As stated by the ADB, this SEFF activity supports project preparation by strengthening emergency health services and laying the foundation for climate-resilient and environmentally sustainable hospital modernization, enhancing institutional capacity and service delivery in the Kyrgyz Republic. The total estimated budget for this activity is $2.00 million (ADB: $1.70 million; the government: $0.30 million).

The country faces serious challenges in delivering timely and effective emergency health services, particularly in rural and remote areas. Ambulance availability is critically low, national benchmarks are unmet, and more than 50% of patients at the National Hospital Bishkek lack access to emergency transport. The vehicle fleets are outdated and poorly equipped, limiting pre-hospital care and emergency referrals. In the provinces, hospital infrastructure is fragmented clinical services are often spread across multiple buildingsand lacking in climate resilience, essential medical equipment, and integrated service delivery systems. This is compounded by weak referral networks, insufficient human resources, and limited institutional capacity to manage the services.
While national strategies and programs exist to guide health sector development, implementation is constrained by technical, financial, and operational inefficiencies. These shortcomings heighten risks to patient outcomes and system responsiveness, and underscore the urgent need for strategic, sustainable investment in emergency services and hospital modernization.

The activity will support the preparation of the Hospital Infrastructure Improvement and Modernization Program by financing key pre-investment activities that form the basis for sustainable and high-quality health sector investments. In addition, the activity will complement output 3 of the ongoing SRHS Project by improving patient care in regional hospitals through the addition of equipped emergency response ambulances. The emergency response system is fragmented and lacks a central coordinating mechanism; the ambulance fleet is outdated; and well-equipped and staffed emergency rooms are missing in the provinces.
As a first response, the grant will provide much needed ambulance vehicles and emergency transport equipment for these ambulances, while laying the groundwork for setting up interregional hospitals that will include equipped and staffed emergency departments and serve as a pilot to be replicated in other regions. This will strengthen emergency transportation services under the SRHS Project and allow scope to hire consultants to help prepare detailed engineering designs, climate-resilient and environmentally sustainable infrastructure plans, a feasibility study report, and procurement strategies for the hospital modernization program.

Additional preparatory work includes financial management and procurement capacity assessments; gender, environmental, and social safeguard reviews; and institutional risk analyses. Hospital planning will focus on optimizing clinical services, infrastructure, and medical equipment needs. Stakeholder consultations, site assessments, and coordination with development partners will take place. A phased implementation plan, capacity building for the project implementation unit (PIU), and monitoring arrangements will guide progress and ensure readiness for the program.

PROJECT RATIONALE AND LINKAGE TO COUNTRY/REGIONAL STRATEGY

Output 1: Emergency health services strengthened. The activity will finance the procurement of new ambulances: (i)/4 Class B ambulances--fully equipped and functioning, and International Organization for Standardization (ISO) certified--for high-acuity patients deployed with standard operating procedures and survivor-centered protocols to National Hospital Bishkek; and 12/Class A ambulances--fully equipped and functioning, and ISO certified--for low-acuity patients deployed with standard operating procedures and survivor-centered protocols to four regional hospitals participating in the ongoing SRHS Project. The SRHS Project currently does not include ambulance procurement, so this procurement can improve access to timely emergency care, especially in underserved rural and remote areas. The Ministry of Health (MOH) will ensure operational readiness through staffing, training, and budget allocation for ambulance services.

Output 2: Project preparation for hospital modernization completed. Consultants will be engaged to prepare detailed engineering designs and assess climate resilience, energy efficiency, procurement planning, financial management, feasibility study report, environmental and social safeguards, and institutional risk. These preparatory activities will support the design and readiness of the proposed $20/million hospital Infrastructure Improvement and Modernization Program, scheduled for ADB Board consideration in 2027.

Output 3: Implementation capacity enhanced. The activity will be implemented by the existing PIU of the SRHS Project, with expanded responsibilities and a proposed 15% salary adjustment for key staff. The PIU will manage procurement, disbursement, and monitoring in line with ADB policies. A dedicated SEFF account will be established, and institutional arrangements will be strengthened to ensure effective execution and coordination with development partners.

The ADB categorized the project E&S risks as follows:

Environment - C
Involuntary Resettlement - C
Indigenous Peoples - C

ADB Team Leader:

Ma. Isabel J. Martin
Email: mimartin@adb.org 

ACCESS TO INFORMATION

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ACCOUNTABILITY MECHANISM OF ADB

The Accountability Mechanism is an independent complaint mechanism and fact-finding body for people who believe they are likely to be, or have been, adversely affected by an Asian Development Bank-financed project. If you submit a complaint to the Accountability Mechanism, they may investigate to assess whether the Asian Development Bank is following its own policies and procedures for preventing harm to people or the environment. You can learn more about the Accountability Mechanism and how to file a complaint at: http://www.adb.org/site/accountability-mechanism/main.