Gaining health : analysis of policy development in European ...

stan and Uzbekistan. Serious concerns have been raised,
however, about the quality and reliability of the data from
all central Asian countries, especially infant and maternal
mortality rates.
The remarkably high rate of excess mortality caused by
chronic lower respiratory disease is explained by a number
of unfavourable environmental and behavioural factors,
particularly the use of solid fuels and smoking.
As for many other countries in the WHO European Region,
NCD are the main cause of death. Morbidity from infectious
diseases is relatively high, however, especially with
respect to tuberculosis, malaria and, increasingly, sexually
transmitted infections.
As to risk factors, tobacco and alcohol use place the greatest
burden on males and high blood pressure and overweight
on females. Between 2000 and 2005, alcohol consumption
increased by 28% and deaths caused by excessive
drinking rose by 130%.
1.3. The main features of the health system
In Kyrgyzstan, as in all countries emerging from the former
USSR, the health care system was developed based on the
strongly centralized Semaško model. The rights and responsibilities
of the population in the field of health protection
are secured in the Constitution of the Kyrgyz Republic
and the Law on health protection of citizens of the Kyrgyz
Republic.
The Government adopts health policy following its approval
by Parliament. The Ministry of Health implements health
policy and other national and specific programmes. Local
state administrations are owners of health care facilities,
including polyclinics and regional and district hospitals.
Through their coordination commission, local administrations
exercise considerable influence on national health
policies.
In 2004, 5.4% of GDP was spent on health, a figure comparable
with that of other CIS countries. Financial planning
and budgetary management for health are the responsibility
of the Ministry of Health, though the Ministry of Finance
and local administrations also play an important role in the
budgetary process. As a result of a major reform in 2000,
fragmentation of the health care budget was halted and the
regional level identified as the ideal distribution and budget
management point. A complementary reform allowed
health facilities more autonomy and greater flexibility in
managing their budgets. Out-of-pocket payments are significant
and represent a major source of revenue for the health
system. The private health sector has developed since the
1990s but remains small, comprising mainly outpatient care
and pharmacies.
2. Kyrgyzstan’s approach to developing
policies to tackle NCD
2.1. How things started
A unique feature of Kyrgyz health policy is the almost total
lack of background or developed sub-policies in the field of
NCD policy development. The situation is characterized by
the legacy of the Semaško system, traditions of health propaganda
and a few isolated and fragmented actions. Kyrgyz
participation in WHO projects such as MONICA and experience
with loans from the World Bank have contributed
to a raised awareness of the need to develop a strategy on
NCD. Thus, policy development to tackle NCD starts with
constructing a broad new umbrella policy framework within
the so-called Manas Taalimi overall health policy strategy
(2). This includes a strong public health element while
emphasizing aspects of health promotion and CVD prevention.
The public health components were proposed by the
World Bank as a loan condition and were accepted by the
Kyrgyz Government. The WHO Regional Office for Europe
and representatives of the international community provided
significant technical support in planning the strategy.
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Case studies: policy development in countries for tackling noncommunicable diseases