IMPACT OF COVID-19 ON THE ACTIVITIES OF MEDIUMAND SMALL-SIZE MEDICAL ENTERPRISES IN KAZAKHSTAN

Kapanova Gulnara; Kosherbayeva Lyazzat; Kalmakhanov Sundetgali; Akhtaeva Nazgul; Dauliyeva Galiya

IMPACT OF COVID-19 ON THE ACTIVITIES OF MEDIUM- AND SMALL-SIZE MEDICAL

ENTERPRISES IN KAZAKHSTAN

1G. Kapanova, 1,2L. Kosherbayeva, 1S. Kalmakhanov, 2N. Akhtaeva, 1G. Dauliyeva

1Higher School of Public Healthcare, AL-Farabi Kazakh National University, Almaty, Kazakhstan; 2Kazakh National Medical University, Almaty, Kazakhstan

Background: The COVID-19 pandemic has led to a rethinking of the processes in medical organizations. Managers and medical staff faced new challenges that needed immediate response.

Aims: To study the impact of the COVID-19 pandemic on the economic conditions of private medium- (<250 employees) and small-size (<100 employees) enterprises (MSEH) and to assess psychological consequences of COVID-19.

Methods: In total, 45 managers (14 %) and 279 medical employees (86 %) of the 25 MSEH took part in a mixed-methods study. Qualitative interviews were conducted with MSEH managers in the city of Almaty and Almaty region. Economic issues and working conditions of the personnel in MSEH during the time pandemic as well as the psychological impact of COVID-19 were studied using a questionnaire. Results: During the pandemic period the respondents' salaries increased, but medical organizations are faced with a decrease in profits (P = 0.003) and substantial shortage of nurses (P = 0.001). All medical organizations developed a preparedness plan in collaboration with the emergency / pandemic outbreak team P < 0.001, with different scenarios P = 0.009, and roles and responsibilities P = 0.007. Anxiety and depression symptoms were greater among the managers compared to the medical staff.

Conclusions: Healthcare professionals and managers of MHES in Kazakhstan face similar challenges as medical workers in other countries during the pandemic. Collaboration and teamwork can strengthen and improve the organization's outbreak preparedness. In addition, medical personnel and particularly the managers of MESH need psychological support. Key words: Managers, Kazakhstan, Pandemic, Medical enterprises, Medical staff

УДК 614.2:616.9(574) DOI: 10.33396/1728-0869-2021-11-58-64

ВЛИЯНИЕ COVID-19 НА ДЕЯТЕЛЬНОСТЬ СРЕДНИХ И МАЛЫХ ПРЕДПРИЯТИЙ В СИСТЕМЕ ЗДРАВООХРАНЕНИЯ В КАЗАХСТАНЕ

2021 г. Т. Ж. Капанова, 1,2Л. К. Кошербаева, 1С. Б. Калмаханов, 2Н. Ахтаева, 1Г. Даулиева

высшая школа общественного здравоохранения, Казахский национальный университет имени Аль-Фараби, г. Алматы; 2Казахский национальный медицинский университет, Казахстан

Введение: COVID-19 привел к переосмыслению процессов в медицинской организации. Руководители и медицинский персонал столкнулись с рядом вопросов, требующих изменения и решения.

Цель: изучить влияние пандемии COVID-19 на экономическое состояние частных средних и малых предприятий здравоохранения и определить психологические последствия COVID-19.

