AGENDA FOR HEALTH

Kazakhstan 2015 | HEALTH & EDUCATION | REVIEW: HEALTH

Although a number of challenges remain, the Kazakhstani government is using sector reforms, progressive policy, and advances in medical technology to promote the national health agenda.

Since the introduction of the State Program of Healthcare Development known as Salamatty Kazakhstan in 2010, the Kazakhstani government has laid out bold and decisive plans for its healthcare system in a move to productively invest its significant profits from natural resources back into social care and development. With this in mind, the central government of Kazakhstan has prioritized healthcare reform as a key step in meeting its long-term social and economic goals. According to the most recent figures from the WHO, Kazakhstan's total expenditure on health per capita in 2012 was $608 and the total expenditure on health as a percentage of GDP was 4.2%. Since 2010 these reforms have begun to take effect, and as a result Kazakhstan has become a market to watch for international investors, medical device manufacturers, pharmaceutical companies, and other health sector stakeholders. The healthcare market in total was worth $7.82 billion in 2012 and $8.95 billion in 2013, up 14.5% in value. Under strong and positive government guidance, the quality and accessibility of healthcare has improved noticeably in the last decade; however, a number of challenges remain, particularly in rural areas where infrastructure is less developed than in the country's two main cities of Astana and Almaty.

As a result of implementing the State Program of Healthcare Development, Kazakhstan plans to achieve the following key indicators by the target year of 2015: An increase in life expectancy of the population to 70 years; a decrease in maternal mortality from 28.1 per 100,000 live births in 2013 to 24.5 per 100,000 live births by 2015; a decrease in infant mortality from 14.1 per 1000 live births in 2013 to 12.3 per 1000 live births by 2015; a decrease in total mortality to 7.62 per 1000 people by 2015; a decrease in the tuberculosis morbidity rate of 98.1 per 100,000 people in 2013 to 94.7 per 100,000 people by 2015; and the maintaining of the spread of HIV in the 15-49 age group at 0.2-0.6% level. In an interview with TBY, Tamara Duisenova, the Minister of Health and Social development, summarized these national goals in the following way: “The measures we have taken helped us stabilize the situation in healthcare, decrease the level of illness and death rates, and improve key demographic indicators. The average life expectancy has gone over the 70-year milestone, and in the past five years birth rates in the country have improved significantly: 338,180 newborns within 10 months of 2014 (to compare with 305,357 in the same period of 2009). As a result of this program, an average life expectancy for many Kazakh people rose to 70 (an indicator initially planned for 2015), and we managed to decrease mortality rates among newborns and mothers."

A particular emphasis has been placed on developing an integrated healthcare system that utilizes and relies on current advanced medical technology to improve overall health and decrease mortality across all sectors. The State Program of Healthcare Development also places strong emphasis on screening and prevention measures. Presently, a service dedicated to promoting a healthy lifestyle has been established in the country and currently consists of 201 healthcare centers, 87 anti-tobacco centers, 44 youth health centers, and 2,501 health schools to teach Kazakhstanis an active role in managing their own health. Advanced medical technologies are also being actively introduced and expanded throughout the country. According to government figures, in 2010, about 40 new technologies in diagnostics and treatment were launched, but in 2011 the number reached 120. A National Screening Program has also been introduced throughout country. In 1H2014, more than 1.5 million adults and 2 million children were diagnosed within the framework of these screening tests, 16% of the people undergoing screening tests were diagnosed early with different diseases. Moreover, 186 telemedicine centers held over 24 thousand distant consultations with specialists for patients living in remote areas of the country. The State Program has also made consultations with leading foreign hospitals a reality, connecting the medical system to its cohorts in the region and around the world.

In another innovation which has fostered further transnational integration, Kazakhstan is now the seventh country in the WHO's European Region to take part in a groundbreaking new initiative—the Global Adult Tobacco Survey (GATS). Tobacco use is a leading cause of mortality in Kazakhstan, with The Guardian reporting that it was responsible for 35% of male deaths in 2013. In February 2014, the GATS team in Kazakhstan developed a survey protocol and began administering the survey by electronic data collection. The GATS shows the “power of medical data" to inform better health outcomes and collects information that will help drive policy change. The GATS data informs policy makers and other relevant stakeholders on the social effects of tobacco use in the country and how smoking effects the overall health of the population. The survey maps how many of its citizens use tobacco and how many are exposed to tobacco smoke. It informs them also of the impact that recent policies may have on reducing tobacco use, as well as the need for public support in strengthening existing tobacco control policies.

