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14STAGES OF FORMATION OF FAMILY MEDICINE IN KAZAKHSTAN
1General Director of the Republican Center for Health Development, Astana, Kazakhstan 2Deputy General Director of the Republican Center for Health Development,
Astana, Kazakhstan 3Republican Center for Health Development, Center for improving medical care,
Astana, Kazakhstan
Abstract
Primary health care is an integral part of the public health system and the provision of medical care to the public. This article discusses the issues of modernization and the creation of an integrated system of primary health care that is human-centered in Kazakhstan.
Key words: Primary Healthcare, Healthcare, Kazakhstan
А.Т. Айыпханова1, А.^. Ыскакова2, Б.9. Жустов3, Д.М. Бэйменова3
1Денсаулыц сацтауды дамыту республикалыц орталыгынын бас директоры,
Астана, Казацстан
2Денсаулыц сацтауды дамыту республикалыц орталыгынын бас директорынын орынбасары,
Астана, Казацстан
3Денсаулыц сацтауды дамыту республикалыц орталыгы, медициналыц KeMe^i жетiлдiру орталыгы,
Астана, Казацстан
Тужырымдама
Бастапцы медициналыц - санитарлыц кемек улттыц денсаулыц сацтаудын ажырамас бел'1г'1 гана емес, сондай-ац халыцца медициналыц кемек кeрсeтудiн нeгiзi болып табылады. Мацалада Казацстандагы адамга багдарланган бастапцы медициналыц-санитарлыц кемет цалыптасу кезендер'г, дамыту мэсeлeлeрi талцыланган. Krnmmi свздер: алгашцы медициналыц - санитарлыц кемек, денсаулыц сацтау, Казацстан.
А.Т. Айыпханова1, А.К. Искакова2, Б.А. Джусипов3, Д.М. Байменова3
1Гэнеральный директор Республиканского центра развития здравоохранения,
Астана, Казахстан
2Заместитель генерального директора Республиканского центра развития здравоохранения,
Астана, Казахстан
3Республиканский центр развития здравоохранения, Центр совершенствования медицинской помощи,
Астана, Казахстан
Первичная медико-санитарная помощь является неотъемлемой частью национальной системы здравоохранения и основой оказания медицинской помощи населению. В данной статье представлено обсуждение вопросов этапы становления и развитие интегрированной системы первичной медико-санитарной помощи ориентированной на человека в Казахстане.
Ainur Aiypkhanova1, Aiman Iskakova2, Bauyrzhan Jussipov3, Dillakhan Baimenova2
казацстандагы отбасылыц медицинаньщ цалыптасу Kese^depi
Этапы становления семейной медицины в Казахстане
Резюме
Ключевые слова: первичная медико-санитарная помощь, здравоохранение, Казахстан.
УДК 614; 614.2;614
Corresponding author: Dillakhan Baimenova, Chief specialist of Republican Center for Health Development. Postal code: 010000
Address: Mangilik El 8 Ave., Entrance 18B, Astana, Kazakhstan Phone: +7 777 221 4094 E-mail: b.dilla@mail.ru
Recieved: 27-03-2018 Accepted: 31-03-2018
(Stages of formation of family medicine in Kazakhstan)
(Ainur Aiypkhanova et al)
The coming autumn of 2018 is going to be a significant year in the medical history of the Republic of Kazakhstan. The 40th anniversary of the Alma-Ata Declaration of Primary Health Care (PHC), adopted at a conference of the World Health Organization in the capital of Kazakhstan in 1978 [1].
Based on the principles of this declaration many countries had begun implementing family medicine in their national health systems. For most countries in the world, ensuring the availability of primary health care has become a priority in the formation of the health care system. The experience of the developed countries shows that one of the ways to build a healthcare system capable of responding to modern challenges is to give a priority for the development of PHC with a focus on general medical practice.
