Overview of Central Asia Region

Central Asia is the region of the World that lies between the Caspian Sea, in the West, and China and Mongolia, in the East, Russia in the North and Afghanistan in the South. Nowadays, the countries that form Central Asia, Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan are all former Soviet Union countries.

In 2019, the number of people living in Central Asia was 72 million, consisting of 18 million people living in Kazakhstan, 6 million people living in Kyrgyzstan, 9 million people living in Tajikistan, another 6 million people living in Turkmenistan and 33 million living in Uzbekistan.

The actual regional healthcare structure is based on the medical structure that has been inherited by all the former member countries of the Soviet Union after its fall. As before 1990s, the Soviet Union was controlling the whole healthcare system throughout all its regions, keeping it uniformed. Nowadays, the former members of the Soviet Union find it difficult to raise the standards of the medical services provided, that are, mostly, over 30 years outdated, due to several reasons, but not impossible.

Overall, the Central Asian countries are very concerned about their healthcare infrastructure. There are some reforms taking place, whose effects have been reflected in the improving life expectancy during the last 10 years, but there is still a lot to improve.

Kazakhstan

Kazakhstan is the top performing country of the Central Asia region as it has vast oil and natural gas resources.  It is accounting for more than 60% of Central Asia’s GDP, absorbing over 70% of all the investments in the region.

In the last twenty years, Kazakhstan’s income status has transitioned from lower-middle-income to upper-middle-income, becoming one of the most interested Central Asian populations to seek for medical services abroad.

The number of general practitioners and primary-care physicians in Kazakhstan is relatively low. The long lines and lack of specialists may daunt Kazakh citizens when receiving basic health care services.

According to the World Health Organization, in the northern rural area of Kazakhstan, there are 266 physicians per 100,000 people, while throughout the rest of the country there are 388 physicians per 100,000 people. As a result, Kazakh patients face multiple difficulties during the process of getting even basic health care services.

Life expectancy has increased in the last 20 years in Kazakhstan and it is now 71.4 years. The average life expectancy for women averages 76.3 years, while for men it averages at only 66.2. The high mortality is mainly a combination of alcoholism, diseases and suicides. Additionally, the traditional dishes are hard to digest meat-based specialties, lacking fresh vegetables might play a role in the high incidence of stomach cancers among Kazakhs.

The Kazakh Government is very concerned about the national healthcare system as in the past it has failed to offer medical solutions for treating chronic diseases, such as blood pressure, while focusing on transmissible diseases, such as Tuberculosis, Hepatitis or HIV. Recently, the Kazakh Government has developed primary-care services, in order to raise the chances of eradicating the growing chronic disease mortality.

The latest reform’s, the Compulsory Social and Medical Insurance (CSMI) program, goal is to create a single-payer healthcare system. The Government intends to cover certain medical expenses and regulate healthcare quality (expenditures that are currently in the responsibility of the patient) through public insurance, in order to reduce the out of the pocket expenses, which made up 45.14% of Kazakhstan’s total health spending. The continuous reforming processes that Kazakhstan tries to perform are made in order to achieve a universal healthcare system with greater cost transparency and a better quality of life. Over the years, the government has steadily increased healthcare funding and reduced the influence of private insurance.

Turkmenistan

Turkmenistan is affected by a high mortality rate across its borders, due to communicable diseases, caused by infections or parasites. Also, the non-communicable diseases affecting the population such as raised blood pressure, diabetes and blood cholesterol are the result of poor lifestyle choices, for instance unhealthy diet and lack of exercise. The average life expectancy in Turkmenistan is just 68 years. For women, life expectancy averages 71 years, while for men it is 68 years.

Overall, Turkmenistan has 22 physicians per 1,000 people. As usual in former Soviet Union countries, there is a dichotomy between the healthcare services provided within the urban and the rural areas. The urban areas of Turkmenistan have available modern hospitals, but the services provided by these might be considered expensive. The rural areas, though, are facing shortages in medicine and in medical personnel, while the medical equipment is outdated. Moreover, about 30% of Turkmenistan’s population does not have access to drinking water, which in itself represents a high risk for bad health.

