Case Study on Piloting Complex Health Reforms in ... - PHRplus

accreditation committee. The report recommended the establishment of medical information systems
for inpatient and outpatient episodes of care, using coding systems for operations and procedures,
diagnostics, and pharmaceuticals. In addition to clinical data, demographic, financial, and cost
accounting data also would be collected and analyzed. Combined, the medical information system
would provide information to facility directors to track and manage resources more efficiently and
measure improvements in quality and efficiency. Further recommendations in the assessment report
outlined steps to establish and build the capacity of an oblast-level MHIF as a single health payer,
investigate the feasibility of extending user fees, and refine the government’s guaranteed benefits
package and eliminate services that were not deemed clinically effective or cost-effective.
3.3 Monitoring and Evaluation Design
The Issyk-Kul pilot design lacked a formal monitoring and evaluation component. The HFS trip
resulted in the design of clinical and financial information systems and the development of a health
financing simulation model (including output variables) that provided a variety of indicators and data
sources that could have been used to monitor and evaluate the pilot project over time. The
ZdravReform Project was required to report progress (and results) of its activities to USAID annually.
Indicators included the number of primary care group practices formed, the percentage of the eligible
population enrolled in the group practices, reduction in referral rates of primary care physicians,
reduction in hospital admission rates and lengths of stay, reduction in the number of hospitals beds,
and the number of health care facilities with improved quality assurance, financial, and clinical
information systems. The World Bank Staff Appraisal Report describing the first health sector loan in
Kyrgyzstan required the government to conduct an evaluation of the Issyk-Kul experience to inform
design of roll-out activities in Bishkek city and Chui oblast by the end of December 1996.
12 The Pilot Process: <strong>Case</strong> <strong>Study</strong> on Piloting Complex Health Reforms in Kyrgyzstan