Методы: С использованием смешанных методов был проанализирован опыт руководства и медицинского персонала средних и малых предприятий системы здравоохранения (МСЭЗ), связанной с COVID-19. В опросе приняли участие 45 руководителей (14 %) и 279 человек (86 %) медицинского персонала из 25 МСЭЗ. Качественные интервью проведены с десятью менеджерами МСЭЗ в городе Алматы и Алматинской области. Была разработана анкета на русском языке, которая охватывала две части: экономические вопросы и условия работы в МСЭЗ во время пандемии; психологическое воздействие карантина COVID-19. Результаты: В период пандемии у респондентов увеличилась заработная плата, медицинские организации столкнулись с падением прибыли (P = 0,003), нехваткой медсестер (P = 0,001). План готовности медицинской организации подготовлен совместно с бригадой по чрезвычайным ситуациям / вспышке пандемии P < 0,001, с различными сценариями P = 0,009, ролями и обязанностями P = 0,007. У руководителей психологическое воздействие COVID-19 на тревогу и депрессию было выше по сравнению с медицинским персоналом.

Выводы: Медицинские работники и руководители средних и малых предприятий системы здравоохранения столкнулись с такими же проблемами, как и в других странах. Сотрудничество и командная работа могут укрепить и улучшить готовность организации к эпидемиям. Кроме того, менеджеры и медицинский персонал нуждаются в психологической поддержке, однако у менеджеров потребность превалирует.

Ключевые слова: менеджеры, Казахстан, COVID-19, средние и малые предприятия, медперсонал

For citing:

Kapanova G., Kosherbayeva L., Kalmakhanov S., Akhtaeva N., Dauliyeva G. Impact of Covid-19 on the Activities of Medium- and Small-Size Medical Enterprises in Kazakhstan. Ekologiya cheloveka (Human Ecology). 2021, 11, pp. 58-64. Библиографическая ссылка:

Капанова Г. Ж., Кошербаева Л. К., Калмаханов С. Б., Ахтаева Н., Даулиева Г. Влияние COVID-19 на деятельность средних и малых предприятий в системе здравоохранения в Казахстане // Экология человека. 2021. № 11. С. 58-64.

Background

COVID-19, which dates back to 2019 [12], has led to a change in the current practice of the private health care system in all countries [11, 13, 16, 18]. The pre-

paredness for the pandemic challenges of medical and preventive care of each country was different depending on the level of country development [14]. At the same time, COVID-19 has changed the cyclical image of entre-

preneurship by introducing changes and restructuring of business processes [5, 14]. Managers with creative ideas were able to move from offline to online mode [20, 22]. There are a number of organizations that have been able to make a profit, while the main business environment has suffered various levels of losses [1].

In Kazakhstan, small and medium-sized businesses in the health sector began to expand through changes in the financing of the health care system [17]. The transition from a budget model to insurance medicine allowed private medical organizations to participate in tenders and purchase medical services for the population. The development of a competitive environment has made it possible to expand the competitive environment [23]. However, to date, it has not been studied how much the pandemic has made changes in the life of small and medium-sized businesses in the healthcare system.

The purpose is to study the economic and work condition of medium and small enterprises in the health care system and determination of the psychological consequences of COVID-19.

Methods

Study design and sample

This mixed-methods study analysed managers and medical staffs of the medium and small enterprises of healthcare system (MSEH) experiences of the Covid-19. In survey attend 45 managers (14 %) and 279 (86 %) medical staffs in MSEH. Qualitative interviews were conducted with ten manager's MSEH (with less than 10 employees) in regions across the Almaty city and Almaty oblast.

More specifically, the analysis focused on the economic issue of MSEH under quarantine conditions, the conditions for medical staffs during a pandemic, the impact of having a preparedness plan on overcoming an organization's crisis, how provided updated information, the protection and support of medical staffs, the availability of timely information and psychological impact of the COVID-19. The psychological impact of quarantine on medical staffs and managers MSEH was studied using the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI) [19].

The use of quantitative and qualitative methods allows a more in-depth study of the issue under study [21].

Managers and medical staffs of the MSEH informed that participation was voluntary before they answered questionnaire and interviews. Moreover, participants informed about the objectives of the study, the questions and duration of the questionnaire and the possibility of leaving the study at any time.

The study was approved by the local ethical committee of Faculty medicine and Health Care No 2668/5 in 01.10.2020 (Al-Farabi Kazakh National University).

