Quality Health Care Project, Central Asia

APMG’s work on the Quality Health Care Project in Central Asia (CA) encompasses technical assistance, advice and capacity building on most aspects of HIV prevention among key populations, and integration between NGO and government health systems in Kazakhstan, Kyrgyzstan and Tajikistan.

To date in Central Asia, donor interventions have provided outreach to marginalized populations and have helped to begin some other services such as medication-assisted treatment (MAT). The geographic reach and breadth of services offered by these programs has been limited and is not at a scale that is likely to significantly reduce HIV incidence and impact in the long-term within the financial resources of CA countries. Unlike in many developing or transitional countries, there is little need for large-scale educational programs to produce sufficient doctors and nurses to meet national health care demands. Until the Quality Project began, the government health care system had not generally been an active partner in donor-funded outreach programs, except where donor programs provide incentive payments to doctors to work with specific groups of MARPs. There is often a significant difference in the quality of services that MARPs receive from donor interventions compared with that received once in the general health system. The Quality Project began work in nine Localities in three countries with aims to learn lessons from implementation of collaborative activities in these sites for national scale-up.

APMG’s work includes a substantial set of activities to build trust among government agencies and NGOs. Unlike most donor programs which have paid direct costs for NGO activities (including staff costs, commodities, incentives for client and for service providers) and for a range of government activities (including, in some cases, staff costs, substantial equipment and commodities and top-up salaries), the Quality Project was tasked with assisting countries to increase the quality of their services through attracting managers, directors, outreach coordinators, doctors and nurses to specific training suited to their roles as well as building trust with governments at the local, oblast and national level that participation in Quality Project-supported activities would lead to better outcomes for key populations and to reduced HIV infection and increased care for people with HIV. The level of acceptance and trust that the Quality Project has achieved can be measured by the ease with which the main HIV stakeholders in Kyrgyzstan, Tajikistan and Kazakhstan agreed to adopt the Comprehensive Packages of Services for PWID, MSM and Sex Workers, based on UN and PEPFAR guidance documents.

These packages are discussed at the local level by Coordination Councils made up of key NGO managers and head doctors of health facilities, to ascertain where services can be co-located, where NGO staff can assist in government clinics, where government doctors can work with NGO outreach efforts and so on. Methods of measuring the integration of specific services for key populations in pilot sites, developed by APMG, have found significant changes after less than two years of implementation.

Some assistance has also been provided to Uzbekistan and Turkmenistan. For the Quality Health Care Project, APMG is subcontracting to Abt Associates, who are funded by USAID to implement the project.

About the author

Lou McCallum's picture

Lou is a director of APMG and is based in Sydney. He has worked in the response to HIV in a variety of roles since 1983 including management of AIDS home and community programmes and was Executive Director of Australia’s national AIDS NGO. Lou has a background in paediatric nursing, nursing service management and public policy. He worked alongside friends and colleagues in the early part of Sydney’s response to HIV in the gay community, setting up volunteer emotional support and home-care programmes, providing community support in outpatient clinics and providing VCT counselling. Lou began working as an HIV and development consultant in 1998, focusing on technical assistance for national and provincial AIDS policy development, and implementation and strengthening of the civil society response to AIDS. Lou is an experienced adult learning trainer and has prepared and conducted training programs for a wide range of health and community workers. He is also a consumer health advocate and has served two terms as national chairperson of the Consumers’ Health Forum of Australia.