Azhar Giniyat speaks about development of healthcare sector as part of instructions of the Head of State

Today, on May 18, a briefing was held at the Central Communications Service with the participation of the Minister of Healthcare of the Republic of Kazakhstan Azhar Giniyat. The Head of the Ministry of Healthcare reported on the implementation of the instructions of the Head of State on health issues in the country.

The Ministry of Healthcare is working within the framework of the instructions of the Head of State, given in the Messages to the people of Kazakhstan and at extended meetings of the Government. A total of 26 instructions were given, of which 15 were executed and 11 had a long-term execution period.

Thus, the Head of State gave a number of instructions aimed at stabilizing the epidemiological situation in the country. Currently, there is a stable stabilization of the epidemiological situation in all regions of the country, about 10 cases of coronavirus infection are registered per day, more than 98% of patients have recovered.

On January 24 of this year, at the meeting of the Interregional Commission, approaches to mitigate quarantine measures were considered and approved. Now the country has lifted all restrictive measures. According to WHO, in the last week, the incidence in the world has been reduced by 12%, but an increase in the incidence is noted in the American and African regions. At the same time, in 97 countries of the world there is an increase in the incidence. For example, in Armenia over the past week, the incidence increased by 217%, in Hungary - by 209%, in the UAE - by 55%, in Japan - by 54%, in Singapore - by 37%, in Israel - by 15%, in Turkey - by 12%.

“The daily assessment of the epidemiological situation continues on an ongoing basis, which makes it possible to predict the number of beds, the amount of funds for the treatment of patients with CVI, the purchase of medicines, medical products, personal protective equipment,” Azhar Giniyat said.

Vaccination and revaccination are still the only protection against infection. Currently, an average of 11,000 people are vaccinated per day. To date, 9.4 million people or 83.3% of the eligible population have been vaccinated with the first component. The second component vaccinated 9.2 million people or 81.3% of the subject population. 4 million people have been revaccinated.

Taking into account all the negative experience that the healthcare system faced during the COVID-19 pandemic, work was intensified to form a modern system of epidemiological forecasting and response. As part of the implementation of the instructions of the Head of State, a draft Law of the Republic of Kazakhstan “On Biological Safety” has been developed. On April 28, 2022, this bill was adopted by the Senate of the Parliament of the Republic of Kazakhstan. Its main goal is the early detection, prevention and prevention of biological threats.

Main biological hazards:

1) natural foci of especially dangerous infections (foci of especially dangerous infections are spread over half of the country's territory: for example, plague (on the territory of 10 regions), tularemia (on the territory of 12 regions), hemorrhagic fever (on the territory of 4 regions and the city of Shymkent), according to anthrax (1795 stationary disadvantaged points);

2) importation of dangerous infections (as a result of the expansion of international tourist and business relations by Kazakhstan, cases of importation of cholera are recorded annually, for example: Dengue fever (3 cases from Thailand in 2019), malaria (4 cases from tropical countries in 2019);

3) violation of the requirements when working with pathogenic bioagents (work without an appropriate permit, non-compliance with the rules, etc.);

4) the impact of sources of increased danger due to emergencies and acts of terrorism (earthquakes can lead to the destruction of facilities and the release of especially dangerous pathogens into the environment);

5) lack of qualified personnel in the field of biological safety (shortage of personnel, the need for postgraduate training, "aging" of personnel).

Within the framework of the bill, it is planned to create an effective system for counteracting biological risk in the following areas:

- strategic planning;

- creation of a coordinated interdepartmental system of state administration and strengthening of its preventive function;

- ensuring the readiness of specialized services and the population for possible emergencies;

- creation of a unified system for recording and monitoring data on the turnover of pathogenic bioagents and regulation of the activities of national and working collections of microorganisms.

As part of the implementation of the national project "Healthy Nation", measures are envisaged to equip 3 laboratories for sanitary and epidemiological expertise annually until 2026. In 2021, 3 laboratories will be equipped. Also this year, 3 more laboratories will be equipped.

The main link in the health care system is primary health care - this is a service that is designed to coordinate all medical care for the population. The coronavirus infection pandemic has exposed the weaknesses and problem areas in the PHC organization. On behalf of the Head of State, for a radical review of approaches to the organization of primary health care, an Action Plan was approved to improve the accessibility of PHC towards greater mobility and accessibility to a wide range of the population, including those living in rural areas. Along with this, work is underway to improve the State standard for the network of healthcare organizations, within the framework of which it is planned to provide settlements with up to 50 people with a medical worker at home.

