Innovation: Community Action for Health
Kyrgyzstan
AAI Domains:
Participation in society (voluntary activity, social connectedness, political participation)
Independent, healthy and secure living (improving access to healthcare)
Kyrgyzstan is a landlocked republic in central Asia with a population of about six million people that achieved independence with the collapse of the USSR in 1991. It is mountainous, relatively economically under-developed with most people living in rural settlements and has average male life expectancy of 65 and 73 for women. Like the rest of the world, Kyrgyzstan’s population is ageing although there are many health challenges throughout the life course that need to addressed.
The Community Action for Health (CAH) programme started as a pilot in one rayon (district) as a partnership financed by the Swiss Agency for Development and Cooperation and implemented by the Swiss Red Cross Society and local Village Health Committees. The CAH is a health promotion programme that aims to increase health literacy for people of all ages across the life course by reducing the disease burden and addressing the social determinants of health locally.
The initial pilot demonstrated that the CAH was a viable innovation and from 2005 it has operated in partnership with the Ministry of Health and attracted funding from a variety of sources including the World Bank, the Asian Development Bank, the Global Fund, USAID, the Word Health Organisation, the World Food Programme and UNICEF. The CAH operates Health Promotion Units in partnership with approximately 1,700 Village Health Committees – some 84% of all villages – across 58 rayons covering nearly four million people or roughly two thirds of the whole population. The Village Health Committees have formed the National Association of Village Health Committees to act as a representative for the programme with donors and in policy making thus enhancing political participation at the local, national and international level.
The CAH, after extensive consultations with Village Health Committees and other local stakeholders on priorities, takes a whole life course approach to improving health starting with education and support on maternal and child health to ensure the best possible start to life. Agricultural livestock pose a significant risk to health through brucellosis, a contagious zoonosis disease caused by the consumption of unpasteurised milk or undercooked meat from infected animals or close contact with animal secretions, that was addressed by education on hygienic practices with lambs and goats.
An estimated 31% of the population have high blood pressure that is a major risk factor for mortality due to coronary heart disease and stroke. Over a million people were screened for hypertension over the 2011–13 period and over 180,000 had the condition of whom 57,000 were not aware of it but could change their lifestyle to reduce their blood pressure and risk of developing these life threatening conditions.
The CAH also addresses sexual health, particularly in relation to HIV, among school age young people – a particularly challenging issue in a largely Muslim and socially conservative culture – as well as the risks of tuberculosis and iodine deficiency disorders that are both prevalent. The more familiar issues of health harm due to alcohol and tobacco – more than half the population smokes and a growing proportion of women are taking up the habit – are also addressed through health education and support to change behaviours.
In relation to active ageing, the CAH aims to improve access to health services and to empower people through increasing levels of health literacy, effectively a form of lifelong learning. The growth in scale of the programme over the period since 2002, which has been due to the ability to attract a wide range of international funders, is impressive. The process of developing the CAH has incorporated empowering local communities in order to enhance political participation across civil society in order to influence policy making and the social determinants of health.