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Central Asia: Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan; is home to 78 million people at the crossroads of Europe and Asia (). All five republics inherited the Soviet Semashko health model, a state-funded, centralized system providing universal free access through extensive hospital networks and salaried physicians, with no private healthcare provision (, ), which collapsed after 1991, triggering life expectancy declines, infrastructure deterioration, and a dual disease burden (, ).

Each country has pursued distinct reforms: Kazakhstan introduced social health insurance, Tajikistan committed to Universal Health Coverage (UHC) by 2030, Uzbekistan expanded international engagement after 2016, yet all face persistent challenges in financing, rural access, and equitable service delivery. Central Asia sits at the convergence of competing geopolitical influences. Russia maintains ties through the Commonwealth of Independent States (CIS) and Eurasian Economic Union (EAEU), with millions of labor migrants creating health governance needs. China’s Belt and Road Initiative and Health Silk Road expand health infrastructure through the Shanghai Cooperation Organization (SCO). The European Union (EU) deploys health as soft power (), while World Health Organization (WHO), the World Bank, and United Nations Development Program (UNDP) provide technical assistance. This multipolar environment creates diverse opportunities but risks fragmenting cooperation when diplomatic interests diverge from health needs.

Health diplomacy (HD) in Central Asia is a vital mechanism for regional cooperation, linking public health infrastructure with geopolitical strategy. The evolution of public health diplomacy (PHD) in the region has occurred alongside major political transitions and growing regional and international engagement, from the post-Soviet transition to contemporary multilateral health partnerships (). These developments illustrate how political and diplomatic processes have increasingly created mechanisms for health system reform, regional health security, capacity building, and cross-border cooperation. Health diplomacy refers to the negotiation and governance processes through which actors address health challenges across national borders. Katz et al. () formalized this concept at the intersection of public health, international affairs, law, and economics. Kickbusch et al. () then introduced global health diplomacy (GHD), arguing that health’s embeddedness in foreign policy demanded new strategic approaches for multilateral negotiations. More recently, Joshi et al. () defined public health diplomacy (PHD) as “a multidisciplinary field that enables its practitioners to effectively communicate, facilitate, negotiate, and build consensus using systems thinking, evidence-based, community-informed approaches, grounded in equity-focused and human-centered values to improve health and well-being for all.”

PHD is a new paradigm in global health perspective and a new chapter for Central Asian region in terms of a discipline. PHD can be employed to transform Central Asia’s health landscape through five critical roles. First, PHD strengthens health systems by facilitating cross-country policy learning, enabling nations to share reform experiences rather than navigating transitions in isolation. Second, PHD addresses transnational threat like transboundary water pollution, the Aral Sea legacy, cross-border tuberculosis, pandemic preparedness, by building coordinated surveillance and governance across borders. Third, PHD empowers Central Asian professionals to negotiate effectively within the SCO, CIS, WHO, and World Bank, ensuring regional health priorities are represented rather than externally imposed. Fourth, PHD reduces healthcare inequality and catastrophic spending by promoting evidence-based financing reforms and coordinating donor investments. Fifth, PHD builds public trust by fostering transparent, community-informed communication that replaces centralized Soviet-era models.

Public health diplomacy can influence health systems by facilitating policy dialog, mobilizing financial and technical resources, strengthening cross-border cooperation, and supporting the transfer of knowledge and institutional capacity. In Central Asia, these mechanisms are particularly relevant because health system development has occurred alongside post-Soviet political transitions and growing engagement with regional and international actors. Examining these interactions provides an opportunity to understand public health diplomacy not only as a foreign policy mechanism but also as a potential instrument for health system strengthening and regional health governance.

Despite the growing importance of public health diplomacy in addressing transnational health challenges, no previous review has comprehensively mapped the evidence on its role in shaping and strengthening the health landscape of Central Asia. To address this gap, this scoping review aims to: (i) examine country-specific health governance systems across the five Central Asian republics; (ii) map the existing literature on health diplomacy and public health diplomacy in the region; (iii) analyze international and regional public health diplomacy mechanisms that influence health cooperation; (iv) assess the alignment of health diplomacy initiatives with Sustainable Development Goal 3 (SDG 3) and Universal Health Coverage (UHC); and (v) identify geographic, thematic, and methodological gaps in the current evidence base on health governance and public health diplomacy in Central Asia. The Central Asian countries included in this review are Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan.

This scoping review follows the methodological framework proposed by Arksey and O’Malley (), which provides a structured, transparent, and replicable approach to mapping the breadth of existing evidence on a given topic. This framework was selected for its suitability to explore emerging and interdisciplinary fields where the evidence base is diverse and heterogeneous. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines to ensure rigor in reporting. The research team conducted the literature search and screening process between March 2026 and April 2026.

The following research question guided this review: What evidence exists regarding the current landscape of health diplomacy in Central Asia, and how can public health diplomacy strengthen health governance, enhance cross-border health cooperation, support policy development and capacity-building initiatives, and advance progress toward Sustainable Development Goal 3 (SDG 3) and Universal Health Coverage (UHC)?

