The global objective of the assignment is to contribute to the acceleration of the Kyrgyz Republic’s progress towards the achievement of the Sustainable Development Goal 3. The technical cooperation programme of which this study forms part will support the Ministry of Health (MoH) and the National Maternal and Child Health Centre (NMCHC) to shape the conditions for an effective, patient-centred national perinatal referral system with focus on strong interaction between all levels of care and disciplines. The effect will be to optimise the interfaces between the future perinatal centre (to be opened 2019), outpatient facilities and hospitals in its catchment area providing support and post-natal care. The focus of the study is therefore on the supply-side factors that influence referral pathways, such as physical distance between health facilities, non-availability of inter-facility emergency transportation, poor staff knowledge and skills, financial implications of referring patients, access to drugs, supplies and equipment, as well as tools for communication and referral when complications arise.
The requested service consists of two tasks:
Task I: To analyse the perinatal referral pathways and to propose achievable recommendations for each of the components of the analysis.
Task II: To translate the recommendations developed under (I) into a costed action plan with objectives achievable by 2020, focusing on the perinatal pathway from primary hospital onwards.
The study adopts a mixed-methods case-study approach which combines qualitative and quantitative elements:
Desk review of policy and strategic documents, relevant laws regulations and guidelines, demographic and health surveys, health and facility mapping data, and programme evaluation reports
Semi-structured interviews with key stakeholders (e.g. representatives of various departments of the MoH on national and sub-national level, the NMCHC, the Mandatory Health Insurance Fund)
Field visits to 16 health facilities in Bishkek, Chui, Osh and Issyk Kul.
A survey of women of reproductive age in the 16 field visit sites using a structured questionnaire and mobile data collection with a cloud server.