Kyrgyzstan empowers communities to participate in improving health

WHO

In Kyrgyzstan, nearly two thirds of the population live in remote rural areas where access to health services, such as regular checkups, can often be a problem. A pilot project initiated by the Swiss Agency for Development and Cooperation and implemented by the Swiss Red Cross in Kyrgyzstan in 2002 addressed this challenge in rural communities through a new approach.

As Tobias Schüth from the Swiss Red Cross notes, “Usually, you have experts and donors coming in, knowing everything and telling people what to do.” Instead, the project team started by giving groups of people from rural areas pens and paper and asking them to analyse what they needed and wanted.

When the team asked participants what they felt were the most common burdensome health conditions, their responses showed that hypertension was a serious issue for them. This matched the overall picture in Kyrgyzstan, where 50% of deaths are cardiovascular-related. The activity enabled people to feel engaged in their health and in the project from the outset.

The Swiss project then set up voluntary Village Health Committees (VHCs) to give people a say in approaches to their health care. VHCs are composed of local volunteers trained by primary health-care professionals to identify hypertension through household screening visits and to give health advice. The volunteers measure blood pressure and explain the danger of cardiovascular disease and its risk factors.

WHO/Europe has supported the Community Action for Health project throughout and worked together with the project team on various issues, including analysis of the impact of community action on hypertension detection rates.

From pilot project to nationwide health action programme

A year after the project started, 15 VHCs were set up to cover a district of Kyrgyzstan. Their success eventually attracted the attention of politicians, who were invited to witness the potential of this approach to improving access to health care.

Ultimately, the Ministry of Health decided that the model should be extended to the entire country. With the Ministry’s strong political support, the pilot project was scaled up into a programme called Community Action for Health.

Community Action for Health fosters direct citizen participation to raise population awareness of nutrition, infectious diseases, reproductive health and noncommunicable diseases – in particular, hypertension. With 1700 VHCs now set up across the country, the programme covers almost 90% of Kyrgyz villages.

The results have been remarkable. In 2007, around 22% of the rural population – compared to 35% of urban population – was aware of having hypertension. Starting in 2011, about half of the entire population was screened for high blood pressure. As a result, by 2015 the large urban–rural gap in awareness of hypertension status had disappeared.

Overall, people’s awareness of having hypertension rose from 27% in 2007 to 45% in 2015. The increase was even greater in rural areas, where VHCs operate. Compliance with treatment by antihypertensive medicines also improved during this period.

The Ministry of Health’s sense of ownership for the project was key to its institutionalization and sustainability. Also critical was the financial support of the Swiss Agency for Development and Cooperation, which provided almost 25 million Swiss francs over 17 years to support its implementation. With the closing of the project in March 2017, the Community Action for Health programme transitioned to full funding by the state.

The project’s success has demonstrated the value of a people-centred approach that engages individuals and empowers communities in rural areas to participate in improving their health. Swiss Ambassador to Kyrgyzstan Véronique Hulmann describes the results: “In starting up Community Action for Health and supporting this over almost 2 decades in Kyrgyzstan, we have been able to make a remarkable contribution to the health of the Kyrgyz population living in rural areas where access to health care and information about health is limited.”

She continues: “The model to promote health of the rural population was introduced countrywide and implemented by VHCs based on solidarity and volunteer principles. We established a strong partnership with the Ministry of Health for increasing the access of local communities to primary health-care services. This was key to institutionalize the model and implement it at the national level.”

The VHC network serves as an example to other countries whose populations struggle to access health care. The project’s success has already paved the way for similar projects in Belarus and Tajikistan.

This example from Kyrgyzstan is part of a package of country briefs that will be presented at the high-level regional meeting Health Systems Respond to NCDs on 16–18 April in Sitges, Spain.