Central and West Asia Health Sector Approach 2025

CENTRALAND WESTASIA HEALTHSECTORAPPROACH2025 HEALTHTRENDS Healthservicesandnoncommunicablediseases PRIORITYAREASFORADB 1.Integratedhealthservicesnetworks 2.Nationalhealthfinancingreforms 3.Digitalhealth 4.Regionalhealthsecurity WAYFORWARD CENTRALANDWESTASIA HEALTHSECTORAPPROACH2025 ADB’sCentralandWestAsiaDepartmentmanagesoperationsin10countries UniversalHealthCoverage 1Afghanistan* 2Armenia 3Azerbaijan 4Georgia 5Kazakhstan 6KyrgyzRepublic 7Pakistan 8Tajikistan 9Turkmenistan10Uzbekistan *ADBplaceditsregularassistancetoAfghanistanonholdeffective15August2021. HEALTHSECTORREFORMS Widerangeofreformsmadeprogress,buthealthservices—includinggovernanceandmanagement,financing,andhumanresourcesdevelopment—requiremuch PRIORITYAREAS 2 Supportnationalhealthfinancingreforms 1 AGING HEALTHSERVICES Reasonablephysicalaccesstohealthservices,buttheseareoftenlimitedandfragmented moreattention NONCOMMUNICABLE DISEASES Majorcontributorto Developintegratedhealthservicesnetworks 4 Enhancingregionalhealthsecurity 3 POPULATION Longerlifeexpectancy,decliningfertility, andoutmigration mortalityandmorbidity,anddecliningslowlywithlifestylechangesandbetterpreventionandcare Advancedigitalhealthforbettersectorperformance Thepandemicshowedthedeepimpactofpublichealtheventsandbroaderweaknessesinthehealthsector andbeyond OVERALLPOSITIVETRENDOFHEALTHINDICATORS Thetotalage-adjustedburdenofdiseaseshasbeendeclininginallCentralandWestAsiacountriesaslivingconditions,foodsecurity,andhealthserviceshaveimproved CONTENTS 6 Introduction 10 Population 14 andHealthTrends ADBSupportfortheRegionandHealthSectorPriorities 23 WayForward 8 Background 12 HealthSector Developments 22 Crosscutting Themes Coverphoto Dr.DamiraTashmamatova,headofmaternitydepartment,posesforaportrait,atthenewly renovatedperinatalcenterofOshCityClinicalHospital,theKyrgyzRepublicinNovember2022.ADBCOVID-19PandemicEmergencyProjectsupports18hospitalsandmedicalfacilitiesinthecountry. Acknowledgments UndertheleadershipofRieHiraoka,formerdirector,SocialSectorDivision,CWRDinADB,thisCentralandWestAsiaHealthSectorApproach2025waspreparedbyBrianChin,seniorhealthspecialist,withtheassistanceofVincentdeWit,publichealthconsultant,with contributionsfromAzizHaydarov,officer-in-charge,SocialSectorDivision,HiddoA.Huitzing,seniorhealthspecialist;KirthiRamesh,socialsectorspecialist;HaymanWin,seniorhealthspecialist;andCebeleWong,healthspecialist.ArinDutta,seniorhealthspecialist,providedpeerreview.CWRDcountrydirectorsandresidentmissionstaffprovidedvaluableinputs. KeisukeTaketaniprovidedgraphicsdesignandlayout,LaylaTanjutcoprovidedcopyediting,JessMacasaetprovidedproofreading,MaricelleAbellarprovidedpageproofchecking,andGladysMaravillaprovidedadministrativeassistance. Notes: Bymakinganydesignationoforreferencetoaparticularterritoryorgeographicarea,orbyusingtheterm“country”inthisdocument,ADBdoesnotintendtomakeanyjudgmentsastothelegalorotherstatusofanyterritoryorarea. Inthispublication,“$”referstoUnitedStatesdollarsAllphotosbyADBunlessotherwisenoted. CreativeCommonsAttribution3.0IGOlicense(CCBY3.0IGO) ©June2023ADB.TheCClicensedoesnotapplytonon-ADBcopyrightmaterialsinthispublication. https://www.adb.org/terms-use#openaccesshttp://www.adb.org/publications/corrigendaPublicationStockNo.ARM230221-2pubsmarketing@adb.org LugarResearchCenteremployeesinGeorgiapreparebiologicalmaterialsinthePCRtestingmachinepurchasedthroughtheADBgrant. TheAsianDevelopmentBank(ADB)iscommittedtoachievingtheSustainableDevelopmentGoals(SDGs)includinguniversalhealthcoverage(UHC)andregionalhealthsecurity(RHS).ToinformADB,members’governments,partners,andotherstakeholders,thispublicationsummarizeshealthsectorprogress,priorities,andchallengesintheCentralandWestAsia(CWA)countries,aswell ascurrentandplannedresponsesofthebank’sCentralandWestAsiaDepartment(CWRD).CWRDmanagesADBoperationsin10CWAcountries(Afghanistan,Armenia,Azerbaijan,Georgia,Kazakhstan,theKyrgyzRepublic,Pakistan,Tajikistan,Turkmenistan,andUzbekistan).1 CWApopulationsareagingwithlongerlifeexpectancy,decliningfertility,andoutmigration.2Noncommunicablediseases(NCDs)contributeabout80%ofmortalityin8CWAcountries,andaredecliningslowlywithlifestylechangesandbetterpreventionandcare.3Maternalandchildconditionsandcommunicablediseasescontributeaboutone-thirdoftheburdenofdiseases(BOD)inAfghanistanandPakistan.LaggingSDGsarelinkedtovulnerablecommunities.Thecoronavirusdisease(COVID-19)pandemicshowedthe deepimpactofpublichealtheventsandbroader weaknessesinthehealthsectorandbeyond. CWAcountrieshaveamixofpublicandprivatehealthservicesthatarecurative-orientedandlesseffective.Physicalaccesstohealthfacilitiesisgenerallysatisfactory,butthehospitalbedstopopulationratioisverylowinAfghanistanandPakistanandbeingreducedfurtherinseveralformerSovietUnioncountries.Therange,quality,andaffordabilityofhealthservicesarelesssatisfactoryintheregion,withsubstandardfacilities,lackofskilledstaffandmedicines,bypassingofhealthservices,andhighout-of-pocket(OOP)payment.4 CWAcountriesareconductingwide-rangingsectorref