10 January 2023, 18:40
During the first 11 months of 2022 in Kazakhstan the total mortality rate decreased by 30% (29.7%) compared to the same period of the previous year. One can also note the reduction of mortality from circulatory system diseases by almost 34% (33.7%), cancer by 8% (8.3%), mortality from respiratory diseases by 1.7 times, and mortality from tuberculosis decreased by 12.5%. These data were reported by Health Minister Azhar Giniyat at the Ministry of Healthcare's Board meeting held today, January 10.
Azhar Giniyat started her speech with medical and demographic indicators.
"Last year we carried out a comprehensive work within the orders of the Head of State to improve the efficiency of medical care to the population. As a result of implementation of the mentioned commissions positive dynamics of main medical and demographic indicators is observed in the country," the Minister of Healthcare said.
Maternal mortality is down by more than 3 times (185 deaths a year in 2021, 57 deaths a year in 2022). Infant mortality has decreased by 3% this year. Life expectancy increased last year.
Instructions of Head of State
Since this year the Ministry of Health has begun implementation of the election platform of the President of Kazakhstan "A Fair Kazakhstan is for everyone. Now and forever". In it before sphere of public health services priority problems on improvement of financing of branch, development of an infrastructure of public health services organizations, including in rural areas, modernization of oncological service, and also service of maternity and childhood, development of digitalization of public health services and strengthening of propagation of a healthy way of life are defined.
In 2022 the efforts of the Ministry of Healthcare were focused on implementing the instructions of the head of state, as well as the activities of the national project "A Healthy Nation". As part of the implementation of the President's instructions, last year the Ministry of Health held meetings, personal meetings and briefings with more than 5,000 people in 17 regions of the country. Appropriate decisions were taken on the issues raised by citizens.
Primary Health Care
Primary health care is the service intended to coordinate all medical care for the population. Poor material and technical equipment, deterioration of buildings and insufficient staffing remain major problems in this sector of health care.
The Ministry has approved and is implementing an action plan to improve the accessibility of primary health care towards greater mobility and accessibility to the general population.
The following activities have been carried out as part of the plan:
In 2022, 9 additional city polyclinics and outpatient clinics will be commissioned.
"Taking into account the wishes of citizens, consultative and diagnostic services on 9 referrals are provided without a referral from a district doctor. Along with this, it should be noted that last year "Green corridor" was introduced to speed up examination and treatment of suspected oncological and haematological diseases," the head of the Ministry of Healthcare informed.
At the same time, the list of outpatient medication provision was expanded, the number of diseases in the list approved by the authorised body increased from 50 to 181, which increased outpatient medication provision to more than 3.8 million people by 54% compared to 2019.
It is worth noting that last year, the world's first WHO primary health care best practice site (for 53 Member States in the European region) was opened in Enbekshikazakh district of Almaty region. Representatives from CIS countries (Uzbekistan, Kyrgyzstan and Tajikistan), deputy heads of health departments and health workers from nine regions (Astana, Turkestan, Atyrau, Kyzylorda, Mangistau, Akmolinsk, Zhambyl, Almaty and Zhetysu) were trained at the site.
In 2023, the standard for the organization of primary health care will be updated. The role of the general practitioner will increase. In addition, advanced patient-oriented practices of primary health care approved by WHO will be introduced across the republic.
In addition, this year, work will be intensified to provide remote medical services that are in demand among the population. Youth mental and reproductive health services will reach about 1 million young people.
Special areas are being set up in prisons to ensure the medical supervision of persons serving sentences, and "prison" medicine is being developed.
"In order to encourage general practitioners, this year we are reviewing the incentive component of the aggregate per capita norm," Giniyat added.
In early 2022, Health Minister Giniyat already said that rural healthcare is lagging in Kazakhstan. In order to improve access to primary health care in rural areas, government regulations for the network of healthcare organisations were revised in 2022.
Medical care in villages with up to 50 people is provided by a nurse without premises, and in villages with 500 people the number of medical workers was increased from one to three (Order No. 59 of the MH of 30 June 2022), and feldsher-midwife stations are being opened.
To ensure accessibility of medical care to rural residents, last year 107 primary care facilities were put into operation (VVA - 22, MP - 67, FAP - 12, CHC - 3, polyclinics - 3). Mobile medical complexes are widely used to provide medical care in hard-to-reach rural settlements.
Also last year, two medical trains, Zhardem and Salamatty Kazakhstan, resumed operation. These trains covered 147 stations and provided medical assistance to more than 77,000 rural inhabitants, including 20,500 children.
