The first medical institutions in Kyrgyzstan appeared in the late 19th century: reception rooms in Pishpek with 6 beds, in Karakol with 6 beds, in Osh with 5 beds, and in Tokmok with 5 beds. Medical and obstetric points (FAP) operated in the villages of Pokrovka, Belovodskoye, and Sazanovka. The health status of the population was poor: smallpox was rampant, and epidemics of cholera, typhus, syphilis, tuberculosis, and childhood infections were ongoing.
Before the revolution, medical assistance in Kyrgyzstan was provided by 9 hospitals with 100 beds, of which four were in the cities of Pishpek, Karakol, Tokmok, and Osh with 70 beds and 5 rural hospitals in the villages of Kara-Balta, Alexandrovka, Belovodskoye, Bazar-Korgon, and Sazanovka with 30 beds; there were 30 outpatient clinics and FAPs. Only 15 doctors were working. During the Civil War, epidemics of cholera and typhus intensified in Kyrgyzstan. Health departments were established in the districts, which headed medical services and took measures to combat epidemics and organize the work of medical institutions. By mid-1923, the main epidemic hotspots were eliminated.
In 1924, the People's Commissariat of Health of the Turkestan Republic sent 2 medical examination teams to Kyrgyzstan, which operated in the north and south of Kyrgyzstan. At that time, a regional health department was also established. In 1925, specialized types of medical assistance appeared. A maternity hospital with 20 beds and a children's consultation were opened in Pishpek, and dental offices were organized in urban outpatient clinics. Venereological institutions were opened in Pishpek, Tokmok, Osh, and Kochkorka. In 1926, the People's Commissariat of Health of the Kyrgyz ASSR was created. By the end of 1926, with the expansion of the network of medical institutions, an improvement in medical services for the population was noted. About 660 hospital beds were operational. Starting in 1926, a new form of medical service for the rural population was introduced: mobile medical teams, which, alongside treating the population, studied regional pathology. In 1927, a special team for identifying and treating eye diseases was sent to Kyrgyzstan by the Ministry of Health of the RSFSR. In 1928, a medical college opened in Frunze. The further development of healthcare in the republic was determined by the development plan for the first five-year plan (1929-32), according to which hospitals were built in Bystrovka, Tamga, Kochkorka, Batken, Uzgen, Karakol, and Tyup. Medical and paramedic health posts were opened at industrial enterprises. Special attention was paid to the protection of motherhood and childhood. The sanatorium-resort business also developed. Intensive work was carried out to study and treat social diseases. Medical examination teams from the center of the country played a certain role in this. Significant work was done to combat and eliminate smallpox. Since 1936, no cases of smallpox have been observed in Kyrgyzstan. In 1936, the republic had 17 urban hospitals with 1,171 beds. Work was underway to expand the network of anti-epidemic institutions; in 1940, the republic had 5 regional, 3 urban, 2 district, and one inter-district sanitary-epidemiological stations. In 1938, the Research Institute of Epidemiology and Microbiology was opened in Frunze. The fight against tuberculosis intensified. By the end of 1940, 2 tuberculosis dispensaries (Frunze, Przhevalsk) and 4 tuberculosis points (Osh, Jalal-Abad, Kyzyl-Kiya, Tash-Kömür) were operational. Issues of training personnel were addressed: medical schools were opened in the cities of Karakol, Osh, Jalal-Abad, and Tokmok. In 1939, a Medical Institute was opened in Frunze — the main higher educational institution preparing medical personnel in the republic. Medical science developed vigorously, and in 1939, the journal "Healthcare of Kyrgyzstan" was established.
During the Great Patriotic War (1941-45), two tasks faced the healthcare system of the republic: ensuring sanitary-epidemiological well-being in the republic and assisting the wounded arriving from the front. Sanitary-epidemiological stations (59) were opened, and temporary epidemiological beds (1300) were deployed. A large vaccination campaign was conducted, especially against typhoid fever and dysentery, along with sanitary-educational work. As a result, outbreaks of individual infectious diseases did not spread. During the war, several dozen hospitals were opened in Kyrgyzstan for the treatment of wounded arriving from the front, with more than 50% of them returned to duty.
In the post-war years, healthcare in the republic received significant development. In 1947, the unification of polyclinics with hospitals began, and district assistance to the population was organized. In 1950, 136 hospitals (6880 beds) were operational in the republic, of which 98 hospitals (2600 beds) were in rural areas.
