16 November 2022, 20:00
Minister of Healthcare Azhar Giniyat met with the population of Akmola region, where she reported on the current situation in the region.
As part of the instructions of the Head of State, the National Project "Quality and Accessible Health Care for Every Citizen, Healthy Nation" is being implemented.
The national project consists of 4 areas:
Work is also under way on the adoption of draft legislation to protect the rights of patients and insure medical professionals and raise their status.
An analysis of the region's medical and demographic indicators shows a positive trend.
Thus, according to the results of the 9 months of 2022 in Akmola region there is a 27% reduction of the total mortality rate. The indicators of maternal mortality, mortality from circulatory system diseases, malignant neoplasms, tuberculosis and injuries are also decreasing.
The Biosecurity Act was adopted in pursuance of the President's instructions to stabilize the epidemiological situation in the country. The main aim of the law is early detection of biological risks and prevention.
Kazakhstan has natural hotbeds of particularly dangerous infections. This year, cases of anthrax and Crimean-Congo haemorrhagic fever have been registered in the country.
Since the beginning of year in Kazakhstan there are 20 laboratory confirmed cases of anthrax in Kazakhstan (13 cases in Zhambyl region, 5 cases in Turkestan region, 1 case in Akmola region, 1 case in Kostanay region), including one case with lethal outcome (Zhambyl region).
Situation on Congo-Crimean haemorrhagic fever
From the beginning of the year 36 confirmed cases of CPHF have been registered (in Kyzylorda region - 16 cases, Turkestan region - 12 cases, Zhambyl region - 2 cases, and in Shymkent city - 6 cases), including 9 lethal cases (in Kyzylorda region - 5 cases, Zhambyl region - 1 case, Turkestan region - 1 case, and in Shymkent city - 2 cases).
Situation on rabies
Since the beginning of the year there was one confirmed case of rabies (Turkestan region) with fatal outcome.
This year there is a decrease in the incidence of 12 nosologies, including a decrease in the incidence of coronavirus infection by 38%.
According to the results of 9 months, the coverage of preventive vaccination of the eligible population was 77.5% or 1.5 million people.
"Stabilization of the situation with coronavirus infection has been noted. Since February this year Akmola region is in the "green zone". No cases of CFI have been registered during the last 24 hours. Measures have been taken to ensure that the population is covered with revaccination against coronavirus infection. To date in Akmola region revaccinated 176 thousand people," Giniyat said.
Revaccination coverage in the region is 64,3% of population to be vaccinated that is lower by 6% than average republican value.
Reproductive Rt number on the basis of registration of confirmed and probable cases of COVID-19 was 3.375, bed occupancy rate was 0.28.
Since the beginning of the school year (from 01.09.2022) 42 cases of coronavirus infection among school children have been registered.
As of today, 1 million people have been vaccinated in the first and second stages in the region, and the coverage rate is 75.4% of the region's population.
Of all those vaccinated with the Comirnati vaccine by Pfizer 110,000 people have been vaccinated, including 95,000 teenagers aged 12-17 years, 2,836 pregnant women, 9,600 women in lactation and 1,896 others.
The total number of revaccinated persons was 741 thousand and the coverage was 89.8% of the eligible population. The number of revaccinated persons was 214 thousand and the coverage was 64.2% of the eligible population.
Vaccination against influenza is continuing; 43,000 people have been vaccinated to date, or 6.2% of the total population of the region.
The basic element in system of public health services is the primary medical-sanitary service which is called to coordinate all medical aid to the population.
There are 531 PHC facilities in Akmola region, which is 9% of all PHC organizations in the republic. Last year, the Ministry carried out an inventory of the country's medical facilities.
On instructions from the Head of State, an action plan to improve the availability of primary health care in the direction of greater mobility and accessibility to a wide range of the population, including those living in rural areas, was approved to fundamentally revise approaches to the organization of primary health care.
In order to improve the quality of medical care in rural areas, projects for best practices in primary health care, a "patient-centred approach" approved by the WHO, are being implemented.
At the request of the population, the Rules for the provision of specialised medical care in outpatient settings were approved, which provide for the provision of consultative and diagnostic services without the referral of a general practitioner.
