Palliative Care in Palliative Care in KyrgyzstanKyrgyzstan

Area 199.900 kmArea 199.900 km22

Population 5.4 millionPopulation 5.4 million

Almost 70% of territory are Almost 70% of territory are high mountainous and hardhigh mountainous and hard--

toto--reach regionsreach regions

Almost 70% - rural Almost 70% - rural population,population,

80% of them are poor80% of them are poor

Kyrgyz RepublicKyrgyz Republic

General informationGeneral information

Birth rateBirth rate: : 26,8 26,8 onon 1000 1000

Average age Average age :: 24.724.7 years years

665 years and older: 5 years and older: 5, 8% 5, 8%

Total mortalityTotal mortality: : 6,6 на 1000 6,6 на 1000 нас. нас.

LLife expectancy : ife expectancy : 69.3 years 69.3 years

male: male: 65.365.3

female:female: 73.64 73.64

Age structureAge structure

MortalityMortality

Mortality from cancer diseasesMortality from cancer diseases

UN total mortality rate in Kyrgyzstan in 2010-2015 - 7.1/1000

UN Mortality rate - 37,500 deaths

Ministry of Health, total number of deaths in 2010 - 36,152 people

Ministry of HealthMinistry of Health,, deaths from deaths from cancer in 2008cancer in 2008 - - 9.1% of all 9.1% of all deaths in deaths in KGKG -- 3,432 deaths 3,432 deaths

WHO estimates in 2004 of cancer in Kyrgyzstan died 4000 WHO estimates in 2004 of cancer in Kyrgyzstan died 4000 peoplepeople

Main achievements of the Main achievements of the health care system in KGhealth care system in KG

Budget for health care increased from 10 % to Budget for health care increased from 10 % to 13 % 13 %

Financial recourses were delivered from oblast Financial recourses were delivered from oblast to national levelto national level

Further development of primary health care Reforming of public health sphere Development of village health committees MoH strengthened main departments Developed M&E system

Lack of health care financingLack of health care financing (GDP 3,7) (GDP 3,7) Brain drainBrain drain, l, lack of medical workersack of medical workers Weak material-technical base of health institutionsWeak material-technical base of health institutions There are areas of health, remaining outside of the There are areas of health, remaining outside of the

reforms - oncology, psychiatry, reforms - oncology, psychiatry, TBTB Imperfection of the system of continuing education Imperfection of the system of continuing education

and training medical workersand training medical workers The high price of drugsThe high price of drugs ((absence of the state absence of the state

regulation of prices regulation of prices )) Imperfect system of primary health careImperfect system of primary health care

Main issues in health care system in KG

PPalliative care services and modelsalliative care services and models

2 hospices for AIDS patients2 hospices for AIDS patients 2 PC departments in 2 Cancer centers2 PC departments in 2 Cancer centers State guarantee programState guarantee program ( (privileged privileged

injectable morphininjectable morphin))

PC Department in National PC Department in National cancercancer ccenter enter serves serves arround arround 500 patients 500 patients perper year, 42.2% year, 42.2% of of them die in the first year of the disease of of them die in the first year of the disease (one-year mortality rate(one-year mortality rate

Positive stepsPositive steps

PC included to the new National strategy of PC included to the new National strategy of reforming of health care system “Den - sooluk”reforming of health care system “Den - sooluk”

PC included to the new National AIDS programPC included to the new National AIDS program PC included to the 4 laws on health care (PC included to the 4 laws on health care (Health care, Health care,

Cancer, HIV/AIDS, TB) - Cancer, HIV/AIDS, TB) - need Parliament approval soon need Parliament approval soon National strategy on PC developed National strategy on PC developed

Positive stepsPositive steps

Working group on PC under the MoHWorking group on PC under the MoH Union for palliative careUnion for palliative care Mandatory healthMandatory health insurance found insurance found hashas budget for opioids budget for opioids by State by State guarantee programguarantee program Political support – MoHPolitical support – MoH, MHIF, , MHIF, Parliament membersParliament members

National PC Program: main characteristics National PC Program: main characteristics and featuresand features

Improve legislation base on PC Establish PC individual service providing on all

levels Scale up public health role in development and

realization of PC programs Include PC into post graduate education of

physicians Define mechanisms and methods of PC financing Establish PC patients register M&E

ProblemsProblems

At least 18 000 patients need PAt least 18 000 patients need PCC annually annually No comprehensive educationalNo comprehensive educational PC PC programsprograms for for

physicians, physicians, medical students medical students No PC No PC standardsstandards, clinical , clinical protocols protocols No oral morphine in the country No oral morphine in the country No developed mechanisms of financing of PC No developed mechanisms of financing of PC

activitiesactivities

No home care No home care multidisciplinary multidisciplinary PC modelsPC models and and hospices for all patients needed PChospices for all patients needed PC

Next stepsNext steps

Implement EPEC Curriculum to Kyrgyz State Medical Academy, Kyrgyz State Medical Institute for Continuing Education, Medical colleges

Develop clinical protocols, standards for PC Begin basic PC course in KSMI Involve Ministry of Social Protection on

education on PC of existing social workers

Next stepsNext steps

2 pilot projects on home based palliative 2 pilot projects on home based palliative care, in Bishkek and Osh on the base of care, in Bishkek and Osh on the base of Cancer centers Cancer centers

Provide technical support for existing 2 Provide technical support for existing 2 hospices for patients with AIDS centers in hospices for patients with AIDS centers in Bishkek and OshBishkek and Osh

To include PC in new National Cancer, TB To include PC in new National Cancer, TB programs and identify sources of fundingprograms and identify sources of funding

Improve access to oral morphine and opioidsImprove access to oral morphine and opioids