Accessibility of medical services and creation of a barrier-free environment — what was discussed at government session

At the regular government session, the issue of improving the quality of life of persons with disabilities was considered. The Minister of Labor and Social Protection of the Population Tamara Duissenova, Minister of Healthcare Azhar Giniyat, Akim of Akmola Region Yermek Marzhikpayev presented their reports on the measures taken in the region.

The Head of State signed a law providing for the adoption of additional measures to improve the quality of life of citizens with disabilities.

“In order to ensure the implementation of the law, more than 300 by-laws will be updated by the end of August. In general, the modernization of the social service system began in 2009 and is being implemented in stages,” said Tamara Duissenova.

Currently, about 700 thousand people with disabilities live in Kazakhstan. Of these, 60% are citizens of working age, 26% are of retirement age, and another 14% are children.

The Minister of Labor and Social Protection of the Population noted that the department is taking phased systemic measures for the full reintegration of citizens with disabilities into society.

First. Diagnosis of disability. According to the Minister of Labor and Social Protection, the agency is currently registering a large number of complaints about the transparency of the examination process from citizens who have applied for the diagnosis of disability.

To solve this problem, in accordance with the instructions of the Head of State, the Ministry began the transition to a proactive or "correspondence" format for determining disability. The brief meaning of this model is as follows.

Information about the state of health of citizens and the conclusion of a doctor on a change in life activity are entered into the medical information system. The information contained in it enters the centralized database of the Ministry of Labor on citizens with disabilities.

“Earlier, he was sent from the base to the place of residence of each. Now we automatically send to the expert commission of the three regions without indicating anyone's personal information. Based on the conclusion of the commission, a decision was made, which is sent to citizens in a convenient format. To date, more than 25,000 documents or 21% of public services provided in this area have been reviewed in this format,” said the Minister Duissenova.

The results of the work revealed a number of new opportunities. In particular:

• define polyclinics as a single window with the complete removal of all types of paper documents provided by citizens to the medical and social expert commission;

• more accurately determine the degree of restriction of citizens in everyday life by involving specialized experts on the types of diseases for examination;

• it became possible to develop an individual targeted rehabilitation program for each citizen in need of assistance with the definition of a specific list of services and technical means to be provided.

Work in this direction is carried out jointly with the Ministry of Health. By the end of 2023, the department plans to radically change the work of medical and social expertise and transfer half of the activities in this area to a proactive format.

Second. As noted by the Minister of Labor and Social Protection of the Population, services and technical means that allow persons with disabilities to overcome life restrictions are provided through the portal of special social services.

“Already this year, 214,000 services have been rendered through the Portal. That is, 62% of those in need of assistance are covered. Previously, all this work was carried out on the spot. Accordingly, criticism of the activities of local and central government bodies was heard very often. The launch of the portal in 2021 ensured the implementation of individual rehabilitation programs by 87%,” she noted.

Also among others:

1) period for providing the necessary means and services for rehabilitation has been reduced from 8 months to 14 days.

2) access to services and technical facilities is provided to all those in need, regardless of their place of residence.

3) possibility of independent choice of equipment and services and their supplier.

“Nevertheless, there are still issues related to the quality of equipment, the pricing policy of manufacturers and the conscientious and accurate performance of their duties. In this regard, the standards of rehabilitation services and facilities, the pricing policy and the conditions for registering the respective service providers on the portal will be reviewed. These measures are aimed at creating conditions for the development of the service market and stimulating service providers to fair competition,” the head of the Ministry of Labor emphasized.

Third. The accessibility of facilities, or the provision of a “barrier-free” environment, is one of the main factors necessary for the full integration of people with disabilities into society.

“Therefore, an interactive map of available objects has been developed and is constantly working. This map is constantly updated by local executive bodies. And the accessibility of facilities is assessed by the citizens with disabilities themselves and public associations in this area,” Tamara Duissenova said at the meeting.

According to local executive bodies, to date, about 25,000 facilities have been adapted for citizens with disabilities. However, according to statistics, only 23% of them meet the approved standards.

