Implementation of Presidential instructions: Ministry of Healthcare develops pilot project "Modernisation of Rural Health Care"

Last week, Minister of Healthcare Azhar Giniyat made a working visit to East Kazakhstan and Abay regions. During the briefing and at meetings with the population the Head of the Ministry of Healthcare told about the ongoing work carried out by the Ministry together with the regions and about the progress in the implementation of the tasks set by the Head of State in the field of health care.

National Healthy Nation Project

The Minister spoke in detail about the Healthy Nation national project "Quality and Affordable Healthcare for Every Citizen", which is being implemented in the framework of the instructions of the head of state.

According to her, the National Project consists of four areas:

- The first direction is related to improving the accessibility and quality of medical care;

- The second direction is to form a modern system of epidemiological forecasting and response;

- The third pillar will contribute to the development of the domestic pharmaceutical industry;

- And the fourth is aimed at increasing the proportion of the population leading a healthy lifestyle and the development of mass sports.

Also, according to the minister, work is underway on a draft law to protect the rights of patients and insure health care workers and raise their status.

An analysis of the region's health and demographic indicators shows a positive trend.

"I would like to point out that based on the results of 9 months of 2022 there is a reduction of total mortality by 13%, mortality from cardiovascular diseases by 23%, from malignant tumours by 9% and from injuries by 2%. Maternal mortality rates are also falling," Giniyat said.

Sanitary and epidemiological well-being

The Law on Biological Safety has been adopted in the framework of the instructions of the head of state on stabilising the epidemiological situation in the country. The law focuses on early detection of biological risks and prevention. Kazakhstan is facing natural hotspots of especially dangerous infections, the Minister said. This year cases of anthrax and Congo-Crimean haemorrhagic fever have been registered in the country.

For reference:

Anthrax situation

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). Of these, one case was fatal (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. East Kazakhstan region has been in the "green zone" since February this year. No cases of CFI have been registered during the past 24 hours," Giniyat said.

Measures have been taken to ensure that the population is up-to-date with revaccination against the coronavirus infection, she said. As of today 741 thousand people in East Kazakhstan region have been vaccinated. Coverage by revaccination in the region is 89,8% of population to be vaccinated that is higher than average republican value by 19% (in Kazakhstan it is 70,7%), Giniyat noted.

For reference:

Reproductive Rt based on registration of confirmed and probable cases of COVID-19 was recorded at 3.375, bed occupancy rate at 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.

Among all vaccinated with a vaccine "Komirnati" company "Pfizer" 110 thousand persons, including 95 thousand teenagers at the age of 12-17 years, 2 836 pregnant women, 9,6 thousand women in the lactation period, others have been vaccinated with 1,896 persons.

The total number of revaccinated persons was 741 thousand and the coverage was 89.8 per cent of the eligible population. The number of revaccinated persons was 214,000 and the coverage was 64.2 per cent of the eligible population.

Vaccination against influenza is continuing; 43,000 people have been vaccinated to date, or 6.2% of the total regional population.

Improvements in primary health care continue

The core link in the healthcare system is primary healthcare. It is a service, called to coordinate all medical care to the population.

In East Kazakhstan region there are 293 PHC facilities, which is 5% of all PHC organizations in the republic. There are 263 primary health care facilities in Abay region.

Last year, the Ministry carried out an inventory of the country's medical facilities.

For reference:

As a result of the nationwide inventory, 493 rural areas without healthcare organizations have been identified. In the East Kazakhstan region there are 69 SNPs without medical organizations.

"On the instructions of the Head of State, an action plan to improve the accessibility 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 of best PHC practices "patient-centred approach", approved by the WHO, are implemented," Giniyat said.

According to her, these include:

- Patient support service, informed public monitoring and community feedback mechanism (IPMOS);

- Early detection of non-communicable diseases, disease management programmes;

- education on healthy lifestyles, nutrition;

- universal progressive model of patronage, family planning, improvement of men's health, child development office.

In this regard, the Minister praised the positive experience of the District Polyclinic in Yenbekshikazakh District of Almaty Region, which has been recognized as a demonstration site of primary health care for 53 Member States of the WHO European Region, along with Spain and Sweden.

