Ministry of Health explores approaches to put patients at the center
Home visit by a midwife in Osh Oblast © GIZ/Maxime Fossat
On October 25, 2019, the Ministry of Health convened a round table discussion in Bishkek entitled ‘Development of a patient-centered approach to primary health care in Kyrgyzstan.’
The event brought together the Minister of Health and other senior Ministry officials, the head of the World Health Organization in Kyrgyzstan, representatives of the Mandatory Health Insurance Fund, health coordinators and directors of Family Medicine Centers from the regional level and Bishkek, international experts, and development partners to discuss the direction of primary health care in the country. The round table provided an opportunity for Kyrgyz policymakers and practitioners to discuss effective approaches to patient-centered care which are being implemented in other countries and to determine suitable models for Kyrgyzstan.
The development of a model for patient-centered integrated care for pregnant women and newborns in Kyrgyzstan is a major area of focus for the Promotion of Perinatal Health project, which is jointly implemented by GIZ and the Ministry of Health.
Primary health care is at the heart of the government’s strategy
Representatives of the Ministry of Health set the stage for the discussion by highlighting the importance of people-centered primary healthcare to Kyrgyzstan’s current health reform strategy. The Minister of Heath, Mr. Kosmosbek Cholponbaev, noted that the development of primary health care is one of the four priority areas in the Healthy Person – Prosperous Country programme and expressed a wish for coordinated action to improve the quality of primary care by strengthening human resources, technical equipment and infrastructure, information technology, and systems within heath care organisations. Dr Anara Eshkhodzhaeva, the head of the Department of Health Service Delivery, and Dr Meder Ismailov, the head of the Department of Strategy and Policy Implementation, gave additional presentations on the main activities currently underway to develop primary health care in Kyrgyzstan and the priorities for the future.
From ‘doing things right’ to ‘doing the right things’
Dr Arnoldas Jurgutis, a consultant with the WHO European Center for Primary Healthcare in Almaty, presented the main findings of an evaluation of primary care in Kyrgyzstan. He noted the lack of family physicians in the regions, the heavy paperwork and reporting burden they shoulder, and the lack of clearly defined tasks for general practitioners and nurses. In addition, primary health care in Kyrgyzstan remains heavily focused on the process of care, not on health outcomes. Turning to recommendations, Jurgutis urged a shift in mindset: primary health facilities should be understood as a patient’s first point of contact with the health care system and efforts should be made to improve the coordination of services so that subsequent care is seamless for the patient. According to Jurgutis, Family Medical Centers are the logical starting points for such an effort. Finally, he underscored that it is necessary to move away from the traditional norms of managing health care organisations and infrastructure (‘doing things right’) to putting the health needs of the population at the forefront (‘doing the right things’).
Before handing over to the next speaker, Jurgutis lay the groundwork for the subsequent discussion by presenting the European Framework for Action on Integrated Service Delivery, ensuring that all participants shared a common understanding of terminology and features of the approach.
Learning from international experience
Dr Klaus Hornetz, a primary healthcare expert with GIZ, presented an overview of the best models and approaches to primary health care being implemented in other countries, and pointed to lessons which should be taken into account as well as mistakes to be avoided. He focused in particular on the models which have been introduced in China, which has transformed the Semashko system into a more patient-centered one, and in Finland.
The final input came from Dr Arsen Korkmazov, the UNICEF Coordinator for Integrated Management of Childhood Illness (IMCI), who shared Kazakhstan’s experience in strengthening the role of visiting nurses, who support post-partum women and newborns in their homes, and the potential benefits of this model for a country like Kyrgyzstan.
Discussion and looking ahead
In the open discussion which followed, participants had the opportunity to ask questions and consider how some of these practices could be implemented in Kyrgyzstan. Dr Anara Eshkhodzhaeva wrapped up the round table by thanking those present for their active participation and urging them to remain involved in the reform process. ‘The presentations today provided a good overview of global trends and best practices. Three working groups have already been formed to create a patient-centered integrated care model in Kyrgyzstan,’ she said. ‘We intend to pilot these approaches in certain communities and then to spread them more widely throughout the country. To efficiently use the resources we need to consolidate the efforts of all stakeholders, including development partners.’