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

8. Conclusions
Despite the absence of a rigorous comprehensive evaluation, the health reform pilot in Issyk-Kul
oblast can be considered a success. It was rolled out nationally and informed national level health
reforms. While each of the factors described above is important in itself, perhaps the greatest
achievement of the health reforms in Kyrgyzstan was the creation of a dynamic interaction and
iteration among the factors, coordinated by health champions and donors guided by a unified health
reform vision. A mechanism that enabled sustainable health system improvements at the facility,
oblast, and national levels was the end result of the pilot rather than the effectiveness of the pilot itself
or its successful roll-out.
Creating a dynamic for system- and facility-level change happened in three stages. The first stage
was the initial pilot process that developed the internal workings or “engine” of the health reform
process and addressed the technical issues at the core of the system – health delivery system
restructuring, population involvement, provider payment systems, and health information systems.
This process was started in Issyk-Kul oblast but was later rolled out to Bishkek and Chui oblast, then
to South Kyrgyzstan, and then nationwide.
The second stage united these technical components under a unifying vision (the single-payer
system) and repackaged the system to respond to consumers and patients (the benefits package) –
adding a “chassis” to the health reform engine. The system-level reforms also created the autonomy
and “space” needed to move forward with facility-level quality improvements. In the first stage, many
attempts at facility improvements had proved unsuccessful or unsustainable due to system-level
barriers and obstacles to implementation and regulation. The single-payer system was piloted in
Issyk-Kul and Chui oblasts, then rolled out each year in two oblasts at a time.
Kyrgyzstan recently entered a third stage in the health reform process where a dynamic for
sustainable change has been created – opportunities for both system-level and facility-level
improvements exist. The MOH continues to design, implement, and evaluate pilot health reform
interventions in Issyk-Kul oblast (and other oblasts), and immediately connects these efforts to
national health reforms. Simultaneously, implementation of facility-level interventions continues to
reveal problems with medical practices and standards, medical education, and public health that only
the health system can address. The development of an effective dynamic process and experienced
health reformers that allow and encourage sustainable health system improvements at both facility
and system levels is the best legacy of the Issyk-Kul oblast pilot, and may be the true measure of its
success.
8. Conclusions 33