In 2016, Kazakhstan launched the Densaulyq State Program for the Development of the Health Care System, designed to ensure the gradual implementation of the OECD standards in the health sector. The main objective of the program is to increase the life expectancy of the population of Kazakhstan to 73 years by 2020.
For one year of the implementation of the Program, the life expectancy of Kazakhstanis has increased by 0.8% compared with 2016 (72.4). Thus, life expectancy in 2017 was 72.95 years, which indicates a possible achievement of the indicator in 2019 to 73.13 years.
In order to improve the efficiency of the domestic health care system further, a lot of legislative work has been done in 2018.
Thus, to implement the Address “New Opportunities under the Fourth Industrial Revolution,” the Law of the Republic of Kazakhstan “On Amendments and Additions to Certain Legislative Acts on Health Issues” was adopted. This document is aimed at improving the corporate management system in medical organizations, developing the institution of donation and transplantation; improving the system of public health, medical education, increasing the quality of training and research, the system of compulsory social health insurance; ensuring the quality and effectiveness of medical care; implementing the National Health Accounts system, etc.
In addition, the Law “On Amendments and Additions to Certain Legislative Acts on the Circulation of Medicinal Products and Medical Devices” was adopted. This will allow to create a patient-oriented drug supply model, taking into account modern requirements of Kazakhstan society. Along with this, legislative changes will make it possible to increase the efficiency of regulation in the sphere of circulation of drugs and medical devices, including the development of the principles of accessibility, quality, efficacy, and safety, which, in turn, are the basis for the rational use of medicines.
For 2019, the Ministry of Healthcare envisages the development of a new version of the draft Code “On Public Health and the Healthcare System” and the accompanying draft law. It should be noted that the drafts of these documents have already been developed. Currently, the projects are under discussion in an interdepartmental working group, as well as with relevant experts and representatives of the business community.
Increasing Quality and Availability of Medical Services
As part of the implementation of the Address of the Head of State dated October 5, 2018, a set of measures is taken to improve the quality and accessibility of primary health care.
The Densaulyq State Program for 2016-2019 provides for a reduction in the burden on the district doctor. Following the results of 9 months of 2018, the average number of the assigned population per 1 general practitioner decreased by 8.3% and amounted to 1,901 people. To reduce the load further, it is planned to open 247 areas of general practitioners in addition. In order to increase the availability of medicine, projects of public-private partnership will also be developed to create compact forms of primary health care, as close as possible to the place of residence of the population.
According to the ministry’s information, the modernization of the ambulance and emergency medical service has reduced the waiting time by 7 minutes. Thus, the required time for today is 18 minutes.
In the framework of the Densaulyq program, in order to get feedback from the population, non-governmental organizations are expected to conduct sociological studies to assess public satisfaction with the quality of medical services.
In 2018, more than 36 thousand people over 18 years old living in cities and rural settlements of Kazakhstan were surveyed. Respondents answered questions about the activities of organizations providing outpatient care and inpatient care. In addition, the survey was conducted through social networks. The results of the study showed the achievement of the indicators planned in the state program (47%). Thus, the indicator of satisfaction of the population with the quality of medical services provided in the country amounted to 47.84%.
The survey results allow you to make adjustments to work plans and make operational decisions to develop the quality of medical services in the regions further.
Public Health Management — Focusing on Prevention
In Kazakhstan, on the basis of international experience, a Public Health Service has been created, the goal of which is to create accessible and effective mechanisms for disease prevention and health promotion. In order to strengthen the capacity of the service, the National Center of Public Health was created in 2018.
The Public Health Management Plan for 2018–2021 has been approved. The activities are aimed at developing regulatory legal acts, intersectoral interaction, school medicine and creating the environment that strengthens the reproductive and mental health of children and young people, preventing non-communicable and infectious diseases, promoting a culture of healthy nutrition, and conducting research and training.
