Kyrgyzstan

The Kyrgyzstan health reforms are unmatched in their scope and results in the former Soviet Union (excepting the Baltic Republics). The large scope and comprehensiveness of health reform, using a broad health systems approach, has extended its impact well beyond the health sector and resulted in sweeping changes in the way the government delivers services to the population. For the past 10 years, ZdravPlus supported health reform leaders in driving the health system strengthening process by building capacity to develop and implement health policy and technical interventions using a step-by-step approach resulting in institutionalized health reforms.

Starting in early 2005, ZdravPlus began a new project, contributing to development and implementation of the Ministry of Health's (MOH) national health reform strategy called Manas Taalimi (translated as Lessons of Manas) which is a follow up to the Manas Health Care Reform Program (1995-2005). The new strategy is a comprehensive five-year program with the central aim of solidifying progress made over the last 10 years in strengthening primary health care, improving health financing, optimizing the hospital sector, and improving efficiency, access, and quality of care. The strategy also expands reform efforts with new focus on Primary Health Care (PHC) emergency care provided by feldshers (remote rural providers), while continuing tomodernize public health services, improve and integrate priority services , vertical programs, meeting Millennium Development Goals, and initiate medical education reform. The strategy will be jointly funded starting in 2006 by the Kyrgyz budget, as well as through a Sector-Wide Approach (SWAp) that pools donor resources to supplement the MOH budget, and through parallel financing by other donors such as USAID.

Stewardship

ZdravPlus activities in Kyrgyzstan already support implementation of the new Manas Taalimi plan. Under the project's Stewardship component, ZdravPlus provides technical input to continue to contribute to the development of a permanent legal and regulatory framework for the reforms. We also support further definition of institutional structure, roles and responsibilities of health sector organizations and actors, and build capacity of institutions involved in the reforms, such as the MOH, Sanitary and Epidemiological Service (SES), Mandatory Health Insurance Fund, Family Medicine Training Centers, and professional associations and NGOs. Through support to the MOH Press Center, ZdravPlus helps market the reforms to create understanding and support not only within the health sector, but also across all levels of government, and most importantly among the population.

Resource Use

Major ZdravPlus objectives in the next phase of strengthening health finance and resource use in Kyrgyzstan focus on institutionalizing the single-payer system and solidifying the structure of the health delivery system. This involves continued work to reorient the system to strengthen primary health care and eliminate over-capacity of inpatient and tertiary care, especially in Bishkek and Osh. Building on 10 years of work in health financing, ZdravPlus continues to provide technical expertise and input to strengthen the single-payer system. In 2006, this includes helping to introduce changes related to implementation of the SWAp mechanism, introducing program budgeting and reporting in the health sector, and pooling health resources nationally to further increase equitable distribution of resources. ZdravPlus continues to actively support efforts to modernize and improve health information systems and to increase management capacity in health care facilities throughout the country.  

Service Delivery

Kyrgyzstan has made great progress in improving Service Delivery with all Family Group Practice (FGP) doctors, and a significant percentage of FGP nurses, having been retrained in a four-month Family Medicine course by ZdravPlus, in coordination with various other donors. Current activities focus on institutionalization of Family Medicine, shifting efforts to begin reforming medical education, continuing to develop Family Medicine faculty, establishing a sustainable Family Medicine Residency Program, and introducing Continuing Medical Education (CME) that includes computer-based distance education. The content of CME modules are linked to the overall health reform process and include: dissemination of new Clinical Practice Guidelines; addressing priority areas in Mother and Child Health (MCH) and infectious diseases; advocating rational drug use; and a health promotion component to increase the role of FGPs in educating the population and community. Additional plans include roll-out of an IUD training program for rural midwives as well as a Safe Motherhood pilot, continued introduction of Evidence Based Medicine and the development of Clinical Practice Guidelines, and accreditation of medical facilities. ZdravPlus continues to support Continuous Quality Improvement (CQI) efforts in pilot facilities throughout Kyrgyzstan, covering all of the FGPs in Issyk-Kul, Naryn, and Talas oblasts, and pilot rayons in the remaining four oblasts.

Population and Community Health

To address issues in Population and Community Health, ZdravPlus continues to help build broad public understanding of the health reforms, emphasizing the benefits for various target audiences. The messages explain how Kyrgyzstan is moving toward a modern health system where the government, health workers and the population are all partners in health, and stress concepts such as preventive health and family-centered care. Other activities include encouraging the population to take greater responsibility for their own health care, by rolling out the “Jumgal model” implemented in Naryn and Talas oblasts, and forming Village Health Committees in Issyk-Kul and Jalal-Abad Oblasts. The Committee members, elected by the village, are trained in identifying health concerns in their village with their PHC providers and then receive further support to begin addressing health concerns through health actions.