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Newborn check-up by feldsher during home visit, Kegety village, Kyrgyzstan. @GIZ/Alina Koshoeva

Health systems are often designed around institutions rather than people. For patients – especially pregnant women – navigating these systems can be complex, fragmented, and at times overwhelming. Across Central Asia, longstanding challenges such as uneven access to services, gaps in the quality of care, and weak coordination between different levels of the health system continue to affect outcomes for mothers and newborns.

While each country has its own context, many of these challenges are shared. Health systems across the region carry similar historical legacies and face comparable constraints, including shortages of skilled health workers, disparities between urban and rural areas, and limited capacity to ensure continuity of care. Addressing these issues requires not isolated interventions but coordinated efforts that strengthen the system as a whole.

Over the past decade, reforms supported by the German Federal Ministry for Economic Cooperation and Development (BMZ) and implemented by GIZ have contributed to this transformation. Early initiatives in Kyrgyzstan focused on improving the quality of perinatal care and strengthening primary healthcare — helping to address gaps in referral systems, clinical standards, and service delivery. Two elements in particular showed tangible results: a shift towards patient-centred integrated care, and the introduction of digital tools for health professionals. These experiences provided an important foundation for broader efforts across the region.

Scaling what works: a regional approach

Building on this foundation, the regional project “Improving Mother and Child Health in Central Asia” brought together Kyrgyzstan, Tajikistan, and Uzbekistan to address shared challenges through a common approach. Rather than replicating individual solutions, the project focuses on adapting and scaling approaches that strengthen the quality of care, empower health professionals, and place women at the centre of services.

At the core of this approach is a shift towards women-centred care. This means designing services around the needs of pregnant women, mothers, and newborns, ensuring that care is accessible, continuous, and responsive across all levels of the system. Improving access alone is not sufficient; quality and coordination are equally essential.

Placing women at the centre: respectful, women-centred obstetric care

Across the three countries, significant progress has been made in improving the skills of female health professionals in respectful, women-centred obstetric care (RWCOC). Training modules were developed based on needs assessments conducted in each country, and a regional training of trainers was held to build a core group of professionals capable of cascading knowledge to their colleagues. 26 trainers from three countries participated. They came from different backgrounds, including trainers from the medical continuous education system, practicing health workers, and professional associations. When back in their countries, they continued with cascade trainings for health professionals.

The results have been measurable. A patient survey across all three countries captured the experiences of the 221 women – pregnant and postpartum, urban and rural – who had been cared for by cascade-trained professionals. Ninety-five per cent confirmed that the essential criteria of women-centred care, such as choice, control, and continuity, had been applied in their care. All respondents said they could understand their healthcare providers well, and 97 per cent felt comfortable asking questions.

“The attitude is excellent; they are so smart and kind. They always explain, visit, and helped with dressings after the C-section. Thank you. They talked about the benefits of breast milk. And how to feed the baby and how to eat myself. The atmosphere is very positive.”

Patient feedback from a survey

To sustain the momentum beyond individual training sessions, communities of practice have been established in all three countries via WhatsApp and Telegram. In Tajikistan and Kyrgyzstan, these are coordinated by national midwives’ associations, providing a sustainable mechanism for professional exchange, mutual support, and continuous learning. An exchange visit between the Kyrgyz and Tajik midwives’ associations led to the signing of a five-year memorandum of cooperation – a concrete step towards regional professional solidarity.

Strengthening female leadership: from individual confidence to system change

Women make up the majority of the health workforce across Central Asia, yet they remain underrepresented in leadership roles. Strengthening female leadership has therefore been a central component of the regional approach.

Through a six-module accredited training course called “Female Leaders in the Health Sector”, 63 female health professionals from Kyrgyzstan, Tajikistan, and Uzbekistan developed leadership and management skills, enabling them to take on more active roles in decision-making within their institutions. The course was accredited by the Centre for the Development of Professional Qualifications of Healthcare Workers of the Uzbek Ministry of Health, and the credits gained are recognised for annual professional certification in all three countries. In Kyrgyzstan and Tajikistan, the leadership module has since been integrated into national vocational training pathways as a continuing medical education course.

Three months after completing the training, 56 of the 63 participants had implemented concrete improvements at their facilities, such as setting up mother-and-child rooms, improving patient guidance, strengthening prenatal counselling, and advocating for essential equipment such as cardiotocography monitors.

To extend the learning and strengthen practical leadership skills, a structured three-month mentoring programme called “Step Forward” was launched immediately after the training. Each of the 63 graduates selected a younger colleague as a mentee, bringing the total number of participants to 126. Ninety-four per cent of mentors and mentees rated the experience as good or excellent, and the majority expressed the wish to continue the relationship beyond the programme’s formal duration.

Zhanara Ismailova, a family doctor and participant from Osh, speaks to the broader ambition: “I am not just a doctor – I am a leader. The GIZ project provided me with tremendous support and helped strengthen my leadership skills. Today, I can say with confidence: women’s voices are heard in society, and they are becoming increasingly influential.”