Also, in order to speed up examination and treatment of suspected oncological and haematological diseases, a "Green corridor" has been introduced, in which patients with suspected cancer are consulted and examined, within 18 working days (laboratory tests, ultrasound, X-ray, ECG, CT, MRI, as well as endoscopy).
Work continues on bringing the proportion of funding for primary health care in the country to 60% of total health care funding, which amounted to 54% this year.
Outpatient surgery is being developed, where the volume of services is expected to increase by 1.7 times this year. Also, the department is taking measures for development of stage III of outpatient rehabilitation.
In the framework of improvement of school medicine, a new standard will be introduced that will systematize approaches to medical examinations of students and strengthen early detection of diseases of gastrointestinal tract, musculoskeletal system, vision, etc.
Consultative and diagnostic services have also been increased by a factor of 1.5, which will improve access to early diagnosis of diseases and reduce private health-care costs.
In order to improve accessibility, the list of medicines within the framework of outpatient drug provision has been expanded to include expensive drugs. So this year 11 names of expensive drugs for the sum of 1,2 billion tg were bought and shipped for the region.
The Minister dwelt separately on rural healthcare. At present time in rural areas 5 thous. 397 medical organizations render medical services (2895 - infirmary, 790 preparatory medical stations, 1282 dispensary, 227 polyclinics, 203 hospitals), in Akmola region - 543.
At the same time, depreciation of these organizations in the republic is 52.6%, in the region - 69.7%. To ensure accessibility of medical care in hard-to-reach rural settlements the potential of mobile medical complexes is widely used (149 mobile medical complexes will cover 1.8 million rural residents in 2021).
"In your region there are 11 mobile medical complexes, which in 2022 covered 255 settlements. About 57,000 people were examined by medical examination, 2,000 of them were diagnosed with diseases, which is 3.4% of the examined rural residents. In accordance with the instructions of the Head of State, the Ministry of Healthcare has developed a pilot project entitled "Modernization of rural health care". Together with the regional Akimats we have started preparatory work for construction of 655 primary healthcare facilities, including 253 first-aid stations, 160 outpatient clinics, and 242 feldsher-midwife stations," Giniyat explained.
In Akmola region, 38 primary healthcare facilities are to be built in the countryside. Besides, in the framework of pilot project 32 multi-district central hospitals are to be opened and reconstructed in the republic including retrofitting of 2 hospitals in Akmola region: these are multi-district hospitals in Atbasar and Bulandin districts.
The hospitals will be equipped with stroke and cardiology departments, cardiovascular centres, intensive care units, intensive care units, units for minimally invasive surgery, traumatology and rehabilitation. It is envisaged to equip the Centre with modern medical equipment (CT, MRI, angiography, expert class ultrasound, endoscopic, reanimation and medical rehabilitation equipment) and to carry out major renovation works.
The pilot project aims to reduce the imbalance between rural and urban healthcare, Giniyat said.
"Since October 20, Kazakhstan has launched a major campaign of preventive examinations of the rural population. Today, early diagnosis of diseases suffers in the countryside, and there is a lack of access to consultative and diagnostic services. The Ministry of Health has therefore revised its approach to preventive check-ups (screenings) for the rural population. Previously, preventive examinations were conducted for early detection of cardiovascular diseases, glaucoma, diabetes, cancer and behavioural risk factors," Giniyat said.
The innovations are expansion of list of screenings for early detection of gastrointestinal diseases, urinary system, respiratory system in older age group, prostate cancer, as well as coverage of persons aged 18 to 29 years old with screenings.
The following target groups have been identified: "Children" from birth to 18 years of age; "Zhastar" from 18 to 29; "Enbek-1" from 30 to 44; "Enbek-2" from 45 to 65; and "Zainetker" over 66 years of age.
To date, of the 37,000 villagers surveyed, more than 800 have been diagnosed with early signs of illness and are found to have high blood pressure, diabetes or kidney problems.
Additional general clinical laboratory tests (of urine and blood) have been included for children aged 1, 3, 6 and 14 years. During the first nine months of the year more than 4 million children were examined, 343,000 children were diagnosed for the first time, and 128,000 of them were placed under active observation.
