of December 26, 2019 No. 982
About approval of the State program of development of health care of the Republic of Kazakhstan for 2020 - 2025
The government of the Republic of Kazakhstan DECIDES:
1. Approve the enclosed State program of development of health care of the Republic of Kazakhstan for 2020 - 2025 (further - the Program).
2. To the central and local executive bodies, other organizations (in coordination), responsible for program implementation:
1) to take measures for program implementation;
2) to provide in the Government of the Republic of Kazakhstan information on course of execution of the Program according to the procedure and the terms determined by the order of the Government of the Republic of Kazakhstan of November 29, 2017 No. 790 "About approval of System of state planning in the Republic of Kazakhstan".
3. To impose control of execution of this resolution on the Ministry of Health of the Republic of Kazakhstan.
4. This resolution becomes effective from the date of its signing and is subject to official publication.
Prime Minister of the Republic of Kazakhstan
A. Mamin
Approved by the Order of the Government of the Republic of Kazakhstan of December 26, 2019 No. 982
Content
1. Passport of the Program
2. Introduction
3. Analysis of the current situation
4. Purposes, tasks, target indicators and indicators of results of program implementation
5. Main directions, ways of achievement of effective objectives of the Program and adequate measures
6. Necessary resources
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Name of the Program |
The state program of development of health care of the Republic of Kazakhstan for 2020-2025 |
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Basis for development |
The message of the First President of the Republic of Kazakhstan – Elbasy Nazarbayev N. A. to the people of Kazakhstan of December 14, 2012 "Strategy Kazakhstan-2050: new political policy of the taken place state"; | |||||
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State body responsible for development of the Program |
Ministry of Health of the Republic of Kazakhstan | |||||
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State bodies responsible for program implementation |
Ministry of Health of the Republic of Kazakhstan, | |||||
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Purpose |
Ensuring high-quality and available health care | |||||
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Tasks |
Forming at the commitment population to healthy lifestyle and development of service of public health; improvement of quality of medical care; sustainable development of health care system | |||||
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Realization terms |
2020 – 2025 | |||||
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Target indicators |
In 2025: | |||||
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Sources and amounts of financing |
In 2020-2025 funds republican and local budgets, assets of fund of social medical insurance (further – FSMS), and also other means which are not forbidden by the legislation of the Republic of Kazakhstan will be allocated for program implementation. Total costs on program implementation will constitute 3, 2 trillion tenges. | |||||
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in one thousand tenges | |||||
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By years |
In total |
REPUBLIC OF BELARUS |
Other sources of financing |
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2020. |
101 479 659 |
79 758 902 |
21 720 757 |
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2021. |
190 302 331 |
112 473 864 |
77 828 467 |
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2022. |
283 529 037 |
171 364 273 |
112 164 764 |
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2023. |
712 064 057 |
483 520 916 |
228 543 141 |
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2024. |
892 247 182 |
580 797 471 |
311 449 711 |
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2025. |
1 000 696 116 |
616 975 228 |
383 720 888 |
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Total: |
3 180 318 382 |
2 044 890 654 |
1 135 427 728 |
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The amount of financing of the State program of development of health care of the Republic of Kazakhstan for 2020 - 2025 (further - the Program) will be specified in case of approval republican and local budgets for the corresponding financial years according to the legislation of the Republic of Kazakhstan and proceeding from opportunities of revenues republican and local budgets, assets of FSMS, and also attraction of the alternative sources of financing which are not forbidden by the legislation.
In long-term Strategy "Kazakhstan - 2050" strategic objective was determined to enter 30-ka of the most developed countries of the world that also implies finishing remaining life expectancy (further - OPZh) Kazakhstan citizens to the average level of the developed states. As one of seven long-term priorities ensuring realization of the new principles of social policy - social guarantees and the personal liability of citizens is determined.
Kazakhstan supports determination of the United Nations (further - the UN) that the crucial element of sustainable development is providing healthy lifestyle and assistance to wellbeing for all people at any age. In the mid-term Strategic plan of development of the Republic of Kazakhstan till 2025 the Government of the Republic of Kazakhstan determined Sustainable development goals of the UN (further - TsUR) important reference point where the third purpose specifies good health and wellbeing of the population.
According to rating assessment of the international agency Bloomberg Kazakhstan on performance indicator of expenses on health care in 2012 took the 111th position among the countries of participants of rating, in 2018 rose to the 44th line item. It demonstrates increase in system effectiveness of health care of Kazakhstan for the specified period.
