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1 Empowering and engaging people: Community Action for Health in Kyrgyzstan April 2016 Geneva Tolkun Djamangulova Community Action for Health (CAH) in Kyrgyzstan Partnership Village Health Committees (VHCs) The Governmental Health System Win-win: Enable rural communities to act on their own for the improvement of their health Enable the governmental health care system to work in partnership with communities for improving health 1

2 Coverage (since 2002) ~1700 village health committees (VHC) or 84% of all villages volunteers, elected by villagers 58 registered NGOs at rayon (district) level (since 2004) under umbrella of National Association of VHCs (since 2010) Main elements of the partnership Village Health Committees (VHC) Independent community based organizations Voluntary work on health issues Close collaboration with: FGP/FAP (PHC providers ) local self government Form 58 NGOs on district (rayon) level Health Promotion Units (HPU) Part of Family medicine centers (PHC system) Work with VHCs, train and support 168 HPU staff in country, specifically introduced for CAH Guided by Republican Centre for Health Promotion (RCHP) National Association of VHCs 2

3 Process of CAH in Kyrgyzstan People s analysis of their health priorities Participatory reflection & action (PRA) sessions Formation of VHCs (election) HPU staff facilitate the formation of VHCs (with help of PHC staff) train VHCs in health actions build organizational capacity of VHCs Health actions for health promotion, disease prevention/control Organisational capacity collect data/do monitoring, feedback to FMC/RCHP Main results of people s analysis of their health priorities Health determinates: Clean water Roads Bath houses Ambulance Street lights Kinder gardens Sport squares PHC buildings repairs Health issues presently addressed by CAH: Hypertension Alcohol Tobacco Tuberculosis Hygiene and sanitation Sexual-Reproductive Health/ HIV/AIDS Mother and child health Iodine deficiency disorders Brucellosis 3

4 Addressing the Health Determinants 1. VHCs cooperate with different state organizations and local NGOs Examples of cooperation: Close cooperation with local self-government entities Small grants program Participation of VHC in forming of local state budget 2. Self initiatives of VHCs/RHCs - village cleaning - village greening - sport activities for youth - small repairing of public buildings - support of vulnerable part of the population Own initiatives of VHC Own initiatives, VHCs of 4 oblasts Number of own initiatives 4

5 Hypertension screening A nationwide health action (villages and cities) VHCs screen adult population (~2m) with automatic blood pressure monitors once a year If BP found 140/90 given leaflet with information incl. results of BP measurement referred to PHC provider Awareness supported through educational classes in schools Results of hypertension screening Population screened 2m People newly diagnosed with high blood pressure > (4%) People who knew they have hypertension & were taking medications (10%) Patients found with high blood pressure (out of those under medications) (65%) Impact Screening of hypertension increased awareness and compliance with treatment and contributed to a decrease in cardio-vascular mortality by 5% over two years (Kydyralieva R, 2013) 5

6 Health action against smoking Trainings for all VHCs, local self governments Tobacco control through Public Commissions at local level (65 municipalities) Educational classes for school students (in 2200 schools) Trainings for PHC providers on counseling for smoking cessation (~1700) Impact on smoking Tobacco related knowledge and behaviour before and after one year of VHC health action, Chui oblast pilot (n=760)* School students (years 5-7) Knows smoking is bad for health 74% 99% Knows passive smoking is unhealthy 71% 96% Knows tobacco creates dependency 25% 66% Someone among friends smokes 29% 17% Someone of family smokes 65% 60% Some family member smokes in house 35% 25% Tried smoking (school students) 31% 23% *surveys by Kyrgyz-Finish Lung Health Project 6

7 Challenges Insufficient of skills VHC in interaction with the local selfgoverning bodies. lack of transparency and accountability of local governments Low accessibility to quality health services Human resources of PHC: Low number and qualification of family doctors insufficient role and competences of nurses Distance and timing to PHC Poverty Lesson learnt Supportive MoH (due to positive pilot results) Starting from people s priorities Formation of independent community organisations (not part of government structure) much input into their organisational capacity building people feel they benefit from all of this Focus on non-dominant behavior by health staff Supportive government policy and government entities Flexible donors 7

8 Community Action for Health project 8

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