On the State Program of Healthcare reform and development of the Republic of Kazakhstan for 2005-2010

Decree of the President of the Republic of Kazakhstan dated September 13, 2004 No. 1438

 In accordance with subparagraph 8) In accordance with Article 44 of the Constitution of the Republic of Kazakhstan, in order to create an effective system of medical care and improve the basic health indicators of the population of the Republic of Kazakhstan, I hereby decree:

     1. To approve the attached State Program of Healthcare Reform and Development of the Republic of Kazakhstan for 2005-2010 (hereinafter referred to as the Program).

     2. The Government of the Republic of Kazakhstan should develop and approve an action plan for the implementation of the Program within one month.

     3. Central and local executive bodies, as well as state bodies directly subordinate and accountable to the President of the Republic of Kazakhstan, take measures to implement the Program.

     4. The Ministry of Health of the Republic of Kazakhstan is responsible for monitoring and coordinating the implementation of the Program.

     5. The Ministry of Health of the Republic of Kazakhstan, once every six months, no later than the 25th day of the month following the reporting period, shall provide the Administration of the President of the Republic of Kazakhstan and the Government of the Republic of Kazakhstan with information on the progress of the Program.

     6. This Decree comes into force from the date of signing.

     President of the Republic of Kazakhstan

                                               Approved                                            By Decree of the President of the Republic of Kazakhstan dated September 13, 2004 No. 1438

State program of reformation and development of healthcare in the Republic of Kazakhstan for 2005-2010

1. Program Passport

Title The State Program of healthcare reform and development of the Republic of Kazakhstan for 2005-2010

The basis for      The President's Address to the People of Kazakhstan dated March 19-24, 2004 "Towards a competitive                   Kazakhstan, a competitive economy, a competitive nation"

Developer Ministry of Health of the Republic of Kazakhstan

Goal               Creation of an effective system of medical care based on the principles of joint responsibility for health protection between the state and the individual, priority development of primary health care aimed at improving public health

Tasks: Division of responsibility for health protection between the state and the individual; transition to international principles of organization of medical care with a shift of the center of gravity to primary health care (hereinafter referred to as PHC); creation of a new model of healthcare management and a unified information system of the industry;                   strengthening the health of mother and child, improving the medical and demographic situation; annual reduction in the level of socially significant diseases; reform of medical education

Implementation dates 2005-2010 First stage: 2005-2007 Second stage: 2008-2010

Necessary        In 2005-2007, the Program will be implemented using resources and funds from the national and local budget sources, as well as other funds that are not prohibited by the legislation of the Republic of Kazakhstan.                   The total cost from the state budget for the implementation of the Program will amount to 165,658.5 million.                   tenge, including from the funds of the republican budget 134,609,9 million tenge, from the funds of local budgets 31 048,6 million tenge.

                  By year   Total Republican-Local budget budget

                  2005 42877.8 32766.2 10111.6 2006 65330.5 54974.5 10356 0 2007 57450.2 46869.2 10581.0

                  In 2008-2010, an annual increase in the volume of financing of the industry is expected, bringing it to 4% of GDP in 2010.

Expected          As a result of the Program:results, an optimal healthcare model will be created that meets the needs of the population, industry and the state; the level of provision of health services to the population will significantly increase, and incentives will be introduced to protect people's own health;                   Equal access of citizens to medical care will be ensured and the principle of joint responsibility of the state and citizens for health protection will be implemented.;                   The volume of preventive and health-improving measures will increase, the effectiveness and quality of medical examinations of patients will increase, and the level of temporary and permanent disability will decrease due to the expansion of the guaranteed volume of free medical care at the primary health care level.;                   imbalances in the provision of medical care will be eliminated by redistributing part of the volume from the inpatient sector to the outpatient sector, the effective use of inpatient replacement technologies; an effective quality management system for medical services will be introduced; accessibility, efficiency and continuity of medical care at all stages of its provision will increase;                   the financing system will be improved, the deficit in financing the guaranteed volume of free medical care will be eliminated, mechanisms for mutual settlements between industry entities will be introduced; the efficiency of using state budget funds and the population for healthcare will increase, while the level of informal payments will significantly decrease; a unified healthcare information system will be created;                   the health index of women of reproductive age and children will increase, maternal and infant mortality rates will steadily decrease; the situation for socially significant diseases will stabilize, the level of infectious and non-communicable diseases will decrease; the effectiveness of state regulation in the field of drug circulation will increase;                   The volume of production of domestic competitive pharmaceutical and medical products will increase; modern diagnostic methods and international treatment standards will be introduced; documents of the state system of sanitary and epidemiological rationing will be harmonized with international standards.;                   The problem of staffing the industry will be solved by 2010 by reforming all levels of medical education through the introduction of staff retention mechanisms, increasing enrollment in medical higher education institutions (hereinafter referred to as universities) and colleges by state order; the rights and responsibilities of doctors and medical professionals will be expanded, their social status and prestige in society will be raised.

2. Introduction

     The health status of the population is an integral indicator of the social orientation of society, social guarantees that characterize the degree of responsibility of the state towards its citizens.      Kazakhstan, having experienced a significant economic downturn during the formation of statehood, carried out serious optimization in the social sphere, including in the healthcare system, where the cumbersome network of medical organizations created during the Soviet era was mainly focused on quantitative performance indicators.      In recent years, the country has achieved significant economic growth, as a result of which the financing of the healthcare industry has been significantly increased (doubled in the last three years), as well as prospects for its further development. Being socially oriented, the government intends to continue paying serious attention to the development of the industry.      Despite the fact that, according to the World Health Organization (WHO), the health of citizens depends only on 8-10% of the health system, the state's efforts to preserve public health should increase with economic and social progress.      In this regard, it is important to involve citizens and employers themselves in health protection and strengthen intersectoral coordination of health-related activities.      The main policy documents that the industry is developing today were adequate to the requirements at the time of their development, but they are currently lagging behind the pace of change both in the economy and in other sectors. The individual measures outlined in these documents were not result-oriented, and structural changes, including changes to the financing system, were not always consistent. Today, it cannot be argued that the state of the healthcare system fully satisfies society, the state and the industry itself.      The accumulated problems require a radical revision of approaches to the management of the healthcare industry. The 2005 Presidential Address states that the industry needs to make serious changes in terms of improving management systems, financing healthcare, organizing the provision of medical care, the regulatory framework of the healthcare system, statistics and informatization of the industry, optimizing reporting, as well as the efficient use of financial resources and mandatory decentralization of procurement.      The following priorities are identified: a real shift of the center of gravity to primary health care, a shift of emphasis from inpatient to outpatient treatment; a systematic transition to international standards, new technologies, modern methods of treatment and medical care; strengthening the health of mother and child; creation of a system of independent expertise with the involvement of independent experts; training of managers of health systems, resource management and financing of the industry; prevention, diagnosis and treatment of socially significant diseases;      strengthening the material and technical base of healthcare organizations.      In order to implement The Development Strategy of the Republic of Kazakhstan for the period up to 2030, the Address of the President to the People of Kazakhstan dated March 19, 2004 "Towards a competitive Kazakhstan, a competitive economy, a competitive nation" has developed this State Program for the reform and development of healthcare for 2005-2010 (hereinafter referred to as the Program).      The Program defines a set of necessary economic, social, organizational and other measures aimed at developing an affordable, high-quality, socially oriented and economically efficient healthcare system in the Republic of Kazakhstan.

3. Analysis of the current state of public health and the healthcare system

     The health status of the population of the Republic of Kazakhstan, the sanitary and epidemiological situation and the development of the healthcare industry in the last decade have been characterized by both positive and negative indicators.      In recent years, it has been possible to stabilize the main medical and demographic indicators - the birth rate, mortality and the average life expectancy. The infectious morbidity has been reduced. A number of reforms have been undertaken in the healthcare sector, some of which have been successfully implemented, while others have not reached their logical conclusion. The latter include the creation of a compulsory health insurance system and an attempt to switch to a family medicine model. Among the positive aspects, one can note the creation of a regulatory framework for the industry, a significant increase in healthcare financing, which allowed the construction of a number of modern clinics, major repairs and improvements in the logistical equipment of medical organizations, and the introduction of new medical technologies into the treatment and diagnostic process. As a result of the improvement in the quality of medical care and its accessibility, positive trends have been achieved in the health status of the population regarding a number of infectious and other diseases. However, most of the parameters of the health status of the republic's population remain unsatisfactory.

