Stakeholders' Involvement in Health Technology Assessment in Kazakhstan, Poland and Bulgaria.

Background: In recent years, involvement of healthcare stakeholders in health technology assessment (HTA) has been discussed as helping the inclusion of social values in the decision-making process. The aim of our research was to identify and compare details from Kazakhstan, Poland and Bulgaria on their stakeholders' involvement in the HTA process. Information was sought on their identification, responsibilities, and regulation. Methods: We conducted a survey of seven types of stakeholders in the healthcare systems of Kazakhstan, Poland, and Bulgaria. They included patients and the public, providers, purchasers, payers, policy makers, product makers, and principal investigators. They were questioned on their involvement in the HTA process, and on the objectives of their participation. Results: Levels of involvement of different kinds of stakeholder varied between countries, reflecting political and administrative developments. There was full or partial agreement on the objectives of stakeholder participation. All respondents agreed that representatives of the ministry of health should be involved in selection of stakeholders for HTA. Conclusion: Progress has been made in the involvement of stakeholders, with interest in further development in all three countries.

Examining disparities in cardiovascular disease prevention strategies and incidence rates between urban and rural populations: insights from Kazakhstan.

Kazakhstan is experiencing a high burden of cardiovascular disease (CVD), and the country has implemented a range of strategies aimed at controlling CVD. The study aims to conduct a content analysis of the policies implemented in the country and augment it with an analysis of official statistics over a 15-year period, from 2006 to 2020. The study also includes comparisons of incidence rates between urban and rural areas. A comprehensive search was conducted to identify policy documents that regulate the provision of primary, secondary, and tertiary prevention of cardiovascular diseases. Additionally, official data on the incidence of arterial hypertension, ischemic heart disease, acute myocardial infarction, and cerebrovascular disease were extracted from official statistics, disaggregated by urban and rural areas. Forecast modeling was utilized to project disease incidences up to 2030. The study reveals that Kazakhstan primarily focuses on tertiary prevention of cardiovascular diseases, with less attention given to secondary prevention, and primary prevention is virtually non-existent. In general, screening for arterial hypertension appears to be more successful than for ischemic heart disease. The incidence of arterial hypertension has increased threefold for urban residents and 1.7-fold for rural residents. In urban areas, residents saw a twofold increase in ischemic heart disease incidence, while it remained the same in rural areas. The findings of this study have practical implications for decision-makers, who can use the results to enhance the effectiveness of existing CVD prevention strategies.

Prevalence of Smoking Various Tobacco Types in the Kazakhstani Adult Population in 2021: A Cross-Sectional Study.

Tobacco use was the second-leading risk factor for death, accounting for 15.4% of total deaths in 2019. In 2019, 20.4% (2.7 million) of the adult population in Kazakhstan, 36.5% of men, and 6.0% of women smoked tobacco. A cross-sectional study of a random sample (n = 1201) was conducted between October and December 2021 in accordance with the STEPwise approach. The tobacco-use questions were focused on current and previous smoking status, initiation and duration of smoking, amount of tobacco use, exposure to secondhand smoke, and information related to quitting smoking. From 20.8% of smokers, 93.8% of men and 80.2% of women use tobacco products daily, χ2 = 10.983, p-score < 0.001. The earliest initiation of smoking was 6 years old. The prevalence of smoking tobacco products in Kazakhstan is 20.8%, which means that every fifth adult smokes. In addition, the proportion of smokers among men was 38.5%, and among women, it was 10.1%. A total of 93.8% of men and 80.2% of women smoked daily. The role of healthcare professionals in smoking prevention is very low, and only 16.9% of respondents have been advised to quit smoking in the last 12 months. New interventions for tobacco smoking prevention are urgently needed in Kazakhstan.

Prevalence of Viral Hepatitis B, C, and D in Kazakhstan.

