CC BY
0УДК 614.2
ASSESSMENT OF THE PROVISION OF PRIMARY HEALTH CARE TO THE
POPULATION
NAGASHBEK MERUERT BAKHYTQYZY
Master's student of the Kazakhstan Medical University "KSPH", Almaty, Kazakhstan
Abstract. This article discusses the principles of primary health care. Currently, an information tool is needed that would allow for an adequate analysis and evaluation of the activities of medical organizations providing primary medical care for the development of operational and strategic management decisions, and to predict development.
Keywords: primary health care, hospitals, healthcare system
According to the definition given at the International Conference on Primary Health Care (Alma-Ata, 1978), primary health care is the first level of contact between the population and the national health system; it is as close as possible to the place of residence and work of people and represents the first stage of the continuous process of protecting their health.
The main directions of reforming the primary health care system were the decentralization of management, the demonopolization of the public health sector, multi-channel financing, the introduction of compulsory health insurance and the introduction of market mechanisms. However, none of these approaches has been fully implemented, and as a result, the society has not achieved the desired result aimed at improving the quality of medical care.
After gaining independence, the Republic of Kazakhstan, like all countries of the Commonwealth of Independent States, inherited massive primary health care, an inefficient health care system, which they could no longer maintain. Currently, the public health system of the regions, including the provision of public services, health financing and medical education, is unable to solve a whole range of problems, which ultimately leads to a decrease in life expectancy in individual regions.
It should be noted that the number of chronic diseases, especially cardiovascular diseases, has increased in the republic; the infant mortality rate has increased; the number of abortions has increased; diseases such as tuberculosis, syphilis and malaria are returning; new ones such as HIV are emerging/AIDS. At the same time, primary health care workers are not well trained enough to treat the most common and urgent conditions faced by the population.
The World Health Organization believes that the new public health is an organized effort by society aimed at developing a health policy that integrates health promotion, disease prevention, and social justice in the overall context of sustainable development.
It is known from the experience of world practice that the system of community-based care, with a sufficient level of its development and appropriate organization, is able to solve up to 80% of health-related problems.
Unfortunately, the primary healthcare sector has completely lost its preventive focus. Today, when the attentive attitude of the population to their health has not yet become a necessity and a social requirement, when the level of public health is steadily decreasing, the primary tasks of the polyclinic, as the main carrier of prevention, should be prevention and active full-fledged monitoring of patients.
Given the current situation, the question clearly arises of the need to develop a Program for reforming primary health care, which should be based on improving the quality of primary health care. At the same time, one of the main conditions for the reform of primary care is the maximum preservation of all available material, labor and financial resources of healthcare. It is not supposed to destroy the existing medical and preventive institutions, but to change their functions, working methods, financing systems and relationships.
The current stage of public health development is characterized by a comprehensive program-oriented approach to solving primary health care problems, extensive development of the
ОФ "Международный научно-исследовательский центр "Endless Light in Science"
methodology of a systematic approach, and the transition to the practice of organizational experiments.
By Order of the Ministry of Health of the Republic of Kazakhstan dated March 21, 2006 No. 124, the regulation on the activities of medical organizations (MO) providing primary health care was approved. This document regulates the activities, standard organizational structure, standard staff and staffing standards of PHC organizations, as well as standards for the volume and level of medical care for the population in a polyclinic, PHC center, outpatient clinic, medical center. It is noted that the main functions of the polyclinic are: provision of primary health care, specialized medical, laboratory and diagnostic care to the population on an outpatient basis, in a day hospital and at home in accordance with the types and volumes approved by the authorized body in the field of healthcare; provision of primary health care by district therapists and pediatricians, obstetricians and gynecologists, general practitioners, nurses, midwives.
The main direction of the reform of primary health care is the structural restructuring of the industry in a market economy and the introduction of health insurance with the mandatory preservation of publicly available medical and medicinal care for all citizens. Naturally, this structural restructuring of the industry involves, first of all, the transformation of primary medical and social care.
Strengthening the role of primary health care is designed to solve a number of medical, social and economic problems, including the prevention of morbidity, early diagnosis, reduction of social losses from disability, saving financial resources allocated to the needs of primary health care.
From a socio-economic point of view, given the special role of medical institutions in regulating the level and quality of life of the population, it is obvious that their universal privatization is unacceptable. Most of the healthcare facilities should remain in state (municipal) ownership. This primarily concerns primary health care institutions, emergency medical services, regional hospitals, dispensaries, sanitary and epidemiological services, diagnostic centers with a high level of development of the material and technical base.