In addition, she said, with the introduction of best practices at the level of polyclinics, approaches to the provision of medical care at the level of multidisciplinary central district hospitals are being improved.

The Minister also cited best practices at Ayagoz multi-disciplinary central district hospital, which introduced modern methods of diagnosis and treatment, used in international and domestic practice, including minimally invasive surgical interventions (diagnostic and therapeutic laparoscopy, cholecystectomy, appendectomy, hernioplasty, arthroscopy, intramedullary osteosynthesis). This experience is being adopted by all regions of the country.

"At the request of the population the Rules for provision of specialized medical care in outpatient settings, which provides for the provision of consultative and diagnostic services without a general practitioner referral," Giniyat continued.

In addition, according to her, to speed up examination and treatment of suspected oncological and haematological diseases the "Green corridor" has been implemented, within which patients with suspected oncological diseases are consulted and examined, within 18 working days (laboratory tests, ultrasound, X-ray, ECG, CT, MRI, as well as endoscopy).

Work is continuing to bring the proportion of funding for primary health care in the country to 60 per cent of total health care funding, which stood at 54 per cent this year.

Outpatient surgery is developing, where the volume of services is planned to increase by 1.7 times this year (the fact of 2021 - 146,835 services, the plan for 2022 - 252,708 services).

Steps are being taken to develop phase III of outpatient rehabilitation.

"Within the framework of improvement of school medicine, a new standard will be introduced, which will make it possible to systematise approaches to check-ups for schoolchildren and strengthen early detection of diseases of the gastrointestinal tract, musculoskeletal system, vision, etc. Consultative and diagnostic services have been increased by 1.5 times, which will increase accessibility of early detection of diseases and reduce private spending on health," Giniyat informed.

According to her, in order to increase accessibility the list of drugs within the outpatient drug supply was expanded to include expensive drugs. Thus, this year the region purchased and shipped 11 high priced drugs worth 1.2 billion tenge.

The Ministry of Healthcare developed a pilot project "Modernization of Rural Health". 

The Minister paid special attention to development of rural healthcare.

"Nowadays medical care in the countryside is provided by 5 thousand 397 medical organizations (2895 - first-aid posts, 790 - feldsher stations, 1282 - outpatient clinic, 227 - polyclinics, 203 - hospitals), in East Kazakhstan region - 297, in Abay region - 294. However, depreciation of these organizations in the republic is 52.6%, in East Kazakhstan - 68%, in Abay region - 69.6%," Giniyat said.

Giniyat reported that in order to provide access to health care in remote rural areas the potential of mobile medical complexes is widely used (149 MMCs will cover 1.8 million rural population in 2021).

In the eastern region there are 16 PMKs, which in 2022 covered 374 settlements, medical examination covered about 94 thousand people, of whom 5.6 thousand people were diagnosed with diseases, which is 6% of the surveyed villagers.

"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 preparatory work has started for the construction of 655 primary health care facilities, of which 253 are first-aid stations, 160 are outpatient clinics and 242 are feldsher-midwife stations. In East Kazakhstan region there are plans to build 36 primary health care facilities in rural areas. In Abay region, 65 primary healthcare facilities will be built in rural areas," Giniyat said.

According to her, 32 multi-district central hospitals are to be opened and reconstructed within the pilot project across the country, including 1 hospital in East Kazakhstan region (an inter-district hospital of Altai District) and 2 hospitals in Abay region (an inter-district hospital of Ayagoz District and an inter-district hospital of Urjar District).

The hospitals will have stroke and cardiology departments, CPR centres, intensive care units, minimally invasive surgery, traumatology and rehabilitation units. Provision has been made to equip the ICRC with modern medical equipment (CT, MRI, angiography, expert ultrasound, endoscopy, intensive care and medical rehabilitation equipment) and to carry out major renovations.

A new State standard for the network of health-care organizations has been approved, which will make it possible to provide home health care workers in settlements with a population of up to 50 people; previously these villages had not had this option.

In villages with between 50 and 500 inhabitants it is planned to open medical centres, and in villages with between 500 and 1,500 inhabitants (previously there were between 800 and 1,500) medical and obstetric centres.

