of May 24, 2012 No. 309
About the National program of reforming of health care of the Kyrgyz Republic "Dan Sooluk" for 2012-2018
Due to completion of implementation of the National program of reforming of health care "Manas taaly" for 2006-2010, considering importance and need of continuation of further development of health care of the Kyrgyz Republic, the Government of the Kyrgyz Republic decides:
1. Approve the National program of reforming of health care of the Kyrgyz Republic "Dan Sooluk" for 2012-2018 according to appendix.
2. To the Ministry of Health of the Kyrgyz Republic in 2-month time to develop the actions plan on implementation of the National program of reforming of health care of the Kyrgyz Republic "Dan Sooluk" for 2017-2018 and to submit for approval of the Government of the Kyrgyz Republic.
3. "Dan Sooluk" for 2012-2018 to assign general coordination and monitoring of implementation of the National program of reforming of health care of the Kyrgyz Republic to the Ministry of Health of the Kyrgyz Republic.
4. To enable the realization of this resolution within the means provided by the republican budget to the Ministry of Health of the Kyrgyz Republic and Fund of compulsory medical insurance under the Government of the Kyrgyz Republic, and also means of compulsory medical insurance for the corresponding year.
5. To the ministries, administrative departments, local public administrations to adopt to execution the National program of reforming of health care of the Kyrgyz Republic "Dan Sooluk" for 2012-2018.
6. Recommend to the city halls of the cities of Bishkek and Osh, to render local government bodies assistance in implementation of the National program of reforming of health care of the Kyrgyz Republic "Dan Sooluk" for 2012-2018.
7. To impose control of execution of this resolution on department of social development of Government office of the Kyrgyz Republic.
The national program of reforming of health care system of the Kyrgyz Republic "Dan Sooluk" for 2012-2018 (further - the Dan Sooluk Program) is logical continuation of the previous national programs of reform of health care system of the Kyrgyz Republic "Manas" (1996-2005) and "Manas taaly" (2006-2011).
During implementation of the specified programs the legislation of new health care system of the Kyrgyz Republic is created. The laws of the Kyrgyz Republic were adopted: "About system of the Single payer in financing of health care of the Kyrgyz Republic", "About the organizations of health care in the Kyrgyz Republic", "About protection of public health in the Kyrgyz Republic", "About public health care", changes are made to the Law of the Kyrgyz Republic "About the basic principles of the budget right in the Kyrgyz Republic", in the Law of the Kyrgyz Republic "About medical insurance of citizens in the Kyrgyz Republic".
The orders of the Government of the Kyrgyz Republic, since 2001, the Program of the state guarantees providing rendering free, preferential or paid (official copayment) of medical care, depending on the social status of citizens and availability or absence at them medical insurance annually affirms.
Since 2006 reforming of health care system is performed within shirokosektoralny approach of Sector Wide Approach (further - SWAp). Within SWAp the Ministry of Health of the Kyrgyz Republic (further - the Ministry of Health) performs implementation of the National program "Manas Taaly", partners in development directed the help to the solution of priority tasks of this Program, joint processes and tools for realization progress monitoring are created. The Ministry of Health organizes carrying out two times in year of joint reviews of activities of the sector during which profound assessment of achievements and shortcomings is performed, actions are planned for the future.
New methods of work within SWAp yeilded tangible results, namely:
- the leading role of the Ministry of Health in development, realization and monitoring of reforms raised;
- extent of synchronization of donor means with priorities of the National program "Manas Taaly" and coordination of all actions performed in health care sector improved;
- extent of use of proofs in development of policy and monitoring of processes raised. Considering outstanding performance of this approach, the Government of the Kyrgyz Republic keeps commitment to the principles of SWAp in development and program implementation "Dan Sooluk".
Within the national programs "Manas" and "Manas Taaly" the health care financing model recognized at the international level was implemented. Despite economic difficulties, over the last 5 years level of financing of health care increased, including thanks to donor means and the carried-out structural changes. The advanced model of financing of health care system and increase in amount of means allowed to achieve certain results in increase in financial protection of the population, access to medical care and its efficiency. These achievements are significant, especially in the conditions of socio-political instability which remained in the republic within the last 5-6 years, and also considering limited resources owing to the developed economic situation.
However, despite number of achievements, also essential shortcomings remain. Contrary to expectations, significant improvement of indicators of health of the population concerning cardiovascular diseases, condition of maternal and children's health is noted; causes concern situation with growth of the cases steady against medicines of forms of tuberculosis. For the purpose of improvement of health of citizens of Kyrgyzstan by the imperative need further change of the attitude of the population towards the health and improvement of quality of services of health care is. The Dan Sooluk Program is designed to solve these problems. Based on achievements of the Manas and Manas Taaly Programs and being guided by the basic principles of the World Health Organization (further - WHO), activities of the Dan Sooluk Program are aimed at providing universal (general) scope of the population with high-quality medical and sanitary and preventive services, irrespective of the social status, gender distinctions and the status of zastrakhovannost of the population.
The Dan Sooluk program was developed during 2010-2011 under the direction of the Ministry of Health, in case of cooperation of all interested structures and support of WHO, other partners in development who are actively involved within SWAp. The technical working groups coordinated by the group of experts participated in development of the Program. The program was discussed with politicians, experts in health sector, representatives of civil community and partners in development taking into account whose notes and offers the final version of the National program of reforming of health care system of the Kyrgyz Republic "Dan Sooluk" for 2012-2018 was created.
