Review of Kazakhstan’s healthcare system: Results of 2020 and plans for 2021

2020 has become a turning point in all spheres of life. The coronavirus infection that caused the pandemic has changed the way people live. It showed that health is the greatest value that requires constant attention, care and strengthening. All governments have come together to fight COVID-19. Extensive work to support and restore the health sector was carried out in Kazakhstan. Read about the year 2020 in this industry in the report review.

Development of healthcare during pandemic

The difficult epidemiological situation of coronavirus infection in the world and in the country requires drastic measures to strengthen the material, technical and staffing of domestic health care.

Currently, there is a reserve of 51,126 beds to provide medical care to patients with coronavirus infection, 100 mobile medical complexes have been delivered to the regions. During the past year, 16 pre-fabricated infectious diseases hospitals were built in the republic and 3 infectious diseases hospitals were reconstructed through re-profiling. Medical organizations have been supplied with 3,264 artificial lung ventilation devices, 1,500 of them were domestically produced.

For timely diagnosis, district hospitals are equipped with 53 X-ray machines, of which 49 were purchased from the domestic manufacturer Aktyubrentgen. The ambulance service has been strengthened by purchasing 1,167 ambulance vehicles.

In order to implement the Address of the Head of State Kassym-Jomart Tokayev to the people of Kazakhstan dated Sep. 1, 2020, approaches to the organization of primary medical care have been revised, and measures have been taken to revive transport medicine for remote rural areas.

At the same time, during the period of the epidemiological situation, the format of medical care was revised. Thus, the provision of advisory services through the national telemedicine network, to which 259 health organizations are connected, began to actively develop. At the same time, specialists of the republican clinics consult patients receiving treatment in regional hospitals.

In order to ensure the availability of primary health care in 2020, 44 outpatient care facilities were built and opened, including 30 facilities in rural areas.

In 2020, the average salary for doctors was increased by 30%, and for nurses by 20%.

Also last year, measures were taken to update the health infrastructure, material and technical support of medical organizations in the regions. These measures are aimed at improving the quality and accessibility of medical services.

Measures are being taken to ensure constant monitoring to prevent further deterioration in the health status of the population.

Kazakhstan's readiness for possible new wave of COVID-19 incidence

As of January 2021, a total of 19,089 infectious beds were deployed throughout the republic, employment is 28% (5,367 beds).

The number of intensive care beds in infectious diseases hospitals is 1,738, employment is 21% (362 beds).

The bed capacity of quarantine hospitals is 6,666 beds, employment in the republic is 6.2% (464 beds).

In infectious diseases hospitals, as of January 2021, there are 5,222 artificial lung ventilation devices, 42,838 beds are provided with oxygen.

Additionally, 14 stationary ventilators are purchased within the framework of the local budget and sponsorship and 101 units at the expense of the World Bank.

According to the information of the Single Distributor of SK-Pharmacy LLP, in order to prepare for a possible new wave of coronavirus infection, a number of the following measures have been taken:

  • A two-month supply of drugs against COVID-19 (irreducible stock) has been formed. 44 items of drugs for the treatment of coronavirus infection have been identified for the purchase (with a forecast of 60,000 patients in hospitals per month). At the moment, 43 types of medicines have been purchased for the amount of 6.1 billion tenge. "Nadroparin" and "Fondarinux sodium" were replaced by "Enoxaparin" within the framework of interchangeability.
  • Free outpatient drug provision for patients with CVI with pneumonia was organized (antipyretic drugs "Paracetamol" and "Ibuprofen", anticoagulants "Rivaroxaban", "Apixaban" and "Dabigatran"). In general, it is planned to cover about 1 million people with drug provision for the amount of about 2 billion tenge. In regional pharmacies of medical organizations for free dispensing to the population, there are the above 5 names of drugs in the amount of 1.3 billion tenge.
  • Medicines were purchased for intervention in the retail network. In order to avoid a shortage of drugs in retail pharmacies, akimats of the regions submitted applications on the portal of the Single Distributor for the purchase of 33 scarce names of drugs for the amount of 3.1 billion tenge (two-month need), 25 of them were purchased. The volume was formed at the operating warehouses of the Single Distributor in 17 regions according to the request of the akimats. A network of retail pharmacies (1,163 pharmacies) has been formed in the regions in remote areas through which the intervention will be carried out. Thus, based on the order of the regions, in the event of a shortage of goods in the retail network of pharmacies, shipment will be started.

