Health Care In Kazakhstan Research Articles

History of health care development in the Republic of Kazakhstan

Introduction: The urgent need to modernize Kazakhstan's healthcare system arises from deep-rooted economic crises and systemic challenges exacerbated during the transition to capitalism from Soviet-era centralized planning. Objective: The research aims to analyze the stages of development of healthcare in the Republic of Kazakhstan since the country gained its independence. Methods: To solve the set tasks the authors applied such methods of knowledge as historical, comparative, systemic, and method of political-legal analysis. Results: Research results consist in the formulation of the basic stages of development of public health in Kazakhstan, the definition of advantages and disadvantages of functioning of the given branch on each of them, and also in the designation of transformations and innovations in the public health sphere for last years. Conclusions: The materials of this research can be applied in the applied and research spheres. In particular, the research may be of interest to the employees of the state authorities who are dealing with the problems of reforming the health care system in post-Soviet countries. In addition, the materials can be used in the work of scientists whose sphere of interest includes the formation of policy in the field of health care management

RETROSPECTIVE ANALYSIS OF STRATEGIC TRANSFORMATIONS IN THE KAZAKHSTANI HEALTHCARE SYSTEM

In this article a retrospective analysis of strategic transformations in the sphere of Kazakhstani healthcare is carried out. The study covers the period of time during which new strategies and approaches to health care delivery were introduced. The authors analyze the key changes caused by strategic decisions and assess their impact on the quality and accessibility of healthcare for the population. Particular attention is paid to successful strategic moves and to the problems and challenges that the health care system faced during the transformation process. The authors seek to draw valuable lessons for the future development of health care in Kazakhstan through a detailed analysis of past strategic transformations. The article makes a significant contribution to understanding the transformation of Kazakhstan's health care system. It also offers valuable recommendations for its further improvement and development. The results of the study may be useful for the development of future strategies to improve the health care system not only in Kazakhstan, but also in other countries. Historical analysis was applied in the preparation of the article to examine the context and previous reforms in the health care system, to understand the dynamics of change and their impact on the current state.

Trends in Avoidable Mortality in Kazakhstan From 2015 to 2021.

The health system performance assessment is a challenging process for decision-makers. In case of Kazakhstan's healthcare system, the calculation of avoidable mortality, which has been underutilized to date, could serve as an additional tool to prioritize areas for improvement. Therefore, the aim of the study is to analyse avoidable mortality in Kazakhstan. The data was retrieved from the Bureau of National Statistics, Kazakhstan. It covers population data by age, mortality rates from disease groups based on the Joint OECD (Organisation for Economic Co-operation and Development)/Eurostat classification of preventable and treatable causes of mortality. The data spans from 2015 to 2021, categorized by gender and 5-year age groups (0, 1-4, 5-9, ..., 70-74). Standardization was performed using the 2015 OECD standard population. We used joinpoint regression analysis to calculate the average annual percentage change (AAPC). From 2015 to 2019, the annual percentage change (APC) in avoidable mortality per 100 000 population was -3.8 (-5.7 to -1.8), and from 2019 to 2021 it increased by 17.6 (11.3 to 24.3). Males exhibited higher avoidable mortality rates compared to females. The preventable mortality rate was consistently higher than the treatable mortality. Both preventable and treatable mortality decreased from 2015 to 2019, with preventable mortality reaching 272.17 before rising to 379.23 per 100 000 population in 2021. Between 2015 and 2021, treatable mortality rates increased from 179.3 (176.93-181.67) to 205.45 (203.08-207.81) per 100 000 population. In Kazakhstan, the leading causes of avoidable mortality were circulatory diseases, respiratory diseases, and cancer. To achieve the goals of universal health coverage (UHC) and improve the overall population health, there is an urgent need to amend the healthcare system and reduce avoidable mortality. While it is important to acknowledge the influence of COVID-19 on these trends, our study's focus on avoidable mortality provides valuable insights that complement the understanding of pandemic-related effects.

Measuring healthcare efficiency in Kazakhstan: an application of data envelopment analysis

The study aims to evaluate the efficiency of the Republic of Kazakhstan's healthcare sector over the period 2014-2021 using the non-parametric method of data envelope analysis. The analysis was carried out based on quantitative indicators of the medical statistics of the Republic of Kazakhstan. The study's results prove that efficiency tends to change over the medium term. Simultaneously, implementing digital technologies based on the computerisation and digitalisation of the healthcare sector in the short term is revealed to reduce overall efficiency, but that efficiency increases in the long term. The events of the COVID-19 pandemic did not reduce the overall efficiency of the healthcare sector in the Republic of Kazakhstan.

