Healthcare reform in Kyrgyzstan

The government in Bishkek is grappling with a Soviet-era system that is no longer viable. The crisis particularly affects the medical profession, with numbers in constant decline: in 2022 there were 18.5 doctors per 10,000 inhabitants, today there are just 15, while in Kazakhstan, for example, there are 40. But the real problem is the lack of resources allocated to healthcare: just per person per year.

Bishkek (AsiaNews) - In launching a reform of the healthcare system, the Kyrgyz government has decided to prioritise the work of family doctors, which is currently in crisis: the number of doctors in the sector is steadily declining, pressure from the population is increasing, and state funding remains at minimal levels.

For these reasons, doctors have created a new Kyrgyzstan Family Medicine Association to defend the interests of their colleagues and restore adequate respect for the profession, without which no development of the national healthcare system is conceivable.

The editorial staff of Kaktus.media interviewed one of the leading members of this association, Dr Nurlan Brimkulov, professor of family medicine. He recalls the reforms that began in 1996 with the Manas healthcare programme, when it became clear that a different economic model was needed for the system due to chronic underfunding.

The hospital sector was severely lacking in resources, so the focus shifted to primary care and family medicine began to be introduced, with the adoption of relevant regulations. However, the programme encountered a number of difficulties, starting with the lack of specific training in family medicine, which was not considered a scientific subject in Kyrgyzstan.

Even today, family doctors are not held in high regard in the country, and governments have never paid sufficient attention to this sector. Brimkulov also warns that “our entire healthcare system is struggling to emerge from a permanent crisis”.

The Soviet legacy of large clinics has long since collapsed, and since 2012, the number of nurses and doctors has also been declining, despite attempts to retain them and direct them towards family practices. In 2022, there were 18.5 doctors per 10,000 inhabitants, today that number has fallen to 15, while in Kazakhstan, for example, there are 40, and it is clear that the fewer doctors there are, the heavier the burden they have to bear.

At a recent conference, Russian professor and international expert Mikhail Favorov spoke remotely from the US, reporting on “Public health in the contemporary world” and comparing medical expenditure in various countries over recent years. In the United States, 16.7% of GDP is invested in healthcare, approximately £15,000 per person per year, while in Kyrgyzstan, this figure stands at between 5% and 7% of GDP, amounting to £86 per person per year, even though the population demands an “American level” of service.

According to the indices commented on by Favorov, about 70% of Kyrgyz people do not have access to healthcare according to the necessary standards, however high or low they may be.

Kyrgyz doctors point out that salaries are really too low, and ‘if they give us 50 tyjyn [cents], you can't expect a 100 som service,’ notes Brimkulov. The current Minister of Health, Erkin Čečejbaev, is considered a knowledgeable and courageous man, who insists on the need for substantial increases in doctors' salaries, without gaining much support from other members of the government. Many citizens are forced to pay under the table to get any results, and when there are serious medical problems, they are forced to sell their most valuable possessions, even their homes.

Without effective help from family doctors, people flock to hospitals even when it is not necessary, or in any case due to the lack of appropriate prophylaxis at the initial stages of medical problems.

The Kyrgyz consider Kazakhstan's experience a good model to emulate, sending delegations to the neighbouring country, including ministers and other members of the government, to try to create teams of doctors with three nurses in their own country, who also have a direct link with psychologists and social workers for “multi-disciplinary” assistance, with midwives on call.

This means that it is no longer just a single doctor, left alone to respond to every need on a miserable salary.