M. Mckee et al., HEALTH SECTOR REFORM IN THE FORMER SOVIET REPUBLICS OF CENTRAL-ASIA, The International journal of health planning and management, 13(2), 1998, pp. 131-147
Health services in the former Soviet Republics of Central Asia face ma
ny challenges, not least a rising burden of disease and severe economi
c constraints. Each government has developed proposals for reform. Thi
s paper describes the key elements of the proposals developed in each
country. They have many features in common, such as financing based on
social insurance, although they also have many differences, reflectin
g national political, economic and historical circumstances. While mos
t attention so far has concentrated on the design of the proposed syst
ems, it is argued here that there has been inadequate attention to the
obstacles to implementation. These stem from the many adverse factors
in the context within which reforms are taking place, weaknesses in t
he process of reform, and failure to involve the groups whose actions
will be necessary for success. It is argued that governments and those
advising them must place greater emphasis on the challenges of implem
entation, including the development of a much better understanding of
the context within which change must take place. (C) 1998 John Wiley &
Sons, Ltd.