Interrupted time series analysis of the impact of the COVID-19 pandemic and compulsory social health insurance system on fertility rates: a study of live births in Kazakhstan, 2019-2023.

The COVID-19 pandemic triggered global health crises, affecting population health directly through infections and fatalities, and indirectly by increasing the burden of chronic diseases due to disrupted healthcare access and altered lifestyle behaviors. Amidst these challenges, concerns regarding reproductive health and fertility rates have emerged, necessitating an understanding of their implications for policymaking and healthcare planning. Furthermore, Kazakhstan's healthcare landscape underwent significant changes with the reintroduction of compulsory social health insurance system in January 2020, coinciding with the onset of the COVID-19 pandemic. This study aims to assess the impact of the COVID-19 pandemic and compulsory social health insurance system on fertility rates in Kazakhstan by examining live birth data from 2019 to 2024. Using Interrupted Time Series analysis, we evaluated the effect of the COVID-19 lockdown announcement and compulsory social health insurance system implementation on monthly birth rates, adjusted for the number of women of reproductive age from January 2019 to December 2023. In the final model, the coefficients were as follows: the effect of the COVID-19 lockdown was estimated at 469 (SE = 2600, p = 0.8576); the centering variable was estimated at 318 (SE = 222, p = 0.1573), suggesting no significant trend in monthly birth rates over time; the insurance effect was estimated at 7,050 (SE = 2,530, p < 0.01); and the effect of the number of women of reproductive age was estimated at -0.204 (SE = 0.0831, p = 0.01). The implementation of the compulsory social health insurance system, rather than the announcement of the COVID-19 lockdown, has had a significant positive impact on live birth rates in Kazakhstan. However, despite governmental efforts, live birth rates are declining, potentially due to unaddressed health needs of fertile women and economic challenges. Urgent policy-level actions are needed to address gaps in healthcare services and promote reproductive health.

Theoretical foundations of management and functioning of the healthcare system in the Republic of Kazakhtan

The research topic related to the healthcare system is relevant, as it is one of the key areas of social policy and the effective management of this system is important to ensure high-quality and affordable medical care to the population. Currently, Kazakhstan is facing a few challenges and changes that require updating and developing the theoretical foundations of management in the healthcare system. The purpose of this work to analyze and assess the current state and problems in the healthcare of Kazakhstan to develop and propose theoretical foundations of management that contribute to its more effective organization. Among the used methods were the analytical, statistical, functional, system analysis, deduction, synthesis and comparison method. The study determined the organizational of the healthcare in Kazakhstan, including the roles and functions of the main institutions and responsible for the management and provision of medical care. The quality and availability of medical care in Kazakhstan is investigated. Various theoretical concepts, models and approaches to healthcare management were studied in order to develop new theoretically sound management models that take into account the unique features of the healthcare system in the Republic of Kazakhstan. This study shows that the financing of the healthcare system is an important aspect for providing affordable medicine to all citizens of the Republic of Kazakhstan. In the course of the research within the framework of this article, scientific and practical recommendations were prepared for government agencies.

Қазақстандағы денсаулық сақтау ісінің қалыптасуы мен дамуындағы нормативті актілерді және мемлекеттік бағдарламаларды жүзеге асырудың маңызы мен рөлі: тарихы, мәселелері және келешегі

Әлеуметтік өмірдің маңызды салаларының бірі — денсаулық сақтау ісі болып табылады. Сондықтан, халықтың денсаулығын сақтау және оны нығайту әрбір өркениетті елдің мемлекеттік саясатының маңызды мүдделерінің біріне айналуда. Денсаулық сақтау ісінің тарихын зерттеу денсаулық сақтау саласындағы өткен тәжірибені бағалауға көмектеседі және оның келешектегі сапалы дамуын бағдарлауға мүмкіндік береді. Осы себептен, мақалада Тәуелсіздік жылдарындағы Қазақстандағы денсаулық сақтау ісінің даму кезеңдері зерттелген және денсаулық сақтау ісіне қатысты қабылданған заң актілеріне және мемлекеттік бағдарламаларға басты назар аударылған. Зерттеу барысында денсаулық сақтау саласына қатысты қабылданған нормативті-құқықтық актілерге және мемлекеттік бағдарламаларға енгізілген көптеген өзгерістер мен қосымшалар анықталды.

