ANALYSIS OF THE SITUATION

Under the Soviet Union, the socialist system provided high quality medical services for free to the whole population. At the same time, health care was state owned, centrally managed, and focused on curative medicine, rather than on primary level and health promotion. Since the collapse of the Soviet Union, the health system underwent an alarming deterioration with severe cuts in health expenditures, and large deterioration of infrastructure and services.

Large parts of the population of the Central Asian countries have experienced a dramatic decrease in quality of life, above all in health: drop in life expectancy at birth, increase in infant mortality rate, rise in morbidity, spread of communicable diseases (tuberculosis, brucellosis and hepatitis), growth of sexually transmitted diseases including HIV/AIDS  etc. The overly centralized health care system could not be maintained at the same level and had to undergo a profound restructuring and reform process.

With the help of international donor agencies, Tajikistan and Kyrgyzstan have developed comprehensive national health care reforms. These reforms aimed at the reorientation of the system towards primary health care, by moving from hospital-based care to more family-oriented health services, with a strong emphasis on health promotion and active community involvement in disease prevention.

COOPERATION GOALS

The goal of the Swiss cooperation in the health sector is to ensure equal access for the whole population to basic, adequate and good quality public health services. Health is understood as an important determinant of social and economic development and as an essential component of the overall aim to increase social justice. Switzerland aims at improving the health of the poor and most vulnerable layers of the population through reducing inequities and promoting sustainable development. In Central Asia, Switzerland is well focused in both Kyrgyzstan and Tajikistan on innovative community-based approaches to primary health care and health promotion as key elements to achieve health MDGs.

APPROACH

In line with the harmonization agenda, Switzerland aims at an optimal coherence of its contribution in the health sector, and at fostering strategic alliances with other like minded donors and multilateral institutions. New aid modalities with partners, like in Central Asia the Health SWAP and delegated implementation agreement, are actively sought and applied.

DEVELOPMENT PROJECTS

► In Kyrgyzstan

Since 1999, the Swiss Government is supporting the health sector reform in Kyrgyzstan, first under the so-called Manas Programme (1996-2005) and then under its successor, the Manas Taalimi Programme (2006-2010). Taking into account the lead of the Ministry of Health in developing a second generation of well structured and prioritised national health reforms, donors decided to align their aid under a Sector Wide Approach (SWAP), by providing budget support as well as parallel financing to the health sector.

Along with other donors (WB, DfID, KfW, Sida) Switzerland is contributing USD 6 million to a total pool of over USD 60 million, which has been allocated directly to the country’s treasury and transferred to the Ministry of Health.  In this approach - funds are added to the government’s own budget and can be used flexibly to meet needs.

At the same time, the Swiss Cooperation is continuing its highly successful Kyrgyz Swiss Swedish Health Project (KYSS).  The  project started in 1999 with the aim of restructuring the health care delivery system in Naryn oblast, which was selected as the poorest of the seven oblasts in Kyrgyzstan.  Since 2001, the project has been developing a community centred health promotion strategy for rural areas to enable people to gain control over their health, called "Community Action for Health (CAH)".

The CAH model has been recognised as the national strategy for health prevention by the Kyrgyz Government.  In 2006, the Swedish Agency for Development and Cooperation (Sida) joined the project through a delegated implementation agreement with Switzerland
and allocated funds to extend the CAH activities to the remaining oblasts of Osh, Batken and Chui.

► In Tajikistan

The Swiss government has been supporting the promotion of Primary Health Care and Family Medicine for several years through the following projects: The Tajik - Swiss Health Reform and Family Medicine Support Project (SINO), the Community and Basic Health Project (with WB and SIDA), and the Community Healthcare Project. Important activities of these projects include training for medical staff, awareness building on a healthy lifestyle, better control of diseases such as tuberculosis and HIV/AIDS, mobilization of Community Health persons, provision of medical equipment  and managerial support to rural health centers.

In view of the still fragmented health sector reform process in Tajikistan, SDC is increasingly aiming to interlink its various health projects and also to build up synergies with other agencies’ engagement in the sector and with the Ministry of Health. As a consequence, from 2006 onwards, SDC together with the World Bank and other donors is supporting preparatory works towards a Sector Wide Approach (SWAP) in the Tajik health sector.  Also since 2006, SDC is looking into ways of how to support the reform of medical education at the Tajik State Medical University. Since 2008, an SDC-funded UNICEF-project (“Saving Lives”) is focusing particularly on improving mother and child health care services.

CROSS CUTTING ISSUES

In general, Swiss health projects aim at strengthening good governance in health systems, empowering communities and the development of a civil society where people are able to define the determinants of their health problems in a participatory approach, and to adopt remedial measures, while at the same time contributing to innovative approaches  to  health care.

Swiss financed projects ensure that in the context of wide spread poverty women and men have equal access to health services. Gender specific health problems are considered, and health personnel is trained on gender issues.

Page was last updated August, 2008

• SDC-Health web site (activities in Kyrgyzstan)