Kyrgyzstan: strengthening primary health care financing
Kyrgyzstan has set out on an ambitious path of health system reforms to improve access to Primary Health Care (PHC) services for its people. A new WHO/Europe study sheds light on the current state of PHC financing in Kyrgyzstan and offers 6 policy suggestions to strengthen it and promote more efficient public spending in PHC.
Evidence demonstrates that PHC is the most effective and cost-effective approach to delivering health care services to people and achieving universal health coverage (UHC). Kyrgyzstan is moving in this direction – counting on sustained support from the Government and from development partners – through the national health strategy for 2019–2030 “Healthy person — prosperous country” and a commitment of funds to enhance access to PHC.
At a national policy dialogue on 26 September 2023, the Mandatory Health Insurance Fund, leaders of public health institutions, development partners, representatives of the Ministry of Health and its expert group responsible for developing the action plan for the 2024–2030 national health strategy reviewed the action points outlined in Strengthening primary health care financing: policy considerations for Kyrgyzstan and reached consensus on the need to incorporate the suggestions into the upcoming 7-year action plan.
Bolstering PHC spending
Notably, the country has prioritized PHC spending within its health budget and spends about 1% of its gross domestic product (GDP) on PHC, which is on par with other countries with a similar financial profile. Despite these efforts, the study reveals that per-capita public spending on PHC in Kyrgyzstan remains among the lowest in the WHO European Region.
“Kyrgyzstan’s strides to move towards UHC, despite budget constraints, are commendable. However, the study shows untapped potential to extract more value and optimize its health spending systems even further,” noted Liviu Vedrasco, WHO representative in Kyrgyzstan.
Budget constraints are not the sole challenge faced by Kyrgyzstan. The policy paper points out that improving the PHC basic benefits package, budget allocation mechanisms, and the payment model can lead to more efficient use of health care resources.
Enhancing equity and efficiency
The policy paper also suggests specific actions to improve how PHC services are structured and delivered to make them more efficient, accessible and fair for everyone.
These actions include streamlining the current PHC organizational model to be better aligned with the population’s health needs, and revising the basic benefits package to make it universally accessible to the entire population, as well as aligned with clinical guidelines. This means ensuring the availability and affordability of medicines and expanding entitlement to include the entire population, as the current model may leave patients vulnerable to paying out of pocket for health services.
“This is Kyrgyzstan’s moment to adopt strategic actions that can address gaps in PHC financing and strengthen its health system financing,” said Triin Habicht, Senior Health Economist at the WHO Barcelona Office for Health Systems Financing. “This study offers a blueprint of actionable opportunities to achieve this goal.”
Redesigning PHC provider payments
The study also calls for redesigning the PHC payment model to align it better with policy goals. The current model doesn’t consider factors such as age and gender, and there are no mechanisms to ensure that the payment rate reflects the real costs of delivering the services included in the benefits package. The authors recommend conducting a PHC costing study to better understand the costs associated with delivering PHC services.
Additionally, it remains unclear whether payments to providers take into account funding needs in remote areas. To improve rural facilities and attract people to work there, investing in both physical and digital infrastructure for PHC is essential. With family doctors ageing, it is crucial to attract young professionals to start working in PHC settings.
To address these issues, the study suggests:
- adjusting PHC financing in remote locations, as a measure to make rural health care facilities more attractive to patients and staff;
- drawing on experiences and lessons learned from the previous implementation of a successful PHC performance payment system; and
- introducing an upgraded performance payment system for PHC teams to incentivize continuous improvement in managing priority PHC-sensitive conditions.
The study also highlights the critical need for improved monitoring mechanisms to ensure accountability and transparency, advocating for longer term contracts to meet the development needs of PHC.
Technical assistance and financing for the study
The policy paper Strengthening primary health care financing: policy considerations for Kyrgyzstan received technical assistance and financial support from WHO under a biennial collaborative agreement for 2021–2022 between the Ministry of Health of the Kyrgyz Republic and the Swiss Agency for Development and Cooperation (SDC) in Kyrgyzstan within the WHO/SDC project “Support for the implementation of the State Program for the Protection of Public Health and the Development of the Health System ‘Healthy person – prosperous country’ for 2019–2030”.