Early detection bonuses for dangerous diseases in patients being paid in pilot mode to Kazakhstan doctors

In Kazakhstan in the pilot mode launched a project to stimulate district doctors to better examine patients.

This was announced by Minister of Health Azhar Giniyat at the Government session, where the issues of improving the availability of primary health care were considered. According to her, 6 indicators have been defined: for each case of early detection of oncological and cardiovascular diseases, tuberculosis or prevention of maternal and child mortality, medical workers will receive bonuses to their salaries. 

In addition, it is now possible to make an appointment with subspecialists in 9 areas without a prior visit to a general practitioner. For patients with suspected oncological disease accelerated examination in PHC organizations in 18 days through the route of the "green corridor". 

"Thanks to these innovations, the early diagnosis of malignant neoplasms has increased by 5.6% in six months," Azhar Giniyat noted. 

According to the minister, primary health care is one of the basic in the health care system, it is provided by 5,617 facilities. To ensure the family principle of service and territorial accessibility, district teams consisting of a doctor, nursing staff, psychologist and social worker have been created. The State standard for the network of health care organizations has been revised. In large villages with about 500 inhabitants, the number of health workers has been increased from one to three. The functions of nursing reception have also been expanded in order to reduce the waiting list to see a general practitioner.

"At the same time, there are also pressing issues in the direction of ensuring accessibility of medical care. It should be noted that the largest number of complaints come to Astana, Almaty, Akmola and Atyrau regions," the Minister emphasized. 

3.3 million Kazakhstani people remain uninsured in the health insurance system, the largest number of them in the region of Zhetysu, Almaty, Zhambyl regions and in the city of Shymkent. At the same time, there is still a need for medical personnel. Especially their shortage remains in Kostanay, Akmola, North-Kazakhstan, Turkestan, West-Kazakhstan regions. Also in more than 200 rural settlements there are no medical facilities, and wear and tear of existing buildings is 56%, medical equipment reaches 50%.

Formation of healthy lifestyle skills among the population is another task that specialists face. According to the Ministry of Health statistics, 21% of the country's adult population uses tobacco, 20% of children are overweight, and 6% suffer from obesity. 10% of adolescents aged 11-15 regularly consume vapes, 17.5% consume energy and sweet drinks. Azhar Giniyat voiced the measures taken to solve the above mentioned problems. 

Financing of outpatient level has increased up to 56% of the total amount, with WHO recommended 60%. For 3 years consultative and diagnostic assistance has increased 7 times, availability of expensive CT services has increased 9 times, MRI - 6 times. Outpatient drug supply to PHC has also improved. If in 2019 medicines were purchased for 48 diseases, in 2023 this list was expanded to 126, covering about 4 million people. 

Since 2022, Kazakhstan has been creating a unified healthcare ecosystem eDensauluq in the eGov mobile application. It reflects such information as laboratory results, electronic prescriptions, pregnancy records, attachments, appointments and house calls, referrals for absentee certification of disability, sick leaves and others.

"On the instructions of the Head of State, we have strengthened early detection of diseases among the child population and rural residents. For children, the package of mandatory preventive examinations has been expanded. For the rural population, screening for early detection of kidney, gastrointestinal, respiratory, prostate cancer diseases has been expanded, as well as the coverage of those aged 18 to 29 who have not been previously screened. We started this work at the end of last year with gradual scaling up across the country in 2023," Giniyat said. 

The Ministry of Health implements projects of best practices of primary health care, approved by WHO. This year they are being broadcasted in 48 PHC organizations throughout the country. Staffing issues are also being solved: 8 thousand graduates trained under the state educational order have been distributed and employed for 3 years. Akimats provide social support to young specialists who have arrived in rural settlements. The salaries of doctors have increased from 397,000 tenge to 519,000 tenge, and those of middle medical workers from 224,000 tenge to 268,900 tenge.

Implementation of the pilot national project "Modernization of Rural Health Care" continues. It is expected to address the issue of accessibility in rural areas. To develop infrastructure, improve the quality and accessibility of medical care, 116 PHC facilities have been opened and built in the regions.

There are 452 healthy lifestyle rooms, 4,608 health schools, anti-tobacco rooms and 157 youth health centers in medical organizations. In order to reduce tobacco consumption from January 1, 2023, the rates of excise tax on tobacco products have been increased, the Majilis envisages amendments to the draft law to introduce a complete ban on the circulation of electronic consumption systems (vape), flavorings and liquids for them. A RBA has been prepared for the norm on the introduction of a ban on the sale of energy drinks to persons under 21 years of age, the discussion procedure is underway.

The Minister noted that ensuring accessibility of medical care also depends on local executive bodies. The tasks of akimats: to organize primary health care; to develop the infrastructure of the health care system; to attract the uninsured population to the health insurance system. 

It is also necessary to implement mechanisms for attracting and retaining medical personnel and to conduct a wide awareness-raising work among the population on the formation of healthy lifestyle skills. The department expects that as a result of realization of all measures life expectancy will be increased up to 75 years by 2025. 

Deputy Mayor of Almaty Assem Nusupova reported on the work carried out in Almaty. Primary health care in the metropolis is represented by 75 medical organizations, of which 40 are public and 35 are private. The number of attached population to PHC organizations exceeded 2.5 million people.

To improve the accessibility and quality of medical services to the population, the Unified Standard of polyclinics was approved according to four main criteria: comfort, accessibility, quality and technology. Taking into account these requirements, a total of 33 new PHC facilities will appear in Almaty by 2030. 

The Akimat believes that all these measures will reduce the load on one doctor and increase the availability of medical services of narrow specialists and high-tech diagnostic methods for more than 25 thousand citizens. 

Kazakhstan is a leader in the development of primary health care and actively promotes this issue at the international level. Thus, on October 22-23 of this year in Astana will be held the Global Conference on PHC, dedicated to the 45th anniversary of the adoption of the Declaration of Alma-Ata and the 5th anniversary of the Astana Declaration on PHC. The event is expected to be attended by WHO Director-General Tedros Ghebreyesus, UNICEF Executive Director Kathryn Russell and about 80 delegations from WHO Member States.

#The Prime Minister of the Republic of Kazakhstan #Government session #Healthcare #Ministry of Healthcare

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