Identifier
Created
Classification
Origin
08BISHKEK192
2008-02-27 07:37:00
UNCLASSIFIED
Embassy Bishkek
Cable title:  

KYRGYZSTAN: STATUS OF BERLIN DECLARATION ON TUBERCULOSIS

Tags:  PGOV PREL TBIO WHO KG 
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RUEKJCS/OSD WASHDC
RUEAIIA/CIA WASHDC
RHEHNSC/NSC WASHDC
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RUEHGV/USMISSION GENEVA 0837
RUEHVEN/USMISSION USOSCE 2829
RUCNDT/USMISSION USUN NEW YORK 2214
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RUEHBS/USEU BRUSSELS
RUEHLMC/MILLENNIUM CHALLENGE CORP
RUMICEA/USCENTCOM INTEL CEN MACDILL AFB FL
UNCLAS SECTION 01 OF 02 BISHKEK 000192 

SIPDIS

SIPDIS

DEPARTMENT FOR EUR/PGI (TESSLER) AND OES/IHB (LAURITZEN)
DEPARTMENT ALSO FOR SCA/CEN

E.O. 12958: N/A
TAGS: PGOV PREL TBIO WHO KG
SUBJECT: KYRGYZSTAN: STATUS OF BERLIN DECLARATION ON TUBERCULOSIS

Ref: STATE 6989

BISHKEK 00000192 001.2 OF 002


UNCLAS SECTION 01 OF 02 BISHKEK 000192

SIPDIS

SIPDIS

DEPARTMENT FOR EUR/PGI (TESSLER) AND OES/IHB (LAURITZEN)
DEPARTMENT ALSO FOR SCA/CEN

E.O. 12958: N/A
TAGS: PGOV PREL TBIO WHO KG
SUBJECT: KYRGYZSTAN: STATUS OF BERLIN DECLARATION ON TUBERCULOSIS

Ref: STATE 6989

BISHKEK 00000192 001.2 OF 002



1. (U) Reftel requested a report on the status of implementation of
the World Health Organization's Berlin Declaration on Tuberculosis.
The Berlin Declaration, which was signed October 22, 2007, contains
specific commitments for combating the disease.


2. (U) Tuberculosis (TB) remains one of the biggest public health
challenges for Kyrgyzstan. The TB case notification rate in
Kyrgyzstan is still higher than 100 TB cases per 100,000 people,
which is 20-30 times greater than in the United States. Poverty
makes the country vulnerable to the threat of TB and dependent on
international assistance to overcome this public health challenge.
Interruptions in the supply of TB drugs in the past years
(2002-2003),poor patient compliance with treatment, high migration,
and a large prison population at high risk for spreading TB have
contributed to TB increases. Multi-drug resistant TB (MDR-TB),
which is more costly, time-consuming, and challenging to treat,
poses a growing threat.


3. (U) The Kyrgyz Government has identified TB as one of the highest
public health priorities, and it is committed to fighting the
disease. The government has developed and implemented
comprehensive, multi-sectoral National TB Programs in 1995-2000 and
in 2000-2005, and at present it is implementing a third program
(2005-2010). Kyrgyzstan was the first country in Central Asia to
adopt the World Health Organization (WHO) endorsed Directly Observed
Treatment, Short Course strategy (DOTS) as a national strategy in
1996, reaching 100% coverage in 1998. Kyrgyzstan is unique in the
region for having almost achieved WHO targets for treatment success
(84.5%, with a target of 85%) rate for addressing MDR TB, both in
civilian and prison population, and for developing legislative and
policy documents on TB control.


4. (U) By signing the Berlin Declaration, Kyrgyzstan demonstrated
its further commitment and political will to combat TB and reverse
the TB epidemic. The government continues its efforts to decrease
TB morbidity and mortality, and to maintain the level of success

achieved through years of effort. At policy level, a draft Decree,
which would improve collaboration between prison and civilian TB
services, to develop reliable referral mechanisms between civilian
outpatient and penitentiary systems for providing TB DOTS, is
pending the Prime Minister's approval. A pilot project on Logistics
Management Information System (LMIS) was successfully implemented in
Talas oblast with USAID assistance, and a draft Order to implement
LMIS nationwide is pending with the Ministry of Health (MOH).


5. (U) USAID continues to help facilitate integration of the
vertical TB system into the broader health system, further increase
the capacity of primary health care (PHC) in early diagnosis of TB
and treatment at the continuation phase, and improve referrals
systems between PHC, inpatient care, and civilian and prison
systems. The integration of vertical programs like TB control is
one of the objectives of "Manas Taalimi," the Kyrgyz national health
reform program.


6. (U) USAID and its implementing partners are participating in the
Thematic Working Group on TB in prisons and collaborate with MOH,
Ministry of Justice, Ministry of Labor and Social Services, and
Ministry of Internal Affairs to seek official government approval
for algorithms for improving referrals between prison and civilian
systems, based on USAID-funded projects assessment of barriers to
improved coordination. Once a government decree is passed, USAID
will work with each Ministry to develop supporting regulatory
documents, begin implementing algorithms, and support monitoring of
the coordination of care between the prison and civilian sectors.


7. (U) The USAID-supported TB Electronic Surveillance and Case
Management system (TB-ESCM) is being implemented nationwide and is
an essential component of the national TB control program. The
pilot laboratory Quality Assurance program is operational in Chui
oblast.


8. (U) To leverage funds on TB control, USAID in cooperation with
other partners assisted the MOH in the preparation of its successful

BISHKEK 00000192 002.2 OF 002


application to the Global TB Drug Facility (GDF) for TB pediatric
drugs. With the award, the government will have the possibility to
treat children with TB using pediatric dose started in 2008.


9. (U) The USG coordinates closely with implementation of the
National TB Program, including TB grants from the Global Fund to
Fight Aids, Tuberculosis, and Malaria (GFATM) ($2.8 million from R2
and $9.9 million from R6). USAID and its implementing partners
assisted with development of the successful sixth round grant; we
will help in development of the country's application to R8.


10. (U) Following the signing of the Berlin Declaration on October
22, 2007, Kyrgyzstan is prioritizing control of its TB epidemic by
identifying existing weaknesses and gaps. In mid-March 2008, the
government is holding a workshop to discuss implementation of the
Berlin Declaration. Continued assistance is required for DOTS+
expansion and enhancement, to maintain quality and develop policy
and tools at the national level to ensure sustained, successful
implementation of DOTS+, and to address TB/HIV co-infection in a
comprehensive manner. Work to improve laboratory capacity and
quality assurance are included. A key area will be TB care and
support, with national communication strategies increasing community
awareness of and responsiveness to TB. Reducing stigma related to
TB diagnosis is a necessary step to increase case detection and
improve treatment outcomes. Country Strategic Information Capacity
must be developed in order to avoid drug shortages and interrupted
treatment.


11. (U) Particular challenges affecting the sustainability of
results in Kyrgyzstan include the socioeconomic situation, low
salaries for health care professionals, and the high turnover of MOH
and health care professionals, many of whom emigrate to Kazakhstan
and Russia. Even though the TB is a high priority for the
government, the TB program is fully funded by donors and probably
will continue to depend on donor support due to the country's poor
economic status.

YOVANOVITCH