The emergence of family medicine in Kyrgyzstan.

Background And Objectives: In post-Soviet Central Asia, Kyrgyzstan has emerged as the leader in family medicine reform. This paper examines the factors that have allowed family medicine to become the foundation of primary care and the rationale for retraining specialists in primary care.

Methods: Critical elements of successful family medicine reform have included national policy, international cooperation, training programs, support structures, and quality measures. The national policy has contributed to an environment that has allowed many international organizations to participate in the process of reforming the health care system. The 9-year training process was a momentous nationwide development task that was supported by various structures, organizations, and events and included the implementation of quality measures.

Analysis: Various reports, studies, and evaluations support the positive impact family medicine has had on patient satisfaction, physician attitude, and scope of practice. Further, one study indicates improved health outcomes in terms of decreased years of potential life lost.

Results: The national policy of reform that is in favor of family medicine, and international donor agencies-supported training, produced the following results: a group of family medicine teachers, 98% (2,691) of the country's primary care doctors retrained in family medicine, and there were 372 family medicine resident graduates. To ensure quality, objective structured clinical exams were implemented in all levels of training.

Conclusions: It will take many more years to fully establish family medicine in the medical culture of Kyrgyzstan and reap its full benefits, but already it is contributing toward improvements in the quality of patient care.