Phase I: 1999-2001<>

Phase II: 2001-2004

Phase <>III: 2004-2006

Phase IV: 2006-2008

Phase V: 2008-2011

Current budget: 9 200 000 CHF

Overall budget: 18 359 000 CHF

Project Location: Naryn, Talas, Batken, Osh and Chui oblasts

Implementing Agency: Swiss Red Cross

Donors: Swiss Agency for Development and Cooperation (SDC) and the Swedish International Development Agency (Sida)

Background

The collapse of the Soviet Union left the Kyrgyz Republic in a difficult socio-economic situation, affecting all sectors and in the health sector the economic decline meant that Kyrgyzstan was unable to maintain the health infrastructure inherited from the Soviet Union. In addition, the percentage of the budget spent on health kept decreasing and the quality and availability of health services declined. The problem was especially acute in rural areas, where more than 60 % of the country's population lives. Poverty linked diseases, such as anemia, tuberculosis and brucellosis, began to reemerge.

In 1996, in order to address these problems in a systematic way, the Kyrgyz government with the help of international donors launched the MANAS national health care reform program. Its key elements included the development of a national health sector policy, new financing mechanism, rationalization of services, and strengthening of primary health care. In 2005 a new phase of the reform called Manas Taalimi was formulated and adopted for the years 2006-2010. The current goal of the reform is to improve the health of the population with a strong emphasis on health promotion.

Project Description

In 1999 the Swiss Agency for Development and Cooperation (SDC) started to support Health care reforms with other donors in the sector through the Kyrgyz-Swiss Health Reform Support Project. Initially, the geographic focus of the project was on Naryn oblast which is the largest and poorest in Kyrgyzstan. A qualitative assessment of people's health priorities revealed brucellosis, anemia, hypertension, cold/influenza, reproductive tract infections (RTI), and dental diseases as the most prevalent. Nutrition, clean drinking water, hygiene and access to drugs were identified as the most important health needs in Naryn oblast.

Health Promotion

During phase II health promotion became the main focus of the project through the development of a community based health promotion strategy for rural areas, called Community Action for Health. It contributes to the development of civil society and empowers local rural communities. People have realized they can take the initiative to improve their health rather than passively waiting for the state to do something.

Communities analyze their health priorities and elect representatives to village health committees (VHC) to coordinate action on these priorities. Campaigns launched so far on the priorities selected by the communities are: promoting iodized salt, brucellosis prevention, promoting vegetable gardening, reducing alcohol abuse and access to treatment of reproductive tract infections. For example, the iodized salt promotion campaign enabled communities to check the salt sold in their villages with simple test kits. It achieved a coverage of 98 % of iodized salt in households. Currently campaigns are being developed to address cardiovascular diseases, anemia, hypertension and tobacco consumption. Using small grants in combination with their own contributions communities under the leadership of village health committees have built or repaired bath houses, drinking water systems, first aid posts or purchased ambulances. Over 100 such projects have been completed or are in progress in Naryn and Talas.

In 2004-2005 Community Action for Health was extended throughout Naryn and Talas oblasts with 213 village health committees already functioning in 2006. The success of this health promotion model convinced the Ministry of Health to endorse it as part of the National Health Reform and ask for it to be extended in rural areas nationwide. Two other donors agreed to support this extension. USAID (through the ZdravPlus project) implements Community Action for Health in Issyk-Kul and Jalal-Abad oblasts, with the technical expertise of the Swiss Red Cross.

In 2004-2005 the project started creation of village health committees in Naryn and Talas oblasts; in 2010 there were 1307 such committees. Success of such model of health promotion was acknowledged by the Ministry of Health, which decided to accept it as priority component of national health care reforms and asked donors to support extension of this model to all villages of the country. USAID and Swedish Sida agreed to support this initiative. USAID (through ZdravPlus projetc) is financing creation of village health committees in Issyk-Kul and Djalal-Abad oblasts with technical assistance of the Swill Red Cross. In 2006, the Swedish International Development Cooperation Agency (Sida) decided to contribute to the extension of the model throughout the remaining oblasts of Batken, Osh and Chui oblasts from 2006 on. Sida and SDC agreed to delegated implementation under which Sida entrusts SDC to implement the extension through its existing set-up from 2006 onwards. With Sida’s contribution the project has been renamed the Kyrgyz-Swiss-Swedish Health Project (KYSS). 

Through extending the Community Action for Health the population covered by the project will increase from 370 000 people in Naryn and Talas to 2.13 million in all five oblasts.

Improving the Health Infrastructure

Four essential rayon level hospitals and one building of oblast merged hospital in Naryn oblast were completely renovated and provided with new equipment in the first two phases of the project. A maintenance scheme was set up and staff trained. All primary health care facilities in Naryn oblast were provided with basic equipment.

A training centre was established in Naryn, to be used by the Family Medicine Centre of the Ministry of Health to train family doctors. Currently the project is working on energy saving measures and on improving insulation of Naryn oblast hospitals. Seven Feldsher-Obstetrician Points have been newly built or repaired in Naryn and Talas oblasts and 16 more are under construction.

Hospital infection control and health care waste management

The project initiated a national working group on hospital hygiene with technical assistance from the WHO. New national guidelines were developed on hospital-acquired infection control, medical waste management and antibiotic resistance control. Specific activities include surveillance methodology for surgical site infections, the establishment of a national reference centre for infection control, self-monitoring of infections by hospitals, introducing hand disinfecting procedures, new guidelines for perioperative antibiotic use, waste separation and the development of a locally appropriate method of waste treatment. These model has been piloted in Naryn hospitals and demonstrated very good results and cost effectiveness. Currently this model of HCWM introduced in all hospitals of Talas oblast and in the process of its extension to Issyk-Kul and Chui oblasts.

Quality Improvement

Under this component access in villages to affordable drugs is being improved in pilot pharmacies in Jumgal region. Also, the project is co-financing continuous quality improvement (CQI) of Family Group Practitioners (FGPs) and FAPs in conjunction with USAID in Naryn and Talas oblasts.

Contacts

Tobias Schueth

Team Leader

Swiss Red Cross

187, Sydykov str.,

Bishkek, Kyrgyzstan

Tel: (+ 996 312) 90 63 10

kshp@elcat.kg