In May, 2011 the Ministry of Health published the Report "Assessment of implementation of the National program of reform of health care of the Kyrgyz Republic "Manas taaly" where results of comprehensive assessment of implementation of this Program were provided. The estimative report is constituted based on results of the joint monitoring approved and performed within SWAp, and also the researches and estimative reports prepared by the Center of the analysis of policy of health care (further - TsAPZ) which are available on the website: www.hpac.kg. The conclusions given in the offered Section are formulated on the basis of the above-mentioned report containing detailed data and confirmatory data. In this Section assessment of achievements of the previous programs is carried out, incomplete line items which can be realized within the Dan Sooluk Program are designated.
Main objective of the Manas Taaly Program was improvement of the state of health of the population by creation of the sympathetic, effective, complex, integrated system of provision of individual and public services of health care, increase in responsibility of each citizen, family, society, state governing bodies for health of each person and society in general. Achievement of this purpose was supposed to be provided at the expense of a number of the measures directed to strengthening of health care system, and organized within the following components:
- involvement of communities;
- financing of health care system;
- provision of individual medical services;
- provision of services of public health care;
- promotion of evidential medicine, development of priority programs, human resources development and forming of strategic management.
The Manas Taaly program was strategically oriented to completion and institutionalization of the reforms begun within the Manas Program, in particular, in the sphere of financing of health care system and its restructuring and also for the beginning of new generation of reforms in public health care and medical education.
Despite the political and economic difficulties experienced by the country, actions of the Manas Taaly Program were realized. The following main reforms are performed:
- the state assignment of health care system increased from 10% up to 13% of the total amount of the republican budget that demonstrates growth of its priority for the state; it allowed to provide improvement of financing of services of health care, in particular, providing the population with medicines, to lower financial burden for patients;
- means for health care system were transferred with regional to the national level that allowed to provide gradual equalization of standard rates of financing on regions and to liquidate the developed injustice in resource allocation within the Program of the state guarantees (further - PGG) and the Additional program of compulsory medical insurance (further - DP compulsory health insurance);
- activities of rural committees of health were considerably stirred up (further - SKZ) on strengthening of health of the population, exceeded the number of the operating committees of health 1200; the institutionalization and stability of help given to SKZ increased; roles of the Republican center of strengthening of health (further - RTsUZ) and offices of strengthening of health (further KUZ) in the Centers of family medicine were accurately determined (further - TsSM);
- primary medical care received further strengthening thanks to capital investments in medical and obstetrical centers (further - medical and obstetrical center) and to increase in share of the financing allocated for primary level from PGG from 23% - in 2006 to 39% - in 2010;
- the foundation was laid for reform of public health care by acceptance of a number of legal acts and review of the departmental acts directed to creation of the modern service of public health care which is adequately reacting to burden of the diseases widespread in the republic;
- The Ministry of Health became driving force in program implementation "Manas taaly", and considerably strengthened the level of management; monitoring and assessment of results of the Manas Taaly Program acquired planned nature and became part of the joint annual reviews which are carried out within SWAp.
Influence of the reforms performed during program implementation "Manas taaly" on its key purposes had the mixed character. On the one hand, considerable progress in ensuring financial protection, availability and efficiency of the provided medical services was shown. On the other hand, progress in questions of improvement of quality of medical care and improvement of health of the population was less impressive. Therefore improvement of quality of medical care and improvement of health of the population remain main objectives and within the Dan Sooluk Program, along with preserving visible achievements in ensuring financial protection, access and efficiency of medical services.
Health of the population. Let's note that some of actions for public health care were rather successful while on others progress was not observed. So, decrease in indicators of infantile and child mortality began, incidence and death rate from tuberculosis decreased, the mortality rate from cardiovascular diseases among adult population was stabilized. But, at the same time improvement of indicators of maternal death rate was not observed, the number of new cases of Vichinfektion continues to grow, origin and growth of incidence of multiresistant form of tuberculosis causes alarm. Therefore important task of the Dan Sooluk Program is building-up of progress in achievement of results on these key indicators.
Financial protection and ensuring availability of medical services. During the period from 2003 to 2009 the financial burden for 40% of the poorest population of the country considerably decreased, the geographical and financial barriers interfering access to medical services decreased. Decrease happened owing to implementation of system of the Single payer, at first at the regional level, to the subsequent accumulation of means at the national level, increase in efficiency due to restructuring and expansion of coverage of PGG is reached. During the period from 2006 to 2009 further decrease in financial burden was not observed. Thus, these issues shall be resolved within the Dan Sooluk Program, with emphasis of attention on the growing cash payments for out-patient medical services and on unofficial payments for treatment in the hospitals located in the large cities and still not affected by restructuring.
Efficiency of use of means. Efficiency rate of distribution of means within PGG undoubtedly increased, thanks to two approved indicators:
a) the share of expenses of health care within PGG directed to less costly primary health care increased from 29% in 2005 up to 38% - in 2009;
b) direct expenses on patients (medicines, products of medical appointment and food) increased from 20% in 2005 up to 30% - in 2009 as a result of optimization of infrastructure of the organizations of health care. Nevertheless, need of further increase in efficiency of use of means remains to the important directions of the Dan Sooluk Program, taking into account the remaining gap of financing of PGG, irrationality of distribution of infrastructure and management of it in the large cities.
Transparency of activities of health care system. Till 2006 unofficial payments for medicines and products of medical appointment considerably decreased that was direct consequence of the increase in efficiency of use of means noted earlier. Therefore, instead of expenses on infrastructure the public expenditures directly on servicing of patients increased. However unofficial payments to medical personnel continued to grow that was connected with very low salary level, and also the growing gap between the salary level of health workers and the rate of inflation. Taking into account recent wages increase to health workers, important role is played by continuation of monitoring in the sphere of unofficial payments.
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