{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T13:45:55Z","timestamp":1782913555619,"version":"3.54.5"},"reference-count":48,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The COVID-19 pandemic exposed the structural fragility of health systems built on volatile external financing. Central Asia\u2014Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan\u2014receives health financing from three divergent donor streams: OECD bilateral and multilateral channels, Chinese Belt and Road Initiative mechanisms, and Eurasian Economic Union frameworks. The 2025 suspension of USAID operations, which eliminated 69\u201378% of program funding in Kyrgyzstan and Tajikistan, transformed chronic financing instability into an acute system-level shock. The relationship between external health financing volatility and pandemic preparedness in Central Asia has not previously been systematically analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This policy and practice review draws on three publicly available datasets: OECD Creditor Reporting System health-sector official development assistance (ODA) (sector 120, all donors, constant 2022 USD, 2010\u20132023); WHO IHR State Party Self-Assessment Annual Reporting composite scores (2018\u20132023); and WHO Global Health Expenditure Database Figures (2018\u20132023). Aid volatility was operationalized as the coefficient of variation of annual health-sector disbursements.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Health sector (ODA) is structurally volatile across all five countries, with coefficient of variation values ranging from 21.3% (Kyrgyzstan) to 53.5% (Uzbekistan). The regional aggregate surged from a pre-COVID-19 mean of USD 160.2 million to USD 307.1 million in 2021, then contracted to USD 227.5 million by 2023. A systematic disconnect between financing volume and preparedness outcomes is evident: Kazakhstan sustained the region\u2019s highest World Health Organization State Party Self-Assessment Annual Reporting (WHO SPAR) scores despite the lowest health aid in absolute terms, while Tajikistan\u2019s current health expenditure of 7.0\u20138.9% of GDP did not prevent SPAR scores from remaining below the 2024 global average of 64. Kazakhstan\u2019s SPAR score fell from 88 in 2021 to 67 in 2023, coinciding with post-COVID-19 aid contraction\u2014a pattern consistent with financing instability rather than capacity management failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Aid volatility, not volume alone, undermines pandemic preparedness in Central Asia. Five policy recommendations are advanced: multi-year pooled financing windows under the World Bank Pandemic Fund; redirecting Chinese Belt and Road Initiative health financing through multilateral channels; expanding the Eurasian Economic Union health security mandate with a dedicated preparedness mechanism; increasing domestic health budgets with ring-fenced IHR capacity lines; and integrating an Aid Volatility Index into the WHO IHR Monitoring and Evaluation Framework. Financing predictability is the primary structural imperative for sustaining preparedness in the post-pandemic era.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1865815","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T12:58:01Z","timestamp":1782910681000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Financing fragility and pandemic preparedness in Central Asia: a policy review of aid volatility, donor dynamics, and health system resilience"],"prefix":"10.3389","volume":"14","author":[{"given":"Bakhodir","family":"Rakhimov","sequence":"first","affiliation":[{"name":"Department of Environmental Hygiene, Tashkent State Medical University","place":["Tashkent, Uzbekistan"]},{"name":"Department of Preventive Medicine, College of Medicine, Korea University","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae Wook","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine, College of Medicine, Korea University","place":["Seoul, Republic of Korea"]},{"name":"Institute for Environmental Health, Korea University","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyung Hee","family":"Kim","sequence":"additional","affiliation":[{"name":"Institute for Environmental Health, Korea University","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,1]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1186\/s12992-024-01058-4","article-title":"How feasible is it to mobilize $31 billion a year for pandemic preparedness and response? 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