By 1955, the main issues of specialized assistance to the population were resolved: anti-tuberculosis, oncological, and psychiatric dispensaries were opened in all regional and district centers. In 1958, the Research Institute of Tuberculosis was established. By 1965, the base of rural health and preventive institutions strengthened: 20 central and 11 numbered district hospitals, 145 rural outpatient hospitals, and 697 medical and obstetric points were operational, with 211 collective farm maternity hospitals. Significant attention was paid to the protection of motherhood and childhood. In 1961, the Research Institute for the Protection of Motherhood and Childhood was opened. Since 1958, thoracic surgery has been developing in the republic, and the first heart surgery was performed. During these years, resuscitation centers were created, and research institutes for oncology, radiology, resort therapy, and cardiology were opened. In subsequent years, dozens of large institutions were put into operation in the republic: a complex of hospitals in the city of Kyzyl-Kiya, treatment buildings of the Research Institute of Obstetrics and Pediatrics, the republican clinical hospital, and the emergency medical hospital in Frunze, as well as a new surgical center and a regional hospital in Osh. The phased provision of medical assistance to the rural population became firmly established. Attention was paid to increasing the number of medical and obstetric points (by 1980 their number reached 905), and the capacity of many outpatient hospitals increased. The therapeutic and pediatric medical sections were reorganized. In 1980, 267 hospital institutions operated in the republic with 43,600 beds, including 4,479 beds for pregnant women and women in labor. The number of pharmacies and pharmacy institutions reached 296 (in rural areas — 190). The number of doctors of all specialties was 10,400, and the number of nursing staff was 32,700.
1980-90 was a period of improvement in the primary healthcare system. Increased attention was paid to organizing medical assistance for specific groups: veterans of the Great Patriotic War, residents of rural areas, especially those living in areas of pasture livestock breeding, preschool and school-age children, and adolescents (15-18 years old), as well as students. Issues of dispensary observation for these groups, their health improvement and treatment, if necessary, in inpatient and sanatorium-resort conditions were developed and implemented. Alongside this, significant attention was paid to the development of specialized services. Large health and preventive institutions capable of providing medical and diagnostic assistance in 25-35 specialties operate in all regional centers. A Republican Diagnostic Center equipped with modern medical technology was opened in Bishkek, and the Republican Rehabilitation Hospital (subsequently, the Research Institute of Resortology and Rehabilitation) was opened in the village of Tash-Töbö. For the first time in the USSR, a polyclinic for veterans of the Great Patriotic War was built and opened, among others.
To develop medical institutions in rural areas, newly built or unfinished facilities intended for various institutions and organizations were transferred to healthcare. More than 600 such facilities were transferred. Children's milk kitchens were opened everywhere, and work was done to telephone medical and obstetric points and rural medical outpatient clinics (over 70% were equipped with telephones). Other work was carried out to bring medical assistance closer to the rural population living in areas of pasture livestock breeding (mobile medical consultations, dental offices, fluorographic offices on "wheels," etc.). The measures taken allowed the number of hospital institutions to increase to 304 by 1990, the number of beds to 52,245, and the number of doctors to 15,043.
After gaining state independence, due to the development of market relations, a process of reforming the economy began in all sectors of the national economy in the Kyrgyz Republic, including the healthcare sector. Healthcare institutions faced complex tasks — preserving and strengthening the health of the population, especially children, women, the elderly, and other categories of low-income citizens in difficult economic conditions. Alongside this, strategies in the field of healthcare were developed, establishing the foundation for the protection of the population's health. The years 1991-2000 were foundational and required the medical community to mobilize all scientific and practical potential, as well as the experience of healthcare organizers to develop projects for new healthcare laws and program documents.
In 1992, Kyrgyzstan became a member of the World Health Organization (WHO). Based on an agreement between the Government of the Kyrgyz Republic and the European Regional Office of WHO, an Information Center for Health Protection for Central Asian republics was opened in Bishkek in 1993, and since 1994, a WHO Coordination and Liaison Office has been operating, which serves as WHO's representation in Kyrgyzstan.
