Medical Accreditation Commission in Kyrgyzstan. Their role has included reorganisation of service delivery, new provider payment mechanisms, and new forms of accounting and reporting. These associations are highly dependent on donor assistance for their survival, but they have shown the ability to be efficient partners to the government in reforming health care and other issues related to regulation of medical practice and delivery of public services. This work highlights the importance of such organisations in improving health-care delivery, but also how associations can be used to address specifi c needs in a given context. Clearly much has to be done to help with the development of PMAs in low-income and middle-income countries, opening up the need for WHO and the World Medical Association to invest in this area of the health system. An approach to develop PMAs in low-income and middle-income countries could be through twinning programmes 8 between medical associations in these settings and high-income settings. PMAs play a crucial role in shaping human resources for health, one of the six building blocks of the health system, but have yet to be supported and fully used in low-income and middle-income settings for the benefi t of the health of the populations they serve.We declare no competing interests. The information provided in this Correspondence is part of a project funded by the Swiss Agency for Development and Cooperation in Kyrgyzstan aimed at reforming medical education.

Human resources are one of the six building blocks of a health system. In order to ensure that these resources are adequately trained to meet the evolving needs of populations, medical education reforms are needed. In Kyrgyzstan, like in many other low- and middle-income countries, human resources for health are a key challenge for the health system in both the quantity and having their training aligned with the health system priorities. Here we present the experience of the Medical Education Reform Project, a project aimed at improving the quality of health professionals through reforming medical education, funded by the Swiss Agency for Development and Cooperation, as a collaborative effort between partners in Kyrgyzstan and Switzerland since 2013. We used a qualitative study taking a cooperative inquiry approach with an experiential perspective in order to present the implementation of the Medical Education Reform Project in Kyrgyzstan. In order to look at the different components impacting the reform process, a framework comprising: Setting the direction; Building a consensus; Engaging stakeholders; Pilot projects and evaluation; Capacity building; Timing, and Key partners was used to disentangle the lessons learnt. Champions and partnering with key institutions were essential in building consensus, as was the catalytic and facilitating role the project played. This enabled active engagement of a variety of stakeholders in the reform process using different means of interaction ranging from large roundtable discussions, workshops, trainings and even study tours. Pilot projects and research provided tangible actions that could be used to further the reforms. For capacity building, the project offered a wide range of activities that improved clinical competencies, empowered stakeholders, and strengthened organizational capacity. The timing of this reform process in medical education was facilitated by the overall reforms and policies in the health system.