Since the mid-90s, Kyrgyzstan is in a process of health system reform, moving from the centralised, hospital-centred Semashko model towards a more rational, modernised health care system. The latter ensures better quality of health care, more efficient use of scarce health care resources, and improved financial protection and equity. A national health sector programme, the Den Sooluk Program (DSP), was developed and approved by the GOK Decree in May 2013. This programme outlining the focus of the health sector reform between 2012 and 2016 is based on the achievements of two previous health sector programmes as well as guided by the basic principles of the World Health Organization (WHO). DSP addresses „unfinished agendas” of the previous health reform programmes.
Objectives and Aims
The objective of the overall project is to promote and facilitate the achievement of greater efficiency and quality in health care delivery by developing, piloting and rolling out a model for health facilities’ autonomy. The project pilots the expansion of autonomy of selected health facilities in 3 pilot rayons with clearly defined managerial, contracting, financing and payment arrangements developed under the leadership of the Ministry of Health and the Mandatory Health Insurance Fund and with technical assistance from the consortium.
Methods / Approaches
Phase I foresees several strategic and technical assistance interventions to assist in piloting the health facility autonomy model:
1) health legislation development 2) establishment of a functional Rayon Supervisory Board 3) development of a quality management system 4) capacity building in health facility management based on the concept of clinical governance 5) development and introduction of a comprehensive management tool package 6) revision of the health information management system 7) raising public awareness about new clinical practices and referral systems and 8) conducting an impact evaluation of the pilot.
In parallel, health care networks are being developed and activated, as to improve referrals between primary and secondary/tertiary health care levels, whilst allowing more space for efficiency and synergies on rayon level, such as possibly merging procurement, contracting-in of non-medical services, disinfection and laboratory services. The implementation modality includes the involvement of the hospital association and the Family Group Practice and Nurses Association.
It is expected that well-functioning autonomous health facilities and health care networks will lead to the availability of more revenues for the health facilities to pay more market-oriented salaries and other incentives to staff and to deliver quality services to the population.
The health service providers will be strengthened and the population in the pilot districts will benefit from improved health service provision.
The project is currently in the middle of its first phase to pilot enhanced health facility autonomy. The results of this phase will feed into a second phase to inform a national roll-out of the HFA interventions.
Swiss TPH is a partner in a consortium with a local partner VEK Consulting LLC lead by GFA Consulting Group GmbH.