MOTHERS AND CHILDREN FIRST

Significant investments in health infrastructure, human resources, and targeted health interventions in recent years have been aimed at mothers and children. Maternal mortality in the country has been reduced by 13% and dropped to 15.4 over 100,000 live births in the first half of 2014 comparing with the same period of the previous year. As a result of the first half of the year, the infant mortality was reduced by 5.1% and made 14.8 over 1000 live births. As a result of the first five months of the year, the growth of birth rate was at the level of 2%, and the total mortality of the population was reduced by 4.3% resulting in natural population growth by 6.3%. These gains are nationwide, and not merely based in or around the major cities. Yet despite this clear progress, inequities and disparities between regions remain a key public health concern.

PHARMA, TECH, TOURISM

Kazakhstan's pharmaceutical and medical technology markets remain highly accessible, transparent, and from a legislative point of view, very progressive. In terms of market size however, there are certain potential limits to growth; for example the relatively small population and significant logistical and infrastructural challenges present a problem. However, the government is moving to meet these challenges. According to Minister Duisenova, “the infrastructure of healthcare is developing, and over 3,300 outpatient facilities are now fully providing the population with medical care. Mobility in medical sector is developing faster, enabling us to provide medical care even in the most remote parts of the country."

Moreover, according to Espicom business intelligence, the Kazakhstani pharmaceutical market was worth over $1.46 billion in 2012 and grew to $1.65 billion in 2013—up 12.8%. The market for medical devices was valued at $630 million in 2012 and worth $690 million in 2013; up 9.8%. Continuing plans to boost government spending on healthcare will be positive for the pharmaceutical industry as well as other participants in the healthcare sector. Over the longer term, the introduction of compulsory health insurance will create a large pool of funding for further growth. However, a key risk the national outlook is oil prices and their effect on Kazakhstani government revenues.

Kazakhstan is also working hard to promote itself as a health tourism destination, but the sector is still in the early days of development. In 2014, most of the foreign patients came from the UK (260), according to the Ministry of Healthcare and Social Development. The US followed with 111 patients, Kyrgyzstan with 51, Turkey with 50, Russia with 44, and others smaller numbers from Bulgaria, Sri Lanka, the Philippines, and 23 other countries. The comparatively low cost as well as increased quality would seem to be a driver of medical tourism to Kazakhstan. According to the Astana Times, the Ministry of Health and Social Development reported that bone marrow transplants, at $51,000 in Kazakhstan, cost half as much as they do in Russia, and kidney transplants at $16,000 cost less as well. Liver transplants at $20,000 are much cheaper in Kazakhstan than they are in Turkey, a country that itself attracts medical tourists in far greater numbers.

Kazakhstan's 800 or so health tourists are, comparatively, a relatively new phenomena and still limited in number. However, for a country still in the early stages of developing both tourism and high quality medical care, with new direct flights being added each season and with the possibility of offering better care than some neighbors and cheaper care than others, the sector certainly seems to hold some promise. Askar Izbassarrov, General Director of the Private Clinic Almaty, tells TBY that, “we should promote Kazakhstan as a destination for medical tourism, but also keep up with the latest standards to ensure that media outlets promote our potential." With its advances in specialized services, its strong and clear vision for the future, and the will to succeed, Kazakhstan could be on its way to becoming a global figure to watch in health.

Ismail Ates
ISMAIL ATES
CEO and Head of Cardiovascular Surgery Departments, Sema Hospital Group
Sema Hospital is contributing to the development of standards in the local healthcare system by bringing doctors and staff from Turkey, as well as Kazakh doctors. Our workload increased by 30% in 2014. Our specialty is cardiology and cardiovascular surgery. We aim to perform all kinds of cardiology surgery here, and also to help train and give experience to local doctors and medical staff. There is also more research and some publications by Kazakhstani doctors and medical academics, and this theoretical side is also important.