According to the WHO, the increased incidence of non-communicable diseases (NCDs) has become a characteristic of low-to-middle-income countries. NCDs include diseases such as cardiovascular, respiratory and mental health conditions, cancer and diabetes. In Kyrgyzstan, NCDs account for 80% of all deaths. This very high rate can be explained by a number of factors, including unhealthy lifestyles led by some sections of the population, gaps in the healthcare system, and the dysfunction of family medical services in the areas of prevention and early screening. These factors have serious consequences in terms of health and public finances.
Non-communicable diseases: a scourge in Kyrgyzstan
According to the World Health Organization (WHO), non-communicable diseases are the biggest cause of death worldwide. On an international average 60% of deaths are linked to NCDs. This rate is often much higher in low-to-middle-income countries. This is the case in Kyrgyzstan where cardiovascular diseases, cancer and diabetes account for 80% of deaths
Primary health care
Health systems strengthening
- The project’s ultimate beneficiaries are citizens in rural areas of four northern oblasts (Chui, Naryn, Issyk-Kul and Talas), which is 31% (around 2 million) of total population in Kyrgyzstan
- Primary health care centers, such as Family Medicine Centers (212 out of 697) and Village Medical Points (434 out of 1029), and medical personnel are direct beneficiaries
- The national level beneficiaries are the Ministry of Health and the Mandatory Health Insurance Fund
- The PHC system delivers efficient, equitable and quality care to the population at risk or living with NCDs
- The population in rural areas has adopted healthier lifestyles which reduces its NCD-related risk behaviour
- The PHC system is reshaped to prevent and control NCDs
- The control and management of NCDs is improved through implementation of adapted PEN protocols
- Gender-specific needs of women and men are addressed through increased awareness of NCDs’ risk factors and changed behavior
- Other international or foreign NGO North
|Background||In 1997, the Ministry of Health (MoH) introduced the family medicine system by restructuring the outpatient facilities and retraining narrow specialists to become family doctors. However, the medical education system was not adapted to this reform and continued preparing narrow specialized doctors. In addition to this, since 2005 many trained family doctors have been migrating to Kazakhstan and Russia due to low salaries. As a result, there are substantial problems of shortage of staff, an excessive workload assigned to family doctors, including heavy administrative work, and low quality of care. Due to the weak primary care services, the referral system does not function; patients prefer to get medical care directly at the hospitals, which is increasing public and out-of-pocket expenditures for medical services (OOP in 2014 was 49%, while public health expenditure was 51% of total health expenditure, WHO 2015). Therefore, the primary health care system is still providing inefficient poor quality care and is not oriented towards prevention, early detection and systemic management of diseases. In such a situation, the primary health care system can hardly cope with a growing double burden of diseases, comprising of the increasing prevalence of NCDs. Overall, NCDs are responsible for 80% of all deaths in the country with probability of premature death (before age of 70) at 24% in 2015, where statistics for men (32%) are twice higher than for women (17%). Altogether, the current NCDs’ cost estimates accounts to USD 2.5 billion per year of the country’s economy (cost for treatment, economic loss due to people dying in working age), which is equivalent to 3.9% of the country’s annual gross domestic product. MoH acknowledges the urgency to address this problem but does not have enough capacities to do it. SDC will support MoH’s efforts to strengthen the PHC system to reduce the NCDs burden countrywide.|
|Objectives||The overall goal of the project is to contribute to improving the health status and well-being of the Kyrgyz population in rural areas through better control and management of NCDs at primary health care level.|
Results from previous phases: The project will be built on the experiences of WHO, SDC-funded Health Facilities Autonomy and Medical Education Reform projects to strengthen the primary care system in Kyrgyzstan. The network of the Village Health Committees, setup by SDC-funded Community Action for Health project, will be used as a key partner to work on health promotion and literacy with the population.
|Directorate/federal office responsible||
Swiss cooperation with Eastern Europe
International or foreign Non-Governmental Organization
Ministry of Health, Mandatory Health Insurance Fund, Kyrgyz State Medical Institute on Retraining and Continuous Medical Education and other concerned line ministries and agencies in relation of intersectoral coordination of activities around NCDs control.
|Coordination with other projects and actors||Strengthening the Primary Health Care System is one of the core components of the National health Reforms strategy ‘Den Sooluk’ (2012-2018), which is coordinated annually at the Joint Annual Review. The project has strong synergies with the Swiss funded health projects such as Health Budget support through SWAp in Kyrgyzstan, Health Facilities Autonomy and Medical Education Reforms.|
|Budget||Current phase Swiss budget CHF 4'810'000 Swiss disbursement to date CHF 1'965'069|
|Project phases||Phase 1 01.01.2017 - 31.12.2021 (Current phase)|
A public health care system in need of reform
The primary health care system has been weakened by the lack of financial and human resources in family medical centres and is now unable to fulfil the task required of it. As a result, people in need of medical help now turn directly to the country's hospitals, which are already overstretched.
The system of primary health care must be able to treat the growing number of patients suffering from NCDs. To achieve this it is essential to:
train doctors in family medicine right from the start of their medical training;
offer better salaries and career prospects to medical personnel to reduce migration to Russia and Kazakhstan;
provide incentives for family doctors to settle in rural areas.
Phase 1 of the SDC’s project will strengthen the primary health care system to enable it to treat NCDs effectively in four provinces of the north of the country (Chui, Naryn, Issyk-Kul and Talas). Thus 2 million people out of a total population of 8 million are potential beneficiaries of the planned improvements. The ministry of health has introduced reforms with a focus on training family doctors from bachelor's degree level on and compulsory training in rural clinics. Phase 2 will concentrate on the provinces in the south of the country and will end with the implementation of the reform of medical training with a focus on postgraduate training and continuing education and training.
Prevention, an essential condition for sustainable improvement
The WHO also claims that a 10% increase in the number of persons affected by NCDs translates into a 0.5% drop in economic growth. Given that these diseases require long-term treatment, they are a considerable load on the health care systems of the countries concerned. Currently, in Kyrgyzstan, the cost of treatments in addition to the economic loss resulting from the decrease in the labour force is estimated at almost 4% of GDP.
The causes of NCDs are manifold, hence the need to adopt a comprehensive approach that goes beyond the health sector and takes into account social, economic and environmental factors that have an impact on health. Prevention is therefore essential. The main risk factors include smoking, sedentary lifestyles, excessive alcohol consumption and malnutrition. Medical personnel have to explain to village communities the kinds of food and ways of living that are good for their health, in other words, forms of behaviour that help prevent diseases taking hold.
This project is helping to improve the health of millions of people and to ensure equitable access to good-quality health care even in rural areas. The aim is to improve on a sustainable basis the well-being of the local population through prevention and promoting healthy lifestyles.