Strengthening Governance in the Primary Health Care System in Kyrgyzstan

Ministry of Health

The overall goal of the project was to contribute to improving the health status and well-being of the Kyrgyz population in rural areas through better control and management of non-communicable diseases (NCDs) at primary health care level. This was achieved through improvement of governance of the primary health care system, training of primary health care staff for improved service delivery and healthy promotion activities to change behaviour of the population towards healthier life-style. The project team assisted the Kyrgyz government to create a conducive environment to improve efficiency, equity and management of the primary health care system to cope with the increasing burden of NCDs.

The two key areas of interventions are:

• Capacity building of the primary health care staff at all levels to detect NCDs in the early stage

• Raising awareness of risk factors associated with the development of NCD among the population.

During the inception phase, the team of consultants formulated the outcomes, outputs and activities for the implementation phase and built consensus among stakeholders (e.g. MoH, MHIF and WHO). The team conducted:

- analysis of the context, health status, stakeholder landscape and SWOT of the Kyrgyz Health system.

- formulation of outcomes, outputs and activities of the implementation phase and their cost-effectiveness.

- conflict and gender sensitivity.

- consensus building among stakeholders, such as MoH, MHIF and WHO.

- mobilization of local networks such as Association of Village Health Committees and Health Promotion Units to support project implantation.

Upon completion of the inception phase, the 4-year implementation phase begun. The general goals were to improve service quality at primary health care level to better prevent, manage and control NCDs through capacity building, improvement of health management information systems and introduction of a comprehensive management tool. Human resource capacity was improved through capacity building, particularly in the area of NCD management. Other activities in this phase were assessment of management capacities, procurement of equipment, economic evaluation of interventions, governance of the primary health care sector, performance-based financing for incentivizing NCD prevention at primary health care level and increase of accountability at the primary health care level. Development of information campaigns focused on the most vulnerable groups - the poor, rural population who is most at-risk of living with undetected NCDs, suffering from high out-of-pocket expenditures, or whose disease is insufficiently managed. Cross cutting themes, like gender and governance, were also addressed. The project aligned with strategic priorities of Kyrgyzstan and built upon existing and past health reform programmes.