In 1993 the World Bank reported that the population of Kyrgyzstan enjoyed better health care than most other countries with similar per capita income, which averaged US$3,410 per year for Kyrgyzstan's category in 1992. The current health conditions and health prospects of Kyrgyzstan's population are difficult to calculate, however, because of the sudden change that independence visited upon the medical community. Until 1991 Kyrgyzstan's medical system was financed through the Soviet Union's Ministry of Health, which guaranteed a health establishment equal to that of other Soviet republics. With the dissolution of the Soviet Union and the slow collapse of fiscal ties between Kyrgyzstan and Moscow, the medical community has inherited an aging but generally adequate physical plant. However, the system often lacks the vaccines, medicines, and other resources needed to maintain the health of the population.
Health Care System
Kyrgyzstan inherited the Soviet system of free universal health care, which in Kyrgyzstan's case generally provided sufficient numbers of doctors, nurses, and doctor's assistants, as well as medical clinics and hospitals. However, since 1991 citizens often have received inadequate care because medical personnel are not well trained; pharmaceuticals, medical supplies, and equipment are insufficient; and facilities are generally inadequate and unsanitary.
In 1991 Kyrgyzstan had 15,354 doctors, or 34.2 per 10,000 people. Paramedical workers totaled 42,448, or 94.6 per 10,000 people. Some 588 outpatient clinics were in operation, averaging 139 hours of patient visits per eight-hour shift. In addition, 246 general and twenty specialized hospitals were in operation; nearly one-third of all hospitals were located in Osh Province (which also had about one-third of the country's total population). By contrast, the capital city, Bishkek, had the fewest hospital facilities per capita of all regions, providing 1.55 general hospitals per 100,000 population. Like other Central Asian countries, Kyrgyzstan has continued the Soviet practice of state enterprises having their own clinics and sanatoriums. With the dissolution of the Soviet Union, Kyrgyzstan's residents lost the right to free treatment in the hospitals of other former republics, making unavailable many types of specialized treatment that the Soviet system had apportioned among adjacent republics.
Very few truly private health facilities have developed in the early post-Soviet period, and those that exist face very high licensing fees. Although it is illegal for state employees in the health field to diversify their activity into private practice, by 1993 many health workers were accepting unreported payments for providing additional treatment. In 1992 the maximum salary of a medical specialist such as a surgeon was only about 18 percent higher than the maximum salary of a technician or laboratory worker. Under such conditions, the rising cost of living in 1992 and 1993 forced many doctors to leave medicine for higher salaries in other professions.
Kyrgyzstan produces no vaccines of its own and almost no medicines or other pharmaceuticals. Drug availability is substantially higher at regional facilities than at smaller ones, but items such as antihistamines, insulin, antiseptics, vaccines, and some narcotics are either extremely scarce or extremely expensive. The other former Soviet republics now demand payment in United States dollars, which Kyrgyzstan does not have, for medical supplies. Because of the scarcity of vaccines, there is a greatly increased likelihood of epidemics of diseases such as diphtheria and measles. An outbreak of measles in Bishkek in early 1993 was said to be just below epidemic level. It has become common practice in hospitals and clinics to require patients to provide their own medicines for operations and other medical procedures. Because virtually the only available medicines are those for sale in the public bazaars, quality is questionable, and accidental poisonings caused by misuse and spoilage have been reported.
Kyrgyzstan's post-Soviet financial crisis has reduced government support of the Soviet-era health system, forcing government planners to formulate an ambitious health care delivery reform program. The center of the program is a transformation of the national health system into a system of public health insurance, in which compulsory employer fees and a health insurance tax on employees would support care for employees, and state contributions would support care for unemployed citizens. All employed citizens would be required to carry health insurance. All care providers would switch from the salary basis of the old system to a fee-for-service payment system. Because the banking, record-keeping, and tax systems of the country are not ready to support such a nationwide program, however, installation has lagged far behind the original timetable, which called for a pilot program in Bishkek in 1993.
The main causes of adult deaths in Kyrgyzstan are, in order of occurrence, cardiovascular conditions, respiratory infections, and accidents (see table 5, Appendix). Sexually transmitted diseases reportedly are very low in incidence; only five cases of acquired immune deficiency syndrome (AIDS) were recorded in 1992. In the early 1990s, major health hazards have been posed by growing shortages of chlorine to purify water supplies and the increasing danger of typhus outbreaks resulting from the closure of most of the country's public baths. In 1993 Kyrgyzstan suffered increasing cases of hepatitis and gastrointestinal infections, especially in the southern provinces of Osh and Jalal-Abad. The cause of such infections is believed to be the use of open water supplies contaminated by livestock and improper disposal of waste (see Environmental Problems, this ch.). Although adults traditionally consume most of their water in the form of boiled tea, children have greater access to untreated water and foods.
Additional stress is placed on the population by the rising cost of food, which has reduced the quality and quantity of most people's diets. In 1993 meat consumption was reported to have dropped by 20 percent since 1990, intake of milk products by 30 percent, and consumption of fish (which was imported in the Soviet period) by 70 percent. The average caloric intake was reported to have decreased by about 12 percent since 1990. There are also frequent reports of deaths or injuries caused by tainted or falsely labeled food and drink, particularly alcoholic beverages, which are widely sold by extralegal private concerns. The rising cost of energy has meant insufficient heat for many apartments and public buildings. Naryn Province, the coldest and most remote part of the country, has been particularly affected. In that region, many buildings lack central heating, and residents have been forced to devise homemade stoves vented directly out the windows. In addition, the availability and range of ambulance services have been restricted severely by fuel shortages.
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