Since 1999, Swiss Agency for Development and Cooperation has been involved in helping the Kyrgyz government deliver vital reforms in the national health sector. This began with a thorough assessment of the health care situation in the country by SDC and its partner the Swiss Red Cross (SRC) and led to the establishment of an innovative and flexible project - The Community Action for Health Project (CAHP). CAHP was designed specifically to find solutions to some of the most pressing problems in the sector. The rehabilitation of hospital infrastructure in rural areas, where income per capita is low and the health needs of the population are most acute, was identified as an immediate priority. <>
Initially, CAHP focused its activities in the poorest region of the country, the mountainous oblast of Naryn, by bringing rural hospitals there up to standard. Later, the project revised its activities and focused on rural health promotion via the “Community Action for Health” (CAH) model, which was designed and tested in Jumgal rayon of Naryn oblast and later expanded to encompass Talas, Osh, Batken and Chui oblasts. The CAH model is implemented through the creation of Village Health Committees, which operate as voluntary bodies addressing health issues identified by rural communities. Based on the health issues identified, the project elaborates health actions and conducts regular trainings for VHCs in cooperation with the Republican Centre for Health Promotion, in order to guide them in their outreach work. There are around 20 health actions implemented across the country focused on improvements in dental health, brucellosis treatment, maternal and infant health, reproductive health, iodized salt consumption to prevent goiter, sanitation & hygiene issues, high blood pressure and nutritional health. While acknowledging the traditional role that women play in solving health problems in rural families, to the project is always striving to engage more men in health actions, especially regarding predominantly male-related health issues such as hypertension, brucellosis and alcoholism.
Community-based health promotion has several advantages over state-driven models.In addition to encouraging a preventative approach to healthcare, the strategy empowers rural communities and opens up possibilities for a stronger and more diversified civil society in the country’s regions. Through this approach, people have realized they can seize the initiative in improving their own health, rather than waiting passively for the government to do something for them. Meanwhile, health related infrastructure is being continually improved in order to support this effort.
The goal of the Community Action for Health Project (CAHP) is to improve health in rural areas of Kyrgyzstan in a way that is sustainable and self-fulfilling. The project’s work constitutes an important element of the government’s national strategy, focused on improving the service delivery and quality of Primary Health Care.
Through the creation of viable structures at community level – the VHCs - the project also strives to provide a forum through which local people can interact with the health system as a whole. Complementary to this are efforts to strengthen capacity at the Republican Centre for Health Promotion, a body under the Ministry of Health, which will eventually assume full responsibility for overseeing the development of the existing community health structures
Finally, the project will also assist the RCHP in introducing modules and educational resources on health promotion and community action for the graduate and post-graduate curricula of medical staff, in partnership with Kyrgyzstan’s state medical academy.
Supported by significant investment in hospital infrastructure, the project steadily contributed to addressing critical in-hospital issues such as infection control, hospital acquired infection control, and health care waste management. Simultaneously, the project has dealt with the importance of primary health care provision and promoting healthy lifestyles in the community. Since it began, the CAH model has been fully endorsed by the Kyrgyz government, allowing for a platform from which the local population can take control of their own health needs and adopt behavior to secure themselves and their families against the risk of short and long-term illnesses.
The role played by the village health committees has been at the fulcrum of this process. Representatives to the VHCs are elected by rural communities, who identify health priorities for discussion and collective action. Campaigns launched on the basis of priorities selected by communities have direct health benefits. For instance, the iodized salt promotion campaign was a particular success, since it enabled communities to check the salt sold in their villages using simple test kits. This campaign resulted in 98% of the households using only iodized salt.
Currently campaigns are being developed to address cardiovascular diseases, anemia, hypertension and tobacco consumption. Using small grants in combination with their own contributions, communities have built or repaired bath houses, drinking water systems and first aid posts. In some cases ambulances have even been purchased. Over 100 such projects have now been completed in Naryn and the adjacent region of Talas.
In the medium term, about 70 health-related infrastructural units (bathhouses, rural health houses) will be built in villages, across the country. These mini projects will be partly financed by a grants competition, partly by villagers themselves. At organizational level, two very important developments will take place.
• The Association for VHCs (AVHC) will take part in the Joint Annual Review of the National Health Strategy. This will allow a mechanism for VHCs to coordinate and lobby the needs of their communities in the development of the national health strategy.
• A consultative forum involving the association, the Ministry of Health, the RCHP and various development partners will also be established to discuss CAH-related issues, and discuss new proposals in the sphere.
Both of these achievements will help ensure that CAH needs are reflected in the ministry’s working plans and budgets, contributing to greater sustainability.
The project’s long-term aim is to pave the way for the permanent empowerment of VHCs, Regional Health Committees (RHCs) and the AVHC, both financially and organizationally. The project will also improve the ability of the AVHC to raise funds for itself and the VHCs that work under it, with a particular focus on ensuring the continuing institutional consolidation of the younger VHCs in Osh, Batken and Chui.
Overall budget: (1999-2014) CHF 22.4 mln
Current budget: (2011-2014) CHF 6.9 mln
Location: All oblasts of the Kyrgyz Republic
Implementing Agency: Swiss Red Cross
Donors: Swiss Agency for Development and Cooperation (SDC),
the Liechtenstein Development Service (LED)
Swiss Red Cross
Tel.: + 996 312 906310
Embassy of Switzerland
in the Kyrgyz Republic
Senior National Program Officer
Tel.: +996 312 301036
Last update: April 2013