Interview: Fighting TB in the Kyrgyz Republic
March 16th, 2020 | Viewpoint
March 16th, 2020 | Viewpoint
Dr. Ainura Ibraimova, chief of party of JSI’s USAID Cure Tuberculosis Project in the Kyrgyz Republic, reflects on her experiences fighting tuberculosis.
She has more than 20 years of experience spearheading reforms in health systems and financing, including designing health policies and strategies to introduce international evidence-based practices and patient-friendly approaches in health, including tuberculosis. Since 2014, Dr. Ibraimova has led USAID-funded tuberculosis activities in the Kyrgyz Republic. She is a former director general of the country’s Mandatory Health Insurance Fund and a former deputy minister of health.
The USAID Cure Tuberculosis Project is a five-year initiative that assists the Kyrgyz government to diagnose, treat, and cure people with drug-resistant tuberculosis.
I have worked in health care management for many years, and TB presented an opportunity to apply my experience and knowledge to a good cause. Before 2012, the TB system in Kyrgyzstan was vertical, meaning that it operated independently from other health care services. Since then, we have made large-scale reforms to integrate TB with other health services, and have increased financing to ensure the implementation of programs to improve TB service quality and cure rates. These efforts contributed to a drop in TB incidence, but drug-resistant forms of TB have increased, bringing with them new challenges to reducing the epidemic.
The TB experience was a great way to demonstrate that seemingly difficult changes to the health care system could both be realized and yield results. When I decided to work in TB, I thought that my experience and understanding of the general health care system would allow more effective reforms in the TB system with the perspective of sustainable functioning of the system in high-providing quality patient-centered TB services in the future.
Kyrgyzstan is a small independent republic in the heart of Central Asia. In the 30 years since independence, we have seen two revolutions, five presidents, more than 25 governments, 25 prime ministers, and almost 10 constitutional changes. This volatile history has created a great number of migrants, both external and internal, along with the concomitant disorder; while the state budget deficit and high turnover in the health care system has also contributed to serious problems in health care service access, including for TB case detection and control. The health care system was falling apart, unable to perform its functions and a well-established system of managing patients, and prescription drugs, including antibiotics, was destroyed. In addition, there was a shortage of medicines, including TB drugs.
All this has led to a sharp increase in TB morbidity and mortality. Violations of patient management and free access to antibiotics, and violations of infection control in hospitals have led to an increase in multi-drug-resistant TB. And today, despite the decline in morbidity and mortality in the country, Kyrgyzstan, with 1,400 new cases of drug-resistant-TB annually, remains one of the 18 high-priority countries for TB in the WHO European Region and is among the 30 highest-burden countries in the world. The estimated proportion of TB cases with RR/MDR-TB is 26% (24–27%) among new, and 61% (58–64%) among previously treated cases (2018, Global TB Report).
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. I saw a lot of projects that were quite successful, but when they closed, all their mechanisms and approaches disappeared. Our project is focused on achieving self-reliance in health care system. We will develop new tools, approaches, and standards that should be implemented in the daily practice of health specialists. In addition, we must involve civil society and other local organizations in the process.
The second important task is to reduce the stigma and discrimination that TB patients and their families experience. High levels of stigma prevent both TB detection and treatment. People often choose not to be treated for TB, thereby posing a threat to their health, their loved ones, and society.
On a global scale, the development of more effective drugs and treatment regimens is making it possible to treat TB patients in a shorter time.
In our country, our achievements in the field of state financing of TB services. For example, for the first time in the country, our health system budget included funding to ensure completion of treatment of TB cases, a system for transporting biological samples to labs, and TB drugs.
This news, along with the fact that effective TB drugs and treatment regimens have been implemented in the country, will help us reduce the burden of drug-resistant TB.