  • A reserve of personal protective equipment has been formed from the volume received within the framework of humanitarian aid in the amount of 200,000 disposable protective suits. This volume is stored at 4 hubs of the Single Distributor as an additional reserve for use in the event of a new wave of coronavirus.
  • The list of the Single Distributor for 2021 from the protocol for diagnostics and treatment of coronavirus infections includes 85 names of medicines, of which 79 items were purchased for the amount of 20.3 billion tenge. At the request of medical organizations in the regions of the republic, personal protective equipment (masks, gloves, shoe covers, disposable protective overalls with a hood) were purchased. Medicines and medical devices purchased for 2021 arrive at the warehouses of the Single Distributor from December 2020.

In Kazakhstan, during pandemic, 15,373 new jobs were created for health workers

According to data from regional health departments within the framework of the implementation of state and government health development programs, as of Dec. 1, 2020, 15,373 new jobs were created for health workers, of which 5,274 are permanent, 10,099 are temporary.

Most jobs were created in Nur-Sultan (3,614, of which 807 are permanent and 2,807 are temporary) and Aktobe region (1,480 new temporary jobs).

It should be noted that these same regions have exceeded the plan to create new jobs. In terms of the percentage of execution of the plan for the current year, the lowest indicator was noted in the Zhambyl region (75%) and the East Kazakhstan region (77%).

The share of new jobs for medical workers is 26% of the total or 3,996 jobs, including 780 for doctors, 1,893 for mid-level medical workers and 1,323 for other personnel.

The largest number of new jobs for medical workers was created in the capital (620), North Kazakhstan (473), Turkistan (452) and Zhambyl (438) regions.

The Ministry of Healthcare of the Republic of Kazakhstan is taking a number of systemic measures to motivate medical personnel.

At the central level:

The salaries of medical workers have been increased. Since July 2019, the salaries of doctors have been increased twice (from 01.07.2019 — by 30%, from 01.01.2020 — by 30%).

Also, as part of the implementation of the instructions of the Head of State, a phased increase in the salary of doctors is envisaged, bringing its ratio up to 2.5 times to the average salary by 2023.

- Measures are being taken to improve the status of medical workers and ensure professional protection of their activities (within the framework of the Code "On People's Health and the Health Care System", decriminalization and humanization of medical criminal offenses, the phased introduction of professional liability insurance are envisaged;

- Social support is provided for young specialists who arrived in rural areas (as of Dec. 1, 2020, within the framework of the republican budget, lifting allowances were paid to 12.4% (89 out of 717 specialists), housing — 3.6% (26 out of 717 specialists).

- The system of training and advanced training of medical personnel is being strengthened (grants for the training of medical personnel were increased to 1,500 places, in 2020 more than 15 thousand medical workers were trained for a total amount of more than 639 million tenge).

At the local level:

- Social support is provided for medical personnel by providing hostels, compensation for utility costs, communication services, social payment of rent, allocation of places in kindergartens, employment of spouses, etc. (as of Dec. 1, 2020, at the expense of the local budget, young specialists who arrived in rural settlements were paid 19 lifting allowances, 2% (138 out of 717 specialists), housing — 7.4% (53 out of 717 specialists), other social support measures — 6.7% (48 out of 717 specialists); 8.5% of those who arrived to work in the city were provided with lifting allowances (60 out of 704), housing — 0.7% (5 out of 704), other social support measures — 2.6% (19 out of 704).

- Within the framework of local budgets, grants are provided for akims for training in residency for targeted training of personnel, depending on the specifics and needs of each individual region;

- A system of distribution of young specialists was introduced, taking into account regional needs, according to which 4,153 doctors were assigned.

At the same time, the relocation of specialists to the regions today amounted to 52% (2,147 out of 4,153 graduates of medical education and science organizations were exempted from working for the following reasons: continuing their studies — 1,731, pregnancy — 76, refunds — 11, military service — 3 , academic leave — 6).

For reference: the largest number of relocations of specialists was noted in Shymkent — 80%, Almaty — 70%, Mangystau region — 62%, Nur-Sultan — 60%.

The smallest indicator is observed in the Akmola region — 23%, North Kazakhstan region — 34%, Karaganda region — 41%, Zhambyl region — 45%.

As a result of the measures taken, there is a certain decrease in the shortage of medical personnel in the whole Republic of Kazakhstan by 25%.

For reference: in the context of regions, there is a decrease in the shortage of personnel in the Kostanay region by 45%, in the Karaganda region by 41%, the Turkistan region by 40%, the Mangystau region by 38%, the Pavlodar region by 55%, and the Aktobe region by 50%.

