|
|
|
|
|
|
|
|
|
|
  |
 |
  |
Kyrgyzstan
>> Regional Overview >> Kyrgyzstan Overview Activity Data Sheet
PROGRAM: Kyrgyzstan
TITLE & NUMBER: Increased Utilization of Quality Primary Health Care for Select Populations, 116-032
STATUS: New
PROPOSED FY 2001 OBLIGATION AND FUNDING SOURCE: $2,300,000 FSA
PROPOSED FY 2002 OBLIGATION AND FUNDING SOURCE: $2,600,000 FSA
INITIAL OBLIGATION: FY 2001 ESTIMATED COMPLETION DATE: FY 2005Summary: Kyrgyzstan is a leader in the Central Asia region in health care reform. Through this strategic objective, USAID will continue build an effective, affordable, and sustainable primary health care (PHC) system, that meets the health needs of families and to strengthen programs for the prevention and treatment of infectious diseases (ID). Health professionals are being re-trained to provide quality health care. Health professionals' clinical and laboratory skills will be upgraded to better diagnose, treat and prevent illness, including infectious diseases, such as acute respiratory infections, tuberculosis (TB), HIV/AIDS and hepatitis.
Program Categories include support for infectious disease prevention, and maternal/child health.
Key Results: Four key results are necessary to achieve this objective : 1) select populations are better informed about personal health care rights and responsibilities; 2) improved quality of health care including infectious diseases and maternal and child health; 3) improved use of health care resources for primary health care; and 4) improved legislative, regulatory and policy framework.
Performance and Prospects: After six years of assistance, USAID continues to achieve outstanding results in the health sector. Exercising rights and responsibilities are themes that excite people in Kyrgyzstan who are participating in the changes in their health care system. Approximately one million citizens of Bishkek and Chui regions exercised their right to choose their doctors through USAID-supported re-enrollment campaigns in late 2000.
The Ministry of Health (MOH) is supporting citizens' rights to information as well as their right to comment on programs affecting them. In 2000 USAID assisted the MOH to develop a national public awareness campaign to inform the public about the next phase of health reform and to get people involved in the process. The population was educated about a new benefits package that identifies those essential services that the Government of Kyrgyzstan (GOKG) plans to provide without cost. Public comment was critical because the draft package listed services that the GOKG can realistically provide, rather than the universal free services that have been decreed but have not been free in years.
People are also becoming accustomed to receiving health information from their family doctors and nurses. In a recent Public Satisfaction Survey, 70% of respondents noticed improved health promotion work, 83% found an increase in the scope of services available to them in PHC and 61% noted improvement in the quality of services after family doctors were retrained and passed accreditation exams. Overall, 91% were satisfied with the services they received.
Updated training of health care personnel contributes to improved quality. More than 1,400 physicians (most of whom are women) have completed a 2-year standard family medicine training program, passed exams, and been state-certified as family doctors. This year, the Family Medicine Training Center launched a one-year residency program with 14 post- graduate students. In addition, through partnership activities, USAID assisted the Kyrgyzstan State Medical Academy to create new departments in health management and higher nursing education.
USAID initiated its efforts to improve the health care delivery system in Issyk-Kul Oblast six years ago, and the process is now well-advanced, including extensive training on acute respiratory infection (ARI) and control of diarrheal diseases, accompanied by monitoring of performance. For the first time in 10 years, ARI has dropped from first to second place as a cause of infant mortality, a trend that will be observed to determine whether it is sustained over time.
USAID assisted the Government to obtain Hepatitis B vaccine. This will enable the GOKG to decrease the levels of acute, chronic and fatal liver diseases by stopping transmission of Hepatitis B to infants. USAID continues to support strengthening of the National Infectious Disease Reference Laboratory and three sentinel surveillance sites that were established for disease specific surveillance, vaccination program monitoring and viral hepatitis control in Kyrgyzstan. This laboratory has received authority from the Ministry of Health to license local level infectious disease diagnostic laboratories to ensure the quality of the laboratory work. Through the Center for Disease Control and Prevention (CDC)-supported training, a core group of infectious disease professionals titled "The Central Asian Epidemiology Network (CAR EPI NET)" was established, strengthening capacity for surveillance and outbreak investigation, as well as training of trainers activities.
The GOKG continues to be a pioneer in health reform in the NIS. In the area of health finance, massive restructuring is taking place. At the district level, the Health Department has been abolished. Health purchaser and health provider functions have been split, with the Health Insurance Fund as the purchaser and the newly created oblast Merged General Hospital as the provider. The Merged General Hospital will incorporate specialty hospitals into its administrative structure as well as its physical plant, when feasible. This change has great potential to increase efficiency and decrease administrative and facility operating costs by eliminating duplication. In addition, two pilot budget projects are underway to create a single payer system by merging budget and health insurance funds into a single pool to allow greater flexibility to the purchaser in buying services.
At the national level, the Health Information Center has replaced the Health Statistics Department and been merged under the Health Insurance Fund so that health information systems are now tied to provider payment systems. This financial connection gives providers an incentive to submit good data that can be used for payments, health statistics, quality assurance, research and monitoring and evaluation. Other developments include an outpatient drug benefit being tested as part of the new proposed health benefits package. If successful, this could make drugs more accessible at the PHC level and decrease the motivation to hospitalize solely to obtain free drugs.
