CC BY
35https://doi.org/10.32921/2225-9929-2021-3-43-13-18 UDC 61:001.12/.18 IRSTI: 76.01.11
Review article
Rural Healthcare in Kazakhstan: Problems and Trends
(Literature Review)
Assiya Turgambayeva 1, Zhazira Imanova 2, Ainagul Tulegenova 3
1 Head of the Department of Public Health and Management, Astana Medical University, Nur-Sultan, Kazakhstan.
E-mail: tak1973@mail.ru
2 Director of the Department for Improving Medical Care, Salidat Kairbekova National Research Center for Health
Development, Nur-Sultan, Kazakhstan. E-mail: imanova.best@mail.ru 3 PhD-student of the Astana Medical University, Nur-Sultan, Kazakhstan. E-mail: ainagul2122@gmail.com
Abstract
Improving the welfare and quality of life of the population, ensuring fair and equal access to health services are priority areas of social policy in Kazakhstan. /4s modern domestic studies show, the quality of health of the rural population lags far behind the urban population and has a steady tendency towards deterioration.
One of the leading factors affecting the health of rural residents is the low level of accessibility of primary healthcare. It should be noted that the availability of healthcare services is directly and to a greater extent related to the availability of medical organizations and their provision with qualified human resources. In Kazakhstan, an imbalance in the provision of personnel between urban and rural healthcare remains, and the availability of medicines for the rural population is much lower than for the urban population.
The purpose of this study was to conduct a literary review of domestic and foreign sources on the problem of rural healthcare in the Republic of Kazakhstan and abroad.
Key words: rural healthcare, the quality of life of the rural population, the availability of medical services, social justice.
Corresponding author: Ainagul Tulegenova, PhD-student of the Astana Medical University, Nur-Sultan, Kazakhstan. Postal code: Z10H8P3
Address: Kazakhstan, Nur-Sultan, Zhenis Ave., 72
Phone: +77785837974
E-mail: ainagul2122@gmail.com
J Health Dev 2021; 3 (43): 13-18 Recieved: 12-08-2021 Accepted: 15-09-2021
@ <D
This work is licensed under a Creative Commons Attribution 4.0 International License
Relevance
The primary tasks of the social policy of the Republic of Kazakhstan are to consistently improve the level and quality of life of the population, to ensure universal availability of basic medical and social services.
Increasing the availability of medical care is especially important for the rural population living in remote and hard-to-reach areas. The issues of health protection of the rural population of the Republic of Kazakhstan are relevant both at the regional and at the national level.
The main goal of all levels of government is to improve the availability and quality of medical care for the rural population and residents of remote areas. Although
The quality of life of the rural population
The issues of improving the well-being of the people and the quality of life of the population is one of the urgent directions and the most important tasks of state policy in the field of healthcare at this stage.
As modern domestic studies show, the quality of health of the rural population lags far behind the urban population and has a steady tendency towards deterioration. Low availability of medical care and a low level of living comfort in rural areas, underdeveloped infrastructure, difficult working conditions lead to a deterioration in the health status of rural residents [3,4].
The standard of living of the rural population in many countries is lower than that of the urban population, which correlates with low health indicators. According to a number of studies, about one billion people in the
Availability of Primary Healthcare
The availability of medical care is the most important problem in the organization of health care. Maintaining and strengthening the health of the population by increasing the availability and quality of medical care is more relevant for rural settlements than for urban ones. This can be explained both by the difficult living conditions of the villagers, the high level of unemployment, the outflow of specialists to cities, the underdevelopment of the road transport infrastructure, and the imperfection of the state social policy and the low quality of medical care in rural areas [8,9].
One of the leading factors affecting the poor health of rural residents is the low level of accessibility of primary healthcare (PHC). Universal coverage of the population by the PHC system provides better health indicators and higher social satisfaction with medical care at lower costs [10]. Many of the health problems can be solved by building a sustainable PHC system. In this regard, the process of improving and strengthening the PHC service, focused on the needs of the population, continues throughout the world [11-13].
