A community-based early childhood development project has helped improve women's and children's health in rural communities of the Kyrgyz Republic.

Alihan from Josholuu village in Kyrgyz Republic's Osh oblast, or province, suffered from anaemia as a small child. Before a private pharmacy opened in the village, Ailhan's father had to skip a day's work to travel to the hospital in a nearby town to buy medicine. The trip cost him as much as the medicine, which was often of suspect quality due poor storage conditions.

"Even if the medicine hadn't expired, they were usually spoiled by the sun or humidity," sighed Dr. Jarkynbai Dooronov.

Following the dismantling of the Soviet Union in 1991, public health standards declined and infant and child mortality rates soared in the Kyrgyz Republic, peaking in 2006. Pregnant women faced greater health risks and many pre-schools closed, increasing women's childcare responsibilities and reducing the time available for economically productive activities.

Thanks to the ADB-supported early childhood development project, once declining health standards among expectant mothers and children have been shored up.

Fortifying flour with micronutrients, opening community-based kindergartens, and increasing the distribution of iron tablets and other medicines through an expanded network of rural pharmacies have helped improve the health of mothers and children in 12 of the poorest raions (districts with staggering poverty levels above 70%) in the oblasts of Jalal-Abad, Naryn, and Osh.

"The project also helped rehabilitate 30 state-run kindergartens in need of major repairs. These kindergartens were then able to support community-based pre-schools. "

Reversing worsening infant and child mortality

The project contributed to reducing infant mortality rate by 12% in Jalal-Abad, 23% in Naryn, and 40% in Osh between 2006 and 2008. The under-5 mortality rate fell 16% in Jalal-Abad and Osh, and 23% in Naryn. The national averages also fell during this period, but nowhere near as much as in the oblasts covered by the project. Nationwide, the infant mortality rate fell 7%, and the under-5 mortality rate declined by 9%.

By 2010, about 95% of all households in the project areas were regularly using iodized salt. The project contributed to the passage of a law requiring all flour to be fortified with micronutrients. And, it has helped the country reduce its reliance on foreign assistance for vaccines, from 100% down to 60%.

Innovative public-private village pharmacies

Under the project, public-private partnerships were established to make medicine readily available, at affordable prices, even in the most remote areas. The model included the government providing the premises, training health workers, and financing the initial cost of medicine and equipment. The Ministry enforced price regulations for essential drugs, but allowed the pharmacies to sell other medicines and products to make a profit.

In 2005, there were less than 100 pharmacies in all 12 raions. By the time the project closed in 2008, there was an additional 123 pharmacies in nine raions, providing 90% of the population with access to a pharmacy, up from just 30% 5 years earlier.

Aiylychy Tanaeva used to buy her expensive heart medicine in Osh. Now she can get it in the village at a more affordable price because the government subsidizes essential medicine. Previously, she was never sure how much medicine to buy because she could not predict how often she would need to take it. Sometimes she would run out of medicine and at other times, she would end up buying too much and some of it would expire. Now, she says she can buy it in smaller amounts.

"If I run out of medicine, it takes only 10 minutes to go and get some at the local pharmacy," she explained.

"No one can argue against the rural pharmacies," said Oljobay Dyikanbaev, owner of the MedPharm company. "But we wouldn't have opened a pharmacy in the village without support from the project."

Looking after the small ones

By 2010, over 300 community-based kindergartens had opened, benefiting 13,000 children. Zeinep Mambetaeva has a daughter, Elina, in a preschool in Toktogul, an opportunity that was once unthinkable. With Elina in kindergarten for part of the day, she says, "I have time to do other things."

The project also helped rehabilitate 30 state-run kindergartens in need of major repairs. These kindergartens were then able to support community-based pre-schools. More than 40,000 parents were also trained to provide better childcare at home.