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RR RUEHLN RUEHVK RUEHYG
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ZNR UUUUU ZZH
R 270737Z FEB 08
FM AMEMBASSY BISHKEK
TO RUEHC/SECSTATE WASHDC 0730
INFO RUCNCIS/CIS COLLECTIVE
RHEFDIA/DIA WASHDC
RUEKJCS/OSD WASHDC
RUEAIIA/CIA WASHDC
RHEHNSC/NSC WASHDC
RUEKJCS/SECDEF WASHDC
RUEKJCS/JOINT STAFF WASHDC
RUEHGV/USMISSION GENEVA 0837
RUEHVEN/USMISSION USOSCE 2829
RUCNDT/USMISSION USUN NEW YORK 2214
RUEHNO/USMISSION USNATO BRUSSELS BE
RUEHBS/USEU BRUSSELS
RUEHLMC/MILLENNIUM CHALLENGE CORP
RUMICEA/USCENTCOM INTEL CEN MACDILL AFB FL

UNCLAS SECTION 01 OF 02 BISHKEK 000192 
 
SIPDIS 
 
SIPDIS 
 
DEPARTMENT FOR EUR/PGI (TESSLER) AND OES/IHB (LAURITZEN) 
DEPARTMENT ALSO FOR SCA/CEN 
 
E.O. 12958: N/A 
TAGS: PGOV PREL TBIO WHO KG
SUBJECT:  KYRGYZSTAN:  STATUS OF BERLIN DECLARATION ON TUBERCULOSIS 
 
Ref:  STATE 6989 
 
BISHKEK 00000192  001.2 OF 002 
 
 
¶1. (U) Reftel requested a report on the status of implementation of 
the World Health Organization's Berlin Declaration on Tuberculosis. 
The Berlin Declaration, which was signed October 22, 2007, contains 
specific commitments for combating the disease. 
 
¶2. (U) Tuberculosis (TB) remains one of the biggest public health 
challenges for Kyrgyzstan.  The TB case notification rate in 
Kyrgyzstan is still higher than 100 TB cases per 100,000 people, 
which is 20-30 times greater than in the United States.  Poverty 
makes the country vulnerable to the threat of TB and dependent on 
international assistance to overcome this public health challenge. 
Interruptions in the supply of TB drugs in the past years 
(2002-2003), poor patient compliance with treatment, high migration, 
and a large prison population at high risk for spreading TB have 
contributed to TB increases.  Multi-drug resistant TB (MDR-TB), 
which is more costly, time-consuming, and challenging to treat, 
poses a growing threat. 
 
¶3. (U) The Kyrgyz Government has identified TB as one of the highest 
public health priorities, and it is committed to fighting the 
disease.  The government has developed and implemented 
comprehensive, multi-sectoral National TB Programs in 1995-2000 and 
in 2000-2005, and at present it is implementing a third program 
(2005-2010).  Kyrgyzstan was the first country in Central Asia to 
adopt the World Health Organization (WHO) endorsed Directly Observed 
Treatment, Short Course strategy (DOTS) as a national strategy in 
1996, reaching 100% coverage in 1998.  Kyrgyzstan is unique in the 
region for having almost achieved WHO targets for treatment success 
(84.5%, with a target of 85%) rate for addressing MDR TB, both in 
civilian and prison population, and for developing legislative and 
policy documents on TB control. 
 
¶4. (U) By signing the Berlin Declaration, Kyrgyzstan demonstrated 
its further commitment and political will to combat TB and reverse 
the TB epidemic.  The government continues its efforts to decrease 
TB morbidity and mortality, and to maintain the level of success 
achieved through years of effort.  At policy level, a draft Decree, 
which would improve collaboration between prison and civilian TB 
services, to develop reliable referral mechanisms between civilian 
outpatient and penitentiary systems for providing TB DOTS, is 
pending the Prime Minister's approval.  A pilot project on Logistics 
Management Information System (LMIS) was successfully implemented in 
Talas oblast with USAID assistance, and a draft Order to implement 
LMIS nationwide is pending with the Ministry of Health (MOH). 
 
¶5. (U) USAID continues to help facilitate integration of the 
vertical TB system into the broader health system, further increase 
the capacity of primary health care (PHC) in early diagnosis of TB 
and treatment at the continuation phase, and improve referrals 
systems between PHC, inpatient care, and civilian and prison 
systems.  The integration of vertical programs like TB control is 
one of the objectives of "Manas Taalimi," the Kyrgyz national health 
reform program. 
 
¶6. (U) USAID and its implementing partners are participating in the 
Thematic Working Group on TB in prisons and collaborate with MOH, 
Ministry of Justice, Ministry of Labor and Social Services, and 
Ministry of Internal Affairs to seek official government approval 
for algorithms for improving referrals between prison and civilian 
systems, based on USAID-funded projects assessment of barriers to 
improved coordination.  Once a government decree is passed, USAID 
will work with each Ministry to develop supporting regulatory 
documents, begin implementing algorithms, and support monitoring of 
the coordination of care between the prison and civilian sectors. 
 
¶7. (U) The USAID-supported TB Electronic Surveillance and Case 
Management system (TB-ESCM) is being implemented nationwide and is 
an essential component of the national TB control program.  The 
pilot laboratory Quality Assurance program is operational in Chui 
oblast. 
 
¶8. (U) To leverage funds on TB control, USAID in cooperation with 
other partners assisted the MOH in the preparation of its successful 
 
BISHKEK 00000192  002.2 OF 002 
 
 
application to the Global TB Drug Facility (GDF) for TB pediatric 
drugs.  With the award, the government will have the possibility to 
treat children with TB using pediatric dose started in 2008. 
 
¶9. (U) The USG coordinates closely with implementation of the 
National TB Program, including TB grants from the Global Fund to 
Fight Aids, Tuberculosis, and Malaria (GFATM) ($2.8 million from R2 
and $9.9 million from R6).  USAID and its implementing partners 
assisted with development of the successful sixth round grant; we 
will help in development of the country's application to R8. 
 
¶10. (U) Following the signing of the Berlin Declaration on October 
22, 2007, Kyrgyzstan is prioritizing control of its TB epidemic by 
identifying existing weaknesses and gaps.  In mid-March 2008, the 
government is holding a workshop to discuss implementation of the 
Berlin Declaration.  Continued assistance is required for DOTS+ 
expansion and enhancement, to maintain quality and develop policy 
and tools at the national level to ensure sustained, successful 
implementation of DOTS+, and to address TB/HIV co-infection in a 
comprehensive manner.  Work to improve laboratory capacity and 
quality assurance are included.  A key area will be TB care and 
support, with national communication strategies increasing community 
awareness of and responsiveness to TB.  Reducing stigma related to 
TB diagnosis is a necessary step to increase case detection and 
improve treatment outcomes.  Country Strategic Information Capacity 
must be developed in order to avoid drug shortages and interrupted 
treatment. 
 
¶11. (U) Particular challenges affecting the sustainability of 
results in Kyrgyzstan include the socioeconomic situation, low 
salaries for health care professionals, and the high turnover of MOH 
and health care professionals, many of whom emigrate to Kazakhstan 
and Russia.  Even though the TB is a high priority for the 
government, the TB program is fully funded by donors and probably 
will continue to depend on donor support due to the country's poor 
economic status. 
 
YOVANOVITCH