The economic crisis led to a sharp decline in healthcare funding levels. If in 1990 healthcare expenditures accounted for 4.2% of GDP, in 1994 it was 3.3% of GDP, and by 1998 this figure had dropped to 2.6% of GDP (880.2 million soms), and in 2000 it was 2.1% of GDP (1,295.9 million soms). The actual reduction in funding for the public healthcare sector, taking inflation into account, is much more significant than the figures mentioned above. Government allocations (the main source of funding) currently allocated for healthcare account for about 50% of their needs. Additional funding sources include mandatory health insurance funds, income from extrabudgetary activities, voluntary health insurance, grants, and loans received by health authorities and institutions.
From 1992 to the present, significant external economic assistance has been provided to the healthcare sector, with which medicines, medical equipment, and medical supplies, contraceptives, and vaccines were purchased. Investments have equipped and outfitted the Republican Children's Clinical Hospital, the maternity hospital of the Research Institute of Obstetrics and Pediatrics, the emergency medical hospital in Bishkek, and the Jalal-Abad Regional Children's Hospital. Medical equipment and instruments for the Central Republican Hospital, rural outpatient hospitals, rural medical outpatient clinics, and medical and obstetric points in remote areas have been received, and repair work has been completed in more than 70 health and preventive institutions in the republic.
Among the foreign investors who provided the most substantial assistance are the governments of the USA, Denmark, Germany, Japan, Switzerland, as well as the World Bank, the Islamic Development Bank, the Asian Development Bank, the German Development Bank, and international organizations such as WHO, UNDP, UNICEF, UNFPA, the European Community Commission, the Swiss Red Cross, and others. In 1999, an agreement was signed with the American International Health Alliance (AIHA) and KGMA, based on which extensive programs aimed at deepening reforms in medical education will be implemented. Productive relations have developed with the British Know-How Fund, the Japanese government agency (JICA), and the German Society for Technical Cooperation (GTZ). Relations with neighboring countries, based on traditional ties and agreements signed in recent years, are stable. The reform and formation of a new healthcare system also include a new model of financing the sector.
The most important milestone in the development of the compulsory health insurance (CHI) system was the adoption of the Law "On Medical Insurance for Citizens of the Kyrgyz Republic" in 1999. As of January 1, 2001, more than 1 million 890 thousand citizens were insured under CHI (in 1999 — 1 million 470 thousand), including over 900 thousand employed (in 1999 — 870 thousand). Currently, there are 82 hospitals (in 1999 — 65) and 413 outpatient clinics (in 1999 — 396) operating in the CHI system. By 2000, despite a limited budget and a decrease in the share of healthcare expenditures from GDP, it was possible to maintain the volume, level, and accessibility of medical assistance, ensure the population's access to medicines and medical supplies, and improve the main health indicators of the population.
Social and economic instability, internal and external migration of the population, and active family planning activities and their accessibility contributed to a decrease in the birth rate in the republic to 19.5 per 1000 population in 2000 (1991 - 29.1; 1994 - 24.6; 1997 - 22.0).
In recent years, there has been a trend towards a decrease in the overall mortality rate of the population from 8.3 per 1000 population in 1994 to 6.9 in 2000, the infant mortality rate from 29.1 per 1000 live births in 1994 to 22.6 in 2000, and maternal mortality from 80.1 per 100,000 live births in 1994 to 46.5 in 2000.
A serious problem in the republic in recent years has been the progressive increase in endocrine pathology, including diabetes mellitus in all age groups. Respiratory diseases occupy a leading place in the structure of morbidity, both in adults and children (in 2000 — 19.3% among adults and adolescents and 35.4% among children). Bronchopulmonary pathology is the second leading cause of mortality after cardiovascular diseases, accounting for 12.9% of all deaths in 2000. Diseases of the circulatory system deserve special attention, as more than 14,000 people die from them annually in the country, or about 40 people daily. The percentage of individuals newly recognized as disabled remains high at +1 percent. The primary incidence of disability from cardiovascular diseases was 3.4 per 10,000 adults in 2000. To ensure timely detection, stabilization, and subsequent reduction of disability and mortality from this pathology, national programs "Diabetes Mellitus" (1999-2004) and "Healthy Heart — to Every Kyrgyz Citizen by 2010" were adopted, and a public organization "Kyrgyz Asthma Center" was created. The efforts undertaken by the Ministry of Health in collaboration with WHO for population vaccination and a series of preventive measures have led to a stable trend in reducing morbidity from 23 out of 33 infectious diseases registered in the country over the past 8 years.
