Competent health care workers and quality medication are essential, but not enough to end the HIV and TB epidemics, as proved by years of experience and research. Traditional models of care, in which patients have to seek help themselves and are not involved in decision-making processes, cannot tackle larger issues such as access to healthcare, prevention and adherence to treatment. That is why the UNDP, under the Global fund’s grant and together with national and international partners, has been implementing people-centered care to save more lives in Kyrgyzstan.

People-centered care is a model in which patients and communities take their health into their own hands. They are informed and involved and become the key actors of their health. Instead of a vertical healthcare system, where patients need to reach out to healthcare workers, people create a horizontal care system, in which they help themselves with the assistance of healthcare workers. It is a way of decentralizing the healthcare system and engaging communities against diseases.

Putting people first

The World Health Organization (WHO) defines people-centered care as “ensuring that health services are tailored to people’s needs and are provided in partnership with them, rather than simply given to them. It means care where people, families and communities are respected, informed, engaged, supported, and treated with dignity and compassion.”

Putting people first also means addressing all issues which may prevent access to healthcare, including psychological, social, financial and legal problems. It implies a comprehensive and inclusive approach to healthcare, all the while empowering patients, families, communities and key population groups.

Based on this approach, the UNDP “Effective HIV and TB Control” project does not only purchase quality medication for HIV and TB, donate modern equipment to laboratories and hospitals and regularly train health care workers around the country, but also engages communities and other local actors to provide timely prevention, consultation, testing and support services.

Engaging communities

One of the key pillars of people-centered care, and of successful HIV and TB control programs, is empowering and engaging communities. That is why the UNDP / Global Fund project works with many NGOs throughout Kyrgyzstan to provide the best services to populations.

For the most part, these are community-based NGOs, meaning that they are led by representatives of key population groups themselves, instead of third parties. All of the partner NGOs employ community members for outreach and support work. This has many benefits. Firstly, on a personal note, employees can get their lives back into their hands thanks to their job. Secondly, they also become activists, and are engaged in decision-making processes. They are able to put the real needs of key population groups on the table and know, better than anyone else, what are the priorities and shortcomings of health programs. Finally, having aid coming from the inside facilitates access to these target groups, which are often financially, socially and psychologically vulnerable and burdened with stigma. As peers, NGO employees are able to gain the trust of key population groups more easily than outsiders and subsequently increase the overall coverage and efficiency of our work. 

What is more, communities are not only engaged in direct work with clients, but also participate in national decision-making processes and grant applications, making their own choices for themselves and their peers.

Informing key groups

An essential part of effective HIV and TB programs depends on proactive prevention, which requires delivering clear and timely information to groups of the population at risk of developing these diseases. Since it is rare for people themselves to seek information, and since they might find misleading and inaccurate information on the Internet, the UNDP / Global Fund project and its partners have developed a strong information component in its programs.

NGOs actively conduct outreach work, meaning that peer consultants work on the ground to meet representatives of key population groups. They distribute free preventive material, consult them on HIV prevention and treatment, offer free testing, and share their personal stories as examples.

As making information available to communities is a priority, UNAIDS, the Partners’ Network Association and the UNDP / Global Fund project are currently developing a unique application on HIV, closely involving key population groups in the process.

Bringing care to people

Another important component of people-centered care is making treatment as convenient as possible for patients. This means reducing the burden entailed by long treatments. The UNDP / Global Fund project and its partners have been introducing innovative, alternative treatment control methods for TB and HIV to facilitate clients’ treatment.

In fact, one of the main obstacles to success in HIV and TB control programs is low treatment adherence: people do not take their treatment systematically, or stop taking it altogether due to a number of difficulties. In this case, they put their own lives at risk, may develop drug-resistance to the medication and could infect other people as well.

Thanks to joint efforts, both TB treatment and antiretroviral therapy (ART) for HIV have become less of a burden. Key population groups and people living with HIV can get consultations on preventive treatment (PEP / PREP) and get tested for HIV in local NGOs, without having to go to a public hospital, and NGO employees can help clients receive the pills for HIV treatment (ART) from public hospitals. For many, this is important due to a high level of stigma and discrimination in the country. As for TB patients, they can now avoid having to go to a health facility every single day to take their pills under the control of a nurse; instead, they may take their treatment at home, at whatever time best suits them, thanks to video observed treatment, or have their treatment brought home by a case manager. This does not only protect them from stigma, but also saves them precious time and money and enables them to work or care for their family while on treatment.

Erasing access barriers

There are many obstacles which keep people from taking, or continuing treatment. And if these are not eradicated, neither will AIDS or TB. That is why people-centered care means more than providing quality healthcare services: it also implies giving financial, psychological, and legal assistance to those in need.

The UNDP / Global Fund project and its partners have put in place a system of comprehensive aid, including free legal assistance to recover documents or register rights violations, peer-to-peer support groups and counseling, and professional psychological help (both offline and online). Case managers regularly check in on patients with drug-resistant tuberculosis to make sure that they are able to take their treatment systematically and that they are not facing any difficulties, and look for patients who have dropped out of treatment to understand and solve their problems. The UNDP / Global Fund also provides monthly motivational payments to TB patients and children living with HIV, covers fees for certain medical exams and for expenses entailed by video observed treatment, distributes food packages to people in need and has put in a place several shelters for clients in difficult life situations.

The idea is to reduce access barriers, such as psychological and economic stress, and create a supportive environment.

Fighting stigma and discrimination

To end TB and HIV, it is also necessary to fight against stigma and discrimination. Only then will people stop being afraid of seeking help, feel loved and supported, and spread correct information.

The UNDP / Global Fund project and its partners also actively work in this direction through a number of activities. Street lawyers, who are not professional legal experts, but trained members of NGOs and communities, document rights violations and help their clients obtain justice. In addition, professional lawyers and activists work with the government to change the legislation and create a more favorable legal environment for key population groups. NGOs constantly work on decreasing self-stigmatization among their clients. This is also one of the main purposes of the yearly summer camp organized by the UNDP for children living with HIV and their parents. Last, but not least, the UNDP / Global Fund project regularly trains health care workers on stigma, helping them become more caring and supportive in the services they deliver.

Put together, all of these activities help complete quality healthcare, empower communities, and support patients in order to decrease the HIV and TB burdens in Kyrgyzstan and save lives. A people-centered healthcare system is essential in order to achieve Sustainable Development Goal number 3 and guarantee health for all.