Cure Tuberculosis Project Builds Sustainability of Transportation System and Financing Methods in Kyrgyz Republic

The Kyrgyz Republic is confronting an epidemic of tuberculosis (TB).  One of 30 countries in the world with the highest-burden of Multi-Drug Resistant TB (MDR-TB), the Kyrgyz Republic sees an estimated 1,400 new cases of drug-resistant TB annually. Drug-resistant TB is particularly difficult to control because diagnosis requires collecting sputum from patients for testing in specialized laboratories, often using tests only available in the capital city of Bishkek at the National Reference Laboratory. The course of treatment for drug-resistant TB is long and complex with many side effects, making it difficult for patients to adhere to treatment.

The Kyrgyz government’s response to TB has so far been largely dependent on donor funding. USAID has been at the forefront of this response for many years, providing long-term technical assistance to the government of the Kyrgyz Republic to help control the TB epidemic. This has included rolling out better diagnostic tests for TB; introducing new drugs and easier, shorter treatment regimens for drug-resistant TB; and piloting outpatient models of treatment for patients. Significant health reform efforts have helped to optimize the TB control system by dismantling a large network of under-used TB hospitals and re-investing savings generated into the national TB program. Over the last three years, USAID developed and implemented a transportation system to transport sputum from health centers to central laboratories and distribute drugs to health centers. The transportation system was rolled out in two pilot regions, Chui and Talas Oblasts, where it has enabled faster diagnosis of TB and earlier start of treatment for patients, which are critical to the successful management of TB. Until now, this system was financed solely through donor funding.

Cure Tuberculosis, a new five-year USAID activity implemented by JSI, is working with the Kyrgyz Government to mobilize funding from local sources of financing to institutionalize the transportation system. USAID provided technical assistance to the Mandatory Health Insurance Fund (MHIF), the primary purchaser of health services in the country, to develop a financing methodology and standards to allocate funding for the transportation system from the state budget. Financial regulations in health were recently amended and these standards were included in the Budget Law of the MHIF for 2020 and Forecast for 2021-2022. These measures will make the transportation system more sustainable by ensuring state funding and providing a mechanism for forecasting financing needs to enable the roll-out of the transportation system nationwide.

Our project is focused on achieving self-reliance in the health care system,” says Dr. Ainura Ibraimova, Cure Tuberculosis Chief of Party. “A lot of projects that are quite successful lose all their mechanisms and approaches when they close. The Kyrgyz health care system needs more effective reforms in the TB system with the perspective of sustainable functioning of the system in the future.”

With the recently-signed Budget Law, two other USAID-supported health reform achievements have been institutionalized into law. Over the last few years, USAID provided technical assistance to help develop and implement a performance-based payment system for health workers for successfully-treated cases of TB. The system incentivizes health workers involved in treating a patient to provide the necessary support to ensure the patient is able to complete the long and difficult course of treatment. The Cure Tuberculosis project also supported the development of a standard for per capita financing of Oblast TB Centers, in addition to existing results-based financing, to ensure adequate funding for all essential functions of Oblast TB Centers in providing coordination, monitoring, and technical support for primary health care services.

The experience of Kyrgyzstan shows that there will be no significant changes until the health system begins to perform certain tasks that are implemented in the functions of the relevant specialists, who are paid accordingly,” explained Dr. Ibraimova.

Thanks to USAID assistance and advocacy, standards for financing of these initiatives – the sputum transportation system, the results-based payment system for successfully-treated cases, and the per capita financing system for Oblast TB Centers – have now been included in an amendment to the Budget Law for the MHIF for 2020 and Forecast for 2021-2022. The Jogorku Kenesh (Parliament) of the Kyrgyz Republic approved the Budget Law and it was signed into law by President Jeenbekov on January 21, 2020. This important achievement ensures the sustainability of these systems and their scale-up countrywide to better finance TB services in the Kyrgyz Republic, contributing to more successful outcomes in diagnosing and treating drug-resistant tuberculosis.