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

Chapter 4
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The existing, often fragmented actions support the dissemination
of modern health promotion concepts and try
to adapt international guidelines and best practices to the
specific needs of rural areas.
The purpose of the health promotion units in rayons is to
support community action for the health strategy and to
act as a link between the health system and community
organizations working on health issues. Since 2003, WHO
has provided assistance in developing a National Population
Health and Development Programme, which envisages the
development of the actual intersectoral strategy of health
promotion.
3. Infrastructure and resources for policies
to tackle NCD
3.1. Human resources
Public health programmes for the general public or the local
community face a lack of skilled personnel. There are very
few (20–30) experts in health promotion and NCD policy
that meet international criteria, and these mainly concentrated
in Bishkek. The broad partnerships in village health
committees and other local initiatives may have a great
potential for human resource development in the future.
The Institute for Public Health of the State Medical Academy
provides training for specialists in public health and
health administration. Within the framework of a rural
sanitation and hygiene project, held in 2004 under the aegis
of the United Kingdom Department for International Development
(DFID), a course in training in health promotion
took place at the State Medical Academy. The course aimed
to demonstrate the introduction of an education curriculum
into a medical school, the outputs of which are to be a
base for further work on preparing public health personnel.
Despite this positive initiative, however, there is generally a
lack of appropriate training schemes in NCD prevention for
graduate, postgraduate and in-service training. In contrary
to initial expectations, the School of Public Health in Almaty
(Kazakhstan) has no practical influence on Kyrgyz human
resource development in health promotion and disease
prevention.
3.2. Financial resources
The funding of NCD prevention and health promotion
programmes basically depends on external assistance. The
Government co-finances a number of investment projects,
but at present NCD prevention programmes have a low
priority.
At village level, initiative groups (within the DFID project)
and health committees (Kyrgyz–Swiss Health Reform Support
Project) are working along with other groups. At the
moment, they are mainly funded by international projects.
Their activities are recognized to be quite effective, but the
issue of sustainability and harmonization of their activities
remains unsolved. Efforts have been made to ensure
mechanisms of self-reimbursement after projects have been
carried out.
Village organizations mobilize funds and human resources as
a contribution to health promotion and disease prevention
projects. This approach is considered the most effective,
especially for rural populations with of scarce social and
economic resources. Recently, some projects have focused
on the social capital of communities, which is a considerable
asset of rural populations.
3.3. Information and research
Kyrgyzstan has limited experience and practice in health
promotion and disease prevention research. With the Manas
Taalimi planning process, there is doubtless an increased
need for and interest in research and information. This also
relates to the establishing of the monitoring and evaluation
system of strategy implementation.
Case studies: policy development in countries for tackling noncommunicable diseases