The main problem in the country remains the incidence of tuberculosis, which reached the level of the 1950s by 1998, amounting to 123.7 per 100,000 population. Starting from 1970, a significant decrease was noted, reaching 51.8 per 100,000 population by 1985. In the last 8 years, due to the deteriorating socio-economic situation, the country has again seen an increase in this disease. To ensure timely detection, treatment of patients, and reduction of mortality from tuberculosis, the National Program "Tuberculosis" was adopted in 1995. New highly effective methods for treating tuberculosis patients (DOTS strategies) recommended by WHO are being implemented throughout the republic, which will ensure early detection and treatment of patients within 4-8 months. Under the influence of a complex of adverse factors, the level of sexually transmitted diseases (STDs) has significantly increased over the past 8 years. For example, the incidence of syphilis has increased 37 times compared to 1991 (from 2.0 in 1991 to 73.9 in 2000).
The growth in the number of HIV-infected individuals is concerning. From 1989 to 2000, 53 HIV-infected individuals were registered, of which 14 were among compatriots. Due to the emergence of a serious problem of a new infectious disease, the Republican Center for Combating AIDS was established in 1989. In 1994, regional centers for combating AIDS were organized. However, the high level of STD morbidity, the increase in the number of drug users, as well as those involved in commercial sex, and intense external and internal migration of the population require caution in interpreting data on HIV infection morbidity.
Certain successes have been achieved in the fight against infections controlled by immunoprophylaxis. According to the implementation of the "Immunoprophylaxis" program (1994-2000), vaccination coverage reached 95-98%. According to conducted studies, vaccination provides a tangible economic effect, where every som invested in immunization against measles and mumps yields a tenfold saving in funds spent on treating patients.
In the republic, the Global WHO Program for the Elimination of Poliomyelitis is successfully implemented, thanks to which only a few cases of the disease were registered by 2000. Immunization has also helped reduce the incidence of viral hepatitis B and D. Given the high importance of immunoprophylaxis in the fight against infectious diseases, a new program "Immunoprophylaxis 2001-2005" has been developed. Despite some trends towards a decrease in the incidence of acute intestinal infections, its level remains high and is mainly associated with unsatisfactory water supply, sewage, and sanitation in populated areas. The population's access to centralized water supply is only 76.3%, with rural water supply being significantly lower, especially in the Osh and Jalal-Abad regions. In this regard, the Law of the Kyrgyz Republic "On Drinking Water" was adopted in 1999, and the National Program "Drinking Water" was developed. The situation with the incidence of malignant neoplasms, alcoholism, and mental disorders remains extraordinary in the republic. Like any country that is a transit point for drug trafficking, Kyrgyzstan has faced the problem of significant growth in drug addiction. Over the past 8 years, the incidence of drug addiction has increased almost fourfold.
The government has adopted program documents aimed at implementing measures to stabilize and reduce morbidity from these pathologies (the Law "On Psychiatric Assistance and Guarantees of Citizens' Rights in Its Provision," approved programs: "On Urgent Measures to Improve Psychiatric Assistance to the Population of the Kyrgyz Republic for 1999-2005," "Alcohol and Health," "Health-21," which developed a strategy for reforming the narcological service, etc.).
Despite the lack of financial resources, over the past 8 years, more than 2000 beds in hospital institutions and 2,500 outpatient clinic visits per shift have been put into operation, including more than 1000 beds and about 2000 visits per shift in rural areas. New facilities have been introduced in the Osh and Jalal-Abad regions, as well as in Bishkek. However, the availability of beds has decreased by 41.2% since 1992.
As part of the reforms, structural changes have been made in healthcare authorities and institutions in accordance with the National Program "Manas." The National Center for Cardiology and Therapy, the National Surgical Center, the Republican Diagnostic Center, the Kyrgyz Scientific Center for Hematology, the Republican Children's Hospital, and the Republican Centers for Narcology and Reproductive Health Protection have been established, and the Kyrgyz State Medical Institute has been transformed into the Kyrgyz State Medical Academy. The tuberculosis hospitals "Cholpon-Ata," "Issyk-Kul," "Shekaftar," "Kyzyl-Bulak," and the psychiatric hospital "Kyzyl-Zhar" have been granted republican status.