For the stable functioning of the healthcare organization, it is necessary to provide a guaranteed amount of free medical care to the population, financial resources in full, as well as legislative determination of the amount of budget allocations for healthcare in the region based on stable standards. At the level of the republic, there is a need to approve a single basic rate of the per capita standard for the treated patient, when approving the budget, these indicators should be taken at least below the approved national rate.
Due to the lack of pharmacy organizations, in most rural settlements, people remain without medical care. To solve this problem, it is necessary for employees of rural medical institutions (FAP, NEA, SUB) to allow the sale of medicines to the population according to the contract.
At the same time, in the new economic conditions, the main aspect of healthcare reform is to ensure affordable high-quality medical care through the phased accelerated development of primary health care.
At the present stage of healthcare reform, improving primary health care, expanding its scope, improving quality and efficiency are considered one of the most important tasks.
Currently, in the Republic of Kazakhstan, as in other CIS countries, public health indicators of the population have significantly deteriorated: life expectancy has sharply decreased, the incidence of socially caused diseases has increased, disability of the able-bodied population is growing at an accelerated pace, the preventive orientation of primary health care has decreased. This, as well as the changed form of government of the CIS countries, with a change in ownership types, caused the need to turn towards a market economy of the entire healthcare system.
The healthcare system of the Republic of Kazakhstan has a wide network of polyclinics and there are grounds for their use at all stages of the development of the general medical practice service. Basically, this is municipal property and the elimination of difficulties in placing general practitioners in polyclinics will have to be solved at the level of local authorities.
The implementation of forms of decentralization can take place only with appropriate legislative support for this activity, before this opportunity arises, a general practitioner can obtain the status of a fund holder, which will allow him to be organizationally independent, have his own checking account. At the same time, he can work in a public medical institution and have a direct connection with insurance medical organizations, having defined his relations with them by the terms of the contract. Currently, the privatization of primary health care facilities is not permitted by law, and therefore a general practitioner cannot privatize that part of the polyclinic that functions as a general practice service.
Local authorities transfer individual premises of the polyclinic to doctors for rent or to operational economic management, in connection with which the organizational issue of the degree of their independence in all manifestations of medical activity is being resolved. At the same time, a separate room is needed for general medical activities during the day. In a polyclinic, this may be an association of 2-3 doctors on the same area of the polyclinic with some functional units common to these doctors, such as a waiting room, a reception room, a staff room, a treatment room, a sanitary and hygienic unit.
All of them are in contractual relations with the administration of the polyclinic or with local authorities, if this part of the polyclinic is alienated to accommodate general practitioners.
Subsequently, the issue of transferring this part of the polyclinic to the ownership of general practitioners, along with items of equipment and equipment, may be resolved. During the operation of these items, the deadlines for their use are exhausted, they are restored or replaced at the expense of doctors and eventually become their property. The advantages of placing doctors in a polyclinic are to preserve the potential of medical and diagnostic equipment, which will provide significant support to a doctor starting independent work.
The implementation of such a scheme for the use of polyclinic premises by doctors will in many ways be hampered by the relatively widespread opinion that one should not rush to change the usual, in the opinion of many, and well-functioning system of a district general practitioner with a team of specialists working at this site. In this regard, the relevant arguments of the chief doctors of polyclinics, their unwillingness to separate an integral medical institution, are not excluded.
Therefore, at present, it is mainly up to the leadership of local authorities and health authorities to decide with what acceleration the transformation of the precinct into a general practitioner's service will take place.
The polyclinic, as the primary link of the patient's contact with the district general practitioner, as well as with doctors of narrow specialties, over the years of its existence has become a place of concentration of many functions for solving the tasks of providing primary health care.
Thus, the implementation of the state program for the reform and development of healthcare involves completely new principles in the work of the industry, strengthening the role and influence of primary health care, optimizing inpatient care, modernizing sanitary and epidemiological services, reorganizing the network and structure of research centers and institutes, convergence and unity of science, education and medical practice.
REFERENCES:
1. Akanov A.A., Kulzhanov M., K., Musataev M.M., Healthcare reforms in Central Asian countries, Almaty, 1996, 138 p.
2. The State program of healthcare development of the Republic of Kazakhstan for 2020-2025
3. Tazhikenova Zh. Sh. Priority development of primary health care within the framework of the state program for the development of healthcare of the Republic of Kazakhstan https://rcez.kz/medicine_ article5