Background: Viral hepatitis is a major burden for the healthcare system worldwide. Up to date, a comprehensive analysis of the prevalence of viral hepatitis in Kazakhstan and Central Asia has not been carried out yet. Our epidemiological study aimed at investigating the frequency and spread of viral hepatitis B, C, and D depending on age and sex in Kazakhstan (5-year period). Materials and Methods: We utilized the data from the primary registration of the incidence of hepatitis B, C, and D in 18 regions of Kazakhstan (period: from 2015 to 2020). Age indicators, gender, and territorial characteristics of registered cases were determined and analysed. The data were obtained from the state information system "Electronic Register of Dispensary Patients", based on the International Classification of Diseases-10 for coding diseases. Results: During the period studied, 268 975 cases of hepatitis B, C, and D were detected in Kazakhstan. Hepatitis B was registered in n = 109 734 cases. In women, the incidence rate was 40.6% of all cases (n = 44545), and in men it was 59.4% (n = 65189) of all cases (p ≤ 0.01). Hepatitis D was detected in 8 656 cases, of which 58.3% (n = 5049) were in men and 41.7% (n = 3607) in women (p ≤ 0.01). Hepatitis C was registered in n = 159 585 cases. The rate was higher in the male population (54.6%; n = 82 203) compared to women 45.4% (n = 68382) (p ≤ 0.01). In 2020 (in comparison with 2015), there was a significant increase in the incidence of hepatitis D by 68.3%, hepatitis B by 49.8%, and hepatitis C by 46.4%. The largest prevalence of hepatitis D was recorded in 2016 which is 22.3% higher compared to 2020. A significant increase in hepatitis C was recorded in 2019 compared to 2015, where indicators were 49.2% higher. Conclusion: An analysis of the prevalence of hepatitis B, C, and D showed an increase in new cases in Kazakhstan. These findings indicate the need to develop effective preventive measures and screening strategies among people in a high-risk group. The results of the study can be used for the development of a national program to combat the spread of viral hepatitis.

A global public health convention for the 21st century.

As shown by COVID-19, infectious diseases with a pandemic potential present a grave threat to health and wellbeing. Although the International Health Regulations provide a framework of binding legal obligations for pandemic prevention, preparedness, and response, many countries do not comply with these regulations. There is a need for a renewed framework for global collective action that ensures conformity with international regulations and promotes effective prevention and response to pandemic infectious diseases. This Health Policy identifies the necessary characteristics for a new global public health security convention designed to optimise prevention, preparedness, and response to pandemic infectious diseases. We propose ten recommendations to strengthen global public health governance and promote compliance with global health security regulations. Recommendations for a new global public health security convention include greater authority for a global governing body, an improved ability to respond to pandemics, an objective evaluation system for national core public health capacities, more effective enforcement mechanisms, independent and sustainable funding, representativeness, and investment from multiple sectors, among others. The next steps to achieve these recommendations include assembling an invested alliance, specifying the operational structures of a global public health security system, and overcoming barriers such as insufficient political will, scarcity of resources, and individual national interests.

Screening of Arterial Hypertension in the Republic of Kazakhstan: Advantages, Disadvantages and Ways of Improving.

BACKGROUND: In the Republic of Kazakhstan, the State screening program for early detection of Arterial Hypertension (AH) and other cardiovascular diseases (CVD) for the target age groups was established in 2008. METHODS: The results of cross-sectional survey conducted at 8 primary health care facilities of Almaty city and Almaty region of Kazakhstan from September 2012 until May 2013 was used. A multistage sampling approach was used to select patients with diagnosed arterial hypertension between 18 to 64 years of age residing in a city (n=405, 50.6%) or village (n=395, 49.4%). Data collection was done via face-to-face interviews using a semi-structured questionnaire. RESULTS: Rural residents (62.7%) mainly were "no-screened". These patients get treatment in policlinics only in case of serious health problems. At younger ages of 18 and 39 years, AH is diagnosed less often among rural than among urban residents (P<0.05). In addition, 71% of the rural residents have incomes below the national average, which has a significant impact on their ability to purchase quality medicines and food and to engage in sports; 16.3% of the rural respondents do not follow doctor's prescriptions due to the lack of money to buy medications. CONCLUSION: The screening for AH and the dissemination of information about screening in rural areas needs a lot of improvement, and that it is necessary to reconsider and improve the public policy for the distribution of free medications.

Kazakhkstan health system review.