According to the Declaration of Alma-Ata, ensuring adequate access to PHC services is vital for governments
Provision of human resources
The provision of the rural population with qualified medical care is mainly influenced by several factors, these are the remoteness of medical organizations, the low quality and high cost of transport and medical services, and the depletion of human resources. A regularity was revealed: the better the provision of qualified specialists,
the rural population of the Republic of Kazakhstan makes up almost 42% of the total population of the country, or about 7697.4 million people, the problems of rural health care are still quite acute and priority directions in the state policy of the country. Given the share of the rural population, it is important to preserve rural health care, so the transformation here is aimed primarily at increasing accessibility [1,2].
The purpose of the study: to conduct a literary review of domestic and foreign sources on the problem of rural health care in the Republic of Kazakhstan and abroad.
world breathe polluted air, suffer from a shortage of clean drinking water, do not have a centralized sewage system, specially designated places for storage and disposal of household waste, etc. [5].
Numerous modern medical studies prove that good health is directly related to the standard of living, a sense of well-being, and an increase in social and economic status [6,7]. Factors that directly affect the state of human health are age, conditions, level and way of life, the presence and composition of the family, the number of children, the level of education, the availability of work, the level of well-being, housing conditions, a sense of security, the availability and quality of medical care.
and health authorities in most countries [15]. Good access increases the timely use of health services [16].
PHC, through its integral user-centeredness and its relationship with the community, is the gateway to other levels of care. Geographic access remains a key determinant of the use of health services when needed, so it is important that health planners minimize barriers to access to the provision of PHC services [17,18].
The village PHC network is more ramified with a variety of organizations created to ensure the availability of PHC, taking into account the geographic and demographic characteristics of the country: a large territory and an uneven population density. PHC for the rural population is provided in 10 PHC departments at district polyclinics, 134 units and organizations of PHC at central district hospitals, which include 3407 MPs, 868 FAPs, 17 independent and 1470 medical outpatient clinics at the Central District Hospital; 28 district and 2 rural polyclinics [19].
the higher the assessment of the quality of their work. Therefore, in order to attract young and highly qualified specialists to healthcare, it is necessary to create decent living conditions in the countryside [20,21].
In Kazakhstan, an imbalance remains in the provision of personnel between urban and rural
healthcare. According to the data reflected in the State Program for the Development of Healthcare of the Republic of Kazakhstan, 83% of all doctors work in the city and only 17% in rural areas [22].
Despite the numerous incentive policies proposed by governments in many countries for some time, recruiting and retaining doctors in small, often isolated, rural communities remains a challenge [23-25].
Insufficient provision of rural areas with medical personnel in the Republic of Kazakhstan has always
existed, but in recent years, this problem has become one of the most important and significant in terms of importance. However, so far the personnel crisis associated with the shortage of medical specialists in rural areas has not been overcome in any way. The concentration of medical workers in large cities of the Republic of Kazakhstan continues to increase from year to year. In rural areas, compared to cities, there is a shortage of competent medical personnel [26,27].
Availability of medicines
It should be noted that the problems of ensuring and organizing drug accessibility to the population living in rural areas are in most countries solved by the state, depending on the current situation and the realities of socio-economic development. The World Health Organization has recognized drug provision and the provision of pharmaceutical services to the population in developing countries as unsatisfactory [28].
Despite the fact that in the Republic of Kazakhstan there are more than 9.000 facilities providing pharmaceutical services to the population, about 4.000 rural settlements do not have pharmacy facilities, and only 64% of them have organized the sale of medicines through medical and sanitary facilities [29]. The provision
of the rural population with medicines on market principles led to a restriction of the availability of the rural population due to the following reasons: remoteness of the territory, difficulties in delivery, and insolvency of the population.
The availability of medicines for the rural population was 30% lower than for the urban population. Therefore, the issues of the organization and quality of medical care for the rural population require further development and, first of all, the development of social programs for young specialists in order to make work in the countryside socially attractive [30].
Conclusion
Having analyzed numerous domestic and foreign sources, we can conclude that medical and social problems are especially pronounced in rural areas: these are high rates of morbidity and mortality, a low level of quality of life of the population. Modern rural settlements
of our country are experiencing a shortage of medical personnel, including narrow specialists, insufficient provision of medicines, the need to update the material and technical base of healthcare.