     Medical and demographic situation and morbidity

There have been certain medical and demographic changes in Kazakhstan in recent years. In 2003, the population of the republic increased by 49.6 thousand people compared to 1999 and amounted to 14 951.2 thousand people at the beginning of 2004.      The birth rate in 2003 was 17.2 per 1,000 people and increased 1.2 times compared to 1999. An upward trend in the birth rate has been observed in the republic since 1999.      Over the past 5 years, natural population growth has increased 1.6 times, reaching 6.7 per 1,000 people in 2003. Since 1999, there has been a slight increase in the mortality rate of the population, which amounted to 10.5 per 1,000 people in 2003 compared to 9.7 in 1999. Over the past 5 years, men and women have had the highest age-related mortality rates at the age of 70 and older, in 2002 it was 104.51 and 79.98, respectively, per 1,000 people of the corresponding age group. Cardiovascular, oncological diseases, and injuries occupy a leading place in the structure of population mortality. One of the factors that distort the indicators of the mortality structure is the lack of an effective system for examining its causes.      The average life expectancy of the population of the republic has stabilized over the past 5 years and at the end of 2003 was 65.9 years: 60.5 years for men and 71.5 years for women. The overall morbidity rate of the population of the Republic of Kazakhstan increased in dynamics in 2003 and amounted to 56413.9 per 100 thousand people against 47972.8 in 1999.      In the structure of morbidity per 100 thousand respiratory diseases occupy the first place among the population (22160.6), injuries and poisoning (4003.7) take the second place, diseases of the genitourinary system (3948.6) take the third place, diseases of the skin and subcutaneous tissue (3847.0) take the fourth place, followed by diseases of the digestive system (3688.7), the eye and its accessory apparatus (2748.2), infectious and parasitic diseases (2482.1). Among socially significant diseases in 2003, the first place was occupied by drug-related disorders (424.7 per 100,000 people), which were 4 or more times higher than other diseases.      The infant mortality rate in the republic tends to decrease, but remains generally quite high compared to European countries, amounting to 15.3 per 1,000 live births in 2003. It should be noted that this indicator is calculated without taking into account WHO recommendations.      There has been a decrease in the maternal mortality rate from 65.3 in 1999 to 42.1 per 100,000 live births in 2003. One of the main causes of maternal mortality in the republic is the low women's health index, which is 20-30%.      The health status of the children's population is causing concern. Mass preventive examinations of children have shown that every second child is sick, and this requires the organization of preventive work, adequate health and rehabilitation measures, primarily at the outpatient level. According to WHO recommendations, most diseases in children under the age of 5 can be effectively treated on an outpatient basis, while in Kazakhstan more than 60% of children of this age are admitted for inpatient treatment. One of the reasons for hospitalization of children is the low economic availability of medicines at the outpatient level.      The rates of socially significant diseases remain high. Serious problems include mental and drug-related disorders, diabetes mellitus, bronchopulmonary, cardiovascular pathology, tuberculosis, sexually transmitted infections (hereinafter referred to as STIs), and malignant neoplasms. Unfortunately, healthcare today is more focused on curative measures than disease prevention, and the population itself is insufficiently focused on protecting its health. This is evidenced, in particular, by the increased detection of advanced tumor diseases, as well as the high mortality rate from cardiovascular diseases. According to WHO, Kazakhstan ranks first among the CIS countries in terms of tuberculosis incidence: 141.0 per 100,000 people in 1999 and 160.4 in 2003.      In connection with the HIV pandemic/The spread of AIDS is increasing in Kazakhstan, including in the penitentiary system. In this regard, the republic has adopted and is implementing The program for combating the AIDS epidemic for 2001-2005. However, the measures taken have so far only allowed to slow down the pace of the epidemic.      In general, the reasons for the unsatisfactory state of health of Kazakhstanis were the weak preventive activity of the healthcare system, insufficient responsibility for their health on the part of the population, ineffective intersectoral cooperation in health protection, as well as socio-economic problems of the transition period.

     The healthcare system

Over the years of independence of the Republic of Kazakhstan, repeated attempts have been made to reform the industry. So, in 1996-1998, the budget-insurance model of healthcare financing was introduced, which allowed creating two fundamentally new elements: the emergence of a buyer-seller relationship and differentiated remuneration depending on the volume and quality of medical care. Since 1999, program financing has been introduced, which made it possible to focus on the final result depending on the funds allocated. At the same time, as the analysis shows, the reforms were not aimed at significant transformations, were brought to a logical conclusion and could not radically change the situation in the healthcare system.      Among the changes that have occurred in recent years in the management structure of the industry, it should be noted the restoration of the Ministry of Health of the Republic of Kazakhstan, the creation of the Committee of Pharmacy, Pharmaceutical and Medical Industry and its territorial divisions, as well as the Committee of State Sanitary and Epidemiological Supervision with the division of the service into state bodies of sanitary and epidemiological supervision, performing control and supervisory functions, and state organizations conducting sanitary and epidemiological expertise and laboratory tests.      Currently, the republic's healthcare system, including all departments, is represented by a network of 886 hospital and 3,463 outpatient medical organizations. The system of organization of medical care in the regions itself differs in a number of parameters, such as: the level of consolidation of financing and management functions; the amount of resources allocated to finance the guaranteed amount of free medical care per inhabitant; the financing methods used; the structure of primary health care; organizational forms of medical organizations;      the quality control system of medical care.      This state of affairs significantly complicates the implementation of a national policy in the field of public health protection and their receipt of state guarantees equally.      Since 2001, there has been an increase in the number of hospital organizations, which numbered 845 in 2001 and 860 in 2002.      The rate of provision of beds for the population is 76.8 per 10,000 people (the total number of beds is 114782). This is slightly higher than the European average, which, according to WHO, is 73.3 per 10,000. a person of the population. The value of this indicator varies significantly even in developed countries (Germany, France, Japan, etc.), and the high rates are mainly due to the large proportion of elderly people who are the main consumers of medical services.      The number of doctors has reached 54.6 thousand people, average medical workers - 115.0 thousand people, provision of doctors is 36.5, average medical staff - 76.9 per 10,000 thousand people of the population. Despite the high average rates of provision of the population with medical personnel and beds, the healthcare system in Kazakhstan does not function effectively enough, especially at the primary health care level.      In recent years, work has been carried out to restore paramedic and midwifery centers (hereinafter referred to as AF and FAP), but the current situation is characterized by insufficient attention to the development and strengthening of primary health care, underestimation of the real capabilities of its primary care, residual financing and technological backwardness. Primary health care workers have no economic motivation to improve their work results, and their prestige in society is reduced.      Currently, PHC facilities are not staffed with qualified personnel. The material and technical base of medical and preventive organizations, especially rural ones, continues to be in poor condition. The analysis shows that the number of actual visits per shift to outpatient clinics in a number of regions exceeds the standard figures by more than 1.5 times.      Medical organizations are mostly located in adapted rooms that do not meet sanitary and hygienic requirements (more than 70% in rural areas). The availability of modern medical equipment and sanitary vehicles is less than 50%. Only 36% of primary health care facilities in rural areas are telephoned. Not all rural healthcare facilities have organized the sale of medicines. According to the certification conducted by the Agency of the Republic of Kazakhstan for Emergency Situations, among the existing buildings and structures in earthquake-prone regions of the republic do not comply with established standards, 447 healthcare organizations are subject to strengthening or demolition. There is no effective medical equipment maintenance system.      There was no systematic increase in the cost of primary health care, based on the needs for the implementation of the assigned functions, which affects the effectiveness of this link. Currently, public health organizations, including primary health care, receive budget funds in three areas - payment for services, major repairs and the purchase of medical and non-medical equipment, and the per capita standard for primary health care, as a rule, increases in proportion to the consumer price index and wage increases. In its current form, the per capita standard is the cost of maintaining the old PHC network, taking into account the optimization performed. The current payment method significantly limits the competitiveness of private medical organizations, as they can potentially claim only one source - the tariff, which hinders the development of this sector in the healthcare system. With this in mind, it is necessary to improve the methodology for the formation of tariffs (per capita standard, tariff rate, clinical cost groups (hereinafter referred to as CCG).      In the current situation, it is necessary to change the attitude towards primary health care by raising the prestige of medical workers, equipping organizations with the necessary medical equipment, introducing new technologies for prevention, diagnosis, treatment, improving the system of free and preferential drug provision at the outpatient level, and providing real per capita funding.      To date, the cost of inpatient care within the framework of providing a guaranteed amount of free medical care at the local level is three times higher than the cost of primary health care, and the medical care system itself is mainly focused on inpatient treatment. Since 2000, there has been a steady increase in the number of beds due to unjustified hospitalization and exceeding the length of stay. One of the main reasons for the desire of citizens for hospitalization is the lack of medical care at the outpatient level, the insufficient quality of primary care services. Inpatient care has not yet been standardized (with the exception of republican organizations), and the quality assessment system is not perfect.      To improve the quality of inpatient care, it is necessary to take a set of measures, including advanced training of medical and secondary staff, logistical re-equipment of hospital organizations, specification of the guaranteed volume of free medical care at the hospital level and standardization of medical services through the introduction of diagnostic and treatment protocols based on the principles of evidence-based medicine. In order to improve the quality of qualified and specialized medical care to residents of remote and hard-to-reach settlements, it is necessary to develop sanitary aviation, mobile and telemedicine.      An important tool for managing medical care is the quality assessment system, which has been formed in the republic since 1996. With the introduction of compulsory medical insurance, tools for quality control of medical care, a system of penalties were developed, and various parameters for evaluating medical care were determined. Subsequently, for objective reasons, the system of penalties and control over the volume of medical care provided were replaced by an analysis and assessment of the quality of medical services based on criteria such as determining the compliance of medical services provided with medical standards, assessing the quality of medical services, and studying the opinions of patients.      The results achieved in the quality management system of medical services include the introduction of an institute for quality assessment and a guaranteed volume of free medical care, elements of software support for quality assessment, and the preparation of a methodological framework for developing quality assessment criteria based on international experience.      At the moment, there are a number of problems in the quality management system of medical services. Administrative penalties, as a rule, do not motivate staff and managers to improve their professional activities, proposals to eliminate identified defects are only advisory in nature and are often not implemented, there is no connection between internal and external quality control of medical care. In addition, departmental medical organizations, government agencies, as well as organizations that do not have contracts for public procurement of medical services are excluded from the examination procedure.