In villages with a population of between 50 and 1,500, midwives, paramedics and obstetricians will be recruited. Outpatient clinics will be opened in localities with a population of between 1,500 and 5,000 (previously there were between 1,500 and 10,000); primary health-care centres will also be set up in villages with populations of over 5,000. The innovations include the expansion of outpatient units at the discretion of the local authorities.

The aim of the pilot project is to reduce the imbalance between rural and urban health care.

Maternal and child health care among priorities

Mother and child health protection remains a top priority for the healthcare system.

The birth rate peaked in 2021, with more than 450,000 births in Kazakhstan's history of independence, including 9,400 births in East Kazakhstan region, the Health Ministry said. For 9 months of 2022 there were 8.3 thousand births and 8.33 thousand babies were born in East Kazakhstan region, 8.5 thousand births and 8.6 thousand babies were born in Abay region.

Following the results of 9 months of 2022 the maternal mortality rate in East Kazakhstan region decreased 3.6 times.

On instructions from the President of Kazakhstan a special programme entitled "Onsagang sabi" has been launched since 2021, which provides for the allocation of 7,000 IVF quotas annually until 2026. In the framework of this programme, 250 quotas have been allocated in East Kazakhstan province in 2021. 

Preventive check-up packages for children have been expanded.

"At the same time there are a number of tasks requiring urgent solution: ensuring improvement of the quality of care for premature babies, early identification of children with pathologies. Maternal and child health is under special control of the ministry," Giniyat said.

According to her, one of the problematic issues is an increase in infant mortality.

As of first eight months of the current year infant mortality rate in East Kazakhstan region increased by 23% (7.7% for 8 months of 2022, 6.2% for 8 months of 2021).

"The main causes of infant mortality remain causes arising in the perinatal period, with congenital birth defects in second place and infectious and parasitic diseases in third. This issue is under constant control of the Ministry," Giniyat assured.

As the head of the Ministry of Healthcare further informed, in order to ensure early coverage and diagnosis of diseases in children, the country introduced a screening program for newborns and infants, which allows implementing a phased comprehensive approach, accompanying each child from the newborn period until school age.

For reference:

1) Neonatal screening covered 445,212 children (99.6%). 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 of 500 grams or more. Surgical treatment was provided to 273 premature babies (29.4%).

A pilot project has also been launched for the selective screening of newborns for 49 inherited metabolic diseases (in order to identify a population of new metabolic diseases).

The level of provision of high-tech medical care is increasing. In 2022, services worth approximately 3 billion tenge were provided within the framework of such assistance in the region, an increase of 50 per cent compared to the previous year.

Shortage of medical personnel in East Kazakhstan region and Abay region is more than 200 specialists

For today in system of public health services provision with 78 thousand regular staff units of physicians, including in East Kazakhstan region 6 thousand regular staff units, in Abay region 1,2 thousand regular staff units. Shortage of medical personnel in East Kazakhstan region is 144 staff units, in Abay region is 81 staff units.

This year 2 980 graduates of medical schools were distributed to the regions of the country, including 154 ones to East Kazakhstan region, 36 of them - to rural areas, 37 ones to Abay region, 13 of them are to rural areas.

"In order to reduce the staff shortage within the state educational order for training of specialists 178 places were allocated for the region, of which 20 are internists, 29 places are for pediatricians, 15 places are for obstetrics and gynecology, 17 places are for anesthesiologists and resuscitation specialists, 5 places are for surgeons," Giniyat said.

As she noted further, the country provides for measures of social support for young professionals coming to work in the countryside. Thus, in 2021 282 specialists received allowances, 222 received accommodation and 92 specialists were provided with other social support measures.

In East Kazakhstan province 7 medical workers were provided with social support measures. In this connection, regional akimat should strengthen social support.

"As for the quality of medical services, last year we developed a draft law providing for introduction of a system of professional liability insurance for medical workers," Giniyat said.

According to her, work is underway to increase medical workers' wages by 2 times the average wage in the economy. By 2023 the average salary of doctors will be 531,000 tenge, and nurses - 250,000 tenge, respectively.

On an annual basis, State educational orders and grants are issued for the training of about 5,000 medical personnel, and the distribution of graduates is carried out. In addition, a pilot project involving obligatory internships for residents in rural areas is being developed.

The Head of State has instructed that the number of residency grants should increase by 70% annually over the next three years.