Preventive examinations for rural inhabitants were also introduced in 2022. To date, of the 838,000 villagers examined, approximately 29,000 have been placed under dynamic observation for signs of high blood pressure, diabetes mellitus and kidney problems.
It should also be noted that the provision of district hospitals with modern CT scanners and X-ray machines has been brought up to 84 per cent (the plan is 74%).
Last year, the law was amended to provide medicines to the rural population, and an additional 72 pharmacies were opened at medical institutions and 161 private pharmacies in rural areas.
A national project on the modernization of rural health care was approved by a Government decision of 30 November 2022. In 2023 under the national project, the following will be provided:
In addition, the national project provides for equipping health care organizations with 575 units of modern medical equipment. As part of the implementation of the national project, 307 health workers will be trained in 2023, including 54 general practitioners and 253 nurses.
As a result of these measures, over 2.4 million rural residents will be provided with additional specialized medical care in 2023.
In view of complaints from the public about the quality of inpatient care and the need to travel abroad for high-tech treatment, work is under way in Kazakhstan to improve inpatient and hospital-substituting medical care.
To ensure the availability of specialized cardiac surgery and cardiology care, the Roadmap for Improving Medical Care for Circulatory System Diseases in the Republic of Kazakhstan for 2022-2023 has been approved and is being implemented (under which regulatory legal acts, organizational and advisory work in the regions, organization of medical care for chronic heart failure on the outpatient and inpatient levels, and improving human resource capacity are being developed).
Thus, at the end of 2022, as part of the Roadmap implementation, monitoring and analysis of equipment, coverage of medical equipment deficit in medical institutions of all levels of medical care for acute coronary syndrome and myocardial infarction, staffing shortage, as well as activities of PCI centres are continuously carried out. Identified coordinators of Roadmap in regions, fully mapped interaction process by levels and developed routes of patients' movement from FAP, SVA, CDH, HB to PCI centre, provided diagnosis (NT-proBNP) to identify heart failure in patients with CHF (not available in 3 regions (VKO, Kostanay, Mangistau), provided registration of patients with CHF.
171 offices for patients diagnosed with CHF have been opened in regional/city PHC organizations in the regions. As a result of work carried out in the republic, mortality from CHD has decreased by 32.2%, including hypertension by 36%, CHD by 42% (angina by 62.8%, acute myocardial infarction by 23.5%) and strokes by 29.4%.
There are 75 stroke centres in the country, 4 of which were opened in 2022 (before 2015 there were 36 SCIs), and 41 percutaneous coronary intervention centres to provide care for patients with acute coronary syndrome. In 2022 alone, 3 Level 2 PCI centres were opened (Astana, Shymkent and Turkestan).
It should be noted that a number of areas of medicine in Kazakhstan are already successfully competing at the international level. Thus, in our country the population is provided with access to 80 types of high-tech medical care. During first 11 months of 2022 there were 209 organ transplants (kidney - 162, liver - 40, heart - 4, lung - ), which is 22% more compared to the same period of 2021 (171 organ transplants).
The availability of highly specialised treatment for cancer patients with technologies such as Gamma Knife, radionuclide therapy and tomotherapy is increasing in the country.
In 2023, as part of the implementation of the President's election platform, it is planned to start a comprehensive modernisation of the oncology service (it includes: modernisation of the available diagnostic equipment, organisation of nuclear medicine centres; development of minimally invasive surgery and interventional treatment methods, increasing accessibility to the latest anti-tumour drugs, creation of modern oncology centres; expansion of the mobile teams for cancer patients, increase of hospice bed capacity, palliative care and the number of patients with cancer.
In order to improve specialized and high-tech medical care for the population, there are also plans to review more than 250 protocols for the treatment and diagnosis of diseases (cardiovascular system, cancer, etc., which will make it possible to bring treatment tactics as close as possible to internationally accepted standards). In addition, the construction of 8 health-care facilities in the regions is envisaged this year to ensure accessibility of medical care to the population.
As well as the commissioning of the National Center for Emergency Medicine in Astana and the National Scientific Center for Infectious Diseases in Almaty. In 2023, it is planned to begin the construction of a multi-purpose hospital with 630 beds in Kokshetau.
Human resources support
At present there is a need in health care manpower supply of more than 7,7 thousand (7,740) pcs. in the republic, including about 3,9 thousand (3,948.75) doctors, about 3,8 thousand (3,791.25) paramedical workers. In 2022, 4,700 educational grants, including 1,500 residency grants, have been allocated from the national budget to meet the needs of physicians, including those in acute deficit professions.
As part of the implementation of the instructions of the Head of State, a draft law on professional liability insurance for medical workers has been elaborated and submitted to the Majilis of the Parliament, which has already been approved by deputies in the first reading.