WITHDRAWN: Credibility of Kazakhstan's health care system and medical advice in the context of Covid-19 and vaccination: Covariation of belief and science credibility

This article has been withdrawn at the request of the authors. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/policies/article-withdrawal.

Re-validation and cultural adaptation of the brief, standardized assessment tool for measuring HIV-related stigma in healthcare settings in Almaty, Kazakhstan.

The HIV epidemic continues to grow in Kazakhstan and HIV stigma remains a major barrier to HIV prevention and treatment in the country. HIV stigma in healthcare setting may also discourage people living with HIV (PLHIV) from getting the care needed. Therefore, studying the attitudes of healthcare workers towards PLHIV is important and requires well-constructed measurement tools adapted to the specific cultural context. In our study, we aimed to adapt and re-validate a brief questionnaire on HIV stigma among healthcare workers in Almaty, Kazakhstan. We held focus group discussions to obtain input on an existing questionnaire and surveyed 448 primary healthcare providers to psychometrically evaluate the scale. The final HIV-stigma scale consisted of 15 items, 6 of them measuring negative opinions about PLHIV and the rest assessing stigmatizing health facility policies towards PLHIV. Both HIV-stigma subscales demons6trated adequate psychometric properties (with Cronbach's alpha α = 0.57 for the first and α = 0.86 for the second subscale, and with factor loadings >0.35 within each subscale). High numbers of respondents holding negative attitudes towards PLHIV, detected in this sample (87%; n = 380), may suggest the need for immediate actions addressing HIV stigma in healthcare in Kazakhstan.

Approaches to Assessing the Effectiveness of Healthcare in Kazakhstan and Abroad

World experience in the field of evaluating the effectiveness of public administration bodies shows that the key aspect of improving the efficiency of public servants in many countries is the creation of an objective and comprehensive system of indicators. For these purposes, all kinds of performance indicators are widely used. Improving efficiency is one of the important health issues, which is largely shaped by the effective work of government bodies. To date, a third of all money spent in the world on healthcare needs is used inefficiently, which is undoubtedly a consequence of the low efficiency of all health care participants, including labor resources with a constant shortage of personnel.Keywords: Efficacy, Effectiveness, Efficiency, Strategy, Health care.

Health-care Accessibility Assessment in Kazakhstan

BACKGROUND: Global health initiatives such as health for all and universal health coverage aim to improve access to health care. These goals require constant comprehensive monitoring to eliminate inequalities in the availability of health care.&#x0D; AIM: The purpose of our study was to assess the physical availability of medical care in Kazakhstan.&#x0D; METHODS: A descriptive study based on a Service Availability and Readiness Assessment (SARA) general availability index calculation that used secondary data as a source of information.&#x0D; RESULTS: The general availability index calculated for the regions of Kazakhstan ranged from 95% to 100%. When considering individual indicators of the index, decrease trends of the volume of inpatient care were identified. Outpatient care had fluctuations with values better than benchmark after 2009. Stable upward trend illustrates positive picture of core health personnel.&#x0D; CONCLUSION: According to the SARA availability index, it can be concluded that health care in Kazakhstan exceeds the threshold values and is available in all regions. Trends for individual indicators of the index should be studied in more detail, taking into account the influence of health policy and other factors.

Сравнительный анализ доступности лекарственного обеспечения пациентов с орфанными заболеваниями в Республике Казахстан за 2015 и 2020 годы

