21 September 2022, 12:33
Minister of Healthcare of Kazakhstan Azhar Giniyat spoke about the implementation of the national project "Quality and affordable health care for every citizen "Healthy Nation" at the Government session, chaired by Prime Minister Alikhan Smailov.
As noted by the head of the Ministry of Healthcare, the main goal of the national project is to increase life expectancy. The project consists of 4 areas, and for each of them tasks, indicators of results and implementation activities are defined.
So, in 2021 there were implemented 26 activities and 17 indicators were achieved. This year, 34 activities and 17 indicators are planned to be implemented.
During today's speech Giniyat informed about the results of activities for the first half of this year.
In the first direction of the national project to ensure affordable health care over the past period the number of visits to primary health care organizations amounted to 51 million visits. The ambulance service served about 4 million calls and medical aviation performed more than 1,000 sorties. About 1.5 million patients were treated in hospitals, more than 350,000 operations were performed and about 200,000 deliveries were performed.
State standards for the network of health-care organizations were also improved. As a result the medical care in villages with up to 50 people is provided by a nurse without premises, and in villages with 500 people the number of medical workers was increased from one to three. In order to reduce the waiting list for narrow specialists, the Rules for providing consultative and diagnostic services without a general practitioner's referral were approved.
During the elapsed period more than 18 thousand services in 80 types of complex and high-tech medical services were provided.
"Gamma Knife and Nuclear Medicine Centers operate to improve the quality of oncological care where more than 300 operations were performed and about 400 patients were treated. It is worth noting the uniqueness of the Nuclear Medicine Center in Semey. It is worth mentioning the uniqueness of Nuclear Medicine Center of Semey, where domestic radiopharmaceuticals are used in full cycle, i.e. from production to diagnostics and treatment," Azhar Giniyat said.
For more than 1 million residents of remote villages, 149 mobile medical complexes provided medical assistance with the provision of consultative and diagnostic services, screening, medicine. Also this year the work of two medical trains "Zhardem" and "Salamatty Kazakhstan" was resumed, which provided medical care to 38,000 residents in 10 regions.
In rural areas 6 obstetrician-obstetrician and medical stations and outpatient clinics have been completed, 17 facilities are under construction and 8 are planned to be opened by leasing buildings. At the same time, the equipment of district hospitals with modern CT scanners and X-ray machines has been brought up to 84%.
The projects of best practices of primary health care "human-centered approach" approved by WHO are implemented.
This year, the world's first demonstration site on Primary Health Care for the 53 member states of the WHO European Region was opened in Yenbekshikazakh District of Almaty region for the provision of best practices.
To ensure the principle of "golden hour" for emergency patients at the level of multidisciplinary central district hospitals, an interdistrict hospital in Shu, Zhambyl region is organized for the 12 existing ones. Two scientific and innovative multidisciplinary clinics are under construction in the cities of Astana and Almaty.
In the framework of the Mandatory Social Health Insurance the accessibility of expensive medical services to the population has been increased. About 886 thousand expensive medical services are currently provided.
"On the instructions of the Head of State, in order to stimulate medical workers, measures are taken from 2020 to annually increase doctors' salaries, with the aim of bringing them to a level twice as high as the average wage in the economy by 2023. In 2022, the average salary of doctors has already been raised to 421,000 tenge, and that of nurses to 235,000 tenge. Thanks to the implementation of the above-mentioned measures the coverage of rural settlements with primary health care and consultative and diagnostic services was brought up to 49 per cent, while the plan was 47 per cent. The volume of medical care in the outpatient setting within the guaranteed volume of free medical care and the system of compulsory social health insurance was brought up to 56%," the Minister of Healthcare noted.
To preserve the health of pregnant women and improve child health coverage of pregnant women with individual and interdisciplinary prenatal care increased by 2% and amounted to 82%; the rate of early detection of pregnancy before 10 weeks increased by 11%, reaching 40%, which allowed to timely identify and predict possible complications of pregnancy.
In order to carry out the President's instructions, a special programme entitled "Ansagan sabi" was launched in 2021, under which 7,000 IVF treatment quotas are granted annually by 2026. Since the programme was launched, more than 3,000 women have become pregnant and 2,300 long-awaited children have been born.
A new standard of organization of prenatal ultrasound screening was approved for examining and counseling children and pregnant women, including children at risk, and 18 fetal protection centers were organized. As a result, prenatal screening coverage of pregnant women increased by 6% to 79%. At the same time, a pilot project for the screening of newborns for 49 hereditary metabolic diseases has been launched, and all children in the risk group have been screened. Coverage of children under 1 year of age with proactive observation and screening increased to 81%.
This year, eight children's rehabilitation centers were opened with a total coverage of about 5,000 children per year. Also, 2 early intervention centers for children under 3 years old with developmental disorders and risks of their occurrence were opened and by the end of 2023 it is planned to open 13 centers with coverage of more than 10 thousand children.
