Kyrgyzstan is among the 27 high burden multidrug-resistant tuberculosis (MDR-TB) countries in the world and also among the WHO European Region 18 TB High Priority Countries. Upon request by the Minister of Health of Kyrgyzstan and as instructed by the Director of the WHO Regional Office for Europe, the WHO Regional Office for Europe, TB and M/XDR-TB Programme including the WHO Country Office in collaboration with the National TB Control Programme (NTP) conducted a midterm programme review of TB prevention, control and care activities during the 30 June-5 July 2014 period. Nonna Turusbekova, a temporary adviser to WHO, who is also a member of TBEC steering committee, assessed the engagement of civil society in TB response.

Since the previous Programme Review conducted in 2010, Kyrgyzstan has made a significant progress in following and addressing its main recommendations including areas such as MDR-TB, infection control and childhood TB. Political commitment shown by recent and updated national policy documents, such as Den Sooluk (State Health Program), stresses the importance of TB prevention and control in the country context. Diagnosis and treatment of TB and MDR-TB are according to WHO recommendations including restructuring of TB services with prioritizing ambulatory treatment and care. Uninterrupted supply of quality assured anti-TB medicines and drugs for management of adverse reactions has been maintained of the last 2 years (with funding from the GFATM and other external donors)

Nonna Turusbekova facilitates a civil society session during the NTP review

Nonna Turusbekova facilitates a civil society session during the NTP review

Despite the achievements, the current funding level for the TB Programme is not sufficient to fully scale up MDR-TB prevention and control activities and achieve and sustainably maintain full MDR-TB country coverage. There are high levels of drug resistant TB. Ambulatory treatment in primary health care services is not functioning to its full potential. Not all primary health care institutions are equally prepared for providing outpatient treatment and care. According to NTP estimates 1200-1400 patients with M/XDR TB will need treatment in 2015 and a considerable gap of second line drugs is expected if extra funds are not allocated.

Kyrgyzstan may receive a 7.1 million for three additional years maximum under the New Funding Model allocation from the Global Fund to fight AIDS, Tuberculosis and Malaria (GF). There might be some more money coming on top of this, however it is likely the last grant and then the GF’s support may end. This is because the government’s funding to TB response seems adequate, according to the information Kyrgyzstan presents to the Global Fund.

Currently the government’s funding goes to support buildings’ infrastructure and staff salaries. External donors such as GF cover many other aspects, ranging from equipment for laboratories to first and second line TB drugs. It is possible during the next 3 years that Kyrgyzstan and its civil society have to prepare for a likely Global Fund’s phase out or at least a GF scale-down. The domestic funding still needs to increase to cover all the needs and fully graduate out of donor dependency.

As part of USAID’s “Dialogue on TB and HIV” projects a number of HIV service organizations started working on TB case finding, referral and accompaniment of people who are not easily reached by the formal TB of primary health care services. Organization of people who use drugs, NGOs working with homeless people and others have started and are ready to continue to address TB but there is no or very little funding coming their way from the government and USAID’s funds may end soon. Participation of local NGOs, which have TB on their agenda, in higher-level decision-making for TB is still limited. There are international NGOs, such as MSF, project HOPE, KNCV that currently are at the forefront of TB response. Policy level advocacy is primarily moved by the international organizations, which are plenty in the country. There is a need to more systematically involve the local civil society actively in TB response and strengthen their capacity to both participate in service delivery and advocate together for an increase in and for effective spending of domestic funds that should go to TB patients.

21 representatives of 18 international and local civil society organizations took part in the prioritization workshop to identify the main challenges of the TB response from the point of view of the civil society. Among the top problems identified were:

  1. stigma and discrimination related to lack of information among the population about TB
  2. informal payment for TB treatment
  3. lack of funding of civil society organizations to work in TB and lack of clarity about their role in TB response
  4. difficult access of vulnerable groups to TB diagnosis and treatment

Additional problems identified were:

–          lack of involvement of religious leaders and community leaders

–          criminalization of certain groups e.g. IDU

–          coordination and leadership on advocacy, communication and social mobilization

–          lack of adherence among TB patients

–          lack of social and psychological support to TB patients

After a one-week review, the WHO team had presented its preliminary key recommendations to the Minister of Health, including the recommendations on engaging the civil society in TB response. A full and official report featuring a comprehensive set of recommendations is currently in the making.