In order to improve the income of medical personnel, the average wage of doctors was increased by 30 per cent (416,000 tenge) and the average wage of nurses by 20 per cent (208,000 tenge) in 2022.
Particular attention is being given to improving the qualifications of medical personnel. Thus, in 2022 the national budget financed the training of 4,200 doctors, 138 of whom were trained abroad, as well as the training of 2,650 mid-level medical staff.
According to the data from the departments of health care at the expense of local executive bodies have been additionally trained more than 15,000 doctors, including 209 abroad, as well as trained more than 29,000 nurses. Thus in 2022 the need for doctors in rural areas was reduced by 12%, and the total need in the country was 26%.
"In 2023, after the adoption of the law, a system of professional liability insurance for medical workers will be introduced. These measures are intended to protect the rights of patients, provide legal protection for medical personnel, raise the prestige and respect for the medical profession, and attract the younger generation to the field of healthcare," the head of the Ministry of Healthcare emphasized.
Also this year it is planned to increase the number of grants at the expense of the state budget by 70% to 2.5 thousand. After the adoption of the bill on professional liability insurance, more than 270,000 health care providers will be provided with legal protection.
The Ministry is working to improve the provision of medicines and the development of domestic pharmaceutical production. In this regard, changes have been developed to simplify the conditions for the conclusion of off-take contracts, which have been worked out with experts from foreign companies. The amendments will make it possible to practically implement the conclusion of contracts with customers for contract manufacturing, to optimize access to the Kazakhstan market of original drugs for the provision of the population.
As part of the implementation of the instructions of the Head of State, centralised procurement of medical equipment has begun. In 2022 177 units of medical equipment to a total value of more than 20 billion tenge have been purchased and distributed in the regions. In this case the saving on public procurement procedures amounted to 3.1 billion tenge.
In addition, last year the state procurement of medicines and medical devices resulted in savings of 22.2 billion tenge.
From 2023 it is planned to carry out procurement of medical equipment with extended service life cycle, medical equipment will be supplied on condition that service will be provided by the supplying companies for the whole life cycle of the MT.
This year, the mechanism of contract manufacturing of medicines through localization of production of original foreign medicines in Kazakhstan will be actively implemented. Work with Big Pharma will be continued within the framework of implementation of the Election Platform to increase the share of domestic production in the pharmaceutical market to 50% by 2025 (a total of 6 memorandums have already been signed at present time including ROSH, Fresenius, Atabay, Nobel, Novartis and Novo Nordisk).
As a result of the implementation of the above measures, the equipment and medical equipment of health care organisations will reach 90% (the share of procurement of drugs and medical devices with local content within the guaranteed volume of free medical care and in the system of mandatory social health insurance will be - 36%).
Implementation of the compulsory social health insurance system
A compulsory social health insurance system has been in place since 1 January 2020.
As of 1 January 2022, the number of insured persons in the system was 15.5 million or 81.3% of the country's population. More than 700,000 more people were enrolled in the system throughout the past year, and the number of insured persons stood at 16.2 million or 83.2% of the country's population.
In 2022, the financing of the compulsory medical insurance system has increased by 25%. Additional financial resources were allocated for the development of the areas that used to suffer from lack of financing. Thus, the financing of preventive examinations was doubled, medical consultation and diagnostic services and rehabilitation increased by 1.5 times, inpatient care by 1.2 times, high-tech medical care by 2.2 times.
At the same time, in order to stimulate citizens last year an alternative mechanism of entry into the system for self-payers, by paying contributions for 12 months in advance with simultaneous cancellation of arrears for the previous period, was introduced.
Also as part of the implementation of the pre-election platform, the ministry is working to raise the level of funding for the sector to at least 5% of GDP in 2027. In 2023 it is planned to increase the financing of medical services by 11 per cent to 2 trillion 488 billion tenge (1 trillion 405 billion tenge within the framework of the State Municipal Health Insurance Fund and 1 trillion 83 billion tenge within the compulsory health insurance system).
At the same time, tariffs for priority areas of medical care will be reviewed, including in the light of an increase in the average wage of medical professionals.
In 2023, work will continue on attracting the population into the compulsory health insurance system.
There are also plans to merge the financial flows of the MHIF and the compulsory health insurance system into a single pool with a clear delineation of the list of medical care. Also in 2023, control of financial flows at all stages will be ensured, including through information systems.
As a result of the aforementioned measures, the salaries of medical workers are expected to increase this year, as well as funding for such areas as emergency medical care by 2.5%, HTMA by 7.8%, inpatient care by 2.7%, CDC by 7.6%, hospital substitution care by 5.3% and rehabilitation by 13.3%.