In general, in the work to reduce the shortage of personnel, it is necessary to highlight the experience of the Kostanay, North Kazakhstan and Akmola regions, as well as the city of Nur-Sultan, where, as a result of social support for young specialists, a high level of their consolidation is noted. This experience was discussed with the participation of representatives of local executive bodies.

The experience of the East Kazakhstan and Kyzylorda regions is also indicative, in which funds are allocated on a regular basis with the involvement of the business community for the training of physicians, including abroad.

Measures to attract medical personnel to villages

According to information as of Jan. 1, 2020, about 64 thousand medical workers worked in the healthcare system in rural areas, including more than 12 thousand doctors and 51 thousand paramedical workers.

According to the data of the akimats, the need for personnel in clinical specialties as of Dec. 1, 2020 in the village was 932 (of which PHC — 766, hospital — 166).

The greatest need for doctors in rural areas is noted in Akmola (108), Almaty (105), Turkistan (84), Karaganda (83), Kostanay (82), West Kazakhstan (78), Mangystau (77), Zhambyl (73) regions. In terms of specialties, the greatest need is noted for general practitioners (251), pediatricians (49), anesthesiologists-resuscitators (44), infectious disease specialists (38), obstetrician-gynecologists (38), cardiologists (33), therapists (30), surgeons ( 24), neonatologists (12), epidemiologists (11).

At present, in order to reduce the shortage of personnel, the system of training and advanced training of medical personnel, based on the needs of practical health care, has been strengthened. Grants are allocated annually for the training of residents — 1,500 places, bachelors — 2,700 places, interns — 4,888 places.

To attract medical personnel to the regions, within the framework of the new Code of the Republic of Kazakhstan "On people's health and the health care system", measures are envisaged aimed at expanding social guarantees and protection of medical workers at all levels of regionalization (obligatory provision of housing, payment of benefits, compensation of utility costs by decision of the Local Executive Office and etc.).

The above measures are aimed at consolidating the professional staff, reducing the shortage of personnel, increasing the availability and quality of medical care for the population, including in the countryside. And also to resolve the imbalance in the medical personnel between the village and the city, to employ graduates of medical universities who studied under the state educational order, to strengthen the responsibility of local executive bodies in attracting and retaining young specialists.

New specialties introduced in healthcare

The coronavirus pandemic has made its own adjustments in the training of medical personnel.

The Ministry of Healthcare of the Republic of Kazakhstan has strengthened topics on biological safety, in particular, in such disciplines as:

- childhood infectious diseases;

- general hygiene;

- general epidemiology;

- clinical epidemiology;

- infectious diseases;

- ambulance emergency medical aid;

- internal illnesses;

- childhood diseases;

- pulmonology.

Additional seminars and lectures were held for interns and residents on epidemiology, pathogenesis, clinic, diagnosis, differential diagnosis and treatment of coronavirus infection, including familiarization with the clinical protocols of the Ministry of Health of the Republic of Kazakhstan and participation in webinars.

At all levels of education, the sanitary and hygienic component of disciplines was strengthened, and educational programs at the residency level were also updated.

In addition, specialized master's programs were developed in the specialties "Epidemiology", «Hygiene".

Since January 2021, short-term courses have been held for more than 60 thousand medical workers on issues related to the CVI pandemic. Within the framework of the republican budget, more than 15 thousand medical workers were trained, including more than 8 thousand in courses in the epidemiology of infectious diseases and biosafety, prevention and effective treatment of non-communicable diseases.

Following the retraining results, the reserve will be supplemented by 150 epidemiologists, 100 infectious disease specialists and 165 emergency doctors. New specialties have been introduced into the nomenclature of specialties and specializations in the field of health care: "kinesitherapy", "ergotherapy", "nuclear medicine", ‘’geriatrics".

However, it is important to note that the introduction of these specialties is a trend of the times. This decision was planned even before the start of the COVID-19 pandemic.

Biosafety and biosecurity courses emphasized in medical schools

The pandemic has had a huge impact on education, including medical education. For the first time, a distance form of medical education was introduced. Undergraduate students studied remotely, while interns and residents worked in hospitals, while studying remotely.

Since January 2021, in regions with a favorable epidemiological situation, residents have been recalled to universities for full-time study. Also, undergraduate students of the first and last years went to full-time education, students of other courses — to a combined form in compliance with all sanitary and epidemiological standards.