Data sources

Contact with hospital staff and managers was organised through the Department of Public Health of the city of Almaty and Department of Health of the Almaty oblast. Medical organizations for each region were included with a coverage of 10 % (due to limited

time), thus the Department sent a letter to the heads of medical organization in Almaty (18) and in Almaty oblast (7), where asking them to invite their managers and medical staffs to participate in the survey.

Contact information was provided for those staff to obtain additional information on the survey and to indicate their interest in participating. Expressions of interest were received from staffs of all 25 medical organizations. A questionnaire in Russian was developed that covered two parts: the economic issue and work condition in MSEH during a pandemic time and the psychological impact of the COVID-19 quarantine.

The questionnaire was pilot tested with five managers and ten medical staffs from three medical organizations who found all items to be understandable and acceptable. The survey was conducted during July to August 2021 (period of the second wave of the highest incidence) with those staff who responded to the invitation, using an online Google platform, and paper based (at respondent's work place) depends on desire of participants.

Statistical processing was carried out using the SPSS 13 software (IBM, USA). Variables are presented as mean and standard deviation M ± SD, and qualitative indicators in %. The analysis of the frequency characteristics of qualitative indicators was carried out using non-parametric methods using the Pearson criterion (x2). Differences in the data were considered statistically significant at p < 0.05.

Qualitative interviews

Semi-structured interviews were covered matters on which full answers had not been obtained in the survey. Background information; the manager's leadership role and impact of work on personal life and health. Interviewees were free to suggest and discuss further related issues.

Interviews were conducted on-line by mobile phone or zoom, depending on the preference of the interviewee, in September 2021. The duration of interviews was 2530 minutes. Interviewing was carried out on the basis of the methodology presented Graneheim and coauthors [9]. The interviews were recorded and the scripts were read several times for the researchers to familiarise themselves with the data, transcripts were encoded line by line, with codes assigned to each meaningful segment of text. Two researchers independently conducted a comparative analysis of transcripts, and identified similarities and differences in the answers from participants. At each stage, there was a discussion of the results and a consensus.

This research has been/was/is funded by the Science Committee of the Ministry of Education and Science of the Republic of Kazakhstan (Grant No IRN AP09562843 The psychological impact of COVID-19 on people employed in small and medium-sized businesses in the healthcare system in urban and rural areas).

Results

The economic issue and work condition in MSEH during COVID-19

During the pandemic period in comparison before the pandemic, respondents' wages increased by 1.3

times. According to respondents, in the context of COVID-19, medical organizations are faced with a decrease in profits 35.5 % (MB 36.9 %, SB 33.3 %) P = 0.003, shortage of nurses 3.7 % (MB 1.0 %, SB 7.9 %) P = 0.001. In addition, medical organizations can solve the problem of lack of funds during COVID-19 by reducing staff salaries 13.9 % (SB 7.9 %, MB 17.7 %) P = 0.013, search for subsidies 14.5 % (SB 20.6 %, MB 10.6 %) P = 0.012, and government assistance 3.4 % (SB 6.3 %, MB 1.5 %) P = 0.019.

The medical organization must have a preparedness plan to cope with a crisis such as COVID-19 indicated 62.8 % respondents. (table 1).

A plan must be prepared: together with the emergency / pandemic outbreak team 92.6 % P < 0.001; preparation of response measures for different scenarios 96.5 % P = 0.009; determine who in the company will be included in the emergency / pandemic outbreak team 92.0 % P < 0.001; roles and responsibilities, as well as possible replacements 96.2 % P = 0.007;

Table 1

Results of the MSEH survey on the economic situation during COVID-19

Economic condition and working conditions Answer Middle business N (%) Small business N (%) Total N (%) P

In your opinion, what problems does the company face in the context of COVID-19?

Insufficient volume of production of oxygen stations No 193 (97,5) 120 (95,2) 313 (96,6) 0.278

Yes 5 (2,5) 6 (4,8) 11 (3,4)