A single health care system has been formed in the country. One of the most effective measures to protect the health of citizens has become a regular screening. For the purpose of early detection of diseases that are the main causes of death and disability, the National Screening Program is being implemented. In 2017, taking into account the recommendations of international experts, the age group of the population to be screened was expanded to 70 years, the multiplicity of screening examinations was increased, and the coverage of target groups by 2022 would rise from 70% to 90%.
During 9 months of 2018, 9,481,767 screening surveys of target populations were carried out, 714,945 cases of diseases were detected, and 341,503 people were registered at dispensary registration. In particular, the amount of children examined — 3,998,813, revealed diseases for 454,797, taken to the dispensary registration — 140,927.
It should be noted that as a result of early detection of malignant neoplasms, mortality from cancer is decreasing. In general, a comprehensive plan has been adopted within the framework of the comprehensive fight against cancer, and the establishment of a scientific cancer center has been ensured. At the same time, the main focus will be on providing highly effective early diagnosis and treatment of cancer based on international best practices.
As part of an order from the Head of State for the construction of the National Scientific Oncology Center, a roadmap for the implementation of the project for 2018-2020 was approved, a permanent working group was established to develop proposals. For the current date, the design organization has been selected and the design and estimate documentation is being developed. Equipping the National Scientific Oncology Center with modern medical and diagnostic equipment is planned using public-private partnership mechanisms. The Memorandums of cooperation were concluded.
Since 2015, in pilot mode, and since 2018, in all regions, a program for the prevention of suicides among minors has been implemented. The number of suicides among adolescents in Kazakhstan over the past 3 years has decreased by 30%.
As part of the implementation of the state program, methodical recommendations of the Uniform Standards on the Diet of Schoolchildren were developed and issued, which contain a 4-week menu of meals for catering for three age groups of students (7-10 years, 11-14 years and 15-18 years) in educational institutions.
According to the Ministry of Healthcare of the Republic of Kazakhstan, the advantages of the developed menus are the balance of the main food substances (proteins, fats, carbohydrates, vitamins and mineral substances) and energy; variety, the content of a large number of vegetables, fruits, the inclusion of fish, dairy products, etc. The diet provides only healthy cooking methods (cooking, steaming, stewing).
At the same time, in order to form common approaches in the provision of school medical services, the Ministry of Healthcare, in coordination with the Ministry of Education and industry research centers, developed guidelines for organizing school medical services.
Considering the impact of advertising on the diet, the Ministry of Healthcare has changed the approaches to advocacy work with the population on the formation of a healthy lifestyle. Thus, in 2018, 29 national programs were developed and implemented, with an emphasis on 7 target groups, including children from 3 years old and persons older than 64 years.
Over the past year, 503,557 events were held on the formation of a healthy lifestyle and prevention of behavioral risk factors (thematic classes, parent meetings, classroom and curator hours, large-scale events, conferences, round tables, events in primary health care organizations, training workshops, sports, etc. ) with a total coverage of 8,921,735 people.
Comprehensive work is being done on the prevention of infectious diseases: preventive and anti-epidemic measures are carried out on an ongoing basis, monitoring, analysis and prediction of infectious morbidity are carried out, and, if necessary, visits to the regions are carried out to provide practical assistance. In 2018, 60 visits were made to 13 regions.
During the implementation of sanitary and quarantine control at the state border of the Republic of Kazakhstan, sanitary and quarantine control measures (examination and survey) covered 2,568,514 people: 105 passengers were detected with fever, five of them with cholera, who were promptly isolated and received the necessary treatment and were under medical supervision. It should be particularly noted that timely anti-epidemic measures have been taken to prevent the spread of infection among the population.
In general, immunization is one of the priorities of preventive health care. Thanks to vaccination, the country has achieved epidemiological success in vaccine-infectious diseases. About 5 million people are vaccinated against infectious diseases in Kazakhstan annually, including 1.3 million children. In order to provide children with vaccines of guaranteed quality, vaccines certified by the World Health Organization are purchased in Kazakhstan.
Guaranteed Amount of Medical Care and System of Compulsory Social Insurance
On behalf of the Head of State, in May 2018, a new model of the Guaranteed Amount of Free Medical Care was developed and introduced with clear boundaries of state obligations, simultaneously with the introduction of Compulsory Social Health Insurance.