For improvement of health care system, at the initiative of the Government of Kazakhstan Organization for Economic Cooperation and Development (further - OECD) carried out the overview of health care system of the Republic of Kazakhstan, having provided number of recommendations which were considered in case of development of this Program.
In addition recommendations on the basis of assessment were made by the World Health Organization (further - WHO) for Kazakhstan in the field of public health, on fight against noninfectious diseases, on primary health care and other directions.
This Program will provide succession of the main directions and key drafts of the previous development program of health care of the Republic of Kazakhstan for 2016 - 2019.
Strengthening of health of children, teenagers and youth by the prevention of diseases, rendering the timely help and full rehabilitation taking into account the best international practice, according to approaches in the Strategy of health for 2016 - 2030 of UNICEF will become one of the main accents of the Program.
In realization long-term and medium-term strategic documents of the Republic of Kazakhstan, TsUR UN and recommendations of the international organizations in this Program the rate of development of health care system till 2026 is determined.
In 2019 WHO designated ten main challenges facing health care systems of the whole world. Threats of bystry spread of infections remain (flu pandemic, Ebola epidemic, epidemic of human immunodeficiency virus - HIV), and integration of economy of the Republic of Kazakhstan into the trade and tourist relations increases risk of import and spread of infections. The refusal of vaccination, antibacterial resistance as a result of irrational use of antibiotics attract increase in death rate from infectious diseases. The burden of such noninfectious diseases as diseases of the blood circulatory system, new growth, diabetes and diseases of respiratory organs accrues. From external threats of health of the population technogenic air pollution and climate change are most urgent.
Risk factors of noninfectious diseases
In Kazakhstan the main burden of noninfectious diseases is the share of 7 leading risk factors: the increased blood pressure, tobacco, alcohol, the increased content of cholesterol in blood, the excessive body weight, insufficient consumption of vegetables and fruit, slow-moving conduct of life. So among the Kazakhstan teenagers (children from 10 to 19 years) of 5% have obesity and 20% of children have excess weight. Consumption of salt in Kazakhstan exceeds recommended indicator of WHO, according to some information four times. Day-to-day consumption by Kazakhstan citizens of fruit and vegetables is lower, than the Central European indicator.
By results of estimates in 2015 28% of men and 25% of women are more senior than 18 years had the increased arterial pressure. The latest data of assessment of level of cholesterol show that 46% of citizens at the age of 25 years and are more senior have the increased level of general cholesterol.
In Kazakhstan prevalence of tobacco smoking makes % 42,4 among men and 4,5 of % among women.
Alcohol intake remains to one of major factors of risk in general burden of diseases in Kazakhstan. In 2016 nearly 74% of male death rate of cirrhosis and 34% of injury rate were caused by alcohol intake, for women these indicators constituted 45% and 31% respectively.
In general the current damage caused by noninfectious diseases to economy of Kazakhstan makes 2, 3 trillion tenges a year that is equivalent to 4,5 of % of annual gross domestic product of the country for 2017. Progress in decline in mortality by the main noninfectious diseases (further - NIZ) managed to be achieved in the countries of OECD thanks to WHO recommendations and separate projects, such as reducing consumption of salt due to improvement of structure of foodstuff; holding information campaigns in mass media and implementation of references on packagings; prohibition of use of trans-fats in the food industry, increase in excises on tobacco products and alcohol, acceptance and implementation of the laws on prohibition of the calculation of tobacco products, smoking prohibition in public places, introduction of the taxation of sacchariferous drinks.
medico-demographic indicators of health
For the ten-year period in the country of OPZh grew almost for 5 years (from 68,41 in 2010 to 73,15 of years in 2018), however in a number of the countries of OECD (Chile, Turkey and others) with the same GDP level as in the Republic of Kazakhstan OPZh constitutes about 80 years. In 2018 aged from 0 up to 35 years every third dead was baby. At the age of 0-18 years on the first place there was death rate of children about one year with downward tendency for 28% in 5 years, on the second place teenage death rate (15-19 years) with decrease by 25%, on the third place death rate of children up to 5 years with decrease by 24%. Among adults death rate among men prevails. The maximum difference of death rate between men and women is observed at the age of 25-29 years, in the ratio 1 to 2,8, that it is connected with the high level of injuries, the road accidents and suicides.