Australia was the first among the OECD countries who changed the emphasis towards PHC. Furthermore, Australia adopted its first national PHC strategy choosing: prioritizing regional integration, information technology, including the electronic health system, improved access and reduction of inequities in access to health care, chronic disease control, prevention, development of PHC infrastructure, and improvement of quality, safety, productivity and accountability as the fundamental components of PHC. In addition, this country still ranks first in almost all activities related to PHC [2]. Which includes: preventive measures of the disease as a result of a mortality reduction, the bulk of the population quit smoking which is a risk factor for many diseases and causes of death. At the same time, Australia shows efficient use of the medical insurance system. Where patient satisfaction and the usage of the electronic medical records are on a high level, moreover, its accompanied by the high life expectancy. Which is the main indicator of the health of the population in every country.
In Spain, the PHC sector has been undergoing a massive process of institutional reform and capacity building since 1984 [3]. The Spanish reform has concentrated on a main activity of PHC as an integrated system, that provides: individual medical care, maintenance and rehabilitation. Within the advisory bodies of the Spanish National System, some of the patient's associations with a certain pathology (cancer, mental disorders, chronic diseases) have the right to influence the policy of PHC reform development and active participation in joint work with the public.
Since 1994 middle-income countries such as Brazil, Chile, Thailand and Turkey had also begun to actively implement PHC reform in the healthcare system. This led to a marked improvement in the health indicators of the population. Moving the health care system from hospitals and narrow specialists to PHC which allowed to bring primary health care closer to the population, and most importantly to improve patient satisfaction [3]. As well as the main wealth and happiness of every person and the future generation is health.
The world experience illustrates that all successful health systems have achieved significant performance and health status of the population mainly through the development of PHC as the main element of health.
The beginning of the history of Kazakhstan's family medicine formation began in 1989. During that time the first mixed-type of the outpatient hospital was opened in Alma-Ata. Which had been included the departments of general practitioner (GP) / family doctor (CB) and in a separate room - family medicine outpatient practice (FMOP). This alternative health care approach was new a direction for the Republic of Kazakhstan. In 1996 the Department of Family Medicine of the Almaty State Institute of Improvement of Doctors organized two-month retreatment courses for district therapists and paediatricians. After the completion of the training, the PHC doctors switched to a mixed reception of the population.
The fearless debutants made their first steps along the unknown path and created the first FMOP in 1995 in Zhezkazgan, Karaganda region. Among this reform was created the first private FMOP which was established in the same city and was the only one in the CIS countries during those years. The healthcare reorganization was carried out by merging of outpatient services of adult and children, and women's counselling. PHC service began to provide independent medical and preventive institutions - FMOP, medical outpatient clinics, PHC centres. Kazakhstan took real steps to reform and strengthen PHC with the evolutionary introduction of the principles of general medical practice and the creation of family medicine. This redefined the relationship in the health system.
Medical care provided by PHC staff focused on the patient and family to plan, provide and evaluate health services. Which is a mutually beneficial partnership between PHC organizations, patients and families. Furthermore, emotional, social and developmental support is a key component of health care. PHC approach promotes the healthy way of life and well-being of the family and each of its members and also provides recovery and exercise control over their health.
This assistance resulted in improved of health outcomes and more rational allocation of resources, as well as increased patient and family satisfaction.
There is a positive trend in increasing the number of general practitioners by 2 times and amounted to 5635 general practitioners at the end of 2017 (2013 - 2,386 and 2015-4014, and 2016 - 5042). However, taking into account the continuing shortage of staff and excessive workload of the GP, there is some work is underway to improve this situation. Since 2017 the issue of introducing a "new" model for organizing a pediatric service. Where had been decided to open pediatric faculties in higher education institutions, and introducing new paediatricians in primary care for children from 0 to 5 years, which may affect the burden on GPs.
The first of nurse bachelors are going to graduate in 2018. It's planned to delegate some of the authority of the GP / FD. These highly educated nurses will independently conduct a reception, make an independent decision within their competence, participate actively in the multidisciplinary team and conduct preventive activities, etc.
In order to solve existing problems and to achieve
goals set in the State Healthcare Development Program of the Republic of Kazakhstan was decided to implement the "Densaulyk" program for 2016-2019, where the priority was given to develop the PHC [4].
In 2017, during the implementation of the healthcare development program, the government of Kazakhstan introduced a project management approach and identified 10 key projects. One of the priority projects within the framework of the state program is the project "Integration of all health services around the needs of the patient on the basis of PHC modernization".