The aim of research: To conduct a comparative analysis of pathologies included in the List of orphan (rare) diseases in Kazakhstan for 2015 and 2020 with a further assessment of the dynamics of changes in the structure of the included diseases. Methods. In this paper, by using logical, systematic, and documentary analysis, a comparative analysis of the current legislation on the regulation of the treatment of orphan diseases in the Republic of Kazakhstan was carried out, as well as a comparative analysis of changes in this legislation. The data was used for 2015 and 2020. Results. Within the framework of the Order "On approval of the List of Orphan (Rare) Diseases" of the year 2015, this List included patients with the following diseases: (C) various types of neoplasms (this group included 16 nosologies, which is 32% of the total number of the included diseases), (E) diseases of the endocrine system, eating disorders and metabolic disorders (9 nosologies were included, the coverage rate was 18%), (D) diseases of the blood, hematopoietic organs and individual disorders involving the immune mechanism (8 nosologies were presented, which accounted for 16% of the total coverage of the included diseases), (G) diseases of the nervous system (total-4 nosologies, 8% of the total coverage), (A-B) some infectious and parasitic diseases (Anthrax, Crimean hemorrhagic fever, Malaria, Leishmaniasis – 4 nosologies, 8% of the total coverage), (Q) Congenital anomalies, deformities and chromosomal abnormalities (there are 3 nosologies, 6% of the total number), (M) Diseases of the musculoskeletal system and connective tissue (there are 2 nosologies, 4% of the total number of nosologies covered) and 1 disease according to the ICD-10 codes: (I) Diseases of the circulatory system, (J) Diseases of the organs, (K) Diseases of the digestive system, (L) Diseases of the skin and subcutaneous tissue. In 2020, the List of orphan diseases and medicines for their (orphan) treatment was updated. According to the new document, 62 groups of nosologies were already covered, that is 12 nosologies more than in 2015 and which accounts for 12%. The ratio of nosology coverage has not changed over time. Conclusions: In conclusion, it should be noted that due to the economic and political changes carried out in the field of health care in Kazakhstan over the past ten years, the coverage of medical care for patients with orphan diseases is constantly increasing. The drug supply of the corresponding categories of patients is also growing. The updated Code and by-laws will contribute to strengthening the health of the nation, including patients with rare (orphan) diseases. It is worth noting that an important factor is the development and approval of rules for the formation of the List of orphan diseases and medicines for their treatment with certain selection criteria. Thus, undoubtedly, there is an improvement in the dynamics of access to medical care for patients with orphan diseases in the Republic of Kazakhstan. Keywords: Orphan diseases, Rare diseases, Orphan medicines, Drug policy, Kazakhstan.

Оценка эффективности реализованных государственных программ в сфере здравоохранения Казахстана

The aim: evaluate the effectiveness of the implemented state programs in the field of healthcare in Kazakhstan. Methods. The paper analyzes 4 state programs for the development of the healthcare system implemented in the years of independence of Kazakhstan and describes preliminary data on the program - "State Program for the Development of Healthcare of the Republic of Kazakhstan for 2020-2025". Results. As a result of the implementation of the state programs "Healthy Nation", the state programs for 2005-2010, "Salamatty Kazakhstan", "Densaulyk", maternal mortality decreased by 3,3 times, infant mortality decreased by 1,7 times, mortality from diseases of the circulatory system almost 3 times, mortality from malignant neoplasms by 1,4 times, mortality from tuberculosis by 8,4 times, as a result, life expectancy increased by 6,96 years and reached 73,18 years. Conclusion. Over the years of implementation of health development programs of the Republic of Kazakhstan, there has been a positive trend in indicators that characterize the health of the population, which in turn contributes to improving the quality and increasing the life expectancy of the country's population. Basic health indicators have been improved and health funding has been increased. However, despite these results, life expectancy and funding remain low compared to other countries.

ОСОБЕННОСТИ ФИНАНСОВОГО ОБЕСПЕЧЕНИЯ СФЕРЫ ЗДРАВООХРАНЕНИЯ КАЗАХСТАНА В НОВЫХ УСЛОВИЯХ

Цель: в представленной статье с целью выявления особенностей финансового обеспечения сферы здравоохранения в Республике Казахстан авторами проанализировано долевое соотношение затрат по функциональному распределению в общем объеме социальных расходов за период 2013-2019 гг. в стране. Обобщены этапы финансового обеспечения системы здравоохранения Республики Казахстан. Выявленный тренд ежегодной динамики роста бюджетных затрат на обеспечение системы здравоохранения в Казахстане свидетельствует о сложившейся бюджетной модели финансирования отечественного здравоохранения. Также рассмотрен механизм программно-целевого финансирования здравоохранения Казахстана. Обсуждение: показано, что методы бюджетного обеспечения качественной медицины в Казахстане в новых условиях позволяет получить следующие эффекты: трехлетнее бюджетное планирование внедряет метод «управления результатами»; более эффективнее управлять средствами бюджета; определять ответственность за достижение результатов программы; достижение индикаторов и стандартов. Результаты: авторами был сделан вывод о том, что в условиях бюджетного финансового снабжения отечественной системы здравоохранения необходимо эффективно управлять государственными средствами.

