Central Asian Post-Soviet health systems in transition: has different aid engagement produced different outcomes?
Central Asian Post-Soviet health systems in transition: has different aid engagement produced different outcomes?
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DOI：
10.3402/gha.v7.24978
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发表时间：
2014-01-01
影响因子：
2.6
通讯作者：
Hill, Peter S.
中科院分区：
文献类型：
--
作者：
Ulikpan, Anar;Mirzoev, Tolib;Hill, Peter S.
背景：1991年苏联解体导致后苏联国家从中央计划的社会主义体制向主要的自由市场体制过渡。中亚后苏联国家（吉尔吉斯斯坦、蒙古、塔吉克斯坦、土库曼斯坦和乌兹别克斯坦）的卫生系统经历了一场深刻的革命。外部发展伙伴通过财政和技术支持对这种重新定位至关重要，尽管关系和结果各不相同。这项研究对cap国家卫生系统提供的发展援助进行了比较审查，并提出了未来的政策选择，以提高发展的有效性。设计：使用Pubmed、Medline/Ovid、Scopus和谷歌学者搜索引擎、当地网站、捐赠者报告和灰色文献进行广泛的文献综述。该审查还补充了主要举报人访谈和参与者观察。结果：苏联在该地区统治地位的崩溃带来了许多卫生系统挑战。捐助者在卫生系统改革中发挥了重要作用。然而，作为新的援助受益者，cap国家的政府和捐助者都没有在这方面进行发展合作的经验。与其他收入相似的国家相比，cap国家的卫生发展援助规模有限，部分原因是它们与捐助界的历史有限，缺乏管理捐助者的经验，以及在国际交往中透明度有限。尽管一开始有共同点，但由于政治和治理背景的不同，cap国家形成了两种截然不同的发展轨迹。结论：捐助者在财政和技术上的影响对卫生部门改革仍然至关重要，尽管它们对总体卫生预算的贡献相对较小。吉尔吉斯斯坦、蒙古、塔吉克斯坦发展合作成效显著，卫生成果有所改善；可以说，乌兹别克斯坦和土库曼斯坦在健康和社会经济指数方面取得的进展较慢，因为它们抵制开放和负责任的发展关系。
Background: The collapse of the Soviet Union in 1991 resulted in a transition from centrally planned socialist systems to largely free-market systems for post-Soviet states. The health systems of Central Asian Post-Soviet (CAPS) countries (Kyrgyzstan, Mongolia, Tajikistan, Turkmenistan, and Uzbekistan) have undergone a profound revolution. External development partners have been crucial to this reorientation through financial and technical support, though both relationships and outcomes have varied. This research provides a comparative review of the development assistance provided in the health systems of CAPS countries and proposes future policy options to improve the effectiveness of development.Design: Extensive documentary review was conducted using Pubmed, Medline/Ovid, Scopus, and Google scholar search engines, local websites, donor reports, and grey literature. The review was supplemented by key informant interviews and participant observation.Findings: The collapse of the Soviet dominance of the region brought many health system challenges. Donors have played an essential role in the reform of health systems. However, as new aid beneficiaries, neither CAPS countries' governments nor the donors had the experience of development collaboration in this context. The scale of development assistance for health in CAPS countries has been limited compared to other countries with similar income, partly due to their limited history with the donor community, lack of experience in managing donors, and a limited history of transparency in international dealings. Despite commonalities at the start, two distinctive trajectories formed in CAPS countries, due to their differing politics and governance context.Conclusions: The influence of donors, both financially and technically, remains crucial to health sector reform, despite their relatively small contribution to overall health budgets. Kyrgyzstan, Mongolia, and Tajikistan have demonstrated more effective development cooperation and improved health outcomes; arguably, Uzbekistan and Turkmenistan have made slower progress in their health and socio-economic indices because of their resistance to open and accountable development relationships.