Integrating nutrition programmes in primary care in Kyrgyzstan
- Widespread evidence of micronutrient deficiencies among young children, particularly iron-deficiency anaemia.
- Elevated levels of growth stunting among children under five.
- A programme to distribute micronutrient sprinkles, locally known as “Gulazyk”, was introduced with donor support. Following successful piloting of the programme, activities were scaled up nationally in 2011.
- Aligning with existing infrastructure and services helped support and stabilize reforms implemented under the initiative.
- Building trust between primary care providers and patients was essential for ensuring uptake of micronutrient supplementation; community health volunteers aided trust building.
- Developing a consistent message across all providers, even those not directly involved with the initiative, safeguarded changes against being undermined at different care levels.
- Encouraging participation of mothers and community members proved valuable in overcoming challenges of potential non-compliance.
High levels of iron deficiency contributed to an elevated prevalence of anaemia among the Kyrgyz population. Children under 24 months of age were particularly affected, with anaemia rates reaching 50% among this group in 2005. Furthermore, widespread micronutrient deficiencies were attributed to growth stunting in children under five; prevalence of stunting in this age group was estimated to be 18% in 2006.
The Ministry of Health launched an initiative in collaboration with international donors to provide micronutrient sprinkles, known locally as “Gulazyk”, to all infants aged 6–24 months. With technical support from international actors, a regional pilot project assessing the use of Gulazyk to prevent iron deficiency in children was conducted in Talas between 2008 and 2010. Every two months during the pilot, as part of routine health visits, primary care providers dispensed Gulazyk to caregivers and counselled them on using the supplement. These messages were reinforced by Village Health Committees (locally appointed volunteers who deliver health messages within their communities), which facilitated successful implementation of activities and ensured widespread use of Gulazyk among the target population. A strong focus on monitoring and evaluation throughout the pilot initiative provided evidence of Gulazyk’s positive impact, leading to national rollout of the programme. Presently, the national Gulazyk programme remains actively implemented across Kyrgyzstan and it continues to prove effective in reducing anaemia among infants. As funding for activities is provided primarily through humanitarian donations, initiative leaders are exploring ways to transition to a more sustainable delivery model. UNICEF is talking with the Global Alliance for Improved Nutrition in an effort to secure funding for local production of Gulazyk and build a local market for selling Gulazyk via pharmacies.
Fully implemented and scaled up
The initiative was led through collaborations between the Ministry of Health and international actors. The Ministry of Health served as the main actor, establishing the necessary national framework to support and oversee activities. International actors played critical roles in conducting research, funding necessary resources, and supporting monitoring and evaluation. While the initiative was developed in a top-down approach, extensive community outreach and engagement with community health volunteers and caregivers supported widespread uptake of Gulazyk within local populations. Health providers incorporated new mandated practices into daily routines and meetings held with Village Health Committees encouraged community health volunteers to promote the use of Gulazyk.
Uptake of Gulazyk among the target population is high and data indicate the initiative has reduced prevalence of anaemia and iron deficiency in infants. Gulazyk is estimated to cover at least 80% of the target population nationally, based on 95% vaccination coverage rates. Key outcomes reported by the pilot study between 2008 and 2010 are:
- Prevalence of anaemia among infants decreased from 51% to 44%.
- Prevalence of iron deficiency among infants decreased from 46% to 33%.
- Almost all caretakers (99%) received Gulazyk at least once, indicating successful outreach.
- Self-reported consumption averaged at 23 doses out of a possible 30; 45% of infants received the full 30 doses in the last two months per self-reports.
- Participant acceptance of Gulazyk was high; caregivers reported that Gulazyk was easy to use (88%), important for the child (96%) and that they would continue its use (89%).
This case was prepared as part of a larger effort by the WHO Regional Office for Europe and published (2016) in the document, "Lessons from transforming health services delivery: Compendium of initiatives in the WHO European Region".
© Copyright World Health Organization (WHO), 2016
The methodology used for the development of this case is slightly different from the templates used on the IntegratedCare4People web platform, in particular in the analysis of enabling factors and barriers to change.
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United Nations Children’s Fund (UNICEF)