The sanitary and epidemiological situation has a significant impact on the health of the population, primarily on the level of infectious, occupational and somatic morbidity associated with exposure to adverse environmental factors, including industrial and domestic.      In recent years, as a result of the improvement of the socio-economic situation and the ongoing preventive, sanitary, hygienic and anti-epidemic measures in the republic, there has been a decrease in infectious diseases, primarily intestinal and especially dangerous diseases, as well as diseases controlled by means of specific prevention. Over the past five years, the incidence of measles has decreased by 58.2 times, tetanus by 5.0 times, whooping cough by 4.7 times, and diphtheria by 3.6 times in the group of vaccine-controlled infections. The country is recognized by WHO as a polio-free territory. In the group of intestinal infections, the incidence of typhoid fever decreased by 3.5 times, bacterial dysentery by 3.1 times, salmonellosis by 1.7 times, acute intestinal infections and viral hepatitis "A" by 1.6 times. Particularly dangerous infections are recorded in isolated cases. This became possible as a result of the restoration of the regulatory and financial base of one of the most effective measures for the prevention and reduction of infectious diseases in the population - routine immunization.      The service has organized and is strengthening a system of units to prevent the importation of particularly dangerous infections from foreign countries into the republic. In recent years, sanitary and quarantine points have been established on the main transport routes and at the points of crossing the state border.      In order to prevent and reduce nosocomial infections, international experience is being gradually introduced into the activities of medical and preventive organizations - the "infection control" system, which saves significant financial resources.      There is an annual decrease in the number of controlled facilities that do not meet sanitary requirements and standards in the republic. The proportion of facilities that do not meet sanitary requirements, including water pipes, decreased from 31.1% in 1999 to 15.1% in 2003, secondary schools - from 14.2% to 5.9%, preschool institutions - from 7.6% to 2.7%, food markets - from 42% to 18%, facilities catering - from 22.2% to 10.5%, trade - from 15.7% to 5.9%.      Despite the measures taken, the situation remains difficult to provide the population with good-quality drinking water, only 75.1% of the population of the republic has access to tap drinking water, in some regions this figure does not exceed 60.0%. In the whole country, the proportion of non-functioning (10.0%) and non-meeting sanitary standards (15.1%) water pipes remains high. The unsatisfactory state of providing the population with drinking water of guaranteed quality annually leads to a complication of the epidemiological situation in a number of regions.      A serious problem is the presence of significant areas of natural foci of particularly dangerous infections, including plague (the territory of 8 regions), tularemia (the territory of 11 regions), hemorrhagic fever (the territory of 4 regions), tick-borne spring-summer encephalitis (the territory of 6 regions), a large number of inpatient facilities with anthrax (1767).      The situation in the food market remains difficult. Due to the lack of proper cooperation between regulatory authorities, a large number of low-quality food products, including those that are not safe for public health, are imported into the republic. The problem was the lack of proper production control at domestic food industry enterprises and catering facilities, which leads to the production and sale of substandard food products.      Among the problematic issues in the field of sanitary and epidemiological well-being, it can be noted: the low integration of the sanitary and epidemiological service into primary health care, which weakens the preventive link of medical care to the population; the inadequacy of laboratory support for sanitary and epidemiological supervision in terms of equipment, timing, and harmonization with international research standards;      implementation of sanitary and epidemiological surveillance and laboratory research at the regional and national levels with a significant weakening of the activities of district-level organizations; lack of coordination in the implementation of a number of functions and powers between the sanitary and epidemiological service and other supervisory and regulatory authorities (veterinary supervision, state standard, environmental protection).

Important decisions have been made in the healthcare financing system within the framework of the differentiation of functions and powers between the levels of government carried out during 2002-2004.      In recent years, the volume of government spending on the healthcare system, including medical education, has increased not only in absolute terms (in 2001 - 63.9 billion tenge, in 2002 - 73.0 billion tenge, in 2003 - 92.4 billion tenge, in 2004 - 133.7 billion tenge). tenge), but also, importantly, as a percentage of GDP (in 2001 - 1.97%, in 2002 - 1.93%, in 2003 - 2.08%, in 2004 - 2.63%) despite significant growth rates. At the same time, the lowest percentage of GDP was recorded in 2002 - 1.93%. According to WHO recommendations, the minimum level of government spending on healthcare should be at least 4% of GDP.      Per capita expenditures have been growing in recent years (in 2001 - 4308 tenge (29 USD), in 2002 - 4911 tenge (32 USD), in 2003 - 6201 tenge (41 USD), in 2004 - 8797 tenge (63.6 USD).      It should be noted that the increase in funding in 2002-2003 did not produce the expected result, except for an increase in the number of treated patients in hospitals by 5-7% per year. Despite repeated increases in salaries for medical workers (by 20% in 2004 alone), the official average monthly salary in the industry is two times less than the national average.      The problem remains that the obligations assumed by the state to provide citizens with a guaranteed amount of free medical care do not have adequate financial security. There is a substitution of free medical care with paid services. Due to the lack of a clear distinction between guaranteed volume and medical services provided on a fee-based basis, there remains a high level of informal payments from the population in favor of medical professionals. There is a lack of proper accounting for the consumption of medical care provided within the guaranteed volume of free medical care, which contributes to the growth of the shadow economy.      There is no comprehensive sectoral resource conservation policy.      The division into buyers and suppliers of medical services that exists today is conditional, since almost all suppliers are government organizations that are administratively and economically subordinate to health authorities. In the regions, the development of healthcare is not a priority in socio-economic policy.      Thus, there are a number of negative trends in the industry that require management decisions.      Firstly, the most important principle of the organization of the healthcare system is violated - the stage-by-stage provision of medical care.      Secondly, there is an inequality between territories within the region in terms of the volume and quality of medical care, as well as indicators of the development of healthcare in general.      Thirdly, the mandatory components of the management system, monitoring and evaluating the activities of organizations and the healthcare system as a whole, are insufficiently formed. The lack of a coordinated policy in the field of healthcare information support leads to a decrease in the reliability of information collected in the industry, delayed receipt of information from the field to the regional and national levels, and the inability to compare data coming from individual subsystems. This ultimately leads to a decrease in the effectiveness of decisions based on this information and an irrational use of healthcare resources.      Fourthly, the lack of uniform approaches and standards in the procurement of medicines leads to an increase in the cost of purchased products and problems with their quality.      Fifth, there is poor coordination of the activities of health authorities with other public administration entities that directly or indirectly affect the level of public health (labor and social protection authorities, ecology, education, culture, and others). This coordination is an important tool for shaping a healthy lifestyle and, ultimately, leads to a reduction in the need for medical services.      Sixth, primary health care, being the central link of the healthcare system, should perform the main function of improving the quality of public health indicators. The effectiveness and quality of the entire healthcare system, the preservation of the country's labor potential, as well as the solution of most of the medical and social problems that arise at the family level and among socially vulnerable groups of the population: children, the disabled and the elderly depend on its condition. Today, PHC doctors have become dominated by "dispatch functions": the frequency of outpatient referrals to specialist consultations is excessively high.      Seventh, there is a significant bias in the amount of funding for outpatient and inpatient care towards the latter, which does not allow the introduction of modern resource-saving technologies for providing medical care at the pre- and post-hospital stages. This leads to an expansion of indications for inpatient treatment, an annual increase in the number of beds, and, consequently, an increase in the cost of medical care.      Eighth, the public health system is not spatially separated from the private one: private structures that provide medical care on a fee basis are located on the squares of public health organizations.      Ninth, the lack of trained, qualified managers in the industry has led to a decrease in manageability and inefficient use of allocated resources. Today, the head of a medical organization is a manager, administrator, chief physician, head of household, practicing clinician, and so on.      Tenth, the activities of the healthcare system in modern conditions cannot be limited only to intra-industry problems. The integral nature of the health status of the population requires increased intersectoral coordination, especially in the formation of a healthy lifestyle and improving the quality of the social, psychological and environmental environment. At the same time, the population is insufficiently informed and does not actively participate in the management of the healthcare system.      In this regard, it is necessary to choose a clear, understandable, manageable, effective model of medical care.

4. The purpose and objectives of the Program

     The aim of the Program is to create an effective system of medical care based on the principles of joint responsibility for health protection between the state and the individual, and the priority development of primary health care aimed at improving public health.

     The main objectives of the Program are: 1. Division of responsibility for health protection between the state and the individual.      2. The transition to international principles of the organization of medical care with the shift of the center of gravity to primary health care.      3. Creation of a new healthcare management model and a unified information system for the industry.      4. Strengthening the health of mother and child, improving the medical and demographic situation.      5. Stable decrease in the level of socially significant diseases.      6. Reforming medical education.

     The scale of the problems solved within the framework of the Program, the need to coordinate the measures being developed with the capabilities of the republican and local budgets determine its implementation in two stages.

     At the first stage (2005-2007), the following tasks are expected to be solved: sharing the joint responsibility of the state and citizens for health protection; setting minimum standards for guaranteed free medical care; working with the population to promote a healthy lifestyle; shifting the focus from inpatient to primary health care; financial and administrative separation of primary health care from hospitals; strengthening the material and technical base of healthcare organizations, primarily primary health care;      rationalization of inpatient and emergency medical services; carrying out measures to promote maternal and child health; strengthening preventive, diagnostic, and therapeutic rehabilitation measures in the field of socially significant diseases; ensuring the quality of medical services through the creation of an independent medical examination system; introducing economic relations between medical organizations; training managers and improving the management of health system resources;      qualitative changes in the system of training and retraining of medical and pharmaceutical personnel to work in the new PHC system; improvement of the regulatory framework of the healthcare system; implementation of measures for the transition to international standards in healthcare; development and implementation of modern information technologies.

