ASTANA — Kazakhstan’s strengthened primary health care (PHC) system has saved an estimated 270 million tenge (US$516,000) in just one region over two years and could save up to 32 billion tenge (US$59.2 million) nationwide if scaled, said Dr. Melitta Jakab, a head of the World Health Organization’s (WHO) European Center for PHC, in an interview with The Astana Times.
Dr. Melitta Jakab, a head of the World Health Organization’s (WHO) European Center for PHC. Photo credit: Nargiz Raimbekova / The Astana Times
She spoke about the country’s evolving model, the integration of mental health services, the role of technology, and Kazakhstan’s growing leadership in the transformation of global health systems.
“Beyond financial efficiency, Kazakhstan has shown that a strong PHC system leads to better health outcomes and greater equity,” said Dr. Jakab.
“The ultimate goal is to ensure that countries and governments prioritize primary health care, that they invest in it so that it is well-resourced, so that primary health care functions well and provides the best care possible to people in the community,” she said.
Multidisciplinary approach and updated standards
“If we look at the CIS [Commonwealth of Independent States] countries, 20 to 30 years ago, they had very similar health care systems—largely driven by specialists and hospitalizations. Primary health care wasn’t very strong in managing population health. But Kazakhstan is the country that has fundamentally changed how primary health care works and has significantly strengthened it,” said Dr. Jakab.
She noted that Kazakhstan’s reforms mark a shift from a hospital and specialist-based model toward a people-centered, multidisciplinary approach. The country has been expanding the roles of nurses, introducing psychologists and social workers into polyclinics, and building community-level support to prevent unnecessary hospitalizations and manage chronic conditions closer to home.
“This model moves beyond the treatment of illness to address the full range of health and social needs. It supports chronic disease management, prevents unnecessary hospitalizations, and strengthens continuity of care,” she said.
Integration of mental health services
One of the most significant advancements is the integration of mental health services into PHC. Historically sidelined or institutionalized, mental health care is becoming increasingly community-based and destigmatized.
“People should be able to get support for their conditions within their communities. This aligns closely with the spirit of the Alma-Ata and Astana Declarations on primary health care, which promote a holistic notion of health and well-being, not just the absence of disease, but fully feeling well mentally and physically,” said Dr. Jakab.
She outlined four strategies for achieving this. It includes training general practitioners and nurses to diagnose and manage common mental health conditions, incorporating psychologists into PHC teams, facilitating joint consultations with psychiatrists, and establishing referral links with community-based mental health providers.
“What we are seeing is that Kazakhstan is a leader in this area, using all these four strategies to expand the availability of mental health services in the community. Many countries are really coming and seeing how Kazakhstan has done it, and trying to emulate this,” said Dr. Jakab.
As an example, Dr. Jakab pointed to a youth health center in a former polyclinic in Astana. The facility has a separate entrance to ensure confidentiality, allowing young people to seek help for issues such as bullying, reproductive health, or anxiety.
Affordability and accessibility
Dr. Jakab emphasized that PHC in Kazakhstan is free of charge and included in the government-funded benefit package. However, she also recognized ongoing challenges in ensuring equitable access in remote areas, where depopulation and staff shortages persist.
Dr. Melitta Jakab and Nagima Abuova, The Astana Times reporter. Photo credit: Nargiz Raimbekova / The Astana Times
To address this, the government is building hundreds of facilities in rural regions. Dr. Jakab noted that strengthening these areas through telemedicine should be a complementary next step.
“These are some of the models we’re seeing in countries like Sweden,” she said.
“For example, in remote villages, you can go to a community center where there is a booth equipped with a monitor and basic diagnostic tools—a device to measure blood pressure, temperature, and even take a small blood sample to check blood sugar levels. That monitor connects to a nurse located in the next village, who oversees the process remotely. Although the nurse may work alone, she is connected via telemedicine to doctors in a nearby town who regularly provide consultations,” said Dr. Jakab.
“I believe that accelerating investment in telemedicine for primary health care would be a very important next step, complementing the progress that has already been made,” she added.
