ASTANA – Life expectancy in Kazakhstan has increased to more than 70 years on average as the government continues efforts to improve the healthcare system, the country’s Minister of Healthcare Salidat Kairbekova told a Mazhilis hearing on Feb. 17. Chair of the Mazhilis Committee on Socio-Cultural Development Dariga Nazarbayeva levelled criticism in response, however, highlighting remaining problems such as the lack of quality healthcare in remote areas of the country and the quality of available drugs.Kairbekova reported on the implementation of the state health development programme, Salamatty Kazakhstan, for 2011-2015 and said basic health and demographic indicators had seen improvement in recent years. Life expectancy increased from 69 years in 2011 to 70.3 years in 2013. The overall mortality rate in 2013 was 8.1 percent, 4.6 percent lower than in 2012. In 2013, more than 838.2 billion tenge (US$4.5 billion) was spent on healthcare, 14 percent more than in 2012 and reaching 2.4 percent of the gross domestic product (GDP).
As part of efforts to improve cancer treatment in Kazakhstan for 2012-2016, 2013 saw a phased expansion of screening for oesophageal, stomach, liver and prostate cancer, the minister said.
The tuberculosis epidemiological situation was stabilised through Salamatty Kazakhstan. During the first phase of the state programme, the number of new TB cases was reduced by 16 percent, from 86.6 cases per 100,000 people in 2010 to 73.5 cases per 100,000 people in 2013. TB mortality decreased by 24.3 percent during the same period, from 7.2 deaths to 5.6 deaths per 100,000 people.
An important issue is providing the population with quality drugs, the minister said, and explained that under the state programme about 139 billion tenge (US$751.5 million) was allocated in 2013 for providing a guaranteed volume of free medical aid. The list of drugs is optimised for free drug provision, taking into account the continuity of inpatient and outpatient care.
In 2013, the state paid to raise qualifications for more than 34,800 qualified practitioners. A comprehensive action plan for developing healthcare manpower resources has been approved for 2013-2016. Thanks to measures taken in 2013, the number of employed specialists has grown to 2,721 people including 2,262 clinical specialities.
The Ministry of Healthcare also began exploring the introduction of compulsory health insurance, following international health insurance practices, and a health analysis of the country’s current system along with interested state bodies and public associations.
In her remarks at the hearing, Nazarbayeva welcomed the report but said that last year the Mazhilis sent a list of 21 recommendations to the government on ways to improve healthcare.
“Of these, only four are implemented,” she lamented. “Indicators of the Ministry of Healthcare reports did improve, while problems do remain.”
According to her, “the most burning question is geographical accessibility of hospitals and clinics for the population.”
“Under the 100 Schools, 100 Hospitals Programme, 71 healthcare facilities were built,” Nazarbayeva said. “Of these, only 25 were built in villages. The remaining facilities are expected to be completed in 2016, and work has not even begun on 13 of those.”
She called the second problem, “the itch of innovation of the Ministry of Healthcare.”
“The ministry is constantly introducing different innovations in the delivery of health services to the population,” the committee chair said. “However, as practitioners say, many innovations are implemented without a proper analysis of their effects and risks, without testing, without feedback to health facilities providing services directly to citizens.”
The third problem relates to the certification and accreditation of healthcare professionals.
To upgrade the skills of working professionals, the ministry has introduced two types of certification: mandatory certification every five years through electronic testing and voluntary certification in order to reach a higher category and be promoted. “Volunteers need to have an electronic test and interview with a panel of 30 people. Why not combine the obligatory and voluntary certification in one electronic test without any interviews?” Nazarbayeva asked.
To improve service quality and patient safety, the Ministry of Healthcare has also introduced the accreditation of medical institutions. “But world practice shows that accreditation bodies should carry out their work independent of state control. Our accreditation, however, is quite formal and directly involves the ministry,” the committee chair said.
The fourth problem Nazarbayeva listed relates to the quality of medicine.
“The introduction of a unified distribution of drugs through SK-Pharmacy has not yet been decided and will not solve the problems of the uninterrupted supply of our hospitals,” she said. SK-Pharmacy reduced purchase drugs in Kazakhstan by 3 billion tenge [US$16.2 million] and mangled domestic producers’ trials. Terms of purchase of medicines change four times a year, creating favourable conditions for corruption and theft.”
She also listed problems with doctors prescribing drugs not suitable for patients and with the great distances some patients have to travel to buy drugs. Among other problems mentioned were management inefficiencies and corruption.
In related news, Gulmira Igeleuova, head of the Centre for Social and Political Research Strategy, announced that a recent poll showed that 47.7 percent of those polled believe the Salamatty Kazakhstan programme was “well designed but is poorly implemented on location.” According to Igeleuova, the people identified five specific problem areas: corruption, a lack of medical professionals, a lack of trust in the national healthcare system, a lack of control over the programme’s execution and a lack of interest among the people themselves in maintaining their own health.”