The research team conducted a systematic search to identify studies related to health diplomacy in Central Asia, with eligibility criteria defined a priori to ensure consistency and transparency in study selection. The information sources for this review included the following electronic databases: PubMed, and Google Scholar, to capture peer-reviewed biomedical, social science, and health policy literature. Additionally, Google was used to ensure coverage of gray literature, policy reports, institutional publications, and less traditional academic outputs (e.g., WHO country reports, UNDP assessments, regional health cooperation agreements, and training manuals).

The team conducted targeted searches using combinations of key terms. The search strategy employed Boolean operators (AND, OR) to combine the following groups of terms presented in . Studies were eligible for inclusion if they comprised peer-reviewed articles, conference papers, reports, policy documents, or relevant gray literature addressing health diplomacy, public health diplomacy, health governance, cross-border health cooperation, or bilateral and multilateral health agreements involving one or more Central Asian countries. Eligible publications also included studies examining health diplomacy competencies, training frameworks, capacity-building initiatives, and the intersection of public health, foreign policy, and international relations in the region, as well as documents assessing the role of international organizations such as the World Health Organization, United Nations Development Program, World Bank, and Shanghai Cooperation Organization in shaping regional health diplomacy. The review included studies published between 2000 and 2025 in English or Russian. Studies were excluded if they were unrelated to health diplomacy, public health governance, or cross-border health cooperation in Central Asia; focused exclusively on clinical or biomedical issues without a policy, governance, or diplomatic component; presented theoretical or conceptual discussions without reference to specific initiatives, programs, policies, or country-level evidence from the region; consisted solely of editorials, commentaries, or opinion pieces lacking empirical or documentary evidence; or focused on other geographic regions without substantial relevance to Central Asia.

The research team imported all retrieved citations into reference management software (Zotero). Following de-duplication, two reviewers independently screened titles and abstracts for relevance against the predefined inclusion and exclusion criteria. Articles passing the initial screening underwent full-text review. Any discrepancies between reviewers were resolved through discussion and consensus, with a third reviewer consulted where necessary. The PRISMA flow diagram () reflects the complete study selection process, including the number of records identified, screened, excluded (with reasons), and included in the final review.

The team developed a standardized data charting form in Microsoft Excel to ensure consistency in extracting and organizing information from the included studies. The charting process captured key characteristics of each publication, as outlined in the data extraction framework ().

The extracted data were synthesized using a combination of descriptive statistics and narrative synthesis. Frequency and distributions were calculated to provide an overview of the types of health diplomacy initiatives, geographic focus, key actors involved, health domains addressed, and alignment with SDG 3 and UHC indicators across the included studies. Health diplomacy initiatives were mapped by Central Asian countries, thematic area (e.g., communicable disease control, health systems strengthening, health security, maternal and child health), and type of diplomatic engagement (bilateral, multilateral, regional). This mapping allowed the identification of patterns, gaps, and contextual variations in public health diplomacy across the region.

In addition, a qualitative thematic analysis was conducted to identify recurring themes, key challenges, and emerging insights across literature. The analysis explored the extent to which public health diplomacy in Central Asia has addressed regional health priorities, facilitated cross-border cooperation, and contributed to progress toward SDG 3 and UHC. To enhance clarity and accessibility, findings are presented using summary tables and thematic charts that visually map the distribution of initiatives across countries, health domains, and diplomatic frameworks. The results are structured around the following thematic areas: (i) geographic distribution of initiatives; (ii) types of health diplomacy engagements; (iii) key actors and stakeholders; (iv) health domains and policy priorities; (v) alignment with SDG 3 and UHC; and (vi) gaps and recommendations.

To complement the evidence identified through the scoping review and provide context for cross-country comparisons, publicly available data were obtained from authoritative international sources, including the World Health Organization (WHO), World Bank, United Nations (UN), and relevant regional and multilateral organizations. These contextual data included selected demographic, economic, health financing, health workforce, Universal Health Coverage (UHC), and health system indicators, as well as information on major political and health diplomacy milestones in Central Asia. These sources were used solely to contextualize and support interpretation of the review findings and were not considered part of the formal scoping review search, screening, or study selection process.

As this study is a scoping review of publicly available literature and does not involve primary data collection from human participants, ethical approval was not required. All data were sourced from published peer-reviewed articles, institutional reports, and publicly accessible policy documents.

A total of 17 studies met the inclusion criteria and were included in this scoping review (). These studies, published between 2000 and 2025, encompassed health system reviews, scoping reviews, cross-sectional studies, qualitative investigations, policy analyses, and commentary papers. The included literature addressed multiple dimensions of public health diplomacy (PHD) in Central Asia, including health system governance, cross-border cooperation, universal health coverage (UHC), environmental health diplomacy, disease surveillance, health communication, and the role of international organizations in shaping health agendas across the five Central Asian republics: Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan.

