I’ve talked about the network, the context, and the actors of the Kyrgyz Health Promotion system, but I feel like I have struggled to relate the structure. It’s complicated, I will be the first to admit (as will most Peace Corps Volunteers who work within it and the majority of Kyrgyz people outside of the health system), but there is kind of a simplicity when you take a step back, turn your head sideways, and look at how the pieces fit together.
It was explained to me by a former Peace Corps Volunteer as a waterfall: things like information, resources, or health interventions flow from top to bottom, traveling through set paths in the system and flooding out to satiate the drought of health knowledge in Kyrgyzstani communities. All very poetic imagery, and admittedly he said it better, but it made sense to me because I already think in pictures, processes, and flow charts. (Flow charts, flow charts, how I love thee, let me count the ways!) But I wanted to find a way to explain it that made sense outside of my own head.
So, I took the information given by other volunteers and combined it with my own experience over the last 9 months at the top of this waterfall, and talked about it, a lot, with people in my organizations and some of the people who were the initial creators of this system. And I made some pictures.
First off, the structure: where do these pieces fit?
How do decisions, health programs, and resources connect these independent actors?
Confusing, right? Now replicate this system to match the 1700 Village Health Committees throughout Kyrgyzstan. It’s a delicate, complicated, and interconnected machine. But there is a kind of harmony to it, if everything works perfectly.
The thing is, it doesn’t always work perfectly – in fact, sometimes it doesn’t work at all. Feedback isn’t valued, community needs aren’t articulated or acknowledged, resources and funding are lost, diverted, stolen, misused. The day-to-day work that makes this possible is ignored in favor of computer solitaire, or it is drowned out in the endless cups of tea while chai-ich-ing. Health information comes most often in the form of leaflets or posters, and – in the bitter cold of winter – are burned for warmth instead of read. The volunteers on which the system depends have lives, responsibilities, families, and very little money – limiting their time and dedication. Like I said, the system doesn’t always work perfectly.
But no system does. This health promotion system struggles to meet the needs of the communities in which it works, but at least it is struggling to work to provide universal healthcare to its citizens. The system recognizes its own shortcomings, and is working to improve. For every non-committed, under-qualified, or indifferent employee, there are equal numbers of passionate, dedicated, and inspiring individuals trying to provide valuable care and investment in their communities. Like many things that flow from top to bottom, this system is ripe with potential energy waiting to be realized.
*I used acronyms for all of these system maps, so if you need a reminder – here’s a list of actors in the Kyrgyz Health Promotion System.