Taking into account the rapid pace of development of scientific research at the international level, the development of new technologies, the working curricula of medical universities are constantly updated. In 2020, with the deterioration of the sanitary and epidemiological situation in all educational programs, the issues of biological safety and biological protection are emphasized.

At the same time, from 2021, it is planned to introduce an educational program in Public Health degree for specialists in the medical-preventive (sanitary-hygienic) profile. The content of this educational program will include such courses as "Fundamentals of Epidemiology", "Health Promotion and Disease Prevention", "Environmental Hygiene", "Occupational Hygiene" and others. The cycle of major disciplines will consist exclusively of the sanitary and hygienic disciplines.

Salaries of medical workers of Kazakhstan increased in January 2021

As part of the instructions of the Head of State, from Jan. 1, 2021, the salaries of medical workers were increased: for doctors — by an average of 30%, for nurses — by 20%.

The size of the average salary, taking into account all incentive payments for a doctor, will be: 320 thousand tenge in 2021 (246 thousand tenge in 2020) and nurses in 2021 — 173 thousand tenge.

10 million people to be vaccinated against COVID-19 in Kazakhstan

The RSE Research Institute for Biosafety Problems of the Science Committee of the Ministry of Education and Science of the Republic of Kazakhstan, on behalf of the President of the Republic of Kazakhstan, on March 23, 2020, began developing a vaccine against coronavirus infection COVID-19. All research and development work is carried out in a biosafety level 3 laboratory (BSL-3).

On May 9, 2020, the domestic inactivated vaccine QazCovid-In against COVID-19 was received and preclinical trials began at two clinical bases of the National Center for Expertise of Medicines and Medical Devices (Almaty) and the Scientific Research Institute for Biosafety Problems using various laboratory animal models (white mice, rats, rabbits, guinea pigs, ferrets, Syrian hamsters and rhesus monkeys). According to the results of research, the World Health Organization on May 15, 2020, included it in the list of candidate vaccines against coronavirus.

The vaccine has been tested for safety and toxicity to animals when administered in high doses. In addition to general research methods, the safety of the vaccine was confirmed by hematological and biochemical blood parameters and an assessment of the effect of the vaccine on the functioning of the internal organs of animals was given. According to preclinical trials, the QazCovid-in vaccine is recommended for clinical trials on volunteers.

Further, on the basis of the permission of the Committee for Quality Control and Safety of Goods and Services of the Ministry of Health of the Republic of Kazakhstan on the basis of the Republican State Enterprise National Scientific Center for Phthisiopulmonology of the Ministry of Health of the Republic of Kazakhstan, I and II phases of clinical trials of the Kazakh vaccine QazCovid-in were carried out.

In clinical trials of the vaccine, healthy adult volunteers aged 18 to 50 years participated.

In the first phase of the study to determine the safety of the vaccine, 44 volunteers who did not recover from coronavirus and did not have antibodies took part.

In the phase II vaccine trial, 200 volunteers took part in the immunogenicity study.

It should be noted that before the start of clinical trials on July 26, 2020, first 7, and then another 22 development scientists, led by the Director General of the institute, were voluntarily vaccinated with the QazCovid-in vaccine.

According to the results of the phase I and II clinical trials of the QazCovid-in vaccine against COVID-19, good tolerance and safety were noted with single and double intramuscular administration. A high immunogenic activity of the vaccine against the SARS-CoV-2 virus was established, which is more pronounced after double vaccination.

On Dec. 19, 2020, the Prime Minister of the Republic of Kazakhstan Askar Mamin gave an official start to the III phase of clinical trials of a domestic inactivated vaccine against COVID-19. Clinical trials are carried out on the basis of two city polyclinics in Almaty (polyclinic No. 4 and Clinic of the International Institute of Postgraduate Education) as well as on the basis of the City Multidisciplinary Hospital in Taraz.

In addition, scientists of the RSE Research Institute of Biological Safety Problems have created a subunit vaccine QazCov-P against coronavirus infection. The vaccine also passed preclinical trials at two clinical bases of the Republican State Enterprise on the RGP National Center for Expertise of Medicines and Medical Devices and BTU Ministry of Healthcare of the Republic of Kazakhstan (Almaty) and the Republican State Enterprise on the RGP Research Institute of Biological Safety Problems. Currently, it is awaiting approval to conduct clinical trials.

Also, scientists of the institute are conducting research on the development of 3 more vaccines (2 vector and 1 attenuated) on various platforms.