In the framework of the guaranteed healthcare, the minimum required amount of medical care will be provided to all citizens, oralmans, foreigners and stateless persons permanently residing in the Republic of Kazakhstan. In particular, these are ambulance and air ambulance, primary health care, emergency inpatient and inpatient care, palliative care, as well as for socially significant, main chronic diseases, consultative and diagnostic aid, outpatient medication, planned inpatient and inpatient care, medical rehabilitation for tuberculosis.
In the Ministry of Healthcare, it is noted that the introduction of a new model will increase the availability of medical care, by increasing the financial support of the health system through state funding and contributions to the Medical Insurance Fund, to reduce the population’s costs of medical services, as well as reduce load of the emergency specialists and medical services.
According to the Social Health Insurance Fund NJSC, the total amount of deductions and contributions of employers and individual entrepreneurs for compulsory social health insurance of 6.5 million people received in the period from July 1, 2017, to Dec. 31, 2018, amounted to 133 billion tenge.
In addition, in accordance with the current legislation, since Jan. 1, 2018, the Foundation is also the operator of the guaranteed volume of medical care. Thus, the Fund has paid for services in the package of the guaranteed healthcare since the early 2018, and within the framework of the health insurance, it will start in 2020.
In order to increase competition in the market of medical services, work has been carried out to deregulate the sphere. As part of the improvement of the regulatory framework, an audit of 66 sanitary rules was carried out, 29 obsolete rules were canceled. To date, there has been an increase in the number of private medical organizations participating in the guaranteed healthcare from 40% (2017) to 46% (2018).
Availability of Drugs — New Pricing Rules
In accordance with the President’s Address “Third Modernization of Kazakhstan: Global Competitiveness” and the creation of a common market for medicines and medical devices in the Eurasian Economic Union, in January 2019, the Law of the Republic of Kazakhstan “On Amendments and Additions to Certain Legislative Acts on the Treatment of Medicines and medical products" was adopted. In addition, within the framework of the law, a number of related regulatory and legal acts have been developed.
The goal of introducing state regulation of drug prices is to ensure uniform pricing mechanisms for medicines in the wholesale and retail segment, regardless of the region. As well as increasing the economic affordability of medicines for the population and securing the responsibility of participants in the pharmaceutical market: manufacturers of medicines, wholesale and retail sales organizations.
Planned changes in the formation of prices for medicines imply four levels of price regulation — at the level of the manufacturer, wholesale, retail sales, as well as purchases under the guaranteed healthcare and the compulsory insurance system.
According to the ministry, the regulation of prices for all medicines will ensure equal economic accessibility of citizens for the use of medicines.
In addition, new pricing rules provide for the strengthening of economic expertise of the validity of prices for drugs and medical devices, including in the guaranteed healthcare and compulsory insurance system, by reviewing reimbursement prices and evaluating pharmacoeconomic data, as well as creating a register of drugs prices. This will increase the availability of pricing information to all interested parties. The entire application process will be carried out in electronic format on the website of the National Center for Drug Evaluation, currently an information system has been developed and launched in test mode.
Development of Health Infrastructure
In the framework of the Densaulyq state program, work is underway to develop a unified infrastructure of the healthcare system based on the strategic goals of the industry, standards of design, construction, equipping of healthcare facilities and ensuring the quality of medical services.
The health infrastructure is shaped according to the needs of the population on the basis of a single long-term plan for the development of a health network, which involves attracting investment and increasing the share of the private sector.
It should be noted that, according to the current legislation, the construction and development of a network of healthcare organizations, and material and technical support are within the competence of local executive bodies. Regional long-term plans for the development of health infrastructure for 2018–2025 were approved by level of medical care, taking into account the specifics of the localities and the population’s need for specific types of medical care. Regional plans are brought to a single structure, reflect information on the existing network of health organizations, the planned restructuring and the need for health facilities.
In the republic as a whole, the percentage of equipment of state healthcare organizations with medical equipment in accordance with the minimum standards increased by 4.5%, from 63.2% in 2017 to 67.7% in 2018.