It should be recognized that the activity of the participants in this process has significantly decreased due to the pandemic. Concerning:

1) local executive bodies continued to conduct public control over the availability of facilities;

2) it is necessary to update the list of objects requiring adaptation;

3) the Ministry of Industry and Infrastructure Development should revise the national standards that ensure the accessibility of facilities.

Fourth. Work is underway to gradually liberalize the market for special social services.

Today there are about 900 private, public and non-governmental organizations in this market. They provide 8 types of guaranteed public services established by the Law on Special Social Services.

“As a result of work in this direction in recent years, 770 disabled children have returned from the boarding school to their families. About 800 parents applied for childcare at the full-time department of social organizations and found a job.

However, these services are provided only in cities and regional centers. More than 45% of citizens with disabilities living in villages have access only to general social assistance provided by local branches at home,” said the head of the Ministry.

Taking into account the previous experience, Tamara Duissenova noted, the work on the demonopolization of boarding schools will be continued.

“Instead, using a partnership between the state and private property, small-capacity houses will be opened in places where citizens with disabilities live. This measure will be implemented in the same way as the Balapan state program,” the Minister of Labor said.

The problem of employment of people with disabilities is still relevant. Today, 100,000 such citizens work. This is only a quarter of people with disabilities of working age.

More than 200 thousand people with disabilities have the opportunity to work in normal conditions, the rest can work under special conditions.

If the task of the state is “to create initially equal conditions for the productive employment of all able-bodied citizens”, this principle should also apply to persons with disabilities.

That's why:

• within the framework of national projects, it is planned to employ 9,000 people with disabilities. Today, about 3 thousand of them are provided with permanent jobs;

• electronic labor exchange has an atlas of special professions and training sessions. To date, it contains more than 5 thousand vacancies that people with disabilities can apply for;

• process of reorientation of subsidized social jobs has also been started. To date, about 6 thousand people have been employed;

• measures are being taken to subsidize employers who create new special jobs. This year alone, 59 million tenge was allocated from the budget for these purposes.

• 10,000 grants are provided to support the entrepreneurial initiative of citizens belonging to the category of vulnerable groups. The grant amount increased to 1.2 million tenge.

Despite the measures taken, it should be recognized that the lack of necessary skills and knowledge among persons with disabilities is the main obstacle to their employment.

As the head of the Ministry of Labor and Social Protection of the Population explained, together with the Ministry of Education, measures will be taken to revise educational programs, especially home education programs.

Fifth. Social support

As part of a comprehensive system of social support for persons with disabilities:

• there is a three-tier system of social security, today about 530 thousand people receive total payments from these three sources;

• within the framework of the social service system, 87 thousand people receive special social services from the state;

• 181 thousand people were provided with technical means;

• provides targeted social assistance to almost 4,000 citizens with disabilities.

In general, more than 600 billion tenge has been allocated from the state budget for the implementation of these programs this year.

The achieved opportunities are the result of joint activities of the Government, public associations and non-governmental organizations.

At the same time, the Minister of Labor and Social Protection of the Population acknowledged that there are a number of new tasks and unresolved problems that still require deepening the initiated reform.

As Tamara Duissenova noted, it is necessary to fully form the institution of social workers and rebrand the social services of local executive bodies. It is also necessary to expand the range of alternative service models, introduce digital technologies and improve the rehabilitation system for persons with disabilities in order to use their potential for the development of the country.

“All these measures will be reflected in the national plan for further modernization of social security, which is being developed on behalf of the Head of State. Its implementation provides for the involvement of social partners, persons with disabilities and members of their families with their initiative. We will submit the plan to the Government in September next year in accordance with the established schedule,” concluded Tamara Duissenova.

The Minister of Healthcare Azhar Giniyat also presented a report at the Government meeting.

Disability is one of the most important indicators of the health of the population, and can serve as an indicator of the quality and effectiveness of social and therapeutic and preventive measures. Disability problems are interdepartmental in nature, affecting the medical, social and professional spheres. The number of people with disabilities is increasing due to the increasing burden of chronic diseases and the aging of the population.

