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Doctor advocates for budget to help those with addiction

A mighty advocate builds coalitions to keep the Kyrgyz government accountable.

01

A childhood of leadership and tragedy forges empathy

Batma was born to lead, and to care. Growing up hungry and poor in the former Soviet Union in the 1940s, she found empathy and activism early. Aside from caring for her two younger brothers, in grade school she was chosen to be a youth leader, shopping for the sick and elderly, tutoring fellow students, and helping her teachers.

As a very young child in what is now the Kyrgyz Republic, she saw that even though her family and friends rarely had enough food or clothes, everyone in the community pitched in to make sure that no one went without.

That spirit followed her to medical school, where she became a physician, and then specialized in psychiatry/drug and alcohol rehabilitation.

A photograph of Batma calling back to the time of her early career as a doctor in the back then Soviet Kyrgyzstan. Bishkek, kyrgyzstan.
Open Budget Dialogue with 6 communites in Gambia on the importance of budget participation. / Gambia Participates
A photograph of Batma's parents. On the right, her father, who fell to alcoholism, and triggered Batma's desire to work in the field of medical and social development, and then later health advocacy and activism. Bishkek, kyrgyzstan.
Local fisherwoman Nilawati runs a training on diversifying income for other women in her community due to budget credibility issues facing fisherfolk in Indonesia.

Why addiction? The issue, she says, hits close to home. Batma’s father was a military reporter during the war in the 1940s but turned to drink when it ended. “Maybe because of the traumas of war, he started drinking,” she says, recalling that it was a big hardship and tragedy for the family at the time.

Although her parents eventually separated, Batma felt empathy for her father and even gave a eulogy years later at his funeral. “I knew it was an illness that didn’t need punishment but help and a cure.”

That empathy informed her career as she headed the psychotherapy department of a drug rehabilitation hospital and chaired the labor union of medical workers in Bishkek. As part of that advocacy, she brought Alcoholics Anonymous and Narcotics Anonymous self-help programs to the Kyrgyz Republic.

02

Government participation in open budget signals openness to change

For the past 25 years, she has focused her efforts on HIV/drug abuse prevention and harm reduction and in advocating for government services for this population. In 1998, she gathered doctors, psychologists, social workers and alcohol and drugs addicts to form an NGO, Sotsium, to successfully push the government to fund more harm reduction strategies and services to help those living with HIV and solve other problems in the field of drug addiction/HIV and TB.

Over the past 10 years, international organizations, including the Kygyzstan Global Fund, began to reduce funding for their programs and transition to state funding. This prompted Batma’s organization to shift its main focus to budget advocacy.

“If the government thinks the main priority of the state is the human and health, then the government must also prioritize the financial part,” she said.

Batma's shows a Kyrgyz Government medal she received as recognition of her accomplished work in the field of fight against narcotics & help to drug addicts. Bishkek, Kyrgyzstan.
Batma's shows a Kyrgyz Government medal she received as recognition of her accomplished work in the field of fight against narcotics & help to drug addicts. Bishkek, Kyrgyzstan. Photo by Maxime Fossat for International Budget Partnership © 2022.

“We knew we needed to increase the sustainability of the current programs, find alternative sources of funding and develop new strategies,” she said. That led her to learn about the power of budgets in advocacy work.

Batma’s group joined forces with IBP and our partner, Precedent Partners, which trained civic activists from NGOs to analyze and use budget information in their work. It also led to the creation of the 4-NGO Consortium, the Coalition for Budget Advocacy (which now counts more than 50 NGO members). “Not only is Precedent a member of the coalition, but it mentors and provides in-demand experts on legal and financial issues,” Batma said. The training opened her eyes to how analyzing the budgets of the health care ministry and the MHIF (Mandatory Health Insurance Fund) could help spur real change.

We learned to study and understand and analyze the budget and make our own conclusions.