Separate work is carried out on the development of PPP projects. Thus, in the period 2016-2018, 241 leasing projects worth 4.9 billion tenge were implemented. In addition, transfers of a general nature for health care organizations allocated for material and technical equipment and major repairs, providing a guaranteed amount of free medical care in 2016-2018, amounted to more than 111.7 billion tenge.
As part of the PPP for the purchase of medical equipment in the period 2017-2018, 16 contracts worth 5.4 billion tenge were concluded (computed tomography – 6, magnetic resonance imaging – 5, x-ray system – 1, equipment for the anesthesiology, resuscitation and intensive care departments – 1).
There are 21 PPP projects in the total amount of 18 billion tenge (centers of positron emission, computer, magnetic resonance imaging; X-ray equipment).
Together with global manufacturers of medical equipment such as Varian Medical Systems, Pharmstandard, Phillips, etc., memorandums of cooperation were concluded on equipping healthcare organizations based on the principles of PPP, as part of the Comprehensive Plan for the fight against cancer in the Republic of Kazakhstan for 2018-2022, as well as in other priority areas.
Also, the Ministry of Health is working to determine the need for medical equipment until 2021 and conduct an audit of previously purchased equipment. Draft amendments to the standards for equipping medical institutions of health care organizations, in terms of revising the standards for equipping multi-purpose hospitals, primary health care and emergency rooms in accordance with international standards, have been developed.
In the regions of the country, according to the information of the local executive bodies of the regions, the cities of Astana, Almaty and Shymkent, contracts were concluded for 101 PPP projects for a total amount of 33.1 billion tenge.
In general, according to the Statistics Committee of the Ministry of National Economy, in January-November 2018, 92.6 billion tenge of investments were attracted to the health care sector, including 38.9 billion extrabudgetary. The index of the physical volume of investments in fixed assets by the corresponding period of 2017 amounted to 118.7%.
According to the Ministry of Healthcare, in 2018, the overall availability of doctors and paramedical personnel per 10,000 people is satisfactory.
An extensive work was carried out in order to ensure the need for medical personnel. So, admission to medical universities has increased. Since 2016, compulsory three-year refining by graduates of residency has been introduced, and since 2019 — graduates from the internship program at medical universities study at the expense of the state educational order. In addition, akimats are given the opportunity to place an educational order at the expense of the local budget for training personnel with higher and postgraduate education for the region. Also universities are responsible for providing social support measures to young professionals.
The measures taken to ensure staffing made it possible to reduce the shortage of medical personnel from 3.8 thousand specialists in 2014 to 2.8 thousand specialists in 2017, i.e., by 34.6%. In 2019, taking into account the employed graduates, the shortage of medical personnel is planned to be reduced to 1,600 posts.
Introduction of Advanced Treatment Methods
The work continues on the introduction of advanced methods of providing medical services. For example, the National Science Center for Oncology and Transplantology uses hybrid technologies in the treatment of vascular pathology, combining the advantages of open classical and minimally invasive endovascular surgery (based on the insertion of catheters and other instruments through a small puncture of the skin – without a cut). These methods give a therapeutic effect comparable to traditional surgery with less pain and without complications. Endovascular techniques are used in the field of vascular surgery, prevention of ischemic strokes, treatment of chronic venous insufficiency, Angiosurgical care for cancer patients.
At the Research Institute of Traumatology and Orthopedics, high-tech operations are carried out, including arthroscopic interventions on the knee and shoulder joints (minimally invasive surgical manipulation performed for the purpose of diagnosing and / or intra-articular injuries) are performed on an ongoing basis. Cellular technologies are being actively developed and introduced in the correction of the pathology of cartilage tissue (growing cells on the basis of the patient’s tissue). Together with the National Center for Biotechnology, stem cell cultivation has been developed, the stage of preclinical studies has been completed, and clinical trials are currently being implemented.