           At the second stage (2008-2010), the following will be implemented: the transformation of primary health care through the systematic step-by-step strengthening and development of the institute of general practitioners; the reorganization and strengthening of inpatient and emergency medical care, strengthening continuity at the stages of medical care; improving the quality of medical services through the introduction of international standards and the creation of competition between medical organizations; fundamental reform of medical education;      a real shift in emphasis from the treatment of established diseases to preventive measures and health promotion of the "healthy"; ensuring the joint responsibility of citizens, employers and the state for the protection and strengthening of individual and public health.

5. Main directions and mechanisms of the Program implementation

The Program will be implemented in the following areas: 1. Solidarity and joint responsibility of the state and the individual for their health.      2. Reforming and developing the system of organizing medical care for the population: primary health care reform is the basis for the effective functioning of the healthcare system; rural health development; ensuring sanitary and epidemiological well-being; healthy lifestyle formation and disease prevention; intersectoral approach to public health protection.      3. Improvement of the healthcare management system: rational differentiation of functions and powers; improvement of the quality management system of medical services; development of competition in the healthcare system; basic approaches to improving the financing system; increasing the effectiveness of state regulation of the sphere of circulation of medicines; unified healthcare information system.      4. Maternal and child health protection.      5. Improvement of prevention, diagnosis, treatment and rehabilitation of socially significant diseases; development of medical science.      6. Training and retraining of healthcare personnel.

5.1. The solidarity and joint responsibility of the State and the individual for their health

     The State must ensure the realization of the constitutional rights of citizens to receive a guaranteed amount of free medical care at the expense of the state budget.      As part of the guaranteed volume of free medical care, the necessary medical services will be provided according to minimum standards (services of doctors and medical staff, necessary research, essential vital medicines, therapeutic nutrition). The formation of a package of services provided within the guaranteed volume of free medical care will be based on the following principles: compliance with the financial capabilities of the state; social justice in the availability of medical care; transparency; dynamism; separation of responsibility of the state, the employer and the citizens themselves for the preservation and promotion of health.      As the financial capabilities of the state expand, the guaranteed amount of free medical care will be expanded and approved every two years.      In addition to providing medical care, the following activities will also be carried out within the guaranteed scope: periodic preventive medical examinations of the population, followed by dynamic monitoring and rehabilitation; providing the population with reliable, objective and accessible information on health protection, principles of rational nutrition, instilling disease prevention skills; implementation of programs and measures to combat drug addiction, alcoholism, tobacco smoking;      sanitary and educational work to strengthen and preserve health in preschool institutions, general education schools, higher and secondary vocational educational institutions.      Responsibility for timely periodic medical examinations will be determined.      The provision of medical care in excess of the guaranteed amount of free medical care will be carried out: at the expense of citizens' own funds; within the framework of the voluntary medical insurance system;      at the expense of the employer's funds and other sources not prohibited by the legislation of the Republic of Kazakhstan.      Additionally, the funds received by medical organizations will be used to increase wages, reimburse costs incurred, strengthen the material and technical base, and retrain personnel. The procedure for using these funds will be determined by the legislation of the Republic of Kazakhstan.

5.2. Reform and development of the system of organization of medical care to the population

5.2.1. PHC reform - the basis for effective functioning of the healthcare system

The experience of developed countries shows that the majority of adults and children receive medical care from primary health care organizations, including general practitioners.      The proposed PHC model in the Republic of Kazakhstan will be based on the principles of general medical practice and consist of PHC centers that receive state orders from local health authorities. This model will be based on the principles of free choice of a doctor and economic management methods, including the introduction of a two-component per capita standard with a "stimulating" component. This will ensure accessibility and improve the quality of medical services provided, and increase the interest of medical professionals in the final results of their work.      The PHC reform and development will be carried out in 2 stages.      At the first stage (2005-2007), the existing network of outpatient clinics, including those operating on the principles of general medical practice, will be maintained and developed. Their material and technical base will be strengthened, which will allow the introduction of new medical and diagnostic technologies. Free or preferential drug provision for types of diseases and certain categories of citizens in outpatient treatment will be improved.      The phased PHC reform will focus on the evolutionary implementation of the principle of general medical practice. In 2005-2007, outpatient care in urban areas will be restructured with the creation of mixed-type polyclinics providing general practitioners and specialized care. Specialized care in polyclinics of regional centers and cities, as well as scheduled hospitalization in hospitals, will be provided to citizens only upon referral by primary health care doctors.      A policy of targeted investment in capital construction, reconstruction and repair of primary health care facilities will be pursued, primarily in regions experiencing a shortage of outpatient services, to implement the principle of leveling and strengthening the material and technical base.      Due to the strengthening of the role and expansion of the functions of PHC, it will be necessary to improve the regulatory framework for its activities, introduce protocols for the diagnosis and treatment of diseases, and develop guidance documents on medical examinations, sanitary and epidemiological rationing, and drug provision to the population.      At the first stage of PHC reform, the following organizational and therapeutic measures will be implemented: financial and legal separation of outpatient polyclinic structures from hospitals;      intersectoral cooperation with social protection authorities and other interested services, as well as non-governmental organizations; study of the morbidity structure of the attached population, development and implementation of measures to reduce and prevent it; preventive examinations of certain categories of citizens; immunoprophylaxis; expansion of the volume of preventive, therapeutic, diagnostic and rehabilitative measures for registered dispensaries, as well as patients with socially significant diseases;      the introduction and development of inpatient replacement technologies with drug provision for patients within the guaranteed volume of free medical care; the introduction of preferential drug provision at the outpatient level for certain categories of the population, as well as patients with a specific list of diseases; further strengthening of laboratory services, including the introduction of express diagnostic methods; improving the quality of services at the primary health care level with the transition from a control system to a therapeutic-the diagnostic process for evaluating activities based on the final result;      public participation in the activities of PHC organizations based on the principle of free choice of a doctor.      The implementation of these measures will lead to a significant increase in the share of outpatient medical services in the overall structure of medical care and a decrease in the level of hospitalization. As the volume and quality of medical care at the primary health care level expand, the size of the per capita standard will increase starting in 2005.      At the second stage (2008-2010), the transition of the PHC system to the principle of general medical practice will begin. Independent PHC centers will be created. The financing of these organizations within the framework of the state order will be carried out on the basis of the per capita financing method with elements of fund maintenance. The scope of services provided by PHC centers will be significantly expanded, and their material and technical base (buildings, communications, equipment) will be brought into line with new requirements. The staff of the centers will have to upgrade their skills and undergo retraining at least once every 5 years.      In order to improve the quality of medical care provided, PHC organizations will be accredited on a regular basis, and every 3 years, medical personnel will be certified for professional competence with the participation of independent experts.      By 2010, primary health care funding will amount to at least 40% of the total funds allocated for guaranteed free medical care.      Primary care reform involves simultaneous transformations in the organization of the emergency medical service as an integral component of primary health care.      The development of this service will be carried out in the following areas: reducing the volume of emergency medical care by reducing the number of unjustified calls and redirecting patients in need of urgent (rather than emergency) care, by organizing outpatient care, as well as by expanding the range of activities and accessibility of the primary level; logistical support for the service in accordance with approved standards;      coordination of first aid activities for life support personnel (police, traffic police, fire department) and vehicle drivers.      At the second stage of PHC reform, organizations providing emergency medical care should become independent.      The ongoing reforms to strengthen the preventive focus and strengthen primary health care will result in the rationalization of inpatient medical care services and a shift away from bed orientation. In the future, multidisciplinary hospitals with specialized departments will be created. Tuberculosis dispensaries, infectious diseases and other hospitals will be strengthened and operate separately due to their specifics.      The construction of new and reconstruction of existing medical institutions will be carried out taking into account the need to develop such forms of inpatient care and the priority of primary health care organizations.      At the same time, the criteria for hospitalization of patients will be defined as clearly as possible, taking into account the principles of phasing and continuity of medical care.      Thus, the priority direction for improving the organization of medical care in the Republic of Kazakhstan will be the creation of a new PHC model based on the principles of general medical practice, along with the rationalization of the activities of the ambulance service and hospitals. This model will fully meet the needs of the population, based on the mutual responsibility of medical workers and citizens for health protection. This will allow us to shift the emphasis from expensive inpatient to outpatient care, ensuring continuity and continuity in the provision of medical care to the population.

5.2.2. Rural healthcare development

Within the framework of The state and regional rural development programs of the Republic of Kazakhstan in 2004-2010 will improve the material and technical base of rural healthcare. Construction, reconstruction, overhaul of healthcare facilities and full equipping of primary health care facilities with medical equipment and sanitary vehicles will be carried out in accordance with established standards, as well as according to the methodology for determining the need for the development of a network of priority healthcare organizations and sources of financing for their construction and reconstruction, developed by the Ministry of Health of the Republic of Kazakhstan.      In 2005-2007, 90 healthcare facilities are to be built and 450 repaired. At the same time, all the needs of the population for tuberculosis treatment and maternity care must be fully met.      The spread of mobile and telemedicine will continue.      The existing PHC system will be maintained in rural areas.      The main focus of improving the organization of medical care will be to enhance the role and expand the activities of the general practitioner. He will be responsible for the management of the staff of the AF and FAPs (paramedics, midwives, nurses), as well as coordinating activities with social workers. To fulfill the tasks set, in-depth training of paramedic and obstetric staff in general practice is provided.      In 2005-2006, the transfer of the NEA, SUB will be completed./SB and district polyclinics to the status of state institutions.      Due to the new funding scheme and the clear division of functions, district polyclinics will be financially and legally separated from central district hospitals.      At the second stage, the issue of changing the organizational and legal form of medical organizations will be considered.      Central district hospitals will play a special role in rural areas.      In order to provide rural healthcare facilities with qualified medical and pharmaceutical personnel, effective mechanisms will be developed to secure specialists with higher and secondary medical and pharmaceutical education in rural areas, such as providing office housing, paying one-time allowances, and paying off state educational loans provided they work in rural areas for three years.      Regional executive bodies will be given the right to allocate targeted grants from the funds of the relevant local budgets for the training of specialists with the condition that they continue to work in rural areas for three years.