With the introduction of Compulsory Social Health Insurance, funding for medical rehabilitation increased by 7 times compared to 2019, of which for children by 27%. In 2022, more than 15 billion tenge are allocated for the rehabilitation of children. The list of drugs includes 17 drugs for the treatment of orphan and severe diseases in children, allocated more than 16 billion tenge. In the first six months of this year it has been possible to reduce the maternal mortality rate by 2.4 times. At the same time the highest rates of maternal mortality are observed in Pavlodar, Karaganda, Kyzylorda and West Kazakhstan regions. In the structure of the cause the obstetric complications made up 70%, somatic diseases made up 30%.
The infant mortality rate was 8.3 per 1000 live births. The highest infant mortality rates were in Shymkent city, Kostanay, West Kazakhstan, North Kazakhstan and Kyzylorda regions. In 60% of cases, premature babies were lost.
"To strengthen human resources capacity of medical organizations the number of grants in the residency is increased up to one and a half thousand for training of medical personnel, including narrow and scarce specialties, such as obstetrician-gynecologists, neonatologists and anesthesiologists-resuscitators," Azhar Giniyat said.
Under the second direction of the National Project "Healthy Nation", measures to ensure the sanitary and epidemiological well-being of the population are implemented.
"In general, the epidemiological situation in the republic in terms of infectious diseases is stable. During the elapsed period of 2022 there were no cases of 25 infectious diseases, including cholera, plague, tularaemia, paratyphoid, typhoid, tetanus, diphtheria, polio and rubella," she said.
Compared with the same period of 2021 there has been a reduction of morbidity in 12 nosologies. On May 21 this year, the Head of State signed the Law "On biological security of the Republic of Kazakhstan" aimed at early detection, response and prevention of biological threats.
"Since 2021, we have switched to a modern model of epidemiological surveillance of infectious diseases, a system of forecasting and response to coronavirus infection has been created, which allowed us to promptly adjust the response and prevention of infection. This year we have begun modeling, forecasting and responding to vaccine-preventable infections," the Minister of Healthcare noted.
The national project also includes measures aimed at ensuring the safety of various products such as food, toys, products designed for children, building materials and other products. So, within the monitoring of product safety this year about 23 thousand samples of food products were examined, more than 3 thousand samples or 13.2% did not meet the requirements of technical regulations.
The material and technical base of laboratories is being strengthened in order to increase the efficiency of control over product safety. For example, high-precision equipment was purchased in a number of regions this year. New research methods are being introduced to determine dyes, flavoring agents, vitamins, salts of heavy metals in various products, and specialists are being trained. These measures will allow this year to increase the list of determinable indicators established in technical regulations up to 84%.
In the third direction, "Affordable Medicines and Medical Devices of Domestic Production" Azhar Giniyat said that the total volume of the pharmaceutical market in 2021 amounted to 820.2 billion tenge, where the share of drugs and medical devices of domestic production in the local pharmaceutical market is 198.8 billion tenge, which is 24%.
To date, there are 89 manufacturers of medicines and medical devices in the country. The key mechanism of support for domestic producers is the conclusion of long-term contracts for the supply of medicines and medical devices for up to 10 years. The single distributor concluded 92 long-term contracts.
Of the 33 drug manufacturers, 27 manufacturers comply with the GMP standard (85%), while 2 major domestic manufacturers can export manufactured medicines abroad.
There are 3 drug testing laboratories in the country.
The Ministry of Healthcare attaches key importance to the development of the production of high-value innovative products, promotion of the industry in the direction of technology transfer, its digitalization, as well as the development of cluster initiatives. At the moment, 3 cluster zones in Astana, Aktobe, and Shymkent are formed by department due to availability of production sites and leading medical universities in these territories, and also availability of free economic and industrial zones.
It should be noted that there are negotiations with 7 leading pharmaceutical companies on 13 investment projects of contract manufacturing. At the same time, the share of procurement of drugs and medical devices with local content within the Guaranteed volume of free medical care and Compulsory social health insurance with the planned value of 37% has already reached 33%.
In the framework of implementation of the fourth direction in order to form a healthy lifestyle measures to prevent and reduce non-communicable diseases such as diabetes, cardiovascular diseases, cancer, chronic respiratory diseases, as well as measures to reduce the consumption of alcohol and tobacco products are implemented.
Approximately 315,000 adolescents and young adults have received services from youth centers in the area of mental and reproductive health. In addition, research is being completed on childhood obesity and tobacco use among adolescents aged 13 to 15 in order to develop further preventive measures.
It should be noted that the implementation of measures of the national project in the first half of 2022 has improved the main indicators of public health.
Mortality from circulatory diseases fell by 21.4 per cent, malignant neoplasms by 8.7 per cent, respiratory diseases by 23.8 per cent and tuberculosis by 11.8 per cent, and total mortality declined by 15.4 per cent.
However, infant mortality remains high. Compared to the first half of 2021, there has been a 6.5% increase in this indicator. The worst values of indicators are noted in the city of Shymkent and Kostanay region.
"By the end of 2021 we secured implementation of all activities of the National Project, as well as achievement of planned values of indicators. The capital, Zhambyl, Pavlodar and Almaty regions show the highest execution of activities and achievement of indicators," the Head of the Ministry of Healthcare said, adding that the national project was approved last autumn and the implementation in 2021 was carried out in a short time, so a number of regions have not reached the planned targets.