At the same time, today in the Republic of Kazakhstan the production of the Sputnik V vaccine against coronavirus infection COVID-19, developed by the National Research Center for Epidemiology and Microbiology named after Gamalei (Russia), launched at the site of the domestic manufacturer Karaganda Pharmaceutical Complex LLP. Activities are carried out according to the production schedule. The project is carried out at the producers' own funds.

The planned production of 2 million doses of the Sputnik V vaccine is envisaged for immunization in the Republic of Kazakhstan, the export of this vaccine was not considered.

The Single Distributor and the Russian Direct Investment Fund Management Company joint-stock company signed an agreement of understanding dated Aug. 25, 2020.

The terms of the agreement provide for the intention to cooperate in the supply of a vaccine containing an adenoviral vector vaccine developed by the National Research Institute of Epidemiology and Microbiology named after Gamalei for SARS-Cov-2.

The amount of vaccine is 2,182,000 doses. The number of vaccine doses is predicted and is subject to agreement between the Government of the Republic of Kazakhstan and Russian Fund. At the next stage, the parties will consider the possibility of increasing the volume of supplies to 5,000,000 doses.

Currently, the Ministry of Healthcare of the Republic of Kazakhstan is studying the issue of determining the contingent to be immunized against coronavirus infection. At the same time, the recommendations of the World Health Organization and the Consultative Commission on Immunization of the Population of the Republic of Kazakhstan are taken into account.

According to preliminary data, vaccinations against CVI are subject to medical workers, teachers and police officers who, by the nature of their activities, are classified as high-risk for CVI infection, as well as persons with chronic diseases of the cardiovascular system, respiratory system, diabetes mellitus, who can receive preventive vaccination against CVI.

For the vaccination of the above categories of citizens, the vaccine will be provided free of charge at the expense of the guaranteed volume of medical care.

It is assumed that the vaccination will be carried out in stages, will begin in Feb. 2021 and first of all the most vulnerable groups of the population will be vaccinated, currently their number is being specified.

At the same time, it is planned to organize vaccination in two stages using two different vaccines available at that time:

I — using the Sputnik V vaccine, developed by the National Research Center for Epidemiology and Microbiology Gamalei (Russia), to immunize 2 million people from February 2021;

II — with the use of a vaccine produced by the Scientific Research Institute of Biological Safety Problems of the Ministry of Education and Science of the Republic of Kazakhstan for the immunization of 8 million people after the completion of the stage of clinical trials and state registration in Kazakhstan from approximately June-August 2021.

Thus, it is planned to vaccinate about 10 million Kazakhstanis.

In 2020, ambulance teams completed more than 7 million trips.

In Kazakhstan, medical organizations operate in a regular mode in compliance with the sanitary-disinfection and epidemiological regime.

To date, for the timely provision of medical care to patients with ARVI or influenza, as well as with coronavirus infection, mobile teams have been organized at the PHC level (in the Republic of Kazakhstan there are only 3,676, taking into account the reserve), call centers, and advisory groups with the participation of specialized specialists.

Medical organizations are provided with medicines and a stock of them has been created, additional infectious beds have been prepared, medical equipment has been provided, personnel have been trained, and other pressing issues have been resolved.

According to the operational data of the information systems of the Ministry of Health of the Republic of Kazakhstan, in 2020, 7,193,333 ambulance calls were made (for 2019 — 8,219,395), including 1-3 categories of urgency — 4,481,672, 4 categories of urgency — 2,711 661.

The number of visits per inhabitant in the republic as a whole was 4.2 times. As part of outpatient drug provision, more than 13.7 million prescriptions have been issued to patients undergoing dispensary observation.

46,361,201 consultative and diagnostic services were provided.

729,424 patients were operated on at the inpatient level, 122,451 patients were operated on as part of outpatient surgery.

Mobile medical complexes have covered 1,105 remote rural settlements and identify about 35 thousand sick people.

Providing healthcare institutions with medical equipment

Regional hospitals of the republic are 100% equipped with mobile medical complexes.

From the local budget, 1,649 units were supplied out of the planned 1,764. Also, another 390 ventilators were supplied (out of the planned 491) within the framework of the World Bank support project.

In addition, 1,500 domestic-made BIOVENT ventilators were supplied, purchased at the expense of the reserve funds of the Government of the Republic of Kazakhstan from Kazakhstan Aselsan Engineering LLP.

The number of beds with centralized oxygen supply increased to 42,838 due to the commissioning of 64 oxygen stations.