Role of technology and artificial intelligence
Public trust in the reformed PHC system has led to increased utilization, but it has also resulted in a greater workload for medical teams. Dr. Jakab noted that while some PHC tasks are complex, many are routine and can be supported by technology. She said AI is an essential tool to manage standardized care, allowing family doctors and nurses to focus on patients with more complex health or behavioral needs.
“This should be the next 10 years to involve artificial intelligence into primary health care. To switch out those things that are routine, that are standardizable, and reserve the time of the family doctors, nurses, and the multidisciplinary teams for the more complex cases,” she said.
She added that AI will be particularly important in managing care for older adults with multiple health conditions and risks of social isolation.
Strengthening the health workforce
Kazakhstan’s PHC model also features a redefined role for nurses.
“In Kazakhstan, you have three nurses per one family doctor, and this is a great ratio. We are seeing examples after examples of expanded roles of nurses, where they are taking forward independent practice, not just supporting the doctors. In fact, we are showing Kazakhstan as a model to many countries,” said Dr. Jakab.
She also pointed to persistent barriers, including underfunding, low salaries, and a lack of recognition for PHC roles.
“Worldwide, we face a challenge in explaining and justifying the importance and value of primary health care. People who don’t use or seek primary care often struggle to understand what it actually does. It is much easier to explain why we need to build a hospital or purchase an MRI or CT machine,” she said.
“In primary health care, a lot of the value is a conversation. A high-quality conversation that convinces you that you really must give up smoking, for example,” added Dr. Jakab.
She noted that facilities often lack appeal, both for patients and health workers, and that salaries and prestige are lower for general practitioners and nurses compared to specialists.
“But the new model can offer a much more attractive working environment—especially for young people. They don’t want to work where they are isolated, alone, where there is nobody to learn from, nobody to communicate. But as soon as you offer a thriving environment where they can work as part of a team with good digital solutions, they can grow. I think it does motivate people,” said Dr. Jakab.
Lessons from the COVID-19 pandemic
Dr. Jakab emphasized that Kazakhstan’s PHC reforms were already underway before the COVID-19 pandemic, but the crisis accelerated their implementation and validated the country’s approach.
“But the movement toward multidisciplinarity at a large scale started around 2018. And the pandemic showed us just how right that approach was, because countries with that kind of system could really identify vulnerable people in the community and give them comprehensive support,” said Dr. Jakab.
Dr. Jakab said that countries with well-developed PHC systems, including Kazakhstan, the United Kingdom, Spain, and Portugal, were better able to address not only medical needs but also social determinants of health, such as loneliness, food access, and mental well-being.
“The pandemic also helped countries with more medically oriented primary care realize that health problems often begin with social issues—and that mental and physical health are deeply linked,” she said.
“Now there’s a real movement toward the Kazakh and Spanish model of multidisciplinarity. We’re working with many countries to help them adopt these principles. The pandemic really accelerated the spirit of the Astana and Alma-Ata Declarations,” Dr. Jakab added.
Demonstration site for the region
Kazakhstan hosts the WHO European Center for Primary Health Care in Almaty. Since 2018, the center has supported more than 20 countries in the WHO European Region. Dr. Jakab highlighted the demonstration platform initiative, with Kazakhstan selected as one of the first countries to host visiting delegations.
“We launched one in Kazakhstan, one in Spain, and one in Sweden. The Kazakh was the first one, and we have hosted seven delegations to visit here. China asked us to host them because they also wanted to see some features of this model, and we are very, very proud of this,” said Dr. Jakab.
She also spoke about the center’s signature webinar series, a talk show-style initiative focused on PHC policy and practice. Over the past four years, the series has garnered more than 10,000 views, reflecting growing global interest in PHC and cross-country exchange.
“Our webinar series has had over 10,000 views of different episodes. That’s very exciting, and it shows there’s strong interest in talking about primary health care and exchanging experiences across countries,” said Dr. Jakab.
The center’s newsletter has also seen an increase in engagement, with more than 8,000 subscribers now following its updates.
