Densaulyq State Healthcare Development Program – 2017 results
In the Kazakhstan-2050 Strategy, the President Nursultan Nazarbayev emphasized that, in order to develop the country further and become one of the 30 most developed countries in the world, the gap between the countries of the Organization for Economic Cooperation and Development (OECD) and Kazakhstan should be reduced by 2050.
In this regard, the state should ensure the phased implementation of OECD standards aimed at increasing the quality and accessibility of health services, improving the management and financing of the health system, and rational use of available resources.
Thus, in accordance with the Decree of the President N. Nazarbayev, for the planned achievement of health indicators of citizens corresponding to the level of the world’s 30 most developed countries, and in continuation of the Salamatty Qazaqstan State Health Development Program for 2011-2015, the Densaulyq program for 2016-2019 was created.
The main goal of the program is to increase the expected average life expectancy of the population of Kazakhstan to 73 years by 2020.
The Ministry of Healthcare informs that according to the results of 2017, the total life expectancy of Kazakhstanis was 72.41 years. Overall mortality decreased by 2.6%, infant mortality � by 6.4%, maternal mortality � by 5.5%, deaths from tuberculosis � by 11.8%, malignant neoplasms � by 5.7%, accidents � by 8.7%.
The state program consists of seven main areas. Let’s take a closer look at the work that has been done on each of them.
The First Direction
As reported by the Ministry of Healthcare, public health service has been formed for the improvement of public healthcare.
“The mission of the service is protection and promotion of the health of the people of Kazakhstan through recognized methods of influence. The service will focus on three key objectives. The first goal is to conduct analytical work on large-scale monitoring and surveillance of both infectious diseases and non-communicable diseases. The second goal is the implementation of measures to promote health. And the third goal is the institutional development of the Public Health Service,” Minister of Healthcare Yelzhan Birtanov said at a meeting of the Government of Kazakhstan.
The Public Health Department has already been established in the Ministry of Healthcare. In the future, they plan to open a national public health center.
The Second Direction
A lot of work has been done in the framework of the integration of all health services around the needs of the population on the basis of modernization and priority development of PHC.
Thus, at the PHC level, in order to improve the quality of medical care for children from under 6 years and reduce the burden on the general practitioner to 1500 attached population, work is underway to restore pediatric sites.
In 2017, more than 100 new pediatric sites were created. On the basis of KazNMU after S. Asfendiyarov, the pediatric faculty was reopened, and 150 additional grants for the Pediatrics specialty were allocated.
The implementation of the project on the introduction of a disease management program based on the active management of patients with chronic diseases (diabetes mellitus, hypertension, chronic heart failure) is continuing.
In 2017, the project was implemented in all 16 regions, the number of patients participating in the project increased twofold (from 3 to 7 thousand).
In 2018, it is planned to gradually expand and involve all dispensary patients in the program. For this purpose, the standards of clinical examination of patients with key chronic diseases will be improved.
It should be noted that mobile applications for arterial hypertension, diabetes mellitus, chronic heart failure, for pregnant women and children are developed and tested for the constant communication between the patients on dispensary and the doctor.
An integrated model for five groups of diseases is being implemented, which provides for the distribution of healthcare organizations in three levels of health care across regions.
In order to improve the provision of emergency medical care in July 2017, the Order was adopted, which approved the new Rules for the provision of medical care, providing for a differentiated approach to rendering emergency and urgent medical assistance.
Thus, the servicing of the calls of the fourth category of urgency (the patient’s condition caused by acute illness or exacerbation of a chronic disease, without sudden and severe disturbances of organs and systems, in the absence of immediate and potential threat to the life and health of the patient) is transferred to the level of emergency medical services at polyclinics.
Training of ambulance stations and inpatient departments of emergency medical services in accordance with international standards is being held.
The new format of activity of the inpatient departments of hospitals has been regulated with the strengthening of triage-sorting of patients and the readiness to accept patients with any form of pathology.
For the admission departments, a new medical specialty will be introduced � the emergency doctor � for the timely provision of emergency medical care.
Also in 2017, the list of diseases for which medicines are given free of charge was expanded.