In the structure of general disability due to diseases, 18% of cases are mental disorders, 15% are diseases of the circulatory system, and 12% are injuries of all localizations.

Primary disability among children in 31% of cases is congenital malformations, deformities and chromosomal abnormalities, in 22% - diseases of the nervous system, these are epilepsy, cerebral palsy, etc. 17% - mental and behavioral disorders.

In order to prevent diseases, early detection and reduce disability, screening of the target group of the adult population and children is carried out annually at the primary healthcare level. Adults are screened for early detection of diseases of the cardiovascular system, diabetes, glaucoma and oncopathologies. Of those identified with diseases, 49% were taken for dynamic observation.

More than 1.1 million patients with chronic non-communicable diseases who are under dynamic observation participate in the disease management program. Of these, 65% of patients with arterial hypertension reached the level of normalization of blood pressure, 28.2% of patients with diabetes mellitus reached the level of glycosylated hemoglobin, 47.5% of patients with chronic heart failure participate in the Disease Management Program.

According to the report of the Minister of Health, at the outpatient level, patients under dynamic observation are provided free of charge, within the framework of the State Compulsory Observatory for 306 drugs for 46 nosologies, for adults - 83 drugs for 27 nosologies, for children - 182 drugs for 52 nosologies.

In acute conditions leading to disability, there are 71 stroke and 39 PCI centers in the country that provide medical care. In order to ensure the principle of the golden hour for injuries, the emergency medical service and medical aviation have been developed.

Newborn screening

For early detection of diseases among newborns, neonatal screening is carried out. More than 445 thousand newborns are covered, phenylketonuria was detected in 231 children, congenital hypothyroidism in 3,549 children.

“For the purpose of early diagnosis of diseases in a child, a screening program for newborns and young children has been implemented in the country, aimed at early detection of hereditary metabolic diseases, hearing pathology, deviations in psychophysical development, retinopathy of premature babies,” said Azhar Giniyat.

Also, from the report of the Minister of Health, it follows that 75.6% of newborns and children under 6 years of age are covered by audiological screening. Of these, 625 children were diagnosed with hearing loss of 1-2 degrees, 646 children with hearing loss of 3-4 degrees. 1,232 children were sent to the psychological, medical and pedagogical commission to carry out correction and determine the tactics of teaching the child.

85.2% of children were examined for early detection of disorders of psychophysical development, disorders were detected in 5%.

In the early stages, 6,532 or 88.2% of premature babies born with extremely low and low body weight were covered by ophthalmological screening for retinopathy, of which 273 premature babies were treated according to indications.

“Since March 2022, a screening test for autism has been introduced, since last year, a new method for studying hearing short-latency auditory evoked potential (SEP) has been introduced, which allows you to accurately identify the place of hearing loss. A pilot project is being implemented on selective screening of metabolic disorders in newborns. Along with this, it is planned to increase up to 1,500 child development rooms and up to 50 catamnesis rooms, provide up to 5,000 children with orphan and serious diseases with medicines, services for preventive examinations of children are expanding, and school medicine is being improved,” the Minister of Healthcare of Kazakhstan explained.

At the same time, the Ministry of Healthcare is developing a Standard for the organization of medical care for schoolchildren. The Health Promoting Schools project has been relaunched. The project includes: improving the health of students, providing quality nutrition, physical activity programs, creating school environment conditions that support healthy lifestyles, psychological and social health, and introducing a health improvement program for school employees.

“Technologies are being introduced and developed in the fields of oncohematology, cardiac surgery, traumatology and orthopedics, neonatal surgery for children. Thus, the ongoing activities allow for early detection and prevention of disability in children,” Giniyat explained.

Development of rehabilitation system

The head of the department noted that in recent years, medical rehabilitation has been actively developing, aimed at restoring lost body functions and preventing disability. Medical rehabilitation is provided by about 637 healthcare organizations, of which 380 are state-owned, 257 are private, including 76 rehabilitation centers.