For timely diagnostics, regional hospitals are being retrofitted with 53 X-ray machines, of which 49 were purchased from the domestic manufacturer Aktyubrentgen.

To date, 1,167 units of ambulance vehicles have already been delivered under a financial lease agreement with DBK-Leasing JSC.

If we talk about where the medical equipment is purchased, the situation looks like this:

Carescape R860 ventilator (USA) — 138 pcs. for $5,609,702, 46.

Hamilton G5 ventilator (Switzerland) — 230 pcs. for $9,447,940.

Ventilator Nellcor Puritan Bennet 980 (Ireland) — 123 pcs for $4,237,989.43.

Computed tomography scanner Somatom GoTop (Germany) — 2 pcs for €1,300,00.

Vibroacoustic apparatus BARK VibroLUNG (Kazakhstan) — 87 pcs for 1,076,999,100 tenge.

Medicine in rural areas becoming more accessible

For the provision of medical care to the rural population, work has been carried out on drug provision, infectious and quarantine beds have been deployed (25,755 in total), mobile teams have been introduced, the availability of remote services, diagnostic research on CVI has been organized, medical personnel have been trained, etc.

In order to ensure the availability of medical care to residents of remote settlements, 100 mobile medical complexes were additionally purchased and delivered to the regions, from February 2021 they will carry out trips to the regions according to the schedule for conducting preventive screenings, providing consultative and diagnostic services, testing the population for CVI, providing medicines etc.

In 2020, 49 operating PMHs provided services to 595,244 villagers, while 215,740 diagnostic tests, 210,653 laboratory tests, 524,520 consultations of specialized specialists were carried out, 78,390 patients were identified, of which 29,173 people were registered.

In order to increase the availability of medical care, 3,676 mobile teams have been provided with work, of which 47.7% are in the countryside. Observation of patients with CVI, persons aged 65 years and older, pregnant women and children, as well as patients under dynamic observation, is carried out remotely through telemedicine, and medical teams make home visits for laboratory and diagnostic studies (sampling of biomaterial for PCR , general clinical and biochemical blood tests, etc.), and drug delivery.

Advisory groups have been created from among the leading profile specialists (pulmonologists, infectious disease specialists, cardiologists, neurologists, endocrinologists, etc.) to provide remote consulting assistance to district doctors and mobile teams, the work of Call centers has been strengthened.

Primary healthcare organizations in villages are provided with 10,026 pulse oximeters, district hospitals have 132 X-ray machines, 53 X-ray machines have been additionally purchased and supplied, 807 ambulances have been purchased, and another 360 units will be delivered to the regions (1,167 in total).

18 laboratories in 8 regions with a total capacity of 6,440 tests per day are involved in the diagnosis of CVI among villagers at the district level (the total capacity in the republic is 103,006 tests per day).

In order to ensure the availability of qualified medical care to the rural population, work continues on staffing, construction and opening of new facilities in the countryside (more than 500 facilities until 2026), drug provision, completion of digitalization and others.

New cancer centers being built in Kazakhstan

One of the priority key areas is the fight against cancer.

Kazakhstan is implementing the Comprehensive Cancer Control Plan for 2018-2022, approved by Government Decree No. 395 of June 29, 2018, which aims to reduce the burden of malignant neoplasms. The plan provides for the strengthening of interagency and intersectoral cooperation in the fight against cancer.

The plan provides for the strengthening of interagency and intersectoral cooperation in the fight against cancer. The recommendations of the European Cancer Control Code are being introduced into educational programs for children and adolescents, teachers and educators, and 70% and more coverage of target groups is ensured in screening studies.

To increase the availability and quality of medical care, measures are being taken to improve infrastructure, material and technical equipment, personnel training, etc.

Along with this, the construction of the National Scientific Cancer Center is being completed, on the basis of which advanced technologies of radiation, laser, proton and nuclear medicine will be presented.

Highly effective early diagnosis is provided through the opening of PET centers, the introduction of nuclear medicine, personalized molecular genetic testing, the development of a telepathology and teleconsultation system.

In 2020, a new cancer center was put into operation in the Mangistau region (Aktau). At the stage of completion of the construction of a new cancer center in Zhambyl region (Taraz), it is planned to equip the center with modern medical and diagnostic equipment (linear accelerator, CT simulator, MRI machine, etc.).

A high-tech linear accelerator was installed in the Regional Center of Oncology and Surgery in Ust-Kamenogorsk.