Despite the fact that only 70% of the population has access to drinking water, the Government of Turkmenistan has been continuously endorsing spending on public health and healthy lifestyle among its citizens, pointing to nutrition through private agriculture and banning unhealthy foods and drinks from schools’ lunches.

Uzbekistan

Uzbekistan’s healthcare structure has decreased by almost 50% in the following years Soviet Union’s fall. The fact that most of the medical practitioners have migrated with the first chance and the fact that the public spending on healthcare has been reduced by 50% have resulted in an average of 27.4 doctors per 10.000 people and an average of 53 hospital beds per 10.000 people in Uzbekistan.

The Uzbekistanis rely mostly on the public healthcare system which is divided in three layers: national, regional and local. The State of Uzbekistan is the principal provider and customer for all health related services and goods. There is almost no private health insurance available in Uzbekistan, due to the unsafe procedures that are performed during treatments and surgeries.

According to a study published in the Lancet, Uzbekistanis hold the record for most diet-related deaths per 100.000 people a year, 892 respectively. The most causes of death are correlated to cardiovascular, respiratory, digestive system’s diseases and infectious and parasitic diseases, some due to the consumption of polluted drinking water. Also, diseases that are altering the lives of the Uzbekistanis are the different types of cancers, typhoid, hepatitis, dysentery and cholera.

Kyrgyzstan

Since 1990, based on concerns about the healthcare services and the quality of life among its population, the Kyrgyzstan Government has performed reforms in order to improve the actual situation.

One of the effects of these reforms is reflected in the fact that it has created a mandatory health insurance fund that covers 39% of the total expenditure of patients on the medical services.

Despite the numerous efforts to increase the health services quality in Kyrgyzstan, due to the lack of pharmacy price regulation and the weakening of the national currency, the co-payments for reimbursed medicine have risen and the out-of-pocket costs have increased.

On average, there are 2.5 doctors and 6.4 nurses per 1.000 people in Kyrgyzstan.

Tajikistan

Despite the fact that the largest hospital from Central Asia is in Tajikistan, the country’s health system is well unfunded and is outdated.

In 2014, there were 2.1 doctors, 4.3 nurses and 4.67 hospital beds per 1.000 people, becoming the country with the lowest ratio of doctors per population in the former Soviet Union countries.

As about 70% of Tajikistan’s population lives in rural areas from where the closest medical facilities are usually far away, preventive care is very inaccessible.

Where do Central Asian people seek medical services?

Due to the lack of financial possibilities, studies show that most people that seek medical treatments or other medical services abroad from the Central Asia region are from Kazakhstan and Uzbekistan. There are no recordings of mass medical tourists from Kyrgyzstan, Turkmenistan or Tajikistan.

Studies show that, during 2018, there were more than 30.000 Central Asians seeking medical treatments abroad and their top destinations have been the U.S.A., Iran and South Korea. Approximately, 27.000 Central Asian patients have chosen South Korea as their medical destination. Throughout these patients, 6.300 needed internal medicine services, over 6.000 needed treatments for cancers and other diseases, and 4.500 went to medical examination centers. More than 1.200 have obtained medical care for obstetrics and gynecology and other 1.200 patients have visited South Korea for general surgery reasons. Moreover, almost 1.200 sought dermatology services, almost 900 urology services. Additionally, over 850 patients were visiting South Korea for ENT (ear, nose, and throat), while another 880 Central Asians have visited it for plastic surgery. Only 700 Central Asians were seeking oriental medicine services.

Conclusion

The main reason that drives Central Asians to get medical services abroad is due to the fact that they are firstly looking for better healthcare services than what they can get in their home countries. For those able to travel abroad for medical purposes it is a great opportunity, as they might increase their own life expectancies.