title: Central Asian Post-Soviet health systems in transition: has different aid engagement produced different outcomes?
abstract: BACKGROUND
  The collapse of the Soviet Union in 1991 resulted in a transition from centrally planned socialist systems to largely free-market systems for post-Soviet states. The health systems of Central Asian Post-Soviet (CAPS) countries (Kyrgyzstan, Mongolia, Tajikistan, Turkmenistan, and Uzbekistan) have undergone a profound revolution. External development partners have been crucial to this reorientation through financial and technical support, though both relationships and outcomes have varied. This research provides a comparative review of the development assistance provided in the health systems of CAPS countries and proposes future policy options to improve the effectiveness of development.
  
  
  METHODS
  Extensive documentary review was conducted using Pubmed, Medline/Ovid, Scopus, and Google scholar search engines, local websites, donor reports, and grey literature. The review was supplemented by key informant interviews and participant observation.
  
  
  RESULTS
  The collapse of the Soviet dominance of the region brought many health system challenges. Donors have played an essential role in the reform of health systems. However, as new aid beneficiaries, neither CAPS countries' governments nor the donors had the experience of development collaboration in this context.The scale of development assistance for health in CAPS countries has been limited compared to other countries with similar income, partly due to their limited history with the donor community, lack of experience in managing donors, and a limited history of transparency in international dealings. Despite commonalities at the start, two distinctive trajectories formed in CAPS countries, due to their differing politics and governance context.
  
  
  CONCLUSIONS
  The influence of donors, both financially and technically, remains crucial to health sector reform, despite their relatively small contribution to overall health budgets. Kyrgyzstan, Mongolia, and Tajikistan have demonstrated more effective development cooperation and improved health outcomes; arguably, Uzbekistan and Turkmenistan have made slower progress in their health and socio-economic indices because of their resistance to open and accountable development relationships.
authors.affiliation: School of Population Health, The University of Queensland, Herston, QLD, Australia; anar.ulikpan@uqconnect.edu.au.
authors.forename: Anar
authors.initials: A
authors.lastname: Ulikpan
authors.affiliation: Nuffield Centre for International Health & Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
authors.forename: Tolib
authors.initials: T
authors.lastname: Mirzoev
authors.affiliation: School of Population Health, The University of Queensland, Herston, QLD, Australia.
authors.forename: Eliana
authors.initials: E
authors.lastname: Jimenez
authors.affiliation: Integrated Health Services, Islamabad, Pakistan.
authors.forename: Asmat
authors.initials: A
authors.lastname: Malik
authors.affiliation: School of Population Health, The University of Queensland, Herston, QLD, Australia.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Hill
mesh_terms: D001209:Asia, Central; D003299:Cooperative Behavior; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration*; D003906:Developing Countries; D057217:Economic Development; D005381:Financing, Organized / Q000458:organization & administration*; D005102:Health Expenditures; D006304:Health Status; D006801:Humans; D007391:International Cooperation; D011057:Politics; D012959:Socioeconomic Factors; D014586:USSR; D014480:United Nations / Q000458:organization & administration
keywords: Central Asian Post-Soviet countries; aid effectiveness; donor aid; health sector