In structure of diseases among the death rate reasons first place is won by blood circulatory system diseases (further - BSK). In 2018 167,38 on 100 thousand people died of BSK that is 13% lower, than in 2015. Among died of BSK in hospitals of patients of 40,4 of % were working-age (from 15 to 64 years). Among BSK are in the lead coronary heart disease (further - IBS) of which in Kazakhstan in year dies 11,3 of one thousand people (71,7 on 100 thousand population); and also sharp violations of brain blood circulation (further - ONMK), in year 11,1 of one thousand patients dies (71,8 on 100 thousand population). From among persons who had sharp myocardial infarction (further - OIM), on dispensary accounting 69% undertake, from among the treated patients from ONMK on dispensary accounting 24% whereas the purpose is observation of all persons who had stroke undertake.
Later BSK on the second place on death rate (% 15,7) in 2018 occupy diseases of nervous system (cause of death of most of elderly persons this category of diseases is specified). On the third place - disease of respiratory organs (% 11,6). On the fourth place of the reasons of death rate - new growths (% 8,8). The Comprehensive plan on fight against oncological diseases for 2018 - 2022 is implemented, the construction of the National oncological center in the capital is begun. Early detection of cancer at the I-II stages constitutes % 60,5.
Death rate from injuries, accidents and poisonings has downward tendency: with 82,5 of one thousand people in 2015 to 66, on 100 thousand people in 2018. There is high number of the dead from the road accidents (in 2015 - 2439 people, in 2018 - 2413 people) - one of the highest rates in the European region of WHO.
Health of children
According to WHO data the main risks for health of children in Kazakhstan up to 5 years are insufficient child care and ignorance by parents of disturbing signs at children and risk factors. Injuries, drownings and accidental suffocations are the most powerful external reasons in death rate of children up to 5 years.
In 2018 the number of children up to 6 years with special educational needs because of the state of health (congenital anomalies, injuries and other diseases) exceeded 46 thousand people. Since 2015 the annual surplus of this category of children constituted 6 thousand children. Children's disability, basic reasons of invalidization tends growth: congenital anomalies (% 32,5), diseases of nervous system (% 22,9), mental disturbances (% 12,5).
The number of children at the age of 6-9 years suffering from excessive body weight because of slow-moving conduct of life and unbalanced food grows. Among children of school age digestive tract diseases (24%) prevail.
By results of routine inspections of children of school age up to 14 years most of all children suffer from sight violations that is connected with uncontrolled use of children of gadgets.
On index of progressiveness of youth Kazakhstan took in 2017 63rd position among 102 countries, on indicator "Food and basic medical attendance" assessment of 96 points from 100 is given. According to the National report "Youth of Kazakhstan - 2018" annually most often the youth dies of accidents, poisonings and injuries (% 62,3).
The mortality rate on all age groupes of youth for 2015 - 2017 decreased. Among male death rate is higher due to risk behavior (suicides, the road accidents, murders, acceptance of drugs).
The most important social problem among youth of Kazakhstan is prevalence of suicides. According to WHO data Kazakhstan is included into leading ten the countries on the level of suicides among the population. The quantity of the registered suicides in 2018 made 3471 cases. In age group of teenagers of 15-17 years the quantity of complete suicides decreased in 5 years on 50,9 of % and suicide attempts on % 49,3.
In 2018 in Kazakhstan 3,4 of one thousand cases of pregnancies and 1237 abortions at girls at the age of 15-18 years was registered. According to sociological poll of the Center of studying of public opinion in which thousands teenagers at the age of 15-19 years from all regions of the country participated 4,, third of youth is sexually active. Among teenagers of urban population the risk behavior is more expressed (the average number of sexual partners - 4). Only 10% of respondents were examined on HIV. 73,5 of % of respondents is not known where it is possible to be examined anonymously on HIV and most of young people aged from 15 up to 24 years (91%) in due measure are not informed on the main ways of transfer of HIV.
Infectious diseases
Epidemiological situation on infectious diseases in the Republic of Kazakhstan for 2018 stable. Decrease in incidence on 34 infectious and parasitic diseases is reached. Growth of incidence of measles, whooping cough, meningococcal infection is noted.