As part of the Kamkorlyk initiative, 8 rehabilitation centers and 2 early intervention centers have been opened for children this year, and 17 early intervention centers are planned to be opened by the end of the year.

“Provision with beds for rehabilitation treatment and medical rehabilitation is 62%, annually there is an increase in the number of rehabilitation treatment beds for children, approximately 2 times. With the introduction of the compulsory medical insurance system, the financing of medical rehabilitation increased by 7.2 times compared to 2019. The coverage of patients with medical rehabilitation services has increased almost 6 times,” Azhar Giniyat said.

Strengthening coordination between government agencies

Within the framework of interdepartmental interaction to improve the quality of life of persons with disabilities, joint work is carried out to improve regulatory legal acts.

“So, the Code ‘On the Health of the People and the Healthcare System’ includes norms for servicing people with disabilities in healthcare organizations out of turn, the competence of local executive bodies in terms of opening rehabilitation centers, regulates the referral of children with developmental disabilities to the psychological, medical and pedagogical commission, the list of diseases for teaching children at home has been approved,” the head of the Ministry of Healthcare emphasized.

As part of the implementation of the roadmap to improve the provision of comprehensive assistance to children with disabilities in the Republic of Kazakhstan for 2021-2023, the Ministry of Health is working to create a register of children with disabilities, train parents in caring for children with autism, introduce an international classification of functioning, remote survey pilot project, which ends in July this year and will be implemented throughout the country.

At the same time, in order to improve the quality of life of the population, the Healthy Nation National Project was adopted, within the framework of which measures are being taken to ensure affordable and high-quality medical care, drug provision, conduct and expand preventive examinations and screenings, including for the rural population, accessibility of youth centers health care to provide mental and reproductive health services.

Also, measures are being taken to promote a healthy lifestyle, reduce the consumption of alcohol, tobacco products, awareness-raising work to reduce infectious non-communicable diseases, injury prevention and healthy lifestyles.

“As a result of the measures taken, by 2025 it is expected to increase the share of citizens leading a healthy lifestyle up to 40%, life expectancy up to 75 years, a decrease in non-communicable diseases up to 7%, coverage of medical rehabilitation services up to 75%, the achievement of these indicators will reduce the level of output for disability,” concluded Azhar Giniyat, Minister of Healthcare of Kazakhstan.

Akmola region is among leaders in rehabilitation

In continuation of the topic, Akim of Akmola region Yermek Marzhikpayev presented a report.

According to the akim, more than 29,000 people with disabilities live in the region, or 4% of the total population. Of these, 50% or 14.5 thousand are people who need to create a barrier-free living environment.

“Today, 343 socially significant facilities have been adapted, and it is planned to adapt another 1,300 by 2025. Every year, there is an increase in budget funds for providing rehabilitation facilities. Over the past five years, funding has been doubled and brought to 1.5 billion tenge,” the regional akim said.

As of July 1, the implementation of individual rehabilitation programs amounted to 75.4%. Out of about 9 thousand people in need, 7 thousand people are provided with rehabilitation.

Within the framework of the state order, 25 million tenge was allocated from the regional budget for the implementation of 4 projects, “Computer without Borders”, “Creation of an office for social, legal and psychological assistance”, “Organization of a leisure center for people with injuries of the musculoskeletal system”.

To expand the network of special preschool organizations in Kokshetau, construction of 2 kindergartens for children with speech impairment for 280 places and for people with limited mobility for 166 places is underway.

According to the head of the region, the Qamkorlyq initiative is being implemented, which provides for the provision of assistance to children with disabilities. There is a Center for Social Support and Employment "Ten Kogam", where persons with disabilities are assisted in finding employment. As part of the employment of persons with disabilities, about 300 people have been employed since the beginning of the year.

Akim of the region also reported on the active work to involve people with disabilities in sports. In general, more than 1,700 people were covered.

“Meetings and round tables with the participation of public organizations are regularly held. I would like to note the Forum "Equal Rights, Equal Opportunities" held on June 17 in the region, at which key issues for improving the quality of life of people with disabilities were discussed. Work in this direction continues,” Yermek Marzhikpayev summed up.

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