5.2.3. Ensuring sanitary and epidemiological welfare

     In order to improve the sanitary and epidemiological situation, including the prevention and reduction of infectious, occupational and non-communicable diseases, and to reduce the harmful effects of adverse environmental factors on public health, the following tasks will be solved: integration of the state sanitary and epidemiological service with PHC, especially in terms of strengthening measures aimed at sanitary and preventive work among the population;      ensuring overall coordination of measures to reduce infectious diseases, including tuberculosis, sexually transmitted infections, and HIV/state bodies of the sanitary and epidemiological service; creation of optimal conditions for laboratory diagnostics of infectious diseases and their centralization in state organizations that carry out sanitary and epidemiological expertise at the district level; phased modernization of laboratories of the sanitary and epidemiological service;      further improvement of ongoing sanitary and anti-epidemic (preventive) measures to combat infections, sanitary protection of territories and eliminate the consequences of biological terrorism; providing scientific justification and support for documents of the state system of sanitary and epidemiological rationing; joint participation with interested government agencies in measures to eliminate the medical consequences of natural and man-made disasters.      In order to strengthen the preventive focus of the activities of sanitary and epidemiological surveillance authorities at the PHC level, the following measures will be implemented: shifting the focus from supervisory and administrative to educational and incentive measures for the safe production of goods and services; transferring a number of functions and powers from the republican to the regional and from the regional to the city and district levels of government.      The modernization of the laboratory network of the sanitary and epidemiological service will provide, first of all, a transition to a qualitatively new level of sanitary and epidemiological expertise based on the use of modern research standards and the establishment of cause-and-effect relationships between the effects of adverse environmental factors on public health.      For this purpose, it is supposed to differentiate the goals, volumes and nomenclature of laboratory research at the appropriate levels (republican, regional and district) along with the modernization of laboratory services at all levels, which will be carried out in 3 stages (I - republican level - 2005; II - regional level - 2006-2007; III - district level - 2007-2009 years).      A centralized, multifunctional laboratory service will be created based on a network of reference laboratories, which will significantly improve the quality of laboratory research.      The fight against particularly dangerous infections, sanitary protection of territories and elimination of the consequences of biological terrorism will be aimed at preventing and preventing the incidence of particularly dangerous infections among the population.      Measures will be taken to strengthen sanitary and quarantine points at border crossings in order to prevent the importation of particularly dangerous infections and products that are not safe for public health into the country.      In the field of sanitary and epidemiological rationing, a scientifically sound regulatory framework will be created that meets international standards for the sanitary and epidemiological welfare of the population, including the requirements of the World Trade Organization.

5.2.4. Formation of a healthy lifestyle and prevention of diseases

     Moving away from a healthcare system focused on the treatment of diseases and the introduction of integrated medical care involves a multi-pronged effort aimed at solving a range of human health problems.      The implementation of the principle of joint responsibility of citizens and the state for health protection will be carried out through preventive measures and the formation of a healthy lifestyle, providing the population with periodic preventive medical examinations followed by dynamic monitoring and rehabilitation.      Public health programs will be developed and implemented, such as health promotion, prevention of infectious and non-communicable diseases, maternal and child health promotion, the introduction of principles of rational nutrition, increased physical activity, family planning, prevention of drug addiction, injuries and accidents, HIV/AIDS, STIs, the fight against smoking and alcohol abuse. The implementation of these programs will be carried out with the cooperation of primary health care, organizations providing specialized medical care, and the sanitary and epidemiological service.      Targeted prevention programs for the most common non-communicable diseases, such as hypertension, diabetes, and others, will also be developed. At the same time, with the development of a new healthcare model, funding for healthy lifestyle promotion and disease prevention programs can be transferred to the district level in order to reach the population more effectively.      On the basis of PHC organizations, programs for teaching the population a healthy lifestyle, rehabilitation, and schools for patients with chronic diseases will be implemented. The number of secondary medical personnel responsible for the patronage service, promotion of a healthy lifestyle and sanitary and epidemiological welfare will be increased by revising staffing standards to strengthen the preventive focus of work in each territorial area of primary health care. Special attention will be paid to conducting medical examinations of preschool and school-age children, students and students. For this purpose, the network of medical centers in all educational institutions will be restored.

5.2.5. Intersectoral approach to health protection of the population

According to WHO, human health largely depends on lifestyle, genetic factors, the environment, and the healthcare system. One of the main tasks in improving healthcare management is to coordinate the activities of healthcare entities and an intersectoral approach to public health protection.      To this end, it is planned to coordinate the work of various government agencies, departments and organizations whose activities directly or indirectly affect the health of the population and the functioning of health services. To successfully fulfill the objectives of the Program, the efforts of interested departments will be combined to implement certain priority areas of state policy in the field of health protection and the National Coordinating Council for Health Protection under the Government of the Republic of Kazakhstan, as well as coordinating councils under local executive bodies, will be established.      The following elements of intersectoral cooperation should be implemented: conducting an active demographic policy and regulating demographic processes in close cooperation with demography and migration authorities; interacting with labor and social protection authorities in the main areas of preventive, medical, social and rehabilitation assistance to citizens, as well as on issues of differentiated remuneration for medical workers; adopting joint environmental protection measures with relevant government agencies;      interaction in matters of upbringing, education and health protection of children and adolescents with state bodies of education, internal affairs, sports, defense, culture and information; solving issues related to the provision of drinking water, telecommunications, roads, sanitary transport, medical care and measures for sanitary and epidemiological welfare in cooperation with the relevant central authorities. and local executive bodies;      further integration of the TB service with law enforcement and other government agencies; strengthening measures to promote physical culture and sports among the general population, coordinate activities with organizations of physical culture, sports, tourism, motivation and create conditions for a healthy lifestyle and sports; widespread use of mass media to promote a healthy lifestyle and prevent diseases;      coordination of actions with emergency services in the event of possible natural and man-made disasters, as well as outbreaks of infectious diseases; development of rehabilitation and palliative care services, including the organization of hospices and nursing hospitals, with the involvement of interested ministries and departments, as well as with the participation of international and non-governmental organizations; strengthening cooperation with transport anda communication complex on the issues of ensuring traffic safety and improving the environmental situation.      The Program provides for close cooperation with international organizations in order to use the positive experience of countries far and near abroad for further adaptation to the national health system.

5.3. Improvement of the environmental management system

     The existing healthcare management system assumes management mainly by administrative methods, as a result of which almost all basic functions are centralized at the Ministry of Health level, including licensing, accreditation, public procurement and a number of others, which generally determines the inefficiency of industry management.      One of the priorities of the Program at the first stage is to change centralized administrative management through the transition to economic methods with a clear differentiation of functions between central, local governments and medical organizations and the creation of an appropriate regulatory framework.      At the second stage, healthcare management will be implemented through the introduction of a quality control system for medical services and other criteria for the effectiveness of the industry, taking into account international requirements and based on modern information technologies.

5.3.1. Rational differentiation of functions and powers

     The main direction of improving the management of the industry is the transition from administrative regulation to a system of economic incentives. To this end, starting in 2005, in accordance with the Budget Code of the Republic of Kazakhstan, functions will be redistributed between central and local health authorities and medical organizations in the direction of greater independence of the latter.      The competence of the central executive body will include: the functions of ensuring the implementation of a unified state policy in the field of healthcare;      executive functions (implementation of measures to ensure equal access to the provision of basic health services throughout the country, guaranteed The Constitution of the Republic of Kazakhstan, setting standards for their provision, planning the development of the industry, developing a regulatory framework); regulatory functions (monitoring the implementation of health policy, monitoring the implementation of state, sectoral programs, accreditation of healthcare organizations, control and supervisory functions).      In addition to the function of controlling the provision of direct general services to the population, licensing procedures for certain types of medical, pharmaceutical, and activities related to trafficking in narcotic drugs, psychotropic substances, and precursors in the healthcare industry, as well as the purchase of vaccines, immunobiological, and other medical products will be transferred to the local level.      In order to prevent a decrease in the quality of local medical services as a result of the decentralization of most functions, at the first stage of the reform, a procedure for coordinating quality parameters of medical care with the Ministry of Health will be introduced by law, and additional funds (for outpatient medicines, etc.) will be allocated in the form of targeted transfers. Next, the transition will be made to the independent use of the allocated funds by local executive bodies.      In connection with the consolidation of the healthcare budget at the regional level, a mechanism will be developed to strengthen the responsibility of executive bodies at all levels for public health issues.      In order to provide the population with safe, effective and high-quality medicines, the legislation of the Republic of Kazakhstan on public procurement will be amended to establish the obligation for public procurement at the local level by local health authorities, taking into account the quality of the drug.      Since 2006, the organizational and financial separation of PHC services from hospitals will be launched, which will streamline budget flows and eliminate unjustified hospitalization as much as possible.      In order to motivate the work of healthcare workers, measures will be taken to improve the remuneration system, the principle of differentiated payment based on the final result will be introduced in accordance with the qualifications, quality and volume of work performed, and the qualification requirements for heads of public health organizations regarding the mandatory qualifications of a healthcare manager will be revised.      As staffing increases, the management structure of healthcare organizations will be reviewed by transferring management issues to trained specialists.      All possible assistance will be provided to the development of professional associations and unions, and they will be involved in the certification of medical personnel and the examination of the quality of medical services.

