The Nation’s Plan "100 Specific Steps" stipulates that primary care will become the central link of national healthcare for the prevention and early fight against diseases. Thus, the Ministry of Healthcare is working on the improvement of primary health care in the Densaulyq State Program.
Minister Birtanov noted that according to the definition of the World Health Organization, PHC is the first level of contact of individuals, families and communities with the national health system, and accordingly PHC should be as close as possible to the place of residence and work of people.
Main functions of primary health care:
- improvement and prevention;
- early detection of diseases;
- medical care;
- observation of chronic diseases.
Currently in Kazakhstan, PHC services are provided by 524 medical organizations, 29% of which are private. In PHC organizations, there are 10,216 sites, of which more than 60% are general practitioners (6,205), 20% are pediatric (2,041), and 18% are therapeutic (1,880).
The minister drew attention to the burden on doctors. According to the Ministry of Healthcare, the number of people attached to one PHC physician in Kazakhstan is 1,950 people, which is higher than that of OECD countries (1,500 people). To achieve the target for the number of the attached population, according to Birtanov, in the PHC organizations it is necessary to open an additional 1,531 sites.
"Reducing the number of the attached population leads to a reduction in the workload of the doctor, the coverage of the population by preventive examinations is increasing. So, in 2017, with a decrease in the number of people per PHC physician to 90 people, the number of visits to the population for preventive purposes increased by 18% or 2 million people," Birtanov said.
According to the Ministry of Healthcare, more than 9 million people applied for PHC in the first half of the year. The analysis of the structure of consultative and diagnostic services in the PHC organizations shows that the services of such narrow specialists as surgeons, ophthalmologists, neurologists, otolaryngologists, obstetrician-gynecologists are in demand in the population of Kazakhstan. These specialists received services for more than 5 million people who contacted the PHC organization.
Speaking about the staff potential, Birtanov emphasized that the healthcare system has a sufficient number of specialists, the provision of medical personnel is 31.2 per 10,000 population, which corresponds to the level in the OECD countries (33).
The share of PHC financing in the structure of the guaranteed volume of free medical care is 43%. The amount of funding in 2018 consists of a comprehensive per capita standard, an incentive component, expensive consulting and diagnostic services (dentistry, CT, MRI, PCR, etc.), outpatient drug support costs and screening for oncological diseases.
Birtanov also reported on a package of planned measures to improve the accessibility and quality of PHC medical care, the availability and qualification of medical personnel in the field, the improvement of consultative and diagnostic services, the development of PHC infrastructure, including through the introduction of PPP projects to create compact PHC centers, close to the place of residence of the attached population. By 2020, 60 PPP projects are planned to be implemented in this direction.
Within the framework of this direction, the positive experience of the Astana akimat has been noted in the implementation of the "Doctor at Home" project. Currently, there are three such PHC centers in the capital. In addition, in 2016, on the basis of the polyclinic No. 8 in Astana, a project was implemented to create a group practice for PHC physicians, where physicians are defined by the founders of group practice. As a result of the project implementation, consultative and diagnostic services decreased by 33%, salaries for doctors and nurses doubled, and PHC quality indicators improved 1.5 times. The Ministry plans to continue work in this direction. Further support will be provided for private, individual and group medical practices through the Fund.
Measures are planned to improve the competence of physicians and nurses of PHC for qualitative examination and treatment of patients and substitution of basic consultative and diagnostic services. In this regard, the expanded functionality of PHC specialists will be introduced, taking into account the delegation of authority from core specialists and ensuring the training of PHC physicians through the introduction of postgraduate education standards for family doctors.
In accordance with the Address "New Opportunities under the Fourth Industrial Revolution," in May the ministry developed and introduced a new model of a guaranteed amount of free medical care with clear boundaries of state obligations, while simultaneously introducing mandatory social health insurance.
The guaranteed package will become the minimum social standard for the whole population and will include PHC, emergency medical care, clinical diagnostic services, free drug provision, planned inpatient care for major, including socially important diseases.
The package of the Compulsive Social Health Insurance will include medical assistance in excess of the guaranteed package: planned inpatient care, expensive diagnostic services and medicines for diseases not included in the package.
In addition, within the framework of the new guaranteed model, it is planned to clearly define the volume of consultative and diagnostic services with phased provision of adequate tariffs and a fixed list of services for 30 groups of major diseases.
Birtanov reported that, as part of the implementation of the new model, it is proposed to continue the transformation of ineffective medical examination of 262 groups of diseases into the management program of 30 groups of diseases, including socially significant diseases, which will provide control over the main diseases accounting for about 70% of mortality, 80% of morbidity, and also the life expectancy of the population. At the same time, it is planned to actively involve the patient in managing his disease, the introduction of a multidisciplinary joint examination, the use of mobile applications.
As part of the digitalization of primary hgealthcare this year, it is planned to launch an interoperability platform that will allow for the phased integration of all medical information systems and launch a single bank of electronic health passports of the country's population. Birtanov assured that by the end of 2020 100% of the country's population will be provided with electronic health passports.
Within the framework of the draft new Health Code, the responsibility of local executive bodies will be strengthened, first of all, for ensuring the effective organization of outpatient and polyclinic assistance to the population. Also, the responsibility of the local bodies for post-licensing control, staffing and monitoring of equipping medical institutions in accordance with standards will be strengthened, regardless of the form of ownership.
The measures taken to improve the quality of primary health care will allow:
- To increase the availability and quality of medical services in PHC organizations. In 2019, the number of visits to a PHC doctor will increase by 30%.
- To create factors of economic motivation for quality improvement. By 2020, the ratio of the average salary of doctors to the average salary across the country will reach 110% (now 85%).
- Ensure staffing, raise the competence and motivation of health workers, reduce the number of people attached to one PHC physician to 1,700 by 2020.
- To increase the effectiveness of state control over the quality of medical services, to increase the share of PHC financing in the total volume of guaranteed package by 2021 to 50%.
During the meeting, akims of a number of regions also took the floor: Almaty — A. Batalov of, Kostanay — A. Mukhambetov of, Karaganda — E. Koshanov and Astana city — A. Issekeshev.