This paper surveys health reform in the former Soviet republics of Central Asia, in the aftermath of their independence and transition from the Soviet command economy. Socio-economic, epidomiological and institutional realities face the countries. Section 2 sets out demographic and epidemiological trends, which suggest the scope and priorities for health services. The next section analyzes recent economic performance, highlighting worsening financial constraints. The existing health systems are evaluated in Section 4, centering on their primary strengths and weaknesses. Section 5 addresses critical institutional elements of the reform process, including decentralization and staffing issues. The reform agenda facing health policymakers in Central Asia is then investigated in Section 6, focusing upon empirical and descriptive aspects, in order to provide a reliable basis for discussing future options. Section 7 concludes that the large declines in real health spending signal that each country will have to do more with less. Consequently, current public health programs like maternal and child health programs will need to be restructured; improvement incentives to induce consumers and providors to behave more efficiently will have to be issued; and modorn management and quality assurance systems will have to be introduced. Although the reform debate focuses on financial sustainability, particularly attempts to bring in additional non-budget revenues, equally important is the need to focus on basic public health activities and delivery system restructuring.
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