4. Paying for services
Adequate funding for health is important to manage the excess demands on the health system. This section considers how countries are PAYING FOR COVID-19 SERVICES. Health financing describes how much is spent on health and the distribution of health spending across different service areas. The section also describes who is covered for COVID-19 testing and treatment, whether there are any notable gaps (in population coverage and service coverage), and how much people pay (if at all) for those services out-of-pocket.
4.1 Health financing
The Government of Kyrgyzstan issued the Decree on the allocation of additional funds of 30 million som (about 430,000 USD) for the response to COVID19 on 3 February 2020. These additional funds were transferred to the Ministry of Health for the epidemiological surveillance service. The Ministry of Health purchased the most critical items, including medical protection consumables, and allocated additional funds for bonus payments to health workers. Some 137.3 million soms were transferred to the account of the Ministry of Health by 12 May for the fight against COVID-19, the government's press service said.
In addition to the regular Ministry of Health account in the Ministry of Finance treasury system, the Ministry of Health opened a special account to accumulate voluntary contributions from the public and from private companies for the fight against COVID-19. By 12 May a total amount of 137 million soms had been collected. 134 million soms were spent for pay supplements and incentives for medical workers involved in the fight against the spread of coronavirus infection.
Premiums for healthcare workers involved in the treatment of coronavirus patients, in addition to regular salaries, were established for March 2020. The premium rate is divided into three categories:
• category 1 – health workers working in the outbreaks: 2,300 soms (doctors), 2,000 soms (nursing staff), and 1,800 soms (junior nursing staff) per day of work.
• category 2 – health workers according to scheduled activities. For one hour of work, doctors - 100 soms, average staff - 90 soms, junior staff - 80 soms. These allowances also depend on the actual work.
• category 3 – health workers of ambulance services, Doctors - 600 soms, paramedic and nursing staff - 500 soms, junior staff - 400 soms. The accrual basis is taken as the number of infected
Payments to medical and other health care workers affected by COVID-19 (in terms of either morbidity or mortality) were as follows as of 2 December 2020:
• Overall budgeted amount: 228.8 million Soms;
• Payments made to affected health workers: 121.8 million Soms (609 health workers were paid 200,000 Soms each);
• Paid to families of healthcare workers who died: 29 million Soms (29 families - 1 million Soms each);
• Total paid: 150.8 million Soms;
• Balance remaining: 78.0 million Soms.
The Mandatory Health Insurance Fund (MHIF) under the Government of Kyrgyzstan acts as the national single payer for both budget and payroll tax funding, runs its own budget and did not receive any additional funding for COVID-19. The Ministry of Health calculated the cost of treatment with COVID-19 with varying severity as follows:
• light form – 7,988 soms;
• average form - 16,370 soms;
• severe form - 74,000 soms;
• very severe form – 118,807 soms.
The cost calculation includes medicines, utilities and food, PPE, tests and salaries for health workers.
The payment rate was revised in June 2020:
• asymptomatic form – 3030.12 som
• light form – 3500.64 som;
• average form – 10,817.78 som;
• severe form - 70,427.31 som;
• very severe form – 132,837.09 som.
In addition, a new payment rate for medical observation of contacts was established at the rate of 1,742 som.
As per MHIF information of September 2020, the budget gap to pay to health organizations with the additional requirements related to the COVID-19 treated cases, medicines, PPE, etc., amounted to 903.4 million som. WHO prepared the policy note “Health financing in Kyrgyzstan: obstacles and opportunities to improve the response to Covid19 “and discussed it with the Ministry of Health, the MHIF and joint financiers, and organized a meeting between the Health Development Partners Coordination Council, the Ministry of Health and the MHIF in September 2020. The issue was agreed to be included in the Thematic Week on COVID-19 in October 2020, but due to the political unrest in October, the Joint Annual Review of 2020 and the Thematic Week were postponed to April 2021.
The IMF Executive Board approved the first requests for emergency financial assistance to help its member countries address the challenges posed by COVID-19. The approval of the request from the Kyrgyz Republic on 27 March made available USD 120.9 million to the authorities to meet the urgent balance of payment needs stemming from the outbreak of the COVID-19 pandemic. The funds will help catalyze donor support and free resources for essential COVID-19-related health expenditure. This is the first IMF emergency loan under the Rapid Financing Instrument/Rapid Credit Facility worldwide since the outbreak of the pandemic.
The World Bank’s Board of Directors approved USD 12.2 million for the Emergency COVID-19 Project. The source of World Bank funds is the COVID-19 Strategic Preparedness and Response Programme funded by the International Bank for Reconstruction and Development (IBRD) and International Development Association (IDA) financing envelope. The following Country Contingency Plan priorities were selected in consultations with the Government and WHO: surveillance and points of entry; case investigation and rapid response; infection prevention and control; case management, and waste management.
In addition, USD 9 million of financing from an ongoing World Bank project will be reallocated to support the country’s efforts to prepare for and respond effectively to the health and social risks associated with the COVID-19 pandemic. The funding will support Kyrgyzstan’s Contingency Plan for COVID-19, including the provision of appropriate preventive measures; the procurement of essential medicines, supplies and equipment; minimizing the risks for frontline health workers; and treating patients. To help detect and prevent the spread of COVID-19, urgently needed supplies will be procured, including testing kits, laboratory reagents, and personal protective equipment for medical personnel. Rapid Response Teams in the capital and in seven regions of the country will receive vehicles specifically for the transfer of equipment and supplies. Medical staff will receive training in COVID-19 care and infection prevention, as well as longer-term capacity-building in critical care provision through other development partners including WHO. The project will also procure Intensive Care Unit (ICU) equipment and supplies to establish or renew 10 eight-bed fully equipped ICUs in designated hospitals, which will include mechanical ventilators, cardiac defibrillators, mobile X-rays, oxygen concentrators, and other essential equipment. Another 20 ICUs and 100 isolation rooms in 24 hospitals around the country will undergo emergency repairs to ensure patient and staff safety.
