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Health Providers’ Success, Achievements and Limitations

On January 20, 2020, at a weekly planning meeting in the Ministry of Health KR where the managers of the health organizations of the Republic were invited, the Minister of Health KR Kosmosbek Cholponbayev reported on the health sector performance in 2019; successes, achievements and shortcomings regarding the delivery of quality public health care in the Republic.

2019 demonstrated good results achieved in all areas of the health system. Regarding review and improvement of NLA, like the Law of the KR "On amendments to the Law KR "On public procurement", which allows the MOH KR and MHIF to contract with healthcare providers of hemodialysis service without a tender, which allowed the MOH to procure dialysis services from all providers regardless of ownership; A number of international agreements were ratified, which allowed attracting grant funds in the country at the amount of more than 30 million US dollars: support for PHC, a grant from the Eurasian Stabilization and Development Fund to finance the "Caravan of health" Project in the amount of 2 million US dollars. The Project will finance 2 road trains, each consisting of three mobile medical sets (gynecological, dental, procedural, and X-ray) and a bus for the shift staff transportation. The project is aimed at financing preventive examinations, primary disease prevention, and raising awareness of rural people and people in hard-to-reach areas of the country. The road trains will be distributed to the Southern and Northern regions.

One of the activities of the Ministry of Health was to improve the infrastructure of the health system, using both the state budget and donor funds. In 2019, 29 facilities were completed (FAPs, FGP) at the amount of 366.4 million KGS. In addition, major repairs were implemented in 17 facilities 31.7 million KGS worth. This amount is comprised of the budget allocation, international donor funds and local government budgets. A lot of laboratory and medical equipment was procured at the expense of the MOH budget and HO budget. This year, the disbursement of Kumtor grant money will be completed. The funds will be used for the procurement of modern high-tech medical equipment, such as a linear accelerator, a computer tomograph, a short-focus x-ray therapy device, and a remotely-controlled diagnostic digital x-ray complex for radioscopy and radiography to be installed in the NCOH. The Minister mentioned the government program "Healthy person: Prosperous country" launched this year. The public health program is based on a program-oriented approach for investing in public health and upgrading the service delivery system. The program consists of four priority areas related to specific types of services (public health, PHC development, hospital system rationalization and emergency care development) and cross-cutting integrated areas (laboratory services, medicines, human resources, e-health, financing and strategic sector management)."Despite the positive results of the reforms, there are still serious problems in the sector that are constantly raised and often deserve fair criticism. This criticism is often focused on quality and availability of services and significant cost of health services from the "pocket of patients". The President of KR issued a decree to declare this year the "Year of regional development, digitalization and children’s support". Current activities will continue with child healthcare strengthened. Another urgent issue that needs to be addressed is insufficient human resources, therefore this year we will aim at increasing the healthcare workers’ salaries. It is necessary to change the system of labor remuneration increasing the base salary and implementing result-based payment. To increase the role and authority of the doctor, it is necessary to review and amend the relevant NLA. I would like to draw your attention to the issue of rational use of medical equipment, particularly the expensive ones. I urge managers to make a serious analysis of the medical equipment operation in your facilities and consider a possibility of their transfer to the other health care organizations which need them. I also suggest that we study and implement equipment-sharing mechanisms and review the current laboratory system. It is necessary to consolidate, centralize and computerize the public laboratories based on the principles of service accessibility to the people. Strengthening of public laboratories is of fundamental significance with focus on the quality and availability of services. It is proposed to create a 3-level laboratory system: sampling points at the level of FGPs and FMCs; express laboratories at the level of territorial hospitals (inpatient) and a centralized laboratory at the oblast/inter-rayon level. The Ministry of Health KR has completed the National plan for optimizing the health system of KR (Master plan) in order to eliminate chaotic, irrational procurement of equipment and low-quality repairs. The Master plan will focus planned investment and modernization in the health sector based on the growth points in the regions and long term perspective so that all the activities 2020 are based on this Master plan. The Ministry of Health will develop a detailed Master plan for optimizing and modernizing healthcare organizations to be approved by the government KR. Within the framework of digitalization it is essential to transfer the reporting and accounting from paper to electronic format. HO managers need to widely implement telemedicine services which would improve the quality of public health care via implementing remote health counseling services and exchange of specialized information based on modern information technologies, bringing diagnostics and treatment of the people from remote and hard-to-reach regions to highly qualified specialists. The emergency departments will be moved to the territorial, oblast hospitals and inpatient departments of the general practice centers with the establishment of inpatient emergency departments and installation of GPS on all vehicles. This issue should be completed step-by-step this year", the Minister, Kosmosbek Cholponbayev said.