Kyrgyzstan's Healthcare System: Organisation, Access for a Foreigner, Emergencies and Risks

The European Observatory on Health Systems and Policies, attached to the WHO, describes a health system that relies on a compulsory health insurance system established in 1996 and on a State Guaranteed Benefit Package. This package provides primary healthcare free of charge to all patients, whatever their insured status and whether or not they are registered with a primary care provider. Three sources finance the system: the public sector (general taxation and compulsory health insurance), households (mainly through out-of-pocket payments) and external funds from development agencies.

Primary care is provided by family medicine practices, family medicine centres and a limited number of general medicine centres. In small isolated villages of 500 to 2,000 inhabitants, feldsher-midwife posts offer basic services. The hospital sector has been restructured and reduced. The WHO profiles also note that the Ministry of Health is taking over much of the role that the compulsory insurance fund played in pooling funds and organising provision.

The Guaranteed Benefit Package offers free primary care to all patients, without any condition of insured status, according to the European Observatory; the WHO profiles describe an entitlement to the whole package for citizens, with registration and identity documents, and additional payments for many services. The official pages consulted present no enrolment rule for a foreign resident: access, cost and any reimbursements should be confirmed with the employer, the facility and the Ministry of Health.

In practice, for a French national passing through or settled, France Diplomatie states that insurance or an assistance contract is essential and that the embassy does not pay the costs. See the pages healthcare reimbursement in Kyrgyzstan and living in Kyrgyzstan.

France Diplomatie describes medical facilities of uneven quality and recommends preferably using private facilities, in particular foreign clinics. The Health page cites neither a facility nor an emergency number; the Safety page gives 112, also to be used to file a high-altitude climbing itinerary before departure. The French embassy in Bishkek (+996 312 97 97 14) has no consular service: the French consulate general in Almaty, Kazakhstan, is competent for Kyrgyzstan, with no number given on the page.

The road is a major source of accidents: France Diplomatie records about 900 to 1,000 deaths a year, on the Bishkek-Osh, Bishkek-Issyk-Kul and Bishkek-Naryn routes in particular. Collective transport (shared taxis and minibuses) combines speeding, poorly maintained vehicles and faulty seat belts. For a medical journey, the choice of a trusted transport matters as much as the choice of facility.

The Tian Shan attracts hikers and mountaineers, and France Diplomatie recalls several health and safety rules: never set off alone, acclimatise before aiming for a high summit, check the qualifications and language of guides and take equipment suited to the cold. Ascents of Lenin Peak cause deaths each year (ascending too fast, falls, frostbite). For ski touring, it recommends going through an organisation registered with the mountain rescue system and a certified guide, with an avalanche transceiver, shovel, probe and airbag pack.

Before leaving, check that the contract covers medical costs, medical repatriation and mountain rescue, that the assistance provider works with a reputable Kyrgyz partner, and have sufficient funds for hospitalisation or evacuation.

France Diplomatie advises taking only the strictly necessary medicines, in their original packaging, with a prescription giving the names as international non-proprietary names, checking that they are permitted in Kyrgyzstan and never buying medicines from street vendors because of counterfeits. For water, drink beverages from a sealed bottle or water made safe by filtration, boiling or disinfectant, wash or peel fruit and vegetables with safe water, and avoid raw or undercooked meat, fish, poultry and milk, salads, shellfish, reheated dishes and cold buffets.

France Diplomatie recommends keeping up the French vaccination schedule (diphtheria, tetanus, poliomyelitis, whooping cough, measles), then studying with the doctor or an international vaccination centre hepatitis A, typhoid, hepatitis B in the event of frequent or prolonged stays, tuberculosis (BCG) for children under 15 in the event of frequent or prolonged stays, rabies for young children and stays in rural or isolated areas, and tick-borne encephalitis for hiking or the countryside.

• Typhoid fever: transmitted by contaminated water or food or from person to person; symptoms about three weeks after contamination; prevention through hygiene and vaccination.
• Rabies: almost always fatal once symptoms appear; avoid contact with suspect animals and consult immediately after any exposure, even if vaccinated.
• Tuberculosis: an airborne disease; prevention through BCG vaccination, early screening and full treatment.
• Ticks: active in April-May and in August-September; wear covering clothing when hiking.

France has no social security agreement with Kyrgyzstan (CLEISS list; CLEISS is the French Centre for European and International Social Security Liaison): the carte Vitale is not used on the spot. An assistance or insurance contract covering all medical costs, surgery, hospitalisation and medical repatriation is presented as essential: without it, access to care can be refused, even in a life-threatening emergency. The choice is made on the annual limit, evacuation, mountain rescue, the network of private clinics and the handling of medical history. See the page expat health insurance.