This shift in mindset reflects a broader transformation: from hierarchical systems towards more inclusive and responsive models of care. As Burulai puts it: “Management is not a position, it is courage.”

Digital tools as a bridge: the Safe Delivery App

Keeping clinical knowledge up to date is a persistent challenge across Central Asia, particularly in remote areas where travel to training is not always feasible. The free Safe Delivery App, developed by the Danish Maternity Foundation and based on WHO recommendations, offers one practical response. Used in more than 70 low- and middle-income countries worldwide, the app provides health professionals with instruction videos and self-assessment tests on care during pregnancy, delivery, and postpartum, and works offline once downloaded.

With support from GIZ’s Mother and Child Health project, the app was introduced in Kyrgyzstan in an earlier phase of cooperation. In the regional project, it has been adapted to national clinical guidelines in all three countries, offering 14 modules in Kyrgyz, Tajik, Uzbek, and Russian after a thorough review by national technical working groups to ensure alignment with each country’s clinical protocols.

The response from health professionals in Tajikistan, where the app has already been rolled out, has been striking. Through cascade training in selected pilot regions, 253 healthcare professionals were trained in the use of the app in clinical practice in 2026. In an online survey, 77 per cent said they had improved their obstetric knowledge; 79 per cent reported greater confidence in providing respectful, women-centred care; and all respondents confirmed improved clinical decision-making.

Zulaikho Rakhmatova, midwife at the Rudaki District Primary Healthcare Center in Tajikistan and participant of the Safe Delivery training, explains why the app matters in practice: “The “Safe Delivery” mobile app in Tajikistan has become a very useful tool for us – primary healthcare professionals – in our daily work. Now, the necessary information and clinical guidelines in our own language are always available on our phones, even without an internet connection. It is especially important that the app helps us make the right decisions more quickly when providing care to mothers and newborns.”

Digital technology in the hands of health professionals, as the video accompanying the app’s introduction puts it, “is not the future, but the reality.”

Emergency care: what digitisation looks like on the ground

The principle of digital transformation extends beyond the clinic: In southern Kyrgyzstan, a phased effort has focused on modernising emergency medical services across a range of settings from the standalone ambulance station in Osh, the country’s second-largest city, to hospital-based emergency departments in Jalal-Abad and Batken, including remote areas and elements of air ambulance services. Together, these experiences illustrate how digital solutions can strengthen entire care pathways and create a scalable model for nationwide expansion.

Until recently, ambulance services in places like Osh relied on paper-based processes. The average time to register a call and dispatch a team was eleven minutes. A new digital dispatch system, developed with German support using open-source technology, changed this: dispatch time dropped to five minutes, and the proportion of emergency teams reaching patients within 20 minutes rose from 83 to 88 per cent. As of May 2026, the digital emergency medical systems developed with GIZ’s support have processed an estimated 92,000 to 93,000 emergency calls and consultation cases in Kyrgyzstan.

The system has changed how teams work together across the care chain. Abdukhalil Musayev, Head of the Emergency Department in Batken Regional Hospital, explains: “Before, we would bring the patient in and only then the admission would call the needed doctors. Now, we send the patient information via an app while we are on the way, and the hospital is ready when we arrive. This is a huge relief.” Myrzayim Toktomamatova, Chief Nurse at Jalal-Abad Regional Hospital, echoes this: “We know in advance who is coming to us and in what condition the patient is. We have time to prepare the ward, equipment, and staff. Every minute is crucial in our work.”

The success in Osh with its large urban ambulance station is relevant to many other cities in Central Asia: The project model was subsequently adapted to different service delivery models and contexts such as hospital-based departments, family medicine centres, remote areas, and elements of air ambulance services. By now, the project covers more than half of the country’s population. This progression demonstrates that the model presents a scalable solution that could be expanded nationwide, even region-wide, across the full spectrum of emergency care settings, from large urban centres to smaller regions and hard-to-reach areas.

Following this successful pilot, the E-Health Centre and Ministry of Health are now expanding the system to additional regions. Deputy Minister of Health Nurgul Adnaeva has been clear about the direction of travel: “This project is implemented as a pilot in the Jalal-Abad, Osh, and Batken regions. But it should not remain as a pilot project – it needs to be scaled up.”

The system also generates a wealth of data on call volumes, diagnostic trends, and response times that enables health system planners to make more informed decisions about where resources are most needed.

A regional network taking root

Across all three strands of this work – women-centred care, female leadership, and digital tools – a common thread runs through: sustainable change requires working with people and systems, not simply introducing technical solutions or running one-off trainings.

The project has built a regional network of female leaders who are confident, connected, and committed to advancing women-centred healthcare in Central Asia. National midwives’ associations are stronger. Communities of practice are active. Leadership modules are being integrated into national training curricula. The Safe Delivery App is being used in facilities that were previously cut off from professional development opportunities. And ambulance teams are arriving faster, better prepared, to patients who need them.

These are not endpoints. They are, as the project teams from Kyrgyzstan, Tajikistan, and Uzbekistan would put it, a foundation that is built carefully, adapted to local realities, and intended to last.

Laura Puttkamer
June 2026