"One of our top priorities remains maternal and child health care. In 9 months of the year 2022, 9.4 thousand babies were born in the region. According to the results for 9 months of 2022 in Akmola region the maternal mortality rate has decreased 4.5 times. On the instructions of the President, a special programme entitled "Onsagan saby" has been launched since 2021 which provides for the allocation of 7,000 IVF treatment quotas annually until 2026. Under the programme, 283 quotas were allocated in Akmola province in 2021, 111 women have become pregnant and 72 families have been blessed with a child. Preventive check-ups for children have been expanded," the Minister of Healthcare informed.
However, there are a number of problems, which require urgent solution: ensuring quality improvement of care for premature babies, early identification of children with pathologies.
Maternal and child health is under special control of the Ministry. One of the problematic issues is the increase of infant mortality.
For 9 months of this year in Akmola region, there is a 2.5% increase (9M 2022 - 5.30 per 1000 live births, 9M 2021 - 5.17).
The main causes of infant mortality remain perinatal causes, with congenital birth defects in second place and infectious and parasitic diseases in third. This question is constantly monitored by the Ministry.
A screening programme for newborns and young children has been introduced in order to ensure early coverage and diagnosis of diseases in children; it provides a step-by-step comprehensive approach, accompanying every child from the newborn period until school age.
1) Neonatal screening covered 445,212 children (99.6%). A total of 231 children with phenylketonuria and 3,549 children with congenital hypothyroidism were identified.
2) Audiological screening covered 1.6 million children (75.6%). A total of 625 children were diagnosed with hearing losses of the 1-2 degree and 646 with hearing losses of the 3-4 degree. 235 children received cochlear implants.
3) Over 1.7 million children (85.2%) were covered by psychophysical screening.
13,863 children with psychophysical developmental disabilities and 1,232 children with hearing impairments were referred to a psychological, medical and pedagogical consultation for further correction.
4) Ophthalmological screening was provided for 6,532 (88.2%) children with extremely low birth weight over 500 gr. Surgical treatment was provided to 273 premature babies (29.4%).
The most problematic region for performing screening tests is Almaty city (9.8), low screening coverage is observed in Kostanai region (65.8), Akmola region (75.0).
Also, a pilot project has been launched for the selective screening of newborns for 49 hereditary metabolic diseases (to identify the population of new metabolic diseases).
In 2022 services worth 867 mln tenge were rendered within the framework of high-tech medical care in the region, which is 17% more compared to the last year.
The Minister also said that to date the healthcare system is provided with 78 thousand staff doctors, including 1.9 thousand staff units in Akmola region. Shortage of medical personnel in the region is 258 staff units.
This year 2,980 graduates of medical schools are distributed in the regions, including in Akmola region - 36, including 17 in rural areas (2021 - 69 graduates, including 44 in rural areas).
In order to decrease personnel shortage within the state educational order 120 places are allocated for training of specialists for the region including 19 places for pediatricians, 12 places for physicians, 10 places for obstetricians and gynecologists, 8 places for anesthesiologists and resuscitators, 4 places for cardiologists.
The Akimat of Akmola region allocates around 300 grants annually, including 35 grants for residency training, 50 grants for training in general medicine, and 190 grants for mid-level medical staff.
Since 2018, the Kokshetau State University named after Sh. A medical faculty has been opened at Ualikhanov State University with 740 students, 200 of whom receive grants from the akim (50 grants are allocated annually).
Kokshetau higher medical college trains intermediate level specialists in eight specializations.
The Republic makes provision for social support measures for young professionals recruited to work in the countryside. In 2021, 282 specialists received such payments, 222 received housing, and 92 were provided with other social support measures.
In Akmola region 12 specialists received assignment allowances, 17 specialists received housing. Akimat of Akmola region determines the amount of installation grants for young specialists employed in cities of district and regional level in the amount of 1,5 million tenge, and for rural areas - 2,5 million tenge.