As of 2 December 2020, a contract was signed for 7 million USD out of a 9 million total budget of the Word Bank “Enhancing Resilience (ERIK-CERC)” project and for 4.6 million USD out of the 12.15 million USD total budget of the “Kyrgyz Republic Emergency COVID-19 project”.
On 20 March USAID announced additional funds of 66 million soms (913,000 USD) dollars) to three specialized organizations to increase their capacity to respond to the COVID-19 outbreak. The focus will be on infection control, disease prevention, detection, diagnosis, treatment and public awareness. These priority areas and activities were developed in consultation with the Ministry of Health.
The United States Centers for Disease Control and Prevention (CDC) has pledged USD 6.8 million to support the governments in Central Asia in managing the ongoing COVID-19 outbreak, including USD 1.38 million for the Kyrgyz Republic, the US Embassy informed on 11 May 2020.
The German Government announced the decision to provide an additional EUR 500,000 via the German Agency for International Cooperation to support the country in its response to the COVID-19 outbreak.
The Asian Development Bank plans to provide USD 200,000 for Infection Prevention and Control, and the Swiss Development Cooperation reprofiled their project to support several Family Medicines Centres to include an Infection Prevention and Control function for the amount of USD 60,000.
UNICEF activated communication, infection prevention and control, case management and social support with a total budget of USD 366,000.
The Asian Development Bank (ADB) and the United Nations Children's Fund (UNICEF) donated equipment for medical personnel working at coronavirus outbreak sites in Kyrgyzstan, the Health Ministry reported on 28 May 2020. The equipment was delivered within the framework of ADB emergency aid to Kyrgyzstan in the amount of $200,000 for the fight against the COVID-19 epidemic.
The President of Kyrgyzstan has ratified the loan and grant agreements between the Kyrgyz Republic and the Asian Development Bank on the COVID-19 Active Response and Expenditure Support (CARES) programme, signed on 5 May 2020 in Bishkek. The Asian Development Bank (ADB) will provide $25 million in loan and $25 million in grant financing to help the Government of the Kyrgyz Republic mitigate the negative health, social, and economic impacts of the novel coronavirus disease (COVID-19) pandemic. The funds will support the government’s immediate priorities to contain the spread of the pandemic, ensure social protection for vulnerable segments of society, and deliver a pro-poor fiscal stimulus to safeguard small and medium-sized enterprises (SMEs) and the economy’s productive sectors. The Kyrgyz Republic will also benefit from ADB’s forthcoming regional technical assistance to address health threats including COVID-19 in the Central Asia Regional Economic Cooperation (CAREC) region. The assistance will support solutions to respond to the COVID-19 pandemic and strengthen health systems to better prepare for potential future outbreaks.
On 18 June 2020, the Asian Development Bank (ADB) approved $20 million in assistance to help the Government of the Kyrgyz Republic strengthen its health sector to deal with the coronavirus disease (COVID-19) pandemic. According to the ADB, the Kyrgyz Republic is at high risk of the impact of the COVID-19 pandemic and the ADB is committed to support the country to strengthen the country’s response and improve its resilience to deal with COVID-19 and future pandemics. This $20 million assistance is in addition to the recently approved $50 million budget support. ADB’s finance consists of a $10 million emergency loan and a $10 million grant. The project will improve facilities at hospitals designated as COVID-19 treatment centers in the country. These hospitals will benefit from an additional 80 ICU beds, ambulances, and other medical supplies. Health workers at these hospitals will benefit from personal protective equipment (PPE), specialist training, and additional hardship allowances.
The aid included intensive care equipment used for ventilators, including 300 endotracheal tubes, 3,000 pediatric tubes and over 1,500 respiratory systems. The equipment was distributed to the state infectious hopsital and Chui regional hospital in Bishkek and to hospitals in Naryn, Osh, Jalal-Abad, Issyk-Kul and Talas regions. In addition, 11,300 pairs of sterile gloves were delivered to 6 maternity hospitals in Bishkek and throughout the country.
As of 2 December 2020, a tranche in the amount of 2.29 million USD was transferred to the Treasury of the Ministry of Finance out of a total 20 million USD budget of the Asian Development Bank “COVID-19 Pandemic Emergency Project”.
There are no discussions yet on re-prioritizing the state budget for health. The private sector is being involved in training on infection prevention and control, and case management, but payment arrangements for its potential involvement have not yet been discussed.
On 13 August the United States Agency for International Development (USAID) announced the provision of more than 190 million soms ($2,500,000) to support the Kyrgyz Republic’s response to the ongoing COVID-19 pandemic. This funding will improve infection control in health care facilities, testing, diagnostics, and help inform the public about risks of COVID-19. These priority areas and interventions were designed in consultations with the Ministry of Health and the Government of the Kyrgyz Republic.
This funding is in addition to the initial emergency assistance provided by USAID in the spring of 2020. In March, USAID donated personal protective equipment for health workers across the country and provided a grant of over 95 million soms ($1.23 million) to support the Kyrgyz Republic’s early response to the pandemic.
Under the Islamic Development Bank project “Preparedness and response to the COVID-19 pandemic”, with a total budget of 15 million USD, ratified in July 2020, contracts were signed for 2.8 million USD.
Overall, Kyrgyzstan receives humanitarian assistance from 15 countries and 65 local and international organizations. The biggest shares of humanitarian assistance are constituted by medical products (48%) and PPE (47%).