Uninterrupted drug supply is one of the important tasks

According to the minister, uninterrupted drug supply to the population of our country is one of the priority tasks of the national healthcare system.

For this purpose, a single distributor SK-Pharmacy LLP purchased medicines to the amount of over 196 billion tenge (196.4 billion tenge) within the framework of out-patient drug supply; 100% of purchased medicines have already been supplied to the regions. At the inpatient level, pharmaceuticals worth more than 177 billion tenge (177.8 billion tenge) have been purchased, with 93% of the purchased volume delivered to the regions.

In East Kazakhstan region, medicinal products worth more than 15.5 billion tenge were purchased at the outpatient level and over 12 billion tenge were purchased at the inpatient level.

"To improve access to medicines not included in outpatient drug provision, amendments have been made to the Code on public health and the health-care system to establish pharmacy outlets at rural health-care facilities. In addition, an inventory of all health facilities, including obstetric and intensive care services, was carried out to provide them with medical equipment, medicines and medical products," Giniyat said.

According to her, medical equipment equipment is 84.7%, wear and tear makes up 43.1%. For East-Kazakhstan region the medical equipment equipment was 85.7%, wear and tear is 41.3%.

Within the limits of formation of transfers of a general character for 2023-2025 for East Kazakhstan region the minimum volumes of budgetary funds on acquisition of medical equipment in size of 5,2 billion tenge, for Abajsk region the minimum volumes of budgetary funds on acquisition of medical equipment in size of 8,2 billion tenge are established.

At the same time, for 2023-2025 it is provided target current transfers for material and technical equipment (the national project "Healthy nation") of health organizations of East Kazakhstan region in amount of 3,1 billion tenge, of Abay region in amount of 2,8 billion tenge.

Within the limits of realization of instructions of the Head of the state given at the enlarged meeting of the government on February 8, 2022 transition to the centralized purchase of medical equipment on the basis of "SK-Pharmacy" is carried out.

"In the country as a whole, the development of domestic pharmaceutical production includes the launch of at least 30 new manufacturing facilities for the production of drugs and MI, including the involvement of Big Pharma (Roche, PFIZER, etc.), development of the national regulator for international recognition of domestic pharmaceutical products (construction of laboratory at NCELS in Astana. Astana), digitalization of all processes of drugs and medical products circulation (from application to turnover), the introduction of labelling and traceability of medicines (from January 1, 2023)," Giniyat said.

Implementation of MSHI

The head of the Ministry of Healthcare also spoke in detail about the system of mandatory social health insurance (MSHI), which, as we know, is implemented in the country from 1 January 2020.

"As of October 1, 2022, 16.2 million people were registered in the MHI system, which is 82.6% of the population of our country. At the same time, 3.4 million people are still outside the MHI system, and in East Kazakhstan region this number reaches 229,900 people (17.1%)," Giniyat said.

According to her, due to implementation of mandatory social health insurance compared to 2021 financing of medical services has increased by 25%, including

- preventive medical examinations - by 2 times;

- 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, the Ministry of Health has taken measures to finance new, expensive technologies with compulsory health insurance funds.

For reference:

- 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.

This year, the Minister said, she is working to increase health insurance coverage for the uninsured population by introducing an alternative mechanism for paying mandatory social health insurance premiums (12 months in advance).

In 2022 61 billion tenge (2021 it was 52,9 billion tenge) are allocated for medical services within the guaranteed volume of free medical care and MHI system, of which 11 billion tenge is allocated additionally after audit of medical organizations of the region.

Talking about the priorities of the Ministry of Healthcare, the Minister pointed out a number of areas requiring special attention. Among them are:

- Implementation of the 'Healthy Nation' national project 'Quality and Accessible Healthcare for Every Citizen'.

- Development and implementation of the pilot national project "Modernization of rural health".

- Adoption of a law on professional liability insurance for medical workers.

- Establishment of multidisciplinary university hospitals and clinics under medical universities.

- A phased increase in the number of grants for residency training by 70% over three years.

"Last year, the ministry did important work in all areas of public health. Alongside the achievements, there are also challenges that need to be addressed immediately. We need to bring together professionals and civil society to develop effective solutions that improve the quality and accessibility of health care for the country's residents," Giniyat said at the end of the meeting in the region.

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