The list of drugs for the treatment of breast, lung, kidney cancer, skin melanoma, etc. has been expanded. The following drugs have been added to the clinical diagnostic and treatment protocols: Ribocyclib, Palbociclib, Durvalumab, Alektinib, Ceritinib, Brigantinib , Atezolizumab, etc.

The annual coverage of the population has been increased to 80% with screening studies for early detection of cancer in target groups (screening for breast, cervical and colon cancer).

For the first time in Kazakhstan, teleconsultations by international experts have been introduced using the telepathology system in complex cases of diagnosis. For 11 months of 2020, 4,283 international consultations were carried out using telepathology and 1,105 patients were consulted.

With the introduction of the compulsory health insurance system in 2020, funding for CT and MRI examinations for patients with suspected oncological diseases is made from the funds of the CSHI.

The measures taken contribute to an increase in the effectiveness of screening programs, a decrease in mortality from malignant neoplasms (at the end of 11 months of 2020 by 0.4%), an increase in the 5-year survival rate of cancer patients to 53.7%.

Epidemiological situation stable for most infectious diseases

In 2020, no cases of plague, cholera, typhoid fever, tularemia, paratyphoid fever, diphtheria, tetanus, poliomyelitis, malaria, visceral leishmaniasis were registered among the population of the republic.

Isolated cases of anthrax, rubella, alveococcosis, heminolepiasis, and rabies have been reported.

In comparison with 2019, the incidence of measles decreased by 4.1 times, whooping cough — 2.7 times, salmonellosis — 2.2 times, bacterial dysentery — 3.6 times, brucellosis by 40.1%, enterobiasis by 43.2%, acute intestinal infections — by 39.4%, meningococcal infection — by 44.4%, respiratory tuberculosis — by 20.6%, echinococcosis — by 14.5%, dermatomycosis — by 11.6%, epidemic mumps — by 48.2%.

For 12 months of 2020, 154,529 confirmed cases of COVID-19 and 15,021 cases of COVID-19 without laboratory confirmation were registered.

According to preliminary data of the Ministry of Health of the Republic of Kazakhstan, for 9 months of 2020, the total morbidity per 100 thousand population decreased by 2.6%, amounting to 53,909.4 compared to the same period in 2019, 55,364.9.

At the current time, the highest incidence rate falls on diseases of the respiratory system (19,715.5 cases per 100 thousand population), then diseases of the circulatory system (an increase in cases by 4.9%) amounting to 3,198.6 cases per 100 thousand population, against 3,049.1 cases in the same period in 2019. At the same time, there is a decrease in the following indicators:

- the incidence of malignant neoplasms decreased by 16.2% and amounted to 166.0 cases per 100 thousand of the population against 198.0 for the same period in 2019;

- the number of accidents, injuries and poisoning decreased by 11.25%, amounting to 2,262.7 cases per 100 thousand of the population against 2,549.5 in the same period in 2019;

- the number of diseases of the musculoskeletal system and connective tissue decreased by 28.4% and amounted to 1,628.4 cases per 100 thousand population 2,273.7 for the same period in 2019.

In addition, there has been a decrease in the incidence of mental behavioral disorders, substance use disorders and predominantly sexually transmitted diseases.

Production of medical devices and drugs carried out by 89 enterprises.

As of 2020, 89 enterprises in the pharmaceutical industry in Kazakhstan manufacture medicines and medical devices, of which 33 enterprises produce medicines, 41 — medical devices and 15 — medical equipment.

17 enterprises that produce medicines comply with the Good Manufacturing Practice (GMP) standard.

In total, 7,455 names of medicinal products are registered in Kazakhstan, of which domestic production — 12% (922 items), foreign production — 88% (7,106 items).

There were 9,154 medical devices registered, of which domestic production — 10% (916), foreign production — 90% (8,238).

Among registered medicines, originals account for 1,863 or 25%, generics — 5,410 or 73%, biotechnological — 182 or 2%.

Pharmaceutical industry attracted 500 million direct investments

Ministry of Health of the Republic of Kazakhstan, in order to create and develop pharmaceutical production and reduce import dependence, is implementing a number of measures of state support for domestic manufacturers are being implemented through the conclusion of long-term contracts for the supply of medicines for up to 10 years.

These measures will allow in the future to launch new and modernize existing production facilities thanks to a guaranteed ten-year procurement of these pharmaceutical products.

Measures to support domestic producers by concluding long-term contracts:

- concluding long-term contracts with OTP on the supply of medicines and medical devices for up to 10 years;

- a special procedure for the procurement of medicines and medical devices from domestic producers during the modernization of their production;

- a special procedure for the procurement of medicines and medical devices from manufacturers.

