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Theses of the speech of the Minister of health and social development of the Republic of Kazakhstan Duysenova T. K. on collegium

Dear Dariga Nursultankyzy !

Dear colleagues!

As you know, on 10 February this year with the participation of heads of State held an extended meeting of the Government, which will assess the current situation, the directions of development of the country in conditions of global instability.

At the same time, 2015, has summed up results of its activities for the coming period, health promotion, social stability and welfare of the citizens should discuss our plan to ensure.

The year 2015 was marked by the establishment of legislative and institutional framework of the national Plan "100 steps" on implementation of five institutional reforms announced by the Head of state, implementation of Plan of anti-recessionary measures of the Government.

In accordance with the Plan of the nation, last year adopted a new Labor code, laws on introduction of compulsory health insurance, targeted social assistance in the new format, new approaches to the regulation of migration developed by the new employment act.

This year we will have specific performance measures arising from the Plan of the Nations.

Yesterday at the sectoral meetings considered in detail the results of the activities of the health system, the socio-labor sphere in 2015.

In this regard, let me focus on the task in 2016.

As you know, last year ended with the implementation of the State program "Salamatty Kazakhstan". Its main results were the increase in life expectancy, a reduction in overall mortality rate, including maternal and infant.

This year we will begin the implementation of a new State program of healthcare development of the Republic of Kazakhstan "Densaulyk" for 2016-2019, as approved by decree of the President dated 15.01.2016, No. 176. It is a logical continuation of previous programs aimed at further deepening of reforms in the health sector.

 Its implementation involves the implementation of 10 steps (slide 2)

The first step of the Program is for the prophylaxis and prevention of diseases.

Vaccination slide 4-7

Worldwide vaccination is considered as the most effective, efficient and affordable tool in the fight against infections. National calendar of preventive vaccinations of Kazakhstan provides for the prevention against 21 infectious diseases. Immunization is free of charge and each year are vaccinated more than 8 million people.

(Reference: the total amount of financing of purchase of vaccines: 2013 - 7,4 billion tenge, in 2014 – 12.3 billion tenge, 2015 – 15,8 billion tenge)

But it should be noted that in recent years there is a tendency to increase the number of refusals from vaccination that may adversely affect the epidemiological situation in the country. In this respect developed and will be implemented the Road map, which includes: identification of existing problems; their gradual elimination; development and implementation of a National registry of immunization; implementation of the plan for social mobilization; improvement of monitoring system and prevention of the epidemiological situation in the regions.

School medicine slide 9-12

Another very important direction of prevention is the health of schoolchildren.

It should be noted that in the structure of newly identified diseases with preventive examinations of schoolchildren in the first place diseases of the gastrointestinal tract, which amount to 24.5%, second place – diseases of the eye (16,2%), the third place – illnesses of respiratory organs and blood-forming organs.

Under the new State program provides for the transfer of the school of medicine from education system to health system.

It is planned to develop a Calendar of Wellness events for students. It provides for the improvement of children throughout the year: January to March – the conduct of professional examinations, forming of groups of health, dispensary registration and the development of individual plans of rehabilitation; April-may – implementation of health promotion activities according to plans; from June to August – the improvement of the students in the school and country camps, the implementation of health resort treatment; September-November – continuation of professional examinations; in December – scheduling professional examinations and formation of mobile teams of specialists.

It should be emphasized that the professional examinations and improvement of the students will be carried out directly in schools, not in organizations of primary health care.

For healing students will apply health saving technologies. This prevention of disorders of posture and vision, additional vitaminization, the use of products with functional food (dairy products).

At the same time, special attention will be paid to raising public awareness with educators and parents on issues of disease prevention, proper development and nutrition of schoolchildren.

Screening slides 14-17

As you know, in the country since 2008 has been implementing a national screening program to identify diseases and 9 kinds of diseases (reference: breast cancer, cervical cancer, glaucoma, hepatitis b and C, BSC, colorectal cancer, cancer of the esophagus and stomach, liver cancer, prostate cancer). This year the program covered about 2 million people. Despite the scale of the program, certain diseases marked by insufficient level of detection of diseases, poor formation of the target population for screening, the inadequate provision of medical equipment and training of medical workers of primary health care.

