REVIEW

A New Prescription

Kazakhstan’s health system is rolling into action having moved away from the centralized system of the past. Committed reforms and funding will see the sector flourish and provide ample opportunity for FDI.

While Kazakhstan’s transformation from Soviet-styled centralized health care to its current form took longer than its CIS neighbors, it is clearly taking strong steps forward. The country’s pharmaceutical market is substantially more advanced with 10,000 products made and sold both internally and exported abroad.

Kazakhstan emerged from Soviet rule with the centralized Sameshko system, like other former republics. It spent the 1990s similarly recovering and adapting a more efficient system of its own. Centralization, while slick under the Soviets, fell down during independence and encouraged little or no development. Delivery and training was uniform and allowed limited room for innovation or flexibility in directing supplies in response to need. On a basic level, the system failed in terms of sanitation (especially in rural clinics) and pharmaceutical supply.

The system has, however, seen a relatively significant level of decentralization since 1991. This has been a steady process filtering down from central to regional government and has seen the rise of private providers. In a move not dissimilar to Azerbaijan, private practice has mostly arisen in the dental and pharmacy spheres. The government still owns 80% of medical institutions in Kazakhstan, and thus plays a significant role in medical issues. As a whole, it has remained committed to the ideal of providing basic health care for free on point of receipt. However, informal payments still occur in facilitating higher quality of care or shorter waiting times.

The government’s 2010 budget allocated KZT411.6 billion, with KZT368.9 billion allocated in 2011. In addition, the structure of paying for the pooling of health funds at the oblast (regional) level has given more autonomy and flexibility in purchasing medical equipment and services. According to the WHO Health Systems in Transition report, the pooling of funds at this level has strengthened the role of oblast health departments as single purchasers of health services on behalf of their respective populations. They enter into agreements with public healthcare providers within their oblast and ensure the necessary funding.

REFORMS

While a number of health reforms have been introduced in the years since independence, few have stuck. The latest series, however, are the most comprehensive and have a strong chance of success. The National Program of Health Care Reform and Development (NPHCRD) for 2005–2010 was adopted by Presidential Decree on September 13, 2004. The program has been developed as part of the broader development strategy “Toward a competitive Kazakhstan, a competitive economy, and a competitive nation”, adopted by the government on March 19, 2004, and has been confirmed in the government program for 2006–2008. Unlike the other programs, the NPHCRD was compiled after lengthy consultations with a number of working groups including the WHO, USAID, the World Bank, and UNICEF. The document makes the case for a strong shift towards primary health care and from inpatient to outpatient care, including a focus on the improvement in training medical professionals and investment in physical infrastructure. For the first stage of the National Program on Health Care Reform and Development (2005–2007), the construction of 90 rural health facilities and the reconstruction/renovation of 450 rural health facilities are planned. The program also provides for an expansion of mobile medicine and tele-medicine and envisages mechanisms to attract medical and pharmaceutical staff to rural areas, such as the provision of housing or publicly funded scholarships, provided that healthcare workers stay for at least three years in rural areas. In 2005–2006, it was planned that SVAs, SUBs, and rayon polyclinics would be granted the status of government facilities, separating them financially and administratively from CRBs.

A process of accreditation of health facilities is envisaged and healthcare workers are expected to prove their professional competence every three years. By 2010, the primary care sector is expected to account for at least 40% of public healthcare resources allocated to the state-guaranteed package of services. “Improving the health system in Kazakhstan is also essential to achieving the objective of becoming one of the 50 most competitive countries in the world,” Sergei Shatalov, the former World Bank Country Manager for Kazakhstan, commented. “A better health system will improve competitiveness by reducing illness-related productivity losses and protecting people from the financial consequences of ill-health,” Shatalov stated at the launch of the project in 2008.

The project comprises seven components: Health Financing and Management ($20.2 million); Health Care Quality Improvement ($59.9 million); Reform of Medical Education and Medical Science ($9.4 million); Health Information System Development ($188.6 million); Pharmaceutical Policy Reform ($4.2 million); Food Safety and WTO Accession ($8.7 million); and Project Management ($4.6 million).