Toward CAREC 2030: Enhancing Regional Cooperation in the Health Sector A Scoping Study i CONTENTS PREFACE iv ABBREVIATIONS ....................................................................................................................... v EXECUTIVE SUMMARY .......................................................................................................... vii 1. INTRODUCTION ................................................................................................................ 1 1.1 Central Asia in Transition .................................................................................... 1 1.2 The CAREC 2030 Strategy ................................................................................. 1 1.3 A Case for Regional Health Cooperation ............................................................ 2 1.4 The Scoping Study .............................................................................................. 3 2. HEALTH trends AND SYSTEMS DEVELOPMENT IN THE CAREC REGION .................... 5 2.1 Population, Health, and Nutrition Trends ............................................................. 5 2.2 Common Risk Factors Affecting Health in the Region ......................................... 6 2.3. Health Challenges of Regional Importance ........................................................ 7 2.3.1. Emerging and infectious diseases ............................................................. 7 2.3.2. Other communicable diseases .................................................................12 2.3.3. Non-communicable diseases ...................................................................13 2.3.4. Migration ..................................................................................................15 2.4 Health Systems Development in the Region ............................................................16 3. OPPORTUNITIES FOR REGIONAL HEALTH COOPERATION ........................................19 3.1 Drivers and Constraints of Regional Health Cooperation ...................................19 3.2 Types of Regional Cooperation and Lessons Learned .......................................23 3.3 Priorities For Regional Cooperation ...................................................................24 3.3.1. Strengthening Regional Health Security ...................................................24 3.3.2 Supporting Health Systems Development through Regional Cooperation .34 3.4 Improving Access to Health Services for Migrants, Mobile Populations, and Border Communities .................................................................................................................43 3.4.1 Access to healthcare for migrants and mobile populations .......................43 3.4.2 Access to healthcare for border communities ..........................................45 4. CAREC COOPERATION IN HEALTH: CONCLUSIONS ....................................................47 4.1 Recommendations ...................................................................................................47 4.1.1 Strengthening regional health security ......................................................47 4.1.2 Strengthening health systems through regional cooperation .....................48 4.1.3. Improving access to health services for migrants, mobile populations, and border ................................................................................................................49 4.2 Proposed Institutional Arrangements and Next Steps ..............................................49 Appendix 1: Selected Indicators ................................................................................................53 Appendix 2: CAREC Health Systems Development Based on WHO Building Blocks ................56 A. Health Services Delivery ...........................................................................................56 B. Health Workforce ......................................................................................................59 C. Health Information Systems ......................................................................................60 D. Access to Medicines and Technology .......................................................................60 E. Health Financing .......................................................................................................61 Appendix 3: Strengths, Weaknesses, Opportunities, and Threats Analysis ...............................65 Appendix 4: Examples of Regional Cooperation in Health .......................................................67 A. Strengthening Regional Health Security ....................................................................67 Regional Disease Surveillance Systems Enhancement (REDISSE) ..................67 Caribbean Public Health Agency (CARPHA) ......................................................67 B. Supporting Health Systems Development through Regional Cooperation .................68 Healthy Ageing Public Procurement of Innovations (HAPPI) ..............................68 Common Market of the South - Mercosur ..........................................................68 Partner support for strengthening domestic pharmaceutical industries ...............69 ii C. Improving Health Services for Migrants and Border Communities .............................69 Thailand’s Migrant Health Insurance Scheme (MHIS) ........................................69 Appendix 5: Summary of Regional Cooperation in Health .........................................................71 Bibliography 74 TABLES Table 1: Life Expectancy and Fertility Indicators for CAREC and Caucasus Countries .............. 5 Table 2: CAREC Risk Factors as Crude Death Rate/100,000 .................................................... 7 Table 3: Virus Epidemics—An Overview .................................................................................... 9 Table 4: COVID-19 Cases and Deaths in CAREC (as of 7 June 2020) .....................................10 Table 5: CAREC Countries IHR Self-Assessment Score 2019 ..................................................11 Table 6: International Migrant Stock in CAREC Countries, 2019 ...............................................16 Table 7: Drivers and Constraints of Regional Health Cooperation in CAREC ............................20 Table 8: Summary of Recommendations ..................................................................................50 Table A1.1: Socioeconomic Indicators ......................................................................................53 Table A1.2: Demographic Indicators .........................................................................................54 Table A1.3: Selective Health and Health Services Indicators ....................................................55 Table A2.1: Universal Health Coverage Index for CAREC Countries ........................................57 Table A2.2: Density of Health Personnel in CAREC and Other Regions ...................................59 Table A3.1: CAREC Health SWOT Analysis .............................................................................65 Table A5.1: Approaches in Regional Cooperation in Health ......................................................71 FIGURES Figure 1: Distribution of Annual Mortality [Rate] by Causes in CAREC Region, 2000–2017 ....... 6 Figure 2: Non-Communicable Diseases in CAREC, 1990–2017 ...............................................14 Figure 3: World Health Organization’s Building Blocks of Health Systems ...............................17 Figure 4: The 4Cs of Design .....................................................................................................19 Figure A2.1: World Health Organization’s Building Blocks of Health Systems ...........................56 Figure A2.2: Hospital Bed Density in CAREC ...........................................................................57 Figure A2.3: Total Health Expenditure as Percentage of GDP, 2016 .......................................62 Figure A2.4: Out-of-Pocket Health Care Expenditure in CAREC ...............................................63 BOXES Box 1: International Health Regulations (2005) Related Initiatives in CAREC ...........................25 Box 2: Greater Mekong Subregion Health Security Project .......................................................27 Box 3: The One Health Approach in CAREC ............................................................................28 Box 4: Modernization of Sanitary and Phytosanitary Standards in CAREC ...............................29 Box 5: Strengthening National Quality Assurance Systems and Laboratory Capacity in CAREC .................................................................................................................................................30 Box 6: Regional Cooperation and Surveillance of Infectious Diseases in CAREC .....................31 Box 7: Regional Human Resources Training in CAREC ............................................................33 Box 8: Implementation of WHO Framework Convention on Tobacco Control in CAREC ...........36 iii Box 9: Regional Cooperation on Non-Communicable Disease Surveillance and Research in Nordic Countries .......................................................................................................................37 Box 10: Health Services under ASEAN Economic Community ..................................................39 Box 11: Regional Training and eHealth in CAREC ....................................................................40