Anfragebeantwortung zu Kirgisistan: Verfügbarkeit und Umfang von Behandlungen psychischer Erkrankungen; Zugänglichkeit und Kosten; Erhältlichkeit erforderlicher Medikamente und Kostenübernahme [a-8029]

24. Mai 2012
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Ein Bericht des European Observatory on Health Systems and Policies[1] zum Gesundheitswesen in Kirgisistan enthält folgende Informationen zur Behandlung von psychischen Erkrankungen:
„The Ministry of Health is responsible for developing national health policies and administers the ‘high-tech’ programme, including tertiary care facilities. It is also responsible for mental health care, and tuberculosis and oncology services that are not part of the single payer system.” (European Observatory on Health Systems and Policies, 2011, S. xv)
“Mental health care has changed little since the Soviet period and still relies on hospitalization and outdated methods of treatment.” (European Observatory on Health Systems and Policies, 2011, S. xviii)
„Many NGOs have emerged in the health sector, mainly in the form of professional associations. More than 100 health-related NGOs were operating in Kyrgyzstan in 2010. They included associations of physicians, pharmacists, nurses, cardiologists, patients with diabetes, patients with mental health disorders, blood donors and public health.” (European Observatory on Health Systems and Policies, 2011, S. 26)
„Mental health care is regulated by the Law ‘On Psychiatric Care and Citizens’ Rights to Receive it’ (adopted 17 June 1999). The law has been generally recognized as being compliant with international standards of human rights. It stipulates that mental health care should be based on the principles of legality, mercy, humanity and observance of human rights and freedom. The law provides for voluntary access to mental health care, except for certain specified cases. According to Article 16 of the law, mental health patients are guaranteed:
• emergency care;
• consultations, diagnostics, treatment, prevention and rehabilitation in outpatient and inpatient facilities;
• all mental health examinations that are undertaken by medical consultative commissions in primary health care facilities;
• social and legal support services and assistance for people with mental disorders in finding employment;
• assistance with guardianship;
• counselling on legal issues and legal support in mental health facilities;
• improvements in social and living conditions and care for people with disabilities and elderly people suffering from mental disorders;
• training for people with disabilities and for young people suffering from mental disorders; and
• mental health care in the case of natural disasters and accidents.
Primary health care for patients with mental disorders is provided in specialized clinics in Bishkek and Osh city and by mental health care units within FMCs in other regions of the country. Emergency mental health care is provided by 16 mental health ambulance brigades (8 in Bishkek and 8 in Osh city). Mental health services for inpatients are provided by 6 independent health organizations, with a total of 2235 beds. These include the Republican Centre of Mental Health (660 beds), the Republican Hospital in Chym-Korgon village (850 beds), the Republican Hospital in Kyzyl-Jar village (555 beds) and the Osh Oblast Centre of Mental Health (170 beds). In addition, inpatient mental health care is delivered in seven psychoneurological departments, which are part of general hospitals. There are two tertiary level health facilities: the Republican Centre of Narcology (in Bishkek) and the Osh Oblast Centre of Narcology (in Osh city). In 2007, there was a total of 161 psychiatrists (3 per 100 000 population) and 84 psychiatrist–narcologists (2 per 100 000 population).
The quality of mental health care remains poor. There has hardly been any change in clinical practice since the Soviet period, and outdated methods of treatment are frequently used. There is an overemphasis on large inpatient facilities, where people with mental disorders from the whole country are concentrated. These facilities work inefficiently, as indicated by a low bed occupancy rate of 66% in 2007. The Ministry of Health has undertaken some steps to reform mental health care provision. Beginning in 2007, activities to integrate mental health care into primary care have been carried out with WHO assistance, including training of general practitioners in the detection and diagnosis of mild forms of mental illness and establishment of nine psychoneurological departments within territorial and oblast hospitals to make specialized mental health care more accessible to the population. In addition, the number of beds in the largest mental health care hospitals has been reduced.
