Project: Voice of Village Health Committees and Social Accountability of Local Self-Government on Health Determinants of Local Communities in Kyrgyzstan
Country: Kyrgyz Republic
Executing Agency: Development Policy Institute (DPI)
Grant Amount: $598,833
Closing Date: January 2018
Frame and Challenge
Under the oversight of the Ministry of Health and national agencies, Local Self-governments (LSGs) in the Kyrgyz Republic are tasked with delivering health services in the country’s 40 rayons (districts). Officials have established 1,600 Village Health Committees (VHCs) – and consolidated them into an Association of Village Health Committees (AVHC) – to empower rural communities to advocate for their needs and interests among LSGs across rayons.
Though VHCs have some impact in promoting good health practices and behaviors, VHCs have not been effective in influencing broader public services linked to a healthy lifestyle, such as: water, sanitation, housing, and recreation services, which are often labeled determinants of health. Cooperation between VHCs and LSGs has been weak. In addition, VHCs do not fully understand how LSGs operate, and often lack capacity to collaborate with them to assess community needs, advocate for community interests, influence health budgets, and develop and implement health-related action plans. This project supports Village Health Committees (VHC) in rural areas to engage with local government officials, to monitor and improve budget allocations for resources that affect the health of the rural population.
The Development Policy Institute (DPI), a Kyrgyz NGO with a track record in community-driven development, received a grant from the GPSA to ensure that community needs are accounted for in local budgeting processes. A key aim of the grant is to enable VHCs to sustainably influence and monitor budgets for services related to broader health determinants. This will be done by implementing three components that are geared towards: 1) building the capacity of VHCs and AVCH to identify health priorities, engage with LSGs, and effectively participate in budget processes; 2) collecting information on health priorities to inform planning and budget allocation; and 3) providing technical assistance to LSGs in the use of social accountability tools to monitor budgets and improve service delivery.
The Project has provided technical assistance and capital to achieve important milestones and results:
87% of 99 identified problems concerning health determinants in 25 pilot villages were addressed jointly by local self-government bodies and local communities.
Over 10,000 citizens helped identify priority issues in their villages, having received access to local budget information and helped shape new health policies.
The AVHC developed a mechanism to bring those priority problems which lie beyond the capability of local communities to the attention of LSGs, the State Health Insurance Fund and the Ministry of Health.
This Kyrgyz Project continues to provide lessons which stem from its design, implementation, and outcomes:
The The original design of this grant benefitted from lessons learned from DPI’s previous work on the importance of working within existing structures rather than creating new ones, and ensuring that project activities translate into tangible action plans and policies.
Open budget hearings are an effective tool for self-governance, however, the concept of the open hearing may not be enshrined in local practice. Open hearings should be established procedurally and defined to include both local governments and citizens.
Installment of open hearings and other social accountability tools may be tackled at both the local and national level, as national actors are responsible for policy in the local spheres of most GPSA operations.
A growing concern to note and monitor is the problem of rural youth leisure. Sports development and improvements upon youth culture and activity should be considered in future health sector projects.
To learn more about the Project, check out the following links: