About it today at meeting of fraction of party "Nur Otan" in the Mazhilis of Parlament of RK on theme "About systemic measures on struggle with diseases with high mortality rate of the population," said Minister of Healthcare and Social Development of RK Tamara Duisenova.
At the beginning of her speech, she reminded, that President set task before healthcare system to increase life expectancy in Kazakhstan to 73 years by 2020.
In the result of implementation of two State programs for development of the healthcare system (2005-2010 and 2011-2015) life expectancy exceeds 71 years, total mortality decreased by 15.3%, maternal and child mortality 1.8 times. The Minister remarked, that along with the positive dynamics of indicators of population health, there are factors which expected life expectancy less than inhabitants of OECD countries.
"In Kazakhstan there is a high consumption of medical services on outpatient and inpatient levels. The costs of treatment in a hospital consist more than 50% of the amount of the allocated funds, while in OECD countries on average only a third. Today, the treatment per patient in hospital costs the same as the average cost of treatment 3 people in other types of medical care in the earlier stages of the disease.
In addition, in our Republic, as elsewhere in the world, increased levels of non-communicable diseases. In the structure of mortality more than half of new cases of circulatory system diseases (26%), acute myocardial infarction (5,5%), malignant neoplasm (13%), injuries (11%); obstetrics and childhood (3,6%). According to experts, the losses on these diseases reduce life expectancy by almost 8 years," Tamara Duisenova said.
In this regard, priority in the new state Program of healthcare development "Densaulyk" for 2016-2019 is paid to the treatment of the above 5 diseases that significantly affect the demographics of the country. This is a set of measures.
1. Based on the experience of OECD countries and recommendations of experts from the World Bank and World Health Organization will be created in Kazakhstan Public Healthcare Services (further - PHS) through integration of sanitary-epidemiological service, services of healthy lifestyle and proper feeding. Its main functions are: surveillance and monitoring of communicable and major non-communicable diseases; the implementation of preventive measures; raising awareness of the population and etc.
2. Implementation of Disease Management Program (further - DMP) in level of primary medical-sanitary care. The implementation of DMP in Kazakhstan began in 2013 in a pilot mode 7 clinics in North Kazakhstan and Pavlodar oblasts on three diseases: hypertension, chronic heart failure and diabetes.
With 1213 participants of DMP concluded agreements issued diaries of self-control that lead patients. Under the agreement, the medical organizations create multidisciplinary team, which being in constant contact with the patient-participant of DMP, provides dynamic monitoring of the patient.
At the clinics of school health, where patients are taught the principles for the provision of self-help, the right attitude to their own health, provide informational material for self-education and healthy lifestyle.
Informed patient keeps a diary of self-control, control the factors affecting to his health, thus changing his behavior, increased responsibility for their own health. Thus, the program enables patients together with medical professionals to manage their disease and prevent complications.
In the result of implementation of the pilot project in 75% of patients stabilized level of blood pressure, formed the skills of control and regularity of intake of antihypertensive drugs. The number of hospitalizations patients with chronic heart failure is reduced in 2 times. Increased the number of patients screened for diabetes mellitus (in NKO - to 64%, in Pavlodar oblast - to 98%). It should be noted 100% coverage by learning self-management of all DMP participants.
Considering the positive experience of implementation of DMP in the pilot regions, in this year its implementation started in clinics of Astana, Almaty, West Kazakhstan, Karaganda and Kostanay oblasts.
3. The implementation of integrated model of rendering medical care in 5 main socially significant, non-communicable diseases and diseases that significantly affect the demographics of the population: acute myocardial infarction, acute violation of cerebral circulation (stroke), malignant neoplasms, injuries, pregnancy and childhood.
In each direction will be the whole cycle of services: prevention, curative measures, including rehabilitation, clinical supervision, medical and social services.