The outpatient and polyclinic service is being improved in the republic. Primary healthcare centers have been established in all regions. Adult, children's polyclinics, and women's consultations are being merged into unified polyclinics based on the principle of single territorial service, and family doctor groups (FDGs) have been created to improve the quality of preventive and therapeutic work directly in families. Currently, about 800 FDGs are already operating in all regions of the republic, including more than 140 that are legally independent. The priority areas of primary healthcare include: protection of women's reproductive health, combating acute respiratory infections (ARIs) and childhood diseases, tuberculosis, STDs, and others. The actively conducted reform for the rational use of hospital bed resources has led to a reduction in inpatient beds by more than 18,800 beds from 1991 to 2000, with bed availability in 2000 being 70.0 per 1000 population (compared to 118.9 in 1991). The reform of rural healthcare continues: the bed fund of rural outpatient hospitals (ROHs) has decreased by more than 5000 beds. About 35% of ROHs have been transformed into primary healthcare centers. Since 2000, 863 medical and obstetric points have been operating in the republic. The Ministry and other healthcare organizations, in collaboration with local government leaders, are taking measures to retain specialists in rural areas and create social and living conditions for them. Work continues to rationalize regional, urban, and republican hospital institutions.
In order to transition to family medicine practice, family doctors and specialists in higher nursing education are being trained at KGMA and the Republican Center for Continuous Training of Medical and Pharmaceutical Workers. The reform of postgraduate medical education, accreditation, and certification of the Kyrgyz Medical Academy Centers for training managers and economists continues. Physicians of therapeutic, pediatric, and obstetric-gynecological profiles are being trained in family medicine for work in FDGs.
In accordance with program documents, a phased reform of the pharmacy network has been carried out. Joint-stock companies and limited liability companies are being created based on pharmacy institutions, and private pharmacies have been opened. Currently, about 97% of the pharmaceuticals sold in the republic are imported from CIS countries and abroad. There is a trend towards the development of domestic pharmaceutical production. Currently, 17 manufacturing firms are engaged in the production of medicines in the republic. The largest of these are the Bishkek Chemical and Pharmaceutical Plant "Aidan-Pharm" and JSC "Bishkekbiofarm." In total, 149 types of medicines are produced at pharmaceutical enterprises in the republic, with the volume of produced goods in 1999 amounting to more than 23,881 thousand soms and the volume of sold products exceeding 23,608 thousand soms. The state provides control over the production, import, and sale of medicines, and the Republican Center for Standardization and Quality Control of Medicines and Medical Equipment has been established, which is equipped and outfitted according to modern requirements. A National Strategy in the field of drug policy has been developed and adopted, which includes the selection of essential medicines, assessment of the need for vital medicines, establishment of criteria, and ensuring the registration of medicines. A National Drug Formulary has been prepared, the information system is being strengthened, and pre-diploma and post-diploma training of pharmaceutical specialists is being carried out.
In Kyrgyzstan, further concentration of state funding and scientific potential in priority areas of healthcare is planned, using competitive funding for fundamental research, promoting scientific and technical entrepreneurship, and developing small innovative enterprises and experimental production.
Highly qualified doctors work in republican health and preventive and research institutions, providing medical assistance in 44-48 specialties. The number of doctors of all specialties in 2000 was 13,608 (availability — 27.8 per 10,000 population), which is 18.2% less than in 1992 (absolute number 15,197; internal indicator — 4.0).
Specialists have access to modern medical equipment, including nuclear magnetic resonance, computed tomography, ultrasound machines, endoscopes, laparoscopes, laser devices, and many others.
The scientific medical personnel of Kyrgyzstan include 8 academicians and corresponding members of the National Academy of Sciences, 102 doctors, and 356 candidates of medical sciences. The priority areas of medical science today are the study of the mechanisms of pathological processes in humans, maternal and child health issues, the birth of healthy offspring, and the reduction of morbidity and mortality from cardiovascular, bronchopulmonary, and oncological diseases.
In connection with healthcare reform and the introduction of medical insurance, the certification of medical workers is being conducted. The first stage (1996-99) of licensing and accreditation of health and preventive institutions in the republic has been completed. Conditions for competition are being created. Alongside state institutions, 91 non-state medical institutions currently operate, employing more than 700 doctors and over 500 nursing staff. The reform has also affected the sanitary-epidemiological service. The State Sanitary and Epidemiological Surveillance Department has been created, laboratories of the SES are being accredited, and the integration of the activities of epidemiologists and FDGs in Primary Healthcare Centers is being carried out. Following the medical and sanitary measures conducted in the emergency zone in the Batken region, proposals for the creation of a "Disaster Medicine" service are being developed.