Thanks to the introduction of the Unified National Health System, the possibilities of providing high-tech medical services to the population have expanded. By technology profile "Traumatology and Orthopedics" for 2012-2017, the number of services rendered increased from 12,023 to 20,168, including: knee joint arthroplasty — by 5.6 times; hip joint — 1.7 times; arthroscopic operations — 1.8 times.
In the first 11 months of 2018, more than 3,000 operations were performed in the framework of the provision of high-tech medical services at the Research Institute of Traumatology and Orthopedics. Thus, the number of complete and partial replacements of the knee and hip joints in 2018 amounted to 1,329 cases treated, revision endoprosthesis of the knee and hip joints — 110, spinal surgery using the navigation system — 99, vertebroplasty — 113, thoracoplasty — 46, spondylodesis using endocorrector — 169, complete replacement of the shoulder joint — 1.
High-tech medical services in the framework of the guaranteed healthcare are provided to citizens of Kazakhstan on a free basis. At that, the cost of one operation itself varies from 170 thousand tenge to 1.7 million tenge.
Since the opening of JSC National Scientific Cardiac Surgery Center, 21 new technologies have been introduced to diagnose and treat circulatory system diseases, and more than 3,400 operations have been performed. On the basis of the center, for the first time in Kazakhstan, a unique high-tech cardiac surgery was introduced for the treatment of patients with severe chronic heart failure: the implantation of a device for long-term mechanical support for blood circulation — an artificial left ventricle of the heart. Only 20 highly developed countries of the world (USA, Japan, Canada, France, Sweden, Switzerland, Austria, etc.) are conducting this operation today. To date, in the center from 2012 to 11 months of 2018, 274 devices have been implanted, 70 heart transplants have been performed. Also, from December 2015 to 2017, 8 lung transplants were performed.
In addition, an innovative technology was introduced - an invasive extracorporeal oxygen saturation method (oxygenation) in patients with severe respiratory, cardiac or cardiorespiratory failure. Already, 271 operations have been performed.
Digitization in Healthcare System
According to the Ministry of Healthcare, within the framework of the Digital Kazakhstan State Program, the Office of Health Digitalization has been established in the Ministry of Healthcare.
Currently, within the framework of the State Program there are four projects:
1) Introduction of elements of mobile health care (mHealth), including “remote consultations”;
2) Creation and implementation of artificial intelligence in terms of establishing the diagnosis and management of treatment plans;
3) Introduction of medical information systems;
4) Implementation of the Information Platform and Interoperability of the information systems in the Ministry of Health.
The Ministry is working to launch the integration Platform together with the Ericsson Nikola Tesla d.d.
One of the fundamental principles of digitalization of health care is patient-centeredness, the implementation of which requires the introduction of an electronic health passport. Patient information will be stored in the Unified e-health passport repository that is part of the Platform and will be available to both medical professionals and patients. The electronic health passport includes data on the results of the examination and treatment of the patient in the medical organizations of the country, including previously suffered and chronic diseases, possible allergic reactions to medicines, recommendations on nutrition, diet and more.
User access to the information stored in the Platform will be organized through the patient’s personal account and the health worker’s office.
The Republican e-health center is working on the integration of 19 information systems of the Ministry of Health of the Republic of Kazakhstan and the Platform.
As part of the introduction of elements of mobile health, mobile applications have been developed for visiting nurses and parents to care for children. Test versions are available for downloading on the Google Play Market.
At the same time, Kazakhstan IT service providers launched about 20 mobile applications. At the regional level, there are mobile applications “DamuMed” and "To the Doctor." The number of downloads of mobile applications Dec. 1, 2018, is 1,562,754.
On the basis of the Kazakh Research Institute of Oncology and Radiology, together with IBM, pilot testing was carried out on the project of artificial intelligence in health care — Watson for Oncology. In the period from July 16 to Aug. 8, 2018, the analysis of existing business and clinical processes, data processing, the provision of a technical review; selection of treated cases and nosologies for approbation work was carried out. Currently, work is underway on the financing model under the PPP.
It should be noted that since January 2018, a phased process of digitization of the health care system of the Republic of Kazakhstan has been launched in terms of the transition to paperless medical records.
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