In the current year with the assistance of world Bank experts will assess the National program, the results of which will be taken measures to improve its effectiveness.

Examination slides 19-21

Annually in the Republic of preventive health examination is approximately 8 million people, including more than 4.5 million women and 3.3 million men.

In order to simplify the procedure of conducting preventive medical examinations and reduce artificial queues at polyclinics in the Republic is to introduce a new scheme of carrying out of preventive medical examinations: to undergo a mandatory preliminary medical examinations (for employment or admission to study, etc.) citizens will have to contact the service centers where you can get a doctor's appointment in CSCS, you will receive the results of screening tests or medical certificate of completion. The transition to this regime will be implemented in phases subject to the availability of the information systems of medical organizations.

Thus, this measure will allow to reduce turns in organizations of primary health care, reduce the burden on specialists.

Reducing queues at polyclinics slides 23-26

The main reason for the queues at polyclinics are weak management medical organization, first and foremost, this concerns the maintenance of the persons on dispensary observation and providing them with preferential medicines.

Currently in Kazakhstan there are more than 2 million recipients of preferential medicines, which is visited monthly by organizations of primary care with the aim of obtaining a prescription.

To simplify this procedure, the Ministry proposed to amend the scheme of obtaining a prescription. Doctors will write a prescription for subsidised medicines for dispensary patients with chronic diseases once a quarter (90%), and for patients with severe illnesses receive expensive drugs – monthly (10%). The pharmacy will keep records and issue monthly needs the appropriate medicines to patients based on prescriptions issued to them. This year this will be held in a pilot regime in pharmacies, having the information system, and in the future they will become one of the conditions when selecting a pharmacy.

Thus, the whole procedure of obtaining preferential medicines will be automated.

This measure will significantly reduce queues at primary health care organizations, to reduce the burden on medical staff, reduction in paperwork.

PUZs slides 28-34

The second step involves the prioritization of primary health care and implementation of disease management Program (DMP).

Currently, the dispensary is located more than 3.3 million people, of which 42,7% are patients with arterial hypertension (32,2%), diabetes (9.1%) and chronic heart failure (1.4 per cent). It should be noted that the amount of damage from urgently hospitalized patients with exacerbation of chronic diseases that are managed at the level of clinics, amounted to 389.6 million tenge or 105% of the total expenditure on the hospitals.

To prevent complications and social impact in 2013

7 outpatient clinics of two pilot regions - North Kazakhstan and Pavlodar oblasts is being implemented PUZs on the three above-mentioned diseases.

The Program covered 1 213 patients. At the same time, medical organizations create a multidisciplinary team which, being in constant contact with the patient, provides dynamic observation of him.

Informed patient keeps a diary of self-control, control the factors affecting his health, which will contribute to changing the behavior of the patient, increasing their responsibility for their own health.

Thus, the Program enables patients together with health professionals to manage their disease and prevent complications.

The project showed positive changes among the participants of the Program: in 75% of patients with arterial hypertension was noted stabilization of the process and the skills of blood pressure control, decrease in the number of hospitalizations patients with chronic heart failure in 2 times.

Given the positive experience of implementation of the Program in pilot regions, its implementation will continue in stages in the period 2016-2017 - additionally, the five new regions in 2018 – in all regions of Kazakhstan.

The integrated model slides 35-36

The third step – involves the deepening of regionalization of medical care.

In the last 5 years in the structure of General mortality the proportion of BSK, neoplasms and injuries accounted for 51%, in the structure of the treated cases is 52%, and the total amount allocated for SGBP - 52.4 per cent. According to experts, a zero mortality rate for these diseases increases life expectancy by almost 8 years.