5.3.2. Improvement of the quality management system of medical services

Quality control of medical services in the world is one of the main management mechanisms of the healthcare industry.      The creation of a quality management system for medical care provides for standardization and the introduction of new (proven positive in international practice and recommended by WHO) methods for the diagnosis and treatment of diseases.      Improvement of the quality of medical services will be carried out on the basis of: providing medical service providers with the necessary resources;      improving the professional level of medical workers, including the introduction of evidence-based medicine courses into educational programs; the introduction of quality management systems in medical organizations in accordance with the requirements of international standards; prioritization for the effective use of allocated resources; licensing, accreditation, external and internal expertise of medical service providers; the introduction of methods of differentiated payment depending on quality medical services provided;      media coverage of ratings of medical service providers; creation of a unified information system; application of necessary administrative and financial sanctions.      In order to implement the tasks of quality management of medical care, a state agency for quality control of medical services will be established in 2005. If necessary, independent experts will be involved in conducting control inspections by the state body. For this purpose, a database of independent experts from among specialists of various profiles will be formed.      One of the primary tasks of medical care quality management is to improve protocols for the diagnosis and treatment of diseases at all levels of medical care. The quality of these protocols will be ensured by bringing them in line with the requirements of evidence-based medicine. Protocols for the diagnosis and treatment of diseases, as well as indicators of the quality of medical care, will be improved and updated in accordance with the requirements of international standards.      The quality assessment at the first stage will be carried out on the basis of the developed indicators for assessing the activities of the hospital and PHC organizations. At the same time, the most common diseases will be monitored. Quality assessment in medical organizations will be carried out selectively, and in some cases (death at home, detection of advanced cases of cancer, tuberculosis, and others), mandatory examination will be conducted.      The quality control of medical care will be based on an analysis of the compliance of the examination and treatment with periodic diagnostic and treatment protocols, the validity and timeliness of prescribing diagnostic tests and treatment, referral to hospital, and errors made during diagnosis and treatment.      In order to carry out a proper examination of medical services, a comprehensive quality management system will be developed, including indicators for each level of medical care, and mechanisms for economic motivation.      In 2005, an improved technology for studying citizens' opinions on the quality of medical services provided to them will be introduced.      Starting in 2006, measures of civil liability will be applied to healthcare entities for errors in diagnosis and treatment, and legislative norms regulating the rights of patients have been developed.      In 2005-2007, activities will be carried out to support non-governmental organizations (associations of medical organizations, professional associations of doctors, patients) and involve them, if necessary, in the independent examination of medical services, accreditation, and certification of specialists.      During 2008-2010, protocols for the diagnosis and treatment of diseases and indicators of the quality of medical care will be further improved in accordance with international standards.      The implementation of the tasks set will make it possible to move away from purely administrative methods and create a comprehensive quality management system aimed at improving medical care, efficient use of budget funds and increasing the responsibility of medical workers for the services provided.

5.3.3. Development of competition in environmental protection systems

     The gradual transition to new economic relations in the healthcare system is a strategically important task in reform and development. Only elements of real competition can significantly improve the efficiency of healthcare as an industry, including optimizing budget costs and improving the quality of services provided.      Government medical organizations receive funding in three main areas - the actual tariff, capital expenditures for the purchase of equipment and major repairs. The existing "multi-channel budget financing" hinders the development of competition, since private medical organizations can only apply for one source - the current tariff. The development of competition in the system is impossible without changing the tariff policy. In 2007, the introduction of a new tariff formation system will begin, including the cost of updating fixed assets. At the second stage of the Program's implementation, with the achievement of the required level of the material and technical base of public health organizations and tariffs, the state will completely move away from "multi-channel" budget financing and strengthen the mechanisms of depreciation regulation. This will ensure the financial stability of medical organizations and create the necessary conditions for the development of the private sector in the provision of medical services. At the same time, suppliers, regardless of their form of ownership or organizational and legal form, will have an appropriate level of independence in matters of strengthening the material and technical base and allocating funds saved as a result of economic activities.      When obtaining expensive types of medical equipment, measures will be developed to expand the use of financial leasing in order to use them effectively and ensure equal opportunities and equal competitive conditions for public and private healthcare organizations.      In addition, the development of competition in the healthcare system involves solving a number of important tasks: 1) improving the system of contractual relations between the customer (government agency) and the supplier (medical organization) in terms of applying economic management methods that clearly define the rights, duties and responsibilities between them.Managers who form and place government orders, in particular at the local level, will receive the necessary training in 2005-2006., because their qualifications and the decisions they make will have a significant impact on the operation of the system as a whole.      Public and private medical organizations will have equal conditions for providing services to provide a guaranteed amount of free medical care based on common standards, requirements, responsibilities and economic conditions. To implement these conditions, it is necessary to strengthen their independence in making managerial decisions by providing the opportunity to change the status of state organizations and reorganize them into state-owned enterprises with the right of economic management, limited liability partnerships, and joint-stock companies. At the same time, individual specialized organizations providing medical care for socially significant diseases such as tuberculosis, oncological diseases, etc. will not change their status. In order to ensure conditions for the provision of high-quality medical care, maximum quantitative and qualitative indicators of the burden on one doctor or one medical organization will be introduced; 2) the gradual filling of the per capita standard and the transition to a partial fund model will have a significant impact on reducing the unreasonably high cost of the healthcare system, in particular on the rationalization of the inpatient unit.      The government will encourage an increase in the share of the private sector at the PHC level, since it is the most attractive in terms of the requirements for the financial equipment of organizations and cost intensity.

5.3.4. Basic approaches to improving the financing system

To ensure the sustainable development of healthcare and the introduction of internal mechanisms to stimulate efficiency improvement, a phased increase in government spending on healthcare to 4% of GDP is envisaged by 2010.      At the first stage, previously adopted decisions in the industry's financing system will be implemented, as well as a financing policy aimed at effective use of funds, attracting investments into the system and inter-regional alignment.      In accordance with the Budget Code of the Republic of Kazakhstan, the function of a single payer will be performed by the regional health management body, which will ensure the alignment of per capita standards for health insurance and hospital treatment rates within the regions and increase control over the quality of medical services. The Ministry of Health will transfer the authority for centralized procurement of goods and services to a lower level.      The per capita standard for primary health care organizations will be determined taking into account the required amount of medical care at this level, the gender and age composition of the attached residents and other factors reflecting regional peculiarities. In order to ensure the fullness of the per capita standard, an annual increase will be carried out, bringing it to an optimal level in 2010. Gradually, as the volume of care provided at the PHC level increases, the share of funds allocated to PHC will increase, including through free and preferential drug provision to patients at the outpatient level by type of disease and certain categories of the population. Part of the funds allocated as part of the additional costs for the provision of a guaranteed amount of free medical care in 2005 in the amount of 15 billion tenge will be used to finance primary health care organizations.      In 2005, a national system for monitoring the quality and efficiency of resource use will be developed and implemented starting in 2006, based on a system of indicators and indicators that allow for performance assessment and the use of financial incentive and punishment components.      The methods of financing health care providers should provide the right incentives for providers at different levels.: for hospitals (clinical and cost groups - CPG) - to pay for services rather than capacities, for primary health care - to stimulate the preventive focus of medical organizations (per capita standard).      Financing methods will be periodically improved. Thus, the CG weights and the group structure will be reviewed as periodic diagnostic and treatment protocols based on evidence-based medicine principles are developed.      During 2005, financial mechanisms for the development of highly specialized medical care and the introduction of new technologies will be developed.      Since 2006, all decisions made to invest in the healthcare system or to make additional commitments by the State should be based on achieving specific results and effects. An appropriate methodology will be developed and approved.      Medical equipment in healthcare organizations, its technical condition and effective use will be constantly monitored, including a system for recording the operation of expensive equipment.      During 2005, measures will be developed to improve the system of remuneration for medical workers and to introduce the principle of payment based on the final result. The remuneration of employees of public health organizations should be differentiated, adequate to the level of qualifications, quality and volume of care provided, including on a fee basis, which will reduce the level of direct informal payments. Starting in 2006, a phased increase in salaries for medical workers will be implemented.      During 2005, a system of measures will be developed to ensure transparency in the use by medical organizations of funds allocated from the State budget for the provision of guaranteed free medical care. The accounting system for funds received by medical organizations from various sources, including for the provision of medical services on a fee basis, will be improved.      Personalized consumption of medical services and goods will be ensured, as well as a system for monitoring services provided by patients.      This work will be accompanied by widespread public awareness of the list and volume of free medical services, and constant monitoring of ongoing processes. The population will receive the necessary information about how much and for what they will have to pay.      In order to ensure an additional inflow of funds to the industry, measures will be taken to encourage voluntary health insurance from both employers and the public themselves, and appropriate amendments and additions will be made to the current legislation of the Republic of Kazakhstan. Voluntary medical insurance will be mutually beneficial for both the insurer and the policyholder, taking into account the solution of the problem of risk selectivity.      Since 2005, preparatory measures will be carried out for the introduction of national health accounts in 2006-2007, which will allow for full information on financial flows throughout the industry, including in the private sector.      At the second stage, a new financing policy for the industry will be introduced, aimed at efficient use of funds, attracting investments into the system and inter-regional alignment, which will make it more stable and create conditions for further progressive development and increased competitiveness.      To ensure equal access to guaranteed free medical care for the population of different regions, inter-regional tariff equalization for similar medical services will be completed by 2010, taking into account the structure of morbidity and other objective factors.      In order to create conditions for more efficient administration of financial resources, increase the structural efficiency of healthcare, establish the relationship between different levels of medical care, and reinvest in cases of rationalization of budget expenditures, it is necessary to carry out maximum programmatic consolidation.      By 2008, as the country's socio-economic development improves and citizens' incomes increase, the possibility of introducing a compulsory health insurance system will be considered.

