PROBLEMS OF AMBULATORY KARDIOLOGY CENTERS DEVELOPING IN THE KYRGYZ REPUBLIC

D.T. Yuldasheva, I. M. Yuldashev
Kyrgyz state medical academy, Bishkek. Kyrgyzstan.

The current stage of the development and reforming of the public health system in the Kyrgyz republic is characterized by new problems, directed on the most further increasing quality and efficiency of the medical servicing the population. Changes in politician-economic conditions has forced to optimization of public health structure, rational use of available resource, clear indication of development priorities.
Beginning of the Reforms realization in public health in our republic was connected with need of the undertaking the structure realignment, maintenance of accessibility of patients to primary medical aid, re-comprehension priorities on background of the financing reduction. Need of observance of social fairness principles, accessibility of primary medical aid have provided to reduction of the number and list of rendered medical services that was reflected on taking the Governmental warranty Program.
The Reasons, on which our state have to go on reforms, the well-known. That are crash of the planned system of the financing from the “centre” with disintegration of the USSR, breach of interregional relationships with former soviet republics, crisis in economy, change of social-political landmark, absence of the own base for production of the high-quality medical equipment and majority of medicine and materials.
In the Kyrgyz Republic, after becoming independent, as a result of influence of the adverse factors of the transitive period there was a sharp fall in charges on Public Health services (1). So in 1990 the charges on Public Health services were made by 3,8 % from an Internal Total Product (ITP) in 1998- 2,6 %, in 2001- 1,8 % from ITP. In the advanced countries this parameter makes more than 8 % (Belgium, Netherlands, Italy) and more than 9 % (Germany, Switzerland, France, Austria) (1, 3, 6).
National program of Public health reforming "Manas" was introduced in 1996. The Program was calculated for a period of 1996- 2006. It was designed so that save and consolidate the main positives of the former Public health system, in particular universal access to medical aid and equal distribution of Public health resources.
The program "MANAS" is developed so that to keep and to strengthen the basic positive features of the former centralized system of Public health services, in particular of universal access to medical aid and equal distribution of resources of public health services.
What structural changes were assumed in system of public health services? First of all - preservation, optimisation and, if is possible, expansion of a primary link of rendering of medical aid. There have been created and are functioning Family Doctors Groups (FDG) - independent and incorporating in the Centres of Family Medicine (CFM). The retraining of medical personnel on family medicine has been carried out; the education of the family doctors in Kyrgyz State Medical Academy has begun. The right to choose of Family doctors Group is submitted to the population, for what are carried out registration companies. The choice of the population defines movement of financial flows (of budget and insurance). On the level of regions and countryside, the rationalization of hospitals is carried out, that assumes their association, reduction, and reduction in beds quantity. If to be expressed more figuratively - it was necessary "to turn a pyramid" - to reduce expenditure, in some cases excessively exaggerated financing of hospitals (more than 70 % of financial assets was directed earlier on the contents of expensive hospitals) and to strengthen the outpatient part – much closer to the consumer.
Currently in the Kyrgyzstan patient with cardiac pathology can receive specialized cardiologic aid in National Centre of the Cardiology and Therapy in Bishkek.
The Development and further specialization of cardiologic aid in Kyrgyzstan can give possibility of more deep investigation of cardiac diseases pathogenesis.
Change the Public health structure in the Kyrgyz republic, alongside with strengthening of primary part of medical aid, reduction of "expensive" hospitals, expect the optimization and support high-tech institutions. One of such subdivisions could become ambulatory cardiology units, organized on the base of reforming medical institutions or as compact independent structure. The Task of this unit could be monitoring of diseases of the population, undertaking the special diagnostic and treatment methods, its collecting and analysis in Information base, with saving it in United Information system of Public health Ministry, creation of the qualitative criteria of the applicable evidence based treatment, introduction of high-tech methods, development scientifically-methodical recommendation on diagnostics, threatment, prevention and rehabilitations.
Natural-ecological particularities of the Kyrgyz Republic territory leads to presence of endemic diseases. The lack of necessary minerals, high mountenous surrounding is a reason of multiple pathology such as toxic goiter, tumor processes, arterial hypertension, brain infracts.
The Influence these and other disadvantage factor to body systems has an effect of specific cardiac and endocrine pathology combination, reflecting on somatic, psychological, reproductive health of nation.
At period of public health reforming, the gradual turning of the medical institutions to new methods of the financing are banded with difficulties in the structure organizing nature.
Creation and further development of Ambulatory cardiology service will help more professional to develop theoretical and clinical aspects of pathology, conduct of patient assistance particularities.
Accounting positive and weak sides of the medical service system financing, such as fairness, accessibility, cutting expenses, it is necessary to find the facilities for maintenance and development of ambulatory cardiology.
In plan of Ambulatory cardiology development it is necessary to include the cardinal principles of the public health reforming, as a following:
1. improvement of the population health condition;
2. increasing to efficiency of the presented services;
3. accessibility of the services;
4. development of the trained staff.
Thereby, climate and geographic condition of the Kyrgyz republic: high mountains, lack of microelements in ration; broad spreading of cardiovascular pathology, big percent of the heavy breaches of heart, brain functions, accents the problem of Ambulatory cardiology as one of the most actual.
The Process of public health reforming, has one of the priorities as support high-tech institutions, allows to put the question about creation of ambulatory cardiology centers for diseases monitoring, co-ordinations of activity of the medical institutions, development of the optimum schemes of the diagnostics, treatment, preventive maintenances and rehabilitations, adapted to local condition.