So, 661 preparations entered the list of medicines within the guaranteed volume of free medical care, including vaccines against typhoid fever, hepatitis B, measles, rubella, tuberculosis, prevention of influenza, tick-borne encephalitis, and so on.
In addition, a list of drugs and medical products purchased only for medical care at the outpatient level, in which 190 preparations are listed, was approved.
The list of medical products contains 288 items.
At the end of 2017, 2.5 million patients were provided with an outpatient level of care, in 2018, 3.8 million patients were scheduled.
The Third Direction
As part of the work to ensure the quality of medical services, the Joint Commission on the Quality of Medical Services (JCQ) operates. The number of NGO representatives in the JCQ reached 43%.
The accreditation of professional medical associations is also being conducted to assess their accordance with the established criteria for the selection and further transfer of certain functions of the state body to them.
In general, it is planned to transfer 14 functions to a competitive environment.
The Fourth Direction
The implementation of the National Policy of Medicinal Support is continuing.
According to experts’ estimates, in 2016, the pharmaceutical market of Kazakhstan amounted to more than 458 billion tenge, the state spent more than 181 billion tenge in approximately equal proportions on inpatient and outpatient medicines.
According to the results of 2016, 7690 trade names of medicinal products were registered in Kazakhstan.
According to the Minister of Healthcare Yelzhan Birtanov, on the instructions of the Head of State additional measures were implemented to support domestic producers and the pharmaceutical industry.
In 2017, 25 long-term contracts were concluded with domestic producers for the supply of 873 items (medicines � 525 and medical appliances � 348).
In general, for the period of 2009-2017, 54 long-term contracts have been concluded for the supply of 1,679 items (1,097 drugs and 582 medical appliances) from 32 domestic producers.
Also, the terms for the long-term contracts implementation have been extended from 7 to 10 years with a deadline for the implementation of projects until 2022.
At the end of 2017, production growth in the industrial sector was achieved due to growth in the pharmaceutical industry by 42%.
As a result of procurement of medicines and medical products in 2017, the 17% increase in purchases from domestic producers was registered (from 398 titles to 478), savings by 3.3 times from 5.5 billion tenge to 18.1 billion tenge.
Taking into account the remarks of the Head of the State, the ministry has completely updated the management staff of SK-Pharmacy LLP. The transparency of the activities of the Single Distributor has been ensured, all purchases are broadcasted online.
At the outpatient level, about 2.5 million patients (91.5 billion tenge) were provided with medicines in 2017, and in 2018 it is planned to provide 3.8 million patients (122.8 billion tenge).
A bill has been developed that provides for the phased regulation of prices for all medicines, changes in the registration procedures for medicines, the introduction of an electronic system for labeling and tracking of all medicines.
The Ministry is also working on other mechanisms for controlling prices in the retail sector, by increasing competition through the introduction of standards for ethical promotion and rational use of medicines, the introduction of international standards of good practices, and the development of information systems for the population, including the issuance of electronic prescriptions.
It should be noted that the prices have been reduced for 309 drugs purchased under the statutory free medical assistance.
For the first time since 2012, the list of drugs purchased by the state has been revised, taking into account the proven clinical effectiveness (53 medicines excluded, 68 medicines included). Negotiations with manufacturers have been held with a view to reducing the cost of medicines. The list of purchased drugs has been expanded, including the inclusion of cost-effective medicines and the exclusion of replaceable or less effective drugs.
The purchase of medicines under direct contracts with manufacturers is increasing, including through partnership with UNICEF, which allows the savings to be spent on the purchase of additional medicines.
The Fifth Direction
In the framework of the introduction of compulsory social health insurance in 2017, branches of the Medical Insurance Fund were established in 16 regions. The strategy of the Medical Insurance Fund was approved. An interdepartmental working group on the integration of information systems of state bodies and organizations of the Republic of Kazakhstan within the framework of the implementation of CSHI was established.
The Minister of Healthcare approved the Integrated Interagency Action Plan on Risk Management for the Implementation of the CSHI System.
A joint order of eight interested state bodies approved the “Instruction for Informational Interaction on Data Exchange between the State Bodies within the framework of CSHI.”