In 2001, with the benefit of additional funds, USAID will develop an HIV program prevention with a behavioral risk assessment, condom social marketing, a high-level regional conference, a pilot project to explore STI treatment approaches using the World Health Organization (WHO)-developed Syndromic Management approach, prevention interventions with high-risk groups and much-needed information campaigns at the community level.
Regarding TB control, WHO and the World Bank (WB) have taken the lead. However, after initial promising results, TB mortality increased from 18.4 per 100,000 in 1998 to 21.3 in 1999. From discussions with donors and the GOKG, as well as results of USAID-supported laboratory monitoring visits, USAID has agreed to significantly increase support for the TB Directly Observed Treatment Short-course (DOTS) program.
In FY 2001, USAID intends to obligate, for technical assistance and training activities, the following amounts per category: Infectious Disease Prevention, $1,800,000 and Maternal/Child Health, $500,000.
In FY 2002, USAID will continue to deepen, broaden, and fully implement health care reforms. USAID will also continue to support efforts to better diagnose, treat and prevent infectious diseases such as TB and HIV/AIDS.
Beneficiaries: The primary beneficiaries are health professionals working in primary health care and infectious disease. The ultimate beneficiaries are users of these health services, who are predominantly women and children.
Possible Adjustments to Plans: Due to a high level of indebtedness, the World Bank Health II loan start date is uncertain and could lead to delays in key procurements, infrastructure development and technical assistance. USAID planned expansion of improved PHC to South Kyrgyzstan could be affected. Political will and support for change could be eroded, particularly in the area of restructuring of the Sanitary and Epidemiologic Services and in rationalizing the tertiary facilities in the capital city, Bishkek.
Other Donor Programs: The World Bank and Asian Development Bank have large health sector loans, specifically in health sector reform. WHO and Germany are active on TB control and Integrated Management of Childhood Illness programs. The Japan International Cooperation Agency (JICA) supports the GOKG in vaccine procurement. United Nations Population Fund (UNFPA) procures contraceptives for the public sector.
Principal Contractors, Grantees, or Agencies: Implementing partners include Abt Associates/ZdravPlus, American International Health Alliance (AIHA), the Centers for Disease Control and Prevention (CDC), Counterpart Consortium, and Project Hope.
FY 2002 Performance Table
Selected Performance Measures: Increased Utilization of Quality Primary Health Care for Select Populations, 116-032
Indicator FY97 (Actual) FY98 (Actual) FY99 (Actual) FY00 (Actual) FY01 (Plan) FY02 (Plan) Indicator 1: % of sputum smear positive tuberculosis (TB) patients cured through Directly Observed Treatment Short-course (DOTS) approach in pilot sites N/A N/A N/A 83.7% 85% 85% Indicator 2: % of children less than 1 year of age completely vaccinated against hepatitis B virus (HBV) N/A N/A N/A 70% 75% 80% Indicator 3: % of total combined pilot site populations voluntarily enrolled in primary health care practices N/A N/A N/A 32% 32% 35% Indicator 4: % of total health expenditures in pilot districts spent on primary health care (new indicator) N/A N/A N/A N/A baseline in May 2001 To be determined in May 2001 Indicator Information:
Indicator Level (S)or(IR) Unit of Measure Source Indicator Description Indicator 1: S % of TB patients cured TB health information system Cure rate is the number of TB patients cured as a result of DOTS treatment plus patients that completed treatment divided by the total number of TB smear positive patients minus number of deaths. DOTS is considered effective in treatment sites if at least 85% of patients are cured. (For recently established DOTS programs, it can be lower, e.g. 75%.) Each annual result represents a different group of TB patients who completed treatment. Indicator 2: S % of children less than 1 year vaccinated Official government data on HBV immunization coverage; sera-survey studies and immunization coverage assessment by CDC "Completely vaccinated" is defined as receiving 3 doses of hepatitis B vaccine as reported in official government data. Indicator 3: IR % of populations voluntarily enrolled Health information system at district or town level; MOH, national census Voluntary enrollment is defined as the opportunity to select one's own PHC practice during a specific delimited time period. A PHC practice is defined as a unit that: serves a mixed population in which all three basic specialties (pediatrics, internal medicine, obstetrics/gynecology) are represented in the practice; is paid or plans to be paid on a per capita basis; has a score in the ZdravPlus minimum standards assessment that is greater than zero; and has or plans to have a population database or voluntary enrollment. Indicator 4: IR % of health expenditures for primary health care Ministry of Finance, Ministry of Health, Health Insurance Fund Total health expenditures consist of all funds allocated to the health sector including inpatient, outpatient, public health, education and research, capital and administrative. "Spent on PHC" refers to funds allocated to primary health care practices defined as units that: serve a mixed population in which all three basic specialties (pediatrics, internal medicine, obstetrics/gynecology) are represented in the practice; are paid or plan to be paid on a per capita basis; have a score in the ZdravPlus minimum standards assessment that is greater than zero; and have or plan to have a population database or voluntary enrollment. U.S. Financing
(In thousands of dollars)
 |
|||
Last Updated on: May 29, 2002 |
