In Kazakhstan , economic growth has taken off. This has allowed the government to increase considerably the health budget with the ambitious goal of spending 4% of GDP on health by 2010. The Government's commitment to health care reform has been confirmed in the comprehensive State Health Care Reform and Development Program 2005-2010 and Implementation Plan.
The ZdravPlus strategy in Kazakhstan focuses heavily on Stewardship - supporting the government in implementing the state health care program and achieving their health goals. Technical effort will focus on bringing together two sides of a sustainable health reform model: the strengthened and restructured health care delivery system with improved clinical practice.
The ultimate goal of strengthening and restructuring in the health care sector is to rationalize Resource Use and increase equity and access across population groups. The institutionalization of new health purchasing mechanisms, including national implementation of oblast-level pooling of health care funds, per capita payment for PHC, and case-based payment for hospital services does this and ensures that those living in rural and urban areas have access to the same level of health care resources. ZdravPlus lends technical support to the MOH as they continue to implement these mechanisms.
Major activities in Kazakhstan aimed at improving Service Delivery include the promotion of Family Medicine, improving Reproductive Health services, and reducing incidence of Arterial Hypertension.
Family medicine (FM) means that one doctor can see an entire family for a variety of common conditions at a PHC facility. This is very different from the Soviet system which relied heavily on specialists. The institutionalization of FM is largely implemented through a grant to ZdravPlus partner organization the Kazakhstan Association of Family Practitioners (KAFP). KAFP works at the medical education level to support faculty development and continuing medical education efforts through the development of computer–based distance learning programs. They are developing family medicine residencies and working to attract more undergraduate students into the FM specialty. KAFP also uses their 14 oblast affiliates to promote and publicize the benefits of family medicine throughout Kazakhstan , both to policy makers and the public.
ZdravPlus' reproductive, maternal, and newborn health strategy is aimed at reducing abortions, making motherhood safer and improving newborn care. Work takes place at the primary and hospital levels to expand the use of family planning and modern contraceptive methods, along with updating medical practice related to pregnancy, birth and newborn care - such as promoting the use of PHC doctors for pre-natal visits, reducing the use of invasive procedures during labor, promoting partner births and emphasizing the importance of exclusive breastfeeding.
Another major area of work for ZdravPlus is Arterial Hypertension, where we are supporting the Government of Kazakhstan to:
At the National level the major focus is institutionalization and implementation of evidenced based clinical guidelines for the screening and management of arterial hypertension. In the Karaganda pilot site, the strategy involves expanding services of FGPs to include outreach services for screening and referral, treatment and monitoring, providing follow up care, and strengthening referrals to hospital level.
Throughout these activities ZdravPlus strives to focus attention on making sure that medical practices are evidence-based. ZdravPlus closely collaborates with the MOH, representatives from republican medical institutes, professional associations, and the Karaganda Drug Information Center to establish a process for developing, implementing and revising clinical practice guidelines based on evidence. Activities related to Arterial Hypertension focus on implementing new clinical guidelines developed under the previous ZdravPlus project, while reproductive health activities are expected to include up-dating guidelines related to post-abortion and post-partum care.
More information on ZdravPlus's activities in Kazakhstan can be found on the Road to Results and Recent Activity Highlights pages of this web-site and Technical Documents can be accessed through our online Public Library; for additional information contact us at office@zplus.kz.