A/HRC/41/34/Add.1 I. Introduction 1. The Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, Dainius Pūras, visited Kyrgyzstan from 22 to 31 May 2018 at the invitation of the Government. The purpose of the visit was to ascertain, in a spirit of dialogue and cooperation, how the right to health is realized in the country. 2. During his visit, the Special Rapporteur met with high-ranking government officials and representatives of the relevant health-related authorities at the central and local levels. He also met with the Ombudsman and representatives of the national preventive mechanism, international organizations and a wide range of civil society groups, including health-care personnel. 3. The Special Rapporteur visited various health-care facilities in Bishkek, Jalal-Abad and Osh, including a psychiatric hospital, two prison hospitals, and health-care services at a pretrial detention centre and at a prison for women. He also visited a school, a number of primary health centres at the community and local levels and a psychoneurological institution. 4. The Special Rapporteur is grateful to the Government of Kyrgyzstan for its invitation and full cooperation during his visit. He appreciates the crucial support provided by the Regional Office for Central Asia of the Office of the United Nations High Commissioner for Human Rights and the useful assistance provided by the United Nations country team. II. Right to health A. Background 5. Kyrgyzstan was the first Central Asian republic to declare independence from the Soviet Union. It became an independent State in August 1991 when the Soviet Union dissolved. Since then, Kyrgyzstan has implemented reforms to become a market economy and a democratic society, including in the context of various economic, fiscal and political crises faced at different points in time. 6. In April 2010, civic unrest led to the establishment of an interim Government and a new Constitution, adopted by referendum in June of that year. The Constitution, inter alia, reduced presidential powers in favour of the parliament and the Prime Minister. Despite the outbreak of inter-ethnic violence in Jalal-Abad and Osh in June 2010, the country managed to return progressively to economic and political stability. Elections were held peacefully in 2015, 2016 and 2017. Some of the progressive measures included in the Constitution, however, were restricted through amendments approved by referendum in December 2016. The amendments were aimed to, inter alia, strengthen the executive branch, reduce the independence of the judiciary and restrict the constitutional oversight of the executive and legislative branches. 7. Since Kyrgyzstan gained independence, the economy has remained stable but highly dependent on other economies and is susceptible to global crises. The structure of the economy has in fact changed significantly over the years. In 1990, it was divided equally between agriculture, industry and services. The tertiary sector, however, has grown continually since then, at the expense of agriculture, accounting for approximately half of the workforce in 2013 and half of value added in 2014. The industry sector is far from its level in 1990.1 1 Organization for Economic Cooperation and Development (OECD), 2018 Development Pathways: Social Protection System Review of Kyrgyzstan, June 2018, p. 26. 3