The Community Action for Health in Kyrgyzstan project aims to improve health in rural areas of Kyrgyzstan in a sustainable manner. It actively includes the rural population in the process of defining their health problems and in working towards solutions with the support of the Ministry of Health. The goal is thus to empower the local community in their engagement for health and prevention and to foster a fruitful partnership with the health authorities.
Village health committees
In each village, the implementation of the project starts with the definition of health priorities: grouped by neighbourhood, the local population discuss their most pressing health issues. During this process, the participants also elect people from their neighbourhood as members of the village health committee, which plays an important role in the project. In a later village meeting, the board of the committee is elected from among the proposed members. The village health committees work on a voluntary basis and members get regular training in medical as well as organisational skills.
Based on the health priorities defined by the population and in cooperation with the Ministry of Health, various campaigns, addressing issues such as dental health, maternal and infant health, reproductive health, nutrition, sanitation and hygiene, are launched. All of these health-related activities – around 20 in all – are then implemented by the village committees. Equipped with information materials and demonstration tools, the trained members of the committee visit the population of their village on a regular basis.
While acknowledging the traditional role that women play in resolving health problems in rural families, the project constantly strives to engage more men in health-related activities, especially on predominantly male-related health issues such as brucellosis, alcoholism and tobacco use.
Lower blood pressure
One very successful health-related activity addresses high blood pressure. Hypertension is a major reason for the high stroke-related mortality rate in Kyrgyzstan but it is seldom recognised as such and thus not treated. During a yearly hypertension action week, the village health committees throughout the country screen as many adults as they can with a blood-pressure cuff. Between 2011 and 2013, over a million people were checked and the committees detected over 180,000 people with high blood pressure, among whom 57,000 were not aware of it. Those affected were sent to primary healthcare providers and given extensive information materials. Based on their documentation, the committee can follow up with these patients at a later date.
Other high-ranking issues among the village’s health priorities were disorders resulting from a lack of iodine, such as goitres. The number of those diseases increased significantly in the early 1990s because salt was no longer universally iodised as it had been under the Soviet Union. Within an iodised salt promotion campaign, the village health committees distributed simple test kits in the villages and enabled the communities to check the salt sold in their villages themselves. This campaign resulted in 98% of the targeted households only using iodised salt.
The project was designed and for the first time tested in the Jumgal district of Naryn oblast in 2002. As the campaigns were very successful, the project was expanded to encompass Talas, Osh, Batken and Chui oblasts. Today, there are village health committees in 84% of all villages in Kyrgyzstan.
Community-based health promotion has several advantages over state-driven models. In addition to encouraging a preventive approach to health care, the strategy empowers rural communities and opens up possibilities for a stronger and more diversified civil society in the country’s regions. Through this approach, people have realised they can take the initiative for improving their own health rather than waiting passively for the government to do something for them. At the same time, medical staff learnt to see the local people in the villages not as passive objects to be taught what is good for them but as active partners in the process of improving health. The underlying principle for the collaboration between the community members, the health staff and the project staff is non-dominant behaviour and mutual appreciation of all contributions. This keeps the motivation for voluntary work alive.
Aside from the health issues, the committees started to take responsibility for further activities identified as beneficial for the community, such as income generating activities, organising social events or collective work in their villages. They work as independent civil society organisations and the number of initiatives is rising constantly.