Sanitary and epidemiological well-being of the population
Over the past 2.5 years, in the context of the coronavirus pandemic, Kazakhstan has experienced six upsurges in the incidence of the disease, which lasted from one to three months. This year, in order to be prepared for new bio-threats, the Law of the Republic of Kazakhstan "On biological security of the Republic of Kazakhstan" was developed and adopted.
To stimulate the development of biopharmaceutical science and industry, the National Holding "QazBioPharm" was established with the transfer of 8 scientific centres and institutes into its composition. In order to maintain collective protection and a stable epidemiological situation, work on revaccination of the population continues.
A phased introduction of digital technologies into the activities of the sanitary and epidemiological service is planned for 2023 (conversion of vaccination reporting forms into electronic format; digitalization of control and surveillance activities; formation of a state biosafety information system).
In 2023, activities to strengthen the material and technical base and the development of epidemiological forecasting and response systems will continue.
Digitalization of health
The Head of State instructed to conduct an audit of the technical state of digitalization of health, based on the results of which measures should be taken to unify and integrate health information systems.
There are 47 health information systems in operation, which are supported by 8 subordinate organisations of the Ministry of Health. This creates fragmentation of medical data and business processes, which in turn affects the quality and timeliness of information provision.
In 2022, as part of the digitalisation of healthcare, the service for patients "eGov.Densaulyk" was launched in eGovMobile mobile applications, as well as SMS notification of citizens for proactive attachment to a medical organisation. As part of the Delivery unit project, 24 health indicators were developed and implemented on SmartDataUkimet. In addition, a pilot project was launched to dispense outpatient medicines by QR code through the "Social Wallet".
"As a result of the activities in 2022 the access to personal health data of citizens was provided, as well as awareness of citizens through SMS-notification," Giniyat said.
In 2023 it is planned to ensure expansion of information for patients in eGovMobile mobile application available in eGov.Densaulyk service.
It is also planned to ensure elimination of duplication of data entry by medical workers in multiple information systems, as well as full conversion of prescriptions into electronic format (including paid ones). It is also planned to implement a digital tool for confirmation of the fact of provision of medical care to patients (mobile applications) and full data exchange between various medical information systems (digital freedom).
International activities in the field of health care are carried out through close mutual cooperation with foreign countries, international organizations and integration associations.
In 2022 a two-year agreement on cooperation between Kazakhstan and the World Health Organization was signed.
In the same year, a number of visits of WHO leadership were organised to Kazakhstan: in August by WHO Director General Tedros Gebreyesus, in March and September by Director of the WHO Regional Office for Europe Hans Kluge. In 2022, Kazakhstan became for the first time the chairman of the Standing Committee of the European Regional Committee and regularly participated in the work of governing bodies of the WHO, including the Executive Board, the World Health Assembly, the WHO European Regional Committee and others, where a wide range of pressing issues of global health are discussed.
Eight international agreements have been signed with foreign states and foreign companies, including two at the intergovernmental level (Turkey and Qatar) and six with pharmaceutical companies (ROSH, Fresenius, Atabay, Nobel, Novartis, Novo Nordisk).
As part of Kazakhstan's chairmanship of the CIS, the XXXV meeting of the CIS Health Cooperation Council was held in Turkestan on 22-23 September 2022. More than 70 participants from 8 CIS member states took part in the meeting, including ministers, deputy ministers and chief sanitary doctors, as well as the director of WHO Regional Office for Europe H. Kluge, representatives of the CIS Executive Committee. Pharmaceutical companies have been involved in localising production in Kazakhstan (ROSH, Fresenius, Atabay, Nobel, Orhun Medical, General Electric, Novartis, Novo Nordisk, M3group).
In 2023, a key aspect of cooperation will be the promotion of the Astana Declaration on Primary Health Care at the level of the United Nations General Assembly.
In view of the agreements reached with the leadership of the WHO, it was decided to hold the 73rd session of the WHO Regional Committee for Europe in Kazakhstan in Astana on 24-26 October 2023. The session will be timed to the celebration of the 75th anniversary of the WHO, the 45th anniversary of the Alma-Ata Declaration and the 5th anniversary of the Astana Declaration on primary health care.
Summing up all of the above, Azhar Giniyat outlined the main objectives of the Ministry of Health in 2023.
"This year we start the implementation of the pre-election platform of the President of the Republic of Kazakhstan, the development plan of the Ministry of Health of the Republic of Kazakhstan for 2023-2027. The measures implemented this year will further increase the life expectancy of our people and improve access to health care," she said.
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