A Healthier Situation

At its independence in 1991, Kazakhstan inherited a Soviet healthcare system dominated by an emphasis on hospital treatment, and it has been trying in fits and starts ever since to reorient the sector toward primary care. Kazakhstan, in May 2014, signed an agreement with the World Health Organization (WHO), which will host a new office on primary healthcare in Almaty. The so-called geographically dispersed office (GDO) aims at developing primary healthcare and, in collaboration with other WHO Europe technical programs, at creating the necessary framework for universal health coverage within the country’s Strategic Development Plan 2020. In 2013, President Nazarbayev set up the new Ministry of Regional Development to manage projects and social infrastructure in regions, an effort that is already paying dividends in 2014. In May, the administration of the Zhambyl region reported that 25 new healthcare facilities are being built there, with 22 of them to be commissioned in 2014, and the remainder next year. The Astana Times reported the cost of the project at $25.2 million. The largest facility, a 300-bed hospital in Taraz, will cost $14.2 million and is being opened through the government’s ambitious 100 Schools/100 Hospitals Program. Nationwide, the government has commissioned 69 new healthcare facilities since 2009.

The World Bank-funded Health System Technology Transfer and Institutionalization Reform Project and the State Health Care Development Program for 2011—2015 “Salamatty Kazakhstan” is implementing several key changes, including a shift from inpatient to outpatient care, standardization of care, focus on prenatal and maternity care, training health professionals, prevention, and treatment of socially significant diseases and, lastly, improving health facilities and equipment. Funding is a special challenge as the state has swung from one model to another over the past two decades. In 2009, the Ministry of Health adopted the Concept on the Unified National Healthcare System, which foresees the establishment of a single-payer national system for healthcare services. Mandatory insurance provision by large employers affects only a small portion of the overall population and contributes to the service disparity between cities and regions, with Almaty having four times as many doctors per 100,000 people as the least-served region.

Nonetheless, the growing middle class and the government’s focus on healthcare are pushing up demand for pharmaceuticals in Kazakhstan. The government’s Pharmaceutical Industry Development Program 2010-14 is being implemented by the Ministry of Industry and New Technologies to help develop the sector and boost the share of locally produced drugs. Over the past five years, imports as a share of total pharmaceutical consumption have dropped from 90% to 80%, and local producers have been established along with new foreign entrants to the market. Turkish pharmaceutical makers Abdi Ibrahim and Nobel have factories in the country, as do Poland-based Plopharm and France’s Sanofi, and Russian producer Pharm-Standard. According to the Ministry of Industry and New Technologies, Kazakhstan’s pharmaceutical industry produced over $220 million in healthcare products in 2013.

Batyrbek Mashkeyev, General Manager and Owner of VIVA Pharm, told TBY that the market is growing and people are buying more medicine. “The 15% to 17% growth in over-the-counter [OTC] products we saw over 2013 was marginally less than the growth rate for government purchases, which saw 20% growth.” According to an Ernst & Young (EY) investor attractiveness report in 2013, foreign investors believe improving social and physical infrastructure, especially healthcare, should be the top government priority in Kazakhstan. The report said that nothing indicates wellbeing like a consistently improving standard of living, but noted the wide gap in wealth between rural areas and cities. Kazakhstan faces basic lifestyle challenges to improve public health, as some unhealthy habits persist, such as high rates of alcohol and tobacco consumption. Nearly half of all adult males smoke tobacco. A WHO report in 2014 showed that non-communicable diseases, such as cardiovascular diseases and cancers, are major causes of adult mortality, as are tobacco- and alcohol-related diseases and injuries. The report’s statistics reveal Kazakhstan as scoring highest on the years of life lost due to drinking-related problems and having a high prevalence of deaths from cirrhosis of the liver: 82.6 per 100,000 people versus around 11 in Switzerland.

The World Bank report noted recent progress in maternal and child health, with infant mortality and under-five mortality rates of 16.7 and 18.7 per 1,000 live births in 2012, respectively, looking likely to achieve the Millennium Development Goals target of 18 per 1,000 live births by 2015. The report said that, “similarly, a national estimate of 13.5 per 100,000 live births in 2012 for the maternal-mortality ratio could indicate that the country has reaped the results of its efforts to reduce this ratio over the past couple of years.”

The government continues to motivate health workers and managers to improve their performance as part of its overall program to foster healthy lifestyles, reform health financing, and improve provider payment systems. The key reality is policy and planning for an integrated and progressive healthcare system in Kazakhstan.