A study by the Open Society Institute (2009) found that the reforms of mental health care provision have helped to increase access to other kinds of health care, as patients attending mental health care departments in most hospitals undergo the same set of basic examinations as other patients. Where found necessary, patients attending mental health care departments are provided with surgical, ophthalmological, gynaecological and other care. Patients can also receive medicines for the treatment of somatic illnesses that hospitals have available under the SGBP.
In 2006, the MHIF, within the SGBP, introduced a programme for providing people suffering from paranoid schizophrenia and affective disorders of various origins with psychotropic drugs. The programme operates through a network of pharmacies. The Additional Drug Package of the MHIF for insured citizens at the outpatient level allows the provision of certain psychotropic drugs at reduced prices.
According to the study by the Open Society Institute (2009), the availability of psychotropic medicines has improved. In 2007, 5699 patients across the country received psychotropic and anti-epileptic medicines included in the list of essential medicines in their area of residence. Reimbursement from the government budget amounted to 2.9 million soms. Patient satisfaction with the availability of psychotropic drugs under the Additional Drug Package of the SGBP was found to be high. The programme also improved the status and job satisfaction of local psychiatric doctors. Patients and members of their families appreciated, in particular, that there was no need to access distantly located mental health care hospitals (Open Society Institute, 2009).
Outpatient rehabilitation programmes aim to support patients requiring mental health care to live independently and with minimal medical intervention. Several projects for people with serious mental disorders are carried out by NGOs with the support of external agencies, including the Soros Foundation Kyrgyzstan, the Mental Health Initiative of the Open Society Institute and the European Department of Caritas.
In 2006, a day-care programme was launched within one FMC in Bishkek. The programme provides services to people with serious mental disorders, including schizophrenia, bipolar affective disorders and depression. It aims to improve the quality of life for people suffering from mental disorders and for their families and to help them to cope better with illness. All participants are involved in the programme voluntarily and based on informed consent. The staff includes social workers and specially trained nurses. Psychiatrists, working on a part-time basis, supervise chemotherapy, counsel patients and members of their families and conduct training for staff, patients and family members.
Within the Republican Centre of Mental Health, a mobile team provides home care to mental health patients in Bishkek who are unable or unwilling to leave their homes. The mobile team aims to integrate patients into society, provide them with problem-solving skills, support them in taking responsibility, prevent recidivism, intervene in crisis situations and support and train family members and carers. The team reaches patients through regular visits and consists of seven professionals, including a psychiatrist, mental health care nurses and social workers. The Republican Centre of Mental Health also contains the Centre for Legal Advice and Information, which provides patients at the centre with information and legal support.” (European Observatory on Health Systems and Policies, 2011, S. 92–95)
Das US Department of State (USDOS) berichtet in seinem Länderbericht zur Menschenrechtslage 2011, veröffentlicht am 24. Mai 2012, wie folgt über die Lage von Personen mit psychischen Erkrankungen:
“The law prohibits discrimination against persons with physical, sensory, intellectual, and mental disabilities, but in practice such persons faced discrimination in employment, education, access to health care, and the provision of other state services. […]
Serious problems continued within psychiatric hospitals. The government did not provide basic needs such as food, water, clothing, heating, and health care, and facilities were often overcrowded. Inadequate funding played a critical factor. In 2008 a parliamentary commission reported violations of patients’ rights in a number of mental hospitals, mainly due to lack of funding.” (USDOS, 24. Mai 2012, Section 6)
In einer Meldung vom August 2011 zitiert die russische Nachrichtenagentur Regnum den Chefpsychologen des Gesundheitsamts der Stadt Bischkek, Kenesch Usenow, dem zufolge in Kirgisistan die Probleme in Bezug auf den Zugang der Bürger zu psychologischer Hilfe „nicht gelöst“ seien. Dadurch werde insbesondere die Lage von besonders schutzbedürftigen Bevölkerungsgruppen verschärft:
„По словам главного психиатра Департамента здравоохранения города Бишкека Кенеша Усенова, психическое здоровье киргизстанцев оставляет желать лучшего, число суицидов особенно подскочило в Ошской и Чуйской областях. "В Киргизии не решены проблемы доступа граждан к психологической помощи. Эта ситуация, прежде всего, усугубляет положение уязвимой категории населения", - сказал Усенов. Между тем, как заявил психолог Владимир Школьный, не менее чем у 40 процентов граждан Киргизии психика находится в пограничном состоянии.“ (Regnum, 1. August 2011)
Eine von der US Social Security Administration (SSA) im März 2011 veröffentlichte Übersicht zu Sozialversicherungssystemen weltweit enthält mit Bezug auf Kirgisistan folgende Informationen zu Barleistungen der Sozialversicherung im Krankheitsfall („cash sickness benefits“) sowie zu den vom „allgemeinen System“ abgedeckten medizinischen Leistungen („medical benefits“):
Sickness and Maternity […]
Regulatory Framework
First law: 1922.
