Different aid engagement, different health system outcomes: Two decades of transition for the Central Asian Post-Soviet states Anar Ulikpan, PhD student, School of Population Health, University of Queensland, Australia Tolib Mirzoev, Nuffield Centre for International Health & Development, Leeds Institute of Health Sciences, University of Leeds Eliana Jimenez, School of Population Health, University of Queensland, Australia Asmat Malik, Integrated Health Services, Islamabad, Pakistan Peter S Hill, School of Population Health, University of Queensland, Australia

CRICOS Provider No 00025B HISTORICAL BACKGROUND

Single country dominance

Collapse of the Soviet Union

Methods Documentary Review: Extensive document review (English, Russian, and Mongolian) Pubmed, Scopus, ProQuest and Google Scholar Institutional websites (ODI, WHO, WB, UN agencies) Grey literature Key informant interview: In-depth interviews were conducted with 11 key informants with experiences in Kyrgyzstan, Mongolia and Uzbekistan Participatory observations: Two authors years experience in participating in the policy development process in Mongolia and Tajikistan

Least studied ( publn/ popn) Language barrier Overlooked by international community

Limitations Few published evidences Limited access to study countries information Key informants: secondary source

Health sector in crisis during 1990s Sharp fall of GDP by % (except Uzbekistan as 15%) Health spending fall to 1.1%-3.4% as percentage of GDP Key health indicators declined Introduction of social health insurance and user fees Profound “revolution” at every level of the system Arrival of new donors (financial, technical, policy support)

From single country dominance to Multi-actor relationship

United States Japan European Union Nordic countries UN agencies South Korea World Bank Asian Developmen t bank Kyrgyzstan Mongolia Tajikistan Kyrgyzstan Mongolia Tajikistan Kazakhstan Turkmenistan Uzbekistan Turkmenistan Uzbekistan

Net ODA received per capita in selected Post-Soviet Central Asian countries

Uniqueness of aid relationship Not too many donors New as an aid recipient No longstanding culture of aid coordination

Differing paths and destiny Kyrgyzstan Mongolia Tajikistan Turkmenistan Uzbekistan

Geopolitics play Rich natural resources Geo-strategically favourable position between the three giants

These countries are neglected in development discussions despite their growing inequality in health and poverty

Where to from here? New aid relationships offer new opportunities for both donors and recipients Fewer partners do not necessarily mean less fragmentation

Where to from here? Aid modalities must reinforce ownership and sustainability Always consider factors beyond the health