At the moment, 63 long-term contracts for the supply of 3,600 names of medicines (727) and medical devices (2,873) have been concluded with 32 domestic producers. Of these, 30 long-term contracts were concluded for medicines and 33 long-term contracts for medical products.

More than $500 million of direct investments (both foreign and Kazakhstani) have already been attracted to pharmaceutical production. As a result, new factories were built, including 4 large ones: Khimpharm (Santo), Karaganda Pharmaceutical Complex LLP, Abdi Ibrahim LLP, Nobel Almaty Pharmaceutical Factory JSC, as well as new workshops in accordance with international standards.

In order to further support domestic producers, a number of legislative measures are envisaged, the Code of the Republic of Kazakhstan "On People's Health and the Healthcare System" provides for norms regarding the contract production of medicines and medical products, which must ensure full compliance with the requirements of good manufacturing practice (GMP) for medicines and quality management system standard (ISO 13 485) for medical devices.

Until now, with the introduction of international GMP standards at the enterprises of Nobel Almaty Pharmaceutical Factory JSC and Khimpharm JSC, contract production has been mastered with transnational pharmaceutical companies Abbott Products Operations AG (a third-generation vasodilator that affects the peripheral vessels of the nervous system — Moxonidin 0.2 mg and 0.4 mg (trade name Physiotens®) and Sanofi (hepatoprotector — Essentiale®N forte, capsules).

The Ministry of Health, together with Ministry of Industry and Infrastructure Development, NCE Atameken and KazakhInvest JSC, is actively working on the creation of contract production of high-tech pneumococcal vaccines Prevenar-13 by PFIZER. Commissioning is scheduled for 2023.

Production capabilities of domestic pharmaceutical manufacturers

Production of pharmaceutical products is concentrated on key enterprises that produce 77% of all drugs and medical devices.

  • JSC Khimpharm, Shymkent (share in the industry 45%) — production of medicines;
  • JSC Nobel AFF, Almaty (share in the industry 10%) — production of medicines;
  • LLP Kelun-Kazpharm, Almaty region (share in the industry 1%) — production of infusion solutions;
  • JSC Abdi Ibrahim GlobalPharm, Almaty region (share in the region 7%) —production of medicines;
  • LLP Dolce-Pharm, Almaty region (share in the region 6%) — production of medical devices.

The share of domestic producers in the purchase of medicines from the Single Distributor is growing annually, which today amounts to 30% of the total volume in monetary terms. By 2024, the share of purchases is planned to increase to 80%.

The production of medical masks and protective suits has been doubled. Export was increased from $58 million to more than $100 million.

During the pandemic, domestic manufacturers of medical devices Khimpharm, Nobel, Kelun-Kazpharm, VIVA-pharm and others significantly increased their production capacity. The production of drugs demanded in the treatment of COVID-19, Azithromycin and Levofloxacin, antiviral drugs, etc. has also increased.

The number of manufacturers of medical masks and protective suits has increased from 6 to 15, and more than 50 additional types of drugs are planned to be produced.

In order to accelerate the entry of medicines and medical devices into the market of Kazakhstan, an accelerated examination is provided for during the state registration of medicines up to 70 calendar days, for medical devices — up to 5 working days.

In addition, preferences are presented for manufacturers of medicines and medical devices in terms of reducing the cost of expertise during state registration by up to 70% for medicines and up to 50% for medical devices.

In a comprehensive plan for the development of the pharmaceutical and medical industry for 2020-2022. provides for the main directions of support and development of the pharmaceutical and medical industry:

- legislative and regulatory acts regulating pharmaceutical activities;

- circulation of medicines and medical devices within the EAEU;

- measures of state support;

- research and development work;

- attraction of investments;

- staffing of the industry;

- labeling, traceability of medicines;

- an increase in the production capacity of medicines and medical devices.

Plans for healthcare sector for 2021

In order to further improve the quality of medical care for the population, especially in rural areas, a set of measures will be taken for 2021-2023. to improve the availability of outpatient care, as well as to develop and strengthen specialized medical care in district hospitals using modern methods of diagnosis and treatment.

Along with this, in 2021 the health care system faces the following tasks:

- development of a regulatory framework for biological safety;

- provision of vaccination against CVI up to 10 million of the population;

- construction of more than 200 new PHC facilities;

- increase in wages for medical workers;

- allocation of 7,000 quotas for in vitro fertilization.

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