From 1 July 2017, the Social Health Insurance Fund NJSC began accumulating payments and contributions to the system. As of January 18, 2018, the amount of contributions to the Fund was 33.8 billion tenge for more than 5.2 million people, of which the share of payments was 82%, the share of contributions � 18%.
Contracts were concluded with 1 385 providers of medical services, of which number of private organizations was 594.
In accordance with the Law, the terms of implementation of the CSHI have been postponed from 1 January 2018 to 1 January 2020.
For the development of the network of health organizations, the network norm was approved, the Single and 16 regional perspective health infrastructure development plans were created. This will increase the capacity of PHC organizations by 12,5% by 2025, and the number of hospitals will be reduced by 28%. Optimization of the infrastructure will save an average of 27 billion tenge per year.
A lot of information and explanatory work is being carried out: according to the results of 2017, more than 203 thousand meetings were held with various categories of the population with a coverage of over 13.3 million people.
Tremendous work is being done to digitize the healthcare system. In particular, medical information systems are being introduced, which will allow to switch to a paperless format from 1 January 2019.
Compared to 2016, the coverage of medical organizations by MIS has doubled, by computer equipment � 2.4 times, and by the access to the Internet � 19%.
In Karaganda, Akmola, Kostanay, West Kazakhstan regions, and four subordinate organizations, the Ministry is implementing a pilot project on the transition to paperless management of medical records.
Two data processing centers of the latest generation, with a capacity of 19 466 GHz, 660 processors, and 2000 TB of memory were launched. The average workload of each is 83%.
To date, the creation of a healthcare platform and an electronic health passport has been completed.
Together with IBM, a pilot project on the use of artificial intelligence in healthcare in the field of oncology � Watson for Oncology, has been launched.
Together with Kazakhtelecom JSC, the service med.mail.kz has been created, which brings together more than 80 thousand doctors into a single professional network.
Mobile applications Patronage Nurse in cooperation with UNICEF in Kyzylorda region (pilot), My Pregnancy, together with a private company, People’s Control � for the evaluation of medical services as part of CSHI, have been launched.
The Sixth Direction
As part of the modernization of medical education, strategic foreign partners of medical universities have been identified, strategic development plans for five years have been developed, the essence of which is to change the training programs, expand the academic and managerial autonomy of universities, establish university clinics, and re-train the faculty.
The new State Compulsory Educational Standards (SCES) for medical personnel training in all specialties have been approved. In the training of general practitioners, the time for pediatric component has been doubled.
In 2017, the enrollment of students to study in medical universities increased by 14%, including 27% of students enrolled in the grant.
The output of young interns in 2017 was 4446, of which 2947 graduates started practical work. The issue for 39 specialties of the residency was 946 people, of which 918 people were employed.
The Ministry, in order to provide the industry with personnel for the most demanded specialties, decided to allow the practice (without passage of residency) of pediatricians, obstetrician-gynecologists, as well as anesthesiologists (after retraining) in the PHC organizations, diagnostic centers, healthcare institutions in the rural areas.
Also, the requirement to pass a residency for clinical laboratory diagnostics, medical rehabilitation, occupational pathology, geriatrics, functional diagnostics, transfusiology and toxicology, neurology, physiology, clinical pharmacology has also been excluded.
The Seventh Direction
It should be noted that significant work is underway to develop the health infrastructure on the basis of public-private partnership, to establish mechanisms for interaction with market participants in the health sector. Thus, 36 PPP contracts have been concluded, 35 of them � in 2017.
At the end of 2017, the volume of investments in healthcare amounted to 91.4 billion tenge and grew by 43.5% to the level of 2016, which is one of the highest indicators among the sectors of Kazakhstan’s economy. The share of private investments increased by 90% (from 23.3 to 44.2 billion tenge) to the level of 2016
The Ministry of Healthcare developed and approved a new state standard of the network of health organizations and is forming a single perspective plan for the development of the health infrastructure.
In general, the development of the health system infrastructure, in addition to budgetary expenditures, will also be implemented through the involvement of private sector resources through PPP mechanisms, trust management and privatization.
The list of PPP projects in healthcare currently includes 109 projects, including 2 national and 107 local projects.
Source: The Prime Minister of Kazakhstan