"Last year, we developed a draft law providing for the introduction of a system of professional liability insurance for medical workers. Work is underway to increase salaries of medical workers by 2 times the average wage in the economy. By 2023, the average salary of doctors will be 531,000 tenge, and that of nurses 250,000 tenge. Every year we issue state educational orders and grants for the training of about 5,000 medical personnel, and ensure the distribution of graduates," Giniyat said.
In addition, a pilot project is under development to provide residents with internships in rural areas. The head of state has instructed to increase the number of residency grants by 70% annually over the next three years.
One of the priority tasks of the national healthcare system is the uninterrupted supply of medicines to the population of our country. For this purpose, the Single Distributor SK-Pharmacy LLP has purchased medicines to the amount of over 196 billion tenge (196.4 billion tenge) within the framework of outpatient drug supply, with 100% of purchased medicines delivered to the regions; medicines to the amount of over 177 billion tenge (177.8 billion tenge) have been purchased at the hospital level, with 93% of purchased medicines delivered to the regions.
In Akmola region, medicines worth over 8.6 billion tenge have been procured at the outpatient level and medicines worth over 5.4 billion tenge have been procured at the inpatient level.
In addition, an inventory of all health-care organizations, including maternity and intensive-care services, was carried out to provide them with medical equipment, medicines and medical devices.
The medical equipment level is 85.2%, and wear and tear stands at 44.4%. In Akmola region provision with medical equipment made up 80.8%, depreciation is 43.6%.
Within the framework of general transfers for 2023-2025 minimum volume of budgetary funds for purchase of medical equipment in Akmola region is established at the rate of 3.6 billion tenge.
At the same time, for 2023-2025 target current transfers for material and technical equipment (National Project "Healthy Nation") of health organizations in the region in the amount of 8.9 billion tenge are provided.
In terms of implementation of instructions of the Head of State given at the enlarged meeting of the Government on February 8, 2022 transition to centralized purchase of medical equipment on the basis of "SK-Pharmacy" is carried out.
Medical equipment will be supplied from November 15, 2022 to December 28, 2022.
Lots for 5 units of medical equipment are at different stages of tender procedures (review by the tender committee, submission of addenda by suppliers, auctions).
Due to the lack of competitive environment during the tender and absence of repeated bids from the customers for procurement of 5 units. MTs were not procured.
On the whole, the launch of at least 30 new facilities for the production of drugs and medical devices, including the involvement of Big Pharma (Roche, PFIZER, etc.), the development of the National Regulator for international recognition of domestic pharmaceutical products (construction of the laboratory at the NCED in Astana), digitalization of all processes of drugs and medical devices (from filing to their turnover), the introduction of labelling and traceability of drugs (from January 1, 2023) are provided within the development of national pharmaceutical production.
On 1 January 2020, a compulsory social health insurance system is implemented in the country. As of 1 November 2022, 16.2 million people were registered with the compulsory health insurance system, representing 82.1% of the country's population. However, 3.5 million people are still outside the MHI system, with 160,000 people (21.3%) in Akmola region.
It should be noted that due to the implementation of compulsory social health insurance the financing of medical services has increased by 25% compared to 2021, including
- Preventive medical examinations - by a factor of 2;
- Consultative and diagnostic services - by 1.5 times
- Inpatient care by a factor of 1.2
- High-tech medical services (2.2 times)
- Rehabilitation by a factor of 1.5.
There has also been an increase in the number of expensive CT, MRI and PET examinations.
In addition, we have recently taken measures to finance new expensive technologies at the expense of the MHI.
- Gamma Knife radiosurgical treatment;
- Selective intra-arterial chemotherapy for retinregionoma;
- percutaneous transpedicular fixation of the spine;
- transpedicular grafting of the vertebral body;
- Corrective tibial osteotomy;
- and 18 radioisotope diagnostic services.
Work is under way this year to increase health insurance coverage for the uninsured population by introducing an alternative mechanism for the payment of mandatory social health insurance premiums (12 months' contributions in advance).
In 2022 the following sums have been earmarked for medical services in Akmola province under the free medical assistance guarantee and CMI system
70,4 billion tenge, of which 6,5 billion tenge is allocated additionally after audit of medical organizations of the region.
The health care system has a number of priorities for implementation by the end of the year: