programs. In 2018, the breakdown is as follows: communicable diseases (46.72%), non-communicable diseases (20.46%), and maternal and child health and reproductive health (8.92%). Less attention is given to health areas such as adolescent health (4.49%) and injury and violence (4.38%). A fairly significant share of funding (15.04%) was allocated to areas not covered by the above-mentioned classification ("other")
In 2019 the picture is slightly but different: the area with the highest funding remains the same - communicable diseases - 58.75%. The emphasis in 2019 shifted slightly toward Maternal and child health and Reproductive health - funding increased by almost 11%. Adolescent health received the smallest funding - 3.16% of the total allocated funds.

Figure 12. Distribution of ODA according to priority health areas, 2018-2019

4. Alignment with national and international priorities

This section outlines the commitment of development partners towards the implementation of certain health sector policies, strategies and programs, as well as the achievement of particular Sustainable Development Goals. Almost all of the development partners interviewed are implementing their projects in line with the objectives outlined in the 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. The only difference is that in 2018 the "Den Sooluk" National Health Reform Programme was active national programme in health sector, while in 2019 it was replaced by the Programme of the Government of the Kyrgyz Republic on health protection and health system development “Healthy person – prosperous country” for 2019-2030.

Table 3: Alignment of partners with national programs and strategies for 2018-2019

General (national) strategies 
The National Development Strategy of the Kyrgyz Republic for the period of 2018 - 2040 GIZ, JICA, KfW, SFD, UNAIDS, UNFPA, UNICEF, USAID, WHO
"Den Sooluk" National Health Reform Programme of the Kyrgyz Republic for 2012 - 2018 GIZ, KfW, SDC, UNAIDS, UNFPA, UNICEF, USAID, WHO
Programme of the Government of the Kyrgyz Republic on health protection and health system development “Healthy person – prosperous country” for 2019-2030 GAVI, GIZ, JICA, KfW, SFD, SDC, UNDP, UNFPA, UNICEF, USAID, WHO
Sub-sectorial strategies 
Health Sector Investment Strategy for 2016-2025 KfW
«Tuberculosis-V» National program KfW, UNDP, USAID, WHO
The State program on stabilization of the HIV epidemic in the Kyrgyz Republic for 2017-2021 KfW, UNAIDS, UNDP, UNFPA, UNICEF, USAID, WHO
The State program on prevention and control of non-communicable diseases in the Kyrgyz Republic for 2013-2020 KfW, SDC, UNAIDS, UNFPA, UNICEF, WHO
Programme of the Government of the Kyrgyz Republic for Mental Health Protection for 2018-2030   WHO
State Guaranteed Benefits Programme to ensure health care for the citizens of the Kyrgyz Republic  GAVI, KfW, UNFPA, USAID, WHO
The concept of creating an electronic database of drugs and medical products in the Kyrgyz Republic  UNAID, UNFPA, USAID, WHO 
Kyrgyz Republic program to develop the sphere of drug circulation in the Kyrgyz Republic for 20142020   UNAIDS, WHO
Program for provision of additional incentives to physicians working in health facilities of small towns and remote and rural areas   USAID
Regulations on the sanitary protection of the territory of the Kyrgyz Republic and the Comprehensive Plan of Anti-Epidemic Measures for the sanitary protection of the territory of the Kyrgyz Republic against the importation and spread of quarantined, highly dangerous infectious diseases that pose a danger to public health and population health for 2018-2022  GAVI, USAID, WHO 


Table 4 summarizes the contributions of donors in support of the health-related Sustainable Development Goals. The table shows that most donors contribute to reducing maternal mortality (SDG 3.1), preventing newborn and under-5 mortality (SDG 3.2), eliminating AIDS, tuberculosis, and malaria (SDG 3.3), and achieving universal health coverage (SDG 3.8). None of the SDGs has been neglected, and WHO, as the leading and coordinating agency for international health within the UN system, seeks to cover all of the health-related SDGs in its activities.

Table 4: Contribution of partners to the Sustainable Development Goals.