Therefore, the main priority in the next four years will be defining the following 5 types of diseases and conditions that significantly affect the demographics of the country: acute myocardial infarction, acute violation of cerebral circulation (stroke), malignant neoplasms, injuries, pregnancy and the state of obstetrics. In each direction will be the whole cycle of services.

Thus, services that require complex technological units and specialists with high qualifications, will be centralized with the creation of the inter-regional, inter-regional and national levels of the respective centers. And services that do not require complex refining units, will be decentralized and be in the organizations at the place of residence.

To this end, developed a Road map for the implementation of the integrated model, the position of the Coordinating Council identified the responsible Republican organization.

Emergency, emergency med.help slides 37-38

As you know, to ensure accessibility and timeliness of medical care in the country along with the ambulance operates aviation, mobile medicine and telemedicine. The availability of this infrastructure allowed us to help thousands of people.

But obsolete equipment (depreciation of vehicles ambulance 49.8 per cent), the lack of uniform standards of care, regulation of intra - and interagency cooperation and most importantly the fragmentation of these services creates a risk of insecurity, quality and speed of medical services provided by mobile medicine.

In this regard, a proposal:

first, the transformation of the Republican center of air ambulance to the national center for integrated emergency medical care to coordinate:

•     air ambulance and ambulance

•     emergency hospital care

  •     mobile medical complexes and EN-route rescue points, and

  • telemedicine;

second, to create a unified dispatch center (in the framework of a world Bank loan), the introduction of international standards of medical services, personnel training;

in-the third, on infrastructure development, modernisation of transport and equipment by attracting private investment, or strategic partners on a PPP basis.

OSMS slide 39

The fourth step – this introduction in accordance with the instructions of the head of state mandatory medical insurance.

To date, developed and approved a Road map for the implementation of the OSMS, in accordance with which will in the current year to develop the legal framework to create a social health insurance Fund (hereinafter – FSS) and ensure all events below from 1 January 2017 began collecting payments and contributions and from 1 July 2017 the payment was made for medical services via FSMS.

In addition, I note that in 2016 for the provision of guaranteed free medical care is allocated

553 billion or 16% more than last year.

This will increase the per capita standard with 865 tenge per 1 inhabitant per month in

2015 to 990 tenge, and at the hospital level – the cost of the base rate from 81 thousand to KZT 89 thousand tenge or 10.5%.

Today, agreements with medical organizations concluded and financed.

The modernization of medical training slides 40-44

The next important component of the programme is staffing.

At present, the annual output of health personnel with higher medical education on clinical specialties is an average of 3 000 people. At the same time, one of the main problems of the industry is that the state order is determined on the basis of official statistics on the shortage of personnel, without regard to surplus occupations and projected requirements personnel, accompanied by a low training.

Thus, the selection model will be JSC "Nazarbayev University" where the criteria for selection of partner for cooperation in the field of medical education in the top 300 in the world rankings, the implementation of all levels of medical personnel training, the presence of University hospitals, accreditation of universities and educational programs, internationalization (academic mobility of students and faculty).

In this regard, in the framework of the Program much attention is paid to the modernization of medical education.

The modernization of medical training will be carried out on the basis of transfer of advanced foreign medical standards. This will be organized in close cooperation of the Kazakhstan medical schools and foreign medical schools. Currently, negotiations have been launched and the number of potential strategic partners of the domestic medical schools are considered US medical schools, UK, Germany, South Korea, Finland and other countries.

PPP slides 45-47

A lot of attention in the work of the Ministry in 2015 was given to development of infrastructure and public-private partnerships in health care. This year, developed a road map "Development of infrastructure and public-private partnerships in health care."

The priority will be the extension of primary health care, strengthening of material-technical base, development and implementation of information systems "FSMS" and the development of the emergency.

Drugs slide 48

Much work is being done to improve policy drug supply.

In the past year, together with British experts developed and implemented the CNF. Updated list of drugs purchased under the SBP, provided the first stage of the implementation of reference pricing. These measures allowed us to purchase 887 items of drugs and medical devices, or 88% of total demand until the beginning of the year totaling approximately 92.8 billion tenge.