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Казакстандагы ауылдык жерлердег денсаулык сактау саласыньщ мэселелерi мен тенденциялары (9деби шолу)
Тургамбаева А.^.1, Иманова Ж.А. 2, Телегенова А.М. 3
1 К,огамды; денсаулы; жэне менеджмент кафедрасыныц мецаеруш1а, Астана медициналы; университетi,
Нур-Султан, К,аза;стан. E-mail: tak1973@mail.ru
2 Медициналы; квмектi жеттд1ру департамент1н1ц директоры, Салидат Цайырбекова атындагы ултты; гылыми
денсаулы; са;тауды дамыту орталыгы, Нур-Султан, К,аза;стан. E-mail: imanova.best@mail.ru
3 Астана медициналы;университет1н1ц PhD-докторанты, Нур-Султан, Цаза;стан. E-mail: ainagul2122@gmail.com
ТYЙiндiме
Халыктыц эл-аукаты мен вм1р сYPУ сапасын жаксарту, медициналык кызметтерае эдл жэне тец %олжет1мдт1кт1 камтамасыз ету - К,азакстанныц элеуметт1к саясатыныц басым багыттарыныц б'р':. Цаз1ра1 замангы квптеаен зерттеулер кврсеткендей, ауыл тургындарыныц денсаулыгыньщ сапасы кала тургындарынан едэу1р артта калып, нашарлау Yрдiсiне ие.
Ауыл тургындарыныц денсаулыгына эсер ететiн жетекшi факторлардыц &р - алгашкы медициналык-санитарлык квмектц колжетiмдiлiаiнiц твмен децаеш. Айта кету керек, денсаулык сактау кызметтерiнih| колжетiмдiлiаi тiкелей жэне кв&рек дэрежеде медициналык уйымдардыц колжетiмдiлiаiне жэне олардыц б^т кадрлiк ресурстарымен камтамасыз ет^не байланысты. Цазакстанда кала мен ауылдыц денсаулык сактау саласы арасында кадрлармен камтамасыз етудеаi тенаерiмсiздiк сакталуда, ауыл тургындарыныц дэ^-дэрмекпен камтамасыз етту'! кала тургындарына караганда элдекайда твмен.
Бул зерттеудih| максаты - Цазакстан Республикасындагы жэне шетелдеаi ауылдык денсаулык сактау мэселеа бойынша отандык жэне шетелдiк дерекквздерае эдеби шолу жасау болды.
Туйш свздер: ауылдык денсаулык сактау, ауыл тургындарыныц вмiр сапасы, медициналык кызметтердщ кол жетiмдiлiаi, элеуметтiк эдшетт^к.
Сельское здравоохранение Казахстана: проблемы и тенденции (Обзор литературы)
Тургамбаева А.К. 1, Иманова Ж.А. 2, Тулегенова А.М.3
1 Заведующая кафедрой Общественного здоровья и менеджмента, Медицинский университет Астана,
Нур-Султан, Казахстан. E-mail: tak@mail.ru
2 Директор Департамента совершенствования медицинской помощи, Национальный научный центр развития здравоохранения имени Салидат Каирбековой, Нур-Султан, Казахстан. E-mail: imanova.best@mail.ru.
3 PhD-докторант Медицинского университета Астана, Нур-Султан, Казахстан. E-mail: ainagul2122@gmail.com
Резюме
Повышение блааосостояния и качества жизни населения, обеспечение справедливым и равным доступом к услуаам здравоохранения являются приоритетными направлениями социальной политики Казахстана. Как показывают современные отечественные исследования, качество здоровья сельскоао населения сильно отстает от аородскоао и отличается устойчивой тенденцией к ухудшению.
Одним из ведущих факторов, влияющих на уровень здоровья сельских жителей, является низкий уровень доступности первичной медико-санитарной помощи. Следует отметить, что доступность услуа здравоохранения в большей степени связана с наличием медицинских ораанизаций и их обеспеченностью квалифицированными кадровыми ресурсами.
В Казахстане сохраняется дисбаланс в обеспечении кадрами между аородским и сельским здравоохранением, а доступность лекарственных средств сельскому населению намноао ниже, чем аородскому. Целью данноао исследования был анализ отечественных и зарубежных литературных источников по проблеме сельскоао здравоохранения.
Ключевые слова: сельское здравоохранение, качество жизни сельскоао населения, доступность медицинских услуа, социальная справедливость.
