Health Facilities Autonomy in Kyrgyzstan

Project completed

The health reform in Kyrgyzstan has resulted in an increasing access to basic medical services. The management of the health facilities remains however centralized and the inefficient use of limited resources is still an issue. The project intends to improve the efficiency and quality of health care by increasing the autonomy of the health facilities in provision of their services. A Model of Health Facilities Autonomy will be introduced in 3 pilot provinces of the Issyk-Kul oblast and shall be applied in remaining health facilities countrywide. During Phase I, the legal framework to support the introduction of decentralized management in the health system will also be adapted.   

Country/region Topic Period Budget
Health systems strengthening
Primary health care
01.08.2013 - 30.06.2020
CHF  4’560’000

Over the last 20 years, the Kyrgyz Republic has optimized its health service delivery system by strengthening the primary care and by increasing access to basic health services. If the reduction of hospitals (and in particular hospital beds) and their consolidation at provincial level have resulted in some optimization, the reforms have ensured neither the devolution of case load, nor the transfer of health expenditures, from the hospital down to the primary health level. Therefore, the Ministry of Health has fully recognized that more decentralized and autonomous health facilities have become necessary to improve the quality of medical services, to use the existing funds in health care organizations more efficiently, to reduce inpatient care at the benefit of preventive measures at primary care level, and to support better optimization of health care structures.


The overall goal of the project is to improve efficiency and quality of health care services by expanding the autonomy of health facilities (hospital and primary health care centers). The underlying impact hypothesis is that by granting expanded autonomy to health facilities’ managers, in combination with clear vision, adequate managerial capacity, appropriate accountability mechanisms and effective incentives, they will be able to provide health care services in a more efficient, patient-centered way and with better quality.

The expected goal of the Phase I is to pilot and introduce the Model for Health Facilities Autonomy in three districts of the Issyk-Kul oblast: Ton, Tyip and Jeti-Oguz rayons, including 3 Hospitals and 3 Family Medicine Centers. 

Target groups

The project’s beneficiaries are at 3 levels of interventions:

  • National level, line Ministries, including Ministry of Finance, Central Treasure and Chamber of Accounts, Mandatory Health Insurance Fund
  • Regional (Oblast) level, newly created health networks and multi-sectoral committee
  • 3 hospitals and 3 family medicine centers at districts (Rayon) level of the Issyk-Kul oblast
Medium-term outcomes
  • Health Facilities are modernized to be effectively managed and capable to utilize expanded autonomy
  • Autonomous Health Facilities supervision and performance improvement enabling systems are in place 

Expected results:  

  • Managerial and operational knowhow in clinical and para-clinical fields applied at health facilities
  • Modernized auxiliary services introduced at health facilities
  • Modernized methods and processes of human resources management, financial management, commodity management and information system introduced at health facilities level
  • Decentralized health governance (rayon and oblast level) improved with consolidated monitoring, accountability mechanism and effective communication strategy in place
  • Health care delivery established at rayon level improved through introduction of better integrated health care organizations networks and services
  • Contracting and provider payment mechanisms improved and introduced to support better performance at health facilities and their networks

Results from previous phases:  

In August 2013, SDC has launched a 10-year program on “Health Facilities Autonomy”. During the Inception phase, the project has been designed based on the strategic orientations of the Entry Proposal, and tendered. A consortium composed of GFA (lead), VEK Consulting and Swiss Tropical and Public Health Institute won the tender and was contracted to design a Model for Health Facilities Autonomy.

Directorate/federal office responsible SDC
Credit area Swiss cooperation with Eastern Europe
Project partners Contract partner
International or foreign NGO
Private sector
  • Other international or foreign NGO North
  • Foreign private sector North
  • Swiss Private Sector

Budget Current phase Swiss budget CHF    4’560’000 Swiss disbursement to date CHF    4’300’703
Project phases Phase 2 01.08.2020 - 31.10.2024   (Current phase)

Phase 1 01.08.2013 - 30.06.2020   (Completed)