Performance of the Health Economy in Kyrgyzstan
Mortality and Morbidity Rates
From the 1980s, population in Kyrgyzstan has been rising indicating that the crude birth rate is higher than the crude death rate. According to the Kyrgyzstan's national population statistics, the country had a total population of 5.3 million in 2009 and 5.5 million in 2012 (IndexMundi, 2013). Additionally, the country's 2012 age structure was 29.6% of the population made up of citizens between the age of 0-14 years with 830939 males and 795025 females. 20% of the population was made up of citizens between the age of 15-24 years with 558689 males and 542484 females; 6.5% of the population was made up of citizens between the age of 55-64 years with 154761 males and 202173 females; and lastly 4.9% of the population is made up of citizens aged 65 years with 103679 males and 165248 females. This translated to a 0.89% population growth (Nationmaster, 2012).
By July 2012, the crude birth rate was 23.9 for every 100 population, and the crude death rate was 6.9 for every 100 population as well as a net migration rate of -8.1 migrants per 1000 population. Further analysis indicated that the rate infant mortality is higher than any other age group followed by the death of mothers between the ages of 20-45 (Nationmaster, 2012). For instance, the 2012 National Population statistics indicated that infant mortality rate was 30.8 per 1000 live births with 35.2 per 1000 death for male infants and 26.1 per 1000 deaths for female infants. Medical sources attribute deaths in the country to several causative agents. According to the report released by the medics in 2004, the highest killer agent in the country was emphysema, which claimed 387 lives. Second in the list was an assault by dangerous objects, which claimed 107 lives (IndexMundi, 2013).
Public and Private Health Spending
Financing of both private and public health system in Kyrgyz comes from several sources inter alia, mandatory health insurance, private households, the public sector, voluntary health insurance, and external funds. So far, the Mandatory Health Insurance Fund contributes the least amount to the health sector (European Observatory on Health Care Systems, 2000). This fund was mandated by the resolution No. 281 of the National Assembly enacted in 16 January 1996. On the other hand, the public sector through taxes contributed the largest percentage of finances to the health sector. External sources have contributed a large portion of health funding to the nation since 1992. These funds are from bilateral and multilateral organizations, which provide funds in terms of donations, loans, and grants (Ibraimova et al., 2011).
According to the 2008 health report, private spending accounted for the largest share (35.8%) of the total health services expenditure. This was followed by the state budget, which accounted for 32.7%, external funding that accounted for 9.5% and lastly the mandatory health insurance that accounted for 4%. In total, the government spent a total 6.4% of the Gross Domestic Product in 2008 with 46.6 current US dollars per capita in 2007 (Ibraimova et al., 2011). However, the health sector has undergone several reforms, which saw the initiation of purchaser-provider split as well as the introduction of a "single player" for medical services under the SGBP, State-Guaranteed benefit Package. In addition, duties of buying health services have been consolidated under the MHIF, Mandatory Health insurance Fund, which is used as a single player in the health system. This incorporates both health insurance and general revenue. Since 2006, the health sector has pooled funds to the national level, which replaced the previous pooling that occurred at oblast level. This transition in funds pooling gave MHIF an opportunity to carry out an equitable distribution of funds (European Observatory on Health Care Systems, 2000).
Health Care Resources
Healthcare facilities in the country can broadly be classified into physical resources and human resources. Under physical resources, the hospital sector has items such as infrastructure, capital stock and investment, medical equipment and devices, and information technology. On the other hand, human resource has dimensions such as healthcare personnel trends and human resource training. Kyrgyzstan's healthcare infrastructure is made up of a network of health organizations that provide both public and individual health services. By 2009, the network had expanded to include 72 FMCs, 19 FGPs, 26 GPCs, as well as 122 hospitals that were equipped with 25975 beds (European Observatory on Health Care Systems 2000). However, it is discouraging to note that the physical conditions of most health facilities in the country are deteriorating. This state of affairs can be attributed to the decline of public expenditure on health activities and the use of extremely limited resource in renewing the health capital stock. Additionally, the medical equipment in the country is poorly maintained. Despite a high degree of investment made by external agencies essential devices, such as x-ray machines, anaesthetic equipment, and respiratory equipment are now out of date in most of the hospitals (Ibraimova et al., 2011).
Despite many challenges in the physical resources, the health sector is properly equipped with sufficient human resources (Ibraimova et al., 2011). Nearly all medical officers are employed by the government. The medical labour force is made up of a large number of highly specialized physicians as well as trained nurses (Ibraimova et al., 2011). Another key encouraging issue is the internal labour mobility with the health sector. For instance, 3080 nurses and 1099 doctors in 2009 left the government health sector, with 180 nurses and 60 doctors emigrating (European Observatory on Health Care Systems, 2000).