5.3.5. Improving the effectiveness of state regulation of the sphere of circulation of medicines

The provision of medicines to the population of the Republic of Kazakhstan is one of the most important tasks of the state. The use of medicines plays a key role in preventive medicine and the treatment of diseases. At the same time, the existing structure of state regulation of the sphere of circulation of medicines requires additional measures to ensure quality and accessibility.      To this end, the following tasks will have to be solved: ensuring equal physical and economic access of the population to essential vital medicines.;      introduction of prescription medicines in the retail pharmacy network according to the list determined by the authorized body; taking measures to ensure the quality and safety of medicines; rational use of medicines; further development of the pharmaceutical and medical industry within the framework of Strategies of industrial and innovative development of the Republic of Kazakhstan for 2003-2015.      The solution of the tasks is planned to be carried out in two stages.      At the first stage, during 2005-2007, it is necessary to: increase the accessibility of essential (vital) medicines to the population and ensure the introduction of a formulary system in healthcare organizations at all levels, especially in rural areas; carry out preparatory work on the introduction of international standards into the domestic pharmaceutical industry; begin implementing international standards in the domestic pharmaceutical industry in 2007. (GLP, GCP, GPP, GDP, GMP);      to increase the efficiency of public procurement by introducing amendments and additions to the legislation of the Republic of Kazakhstan on public procurement, guaranteeing the quality of purchased medicines; to monitor the side effects of medicines used; to create structures for organizing and conducting scientific research in the field of drug circulation on the basis of the republican state enterprise "National Center for Expertise of Medicines, Medical Devices and medical equipment" of the Ministry of Health;      to create and equip an immunobiological and four interregional laboratories to carry out quality control of medicines in accordance with the requirements of the international standard "Good Laboratory Practice"; to increase the effectiveness of state control in the field of drug circulation in order to prevent counterfeit products from entering the pharmaceutical market and reduce the threat of pharmacoterrorism;      to organize training in the quality management system and international standards for specialists of the state body in the field of drug circulation and its territorial divisions, as well as specialists from testing centers; to provide training conditions for pharmaceutical sector entities on drug quality management; to develop a methodology for organizing the collection and processing of information in the field of drug circulation within the framework of the created unified information system healthcare.      At the second stage, in 2008-2010, it is planned to implement a plan for the phased transition of the pharmaceutical sector to international quality standards in the field of drug circulation. The accreditation of testing laboratories in the field of circulation of medicines, medical equipment and medical devices in accordance with international standards will be completed, a quality management system for medicines will be created, and a methodology for informing the public about the safety and effectiveness of the use of medicines will be developed.

5.3.6. Unified information system of environmental Protection

     As part of the informatization of the Republic of Kazakhstan in 2005-2007, a unified health information system (hereinafter - UISZ) will be created, the main directions of which will be: development of a unified methodology for collecting, processing and storing information on the health status of citizens, receiving medical and medicinal care; analysis, synthesis and provision of information to healthcare organizations and government agencies;      creation of an information and reference system, a central data bank that allows obtaining the necessary information from each medical and preventive organization and public health management body; creation of an electronic passport of citizens' health, an electronic medical history that allows effective monitoring of a complex of medical and demographic indicators and the volume of medical care consumption by citizens;      the use of a single identification code of an individual for personalized patient registration, which allows ensuring continuity of medical care at the primary health care level, polyclinics, hospitals, as well as taking into account medical aspects, social benefits and allowances in a single format, while respecting the confidentiality of medical information, within the framework of the state database "Individuals".      Since 2007, pilot projects on the use of medical electronic patient records, providing personalized accounting of medical care consumption, will be implemented in certain regions of the republic.      For the development of the UISZ in the period up to 2010, the following tasks will be solved: automation of the management decision-making process and quality management of medical care at all levels based on information accumulated in the UISZ; modernization and integration of existing departmental information systems and their logistical support;      development and implementation of departmental, statistical, and medical technology information systems and their logistical support; implementation of medical electronic patient records.      In order to develop information support for healthcare, an information and analytical center (hereinafter referred to as the IAC) will be established, subordinate to the authorized body in the field of healthcare. The IAC will create an information model of the industry corresponding to the tasks set, which will serve as the basis for the development of basic standardized, terminologically agreed information and reference classifiers of the parameters of health organizations and public health indicators. Based on the developed classifiers, the existing accounting and reporting systems in healthcare will be reviewed in order to further implement automated information processing and eliminate duplication of accounting. As a result, a methodology for data collection and processing will be developed at each stage of the implementation of information systems in healthcare at all levels, starting with management bodies and ending with medical personnel directly involved in providing medical care to the population, as well as a methodology for analyzing the information collected and making managerial decisions. The existing accounting and reporting system will be aligned with the clinical and medical-economic aspects of the activities of healthcare organizations.      The unified information system will meet the needs of all individuals and legal entities in information about the health status of the population, consumption of medical services and other parameters.

5.4. Maternal and child health protection

One of the main priorities of the development of the Republic of Kazakhstan is the improvement of the medical and demographic situation, which is primarily related to the protection of maternal and child health (hereinafter - OZMiR).      Despite the ongoing activities related to strengthening the maternity and childhood services, the efficiency of the resources used remains low. The birth rate is slowly increasing, perinatal, infant and maternal mortality are decreasing at a low rate, and indicators of children's physical and mental health remain unsatisfactory.      The main directions of the OZMiR service are the creation of an effective system integrated with primary health care and other interested services to preserve and promote maternal and child health, and reduce maternal, infant and child mortality.      In order to improve the OZMiR service, the following measures will be taken: ensuring the provision of medical care to women of reproductive age and children within the guaranteed volume of free medical care;      conducting annual medical examinations, medical examinations and rehabilitation of children and women of reproductive age; completion of construction in 2005 in Astana of the Republican Center for Motherhood and Childhood, meeting international standards, and staffing it with highly qualified personnel;      provision of medicines to pregnant women since 2005 for the treatment of diseases affecting reproductive and child health, as well as certain categories of children in outpatient treatment (children under 5 years of age - since 2005, children registered at the dispensary - since 2006); completion by 2007 of the staffing of children's and obstetric medical-preventive organizations with the necessary specialists; financing of scientific and technical programs in the field of Oh&S with the subsequent implementation of research results in practical healthcare;      to fully equip children's and obstetric medical institutions with modern medical equipment by 2008 in accordance with approved standards; to ensure early coverage of pregnant women with follow-up by 2007 in accordance with international standards; to improve and introduce assisted reproductive methods and technologies by 2008, including screening programs for prenatal diagnosis of congenital and hereditary fetal diseases using modern technologies of genetic analysis and family planning;      further development of highly specialized medical care for children in the field of transplantation (including bone marrow transplantation), neurosurgery, surgery, neonatal resuscitation, cardiac surgery, neurology; implementation of family planning and healthy lifestyle measures, including the prevention of alcoholism, drug addiction, tobacco smoking among children, adolescents and women, with the involvement of the media;      Intensification of work on the implementation of educational programs recommended by WHO in secondary schools aimed at preserving and strengthening the health of schoolchildren.      The implementation of the above measures will strengthen and improve the World Health Organization system, reduce maternal and infant mortality, and improve demographic indicators of the population.

5.5. Improvement of prevention, diagnosis, treatment and rehabilitation of socially significant diseases

     Socially significant diseases of the population should be under the close attention of the state.      In order to improve the quality and life expectancy of the population, measures will be taken for the prevention, early detection, effective treatment and rehabilitation of patients with socially significant diseases. In this direction, targeted measures will be implemented to prevent and further reduce the incidence of STIs in active cooperation with interested agencies, international and non-governmental organizations.;      international standards for the antiviral treatment of HIV-infected and AIDS patients have been introduced; comprehensive treatment and rehabilitation programs for patients with mental and behavioral disorders have been developed and implemented; regional centers (departments) for the medical and social rehabilitation of drug-dependent persons, inpatient departments in drug treatment organizations for the treatment and medical and social rehabilitation of drug-dependent minors have been established; advanced technologies in the field of treatment and medical prevention of drug addiction;      An effective, coordinated system to counter the spread of drug addiction in the Republic of Kazakhstan has been created; since 2006, positions of endocrinologists in district medical organizations have been introduced in stages to ensure early diagnosis, treatment and improve the effectiveness of medical examinations for patients with endocrine diseases, primarily diabetes mellitus.      Special attention will be paid to strengthening the fight against tuberculosis, reducing morbidity and mortality. Therapeutic and preventive measures at all stages of tuberculosis management will be carried out with the broad involvement of primary health care organizations. The national register of tuberculosis patients will be improved, control over compliance with uniform protocols for managing patients and the effectiveness of measures taken to combat tuberculosis will be ensured.      Specialized departments will be gradually opened at regional tuberculosis dispensaries for the treatment of patients with chronic forms of tuberculosis with persistent bacillus production. Specialized departments of regional tuberculosis institutions will be reorganized for the compulsory treatment of tuberculosis patients with contagious forms who evade treatment.      Therapeutic and diagnostic measures will provide for the further implementation of the DOTS-plus strategy and the introduction of effective antibacterial therapy schemes for multidrug-resistant forms of tuberculosis.      In the future, measures will be taken to expand social support for tuberculosis patients and medical staff of the tuberculosis service.      With regard to oncopathology, emphasis will be placed on early detection of malignant neoplasms through preventive examinations of target groups using advanced diagnostic and treatment methods.      Measures for the prevention and effective treatment of bronchial asthma, arterial hypertension, coronary heart disease and other cardiovascular diseases, including those requiring surgical treatment, will be developed and implemented.      In order to establish the reliability of the causes of death, technical re-equipment of the forensic medical examination bodies will be carried out.      In order to regulate the provision of medicines to patients with socially significant diseases, the list of medicines dispensed on a free/preferential basis will be revised, taking into account modern approaches to treatment.      The measures taken will help to stabilize the situation, reduce the spread of socially significant diseases and reduce the damage they cause to the health of the population and the economy of the country.

