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: 2016 to 2018
Kyrgyzstan was one of two dozen low- and middle-income countries worldwide to achieve Millennium Development Goal 4, having reduced its child mortality rate from 65 deaths per 1000 live births in 1990 to 21 in 2015. Progress in reducing the number of maternal deaths, however, has been significantly slower. Kyrgyzstan currently has the highest maternal mortality rate in Eastern Europe and Central Asia.
Despite strong commitment by the Government of Kyrgyzstan, reducing the number of maternal deaths and further improving child mortality indicators remains a challenge. There is not enough properly-qualified health personnel to meet the needs of at-risk pregnant women as well as critically ill premature babies and new-borns. Diagnostic as well as treatment options are limited and focus on patients with serious illnesses. Apart from that, the existing patient referral system does not function as intended across different levels of the health system. Country reports show that most cases of maternal deaths are preventable, but institutional, staffing and organizational limitations in the health system mean that a lot of women do not have access to the necessary preventive and emergency perinatal services.
In 2011 Germany and Kyrgyzstan identified improving maternal and child health as a central focus for a development cooperation. The governments agreed to establish a National Perinatal Centre, on the basis of the current Maternity House at the National Mother and Child Health Centre in Bishkek, which will serve as the first specialised institution for pregnant women and new-borns in the country and as a centre of excellence for perinatal care. The German Ministry for Economic Cooperation and Development (BMZ) has commissioned both financial and technical cooperation measures aimed at establishing, equipping and strengthening the capacity of the future National Perinatal Centre.
Important institutional, staffing and organisational prerequisites for needs-based medical care for women with high-risk pregnancies and for critically ill premature babies and new-borns in the programme region have been established.
In line with the national health programme Den Sooluk (2012-2018), the GIZ-implemented promotion of Perinatal Health in Kyrgyzstan project supports the Ministry of Health of Kyrgyzstan and the National Mother and Child Health Centre. Together they are developing and strengthening the systems, processes and procedures which will be needed to operate the National Perinatal Centre in line with international standards. It focuses on three main fields of activity:
Strengthening human resources planning and recruitment
The project aims to establish the prerequisites for human resources planning, recruitment and development for the occupational groups which will staff the future National Perinatal Center, i.e. medical, nursing, managerial and support personnel. Supportive measures include continuous training of staff responsible for human resource management in areas of planning, administration and financing at the Ministry of Health and the National Mother and Child Health Centre and the formalisation of transparent and gender-sensitive recruitment and human resource management procedures.
Improving the quality of health care, management and support services
In the second area of activity, the project seeks to improve the quality of care and management at the maternity hospital at the National Mother and Child Health Centre. This is done by training medical, nursing, management and support staff in the principles of multidisciplinary perinatal teamwork, with an emphasis on client orientation and patient rights. The project also organises supportive supervision at the workplace and sets up professional exchanges, which are linked to hospital cooperation arrangements.
Strengthening the perinatal care referral system
Through the project GIZ supports the Ministry of Health and NMCHC to generate the information base needed to adapt the referral system for pregnant women, critically ill premature babies and new-borns in the perinatal centre's catchment area. This includes, among others, determining the position of the new perinatal centre within the national care system, and improving the referral patterns and logistics of hospitals in the care sector.
The Promotion of Perinatal Health in Kyrgyzstan builds upon and expands work initiated by the regional programme Health in Central Asia (2012-2015). Policy advice and capacity development measures supported through these technical cooperation measures have contributed to improvements in the organisation and delivery of perinatal health services:
- Referral system. The criteria guiding the perinatal referral system have been modified to allow risky births to be managed at the appropriate levels of the health system, which has resulted in a significantly increased chance of survival among premature infants. In addition, the proportion of medically-indicated cases at the Maternal and Child Health Center in Bishkek has risen.
- Infection control. Progress has been made in preventing, managing, monitoring and registering healthcare-associated infections (HCAI) among mothers and new-borns at the Maternal and Child Health Center.
- Quality of care. With technical support from the project, the NMCHC has become the leading institution in Kyrgyzstan for the implementation of two World Health Organization (WHO) quality tools: Confidential Enquiry into Maternal Death and Near-miss Case Reviews.