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

Table of Contents
Acronyms............................................................................................................................................. vii
Foreword............................................................................................................................................... ix
Executive Summary.............................................................................................................................. xi
1. Introduction.....................................................................................................................................1
2. Pilot Context ...................................................................................................................................3
2.1 Emergence of the Pilot Concept ........................................................................................... 3
2.2 Pilot Site Selection................................................................................................................ 4
2.3 Principal Actors in the Pilot Process..................................................................................... 5
3. Pilot Design.....................................................................................................................................9
3.1 Pilot Objective ...................................................................................................................... 9
3.2 Technical Aspects of Design .............................................................................................. 10
3.3 Monitoring and Evaluation Design..................................................................................... 12
4. Implementation .............................................................................................................................13
4.1 Technical Approach............................................................................................................ 13
4.2 National Health Reform Planning....................................................................................... 15
4.3 Top Down, Bottom Up ....................................................................................................... 16
5. Monitoring and Evaluation ...........................................................................................................19
6. Pilot Outcomes..............................................................................................................................21
6.1 Reforming Health Care Delivery in Issyk-Kul Oblast........................................................ 21
6.2 Expanding Reforms Geographically................................................................................... 22
6.2.1 Rolling Out Reforms to the City of Bishkek and Chui Oblast.................................... 22
6.2.2 National Roll-out by Oblast ........................................................................................ 23
6.3 Informing National Policy .................................................................................................. 23
6.3.1 National Mandatory Health Insurance ........................................................................ 24
6.3.2 Single-payer System ................................................................................................... 24
6.4 Building Capacity to Implement Health Reform ................................................................ 25
7. Lessons Learned............................................................................................................................27
7.1 Appropriateness of the Health Reform Model.................................................................... 27
7.2 Political Context ................................................................................................................. 27
7.3 Health Reform Vision......................................................................................................... 28
7.4 Implementation Approaches ............................................................................................... 29
7.5 Crisis Management ............................................................................................................. 29
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