It is also offered in rural settlements with a population of:

  • from 50 to 500 people creation of medical centers;
  • from 500 to 1500 people creation of feldsher-obstetric stations;
  • from 1500 to 5000 people creation of medical outpatient clinics.

Also, taking into account the numerous appeals of citizens, the Rules for the provision of specialized medical care on an outpatient basis have been approved, which provide for the provision of consultative and diagnostic services without a referral from a general practitioner.

To speed up examination and treatment for suspected oncological and hematological diseases, a “green corridor” has been introduced, within which patients with suspected oncological diseases are consulted and examined within 18 working days (laboratory tests, ultrasound, X-ray, ECG, CT, MRI, and See also endoscopy.

Along with this, the construction of 500 PHC facilities will be ensured by 2025, the introduction of new prevention approaches for rural residents and children, the development of patient-centeredness (mobile teams, best practice centers, PHC), the expansion of consultative and diagnostic services, the annual graduation of 1,500 doctors, the development telemedicine and remote medical services, opening of geriatric sites in PHC organizations, opening of specialized medical sites for serving convicts, development of outpatient rehabilitation, stage III. As a result of the implementation of these measures, it is expected to increase the number of PHC visits to 6 per inhabitant per year (in 2021 - 5.8), as well as an increase in the share of PHC funding from 54% to 60% (according to WHO recommendations).

2022 has been declared the Year of the Child in Kazakhstan. As part of the implementation of measures to protect the health of children, the Ministry of Health will pay special attention to prevention. In this regard, packages of preventive examinations of the child population will be expanded, taking into account the current volume of ongoing research (OAC, OAM, optoacoustic remission).

“The republican budget provides funding in the amount of 16.4 billion tenge for the purchase of 24 items of medicines for the treatment of children with 9 rare diseases, including spinal muscular atrophy and epilepsy,” the Minister of Health noted.

Since 2021, on behalf of the President of the Republic of Kazakhstan, a special program "Ansagan Sabi" has been launched, which provides for the annual allocation of 7,000 quotas for IVF until 2026. As of April this year, 3063 women (43%) became pregnant through IVF, 1307 children were born.

In Kazakhstan, much attention is paid to the well-being of the population in general and medical workers in particular. So, from January 1, 2021, the salary of 247 thousand medical workers was increased. In 2022, the salary of doctors was increased by an average of 30% (416 thousand tenge), nurses - by 20% (208 thousand tenge). In 2023, the salary of doctors will be increased by an average of 30% (531 thousand tenge), nurses - by 20% (249 thousand tenge).

To ensure the introduction of a professional liability insurance system for medical workers, a Draft Law “On Amendments and Additions to Certain Legislative Acts on Health Issues” has been developed, which is planned to be submitted to the Majilis of the Parliament of the Republic of Kazakhstan this month. The bill provides for the introduction of norms for the humanization of criminal norms of Art. 317 with mitigation of penalties. The terms of deprivation of liberty were also reduced with the introduction of an alternative to the restriction of liberty for consideration by the court. The norms regarding guarantees and social support for medical workers, raising their status, i.e. professional liability insurance for causing harm to the life and health of the patient and the establishment of the honorary title "Honored Doctor of Kazakhstan" with the payment of a one-time incentive payment are also provided for by the draft law.

Medical workers are awarded state awards. So, if in 2018 only 49 awards were presented to medical workers, then in two years the President of the country has already awarded 1,225 various awards to medical workers, which is a high assessment of the selfless work of health workers.

To provide support and satellite settlements with medical outpatient clinics and feldsher-obstetric stations, an inventory was carried out and the need to open outpatient clinics in 69 villages was determined. In 2021, 12 facilities were put into operation. This year it is planned to open 20 objects. In 2023, it is planned to open 37 facilities. At the same time, it is planned to build 500 PHC facilities by 2025. This year it is planned to build 92 PHC facilities.

Along with this, an inventory of all healthcare organizations, including obstetric and resuscitation services, was carried out in terms of their provision with medical equipment, medicines and medical products. The equipment of medical facilities was 83%, the depreciation of buildings of medical facilities is 53%.

As part of the implementation of the instructions of the Head of State, the construction of 2 scientific and innovative multidisciplinary clinics was ensured in the cities. Nur-Sultan and Almaty. Currently, construction and installation work is underway at the facilities. The deadline for commissioning the facilities is 2023. These centers will comply with international quality standards, taking into account the requirements of JCI.

