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

Chapter 4
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disease prevention at government level are at the planning
stage.
Currently, as in other central Asian countries, the role of
the Kyrgyz Ministry of Health is mostly administrative, managerial
and regulatory. It directly administers government
health facilities such as the scientific research institutes and
national centres of excellence and manages the Kyrgyz State
Medical Academy. Until recently, the Medical Academy was
unable to control the number of admissions. It appoints the
heads of government-based health care organizations and
its prior agreement has to be obtained to appoint heads of
municipal health organizations. The overwhelming role of
academic bodies is a rather conservative and an obstruction
to health policy development.
Since donors play an important role in Kyrgyzstan, the
Ministry of Health is also responsible for coordinating
relevant donor activities and distributing of humanitarian
aid. This very complicated and sensitive task is not carried
out in a satisfactory way at the moment. At least in the field
of public health and health promotion, most activities are
driven by external donors and the Ministry of Health has
rather limited influence on the support of the international
community.
The Ministry of Health develops a health budget according
to national health policy priorities, taking into account
donors and health revenue estimates. The budget planning
process is a sensitive issue in Kyrgyzstan, in which the Ministry
of Finance also plays a crucial role. The basic problem
is the poor economic development of the country, and the
budgetary possibilities of financing health care are rather
limited and inflexible. In the face of serious underfinancing,
one of the specific dilemmas of the Kyrgyz situation is
how to integrate strategic considerations of health promotion
and NCD prevention to a policy basically under crisis
management. If successfully implemented, Manas Taalimi
may serve as a good example of moving from incremental,
emergency-type action to long-term, sustainable policy
development in the field of health.
Local state administrations are responsible for health
planning, regulation, coordination and implementation at
subnational level. Prior to major local reforms in 2000,
these functions were performed by oblast health departments.
As the result of the reforms, these departments
were abolished and their functions transferred to regional
hospitals and then to the supervisory councils for health
management, which became the coordination commissions
on health management in 2003.
According to Kyrgyz law, NGOs (at least theoretically)
“take part in ensuring health security and promotion and
provide scientific and health information” (3). A large
number of NGOs are active, including initiative groups and
health committees and international agencies such as the
Soros Foundation–Kyrgyzstan and Counterpart Consortium,
along with projects funded by international organizations
to support the development of civil society initiatives.
2.4.1. Primary health care
The PHC system includes various levels and entry points for
patients:
• feldsher-obstetrical posts
• family group practices
• rural outpatient centres
• family medicine centres
• polyclinics.
In rural areas, the feldsher-obstetrical posts are the most
important points of entry to health care, including NCD
prevention. In cities, health providers include general and
specialized polyclinics, as well as city hospitals and maternity
homes.
Case studies: policy development in countries for tackling noncommunicable diseases