5.5.1. Development of medical science

     The development of medical science involves the development of priority areas of fundamental and applied research conducted in order to preserve and improve the health of citizens.      In the process of developing medical science, it will be envisaged to solve urgent problems of practical healthcare through the introduction of innovative effective resource-saving technologies.      Medical science will develop in the following areas: priority development and implementation of advanced technologies for the prevention, early detection, treatment and rehabilitation of socially significant diseases;      continuity of fundamental and applied medical science with the participation of the Ministry of Health in shaping the main directions of its development and administering basic medical research programs; strengthening the link between medical science and production and practice, introducing its own and borrowed scientific developments into practical healthcare; integration of Kazakh medical science with international research organizations, development of international partnership;      integration of medical science, education and clinical practice; scientific assessment and justification of the economic and social effectiveness of planned and undertaken measures in the field of public health; implementation of the principles of evidence-based medicine in the field of medical science.

5.6. Training and retraining of health protection personnel

In order to improve the quality of medical and pharmaceutical education, major changes will be made to the system of training and retraining of medical personnel. Taking into account medical specifics, a regulatory legal framework for medical education will be formed, aimed at creating an effective training and retraining system focused on strategic areas of healthcare development.      Strengthening PHC requires the availability of qualified medical personnel, including general practitioners and nursing staff. The training of medical personnel will be based on long-term planning and based on the strategic needs of the industry.      In this regard, a scientifically based methodology for determining the long-term human resources needs of the healthcare industry will be developed and introduced.      The staffing of PHC organizations with general practitioners will be carried out both through retraining of doctors of the general medical network and training of general practitioners in medical universities starting in 2005 on the basis of developed training programs in subordination and internship.      Improving the management of the healthcare industry provides for the training of professional managers and healthcare economists.      At the first stage, the following measures will be implemented: appropriate changes have been made to the licensing and state certification system and, in order to bring medical and pharmaceutical education organizations closer to international standards, state accreditation, regardless of their forms of ownership; requirements for admission and training in medical educational organizations have been increased.;      The cost of training in medical and pharmaceutical specialties has been gradually increased; the material and technical base of medical educational organizations has been strengthened and clinical training centers have been established at state medical higher educational institutions, providing a real link between education, science and practice.;      Taking into account the development of a new healthcare model, the need to introduce new specialties, and the needs of the population for medical care, the principles and volumes of medical personnel training will be reviewed, enrollment in medical colleges and medical universities by state order will be increased, and training programs at medical universities will be revised with an emphasis on a "problem-based" approach to education, in-depth practical training and study foreign languages;      training programs for general practitioners have been improved by changing state training standards with the introduction of practical internship (residency) training, taking into account international experience; regular (every 5 years) training has been introduced certification of the teaching staff of medical universities; new programs (standards) have been developed and implemented in the field of advanced training and retraining of personnel, including general practitioners; distance learning forms have been introduced as part of the healthcare informatization program;      Funds have been allocated from local budgets for advanced training and retraining of medical and pharmaceutical personnel in rural health care; since 2005, the training of health managers has been started on the basis of basic economic and medical education, mainly in universities that train economic specialists, and as part of advanced training and retraining programs for health personnel in organizations that implement appropriate additional education programs.;      Since 2005, foreign specialists will be involved in the retraining of healthcare system personnel (including management bodies), and the practice of advanced training in foreign medical centers will be introduced.      At the second stage, medical training programs will be reviewed and medical personnel with higher medical education in bachelor's and master's degrees will be trained; health care managers and economists with basic economic education in bachelor's and master's degrees will be trained; an independent quality control system for medical education will be introduced.

5.7. Program implementation Mechanisms

     The Program will be implemented through an action plan for its implementation, approved by the Government of the Republic of Kazakhstan.      The comprehensive implementation of the Program implies the coordination of the activities of central and local government bodies for the reform and development of healthcare.      The Government of the Republic of Kazakhstan will monitor the implementation of the action plan and the achievement of the planned Program indicators.      In 2005, a new structural unit will be created within the central authorized body, the main functions of which should be: monitoring and analyzing the progress of the Program; organizational and methodological support of the Program; development and use of advanced technologies for collecting and analyzing information, allowing to make optimal decisions on the reform and development of the healthcare industry.;      assessment of the medical, economic and social effectiveness of measures taken to protect public health, taking into account generally accepted approaches in public health; coordination of explanatory work on the reform of the industry among the medical community and the population.      At the first stage, in accordance with this Program, the necessary changes and additions will be made to the current regulatory framework and regulatory legal acts will be developed regulating the activities of the created healthcare model, consolidating the joint responsibility of citizens, employers and the state for health protection, aimed at preserving and developing the public health system, supporting the private, including non-profit sector, formation of the market and competitiveness of medical services.      With the involvement of domestic and international experts, a program for monitoring and evaluating the process of healthcare reform and development based on indicators reflecting health indicators and the activities of the healthcare system will be developed.      At the second stage, in order to consolidate and systematize the legal norms governing public relations in the field of health protection, the Code of the Republic of Kazakhstan "On the Health of the People and the healthcare system in the Republic of Kazakhstan" will be adopted.

6. Necessary resources and sources of financing

     Funds from the republican and local budgets, as well as other funds not prohibited by the legislation of the Republic of Kazakhstan, will be allocated for the implementation of the Program in 2005-2007.      Total expenditures from the state budget for the implementation of the Program will amount to KZT 165,658.5 million, including KZT 134,609.9 million from the republican budget (including targeted transfers to local budgets), and KZT 310,486 million from the local budget.      Some measures will be implemented at the local level through targeted transfers allocated from the national budget.      In 2008-2010, an annual increase in the volume of financing of the industry is expected, bringing it to 4% of GDP in 2010.      The amount of Program financing for 2005-2010 will be specified when forming the republican and local budgets for the relevant financial years in accordance with the legislation of the Republic of Kazakhstan.

7. Expected results from the implementation and Program indicators

The implementation of the Program's activities will create a system that will increase the availability of medical care to the population and the quality of its provision.      As a result of the Program's implementation: an optimal healthcare model will be created that meets the needs of the population, industry and the state; the level of provision of healthcare services to the population will significantly increase, and incentives for people to protect their own health will be introduced.;      equal access of citizens to medical care will be ensured and the principle of joint responsibility of the state and citizens for health protection will be implemented; the volume of preventive and health-improving measures will increase, the effectiveness and quality of medical examinations of patients will increase, the level of temporary and permanent disability will decrease due to the expansion of the guaranteed volume of free medical care at the primary health care level;      the morbidity rate of the population will decrease due to ongoing preventive measures, increasing public awareness of the impact of risk factors on health, which will lead to a gradual decrease in hospitalization by 10-15% at the first stage and by 25-30% at the second; the number of calls will be reduced and the quality of emergency medical care will be improved by expanding the volume of care at the Primary health care; by 2010, primary health care organizations will be provided with qualified medical and secondary medical personnel and equipped with equipment in accordance with the standards;      the imbalances in the provision of medical care will be eliminated by redistributing part of the volume from the inpatient sector to the outpatient sector, the effective use of inpatient replacement technologies; an effective quality management system for medical services will be introduced; accessibility, efficiency and continuity of medical care at all stages of its provision will increase; the financing system will be improved, the deficit in financing the guaranteed volume of free medical care will be eliminated, mechanisms of mutual settlements between the subjects of the industry have been introduced;      the efficiency of using state budget funds and the population for healthcare will increase, while the level of informal payments will decrease significantly; a unified health information system will be created; the health index of women of reproductive age and children will increase, maternal and infant mortality rates will steadily decrease, by 2010 maternal mortality will decrease from 42.1 in 2003 to 30.0 per 100,000 live births and infant mortality from 15.3 in 2003 to 10.0 per 1,000 live births (using the current calculation method);      the situation of socially significant diseases will stabilize, the level of infectious and non-communicable diseases will decrease; the incidence of tuberculosis will decrease from 160.4 in 2003 to 150.0 by 2007, to 135.0 per 100,000 people by 2010; the incidence of sexually transmitted infections will decrease by 10% annually; the effectiveness of state regulation in the field of circulation of medicines; the volume of production of domestic competitive pharmaceutical and medical products will increase;      modern diagnostic methods and international treatment standards will be introduced; the documents of the state system of sanitary and epidemiological rationing will be harmonized with international standards; the material and technical base of medical education organizations will be improved, training and retraining programs for medical personnel will be improved, and the requirements for training in medical higher education institutions and colleges will increase. Through the introduction of staff retention mechanisms, increased enrollment in medical universities and colleges by state order, the problem of staffing the industry will be solved; the quality of training and retraining of medical workers will significantly improve, the rights and responsibilities of doctors and medical workers will be expanded, their social status and prestige in society will be raised.

President    

Republic of Kazakhstan     

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