Health Care In Central Asia (european Observzatory On Healh Care Systems)

Central Asia remains one of the least known parts of the former Soviet Union. The five central Asian republics gained their unexpected independence in 1991. They have faced enormous challenges over the last decade in reforming their health care systems, including adverse macro-economic conditions and political instability. To varying extents, each country is diverging from a hierarchical and unsustainable Soviet model health care system. Common strategies have involved devolving the ownership of health services, seeking sources of revenue additional to shrinking state taxes, 'down-sizing' their excessive hospital systems, introducing general practitioners into primary care services, and enhancing the training of health professionals. This book draws on a decade of experience of what has worked and what has not. It is an invaluable source for those working in the region and for others interested in the experiences of countries in political and economic transition. Health care in central Asia......Page 2 Contents......Page 6 List of .gures and tables......Page 8 List of contributors......Page 11 Series editors’ introduction......Page 13 Foreword......Page 15 Acknowledgements......Page 16 part one Context......Page 18 chapter one Health care systems in the central Asian republics: an introduction......Page 20 chapter two History and politics in central Asia: change and continuity......Page 29 chapter three Macroeconomic pressures......Page 48 chapter four Poverty, affordability and access to health care......Page 59 chapter five Patterns of health......Page 74 chapter six The Soviet legacy: the past as prologue......Page 84 part two Health systems and services......Page 94 chapter seven The reform process......Page 96 chapter eight Health system funding......Page 109 chapter nine Allocating resources and paying providers......Page 125 chapter ten The health care workforce......Page 142 chapter eleven Modernizing primary health care......Page 158 chapter twelve Rationalizing hospital services......Page 168 chapter thirteen Restructuring public health services......Page 182 chapter fourteen Health care systems in transition......Page 196 part three The countries......Page 212 Kazakhstan......Page 214 Kyrgyzstan......Page 218 Tajikistan......Page 221 Turkmenistan......Page 224 Uzbekistan......Page 227 Index......Page 231 At the crossroads between Europe and Asia, the countries of central Asia have been occupied over the last decade with the enormous challenges of establishing and stabilizing their states and societies and with claiming their place in the international community.