A/HRC/41/34/Add.1 during hospitalization, although not a significant portion of out-of-pocket spending, also increased. These patterns led the World Bank and WHO to recommend a review of the State-guaranteed benefit package and better control of the pharmaceutical market in the country.15 The recommendations, particularly on a review of the State-guaranteed benefit package, were taken into consideration by the State during the development of the “healthy person – prosperous country” health strategy for 2019–2030. 32. The national health-care system currently offers three types of insurance: the Stateguaranteed benefits package 16 covers free access to primary health care for the entire population and defines co-payment exemptions; the mandatory health insurance programme covers specific co-payments and contributing members; and voluntary health insurance with private insurers covers limited specialist services and provides types of insurance other than health insurance. Both the State-guaranteed benefits package and the mandatory health insurance programme are managed by the mandatory health insurance fund. There is no opt-out of the fund; voluntary health insurance schemes are therefore unlikely to expand. 33. Primary health-care facilities in Kyrgyzstan 17 include family group practices (or feldsher obstetrical ambulatory points) and family medicine centres. Family medicine centres are separate from hospitals and provide free health-care services to all individuals assigned to them. In some districts, family medicine centres are still connected to hospitals, in which case they are called general practice centres. In the districts that have family medicine centres, hospitals do not usually provide outpatient services, but on the rare occasions that they do, they are provided through co-payment. 34. Free primary health-care services include access to laboratory testing and medical advice, including on breastfeeding. Primary health care also includes the provision of some medicines through an additional programme. 35. The Special Rapporteur confirms that there is a continuing political will to focus on investing in primary health care and efforts have been made to keep the entire health-care system sustainable. Progress in this direction is shown by the reduction in child mortality and the prevention and treatment of communicable diseases, in particular tuberculosis. Although government funding has been increasingly directed to family primary health-care services, the services still face the challenge of retaining health-care workers, particularly in rural areas. 1. Transparency in the health-care system and role of health-care personnel 36. The Special Rapporteur was informed, throughout his visits to health-care facilities and in most of his meetings with government officials and stakeholders, that informal payments in exchange for health-care services are still common practice in Kyrgyzstan. Groups in vulnerable situations suffer disproportionately from this system, as they have the most difficulty affording informal payments. 37. Addressing remaining corrupt practices and improving transparency at all levels of the health-care system is a key factor in the realization of the right to physical and mental health. Lack of transparency, compounded by unclear rules in the provision of services, reduces trust between health-care users, health-care providers and policymakers. 38. To address these issues, there is a clear need to invest significantly more in human resources, which should be a priority. Health-care personnel play an indispensable role in the realization of the right to health. They help to document and provide redress for human rights violations, such as violence and torture. In some cases, they are, intentionally or 15 16 17 8 World Bank and WHO, “Den Sooluk national health reform programme: joint review summary note”, April 2017. The State-guaranteed benefits package provides for primary health care, outpatient emergency care, emergency consultation services (air ambulances), specialized outpatient health care, inpatient health care, health-care services financed by the high-tech medical care fund, dental care, medicines and vaccines, and immunization. See OECD, 2018 Development Pathways, p. 89. Until 2018, primary health care in Bishkek was still funded by the budget for the Bishkek municipality.