In Kazakhstan prevalence of HIV infection in the concentrated stage keeps. In rating City Elections Commission of the WEF Kazakhstan within the last three years entered group of the countries with low prevalence of HIV. In age group of 15-49 years the number of persons living with HIV infection constituted one thousand 22,7, prevalence of HIV infection following the results of 2018 - % 0,23. In the country conditions for effective implementation of the international recommendations about fight against HIV, including the strategy of YuNEYDS "90-90-90 are created: the ambitious goals which are bringing closer victory over AIDS epidemic".
In Kazakhstan at the expense of the state 95% of financing of service on fight against tuberculosis, including for identification and treatment of tuberculosis at foreigners and stateless persons are provided. Annually about 12 thousand new cases and recurrence come to light. The indicator of success of treatment among new cases and recurrence constitutes 88%.
Primary health care
Kazakhstan is the member country of WHO with which name development of primary health care in the world, after adoption in 1978 of the Almaty declaration of WHO on PHC is connected. In 2018 in Astana the anniversary conference of WHO and UNICEF is held, the Astana declaration on PHC is adopted.
In days of independence of PHC was priority in development of health care of the country. The Actions plan on development of primary health care in the Republic of Kazakhstan for 2019 - 2020 approved by the order of the Prime Minister of the Republic of Kazakhstan of June 10, 2019 No. 103-r is implemented.
The screening program of key noninfectious diseases at the level of PHC is successfully implemented. Measures for stimulation of general practitioners and decrease in quantity of the attached population on one doctor to 1 700 people are undertaken. Interest of business in rendering services PHC grows. The share of private service providers of PHC in 2019 constitutes 36,2 of % of all suppliers.
Management programs diseases (further - PUZ) on three diseases take root: arterial hypertension, chronic heart failure, diabetes. PUZ allows to create joint liability of people for the health and to manage disease for the purpose of prevention of complications and unreasonable hospitalization. Dynamic observation covers more than one and a half million people, from them in PUZ are involved by 462,5 of one thousand people (% 28,4).
For increase in availability of PHC, except increase in number of general practitioners in industry, disaggregation of subjects of health care is carried out. Private investors for ensuring step availability small the practician of PHC in the cities are attracted. In the rural zone of service PHC are integrated with district hospitals on which staff general practitioners are, the paramedic and the nurses working in medical aid stations, medical and obstetrical centers and medical out-patient clinics.
For improvement of quality of training of doctors of primary link since 2019 residency in "family medicine" is entered.
Personnel resources in health care
In Kazakhstan more than 248 thousand health workers, including doctors - the 72nd 877, average health workers - 175 705 work. Security with doctors in Kazakhstan makes 39,6, in OECD - 33, security to average medical personnel in Kazakhstan - 95,5, in OECD - 91 on 10 thousand of the population.
There is imbalance in staffing between urban and rural health care. In the city 56,8 of doctors works for 10 thousand population, in the rural zone - 16,1 on 10 thousand population. 83% of all doctors work in the city area, 17% - in rural.
In 2018 deficit of doctors made 2482 on unoccupied established posts. The greatest deficit is noted on specialties anesthesiology resuscitation, psychiatry, general medical practice, obstetrics and gynecology, pediatrics. For the purpose of ensuring need for medical personnel obligatory three years' working off in the state organizations of health care is entered; the state educational orders at the expense of means of republican and local budgets are selected.
The ratio of the average salary of the doctor to average salary in economy in 2018 constituted 0, in Kazakhstan whereas in the countries of OECD it is 2,6:1 ratio. The difference in the value of the salaries of the doctor of RK and the doctor of OECD constituted in 6,9 of times: the Kazakhstan doctor on the monthly salary can purchase 2,4 consumer goods baskets whereas the doctor in the countries of OECD can purchase 16,4 consumer goods baskets 2017. For wages increase of medics within realization of new social measures of Elbasa "Aleumett_k kamkorlyk" since June 1, 2019 the salary to workers of health care is raised for 30%. In 2019 100% of the state medical organizations are transferred to form of the company on the right of economic maintaining that allows within opportunities of the organization in addition to raise the salary on the basis of regulations on compensation of the organization, without applying wage rate from the order of the Government of December 31, 2015 No. 1193, regulating salary of government employees.
Training for health care system is conducted in 13 HIGHER EDUCATION INSTITUTIONS and 83 medical colleges. Annual release of HIGHER EDUCATION INSTITUTIONS constitutes more than 3 thousand specialists. In HIGHER EDUCATION INSTITUTIONS practice of involvement of teachers and managers from large foreign medical universities together with which strategic partnership and the academic mobility are implemented is implemented.