1 3.1. By 2030 reduce the global maternal mortality ratio to less than 70 per 100,000 live births  GIZ, SDC, UNFPA, UNICEF, WHO
2 3.2. By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births  GAVI, GIZ, SFD, SDC, UNFPA, UNICEF, WHO
3 3.3. By 2030 end the epidemics of AIDS, tuberculosis, malaria, and neglected tropical diseases and combat hepatitis, water-borne diseases, and other communicable diseases  UNAIDS, UNDP, UNFPA, USAID, WHO
4 3.4. By 2030 reduce by one-third pre-mature mortality from non-communicable diseases (NCDs) through prevention and treatment, and promote mental health and wellbeing SDC, UNFPA, WHO
5 3.5. Strengthen prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol  WHO
6 3.6. By 2030 halve global deaths from road traffic accidents  WHO
7 3.7. By 2030 ensure universal access to sexual and reproductive health care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programs  GIZ, UNFPA, WHO
8 3.8. Achieve universal health coverage (UHC), including financial risk protection, access to quality essential health care services, and access to safe, effective, quality, and affordable essential medicines and vaccines for all  GAVI, GIZ, UNFPA, USAID, WHO
9 3.9. By 2030 substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water, and soil pollution and contamination  WHO
10 3.a. Strengthen the implementation of the WHO Framework Convention on Tobacco Control in all countries, as appropriate  SDC, WHO
11 3.b. Support the research and development of vaccines and medicines for the communicable and noncommunicable diseases that primarily affect developing countries, provide access to affordable essential medicines and vaccines, in accordance with the Doha Declaration on the TRIPS Agreement and Public Health, which affirms the right of developing countries to use to the full the provisions in the Agreement on Trade-Related Aspects of Intellectual Property Rights regarding flexibilities to protect public health, and, in particular, provide access to medicines for all  WHO
12 3.c. Substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries, especially in least developed countries and small island developing States  JICA, SDC, WHO
13 3.d. Strengthen the capacity of all countries, in particular developing countries, for early warning, risk reduction and management of national and global health risks  SDC, WHO
14 Other SDG targets related to health  JICA, UNFPA, WHO

A more schematic coverage of the SDGs is shown in Figure 13.

Figure 13. Contribution of partners to SDGs (coverage)

5. Financial management systems

Section VI of the questionnaire requested Development partners to indicate what national financial instruments, accounting systems, and/or national procurement systems they utilize. In 2018, 6 of 12 development partners indicated their recording of their ODA in the national health budget, six development partners did not have this information. In 2019, 9 of 14 donors answered this question; 5 partners had no information in this regard.

Figure 14. ODA recorded in the annual budget for 2018-2019

6. Aid Predictability

Figure 15 shows the commitments of the development partner community to support Kyrgyz health sector in the upcoming years up to 2024.
10 organizations planned to provide support in 2019 - based on the fact that their projects were present in the analysis for 2019, we can conclude that they have fulfilled their commitment. Only two organizations have long-term plans for support - the Saudi Fund for Development and WHO. They plan to support the health sector until 2024.
it should be separately noted the PHC Quality Improvement Program will soon be launched within the framework of the Programme of the Government of the Kyrgyz Republic on health protection and health system development “Healthy person – prosperous country” for 2019-2030, which will become the successor of SWAp project. This Program will be supported by Joint Financiers - the World Bank, the KfW Development Bank and the Swiss Agency for Development and Cooperation (SDC). The total amount of funding commitments to the Program for the five-year period up to 2024 is estimated at $37 million.
The World Bank has allocated $20 million for the project including $10 million grant and $10 million loan. Swiss Agency for Development and Cooperation pledged $9 million, and KfW Bank - €9 million. All financing agreements have passed the ratification procedures.

Figure 15. Commitment of the development partner community to support Kyrgyz health sector in future.

7. Coordination and Complementarity

Nine development partners reported a total of 35 missions during 2019. In addition, GAVI, UNAIDS, UNFPA, USAID, and WHO reported a total of 16 analytical works undertaken in 2019.
For 2018, the partners reported much fewer of both joint missions and analytical works - 17 and 6, respectively.

Figure 16. Missions and analytical works of development partners in health sector, 2018-2019

All organizations provided their feedback onpartner coordination in health sector for 2018 and 2019. Six of twelve development partners in 2018 reported a good level of coordination. Nine of the fourteen partners in 2019 also rated the level of coordination as good. One partner was very satisfied with the quality of coordination and rated it as excellent.

Figure 17. Partners' opinions on coordination in the health sector

Opinions regarding the effectiveness of the policy dialogue between the Ministry of Health of the Kyrgyz Republic and partner organization were provided by ten partners for 2018 and 11 partners for 2019. Overall, development partners believe that policy dialogue has a medium to high impact on the effectiveness of collaboration between the Ministry of Health and their organization.

Figure 18. Perceived impact of the policy dialogue in 2018 - 2019

According to partners, the main problems that prevent full alignment and harmonization with health sector priorities are:
• Peculiarity of the cooperation schemes of each development partner and the peculiarities of the public system;
• Decreasing capacity to implement the health sector reforms and activities at national and local levels as well as staff reshuffling including the senior management positions;
• Poor political vision on the sectoral reforms and weak capacities of policy makers;
• Different interests of the donor countries and agencies;
• Weak capacity of the Government to coordinate and provide technical and data inputs, which makes it heavily reliant on the active contributions of development partners;
• Limited capacity and resources at the national and local levels do not allow to further implement successful programmes;
• Outbreaks and overall vulnerability of the country to disasters;
• Unaligned investment strategies and technical assistance package.

Resolution of these problems, especially in terms of capacity building, would allow the Ministry of Health to ensure more effective implementation of projects and programs of the donor community for the benefit of the country.