Current laws: 1955, 1996 (social insurance), and 1997 (medical insurance).
Type of program: Social insurance (cash benefits) and universal (medical benefits) system.
Cash sickness and maternity benefits: Employed persons, students, and members of cooperatives. Exclusions: Self-employed persons.
Medical benefits: All persons residing in Kyrgyzstan.
Qualifying Conditions
Cash sickness and maternity benefits: There is no mini­mum qualifying period.
Medical benefits: There is no minimum qualifying period.
Sickness and Maternity Benefits
Sickness benefit: The monthly benefit is 75% of 7 times the minimum wage or 7 times the minimum wage with three or more dependent children, if a disabled veteran, or if disabled as a result of the Chernobyl catastrophe. Benefit adjustment: Benefits are adjusted periodically according to changes in the cost of living. […]
Workers’ Medical Benefits
Medical services are provided directly by government or enterprise-administered health providers. Benefits include general and specialist care, hospitalization, laboratory services, dental care, maternity care, and transportation. Providers may charge fees for services.
Dependents’ Medical Benefits
Medical services are provided directly by government or enterprise-administered health providers. Benefits include general and specialist care, hospitalization, laboratory services, dental care, maternity care, and transportation. Providers may charge fees for services.“ (SSA, März 2011, S. 122-123)
Ausführliche Informationen zur psychischen Gesundheitsversorgung in Kirgisistan finden sich weiters in folgendem bereits älteren Bericht der World Health Organization (WHO) aus dem Jahr 2008:
·      WHO - World Health Organization: WHO-AIMS Report on Mental Health System in the Kyrgyz Republic, 2008 (verfügbar auf
In den ACCORD derzeit zur Verfügung stehenden Quellen konnten im Rahmen der zeitlich begrenzten Recherche keine weiteren Informationen bezüglich des Zugangs zu Behandlungen und der Verfügbarkeit und Kosten von Medikamenten gefunden werden.

Quellen: (Zugriff auf alle Quellen am 24. Mai 2012)
·      European Observatory on Health Systems and Policies: Kyrgyzstan: Health system review. Health Systems in Transition Vol. 13 No. 3, 2011 (verfügbar auf
·      Regnum: В Джалал-Абаде растет количество школьников-самоубийц (Киргизия) [In Dschalal-Abad steigt die Zahl der Selbstmorde von SchülerInnen (Kirgisistan)], 1. August 2011
·      USDOS - US Department of State: Country Reports on Human Rights Practices 2011 – Kyrgyz Republic, 24. Mai 2012 (verfügbar auf
·      US Social Security Administration: Social Security Programs Throughout the World: Asia and the Pacific 2010, März 2011
·      WHO - World Health Organization: WHO-AIMS Report on Mental Health System in the Kyrgyz Republic, 2008 (verfügbar auf

[1] The European Observatory on Health Systems and Policies is a partnership between the WHO Regional Office for Europe, the Governments of Belgium, Finland, Ireland, the Netherlands, Norway, Slovenia, Spain, Sweden and the Veneto Region of Italy, the European Commission, the European Investment Bank, the World Bank, UNCAM (French National Union of Health Insurance Funds), the London School of Economics and Political Science, and the London School of Hygiene & Tropical Medicine (European Observatory on Health Systems and Policies, 2011)