The main directions of the project are the reduction of the burden on the PHC physician, development of the concept of centres of the best practices in PHC for the introduction of advanced practices, methods, standards, and technologies, an introduction of disease management programs, and integrated models of medical care.
In addition, within the framework of the implementation of the State Health Development Program of the Republic of Kazakhstan "Densaulyk" for 2016-2020 was to create 16 centres of excellence (centres of best practices) (CBP) aimed to develop family service principle. Currently, at the beginning of 2018, 16 CBPs are identified in the regions of the country based on the existing centres of PHC / outpatient care CBP in each region. They will provide methodological assistance to PHC organizations, train staff, and actively introduce innovative technologies [4].
Despite the achieved results, Kazakhstan lags far behind the countries of the Organization for Economic Cooperation and Development in the issue of the PHC development.
Currently, there is a problem of systemic nature of primary care: the low level of management leaders of the PHC organizations which led to misunderstanding the role, system and the reforms of primary care in the healthcare system. Furthermore, the widespread practice of appointing the heads of organizations of primary care hospitals sector specialists or specialized doctors, who have a weak level of training of managers-leaders of PHC. In accordance with modern requirements, low modernization of PHC infrastructure still exists.
One of the main obstacles to the development of GP in Kazakhstan is the excessive workload of primary care workers. Under the established load for GP physicians - 2 000 people (adults and children), the actual workload on average in the regions of Kazakhstan at the beginning of 2018 was 2093 of the attached population. Therefore, work was begun to gradually reduce the burden on GPs to 1500 people per physician, to develop small forms of general medical practice, which will reduce the burden to the level of OECD countries by 2019.
Additionally, one of the important aspects of reducing the burden on physicians is an involvement of medical personnel. Such as leading consultations by phone or online resources, substitute for the traditional reception of patients in the doctor's office and the development of information and communication between medical personnel and patients.
During the years, the amount of per capita norm in Kazakhstan remains unchanged, while new methods of diagnosis and treatment were introduced. Consequently, the main a fading effect factor in the development of PHC is a low salary of medical workers of PHC. For the successful development of all-inclusive projects of PHC is urgently needed to expand the size. As an alternative approach can be suggested: the transfer of property to the replacement of housing or free housing with the right of further repayment, the free maintenance of the employers and members of his/ her family.
Over the years of formation and development of family medicine, increased a need to establish a National PHC Center in the Republic of Kazakhstan. In order to find solutions for the listed problems and for the further development of primary health care, and particularly for the centres of best practice. It will provide methodological assistance in the creation of the CBP to ensure the sustainability of the PHC system, oriented to people's needs, introduction of international best practices, new medical and social preventative technologies, development of science and education, and coordination of the PHC activities in the country.
The National PHC centre will implement projects, new technologies for working with socially vulnerable categories of the population through social therapy methods, establish a strategic partnership in general medical practice, nursing, social work and psychology. In accordance with the needs of a person, they will focus on programs to promote health, prevent chronic noncommunicable diseases, medical literacy, and rehabilitation. And one of the very important sections of the National Center's will be to evaluate and monitor the activities of PHC organizations in the country.
Conclusions
Continuous priority development of PHC in Kazakhstan can improve health services for the entire population of the country, especially those who currently suffer from unequal and unfair access to PHC services. Increase the capacity and support of public health and raise the joint responsibility of patients.
The prevention of diseases and development of their complications will result in an increase in the health index. Over the time, the need for a large number of hospitals and emergency medical care in the country will be reduced. Through the improvement of the management of complex and chronic health conditions, the introduction of Disease management programs in all regions, and application of the Out-patient Drug Supply with increasing the use of effective drugs which is based on evidence-based medicine, self-management / self-management can reduce the number of exacerbations and unjustified hospitalization. To sum up, to continue the development of the PHC and the creation of CBP among the regions, the formation of a national PHC centre for the Republic of Kazakhstan, actively involve population to manage their health, and other listed activities will strengthen the health of the, increase in average life expectancy of Kazakhstan.
References
1. Primary health care: report of the International Conference on Primary Health Care. Alma-Ata, USSR, 6-12 September 1978.Geneva: World Health Organization, 1978.
2. National Primary Health Care Strategic Framework. Commonwealth of Australia, April 2013: 26 р.
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