Review of acute care and rehabilitation services for heart attack and stroke in Kyrgyzstan (2017)

Cardiovascular diseases are responsible for half the number of deaths in Kyrgyzstan and are a major theme of the national health reform programme 2012–2016 “Den Sooluk”.

A WHO review of acute and rehabilitative services for heart attack and stroke took place in October 2016. There are services in place for these, more developed for the former than the latter, and more concentrated in the capital. Clinical guidelines exist and are largely evidence-based but implementation is impeded by gaps in resources and infrastructure, design of services, fragmented clinical pathways and networks, and limited performance management. There was some indication of the use of non-evidence-based medicine and opportunities for release of resources.

There appears to be a growing gap between what is possible in the private sector and the public sector. Fragmentation of the clinical pathway and charges (formal and informal) place a heavy cost on the patient, both financially and in terms of clinical outcome. Nevertheless, there are good and emerging practices, developing international networks, and investment opportunities. A more strategic approach and roadmap for the development of these services could capitalize on the strengths and upcoming opportunities.

A number of key messages are proposed, which are summarized as:

• manage the existing resources effectively;
• design the system and direct further investment; and
• demonstrate success.