Perinatal Health in Kyrgyzstan
Title: Promotion of Perinatal Health in Kyrgyzstan
Commissioned by: German Federal Ministry for Economic Cooperation and Development (BMZ)
Lead executing agency: Ministry of Health of the Kyrgyz Republic
Overall term: 2018 to 2020
While Kyrgyzstan has experienced great success since 1990 in reducing deaths among children under five, neonatal deaths have fallen at a slower rate and maternal deaths have hardly declined at all. Despite high coverage of antenatal care and specialised obstetric services, Kyrgyzstan has the highest maternal mortality rate in the World Health Organization European region. Many maternal deaths could be prevented, but a lack of standards and poorly regulated referral practices mean that high-risk pregnancies are often not detected in time, referred to the correct level of care, or adequately treated. In rural areas, primary health care workers are few in number, insufficiently skilled in the provision of antenatal care, and often difficult to reach.
The Government of Kyrgyzstan is working to strengthen the health system so that it can deliver quality services across the life cycle, including for mothers and children. The National Health Strategy 2019-2030, entitled ‘Healthy Person – Prosperous Country,’ places particular emphasis on high-quality primary health care focused on prevention, early detection and case management and on patient-centred integrated care.
The quality of integrated care services for pregnant women and newborns in the five pilot regions has improved.
On behalf of Germany’s Federal Ministry for Economic Cooperation and Development (BMZ), the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH is implementing the Promotion of the Perinatal Health project, the first-ever health-related bilateral technical cooperation project between Germany and Kyrgyzstan. As a new development partner in the health sector, GIZ brings a systemic and multi-level approach to policy advice and capacity building, with a focus on developing models for broader health system reforms.
In line with ‘Healthy Person – Prosperous Country,’ the project aims to improve the quality of integrated care services for pregnant women and newborns in five regions of Kyrgyzstan. To achieve this goal, GIZ works closely with partner institutions at the national level, including the Ministry of Health, the Mandatory Health Insurance Fund and the E-Health Center at the regional level in Bishkek, Chuy, Issyk-Kul, Naryn and Osh. A total of nearly 500 people are involved in implementing project measures which build the expertise of health workers, improve the quality of perinatal care services, and strengthen referral pathways and approaches to patient-centered care for pregnant women and newborns.
This technical cooperation project is one module in a larger German-supported health sector programme in Kyrgyzstan which also includes financial cooperation measures implemented by the KfW Development Bank, which has been supporting the Kyrgyz government’s health reforms for more than two decades.
To deliver high-quality perinatal services, health facilities need to be staffed with an adequate number of clinical personnel who need to have the proper competencies and can work as an integrated team to manage complex cases.
In cooperation with the Ministry of Health, the project supports the development and introduction of transparent, competence-based human resource planning, management and recruitment tools which will help to guarantee quality standards at the new National Perinatal Center, which is being established in Bishkek with German support. The centre will serve as the first specialised tertiary-level institution for pregnant women and newborns in the country and as a centre of excellence for perinatal care. Technical measures implemented by the project in support of the National Perinatal Center complement the financial support for infrastructure and equipment provided by KfW.
The project also works with selected hospitals to optimise roles and responsibilities in the provision of perinatal care services by developing and piloting approaches to task-shifting between doctors and midwives.
Improving the quality of perinatal services
According to the second Confidential Enquiry into Maternal Deaths (CEMD), 37 per cent of maternal deaths in Kyrgyzstan occurred at secondary-level health facilities. In 58 per cent of cases, care had not been provided in line with clinical guidelines.
In order to improve the quality of care provided to women before, during and after delivery, the project is helping to establish and guide the work of quality improvement committees at selected hospitals in the five regions. Using a mentoring approach, it supports facility-based interdisciplinary teams to identify obstacles to compliance with standards and to develop quality improvement plans to address gaps. Where necessary, the project organises support services in the form of technical advice or equipment.
It also works in cooperation with the Mandatory Health Insurance Fund to steer funding and incentives to support the implementation of quality improvement plans, and with the E-Health Center to improve the quality of data being used to monitor perinatal and obstetric services. In addition, the project supports a national-level working group under the Ministry of Health which is developing a new maternal and child health strategy for the country.
Promoting patient-centred integrated care
The referral system for pregnant women and newborns in Kyrgyzstan lacks clearly-defined clinical pathways and mechanisms for managing patients’ journeys through different levels of care. Linkages between primary health care workers and specialists are insufficient or entirely absent, which impedes the continuum of care. In addition, pregnant women sometimes arrive at health facilities very late, after complications have already arisen. Low standards, a lack of transparency and the wrong incentives for referrals means that women with high-risk pregnancies do not always receive specialist care on time, while widespread ‘self-referral’ results in a high proportion of uncomplicated deliveries taking place at higher-level facilities.
To improve the referral system so that it meets the standards required by an integrated patient-centred system, the project supports working groups in each region to develop and introduce process and communication standards for referrals. In one district of the Osh region, it is working with local health authorities and inpatient and outpatient service providers to pilot a case management-based approach to high-risk pregnancies. At the same time, the project is supporting the implementation of recommendations from the second CEMD to improve the quality of antenatal care at primary care level in the Osh region, including developing training materials for family doctors, family nurses and midwives.