“We compared numbers from the previous budget to current numbers and we were able to ask questions like, “Funding does not reach its targets and does not fully cover the needs of healthcare. Why is the funding distributed unfairly? We learned to study and understand and analyze the budget and make our own conclusions.”
Open Budget Dialogue with 6 communites in Gambia on the importance of budget participation. / Gambia Participates
Local fisherwoman Nilawati runs a training on diversifying income for other women in her community due to budget credibility issues facing fisherfolk in Indonesia.

03

Tracking the numbers – and the power of coalitions

The government of Kyrgyzstan became a member of the Open Government Partnership (OGP) and has provided opportunities for the public to participate in parliamentary hearings, working groups and public councils of various ministries and agencies. As a result, Batma’s coalition was able to participate in many public hearings and the working groups of various ministry councils.

“When participating in councils under the state, we can quickly report needs and problems and attract government attention to them,” Batma said. “We’re the intermediary between citizens and the state.”

“Participation in the budget process has helped and continues to help us in our budget advocacy activities,” she added. “In 2019, we were able to prevent a reduction of over 800 million soms ($9.6 million USD) in the MHIF budget.” Since then, the budget for both the Ministry of Health and the MHIF has increased and is increasing each year. In 2021, partly due to the coalition’s advocacy, 1 billion soms ($12 million USD) was added to the approved budget to purchase essential, life-saving medicines.

The power of coalitions, Batma says, is gathering many together to fight for a common cause.

Batma and her employees of Sotsium NGO are gathering and discussing the upcoming Kyrgyz Parliament session on budget that they are about to attend. Bishkek, Kyrgyzstan.
Batma and her employees of Sotsium NGO are gathering and discussing the upcoming Kyrgyz Parliament session on budget that they are about to attend. Bishkek, Kyrgyzstan. Photo by Maxime Fossat for International Budget Partnership © 2022.

“At the beginning, everyone was going to public hearings, screaming about their own problems, saying. ‘Give me, give me.’ What we’ve been teaching in our coalition is that the budget is not rubber that can be expanded. We need to work with the resources we have. Firstly, we teach our coalition members to fully understand the budget.”

Then, the coalition teaches the members how to prioritize the really important issues, put others on the back burner for a time, and even give the government recommendations on how to fund those top priorities. “We’re teaching them to have a conversation together, prepare together and give each one a role. Before it was chaos. Now we have a strategy.”

Although the coalition has notched many successes, and now includes 50 NGOs and other groups dedicated to the cause, there is still plenty of work left to be done. “Health care services should be free and accessible for everyone. We have a really poor population and people are selling their houses to cover their health care expenses,” Batma said.

The coalition is currently working to harness new technology to monitor the public procurement process, increase the efficiency of budget analysis and is finalizing an application, baa.kg, to use analytical models in real time. “It will allow fast analysis and understanding of the budget. We need information to have proof and conclusions. In the past, we had to go to the portal and make an official requisition for information and then wait to hear back. With this model, we get the information much quicker,” Batma said.

04

The road ahead

Although Batma is long retired from her state medical job and hopes more young people will take on the work she and her colleagues have spent so many years on moving forward, she is still driven to keep working with the coalition (“learning, learning and more learning”) to help make a brighter future for the people it serves.

Holding her cat, Dayra, (which loosely translates to ‘giving happiness’), she reminisces about the time in fourth grade, when she was chosen to spend a year studying ballet in what was then Leningrad. That exposure to opera, to classical music and dance struck a chord in her back then and helps her to this day. “Music helps us to be optimistic. Music, dance, flowers, and animals are an inspiration.” she says.

After all these years of advocacy, what would Batma view as success when she finally hands her work over to successors? “Success will be that our health sector is transparent, open, and fair for everyone. It would mean that ordinary people – patients, citizens, know our rights in the health sector and how to use these rights. That would be the ultimate success for me.”

Batma, Bishkek, Kyrgyzstan. Photo by Maxime Fossat for International Budget Partnership © 2022.

This story was produced with the financial support of the European Union.

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