The results are organized into four major sections. First, we present an overview of the included studies. Second, we examine health diplomacy within each Central Asian country, analyzing country-specific health governance, health system reform, and diplomatic engagement. Third, we examine international health diplomacy with Central Asia, including bilateral, multilateral, and institutional cooperation. Forth, we present an assessment of gaps and cross-cutting themes that emerged from the synthesis. Finally, we linked the existing health diplomacy literature to show how Public Health Diplomacy can be incorporated with these gaps and cross-cutting themes that emerged from the synthesis. Summary of Findings are presented in .

The 17 included studies represented a range of document types (). Peer-reviewed original research articles constituted the largest proportion ( n = 8; 47%), followed by review and scoping review papers ( n = 5; 29%), health system reviews and institutional reports ( n = 2; 12%), and commentaries or editorials ( n = 2; 12%). In terms of geographic focus, four studies examined Central Asia as a multi-country region, four focused specifically on Kazakhstan, two on Uzbekistan, one on Kyrgyzstan, one on Tajikistan, one on Iran as a comparative case, and four addressed global health diplomacy frameworks with relevance to the Central Asian context. No study focused exclusively on Turkmenistan, although it was covered within multi-country analyses. The strongest thematic concentration was observed in health system reform and UHC ( n = 5), followed by health diplomacy and governance ( n = 4), environmental health ( n = 3), healthcare inequality ( n = 3), public health communication ( n = 2), NCD risk factors ( n = 2), and one study each on communicable disease control, access to medicines, and health diplomacy training. The following sections present the findings organized first by country and then by international engagement.

This section examines the evidence on public health diplomacy within each of the five Central Asian republics. The analysis is structured country by country to highlight the distinct health governance trajectories, domestic health challenges, and diplomatic engagement patterns that characterize each nation’s approach to health cooperation ().

Beyond the specific health challenges documented in the included studies, Kazakhstan has positioned itself as a regional leader in health diplomacy through several mechanisms. The country hosts the WHO Country Office for Kazakhstan, which also coordinates technical support for the broader Central Asian sub-region (, ). Kyrgyzstan’s health system challenges present both needs and opportunities for public health diplomacy. The country’s active engagement with civil society and international partners provides opportunities for collaboration on health system strengthening and reform. Kyrgyzstan has received substantial international health development assistance, particularly from the World Bank, WHO, and bilateral donors, which has influenced the trajectory of health reform (, ). However, the sustainability of externally supported reforms and the alignment of donor priorities with national health needs remain ongoing concerns that require diplomatic negotiation and strategic engagement (). The country’s experience with community-based health governance models could also serve as a valuable case for regional knowledge exchange through diplomatic channels.

Despite these challenges, the Tajik government has formally committed to achieving UHC by 2030, signaling political that could be leveraged through diplomatic engagement and international cooperation (). This commitment creates a framework for development partners, regional organizations, and multilateral agencies to support Tajikistan’s health system strengthening efforts through coordinated technical assistance, capacity building, and financial support (, ). The country’s geographic vulnerability to natural disasters and cross-border health threats, including drug-resistant tuberculosis from neighboring Afghanistan, further underscores the importance of health diplomacy in addressing Tajikistan’s health security needs (, ).

Non-state actors also play an important role in Tajikistan’s health landscape. The Aga Khan Development Network (AKDN), through its constituent agencies the Aga Khan Foundation (AKF) and the Aga Khan Health Services (AKHS), has operated in Tajikistan since 1993, providing 650,000 individuals with improved primary healthcare access through the capacity building of 668 doctors and nurses and the construction or rehabilitation of 273 healthcare facilities (). AKDN’s cross-border programming, including the Central Asia Stunting Initiative (CASI) spanning Tajikistan, Pakistan, and Afghanistan, and the Aga Khan Medical Centre in Khorog with telemedicine links to university hospitals in Kabul and Karachi, illustrates how non-state actors contribute to health diplomacy objectives beyond traditional government-to-government channels (). The inclusion of such actors broadens the conceptual framework of public health diplomacy to recognize the diverse ecology of organizations shaping health governance in Central Asia.

The under-representation of Turkmenistan in the public health diplomacy literature (n = 0) has significant implications for regional health governance. As a geographically central country sharing borders with all other Central Asian states as well as Iran and Afghanistan, Turkmenistan occupies a strategically important position for cross-border disease surveillance, environmental health cooperation, and regional health security (). The country’s substantial natural gas revenues theoretically provide fiscal capacity for health system investment, yet the extent to which these resources are allocated to health remains unclear from available evidence (). Engaging Turkmenistan more effectively in regional health diplomacy represents a critical priority for strengthening the Central Asian health governance architecture.

Since the political transition in 2016, Uzbekistan has pursued a more open foreign policy and has actively engaged with international organizations, regional cooperation platforms, and development partners. This diplomatic opening has created new opportunities for public health cooperation, including increased participation in WHO programs, expanded bilateral health agreements, and greater receptivity to international technical assistance (, ). The included literature, however, did not systematically analyze how this political transition has affected health governance or health diplomacy outcomes, representing an important area for future research (, ).