PPP projects have been optimized up to 8 projects for the construction of 5 university hospitals (Almaty, Shymkent, Karaganda, Aktobe, Nur-Sultan), 3 multidisciplinary hospitals (Turkestan, Petropavlovsk, Kokshetau). To develop standard provisions for construction projects for healthcare facilities based on PPP principles, taking into account the requirements of JCI, the following is currently being determined: the marginal cost of 1 sq. m. of hospital construction, the norm of the maximum area per 1 bed, the list of medical equipment and the optimal financial model.

To ensure drug safety, a list of basic drugs (730 drugs) for their production in Kazakhstan has been determined. Long-term contracts were concluded with domestic pharmaceutical manufacturers for the supply of medicines for 182 positions from the basic list. The possibility of producing 548 items is being studied.

To ensure an increase in the share of domestic production of medicines and medical devices, it is planned to open at least 30 new production facilities for the production of medicines and medical devices by 2026, including with the involvement of Big Pharma. In 2021, the share of domestic production of medicines and medical devices has already amounted to 37%.

The transition to a centralized procurement of medical equipment based on SK-Pharmacy is planned to be carried out in 2 stages:

Stage I: in 2022, centralized procurement of MT worth more than 20 million tenge, as well as approval of the MT Equipment Program until 2025.

Stage II: from 2023, centralized purchase of MT for complex equipment in priority areas, development of mechanisms for concluding DD on the terms of localization of production in the Republic of Kazakhstan.

Answering journalists' questions about expanding the list of services provided under the Compulsory Medical Insurance, the Minister of Health of the Republic of Kazakhstan Giniayt said that the amount of funding for this is increasing.

“Within the framework of the CSHI, we have increased the amount of funding. We cannot yet pay for expensive services within the framework of compulsory health insurance. Because there is not much money to provide everyone with expensive dental services. We are currently developing a package to improve assistance within the framework of the CSHI,” Giniyat said.

In particular, according to the minister, the possibility of treating other diseases within the framework of one admission is being considered.

“Today, a lot of people apply and write that they are going to the hospital for an operation, but they have revealed another disease, and the doctor cannot treat, because the other disease is not paid for by the fund. We want to expand these services,” explained Giniyat.

Earlier it was reported that the salary of doctors will increase by another 30% in Kazakhstan.

“The Head of State pays great attention to the well-being of the population as a whole, including medical workers. In this regard, since January 1, 2021, the wages of 247 thousand medical workers have increased. In 2022, the salaries of doctors increased by an average of 30%, which is more than 400 thousand people, of paramedical personnel by 20%,” Giniyat said.

The Minister of Health also stated that in 12 regions one of the types of the omicron strain of coronavirus infection was found. The Stealth Omicron strain is milder but spreads quickly.

“In 12 regions, one of the types of“ omicron ”-a strain of coronavirus infection was found. This is a kind of "stealth omicron". This type of coronavirus infection is milder than the “delta” virus, but it is dangerous because it spreads quickly and leads to a recurrence. Today we see that the virus is spreading throughout the country,” Giniyat said.

The head of the Ministry of Health of the Republic of Kazakhstan added that the incidence is monitored daily.

“Patients who present with symptoms receive full treatment. We do not expect the introduction of any quarantine measures in this course of the disease. All quarantine measures have been lifted, now mainly preventive work is underway among the population,” Giniyat explained.

The minister also answered a question about the possible introduction of a mask regime.

“There are no grounds for introducing a mask regime today, it will depend on the epidemiological situation in the country,” Giniyat emphasized.

Asked about vaccine stocks, the minister explained that Pfizer's current stock of vaccine is 1 million doses.

“Today, Pfizer's vaccine inventory is 1 million doses. Regarding the timing, there are 500,000 doses by the end of June,” Giniyat said.

The Minister also spoke about the progress of revaccination of the population.

“Today, our population is very willing to get vaccinated and revaccinated. About 15 thousand people are vaccinated every day. Therefore, the implementation of the Pfizer vaccine is proceeding as planned,” said Giniyat.

The head of the Ministry of Health also answered the question of why there are so many vaccines with a burning expiration date.

Initially, Pfizer's vaccine was purchased for children and pregnant women, given the types of vaccines we had. To date, only 30% of pregnant women eligible for vaccination have been vaccinated. The remaining vaccine doses from more than 70% of children are now being sold to the public.

The Minister of Health also answered a question about the construction of a modular hospital, the quality of construction of which was criticized by the deputies.

“This hospital was not built by the ministry. According to the contract, this hospital was built through the akimat. The ministry has nothing to do with its reception or quality and cannot answer. It is not on our balance sheet,” Giniyat said.

Earlier, the deputies of the Majilis demanded to initiate detailed and public inspections of the construction of hospitals for the treatment of patients with coronavirus.

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