The services demanding difficult process units and specialists with high qualifications, will be centralized at the district, regional and republican levels. And services that do not require complex processing plants would be in the medical organizations at the place of residence.
For implementation of integrated model of rendering inpatient care have developed a Road map created 5 coordinating councils and identified the responsible national organization of healthcare.
Coordinating councils coordinate the work of departments of healthcare oblasts, Astana and Almaty cities, republican and regional medical organizations and monitor the implementation of measures in the framework of the implementation of the Roadmap.
Coordinating councils have examined the current situation and developed specific measures to improve the quality of medical care:
- organized courses of improvement of qualification of medical workers at all levels of medical care. In this year specialized residency 65 of cardiology, which will be sent to medical organizations. In the framework of the state task for the implementation of educational services in priority areas will be trained 473 employees, of them 441 physician trained in the direction of "Introduction of integrated model of medical care in acute myocardial infarction and 32 doctors in the direction of "Introduction of integrated model of medical care in acute stroke";
- started work on the revision of standards of care, to improve clinical protocols and algorithms of processes and routes of patients. Developing the monitoring program and evaluation of service activities (with check sheets, job instructions and end indicators);
- in this year in the regions provided for the opening and equipping of wards (teams) intensive therapy and resuscitation departments and intensive therapy for patients with acute myocardial infarction;
- prepared legal acts on creation of Republican stroke center at the Medical University of Astana. It is scheduled to open on 1st August of the current year.
"One of the weak links in the provision of medical services for all groups of diseases are imminent and emergency. To solve the existing problematic issues of the planned creation of integrated two-level model of emergency care. On the first level will be single dispatching service for emergency care with automated GPS system. It will include the sanitary aviation of oblasts, the ambulance station of cities, districts and rural districts. The second republican level service will include sanitary aviation, telemedicine and integrated with the first level of information system. The functioning of the new model will ensure coordination of this work across the country, the operational direction on the scene crews sanitary aviation, counseling through telemedicine," - Tamara Duisenova said.
Along with this, will be modified the itinerary of the patients, the brigade of ambulance will carry the patient not in a hospital, to medical organization, where he will be provided by necessary expert assistance.
"With aim of improving the quality of training in domestic medical Universities are working to attract strategic partners included in the top 500 best global universities. This medical schools of USA, UK, Germany, South Korea, Finland and other countries. In addition, since September of this year in 6 medical colleges introduced Finnish model of nursing education," - Tamara Duisenova said.
To ensure the further development of healthcare infrastructure created the project team and approved Roadmap for the development of infrastructure and PPP for 2016-2018 years. Jointly with local executive bodies are formed medical map of the regions. They will determine the number of healthcare facilities, which is necessary to ensure the availability of medical services, regardless of their place of residence. A list of objects will include the construction, reconstruction, private sector involvement and transfer of individual objects in trust management with the use of PPP mechanisms.
Currently conducted a complete inventory of all used medical equipment with determination of the level of wear. "The proposals for the change of procurement order of medical equipment: medical institutions will be able to buy medical equipment costing to 5 million tenge, from 5 to 100 million tenge – lease and with cost exceeding 100 million tenge is purchased at the expense of Republican and local budgets", - Tamara Duisenova said.
With the aim of improving drug provision of the MHSD of RK drafted regulatory legal acts on simplification of registration of medicines that meet international quality standards.
"In the last year, jointly with foreign experts developed and implemented the national drug formulary. It includes all registered in the Republic of drugs with proven clinical efficacy and limit price of each trade name. Updated list of medicines purchased within the guaranteed volume of free medical care, provided the first stage of the implementation of reference pricing. Holding the work on the transition to the standards of good pharmaceutical practice (GXP)," - Tamara Duisenova said.
At the end of her speech, she said that to ensure the financial sustainability of healthcare system, pursuant to the instructions of the President, carries out preparatory work on introduction of system of obligatory social medical insurance, which provides joint liability for health of the citizens of the state, employers and employees.