Feasibility of alcohol screening and brief intervention in primary health care in Kazakhstan: study protocol of a pilot cluster randomised trial

BackgroundIdentifying and addressing heavy drinking represents a major public health priority worldwide. Whilst the majority of alcohol screening and brief intervention (ASBI) research has been conducted in western, high-income countries, evidence is growing that ASBI can also impact positively on heavy drinkers in low- and middle-income country populations. This mixed methods study aims to assess the feasibility of conducting a fully randomised controlled trial of the effectiveness of ASBI in primary care in Kazakhstan and explore the feasibility and acceptability of implementing ASBI in this setting from patients’ and physicians’ perspectives.MethodsSix primary health care units in the region of Pavlodar will be cluster randomised to either an intervention (WHO manualised 5 min alcohol brief intervention plus alcohol leaflet) or control group (simple feedback plus alcohol leaflet). Primary feasibility measures will be rates of participation at baseline and retention of eligible patients at the 3-month follow-up point. Patient/physician questionnaires and physician focus groups will assess additional dimensions of feasibility, as well as acceptability, according to the RE-AIM framework: Reach (rates of eligible patients screened/received advice); Effectiveness (change in AUDIT-C score); Adoption (rate/representativeness of participating physicians); Implementation (quality of ASBI/barriers and facilitators to delivery); and Maintenance (potential sustainability of intervention).DiscussionThis is the first trial of the feasibility and acceptability of ASBI in Kazakhstan. As the planning and assessment of implementation determinants is based on the RE-AIM framework, the project outcomes will be relevant for the future development, tailoring and implementation of ASBI in Kazakhstan.Trial registrationDRKS, DRKS00015882, Registered 17 December 2018.

Перспективы планирования развития приемно - диагностического отделения детской больницы

This article discusses the current state of children’s medical organizations on the example of the reception and diagnostic center of the city children’s hospital in Nur-Sultan. The main goals and objectives of planning the development of children’s medical institutions are also presented. In addition, measures are shown to improve the work of the children’s clinic. Improving the efficiency of health care in Kazakhstan is carried out within the framework of government programs developed to improve the key indicators of the country’s health care. Key words: healthcare, medical institutions, children’s hospital, Kazakhstan.

Development of electronic healthcare in Kazakhstan as a factor of improving the quality of medical services

The relevance of the article is determined by the priority of the task of improving the quality and availability of medical care to the population, improving medical education and the health care management system, in the context of the systemic implementation of e-health technologies. According to WHO terminology, e-health involves the use of information and communication technologies not only in the health care system, but also covers public health, health management, financial and economic, educational and scientific aspects related to this area.&#x0D; The article deals with the development of digital health care in Kazakhstan, the pace of development of which allows us to predict with confidence the intensive development of smart medicine in the future. The main stages of digitalization of health care were considered, while the main trends that characterize the features and problems of its development at the present stage were highlighted. It is expected that the introduction of information communication technologies into the health care system will allow a new level of quality of medical care provided to the population. The introduction of e-health technologies will allow remote monitoring of the population, increase patient awareness, improve access to health care, especially in remote areas.

The Adjusting use of Cost-Effectiveness Analysis in Formulary Management Within The Kazakhstan Healthcare System

The Adjusting use of Cost-Effectiveness Analysis in Formulary Management Within The Kazakhstan Healthcare System

The importance of Leadership towards universal health coverage in Low Income Countries.

Universal health coverage--defined as access to the full range of the most appropriate health care and technology for all people at the lowest possible price or with social health protection--was the goal of the 1978 Alma-Ata Conference on Primary Health Care in Kazakhstan. Many low-income (developing) countries are currently unable to reach this goal despite having articulated the same in their health-related documents. In this paper we argue that, over 30 years on, inadequate political and technical leadership has prevented the realization of universal health coverage in low-income countries.

A New Paradigm of Primary Health Care in Kazakhstan: Personalized, Community-based, Standardized, and Technology-driven.

This paper discusses the need for change from Kazakhstan’s current disease-centric healthcare paradigm to a new primary health and wellness-centric health care paradigm, technology-driven and based on personal relationships within a social context. While many different papers have been published about the importance of prevention and primary health care, few have focused on healthcare transition in Kazakhstan or other countries in Central Asia. The WHO’s historic 1978 Alma-Ata Declaration signed in Kazakhstan promoted the centrality of primary care to the provision of effective, efficient, and equitable health services. Modern technologies such as the Internet, social media, and portable medical devices democratize medicine, providing great opportunities to rethink the Alma-Ata Declaration and reinvent primary health care on an entirely new platform that is knowledge-based and technology-assisted. The new paradigm suggested for the future development of health in Central Asian region emphasizes personal relationships and encourages sustainable solutions created by communities. This paper also introduces HealthCity, a new project in Kazakhstan aiming at introducing private, community-based and standardized primary healthcare that is driven by SmartHealth innovative technology.