Since becoming independent, Kazakhstan has undertaken major efforts in reforming its post-Soviet health system. Two comprehensive reform programmes were developed in the 2000s: the National Programme for Health Care Reform and Development 2005-2010 and the State Health Care Development Programme for 2011-2015 Salamatty Kazakhstan. Changes in health service provision included a reduction of the hospital sector and an increased emphasis on primary health care. However, inpatient facilities continue to consume the bulk of health financing. Partly resulting from changing perspectives on decentralization, levels of pooling kept changing. After a spell of devolving health financing to the rayon level in 2000-2003, beginning in 2004 a new health financing system was set up that included pooling of funds at the oblast level, establishing the oblast health department as the single-payer of health services. Since 2010, resources for hospital services under the State Guaranteed Benefits Package have been pooled at the national level within the framework of implementing the Concept on the Unified National Health Care System. Kazakhstan has also embarked on promoting evidence-based medicine and developing and introducing new clinical practice guidelines, as well as facility-level quality improvements. However, key aspects of health system performance are still in dire need of improvement. One of the key challenges is regional inequities in health financing, health care utilization and health outcomes, although some improvements have been achieved in recent years. Despite recent investments and reforms, however, population health has not yet improved substantially.

Kazakhstan: health system review

Since becoming independent, Kazakhstan has undertaken major efforts in reforming its post-Soviet health system. Two comprehensive reform programmes were developed in the 2000s: the National Programme for Health Care and Development 2005–2010 and the State Health Care Development Programme for 2011–2015 “Salamatty Kazakhstan”. Changes in health service provision included a reduction of the hospital sector and an increased emphasis on primary health care. However, inpatient facilities continue to consume the bulk of health financing. Partly resulting from changing perspectives on decentralization, levels of pooling kept changing. After a spell of devolving health financing to the rayon level in 2000–2003, beginning in 2004 a new health financing system was set up that included pooling of funds at the oblast level, establishing the oblast health department as the single-payer of health services. Since 2010, resources for hospital services under the State Guaranteed Benefits Package have been pooled at the national level within the framework of implementing the Concept on the Unified National Health Care System. Kazakhstan has also embarked on promoting evidence-based medicine and developing and introducing new clinical practice guidelines, as well as facility-level quality improvements. However, key aspects of health system performance are still in dire need of improvement. One of the key challenges is regional inequities in health financing, health care utilization and health outcomes, although some improvements have been achieved in recent years. Despite recent investments and reforms, however, population health has not yet improved substantially.

Challenges for injury prevention among the elderly in Kazakhstan.

Injury prevention is one of the most important issues facing governmental public health programs today. Injuries lead to premature mortality and disability of the population, decrease quality of life, and damage community property. Data demonstrate that 54.1% of domestic (household related) and traffic injuries among the elderly were caused by a general lowering of attention and inadequate caution associated with increased age. This shows the necessity for the development of injury-prevention programs targeting the elderly. Currently, several different types of institutions working in areas such as public health, promotion of healthy lifestyles, social and clinical medicine are engaged in a period of detailed study of the injury status and discussion of strategies to implement injury prevention programs among the elderly. These programs must be oriented toward both the creation of safe injury-free environments and to actively engage the elderly to increase overall physical fitness to increase self-injury protection.

Kazakhstan: health system review

The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policyinitiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and therole of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. When Kazakhstan became independent in 1991, it faced many of the same challenges as other countries from the former Soviet Union, including an oversized and inpatient-oriented system of health facilities and a drop in health financing in the early transition years. Although the country embarked on several major health reforms in the second half of the 1990s, these often lacked consistency and clear direction. In the wake of the economic upswing fuelled by oil revenues in recent years, in 2004 Kazakhstan initiated a comprehensive National Programme of Health Care Reform and Development for the period 2005–2010. One of the key challenges addressed by the reform programme is the considerable inequities in terms of health financing per capita between the country’s oblasts (regions) and between urban and rural areas. Another major challenge is out-of-pocket payments for health services and pharmaceuticals, although the magnitude of these payments remains unknown. Despite an increased emphasis on primary care, the inpatient sector continues to consume the bulk of health funding, and the question of specialized and parallel health services has so far not been addressed by the reform programme. Overall, more attention will need to be paid to the quality and efficiency of health services. A system of monitoring and evaluation, as well as the establishment of clinical practice guidelines, could play an important role in achieving these aims.Many rural areas are lacking sufficient numbers of health care workers, while an oversupply exists in the major cities. A comprehensive system of human resources planning and the introduction of incentives for health care workers in rural areas might present an avenue for addressing this challenge.