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Central Asia: Twenty Years of Health System Strengthening Delivers Better Primary Care, Population Health

More than 20 years have passed since USAID first came to Central Asia to help several newly independent countries strengthen their health systems.

In 1994, Kazakhstan, the Kyrgyz Republic, Tajikistan, Turkmenistan, and Uzbekistan faced a dramatic transformation not only in the structure of their systems, but also in the very way that they thought about health care. Dramatically shrinking health budgets and overall poor health outcomes meant the inherited Soviet health systems could no longer be sustained and a less specialized, more efficient primary health care system was needed.

Representatives from Abt Global, USAID, and other partners spoke about the legacy of the USAID-sponsored health systems strengthening work in Central Asia at an Aug. 17 event, “An Afternoon Celebrating The Health Systems Successes in Central Asia: 1994-2015.” The forum, held in Crystal City, Va., was a reunion of sorts for some of the people involved with the transformation of the Central Asian republics’ health systems in the early years.

Several representatives from Abt Global and USAID participated in the event, which included panel discussions on the reasons for health systems success and changing the culture of health care.

In advance of the event, Abt Global and USAID prepared a report titled “USAID’s 20-Year Legacy of Health Systems Strengthening in Central Asia.” The report details the history, approach, impact, and lessons learned from the two decades of health systems strengthening activities, which were implemented by local counterparts with technical assistance from four successive Abt-implemented USAID projects in Central Asia.

Abt Global, USAID, and other partners worked with health professionals and governments in several Central Asian countries for twenty years to transform their health systems to deliver evidence-based primary care.

Changing to Evidence-Based Primary Care

The institutions, processes, and the citizens of Central Asia have evolved to a degree that would have been difficult to imagine in 1994.

Entering the new Central Asia Republics in the mid-1990s was like walking into a new world, according to Jennifer Adams, Deputy Assistant Administrator, USAID Bureau for Global Health, speaking at the Aug. 17 event. These nations had too much health care capacity and over-relied on their vast hospital networks as well as their numerous specialist physicians. USAID, as Adams noted, didn’t need to build up these health care systems as the agency did in Asia and Africa, Instead, USAID needed to downsize the Central Asia systems.

Today, evidence-based practices are the foundation for medical care. Health care agencies use data for decision making and implementing policies and best practices that benefit patients. This has contributed to dramatic improvements in patient outcomes. Fewer children are stunted or undernourished. More mothers survive pregnancy: Maternal mortality declined throughout the region, with decreases between 7 percent in Turkmenistan and 71 percent in Kazakhstan.

Patients, doctors, and policymakers see the benefit of treating patients at the primary care level. With strengthened primary health care, patients are able to stay out of hospitals and live healthier lives.

“True collaboration and partnership along with a commitment to common goal allowed health system strengthening success in Central Asia,” said Diana Silimperi, Division Vice President for International Health at Abt Global.

Work Not Finished 

Not all work is done, as Manpreet Anand, Deputy Assistant Administrator, USAID Asia Bureau noted, “although there have been many successes in Central Asia, tuberculosis and HIV are still an issue.” USAID continues to support HIV and TB work in the region.

However, USAID projects in Central Asia have contributed to concrete, sometimes dramatic improvements in health systems and measures of health. Panelists at the event said that the changes had taken hold and that the practice of evidence-based medicine is the norm. Each year, these health systems have more and more health care workers who never worked under the Soviet system and fewer who did, further ensuring the reforms will endure.