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Kazakhstan: A Country Overview 251

Another result of, or perhaps a reason for, the breakup of the Soviet Union was
the state’s inability to continue to deliver the massive entitlements that the socialist
system had guaranteed. Consequently, provision of social services became the re-
sponsibility of each newly independent republic. In truth, the Soviet entitlement
system had not been able to deliver its promised benefits for some time. At inde-
pendence, the deficit became public and even more pronounced as the new re-
publics’ ability to meet the entitlement requirements were no better, and in most
cases much worse, than the Soviet central government had been.
Kazakhstan’s response was typical of the choices made by the newly inde-
pendent republics. Farmatsyia, its central pharmacy, continued to be held re-
sponsible for providing most of its drugs free of charge to the majority of the
population. At the same time, it was charged with becoming self-sufficient.
From a Western perspective, this was clearly impossible, but without any real
understanding of the fundamentals of business or markets, Farmatsyia forged
ahead and attempted to resolve the two directives by increasing prices of those
pharmaceuticals for which it was allowed to charge to cover the cost of those it
was required to provide free. Prices skyrocketed, in some cases to more than
250% of world prices (Hausloner, 1995), and the market stalled, further ce-
menting abortion as the principal means of fertility regulation available to the
women of Kazakhstan.

U.S. Interest in Providing Assistance to the “Evil Empire”

U.S. foreign assistance, one of the primary funding tools for international social mar-
keting programs in health, has traditionally been focused on the expressed needs of
the governments of developing/third-world countries. However, the historic and
unique nature of the dissolution of the Soviet Union (the “second world”) and the
challenges it presented, provided an unprecedented opportunity for the United States
to influence what shape the broken “Evil Empire” would assume as it was reassem-
bled. Consequently, the United States offered Russia and the newly independent
republics a comprehensive assistance plan focused on aiding them in their transition
from command economies to market-based ones (Tarnoff, 2002). While most of the
assistance was concentrated on macro-economic concerns and the privatization of
the vast assets of what had been the communist state government, it also came to be
recognized that in order for these unprecedented fundamental changes to be ac-
cepted by the population, it was critical to address the well-being of individuals along
with the massive failure of the public entitlement system. As a result, aid from the
West included social sector components borrowed from traditional developing