TB REP mission to Kyrgyzstan, 6–8 June 2017

WHO

Despite notable progress in the past decade, tuberculosis (TB) is still of public health concern in Kyrgyzstan. The country is among the 30 high-burden countries for multidrug-resistant TB (MDR-TB) in the world and is one of the 18 high-priority countries in the WHO European Region.

TB services in Kyrgyzstan are still, to a certain extent, practicing outdated and excessive hospital-based treatment and care, often characterized by unnecessarily long hospital stays. Health authorities often focus on hospital maintenance and not chiefly on the needs of the patient. People-centeredness needs to be further boosted.  At the same time, the conditions in the majority of TB facilities may actually foster the growth of MDR-TB due to noncompliance with sufficient standards of infection control.

Recently, the country has developed several strategic documents addressing TB prevention and care through a health systems approach, such as the “TB Roadmap” on optimization of TB services, and “Tuberculosis 5”, a national 5-year TB programme, where a meaningful reduction of excessive TB bed capacity and further implementation of ambulatory models of treatment is strengthened.

In order to boost implementation of the strategic documents, a 2-day roundtable was held on 6–7 June with the participation of key staff from the national treatment programme (NTP), the Ministry of Health, the Mandatory Health Insurance Fund, donors and international partners. During the roundtable, participants discussed progress made in the country on implementation of integrated models of TB service delivery and efficient health system financing mechanisms. A blueprint on “A people-centred model of tuberculosis care”, developed by the Tuberculosis Regional Eastern European and Central Asian Project (TB REP) was presented and discussed.

Besides the roundtable event, mission members had separate meetings at the NTP and Mandatory Health Insurance Fund; attended a partners meeting organized by the Global Fund to Fight AIDS, Tuberculosis and Malaria portfolio manager; visited Bishkek City TB dispensary; and met representatives of “Defeat TB” (funded by the United States Agency for International Development (USAID)), “Challenge TB” (implemented by KNCV), Médecins Sans Frontières (MSF), the International Committee of the Red Cross (ICRC) and the United Nations Development Programme (UNDP) (primary recipient of the Global Fund grant).

Next steps to be taken, taking fully into account the TB REP-developed blueprint, the existing country documents, and the ongoing national health care reform, include:

  • distribute roles clearly among primary health care and TB facilities, and ensure clear division of functions between hospitals and dispensaries, with regards to TB prevention and care;
  • consider and address possible legislative barriers and bottlenecks preventing further progress towards more people-centeredness in TB services in the country;
  • establish an adequate financing mechanism for each TB service activity related to TB care and link this to service delivery;
  • continue to support full speed implementation of planned reforms by conducting a synergistic and complementary linkage of grassroots and high-level advocacy.