Incluye bibliografía

1. Introduction -- 2. Health status - demographic and epidemiological trends -- 3. Macro-economic context and constraints -- 4. The inherited health systems -- 5. The enabling environment for health reform -- 6. Health policy reform agenda -- 7. Conclusion -- Annexes

This paper surveys health reform in the former Soviet republics of Central Asia, in the aftermath of their indopendonce and transition from the Soviet command economy. Socio-economic, epidomiological and institutional realities face the countries. Section 2 sets out domographic and epidomiological trends, which suggest the scope and priorities for health services. The next section analyzes recent economic performance, highlighting worsening financial constraints. The existing health systems are evaluated in Section 4, centering on their primary strengths and weaknesses. Section 5 addresses critical institutional elements of the reform process, including docentralization and staffing issues. The reform agenda facing health policymakers in Central Asia is then investigated in Section 6, focusing upon empirical and doscriptive aspects, in ordor to provido a reliable basis for discussing future options. Section 7 concludos that the large doclines in real health spending signal that each country will have to do more with less. Consequently, current public health programs like maternal and child health programs will need to be restructured; improvement incentives to induce consumers and providors to behave more efficiently will have to be issued; and modorn management and quality assurance systems will have to be introduced. Although the reform dobate focuses on financial sustainability, particularly attempts to bring in additional non-budget revenues, equally important is the need to focus on basic public health activities and delivery system restructuring.