Educational programs of medical schools will be accredited by the independent accreditation agencies which are members of the European association on quality assurance of the higher education (ESG ENQA). Kazakhstan is member of the European space of the higher education (EHEA) that promotes improvement of quality of the higher education in the Republic of Kazakhstan.
Implementation of compulsory social medical insurance
Since 2017 funds for OSMS are accumulated, since 2018 the Fund of social medical insurance acts as the strategic purchaser of medical care within the guaranteed amount of free medical care (further - GOBMP). In one of areas implementation of OSMS for the purpose of realization of reform of OSMS at the national level since January 1, 2020 is piloted.
Infrastructure of network of health care is changed. Within implementation of the state standard rate of network of the organizations of health care perspective plans of regions for the period till 2025 are approved. On average on the republic more than a half of medical objects (% 59,7) are worn-out.
Mechanisms on increase in independence of management of the state medical organizations are realized. In the state medical organizations elements of corporate management are implemented: the supervisory boards with participation of independent directors are created, implemented practice of independent salary level determination of health workers and independent determination of the staff list. The rating of the state medical organizations for indicators of management, clinical and scientific activities, and also level of corporate management is conducted.
With introduction of OSMS the role of medical community in quality assurance of medical care raises. The institutional mechanism of improvement of quality of medical services by creation of advisory advisory body - the Joint commission on quality of medical services is realized. More than 30 standards of the organization of medical care are implemented, over 1300 clinical protocols based on evidential medicine are approved. Assessment of technologies of health care is carried out.
For the purpose of continuous quality management system the national accreditation system of the medical organizations conforming to international standards is implemented (International society on quality in health care, ISQua). For today 30% of medical supply agencies at FSMS - have national accreditation. Seven leading medical organizations of the country have the international accreditation of JCI.
At the legislative level state regulation of the prices of medicines is fixed, transition to reference pricing is performed. For achievement of strategic objective on increase in availability and quality of medicines the procedure of purchase of medicines within GOBMP underwent number of organizational innovations: the purchase is carried out in the online broadcasting mode in open access for all population. 49 long-term agreements are signed with 30 domestic manufacturers on more than 1500 names of medicines and medical products that allowed to save means on expensive logistics and to expand purchase amounts. For the purpose of rational use of medicines the Kazakhstan national form developed with the assistance of the Kazakhstan and international experts and containing medicines with the proved clinical efficiency is supported.
During preparation for OSMS medical information systems are implemented, paperless maintaining medical documentation takes root. Electronic passports of health for the country population are created. The centralized registers necessary for data exchange about the provided medical care are created. Standards for ensuring single approaches to forming of IT architecture of digital health care are approved. Development of integration platform of health care is complete. Development of information systems expanded range of the automated state services, reduced paper document flow in the medical organizations, increased quality of information on medical and pharmaceutical services.
Private expenses in 2018 constituted 679, one billion tenges or 1,2 of % to GDP or 38,5 of % of current expenses for health care. In comparison with the countries of OECD where the share of private expenses from current expenses on health care constitutes 26, %, this indicator is high. In comparison with 2017 private expenses increased on % 8,4 in 2018. Directly payments of the population for services of health care constitute 33% of current expenses (86% as a part of private expenses). The big share of payments of the population for services of health care is constituted by expenses on provision of medicines of 353 billion tenges (% 60,7).
Health sector infrastructure
Following the results of 2018 the percent of equipment of the state organizations of health care by medical equipment made % 72,5. 272 organizations of health care require capital repairs. Depreciation of medical equipment made 37%, only 55% of all medical equipment are used for 100%.
Health care digitalization
For the beginning of 2019 equipment computers of the organizations of health care makes % 94,1. At the level of the cities and the district centers 65,8 of % of the organizations of health care are provided with Internet access.
In the organizations of health care of the republic implementation of medical information systems (further - MIS) constituted % 65,1.
At the regional level in MIS are created and filled 16,3 of one million electronic passports of health that constitutes 89% of total quantity of the population.
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Strengths |
Weaknesses |
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The document ceased to be valid since October 12, 2021 according to item 4 of the Order of the Government of the Republic of Kazakhstan of October 12, 2021 No. 725