The share of original drugs is about 50.3% of the total volume and generic 49.7 per cent.

Now we need to work on transition to GXP. From 2018 these requirements will be mandatory. Therefore prepared a plan for a phased introduction of good international practice that will be implemented with domestic producers and other actors in the pharmaceutical market. 

Employment and labor relations

Dear colleagues, one of the questions a special place among the measures undertaken by the Government, is the problem of employment of citizens. As you know, in the activities of social employment and the preservation obligations of the State will always pay attention to.

Slide 50

One of the effective tools in the implementation of employment policy remains "employment Road map 2020".

In 2015, in all directions of "employment roadmap 2020" employed 156 thousand persons, including direct employment for open positions. Of these, 91% of permanent jobs (142 million people).

More than 6.0 thousand participants received microloans to start or expand their business, 14 thousand people benefited from vocational training. Subsidized jobs (SRM and MP) reached more than 24,5 thousand people and 1,200 people were resettled in the framework of increasing labor mobility.

Slide 51

In 2015, on behalf of the Head of the state also implemented a Comprehensive regional plans for promoting employment, including employment on the projects implemented in all regions of the state, sectoral and regional programs.

In the end, Comprehensive plans for the country are covered by 423 thousand. Employed more than 396 thousand people, of which 218 thousand permanent jobs.

Slide 52

Overall, the measures taken had a positive impact on labour market indicators - unemployment rate according to the provisional results 2015, was 5.0%.

But despite positive macroeconomic indicators, the situation in the labour market remains difficult. The global slowdown of the world economy in 2015 will have a delayed impact on the labour markets in 2016. According to experts it is projected that the number of unemployed worldwide will rise by 2.3 million in the current year and 1.7 million in 2017.

Slide 53

Given this trend, in December 2015, the Government updated "Road map of employment-2020", where we have built new tools to preserve jobs.

This is an introduction of the instruments of subsidizing the lost wages of skilled workers, provide grants to employers for training (retraining and improvement of professional skill) of their employees, the organization of vocational training of young workers, with the obligatory condition of keeping their jobs.

For the implementation of new initiatives under the "roadmap employment 2020" it is planned to allocate 63 billion, covering about 60 thousand people. Including;

Slide 54

- 37 billion tenge in the first direction on repair of social facilities and infrastructure, to create not less than 18 thousand temporary jobs (about 1000 projects);

- micro-loans of 20 billion tenge, including projects on organization of small-scale production of "Nur Otan" pilot regions, which will cover more than 11 thousand people;

2.5 billion tenge of measures of subsidizing the lost wages of qualified workers and training, training in the field of services;

 and 3.5 billion tenge for the construction of hostels for youth employment and benefits to immigrants.

In this regard, to February 26, this year all the regions will prepare an updated Comprehensive plans that we, Dariga Nursultanovna, we will present to You for consideration. 

Social security Slides 56-57

Following the direction of the Ministry is the organization of an adequate system of social security and social support of the population.

This year the state budget allocated 1.6 trillion. tenge. Within this amount is subject to increase solidarity pensions by 9%, state social benefits, disability and survivor benefits by 25%, scholarships 25% and provides the transition to the new system of remuneration of civil servants, the implementation of which is allocated 268 billion.

Continuation of consistent action to improve social well-being of our citizens was the number of President's instructions on social support.

Support will be provided only to needy citizens, on the basis of assessment of their income and living conditions.

In the reporting year, these approaches involve mandatory participation of able-bodied poor people in measures to promote citizens applied in three pilot areas where continued implementation of the national project "Orleu" on introduction of conditional cash transfers to poor citizens.

All regions in the current year should ensure the implementation of this project in all districts as a preparation for the introduction of the new TSA

Dear colleagues, in the current difficult economic environment, while important social support of the population of the state, we should fully realize the responsibility which rests on us.

Thank you for your attention.

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